Multivariate Longitudinal Analysis Research Articles

Building Financial Wellness: Randomized Controlled Trial of a Financial Education and Support Intervention.

Many people receiving services for psychiatric disorders live on low incomes, navigate complex financial situations, and have limited economic security. The authors sought to determine whether a financial wellness intervention delivered virtually by peers would increase financial literacy, reduce economic strain, and improve financial competency. One hundred participants receiving services for psychiatric disorders were recruited from community programs and via social media and were randomly assigned (1:1) to receive either an intervention called Building Financial Wellness (N=51) or services as usual (N=49). The intervention involved six virtual 1.5-hour group sessions, followed by three virtual one-on-one booster sessions. Outcomes were assessed with the Consumer Financial Protection Bureau's Financial Well-Being Scale (primary), Financial Strain Questionnaire, Financial Capability Scale, and Financial Self-Sufficiency Scale. Knowledge regarding money management was measured with a financial literacy assessment based on class content. Intent-to-treat longitudinal multivariable analysis included random-effects linear and logistic regression models. Overall, 86% of the study participants either lived in poverty (46%) or met the federal definition of low income (40%). Participants assigned to the intervention had greater improvement over time in financial well-being, capability, strain, self-sufficiency, and literacy. Satisfaction with the intervention was high. Reports from participants receiving booster sessions indicated that ongoing support facilitated their achievement of longer-term financial goals. Provision of financial education and support improved monetary well-being, competence, and literacy. With poverty long considered to be an intractable problem associated with psychiatric disorders, peer-taught financial education focused on financial wellness can help people acquire money management skills and manage economic stressors.

Developmental patterns of athletic performance and physical fitness in youth baseball players: A longitudinal analysis

ABSTRACT This study aimed to evaluate developmental patterns in athletic performance during youth and determine their association with changes in physical fitness. The testing included three athletic performance (i.e. ball speed in pitching, swing velocity in batting, 30-metre sprint time) and two physical fitness tests (i.e. medicine ball [MB] back throw and modified star excursion balance test [SEBT]). Data from 235 players (557 measurements) aged 6 to 14 were eligible for a longitudinal evaluation. The statistical analysis was based on the latent growth curve models of the athletic performance development process and the random-effect panel data multivariate regression analysis for ball speed, swing velocity, and 30-metre sprint time. The 30-metre sprint time showed a small curvature but an accelerated increase around 12‒13 years old. However, the ball speed, swing velocity, and modified SEBT demonstrated a slower or less accelerated change in the developmental pattern starting around 12‒13 years old. Multivariate longitudinal analysis revealed that developmental change in athletic performance was positively associated with age and MB back throw. Our findings highlight the developmental patterns of athletic performance associated with baseball exhibiting stagnation as well as acceleration, which may help develop effective age-appropriate strategies for improving performance in youth baseball players.

Estimating pneumococcal carriage dynamics in adults living with HIV in a mature infant pneumococcal conjugate vaccine programme in Malawi, a modelling study

BackgroundAdults living with human immunodeficiency virus (ALWHIV) receiving antiretroviral therapy (ART) exhibit higher pneumococcal carriage prevalence than adults without HIV (HIV-). To assess factors influencing high pneumococcal carriage in ALWHIV, we estimated pneumococcal carriage acquisition and clearance rates in a high transmission and disease-burdened setting at least 10 years after introducing infant PCV13 in routine immunisation.MethodsWe collected longitudinal nasopharyngeal swabs from individuals aged 18–45 in Blantyre, Malawi. The study group included both HIV- individuals and those living with HIV, categorised based on ART duration as either exceeding 1 year (ART > 1y) or less than 3 months (ART < 3 m). Samples were collected at baseline and then weekly for 16 visits. To detect pneumococcal carriage, we used classical culture microbiology, and to determine pneumococcal serotypes, we used latex agglutination. We modelled trajectories of serotype colonisation using multi-state Markov models to capture pneumococcal carriage dynamics, adjusting for age, sex, number of under 5 year old (< 5y) children, social economic status (SES), and seasonality.ResultsWe enrolled 195 adults, 65 adults in each of the study groups. 51.8% were females, 25.6% lived with more than one child under 5 years old, and 41.6% lived in low socioeconomic areas. The median age was 33 years (IQR 25–37 years). The baseline pneumococcal carriage prevalence of all serotypes was 31.3%, with non-PCV13 serotypes (NVT) at 26.2% and PCV13 serotypes (VT) at 5.1%. In a multivariate longitudinal analysis, pneumococcal carriage acquisition was higher in females than males (hazard ratio [HR], NVT [1.53]; VT [1.96]). It was also higher in low than high SES (NVT [1.38]; VT [2.06]), in adults living with 2 + than 1 child < 5y (VT [1.78]), and in ALWHIV on ART > 1y than HIV- adults (NVT [1.43]). Moreover, ALWHIV on ART > 1y cleared pneumococci slower than HIV- adults ([0.65]). Residual VT 19F and 3 were highly acquired, although NVT remained dominant.ConclusionsThe disproportionately high point prevalence of pneumococcal carriage in ALWHIV on ART > 1y is likely due to impaired nasopharyngeal clearance, which results in prolonged carriage. Our findings provide baseline estimates for comparing pneumococcal carriage dynamics after implementing new PCV strategies in ALWHIV.

Impact of Cystic Fibrosis Transmembrane Conductance Regulator Modulators on Maternal Outcomes During and After Pregnancy

Cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators are available to the majority of people with CF in the United States; little is known about pregnancy outcomes with modulator use. The aim of this retrospective study was to determine the impact of CFTR modulators on maternal outcomes. Does pregnancy differentially affect outcomes in female subjects with CF with and without CFTR modulator exposure? Data on pregnancies from 2010 to 2021 were collected from 11 US adult CF centers. Multivariable longitudinal regression analysis was performed to assess whether changes in percent predicted FEV1 (ppFEV1), BMI, pulmonary exacerbations (PEx), and Pseudomonas aeruginosa prevalence differed from prior to, during, and following pregnancy according to CFTR modulator use while adjusting for confounders. Infant outcomes are also described based on maternal modulator use. Among 307 pregnancies, mean age at conception was 28.5 years (range, 17-42 years), prepregnancy ppFEV1 was 74.2, and BMI was 22.3kg/m2. A total of 114 pregnancies (37.1%) had CFTR modulator exposure during pregnancy (77 with highly effective modulator therapy [HEMT] and 37 with other modulators). The adjusted mean change in ppFEV1 from prepregnancy to during pregnancy was -2.36 (95%CI, -3.56 to -1.16) in the unexposed group and 2.60 (95%CI, 0.23 to 4.97) in the HEMT group, with no significant change from during pregnancy to 1 year postpregnancy. There was an overall decline in ppFEV1 from prepregnancy to postpregnancy in the no modulator group (-2.56; 95%CI, -3.62 to -1.49) that was not observed in the HEMT group (1.10; 95%CI, -1.13 to 3.34). PEx decreased from prepregnancy to postpregnancy in the HEMT group, and BMI increased from prepregnancy to during pregnancy in all groups but with no significant change postpregnancy. Missing infant outcomes data precluded firm conclusions. We observed superior pregnancy and postpregnancy pulmonary outcomes in individuals who used HEMT, including a preservation of ppFEV1, compared with those unexposed to HEMT.

Branched-Chain and Aromatic Amino Acids, Type 2 Diabetes, and Cardiometabolic Risk Factors among Puerto Rican Adults.

(1) Background: Branched-chain and aromatic amino acids (BCAAs/AAAs) have been considered as markers of type 2 diabetes (T2D); however, studies on associations between these metabolites and T2D and cardiometabolic traits in Hispanic populations are limited. The aim of this study was to examine the associations between baseline BCAAs (isoleucine, leucine, valine)/AAAs (phenylalanine, tyrosine) and prevalent and incident T2D, as well as baseline and longitudinal (2 year) changes in cardiometabolic traits (measures of glycemia, dyslipidemia, inflammation, and obesity) in two large cohorts of adults of Puerto Rican descent. (2) Methods: We included participants of the Boston Puerto Rican Health Study (BPRHS, n = 670) and San Juan Overweight Adult Longitudinal study (SOALS, n = 999) with available baseline metabolite and covariate data. T2D diagnosis was defined based on American Diabetes Association criteria. Multivariable logistic (for baseline T2D), Poisson (for incident T2D), and linear (for cardiometabolic traits) regression models were used; cohort-specific results were combined in the meta-analysis and adjusted for multiple comparisons. (3) Results: Higher baseline BCAAs were associated with higher odds of prevalent T2D (OR1SD BCAA score = 1.46, 95% CI: 1.34-1.59, p < 0.0001) and higher risk of incident T2D (IRR1SD BCAA score = 1.24, 95% CI: 1.13-1.37, p < 0.0001). In multivariable longitudinal analysis, higher leucine and valine concentrations were associated with 2-year increase in insulin (beta 1SD leucine = 0.37 mcU/mL, 95% CI: 0.11-0.63, p < 0.05; beta 1SD valine = 0.43 mcU/mL, 95% CI: 0.17-0.68, p < 0.01). Tyrosine was a significant predictor of incident T2D (IRR = 1.31, 95% CI: 1.09-1.58, p < 0.05), as well as 2 year increases in HOMA-IR (beta 1SD tyrosine = 0.13, 95% CI: 0.04-0.22, p < 0.05) and insulin concentrations (beta 1SD tyrosine = 0.37 mcU/mL, 95% CI: 0.12-0.61, p < 0.05). (4) Conclusions: Our results confirmed the associations between BCAAs and prevalent and incident T2D, as well as concurrent measures of glycemia, dyslipidemia, and obesity, previously reported in predominantly White and Asian populations. Baseline leucine, valine, and tyrosine were predictors of 2 year increases in insulin, whereas tyrosine was a significant predictor of deteriorating insulin resistance over time. Our study suggests that BCAAs and tyrosine could serve as early markers of future glycemic changes in Puerto Ricans.

A Longitudinal Multivariable Analysis: State Policies and Opioid Dispensing in Medicare Beneficiaries Undergoing Surgery.

States have implemented policies to decrease clinically unnecessary opioid prescribing, but few studies have examined how state policies affect opioid dispensing rate trends for surgical patients. To examine trends in the perioperative opioid dispensing rates for fee-for-service Medicare beneficiaries and the effects of select state policies. A retrospective cohort study using 2006 to 2018 Medicare claims data for individuals undergoing surgical procedures for which opioid analgesic treatment is common. State policies mandating prescription drug monitoring program (PDMP; PDMP policies) use, initial opioid prescription duration limit (duration limit policies), and mandated continuing medical education (CME; CME pain policies) on pain management. Opioid dispensing rates, days' supply, and the daily morphine milligram equivalent dose (MMED). The percentage of Medicare beneficiaries dispensed opioids in the perioperative period increased from 2007 to 2018; MMED and days' supply decreased over the same period, with significant variation by age, sex, and race. None of the three state policies affected the likelihood of Medicare beneficiaries being dispensed perioperative opioids. However, CME pain policies and duration limit policies were associated with decreased days' supply and decreased MMED in the several years following implementation, respectively. While we observed a slight increase in the rate of Medicare beneficiaries dispensed opioids perioperatively and a substantial decrease in MMED and days' supply for those receiving opioids, state policies examined had relatively modest effects on the main measures. Our findings suggest that these state policies may have a limited impact on opioid dispensing for a patient population that is commonly dispensed opioid analgesics to help control surgical pain, and as a result may have little direct effect on clinical outcomes for this population. Changes in opioid dispensing for this population may be the result of broader societal trends than such state policies.

Association of estimated plasma volume with new onset acute kidney injury in hospitalized COVID-19 patients

PurposeTo explore the association of estimated plasma volume (ePV) and plasma volume status (PVS) as surrogates of volume status with new-onset AKI and in-hospital mortality among hospitalized COVID-19 patients. Materials and methodsWe performed a retrospective multi-center study on COVID-19-related ARDS patients who were admitted to the Mayo Clinic Enterprise health system. Plasma volume was calculated using the formulae for ePV and PVS, and longitudinal analysis was performed to find the association of ePV and PVS with new-onset AKI during hospitalization as the primary outcome and in-hospital mortality as a secondary outcome. ResultsOur analysis included 7616 COVID-19 patients with new-onset AKI occurring in 1365 (17.9 %) and a mortality rate of 25.96 % among them. A longitudinal multilevel multivariate analysis showed both ePV (OR 1.162; 95 % CI 1.048–1.288, p = 0.004) and PVS (OR 1.032; 95 % CI 1.012–1.050, p = 0.001) were independent predictors of new onset AKI. Higher PVS was independently associated with increased in-hospital mortality (OR 1.038, 95 % CI 1.007–1.070, p = 0.017), but not ePV (OR 0.868, 95 % CI 0.740–1.018, p = 0.082). ConclusionA higher PVS correlated with a higher incidence of new-onset AKI and worse outcomes in our cohort of hospitalized COVID-19 patients. Further large-scale and prospective studies are needed to understand its utility.

An expanded chronic care management approach to multiple chronic conditions in Hispanics using community health workers as community extenders in the Rio Grande Valley of Texas

IntroductionThe synergistic negative effects of type 2 diabetes (T2DM) and hypertension increases all-cause mortality and the medical complexity of management, which disproportionately impact Hispanics who face barriers to healthcare access. The Salud y Vida intervention was delivered to Hispanic adults living along the Texas-Mexico Border with comorbid poorly controlled T2DM and hypertension. The Salud y Vida multicomponent intervention incorporated community health workers (CHWs) into an expanded chronic care management model to deliver home-based follow-up visits and provided community-based diabetes self-management education. MethodsWe conducted multivariable longitudinal analysis to examine the longitudinal intervention effect on reducing systolic and diastolic blood pressure among 3806 participants enrolled between 2013 and 2019. Participants were compared according to their program participation as either higher (≥ 10 combined educational classes and CHW visits) or lower engagement (<10 encounters). Data was collected between 2013 and 2020. ResultsBaseline mean systolic and diastolic blood pressure were 138 and 81 mmHg respectively. There were overall improvements in systolic (−6.49; 95% CI = [−7.13, −5.85]; p < 0.001) and diastolic blood pressure (−3.97; 95% CI = [−4.37, −3.56]; p < 0.001). The higher engagement group had greater systolic blood pressure reduction at 3 months (adjusted mean difference = −1.8 mmHg; 95% CI = [−3.2, −0.3]; p = 0.016) and at 15 month follow-up (adjusted mean difference = −2.3 mmHg; 95% CI = [−4.2, −0.39]; p = 0.0225) compared to the lower engagement group. ConclusionThis intervention, tested and delivered in a real-world setting, provides an example of how CHW integration into an expanded chronic care model can improve blood pressure outcomes for individuals with co-morbidities.

Impact of serum leptin and adiponectin levels on brain infarcts in patients with mild cognitive impairment and Alzheimer's disease: a longitudinal analysis.

The adipokines leptin and adiponectin have been associated with atherosclerosis and the risk of cerebral infarcts. Pre-clinical studies, however, suggest a protective role against ischemic brain damage. In this study we analyzed the relationship between serum leptin and adiponectin levels and the onset or progression of brain infarcts in subjects with mild cognitive impairment (MCI) and Alzheimer's disease (AD). All data were extracted from the ADNI database. The final population included 566 subjects, with 58 healthy controls, 396 MCI and 112 AD. All patients with available serum leptin and adiponectin levels at baseline were selected. Demographics, neuropsychological test results, CSF biomarkers, regional brain metabolism with FDG-PET data and the number of brain infarcts on longitudinal MRI scans were extracted. Leptin levels were significantly lower in patients with MCI than controls at baseline, while adiponectin levels were not different between the groups. Multivariate logistic regression analysis at baseline for the presence of brain infarcts showed a predictive value for leptin but not for adiponectin. Multivariate longitudinal analysis showed that age was the only significant predictor of brain infarcts development at 15-year follow-up, while serum leptin and adiponectin levels did not play a role in this population. The evidence on the pathogenetic or protective role of adipokines on ischemic brain damage is mixed. In this MCI and AD population, serum leptin and adiponectin were not associated with the development of brain infarcts; therefore, these results do not support the use of adipokines as biomarkers of cerebrovascular pathology in this population.

Abstract 3410: Financial toxicity among patients with advanced prostate cancer in the United States

Abstract Background: Advanced prostate cancer is defined as metastatic hormone-sensitive prostate cancer (mHSPC) or castration-resistant prostate cancer (CRPC). Newer and aggressive treatments are leading to increasing lifespans in this population. As such, studying quality of life could have a large impact on the survivorship experience. An important component of quality of life is financial toxicity, defined as the financial burden and distress that can arise for patients and their families because of cancer treatment. Objectives: To understand the prevalence and predictors of financial toxicity in advanced prostate cancer. Methods: IRONMAN (International Registry of Men with Advanced Prostate Cancer) is a prospective cohort of patients with newly diagnosed mHSPC or CRPC enrolling in 15 countries. Financial toxicity was collected using the EORTC QLQ-C30 (“has your physical condition or medical treatment caused you financial difficulties?”) at enrollment and every three months thereafter. For this analysis, we studied 997 patients cared for at 37 US sites enrolled from 7/2017 to 7/2023. We examined baseline and longitudinal reports of financial toxicity across clinical and demographic factors: age at enrollment, race and ethnicity, disease state, marital status, education, employment, military status, and type of health center. We conducted adjusted risk difference analysis and multivariable regression modeling to identify predictors of financial toxicity using a generalized estimating equations approach to calculate odds ratios (OR and 95% confidence intervals, CI). Results: At enrollment, 125 (13%) patients reported experiencing “quite a bit” or “very much” financial toxicity. 21% of Black patients experienced toxicity compared to 10% of White patients. Even after incorporating all other predictors, Black patients experienced 5% (95% CI: 0, 11) greater toxicity than White patients. Independently of other predictors, patients &amp;gt;75 experienced 11% (CI: -17, -4) lower toxicity compared to those &amp;lt;65 years (while patients in the 65-74 group experienced 6% less, CI: -12, 1). Toxicity was 6% greater in patients with mHSPC (CI: 2, 10) than in patients with CRPC, and disabled or unemployed patients were at substantially higher risk. In the multivariable longitudinal analyses, older age (&amp;gt; 75) remained associated with significantly lower odds for financial toxicity (OR: 0.30, 0.15-0.61) while mHSPC (OR: 1.91, 1.14-3.20) and being unemployed (OR: 2.69, 1.03-6.99) or disabled (OR: 5.14, 2.29-11.6) were associated with higher odds. Conclusions: Financial toxicity is prevalent in advanced prostate cancer, especially in patients who are Black, younger than 75, diagnosed with mHSPC, or unemployed/disabled. These results may inform identification of patients at high risk for financial toxicity to support delivery of patient-situation-informed care by clinicians and targeted aid for patients at highest risk. Citation Format: Isani Singh, Bailey Vaselkiv, Emily Rencsok, Karen Autio, Deborah Enting, Alicia Morgans, Joel Nowak, Kevin Kensler, David Nanus, Robert Dreicer, Brian Lewis, Oliver Sartor, Elisabeth Heath, Phillip Kantoff, Deborah Kaye, Daniel George, Lorelei Mucci. Financial toxicity among patients with advanced prostate cancer in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3410.

Trajectories of Kidney Function in Heart Failure Over a 15-Year Follow-Up: Clinical Profiling and Mortality

BackgroundLimited data are available on the long-term trajectory of estimated glomerular filtration rate (eGFR) in patients with chronic heart failure. ObjectivesThe authors evaluated eGFR dynamics using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation and its prognostic significance in a real-world cohort over a 15-year follow-up. MethodsA prospective observational registry of ambulatory heart failure outpatients was conducted, with regular eGFR assessments at baseline and on a 3-month schedule for ≤15 years. Urgent kidney function assessments were excluded. Locally weighted error sum of squares curves were plotted for predefined subgroups. Multivariable longitudinal Cox regression analyses were conducted to assess associations with all-cause and cardiovascular death. ResultsA total of 2,672 patients were enrolled consecutively between August 2001 and December 2021. The average age was 66.8 ± 12.6 years, and 69.8% were men. Among 40,970 creatinine measurements, 28,634 were used for eGFR analysis, averaging 10.7 ± 8.5 per patient. Over the study period, a significant decline in eGFR was observed in the entire cohort, with a slope of −1.70 mL/min/1.73 m2 per year (95% CI: −1.75 to −1.66 mL/min/1.73 m2 per year). Older patients, those with diabetes, a preserved ejection fraction, a higher baseline eGFR, elevated hospitalization rates, and those who died during follow-up experienced more pronounced decreases in the eGFR. Moreover, the decrease in kidney function correlated independently with all-cause mortality and cardiovascular death. ConclusionsThese findings highlight the sustained decline in eGFR over 15 years in patients with heart failure, with variations based on clinical characteristics, and emphasize the importance of regular eGFR monitoring in this population.

Circulating biomarkers of airflow limitation across the life span

BackgroundAirflow limitation is a hallmark of COPD, which can develop through different lung function trajectories across the life span. There is a need for longitudinal studies aimed at identifying circulating biomarkers of airflow limitation across different stages of life. ObjectiveTo identify a signature of serum proteins associated with airflow limitation and evaluate their relation to lung function longitudinally in adults and children. MethodsWe used data from three adult (TESAOD, SAPALDIA, LSC) and one birth (TCRS) cohort (total N=1,940). In TESAOD, among 46 circulating proteins, we identified those associated with FEV1/FVC % predicted levels and generated a score based on the sum of their z-scores. In cross-sectonal analyses, we tested the score for association with concomitant lung function. In longitudinal analyses, we tested the score for association with subsequent lung function growth in childhood and decline in adult life. ResultsAfter FDR, serum levels of five proteins (Haptoglobin, CEA, ICAM1, CRP, TIMP1) were associated with % predicted levels of FEV1/FVC and FEV1 in TESAOD. In cross-sectional multivariate analyses the 5-biomarker score was associated with FEV1 % predicted in all adult cohorts (meta-analyzed FEV1 decrease for 1-SD score increase: -2.9%; 95% CI: -3.9%, -1.9%; p=2.4x10-16). In multivariate longitudinal analyses, the biomarker score at 6 years of age was inversely associated with FEV1 and FEV1/FVC levels attained by young adult life (p=0.02 and 0.005, respectively). In adults, persistently high levels of the biomarker score were associated with subsequent accelerated decline of FEV1 and FEV1/FVC (p=0.01 and 0.001). ConclusionA signature of five circulating biomarkers of airflow limitation was associated with both impaired lung function growth in childhood and accelerated lung function decline in adult life, indicating that these proteins may be involved in multiple lung function trajectories leading to COPD.

Changes in the Perceptions of the Neighborhood Environment and Physical Activity Patterns Among Mexican Americans on the Texas-Mexico Border.

Little research on the association of neighborhood environment with physical activity in resource-poor communities has been done. This study assessed changes in perceptions of the neighborhood environment and the association between those perceptions and physical activity in Mexican Americans on the Texas-Mexico border in an area where there would be community efforts to enhance pedestrian and cycling infrastructure and programming. We analyzed data from a population-based cohort of Mexican American individuals on the Texas-Mexico border. From 2008 to 2018, interviewer-administered questionnaires were used to collect perceptions of neighborhood environment and physical activity at baseline, 5- and 10-year follow-ups, and at other ancillary study visits, with an average of 3 data points per participant. We conducted multivariable longitudinal logistic regression analyses to assess if the changes in odds of positive perceptions of the neighborhood environment over the study years differed by physical activity patterns. The sample (n = 1036) was mostly female (71%), born in Mexico (70%), and had no health insurance (69%). We saw improvements in the perceptions of several neighborhood environment attributes from 2008 to 2018, though we saw different longitudinal trajectories in these perceptions based on an individual's longitudinal physical activity patterns. By 2014-2018, we saw significantly higher positive perceptions of the neighborhood environment for those who consistently met physical activity guidelines compared with those who did not (adjusted rate ratio = 1.12, P = .049). We found that perceptions of many neighborhood environment attributes improved between 2008 and 2018, and that overall positive perceptions were associated with consistently meeting physical activity guidelines over time.

Prenatal coparenting and attachment style in Japanese pregnant women: A cross-sectional survey.

Developing prenatal coparenting is important for preparing couples for parenting immediately after childbirth, but knowledge of prenatal coparenting remains limited. Adult attachment style has been shown to be one of the factors during pregnancy that predict coparenting after childbirth, as well as a significant factor in the developmental process of the coparenting relationship. The present study mainly examines the relationship between prenatal coparenting as perceived by pregnant women and their attachment style. A cross-sectional survey was conducted at a tertiary emergency medical facility in Japan. Data from 181 pregnant women at 22-36 weeks' gestation who completed a self-reported questionnaire consisting of the Prenatal Coparenting Scale (PCS), relationship-specific attachment styles, and characteristics were subjected to analysis. The mean age of the women in this study was 33.1 years (standard deviation = 5.2), 80 (44.2%) were expecting their first child, and 101 (55.8%) were expecting their second or subsequent child. Women's attachment avoidance toward their mother (r = -.26), father (r = -.23), and partner (r = -.60) and attachment anxiety toward their partner (r = -.33) were significantly negatively correlated with PCS scores. When classified into two groups by fetal birth order, attachment avoidance and attachment anxiety toward the partner were significantly negatively correlated with PCS scores, regardless of fetal birth order. Unlike attachment style toward the partner, attachment avoidance toward the mother (r = -.33) and father (r = -.32) was significantly negatively correlated with PCS scores in the group of women expecting their second or subsequent child only. These results provide valuable insights into the relationship between prenatal coparenting and adult attachment style and deepen the understanding of prenatal coparenting. Future studies using longitudinal surveys and multivariate analyses could present relevant suggestions for specific types of support that promote the development of prenatal coparenting.

Stress and job satisfaction over time, the influence of the managerial position: A bivariate longitudinal modelling of Wittyfit data.

The managerial position affects stress and job satisfaction of workers, but these influences have always been studied separately. We aimed to assess bivariate influence of the managerial position on workers' stress and job satisfaction and the inter-relationship of these indicators over time. We have analyzed data from workers who use the Wittyfit software, collected annually between 2018 and 2021. Stress and job satisfaction were evaluated by self-report questionnaires. Job position (manager or employee) was provided by the software's client companies. Data of 704 workers were included in the study. Cross-sectional and longitudinal multivariate analyses revealed that managerial position improves job satisfaction (p<0.001), but not stress (p = 0.4). Overall, while workers' job satisfaction has improved (p<0.001), stress has remained stable over time (p = 0.3). Three latent groups, with specific evolutionary multi-trajectory of stress and job satisfaction were identified in the sample (entropy = 0.80). Age and seniority, but not gender tended to influence managers' and employees' indicators. Over time, stress and job satisfaction have tended to negatively interconnect, in cross-section and in a cross-lagged manner (p<0.001). The managerial position improves workers' job satisfaction but has no effect on stress. Sociodemographics including age and seniority, but not gender, can affect this relationship. Stress and job satisfaction can influence each other, both cross-sectionally and over time. To be more effective, organizations should implement holistic strategies targeting multiple indicators. Clinicaltrials.gov: NCT02596737.

Presence and detection of endogenous steroids in the horse-A review.

Detection of doping with steroids that are also endogenous in the horse can be challenging, and a variety of approaches to distinguish exogenous administration from their natural presence are employed. Knowledge of endogenous concentrations of various steroids in different genders of horses (intact male, castrated male and female) and factors that could naturally affect them is beneficial for establishing ways for detection of their use. The current internationally adopted approaches include concentration-based thresholds in urine and plasma, steroid ratios in urine and targeting the administered intact steroid esters in plasma and hair. However, these have their limitations, and therefore, other strategies, such as additional biomarkers and steroid profiling based on longitudinal testing and multivariate analysis, have been investigated and could potentially improve detection of the use of endogenous steroids in horses. This paper aims to provide a comprehensive overview of the steroids (androgens, oestrogens and progestogens) that have been reported to be endogenous to horses in literature, their concentration ranges in different genders and factors potentially affecting them as well as current and possible future approaches to detect their use.

How adolescents’ popularity perceptions change: Measuring interactions between popularity and friendship networks

Longitudinal multivariate social network analysis (N=3692 adolescents; 136 classrooms) showed that adolescents were more likely to perceive their friends as popular but did not choose peers that they perceived to be popular as friends. Adolescents aligned their perceptions of popularity with their friends. Adolescents who received many popularity nominations attracted more popularity but not more friendship. Friends of peers seen as popular by an individual were more likely to be seen as popular by that individual. These results highlight the importance of describing popularity as a network, exploring dyadic, triadic, and group processes separately.

Multivariate longitudinal analysis for the association between brain atrophy and cognitive impairment in prodromal Huntington's disease subjects.

Cognitive impairment has been widely accepted as a disease progression measure prior to the onset of Huntington's disease. We propose a sophisticated measurement error correction method that can handle potentially correlated measurement errors in longitudinally collected exposures and multiple outcomes. The asymptotic theory for the proposed method is developed. A simulation study is conducted to demonstrate the satisfactory performance of the proposed two-stage fitting method and shows that the independent working correlation structure outperforms other alternatives. We conduct a comprehensive longitudinal analysis to assess how brain striatal atrophy affects impairment in various cognitive domains for Huntington's disease.

Health-related quality of life among adults newly diagnosed with pulmonary tuberculosis in Lagos State, Nigeria: a prospective study.

Tuberculosis (TB) has far-reaching effects on the social, mental, and emotional well-being of patients and consequently, their health-related quality of life (HRQOL). Few studies in Nigeria have examined changes in quality of life over the course of treatment. changes in (PTB) and factors associated with HRQOL. A prospective cohort study was conducted with patients recruited from health facilities in Lagos State. The World Health Organization Quality of Life Instrument, Short-Form (WHOQOL-BREF) was used to assess HRQOL. A semi-structured questionnaire was also administered to elicit information on socio-demographic characteristics and the medical and social history of the respondents. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23. A repeated measures analysis of variance (ANOVA) test with polynomial contrasts was used to assess how domain scores varied over time. Multivariable analysis was conducted using generalized estimating equations (GEE) to assess change in HRQOL and its predictors. Two hundred and ten patients, predominantly male [108 (63.3%)] were recruited. The mean age was 36.7 ± 12.3years. The HRQOL was impaired in all four domains at baseline. However, HRQOL scores increased over the treatment period with the largest improvement being in the 'environment' domain, where mean scores increased from 45.27 ± 14.59 to 61.28 ± 15.86. The proportion of respondents that expressed satisfaction with their health increased from 13.5% at baseline to 55.7% at the end of treatment. Low socio-economic status, delay in presentation, and an HIV-positive status were found to be significantly associated with reduced HRQOL at baseline (p < 0.05). In the multivariable longitudinal analysis, patients who were employed had higher HRQOL scores while persistent symptoms and a delay in presentation (≥ 4weeks) were negatively associated with change in HRQOL scores over the course of treatment. The HRQOL of respondents progressively improved over the six-month treatment period. However, change in HRQOL was influenced by a delay in presentation and persistence of symptoms. The study also highlights the need for increased recognition of patient-reported outcomes as an adjunct outcome measure.

Racial Disparities in Opioid Use and Lumbar Spine Surgery for Chronic Pain and in Pain and Function Over 3 Years: A Retrospective Cohort Study

This study aims to compare treatments and outcomes among Black and White patients with chronic low back pain in the United States. A retrospective cohort study was conducted within a pain research registry, including 1,443 participants with up to 3 years of follow-up. Pain treatments were measured at quarterly research encounters using reported current opioid use and prior lumbar spine surgery. Pain intensity and functional disability were also measured quarterly with a numerical rating scale and the Roland-Morris Disability Questionnaire, respectively. Longitudinal data were analyzed with generalized estimating equations, including multivariable models to measure temporal trends and adjust for potential confounders. The mean baseline age of participants was 53.5 years (SD, 13.1 years); 1,074 (74.4%) were female, and 260 (18.0%) were Black. In longitudinal multivariable analyses, Black participants reported more frequent current opioid use (odds ratio, 1.40; 95% confidence interval [CI], 1.03–1.91; P = .03) and less frequent lumbar spine surgery (odds ratio, .45; 95% CI, .28–.72; P < .001). Black participants also reported greater pain intensity (mean, 6.6; 95% CI, 6.3–6.9 vs mean, 5.6; 95% CI, 5.4–5.8; P < .001) and functional disability (mean, 15.3; 95% CI, 14.6–16.0 vs mean, 13.8; 95% CI, 13.2–14.3; P = .002). Racial disparities were clinically important (risk ratio = 1.28 and risk ratio = .49, respectively, for opioid use and surgery; and d = .46 and d = .24, respectively, for pain and function). Racial disparities in pain and function also widened over time. Thus, barriers to guideline-adherent and specialized pain care among Black patients may affect pain and function outcomes. Greater efforts are needed to address the observed racial disparities. PerspectiveWidening racial disparities in pain and function over time indicate that new approaches to chronic pain management are needed in the United States. Considering race as a social framework represents an emerging strategy for planning and improving pain treatment services for Black patients.