Multinomial Regression Research Articles

중고령 남성 은퇴자의 은퇴만족도 변화궤적 유형과 영향 요인

The purpose of this study was to identify patterns of retirement satisfaction trajectory and their associated factors among middle-aged and older male retirees using data from the 5th (2014) to 8th (2020) waves of the Korean Longitudinal Study of Ageing (KLoSA). To this end, a three-step approach to the Latent Class Growth Model (LCGM) and multinomial logistic regression analysis were conducted on the sample of 543 male retirees over the age of 50 who responded that they had fully retired during the 5th to 8th waves. As a result of the analysis of the Latent Class Growth Model analysis, the retirement satisfaction of middle-aged and older male retirees was derived as 'high-level of retirement satisfaction maintaining type', 'increased retirement satisfaction type', and 'low-level of retirement satisfaction maintaining type'. The results of the multinomial logistic regression analysis showed that subjective economic status, frequency of social activities, subjective health status, and age significantly predicted the trajectories of retirement satisfaction, and in particular, it was found that those with high subjective economic status were more likely to belong to the high-level of retirement satisfaction maintaining type than the low-level of retirement satisfaction maintaining type or the increased retirement satisfaction type. This study examined the patterns of retirement satisfaction trajectory among middle-aged and older male retirees by subdividing them, and in particular discussed what level of preparation would be needed to prepare for their retirement.

Tanzania’s repeat tourists: unraveling choice of attractions patterns through demographic perspectives

Purpose This study aims to explore the connection between demographic traits and the choice of attraction patterns among international repeat tourists. Design/methodology/approach The study employed a questionnaire survey to collect data from 1550 international repeat tourists who visited Tanzania between November 2022 and July 2023. Convenient sampling was employed as tourists were selected from the three international airports of Tanzania, namely Kilimanjaro International Airport, Julius Nyerere International Airport, and Abeid Aman Karume International Airport. A multinomial logistic regression model was used to examine the impact of socio-demographic characteristics on the selection of attraction patterns among international repeat tourists. Findings The study revealed that demographic factors, including age, marital status, income level, occupation, and education level, exhibit statistically significant correlations with preferences for distinct attraction patterns. This significance was established through a p-value of less than 0.05 for all the aforementioned variables. Research limitations/implications This study is primarily focused on international repeat tourists, thereby limiting insights into the preferences of domestic tourists. To better inform strategies aimed at attracting a larger domestic tourist base, future research may prioritize the investigation of choice of attractions patterns among domestic tourists in relation to their demographic characteristics. Originality/value This study contributes to the nuanced understanding of international tourist behavior by unraveling the extent to which demographic traits impact tourists’ choices of attraction patterns, thereby providing insights crucial for effective marketing strategies, improved visitor experiences, and sustainable tourism development strategies.

Associations between receiving non-consensual image and video sexts and average sleep duration among adolescents and young adults

Background Sexting is the sending and receiving of nude or partially nude images or videos. Despite it being a part of contemporary relationships, it can have adverse effects. This is particularly the case when receiving non-consensual sexts. To date, there remains a gap in the literature on whether receiving non-consensual sexts is associated with poor sleep. Therefore, the aim of this study was to determine the association between receiving non-consensual sexts and average sleep duration. Methods Data from Wave 2 (2022) of the Canadian Study of Adolescent Health Behaviours (N = 906) were analysed. Multinomial logistic regression analyses were used to determine the association between receiving non-consensual sexts (both image and video) in the past 12 months and average sleep duration (≤5 h, 6 h, 7 h, 8 h, and ≥9 h) in the past 2 weeks. Analyses were stratified by gender. Results Girls and women who received non-consensual image and video sexts, compared to those who did not, were more likely to report ≤5 h of average sleep in the past 2 weeks, relative to 8 h of average sleep. There were no significant findings among boys and men. Conclusion Findings underscore that receiving non-consensual image and video sexts may negatively impact sleep among girls and women, which may be contextualised by trauma responses experienced because of gender-based sexual violence. Healthcare and mental health professionals should be made aware of this association to provide effective care to girls and women.

Identifying Patterns of Primary Care In-Person and Telemedicine Use in the Veterans Health Administration: A Latent Class Analysis.

The Veterans Health Administration increased synchronous telemedicine (video and telephone visits) in primary care in response to the COVID-19 pandemic. Our objective was to determine veteran use patterns of in-person and telemedicine primary care when all modalities were available. A retrospective cohort analysis. We performed a latent class analysis of primary care visits over a 1-year period to identify veteran subgroup (i.e., class) membership based on amount of primary care use and modality used. Then, we used multinomial logistic regression with a categorical outcome to identify patient characteristics associated with class identification. A random national sample consistingof 564,580 primary care empaneled veterans in June 2021. Latent class membership. We identified three latent classes: those with few primary care visits that were predominantly telephone-based (45%), intermediate number of visits of all modalities (50%), and many visits of all modalities (5%). In an adjusted model, characteristics associated with the "few" visits class, compared to the intermediate class, were older age, male sex, White race, furtherdriving distance to primary care, higher Gagne, optimal internet speed, and unmarried status (OR 1.002, 1.52, 1.13, 1.004, 1.04, 1.05, 1.06, respectively; p < .05). Characteristics associated with membership in the "many" visits class, compared to the intermediate class, were Hispanic race, higher JEN Frailty Index and Gagne (OR 1.12, 1.11, 1.02, respectively; p < .05), and higher comorbidity by Care Assessment Need score quartile (Q2 1.73, Q3 2.80, Q4 4.12; p < 0.05). Veterans accessing primary care in-person or via telemedicine do so primarily in three ways: (1) few visits, predominantly telephone; (2) intermediate visits, all modalities, (3) many visits, all modalities. We found no groups of veterans receiving a majority of primary care through video.

Networks and securing an internship during an environmental anomaly: the COVID-19 pandemic

PurposeThe outbreak of COVID-19 has caused a slowdown of economic activity across the globe, which has resulted in high levels of disruption to labour markets. This study seeks to examine how the outbreak of COVID-19 has impacted the search strategies of students seeking for an internship, and whether these have changed since the start of the pandemic. The study utilises the strength of weak ties hypothesis, social capital theory and status attainment theory to explore the changes in securing a position since the outbreak of COVID-19.Design/methodology/approachThis study draws on data from two cohorts of MBA students seeking to secure internships: one before the outbreak and one during. A multinomial regression is employed to examine how students have used network ties to secure internships and how this has changed since the outbreak of COVID-19.FindingsThe multinomial regression results indicate that there was little difference in the strategies employed by students before the crisis compared to those that secured them during, potentially indicating that students are unwilling to deviate from typical job search strategies, especially in times of uncertainty.Originality/valueThis study provides insights into how network ties are used by job seekers during a period of economic and environmental uncertainty.

Impact of corporate disclosure on dividend policy: a novel setting of COVID-19-related disclosure by Vietnamese listed firms

Purpose This study aims to investigate whether the extent of corporate disclosure, proxied by COVID-19-related disclosure, affects the dividend policy of listed firms. Design/methodology/approach The study uses a multinomial logistic regression model to examine the relation between corporate disclosure and the dividend policy of the 100 largest market-cap firms in Vietnam in 2021. The COVID-19 pandemic, with its unique impact on business operations, serves as the backdrop for this analysis. Findings The findings indicate that firms with more extensive COVID-19-related disclosure are more inclined to distribute dividends in the form of stocks or cash instead of omitting them. Originality/value This research contributes to the understanding of how corporate disclosure practices influence a firm’s financial decisions, particularly in the context of the COVID-19 pandemic. The findings hold implications for corporate financial decision-making during times of macroeconomic shock.

Antiepileptic Medication-induced Severe Cutaneous Adverse Reactions in Hospitalized Children: A Retrospective Study

There are limited data on severe cutaneous adverse reactions (SCARs) associated with antiepileptic medications. The current study aims to investigate the clinical and epidemiological characteristics of antiepileptic medication-induced SCARs in hospitalized children.&#x0D; This five-year retrospective study was conducted at Isfahan University of Medical Sciences, Iran. The study included all children with a diagnosis of SCARs secondary to antiepileptic medications as defined by the World Health Organization (WHO). In our study SCARs were categorized into three groups: drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), and a group with symptoms overlapping between maculopapular eruptions (MPE) and DRESS.&#x0D; Among 259 children with SCARs induced by antiepileptic medications, 199 (76.83%), 42 (16.22%), and 18 (6.95%) had overlapping MPE/DRESS, DRESS, and SJS/TEN, respectively. Phenobarbital was the most common offending drug among SCARs. The multinomial logistic regression model revealed that lymphadenopathy increased DRESS occurrence by 35 times compared to overlapping MPE/DRESS. Girls were at risk of SJS/TEN approximately 6 times more than boys. Age, weight, and mucosal involvement affected hospitalization duration in children with SCARs related to antiepileptic medication.&#x0D; There are some similarities and differences in the clinical and epidemiological features of Iranian children suffering from antiepileptic medication-induced SCARs.&#x0D;  

Educational level and characteristics of invasive breast cancer: findings from a French prospective cohort.

Breast cancer (BC) characteristics are known to influence patients survival. Social differences have been reported by previous studies for those characteristics but questions persist because of inconsistent conclusions. We aimed to investigate the impact of education on BC stage, grade, and hormone receptor (HR) status, while adjusting for potential confounders including a broad set of health behaviors, anthropometric measures, and reproductive factors. In the French E3N cohort, 5236 women developed a primary invasive BC for which there was available information on stage, grade, and HR status. No multivariate analyses was performed for BC stage based on the lack of association in bivariate analyses. Odds ratios and confidence intervals were estimated using multinomial logistic regression models for BC grade or binomial logistic regression models for HR status of BC. Women with a lower education were diagnosed with higher grade BC compared to women with a higher education (1.32 [1.12; 1.57]). This association was slightly attenuated after adjustment for covariates independently and more strongly affected in the fully adjusted model (1.20 [0.99; 1.45]). A significant association was observed between lower education and HR- status of BC (1.20 [1.02; 1.42]) attenuated after adjustment for age at first childbirth (1.12 [0.95; 1.33]). In this cohort, education was associated with BC grade and HR status but not stage at diagnosis. The link between education and BC grade was not entirely explained by the different adjustments. A specific mechanism could be at play and deserves further investigations.

Determinants of Referral Outcomes for Victim–Survivors Accessing Specialist Sexual Violence and Abuse Support Services

ABSTRACT Sexual violence and abuse (SVA) is highly prevalent globally, has devastating and wide-ranging effects on victim-survivors, and demands the provision of accessible specialist support services. In the UK, Rape Crisis England & Wales (RCEW), a voluntary third sector organization, is the main provider of specialist SVA services. Understanding the profile of victim-survivors who are referred to RCEW and their referral outcomes is important for the effective allocation of services. Using administrative data collected by three Rape Crisis Centres in England between April 2016 and March 2020, this study used multinomial regression analysis to examine the determinants of victim-survivors’ referral outcomes, controlling for a wide range of potentially confounding variables. The findings demonstrate that support needs, more so than the type of abuse experienced, predicted whether victim-survivors were engaged with services. Particularly, the presence of mental health, substance misuse and social, emotional, and behavioral needs were important for referral outcomes. The referral source also influenced referral outcomes, and there were some differences according to demographic characteristics and socioeconomic factors. The research was co-produced with stakeholders from RCEW, who informed interpretation of these findings. That victim-survivors’ engagement with services was determined by their support needs, over and above demographic characteristics or the type of abuse they had experienced, demonstrates the needs-led approach to service provision adopted by RCEW, whereby resources are allocated effectively to those who need them most.

Dengue hospitalizations and in-hospital mortality changes in trend in Ecuador: a nationwide study from 2015 to 2022

During recent years, dengue infection has spread rapidly within countries and between regions. Rapid rise in the global burden has been related to sociodemographic changes. Objective This study aimed to analyze dengue hospitalizations and in-hospital mortality trends in Ecuador, along with sociodemographic factors influencing adverse outcomes. Methods This study included 31,616 dengue hospitalizations in Ecuador during 2015–2022, of which 115 (0.36%) died. Data were extracted from national hospital registries. Age adjusted rates were calculated, and for the analysis of changes in trend, a Joinpoint regression was performed. Multivariate binary and multinomial logistic regressions were performed for assessing sociodemographic factors influencing dengue adverse outcomes. Results During 2015–2022, the mean age adjusted dengue hospitalization rate was 22.3 per 100,000 inhabitants with 49.41% annual decrease during 2015–2017 and 31.73% annual increase during 2017–2022 with higher rates in 2020 with 31.61, 2021 with 34.42, and 2022 with 25.81. The mean dengue in-hospital mortality rate was 0.08, mortality rates did not show significant changes during 2015–2022. Higher probability of death was observed in ages ≥50 years and ethnic minorities. People living in rural areas exhibited a 64% higher risk for complicated dengue hospitalization. Conclusions It was observed as an important accomplishment in Ecuador’s ongoing efforts to improve healthcare regarding dengue. 0.36% of dengue hospitalizations ended in death which is below the recommended 1%. The increase in dengue hospitalizations in Ecuador during recent years remains a concern. The COVID-19 pandemic might have influenced dengue prevention and vector control to be neglected leading to an increase in cases.

Occupational differences in a Dutch sample of patients with primary progressive aphasia, behavioral variant frontotemporal dementia, and Alzheimer’s dementia

Background Cognitive reserve is a potential mechanism to cope with brain damage as a result of dementia, which can be defined by indirect proxies, including education level, leisure time activities, and occupational attainment. In this study we explored the association between dementia diagnosis and type of occupation in a retrospective Dutch outpatient memory clinic sample of patients with primary progressive aphasia (PPA), behavioral variant frontotemporal dementia (bvFTD), and Alzheimer’s Dementia (AD). Methods We included data from 427 patients (bvFTD n = 87, PPA n = 148, AD n = 192) and compared the frequency of occupations (11 categories) between patients and data from the Dutch census using Pearson Χ 2 tests and we calculated odds ratios (OR) by means of multinomial logistic regression analyses. We also investigated patient group differences in age, sex, education, disease duration, and global cognition. Results The frequency of teachers in patients with PPA was significantly higher than the frequency of teachers in patients with bvFTD [OR = 4.79, p = .007] and AD [OR = 2.04, p = .041]. The frequency of teachers in patients with PPA (16%) was also significantly higher than the frequency of teachers in the Dutch census [5.3%; OR = 3.27, p < .001]. The frequency of teachers in both bvFTD and AD groups were not significantly different from the frequency of teachers in the Dutch census (p = .078 and p = .513, respectively). Conclusions A potential explanation for our results is the so called “wear and tear” hypothesis, suggesting that teachers have a communication-wise demanding occupation – and therefore are at higher risk to develop PPA. Alternatively, teaching requires continuous communication, hence teachers are more sensitive to subtle changes in their speech and language abilities. Our findings broaden our understanding of the relationship between occupational activity and cognitive reserve in the development of dementia.

The relationship between type, timing and duration of exposure to adverse childhood experiences and adolescent self-harm and depression: findings from three UK prospective population-based cohorts.

Adverse childhood experiences (ACEs) are well-established risk factors for self-harm and depression. However, despite their high comorbidity, there has been little focus on the impact of developmental timing and the duration of exposure to ACEs on co-occurring self-harm and depression. Data were utilised from over 22,000 children and adolescents participating in three UK cohorts, followed up longitudinally for 14-18 years: the Avon Longitudinal Study of Parents and Children (ALSPAC), the Millennium Cohort Study (MCS) and the Environmental Risk (E-Risk) Longitudinal Twin Study. Multinomial logistic regression models estimated associations between each ACE type and a four-category outcome: no self-harm or depression, self-harm alone, depression alone and self-harm with co-occurring depression. A structured life course modelling approach was used to examine whether the accumulation (duration) of exposure to each ACE, or a critical period (timing of ACEs) had the strongest effects on self-harm and depression in adolescence. The majority of ACEs were associated with co-occurring self-harm and depression, with consistent findings across cohorts. The importance of timing and duration of ACEs differed across ACEs and across cohorts. For parental mental health problems, longer duration of exposure was strongly associated with co-occurring self-harm and depression in both ALSPAC (adjusted OR: 1.18, 95% CI: 1.10-1.25) and MCS (1.18, 1.11-1.26) cohorts. For other ACEs in ALSPAC, exposure in middle childhood was most strongly associated with co-occurring self-harm and depression, and ACE occurrence in early childhood and adolescence was more important in the MCS. Efforts to mitigate the impact of ACEs should start in early life with continued support throughout childhood, to prevent long-term exposure to ACEs contributing to risk of self-harm and depression in adolescence.

Patient Reported Sexual Adaptation Following Prostate Cancer Treatment: An Analysis of Related Variables and Sexual Outcomes Associated with Sexual Adaptation Styles.

Sexual concerns after prostate cancer (PCa) treatment are high. Flexible coping is a crucial element to maintaining sexual activity after PCa and improves adaptation outcomes. We aimed to identify potential sexual adaptation styles reported by men following PCa treatment, and to assess relationships among associated variables and outcomes. Individuals (n = 223) with PCa treatment history (e.g., radical prostatectomy [n = 165, 74.0%], external beam radiation [n = 83, 37.2%], hormone/androgen deprivation therapy [n = 83, 37.2%]), completed an online survey assessing sexual variables and processes of sexual adaptation. Using a combination of inductive and deductive coding, open-ended responses were thematically analyzed and grouped into sexual adaptation styles. Factors potentially associated with sexual adaptation styles (e.g., age, perceived partner involvement, co-morbidities, relationship duration, time since PCa treatment, desire for physical affection, depression, relationship adjustment) were tested using multinomial logistic regression. Outcomes of sexual well-being (sexual distress, sexual bother, sexual satisfaction) and relationship adjustment were compared against each sexual adaptation style using a multivariate analysis of variance. Sexual activity status and satisfaction with the adaptation process was assessed across the sexual adaptation styles using a chi-square analysis and post-hoc tests. Two distinct categories were identified: those who had Adapted (n = 185) and those who had Not Adapted (n = 38). Four sexual adaptation styles emerged in the adapted category: Relationship Renegotiation (n = 53) and Sexual Renegotiation (n = 47), which were couples-focused styles, and Acceptance/Resignation (n = 34) and Masturbation/Erection (n = 48), which were individual-focused styles. Participants who could not be categorized as one style, but rather met several, were identified as Mixed (n = 3). Higher rates of depression, lower relationship adjustment, lack of sexual activity, and greater dissatisfaction with the adaptation process were observed for Not Adapted participants. Participants engaged in any type of adaptation style fared better than those who had Not Adapted. Couples-focused styles tended to emphasize renegotiation, including a changed perspective on the expression of the relationship. Perceived direct engagement of the partner facilitated adaptation and emphasized engagement with flexible coping, either through redefining priorities or ways of being sexual. Individual-focused styles emphasized pre-cancer erectile function, and either aimed to return to capacity for penetrative sexual activity or accepted its inaccessibility and largely an abandonment of partnered sexual activity.

Guarding the Vulnerable: Perceptions of Security and Workplace Violence in Pediatric and Gynecological Care Settings of Karachi

Background: Violence in the workplace against medical professionals is a serious problem, especially in developing nations like Pakistan. The purpose of this study was to evaluate the opinions of medical professionals regarding Karachi's current hospital security protocols and pinpoint opportunities for enhancement.&#x0D; Methods: A cross-sectional survey of 414 healthcare providers from public and private hospitals in Karachi, Pakistan was undertaken. The participants' sociodemographic characteristics, encounters with workplace violence, evaluations of hospital security measures, and recommendations for enhancement were all encompassed in the questionnaire. The data were analysed utilising descriptive statistics, chi-square tests, and multinomial logistic regression.&#x0D; Results: A significant proportion of the participants expressed discontentment with security standards, citing insufficient staffing (71.7%), absence of monitoring systems (72.7%), and inadequate access control guidelines (64.7%). A greater frequency of reported workplace violence was substantially correlated with overall dissatisfaction with security (82.3% vs. 58.1%, p &lt; 0.001). The results of multinomial logistic regression showed that being a nurse (OR = 1.73, 95% CI: 1.12-2.68) and being dissatisfied with security measures (OR = 3.21, 95% CI: 1.87-5.52) were independent risk factors for workplace violence. Increasing security staff, improving surveillance systems, and fortifying access control protocols were among the recommendations for improvement.&#x0D; Conclusions: Improved hospital security measures are essential to address workplace violence against healthcare providers in Karachi. Implementing the recommended strategies can create a safer work environment and enhance the quality of patient care.&#x0D; Keywords: Workplace violence, healthcare providers, hospital security, Karachi, Pakistan, perceptions.

Association of sense of coherence and periodontal disease severity, in two cross-sectional studies.

To investigate the association between the individuals' level of sense of coherence (SOC) and periodontal disease severity. The study populations originated from two stratified cross-sectional random samples of residents in a medium-sized Swedish city in 2003 and 2013, respectively. The final samples constituted 491 individuals in 2003 and 538 individuals in 2013. The samples were classified into three groups according to the severity of periodontitis (no/minor, moderate and severe). The 13-item Swedish version of Antonovsky's "Orientation to life" questionnaire, measuring the individual's SOC, was filled out. Descriptive statistics were performed as well as multinomial logistic regression analysis. Dependent variable was the severity of periodontal disease and independent variables, age in years, presently smoking and education at university level. In the multinomial regression analysis, smoking, age, and total SOC score were significantly associated with severe periodontitis at both examinations. The strongest predictor of severe periodontal disease was smoking. The total SOC score did not differ between the examinations, but there was a statistically significant difference in two of the SOC dimensions, manageability (lower), and comprehensibility (higher), over time. Individuals with severe periodontitis had significantly lower SOC compared to subjects periodontally having no/minor periodontal disease. Smoking was the strongest overall predictor of having severe periodontitis.

Hypertension subtypes at high altitude in Peru: Analysis of the Demographic and Family Health Survey 2016-2019.

The prevalence of hypertension in Peru has increased over the years. Approximately one third of the Peruvian population lives at high altitudes. This population presents particular physiological, genetic and environmental characteristics that could be related to the prevalence of hypertension and its subtypes. To assess the association between altitude and hypertension in the Peruvian population through an analysis of a nationally representative survey. We conducted a cross-sectional analysis of the Demographic and Family Health Survey for the period 2016-2019. We included 122,336 individuals aged 18 years and older. Hypertension was defined according to the JNC-7 guidelines. High-altitude location was defined as a residential cluster located above 2,500 meters above sea level. We utilized generalized linear models from the Poisson family with a log-link function to assess the magnitude of the association between high altitude and hypertension. Additionally, we employed multinomial regression models to analyze the association between high altitude and subtypes of hypertension, including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). In the adjusted Poisson regression model, we found that the prevalence of hypertension among participants living at high altitudes was lower compared to those living at low altitudes (aPR: 0.89; 95% CI: 0.86-0.93). In the adjusted multinomial regression model, we observed a lower prevalence rate of ISH among participants residing at high altitudes (aRPR: 0.68; 95% CI: 0.61-0.73) and a higher prevalence rate of IDH among participants residing at high altitudes (aRPR: 1.60; 95% CI: 1.32-1.94). Residents at high altitudes in Peru have a lower prevalence rate of ISH and a higher prevalence rate of IDH compared to those living at low altitudes. Further studies are needed to determine the influence of other biological, environmental, and healthcare access factors on this relationship.

Prenatal perceived stress and urinary cortisol as risk factors for ASD and non-typical developmental outcomes in the MARBLES study

BackgroundFindings for prenatal stress, previously measured through stressful life event surveys items or biomarkers, in association with ASD are inconsistent. We prospectively examined prenatal perceived stress and prenatal urinary cortisol (PUC) in association with ASD and other non-typical developmental (Non-TD) outcomes in the child in a high familial likelihood cohort. MethodsThe Perceived Stress Scale questionnaire was used to measure perceived stress in the longitudinal Markers of Autism Risk in Babies: Learning Early Signs (MARBLES) Study. Cortisol was measured through 24-hr urine collections. At three years of age, an algorithm consisting of scores from the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL) was used to classify children with ASD, Non-TD, or typically developing (TD) outcomes. Relative risk ratios (RRR) with TD as the reference were estimated using multinomial logistic regression. ResultsIncreased perceived stress was associated with Non-TD in trimester 1 (RRR 1.10; 95% CI: 1.00, 1.21) and ASD in trimesters 2 and 3 (RRR 1.08; 95% CI: 1.02, 1.14 and RRR 1.08; 95% CI: 1.03, 1.14, respectively). Results with PUC were non-significant but were in the direction consistent with previous findings suggesting that decreased cortisol levels are associated with higher likelihood of ASD. ConclusionsFindings support the hypothesis that higher perceived stress is associated with increased likelihood of ASD and possibly Non-TD, relative to TD. This suggests that stress reduction interventions during pregnancy could serve as preventative measures that help optimize the child’s long-term health. Larger studies are needed to replicate these findings.

Mental health impact of multiple sexually minoritized and gender expansive stressors among LGBTQ+ young adults: a latent classanalysis.

In the United States, lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexually minoritized and gender expansive (LGBTQ+) young adults are at increased risk for experiencing mental health inequities, including anxiety, depression and psychological distress-related challenges associated with their sexual and gender identities. LGBTQ+ young adults may have unique experiences of sexual and gender minority-related vulnerability because of LGBTQ+-related minority stress and stressors, such as heterosexism, family rejection, identity concealment and internalized homophobia. Identifying and understanding specific LGBTQ+-related minority stress experiences and their complex roles in contributing to mental health burden among LGBTQ+ young adults could inform public health efforts to eliminate mental health inequities experienced by LGBTQ+ young adults. Therefore, this study sought to form empirically based risk profiles (i.e., latent classes) of LGBTQ+ young adults based on their experiences with familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment, and then identify associations of derived classes with psychological distress. We recruited and enrolled participants using nonprobability, cross-sectional online survey data collected between May and August 2020 (N=482). We used a three-step latent class analysis (LCA) approach to identify unique classes of response patterns to LGBTQ+-related minority stressor subscale items (i.e., familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment), and multinomial logistic regression to characterize the associations between the derived classes and psychological distress. Five distinct latent classes emerged from the LCA: (1) low minority stress, (2) LGBTQ+ identity concealment, (3) family rejection, (4) moderate minority stress and (5) high minority stress. Participants who were classified in the high and moderate minority stress classes were more likely to suffer from moderate and severe psychological distress compared to those classified in the low minority stress class. Additionally, relative to those in the low minority stress class, participants who were classified in the LGBTQ+ identity concealment group were more likely to suffer from severe psychological distress. Familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment are four constructs that have been extensively examined as predictors for mental health outcomes among LGBTQ+ persons, and our study is among the first to reveal nuanced gradients of these stressors. Additionally, we found that more severe endorsement of minority stress was associated with greater psychological distress. Given our study results and the previously established negative mental health impacts of minority stressors among LGBTQ+ young adults, findings from our study can inform research, practice, and policy reform and development that could prevent and reduce mental health inequities among LGBTQ+ young adults.

Severity of Airflow Obstruction Based on FEV1/FVC vs FEV1% of Predicted in the General US Population.

According to GOLD, the ratio of FEV1/FVC is used to confirm airflow obstruction in COPD diagnosis, whereas FEV1% of predicted (FEV1%pred) is used for severity grading. STaging of Airflow obstruction by the FEV1/FVC Ratio (STAR) and its prediction of adverse outcomes has not been evaluated in general populations. To compare the STAR (FEV1/FVC) versus GOLD (FEV1%pred) classification for the severity of airflow limitation in terms of exertional breathlessness and mortality in the general US population. Severity stages according to STAR and GOLD were applied to the multi-ethnic National Health and Nutrition Examination Survey (NHANES) 2007-2012 survey including ages 18-80 years, using post-bronchodilatory FEV1/FVC<0.70 to define airflow obstruction in both staging systems. Prevalence of severity stages STAR 1-4 and GOLD 1-4 was calculated and associations with breathlessness and mortality were analyzed by multinomial logistic regression and Cox regression, respectively. STAR versus GOLD severity staging of airflow obstruction showed similar associations with breathlessness and all-cause mortality, regardless of ethnicity/race. In those with airflow obstruction, the correlation between the two classification systems was 0.461 (p<0.001). STAR reclassified 59% of GOLD stage 2 as having mild airflow obstruction (STAR 1). STAR 1 was more clearly differentiated from the non-obstructive compared to GOLD stage 1 in terms of both breathlessness and mortality. FEV1/FVC and FEV1%pred as measures of severity of airflow limitation show similar prediction of breathlessness and mortality in the adult US population across ethnicity groups. However, stage 1 differed more clearly from non-obstructive based on FEV1/FVC than FEV1%pred. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

Fresh or dry maize or both: Which is most economical and preferred by farmers?

As a staple crop of great importance in sub-Saharan Africa, maize is essential for the production of food for humans and animals, particularly in the raising of poultry and livestock. Smallholder farmers in Ghana are the main producers of maize, and they frequently have difficulties in turning their crop into a sustainable source of income. As a result, there is an increasing need for these farmers to look into other options such as switching from traditional dry maize production to growing fresh maize. This circumstance calls for a critical analysis to ascertain whether producing for fresh or dry maize markets yields higher profitability. Therefore, the main objective of this study is to estimate the profitability of Ghana's fresh and dry maize markets, examine the factors influencing farmers' market choices as well as rank the production constraints. Data was collected from 390 maize farmers using questionnaires. Gross margin analysis, multinomial logit regression and Kendall's Coefficient of Concordance, were the methods of analysis. According to the study, fresh maize yields a profit of 78.00 pesewas for every GH¢ 1.00 invested, both alternatives generate 71.00 pesewas, and dry maize yields 67.00 pesewas. This implies that even though all three businesses are profitable, fresh maize cultivation stands out as the most lucrative. The results of the multinomial logit regression analysis showed that the choice of maize production systems is influenced by socioeconomic characteristics, farming experience, and loan availability. The Kendall's Coefficient of Concordance analysis confirms consensus on constraints, with lack of finance, pest issues, poor roads, and low maize prices as key challenges. According to the report, farmers may increase their profits by diversifying their crops to include the fresh maize market. Additionally, the government could assist these farmers by making financing more accessible to them through collaborations with financial institutions and specially designed agricultural loan programs.