Multinomial Regression Research Articles

DIVIDEND POLICY IN MAINLAND CHINA AND THE US: A STUDY ON NON-FINANCIAL LISTED COMPANIES

This paper aims to assess the common characteristics of dividend payers and non-payers in both China and the US, as well as the stability of dividend policies in each respective nation. The study addresses issues related to catering theory, signal theory, smoothing assumptions, and Fama-French hypotheses. Our analysis covers 509 non-financial firms during the period 2006-2016, comprising 419 firms from the US and 90 firms from China. The multinomial regression reveals that past dividend payouts are critical in explaining dividend policy in both the US and China. Firms that have consistently paid higher dividends in the preceding year are more likely to opt for dividend increases rather than omitting dividends, thus aligning with the dividend smoothing hypothesis. Additionally, firm size and stock market performance were found to be significantly influencing dividend payouts across different categories in both the US and China. However, US firms primarily drove dividend payouts through profitability and the dividend premium, while firm size and leverage heavily influenced Chinese dividends. Interestingly, Chinese firms appear to practice a less sticky dividend policy than US firms, implying that the role played by dividend policy in signalling and catering theories in China is less significant than in the US.

Machine Learning-Based Crop Suitability Prediction: An Emerging Technique for Sustainable Agricultural Production in the Desert Region of India

ABSTRACT Machine learning (ML) algorithms can be applied to predict the suitability of soil for crop cultivation based on digital soil mapping. We used three distinct models viz. Multinomial Logistic Regression (MnLR), Random Forest (RF), and Extreme Gradient Boosting (XGBoost) to predict the suitability of wheat and pearl millet in the Barmer district of the Thar Desert. After the computation of crop suitability classes, ML techniques were used to develop suitability maps of wheat and pearl millet in the study area. The study found that the RF and XGBoost models worked well to classify crop suitability. The RF model showed that 11.9% of the total area was highly suitable, 1.6% was moderately suitable, 14.9% was marginally suitable, and 71.6% was not suitable for wheat crop. RF model for pearl millet showed that 15.5% of the area is highly suitable. Soil suitability mapping for wheat showed a Kappa index ranging from 0.23 to 0.57 and an overall accuracy ranging from 0.79 to 0.86, whereas the prediction of suitability for pearl millet showed a moderate range of Kappa index from 0.31 to 0.58 and accuracy from 0.63 to 0.77. The area under curve (AUC) for wheat crop was 0.72, 0.88, and 0.91 for MnLR, RF, and XGBoost models, respectively. Overall, the RF model performed better than the MnLR model, showing a 16% increase in accuracy. Therefore, the developed suitability maps using ML provide valuable details on agricultural potential in the Indian desert region while harmonizing its impact on the environment and the economy.

The Impact of Parental Monitoring on Exposure to Multiple Substances and Bullying in Croatian Students

Background/Objectives: Adolescence is a critical period for experimenting with a wide range of risky behaviors, which are often influenced by family dynamics, including parental monitoring. This study aims to analyze the patterns of exposure to multiple substances and bullying among Croatian students by age and gender in 2022 and examine the association of exposure to multiple substances and bullying with maternal and paternal monitoring. Methods: The data were obtained from the 2022 Health Behaviour in School-aged Children (HBSC) study conducted in Croatia among students aged 11, 13, and 15. Two multinomial logistic regressions were performed separately by age and gender. Results: Exposure to multiple instances of bullying is more common among boys than girls in all three age groups, while exposure to multiple substances varies depending on age. The analysis revealed the strong protective effect of maternal monitoring against both substance use and bullying. Paternal monitoring showed less consistent effects but still indicated that lower paternal monitoring was associated with higher exposure to multiple substances and bullying, particularly at age 13. Conclusions: The patterns of multiple substance use and bullying vary by gender and age, emphasizing the need for tailored intervention strategies. Programs that strengthen parental monitoring, particularly maternal monitoring, should be prioritized.

Exploring the Link Between Physical Activity, Sports Participation, and Loneliness in Adolescents Before and Into the COVID-19 Pandemic: The HUNT Study, Norway

Background: The COVID-19 pandemic’s effects on adolescents’ physical activity, sports involvement, and feelings of loneliness remain inadequately understood. This study aimed to explore the shifts in leisure-time physical activity, sports participation, and loneliness among adolescents before and during the pandemic, positing that the pandemic has led to decreased physical activity and sports engagement, as well as heightened loneliness, where more active adolescents experience lower loneliness levels. This study included a prior four-year follow-up cohort from the same region two decades earlier to explore the existence of typical longitudinal aging effects in a cohort not affected by the pandemic. Methods: Prospective and longitudinal data from two cohorts of the Young-HUNT Study two decades apart involving adolescents aged 13–19 years were utilized. The controls were as follows: Cohort 1 from the Young-HUNT1 (YH1) Survey included 2399 adolescents with follow-up in the Young-HUNT2 (YH2) Survey four years later. Cohort 2 included the Young-HUNT4 (YH4) Survey (2017–2019) of 8066 adolescents, with a subset of 1565 participants followed up in the Young-HUNT COVID Survey (YHC) (2021) after exposure to the COVID-19 pandemic and associated restrictions. Changes over time were assessed using McNemar’s tests and dependent sample T-tests, while multinomial logistic regression modeled within-individual changes in loneliness, adjusting for age, gender, and other factors. Results: The findings revealed a significant decline in physical activity and sports participation in both cohorts from early to late adolescence. Additionally, there was a considerable increase in reported loneliness, more after exposure to the pandemic and especially among girls, but without any difference in historical initial levels (between cohorts). Inactive adolescents faced a greater risk of increased loneliness, while those participating in sports had a lower risk of loneliness. Physically inactive boys had a higher risk of loneliness compared with physically active boys at both time points in Cohort 2, which was higher than in the control Cohort 1. There was no historical difference between initial assessments. Conclusion: Adolescents experienced a significant decrease in physical activity and sports participation, along with increased loneliness, from early to late adolescence. Given the protective benefits of physical activity against loneliness and the negative longitudinal trends observed, public health initiatives should focus on increasing physical activity and reducing sports drop-out rates among adolescents to combat rising loneliness.

Comparison of depressive symptoms among emergency physicians and the general population in China: a cross-sectional study based on national data

BackgroundWhile physicians are considered to be more susceptible to developing depressive symptoms, empirical data are lacking. The study aims to compare the risk of depressive symptoms between emergency physicians and the general population in China based on national data.MethodsThis was a national cross-sectional study. 10 457 emergency physicians and 101 120 participants from the general population were investigated from July 2018 to August 2018 and January 2019 to February 2019, respectively. PHQ-9 was used to measure depressive symptoms, and a score ≥ 10 indicates major depression. Propensity score matching was adopted to balance the characteristics between emergency physicians and the general population. Multinomial logistic regression model was used to examine the association between occupational groups and the severity of depressive symptoms. Binary logistic regression model was performed to explore the risk factors of major depression among emergency physicians.ResultsThe prevalence of major depression among emergency physicians was 35.7%, whereas among the general population was 13.9%. Emergency physicians had a 3.65 times higher risk of major depression than the general population. And emergency physician was significantly associated with mild (OR: 3.12, 95% CI 2.95–3.30), moderate (OR: 4.94, 95% CI 4.60–5.30), moderately severe (OR: 9.48, 95% CI 8.61–10.44), and severe depressive symptoms (OR: 14.18, 95% CI 12.47–16.13) compared with none depressive symptoms. Even after matching, the results remained consistent. Factors associated with major depression among emergency physicians included bachelor degree or above (OR: 1.22, 95% CI 1.06–1.40), worked long years (OR: 1.26, 95% CI 1.08–1.46 for 1–5 years; OR: 1.56, 95% CI 1.32–1.84 for ≥ 6 years), experienced workplace violence (OR: 2.51, 95% CI 2.16–2.94), worked more night shifts per month (OR: 1.33, 95% CI 1.16–1.51 for 6–10 times; OR: 1.83, 95% CI 1.58–2.11 for ≥ 11 times), smoked (OR: 1.64, 95% CI 1.47–1.84), and effort-reward imbalance (OR: 4.18, 95% CI 3.62–4.85).ConclusionsEmergency physicians had a higher risk of depressive symptoms than the general population. There is a need for greater awareness of the mental health issues faced by emergency physicians.

Trajectories of depressive symptoms in early to mid-adolescence: associations with school pedagogical and social climate.

Adolescence is a critical period for mental health development, yet research exploring how contextual factors influence the development of depressive symptoms remains limited. This study explored trajectories of depressive symptoms during early to mid-adolescence and their association with various aspects of school climate. The study sample comprised 3671, 7th-grade students (aged 12-13 years) from 101 schools across Sweden, followed longitudinally across three time points spanning grades 7, 8 and 9. Depressive symptom trajectories were identified using latent class growth modelling. The Pedagogical and Social Climate questionnaire assessed school climate, and multinomial logistic regression was employed to predict trajectory membership based on sociodemographic and school climate factors. Four distinct developmental patterns of depressive symptoms emerged: 'Sustained low symptoms' (76.7%), 'Low-increasing' (10.9%), 'Sustained high symptoms' (7.9%), and 'High-decreasing' (4.5%). Gender, parental education and six specific school climate factors, out of the total 19 examined, significantly distinguished these trajectory classes. Positive teacher expectations and strong principal involvement were associated with more favourable trajectories, whereas teaching activities, teacher support and communication between school and home were associated with less favourable trajectories, suggesting a nuanced understanding of their relationship with depressive symptom trajectories. Few school factors were found to be relevant to depressive symptoms, highlighting the importance of considering external factors beyond the school environment in supporting adolescents during this developmental stage. Although the findings are multifaceted, it is primarily positive interpersonal relationships, especially through teacher expectations, that stand out as significant factors in promoting youth mental health.

Prevalence of Cannabis Use Disorder Among Primary Care Patients with Varying Frequency of Past-Year Cannabis Use.

Valid, single-item cannabis screens for the frequency of past-year use (SIS-C) can identify patients at risk for cannabis use disorder (CUD); however, the prevalence of CUD for patients who report varying frequencies of use in the clinical setting remains unexplored. Compare clinical responses about the frequency of past-year cannabis use to typical use and CUD severity reported on a confidential survey. Among adult patients in an integrated health system who completed the SIS-C as part of routine care (3/28/2019-9/12/2019; n = 108,950), 5000 were selected for a confidential survey using stratified random sampling. Among 1688 respondents (34% response rate), 1589 who reported past-year cannabis use on the SIS-C were included. We compared patients with varying frequency of cannabis use on the SIS-C (< monthly, monthly, weekly, daily) to survey responses on the Composite International Diagnostic Interview Substance Abuse Module for CUD (any and moderate-severe CUD) and cannabis exposure measures (typical use per-week, per-day). Adjusted multinomial (categorical) and logistic regression (binary), weighted for population estimates, estimated the prevalence of outcomes across frequencies. Patients were predominantly middle-aged (mean = 43.3years [SD = 16.9]), male (51.8%), white (78.2%), non-Hispanic (94.0%), and commercially insured (68.9%). The prevalence of any and moderate-severe CUD increased with greater frequency of past-year cannabis use reported on the SIS-C (p-values < 0.001) and ranged from 12.7% (6.3-19.2%) and 0.9% (0.0-2.7%) for < monthly to 44.6% (41.4-47.7%) and 20.3% (17.8-22.9%) for daily use, respectively. Greater frequency of use on the SIS-C in the clinical setting corresponded with greater per-week and per-day use on the confidential survey. Among patients who reported past-year cannabis use as part of routine screening, the prevalence of CUD and other cannabis exposure measures increased with greater frequency of cannabis use, underscoring the utility of brief cannabis screens for identifying patients at risk for CUD.

Insomnia symptoms in children and adolescents: screening for sleep problems with the two-item Sleep Condition Indicator (SCI-02)

BackgroundSleep problems are common in young people. Yet brief screening measures to identify those most in need of an intervention are lacking. This study investigated the potential of the two-item Sleep Condition Indicator (SCI-02) for screening insomnia symptoms in children and adolescents. We sought to establish whether there are distinct subgroups with different sleep profiles and whether subgroup membership varied with gender and school year group.MethodsStudents (school years 5–13; typical age 9–18 years) in England completed the OxWell Student Survey in 2021. Sleep measures included: SCI-02, sleep onset latency (SOL), sleep duration, daytime sleepiness, and worry disrupting sleep. Latent profile analysis and multinomial logistic regression explored sleep profiles and predicted class membership.ResultsIn total, 29,304 participants answered sleep items. Of these, 95% provided binary gender (n = 27,802, 55% female) for analyses. Five sleep profiles emerged. The profiles, labelled “good”, “moderate”, or “poor” sleepers, vary by sleep quality – which includes time taken to fall asleep (SOL), amount of sleep (sleep duration), and the disruption of sleep due to worry. The profiles are then further differentiated by high levels of daytime sleepiness – labelled “sleepy”. “Good Sleepers” (18,355, 66%), “Moderate Sleepers” (4825, 17.4%), “Moderate Sleepy Sleepers” (1250, 4.5%), “Poor Sleepers” (1037, 3.7%) and “Poor Sleepy Sleepers” (2335, 8.4%). Probable insomnia rates (SCI-02 ≤ 2) were high in both poor sleeper profiles (70–80%) compared with other profiles (0%) and the sample overall (9%). Compared with “Good Sleepers”, all other profiles were mostly female. Daytime sleepiness – the defining characteristic of the sleepy sleeper profiles – was more common in secondary school participants than primary school.ConclusionsThe SCI-02 is an efficient, two-question measure to screen for potential sleep problems in young people. Sleep disruption was high: one in ten were experiencing poor sleep. Females and adolescents appeared more vulnerable to poor sleep and daytime sleepiness. The SCI-02 has the potential for use in school and community contexts to identify children and adolescents who may benefit from support managing their sleep.

An assessment of adequate quality antenatal care and its determinants in India

BackgroundAntenatal care (ANC) is an important component in the continuum of care. Providing adequate quality ANC is necessary to prevent maternal and newborn mortality. The coverage of ANC has increased significantly in the last decade in India, but a mere increase in coverage is insufficient if the issue of quality is not simultaneously addressed. This study examines the change in each component of quality ANC between 2015-16 and 2019-21, highlights the factors associated with adequate quality ANC, and observes the state- and district-level distribution of adequate quality ANC during 2019-21.MethodsThis study is based on data from the two most recent rounds of the National Family Health Survey (NFHS), the Indian equivalent of the Demographic and Health Surveys (DHS). These rounds were conducted in 2015-16 and 2019-21 in selected households of India with a total of 190,797 and 176,843 sampled births, respectively. The dependent variable was quality antenatal care, a composite variable consisting of skilled healthcare providers, timeliness, sufficiency, and appropriateness of content. The independent variables were mother’s age, education, wealth quintile, birth order, mass media exposure, health insurance coverage, relationship with the head of household, facility exposure, intended pregnancy, history of adverse pregnancy outcomes, and other socio-demographic variables. Change in each component and dimension of quality antenatal care was assessed using data from both rounds of the survey. A multivariate multinomial logistic regression analysis was employed to identify the determinants of adequate quality ANC using the NFHS-5 data.ResultsThe findings revealed that 32 per cent of mothers received adequate quality antenatal care in 2019–2021, an increase of only 9% points compared to the 2015-16 period. Two significant barriers to achieving adequate quality antenatal care, in terms of appropriateness of content, were the provision of Iron and Folic Acid (IFA) tablets and counselling. The highest utilisation of adequate quality antenatal care was observed in the southern states. The utilisation of quality ANC increased with an increase in women’s education and wealth status; and was more prevalent among those with health insurance coverage and exposure to mass media.ConclusionDespite some improvements in the coverage of antenatal care, the quality of antenatal care continues to be very low and needs urgent attention. Achieving quality antenatal care in both content and experience requires addressing service gaps and developing better measures to capture and improve women’s care experiences.

Sexual identity differences in the association between psychological distress and cardiometabolic health among women: 2013-2018 National Health Interview Survey.

Poor psychological health has been consistently documented for sexually minoritized women. However, little is known about the association between poor psychological health and physical health. This study examined associations between psychological distress and cardiometabolic health, including cardiovascular disease risk conditions (hypertension, high cholesterol, and diabetes) and diagnoses (stroke, coronary heart disease, myocardial infarction, and angina), by sexual identity among women. Data are from the 2013-2018 National Health Interview Survey and included 102,279 women, who were straight (n = 97,909), lesbian/gay (n = 1,424), bisexual (n = 1,235), something else (n = 360), did not know (n = 712), and refused to disclose (n = 639). Multivariable multinomial logistic regression models were fit to estimate associations between psychological distress (measured with Kessler-6) and cardiometabolic health (self-reported diagnosis) and to examine sexual-identity differences in these associations. Covariates included sociodemographic characteristics. Overall, severe psychological distress was associated with significantly higher odds of having a cardiometabolic health condition (OR = 2.66). These associations generally did not statistically significantly differ based on sexual identity. However, potential substantive differences in the magnitude of the association existed among lesbian/gay (OR = 4.00) compared to straight women (OR = 2.73). Moreover, women who identified as gay/lesbian, bisexual, "something else," or "I don't know" all reported significantly higher prevalence of severe psychological distress than straight women. Given the overall positive association between psychological distress and cardiometabolic health as well as the higher prevalence of severe psychological distress among sexual minority women, more work is needed to longitudinally examine the effects of psychological distress on health among sexually minoritized women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identifying Patients at Increased Risk for Poor Outcomes Among Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients: The IPOGRO Risk Model

Background: A subarachnoid hemorrhage due to an aneurysmal rupture (aSAH) is a serious condition with severe neurological consequences. The World Federation of Neurosurgical Societies (WFNS) classification is a reliable predictor of death and long-term disability in patients with aSAH. Poor-grade neurological conditions on admission in aSAH (PG-aSAH) are often linked to high mortality rates and unfavorable outcomes. However, more than one-third of patients with PG-aSAH may recover and have good functional outcomes if aggressive treatment is provided. We developed a risk model called Identifying POor GRade Outcomes (IPOGRO) to predict 6-month mRS outcomes in PG-aSAH patients as a secondary analysis of a previously published study. Methods: All consecutive patients in poor-grade neurological conditions (WFNS IV-V) admitted to our institute from 2010 to 2020 due to aSAH were considered. Clinical and neuroradiological parameters were employed in the univariable analysis to evaluate the relationship with a 6-month modified Rankin Scale (mRS). Then, a multivariable multinomial regression model was performed to predict 6-month outcomes. Results: 149 patients with PG-aSAH were included. Most patients were surgically treated, with only 33.6% being endovascularly treated. The 6-month mRS score was significantly associated with clinical parameters on admission, such as lowered Glasgow Coma Scale (GCS), leukocytosis, hyperglycemia, raised Systolic Blood Pressure (SBP), greater Simplified Acute Physiology Score (SAPS II score), increased initial serum Lactic Acid (LA) levels, and the need for Norepinephrine (NE) administration. Neuroradiological parameters on the initial CT scan showed a significant association with a worsening 6-month mRS. The IPOGRO risk model analysis showed an association between a WFNS V on admission and a poor outcome (mRS 4-5), while raised SBP was associated with mortality. Conclusions: Our IPOGRO risk model indicates that PG-aSAH patients with higher SBP at admission had an increased risk of death at 6-month follow-up, whereas patients with WFNS grade V at admission had an increased risk of poor outcome but not mortality.

Junior to senior transition of male elite junior tennis players: A retrospective study.

This study explores the intricate dynamics of the Junior-to-Senior (JTS) transition phase in elite tennis. Focusing on challenges faced by young talents, the research aims to unveil factors influencing successful transitions and the role of elite junior tournaments. In a retrospective analysis, male tennis players (n = 240) from national teams in the ITF World Junior Tennis Finals tournament (2012-2016) were analyzed using Chi-square tests, Cramer's V, Bayesian statistics, and Multinomial Logistic Regression (MLR). Results revealed that 62.1% of elite junior participants were found in the Association of Tennis Professionals database, emphasizing the significance of team nominations and tournament results as important variables to monitor. Inferential and Bayesian statistics confirmed robustness, with MLR highlighting tournament results' importance. The findings highlight the complexities of the JTS transition and underscore the pivotal roles of participation, national team nominations, and tournament results. The study recommends the implementation of comprehensive player development programs, urging strategic team selections by national federations and academies. Coaches, stakeholders, and organizations should prioritize monitoring these variables for early talent identification and support. These measures collectively aim to optimize success trajectories, navigating the critical JTS phase in junior tennis players' sporting careers.

Enhanced multinomial logistic regression analysis of determinants influencing technical and vocational education and training (TVET) choices among Ghanaian youth: Implications for policy development

In Ghana, youth unemployment remains significant challenges, with technical and vocational education and training (TVET) emerging as a potential solution to equip young people with practical skills for the job market. However, the uptake of TVET programmes among Ghanaian youth remains low, particularly among females. This study therefore explores the determinants that influence TVET choices among Ghanaian youth, with the goal of informing policy development to enhance participation in vocational education. Applying an enhanced multinomial logistic regression (MLR) model, this research examines the influence of socio-economic, demographic, and attitudinal factors on career decisions. The enhanced model accounts for class imbalances in the dataset and improves classification accuracy, making it a robust tool for understanding the drivers behind TVET choices. A sample of 1600 Ghanaian youth engaged in vocational careers was used, ensuring diverse representation of the population. Key findings reveal that males are approximately three times more likely to choose TVET programs than females, despite females making up 50.13% of Ghana’s population. Specific determinants influencing TVET choices include financial constraints, parental influence, peer influence, teacher influence, self-motivation, and vocational limitations. In regions with limited vocational options, youth often pursue careers based on availability rather than preference, which highlights a gap in vocational opportunities. Parental and teacher influences were found to play a dominant role in steering youth towards specific careers. The study concludes with recommendations for policymakers, instructors, and stakeholders to increase the accessibility, relevance, and quality of TVET programmes to meet the socio-economic needs of Ghanaian youth.

Adherence to Mediterranean diet in Moroccan school-age adolescents: sociodemographic, socioeconomic and lifestyle determinants

BackgroundDespite its benefits, the Mediterranean diet (MD) is abandoned or not adopted by the younger generations in most Mediterranean countries.ObjectiveThe aim here was to examine some factors determining adherence to MD in Moroccan school-age adolescents.Material and methodsA cross-sectional survey was conducted in a school setting among 386 students (148 boys and 238 girls), aged 14 to 18 years, randomly selected and from different socioeconomic strata. A structured questionnaire was used to collect sociodemographic, socioeconomic and lifestyle data. Physical activity was assessed using the short French version of the IPAQ questionnaire. The KIDMED test was used to assess adherence to the Mediterranean diet. Weight, height and waist circumference were measured according to WHO standards. Body mass index (BMI) and waist�to-height ratio (WHtR) were calculated. Statistical ANOVA test was used for to compare multiple means, Student’s t-test for independent samples, &lt;i&gt;Chi&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; test for categorical variables and multinomial logistic regression analysis to identify factors associated with adherence to the MD amongst adolescents sample.ResultsAdherence to the MD in this population was very low, with nearly 53% having poor adherence and only 7.7% reporting optimal adherence. Multinomial regression analyses showed that poor adherence is correlated with female gender (p=0.042), low paternal education (p=0.004), limited number of meals (p=0.006), advanced age (p=0.005) and inadequate sleep duration (p=0.027). In contrast, better adherence appears to be correlated with a high number of meals per day (p&lt;0.001) and a better socio-professional class of the father (p&lt;0.001).ConclusionsThis study revealed a low prevalence of good adherence to MD confirming a transition of the study adolescents towards a Westernized diet. Targeted nutritional intervention programs should be implemented to improve adherence to the MD among Moroccan adolescents, by promoting healthy eating habits.

Antenatal Care Services Uptake and Associated Factors in Somaliland: Further Analysis of the 2020 Somaliland Demographic Health Survey

Purpose Antenatal care (ANC) is vital to maintain the health of pregnant women and their unborn babies. It was linked to a positive pregnancy experience. However, ANC uptake remained low in Somaliland, and no study has been conducted to assess possible predictors. Hence, the current study aimed to determine the level of ANC utilization and to identify its associated factors in Somaliland. Materials and Methods Somaliland Demographic Health Survey (SLDHS) Data 2020 were used. A weighted sample of 3,192 women aged 15-49 years participated in the study. The survey used a two-stage cluster design for sample selection. Descriptive statistics in the form of frequency and percentage and multilevel multinomial logistic regression analysis were carried out to determine associated factors and statistical significance was declared by p&lt; 0.05. Results The findings showed that 62.4% (95% CI: 60.7-64.1) of the women did not utilize ANC services, while 23.4% (95% CI: 21.9, 24.9) partially utilized and 14.2% (95% CI: 13.0, 15.4) adequately utilized ANC services. The odds of adequately utilizing ANC service decreased by a factor of 0.88 for women aged 35 and above compared to 15 - 24 year old women (AOR= 0.88, 95% CI: 0.61, 1.26). Women with higher educational levels had significantly higher odds (AOR=4.31, 95% CI: 1.54, 12.02) of adequately utilizing ANC compared to those with no formal education. The employment status, marital status, household wealth index, residence and region were also found to be associated with the utilization of Antenatal care. Conclusion The study showed low adequate utilization of ANC services in Somaliland. The variables, including age, education, wealth index, marital status, employment status, residence and region, were significantly associated with ANC utilization. Governmental and non-governmental organizations should enact a strategy with targeted intervention focusing on women from nomadic and rural communities, those from poor households, and low educational levels.

Health literacy demand and attitudes toward COVID-19 prevention measures among Korean American older adults and their caregivers

BackgroundHealth literacy has been linked to positive attitudes toward COVID-19 preventive measures among adolescents and young- or middle-aged adult populations. This study examined the relationship between health literacy and attitudes toward COVID-19 preventive measures among non-English speaking Korean American older adults and their caregivers. The study additionally investigated how sociodemographic characteristics were associated with attitudes.MethodsCOVID-19 survey data was collected from potential participants for an ongoing randomized controlled trial involving both Korean American older adults and their caregivers in the Baltimore-Washington and the New York Metropolitan areas (ClinicalTrials.gov Identifier: NCT03909347). Korean American older adults with normal cognition and their caregivers were allowed to participate in the survey. We used latent profile analysis to find unique clusters of participants with a similar pattern of responses to attitudes toward COVID-19 preventive measures. Based on the analysis, we employed multinomial logistic regression to investigate how health literacy and sociodemographic characteristics were associated with the clusters.ResultsWe found three clusters based on participant responses to COVID-19 preventive measures—Positive, Negative, or Mixed. Health literacy was not associated with COVID-19 related attitudes in the study sample. Men were 2.37 times more likely to be categorized as Mixed than having Positive Attitudes compared to women. The odds of a person living in the New York metropolitan area being categorized as having Mixed Attitudes compared to Positive Attitudes were also 2.67 times more than for a person living in the Baltimore-Washington area.ConclusionsDifferences in attitudes toward COVID-19 preventive measures were found among sociodemographic variables but not health literacy. Investigating what information channels or methods drive perception of public health information such as COVID-19 may help identify effective dissemination strategies for non-English speaking Korean older adults.

Why do older adults stop cancer screening? Findings from the Medicare Current Beneficiary Survey.

Prostate and breast cancer screening are prevalent among older adults, even among those unlikely to benefit. We aimed to evaluate why older adults stop cancer screening, including the role of physician recommendations. We used nationally representative data from the 2019 Medicare Current Beneficiary Survey (MCBS). We included women aged 76 and older without a history of breast cancer and men aged 71 and older without a history of prostate cancer. The primary outcome was reason for discontinuing screening, categorized as follows: (1) physician recommendation against screening; (2) absence of a recommendation to screen; and (3) patient-driven reason, such as patient preferences or beliefs. We evaluated reasons for screening discontinuation by health status and educational attainment using age-stratified multinomial logistic regression. The sample included 7350 participants representing a weighted population of 22,498,715. Overall, 53% of women underwent screening mammography in the past year or intended to continue screening. Among those who stopped screening, 5% reported a recommendation to stop screening from their doctor, 48% reported no recommendation, and 32% reported a patient-driven reason for cessation. Findings did not differ by educational attainment or health status, including among the oldest patients. For men, 61% were screened with PSA in the past year or intended to continue. Among those who stopped, 3% reported a recommendation against screening, 54% reported no recommendation, and 27% reported a patient-driven reason for cessation. Men with higher educational attainment were more likely to report that their physician recommended against screening (4% vs. 1%, p = 0.01) and that their doctor did not recommend screening (58% vs. 47%, p = 0.01). Reasons for screening cessation did not differ by health status, including among the oldest patients. Cancer screening remains common, even among those with limited potential for benefit, but discussions around screening cessation are rare. Improving communication between patients and physicians may improve screening decision quality.

Disability, poverty and health-service accessibility in the context of the COVID-19 pandemic: a population-based repeated cross-sectional study in Colombia

ObjectivesIn Colombia, 4.3% of the population 5 years or older lives with a disability. They face higher levels of poverty and social exclusion compared with persons without disabilities. This article...

High-cost users still came to hospitals during the COVID-19 pandemic during first wave data in Thailand: secondary data analysis

BackgroundThe phenomenon of high-cost users (HCUs) in health care occurs when a small proportion of patients account for a large proportion of health care expenditures. By understanding this phenomenon during the COVID-19 pandemic, tailored interventions can be provided to ensure that patients receive the care they need and reduce the burden on the health system.ObjectivesThis study aimed to determine (1) whether the HCUs phenomenon occurred during the pandemic in Thailand by exploring the pattern of inpatient health expenditures over time from 2016 to 2021; (2) the patient characteristics of HCUs; (3) the top 5 primary diagnoses of HCUs; and (4) the potential predictors associated with being an HCU.MethodsThe secondary data analysis was conducted via inpatient department (IPD) e-Claim data from the National Health Security Office for the Universal Coverage Scheme, which provides health care to ~ 80% of the Thai population. Health care expenditure over time was calculated, and the characteristics of the population were examined via descriptive analysis. Multinomial logistic regression was applied to explore the potential predictors associated with being an HCU.ResultsThe characteristics of HCUs remained relatively the same from 2016 to 2021. In terms of the proportion of male (55%) to female patients (45%), the age ranged from 55 to 57 years, with an estimated 8-day length of hospital stay and 7 admissions per year, and the average health care cost per patient was ≥ USD 2,860 (100,000 THB). The low-cost users (LCUs) group (the bottom 50% of the population), had more female patients (55%), a younger age ranging from 27 to 33 years, a 3-day length of stay, 1‒2 admissions per year, and a lower average health care cost per patient, which was less than USD 315 (≤ 11,000 THB).ConclusionThe HCUs phenomenon still existed even with limited health care accessibility or lockdown measures implemented during the COVID-19 pandemic. This finding could indicate the uniqueness of the need for health services by HCUs, which differ from those of other population groups. By understanding the trends of health care utilization and expenditure, along with potential predictors associated with being an HCU, policies can be introduced to ensure the appropriate allocation of health resources to the right people in need of the right care during future pandemics.

Differences in setting of initial dementia diagnosis among fee-for-service Medicare beneficiaries.

Accurate and timely diagnosis of dementia is necessary to allow affected individuals to make informed decisions and access appropriate resources. When dementia goes undetected until a hospitalization or nursing home stay, this could reflect delayed diagnosis or misdiagnosis, and may reflect underlying disparities in healthcare access. In this retrospective cohort study, we used 2012-2020 Medicare claims and other administrative data to examine variation in setting of dementia diagnosis among fee-for-service Medicare beneficiaries with an initial claims-based dementia diagnosis in 2016. We used multinomial logistic regression to evaluate the association of person and geographic factors with diagnosis location, and Cox proportional hazards regression to examine 4-year survival relative to diagnosis location. Among 754,204 Medicare beneficiaries newly diagnosed with dementia in 2016, 60.3% were diagnosed in the community, 17.2% in hospitals, and 22.5% in nursing homes. Adjusted 4-year survival rates were significantly lower among those diagnosed in hospitals [-16.1 percentage points (95% CI: -17.0, -15.1)] and nursing homes [-16.8 percentage points (95% CI: -17.7, -15.9)], compared to those diagnosed in the community. Community-diagnosed beneficiaries were more often female, younger, Asian or Pacific Islander, Native American or Alaskan Native, Hispanic, had fewer baseline hospitalizations and higher homecare use, and resided in wealthier ZIP codes. Rural beneficiaries were more likely to be diagnosed in hospitals. Many older adults are diagnosed with dementia in a hospital or nursing home. These individuals have significantly lower survival than those diagnosed in the community, which may indicate diagnosis during an acute illness or care transition, or at a later disease stage, all of which are suboptimal. These results highlight the need for improved dementia screening in the general population, particularly for individuals in rural areas and communities with higher social deprivation.