Multilevel Poisson Regression Models Research Articles

Multi-level drivers of congenital syphilis, Oregon, 2013-2021.

Despite the availability of curative penicillin treatment for syphilis during pregnancy, congenital syphilis (CS) cases have surged in the United States, including in Oregon. We conducted a retrospective analysis of individual- and county-level predictors of CS among pregnant people with syphilis in Oregon from 2013-2021. Data were collated from surveillance reports, County Health Rankings, and other sources with upstream county-level data. We used multi-level Poisson regression models to assess associations between CS and individual- and county-level factors. Among 343 people with syphilis during pregnancy, 95 (27.6%) were associated with a case of CS. At the individual-level, a history of injection drug use and a history of corrections involvement were associated with an increased risk of CS, while a recent gonorrhea diagnosis was associated with a decreased risk of CS. County-level violent crime rate, unemployment, income inequality, and adverse childhood experiences increased the risk of CS. Higher county-level socioenvironmental challenges exacerbated CS risk, particularly among people with corrections involvement. Injection drug use, corrections involvement, and county-level socioenvironmental challenges increased CS risk among pregnant people with syphilis in Oregon. Urgent interventions are needed, including innovative care models, policy reforms targeting systemic issues, and enhanced collaboration with community services to address the escalating CS crisis.

Frequency of antimicrobial-resistant bloodstream infections in 111 hospitals in Thailand, 2022

To evaluate the frequency of antimicrobial-resistant bloodstream infections (AMR BSI) in Thailand METHODS: We analyzed data from 2022, generated by 111 public hospitals in health regions 1 to 12, using the AutoMated tool for Antimicrobial resistance Surveillance System (AMASS) and submitted to the Ministry of Public Health, Thailand. Multilevel Poisson regression models were used. The most common cause of community-origin AMR BSI was third-generation cephalosporin-resistant Escherichia coli (3GCREC, 65.6%; 5,101/7,773 patients) and of hospital-origin AMR BSI was carbapenem-resistant Acinetobacter baumannii (CRAB, 51.2%, 4,968/9,747 patients). The percentage of patients tested for BSI was negatively associated with the frequency of community-origin 3GCREC BSI and hospital-origin CRAB BSI (per 100,000 tested patients). Hospitals in health regions 4 (lower central region) had the highest frequency of community-origin 3GCREC BSI (adjusted incidence rate ratio, 2.06; 95% confidence interval: 1.52-2.97). Health regions were not associated with the frequency of hospital-origin CRAB BSI, and between-hospital variation was high even adjusting for hospital level and size. The high between-hospital variation of hospital-origin CRAB BSI suggests the importance of hospital-specific factors. Our approach and findings highlight health regions and hospitals where actions against AMR infection, including antimicrobial stewardship and infection control, should be prioritized.

A Digital Approach to Improve Infection Screening Among Solid Organ Transplant Candidates.

Pretransplantinfection screening (IS) of potential organ recipientsis essential to optimal outcome of solid organ transplantation (SOT). A pre-post study was performed during 2020-2023 to investigate the impact of the STREAM (Solid organ TRansplant stEwArdship and Multidisciplinary approach) intervention to improve IS in SOT. The intervention, performed in 2022, included the implementation of IS through educational meetings, local guidelines, and the availability of a digital screening tool. The objective of the study was the assessment of IS completion, including a list of 17 laboratory tests and the investigation of vaccination status. The reduction of unnecessary tests was also analyzed. The test of proportions and a multilevel multivariate Poisson regression model were used to compare IS completion before and after STREAM. infectious diseases (ID) consultation and urgent evaluation were investigated as predictors of IS completion. A total of 171 patients were enrolled, including liver (44%), heart (32%), and kidney (24%) transplant candidates. Mean age was 56 ± 11 years, and most patients (77%) were males. Ninety-five (56%) patients were included before the intervention and 76 (44%) after STREAM. IS completion increased after STREAM (IRR 1.41, p < 0.001) with significant improvement recorded for seven (39%) IS items. Unnecessary tests decreased by 43% after the intervention. ID consultation (IRR 1.13, p = 0.02) and urgent evaluation (p = 0.68, p < 0.001) were predictors of IS improvement. STREAM was successful in improving IS completion. Further research is needed to investigate the impact of this intervention on posttransplant infections.

Discharged from the emergency department following hospital-presented self-harm: referral patterns and risk of repeated self-harm.

Presentation to the emergency department (ED) with self-harm provides an important opportunity for intervention. To investigate characteristics and self-harm repetition risk of those discharged from the ED without a referral for mental health-related aftercare. Data on consecutive self-harm presentations to EDs for the years 2013-2019 (n = 55,770) were obtained from the National Self-Harm Registry Ireland. Multilevel Poisson and Cox regression models were estimated. Half of the self-harm presenters were discharged from the ED (49.8%) and almost half of them did not receive a mental health-related referral (46.8%). Receipt of a psychosocial assessment was associated with a 50% reduced risk of non-referral (IRR 0.54; 95% CI 0.51-0.57). Non-referral was also less likely for young people (< 18 years), presentations involving attempted hanging, persons with previous self-harm presentations, and in the latter half of the study period (2017-2019 vs. 2013-2016), but was more likely for those brought by ambulance, presenting outside 9am-5pm and admitted to an ED medical assessment unit. Of those not referred, 19.3% had a repeat presentation within 12 months, compared to 22.4% of those referred. No difference in repetition risk between these two groups was evident in adjusted analyses. Self-harm history had the strongest association with repetition, with highest risk among individuals with four or more previous presentations (HR 9.30, 95% CI 8.14-10.62). The findings underline the importance of assessing all individuals who present with self-harm and highlight the need for comprehensively resourced 24hr services providing mental health care in the ED.

Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants.

The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21-29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9-8.9) was revealed. A percentage of 19.2% (95% CI: 17.0-21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8-10.1) were obese. A total of 41.5% (95% CI: 38.7-44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4-28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20-7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study.

Sleep hygiene measures combined with mindfulness meditation in the management of sleep bruxism in children: A randomized controlled clinical trial.

Sleep hygiene measures and meditation may reduce stress and improve sleep quality, but their effect on the occurrence of sleep bruxism in children has not yet been investigated. To explore the effects of sleep hygiene measures combined with mindfulness meditation (relaxation audio) in the management of probable sleep bruxism (SB) in children. This clinical trial (no. NCT04501237) randomized 36 children with 3-8 years of age. Probable SB detection was performed according to the criteria established by the International Consensus on The Assessment of Bruxism-2018. Intervention group was instructed to practice sleep hygiene measures and mindfulness meditation (i.e., the use of a digital app to broadcast audio relaxation) each night before bedtime for 5 weeks; control group did not receive guidance for therapies. Parents completed a bruxism diary for 5 weeks, and the outcome was the number of SB episodes-day reported in the week (ranging from 0 to 7) in each period. A multilevel mixed-effects Poisson regression model was performed. A total of 32 children (mean age: 6.1 years) completed the study. The children who received the therapies related to sleep hygiene measures and mindfulness meditation had a reduction in the SB incidence rate ratio (IRR)of 46% (IRR = 0.54 [Confidence Interval 95%, 0.45-0.65]) during a 5-week observation period. The sensitivity analyses did not show relevant changes in the measure of the effect. Sleep hygiene measures combined with mindfulness meditation reduced the SB in children.

Geographically weighted regression analysis to assess hotspots of early sexual initiation and associated factors in Ethiopia

BackgroundEarly sexual initiation (ESI) causes unintended pregnancy, sexually transmitted infections (STI), high risk of depression and anxiety, developmental delays, lack of emotional maturity, and difficulty in pursuing education. This study aims to analyze the geographically weighted regression and associated factors of ESI of women in Ethiopia. MethodsThe study utilized data from the Ethiopian Demographic and Health Survey, 2016. It included a weighted sample of 11,775 women. Spatial regression was carried out to determine which factors are related to hotspots of ESI of women. To identify the factors associated with ESI, a multilevel Poisson regression model with robust variance was conducted. An adjusted prevalence ratio (APR) with its 95 % confidence interval was presented. ResultsThe prevalence of ESI was 75.3 % (95%CI: 74.6 %, 76.1 %), showing notable spatial variation across different regions of Ethiopia. Areas of significant hotspots of ESI were identified in Western and Southern Tigray, most parts of Amhara, Southern, Central and Western Afar, Eastern Gambella, and North Western SNNPR. The significant variables for the spatial variation of ESI were; being single, rural residence, and having no formal education of the women. Factors including; wealth index, marital status, khat chewing, education level, residence, and region were associated significantly with ESI in the multilevel robust Poisson analysis. ConclusionA higher proportion of ESI in women was found. Public health interventions must be made by targeting hotspot areas of ESI through increasing health care access and education (specifically among rural residents), developing a comprehensive sexual education, implementing policies and laws that outlaw early marriage, and mass community-based programs to increase awareness about the importance of delaying sexual activity.

Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis

The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.

Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design

BackgroundLow haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin...

Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe

BackgroundVentilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. MethodsWe implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4–15 month, 16–27 month, and 28–39 month periods. Results174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58–0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46–0.52; P < 0.001); 14.44 at the 4–15 month (RR = 0.51; 95% CI = 0.48–0.53; P < 0.001); 11.40 at the 16–27 month (RR = 0.41; 95% CI = 0.38–0.42; P < 0.001), and to 9.68 at the 28–39 month (RR = 0.34; 95% CI = 0.32–0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention. ConclusionsThis intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.

Evaluating the outcome of a bundle with 11 components and the INICC multidimensional approach in decreasing rates of central line-associated bloodstream infections across nine Asian countries.

Central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs) across Latin America exceed those in high-income countries significantly. We implemented the INICC multidimensional approach, incorporating an 11-component bundle, in 122 ICUs spanning nine Asian countries. We computed the CLABSI rate using the CDC/NSHN definition and criteria. The CLABSI rate per 1000 CL-days was calculated at baseline and throughout different phases of the intervention, including the 2nd month, 3rd month, 4-16 month, and 17-29 month periods. A two-sample t-test was employed to compare baseline CLABSI rates with intervention rates. Additionally, we utilized a generalized linear mixed model with a Poisson distribution to analyze the association between exposure and outcome. A total of 124,946 patients were hospitalized over 717,270 patient-days, with 238,595 central line (CL)-days recorded. The rates of CLABSI per 1000 CL-days significantly decreased from 16.64 during the baseline period to 6.51 in the 2nd month (RR = 0.39; 95% CI = 0.36-0.42; p < 0.001), 3.71 in the 3rd month (RR = 0.22; 95% CI = 0.21-0.25; p < 0.001), 2.80 in the 4-16 month (RR = 0.17; 95% CI = 0.15-0.19; p < 0.001), and 2.18 in the 17-29 month (RR = 0.13; 95% CI = 0.11-0.15; p < 0.001) intervals. A multilevel Poisson regression model demonstrated a sustained, continuous, and statistically significant decrease in ratios of incidence rates, reaching 0.35 (p < 0.0001) during the 17-29 month period. Moreover, the all-cause in-ICU mortality rate significantly decreased from 13.23% to 10.96% (p = 0.0001) during the 17-29 month period. Our intervention led to an 87% reduction in CLABSI rates, with a 29-month follow-up.

Short and long effects of the COVID-19 context on oral health-related quality of life of adolescents.

To assess the immediate and late effects of the COVID-19 pandemic on the oral health-related quality of life (OHRQoL) of adolescents. This is a longitudinal study performed with adolescents (11-15 years old) from Southern Brazil who were evaluated before the COVID-19 outbreak, and 3 (T2) and 15 (T3) months after the beginning of the pandemic. OHRQoL was assessed using the CPQ11-14. Sociodemographic and clinical variables were also collected. Changes in OHRQoL before, 3 and 15 months after the start of the pandemic were analyzed through multilevel Poisson regression models for repeated measures. A total of 290 adolescents were evaluated at T1, 207 were re-evaluated at T2, and 204 at T3. Overall CPQ11-14 scores over follow-ups were 11.0 (SD 8.0) at T1, 8.3 (SD 7.8) and 12.8 (SD 8.8) at T3. Compared to T1, adolescents presented 29% lower overall CPQ11-14 scores (IRR 0.71 95% CI 0.66-0.75) at T2, and 11% higher scores at T3 (IRR 1.11 95% CI 1.05-1 0.17), especially for the emotional and social well-being domains. COVID-19 pandemic impacted the adolescents' OHRQoL differently over time, indicating a reduction in impacts immediately after the beginning and worsening over long term exposure to this scenario.

Trends in low-value GP care during the COVID-19 pandemic: a retrospective cohort study

BackgroundSeveral studies showed that during the pandemic patients have refrained from visiting their general practitioner (GP). This resulted in medical care being delayed, postponed or completely forgone. The provision of low-value care, i.e. care which offers no net benefit for the patient, also could have been affected. We therefore assessed the impact of the COVID-19 restrictions on three types of low-value GP care: 1) imaging for back or knee problems, 2) antibiotics for otitis media acuta (OMA), and 3) repeated opioid prescriptions, without a prior GP visit.MethodsWe performed a retrospective cohort study using registration data from GPs part of an academic GP network over the period 2017–2022. The COVID-19 period was defined as the period between April 2020 to December 2021. The periods before (January 2017 to April 2020) and after the COVID-19 period (January 2022 to December 2022) are the pre- and post-restrictions periods. The three clinical practices examined were selected by two practicing GPs from a top 30 of recommendations originating from the Dutch GP guidelines, based on their perceived prevalence and relevance in practice (van Dulmen et al., BMC Primary Care 23:141, 2022). Multilevel Poisson regression models were built to examine changes in the incidence rates (IR) of both registered episodes and episodes receiving low-value treatment.ResultsDuring the COVID-19 restrictions period, the IRs of episodes of all three types of GP care decreased significantly. The IR of episodes of back or knee pain decreased by 12%, OMA episodes by 54% and opioid prescription rate by 13%. Only the IR of OMA episodes remained significantly lower (22%) during the post-restrictions period. The provision of low-value care also changed. The IR of imaging for back or knee pain and low-value prescription of antibiotics for OMA both decreased significantly during the COVID-restrictions period (by 21% and 78%), but only the low-value prescription rate of antibiotics for OMA remained significantly lower (by 63%) during the post-restrictions period. The IR of inappropriately repeated opioid prescriptions remained unchanged over all three periods.ConclusionsThis study shows that both the rate of episodes as well as the rate at which low-value care was provided have generally been affected by the COVID-19 restrictions. Furthermore, it shows that the magnitude of the impact of the restrictions varies depending on the type of low-value care.This indicates that deimplementation of low-value care requires tailored (multiple) interventions and may not be achieved through a single disruption or intervention alone.

Tobacco use and oral health related quality of life among Indian adolescents.

The present study was conducted to assess tobacco use and its effect on Oral Health-Related Quality of Life (OHRQoL) in Indian adolescents. The present study was conducted on 1,600 13-14 year old adolescents from the schools of Modinagar, western Uttar Pradesh, India selected using stratified random sampling technique. OHRQoL was assessed using Hindi version of Child Perceptions Questionnaire (CPQ). Information regarding demographic, socioeconomic and oral health measures was also collected from the study participants. Tobacco use was assessed through questions derived from Global Youth Tobacco Survey (GYTS) questionnaire. Influence of predictor variables on tobacco use was evaluated using multilevel Poisson regression model. The tobacco use among the study population was 8.1 % and CPQ scores were 9.15±0.32. Adolescents who used tobacco had worse OHRQoL scores. Low socioeconomic status, presence of dental caries, absence of regular dental visits (last 6months) were associated with increased regular consumption of tobacco products. The findings of the present study play an important role in planning public health strategies to improve adolescent OHRQoL and reduce tobacco use.

Sex differences in the association between socioeconomic status and untreated hypertension among residents with hypertension in rural Khánh Hòa, Vietnam: a post-hoc analysis

BackgroundSeveral studies have examined the association between socioeconomic status (SES) and the proportion of untreated hypertension, but have produced conflicting findings. In addition, no study has been conducted to determine sex differences in the association between SES and untreated hypertension. Thus, the aim of this study was to examine whether the associations between SES and the proportion of untreated hypertension differed by sex in Vietnam.MethodsThis study was conducted using the data of 1189 individuals (558 males and 631 females) who were judged to have hypertension during the baseline survey of a prospective cohort study of 3000 residents aged 40–60 years in the Khánh Hòa Province. A multilevel Poisson regression model with a robust variance estimator was used to examine whether sex and SES indicators (household income and educational attainment) interacted in relation to untreated hypertension.ResultsThe proportion of untreated hypertension among individuals identified as hypertensive was 69.1%. We found significant interaction between sex and SES indicators in relation to untreated hypertension (education: p < 0.001; household income: p < 0.001). Specifically, the association between SES and untreated hypertension was inverse among males while it was rather positive among females.ConclusionsOur finding suggests that the role of SES in the proportion of untreated hypertension might differ by sex.

Trends in social determinants of inequality in child undernutrition from the Ethiopian Demographic and Health Surveys, 2005-2016.

While child undernutrition has been eliminated in some middle-income countries, it remains highly prevalent in sub-Sahara African (SSA) and South Asian regions, and is disproportionately concentrated among the poor. In this study, we estimated trends in child undernutrition by social determinants and related risks from wealth inequality in Ethiopia, from 2005 to 2016. We analyzed data from three consecutive surveys (2005, 2011, and 2016) from the Ethiopian Demographic and Health Survey. First, we estimated trends in the prevalence of childhood undernutrition variables (stunting, underweight, and wasting) and social determinants (household wealth status, education level, place of residence, and administrative regions). Then we assessed evidence of undernutrition by wealth-related inequality with concentration curves (visual) and concentration indeces (quantitative). A multilevel mixed-effect Poisson regression model was used to identify predictors of undernutrition variables expressed as covariate-adjusted rate ratios, with 95% confidence intervals (RRs, 95%CI). A total of 23,934 mother-child pairs were obtained from the three surveys. The average prevalence decreased by 12.4 percentage points for stunting (from 50.8 to 38.4%, P<0.01), 9.5 percentage points for underweight (33.2% to23.7%, P<0.01), and 2.1 percentage points for wasting (12.2% to10.1%, P<0.01). There was persistent and statistically evidence of wealth inequality in stunting, underweight, and wasting (concentration indeces of -0.2 to -0.04, all P values <0.05). Stunting, underweight, and wasting variables were associated with male sex of the child (RR 0.94, 0.95, 0.85, all P-values <0.01) recent diarrhea (RR 1.18, 1.27, 1.37, all P-values <0.01), secondary education status of the mother (RR 0.66, 0.57, 0.61, all P-values < 0.057), increasing wealth index (richest) (RR 0.73, 0.70, 0.50, all P-values < 0.05), and having no toilet facility (RR 1.16, 1.22, 1.18, all P-values < 0.05). Despite the decreased burden of stunting and underweight, the prevalence of wasting remained relatively unchanged in Ethiopia from 2005 to 2016. Moreover, wealth-related inequality in child undernutrition increased for most of the child undernutrition indicators during this period. Social determinants of child undernutrition warrant urgent implementation of strategies to reduce their health impacts in SSA.

Association between underlying dentin shadows (ICDAS 4) and OHRQoL among adolescents from southern Brazil.

This study aimed to assess the association between underlying dentin shadows (UDS) and oral health-related quality of life (OHRQoL) among 15-19-year-old adolescents from southern Brazil. This population-based cross-sectional study included a representative sample of 1,197 15-19-year-old adolescents attending 31 public and private schools from Santa Maria, Brazil. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate the OHRQoL, and clinical examinations were performed by two calibrated examiners (intra/interexaminer kappa values for caries examination ≥ 0.80) to diagnose UDS (ICDAS code 4 caries lesions). Sociodemographic information and clinical characteristics (overall caries experience, traumatic dental injury, malocclusion, and gingivitis) were also collected as adjusting variables. Multilevel Poisson regression models were used to assess the association between UDS and OHRQoL. Rate ratios (RR) and 95% confidence intervals (CI) were estimated. The UDS prevalence was 8.8% (n = 106 adolescents). In the adjusted models, adolescents with UDS had poorer OHRQoL than those without UDS, and the strength of the association was dependent on the number of lesions per individual. Individuals with 1-2 UDS had a mean OHIP-14 score 8% higher (RR = 1.08; 95%CI: 1.01-1.17) than adolescents without UDS, while those with 3-4 UDS had a mean score 35% higher (RR = 1.35; 95%CI: 1.12-1.63). This negative association was related to physical disability, psychological disability, social disability, and handicap domains. This study showed that UDS was associated negatively with OHRQoL among 15-19-year-old adolescents from southern Brazil. The negative effect of UDS on OHRQoL emphasizes the importance of addressing issues regarding OHRQoL even in the posterior teeth of adolescents.

Is sexual autonomy a protective factor against intimate partner violence? Evidence from 27 sub-Saharan African countries.

Though women in sub-Saharan Africa have increased risk of intimate sexual violence, research on the association between sexual autonomy and intimate partner violence among this population has not received the requisite attention. Consequently, we investigated if sexual autonomy is a protective factor against intimate partner violence among women in sub-Saharan Africa. Secondary data analysis was conducted based on the Demographic and Health Surveys (DHSs) of 27 sub-Saharan African countries from 2008 to 2021. A total of 104,523 married or cohabitating women were included in the study. We applied a multilevel Poisson regression model with robust variance to identify associated factors. Variables with a p-value<0.2 in the bi-variable multilevel Poisson regression analysis were considered for the multivariable analysis. The Adjusted Prevalence Ratio (APR) with its 95% confidence interval (CI) was reported, and variables with a p-value <0.05 were included in the multivariable analysis. The prevalence of intimate partner violence and sexual autonomy among women in SSA were 32.96% [95% CI: 32.68%, 33.25%] and 88.79% [95% CI: 88.59%, 88.97%], respectively. Women in Sierra Leone had the highest prevalence of IPV (52.71%) while Comoros had the lowest prevalence of IPV (8.09%). The prevalence of sexual autonomy was highest in Namibia (99.22%) and lowest in Mali (61.83%). The MOR value in the null model was 1.26. We found that women who had sexual autonomy are 1.28 times [APR = 1.28, 95% CI: 1.17, 1.40] more likely to experience IPV than women who had no sexual autonomy. This study has demonstrated that sexual autonomy is significantly associated with intimate partner violence, however, it does not necessarily act as a protective factor. The study suggests the need for more education on intimate partner violence targeting women's partners. This can help secure the commitment of the perpetrators to rather become proponents of anti-intimate partner violence and further offer women the necessary support for them to attain their full fundamental rights in all spheres of life.

Trends and age-period-cohort effect on dental caries prevalence from 2008 to 2019 among Brazilian preschoolers.

This study aimed to evaluate trends in the prevalence of dental caries in preschool children and associated factors considering different time variations. This is a time series study performed using data from three cross-sectional studies with pre-school children from southern Brazil in 2008, 2013 and 2019. This children group was born between the years of 2003 to 2018. Dental caries was evaluated by decayed, missing and filled deciduous teeth (dmft index). Demographic, socioeconomic, behavioural and psychosocial variables were also collected. Chi-square test for trends and a hierarchical age-period-cohort (HAPC) analysis using multilevel Poisson regression model for testing the associations between predictor variables and dental caries experience were used. A total of 1,644 pre-school children participated in all surveys. There was a significant difference in caries experience considering all APC effects. The prevalence of dental caries was 25.0% in 2008, 16.3% in 2013, and 19.4% in 2019 (p < 0.01) and no statistical difference was observed. An age effect showed that older children were more likely to experience dental caries. Considering the cohort effect, there is a significant difference between the generations, mainly between 2003 and 2018. Household income, use of dental services, and parent's perception of child oral health were associated with dental caries experience no matter the time variation. Despite recent declines in dental caries prevalence among preschool children, caries levels increased with age and social inequalities persisted through the years, indicating a need of reviewing the policies to reduce the burden of this oral disease.

ENDS, Cigarettes, and Respiratory Illness: Longitudinal Associations Among U.S. Youth

Introduction: Electronic nicotine delivery system (ENDS) use is highly prevalent among U.S. youth, and there is concern about its respiratory health effects. However, evidence from nationally representative longitudinal data is limited. MethodsUsing youth data (ages 12-17) from waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study, multilevel Poisson regression models were estimated to examine the association between ENDS use, cigarettes, and diagnosed bronchitis, pneumonia, or chronic cough. Current product use was lagged by one wave and categorized as: (a) never/non-current use; (b) exclusive cigarette use; (c) exclusive ENDS use; and (d) dual ENDS/cigarette use. Multivariable models adjusted for age, sex, race and ethnicity, parental educational, asthma, body mass index, cannabis use, secondhand smoke exposure, and household use of combustible products. Data analysis was conducted in 2022–2023. Results7.4% of respondents were diagnosed with bronchitis, pneumonia, or chronic cough at follow-up. In the multivariable model, exclusive cigarette use (IRR = 1.85; 95% CI 1.29-2.65), exclusive ENDS use (IRR = 1.49; 95% CI 1.06-2.08), and dual use (IRR = 2.70, 95% CI 1.61-3.50) were associated with a higher risk of diagnosed bronchitis, pneumonia, or chronic cough, compared to never/non-current use. ConclusionsThese results suggest that ENDS and cigarettes, used exclusively or jointly, increased the risk of diagnosed bronchitis, pneumonia, or chronic cough among U.S. youth. However, dual use was associated with the highest risk. Targeted policies aimed at continuing to reduce cigarette smoking and ENDS use among youth, especially among those with dual use, are needed.