Multiple Regression Analysis Research Articles

Prevalence and determinants of unintentional injuries and violence among high school students in Turkey: A cross-sectional study.

Injuries and violence are among the most prominent public health problems in the world. As well as being a leading cause of mortality - particularly among children and young adults - many of the millions of non-fatal injuries result in life-long disabilities and health consequences. The aim of this study was to estimate the prevalence of unintentional injuries and violence, and their associated factors among high school students. This cross-sectional study included a total of 1218 high-school students in Turkey. Data were collected through a facilitated self-administered questionnaire with questions adapted from the Global School-based Student Health Survey instrument. Data were analyzed in IBM SPSS Statistics 28.0 using chi-square test to find statistical significance if any. The significant variables from the chi-square test were selected for multiple logistic regression analysis. The overall prevalence of physical attack, physical fighting, and serious injuries were 8.3 %, 14.8 %, and 11.7 %, respectively. In a multiple regression analysis, student truancy and lateness, worry, suicide attempts, and not having close friends were found to be associated with physically attacked, physical fight, and serious injuries. This study demonstrated that the prevalence of unintentional injuries and violence among high school students is a major public health problem in Turkey. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions.

Prevalence and determinants of lower urinary tract symptoms in pregnant women.

The management of lower urinary tract symptoms (LUTS) is crucial for providing quality pregnancy care. This study aims to determine the prevalence and predictors of LUTS in pregnant women. This cross-sectional study was conducted between November 2023 and February 2024 with a total of 1703 pregnant women who attended routine pregnancy care at four state hospital obstetrics outpatient clinics. Data were collected using a pregnant woman information form and the "Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF)". Descriptive statistics, the independent sample t-test, analysis of variance (ANOVA) test, Tukey or Tamhane's T2 post-hoc tests, and multiple linear regression (Stepwise) analysis were carried out. All analyses were conducted with a 95% confidence interval and a significance level of p<0.05. The prevalence of LUTS among pregnant women was found to be 99.2%. High prevalence rates were obtained for storage symptoms, voiding symptoms, and urinary incontinence symptoms (respectively, 99.2%, 48.8%, and 61.2%). Multiple linear regression analysis indicated that previous pregnancy stress urinary incontinence (SUI), history of curettage and urinary tract infection (UTI), absence of episiotomy, presence of SUI in the mother and/or sister, smoking, being employed, and being in the third trimester are significant predictors of LUTS during pregnancy (p<0.05). The findings of this study indicate that LUTS is commonly in pregnant women. For quality pregnancy care, it is recommended to organize community-based, repeated educational programs and counseling services aimed at preventing and reducing LUTS in women.

The Effect of Health Literacy Level of Caregivers of Individuals With Diabetes on Care Activities and Supportive Behaviours.

To determine the effect of the health literacy levels of caregivers of individuals with T2DM on caregiving activities and supportive behaviours. Cross sectional study. The sample for the study comprised of people who provided care for 442 individuals who were diagnosed with diabetes. The data were collected using the Personal Information Form, HLS-14 and D-CASS. Descriptive statistics, Independent samples t test, One-Way ANOVA and multiple linear regression analysis were used to analyse the data. According to the results of the multiple linear regression analysis, the model was found to be statistically significant, and the variables that were incorporated into the model were able to explain 68.1% of the variance. Among the variables included in the model, HLS-14, educational status, employment status, income status and diabetes-related education were found to affect the care activities and supportive behaviours of caregivers of individuals with diabetes. In the research, it was determined that care activities and supportive behaviours were higher in those with higher levels of HL, higher levels of education, those who were not employed, those with higher income levels, and those who received education about diabetes. Nurses should develop training programmes to increase the HL levels of caregivers.

Delivery mode and risk of intraventricular hemorrhage: A retrospective single-center study on 1760 preterm infants of less than 32 weeks.

To evaluate the association between delivery mode and intraventricular hemorrhage (IVH) in infants with a gestational age (GA)<32weeks. We retrospectively reviewed data of 1760 infants with a GA between 24+0/7 and 31+6/7 weeks/days born between 01.01.2004 and 31.12.2022. We excluded outborn, congenital malformations, infants born by complicated delivery and without antenatal corticosteroid administration. Exposure was the delivery mode: cesarean section (CS) versus vaginal delivery (VD). IVH within the first week of life was the primary outcome. Multiple regression analyses were used to evaluate the association between delivery mode and IVH. CS infants were also match-paired for GA and small for gestational age (SGA) with VD infants. The incidence of IVH was lower in 1046 CS than in 144 VD study infants (IVH I-IV: 14 vs 29%, p<0.001; IVH I-II: 10 vs 22%, p<0.001; IVH III-IV: 3 vs 8%, p=0.008). CS was associated with a lower risk of IVH grades I-IV (aOR: 0.52, p=0.012) after the adjustment for GA, year of birth, sex, singleton pregnancy, SGA, hypertensive disorders of pregnancy, pH≤7.00 and/or standard base excess (SBE)≤-12mmol/L at cord blood gas analysis, early-onset sepsis, hemodynamically significant patent ductus arteriosus, thrombocytopenia, need of blood transfusion, mechanical ventilation and inotropes/vasoactive amines. CS was associated with lower risk of IVH than VD in infants with a GA between 24+0/7 and 31+6/7 weeks/days, born by uncomplicated delivery and who have received antenatal corticosteroids.

Seeing is believing: How front-of-pack food imagery shapes parents' perceptions of child-oriented snack foods.

Child-oriented snack foods often display front-of-pack images suggesting they are natural or wholesome, yet many of these products are ultra-processed and nutrient poor. This study investigated parent's perceptions in response to common forms of front-of-pack food imagery on child-orientated snacks. An online experiment comprising four between-subjects food image conditions (no image; food photo; food cartoon; cartoon of children gardening) and two within-subjects snack type conditions (fruit; vegetable) was conducted with N=800 Australian adult parents/guardians of children aged 4-10 years. Participants viewed packaged snacks then rated them on visual appeal, perceived healthfulness, suitability for their child, and purchase intentions. For each outcome, 4 (between-subjects) x 2 (within-subjects) mixed ANOVAs were performed, with significant main effects explored using post-hoc pairwise t-tests with Bonferroni adjustment. The extent to which perception metrics predicted purchase intention within each condition was examined using multiple regression analyses. Participants perceived snacks displaying food photographs as healthier compared to all other conditions. When children's snacks displayed food photos, participants perceived the snack as more suitable for their child and showed stronger intentions to purchase the product than when cartoon children were displayed. Participants preferred fruit over vegetable snacks across all metrics, particularly when the picture was photorealistic. Visual appeal was the only perception metric that consistently predicted purchase intention across conditions. Findings provide clear evidence that parent's perceptions and purchase intentions towards children's snack foods are enhanced by pictures displayed on the packaging. Policy to regulate food packaging should require that foods depicted on the packaging accurately reflect product ingredients, particularly where whole foods are represented, and the actual ingredients are highly processed and no longer provide the nutrition of whole foods.

Change and predictors of body composition after gastrectomy for gastric cancer during first postoperative year.

After gastrectomy for gastric cancer, patients often lose significant body weight because of decreased caloric intake and nutrient absorption. Body weight typically requires approximately 1 year to stabilize. This study aimed to examine the changes and predictors of body composition during the first postoperative year. A total of 230 patients underwent radical gastrectomy for stage I to III gastric cancers. Body composition was measured using bioelectrical impedance analysis, and changes were analyzed over 1 year. Multiple regression analysis was used to identify predictors of body composition changes. Body composition changes and significant body weight and body fat mass reductions occurred primarily within the first 6 months postoperatively. Skeletal muscle mass initially decreased but improved after 6 months without significant changes related to adjuvant chemotherapy. Increased edema was observed at 6 and 12 months postoperatively in patients after total gastrectomy and adjuvant chemotherapy. Gastrectomy type and body mass index significantly affected postoperative body weight changes. In addition, gastrectomy type was associated with changes in skeletal muscle mass and bone mineral content. Adjuvant chemotherapy significantly affected the whole-body phase angle at 6 and 12 months. Our findings emphasized the initial significant reductions postoperatively and subsequent adjustments over time and elucidated the complex interplay between surgical techniques, adjuvant treatment, and patient characteristics and midterm changes in body composition.

Evaluation of mild cognitive impairment in older patients with essential tremor.

Recent studies have reported that essential tremor (ET) presents with not only motor symptoms but also cognitive dysfunction. However, detailed pathological mechanisms remain unclear. Here, we evaluate the characteristics of cognitive changes in older patients. Eighty-five patients aged 65 years or older with ET but without dementia were evaluated for cognitive function using the Addenbrooke Cognitive Examination Revised (ACE-R). The patients were compared with healthy controls (HCs), and the characteristics of cognitive dysfunction were examined. Age at onset and correlations with tremor severity were also investigated. Moreover, we performed resting-state network (RSNs) analysis in a subset of these patients, and the functional connectivity (FC) within the networks was compared with age-matched controls. Compared to HCs, older patients with ET showed a clear reduction in the total (p=0.001), attention (p=0.005), verbal fluency (p=0.001), and memory (p=0.001) ACE-R scores. Older-onset patients showed significant cognitive dysfunction compared with younger-onset patients. Verbal fluency correlated with tremor severity in the multiple regression analysis (p<0.001). RSNs showed an increase in FC in the frontal lobes within the language network in patients with ET compared to HCs (p<0.05, FWE-corrected). Older patients with ET showed obvious cognitive dysfunction compared to HCs, indicating that cognitive dysfunction varies by age of onset and correlates with tremor severity. The results of the RSNs analysis suggest that the pathological mechanism of cognitive dysfunction in ET patients involves network changes similar to those in the early stages of Alzheimer's disease.

Utility of a Wearable Tracker to Assess Sleep Quality in Nurses and Their Spouses: A Prospective Cohort Study.

Sleep disturbances among nurses engaged in night duty and their spouses need to be improved to ensure their ability to provide care and perform daily tasks. Therefore, an objective investigation is needed to establish a sleep improvement strategy. To investigate the utility of a sleep tracker to assess sleep quality in nurses and spouses. Nurses (n = 30) and spouses (n = 30) wore a sleep tracker for 14 days to investigate sleep scores. Sleep quality and number of steps were evaluated by Fitbit. They responded to the Richards-Campbell Sleep Questionnaire and Pittsburgh Sleep Quality Index. A multiple regression analysis was performed to identify the factors affecting sleep quality. Factors affecting sleep scores in nurses were hypnotic medication, night duty, and steps, while those in spouses were mental instability, hypnotic medication, alcohol, night duty, and steps. Factors affecting the Richards-Campbell Sleep Questionnaire in nurses were household chores, night duty, and steps, while those in spouses were hypnotic medication and steps. The sleep quality of nurses was affected by household chores, hypnotic medication, night duty, and steps. Besides the factors of nurses, spouses were affected by mental instability and alcohol. Night duty affected negativity in both nurses and spouses. Steps exerted positive effects in both the sleep tracker and the Richards-Campbell Sleep Questionnaire. The sleep tracker may be useful for identifying factors that improve sleep quality.

Strategic evaluation of European Inland transport companies for European green deal compliance: A multi-criteria decision making-analysis.

The purpose of this study is to evaluate the readiness of European inland transport companies for the European Green Deal by analyzing the causal relationships between key factors essential for EGD implementation. The research identifies six critical factors: Investment in Green Technologies, Policy Alignment and Compliance, Stakeholder Collaboration, Resource Management, Employee Training and Engagement, and Emission Reduction Initiatives. This research offers the first integrated evaluation of EGD readiness utilizing a combination of fuzzy-DEMATEL, multiple regression analysis, and Structural Equation Modeling aimed at uncovering systemic interactions among the factors in the system. The study revealed Resource Management and Employee Training as significant drivers in enhancing the readiness, highlighting the role of human capital and resource optimization in environmental sustainability. Expert panel, consisting of 19 industry representatives selected through purposive sampling, provided insights on the effective relationships which offer practical strategies for managers to prioritize resource management and employee engagement to achieve Green Deal compliance and guiding more strategic and efficient allocation of resources to enhance alignment with European Green Deal stipulations.

Sex differences in dorsal striatal volume and interest in quitting smoking.

Over the recent decades, smoking among women has become an increasingly pressing public health challenge. Mounting evidence suggests that, compared to men, women's smoking is more strongly influenced by habitual responses to sensorimotor cues. To understand the brain mechanisms underlying the cessation challenges commonly reported by women who smoke, the present study used voxel-based morphometry (VBM) to investigate sex-related volumetric differences in the dorsal striatum, a region implicated in habitual substance use behavior, and their associations with self-reported quit interest among daily smoking adults. Structural magnetic resonance imaging (MRI) data were collected from 41 women and 52 men (30.1 ± 7.5 years) who reported smoking an average of 15-40 cigarettes per day for at least past 24 months. Multiple regression analyses were carried out with sex and average gray matter volumes (GMV) of predetermined brain regions of interest (ROIs; bilateral caudate, putamen) and control regions (bilateral nucleus accumbens, thalamus) as predictors of self-reported interest in quitting smoking. Women displayed greater striatal GMV and lower current quit interest than men. ROI-based analyses revealed an interaction between sex and putamen GMV, wherein putamen GMV was more strongly and negatively linked to quit interest in women than men. Greater GMV in the putamen could be linked to an attenuated desire to stop smoking among women. This may serve as a neuroanatomical mechanism underlying the higher prevalence of habit-driven smoking behavior observed in women as compared to men.

Illness behavior and its predictors in young and middle-aged colorectal cancer patients: A latent profile analysis.

To describe the characteristics of sick role adaptation and understand the differences in young and middle-aged colorectal cancer (CRC) patients. 225 colorectal cancer patients aged 18-59 admitting to a specialized oncology hospital in Guangzhou, China were involved from January to April 2022. Socio-demographic characteristics, disease-related characteristics, scores of Illness Behavior Questionnaire, Hospital Anxiety and Depression Scale, the Brief Illness Perception Questionnaire, Mishel Uncertainty in Illness Scale and Medical Coping Modes Questionnaire were applied to collect quantitative data. Latent profile analysis (LPA) of illness behavior, analysis of variance (ANOVA) and multiple logistic regression were performed. Three latent classes of illness behavior were identified: low maladaptive illness behavior group, moderate maladaptive illness behavior group, and high maladaptive illness behavior group. Univariate analysis revealed statistically significant differences among the three latent classes with respect to education level, anxiety and depression, illness perception, uncertainty in illness and coping modes. Multiple logistic regression analysis revealed that marital status, family history of cancer, education level, family monthly income, anxiety and depression, illness perception, uncertainty in illness and coping modes were predictors of maladaptive illness behaviors among young and middle-aged CRC patients. The results of the study raise a concern of maladaptive illness behaviors in young and middle-aged colorectal cancer patients, highlighting the need for age-appropriate psychosocial care approaches to promote adjustment of the illness behaviors followed by the diagnosis and treatment of CRC.

Factors Influencing Knowledge and Attitudes towards Second-Hand Smoking Exposure Among University Students: An Exploratory Study.

Despite extensive global research on second-hand smoking (SHS) exposure, there is a noticeable lack of studies focusing on the knowledge and attitudes of university students in Bangladesh. This cross-sectional study aimed to address this gap by assessing the levels of knowledge and attitudes towards SHS exposure among university students in Bangladesh. Utilizing a convenience sampling technique, data were collected from 383 university students, encompassing socio-demographic information, as well as knowledge and attitude-related inquiries. Statistical analyses were conducted using SPSS software, including independent t-tests and analysis of variance (ANOVA) and multiple linear regression. The findings revealed that participants exhibited a moderate level of knowledge and attitude towards SHS exposure. Multiple linear regression identified age, gender, mother's education, and self-rated health status as significant predictors of knowledge, explaining 12.9% of its variance (R2 = 0.129, F = 6.117, P < .001). Furthermore, age, gender, and living with parents emerged as significant predictors of attitude, explaining 14.7% of its variance (R2 = 0.147, F = 7.165, P < .001). The study highlights the need for interventions aimed at enhancing awareness and fostering positive attitudes towards SHS exposure among university students in Bangladesh. It is recommended that university authorities organize seminars and implement health education initiatives targeting vulnerable populations to address the findings and promote a smoke-free environment on campus.

Readiness for hospital discharge among patients requiring home nutrition support: a cross-sectional study.

This study aimed to investigate readiness for hospital discharge of patients requiring home nutrition support and explore the factors that influence this readiness. This cross-sectional survey included 220 patients discharged from the general surgery department of a tertiary-care teaching hospital in China with home nutrition support. Readiness for Hospital Discharge Scale and Quality of Discharge Teaching Scale scores were calculated and general, disease- and therapy-related information were collected. Univariate, correlation, and multiple linear regression analyses were performed. The mean standardized total Readiness for Hospital Discharge Scale score was 7.33±1.65, with the subscales expected support, personal status, perceived coping ability, and knowledge scoring 7.40±1.78, 7.35±1.66, 7.30±1.73, and 7.26±1.74, respectively. The mean standardized Quality of Discharge Teaching Scale score was 7.48±1.59. The Quality of Discharge Teaching Scale score, length of hospital stay, expected length of home nutrition support, first-time use of home nutrition support, Nutrition Risk Screening 2002 score, and diagnosis were all identified as influencing factors of readiness for discharge (adjusted R2=0.564, F=14.5, p<0.001). Patients requiring home nutrition support were only moderately ready for discharge. Enhancing the quality of education on patient discharge could significantly improve readiness for discharge, in which patients who have been admitted for longer periods require more attention. They are expected to utilize home nutrition support in the long-term, are at risk of malnutrition, are using home nutrition support for the first time, or have a digestive system malignancy.

Readiness for hospital discharge and associated factors in patients with oral cancer: A cross-sectional study.

To evaluate the current status of discharge readiness among postoperative oral cancer patients and identify the primary associated factors. Information from 713 oral cancer patients was collected using questionnaire surveys. One-way ANOVA or t-tests were employed to compare differences in discharge readiness across various demographic characteristics. Correlation analyses were conducted to examine the relationships between discharge readiness and discharge teaching quality, as well as social support. Multiple stepwise regression analysis was utilized to identify independent factors associated with discharge readiness. The mean discharge readiness score of postoperative oral cancer patients was 89.52±8.63. Seven variables, such as age, marital status, and income, were identified as significant associated factors. Furthermore, both the quality of discharge teaching and social support exhibited a significant positive correlation with discharge readiness. Postoperative oral cancer patients had moderate levels of discharge readiness and social support but low levels of discharge teaching quality. Discharge readiness among these patients is linked to various factors.

Low energy density, high nutrient adequacy and high nutrient density are each associated with higher diet costs in Chinese adults from Henan Province

ObjectivesFood price is a determining factor in food choice which affect diet quality accordingly. However, the association between food price and diet quality has not been thoroughly discussed among Chinese adults. This study aimed to analyze the association of daily energy-adjusted dietary costs (CNY/2000 kcal) and diet quality among Chinese adults.MethodsA total of 680 Chinese adults aged above 25 years from Henan province were investigated in 2020. Three indices were adopted for evaluating diet quality: the nutrient-rich foods 9.2 (NRF 9.2) index for evaluating nutrient density, the mean adequacy ratio (MAR) for evaluating nutrient adequacy, energy density (ED) based on solid foods only for evaluating energy density. The daily energy-adjusted diet cost was calculated by dividing the estimated daily diet costs (CNY/day) by the energy intake per day (kcal/day) and multiplying the result by 2000.ResultsSubjects who closely adhered to the NRF9.2, MAR, and ED paid ¥8.92, ¥13.17, and ¥14.34 more for daily food consumption, respectively, than those who weakly adhered to these dietary patterns did. Furthermore, multiple linear regression analysis adjusted covariance revealed that an increase in ¥1 of the energy-adjusted diet cost per day was associated with changes of 0.494 units (P < 0.001), 0.003 units (P < 0.001), and − 0.018 units (P < 0.001) in the NRF9.2, MAR, and ED, respectively.ConclusionHigher energy-adjusted diet cost was associated with higher quality diets. This might be important for public health policies to develop strategies to promote healthy diets by regulating food supply and its costs.

Longitudinal relationship between internet addiction and psychotic-like experiences among Chinese college students.

While previous cross-sectional studies have suggested a link between psychotic-like experiences (PLEs) and internet addiction (IA), longitudinal evidence remains scarce. This study aimed to explore the prospective relationship between IA and PLEs among college students. A total of 636 college students (80% female) were assessed in November 2022 and again one year later. IA was measured using the Internet Addiction Diagnosis Questionnaire (IADQ), and PLEs were assessed with the 16-item Prodromal Questionnaire (PQ-16). Demographic, psychological, and environmental factors were collected and controlled. Multiple logistic regression and cross-lagged panel analyses examined the longitudinal associations between IA and PLEs. At baseline, the prevalence of IA and PLEs was 11.3% and 16.8%, respectively. Higher baseline IADQ scores (Adjusted odds ratio=1.035; 95% confidence interval=1.002-1.069; p=0.036) were independently associated with an increased risk of PLEs at follow-up, while baseline PQ-16 scores were not linked to later IA. Cross-lagged panel analysis revealed that IA at baseline predicted later PLEs (β=0.082, p=0.043), whereas baseline PLEs did not predict IA (β=0.049, p=0.255). Specifically, IA predicted unusual thoughts (β=0.122, p=0.003) and negative PLEs (β=0.111, p=0.008), but not perceptual abnormalities (β=0.040, p=0.301). IA may be an independent risk factor for PLEs in college students, particularly for unusual thoughts and negative PLEs, but not for perceptual abnormalities. Targeted interventions addressing IA may help reduce PLEs.

Association of systemic inflammatory markers with white matter hyperintensities and microstructural injury: an analysis of UK Biobank data.

White matter damage is closely associated with cognitive and psychiatric symptoms and is prevalent in cerebral small vessel disease (CSVD); although the pathophysiological mechanisms involved in CSVD remain elusive, inflammation plays a crucial role. We sought to investigate the relationship between systemic inflammation markers and imaging markers of CVSD, namely white matter hyperintensity (WMH) and microstructural injury. We conducted a study involving both cross-sectional and longitudinal data from the UK Biobank Cohort. We performed multiple linear regression analyses, adjusted for potential confounders, to explore the associations between systemic inflammation markers (e.g., systemic immune-inflammation index [SII], neutrophil-to-lymphocyte ratio [NLR], C-reactive protein [CRP] levels, monocyte count, neutrophil count) and macro- and microstructural white matter injury, as markers of CSVD. We performed Mendelian randomization analysis to investigate the genetically predictive effect of monocytes on WMH, as well as mediation analysis to clarify whether inflammatory markers affected cognitive function via white matter injury. We included 36 411 participants (mean age 54.8 ± 7.5 yr, 51.9% female) from the UK Biobank Cohort. We found that SII was significantly associated with both WMH and microstructural injury markers (fractional anisotropy, mean diffusivity, intracellular volume fraction, and isotropic compartment volume fraction [ISOVF]), and the neutrophil-to-lymphocyte ratio was significantly associated with WMH and some markers of microstructural injury (mean diffusivity and ISOVF). Our analysis revealed that the CRP level was significantly associated with WMH and WMH progression but not with microstructural injury. We also demonstrated that monocyte count was significantly associated with WMH and ISOVF, and that neutrophil count was significantly associated with WMH, mean diffusivity, and ISOVF. In 2-sample Mendelian randomization analyses, we found positive associations between genetic determinants of monocytes and WMH. The mediating role of WMH suggested that a higher SII value and monocyte count could contribute to cognitive impairment through white matter injury. Although the study includes both cross-sectional and longitudinal components, the sample size for the longitudinal aspect is limited, and the use of blood biomarkers from a single timepoint is also a limitation of this research. The SII and neutrophil-to-lymphocyte ratio may be early detection markers for white matter damage in patients with CSVD, whereas the CRP level is more closely associated with disease severity and progression. Our findings highlight the clinical relevance of systemic inflammation markers with white matter macro- and microstructural injuries, revealing that systemic inflammation is likely involved in the mechanism of early white matter injury among patients with CSVD.

The Impact of Body Mass Index and Benign Prostatic Hyperplasia on Bone Health of Middle-Aged and Older Men.

Osteoporosis significantly affects older adults by reducing bone mass and increasing fracture risk, thereby impacting morbidity and mortality. This study aimed to investigate the relationship between bone mineral density (BMD), body mass index (BMI), and trabecular bone score (TBS) among middle-aged and older men with or without benign prostatic hyperplasia (BPH). A retrospective study was conducted using health examination data from male participants aged 50-98years collected at a regional hospital in southern Taiwan. Simple and multiple linear regression analyses were employed to examine the relationships between TBS and the independent variables. A total of 3714 middle-aged and older men were included in the analysis. Findings indicated that higher BMI was associated with greater BMD; however, the relationship with TBS suggested potential bone quality degradation in cases of underweight and obesity. Multiple linear regression analysis demonstrated that age, waist circumference, BMD, underweight status, and obesity were significantly associated with TBS. This study revealed the associative relationship between BMI and bone health: higher BMI was associated with increased bone density but also related to a decline in bone quality as measured by TBS, particularly in cases of obesity. These results emphasized the importance of managing BMI to optimize both bone density and quality, especially in middle-aged and older men with or at risk of BPH.

Abstract TP144: Telemedicine Appointments early after Acute Ischemic Stroke may Reduce 30-day Emergency Department Visits

Introduction: Limiting the rate of unplanned emergency department (ED) revisits for patients with acute ischemic stroke is an important aspect of secondary stroke prevention. This is influenced by patients’ demographics, comorbidities, stroke severity, disposition destination, and may be impacted by early outpatient follow-up where stroke risk factors and etiology continue to be evaluated. Methods: We retrospectively identified all acute ischemic stroke patients discharged from an 11-hospital network, the largest healthcare system in the state of Georgia, from October 1, 2022 to March 31, 2024; we excluded patients who were discharged to a long-term acute care or hospice facility. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with ED visits within 30- and 90-days after discharge. Results: Of 2,191 patients, 143 (6.5%) had ED visits within 30 days and 296 (13.5%) within 90 days. The median age was 68 [IQR 57, 77]. History of heart failure (HF), atrial fibrillation (AF), chronic kidney disease and end stage renal disease each increased the likelihood of an ED re-visit within 30 and 90 days whereas diabetes mellitus increased the likelihood of an ED re-visit at 90 days only. In multiple logistic regression analyses, factors independently associated with 30-day ED visit was a history of HF (OR 1.57, 95% CI 1.07-2.28; p=0.02) and AF (OR 1.49, 95% CI 1.00-2.19; p=0.04); at 90 days, only an increased Charlson Comorbidity Index score was associated with ED visit (OR 1.09, 95% CI 1.02-1.16; p=0.01). There were 501 (23%) patients who completed an outpatient neurology clinic follow-up within 30 days of discharge, including 81 patients (4%) who completed a telemedicine outpatient visit; patients completing a telemedicine visit were less likely to have a 30-day ED visit than those who had an in-person visit (OR= 0.13, 95% CI 0.01-0.62; p=0.05). Conclusion: ED revisits after hospitalization for acute ischemic stroke are relatively common and associated with patients who have comorbid conditions including HF and AF. Our study suggests that telemedicine-based follow-ups were associated with lower rates of unplanned ED revisits within 30 days. Efforts to increase outpatient neurology clinic access through telemedicine may reduce ED visits after discharge for acute ischemic stroke patients.

Being underweight or obese in adolescence may increase the risk of female infertility later in life: The Japan Nurses' Health Study.

Underweight or obesity is associated with infertility in women, but large cohort studies with a life course perspective are rare. We explored the association between body mass index (BMI) at age 18 and subsequent infertility among Japanese women. In total, 15,907 married women aged 30-44years who participated in a prospective cohort baseline survey during 2001-2007 were cross-sectionally analyzed. Those with a history of cancer, and those with a partner with infertility or missing data were excluded. All data were obtained from self-reported questionnaires. The main outcome measure was infertility, defined as a self-reported history of infertility for at least 2years. Age and cause of infertility were also recorded. Overall, 2825 participants (17.8%) reported being infertile. The proportions of women who were underweight (BMI <18.5kg/m2), overweight (BMI ≥25 and<30kg/m2), and obese (BMI≥30kg/m2) at age 18 were 12.8%, 4.5%, and 0.4%, respectively. Multiple logistic regression analysis revealed a 1.31-fold and a 1.82-fold increase in the rate of infertility in those women who were underweight or obese during adolescence, respectively, compared with those of normal weight. Further analysis by cause of infertility revealed no significant associations with overweight or obesity at age 18, but being underweight was positively associated with infertility of unknown cause. Being underweight or obese at adolescence is a potential risk factor for subsequent infertility among Japanese women. In particular, being underweight during adolescence may be a contributing factor to unexplained infertility later in life.