Multinomial Logistic Regression Models Research Articles

Effects of disability on adverse health outcomes and anthropometric deficits among under-five children in South Asian countries: evidence from multiple indicator cluster surveys

Children with disabilities face an increased risk of adverse health outcomes and poor anthropometric deficits, although the focus on them is limited in the South Asian context thus far and need newer and more evidence. This study investigates the effects of disability on adverse health outcomes and anthropometric deficits among 2-4 years aged children in South Asian countries. We analyzed data from 93,180 children aged 2-4 years across Bangladesh, Nepal, Pakistan, and Afghanistan using Multiple Indicator Cluster Surveys (2017-2023). Disability status was the primary exposure, and outcomes included adverse health outcome (acute respiratory infection, diarrhea, fever), anthropometric deficit (stunting, wasting, underweight), and healthcare service sources during adverse health events (care received from skilled healthcare personnel, care received from non-professional personnel, and care received from health facility workers other than skilled healthcare personnel). Using multilevel and multinomial logistic regression models, we examined associations between exposure and outcome variables, adjusting for covariates. We found average disability prevalence in South Asia was 8.7% (8.3-9.0; n=8072), varying from 3.4% (3.0-3.8; n=446) in Bangladesh to 12.3% (11.4-13.3; n=1259) in Afghanistan. Common health issues included fever (n=24,982, 26.8%, 26.2-27.4) and diarrhea (n=14,081, 15.1%, 14.7-15.6), while prevalent poor anthropometric deficits were stunting (n=39,766, 42.7%, 42.0-43.3) and underweight (n=22,390, 24.0%, 23.5-24.5). Children with disability had 1.30 (95% CI: 1.21-1.40) to 1.60 (95% CI: 1.47-1.75) times and 1.17 (95% CI: 1.05-1.29) to 1.39 (95% CI: 1.30-1.48) times higher likelihoods of adverse health outcomes and anthropometric deficits, respectively, with variations observed among countries and different disability types. Individuals with disability were 1.16 (95% CI: 1.00-1.35) to 1.26 (95% CI: 1.01-1.58) times more likely to receive healthcare services from skilled healthcare personnel compared to health facility workers other than skilled healthcare personnel. This study findings emphasizes the need for community-level awareness programs to improve anthropometric well-being and healthcare of the children with disability. This research did not receive any specific funds.

Association between preoperative anxiety states and postoperative complications in patients with esophageal cancer and COPD: a retrospective cohort study

BackgroundEsophageal cancer brings emotional changes, especially anxiety to patients. Co-existing anxiety makes the surgery difficult and may cause complications. This study aims to evaluate effects of anxiety in postoperative complications of esophageal cancer patients with chronic obstructive pulmonary disease (COPD).MethodsPatients with esophageal cancer and co-existing COPD underwent tumor excision. Anxiety was measured using Hospital Anxiety and Depression Scale (HAD) before surgery. Clavien-Dindo criteria were used to grade surgical complications. A multiple regression model was used to analyze the relationship between anxiety and postoperative complications. The chi-square test was used to compare the differences in various types of complications between the anxiety group and the non-anxiety group. A multinomial logistic regression model was used to analyze the influencing factors of mild and severe complications.ResultsThis study included a total of 270 eligible patients, of which 20.7% had anxiety symptoms and 56.6% experienced postoperative complications. After evaluation by univariate analysis and multivariate logistic regression models, the risk of developing complications in anxious patients was 4.1 times than non-anxious patients. Anxious patients were more likely to develop pneumonia, pyloric obstruction, and arrhythmia. The presence of anxiety, surgical method, higher body mass index (BMI), and lower preoperative oxygen pressure may increase the incidence of minor complications. The use of surgical methods, higher COPD assessment test (CAT) scores, and higher BMI may increase the incidence of major complications, while anxiety does not affect the occurrence of major complications (P = 0.054).ConclusionPreoperative anxiety is associated with postoperative complications in esophageal cancer patients with co-existing COPD. Anxiety may increase the incidence of postoperative complications, especially minor complications in patient with COPD and esophageal cancer.

Factors associated with differential seropositivity to Leptospira interrogans and Leptospira kirschneri in a high transmission urban setting for leptospirosis in Brazil.

Leptospirosis is a zoonosis caused by pathogenic species of bacteria belonging to the genus Leptospira. Most studies infer the epidemiological patterns of a single serogroup or aggregate all serogroups to estimate overall seropositivity, thus not exploring the risks of exposure to distinct serogroups. The present study aims to delineate the demographic, socioeconomic and environmental factors associated with seropositivity of Leptospira serogroup Icterohaemorraghiae and serogroup Cynopteri in an urban high transmission setting for leptospirosis in Brazil. We performed a cross-sectional serological study in five informal urban communities in the city of Salvador, Brazil. During the years 2018, 2020 2021, we recruited 2.808 residents and collected blood samples for serological analysis using microagglutination assays. We used a fixed-effect multinomial logistic regression model to identify risk factors associated with seropositivity for each serogroup. Seropositivity to Cynopteri increased with each year of age (OR 1.03; 95% CI 1.01-1.06) and was higher in those living in houses with unplastered walls (exposed brick) (OR 1.68; 95% CI 1.09-2.59) and where cats were present near the household (OR 2.00; 95% CI 1.03-3.88). Seropositivity to Icterohaemorrhagiae also increased with each year of age (OR 1.02; 95% CI 1.01-1.03) and was higher in males (OR 1.51; 95% CI 1.09-2.10), in those with work-related exposures (OR 1.71; 95% CI 1.10-2.66) or who had contact with sewage (OR 1.42; 95% CI 1.00-2.03). Spatial analysis showed differences in distribution of seropositivity to serogroups Icterohaemorrhagiae and Cynopteri within the five districts where study communities were situated. Our data suggest distinct epidemiological patterns associated with the Icterohaemorrhagiae and Cynopteri serogroups in the urban environment at high risk for leptospirosis and with differences in spatial niches. We emphasize the need for studies that accurately identify the different pathogenic serogroups that circulate and infect residents of low-income areas.

Disagreement concerning atopic dermatitis subtypes between an English prospective cohort (ALSPAC) and linked electronic health records.

Subtypes of atopic dermatitis (AD) have been derived from the Avon Longitudinal Study of Parents and Children (ALSPAC) based on presence and severity of symptoms reported in questionnaires (Severe-Frequent, Moderate-Frequent, Moderate-Declining, Mild-Intermittent, Unaffected/Rare). Good agreement between ALSPAC and linked electronic health records (EHRs) would increase trust in the clinical validity of these subtypes and allow inferring subtypes from EHRs alone, which would enable their study in large primary care databases. 1. Explore if presence and number of AD records in EHRs agrees with AD symptom and severity reports from ALSPAC; 2. Explore if EHRs agree with ALSPAC-derived AD subtypes; 3. Construct models to classify ALSPAC-derived AD subtype using EHRs. We used data from the ALSPAC prospective cohort study from 11 timepoints until age 14 years (1991-2008), linked to local general practice EHRs. We assessed how far ALSPAC questionnaire responses and derived subtypes agreed with AD as established in EHRs using different AD definitions (e.g., diagnosis and/or prescription) and other AD-related records. We classified AD subtypes using EHRs, fitting multinomial logistic regression models tuning hyperparameters and evaluating performance in the testing set (ROC AUC, accuracy, sensitivity, and specificity). 8,828 individuals out of a total 13,898 had both been assigned an AD subtype and had linked EHRs. The number of AD-related codes in EHRs generally increased with severity of AD subtype, however not all with the Severe-Frequent subtypes had AD in EHRs, and many with the Unaffected/Rare subtype did have AD in EHRs. When predicting ALSPAC AD subtype using EHRs, the best tuned model had ROC AUC of 0.65, sensitivity of 0.29 and specificity of 0.83 (both macro averaged); when different sets of predictors were used, individuals with missing EHR coverage excluded, and subtypes combined, sensitivity was not considerably improved. ALSPAC and EHRs disagreed not just on AD subtypes, but also on whether children had AD or not. Researchers should be aware that individuals considered as having AD in one source may not be considered as having AD in another.

The association between probable post-COVID-19 condition and sleep-related parameters: a longitudinal study of non-hospitalised patients.

The long-term effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection on sleep remain poorly known. We evaluated the association between probable post-COVID-19 condition and changes in sleep quality and quantity before and after SARS-CoV-2 infection in a consecutive sample of non-hospitalized adults. Individuals were identified with SARS-CoV-2 infection in 2020 at the central laboratory of a tertiary hospital in Porto and followed as outpatients. We included patients diagnosed with SARS-CoV-2 infection ≥3 months before this evaluation, with no missing data on key variables (n = 2445). Participants completed a questionnaire that included sociodemographic, clinical, and infection-related questions. We computed changes in sleep-related parameters referred to 1 month before diagnosis and 1 week before the questionnaire. Multinomial logistic regression models were fitted to compute crude and adjusted odds ratios and 95% confidence intervals (95% CIs). Compared to the pre-infection period, those with probable post-COVID-19 condition reported a greater decrease in hours of sleep, had a 2.60 (95% CI 2.02-3.34) higher adjusted odds of perceiving their sleep quality as worsened and experienced a significant increase in number of days with sleeping disturbances as defined according to multiple items. The association between post-COVID-19 condition and indicators of poor sleep health requires special attention from healthcare professionals and services. It is essential that appropriate multidisciplinary care is provided to mitigate the physical, psychological, social, and professional impact of sleeping problems in these already burdened patients.

Longitudinal trajectories of self-esteem, related predictors, and impact on depression among students over a four-year period at college in China

Self-esteem plays a crucial role in the psychological development of college students. Based on four-wave longitudinal data, this study empirically investigated the longitudinal trajectories of self-esteem, related predictors, and the impact on depression in a sample of Chinese college students. Piecewise growth mixture modeling was utilized to identify potential self-esteem trajectories. Furthermore, multinomial logistic regression models were employed along with the Kruskal‒Wallis test to analyze the factors that influence self-esteem development trajectories and assess variations in depression. The results showed that college students’ self-esteem trajectories can be divided into three categories: slowly decreasing (81.04%), rising then falling (16.94%), and falling then rising (2.02%). Various personal factors (e.g. ethnicity, family residence, self-reported health status, extroversion) and socioeconomic factors (e.g. closeness with classmates, family economic level, family social status, and the mother’s educational level) can influence the classification of students’ self-esteem development trajectories. Moreover, notable differences in depression were observed among students in different self-esteem trajectory groups. The results emphasize the imperative of implementing interventions to enhance self-esteem among college students.

Non-tobacco nicotine E-cigarette use and flavored E-cigarette use among young adults in the United States

BackgroundE-cigarette flavors can create sensations of sweetness and coolness while masking the aversiveness of nicotine. Recently, non-tobacco nicotine (NTN) products were introduced to the market, but little is known about flavors in NTN e-cigarette use. We examined associations between flavors (i.e., sweet, mint/menthol) and susceptibility to and use of NTN e-cigarettes. Methods1239 US young adults (18–25 years) completed an anonymous, online survey in Fall 2021. The analytic sample included 520 participants who had used e-cigarettes and heard of NTN. Multinomial logistic regression models analyzed associations of flavored e-cigarette use (sweet and mint/menthol) with NTN e-cigarette use status (i.e., current [past-month] use, past [ever but not current] use, susceptible to use, and non-susceptible to use [reference]). ResultsOverall, 46.2% of participants reported current NTN use, 14.8% reported past use, 16.7% were susceptible to use, and 22.3% reported no susceptibility. Participants reported dual-use of sweet and mint/menthol NTN e-cigarette flavors (56.5%), sweet flavors use (24.8%), and mint/menthol flavor use (1.7%). Ever dual use of sweet and mint/menthol flavors was associated with current (OR = 9.64, 95%CI: 3.21–28.98) and past NTN e-cigarette use (8.30, [2.10–32.80]). Ever sweet flavor use was associated with current NTN use (3.80, 95%CI: 1.44–10.03) and susceptibility to future use (4.25, [1.53–11.81]). Similar findings were observed for mint/menthol flavors (current: 5.03, [1.41–17.99]; susceptible: 5.65, [1.64–19.51]). ConclusionThe use of sweet and mint/menthol flavors was significantly associated with NTN e-cigarette use among US young adults, highlighting the need for ongoing surveillance of flavored NTN e-cigarettes and appropriate regulations to discourage use.

Clinical distinctions in symptomatology and psychiatric comorbidities between misdiagnosed bipolar I and bipolar II disorder versus major depressive disorder

BackgroundTo explore the demographic and clinical features of current depressive episode that discriminate patients diagnosed with major depressive disorder (MDD) from those with bipolar I (BP-I) and bipolar II (BP-II) disorder who were misdiagnosed as having MDD .MethodsThe Mini-International Neuropsychiatric Interview (MINI) assessment was performed to establish DSM-IV diagnoses of MDD, and BP-I and BP-II, previously being misdiagnosed as MDD. Demographics, depressive symptoms and psychiatric comorbidities were compared between 1463 patients with BP-I, BP-II and MDD from 8 psychiatric settings in mainland China. A multinomial logistic regression model was performed to assess clinical correlates of diagnoses.ResultsA total of 14.5% of the enrolled patients initially diagnosed with MDD were eventually diagnosed with BP. Broad illness characteristics including younger age, higher prevalence of recurrence, concurrent dysthymia, suicidal attempts, agitation, psychotic features and psychiatric comorbidities, as well as lower prevalence of insomnia, weight loss and somatic symptoms were featured by patients with BP-I and/or BP-I, compared to those with MDD. Comparisons between BP-I and BP-II versus MDD indicated distinct symptom profiles and comorbidity patterns with more differences being observed between BP-II and MDD, than between BP-I and MDD .ConclusionThe results provide evidence of clinically distinguishing characteristics between misdiagnosed BP-I and BP- II versus MDD. The findings have implications for guiding more accurate diagnoses of bipolar disorders.

Obstetric risk profiles and causes of death: Estimating their association with cesarean sections among maternal deaths in Mexico.

Maternal mortality is a critical indicator of healthcare quality, and in Mexico, this has become increasingly concerning due to the stagnation in its decline, alongside a concurrent increase in cesarean section (C-section) rates. This study characterizes maternal deaths in Mexico, focusing on estimating the association between obstetric risk profiles, cause of death, and mode of delivery. Utilizing a retrospective observational design, 4,561 maternal deaths in Mexico from 2010-2014 were analyzed. Data were sourced from the Deliberate Search and Reclassification of Maternal Deaths database, alongside other national databases. An algorithm was developed to extract the Robson Ten Group Classification System from clinical summaries text, facilitating a nuanced analysis of C-section rates. Information on the reasons for the performance of a C-section was also obtained. Logistic regression and multinomial logistic regression models were used to estimate the relation between obstetric risk factors, mode of delivery and causes of maternal death, adjusting for covariates. Among maternal deaths in Mexico from 2010-2014, 47.1% underwent a C-section, with a significant history of previous C-sections observed in 31.4% of these cases, compared to 17.4% for vaginal deliveries (p<0.001). Early prenatal care in the first trimester was more common in C-section cases (46.8%) than in vaginal deliveries (38.3%, p<0.001). A stark contrast was noted in the place of death, with 82.4% of post-C-section deaths occurring in public institutions versus 69.1% following vaginal births. According to Robson's classification, the highest C-section rates were in Group 4 (67.2%, p<0.001) and Group 8 (66.9%, p<0.001). Logistic regression analysis revealed no significant difference in the odds of receiving a C-section in private versus other settings after adjusting for Robson criteria (OR: 1.21; 95% CI: 0.92, 1.60). A prior C-section significantly increased the likelihood of another (OR: 2.38; CI 95%: 2.01, 2.81). The analysis also indicated C-sections were significantly tied to deaths from hypertensive disorders (RRR = 1.25, 95% CI [1.12, 1.40]). In terms of indications, 6.3% of C-sections were performed under inadequate indications, while the indication was not identifiable in 33.1% of all C-sections. This study highlights a significant overuse of C-sections among maternal deaths in Mexico (2010-2014), revealed through the Robson classification and ana analysis of the reported indications for the procedure. It underscores the need for revising clinical decision-making to promote evidence-based guidelines and favor vaginal deliveries when possible. High C-section rates, especially noted disparities between private and public sectors, suggest economic and non-clinical factors may be at play. The importance of accurate data systems and further research with control groups to understand C-section practices' impact on maternal health is emphasized.

Associations of Interpersonal Trauma, Distress Intolerance, and Posttraumatic Stress Symptoms With Recent Problem Opioid Use in a Non-Clinical Sample of Women

Exposure to potentially traumatic events (PTE), higher rates of Posttraumatic Stress Disorder (PTSD) and higher distress intolerance have been associated separately with opioid misuse in clinical samples. Adult women who reported past year misuse of a prescription drug were recruited on Prolific Academic (ProA) to participate in an online survey ( n = 154). Measures included the Trauma History Questionnaire (THQ) for lifetime trauma histories, PTSD Checklist for DSM-5 (PCL-5), Distress Intolerance (DI), NIDA-Modified ASSIST, and the Drug Abuse Screening Test (DAST-10). In a multinomial logistic regression model, experiencing a potentially traumatic event involving interpersonal victimization, having higher distress intolerance, and having greater PTSD symptoms, were significantly associated with drug use class. In particular, higher distress intolerance was associated with problem opioid use relative to problem use of other drugs. Distress intolerance is a potentially salient and modifiable target for mental health and substance use interventions.

More romantic or more realistic: trajectories and influencing factors of romantic love among Chinese college students from entering college to graduation

College is a significant transition in the growth of individuals, and romantic relationships play an important role in the future development of individuals. Understanding young people’s attitudes toward love is helpful for formulating strategies to guide them to form correct attitudes toward love, promote the formation of positive and healthy attitudes toward marriage and life. This study aimed to explore the trajectories of college students’ attitudes toward love, reveal the development law of their attitudes toward love, and identify the influencing factors that lead to changes in their attitudes toward love. Descriptive and correlation analyses were performed on participants’ attitudes toward love, followed by utilization of a growth mixture model to explore latent trajectory classes and a multinomial logistic regression model to analyze influencing factors across trajectories.The results indicated that romantic attitudes could be divided into three groups: “high-increasing”, “low-decreasing” and “low-increasing”, and realistic attitudes could be divided into three groups: “high-increasing”, “low-increasing” and “high-decreasing”. Gender, major, extroversion, and hometown location were factors influencing whether students fell into different trajectory classes. Overall, society and colleges should pay more attention to changes in college students’ attitudes toward love, provide timely intervention and guidance, and prevent them from suffering from behavioral, physical, and psychological problems.

Psychological inflexibility as a predictor associated with insomnia.

Psychological flexibility has recently attracted the attention of researchers in the field of sleep disorders; therefore, in the study, psychological flexibility was evaluated as a predictor or factor related to the presence/severity of insomnia. We included 2218 individuals selected from the randomized-control trial for behavioural therapy for insomnia and cross-sectional studies, including 1797 individuals with insomnia and 421 controls without insomnia. All participants completed the DSM-5-based insomnia diagnosis interview, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Acceptance Action Questionnaire-II. Linear regression and multinomial logistic regression models were used. Sex, education, occupation, marital status, anxiety, depression and psychological inflexibility were possible predictors or factors associated with the severity of insomnia. Multivariate linear regression analysis demonstrated that sex (𝛽 = 0.88; t = 2.80; p = 0.005), depression (𝛽 = 0.41; t = 10.7; p < 0.001), anxiety (𝛽 = 0.58; t = 14.1; p < 0.001) and psychological inflexibility (𝛽 = 0.09; t = 5.07; p < 0.001) were predictors of insomnia. The results of the multinomial logistic regression demonstrate that, in comparison to the absence of insomnia, insomnia at all levels (mild, moderate and severe) was associated with sex, anxiety and depression. Psychological inflexibility was only associated with severe insomnia (odds ratio = 1.04). These findings are important from a public health perspective because behavioural strategies designed to treat insomnia with a focus on psychological flexibility are low-cost and may help improve sleep quality in adults with insomnia, which also influences mental health.

Association between Gestational Weight Gain and Maternal and Birth Outcomes in Northern Ghana.

Although inappropriate gestational weight gain is considered closely related to adverse maternal and birth outcomes globally, little evidence was found in low- and middle-income countries. Study Objectives. This study is aimed at identifying the determinants of gestational weight gain and examine the association between gestational weight gain and maternal and birth outcomes in the Northern Region of Ghana. Study Methods. The study used a facility-based cross-sectional study design involving 611 antenatal and delivery records in Tatale district, Tamale west, and Gushegu municipal hospitals. A two-stage sampling method involving cluster and simple random sampling was employed. Descriptive statistical analysis and measures of central tendency were used to describe the sample. The multinomial logistic regression model was used to determine the determinants of gestational weight gain and its association with maternal and birth outcomes. Among the 611 women included in the study, 516 (84.45%) had inadequate gestational weight gain, and 19 (3.11%) had excessive gestational weight gain. The gestational weight gain ranged from 2 kg to 25 kg with a mean of 7.26 ± 3.70 kg. The risk factor for inadequate gestational weight gain was low prepregnancy BMI (adjusted odds ratio (AOR) = 1.33, 95% CI = 1.18 - 2.57, P = 0.002). Pregnant women who had inadequate gestational weight gain were significantly less likely to deliver through caesarean section (AOR = 0.27, 95% CI = 0.12 - 0.61, P = 0.002), and those who had excessive weight gain were more likely to undergo caesarean section (AOR = 19.81, 95% CI = 5.38 - 72.91, P = 0.001). The odds of premature delivery (birth < 37 weeks) among pregnant women with inadequate weight gain were 2.88 (95% CI = 1.27 - 6.50, P = 0.011). Furthermore, subjects who had excessive weight gain were 43.80 times more likely to give birth to babies with macrosomia (95% CI = 7.07 - 271.23, P = 0.001). Inappropriate gestational weight gain is prevalent in Ghana, which is associated with caesarean section, preterm delivery, delivery complications, and macrosomia. Urgent policy interventions are needed to improve on the frequent monitoring and management of gestational weight gain of pregnant women till term.

Abstract PO2-12-02: Frailty among long-term breast cancer survivors

Abstract Background Cancer and its associated treatments may accelerate aging, resulting in increased frailty in survivors. However, the effect of breast cancer (BC) and treatment on frailty among long-term BC survivors has not been well investigated. This study aims to evaluate frailty prevalence and its association with clinical characteristics and treatment among 5-year BC survivors. Methods This study included 353 5-year BC survivors and 214 non-cancer control women aged ≥40 who were recruited to an ongoing breast health study at Vanderbilt University Medical Center between 2004 and 2017, and completed an online survey between May, 2022 and June 2023. Information collected includes demographics, lifestyle, disease history, and current health/functional status. A 26-item cumulative deficit index (CDI) was calculated as the proportion of deficits presented, including aging-related diseases, physical and mental health, activities of daily living, and social well-being, based on survey responses. CDI was categorized as robust (≤0.2), pre-frail (0.2-≤0.35), and frail ( &amp;gt;0.35). Cancer characteristics and treatment information was gathered from tumor registry. Multinomial logistic regression models were used to assess the association of CDI levels with case-control status, and BC clinical characteristics and cancer treatment among BC cases, with adjustment for age at survey (years), follow-up duration (5-≤10 and &amp;gt;10 years), and baseline Charlson comorbidity index (0, 1, and ≥2), and additional adjustment for BC stage and subtype in the analysis of treatment. Results The median time interval from BC diagnosis to survey was 12 years (range 5-34 years) for BC survivors. 90% of the participants were White. On average, BC patients were 3.8 years older at survey than controls [mean±SD (range) 64.5±9.2 (40-88) vs 60.7±10.3 (40-87), p&amp;lt; 0.001]. Among BC survivors, 41% had stage I, 39% stage II, and 8% stage III-IV cancer; 62% had a hormone receptor+/HER2- BC, followed by 22% HER2+ and 16% triple-negative BC. The majority of BC survivors underwent surgical resection (97%), and &amp;gt;50% received hormone therapy (59%), radiation therapy (53%), and chemotherapy (51%). BC survivors had a higher CDI score than controls (median 0.23 vs 0.19, p=0.01), with 34% and 18% of BC survivors being pre-frail and frail, compared with 25% and 16% in controls. After multivariable adjustment, BC survivors had a non-significantly increased prevalence of pre-frailty with odds ratio (OR) and 95% confidence interval (CI) of 1.49 (0.98-2.25), but a similar prevalence of frailty [OR (95% CI) = 1.08 (0.65-1.79)] compared to controls. BC survivors aged 40-65 had significantly elevated odds of pre-frailty [OR (95% CI) = 2.59 (1.44-4.63)]. Among BC survivors, frailty was significantly associated with stage [stage III-IV vs I: OR (95% CI) = 4.03 (1.27-12.78)] and chemotherapy [OR (95% CI) = 4.39 (1.71-11.30)], particularly among survivors aged ≥65 and 10-year survivors, but not BC subtype. Radiation therapy was associated with increased odds of pre-frailty among BC survivors aged 40-65. Conclusions This study suggests that long-term BC survivors younger than 65 are at increased odds of pre-frailty than non-cancer women. Frailty is associated with BC stage and chemotherapy among BC survivors, and radiotherapy among survivors younger than 65. More research is needed to investigate whether specific cancer treatment regimen is associated with frailty and other factors (e.g. lifestyle and genetics) that may modify the risk of frailty. The associations of frailty with cancer characteristics and treatments among breast cancer survivors Citation Format: Cong Wang, Jill De Vis, Kirsten Nguyen, Mason Alford, Brigitte Jia, Bapsi Chakravarthy, Xiao-Ou Shu. Frailty among long-term breast cancer survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-02.

ENHANCING ELECTIVE SURGERY MANAGEMENT WITH OPENPREDICTOR: VALIDATION OF A CLINICAL DECISION AID FOR OPTIMIZING ELECTIVE PATHWAYS

OpenPredictor, a machine learning-enabled clinical decision aid, has been developed to manage backlogs in elective surgeries. It aims to optimise the use of high volume, low complexity surgical pathways by accurately stratifying patient risk, thereby facilitating the allocation of patients to the most suitable surgical sites. The tool augments elective surgical pathways by providing automated secondary opinions for perioperative risk assessments, enhancing decision-making. Its primary application is in elective sites utilising lighter pre-assessment methods, identifying patients with minimal complication risks and those high-risk individuals who may benefit from early pre-assessment.The Phase 1 clinical evaluation of OpenPredictor entailed a prospective analysis of 156 patient records from elective hip and knee joint replacement surgeries. Using a polynomial logistic regression model, patients were categorised into high, moderate, and low-risk groups. This categorisation incorporated data from various sources, including patient demographics, co-morbidities, blood tests, and overall health status.In identifying patients at risk of postoperative complications, OpenPredictor demonstrated parity with consultant-led preoperative assessments. It accurately flagged 70% of patients who later experienced complications as moderate or high risk. The tool's efficiency in risk prediction was evidenced by its balanced accuracy (75.6%), sensitivity (70% with a 95% confidence interval of 62.05% to 76.91%), and a high negative predictive value (96.7%).OpenPredictor presents a scalable and consistent solution for managing elective surgery pathways, comparable in performance to secondary consultant opinions. Its integration into pre-assessment workflows assists in efficient patient categorisation, reduces late surgery cancellations, and optimises resource allocation. The Phase 1 evaluation of OpenPredictor underscores its potential for broader clinical application and highlights the need for ongoing data refinement and system integration to enhance its performance.

Lung function trajectories from school age to adulthood and their relationship with markers of cardiovascular disease risk

RationaleLung function in early adulthood is associated with subsequent adverse health outcomes.ObjectivesTo ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association...

Coffee and tea consumption and dementia risk: The role of sex and vascular comorbidities

Coffee and tea consumption and dementia risk: The role of sex and vascular comorbidities

Perceived Discrimination among Caregivers of Children with Disabilities in China: Unraveling the Effects of Social Determinants

PurposeAlthough discrimination has gained increasing attention in research and practice intervention for family caregivers of children with disabilities, little is known about the social determinants that associate with the perceived discrimination among caregivers, especially in non-Western contexts. This study aims to examine the socio-familial and child-level determinants of perceived discrimination among family caregivers of children with disabilities in China. MethodThis study drew from a population-based cross-sectional survey in Shenzhen, China. Proportional quota sampling was conducted to get data from 2,500 family caregivers of children with disabilities in rehabilitation service centres (response rate = 94.9%, n=2,373), accounting for 25% of the total population of children with disabilities receiving service in Shenzhen. Latent profile analysis was conducted to categorize three perceived discrimination groups among caregivers (i.e., severe perceived discrimination group, moderate perceived discrimination group, and low perceived discrimination group). The multinomial logistic regression models were conducted to test the association between these social determinants and perceived discrimination. ResultsMost caregivers (82.9%) reported moderate or severe levels of perceived discrimination. Caregivers of children with moderate and severe impairments and children with mental and multiple disabilities were more vulnerable to perceiving severe social discrimination. Socio-familial characteristics, particularly the intersectionality between gender and employment, influence caregivers’ perceived discrimination. ConclusionCaregivers of children with disabilities experience pervasive social discrimination in contemporary urban China. Our study demonstrates that the social construction of disablism and the affiliate discrimination against family caregivers of children with disabilities is complex and multidimensional and depends upon the children’s disability and the caregivers’ socio-demographic characteristics.

Predictors of adherence to direct oral anticoagulants after cardiovascular or bleeding events in Medicare Advantage Plan enrollees with atrial fibrillation.

Direct oral anticoagulants (DOACs) are recommended for patients with atrial fibrillation (AF) given their improved safety profile. Suboptimal adherence to DOACs remains a significant concern among individuals with AF. However, the extent of adherence to DOACs following a cardiovascular or bleeding event has not been fully evaluated. To evaluate the pattern of adherence trajectories of DOACs after a cardiovascular or bleeding event and to investigate the sociodemographic and clinical predictors associated with each adherence trajectory by using claims-based data. This retrospective study was conducted among patients with AF prescribed with DOACs (dabigatran/apixaban/rivaroxaban) between July 2016 and December 2017 and who were continuously enrolled in the Texas-based Medicare Advantage Plan. Patients who experienced a cardiovascular or bleeding event while using the DOACs were further included in the analysis. The sample was limited to patients who experienced a clinical event such as a cardiovascular or bleeding event while using the DOACs. The clinical events considered in this study were cardiovascular (stroke, congestive heart failure, myocardial infarction, systemic embolism) and bleeding events. To assess adherence patterns, each patient with a DOAC prescription was followed up for a year after experiencing a clinical event. The monthly adherence to DOACs after these events was evaluated using the proportion of days covered (PDC). A group-based trajectory model incorporated the monthly PDC to classify groups of patients based on their distinct patterns of adherence. Predictors associated with each trajectory were assessed using a multinomial logistic regression model, with the adherent trajectory serving as the reference group in the outcome variable. Among the 694 patients with AF who experienced clinical events after the initiation of DOACs, 3 distinct adherence trajectories were identified: intermediate nonadherent (30.50%), adherent (37.7%), and low adherent (31.8%); the mean PDC was 0.47 for the intermediate nonadherent trajectory, 0.93 for the adherent trajectory, and 0.01 for low adherent trajectory. The low-income subsidy was significantly associated with lower adherence trajectories (odds ratio [OR] = 4.81; 95% CI = 3.07-7.51) and with intermediate nonadherent trajectories (OR = 1.57; 95% CI = 1.06-2.34). Also, nonsteroidal anti-inflammatory drug use was significantly associated with lower adherence trajectories (OR = 5.10; 95% CI = 1.95-13.36) and intermediate nonadherent trajectories (OR = 3.17; 95% CI = 1.26-7.93). Other predictors significantly associated with both nonadherent trajectories are type of DOACs (OR = 0.53; 95% CI = 0.35-0.79), presence of coronary artery disease (OR = 1.89; 95% CI = 1.01-3.55), and having 2 or more clinical events (OR = 1.65; 95% CI = 1.09-2.50). Predictors identified provide valuable insights into the suboptimal adherence of DOACs among Medicare Advantage Plan enrollees with AF, which can guide the development of targeted interventions to enhance adherence in this high-risk patient population.

Associations between motor competence and the risk of obesity in Brazilian adolescents

Purpose: To assess whether motor competence is associated with the risk of obesity in adolescents. Methods: The sample consisted of 296 adolescents (56.1% girls) aged 12 to 15 years recruited from Rio de Janeiro, Brazil. Motor competence was assessed using the Körperkoordinationtest fur kinder (KTK). Body mass index (BMI) measures were used to classify the participants’ weight status. Physical activity was determined through a validated self-administered questionnaire. Multinomial and binary logistic regression models, adjusted for potential confounders (i.e. age, sex and physical activity), were executed to examine the association between motor competence and risk of obesity. Results: Almost half of participants (48%) presented low motor competence. Among adolescents with obesity, 92.9% showed low motor competence. In addition, low motor competence was associated with a higher risk to be overweight (OR: 2.940, p=.006) and obese (OR: 18.366, p&lt;.001), even after adjusting for potential confounders. Conversely, adolescents with adequate motor competence were less likely to be overweight (OR: .340, p = .006) and obese (OR: .054, p&lt;.001). Conclusion: Having low motor competence can be a risk factor for obesity, while adequate motor competence was a protective factor against this disease. Pediatric obesity is multifactorial, including environmental aspects, yet this study showed that motor competence seems to be important to maintaining a healthy weight status in youth. Keywords: motor development; weight status; overweight; physical activity; children.