Ordinal Logistic Regression Analysis Research Articles

A community-based study of intention to use HIV self-testing among young people in urban areas of southern Ethiopia

In sub-Saharan Africa, young people are at high risk of HIV infection, representing nearly 4 out of 5 new infections. HIV self-testing (HIVST), a new and proactive testing scheme that involves self-collection of a specimen and interpretation of results, is deemed potentially helpful for increasing testing amongst population groups like young people who do not frequently use routine testing services. This study assessed young people’s intention to use HIVST in urban areas of southern Ethiopia drawing on the Theory of Planned Behaviour. A community-based cross-sectional study was conducted with 634 participants aged 15–24 years from six town administrations of two zones in January to February 2023. The participation rate was 634/636 yielding 99.7%. The OraQuick HIVST kit was demonstrated to young people recruited in a door-to-door survey with a face-to-face interview using an electronic questionnaire in a mobile phone-based application. Intention to use HIVST was measured from a 6-point Likert scale with scores of agreements ranging from 1 to 6. Descriptive statistics and ordinal logistic regression analysis were done using STATA version 18. Most of the participants agreed that they would use HIVST if it was available (86.3% agreeing or strongly agreeing). Interestingly, young people who perceived themselves at some to high risk were 0.51 times less likely to be in the higher order of intention to use when HIVST is available to them than those who perceived themselves at no to low risk. Intention to use HIVST increased by a factor of 1.29, 1.84 and 2.35 for every one-unit increase on the mean favourable attitude, perceived behavioural control, and acceptability scores, respectively. The majority of young people intended to use HIVST. Young people’s perceived behavioural control, and acceptability of HIVST affected their intention to use. Intention and subsequent use of HIVST can be enhanced through an understanding of the role of risk perception and positive attitude, confidence to perform and acceptance of the test. Implementation studies are required to examine the actual uptake of HIVST among young people.

Concordance of patient- and clinician-reported outcomes of acute radiation dermatitis in breast cancer.

The study evaluated the concordance between patient-reported outcomes (PRO) and clinician-reported outcomes (CRO) of acute radiation dermatitis (RD) symptoms following adjuvant radiotherapy for early-stage and locally advanced breast cancer. This is a secondary analysis of a multi-center randomized phase 3 trial (376 patients). Ordinal logistic regression analysis was used to compare the Skin Symptom Assessment (SSA) independently reported by both patients and clinicians. Concordance between patient- and clinician-reported SSAs for RD symptoms was measured by percent concordance, concordance index (C-statistic), and Cohen's Kappa. Analyses were performed across all patients in the original modified intention-to-treat analysis and those with only grade 2-3 (CTCAE) RD. PROs were significantly more severe than CROs across all RD symptoms (Odds Ratio [OR] > 1; p < 0.0001). Pigmentation (OR 5.4), blistering/peeling (OR 4.0), and pain/soreness (OR 3.9) were the most differentially reported symptoms. Poor-to-low concordance was noted between patient- and clinician-reported SSAs for all RD symptoms for the entire cohort (percent concordance < 50%, C-statistic 0.52-0.63, Cohen's Kappa 13.9-23.4%) and those with grade 2-3 RD (percent concordance < 50%, C-statistic 0.56-0.66, Cohen's Kappa 2.0-24.5%). Similarly, poor-to-low concordance was noted in both Mepitel film and standard-of-care arms. PROs and CROs have poor concordance in breast RD, and patients report worse outcomes than clinicians, regardless of RD severity or prophylaxis. PROs must be further integrated into routine clinical practice and clinical trial design to reduce the risk of underreporting symptoms.

Sex-Specific Associations Between Leucocyte Measures and Obstructive Sleep Apnea in Han Chinese.

White blood cell (WBC) and its subset counts are standard, inexpensive, direct markers of inflammation. Obstructive sleep apnea (OSA) is implicated in changes in inflammation markers, and sex differences are evident in both OSA and inflammation. It is unknown whether sex modulates the relationship between OSA severity and leukocyte measures. 1222 patients (914 males, 308 females) underwent overnight laboratorial polysomnography and measurement of WBC and its subset (lymphocyte, neutrophil, monocyte) counts. Patients were divided into primary snoring and mild, moderate, and severe OSA groups, and differences in leukocyte parameters were analyzed separately by sex in multivariable analyses. In multiple regression models, higher apnea-hypopnea index (AHI) was independently associated with neutrophil counts only in men, and with higher total WBC, lymphocyte and monocyte counts both in women and men. Further ordinal logistic regression analysis revealed a significant association between AHI and total WBC (OR 1.87, 95% CI 1.09-3.23) and neutrophil (OR 1.77, 95% CI 1.02-3.07) counts in men only. Correlation analysis also revealed more robust relationships between leukocyte measures and cardiometabolic risk markers in men than in women. This study provides novel data suggesting a significant association between neutrophil count and OSA severity only in men but not women. Similarly, the relationship between leukocyte parameters and cardiometabolic risk markers were more pronounced in men than women. Our findings suggest a sex-specific impact of OSA on leukocyte measures and on their relationship with indices of cardiometabolic risk.

Factors affecting outcome of acquired comitant esotropia with restricted use of digital devices: ACEDD Study 3.

The objective of this study is to investigate factors associated with outcomes after 3 months of instructed usage of hand-held digital devices (DD) in patients with acquired comitant esotropia (ACE). This prospective multicentre observational study included patients with ACE, aged 5-35 years, who used DD within 1 year of onset and were followed up for clinical findings and instructed use of DD. The outcomes were classified into four groups: cured, improved, unchanged and worsened. After the analysis of group differences in the clinical and DD use-related factors by univariate analysis, we used ordinal logistic regression models to identify factors associated with favourable outcomes. Of 156 patients (mean age (SD): 16.4 (7.4) years), 10 (6%), 58 (37%), 67 (43%) and 21 (14%) were classified into the cured, improved, unchanged, and worsened, respectively. In the univariate analysis, consultation within 3 months of onset, small-angle strabismus at distance and good stereoacuity were associated with good outcomes. Ordinal logistic regression analysis on adjusting for age with stereoacuity or successful DD-use time halving showed that small-angle strabismus at distance (OR: 1.02, 95% CI 1.00 to 1.03, p=0.023), good stereoacuity (OR: 1.31; 95% CI 1.10 to 1.56; p=0.003) and successful halving of DD-use time (OR: 0.63; 95% CI 0.43 to 0.92; p=0.016) influenced favourable outcomes. Patients with small-angle esotropia, good stereoacuity on consultation and success in halving DD-use time had a higher chance of recovery through instructional DD usage. Further studies using objectively measurable systems are needed to ensure the accuracy of DD-use time.

Outcomes of different anesthesia techniques in nonagenarians treated with mechanical thrombectomy for anterior circulation large vessel occlusion: An inverse probability weighting analysis.

There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT. Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3. We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77-7.77, p = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00-28.09; p = 0.003). Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. Further studies in larger cohorts are warranted to evaluate the optimal type of anesthesia in this patient population.

Comparative analysis of vascular closure devices for neuroendovascular procedures using Perclose versus Angioseal

BackgroundThe common femoral artery is most frequently accessed for neuroendovascular procedures. Occasionally, postoperative hemostasis is difficult to attain. We comparatively analyzed the vascular closure devices, Angioseal and Perclose, and evaluated the puncture-site complications. Methods357 patients who underwent endovascular treatment via femoral artery puncture and achieved hemostasis using a device were included. We studied the hemostatic method and associated puncture-site complications for various conditions. Ordinal logistic multiple regression analysis was performed for age, sex, sheath diameter, hemostatic method, number of antiplatelet agents, and object disease to identify the factors associated with puncture-site complications. ResultsAngioseal was used in 233 cases, and Perclose in 124 cases. Non-surgical complications were observed in 7.3 % and 0.8 % patients respectively. Complications requiring surgery occurred in 0.9 % of Angioseal, while none of Perclose. The complication rate at the puncture site was 10 % for unruptured aneurysms, 2.3 % for ruptured aneurysms, 3.5 % for carotid artery stenosis, and 4.0 % for acute arterial occlusive disease. Complication-related factors (P < 0.05) were fewer for Perclose (P = 0.0013,OR = 0.09) and higher for unruptured aneurysms (P = 0.0085, OR = 3.62). ConclusionsPerclose is a vascular closure device with rare puncture-site complications for neurosurgical diseases. Unruptured aneurysm cases require careful attention to puncture-site complications.

Consumer Preferences for Health Services Offered by Health Insurance Companies in Germany

Abstract German health insurance companies increasingly strive to position themselves as health partners to their customers to improve customers’ health and contain costs. However, there is uncertainty about customers’ preferences for health services offered by health insurance companies. Therefore, this paper studies consumer preferences for health services that are or could be provided by health insurance companies in Germany. An online survey was conducted using two stated preference techniques to collect and analyze the data (namely, rating and ranking of health services considered by insurance companies). A sample of 880 German health insurance customers between 18 and 65 years old filled out the online questionnaire, of which 860 submitted complete responses. Ordinal logistic regression analysis was used for the rating and ranking. Preliminary examinations, care management, and health programs were the three health services most important to the respondents. The results suggest that people want their health insurance to support them with preventive health services that offer direct therapeutic value and not just informational, economic, access-related, or convenience-related benefits. These preferences for health services are homogeneous for most subgroups of the population, implying that health insurance companies could consider an overall strategy to address these preferences for all clients by focusing on the important health services. Key messages • People value health services provided by health insurers that offer direct therapeutic value over those that offer only informational, economic, access or convenience benefits. • As preferences are homogeneous across the population, insurers could consider an overall strategy by focusing on the important health services.

The nexus between digital financial knowledge and financial inclusion: digital financial attitudes and behaviour as mediators enhancing financial inclusion

Purpose The purpose of this study is to measure financial inclusion (FI) and to examine the role of digital financial literacy (DFL) and its components, and various socio-demographics in relation to FI. In addition, the mediating effect of digital financial attitudes (DFA) on the relationship between digital financial knowledge (DFK) and digital financial behaviour (DFB), as well mediating effect of DFA and DFB on the relationship between DFK and FI, is being explored.Design/methodology/approach Using a cross-sectional research design, we utilize a dataset from the survey of adults’ financial literacy in Bosnia and Herzegovina, collected from the representative sample of 1,096 adults in 2022. The main methodology relies on logistic and ordinal logistic regression analyses and PROCESS for mediation analyses.Findings The findings suggest that the effect of DFK on DFB is partially mediated by DFA. In addition, the effect of DFK on FI is fully mediated through three pathways: DFA, DFB, and DFA and DFB in serial mediation. Age, education, employment status and residence are significantly related to FI. Internet access is significant only for FI scores but not for adults’ banking status. Although women are almost twice as unbanked as men, we find no gender-based differences in financial product holdings, FI or adults’ banking status.Practical implications There is a need to enhance DFK and DFA to enable adults to use financial products. Financial institutions could use our results in designing and promoting their services.Social implications Policy implications are seen in the need for developing national strategies for financial education, with an emphasis on strengthening DFL, especially DFK and DFA, which will enhance the formal FI of adults. Also, governments should work on expanding Internet access.Originality/value The results make a contribution to the theory of planned behaviour. They contribute to the limited empirical evidence of the mediating role of DFA in relationship to DFB, as well as the mediating role of DFA and DFB in relationship to FI.

Impact of Hyponatremia and ADH Secretion in MIS-C and COVID-19: An Integrative Approach of Prognostic and Diagnostic Markers

The COVID-19 pandemic has introduced challenges in pediatric care, especially due to the emergence of Multisystem Inflammatory Syndrome in Children (MIS-C), a severe condition associated with SARS-CoV-2 infection. This study investigated the impact of hyponatremia and antidiuretic hormone (ADH) secretion corelated to clinical outcomes in these patients. We conducted a retrospective cohort study, including 118 pediatric patients, with a detailed sub-cohort analysis of 53 patients for ADH secretion markers. Hyponatremia, defined by age-specific sodium thresholds, was present in 47.22% of MIS-C cases and 28.04% of COVID-19 cases. Ordinal logistic regression analysis revealed that severe hyponatremia significantly increased the likelihood of more severe clinical outcomes (β = 3.514, p &lt; 0.001). A significant correlation was found between hyponatremia and prolonged hospitalization. For ADH secretion, a predictive model using ridge regression was analysed, which demonstrated that serum sodium level, U/P ratio, and hospitalization duration are key predictors of SIADH. This model fit was assessed using the ROC curve with an AUC of 0.96, indicating reliable model performance. Our findings underscore the significant role of hyponatremia on the clinical severity and hospitalization outcome of COVID-19 and MIS-C in pediatric patients.

Willingness to pay and price elasticity of demand for long-acting injectable cabotegravir among men who have sex with men in Guangxi, China.

There is still no study focused on willingness to pay for long-acting injectable cabotegravir (CAB-LA) after it was available on the market in the United States in 2021. Here, we explored the willingness to pay for CAB-LA and associated factors and price elasticity of demand (PED) of CAB-LA among men who have sex with men (MSM) in Guangxi, China. A cross-sectional study was conducted. Univariate and multivariate ordinal logistic regression analyses were performed to explore the associated factors of willingness to pay for CAB-LA. PED was used to measure the change in the number of participants willing to pay to a change in price. A total of 1,006 MSM were recruited, among which 84.1% were aged between 18 and 39years old. The median (interquartile) of the maximum amount of willing to pay for CAB-LA was 200 (100-500) Chinese yuan (CNY) per month. Most (84.2%) were willing to pay less than 600 CNY per month. The number of participants willing to pay for CAB-LA significantly increased with decrease in the price. When the price (CNY per month) decreased from 600 to 500, 500 to 400, 400 to 300, and 300 to 200, PED was 3.13, 1.64, 1.33, and 1.17, respectively. The maximum amount of willing to pay for CAB-LA was positively associated with younger age (vs. ≥40years group, 18-24years group, aOR: 1.94, 95% CI: 1.32-2.85; 25-39year group, aOR: 1.70, 95% CI: 1.20-2.42), being high educated (vs. middle school or lower group, high school or college group, aOR: 1.61, 95% CI: 1.06-2.48; bachelor's degree or above group, aOR: 2.21, 95% CI: 1.41-3.49), monthly income ≥6000 CNY (vs. <3000 CNY, aOR: 1.46, 95% CI: 1.02-2.09), being bisexual/unsure sexual orientation (vs. gay, aOR: 1.73, 95% CI: 1.24-2.43), and heard of PrEP and used (vs. never heard of PrEP, aOR: 1.76, 95% CI: 1.11-2.77). The maximum amount of willing to pay for CAB-LA was low in Guangxi, China. PED of CAB-LA is relatively elastic. The waived patent protection should be considered for the wide promotion of CAB-LA, and the health education should be strengthened to improve the recognition of CAB-LA.

Investigating factors influencing overweight and obesity among adult households in Ethiopia: a multilevel ordered analysis of 2016 EDHS data.

In both high- and low-income countries, including Ethiopia, overweight and obesity have emerged as public health issues of the 21st century. Hence, obtaining conclusive evidence concerning the factors that influence adults' body mass index is important. Therefore, using representative data, our study sought to provide solid evidence on factors influencing overweight and obesity among adults in Ethiopia. The 2016 Ethiopia Demographic and Health Survey (EDHS), a dataset composed of a nationally representative sample of the survey, served as the basis for the study. Both descriptive and analytic findings were produced using STATA version 14. The data collection were conducted from January to June 2016. A total sample of 39,749 adults, 18 years and older, were included. Predictors were assessed using multivariable ordinal logistic regression analysis, and the results were presented as an adjusted proportional ratio (POR) with a 95% confidence interval. Statistical significance was declared at a p-value of <0.05. Overall, the magnitude of overweight and obesity among adults in Ethiopia was 8.5% (95% CI: 8.2% to 8.7%) and 2.9% (95% CI: 2.7% to 3.1%), respectively. Predictor variables such as smoking (POR = 0.53, 95% CI: 0.42-0.67); being female (POR = 1.21, 95% CI: 1.13-1.30); being married (POR = 1.91, 95% CI: 1.26-2.90); having a secondary education (POR = 1.42, 95% CI: 2.23-1.64); having a diploma and above education (POR = 1.78, 95% CI: 1.44-2.21); having a poorer (POR = 1.22, 95% CI: 1.13-1.31), middle (POR = 1.30, 95% CI: 1.20-1.40), richer (POR = 1.35, 95% CI: 1.25-1.47), and richest (POR = 3.13, 95% CI: 2.79-3.51) wealth index rating; and having a rural residence (POR = 0.48, 95% CI: 0.43-0.54) were significantly associated with overweight and obesity. Overall, 8.5% and 2.9% of Ethiopian adults were overweight and obese, respectively. Factors such as smoking, sex, marital status, educational status, wealth index, residence, and region were significantly associated with overweight and obesity among adult households. As a result, enhancing lifestyle modifications is enormous, and it is necessary to have more tangible evidence concerning the factors influencing body mass index utilizing more representative data from local and global.

Impact of physical activity on life satisfaction among middle-aged and older adults in China: A longitudinal national study.

This study examined the impact of physical activity on life satisfaction in middle-aged and older adults in China. Utilizing longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015 and 2018, a total of 6484 participants aged 45 or older were included in the analysis. Data were collected on sociodemographic, health, and lifestyle variables, physical activity, and life satisfaction. Physical activity was categorized into 3 levels: low (71%), moderate (25%), and high (4%). Ordinal logistic regression and subgroup analysis were used to examine the effect of baseline physical activity on life satisfaction, including the examination of interaction effects. After adjusting for age, gender, education, marriage, residence, smoking, alcohol use, depressive symptoms, and self-rated health at baseline (2015), compared to the moderate-intensity physical exercise group, those in the low-intensity group experienced significantly lower levels of life satisfaction on follow-up (2018). In the subgroup analyses, a significant negative effect of low-intensity physical activity on life satisfaction was found in all groups regardless of age, education, marital status, smoking, alcohol use, sleep duration, weight, presence of chronic diseases, or self-rated health. These results support the promotion of physical exercise to enhance life satisfaction among middle-aged and older adults in China.

Unmet Financial Needs of People with Psychotic Disorders-A Cross-Sectional Study in People with Psychotic Disorders, Parents, Siblings, and Controls.

Background. Psychotic disorders have a strong negative impact on people's lives, including their financial situation. This study aimed to examine differences in unmet financial needs between people with psychotic disorders, parents, siblings, and controls. Secondly, we aimed to examine whether family clustering contributes to unmet financial needs. Lastly, we aimed to examine to what extent demographic, economic, psychiatric, functional, and cognitive characteristics and substance use predict unmet financial needs in people with psychosis. Methods. Data from the first assessment of people with psychosis (n = 956), siblings (n = 889), parents (n = 858), and controls (n = 496) included in the Genetic Risk and Outcome of Psychosis study were used. Group differences were assessed with Kruskal-Wallis tests (aim 1), while a mixed-effects logistic regression analysis and explorative and confirmative ordinal logistic regression analyses were conducted for aims 2 and 3, respectively. Results. Twenty-four percent of people with psychotic disorders reported unmet financial needs. These levels of unmet financial needs were significantly higher than levels for siblings, parents, and controls. We found a negligible influence of (direct) familial clustering on unmet financial needs. Lastly, cannabis and tobacco use significantly and consistently predicted higher levels of unmet financial needs of people with psychosis. Conclusions. Relatively high levels of unmet financial needs occurred in a heterogeneous group of people with psychosis, especially when people used cannabis or tobacco. Unmet financial needs can have detrimental consequences for mental health, stigmatization, leisure time activities, and social engagement. Thus, it is pivotal to recognize unmet financial needs, especially combined with substance use, as a crucial stressor for people with psychosis.

Prevalence and influencing factors of suicidal ideation among doctors and nurses during the surge period of the COVID-19 pandemic in China: a multicenter cross-sectional study.

From November 2022 to February 2023, China has experienced a surge period of COVID-19 pandemic and doctors and nurses working in hospitals have suffered from serious psychological crisis because of the medical crowding, which may result in the occurrence of suicidal ideation (SI). This study aims to explore the prevalence and influencing factors of SI during this surge phase. A multicenter cross-sectional study was conducted in China from January 5 to February 9, 2023. Data were collected by online questionnaires, with SI measured by a single item. Ordinal logistic regression analysis and stratified analyses were preformed to identify influencing factors. A total of 5696 doctors and nurses were retained for further analysis, with 25.28% reporting SI during the COVID-19 surge phase. Participants experiencing anxiety symptoms or supporting other departments treating COVID-19 patients were more likely to report SI. Additionally, higher levels of resilience, mindfulness, and perceived social support were protective factors against SI. During the COVID-19 surge phase, over a quarter of doctors and nurses in China suffered from SI, which should be of great concern. Tailored interventions should be implemented to alleviate SI among doctors and nurses when new infectious diseases outbreak in the future.

Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting

Background: Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied. Objectives: To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening. Research Design: Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs. Subjects: Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic). Measures: The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening. Results: Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21). Conclusions: Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.

A novel pelvic magnetic resonance imaging measurement for pelvic organ prolapse evaluation

BackgroundPelvic magnetic resonance imaging has been proven effective for quantifying the extent of prolapse. The pubococcygeal line is used universally as a reference line in measuring pelvic organ prolapse, however, it focuses solely on three lowest points in the anterior, middle, and posterior pelvic compartments, without taking into account other pelvic floor structures and their interactions. ObjectivesThis study aimed to introduce and validate the area under the pubococcygeal line, a novel measurement method for evaluating pelvic organ prolapse, to examine its correlation with clinical Pelvic Organ Prolapse Quantification staging, and assess its reliability across different raters. Study DesignThis study recruited 225 women who underwent evaluations involving both magnetic resonance imaging measurements and clinical Pelvic Organ Prolapse Quantification staging. A comprehensive statistical approach involving descriptive analysis, correlation analysis, reliability assessment, and ordinal logistic regression analysis was adopted to evaluate the applicability and reliability of the area under the pubococcygeal line measurement. ResultsAnalysis of participant characteristics across different POP-Q stages revealed a significant association between increased values of the area under the pubococcygeal line and severity of Pelvic Organ Prolapse Quantification staging. Correlation analysis was performed to identify and quantify the strength of the associations between the variables. The area under the pubococcygeal line showed a strong positive correlation with Pelvic Organ Prolapse Quantification stages (Spearman's r = 0.878, p < 0.001), outperforming the pubococcygeal line grades (Spearman's r = 0.777, p < 0.001). Reliability assessments yielded excellent intra- and inter-rater reliability, with intraclass correlation coefficient values of 0.980 and 0.906, respectively. Ordinal logistic regression analysis was used to determine the association between these variables and POP severity, highlighting significant associations between the area under the pubococcygeal line and Pelvic Organ Prolapse Quantification stages. ConclusionThe area under the pubococcygeal line measurement method is a novel and comprehensive magnetic resonance imaging technique for evaluating pelvic organ prolapse. This method strongly correlates with clinical Pelvic Organ Prolapse Quantification stages and exhibits excellent intra- and inter-rater reliability, holding a potential for enhanced diagnostic accuracy, optimized treatment strategies, and improved patient outcomes.

Dose-dependent Effect of Current Smoking on Enlarged Perivascular Space Identified on Brain MRI.

Cerebral small-vessel disease (CSVD) is a common cause of cognitive decline and stroke. Several studies have shown that smoking is a risk factor for CSVD progression. However, the extent to which smoking exacerbates CSVD lesions remains unclear. In this study, we aimed to clarify the association between total smoking exposure and the severity of CSVD in healthy participants. We analyzed the data of participants aged ≥ 50 years who underwent brain screening. The participants' age, sex, body mass index, alcohol consumption history, and medical history (hypertension, diabetes mellitus, and dyslipidemia) were investigated. Smoking status was assessed in pack-years, and smokers were classified as current or past smokers. CSVD findings on magnetic resonance imaging were used to evaluate the severity of periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DSWMH), and enlarged perivascular spaces (EPVSs). The EPVSs were measured in the basal ganglia and centrum semiovale regions. Multivariable ordinal logistic regression analyses were performed to evaluate the effect of smoking, adjusted for the participants' baseline characteristics. A total of 2,137 participants were included in this study. The mean age of the participants was 58.7 years. The mean pack-years were 20.5 for past smokers and 26.8 for current smokers. Among current smokers, increased pack-years were significantly associated with a high EPVS burden in the basal ganglia (odds ratio: 1.14, 95% confidence interval: 1.00-1.28), whereas no such significant association was found for past smokers. No statistically significant association was found between pack-years and the risks of PVH, DSWMH, or EPVS in the centrum semiovale. Current smoking was associated with a dose-dependent risk of EPVS in the basal ganglia in healthy participants.

Early recurrence as a pivotal event in nasopharyngeal carcinoma: identifying predictors and key molecular signals for survivors

PurposeThe duration of response to treatment is a significant prognostic indicator, with early recurrence (ER) often predicting poorer survival outcomes in nasopharyngeal carcinoma (NPC) survivors. This study seeks to elucidate the factors contributing to the onset of ER following radiotherapy in NPC survivors.MethodsThis investigation encompassed 2,789 newly diagnosed NPC patients who underwent radical intensity-modulated radiotherapy. Ordinal logistic regression analysis was employed to evaluate the independent predictors of earlier recurrence. A machine learning-based prediction model of NPC recurrence patterns was developed. Tumorous RNA-sequencing (in-house cohort: N = 192) and biological tipping point analysis were utilized to infer potential molecular mechanisms associated with ER.ResultsOur results demonstrated that ER within 24 months post-initial treatment was the optimal time frame for identifying early malignant progression in NPC survivors. The ER cohort (150 of 2,789, 5.38%) exhibited a notably short median overall survival of 48.6 months. Multivariate analyses revealed that male gender, T4 stage, local or regional residual disease, detectable pre- and post-radiotherapy EBV DNA, and the absence of induction chemotherapy were significant predictors of earlier recurrence. The machine learning-based predictive model further underscored the importance of tumor-related factors in NPC recurrence. Moreover, ER emerged as a pivotal stage in NPC progression, with 15 critical transition signals identified potentially associated with the negative modulation of the immune response.ConclusionsOur comprehensive analysis of NPC recurrence patterns has unveiled insights into the key factors driving ER and provided novel insights into potential early warning biomarkers and the mechanisms underlying NPC progression.

Education Research: Burnout and Perception of Value in a Cross-Section of Neurology Residency Program Directors.

There are no dedicated studies specifically assessing burnout in neurology residency program directors (PDs). A study of residency and fellowship directors across specialties found neurology residency PDs had the highest work-related Copenhagen Burnout Inventory (CBI) score, which may reflect high-level burnout in neurology in general. Indeed, the American Academy of Neurology Burnout Task Force reported burnout in 60% of neurologists. The aims of this study are to determine the level of burnout in adult and pediatric neurology residency PDs, and to determine whether perception of value is related to burnout. In an IRB-approved study, 184 neurology residency PDs were emailed an anonymous survey consisting of the full CBI, demographic information, and 2 items addressing perception of value in the PD role: "I feel valued by my department in my educational role," to which the participant could respond "strongly disagree, disagree, agree, or strongly agree," and "satisfaction with current percent effort for the educational role," to which the participant could respond "very dissatisfied, dissatisfied, satisfied, or very satisfied." Data were analyzed through analysis of variance and ordinal logistic regression. A total of 85 PDs (46%) responded to the survey. The average ± SEM personal, work-related, and patient-related CBI scores were 41.8 ± 2.2, 39.7 ± 2.2, and 32.4 ± 2.2, respectively. Higher personal and work-related CBI scores were associated with less positive perception of value (proportional odds ratio 1.03, 95% CI 1.01-1.06, p = 0.004 and proportional odds ratio 1.04; 95% CI 1.01-1.06, p = 0.003, respectively). Higher personal and work-related CBI scores were also associated with greater dissatisfaction with percent effort granted for the PD role. Level of burnout did not differ between adult and pediatric PDs. Burnout was not related to sex, years in practice, years as PD, academic rank, or percentage effort granted for the PD role. Despite working in a field associated with high burnout, neurology residency PDs were found to have lower-level burnout than previously reported. Ninety-four percent of the PDs reported feeling valued in their role which was associated with lower-level personal and work-related burnout and may represent a key target for reflection and burnout intervention in the future.

Impact of the Information System and Emotional Intelligence on Corporate Social Responsibility in the Criminal Justice Modules of Piura, 2023

The research on the information system and emotional intelligence in the corporate social responsibility of criminal justice modules in Piura 2023 analyses how the information system and emotional intelligence influence corporate social responsibility. The study, of a quantitative and explanatory nature, was carried out with a sample of 100 collaborators of the Criminal Justice Modules of Piura. Using questionnaires and ordinal logistic regression analysis, it was found that both emotional intelligence and an effective information system are essential to improve corporate social responsibility in these modules. The research concludes that the development of emotional and technological capabilities is crucial to foster a more responsible and effective organizational environment.