Multinominal Logistic Regression Analyses Research Articles

Is the association between infant regulatory problems and trajectories of childhood co-developing internalizing and externalizing symptoms moderated by early screen media exposure?

Regulatory problems in infancy are associated with internalizing and externalizing symptom trajectories across childhood, however, it is unknown whether early screen media exposure exacerbates this association. We studied 10,170 individuals from the Growing Up in Ireland '08 cohort. Parents reported on their children's regulatory problems at 9 months, screen media exposure at 3 years, and internalizing and externalizing symptoms at 3, 5, 7, and 9 years. Children were categorized based on their patterns of co-developing internalizing and externalizing symptoms. Subsequently, multinominal logistic regression analyses were conducted to estimate whether screen media exposure (> 1h or > 2h) moderated the association between regulatory problems in infancy and co-developing internalizing and externalizing symptom classes across childhood. There were four groups of children with distinct patterns of co-developing internalizing and externalizing symptoms. Presence of regulatory problems at 9 months and excessive screen media exposure at 3 years (particularly > 2h) were independently associated with increased likelihood of all classes. Excessive screen media exposure at 3 years did not significantly moderate the association between regulatory problems at 9 months and internalizing and externalizing symptom trajectories.

Association of depression with widowhood, loneliness, and social non-participation among older women in India

BackgroundWidowhood is a disastrous incident occurring at any stage of life for surviving oneself particularly the older women having critical reflexes on their physical, emotional and as well as socio-economic well-bring. Living alone and being cornered to home may also have serious repercussions on psychological health conditions of geriatric population, a public health concern in recent times.The main essence of this present study was to investigate the impact of widowhood, loneliness and social non-participation on older women depression in Indian context. MethodsData for the present study were obtained from the first wave of the Longitudinal Ageing Study in India (LASI), conducted during 2017–2018. A total of 15,559 older adult women were availed for this present study. Descriptive analyses, association studies and finally multinominal logistic regression analyses were performed to fulfill the study objectives. ResultCurrently, 5 % of total study participant’s suffered from depression for most of the times. Findings suggested that widowhood is a catastrophic event giving rise to depression for most of the old women in their later life. With this, living alone in old age period also had a great impact on the prevalence of depression. Preponderance of older women depression is also found among those, not getting involved any social events. ConclusionThis study suggested that to reduce the prevalence of older women depression, targeted interventions in the form of psychological counseling, screening services and community involvement are very much needed.

Assessing the modifiable and non-modifiable risk factors associated with multimorbidity in reproductive aged women in India

BackgroundReproductive span is the foundation of every woman’s health in later life. India is currently facing a growing burden of multiple morbidities among the women in their reproductive age group which may further increase over the coming decades. The purpose of the present study aimed to identify different modifiable and non-modifiable risk factors affecting multimorbidity among the women in reproductive age group in Indian context.MethodsSecondary data were obtained from the Demography and Health Survey (DHS), conducted in India during 2019–2021. A total of 671,967 women aged 15–49 years were selected for this present study. Descriptive, association studies and multinominal logistic regression analyses were performed to accomplish the objectives.ResultsCurrently, 6.3% of total study participant’s reproductive age group women suffered from multimorbidity in India. Never consuming protein, fruits, vegetables and milk increase the chances of developing multimorbidity. Consumption of fried foods, aerated drinks and addiction towards tobacco and alcohol also has a greater influence on the prevalence of multimorbidity. The prevalence of multimorbidity is sharply increased with increasing age and Body Mass Index (BMI). Regionally, the prevalence of multimorbidity was found more among the women hailed from eastern and north-eastern India.ConclusionTo reduce the risk of developing multimorbidity, targeted interventions are needed in the form of educating every woman concerning the importance of having minimum health-related knowledge, maintaining healthy lifestyle, weight management and having proper and balanced diet.

The role of primary care attributes in preventing loss or change of usual source of care: a nationwide cohort study.

The existence of a stable usual source of care (USC) is fundamental to the provision of quality health care. However, no longitudinal studies have examined whether core primary care attributes influence the stability of USC status. We aimed to examine the association between primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) and the loss or change of USC. This nationwide cohort study was conducted during the coronavirus disease 2019 pandemic using a representative sample of the Japanese adult population aged 40-75 years. The primary outcome measures were loss of USC and voluntary change in USC during the 12-month follow-up period. Primary care attributes were evaluated in the baseline survey using the Japanese version of Primary Care Assessment Tool (JPCAT). Data were analyzed for 725 participants who had a USC at baseline. Among them, 93 (12.8 %) lost their USC and 46 (6.3%) changed their USC during the follow-up period. Multivariable multinominal logistic regression analyses showed that the JPCAT total score was associated with decreased loss of USC and change in USC. Among the JPCAT domains, longitudinality, comprehensiveness (services available), and community orientation were associated with reductions in both USC loss and change. Our study indicates that primary care attributes play an important role in preventing the loss or change of USC and contribute to the stability of USC status. These findings provide additional rationale for policymakers, healthcare providers, and managers to seek to strengthen core attributes of primary care.

Anaemia prevalence and socio-demographic factors among women of reproductive age (WRA): A geospatial analysis of empowered action group (EAG) states in India

Anaemia remains a major nutritional-related health concern for women under reproductive age (WRA) in developing nations like India as well as the Indian EAG states. According to NFHS round-5, EAG states constitute 57% of WRA having any form of anaemia, higher than many other states of India and other developed and developing nations. This study aimed to assess the frequency of anaemia among the WRA in India's eight EAG states. Also, it attempts to analyse the causes associated with anaemia by the women's background characteristics with spatial correlation with its co-variates across 291 districts of the EAG states. One of the most current Demographic and Health Survey's (DHS) cross-sectional data is the NFHS-5th (2019–21) round taken, conducted by the IIPS under the administration of MoHFW, India. This study only included 315,069 women under reproductive age (WRA). The variables related to anaemia among women's (WRA) background socio-demographic characteristics were assessed using bivariate statistics and multinominal logistic regression analysis to comprehend the spatial correlation between women and their determinant factors. Among the EAG states, the overall prevalence of anaemia was 57%, varying from 42.6% in Uttarakhand to 65.3% in Jharkhand. Multinominal logistic regression analyses reveal that the chances of anaemia are remarkably more prevalent in younger women (15–19 years of age), women living in rural areas, no educated and primary level educated women, women belonging to the middle to poorest wealth quintile, women no longer living together, women of the Christian religion, women who are not exposed to reading newspapers, underweight BMI women, and scheduled tribe women. Mainly, the prevalence is observed in the North-eastern and southeastern states of Bihar, Jharkhand, Odisha, Chhattisgarh, some parts of Madhya Pradesh, Uttar Pradesh, and Rajasthan, which is shown by the hotspot map. According to the findings of this study, numerous factors like family, socioeconomic, educational, awareness, and individual characteristics such as caste and domicile all lead to a risk of anaemia. The WRA suffers from anaemia as a result of their socioeconomic background and awareness, which leads to a lack of nourishment, and they seek nutrient deficiencies. To overcome this anaemia, multiple discipline policies and initiatives need to be taken targeting women's wellness and nutritional status by increasing women's education and socioeconomic status.

Associations of diet quality and daily free sugar intake with depressive and anxiety symptoms among Chinese adolescents

BackgroundAssessing diet quality has been challenging, and the associations of diet quality and daily free sugar intake with depressive and/or anxiety symptoms have shown inconsistency. MethodsA total of 1749 students aged 12–16 years were recruited using stratified random cluster sampling across three cities in China. The overall Global Dietary Recommendations (GDR) score, a novel indicator of diet quality, was constructed using the low-burden Diet Quality Questionnaire. Free sugar intake, including from beverages and foods, was measured using the Food Frequency Questionnaire. Daily free sugar intake was divided into low, medium, and high categories based on the latest version of the dietary guidelines for Chinese residents. Binomial and multinominal logistic regression analyses were used to examine the associations of the overall GDR score and daily free sugar intake categories or different sources of free sugar intake with depressive and/or anxiety symptoms. ResultsThe overall GDR score was negatively associated with depressive symptoms (adjusted odds ratio[aOR] = 0.92, 95%CI: 0.87–0.98) and anxiety symptoms (0.95, 0.90–0.99), particularly with comorbid depression and anxiety (0.90, 0.84–0.97). Conversely, daily free sugar intake was positively associated with symptoms of depression and/or anxiety, the multiple aOR for symptoms depression or anxiety were significantly increased with higher daily free sugar intake (all Ptrend < 0.05). Both free sugar from beverages and from foods were positively associated with depressive and/or anxiety symptoms. These associations were consistent between males and females. LimitationsCross-sectional design and self-reported symptoms. ConclusionsDiet quality was negatively associated with symptoms of depression or anxiety, especially with comorbid symptoms among adolescents. Daily free sugar intake, regardless of its sources, was positively associated with symptoms of depression and/or anxiety.

Abstract 13339: Proteomic Associations of Cardiac Function Trajectories Through Mid- to Late Life

Introduction: Using a novel Bayesian nonparametric modeling approach based jointly on LVEF and E/A ratio, we previously identified 3 trajectories of cardiac function through mid- to late life that associated with heighted risk of incident heart failure (HF): trajectory 1 demonstrated failure to increase LVEF with age; trajectory 2 had progressive LVEF decline; and trajectory 3 had steeper than expected rise in E/A ratio. Trajectories 1 and 2 associated with higher risk of HFrEF while trajectory 3 associated with HFpEF. Whether circulating proteins differ between trajectories is unknown. Methods: We assigned 4,419 HF-free participants with available proteomic data (SomaScan v4) at study Visit 5 of the Atherosclerosis Risk in Communities study to their most likely trajectory (2,201 trajectory 1, 162 trajectory 2, 348 to trajectory 3). Associations of plasma proteins with trajectory membership were assessed using multinominal logistic regression analyses adjusted for age and sex at a false discovery rate &lt;0.05. Two-sample Mendelian randomization (MR) was performed to assess potential causal effects between trajectory-associated proteins and LV volume and LVEF. Results: Mean age was 75±5 years and 58% were women. Several unique and shared proteins associated with each high-risk trajectory (Figure). MR identified potential causal effects of 13 trajectory-associated proteins on LV volume and LVEF. These included trajectory 3-associated proteins (B3GNT2, MFAP4) with genetically higher levels associated with smaller LV size and higher LVEF, consistent with the observed association with HFpEF. One trajectory 1-associated protein (HADH) had MR association with lower LVEF, consistent with the observed association with HFrEF. Conclusions: A Bayesian nonparametric model using multidimensional imaging data identifies trajectories of cardiac function with distinct proteomic associations, a subset of which have potential causal effects on cardiac function.

Bouncing back or staying inactive? The social inequality in sport participation before, during and after the COVID-pandemic

ABSTRACT This contribution addresses the development of educational and financial inequality in sport participation in the Netherlands over the course of the COVID-pandemic. More specifically, we deal with the issue whether increased educational and financial inequality during the COVID-pandemic is temporary or becomes permanent after relaxation of the COVID-measures. We expected lower educated and people with financial problems to have less resources to bounce back to sport participation or to continue sport participation in sport over the course of the COVID-pandemic. To test our expectations, we performed multinominal logistic regression analyses on longitudinal data from the Dutch LISS-panel (n = 1.157). Our results confirmed that higher educated more often bounced back in their sport participation after COVID. Lower educated and people with financial problems were more likely to completely dropout. Our main conclusion is that educational and financial inequality in sport participation further increased after relaxation of the COVID-measures. This study enhances the understanding of the long-term impact of the COVID-pandemic on inequality in sport participation, and that might lead to more intensified sport promotion policies. Ongoing attention of policymakers for vulnerable groups is required to tackle social inequality in sport participation enlarged by the COVID-pandemic.

Determinants of household credit behavior of low-income households in Sri Lanka

The paper aims to achieve three objectives in relation to household borrowing behavior among low-income households in Sri Lanka. First, it attempts to understand the patterns of savings and credit behavior of households. Second, it identifies the underlying reasons for the credit demand of households. Third, it investigates the relative significance of demographic and other socioeconomic factors that influence the reasons for households’ credit demand. Primary data collected from 1,500 household units were utilized for the analysis. Thematic and multinominal logistic regression analyses were used to achieve objectives. The thematic analysis identified 533 household units in debt and has revealed eight reasons behind households’ borrowing decisions, with borrowing for housing renovations, investing and consumption being the top three reasons. The results of the multinominal regression analysis revealed that having children is the most influential demographic factor that lies behind most reasons. The paper concludes that only a few households have borrowing habits, and their borrowing purposes vary. Most are not used for productive investments, and having young dependents induces household borrowing decisions. Based on the outcome, the study suggests strengthening social assistance for households with young dependents to protect low-income families from indebtedness.

Current Status of Core Competencies of Chinese Nurses in Burn Departments: A Latent Profile Analysis

Aim. To investigate the current status of NBDs’ core competencies through latent profile analysis, identify potential subgroups and their population characteristics, and analyze the influencing factors of different categories. Background. NBDs are essential in the treatment and rehabilitation of burn patients. However, the core competencies of Chinese NBDs are seldom reported. Methods. Our analyses were based on a cross-sectional and multicenter study of 267 Chinese NBDs. Latent profile analysis was employed to identify NBDs’ core competence profiles using the NBD Core Competencies Self-rating Scale (NBD-CCSS). We then explored the characteristics among different profiles and determined socio-demographic variables associated with profile membership by conducting ANOVA, Chi-square test, and multinominal logistic regression analyses. Results. A 3-profile model provided the best fit. The three profiles were titled “skillful competencies” (Class 1, n = 77, 28.8%), “moderate competencies” (Class 2, n = 140, 52.4%), and “poor competencies” (Class 3, n = 50, 18.7%). Regression analysis suggested that professional title, years of employment, and BICU experience were influencing factors of NBDs’ profile membership of core competencies. NBDs who were supervisor nurses or above (OR = 0.802, 95% CI: 0.009, 0.759), with more than 7 years of employment (OR = 0.091, 95% CI: 0.009, 0.906) and BICU experience (OR = 3.564, 95% CI: 1.423, 8.925) were more likely to fall into Class 1. Conclusions. Our findings could provide evidence for nursing administrators to develop training programs to enhance NBDs’ core competencies. In particular, variables associated with profile membership determined in the study may facilitate more tailored training strategies.

Profiles of Chinese preschoolers' academic and social-emotional development in relation to classroom quality: A multilevel latent profile approach.

Linking classroom quality to separate domains of child development might neglect the transactional interactions across developmental domains. This research utilized latent profiles across academic and social-emotional development to explore which aspects of classroom quality can predict children's profiles at the classroom level. Data were drawn from 96 preschool classrooms and 547 children (3-5 years old) in China in 2020. Multilevel latent profile analysis identified three profiles (entitled low-, average- and high-level development at the individual level), and two classes (entitled average and below-, average and above) at the classroom level. Multinominal logistic regression analyses revealed that instructional quality in math, science, and diversity, and the interactional quality in supporting children's learning and critical thinking, predicted children's profiles.

Mpox vaccination willingness, determinants, and communication needs in gay, bisexual, and other men who have sex with men, in the context of limited vaccine availability in the Netherlands (Dutch Mpox-survey).

In the 2022 multicountry mpox (formerly named monkeypox) outbreak, several countries offered primary preventive vaccination (PPV) to people at higher risk for infection. We study vaccine acceptance and its determinants, to target and tailor public health (communication-) strategies in the context of limited vaccine supply in the Netherlands. Online survey in a convenience sample of gay, bisexual and other men who have sex with men, including transgender persons (22/07-05/09/2022, the Netherlands). We assessed determinants for being (un)willing to accept vaccination. We used multivariable multinominal regression and logistic regression analyses, calculating adjusted odds ratios (aOR) and 95 percent confidence-intervals. An open question asked for campaigning and procedural recommendations. Of respondents, 81.5% (n = 1,512/1,856) were willing to accept vaccination; this was 85.2% (799/938) in vaccination-eligible people and 77.7% (713/918) in those non-eligible. Determinants for non-acceptance included: urbanization (rural: aOR:2.2;1.2-3.7; low-urban: aOR:2.4;1.4-3.9; vs. high-urban), not knowing mpox-vaccinated persons (aOR:2.4;1.6-3.4), and lack of connection to gay/queer-community (aOR:2.0;1.5-2.7). Beliefs associated with acceptance were: perception of higher risk/severity of mpox, higher protection motivation, positive outcome expectations post vaccination, and perceived positive social norms regarding vaccination. Respondents recommended better accessible communication, delivered regularly and stigma-free, with facts on mpox, vaccination and procedures, and other preventive options. Also, they recommended, "vaccine provision also at non-clinic settings, discrete/anonymous options, self-registration" to be vaccinated and other inclusive vaccine-offers (e.g., also accessible to people not in existing patient-registries). In the public health response to the mpox outbreak, key is a broad and equitable access to information, and to low-threshold vaccination options for those at highest risk. Communication should be uniform and transparent and tailored to beliefs, and include other preventive options. Mpox vaccine willingness was high. Public health efforts may be strengthened in less urbanized areas and reach out to those who lack relevant (community) social network influences.

Quality of life in patients with neurofibromatosis type 1: a nationwide database study in Japan from 2015 to 2019.

This study examined the association between dermatological, neurological, and bone manifestations of neurofibromatosis type 1 (NF1) and quality of life (QoL) in patients with NF1 using a nationwide database of all patients who newly claimed for medical expense subsidies in Japan from 2015 to 2019. The Japanese Ministry of Health, Labour and Welfare provided the "National Database of Designated Intractable Diseases of Japan" containing clinical and personal records ("Medical Certificates of Designated Intractable Diseases") of all patients with NF1 following approval of the study protocol. To examine the association between the severity of symptoms and QoL, multinominal logistic regression analyses were performed, adjusted for potential confounders. The final study population consisted of 1,487 patients (775 females and 712 males; mean (standard deviation) age, 45.4 (17.9) years). More than 50% and nearly 45% of participants were recorded as having moderate or severe "pain/discomfort" and "anxiety/depression," respectively. The severity of neurological symptoms was significantly associated with all components of QoL, whereas the severity of dermatological symptoms was significantly associated with only moderate or severe subjective and mental health-related components of QoL, and the severity of bone lesions was associated with only moderate or severe physical health-related components of QoL. Subjective and mental health-related components of QoL tended to be deteriorated more than physical health-related components of QoL in younger and female patients. Severities of neurological and dermatological symptoms were significantly associated with subjective and mental health-related components of QoL, while the severity of bone symptoms was associated with only moderate and severe deterioration of physical health-related components of QoL.

Emergency Online Learning: The Effects of Interactional, Motivational, Self-Regulatory, and Situational Factors on Learning Outcomes and Continuation Intentions

This study investigated the effects of interactional, motivational, self-regulatory, and situational factors on university students’ online learning outcomes and continuation intentions during the COVID-19 pandemic. Data were collected from 255 students taking a business course at a university in southern China. Hierarchical multiple regression analyses revealed that while family financial hardship caused by COVID-19 was a marginally significant negative predictor of students’ learning outcomes, learner–content interaction; instructors’ provision of e-resources, course planning, and organisation; and students’ intrinsic goal orientation and meta-cognitive self-regulation were significant positive predictors with the latter two sets of predictors mediating the effects of learner–instructor and learner–learner interactions, respectively. Multinominal logistic regression analyses showed that learner–instructor interaction, learner–content interaction, and private learning space were significant positive predictors of students’ intentions to continue with online learning, but learner–learner interaction was a significant negative predictor. These findings point to the differential effects of various types of interactional and situational factors on learning outcomes and continuation intentions, and the instructor- and learner-level factors that mediate the effects of learner–instructor and learner–learner interactions on learning outcomes. They contribute to our understandings of emergency online learning and provide implications for facilitating it.

Associations between admissions factors and the need for remediation.

This study examines the way in which student characteristics and pre-admissions measures are statistically associated with the likelihood a student will require remediation for academic and professionalism offenses. We anchor our inquiry within Irby and Hamstra's (2016) conceptual framework of constructs of professionalism. Data from five graduating cohorts (2014-2018) from McMaster University (Hamilton, Canada) (N = 1,021) were retroactively collected and analyzed using traditional and multinominal logistic regression analyses. The relationship among student characteristics, pre-admissions variables, and referral for potential remediation both by occurrence (yes/no) as well as type (academic/professional/no referral) were examined separately. Findings indicate that gender (OR = 0.519, 95% CI 0.326-0.827, p < 0.01) and undergraduategrade point average (GPA) (OR = 0.245, 95% CI 0.070-0.855, p < 0.05) were significantly associated with instances of referral for potential professionalism and academic remediation, respectively. Women were less likely than men to require remediation for professionalism (OR = 0.332, 95% CI 0.174-0.602, p < 0.001). Undergraduate GPAs (OR = 0.826, 95% CI 0.021-0.539, p < 0.01) were significantly associated with remediation for academic reasons. Lower undergraduate GPAs were associated with ahigher likelihood of remediation. These findings point to the admissions variables that are associated with instances that prompt referral for potential remediation. Where associations are not significant, we consider the application of different conceptualizations of professionalism across periods of admissions and training. We encourage those involved in applicant selection and student remediation to emphasize the importance of the interactions that occur between personal and contextual factors to influence learner behaviour and professional identity formation.

Psychosocial factors influencing distress among cancer patients in South India

Abstract Background: The increase of cancer rates in India over the last decade has placed a significant psychosocial burden on patients and their families. To address the psychosocial issues, cancer centers in India have integrated psychosocial services into cancer care by routinely measuring the distress of patients and responding to their distress. In this study, we sought to determine the association between self-reported distress and patient demographic and clinical variables and awareness of their diagnosis and prognosis. Methods: The Department of Psycho-oncology conducted a cross-sectional, cohort study of patients who were being treated for a variety of cancers in a comprehensive cancer center in Chennai, India. Cancer patients (N = 2019) completed a standardized measure of distress and participated in a clinical interview during their admission to a ward or at the time of referral to psycho-oncology. The level of distress was measured by the NCCN Distress Thermometer and problem list. Chi-square tests were used to examine variations in overall distress. Multi-nominal logistic regression analyses were used to assess the level of patients’ reported distress as a function of clinical characteristics (stage of cancer, awareness of diagnosis and prognosis, physical symptoms). Results: The majority (60.3%) of the sample reported a moderate to high level of emotional distress. There were significant associations (P &lt; .05) of younger age, awareness of diagnosis, prognosis, sleep issues, and physical pain with higher levels of distress. Patients who were aware of their diagnoses were more likely to report moderate (P &lt; .01) or severe distress (P &lt; .05) than those who were unaware. Patients who were aware of their prognoses were less likely to report moderate distress (P &lt; .001) and severe distress (P &lt; .001. Implications for Practice and Research: Given that a majority of patients rated at or above the clinical cut-off for distress, oncology centers in India need to provide training for professional psycho-oncology clinicians and incorporate psycho-oncology services to adequately address patients’ distress. Qualitative research may be needed to advance our understanding of specific social and cultural factors that may influence the psychosocial challenges faced by patients. Further investigation of patient distress related to diagnostic disclosure may be helpful in informing practice.

Finnish late adolescents\u2019 physical activity during COVID-19 spring 2020 lockdown

BackgroundPhysical activity (PA) is recognised as one of the leading and effective strategies to prevent non-communicable diseases that boosts the immune system to fight against diseases. Closures of schools, sport clubs and facilities because of COVID-19 reduced the opportunities to participate in PA. We aimed to examine physical activity levels of late adolescents, the contexts to be physical active and its changes during the spring 2020 lockdown.MethodsA national representative sample of late adolescents in general upper secondary school (n = 2408, females = 64%, mean age = 17.2y, SD = 0.63) completed self-report online surveys on PA behaviours between March and June 2020. Multinominal logistic regression analyses were performed to identify correlates with PA, and decision tree analyses to ascertain the perceived changes on PA during lockdown based on sport club aspirations and levels of PA.ResultsAmong the late adolescents, the distribution of PA frequency was 23% (0-2 days/week), 35% (3-4 days/week), 30% (5–6 days/week) and 12% (7 days/week), and differences between males and females were not statistically significant. Participation in both indoor and outdoor PA were 50 times more likely to report daily PA (OR = 54.28, CI = 15.16–194.37) than non-participation. A quarter of late adolescents were not part of a sports club, yet their PA levels increased. Although sports club members generally perceived they did less PA during lockdown, over a third of sport club members with competitive aspirations reported daily PA.ConclusionsOverall, most late adolescents reported their PA levels decreased during lockdown. Findings from this study continue to demonstrate factors associated with PA in the context of the COVID-19 lockdown.

Association of Perceived Threat, Negative Emotions, and Self-Efficacy With Mental Health and Personal Protective Behavior Among Chinese Pregnant Women During the COVID-19 Pandemic: Cross-sectional Survey Study.

BackgroundCOVID-19 is an emerging infectious disease that has created health care challenges worldwide. Pregnant women are particularly affected by this disease.ObjectiveThe aims of this study are to assess the levels of perceived threat (susceptibility, severity, impact), negative emotions (fear, worry), and self-efficacy of pregnant women in China related to COVID-19 and to examine their associations with mental health (depression and anxiety) and personal protective behavior (wearing a face mask).MethodsA total of 4087 pregnant women from China completed a cross-sectional web-based survey between March 3 and 10, 2020.ResultsThe prevalence of probable depression and anxiety was 48.7% (1989/4087) and 33.0% (1347/4087), respectively; 23.8% participants (974/4087) reported always wearing a face mask when going out. Of the 4087 participants, 32.1% (1313) and 36.4% (1490) perceived themselves or their family members to be susceptible to COVID-19 infection, respectively; 3216-3518 (78.7%-86.1%) agreed the disease would have various severe consequences. Additionally, 2275 of the 4087 participants (55.7%) showed self-efficacy in protecting themselves from contracting COVID-19, and 2232 (54.6%) showed efficacy in protecting their family members; 1303 (31.9%) reported a high level of fear of the disease, and 2780-3056 (68.0%-74.8%) expressed worry about various aspects of COVID-19. The results of the multivariate multinominal logistic regression analyses showed that perceived severity, perceived impact, fear, and worry were risk factors for probable depression and anxiety, while self-efficacy was a protective factor. The results of the multivariate logistic regression analysis showed that perceived susceptibility was associated with always wearing a face mask.ConclusionsChinese pregnant women showed high levels of mental distress but low levels of personal protective behavior during the COVID-19 pandemic. Interventions are needed to promote the mental health and health behavior of pregnant women during the pandemic.

How do agro-pastoralists cope with climate change? The case of the Nyangatom in the Lower Omo Valley of Ethiopia

This study has examined traditional coping systems, emerging adaptation strategies and barriers to the adoption of these strategies. Structured questionnaires on coping and adaptation strategies were conducted among Nyangatom households, expounded by focus group discussions and key informant interviews. Correlations between times series (1987–2016) on rainfall, temperature and the local perceptions on CC were examined. The time series analysis confirmed pastoralists' perception that the frequency of extreme drought has increased since 1987. The Nyangatom responded by temporal migration and herd diversification. Other responses include flood cultivation and enhancing alliance formation with other ethnic groups. Multi-nominal logistic regression analyses indicated that age of household head (−), livestock ownership (+), crop productivity (+), off-farm income (+) and access to climate information (+) proved to be key determinants with a statistically significant (negative or positive) effect on adoption. Other factors that hindered climate change adaption include intermittent conflicts with neighbouring ethnic groups and limited access to alternative livelihood options. Interventions to facilitate transition towards sustainable, adaptation-based communities need to incorporate deliberate, longer-term, risk-reducing strategies, including rangeland management, water harvesting and small scale-irrigation schemes. Improved education access, extension services, and a conducive pastoral policy environment will help to enhance the Nyangatom adaptive capacity.

Development of New Solitary Retinoblastoma Tumors during and after Chemotherapy.

PurposeTo review the occurrence of new solitary tumors during and after intravenous chemotherapy against retinoblastoma.MethodsFrom 115 eyes of 78 patients with a diagnosis of intraocular retinoblastoma who underwent intravenous chemotherapy and focal treatment without prior treatment, patient demographics, age at diagnosis, laterality, classification (Reese-Ellsworth and International Classification of Retinoblastoma), and treatment options were recorded. In addition, the occurrence of small tumors during and after chemotherapy was documented with a detailed review of medical records and fundus photographs.ResultsOf a total of 115 eyes of 78 consecutive patients, new solitary tumors were observed in 50 eyes (50 / 115, 43%) of 40 patients (40 / 78, 51%). Multinominal logistic regression analyses showed that age at diagnosis (before 1 year) and vitreal seeding at diagnosis were linked to the development of isolated and miliary tumors, respectively. Kaplan-Meier analyses demonstrated that all small tumors developed with 20 months from the start of chemotherapy. Twenty-eight eyes (28 / 34, 82%) were salvaged with additional focal treatment in 34 eyes with isolated tumors.ConclusionsSmall tumors were observed during and after chemotherapy against retinoblastoma in patients who underwent intravenous chemotherapy and focal treatment. It is necessary to promptly identify and address small tumors for the preservation of eyeball and vision.