Multiple Poisson Regression Models Research Articles

Association Between Television Viewing and Sensory Reactivity in Childhood: The Cross-Sectional InProS Study

BackgroundCurrent evidence suggests a potential detrimental effect of increased television viewing on children's health, including sensory processing issues. Therefore, this study examined the association between television viewing time and atypical sensory reactivity (SR) in children aged from three to seven years. MethodsWe evaluated data from the InProS cross-sectional study (n = 545). Daily television viewing was categorized into tertiles: ≤1.5, 1.5 to 2.5, and ≥2.5 hours. SR was evaluated using the Short Sensory Profile (SSP). Children with atypical SR were those with a global SSP score below 155, 30 for tactile sensitivity, 15 for taste/olfactory sensitivity, 13 for movement sensitivity, 27 for under-responsive/seeks sensation, 23 for auditory filtering, 26 for low energy/weak, and 19 for visual/auditory sensitivity. We used multiple Poisson regression models with robust variance to explore associations. ResultsAfter adjusting for covariates, children who watched television 1.5 to 2.5 and ≥2.5 hours/day showed a higher prevalence of atypical global SR (prevalence ratio [PR]: 1.54; 95% confidence interval [CI]: 1.03 to 2.30; PR: 1.81; 95% CI: 1.19 to 2.76, respectively) and auditory filtering (PR: 1.50; 95% CI: 1.15 to 1.96; PR: 1.36; 95% CI: 1.01 to 1.83, respectively), compared with children who watched ≤1.5 hours/day. In addition, watching television ≥2.5 hours/day, compared with watching ≤1.5 hours/day, was associated with having atypical SR in movement sensitivity (PR: 1.73; 95% CI: 1.06 to 2.83), under-responsive/seeks sensation (PR: 1.31; 95% CI: 1.02 to1.69), and low energy/weak (PR: 2.02; 95% CI: 1.01 to 4.06). ConclusionsThe findings showed that television viewing ≥1.5 hours/day was associated with a higher prevalence of atypical SR in childhood. However, further longitudinal studies are required to confirm these results.

How general practitioners in France are coping with increased healthcare demand and physician shortages. A panel data survey and hierarchical clustering

BackgroundGeneral practitioners (GPs) face quantitative and qualitative changes in patient demand and doctor shortages. ObjectivesTo investigate how GPs cope with doctor shortage issues. Materials and methodsTwo cross-sectional surveys of a representative panel of 1530 GPs in 2019 and 2022 about their perceptions of physician shortages, working hours worked (WHW), and adaptive behaviors. Hierarchical clustering enabled identification of profiles with different adaptation patterns. Multiple Poisson or logistic regression models studied associations between GPs’ profiles and professional characteristics. Results87.4 % of GPs applied at least one adaptation to control patients’ healthcare demand. 24 % adopted task-shifting while their average WHW decreased by 3.6 h between 2019 and 2022. Four GP profiles were identified. “Low adapters/low workload” and “Low adapters/high workload” (25 % of the sample each) reported 2.4 adaptive measures: 75.5 % refused to be new patients' preferred doctor in the former group (vs 5.1 %). “High adapters/unchanged consultations” (30.7 %) and “High adapters/shortened consultations” (18.9 %) reported 4.8 and 6.1 adaptations, respectively. They were more likely to practice in medically underserved areas. ConclusionThese results call into question GPs’ gatekeeper role in the French healthcare system. Moreover, the marked reduction in WHW in underserved areas is likely to exacerbate their uneven distribution nationwide. Encouraging vertical integration between HCPs while enhancing cooperation and task-shifting is probably a pathway toward improving the relative GP shortage.

Prenatal incarceration exposure and adverse COVID-19 related experiences during pregnancy

ABSTRACT This study examines the relationship between exposure to incarceration and stressful experiences endured during the initial months of the COVID-19 pandemic (June-December 2020). Using data from the 2020 Pregnancy Risk Assessment Monitoring System (PRAMS), multiple Poisson and logistic regression models were used to assess the association between incarceration of a woman or her partner in the year before birth and the likelihood of experiencing 13 different types of adverse experiences due to the COVID-19 pandemic between June and December 2020. Results indicate that women’s incarceration exposure – either personally or vicariously through a partner – was associated with more total COVID-19 experiences. Additionally, women with incarceration exposure encountered several adverse experiences, including problems paying rent, mortgage, or bills, worried food would run out, felt more anxious, felt more depressed, had more verbal augments or conflicts with husband/partner, and husband/partner was more physically, sexually, or emotionally aggressive, than their non-incarceration-exposed counterparts. Implications of the findings for theory and public policy are discussed.

Exploring the Association between Parental Employment Status, Education Level, and Sensory Reactivity in Spanish Children Aged 3-7 Years: Findings from the InProS Study.

This study explored the association between parental employment status and education level and the prevalence of sensory reactivity (SR) in population-based sample of school-aged children. SR was assessed in 495 children using the parent-reported Short Sensory Profile (SSP) questionnaire. Children with SR were identified based on probable or definitive differences in total SSP and subscales. Association between parental employment and education level were explored using multiple Poisson regression models with robust variance, adjusted for potential confounders. The main findings showed that a mother's unemployment status was associated with higher prevalence of SR for the taste/smell sensitivity subscale (PR = 1.66, 95%CI: 1.08-2.56), and the low energy/weak (PR = 2.18, 95%CI: 1.31-3.49) subscale. A lower education level of a father was also associated with a higher prevalence of sensory problems on the tactile sensitivity subscale (PRprimary education = 2.68, 95%CI: 1.27-5.61; PRsecondary education = 1.96, 95%CI: 1.004-3.66) and the low energy/weak subscale (PRsecondary education = 1.95, 95%CI: 1.02-3.73). This study underscores the impact of parental employment and education on SR in school-aged children, offering insights for interventions and support systems aimed at improving their sensory functioning and overall well-being.

Breakfast consumption, saturated fat intake, and body mass index among medical and non-medical students: a cross-sectional analysis

Changes in dietary patterns and body weight have become a focus of research in undergraduate students. This study compared breakfast consumption, intake of foods high in saturated fat, and BMI between medical and non-medical students. A comparative cross-sectional study was conducted in 4,561 Peruvian university students, of whom 1,464 (32.1%) were from the medical field and 3,097 (67.9%) from the non-medical field. We compared the frequency of breakfast consumption (categorized as regular: 6 to 7 days/week; occasional: 3 to 5 days/week; and rarely or never: 0 to 2 days/week) and the frequency of consumption of foods high in saturated fat. We created simple and multiple linear and Poisson regression models with robust variance to evaluate the association of the mentioned variables with academic fields. Non-medical students (Adjusted Prevalence Ratio [PR] = 0.92, 95% CI 0.86–0.99; p = 0.008) were less likely to eat breakfast regularly compared to medical students. Likewise, consumption of foods high in saturated fats was higher in non-medical students (B = 1.47, 95% CI 0.91–2.04; p < 0.001) compared to medical students. Similarly, the mean BMI of these students was significantly higher than that of medical students (B = 0.33, 95% CI 0.12–0.53; p = 0.002). Although medical students reported relatively healthy eating habits and a lower BMI, there is a widespread need to promote improved diet and lifestyle among the entire university population to reduce the risks of communicable diseases and improve quality of life.

Depression, Anxiety, Emotional Eating, and Body Mass Index among Self-Reported Vegetarians and Non-Vegetarians: A Cross-Sectional Study in Peruvian Adults.

Background: Vegetarianism is commonly associated with various health benefits. However, the association between this dietary regimen and aspects of mental health remains ambiguous. This study compared the symptoms of depression and anxiety, emotional eating (EmE), and body mass index (BMI) in Peruvian vegetarian and non-vegetarian adults. Methods: A cross-sectional study was conducted on 768 Peruvian adults, of whom 284 (37%) were vegetarians and 484 (63%) were non-vegetarians. The Depression Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale-2 (GAD-2), and an EmE questionnaire were applied; additionally, the BMI was calculated. Simple and multiple linear regression and Poisson regression models with robust variance were used to evaluate the association between depression, anxiety, EmE, and BMI with dietary patterns. Results: The vegetarians (Adjusted Prevalence Ratio [PR] = 0.24, 95% CI 0.16-0.31; p < 0.001) reported more depressive symptoms than the non-vegetarians. This trend persisted for anxiety, with an adjusted PR of 0.17 (95% CI: 0.01-0.29; p = 0.012). However, the vegetarians (adjusted PR = -0.38, 95% CI: -0.61--0.14; p < 0.001) reported lower EmE scores compared to the non-vegetarians. Likewise, the vegetarians had a lower mean BMI than the non-vegetarians (B = -0.16, 95% CI: -0.21--0.08; p < 0.001). Conclusions: Vegetarian diets are associated with increased symptoms of depression and anxiety, as well as lower EmE and BMI scores. Further longitudinal studies are needed to elucidate these associations and determine causality and the underlying mechanisms involved.

Socioeconomic and Demographic Effects on SARS-CoV-2 Testing: Evidence From the State of Uttar Pradesh, India.

Background The rapid global spread of SARS-CoV-2 highlighted critical challenges in healthcare systems worldwide, with differences in testing access and utilization becoming particularly evident. This study investigates the socioeconomic and demographic factors influencing SARS-CoV-2 testing service access and utilization during the second wave of the pandemic in Uttar Pradesh (UP), India. Methods The study was conducted from July to October 2023 in twodistricts of Uttar Pradesh (UP). These districts were chosen because one had the highest and the other the lowest SARS-CoV-2 testing rates per million population as reported from March to June 2021. The study population included consenting adult individuals with self-reported symptoms indicative of SARS-CoV-2 infection during March-June 2021. The study excluded individuals under 18 years, those who did not consent, pregnant or lactating mothers, and those with communication-impairing medical conditions. Data were collected using a structured questionnaire based on Andersen's Behavioural Model of Health Services Use. We used chi-squared tests for all categorical variables to obtain p-values and Poisson regression to identify factors influencing testing rates. Results We screened 4,595 individuals and identified 675 eligible participants for this study. Adjusted prevalence ratios derived from multiple variate Poisson regression models showed that participants in Sitapur had a 0.47 (95% CI: 0.39-0.57) times the prevalence of being tested than those in Lucknow. Furthermore, individuals from other backward castes and scheduled castes had a 1.15 (95% CI: 0.99-1.34) and 1.22 (95% CI: 0.95-1.56) times prevalence of being tested for SARS-CoV-2, respectively, when compared to the general caste population. Scheduled Tribes showed a higher prevalence of being tested, contrasting with existing literature. Households with low, middle, and high income showed a 1.46 (95% CI: 1.12-1.89), 1.52 (95% CI: 1.14-2.02), and 1.73 (95% CI: 1.23-2.45) times the prevalence of SARS-CoV-2 testing compared to those below the poverty line, respectively. Behavioral factors such as media use showed an inverse relationship with testing prevalence; individuals who did not watch TV at all had a 0.83 (95% CI: 0.70-0.99) times prevalence of being tested compared to frequent viewers, and similarly, those not using the internet on mobiles had a 0.82 (95% CI: 0.67-0.99)times prevalence than daily users. Individuals using private healthcare facilities had a 0.87 (95% CI: 0.77-0.99) times prevalence of SARS-CoV-2 testing compared to those using government facilities. Conclusions These findings highlight the importance of public health strategies that address socio-economic and behavioral disparities to ensure equitable testing access across all community groups.

Adolescent Health Care Needs and Relationship to Disease in Patients With Childhood-Onset Systemic Lupus Erythematosus.

Our objective was to characterize adolescent health and psychosocial issues in patients with childhood-onset systemic lupus erythematosus (cSLE) and evaluate demographic and disease characteristics associated with adolescent health. We retrospectively examined adolescents aged 12 to 18 years with cSLE seen at the Hospital for Sick Children meeting the American College of Rheumatology/Systemic Lupus International Collaborating Clinics classification criteria, assessed by adolescent medicine in the cSLE clinic between 2018 and 2020. Adolescent health issues were characterized using the Home, Education/Employment, Activities, Diet/Drugs, Sexuality, Suicide/mood (HEADDSS) framework. Issues were classified as presenting and/or identified; adolescent health burden was tabulated as the number of distinct adolescent issues per patient. Multiple Poisson regression models examined associations between patient and disease characteristics (age, sex, material deprivation, disease activity, disease damage, and high-dose glucocorticoid exposure) and adolescent health issues. A total of 108 (60%) of 181 adolescents with cSLE were seen by adolescent medicine, with a median of 2 (interquartile range [IQR] 1-3) visits and a median of 2 (IQR 1-5) adolescent health issues during the study period. Common issues were mood (presenting in 21% vs identified in 50%), sleep (27% vs 2%), school and education (26% vs 1%), and nonadherence (23% vs 8%). Psychoeducation was provided by adolescent medicine to 54% of patients. High-dose glucocorticoids (risk ratio [RR] 1.82, 95% confidence interval [CI] 1.41-2.35, P < 0.001), material deprivation (RR 1.17, 95% CI 1.04-1.30, P = 0.007), and lower SLE Disease Activity Index scores (RR 0.95, 95% CI 0.92-0.98, P = 0.004) were associated with higher adolescent health burden. Adolescents with cSLE experience many adolescent issues, especially low mood. High-dose glucocorticoids and social marginalization are associated with greater adolescent health burden. This study highlights the importance of addressing adolescent health needs as part of routine care.

Adolescent pregnancy in Cruzeiro do Sul, Acre, Brazil: socioeconomic characteristics, prenatal and obstetric care.

The present study aimed to investigate the socioeconomic and obstetric characteristics of adolescent mothers and the complications they cause to maternal and neonatal health. This baseline data analysis of the MINA-Brazil birth cohort was conducted in the municipality of Cruzeiro do Sul, state of Acre, Brazil. The chi-square test was used to compare characteristics of adolescent and adult postpartum women, and multiple Poisson regression models with robust variance were used to assess associated factors. Among the postpartum women, 26.2% (95%CI: 24.0-28.4) were adolescents. Factors associated with childbirth in adolescence included: nine years or less of schooling (adjPR:1.36; 95%CI: 1.14-1.61), belongs to the lowest quartiles of the wealth index (1st quartile: adjPR:1.40; 95%CI: 1.08-1.80) (2nd quartile: adjPR:1.37; 95%CI: 1.08-1.74), primigravidae (adjPR:3.69; 95%CI: 2.98-4.57), low pre-pregnancy BMI (adjPR:1.28; CI95%: 1.04-1.57), urinary tract infection during pregnancy (adjPR:1.25; CI95%: 1.07-1.46) and less than six prenatal consultations (adjPR:1.42; 95%CI: 1.21-1.66). Poverty, little schooling, primigravidae, low pre-pregnancy BMI, urinary tract infection during pregnancy and few prenatal consultations were associated with childbirth during adolescence in a municipality in the Northern region of Brazil.

Parturientes adolescentes em Cruzeiro do Sul, Acre, Brasil: características socioeconômicas e obstétricas

Abstract The present study aimed to investigate the socioeconomic and obstetric characteristics of adolescent mothers and the complications they cause to maternal and neonatal health. This baseline data analysis of the MINA-Brazil birth cohort was conducted in the municipality of Cruzeiro do Sul, state of Acre, Brazil. The chi-square test was used to compare characteristics of adolescent and adult postpartum women, and multiple Poisson regression models with robust variance were used to assess associated factors. Among the postpartum women, 26.2% (95%CI: 24.0-28.4) were adolescents. Factors associated with childbirth in adolescence included: nine years or less of schooling (adjPR:1.36; 95%CI: 1.14-1.61), belongs to the lowest quartiles of the wealth index (1st quartile: adjPR:1.40; 95%CI: 1.08-1.80) (2nd quartile: adjPR:1.37; 95%CI: 1.08-1.74), primigravidae (adjPR:3.69; 95%CI: 2.98-4.57), low pre-pregnancy BMI (adjPR:1.28; CI95%: 1.04-1.57), urinary tract infection during pregnancy (adjPR:1.25; CI95%: 1.07-1.46) and less than six prenatal consultations (adjPR:1.42; 95%CI: 1.21-1.66). Poverty, little schooling, primigravidae, low pre-pregnancy BMI, urinary tract infection during pregnancy and few prenatal consultations were associated with childbirth during adolescence in a municipality in the Northern region of Brazil.

Perfil sociodemográfico e de formação dos profissionais de Enfermagem do estado de São Paulo em relação às Práticas Integrativas e Complementares em Saúde

Objective: to analyze the sociodemographic and training profile of nursing professionals in the state of São Paulo in relation to Integrative and Complementary Practices in Health. Method: cross-sectional study, developed with 3,794 nursing professionals in the state of São Paulo, from 645 municipalities. To collect data, an online questionnaire was used containing sociodemographic and professional training variables. A hierarchical multiple Poisson regression model was constructed, considering training in practices as the dependent variable, with a significance level of 5%. Results: of the 3,794 (100%) participants, 479 (12.62%) had training in Integrative and Complementary Health Practices. The most frequent practices were auriculotherapy, Traditional Chinese Medicine/acupuncture and Reiki. The predominant training modalities were free, face-to-face and theoretical-practical courses. The variables age, no formal religion, higher education and specialization level, working hours and knowledge and previous experience on integrative practices were significant. Conclusion: the results indicate the need to encourage and expand the training of Integrative and Complementary Health Practices for nursing professionals, in order to strengthen their performance in health services.

Labour Force Participation, Gender Equality and Women’s Empowerment Through Micro-entrepreneurship: Evidence from Odisha, India

In this 21st century, the aggregative model of democracy would not be able to address the complex problem of a plural society where structural inequality is rampant. Hence, it is imperative to unearth a convenient way of the decision-making process through various social and economic empowerment factors, which enhance women’s participation and awareness despite structural inequalities deeply rooted in Indian society in general and Odisha in particular. This article seeks to highlight the factors determining women’s empowerment and identify issues related to the management of the enterprise. We have surveyed a hundred women entrepreneurs in the Ganjam district of Odisha, India, for the study. We have used multiple regression and Poisson regression models to identify the key determinants of women’s empowerment. The study found that domestic decision, autonomy, self-confidence, business skills and public deliberation are significant determinants of the number of indicators adopted to enhance the overall empowerment index. The multiple regression models found that women’s leisure, unpaid work, self-confidence, business skills and social status positively affect empowerment. The study found that micro-entrepreneurship is successful in the Ganjam district of Odisha. Hence, it is imperative to empower women through public deliberation and motivate them to participate in micro-entrepreneurship.

Effect of implementing a heart failure admission care bundle on hospital readmission and mortality rates: interrupted time series study

This study aimed to evaluate the impact of developing and implementing a care bundle intervention to improve care for patients with acute heart failure admitted to a large London hospital....

Association between sensory reactivity and feeding problems in school-aged children: InProS Study

This study aimed to explore the association between sensory reactivity (SR) and feeding problems in children at 3–7 years of age. We analysed data from 589 Spanish children from the InProS project, a population-based cross-sectional study. SR was measured using the Short Sensory Profile (SSP) as a two-level categorical variable (SR or no SR) and feeding problems (food variety, texture problems, or both feeding problems) were collected using closed questions (yes or no). Multiple Poisson regression models were used to estimate associations adjusted for potential confounding variables. Results showed the following prevalence rates for SR: 29.0% (SSP total score <155), 11.4% (tactile sensitivity <30), 14.8% (taste/smell sensitivity <15), 22.1% (movement sensitivity <13), 49.1% (low responsiveness/seeking sensation <27), 43.6% (auditory filtering <23), 11.6% (low energy/weak <26), and 25.3% (visual/auditory sensitivity <19). Around a fifth of children (18.3%) consumed a limited variety of foods, 4.9% had difficulties in the transition/introduction of textures, and 3.9% had both feeding problems. The presence of taste/smell sensitivity was associated with difficulties in the transition/introduction of textures (PR = 1.17, 95%CI = 1.09–1.27), limited variety of foods (PR = 1.42, 95%CI = 1.31–1.53), and both feeding problems (PR = 1.31, 95%CI = 1.19–1.44). In addition, children with total SR or auditory filtering SR were associated with a higher prevalence of consuming a limited variety of foods (PR = 1.13, 95%CI = 1.06–1.20 and PR = 1.08, 95%CI = 1.02–1.15, respectively). These findings highlight the importance of considering SR as a potential predictor of feeding problems, especially in children with taste/smell sensitivity. However, further studies are needed to confirm these findings.

Magnitude of risk factors for chronic noncommunicable diseases in adolescents and young adults in Brazil: A population-based study.

Estimate the magnitude and factors associated with risk factors for chronic noncommunicable diseases in adolescents and young adults in Brazil. Cross-sectional study that analyzed data from the 2019 National Health Survey. The population of interest was adolescents and young adults aged 15 to 24 years. Data were collected through individual interviews during home visits. Dependent variables included major risk factors for chronic noncommunicable diseases. Demographic and socioeconomic characteristics were used as independent variables. Multiple Poisson regression models were used to assess the relationship between independent variables and risk factors. A total of 10,460 individuals (5,001 men and 5,459 women) were included. Regardless of sex, the most prevalent risk factors were insufficient fruit and vegetable consumption (92.6%) and leisure-time physical inactivity (43.3%). The prevalence rates of tobacco smokers, alcohol consumption once a month or more, and alcohol abuse were 8.9%, 28.7%, and 18.5%, respectively. Regular consumption of soft drinks and/or artificial juices was described by 17.2%. The prevalence of overweight was 32.5%. Young adults, males, and individuals with lower educational levels, of black race/skin color, with lower household income, and residents of urban areas had a higher prevalence for most risk factors. Differences in the determinants were found for some factors. Inequalities between Brazilian regions were recorded for seven of the nine factors analyzed. The most socioeconomically developed regions had the highest prevalence of most risk factors. The high magnitude of risk factors indicates a potential increase in the burden of chronic noncommunicable diseases in a future scenario for Brazil.

Inequalities in end-stage renal disease: underprivileged and ethnic minority members are at higher risk.

Incidence of end-stage renal disease (ESRD) is higher in Israel than the European average. Socio-economic differences in ESRD have been reported globally, but many countries lack a national register. Using national data, we assessed which socio-demographic factors are associated with 5-year incidence of ESRD in Israel, where there is universal access to renal replacement therapy (RRT). Data on all incident ESRD cases aged ≥20 years receiving chronic RRT between 1 January 2014 and 31 December 2018 (N = 7883) were collected from Israel's National Dialysis & Renal Transplant Register. Individual-level data on ESRD cases requiring RRT included residential area, age, gender, ethnicity (Jewish or Arab) and ESRD cause (diabetes, other, unknown/missing). Area-level data included age and sex distribution, socio-economic status (SES) and proportion of Arab population. The associations between individual-level socio-demographic characteristics and ESRD cause were tested in bivariate comparisons. The risk of developing ESRD during the study period (from all and specific causes) was estimated using multiple Poisson regression models with negative binomial distribution, using four parameters, namely sex, ethnicity, SES category and age strata, based on area-level distribution of these parameters, and with the whole population (aged ≥20 years) as the denominator. A socio-economic gradient was seen for ESRD from all causes, more marked for diabetic aetiology [rate ratio (RR)=0.45, 95% CI: 0.39-0.52 highest vs lowest SES categories] than from other (RR = 0.64, 95% CI: 0.55-0.75) or unknown cause (RR = 0.79, 95% CI: 0. 62-0.99). Based on population area-level data, predominantly Arab neighbourhoods showed higher risk for ESRD requiring RRT for all causes, with the strongest association for diabetes (RR = 1.69, 95% CI: 1.53-1.86) adjusted for SES, age and sex. A strong socio-economic gradient was demonstrated for ESRD requiring RRT. Arab ethnicity was associated with higher risk for ESRD, especially due to diabetes. Our findings suggest the need for allocation of health resources according to needs and culturally appropriate interventions for improving control of modifiable risk factors for chronic renal failure.

Composite dietary antioxidant intake and osteoporosis likelihood in premenopausal and postmenopausal women: a population-based study in the United States.

Osteoporosis is a skeletal disease characterized by low bone mass, reduced bone strength, and increased fracture risk. We aimed to investigate the association between combined dietary antioxidant intake and the likelihood of osteoporosis in premenopausal and postmenopausal women, based on data from the National Health and Nutrition Examination Survey. Nutrient intake data were obtained using two 24-hour recalls. Composite dietary antioxidant index (CDAI), which refers to the intake amounts of β-carotene, vitamin A, vitamin C, vitamin E, selenium, zinc, copper, and iron, was then constructed. Prevalent osteoporosis was defined according to bone mineral density T scores of ≤ -2.5 and self-reports. Multiple logistic and Poisson regression models were used for association analyses. A total of 3,418 participants (1,157 premenopausal and 2,261 postmenopausal women) 40 years or older were included, 776 (22.70%) of whom had prevalent osteoporosis. In terms of individual nutrients, postmenopausal women in the highest CDAI quartiles for dietary β-carotene, vitamin A, vitamin C, and iron intakes had a low likelihood of osteoporosis. Regarding the CDAI-osteoporosis association, postmenopausal women in the highest quartile were less likely to have osteoporosis (OR Q3 vs Q1 , 0.64; 95% CI, 0.43-0.96; OR Q4 vs Q1 , 0.56; 95% CI, 0.35-0.89; P for trend = 0.013), after controlling for covariates. CDAI was negatively associated with the likelihood of osteoporosis in postmenopausal women. Our findings suggest that the combined intake of antioxidant nutrients can help reduce the likelihood of osteoporosis in women.

Desires for Individual- and Interpersonal-Level Patient Portal Use for HIV Prevention Among Urban Sexual Minority Men: Cross-sectional Study.

Gay, bisexual, and other sexual minority men have expressed the acceptability of patient portals as tools for supporting HIV prevention behaviors, including facilitating disclosure of HIV and other sexually transmitted infection (STI/HIV) laboratory test results to sex partners. However, these studies, in which Black or African American sexual minority men were undersampled, failed to determine the relationship of reported history of discussing HIV results with sex partners and anticipated willingness to disclose web-based STI/HIV test results using a patient portal. Among a sample of predominantly Black sexual minority men, this study aimed to (1) determine preferences for patient portal use for HIV prevention and (2) test the associations between reported history of discussing HIV results and anticipated willingness to disclose web-based STI/HIV test results with most recent main and nonmain partners using patient portals. Data come from audio-computer self-assisted interview survey data collected during the 3-month visit of a longitudinal cohort study. Univariate analysis assessed patient portal preferences by measuring the valuation rankings of several portal features. Multiple Poisson regression models with robust error variance determined the associations between history of discussing HIV results and willingness to disclose those results using web-based portals by partner type, and to examine criterion validity of the enhancing dyadic communication (EDC) scale to anticipated willingness. Of the 245 participants, 71% (n=174) were Black and 22% (n=53) were White. Most participants indicated a willingness to share web-based STI/HIV test results with their most recent main partner. Slightly fewer, nonetheless a majority, indicated a willingness to share web-based test results with their most recent nonmain partner. All but 2 patient portal features were valued as high or moderately high priority by >80% of participants. Specifically, tools to help manage HIV (n=183, 75%) and information about pre- and postexposure prophylaxis (both 71%, n=173 and n=175, respectively) were the top-valuated features to include in patient portals for HIV prevention. Discussing HIV test results was significantly associated with increased prevalence of willingness to disclose web-based test results with main (adjusted prevalence ratio [aPR] 1.46, 95% CI 1.21-1.75) and nonmain partners (aPR 1.54, 95% CI 1.23-1.93). Our findings indicate what features Black sexual minority men envision may be included in the patient portal's design to optimize HIV prevention, further supporting the criterion validity of the EDC scale. Efforts should be made to support Black sexual minority men's willingness to disclose STI/HIV testing history and status with partners overall as it is associated significantly with a willingness to disclose testing results digitally via patient portals. Future studies should consider discussion behaviors regarding past HIV test results with partners when tailoring interventions that leverage patient portals in disclosure events.

Impact of heat and cold on cause -specific mortality in Italy

to estimate the impact of daily exposure to extreme air temperatures (heat and cold) on cause-specific mortality in Italy and to evaluate the differences in the association between urban, suburban and rural municipalities. time series analyses with two-stage approach were applied: in the first stage, multiple Poisson regression models and distributed lag non-linear models (DLNM) were used to define the association between temperature and mortality; in the second one, meta-analytic results were obtained by adopting BLUP (Best Linear Unbiased Prediction) coefficients at provincial level, which were then used to estimate the Attributable Fractions of cause-specific deaths. cause-specific deaths from 2006to 2015 in Italy have been analysed by region and overall. 5,648,299 total deaths included. Fractions (and relative 95% empirical confidence interval) of deaths attributable to increases from 75th to 99th percentiles of temperature, for heat, and decreases from 25th to 1st percentile, for cold. the overall impact of air temperature on causespecificmortality is higher for heat than for cold. When considering heat, the attributable fraction is higher for diseases of the central nervous system (3.6% 95% CI 1.9-4.9) and mental health disease (3.1% 95% CI 1.7-4.4), while considering cold, ischemic disease (1.3% 95% CI 1.1-1.6) and diabetes (1.3% 95% CI 0.7-1.8) showed the greater impact. By urbanization level, similar impacts were found for cold temperature, while for heat there was an indication of higher vulnerability in rural areas emerged. results are relevant for the implementation and promotion of preventive measures according to climate change related increase in temperature. The available evidence can provide the basis to identify vulnerable areas and population subgroups to which address current and future heat and cold adaptation plans in Italy.

Surgical site infections in liver transplantation in the era of multidrug-resistant bacteria.

Surgical site infection (SSI) is the major complication in orthotopic liver transplantation (LT). It is of prime importance to assess the incidence of infections in liver transplants and to analyze the risk factors associated with morbidity and mortality. Between 2014 and 2019, we performed a retrospective cohort study at the Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. The liver transplant procedure and its related infections were examined in 4 timepoints, both prior and post-surgery. Multiple random-intercept Poisson regression models with robust variance were fitted to calculate the adjusted risk ratios (RR) and the 95% confidence intervals (CI) according to selected recipient and donor variables. We included in the analysis 249 transplants (in 241 patients). The SSIs (mostly due to S. aureus, E. faecium, and K. pneumoniae) were 7 (2.8%) in the days following LT, increasing to 61 (24.5%) within the first month after LT, and declining to 35 (14.1%) between 31 and 60 days, and to 19 (7.6%) afterwards. The factors associated with increased risk of infection were age (RR=1.17 per 10 years, CI: 0.99-1.38), BMI (RR=1.04 per BMI Unit, CI: 0.99-1.08), donor age (RR=0.88 per 10 years, CI: 0.78-0.98), re-interventions (30 infections, RR=2.02, CI: 1.21-3.38) and the Roux-en-Y approach (25 infections, RR=2.75, CI: 1.47-5.15). The risk of infection occurred mainly in the first two months after LT. Important determinants were age and BMI, donor age, reinterventions, and Roux-en-Y procedure. Our study suggests that these factors should be assessed when performing LT.