Negative Binomial Regression Analysis Research Articles

The Effect of Daytime Surgical Hospitalists on Reducing Night Shift Physicians' Workload.

The shortage of doctors at night makes it difficult to execute complex tasks and deliver accurate decisions. Therefore, reducing the night shift physician's workload is essential for patient safety. This study aimed to observe the effect of daytime surgical hospitalists on the reduction in night shift physicians' workload by analyzing the volume of electronic orders generated at night for postoperative patients. A total of 9328 hospitalized patients who underwent colorectal or gastrointestinal surgery for more than 120 minutes were reviewed retrospectively. This study reviewed the nighttime volume difference of electronic orders between patients cared for by a daytime surgical hospitalist and patients cared for by a resident. Multiple logistic regression analysis was performed to analyze the risk factors of nighttime orders during hospitalization (dichotomous end point). Negative binomial regression analysis was also performed to analyze the volume of electronic orders as countable data, and the incident rate ratio was estimated (count end point). The risk of the occurrence of nighttime electronic order for patients treated by a surgical hospitalist was lower than that of patients cared for by a resident (adjusted odds ratio, 0.616; 95% confidence interval, 0.558-0.682; P < 0.001). In the negative binomial regression analysis, the total volume of electronic orders at night was lower in patients cared for by a surgical hospitalist than in patients cared for by a resident (adjusted incident rate ratio, 0.653; 95% confidence interval, 0.623-0.685; P < 0.001). The introduction of daytime surgical hospitalists is associated with the lower workload of night shift physicians.

What is next? The effect of reverse logistics adoption on digitalization and inter-organizational collaboration

PurposeThis study aims to examine and understand the impact of reverse logistics adoption on firms' digitalization and collaboration activities. Specifically, leveraging the knowledge-based view, this study examines how adopting sustainable logistic practices (reverse logistics) prepares firms to embrace digitalization and encourages them to collaborate with other organizations.Design/methodology/approachThe study used longitudinal survey data from two waves (2017 and 2019) from the Mannheim Centre for European Economic Research. The authors used the negative binomial regression analyses to test the impact of reverse logistics adoption on the digitalization and inter-organizational collaboration dependent count variables.FindingsThe study's findings highlight the usefulness of reverse logistics in enabling digitalization and inter-organizational collaboration. The results show that the firms investing in sustainable supply chains will be better positioned to nurture digitalization and inter-organizational collaboration.Practical implicationsFor resource-bound managers, this study provides an important insight into prioritizing activities by highlighting how reverse logistics can facilitate digitalization and collaboration. The study demonstrates that the knowledge generated by reverse logistics adoption can be an essential pillar and enabler toward achieving firms' digitalization and collaboration goals.Originality/valueThe study is among the first to examine the effect of reverse logistics adoption on firm activities that are not strictly associated with the circular economy (digitalization and collaboration). Utilizing the knowledge-based view, this study reports on the additional benefits of reverse logistics implementation previously not discussed in the literature.

Total Hip Arthroplasty in Chile Is Characterized By Low Utilization Rates and Disparity in Access

Background: Disparity in access to total hip arthroplasty (THA) is an internationally recognized phenomenon influenced by social and geographical factors. The Organisation for Economic Co-operation and Development (OECD) employs the utilization rates of THA to evaluate and compare healthcare utilization by its 37 country members, including Chile. Purpose: We sought to describe THA utilization rates in the elderly Chilean population and to compare it with data from other OECD countries. In addition, we sought to identify whether sociodemographic variables influence access to THA in Chile. Methods: We conducted a retrospective review of THA cases performed in Chile between 2016 and 2018 in patients aged 65 years and older in a large database regulated by the Ministry of Health; 8970 patients were included. Mean utilization rates (MURs) of THA within Chile’s 346 administrative-territorial divisions (called communes) were calculated. We analyzed associations between the communal MUR and poverty, rurality, insurance type, and geographical health administration dependency. Results: The national MUR of THA in the elderly population in Chile was 144/100,000 for the period studied. The median communal MUR was 107 (interquartile range [IQR]: 66–153). A lower MUR of THA was observed in communes with higher poverty levels, higher rurality, and a lower rates of private insurance. After negative binomial regression analysis, only rurality rate and geographical healthcare service dependency were associated with MUR. Conclusions: This retrospective database study suggests that the utilization of THA in Chile is unequal and well below the average of other OECD countries. Higher rates of rurality and administrative healthcare dependence (a geographical/administrative factor) were associated with disparities in access to THA within Chile.

What Drives the News Coverage of US Social Movements?

Abstract What drives the news coverage of social movements in the professional news media? We address this question by elaborating an institutional mediation model arguing that the news values, routines, and characteristics of the news media induce them to pay attention to movements depending on their characteristics and the political contexts in which they engage. The news-making characteristics of movements include their disruptive capacities and organizational strength, and the political contexts include a partisan regime in power, benefitting from national policies, and congressional investigations. To appraise these arguments, we analyze approximately 1 million news articles mentioning 29 social movements over the twentieth century, published in four national newspapers. We use negative binomial regression analyses and separate time-series analyses of the labor movement to assess the model’s robustness across different movements, time periods, and news sources. In each analysis, the results support the hypotheses based on the institutional mediation model. More generally, we argue that the influence of social movements on institutions depends on the structure and operating procedures of those institutions. This insight has implications for future studies of the influence of movements on major social institutions.

Effect of knowledge network embedding on exploitative and exploratory innovation: evidence from Chinese advanced manufacturing firms

ABSTRACT This study constructs firm knowledge networks using patent data of advanced Chinese manufacturing firms. It applies panel stochastic negative binomial regression analysis to explore the mechanism of the effect of knowledge network (KN) embedding on exploitative innovation (EI) and exploratory innovation (EY) in advanced manufacturing firms. The results indicate, relationship embedding (RE) has a clear inverted U-shaped relationship with EI and EY, while structure embedding (SE) has a significant positive impact on EI and an inverted U-shaped effect on EY. An increase in knowledge diversity (KD) flattens the inverted U-shaped relationship between RE and EY. Conversely, weakening the positive impact of SE on EI. Knowledge integration capacity (KIC) mediates the relationship between KN embedding (RE and SE), EI, and EY.

Policy &amp; Change: An Analysis of Veteran Perpetrated Mass Shootings &amp; Social Work's Call to Action

Public mass shootings are relatively rare occurrences in the United States. As such, focusing on individual-level factors to develop a prevention framework is ill-advised. However, starting with veterans, as an overrepresented group of offenders, may be an important step to determining and developing policies that work to prevent mass shootings. The Veteran’s Administration (VA) is the largest employer of social workers in the United States and employs more than 15,000 master’s level social work professionals. Policy and training changes made to the VA system have the potential to begin reducing incidents of public mass shootings. The purpose of this study was to determine whether veteran-status or the phenomenon of leakage influences the number of casualties in public mass shootings. Further, a renewed call-to-action is issued for social workers engaged with veterans, military personnel, and their families. A negative binomial regression analysis was utilized to examine 168 public mass shootings events in the United States from 1966 until 2019. While veteran status was not associated with increased casualty this does not underscore the importance of policy changes that limit access to firearms for high-risk people. Further, because leakage was statistically significant in explaining casualty rates in mass shootings additional training related to duty to warn may be necessary for social workers engaged in therapeutic relationships with veterans, military personnel, and their families. The results of the negative binomial regression offer insights into what effective policy interventions may look like to reduce mass shootings.

Serious Mortgage Arrears among Immigrant Descendant and Native Participants in a Low-Income Public Starter Mortgage Program: Evidence from Norway

Although low-income homeownership programs serving vulnerable families at the lower end of the income distribution have been the focus of housing policy in many countries over the past 50 years, little is known about the post-origination experiences of immigrant families participating in these programs. Notably absent from the extant literature are studies examining the sustainability of homeownership among immigrant homebuyers and their susceptibility to falling behind on payments and experiencing mortgage defaults, evictions, or short sales. Utilizing data from 8263 families participating in Norway’s Starter Mortgage Program (Startlån) during the first three calendar years after mortgage origination, we examine the extent to which serious mortgage arrears varies by immigrant background. Two primary questions shape our research: (1) What is the incidence of serious mortgage arrears among Western, Eastern European, and non-Western immigrant homeowners relative to ethnic Norwegians participating in a public low-income homeownership program? and (2) What pre- and post-origination characteristics of applicants and households, mortgage terms at the time of origination, and experiences of household financial vulnerability or economic shocks predict heterogeneity in serious mortgage arrears by immigrant backgrounds? We found that 6.1% of ethnic Norwegian, 6.2% of Western, 4.9% of non-Western, and 3.2% of Eastern European immigrant homeowners participating in the Starter Mortgage Program were in serious mortgage arrears at least once during the first three calendar years after mortgage origination. Results from our negative binomial regression analyses suggest that program participants who were sole owners, with larger families, and higher debt were more likely to experience serious mortgage arrears; these effects were accentuated for ethnic Norwegians. Additionally, mortgage terms at the time of origination produced differential effects by immigrant background. Compared to Western and Eastern European immigrant homeowners, ethnic Norwegians were more likely to have experienced serious mortgage arrears if they purchased a single-family home, had larger LTV and DTI ratios, or if the Startlån share of their mortgages was higher. Non-Western immigrant mortgagors were more likely to make late mortgage payments if they had larger LTV ratios, interest-only mortgage servicing, or if they were more reliant on Startlån funds to finance their mortgages; however, this risk was reduced if they had fixed-rate mortgages. Financial vulnerability in terms of higher debt or fewer assets also increased the risk of serious mortgage arrears for ethnic Norwegians and non-Western immigrant homeowners, while increases in real wealth reduced that risk for all immigrant mortgagor groups.

Predictive ability of a self-rated fall risk assessment tool in community-dwelling older women

BackgroundFalls are a substantial health problem among older adults. An accessible and reliable tool for assessing individual fall risk is needed.AimsThe predictive ability of a one-page self-rated fall risk assessment form (KaatumisSeula® [KS]) was evaluated among older women in its current form.MethodsA subsample (n = 384) of community-living older women (aged 72–84 years) participating in the Kuopio Fall Prevention Study (KFPS) completed the KS form. Participants’ falls were prospectively registered for 12 months with SMS messages. Their group status and form-based fall risk category were compared to the verified fall events during the KFPS intervention. Negative binomial regression and multinomial regression analyses were used. Physical performance measurements (single leg stance, leg extension strength and grip strength) were used as covariates.ResultsDuring the follow-up, 43.8% of women fell at least once. Among the fallers, 76.8% had at least one self-determined injurious fall, and 26.2% had falls requiring medical attention. According to KS, 7.6% of the women had low fall risk, 75.0% moderate, 15.4% substantial, and only 2.1% high fall risk. Women in the “moderate fall risk” group had 1.47-fold (95% CI 0.74–2.91; nonsignificant), in “substantial fall risk” 4.00-fold (1.93–8.3; p < 0.001) and in “high fall risk” 3.00-fold (0.97–9.22; nonsignificant) higher risk of falls compared to the “low fall risk” group. Performance in physical tests did not account for future falls.ConclusionsThe KS form proved to be a feasible tool for self-administered fall risk assessment with moderate predictive ability.Trial registrationClinicalTrials.gov identifier: NCT02665169, date of first registration 27/01/2016.

Mortality in residential care facilities for people with disability: a descriptive cross-sectional analysis of statutory notifications in Ireland

ObjectivesTo determine incidence of death in residential care facilities for people with disability in Ireland, primary cause of death, associations of facility characteristics and deaths, and to compare characteristics of...

Neighborhood Socioeconomic Characteristics Associated with the COVID-19 Incidence in Elementary School Children: An Ecological Study in Osaka City, Japan.

We aimed to determine whether neighborhood socioeconomic characteristics are associated with the coronavirus disease 2019 (COVID-19) incidence in elementary school children and, if so, the associated characteristics. We obtained data on the number of infected children from 282 public elementary schools and the socioeconomic characteristics of each school district in Osaka City, Japan. We examined associations between these variables through negative binomial regression analyses. The proportion of employment in the wholesale and retail trade industry and the college graduation rate were significantly positively and negatively associated, respectively, with the total number of COVID-19-infected children. It was discovered that percentages of employment in the accommodation and food service industries in Wave 2, wholesale and retail trade industries after Wave 3, and healthcare and social assistance industries in Wave 5 were significantly positively associated with the number of infected children; likewise, the college graduation rate in Wave 5 was significantly negatively associated with the number of infected children. Our findings provide insight into the relevant and important areas of focus for public health policymakers and practitioners to ensure reduced disparities in COVID-19 infection rates.

Socioeconomic Factors Are Associated With Severity of Hospitalization in Pediatric Lupus: An Analysis of the 2016 Kids' Inpatient Database.

Health disparities in adult lupus, including higher disease severity and activity among those in poverty, have been identified. Similar associations in pediatric lupus have not been clearly established. This study was undertaken to investigate the relationship of income level and other socioeconomic factors with length of stay (LOS) in the hospital and severe lupus features using the 2016 Kids' Inpatient Database (KID). Lupus hospitalizations were identified in children ages 2-20 years in the 2016 KID using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes (M32). Univariate and multivariate negative binomial regression analyses were used to analyze the association of income level, race and ethnicity, and insurance status with LOS in the hospital. Univariate and multivariate logistic regression analyses were used to analyze the association of the same predictors with the presence of severe lupus features, defined using ICD-10 codes associated with lupus sequelae (e.g., lupus nephritis). A total of 3,367 unweighted (4,650 weighted) lupus hospitalizations were identified. Income level was found to be a statistically significant predictor of increased LOS in the hospital for those in the lowest income quartile (adjusted incidence rate ratio 1.12 [95% confidence interval (95% CI) 1.02-1.23]). Black race, "other" race, and public insurance were also associated with severe lupus features (adjusted odds ratio [ORadj ] 1.51 [95% CI 1.11-2.06]; ORadj 1.61 [95% CI 1.01-2.55]; and ORadj 1.51 [95% CI 1.17-2.55], respectively). Using a nationally representative data set, income level was found to be a statistically significant predictor of LOS in the hospital among those with the lowest reported income, highlighting a potential target population for intervention. Additionally, Black race and public insurance were associated with severe lupus features.

CD8 + T cell infiltration is associated with improved survival and negatively correlates with hypoxia in clear cell ovarian cancer

Unlike other histological types of epithelial ovarian carcinoma, clear cell ovarian carcinoma (CCOC) has poor response to therapy. In many other carcinomas, expression of the hypoxia-related enzyme Carbonic anhydrase IX (CAIX) by cancer cells is associated with poor prognosis, while the presence of CD8 + tumor-infiltrating lymphocytes (TIL) is positively prognostic. We employed [18F]EF5-PET/CT imaging, transcriptome profiling, and spatially-resolved histological analysis to evaluate relationships between CAIX, CD8, and survival in CCOC. Tissue microarrays (TMAs) were evaluated for 218 cases in the Canadian COEUR study. Non-spatial relationships between CAIX and CD8 were investigated using Spearman rank correlation, negative binomial regression and gene set enrichment analysis. Spatial relationships at the cell level were investigated using the cross K-function. Survival analysis was used to assess the relationship of CAIX and CD8 with patient survival for 154 cases. CD8 + T cell infiltration positively predicted survival with estimated hazard ratio 0.974 (95% CI 0.950, 1000). The negative binomial regression analysis found a strong TMA effect (p-value < 0.0001). It also indicated a negative association between CD8 and CAIX overall (p-value = 0.0171) and in stroma (p-value = 0.0050) but not in tumor (p-value = 0.173). Examination of the spatial association between the locations of CD8 + T cells and CAIX cells found a significant amount of heterogeneity in the first TMA, while in the second TMA there was a clear signal indicating negative spatial association in stromal regions. These results suggest that hypoxia may contribute to immune exclusion, primarily mediated by effects in stroma.

Effect of the COVID-19 Pandemic on the Psychological Health of Patients Who Underwent Liver Transplantation Due to Hepatocellular Carcinoma

The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress. A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case-control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine. Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total (p < 0.001) and CAS-SF (p = 0.002) scores. Cronbach's alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively. This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.

Risk factors for hospital outcomes in pulmonary embolism: A retrospective cohort study.

Pulmonary embolism (PE) is not only a life-threatening disease but also a public health issue with significant economic burden. The aim of the study was to identify factors-including the role of primary care-that predict length of hospital stay (LOHS), mortality and re-hospitalization within 6 months of patients admitted for PE. A retrospective cohort study was conducted with patients presenting to a Swiss public hospital with PE diagnosed at the hospital between November 2018 and October 2020. Multivariable logistic and zero-truncated negative binomial regression analyses were performed to assess risk factors for mortality, re-hospitalization and LOHS. Primary care variables encompassed whether patients were sent by their general practitioner (GP) to the emergency department and whether a GP follow-up assessment after discharge was recommended. Further analyzed variables were pulmonary embolism severity index (PESI) score, laboratory values, comorbidities, and medical history. A total of 248 patients were analyzed (median 73 years and 51.6% females). On average patients were hospitalized for 5 days (IQR 3-8). Altogether, 5.6% of these patients died in hospital, and 1.6% died within 30 days (all-cause mortality), 21.8% were re-hospitalized within 6 months. In addition to high PESI scores, we detected that, patients with an elevated serum troponin, as well as with diabetes had a significantly longer hospital stay. Significant risk factors for mortality were elevated NT-proBNP and PESI scores. Further, high PESI score and LOHS were associated with re-hospitalization within 6 months. PE patients who were sent to the emergency department by their GPs did not show improved outcomes. Follow-up with GPs did not have a significant effect on re-hospitalization. Defining the factors that are associated with LOHS in patients with PE has clinical implications and may help clinicians to allocate adequate resources in the management of these patients. Serum troponin and diabetes in addition to PESI score might be of prognostic use for LOHS. In this single-center cohort study, PESI score was not only a valid predictive tool for mortality but also for long-term outcomes such as re-hospitalization within 6 months.

Persistent incisional pain at 1 year after craniotomy: a retrospective observational study

BackgroundThere have been few reports on persistent incisional pain at 1 year after craniotomy. Hence, this study aimed to explore the distribution of pain at 1 year after elective craniotomy and its related factors.MethodsThis retrospective study included data prospectively collected to assess postoperative functional disability. We included patients aged > 55 years at the time of recruitment for our initial study and who had complete data regarding the pain numeric rating scale (NRS) score at 1 year post craniotomy. The primary outcome was the pain NRS score, which was assessed at the postanesthetic clinic as well as at 3 months and 1 year after craniotomy. Multivariable negative binomial regression analysis was performed to analyze the relationship between the pain NRS score at 1 postoperative year and 12 clinically meaningful covariates. These included the Short Form-8 scores for bodily pain and mental health, with higher scores indicating better health.ResultsWe analyzed data from 102 patients. The mean (95% confidence interval) pain NRS scores at the three measurement points were 2.8 (2.3–3.3), 1.2 (0.8–1.6), and 0.6 (0.3–0.8), respectively. Multivariable analysis revealed that preoperative bodily pain (risk ratio, 0.93; 95% confidence interval, 0.88–0.98) and the pain NRS score at the postanesthetic clinic (risk ratio, 1.32; 95% confidence interval, 1.14–1.52) were associated with the risk of persistent pain at 1 postoperative year.ConclusionsThe pain score at 1 year after elective craniotomy was minor; however, preoperative bodily pain and postoperative pain scores were significantly related factors.

Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study

BackgroundPrevious studies linked a high intensity of ventilation, measured as mechanical power, to mortality in patients suffering from “classic” ARDS. By contrast, mechanically ventilated patients with a diagnosis of COVID-19 may present with intact pulmonary mechanics while undergoing mechanical ventilation for longer periods of time. We investigated whether an association between higher mechanical power and mortality is modified by a diagnosis of COVID-19.MethodsThis retrospective study included critically ill, adult patients who were mechanically ventilated for at least 24 h between March 2020 and December 2021 at a tertiary healthcare facility in Boston, Massachusetts. The primary exposure was median mechanical power during the first 24 h of mechanical ventilation, calculated using a previously validated formula. The primary outcome was 30-day mortality. As co-primary analysis, we investigated whether a diagnosis of COVID-19 modified the primary association. We further investigated the association between mechanical power and days being alive and ventilator free and effect modification of this by a diagnosis of COVID-19. Multivariable logistic regression, effect modification and negative binomial regression analyses adjusted for baseline patient characteristics, severity of disease and in-hospital factors, were applied.Results1,737 mechanically ventilated patients were included, 411 (23.7%) suffered from COVID-19. 509 (29.3%) died within 30 days. The median mechanical power during the first 24 h of ventilation was 19.3 [14.6–24.0] J/min in patients with and 13.2 [10.2–18.0] J/min in patients without COVID-19. A higher mechanical power was associated with 30-day mortality (ORadj 1.26 per 1-SD, 7.1J/min increase; 95% CI 1.09–1.46; p = 0.002). Effect modification and interaction analysis did not support that this association was modified by a diagnosis of COVID-19 (95% CI, 0.81–1.38; p-for-interaction = 0.68). A higher mechanical power was associated with a lower number of days alive and ventilator free until day 28 (IRRadj 0.83 per 7.1 J/min increase; 95% CI 0.75–0.91; p < 0.001, adjusted risk difference − 2.7 days per 7.1J/min increase; 95% CI − 4.1 to − 1.3).ConclusionA higher mechanical power is associated with elevated 30-day mortality. While patients with COVID-19 received mechanical ventilation with higher mechanical power, this association was independent of a concomitant diagnosis of COVID-19.

Childhood use of coin pusher and crane grab machines, and adult gambling: A conceptual replication of Newall etal. (2021).

Youth gambling research mainly focuses on the illegal use of age-restricted machines, but coin pusher and crane grab machines are gambling machines that can be used by people of any age in the UK, and are also in use internationally. Previous cross-sectional evidence has associated recollected childhood usage of these machines with adult gambling participation and levels of problem gambling amongst adult gamblers. We attempted to conceptually replicate the findings of one of these studies (Newall etal., 2021), while addressing some limitations of that study. A cross-sectional survey of 2,000 UK-based and -born participants aged 19-24 years. The measures were participants' recollected usage of coin pusher and crane grab machines as a child, whether they had gambled in the past 12-months or not, and the PGSI for past 12-month gamblers. Overall, 5 of 7 tested associations were significant and in the hypothesized direction. Logistic regression models showed that adult gamblers were more likely to recollect using, and used at higher levels of frequency, coin pusher and crane grab machines, than non-gamblers. Then, negative binomial regression analysis showed that adults who recollected using crane grab machines at higher levels of frequency showed more gambling-related problems. These results suggest that childhood usage of coin pusher and crane grab machines may act as an underappreciated risk factor for the development of gambling-related harm across the lifespan. This information may be considered for further youth gambling research and policy.

Hospital readmissions in children with new-onset infantile epileptic spasms syndrome.

To describe inpatient resource use in the 2 years following infantile epileptic spasms syndrome (IESS) diagnosis, examine the association between clinical/demographic variables and incidence of readmission, and identify risk factors/reasons for frequent readmissions. Retrospective cohort analysis of readmissions (scheduled/unscheduled) within the first 2 years following IESS diagnosis, details of readmissions (number/time between rehospitalizations, and length of stay), demographic/clinical variables, and reasons for readmissions were collected. Negative binomial regression analysis evaluated associations between incidence of readmissions (both scheduled/unscheduled and unscheduled alone) and demographic/clinical factors. Logistic regression assessed the risk of having recurrent readmissions (≥5 readmissions). Among 93 (60% males) new-onset IESS patients, there were 394 readmissions (56% scheduled and 44% unscheduled) within 2-years following IESS diagnosis. Mean length of stay was 3.5 days (SD: 5.9). Readmissions occurred in 82 patients (88%) and 37 (40%) experienced ≥5 readmissions. On multivariate regression analysis, readmissions were increased with use of multiple first-line treatments for IESS (P= 0.006), technology assistance (P≤ 0.001), and multispecialty care (P= 0.01); seizure freedom (P= 0.015) and known etiology (P= 0.011) lowered the incidence of readmissions. Examining unscheduled readmissions separately, increased readmissions occurred with public insurance (P= 0.013), technology use (P≤ 0.0.001), and multispecialty care (P= 0.013); seizure freedom decreased unscheduled readmissions (P= 0.006). Technology assistance (G-tube, NG tube, VP shunt, and tracheostomy use) increased the odds (P= 0.007) for recurrent readmissions. Reasons for readmissions included EEG monitoring (protocol driven for verification of IESS remission/characterization of events/EEG surveillance/presurgical monitoring) (51%), acute medical issues (21%), and seizure exacerbation (15%). Protocol-driven readmissions declined an estimated 52% following protocol modification during the study. In the 2 years following IESS diagnosis, there is substantial inpatient resource use with nearly 40% experiencing ≥5 readmissions (mostly epilepsy related). Since readmissions are increased by intrinsic patient characteristics such as medical complexity (technology use and multispecialty care) or epilepsy-related issues, the preventability of readmissions is uncertain, except for protocol-driven ones.

Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial.

Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction. The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention. Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy. Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement. We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing. ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116. RR2-10.1186/s12889-020-8154-6.

Association between oral hygiene and gingival abrasion in a rural population in southern Brazil: A multilevel secondary analysis.

To evaluate associations between oral hygiene and gingival abrasion (GA) in a rural population from southern Brazil. A population-based sample representative of individuals from a rural community in southern Brazil was included. Individuals aged 15 years or older and who had five teeth or more present were selected for this analysis. GA extent was defined as the total number of abrasions per individual. An adjusted multilevel negative binomial regression analysis was used to investigate the associations between site-, tooth- and individual-level variables and GA. Mean ratios (MR) and 95% confidence intervals (95% CI) were calculated. Five hundred ninety-five dentate individuals aged 15-82 years were analysed. In the adjusted models, brushing more than twice a day (MR=1.13; 95% CI 1.02-1.26) and brushing with a hard/medium-bristle toothbrush (MR=1.11; 95% CI 1.01-1.23) were significantly associated with more generalized GA. The extent of GA was independently associated with greater brushing frequency and the use of a toothbrush with harder bristles in residents of a rural area.