Multinominal Logistic Regression Models Research Articles

Food Insecurity Is Associated with Short and Long Sleep Duration and Circadian Misalignment Among US Adults in the 2017–18 National Health and Nutrition Examination Survey

ObjectivesFood insecurity is a leading public health issue associated with negative health consequences. Poor sleep and circadian misalignment, the discrepancy between the natural circadian rhythm and the cycle imposed by the social clock, may contribute to these health problems. This study examined relationships between food insecurity and sleep and circadian characteristics, including sleep duration and circadian misalignment, characterized by social jetlag and later midpoint of sleep (MPS), in a nationally representative sample of adults.MethodsData were from the 2017–18 National Health and Nutrition Examination Survey (NHANES), which included 5410 adults ≥18 years old with household food security and usual weekday and weekend sleep and wake times. Self-reported sleep measures were used to calculate MPS (median sleep and wake time) and social jetlag (difference between weekend and weekday MPS). MPS and social jetlag were classified into 3 categories based on the 25th and 75th percentiles. Self-reported sleep duration was classified as short (<7 hours), adequate (7–9 hours), and long (>9 hours). Multinominal logistic regression models were conducted between household food security and sleep variables, adjusting for sociodemographic characteristics and accounting for complex survey weights.ResultsIn the analytic sample, 14.3% had low and 8.9% had very low food security. The average MPS was 2:46 AM ± 2.1 hours on weekdays and 3:34 AM ± 1.8 hours on weekends. The average sleep duration was 7.6 hours on weekdays and 8.3 hours on weekends. Greater food insecurity was associated with higher social jetlag in a dose-response manner (p-trend = 0.01). Compared to food-secure adults, adults with very low food security had later weekday MPS (OR 1.37, 95% CI 1.10–1.72) and weekend MPS (OR 1.55, 95% CI 1.24–1.95). In contrast, low food security was related to early weekday MPS (OR 1.23, 95% CI 1.00–1.50). Low and very low food security were each associated with short weekday (OR 1.34, 95% CI 1.08–1.66 and OR 1.22, 95% CI 1.03–1.45) and weekend (OR 1.39, 95% CI 1.11–1.75 and OR 1.42, 95% CI 1.17–1.73) sleep duration. Low and very low food security were also related to long weekday sleep duration.ConclusionsGreater severity of food insecurity was related to multiple markers of circadian misalignment and with short and excessive sleep duration.Funding SourcesUniversity of Michigan.

The course, trajectories and predictors of depression 23 years after the 1988 Spitak earthquake in Armenia: A prospective cohort study

There is a scarcity of long-term studies of depression after natural disasters. This prospective epidemiologic study evaluated the course of depression and factors associated with it among survivors 23-years post-earthquake. A geographically stratified subsample of 725 adults exposed to the Spitak earthquake was assessed for depression using DSM-III-R criteria in 1991 and 2012. Additionally, an adapted CES-D-16 scale was used to assess depressive symptoms in 2012. A fitted multi-nominal logistic regression model identified predictors of different trajectories of depression. For the whole group, the rate of clinical depression dropped from 51.5% in 1991 to 31.7% in 2012. Earthquake intensity and experiencing strong fear at baseline were strongly associated with chronic (depressed at both assessments, 18.1%) and recovered (depressed only in 1991, 33.5%) depression trajectories compared with the healthy group, with odds ratios (OR) over 4.0 and 3.0, respectively. Predictors distinguishing chronic depression included earthquake-related nuclear-family deaths (OR=3.79), chronic illnesses at baseline (OR=1.24), and social support (OR=0.91). Predictors of the late-onset trajectory (depressed only in 2012, 13.5% of the cohort) included post-earthquake trauma (OR=1.42), socioeconomic status (OR=0.45), and social support (OR=0.86). The factors associated with the different trajectories of depression provide guidance for planning more effective mental health interventions after disasters.

Variation in the prevalence of different forms of bullying victimisation among adolescents and their associations with family, peer and school connectedness: a population-based study in 40 lower and middle income to high-income countries (LMIC-HICs)

This study aimed to estimate the prevalence of different forms of bullying victimization experiences and their association with family functioning, peer relationships and school connectedness among adolescents across 40 lower and middle income to high-income countries (LMIC-HICs). Data were drawn from the Health Behaviour in School-Aged Children (HBSC) school-based survey of adolescents aged 11–15 years, between 2013 and 2014. We estimated the weighted prevalence by categorising experiences into traditional bullying victimization only, cyberbullying victimization only, and combined traditional and cyberbullying victimization, at country and country income classification. We used multinominal logistic regression models to estimate the adjusted association with the form of bullying victimization by demographic characteristics, family functioning, peer relationships and school connectedness. Overall, 8.0% reported traditional bullying victimization only (8.8% males, 7.4% females), 2.3% of adolescents reported cyberbullying victimization only (2.1% males, 2.2% females), and 1.7% reported combined traditional and cyber bullying victimization (1.7% males, 1.8% females). All three forms of bullying victimization during adolescence were significantly associated with poor family functioning, poor peer relations and poor school connectedness. A consistent finding is that traditional bullying victimization is considerably more common among adolescents across both LMICs and HICs than cyberbullying victimization. This study also demonstrated that a significant proportion of adolescent’s experience victimization in both forms. Positive family functioning, strong peer relationships and greater school connectedness are associated with a lower risk of both forms of bullying victimization.

Statistical Methods for Modeling the Compressive Strength of Geopolymer Mortar.

In recent years, geopolymer has been developed as an alternative to Portland cement (PC) because of the significant carbon dioxide emissions produced by the cement manufacturing industry. A wide range of source binder materials has been used to prepare geopolymers; however, fly ash (FA) is the most used binder material for creating geopolymer concrete due to its low cost, wide availability, and increased potential for geopolymer preparation. In this paper, 247 experimental datasets were obtained from the literature to develop multiscale models to predict fly-ash-based geopolymer mortar compressive strength (CS). In the modeling process, thirteen different input model parameters were considered to estimate the CS of fly-ash-based geopolymer mortar. The collected data contained various mix proportions and different curing ages (1 to 28 days), as well as different curing temperatures. The CS of all types of cementitious composites, including geopolymer mortars, is one of the most important properties; thus, developing a credible model for forecasting CS has become a priority. Therefore, in this study, three different models, namely, linear regression (LR), multinominal logistic regression (MLR), and nonlinear regression (NLR) were developed to predict the CS of geopolymer mortar. The proposed models were then evaluated using different statistical assessments, including the coefficient of determination (R2), root mean squared error (RMSE), scatter index (SI), objective function value (OBJ), and mean absolute error (MAE). It was found that the NLR model performed better than the LR and MLR models. For the NLR model, R2, RMSE, SI, and OBJ were 0.933, 4.294 MPa, 0.138, 4.209, respectively. The SI value of NLR was 44 and 41% lower than the LR and MLR models’ SI values, respectively. From the sensitivity analysis result, the most effective parameters for predicting CS of geopolymer mortar were the SiO2 percentage of the FA and the alkaline liquid-to-binder ratio of the mixture.

The color and gender of hunger: analysis of food insecurity from an intersectional gaze

The aim of this study is to analyze home food (in)security via intersectionality. The data are from the cross-sectional study Quality of the Urban Environment of Salvador - QUALISalvador, conducted from 2018 to 2020 in Salvador, Bahia State, Brazil. A structured questionnaire and the Brazilian Food Insecurity Scale were used. A total of 14,713 households were analyzed. The outcome variable was the situation of food security: mild, moderate, or severe food insecurity. The exposure of interest variable was the intersection of the variables self-declared race/color and gender: white man, white woman, black man, black woman. Multinominal logistic regression models were used to estimate the association between exposure of interest and outcome, adjusted for socioeconomic variables and stratified according to education level and per capita family income. Households lead by black women had a higher chance of experiencing mild (OR = 1.39; 95%CI: 1.15-1.68; p = 0.001) and moderate or severe (OR = 1.94; 95%CI: 1.49-2.52; p < 0.001) food insecurity in relation to households lead by white men. They also had a higher chance of experiencing moderate or severe food insecurity in all levels of education and in the ranges of up to 1/2 minimum wage and > 1 minimum wage. When the person responsible for the household was a black man, the greatest chance for this condition was in the > 1 minimum wage. Food insecurity in households lead by black women, even in socioeconomically favorable conditions, is revealed as one of the consequences of the structural interaction of racism and sexism.

Ten years of NIHR research training: who got an award? A retrospective cohort study

ObjectiveIn 2017, the National Institute for Health Research (NIHR) academy produced a strategic review of training, which reported the variation in application characteristics associated with success rates. It was noted...

Perceived Accomplishment in Later Life: The Influence of Past Decisions Between Family and Work

Whereas previous studies have investigated life regrets, little attention has been paid to the important accomplishments older adults include in their autobiographic life narratives. Phenomenon such as the memory positivity effect suggest that accomplishments should be observed. We used a Health and Retirement Study 2017 Life History Mail Survey (N = 2,165) to examine the characteristics of participants over age 65 who reported accomplishments (max = 3), what was reported, and whether early-life decisions about balancing family and work are associated with the reports. Women, whites, and people with at least high school education and normal cognitive status were more likely to report accomplishments (67%). We categorized reports as family-related (39%), personal (19%), combined family/personal (25%) or other (16%). Multinominal logistic regression models revealed that participants who themselves favored family over work in early life or whose spouse decided for family, were more likely to report family-related accomplishments.

Abstract 10699: Predictors of Health Activation in Rural Caregivers with Multiple Cardiovascular Disease Risks

Introduction: Caregivers of patients with chronic conditions are at higher risk for cardiovascular disease (CVD) than their urban counterparts. Despite the burden related to caregiving, caregivers need to be activated for their own health to decrease this risk. Health activation has not been studied in rural caregivers. It is particularly relevant because most rural dwellers live in low-resourced, socioeconomically distressed environments where their health activation may be challenging. The purpose of this study was to identify characteristics of rural caregivers with multiple CVD risk factors who were not considered “activated” in their own health. Methods: Rural caregivers who had at least two CVD risk factors completed surveys on caregiver burden (Zarit Burden Interview), adherence to a healthy lifestyle (MOS Specifical Adherence Scale), perceived health status, and caregiving characteristics, and we calculated the Framingham CVD risk score. Health activation was assessed using the Patient Activation Measure, which categorizes people into four categories: overwhelmed, struggling, taking action, and maintaining levels. A multi-nominal logistic regression model was used to determine predictors of patient activation category. Results: Of the total of 269 rural caregivers (mean age= 54.1 years, 78% female), 36% were in the maintaining level, 42% were in the taking action level, and 22% in overwhelmed/struggling level. There were no significant differences in demographic or caregiving characteristics among the groups. Compared to the maintaining group, caregivers who had high caregiving burden (OR = 1.035, P = .007) and high Framingham CVD risk (OR = 1.061, P = .025), and low adherence to healthy behavior (OR = .917, P &lt; .001) were more likely to be in the overwhelmed/struggling group. Caregivers who had a high burden (OR = 1.026, P = .012) and low adherence to healthy behaviors (OR = .926, P &lt; .001) were more likely to be in the taking action group. Conclusions: Most rural caregivers were not activated on their health management even though they have multiple CVD risk factors. Screening health activation levels are needed for caregivers, and developing tailored intervention based on activation levels is needed.

Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China

BackgroundMultiple chronic diseases (MCDs) and social isolation are independent risk factors related to stroke and disability, but it is unknown whether the combination of these two conditions resulted from aging-related to functional disability in stroke patients. This study aimed to probe the relationship between the combination of MCDs, social isolation, and functional disability after stroke in elderly patients.MethodsA multicenter and cross-sectional study was conducted in the Departments of Rehabilitation of 103 hospitals located in 23 cities across China. Stroke patients aged 60–90 years were selected for analysis. Demographic characteristics, lifestyles, and clinical information were investigated by questionnaires and medical records. MCDs (hypertension/ diabetes/ hyperlipidemia/heart disease/kidney disease) were categorized into three levels: 0, 1, and ≥ 2. Functional disability was assessed by the Barthel Index and categorized into four groups: no, mild, moderate, and severe disability. The multi-nominal logistic regression model was used to explore the independent and combined association of MCDs and social isolation with functional disability.ResultsA total of 4046 elderly stroke patients (55 % males) were included in the final analysis. The prevalence of social isolation, MCDs ≥ 2, and severe disability increased with aging. In the fully adjusted model, patients with social isolation or MCDs had a higher risk of functional disability significantly than those without. Patients with social isolation combined MCDs ≥ 2 were 35 times (95 % CI: 18.89–64.69) more likely to suffer severe disability after stroke, and 8 times (95 % CI: 18.89–64.69) for moderate disability than those without social isolation and MCDs.ConclusionsMCDs, social isolation, and their combination were associated with a higher risk of functional disability after stroke in Chinese elderly patients. The elderly population should be encouraged to participate in more social activities, particularly in those with MCDs. Future secondary prevention and rehabilitation treatments to the functional ability of elderly stroke patients should underscore both social activity and the combined treatments of MCDs.Trial registrationNO: ChiCTR2000034067.

Prevalence of Food Addiction during Covid-19 Pandemic in Amman, Jordan: A Cross Sectional Study

Aim: Emerging evidence highlights the impact of stressful conditions on eating behaviours, particularly the consumption of foods high in salt, sugar and fat. The impact of the Coronavirus disease-19 (COVID-19) pandemic on food addiction is still un-estimated. This study aimed to examine the prevalence of food addiction among the Jordanian population during the quarantine. Materials and methods: A Cross-sectional study has been conducted between the 27th of April and the 4th of June of 2020. An online survey of Yale food addiction scale v.2.0 (YFAS 2.0) was distributed. A convenience sample was collected through social media sites. Differences in socio-demographic characteristics were analysed using t-test and chi-square tests. Food addiction was classified based on the scoring scale. Determinants of food addition were predicted by using multivariate logistic regression. Results: The results revealed that the prevalence of food addiction was 21.5% among adults. Among food addiction participants, 76.4% were diagnosed as severely food addicted. More than 50% of the participants reported high consumption of foods rich in sugar, salt, and fat (48.2%, 51.8%, and 52.5%, respectively). Overweight and obese young adults were more likely to have food addiction compared to normal weight. The multinominal logistic regression model revealed that there was no determinants of food addiction among adults. Conclusion: During the first months of the quarantine, the prevalence of food addiction was higher among obese and overweight adults compared to normal-weight adults.

Psychiatric Presentations and Medication Use in Older Adults With Intellectual and Developmental Disabilities

ObjectiveAdults with intellectual and developmental disabilities (IDD) are living longer, yet research about the medical and psychiatric needs of older adults still lags behind that of younger individuals with IDD. The aim of this study was to assess age-related differences in the mental health presentations of adults with IDD. MethodsFully deidentified data for adults 30 years and older were extracted from the START (Systemic, Therapeutic, Assessment, Resources, and Treatment) Information Reporting System, a deidentified database housed at the Center for START Services. Caregivers and START team documents reported psychiatric diagnoses, service use, recent stressors, and challenging behaviors. t Tests, Mann Whitney U tests, χ2 tests, and multinominal logistic regression models were used to compare the two age groups, 30–49 years (n = 1,188) versus 50 years and older (n = 464). ResultsOlder adults had more medical conditions, fewer reported psychiatric conditions, and were more likely to be taking more psychiatric medications compared to younger adults, after adjusting for demographic variables, disability level, and number of recent stressors. ConclusionAlthough older individuals reported fewer psychiatric diagnoses, they were more likely to take higher numbers of psychiatric medications and have more medical conditions. Clinicians and researchers ought to devote more attention to the healthcare needs of older adults with IDD, a vulnerable group exposed to polypharmacy and at risk of adverse events.

Working from home, quality of life, and perceived productivity during the first 50-day COVID-19 mitigation measures in Austria: a cross-sectional study

ObjectivesTo explore changes in quality of life and perceived productivity, focusing on the effects of working from home during the first COVID-19 50-day mitigation period in Austria.MethodsWe conducted an Austrian-representative online survey (N = 1010) of self-reported life- and work-related changes during the first COVID-19 50-day mitigation period (March 16 through May 1 2020) compared to the situation before. We used multinominal logistic regression models to identify correlates of improved/decreased quality of life in the entire sample, and of improved/decreased productivity in a subsample of the working population (N = 686). We also calculated age- and multivariable-adjusted ORs and 95% CIs of an improved/decreased quality of life and an improved/decreased productivity by work from home status.ResultsDuring the COVID-19 mitigation period, quality of life improved in 17.5%, but decreased in 20.7% of the general Austrian population; perceived productivity at work increased in 12.7%, but decreased in 30.2% of the working population. Working from home during the mitigation period was associated with an increased quality of life (vs. none, partially: OR 2.07, 95% CI 1.09–3.91; all the time: 3.69, 1.86–7.29). In contrast, perceived productivity seemed to decrease when people worked from home (vs. none, partially: 1.42, 0.86–2.35; all the time: 1.48, 0.85–2.58). Working from home and related benefits were not equally distributed among gender, age, and educational attainment.ConclusionsA transition to more flexibility of workplace and working hours for employees could have important positive consequences for family and professional life, for stakeholders, for public health, and ultimately for the environment.

A new conditional random field based on mixture of generalized Gaussian model for synthetic aperture radar image segmentation

ABSTRACT In this paper, we propose a new algorithm using a conditional random field (CRF) model based on texture features for Synthetic Aperture Radar (SAR) image segmentation. Using the benefit of contourlet transform in describing the texture of SAR image, first, we extract contourlet coefficients from the image. Then, to take advantage of the simultaneous use of low- and high-frequency contourlet subbands, we apply the mixture of generalized Gaussian model (MoGGM) on all contourlet sub-bands to obtain more accurate texture features. Suggesting a new unary potential function based on MoGGM in our proposed CRF, we no longer require estimating the parameters in the multinominal logistic regression (MLR) model in previous CRF methods. Furthermore, we utilize the fifth-order moment to estimate the parameters of MoGGM for achieving better statistical properties of a specific region in SAR images and improving the accuracy of the texture recognition process. The experimental analysis demonstrates that segmentation results using the proposed algorithm are effectively improved compared to the previous CRF methods for SAR image segmentation.

The accuracy and influencing factors for preference of self-sampling in group B streptococcus screening: a cross-sectional study

Objective Self-sampling with proper instruction in 35–37 weeks’ gestation is an option to clinician sampling to prevent early-onset invasive group B streptococcal disease of infants. We aimed to assess the accuracy of self-sampling and influencing factors of preference for collection method in Chinese women. Methods We compared the screening results of self-sampling with clinician collection in a sample of 520 women in late pregnancy. We collected their demographics, clinical information and preference for collection method. A multi-nominal logistic regression model was used to measure the association between the influencing factors and these participants’ preference. Results A good agreement between the two collection methods was found with a Cohen’s Kappa coefficient 0.83 (95%CI = 0.71–0.95). The prevalence of GBS infection in the two methods is statistically different in this low-risk group when self-sampling presented a better outcome in terms of detecting positive cases. Self-sampling is preferable by 20.9% of the participants. No less pain during self-sampling and age older than 35 years old was statistically related to preference for clinician collection. Conclusion The accuracy of self-sampling is no worse than clinician collection. It could be an option for those younger than 35 years old, especially for those who report low pain threshold. Pregnant women are able to collect rectovaginal samples prior to their antenatal visit. Self-sampling followed by appropriate transportation of the sample to an advanced laboratory could eliminate the effects of local laboratory capacity. There are implications in increasing GBS screening participation in resource-limited settings.

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA1c in type 2 diabetes in norwegian general practice.

AimsTo identify individual and general practitioner (GP) characteristics associated with potential over‐ and undertreatment of hyperglycaemia in type 2 diabetes and with HbA1c not being measured.MethodsA cross‐sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA1c > 64 mmol/mol (8.0%) or HbA1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations.ResultsOverall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non‐western origin and low educational level. Characteristics associated with not having an HbA1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs’ use of a Noklus diabetes application reduced the risk of not having an HbA1c measurement performed.ConclusionPotential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de‐intensification or intensification of treatment and regular HbA1c measurement in identified subgroups is warranted.

Identifying Antibiotic Prescribing Patterns Through Multi-Level Latent Profile Analyses: A Cross-Sectional Survey of Primary Care Physicians.

Background: Overuse of antibiotics significantly fuels the development of Antimicrobial resistance, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. Methods: A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n = 501,072) made by the participants from 1 January to March 31, 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. Results: On average, each primary care physician issued 909 (ranging from 100 to 11,941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD = 17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD = 15.83%) contained broad-spectrum antibiotics; 71.92% (SD = 21.42%) contained parenteral administered antibiotics; 23.52% (SD = 19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD = 20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. Conclusion: Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

Age at menarche and risk of vasomotor menopausal symptoms: a pooled analysis of six studies.

To examine the association between age at menarche and risk of vasomotor menopausal symptoms (VMS) and whether midlife body mass index (BMI) modified the association. A pooled analysis of six cohort studies. The International collaboration on the Life course Approach to reproductive health and Chronic disease Events (InterLACE). 18555 women from the UK, USA and Australia. VMS frequency data (never, rarely, sometimes and often) were harmonised from two studies (n=13602); severity data (never, mild, moderate and severe) from the other four studies (n=4953). Multinominal logistic regression models were used to estimate relative risk ratios (RRRs) and 95%CIs adjusted for confounders and incorporated study as random effects. Hot flushes and night sweats. Frequency data showed that early menarche ≤11years was associated with an increased risk of 'often' hot flushes (RRR 1.48, 95% CI 1.24-1.76) and night sweats (RRR 1.59, 95% CI 1.49-1.70) compared with menarche at ≥14years. Severity data showed similar results, but appeared less conclusive, with RRRs of 1.16 (95% CI 0.94-1.42) and 1.27 (95% CI 1.01-1.58) for 'severe' hot flushes and night sweats, respectively. BMI significantly modified the association as the risk associated with early menarche and 'often' VMS was stronger among women who were overweight or obese than those of normal weight, while this gradient across BMI categories was not as strong with the risk of 'severe' VMS. Early age at menarche is a risk factor for VMS, particularly for frequent VMS, but midlife BMI may play an important role in modifying this risk. Overweight and obesity exacerbate the risk of vasomotor symptoms associated with early menarche.

An Analysis of Korean Learners’ Errors by Proficiency: Focus on Statistical Analysis using the Multinominal Logistic Regression Model

An Analysis of Korean Learners’ Errors by Proficiency: Focus on Statistical Analysis using the Multinominal Logistic Regression Model

Borderline Personality Disorder With Depression Confers Significant Risk of Suicidal Behavior in Mood Disorder Patients-A Comparative Study.

ObjectiveWe investigated risk factors for suicidal ideation and behavior among currently depressed patients with major depressive disorder (MDD), major depressive episode (MDE) in bipolar disorder (BD), or MDE with comorbid borderline personality disorder (MDE/BPD). We compared current and lifetime prevalence of suicidal ideation and behavior, and investigated dimensional measures of BPD or mixed affective features of the MDE as indicators of risk.MethodsBased on screening of 1,655 referrals, we recruited 124 psychiatric secondary care outpatients with MDE and stratified them into three subcohorts (MDD, BD, and MDE/BPD) using the Structured Clinical Interview for DSM-IV I and II. We examined suicidal ideation and behavior with the Columbia Suicide Severity Rating Scale (CSSRS). In addition, we quantified the severity of BPD symptoms and BD mixed features both categorically/diagnostically and dimensionally (using instruments such as the Borderline Personality Disorder Severity Index) in two time frames.ResultsThere were highly significant differences between the lifetime prevalences of suicide attempts between the subcohorts, with attempts reported by 16% of the MDD, 30% of the BD, and 60% of the BPD subcohort. Remarkably, the lifetime prevalence of suicide attempts in patients with comorbid BD and BPD exceeded 90%. The severity of BPD features was independently associated with risk of suicide attempts both lifetime and during the current MDE. It also associated in a dose-dependent manner with recent severity of ideation in both BPD and non-BPD patients. In multinominal logistic regression models, hopelessness was the most consistent independent risk factor for severe suicidal ideation in both time frames, whereas younger age and more severe BPD features were most consistently associated with suicide attempts.ConclusionsAmong patients with major depressive episodes, diagnosis of bipolar disorder, or presence of comorbid borderline personality features both imply remarkably high risk of suicide attempts. Risk factors for suicidal ideation and suicidal acts overlap, but may not be identical. The estimated severity of borderline personality features seems to associate with history of suicidal behavior and current severity of suicidal ideation in dose-dependent fashion among all mood disorder patients. Therefore, reliable assessment of borderline features may advance the evaluation of suicide risk.

Application of single-level and multi-level modeling approach to examine geographic and socioeconomic variation in underweight, overweight and obesity in Nepal: findings from NDHS 2016

Nepal’s dual burden of undernutrition and over nutrition warrants further exploration of the population level differences in nutritional status. The study aimed to explore, for the first time in Nepal, potential geographic and socioeconomic variation in underweight and overweight and/or obesity prevalence in the country, adjusted for cluster and sample weight. Data came from 14,937 participants, including 6,172 men and 8,765 women, 15 years or older who participated in the 2016 Nepal Demography and Health Survey (NDHS). Single-level and multilevel multi-nominal logistic regression models and Lorenz curves were used to explore the inequalities in weight status. Urban residents had higher odds of being overweight and/or obese (OR: 1.89, 95% CI: 1.62–2.20) and lower odds of being underweight (OR: 0.81, 95% CI: 0.70–0.93) than rural residents. Participants from Provinces 2, and 7 were less likely to be overweight/obese and more likely to be underweight (referent: province-1). Participants from higher wealth quintile households were associated with higher odds of being overweight and/or obese (P-trend < 0.001) and lower odds of being underweight (P-trend < 0.001). Urban females at the highest wealth quintile were more vulnerable to overweight and/or obesity as 49% of them were overweight and/or obese and nearly 39% at the lowest wealth quintile were underweight.