Negative Binomial Regression Models Research Articles

Radiology resident proficiency in pediatric trauma cases: a comparative analysis based on trauma center status using the WIDI SIM exam.

To investigate the correlation between pediatric and adult trauma center status and radiology resident performance on pediatric trauma cases using the WIDI SIM exam. The WIDI SIM is a validated computer-aided simulation that assesses radiology residents' preparedness for independent call duty. It includes 65 cases across various imaging modalities derived from actual patient encounters. Faculty score free-text responses using a standardized 0-10 scale rubric. We analyzed 8,488 WIDI SIM exam scores from 35 pediatric trauma cases across 52 programs. A negative binomial regression model adjusting for resident level, imaging modality, and case specialty was employed to evaluate the impact of pediatric and adult trauma center status on resident performance. Both pediatric trauma center status (p = 0.0005) and adult trauma center status (p = 0.0003) were significant predictors of higher resident scores. Resident level was also significant, with higher-level residents performing better than first-year residents (p < 0.001). Residents performed worse on MR and US modalities compared to CT, and performance varied by case specialty. Radiology residents' pediatric trauma imaging skills are significantly linked to pediatric and adult trauma center status. Given most pediatric traumas occur outside pediatric trauma centers, targeted training strategies should be considered to ensure residents develop essential diagnostic skills.

Impact of the COVID-19 pandemic on breast cancer surgeries in a Canadian population.

The COVID-19 pandemic significantly impacted breast cancer (BC) surgeries. Most studies showing reduced BC surgical volumes during the pandemic are from single institutions, few have described volume changes in different types of surgical procedures. This study aimed to assess the impact of the pandemic on BC surgery volumes and types at a population level. Patients diagnosed with BC between January 1, 2018, and June 25, 2022, in Ontario, Canada, were analysed from population-based datasets. Time periods were defined as pre-pandemic (Jan 2018-Mar 2020), immediate pandemic (Mar-Jun 2020), and peri-pandemic (Jun 2020-Jun 2022). Weekly BC surgery volume and type (lumpectomy, mastectomy, or mastectomy with immediate reconstruction) were evaluated using segmented negative binomial regression models. Among 44 226 patients, 50 440 surgeries were performed. Weekly BC surgeries decreased by 16.9% during the immediate pandemic compared to pre-pandemic levels (180.5 vs. 217.1; p = 0.03). Surgical volumes recovered to pre-pandemic levels by June 2021. Mastectomies represented a higher proportion of BC surgeries during the pandemic (31.1% pre, 36.3% immediate, 32.4% peri-pandemic; p < 0.01). The proportion of mastectomies with immediate reconstruction remained stable during the immediate pandemic but increased in the peri-pandemic (20.1% vs. 17%; p < 0.01). There was a significant reduction in all BC surgeries during the pandemic. Mastectomies accounted for a higher proportion of BC surgeries in the pandemic period however access to reconstruction was maintained. Surgical volumes recovered within a year despite ongoing pandemic hospitalizations. Future studies are needed to explore the pandemic's long-term impact on BC care.

Are there differences in low-acuity emergency department visits between culturally and linguistically diverse migrants and people with English-speaking background: a population-based linkage study of adults over 45

BackgroundGrowing numbers of avoidable low-acuity visits to emergency departments (ED) are a major health policy concern globally and are thought to contribute to ED crowding. This study explores the differences...

Short-term effects of opioids during therapeutic hypothermia for neonatal encephalopathy

ObjectiveTo examine the effects of opioids during therapeutic hypothermia (TH) on short-term outcomes in neonates with neonatal encephalopathy (NE).MethodsMulticenter retrospective study of neonates with moderate/severe NE from Jan. 2013–Feb 2021. Opioid exposure was classified as positive (&amp;gt;0.1 mg/kg) or negative (no exposure or ≤0.1 mg/kg) based on cumulative morphine milligram equivalents (MME). Negative binomial regression models were used to evaluate clinical outcomes.ResultsOne hundred and twenty neonates were included. Adjusted analyses indicated that opioid exposure was associated with an increase in (1) length of hospitalization, (2) hypotension/use of vasopressors, and (3) need for and longer duration of mechanical ventilation. Many findings persisted even after adjusting for site and the presence of confirmed seizures (a marker of disease severity).DiscussionOpioid use during TH was associated with adverse effects on short-term outcomes. Caution should be exercised when using opioids during TH until longer-term neurodevelopmental outcome studies can be conducted in larger cohorts.

Postpartum Access to Health Care and Opioid Use Treatment: An Evaluation of a Medicaid Population

Background In this study, we aimed to examine postpartum health care utilization and identify gaps in care among a postpartum Medicaid population of patients diagnosed with opioid use disorder (OUD) during pregnancy. Methods We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of OUD during pregnancy from 2015 to 2019. We examined any evidence of postpartum health care utilization and evidence of medications for OUD (MOUD) during postpartum. We also determined the impact that 4 factors may have had on these outcomes: type of Medicaid coverage (Medicaid for Pregnant Women as compared to other types of Medicaid coverage), rurality, race, and the prenatal use of MOUD. Descriptive statistics, Kaplan-Meier curves with log-rank tests, and negative binomial regression were used. Results Of the 6,186 individuals in the study, 84.5% were White, 29.6% lived in rural areas, and 35.0% had MPW coverage. Of the sample, 77.4% sought health care services during the postpartum period. In the multiple negative binomial regression model, individuals who were MPW beneficiaries, non-White, lived in rural areas, and had no evidence of prenatal MOUD all had significantly lower rates of postpartum health care utilization. Of the sample, 53.6% had evidence of MOUD utilization during the postpartum period. We found that patients with MPW continued MOUD at much lower rates compared to patients with other forms of Medicaid (86% versus 93% at 60 days; 57% versus 78% at 180 days, respectively). Limitations Limitations to this analysis are inherent to administrative claims data, such as misclassification of outcomes and covariates, as well as loss to follow-up. Conclusions Significant gaps in health care use remain across type of Medicaid coverage, race, geographic setting, and prenatal care access.

Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England.

The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population. This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories. We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices). We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=-34%, log-ins=-34.9%, appointments booked=-39.7%, medical record views=-32.3%, and prescriptions ordered=-9.9%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=-7.1%, log-in=-10.4%, and appointments booked=-36.4%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2%, log-ins=11.7%, appointments booked=73.4%, medical record views=23.9%, and prescriptions ordered=20.7%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9%, log-ins=9.1%, appointments booked=14.1%, medical record views=28.7%, and prescriptions ordered=130.4%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=-3.6%, appointments booked=-20%, and medical record views=6%; P≤.001). This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived areas. Tailored interventions and patient support are required to ensure that any benefits from the NHS App are spread equally throughout the population.

Analyzing the adoption of nutrition-sensitive carp-SIS polyculture technology: evidence from a case study in Bangladesh

IntroductionSmall indigenous species (SIS) of fish are rich in micronutrients that are essential to combat the existing malnutrition in Bangladesh. However, their availability is constantly decreasing due to gradual environmental degradation making their availability irregular and hence expensive in the market. Integrating SIS with carps in homestead ponds is being promoted as a form of nutrition-sensitive aquaculture to enhance both production and consumption of these nutrient-rich species. Various improved pond management techniques (IPMTs) are suggested to boost the nutrition-sensitive carp-SIS polyculture.ObjectivesThis study examines the trends and factors influencing the adoption of IPMTs using the sustainable livelihood framework (SLF) approach. We address the following three key questions: (i) What are the trends in production and consumption of fish, in particular SIS from homestead ponds? (ii) Have farm households adopted or disadopted IPMTs over time? (iii) What are the determinants of adoption and disadoption of IPMTs?MethodsBased on primary data of 234 households from Barishal district from 2014 and 2022, we perform significance tests to compare project and non-project households in 2014 versus 2022 and apply fixed effects Poisson regression and fixed effects negative binomial regression models to identify household decisions to adopt the IPMTs.Results and conclusionQuantitative survey results indicate a significant increase in the production and consumption of SIS over time. In 2014, the project households exhibited adoption rates of 60% or more for various IPMTs such as stocking of fast-growing species, pre-stocking liming, pond dike construction, fertilizer application, stocking of high quality fish seeds, aquatic weed control, and turbidity management. However, by 2022, some of these IPMTs were disadopted by project households and only a few techniques, including providing sunlight exposure to ponds, pre-stocking liming, and supplementary feeding, were more widely used. Additionally, many non-project households also increased their adoption rates of IPMTs significantly. The fixed effects regression model shows that adoption is positively influenced by the number of household members participating in aquaculture, size of the pond, sole ownership of the pond and the number of years household has been involved in aquaculture. Follow-up activities such as monitoring and training of the project beneficiaries and government support are recommended to support long-term adoption of the IPMTs.

Abstract 4138516: Effects of Serious Mental Illness on Transcatheter Aortic Valve Replacement (TAVR) Outcomes and Access

Introduction: Serious mental illness (SMI) is associated with higher risk of immediate procedural complications after transcatheter aortic valve replacement (TAVR), including myocardial infarction, major bleeding, and acute renal failure. There is limited data on the impact of SMI on in-hospital mortality and 30-day readmissions. We aimed to evaluate access to and outcomes after TAVR for patients with SMI compared to those without SMI. Methods: We performed a retrospective cohort study of adults aged ≥18 years who received TAVR with a primary diagnosis of aortic stenosis using the Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery and Services Database in FL, MD, VT, UT, and WI (2016-2019). SMI was defined using ICD-10 codes for schizophrenia spectrum, mood, or anxiety disorders. Primary outcomes include in-hospital mortality, 30-day readmission, length of stay, and routine discharge. The secondary outcome was access type (elective vs. urgent/emergent). Multivariable logistic and negative binomial regression models with adjustment for patient demographics, co-morbidities, and hospital characteristics were used to examine outcomes. Results: Of 21,905 patients who underwent TAVR for aortic stenosis, 2,954 (13.5%) patients had SMI. Overall, 16,762 (76.5%) of patients had elective procedures. Patients with SMI were more likely to be female (59% vs. 41%, p&lt;0.001) and have 3+ co-morbidities (91% vs. 77%, p&lt;0.001) but had similar income quartile distribution (p=0.18), home-to-hospital distance (p=0.09), and clinically similar hospital TAVR volume over the study period (435 vs. 430, p=0.01). After adjustment for potential confounders, access to and outcomes of TAVR differed significantly by SMI status (See Table). Conclusions: SMI patients had increased odds of emergent access to TAVR. After TAVR, SMI patients had longer length of stay and were less likely to be discharged to home. These findings suggest increased discharge planning may be required for patients with SMI after TAVR and highlight the need for additional investigation into barriers to elective TAVR in this vulnerable population.

Abstract 4128526: Brain Natriuretic Peptide is Not Predictive of Days Alive and Out of Hospital During the Interstage Period in Infants with Hypoplastic Left Heart Syndrome

Background: Infants with hypoplastic left heart syndrome (HLHS) have the highest risk of morbidity and mortality during the interstage period. Brain natriuretic peptide (BNP) is frequently measured during the Stage I palliation (S1P) hospitalization. However, there is limited data on the association of BNP with interstage morbidity and mortality. In this context, we sought to examine the association between maximum BNP during the S1P hospitalization and last BNP prior to S1P discharge with days alive and out of hospital (DAOH) during the interstage period. We hypothesized that patients with higher BNPs during their S1P hospitalization would have fewer DAOH during the interstage period. Methods: We performed a single-center retrospective cohort study of infants with HLHS who underwent S1P at our institution between December 1, 2010 and December 31, 2022. Subjects were categorized based on maximum BNP and pre-discharge BNP tertiles. DAOH was calculated by subtracting the number of days hospitalized from the number of days alive during the interstage period. Multivariable zero-truncated negative binomial regression models were used to examine whether there was an association between BNP and DAOH. Models were adjusted for demographic, operative, and discharge characteristics and included an offset for interstage duration. Results: Of 251 infants, 221 (88%) had at least one BNP measured during their S1P hospitalization. The median maximum BNP was 529 (289-944) pg/mL, pre-discharge BNP was 346 (216-589) pg/mL, and DAOH was 97 (89-100) per 100 interstage days. The median maximum BNP in patients who remained admitted during the interstage period (n=32) was 1,027 (446-1,968) pg/mL which was significantly higher than the study cohort (p&lt;0.001). Patients in the maximum BNP upper tertile were more likely to have moderate to severe atrioventricular valve regurgitation (p=0.04) and had higher pre-discharge and pre-Stage 2 palliation BNPs (p&lt;0.001). There was no association between either maximum BNP or pre-discharge BNP with DAOH. Patients in the maximum BNP upper tertile had significantly more BNPs collected during their S1P hospitalization and interstage period. Conclusions: BNP during the S1P hospitalization is not predictive of interstage DAOH. In patients deemed candidates for discharge after S1P, repeated BNP measurements may have limited utility. Further work is needed to assess the association between BNP measured in the interstage period and longer-term outcomes.

Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial.

People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ≥18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509. DERR1-10.2196/64575.

Is poor self-rated health associated with higher caries experience in adults? The HUNT4 Oral Health Study.

The association between lower socioeconomic status and a higher risk of dental caries is well established, but the independent association between general health status and dental caries on a population level is less investigated. The aim of this study was to assess the association between self-rated general health and caries experience in an adult Norwegian population and to assess if the associations were modified by age and sex. Data was collected as part of the Trøndelag Health Study (HUNT4) conducted 2017-2019 and a randomly selected subsample (20%) were invited for the HUNT4 Oral Health Study. This cross-sectional study included 4,880 dentate participants aged 19-94 years (response rate 67%). Participants underwent clinical and radiographic oral examinations and caries experience was measured by numbers of decayed (DT), missing (MT), and filled teeth (FT), DMFT index. The DT component consisted of primary and secondary caries in dentine, cavitated root caries and remaining roots. Questionnaires were used to assess self-rated general health and socioeconomic position, denoted by education, household income and employment status. Associations between self-rated health and caries experience (DMFT) and components (DT, MT, and FT) were assessed using negative binomial regression models. Ratios of means (RMs) with 95% confidence intervals (CI) for the associations were estimated, adjusting for socioeconomic position. Individuals with poor self-rated general health had a 29% higher mean number of MT (RM 1.29 (95%CI 1.13-1.46)), a 22% higher mean number of DT (RM 1.22 (95%CI 1.07-1.39)), and a 7% higher mean number of DMFT (RM 1.07 (95%CI 1.04-1.11)) than individuals reporting very good health. Age stratified analyses presented a more pronounced association between self-rated health and caries experience for individuals below the age of 55 years than for those 55 years or older. Similarly, the association was more evident for women, with significantly higher mean values for DMFT, MT and FT among women reporting poor health. The present study demonstrated an independent association between poor self-rated health and a higher burden of caries experience, adjusted for education, income and employment status. The association was stronger for women and individuals below the age of 55 years. These findings add new evidence in understanding caries inequalities through self-rated health.

Early‐life disadvantage and parent‐to‐child financial transfers

AbstractObjectiveTo determine (1) how parental childhood disadvantage is associated with parent‐to‐child financial transfers for schooling and other unspecified purposes and (2) whether the association holds when parental socioeconomic status (years of education, family income, wealth) is considered.BackgroundCumulative inequality theory posits that early life disadvantage may not only adversely affect one's resource accumulation across the life course, but it may also shape one's ability to provide assistance to offspring.MethodData from the Panel Study of Income Dynamics were used to estimate zero‐inflated negative binomial regression models to predict the amount of parent‐to‐child transfers (N = 2364 for school transfers, N = 3618 for other transfers), controlling for parents' and children's sociodemographic factors. Childhood disadvantage score (0 as reference, 1, 2, 3, 4+) was constructed using 13 items that reflect the economic, psychosocial, environmental, and health domains of early life. The associations of each domain with financial transfers were also estimated.ResultsParents with 4+ disadvantages gave about $2200 less for schooling. Economic and environmental disadvantage lessened levels of school transfers, while environmental disadvantage decreased the odds of being a non‐provider of other transfers. The disparity in transfer amounts generally narrowed when the mediating role of parental socioeconomic status was accounted for.ConclusionHigher education has become one of the major mechanisms through which class stratification, social inequality, and health disparities ensue. Educational outcomes among current cohorts of young adults could have been shaped by the preceding generation's childhood through intergenerational exchanges.

Physical Activity as a Predictor of Internet Gaming Disorder in a Swiss Male Cohort (C-SURF): L'activité physique comme prédicteur des troubles liés aux jeux vidéo en ligne dans une cohorte de jeunes hommes suisses (C-SURF).

This study addresses the increasing global concerns surrounding Internet gaming disorder (IGD) by exploring their connection to physical activity (PA) as a potential preventive and early intervention measure. The research aims to examine the relationship between PA and the progression of IGD. Longitudinal data from the Cohort research on Substance Use Risk Factors involving young Swiss men undergoing army conscription was employed. PA levels were assessed using the International PA Questionnaire (IPAQ), while the Game Addiction Scale (GAS) and Compulsive Internet Use Scale determined IGD presence. Analysis involved zero-inflated negative binomial regression models. Higher PA levels were associated with lower IGD risk. Notably, individuals engaging in high physical exercise exhibited a lower IGD prevalence compared to those with moderate or low activity levels. The study suggests that intensive physical exercise might serve as a preventive strategy against developing IGD. This protective effect could stem from various mechanisms. However, the study's limitations, such as a male-only sample and a small low-activity group, should be considered when interpreting results. The longitudinal study demonstrates the positive influence of intense physical exercise on mitigating gaming-related issues. These findings underscore the potential of PA interventions in addressing the growing problem of IGDs and their impact on health. Further research is necessary to uncover underlying mechanisms behind the PA-IGD relationship and validate these findings across diverse demographics.

Identifying and Predicting Risk for Hospital Admission among Patients with Parkinsonism.

Patients with parkinsonism are more likely than age-matched controls to be admitted to hospital. It may be possible to reduce the cost and negative impact by identifying patients at highest risk and intervening to reduce hospital-related costs. Predictive models have been developed in nonparkinsonism populations. The aims were to (1) describe the reasons for admission, (2) describe the rates of hospital admission/emergency department attendance over time, and (3) use routine data to risk stratify unplanned hospital attendance in people with parkinsonism. This retrospective cohort study used Clinical Practice Research Datalink GOLD, a large UK primary care database, linked to hospital admission and emergency department attendance data. The primary diagnoses for nonelective admissions were categorized, and the frequencies were compared between parkinsonism cases and matched controls. Multilevel logistic and negative binomial regression models were used to estimate the risk of any and multiple admissions, respectively, for patients with parkinsonism. There were 9189 patients with parkinsonism and 45,390 controls. The odds of emergency admission more than doubled from 2010 to 2019 (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.96, 2.76; P-value for trend <0.001). Pneumonia was the most common reason for admission among cases, followed by urinary tract infection. Increasing age, multimorbidity, parkinsonism duration, deprivation, and care home residence increased the odds of admission. Rural location was associated with reduced OR for admission (OR 0.79; 95% CI 0.70, 0.89). Our risk stratification tool may enable empirical targeting of interventions to reduce admission risk for parkinsonism patients.

Impact of extreme bushfire seasons on rates of occupational injury and disease compensation claims in first responders.

This study aimed to use workers' compensation (WC) data to explore the impact of the extreme bushfires on injury/disease claim rates amongst first responders (FR) compared with other occupations and off-seasons. Data on WC claims for FR (ambulance officers, paramedics, firefighters, police) and other occupations were obtained from WorkSafe Victoria 2005-2022. Negative binomial regression models adjusting for age, gender and number of employed people were used to estimate incident rate ratios of all injury/disease, mental, musculoskeletal and respiratory claims among FR in summer and extreme bushfires compared to off-season/summer and other occupations. There were 120,022 claims in 2005-2022; 54% were musculoskeletal injuries. Claims rates were significantly higher for all injuries/diseases, mental, musculoskeletal and respiratory conditions in FR than other occupations across off-season, summers and extreme bushfires. FR were 1.5-3.9 times more likely to claim for mental health conditions during extreme bushfires than off-season compared with other occupations. Firefighters were at increased risk of all injury/disease and mental and musculoskeletal injury claims during summer and extreme bushfires than off-seasons. Ambulance officers and paramedics had the highest claim rates, particularly in off-seasons, with a higher risk of all injury/disease and mental claims in extreme bushfires than in summers. Respiratory and mental claims were increased amongst police and other occupations during extreme bushfires. Extreme bushfire events were associated with increased mental claims rates in all FR, with the highest in firefighters. Strategies to better prevent and manage injury/disease risk in FR are urgently required, particularly for mental health conditions.

Association of Homelessness and Unstable Housing With Cardiovascular Care Utilization Among Veterans.

Veterans are disproportionately more likely to experience homelessness and unstable housing (HUH) compared with the general population. Cardiovascular disease is the leading cause of death among Veterans experiencing HUH. We aimed to understand whether HUH status among Veterans with preexisting cardiovascular disease was associated with disparities in cardiovascular care access and utilization. Retrospective study of all Veterans with preexisting cardiovascular disease between 2017 and 2019 using Veterans Affairs Corporate Data Warehouse and Homeless registry data. Primary outcomes were annual outpatient visits for cardiovascular disease management and visits with cardiovascular disease-related specialists. Secondary outcomes included cardiovascular disease-related procedures and emergency department visits and hospitalizations. HUH status was determined based on response to a screener, diagnostic codes, or use of homelessness services, and outcomes were assessed in the first year HUH status was determined. After applying inverse probability of treatment weighting, negative binomial and logistic regression models were fit to estimate the association between experiencing HUH and the outcomes of interest. Among 1 357 973 Veterans (mean age, 71.6 [SD=10.6] years; 2.5% female) with preexisting cardiovascular disease, 56 093 were identified as experiencing HUH during the study period. Veterans experiencing HUH had fewer outpatient visits for cardiovascular disease management or with cardiovascular disease-related specialists (4.3% [95% CI, 2.5%-6.1%] and 14.1% [95% CI, 12.5%-15.8%], respectively) compared with housed Veterans. HUH status was associated with lower rates of receiving certain procedures including coronary artery bypass graft, lower extremity revascularization, and carotid artery stenosis interventions and higher rates of all-cause and cardiovascular emergency department visits and hospitalizations. Veterans with chronic cardiovascular conditions experiencing HUH had lower rates of outpatient visits for cardiovascular disease management and higher rates of emergency department visits and hospitalizations. Given the disproportionate burden of cardiovascular disease in this population, interventions to improve access to cardiovascular care are needed.

Efficacy of PermaNet® Dual compared to Interceptor® G2 and PermaNet 3.0 in experimental huts in Siaya County, western Kenya

BackgroundPyrethroid-chlorfenapyr nets have shown significant epidemiological impact over pyrethroid-only and pyrethroid plus piperonyl-butoxide (PBO) in Africa. A non-inferiority evaluation of PermaNet® Dual, a new chlorfenapyr plus deltamethrin net, compared to Interceptor® G2, was conducted in experimental huts in Siaya, Kenya against free-flying pyrethroid-resistant Anopheles funestus.MethodsThis study was an experimental hut trial, following a 7 by 7 Latin Square design. Seven treatments and seven sleepers were deployed in the experimental huts daily and rotated weekly and daily, respectively. Mosquitoes were collected every morning between 06:30 h and 08:30 h and were assessed for blood feeding and then monitored for immediate knockdown 1-h post collection and delayed mortality after 72 h. Differences in proportional outcomes were analysed using the blocked logistic regression model, while differences in numerical outcomes were analysed using the negative binomial regression model. Non-inferiority determination was performed based on World Health Organization (WHO) protocol.ResultsMortality at 72 h was 30.2% for PermaNet 3.0, 44.4% for the Interceptor® G2 and 49.2% for the PermaNet® Dual. Blood feeding was highest with PermaNet® Dual at 15%, and least with PermaNet® 3.0 at 10%. PermaNet® Dual and Interceptor® G2 had no significant differences in mortality (OR = 1.10, 95% CI 1.00–1.20) or blood feeding (OR = 1.18, 95% CI 1.04–1.33) and the lower confidence bounds were within the non-inferiority margins but for blood feeding, non-inferiority was relatively high to the upper 95% confidence bound. PermaNet® Dual was non-inferior to the Interceptor® G2 and superior to the PermaNet® 3.0 nets in causing mortality but inferior to PermaNet ®3.0 in blood feeding inhibition of the vectors.ConclusionPermaNet® Dual met the WHO criteria for non-inferiority to Interceptor® G2 and may be considered for deployment for public health use against pyrethroid-resistant Anopheles vectors of malaria.

Exploring the Dimensions and Correlates of Teen Economic Abuse Through a Cross-Sectional Survey

PurposeTeen economic abuse (TEA) is an understudied form of adolescent relationship abuse with limited measures available to assess prevalence. The purpose of this article is to assess the underlying dimensions of survey items (developed with youth) to refine measurement of and validate the structures comprising TEA and examine differences in prevalence of TEA perpetration (Prp) and victimization (Vct) by demographic characteristics. MethodsThis cross-sectional, online survey was conducted between July and September 2021. Youth ages 13–19 who read English and reside in the United States were eligible to complete this study. Recruitment occurred through a national violence prevention listserv with an emphasis on reaching organizations serving youth who are unhoused, juvenile justice and child welfare-system involved, identifying as sexual or gender minorities, or from communities of color. Based on exploratory and confirmatory factor analysis, negative binomial regression models were run to assess associations of demographic characteristics, with levels of TEA Vct and Prp. ResultsAdolescents who identify as White reported significantly more types of TEA exposures than their American Indian or Alaskan Native (adjusted incident rate ratios = 1.3; 95% CI = [1.1, 1.4]), Hispanic Latino (1.2 [1.1, 1.4]), and Multiracial peers (2.4 [1.8, 3.1]). Gender diverse adolescents (1.14 [1, 1.3]) and cisgender females (1.08 [1, 1.2]) had significantly more types of TEA exposures than cisgender males. Those with past-year physical or sexual violence in dating relationships reported more types of TEA exposures (4.1 [3.8, 4.4]) than those who had not experienced such violence. Adolescents with exposure to foster care or homelessness had more types of TEA (1.3 [1.2, 1.4]) than those without such experiences. DiscussionHealthcare providers serving youth should be aware of how economic abuse manifests in adolescent relationships when providing support and resources for youth, especially those who are system-involved or experiencing housing instability. Findings also highlight the need for education about TEA and economic justice in violence prevention programs.

Transitioning to fatherhood: Prospective effects of wellbeing on future depression symptoms.

Becoming a father is a critical period of life transition. Evidence suggests that lifetime history of mental health disorder/s and elevated depressive symptoms prior to conception increase risk for men's postnatal depression. Less is understood about the role of positive mental health, or wellbeing, as a protective factor for future depressive outcomes during the transition to fatherhood. The present study investigated whether men's post-natal depressive outcomes were associated with pre-conception levels of wellbeing and whether wellbeing during the post-natal period predicted depressive outcomes post-infancy. Secondary analysis of data from a national, longitudinal cohort study of men's health, namely, The Ten to Men Study (TTM), was conducted. Participants in the pre-conception sample were n = 350 men for whom data were available at both a pre-conception baseline and post-natal follow-up. The post-natal sample were n = 427 men with post-natal baseline data and post-infancy follow-up. Multivariate negative binomial regressions and logistic regression models were used to determine pre-conception and post-natal predictors of future depressive outcomes. Men's pre-conception depressive symptoms were the best predictor of post-natal depressive symptoms (IRR = 1.089, p < 0.001) and risk of moderate-severe depression (IRR = 1.193, p = 0.005) the latter of which was also predicted by a previous mental health diagnosis (IRR = 3.079, p = 0.029). Similarly, post-natal depressive symptoms were the best predictor of post-infancy depressive symptoms (IRR = 1.089, p < 0.001) and risk of moderate-severe depression (IRR = 1.193, p = 0.005) alongside lifetime prevalence of a mental health disorder (symptoms: IRR = 1.317, p = 0.011; moderate-severe depression: IRR = 2.606, p = 0.023). Preconception levels of wellbeing predicted lower post-natal depressive symptoms (IRR = 0.988, p < 0.001) and reduced risk of moderate-severe depression (IRR = 0.940, p = 0.002) after controlling for baseline symptoms and sociodemographic and behavioural confounds; however, wellbeing during the post-natal period did not predict either depressive outcome post-infancy. Fatherhood-specific risk factors for mental health outcomes (e.g., conception difficulties, maternal postnatal mental health) were not assessed in the present study, and only one aspect of wellbeing was captured. Screening for history of common mental health disorders and current symptoms is recommended to inform preventative approaches to paternal mental health care during early fatherhood. Inclusion of wellbeing in such screening procedures may be beneficial, however, further research is required to elucidate the prospective associations between wellbeing and depressive symptoms during the transition to fatherhood.

Comorbid depression and anxiety and their association with health care resource utilization among individuals with type 1 diabetes in the United States.

Type 1 diabetes mellitus (T1DM) is a prevalent chronic endocrine disorder and accounts for 5%-10% of all diabetes cases worldwide. T1DM can have a substantial impact on health care utilization. Although it is well known that individuals with diabetes are at a greater risk of mental health disorders, specific evidence addressing the health care burden of comorbid depression/anxiety in people affected by T1DM is lacking. To assess health care resource utilization (HCRU) among adults with T1DM and comorbid depression or anxiety. We identified individuals aged 18 to 64 with a T1DM diagnosis from January 1, 2017, to December 31, 2021, using a 25% random sample of the IQVIA PharMetrics Plus for Academics database. The index date was the date of the first medical claim with a T1DM diagnosis. Eligibility required continuous medical and prescription coverage for 12 months before (baseline) and after (follow-up) the index date. Comorbid depression/anxiety and baseline characteristics were assessed during the baseline period. The following 2 mutually exclusive groups were created: individuals with T1DM and comorbid depression/anxiety, and those with only T1DM. To balance baseline demographic and clinical characteristics between the groups, we implemented 1:1 propensity-score matching. We assessed all-cause, diabetes-related, and major adverse cardiovascular event-related HCRU during the follow-up period. Logistic (binary) and negative binomial (count) regression models examined the association between comorbid depression/anxiety and HCRU across types of health care settings. Out of 6,491 eligible individuals with T1DM, 1,168 (18%) had either depression or anxiety. In the matched cohort of 2,314 individuals, those with T1DM and comorbid depression/anxiety had significantly higher odds of all-cause emergency department visits (odds ratio = 1.67; 95% CI = 1.39-2.00) and higher rates of physician office visits (incidence rate ratio = 1.37; 95% CI = 1.27-1.47) and other outpatient encounters (incidence rate ratio = 1.23; 95% CI = 1.13-1.34) than those with only T1DM. Findings were similar for diabetes-related and major adverse cardiovascular event-related HCRU. Comorbid depression/anxiety among individuals with T1DM results in significantly higher HCRU than T1DM alone. The findings underscore the importance of effective management of comorbid depression/anxiety in the T1DM population.