Multinominal Logistic Regression Research Articles

Preferences on treatment decision making in sarcoma patients. Prevalence and associated factors - Results from the PROSa Study.

The impact of being diagnosed with a life-threatening illness may influence preferences to participate in treatment decisions. The objective of this analysis was to identify factors that are associated with sarcoma patients wanting to take a more active or passive role. Data was obtained as part of a nationwide multicenter study (PROSa) aiming to investigate the structure and quality of medical care of sarcoma patients in Germany and their determinants. The study was conducted between 2017 and 2020 in 39 study centers. For the present analysis, cross-sectional data of adult patients with sarcoma of any entity were analyzed. Control preference was measured with the control preference scale (CPS). Preferences were divided in patient-led, shared, or physician-led-decision-making. Associated factors were analyzed exploratively using multivariable multinominal logistic regression models. We included socio-economical and medical variables with stepwise backward variable selection. We included 1081 patients (48.6% female). 402 patients (37.2%) preferred to be in control about treatment decisions, while 400 patients (37.0%) favored shared responsibility. 25.8% (n = 279) wished to rather leave the control to the treating physician. Older patients were more likely to prefer shared decision-making than younger patients aged 18 to 40 years (age group: > 75 years: Odds Ratio (OR) .53, 95% confidence interval (95% CI) .28; .99). Patients with a metastatic tumor desired shared decision making compared to those without metastases (metastasis: OR 1.61, 95% CI 1.09; 2.38). When comparing the patients who preferred physician-led decision making with those who favored to be in control, older patients also preferred leaving the control to the physician and were less inclined to make the decisions by themselves: (18 to > 40 years vs > 75 years: OR .28, 95% CI .15; .55). With secondary school (8/9 years) as reference, patients holding a high school degree were more likely to prefer patient-led decision-making over physician-led decision making (OR 2.00, 95% CI 1.26; 3.09). Patients with sarcoma of the abdomen/retroperitoneum were more predisposed to taking control in treatment decisions compared to those with sarcoma of the back/spine or lower limb (back/spine: OR .18, 95% CI .06; .54, lower limb: OR .56, 95% CI .37; .85). With an income of 1250 €/month as reference, patients with a higher income were more likely to take control (> 2750€/month: OR 1.7, 95% CI 1.0; 3.1). The findings of our study demonstrate that patients with metastatic disease are more likely to seek a joint decision, while those of higher age and lower education level are less likely to actively participate in treatment decisions. The results suggest that the impact of advanced illness may influence preferences to participate.

Place of death and healthcare utilisation at the end of life among individuals with mental and behavioural disorders as underlying cause of death: population-level multiple-register study.

Understanding the place of death for individuals with mental and behavioural disorders (MBDs) is essential for identifying disparities in healthcare access and outcomes, as well as addressing broader health inequities within this population. To examine the place of death among individuals in Sweden with the underlying cause of death reported as a MBD and compare variations between diagnostic groups, as well as explore associations between place of death and individual, sociodemographic and clinical factors. This population-level analysis used death certificate data (gender, age, underlying cause of death and place of death) recorded between 2013 and 2019 and other national register data. MBD group differences were compared using chi-square tests (χ2) and multinominal logistic regressions explored variations in place of death. The final sample consisted of 2875 individuals. Our regression model revealed that individuals with MBDs other than intellectual disabilities were less likely to die in hospitals (odds ratio 0.60-0.134 [95% CI = 0.014-0.651]) or care homes (odds ratio 0.11-0.97 [95% CI = 0.003-0.355]) than at home. Substance use disorders were the most common underlying cause of death (61.3%). This group consisted predominantly of men (78.8%, χ2, P < 0.001), and tended to be younger (χ2, P < 0.001). Individuals with intellectual and developmental disabilities are more likely to die in hospitals or care homes than at home. Those with MBDs, particularly substance use disorders, face a high risk of premature death, highlighting gaps in healthcare and palliative care provision for these populations.

Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths.

Although cognitive biases are one of the most frequent causes of diagnostic errors, their influence remains underestimated in allied health professions, especially in osteopathy. Yet, a part of osteopathic clinical reasoning and diagnosis rely on the practitioner's intuition and subjective haptic perceptions. The aim of this study is to highlight links between the cognitive biases perceived by the practitioner to understand cognitive patterns during osteopathic diagnosis, and to suggest debiasing strategies. A mixed method based on an explanatory sequential type is used. (QUAN→QUAL). A quantitative cross-sectional survey of 272 French osteopaths and three focus groups including 24 osteopaths were carried out. The quantitative analysis includes multinominal logistic regression models and multiple correspondence analysis. The qualitative analysis is based on the framework method (within thematic analysis) and followed a step-by-step guide (Gale etal.). Among 19 selected biases, osteopaths feel to be affected by 9.4±0.28 biases (range [1-19], median=9). Some presumed biases would be associated, and socio-demographic (gender, age) and professional (experience and types of practice) factors would modify how practitioners perceive the presence of biases. Main debiasing solutions are supervision and transcultural clinical competences. Osteopaths believe their diagnosis is impaired by the presence of cognitive biases as observed in clinical reality. Some biases are shared with medical doctors, but others are more specific to osteopaths, such as confirmation bias. To reduce their effect, the practitioner needs to be aware of these cognitive patterns of clinical reasoning, understand the patient and himself better, and use objective tests.

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

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

Three-year trajectories and associated factors of fear of cancer recurrence in newly diagnosed head and neck cancer patients: a longitudinal study.

Limited data exists on the long-term course of fear of cancer recurrence (FCR) in head and neck cancer (HNC) patients. One in five patients was found to experience persistent high FCR in the first months after diagnosis. This study assessed the 3-year trajectories and associated factors of FCR in newly diagnosed HNC patients. Six hundred twenty-one patients from the NETherlands Quality of life and Biomedical Cohort study (NET-QUBIC) completed the FCR assessment at baseline, 3-, 6-, 12-, 24-, and 36-months posttreatment. Trajectories of FCR were identified using latent class growth analysis. Multinominal logistic regression analysis was used to assess associations between FCR trajectories and baseline demographic and medical variables, personality, and coping. Three FCR trajectories were identified: "consistently high" (n = 45, 7%), "elevated and declining" (n = 209, 34%), and "low and declining" (n = 367, 59%). Patients in the "elevated and declining" and "consistently high" trajectory were younger, had more comorbidities, higher negative adjustment, a higher level of neuroticism, more social support seeking, and more reliance on passive and palliative coping strategies. Three years following diagnosis, the majority of HNC patients showed a resilient FCR trajectory whereas a small percentage of HNC patients (7%) showed persistent high FCR over time. Younger patients and those with a higher level of neuroticism or maladaptive coping strategies were more vulnerable to have a consistent high level of FCR over time. It is important to identify these patients to provide optimal and tailored psychosocial support.

Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis.

Inflammatory bowel disease (IBD) causes fatigue, pain and faecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways. This study was nested within a randomised controlled trial of a digital symptom intervention for people with IBD (n=780). Latent profile analysis (LPA) was conducted on pre-randomisation baseline measures of fatigue, pain, and faecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors. LPA determined a three-profile model: Moderate (50%), High (40%) and Severe symptoms (10%). Diagnosis and faecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis and IBS-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviours significantly increased the relative risk of High and Severe symptoms profile membership. Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioural factors. These factors were also associated with IBS-type symptoms. Recognising the potential impact of cognitive behavioural factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioural interventions to enhance patient care and improve outcomes.

Validity of prenatal AUDIT screening for alcohol disorders - a Nationwide Swedish register study.

This study aims to assess the external validity of the Alcohol Use Disorders Identification Test (AUDIT) in Swedish prenatal care as an indicator for alcohol-addiction disorders, and to characterize women with mismatched information in healthcare registers. This study was designed as a National register-based study. Sweden. The study sample included 739,735 pregnancies over the period 2014-2020. Prospectively collected prenatal AUDIT screening in the Swedish Pregnancy register was linked to national health databases through individual identification number. The AUDIT score was dichotomized into < 6 points (low-risk use) and ≥ 6 points (hazardous use). Alcohol addiction disorders were defined by a diagnostic code in The Swedish National Patient Register or drugs dispensed for alcohol dependence in the Swedish Prescribed Drug Register. The diagnostic properties of AUDIT were assessed based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and accuracy (proportion of true positive and true negative) for an AUDIT score of ≥ 6 points for alcohol disorders. Women with mismatched information in the register were characterized and assessed by multinominal logistic regression, using women with matched information in the registers for reference. An alcohol-related disorder was recorded in 3.1%, while 25,770 (3.5%) had an AUDIT point ≥ 6. The diagnostic accuracy of the AUDIT ≥ 6 points for detection of an alcohol related disorder during a year prior to pregnancy was 95.7% (95% confidence interval [CI]: 95.7, 95.8), with a positive LR of 8.03 (95% CI: 7.5, 8.6). The sensitivity for detecting a pre-pregnancy alcohol related disorder was 33.0% (95% CI: 30.9, 35.1). Being young, nulliparous, of low education, and of Swedish origin increased the likelihood of being misclassified with the AUDIT. Prior psychiatric care was associated with false negatives, especially for women with neuropsychiatric disorders (odds ratio [OR]: 10.39, 95% CI: 9.89, 10.90). The accuracy of AUDIT in screening for alcohol disorders at a population-based level was high, but only identified one third of women with alcohol-related disorders when using a cut-off of six points criterion.

Histology-specific long-term oncologic outcomes in patients with epithelial ovarian cancer who underwent complete tumor resection: The implication of occult seeds after initial surgery.

Assessing the histology-specific prognosis of epithelial ovarian cancer (OvCa) is clinically challenging, especially in a patient population with a favorable prognosis. This study investigated the histology-specific long-term oncologic outcomes in OvCa patients who underwent complete tumor resection using a large-scale patient cohort form multiple institutions under a central pathological review system. A regional multi-institutional study was conducted from 1986 to 2019. Of the 4,898 patients with ovarian tumors enrolled, 1,175 patients who underwent complete tumor resection were classified into three classes based on clinically important prognostic factors: stage, cytology, ascites volume. For each class category, the effect of histology types on recurrence-free survival, the site of recurrence, and post-recurrence survival was evaluated. Recurrence-free survival varied significantly across different histologies (P < 0.001). The risk of recurrence was higher in serous carcinoma compare to other histologies (P < 0.001). The site of tumor recurrence varied by the histology type. Multinominal logistic regression analysis revealed that mucinous histology had a significantly higher likelihood of developing recurrent tumors at distant sites from the peritoneum compared to other histologies (P = 0.002). Conversely, serous histology was associated with better post-recurrence survival (Log-rank P < 0.001). Long-term oncologic outcomes significantly differ by histology type in OvCa patients who have undergone complete tumor resection at the initial surgery. A careful evaluation of the clinical background is necessary for these patients, and further clinical research into individualized treatment approaches is essential.

Loneliness and social isolation in people with HIV aged ≥50 years. The No One Alone (NOA)-GeSIDA study conducted by the GeSIDA 12021 study group.

There is a growing number of people with HIV who are aged 50 years or older, and the prevalence of loneliness and social isolation remains unknown. A multicentre study was conducted across 22 GeSIDA centres. A survey was carried out to assess loneliness [UCLA 3-item Loneliness Scale-3 (UCLA-3)] and social isolation [Lubben Social Network Scale-Revised (LSNS-R)], along with sociodemographic aspects, HIV-related factors, comorbidities, tobacco, alcohol and drug consumption, quality of life, anxiety and depression, and stigma. The prevalence of loneliness (UCLA-3 ≥ 6) and evident social isolation (LSNS-R ≤ 20) was calculated, and multivariable multinominal logistic regression models were used to identify associated factors. A total of 399 people with HIV were included; 77.4% were men, of average age 59.9 years (SD 6.5); 45.1% were aged ≥60 years; 86% were born in Spain; 86.7% in urban areas; 56.4% with secondary or higher education; 4.5% living alone against their wishes. A total of 66.9% were infected through sexual transmission, with a median of 22.9 years since diagnosis [interquartile range (IQR): 12.6-29.5] and a median nadir CD4 count of 245 cells/μL (IQR: 89-440). Overall, 90.7% had viral load <50 copies/mL, 93.5% had adherence >95%, and 26.3% had a prior AIDS diagnosis. In all, 29.1% and 21% reported significant symptoms of anxiety and depression, respectively, 24.3% had mobility issues, and 40.8% reported pain. Overall, 77.7% of participants reported neither loneliness nor social isolation, 10.0% loneliness only, 5.8% social isolation only and 6.5% both. Multivariable analyses identified that being aged 50-59, unemployed or retired, living alone unwillingly, single, poor quality of life, anxiety, and HIV-related stigma were associated with loneliness. Meanwhile, lower education, living alone unwillingly, and depressive symptoms were associated with social isolation. Individuals living alone unwillingly, with depressive symptoms and experiencing HIV-related stigma were at higher risk for both loneliness and social isolation. There is a relatively high prevalence of loneliness and social isolation in our population. Living alone against one's wishes, being unmarried, and experiencing mobility issues could predispose individuals to feel lonely and socially isolated. Those with anxiety and stigma are more prone to loneliness, while individuals with depression are more predisposed to social isolation. It is necessary to develop strategies for the detection and management of loneliness and social isolation in people with HIV aged >50 years.

청소년의 학교적응 잠재프로파일 연구: 잠재프로파일에 따른 또래애착과 자기조절학습 영향력 탐색 및 사이버비행 인식 차이 검증

Objectives The purposes of this study is to identify the latent profiles of adolescents's school adjustment and differences in cyber delinquency awareness, and to explore the effects of peer attachment and self-regulated learning of predictors. Methods To this end 1,326 middle school students were surveyed in the 14th year of Korean Children's Panel were selected. The data were analyzed using latent profile analysis(LPA), multinominal logistic regression model, and analysis of variance. Results Major findings were as follows. First, as a result of latent profile analysis, the three-profile model that includes ‘low school adjustment group,’ ‘moderate school adjustment group,’ and ‘high school adjustment group’ was selected. Second, there was a significant difference in the awareness of cyber delinquency according to the latent profiles of school adjustment. The ‘high school adjustment group’ showed the highest level of cyber delinquency awareness, while the ‘low school adjustment group’ showed the lowest. Third, peer attachment and self-regulated learning had a significant impact on the classification of the latent profiles of school adjustment among adolescents. Conclusions This study identified different groups of school adjustment among adolescents using LPA and found that varying interventions for each latent profile can be effective in enhancing awareness of cyber delinquency issues by improving school adjustment. Our findings provide valuable implications for increasing adolescents' awareness of cyber delinquency through tailored interventions based on their school adjustment levels.

Polygenic Risk Scores and Hearing Loss Phenotypes in Children

Monogenic causes of childhood hearing loss are well established, as are polygenic risk contributions to age-related hearing loss. However, an untested possibility is that polygenic risk scores (PRS) also contribute to childhood hearing loss of all severities, alongside environmental and/or monogenic causes. To examine the association between a PRS for adult hearing loss and childhood hearing loss phenotypes. This cross-sectional study used a unique population-based dataset spanning normal hearing to profound loss, combining 2 contemporaneous population cohorts in Australia. This included the Child Health CheckPoint, a national population-based cross-sectional study nested within the Longitudinal Study of Australian Children, and the Victorian Childhood Hearing Longitudinal Databank (VicCHILD), a statewide population-based longitudinal data bank open to every child with congenital hearing loss in Victoria, Australia. The analysis took place from March to August 2023. Genotype data were generated from saliva- or blood-derived DNA using global single-nucleotide variations arrays. Based on genotype data, PRS was computed using published UK Biobank genome-wide association study results for self-reported hearing difficulty in individuals aged 40 to 69 years. Hearing outcomes were classified by laterality (bilateral, unilateral), severity (mild, moderate, severe or worse) and types (sensorineural, conductive, mixed, auditory neuropathy, atresia). Analyses included multinominal logistic regressions of PRS with hearing outcomes. Overall, 1488 CheckPoint study children (49.8% boys, aged 11-12 years) and 527 VicCHILD study children (55.2% boys, aged 0-13 years) with hearing and genotype data were included. A 1-SD increment in PRS was associated with higher odds of mild (odds ratio [OR], 1.3; 95% CI, 1.0-1.6), moderate (OR, 5.1; 95% CI, 3.2-8.1), and severe or worse (OR, 5.3; 95% CI, 3.9-7.3) unilateral hearing loss compared with normal hearing. Similarly, the PRS was associated with increased odds of mild, moderate, and severe or worse bilateral hearing loss (per-SD ORs, 3.9-6.6) and all hearing loss types (per-SD ORs, 8.5-10.6). In this cross-sectional study, a PRS initially developed for adult hearing difficulty was associated with wide-ranging childhood hearing loss phenotypes, partly explaining hearing phenotype variations despite shared genetic and environmental factors (eg, preterm birth). Large-scale studies with objectively defined hearing phenotypes are crucial for refining PRS and predicting high-risk children.

The early COVID-19 pandemic period and associated gestational weight gain.

The aim of this study was to investigate if gestational weight gain was altered during the early COVID-19 pandemic period. This a retrospective cohort study evaluating gestational weight gain among individuals delivering during the early COVID-19 pandemic epoch (March 10-December 31,2020) compared to temporally matched pre-pandemic (matched months in 2018 and 2019) controls using electronic medical record data from a large tertiary care hospital. The primary outcome was gestational weight gain defined as a categorical measure representing below, meeting, or above Institute of Medicine (IOM) criteria with further adjustment for gestational age at delivery. The early-pandemic exposure group was also categorized by gestational age at the start period (<14weeks' and 14-20weeks') to assess if duration of exposure affected gestational weight gain risks with the use of multinominal logistic regression. Among 5,377 individuals 3,619 (67.3 %) and 1,758 (32.7 %) were in the pre and early pandemic epochs respectively. Overall, 934 (17.4 %) individuals gained below recommended, 1,280 (23.8 %) met recommendations, and 3,163 (58.8 %) gained above IOM recommended gestational weight gain. Compared to the pre-pandemic epoch, the early pandemic period was not associated with weight gain below (OR 1.06, 95 % Cl 0.89-1.27) or above (OR 1.03, 95 % Cl 0.89-1.19) IOM recommendations. This was also true when the early pandemic group was stratified based on gestational age at the start of the early pandemic period (<14weeks' and 14-20weeks'). This study demonstrated no significant difference in maternal weight gain between pre and early COVID-19 pandemic periods.

Ride-Hailing Drivers’ Preference for Fairwork Principles of Trustworthy Labour-Platform Management and Greater Worker-Autonomy and Willingness to Form and Join Worker-Platform Co-Operatives in Kenya

Ride-hailing worker-platform co-operatives had emerged as part of and for at least fairwork principles. Moreover, studies on e-drivers have recommended the formation of worker-platform co-operatives in Kenya. The actual worker-platform co-operatives by e-drivers are yet to be established. It was against this backdrop that a study was conducted to determine the extent of ride-hailing drivers’ preference for fairwork principles of trustworthy labour-platform management, greater worker-autonomy and willingness to form and join worker-platform co-operatives. The study was grounded in the social exchange theory, affective theory of social exchange, and utility theory. The researcher applied critical-realism research philosophy and multimethod research designs of discrete choice experiments and sequential explanatory mixed method research designs. Using the Yamane sampling formula, the study used quantitative data from 497 respondents from sampled 600 of the 20,000 e-drivers in the Nairobi Metropolitan Region. The quantitative data was analysed using multinominal logistic regression. Moreover, the study used qualitative data from 11 participants, analysed using thematic analysis. Results indicated that the two fairwork principles were statistically significant to e-drivers’ willingness to form and join worker-platform co-operatives. The trustworthy platform management (TPM) principle, in particular, was a highly preferred fairwork principle in terms of e-drivers’ willingness to form and join worker-platform co-operative model (Coeff=2.62; SE = 0.400, Z = 6.54, p&lt; .001), compared to the greater worker-autonomy contract (GAC) principle (Coeff=1.565, SE = 0.202, Z = 7.74, p&lt; .001). This study brings practical and theoretical contributions to improve the e-drivers’ benefits from the ride-hailing sector. Policymakers, promoters, and platform workers like e-drivers could understand how best to promote worker-platform co-operatives to succeed in the country’s societal context.

Ride-Hailing Drivers' Preferences for Fairwork Principles of Satisfactory Working Conditions and Fair Pay-Profit Distribution and Willingness to Form and Join Worker-Platform Co-Operatives in Kenya

Ride-hailing drivers (e-drivers) are among the platform workers who successfully embrace the worker-platform co-operative model's emergence to counter capitalistic ride-hailing platforms and their complex ecosystems, which align with fairwork principles of pay, condition, contracts and (platform) management. This study was conducted to determine the extent of ride-hailing drivers' preferences for satisfactory working conditions, fair pay-profit distribution and willingness to form and join worker-platform co-operatives in Kenya. The study was grounded in the social exchange theory, affective theory of social exchange, and utility theory. The researcher applied critical-realism research philosophy and multimethod research designs of discrete choice experiments and sequential explanatory mixed method research designs. Using the Yamane sampling formula, the study used quantitative data from 497 respondents from sampled 600 of the 20,000 e-drivers in the Nairobi Metropolitan Region. The quantitative data was analysed using multinominal logistic regression. Moreover, the study used qualitative data from 11 participants, which was analysed using thematic analysis. Results indicated that the two fairwork principles were statistically significant to e-drivers’ willingness to form and join worker-platform co-operatives. fair pay-profits distribution (FPD) principle, in particular, was a highly preferred fairwork principle in terms of e-drivers’ willingness to form and join the worker-platform co-operative model (Coeff=1.564, SE = 0.234, Z = 6.67, p&lt; .001), compared to the satisfactory working conditions (SWC) principle (Coeff=0.783, SE = 0.156, Z = 5.012, p&lt; .001). This study brings practical and theoretical contributions to improve the e-drivers’ benefits from the ride-hailing sector. Policymakers, promoters, and platform workers like e-drivers could understand how best to promote worker-platform co-operatives to succeed in the country’s societal context.

Trajectories of cold but not mechanical sensitivity correspond with disability trajectories after whiplash injury.

Developmental trajectories for neck disability after whiplash injury have been identified. Their relationship to cold and mechanical sensitivity trajectories is not known. We aimed to (1) identify recovery trajectories of cold and mechanical sensitivity, (2) explore their codevelopment with disability trajectories, (3) identify predictors of sensitivity trajectories, and (4) explore codevelopment of cold and mechanical sensitivity trajectories. Participants (n = 233) were assessed at <1, 3, 6, and 12 months after whiplash injury. Outcomes were cold pain detection threshold (CPT at neck), pressure pain detection thresholds (PPT, neck C5, and tibialis anterior), and the Neck Disability Index. We used group-based trajectory models to identify postinjury recovery trajectories and multinominal logistic regression to explore associations between baseline characteristics and trajectory membership. We identified the following trajectory groups: CPT (low [50.0%], moderate [29.7%], and high [20.4%] sensitivity); PPT C5 (low [10.8%] and high [89.2%] sensitivity); and PPT tibialis anterior (low [23.9%], moderate [39.0%], and high [37.1%] sensitivity); all were stable over the 12 months. There was good correspondence between disability and cold sensitivity trajectory groups but not for mechanical sensitivity; cold and mechanical sensitivity trajectories were not well associated. Higher baseline pain predicted membership of the high cold sensitivity trajectory (RR 1.27, 95% CI 1.01-1.59) and hyperarousal symptoms predicted membership of the moderate cold sensitivity trajectory (RR 1.17, 95% CI 1.01-1.36). We found no associations between baseline characteristics and mechanical sensitivity. There is an interplay between cold allodynia, pain, and hyperarousal symptoms in development of ongoing disability after whiplash injury. Different mechanisms likely underlie cold and mechanical sensitivity.

Factors associated with household willingness to pay for Universal Health Coverage in Cameroon: a nationwide cross-sectional analysis

BackgroundSustained financing for Universal Health Coverage (UHC) has been a concern for the Cameroon government. Household contributions have been considered as a financing mechanism, but this raises concerns on the willingness of households to pay for UHC. The current study assessed factors associated with the willingness to pay (WTP) for UHC in Cameroon.MethodsCommunity based, cross-sectional analysis of data from households (selected via multi-stage, randomized, cluster sampling) across all ten regions of Cameroon, during July 2020. Factors associated with WTP for UHC were determined using a multinominal logistic regression model, tested at varying significance levels (1%, 5%, and 10%) to enhance its ability to detect meaningful and practical value associations.ResultsOverall, 5,014 households were surveyed, 64.3% and 35.6% from rural and urban areas respectively. Household heads were 40.2 ± 10.1 years old and mostly male (60.6%). Most surveyed households (72%) were willing to contribute for UHC. Amongst these willing households, WTP varied with the sex (females opted for lower payments) and educational level (those with ≥ high school education opted for contributions ≥ US$ 165.6 annually, p < 0.01) of the household head. WTP also varied proportionally with household income and was influenced by the sector of activity (formal secondary/tertiary and informal sector workers opted for contributions > US$ 165.6 annually, p < 0.01) of the household head. Other factors affecting WTP included household size (households with ≥ 13 persons opted for contributions ≥ US$ 165.6, p < 0.01) and the age of the household head (those ≥ 55 years opted for higher contributions; US$ 33.1–82.6, p < 0.01). WTP varied positively with knowledge on UHC and affiliation to a health insurance scheme. Household who did not resort to self-medication/prayers when in need of healthcare services opted for higher contributions (US$ 82.6– 165.6, p < 0.01).ConclusionUHC implementation in Cameroon will require that factors shown here-in to influence WTP be carefully considered. Modifiable factors such as self-medication/prayers and poor knowledge on UHC, underlines the need for greater sensitization on UHC. Given the high WTP from the informal sector, characterization of the sector could go a long way to increase the financial envelope allocated for UHC.

Preferences for genetic interventions for SCA and Huntington’s disease: results of a discrete choice experiment among patients

BackgroundAlthough genetic interventions are on the horizon for some polyglutamine expansion diseases, such as subtypes of spinocerebellar ataxia (SCA) and Huntington’s disease (HD), the patients’ preferences regarding these new therapies are unclear. This study aims to get insight into what extent different characteristics of genetic interventions affect the preferences of patients with SCA and HD with regard to these interventions.MethodsManifest and premanifest patients with SCA or HD were recruited online by platforms of patient associations. The respondents conducted a questionnaire that included a discrete choice experiment (DCE). The experimental design included 24 choice sets, but these were divided into three blocks of eight to reduce the number of tasks per respondent. Each choice set included two alternative treatments and consisted of four attributes (mode and frequency of administration, chance of a beneficial effect, risks, and follow-up), each with three or four different levels. The forced choice-elicitation format was used. Data were analyzed by using a multinominal logistic regression model.ResultsResponses of 216 participants were collected. The mode and frequency of administration of a genetic intervention, as well as the chance of a beneficial effect both influence the choice for a genetic intervention. Respondents less prefer repeated lumbar punctures compared to a single operation. As expected, a higher beneficial effect of treatment was preferred. Risks and follow-up did not influence the choice for a genetic intervention.ConclusionsThe results can be used for the design and implementation of future genetic interventional trials as well as of patient-centered care pathways for rare movement disorders such as SCA and HD.

Changes in opinions on health insurance benefits deservingness in the Netherlands between 2013-2023

Abstract Background In many European countries, including the Netherlands, the healthcare system is financed according to the principles of solidarity. Although people are generally highly supportive of collectively financed healthcare services, some groups are considered more deserving of health insurance benefits than others. Increasing knowledge of the health risks of certain lifestyle choices and pressure on healthcare systems may result in changing opinions on the allocation of resources. Our study looks into changes in citizen’s opinions on the deservingness of different groups between 2013 and 2023. Methods Questionnaires were sent out to samples of 1.500 members of the Dutch Health Care Consumer Panel in 2013, 2015, 2017, 2019, 2021, and 2023. Response rates varied between 42% (2015) and 56% (2021). Deservingness was studied by asking respondents about their opinions on the amount of health insurance premium for different, opposing groups, for example older and younger people and those with a healthy and unhealthy lifestyle (group A should pay more, both groups should pay the same amount, or group B should pay more). Multinominal logistic regression models were used to examine changes in deservingness opinions over time. Results Our study showed year-to-year fluctuations in opinions on the premium amount for health insurance for different, opposing groups. However, no distinct increases or decreases were observed over the whole time period. This applies to both the general population and to people who do and do not belong to the different groups. Conclusions Although there are differences in the degree to which groups are considered deserving of health insurance benefits, deservingness opinions were found to be fairly stable in the Netherlands between 2013 and 2023. Our results do not point to increasing support for premium differentiation based on personal characteristics. This suggests that support for solidarity in healthcare financing is not in decline. Key messages • Opinions on the deservingness of health insurance benefits of different groups were found to be fairly stable in the Netherlands between 2013 and 2023. • No evidence of increasing support for premium differentiation based on personal characteristics was found.

Pattern of Prescribing Proton Pump Inhibitors: Evaluating Appropriateness and Factors Contributing to Their Adverse Effect Reaction Risk.

Background/Objectives: Proton pump inhibitors (PPIs) are amongst the most commonly prescribed classes of medication. However, inappropriate PPI use can lead to several adverse drug reactions (ADRs). Limited data exist on factors contributing to the risk of ADRs associated with PPI prescribing patterns in the Eastern Region of Saudi Arabia. This retrospective, cross-sectional study aimed to assess the prevalence and the pattern of PPI use and to identify factors contributing to the risk of ADRs. Methods: Data were collected from electronic medical records of patients at Al-Qateef Central Hospital from January 2020 to December 2021. The inclusion criteria included patients aged ≥40 years attending an outpatient medical care clinic. PPI prescribing patterns were categorized based on their dosage intensity into low-dose, medium-dose (MD), and high-dose (HD) categories. Binary and multinominal logistic regression models were used to determine the relationship between PPI prescribing patterns and use, categorized by MD or HD, and patient characteristics, adjusted for significant covariates. Results are presented as adjusted odds ratio (OR) with corresponding 95% confidence intervals (95% CI). Results: The study included 41,084 patients. The prevalence of PPI prescribing was 31%. PPI users were more frequently found to be females than males (52% vs. 50%, p = 0.013); they were also likely to be prescribed more medications (7 vs. 6, p < 0.001), but less likely to have gastritis-related diseases (34% vs. 32%, p < 0.001) compared to non-users. PPI HD users were more likely male (56% vs. 43%, p < 0.001), older (53 vs. 52 years, p < 0.001), and prescribed more medications (11.8 vs. 2.8, p < 0.001) compared to MD users. PPI usage was associated with concurrent use of antiplatelet drugs (OR = 1.08, 95% CI 1.01-1.15). An increasing number of prescribed medications was associated with HD usage (OR = 1.13, 95% CI 1.12-1.14), but negatively associated with MD usage (OR = 0.7 95% CI 0.69-0.71). Female gender was negatively associated with HD usage (OR = 0.85, 95% CI 0.79-0.91). Conclusions: Our findings indicate that 31% of the included cohort were prescribed PPI. Inappropriate PPI prescribing related to the drug's omission is a concern as PPI non-users presented with valid indications such as gastritis. Male gender and increasing NPM were the common factors contributing to increased risk of PPI ADR. This study points to the importance of re-evaluating PPI use to ensure effective therapy with minimum risks of ADR.

Psychological Correlates of Post-COVID Condition

&lt;span lang="SK"&gt;This article deals with psychological correlates of the post-COVID condition - depression, anxiety, and memory problems including remembering and forgetting. The work has a longitudinal character, while it examines the post-COVID condition in a group of participants based on infection of the disease Covid-19. At the same time, participants who never had this disease (N=86, for the 1. measure and N=38 for the 2. measure) are compared with those who were infected with COVID-19 (N=112, for the 1. measure and N=36 for the 2. measure), while participants were separated for analysis in groups based on the time from infection. Group of respondents who were infected within 3 months, from 3-9 months from infection and 9+ months since infecting with the disease. We used tests for comparison, such as the Kruskal Wallis test and multivariate procedures for within-subject and between-subject changes, using Anova for mixed experimental designs. We also determined the risk of being included in a group based on the time of infection with COVID-19 through multinominal logistic regression. We found differences in all variables in general between those infected with COVID-19 and those not. In neuropsychiatric aspects- anxiety and depression were confirmed cyclical features in those who were infected with COVID-19 in time, with the worst value of variables in the group from 3-9 months from infecting with the disease. In the current memory scale and its subscale, the act of remembering was a value that worsened over time and it was confirmed as an effect of group inclusion.&lt;/span&gt;