Multinomial Analysis Research Articles

Prevalence and factors associated with frailty and pre-frailty in the older adults in China: a national cross-sectional study.

Frailty increases poor clinical outcomes in older adults, the aim of this study was to investigate the prevalence and factors associated with frailty and pre-frailty in older adults in China. Data were obtained from the Sample Survey of the Aged Population in Urban and Rural China in 2015, which was a cross-sectional study involving a nationally representative sample of older adults aged 60 years or older from 31 provinces/autonomous regions/municipalities in mainland China. The frailty index (FI) based on 33 potential deficits was used to classify individuals as robust (FI < 0.12), pre-frail (FI ≧0.12 and <0.25) and frail (FI ≥0.25). A total of 208,386 older people were included in the study, and the age-sex standardised prevalence of frailty and pre-frailty among older adults in China was 9.5% (95% CI 9.4-9.7) and 46.1% (45.9-46.3) respectively. The prevalence of frailty and pre-frailty was higher in female than in male older adults, higher in rural than in urban older adults, and higher in northern China than in southern China. The multinomial analysis revealed similar risk factors for frailty and pre-frailty, including increased age, being female, living in a rural area, low educational attainment, poor marital status, living alone, difficult financial status, poor access to medical reimbursement, and living in northern China. Frailty and pre-frailty are very common among older adults in China and differ significantly between southern and northern China, men and women, and rural and urban areas. Appropriate public health prevention strategies should be developed based on identified risk factors in frail and pre-frail populations. The management of frailty and pre-frailty should be optimised according to regional and gender differences in prevalence and associated factors, such as strengthening the integrated management of chronic diseases, increasing reimbursement rates for medical costs, and focusing on vulnerable groups such as the disabled, economically disadvantaged, living alone and those with low literacy levels, in order to reduce the burden of frailty among older adults in China.

The clustering of multiple health and lifestyle behaviors among Swedish adolescents: a person-oriented analysis.

Knowledge of the distribution, prevalence, and clustering of multiple health and lifestyle related behaviors (HLBs) among adolescents can inform the development of effective health-promoting policies and interventions. We assessed the clustering of multiple HLBs among 11, 13 and 15-year-old Swedish adolescents and examined the socioeconomic and demographic correlates for the identified clusters. We used data from the 2017/2018 Swedish Health Behaviour in School-aged children (HBSC) study to conduct sex and age-stratified latent class analysis (LCA). The LCA was based on five HLBs: eating behavior and habits (EBH), physical activity (PA), tobacco usage (TU), alcohol consumption (AC) and sleeping habits and patterns (SHPs). Multinomial logistic regression models were used to assess the associations between the identified clusters and the socioeconomic and demographic characteristics of adolescents and their parents. Health behaviors varied by sex and age. Four distinct clusters were identified based on sex: cluster 1 (Mixed eating behaviors and habits, physical activity and low alcohol consumption), cluster 2 (Healthy lifestyle behaviors), cluster 3 (Unhealthy lifestyle behaviors), and cluster 4 (Breakfast, low alcohol consumption and tobacco usage). In the age-stratified analyzes, three clusters were identified: cluster 1 (Unhealthy lifestyle behaviors), cluster 2 (Moderately healthy lifestyle behaviors) and cluster 3 (Healthy lifestyle behaviors). The multinomial analysis showed that sex, age, family situation and perceived family wealth were strong predictors of health behaviors. Unhealthy behaviors were most commonly associated with socioeconomic disadvantage, having a migrant background, and living in reconstructed families or single-parent households. Health behaviors vary significantly based on socioeconomic and demographic circumstances. Targeted policies and intervention programs are necessary to improve HLBs among vulnerable and at-risk adolescents.

Double burden of malnutrition and its associated factors among adolescents in Debre Berhan Regiopolitan City, Ethiopia: a multinomial regression model analysis.

The double burden of malnutrition (DBM), contained both undernutrition and overnutrition, is a growing public health concern that presents a significant challenge to the food and nutrition policies of developing nations such as Ethiopia. However, the prevalence and contributing factors of DBM among adolescents in the study area have not been adequately investigated by Ethiopian researchers. Therefore, this study aims to determine the prevalence of DBM and contributing factors among secondary school students in Debre Berhan City, Ethiopia. A school-based cross-sectional study was conducted among 742 adolescents aged 10-19 years from October 13, 2022, to November 14, 2022, using a multi-stage sampling method. Data were collected using the online Kobo toolbox tool. A multinomial logistic regression model was used to analyze the data. The data were cleaned and analyzed in R software 4.2.2. Adolescents who had body mass index for age Z score (BAZ) < -2 SD, > +1 SD, and > +2 from the median value were considered thin, overweight, and obese, respectively. The overall prevalence of DBM was 21.5% (14.8% thinness and 6.7% overweight/obesity). In the multivariable multinomial logistic regression analysis models factors such as age [AOR = 0.79, 95% CL: (0.67, 0.93)], sex [AOR = 3.86, 95% CL: (2.35, 6.32)], school type [AOR 5.03, 95% CL: (2.30, 10.99)], minimum dietary diversity score [AOR = 2.29, 95% CL: (1.27, 4.14)], frequency of meals [AOR = 2.09, 95% CL: (1.13, 3.89)], home gardening practice [AOR = 2.31, 95% CL: (1.44, 3.67)], history of illness [AOR = 0.57, 95% CL: (0.36, 0.93)], and knowledge of nutrition [AOR = 4.96, 95% CL: (1.61, 15.33)] were the significant predictors of either thinness or overweight/obesity (DBM). More than one-fifth of adolescents were affected by DBM in the study area. This prevalence is higher compared with the national and regional prevalence that found to be a public health concern. Thus, interventions like double-duty interventions should consider the age, sex, school type, minimum dietary diversity score, frequency of meals, home gardening practice, history of illness, and nutritional knowledge of adolescents. clinicaltrial.gov, identifier NCT05574842.

A MIDAS multinomial logit model with applications for bond ratings

In multinomial classification analysis, the issue of mixed-frequency data is becoming increasingly common. To solve the multiclassification problem in a mixed-frequency data environment with a large frequency ratio, we combine the restricted mixed data sampling (MIDAS) method with a multinomial logit (MLogit) model to construct a MIDAS-MLogit model. The MIDAS-MLogit model imposes functional constraints on high-frequency variable parameters and fully uses high-frequency information to complete multiclassification tasks in a mixed-frequency data environment. Through extensive Monte Carlo simulations, we prove that this novel MIDAS-MLogit model has better classification performance than conventional MLogit and U-MIDAS-MLogit models for solving multiclassification problems with a large frequency ratio. In addition, we use the MIDAS-MLogit model to predict the ratings of corporate bonds issued by Chinese-listed companies from 2008 to 2021 and find that its prediction accuracy outperforms several competitive models. We further verify the validity of the MIDAS-MLogit model for different periods, including the global financial crisis, the post-financial crisis, and the pandemic. The results show that all three models perform well during the global financial crisis, but the MIDAS-MLogit model predominates the post-financial crisis and pandemic periods. The empirical results also show that covariates from bond, corporate, and financial environment levels have varying effects on corporate bond ratings.

Estimation of differential growth of the protandrous hermaphrodite marine gastropod Trochita trochiformis (Littorinimorpha: Calyptraeidae) using Schnute model cases

The snail Trochita trochiformis is a mollusk captured on the coasts of Jalisco and Guerrero of the Mexican Pacific. Despite its importance in artisanal fisheries, information on its population parameters is still being determined. This research aimed to determine the diameter-weight relationship, sex ratio, cohorts, and growth of this species. Specimens were captured from October 2019 to September 2021. Shell diameter (Sd), total weight (Tw), and the sex of the organisms were gathered from a total of 1763 females and 956 males. The sex ratio was 1.84:1, and the X2 test (P &lt; 0.05) indicated significant differences. The Sd-Tw relationship for females and males was potential-type. The values of the allometry coefficient for both sexes were b = 2.61, b = 2.60 for females, and b = 2.62 for males. In all three cases, the t-Student test indicated negative allometric growth, which indicates that the species first grows in shell diameter, then in body weight. The ANCOVA did not show significant differences in the Sd-Tw relationships between sexes (P = 0.902). The Kolmogorov-Smirnov test applied to the Sd data showed differences between sexes (P &lt; 0.001). In females, differences were observed in 71.5% by monthly comparisons, while in males, differences were found in 58.1%. Multinomial analysis showed three modal groups and 14 individual cohorts for both females and males. Case 2 of the Schnute model was the best for females (wi = 0.39) and males (wi = 0.53), showing sigmoidal Gompertz-type growth. The resulting growth curves showed that females exhibit accelerated growth concerning males and that both sexes reach their maximum size, 88.04 and 86.23 mm, respectively, at approximately 10 years of age.

Baseline preferences for oral pre-exposure prophylaxis (PrEP) or dapivirine intravaginal ring for HIV prevention among adolescent girls and young women in South Africa, Uganda and Zimbabwe (MTN-034/IPM-045 study).

Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the HIV epidemic and face an array of challenges using proven behavioral and biomedical prevention methods. To address the urgent need for expanding prevention options, we evaluated the baseline preferences of HIV prevention methods among participants enrolled in the MTN-034/REACH crossover trial along with their stated product preference prior to product initiation. AGYW aged 16-21 years were enrolled at 4 study sites: Cape Town and Johannesburg, South Africa; Kampala, Uganda; and Harare, Zimbabwe and randomly assigned to the sequence of using oral PrEP and the dapivirine ring for 6 months each, followed by a choice period in which they could choose either product (or neither) for an additional six months. Eligible AGYW were HIV-negative, not pregnant and using effective contraception for at least two months prior to enrollment. Descriptive statistics were used to summarize demographic and behavioral data while multinomial analysis was used to determine predictors of stated product preference (ring or oral PrEP). Of the 247 AGYW enrolled in REACH, 34% were aged 16-17 and 89% had a primary partner.The median age of sexual debut was 16 years and 40% had ever been pregnant. At screening, 35% of participants were diagnosed with a sexually transmitted infection (STI), 39% had an AUDIT-C score associated with harmful drinking and 11% reported intimate partner violence in the past 6 months. Overall, 28% of participants, had CESD-10 scores suggestive of depressive symptoms (≥12) in the past week. At baseline, similar proportions stated a preference for the ring and oral PrEP (38.1% and 40.5% respectively), with 19% of participants stating they preferred both products equally. Only study site was significantly associated with product preference (P<0.05) with AGYW from Johannesburg having higher odds of preferring the ring and those from Kampala having higher odds of preferring both options equally. We successfully enrolled African AGYW with a clear unmet need for HIV prevention. The balanced preference between the two products suggests that multiple biomedical prevention options may be appealing to this age group and could address their prevention needs.

Regional differences in the associations of diet quality, obesity, and possible sarcopenia using the seventh Korea National Health and Nutrition Examination Survey (2016-2018).

Sarcopenic obesity is closely related to aging and the prevalence of various chronic diseases and frailty. The purpose of this study was to analyze whether diet quality is related to obesity, sarcopenia, and sarcopenic obesity, and if so, to explore the difference in that relationship between urban and rural settings. Using data from the Korea National Health and Nutrition Examination Survey of 2016-2018, a total of 7,151 participants aged 40 years or older were analyzed. Sarcopenia was diagnosed using handgrip strength. Diet quality was assessed using Korea Healthy Eating Index (KHEI) scores, and obesity was determined based on participants' abdominal circumference. Multinomial logistic analysis was used for testing statistical significance. Rural participants had significantly lower KHEI scores and a higher prevalence of sarcopenic obesity than urban participants. The study findings demonstrate that participants without obesity, sarcopenia, or sarcopenic obesity had significantly higher KHEI scores in both rural and urban settings. Multinomial regression analysis further revealed that a higher KHEI score was associated with a lower risk of sarcopenia and sarcopenic obesity among urban residents, while only the risk of obesity was lower with higher diet quality scores among rural residents. Since diet quality and health status were lower in rural areas, it is important to address this regional disparity with appropriate policy measures. To mitigate urban health disparities, urban residents in poor health with few resources should also be supported.

COVID-19 vaccine hesitancy among first-generation immigrants living in Sweden.

In many countries, immigrants face higher risks of contracting and dying from COVID-19 compared with the native-born population. Moreover, their COVID-19 vaccination uptake tends to be lower. This study aimed to investigate COVID-19 vaccine hesitancy in relation to sociodemographic characteristics, COVID-19-related exposures and social values, norms and perceptions among first-generation immigrants in Sweden. Vaccine hesitancy is an important public health issue to ensure protection against vaccine-preventable mortality and morbidity. Nation-wide representative data were collected by the Migrant World Values Survey. Descriptive and multinomial multivariate analyses were performed to analyze vaccine hesitancy among 2612 men and women aged ≥16 years. One-quarter of the respondents expressed some degree of vaccine hesitancy; 5% said they would definitely not vaccinate, 7% probably not, 4% did not know and 7% did not want to answer. Young age, arriving to Sweden during the large migration wave in 2015, Eastern European origin, female gender, lower education and low trust in authorities, and less perceived benefits of vaccination were all significant determinants of vaccine hesitancy. The results underscore the importance of trust in healthcare providers and government authorities. Additionally, the importance of providing adequate and targeted information about vaccination to groups who face the largest barriers to care, enabling informed decision-making about the benefits and risks of vaccination in relation to health risks. Given these health risks, it is crucial that government agencies and the health sector address the multiple social dimensions that shape the low vaccine uptake and, in turn, health equity.

Molnupiravir, Nirmatrelvir/Ritonavir, or Sotrovimab for High-Risk COVID-19 Patients Infected by the Omicron Variant: Hospitalization, Mortality, and Time until Negative Swab Test in Real Life.

Background. Several drugs which are easy to administer in outpatient settings have been authorized and endorsed for high-risk COVID-19 patients with mild-moderate disease to prevent hospital admission and death, complementing COVID-19 vaccines. However, the evidence on the efficacy of COVID-19 antivirals during the Omicron wave is scanty or conflicting. Methods. This retrospective controlled study investigated the efficacy of Molnupiravir or Nirmatrelvir/Ritonavir (Paxlovid®) or Sotrovimab against standard of care (controls) on three different endpoints among 386 high-risk COVID-19 outpatients: hospital admission at 30 days; death at 30 days; and time between COVID-19 diagnosis and first negative swab test result. Multivariable logistic regression was employed to investigate the determinants of hospitalization due to COVID-19-associated pneumonia, whereas time to first negative swab test result was investigated by means of multinomial logistic analysis as well as Cox regression analysis. Results. Only 11 patients (overall rate of 2.8%) developed severe COVID-19-associated pneumonia requiring admission to hospital: 8 controls (7.2%); 2 patients on Nirmatrelvir/Ritonavir (2.0%); and 1 on Sotrovimab (1.8%). No patient on Molnupiravir was institutionalized. Compared to controls, hospitalization was less likely for patients on Nirmatrelvir/Ritonavir (aOR = 0.16; 95% CI: 0.03; 0.89) or Molnupiravir (omitted estimate); drug efficacy was 84% for Nirmatrelvir/Ritonavir against 100% for Molnupiravir. Only two patients died of COVID-19 (rate of 0.5%), both were controls, one (a woman aged 96 years) was unvaccinated and the other (a woman aged 72 years) had adequate vaccination status. At Cox regression analysis, the negativization rate was significantly higher in patients treated with both antivirals-Nirmatrelvir/Ritonavir (aHR = 1.68; 95% CI: 1.25; 2.26) or Molnupiravir (aHR = 1.45; 95% CI: 1.08; 1.94). However, COVID-19 vaccination with three (aHR = 2.03; 95% CI: 1.51; 2.73) or four (aHR = 2.48; 95% CI: 1.32; 4.68) doses had a slightly stronger effect size on viral clearance. In contrast, the negativization rate reduced significantly in patients who were immune-depressed (aHR = 0.70; 95% CI: 0.52; 0.93) or those with a Charlson index ≥5 (aHR = 0.63; 0.41; 0.95) or those who had started the respective treatment course 3+ days after COVID-19 diagnosis (aOR = 0.56; 95% CI: 0.38; 0.82). Likewise, at internal analysis (excluding patients on standard of care), patients on Molnupiravir (aHR = 1.74; 95% CI: 1.21; 2.50) or Nirmatrelvir/Ritonavir (aHR = 1.96; 95% CI: 1.32; 2.93) were more likely to turn negative earlier than those on Sotrovimab (reference category). Nonetheless, three (aHR = 1.91; 95% CI: 1.33; 2.74) or four (aHR = 2.20; 95% CI: 1.06; 4.59) doses of COVID-19 vaccine were again associated with a faster negativization rate. Again, the negativization rate was significantly lower if treatment started 3+ days after COVID-19 diagnosis (aHR = 0.54; 95% CI: 0.32; 0.92). Conclusions. Molnupiravir, Nirmatrelvir/Ritonavir, and Sotrovimab were all effective in preventing hospital admission and/or mortality attributable to COVID-19. However, hospitalizations also decreased with higher number of doses of COVID-19 vaccines. Although they are effective against severe disease and mortality, the prescription of COVID-19 antivirals should be carefully scrutinized by double opinion, not only to contain health care costs but also to reduce the risk of generating resistant SARS-CoV-2 strains. Only 64.7% of patients were in fact immunized with 3+ doses of COVID-19 vaccines in the present study. High-risk patients should prioritize COVID-19 vaccination, which is a more cost-effective approach than antivirals against severe SARS-CoV-2 pneumonia. Likewise, although both antivirals, especially Nirmatrelvir/Ritonavir, were more likely than standard of care and Sotrovimab to reduce viral shedding time (VST) in high-risk SARS-CoV-2 patients, vaccination had an independent and stronger effect on viral clearance. However, the effect of antivirals or COVID-19 vaccination on VST should be considered a secondary benefit. Indeed, recommending Nirmatrelvir/Ritonavir in order to control VST in high-risk COVID-19 patients is rather questionable since other cheap, large spectrum and harmless nasal disinfectants such as hypertonic saline solutions are available on the market with proven efficacy in containing VST.

Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia.

Ethiopia is one of the countries facing a very high burden of perinatal death in the world. Despite taking several measures to reduce the burden of stillbirth, the pace of decline was not that satisfactory. Although limited perinatal mortality studies were conducted at a national level, none of the studies stressed the timing of perinatal death. Thus, this study is aimed at determining the magnitude and risk factors that are associated with the timing of perinatal death in Ethiopia. National perinatal death surveillance data were used in the study. A total of 3814 reviewed perinatal deaths were included in the study. Multilevel multinomial analysis was employed to examine factors associated with the timing of perinatal death in Ethiopia. The final model was reported through the adjusted relative risk ratio with its 95% Confidence Interval, and variables with a p-value less than 0.05 were declared statistically significant predictors of the timing of perinatal death. Finally, a multi-group analysis was carried out to observe inter-regional variation among selected predictors. Among the reviewed perinatal deaths, 62.8% occurred during the neonatal period followed by intrapartum stillbirth, unknown time of stillbirth, and antepartum stillbirth, each contributing 17.5%,14.3%, and 5.4% of perinatal deaths, respectively. Maternal age, place of delivery, maternal health condition, antennal visit, maternal education, cause of death (infection and congenital and chromosomal abnormalities), and delay to decide to seek care were individual-level factors significantly associated with the timing of perinatal death. While delay reaching a health facility, delay to receive optimal care health facility, type of health facility and type region were provincial-level factors correlated with the timing of perinatal death. A statistically significant inter-regional variation was observed due to infection and congenital anomalies in determining the timing of perinatal death. Six out of ten perinatal deaths occurred during the neonatal period, and the timing of perinatal death was determined by neonatal, maternal, and facility factors. As a way forward, a concerted effort is needed to improve the community awareness of institutional delivery and ANC visit. Moreover, strengthening the facility level readiness in availing quality service through all paths of the continuum of care with special attention to the lower-level facilities and selected poor-performing regions is mandatory.

Analyzing patient satisfaction in a rural wound care center

PurposeAs healthcare continues to become more expensive and complex, considering the voice of the patient in the design and operation of healthcare practices is important. Wound care and rural healthcare scenarios pose additional complexities for providers and patients. This study sought to identify key determinants of patient service quality in wound care.Design/methodology/approachPatients at the wound care/ostomy clinic (WOC) in a rural hospital were surveyed using the Kano model. The Kano model enables the categorization of quality attributes based on the attributes' contribution to the subject's overall satisfaction (and dissatisfaction). Chi-square goodness-of-fit testing, multinomial analysis and power analysis were then used to determine the Kano categories for each satisfaction-related attribute.FindingsThe analyses resulted in 14 one-dimensional attributes and 3 indeterminable attributes. For the one-dimensional attributes, customer satisfaction is directly proportional to the level of performance for that attribute. The one-dimensional attributes included providing correct care on the first, provision of necessary supplies for care, appropriately qualified medical staff and confidence in care provided by medical staff, among others. Understanding the attributes important to the patient drive patient-centered care, which improves positive patient outcomes and recovery. These attributes can then be used by healthcare professionals to design patient-centric processes and services. This research provides a framework for incorporating the voice of the patient into healthcare services.Research limitations/implicationsWhile the research methodology can be used in other healthcare settings, the findings are not generalizable to other wound care clinics. This research was conducted in one small, rural hospital. In addition, the sample size was small due to the size of the wound clinic; therefore, an analysis of the differences between demographics could not be performed.Practical implicationsConsidering the perspectives of rural wound care patients is important, as the patients are an under-served population with unique challenges related to patient care. The research findings detail rural patients' expectations during wound care treatments, which enable the clinic to focus on improving patient satisfaction. This research contributes to understanding the factors that are important to patient satisfaction in wound care. Further, the methodology presented can be applied to other healthcare settings.Originality/valueWhile studies exist using the Kano model in healthcare and the literature is sparse in rural healthcare, this is the first case study using the Kano model in wound care to understand patient preferences.

Perceived Stress, Psychological Flexibility Profiles, and Mental Health During COVID-19: A Latent Profile Analysis.

Although the link between psychological flexibility and healthy functioning has been widely analyzed, the employed measurements often lacked accuracy. The current study introduced a person-centered approach that identified subgroups of college students across the dimensions of the Personalized Psychological Flexibility Index (PPFI) and explored how these subgroups relate to a risk factor (perceived stress) and mental health outcomes (depression, anxiety, negative affect, and positive affect) in the context of COVID-19. A sample of 659 participants (Mage = 19. 99, SD = 1.27; 57.97% females) completed the questionnaires online. Latent profile analysis (LPA) was employed to determine the optimal number of subgroups or profiles. Then, multinomial logistic regression and analyses of variance were used to identify variables associated with profile membership. LPA identified three distinct profiles (active strategy, inconsistent strategy, and passive strategy). Furthermore, multinomial logistic regressions indicated that students with high perceived stress were more likely to be in the passive strategy group than the active strategy group (β = -0.104, OR = 0.901, p < 0.001) and the inconsistent strategy group (β = -0.087, OR = 0.917, p < 0.001). Additionally, analyses of variance revealed that the three profiles differed in depression (η2 = 0.062, p < 0.001), anxiety (η2 = 0.059, p < 0.001), negative affect (η2 = 0.047, p < 0.001), and positive affect (η2 = 0.048, p < 0.001). The current study employed LPA based on the PPFI to identify and confirm three profiles of psychological flexibility. We found that perceived stress and mental health outcomes were associated with these three profiles. This study offers a new perspective on understanding psychological flexibility through a person-centered approach. Furthermore, interventions aimed at reducing college students' perceived stress during the COVID-19 crisis are critical for preventing the deterioration of psychological flexibility.

Factors Affecting Postoperative Complications of Suction-Curettage by Arthroscopic Shaver for Bromhidrosis.

Suction-curettage by arthroscopic shaver is the most effective treatment for bromhidrosis; however, postoperative complications require wound management and exhibit a high risk of hypertrophic scarring. We investigated factors affecting postoperative complications. We retrospectively evaluated data for 215 patients (430 axillae) with bromhidrosis treated with suction-curettage by arthroscopic shaver between 2011 and 2019. Cases followed for less than 1 year were excluded. Complications of hematoma or seroma, epidermis decortication, skin necrosis, and infection were recorded. Multinomial logistic analysis was used to calculate odds ratios and corresponding 95% confidence intervals for the complication of the surgery, adjusting for relevant statistically significant variables. Complications occurred in 52 axillae (12.1%). Epidermis decortication occurred in 24 axillae (5.6%), with a significant difference for age (P < 0.001). Hematoma occurred in 10 axillae (2.3%) with a significant difference in tumescent infiltration use (P = 0.039). Skin necrosis occurred in 16 axillae (3.7%) with a significant difference for age (P = 0.001). Infection occurred in 2 axillae (0.5%). Severe scarring occurred in 15 axillae (3.5%), with complications related to more severe skin scarring (P < 0.05). Older age was a risk factor for complications. Use of tumescent infiltration resulted in good postoperative pain control and less hematoma. Patients with complications presented with more severe skin scarring, but none experienced limited range of motion after massage.

Implementation and Effectiveness of In-Prison Programs for Intimate Partner Violence Perpetrators: Evidence From Spain

The article describes the supply and demand of programs for imprisoned perpetrators of intimate partner violence and their consequences on recidivism in a Spanish penal system with multiple interventions. Four aspects are studied with descriptive, multinomial, survival, and canonical correlation analyses—programs’ features (number, content, duration, combinations, compliance); users and nonusers’ characteristics (socioeconomic profiles, criminological histories, incarceration experiences); the ensuing outcomes (prison behavior and postrelease recidivism); and the profiles of the clients benefiting the most and least from them. The results show great heterogeneity in program supply and in how they are taken, and marked differences in the profiles of nonusers and users of programs of different durations. This helps interpret the main finding that short-program users have lower rates of recidivism, partly due to the programs’ more appropriate formats and partly due to the users’ less problematic characteristics and higher opportunities to take them. Policy recommendations are accordingly made.

Fatty liver mediates the association of hyperuricemia with prediabetes and diabetes: a weighting-based mediation analysis.

Fatty liver, obesity, and dyslipidemia are associated with prediabetes or diabetes risk, and hyperuricemia co-exists. The present study evaluated the role of multiple mediators, namely, fatty liver, body mass index (BMI), and dyslipidemia, in the association between hyperuricemia and diabetes status. Baseline data from the ongoing Fuqing cohort (5,336 participants) were analyzed to investigate the association of hyperuricemia with diabetes status using a multinomial logistic regression model. Furthermore, causal mediation analysis with the weighting-based approach was performed to estimate hyperuricemia's total natural direct effect (tnde), total natural indirect effect (tnie), and total effect (te) on prediabetes and diabetes risk, mediating jointly via fatty liver, BMI, and dyslipidemia. In multinomial analysis without considering mediators' effects, hyperuricemia was associated with a higher risk of prediabetes only (odds ratio: 1.25; 95% CI: 1.09-1.43; p < 0.001). When fatty liver, BMI, and dyslipidemia were considered as multiple mediators in the association, hyperuricemia was linked to both prediabetes [tnde: 1.11, 95% CI: 1.04-1.11; tnie: 1.07, 95% CI: 1.05-1.09; and overall proportion mediated (pm): 42%, 95% CI: 27%-73%] and diabetes risk (tnde: 0.96, 95% CI: 0.82-1.14; tnie: 1.25, 95% CI: 1.18-1.33; and pm: 100%, 95% CI: 57%-361%). Hyperuricemia showed significant tnde, te, and tnie, mediated by fatty liver jointly with dyslipidemia (pm = 17%) or BMI (pm = 35%), on prediabetes risk. Hyperuricemia could increase prediabetes or diabetes risk, partially mediated by fatty liver, BMI, and dyslipidemia. Fatty liver is the crucial mediator in the association between hyperuricemia and prediabetes.

Developmental trajectories of successful aging among older adults in China: Evidence from the China Health and Retirement Longitudinal Study

This study aimed to identify potential trajectory groups of successful aging in older adults and to explore the influencing factors of each trajectory group. We used four waves of longitudinal data from the China Health and Retirement Longitudinal Study from 2011 to 2018, which involved 1,949 older adults. The developmental trajectories were determined using growth mixture modeling (GMM), and the influencing factors of each trajectory group were identified using multinomial logistic analysis. We identified three different groups of successful aging trajectories: high level-declining group (45%), medium level-declining group (39%), and low level-steady group (16%). Gender, education, marital status, place of residence, self-rated health, life satisfaction, and retirement pension were the influencing factors for the high level-declining group. Influencing factors for the medium level-declining group included gender, education, self-rated health, life satisfaction, and retirement pension. Healthcare professionals should formulate targeted measures according to different trajectory categories to promote successful aging in older adults.

Determinants of the choice of adaptation strategies to climate variability and extremes among pastoralist and agro-pastoralist households in Yabello and Arero Districts, Southeast Ethiopia

Climate variability and extremes adversely affect the livestock sector by reducing pasture availability, polluting and depleting water resources, aggravating livestock diseases, and distorting the production systems. The cumulative effect of climate variability undermines the adaptive capacity of pastoralists and worsens food insecurity. This study assesses the impact of climate variability and the determinants of pastoralists and agro-pastoralists adaptation strategies in Yabello and Arero Districts, southern Ethiopia. Accordingly, data were collected from randomly selected 296 sample households using a questionnaire survey. Data were also gathered from a purposively selected key informants and focus group discussion participants. Areal gridded dikadal rainfall and temperature data were collected from the National Meteorological Institute. Descriptive statistics and multinomial logistic regression data analysis methods were used. The results show that all seasons were significantly warming, while rainfall declined at various degrees and the distribution was highly variable across the study period. The ever rising minimum and maximum temperature and the erratic nature of rainfall has undermined the availability of pasture and water resources, especially during drought years resulting in the prevalence of livestock diseases. The age of the household head, poor access to information, lack of credit and saving services, limited knowledge, and erratic rainfall were found to be the determinant factors in the choice of adaptation options to climate variability and extremes. The study also found that lack of appropriate intervention and support mechanisms by government and non-government actors as well as the reluctance of pastoralists and agro-pastoralists to accept the stakeholders’ advice were the barriers to climate variability adaptation. Thus, it is clear that pastoralists’ and agro-pastoralists’ livelihood is at risk for climate variability and extremes and hence, requires context specific adaptive capacity building intervention that ranges from awareness creation to strengthening basic infrastructures and rangeland management.

Socio-economics characteristics, income inequality, and poverty status of female headed cassava (Manihot esculenta Crantz) farming households in federal capital territory, Nigeria

The study evaluated the socio-economic characteristics, income inequality and poverty status of female headed cassava farming households in Federal Capital Territory, Nigeria. Primary data were used for the study. A multi-stage sampling technique was used to select a total sample size of three hundred and three (303) households from the two area councils. The data were analyze using descriptive statistics, Foster-Greer-Thorbecke (FGT) poverty index, Gini coefficients, Probit model analysis, and principal components analysis (Factor Analysis). From the results about 59.73% of the female headed cassava farming households were less than 50 years old. 31.35% of the female headed cassava farming household were married. The mean household size was about12.00 persons. The mean annual income was 374, 868 Naira. About 56.77% of the female headed cassava farming household were poor given a poverty line N9, 009.37. In addition, 76% of female headed cassava farming households fell into annual income of below N500, 000 and they control 40% of the market share. The Gini coefficient was calculated to be 0.62. Maximum Likelihood Estimates (MLE) of the Probit Model shows that the coefficients of marital status (P&amp;lt;0.01), educational level (P&amp;lt;0.05), household size (P&amp;lt;0.01), income (P&amp;lt;0.1), and sources of livelihood (P&amp;lt;0.1) were the statistically and significant factors influencing poverty status among the female headed farming households in the study area. The results of the multinomial Logit model analysis show that the factors that statistically and significantly influencing the income inequality of female headed farming households in the study area, were coefficient of marital status (P&amp;lt;0.05), educational level (P&amp;lt;0.10), access to credit(P&amp;lt;0.05), and sources of livelihood (P&amp;lt;0.05) for low income earners. Educational level (P&amp;lt;0.01), access to credit (P&amp;lt;0.10) and farm size (P&amp;lt;0.01), were statistically and significant factors influencing income inequality or income distribution among high income earners among female headed farming households. Trading enterprise, cassava flour/garri processing, and palm/ groundnut oil pressing were major coping strategies employed by the female headed households to against poverty and income inequality. Based on the findings it was concluded that there was high income gap or income inequality among female headed farming households and they were poor. It was recommended that policies that will help create more credit access/programs in terms of loan at low interest rates for women should be implemented at all tiers of government to help mitigate and reduce the poverty among female headed household. Women should also be encouraged to diversify their sources of livelihood this will help them to have a relative equality or balance in their income levels all year round. Facilities should be made accessible to farmers, provision of rice processing equipment should be made available, more effort to empower women should be designed, contract farming and marketing should be encouraged, and information dissemination via communication devices for increased market participation and increased value sold among rice farmers should be a priority to eradicate poverty and improve livelihood.

PHQ-9, CES-D, health insurance data—who is identified with depression? A Population-based study in persons with diabetes

AimsSeveral instruments are used to identify depression among patients with diabetes and have been compared for their test criteria, but, not for the overlaps and differences, for example, in the sociodemographic and clinical characteristics of the individuals identified with different instruments.MethodsWe conducted a cross-sectional survey among a random sample of a statutory health insurance (SHI) (n = 1,579) with diabetes and linked it with longitudinal SHI data. Depression symptoms were identified using either the Centre for Epidemiological Studies Depression (CES-D) scale or the Patient Health Questionnaire-9 (PHQ-9), and a depressive disorder was identified with a diagnosis in SHI data, resulting in 8 possible groups. Groups were compared using a multinomial logistic model.ResultsIn total 33·0% of our analysis sample were identified with depression by at least one method. 5·0% were identified with depression by all methods. Multinomial logistic analysis showed that identification through SHI data only compared to the group with no depression was associated with gender (women). Identification through at least SHI data was associated with taking antidepressants and previous depression. Health related quality of life, especially the mental summary score was associated with depression but not when identified through SHI data only.ConclusionThe methods overlapped less than expected. We did not find a clear pattern between methods used and characteristics of individuals identified. However, we found first indications that the choice of method is related to specific underlying characteristics in the identified population. These findings need to be confirmed by further studies with larger study samples.

Set in Stone? Mobile Practices Evolution in Later Life

In what ways do mobile communication practices change through later life? To what extent do sociodemographic characteristics, country of residence, and well-being relate to these changing practices? To answer these questions, we used an online, longitudinal study targeting internet users aged 60 and over in six countries (Austria, Canada, Israel, the Netherlands, Spain, and Romania). The focus is on the 3,125 respondents who declared using a mobile phone in every wave (2016, 2018, and 2020). Results show an increasing usage diversification already before the Covid-19 pandemic. A latent class analysis identified three different styles of mobile practices. The most sophisticated relies on almost all the analyzed functions, while the most unsophisticated is limited to voice calls, texting (mainly SMS), and photographs to a lesser extent. Finally, a multinomial analysis provided a picture of the individual characteristics related to the usage styles in the period. The most relevant dimensions were country of residence and age, followed by internet use intensity. The country of residence is relevant to explaining usage because the telecommunications price structure determines the priority given to the mobile phone in (senior) individuals’ everyday lives. The article contributes nuanced evidence of the trajectories of digital practices in later life. At the same time, the findings support and better inform country-based policies, services, and products for more effective inclusion of the older population in today’s hyper-digitized societies.