Multinomial Logistic Regression Models Research Articles

Alcohol intake and patterns of multi-site musculoskeletal pain in the British Whitehall II study

Abstract Background Patterns of multi-site musculoskeletal (MSK) pain and its relationship with alcohol drinking among white-collar employees and retirees remain unclear compared to blue-collar workers. This study aimed to examine the relationship between alcohol drinking and MSK pain through latent class analysis (LCA) in current and retired white-collar employees. Methods We used the data from the 7th phase (2000-2002, n = 6,967, response rate 71.6%) of the British Whitehall II study, chosen for its availability of MSK items and approximately 1:1 ratio of employees to retirees, allowing for an evaluation of the relationship between alcohol drinking and MSK pain by employment status. LCA was used to distinguish patterns of multi-site MSK pain. A multinomial logistic regression model was used to examine the association between alcohol drinking and the identified pain patterns, with analyses conducted separately for employees and retirees. Results We identified five latent classes for pain (back/cervical: 7.1%, cervical: 28.9%, upper limb: 29.4%, combined LBP/upper limb/cervical: 13.2%, and LBP alone: 21.5%). Increased alcohol intake might be associated with elevated odds of upper limb pain in current drinkers, but this could not be statistically confirmed (OR: 1.04, 95% CI: 0.99-1.09). Employment status may modify the association with a significant interaction found between alcohol intake and retirement (p-value: 0.043). Every 7-unit increase in alcohol intake is associated with 18% and 12% higher odds of pain in LBP/UBP/cervical and upper limbs, respectively (95% CI: 1.02-1.37; 1.02-1.23). Conclusions Increased alcohol intake was associated with pain patterns only among retired white-collar employees but not the current ones. Interventions on alcohol consumption could help confirm if, reducing alcohol intake or avoiding hazardous drinking, for white-collar retirees prevents not only upper limb pain but also more complex pain patterns. Key messages • Musculoskeletal pain in white-collar employees and retirees contributes to the cervical and upper extremities, differing from low back/neck pain studies among general or blue-collar workers. • The association between alcohol drinking and pain patterns may differ across employment status. Reducing alcohol intake might be advised to retired drinkers for preventing multi-site pain.

To monitor or not after detected AF, this is a question: report from the consumer-led screening programme of long-term extension mAFA cohort

Abstract Background The consumer-led screening for atrial fibrillation (AF) is evolving with the widespread availability of wearables. Nonetheless, what the long-term impact on the individual's behavior of rhythm monitoring after detected AF is unclear. Objective To investigate the long-term impact on health behavior for the individuals using wearables for cardiac rhythm. Methods In the mobile technology supported screening and integrated care in atrial fibrillation (mobile atrial fibrillation application, mAFA programme), the general population freely decided to enter the screening programm with wristbands or watches across China. At least 14-day monitoring was proposed, the individuals with detected AF can consider to receive the mAFA App for AF care. The adherence of rhythm monitoring after detected AF with wearables was calculated, while the multinomial logistics regression model was utilised to analyze the independent factors associated with the adherence. Results There were 4337172 individuals entered into AF screening programme using wearables between Oct, 2018 and Feb 14, 2024. Among them, 22224 individuals (0.5%, 22224/4337172, mean age, SD, 55, 16 years old, male 82.4%) were monitored with AF episodes. There were 21223 individuals remaining the wearables use for rhythm monitoring after first AF identification. The time (days, median, interquartile ) using wearables for monitoring the pulse rhythm were 465 (130, 889) days. The time to first identified AF (days, median, interquartile) were 16 (1, 176) days. The continuing monitoring time since first identified AF (days, median, interquartile) were 290 (54, 668) days. The adherence of cardiac rhythm monitoring after detected AF with wearables (Figure): 96.0% individuals continued the rhythm monitoring using wearables during 30 days, 58.8% in 2 years, and 35.7% in 3 years and over. In the adjusted multinomial logistics regression model, the palpitation, hypertension, obstructive sleep apnea, heart failure, age and mAFA use were independently associated with the adherence for the individuals remaining the wearables use for rhythm monitoring after detected AF (all p<0.05). Conclusions The general population at risk were likely to receive long-term rhythm monitoring after detected AF, and the mAFA use, with the self-care support, was an independent factor for the continuing monitoring.

Association between household solid fuel usage and trajectories of multimorbidity among middle-aged and older adults: a nationwide population-based cohort study

BackgroundThis study aimed to explore the effect of household solid fuel usage on the multimorbidity trajectories among middle-aged and older adults.MethodsBased on the 2011–2018 China Health and Retirement Longitudinal Study, the group-based trajectory modeling and the multinomial logistic regression model were used to explore the relationship between multimorbidity trajectories of older adults with different fuel types, duration of solid fuel usage, and potential interaction with PM2.5. Three multimorbidity trajectory patterns were identified by group-based trajectory modeling and labeled as “non-chronic morbidity” (no disease increase), “newly developing multimorbidity” (diseases grew from 0 to 2), and “multi-chronic multimorbidity” (diseases grew from 2 to 4).ResultsCompared to “Non-chronic morbidity,” solid fuel was significantly associated with adverse multimorbidity trajectories, with an odds ratio (OR) and 95% confidence interval (CI) of 1.33 (1.11, 1.60) and 1.35 (1.18, 1.55) for newly developing and multi-chronic group, respectively. An adverse multimorbidity trajectory tended to be established with longer durations of solid fuel usage than “Non-chronic morbidity.” For “Newly-developing multimorbidity,” the ORs (95% CI) for 1–7 years and ≥ 8 years of solid fuel usage were 1.16 (0.94, 1.42) and 1.41 (1.12, 1.76), respectively, with P trend=0.001, while in “Multi-chronic multimorbidity,” those were 1.25 (1.07, 1.47) and 1.68 (1.41, 2.00), respectively, with P trend <0.001. In the interaction analysis, the association between solid fuel usage and trajectories was significant only in areas where PM2.5 was lower than 50 μg/m3.ConclusionFor the middle-aged and older Chinese population, a higher risk of multimorbidity trajectory is associated with household solid fuel usage, especially in the areas with lower PM2.5.

Social health gradient and risk factors among patients hospitalized for COVID-19 and pre-pandemic respiratory infections. A linked national individual case-control study in Belgium

IntroductionThe literature establishes a clear social gradient in health for transmissible respiratory diseases. However, this gradient’s extent remains largely unexplored in the context of COVID-19, and it is uncertain whether the pandemic has exacerbated this gradient. The study aims to compare the socio-economic profiles and comorbidities during the COVID-19 pandemic with a control population affected by viral pneumonia/respiratory disease in 2019.MethodsThis case-control study analyzed linked data from all patients hospitalized for COVID-19 in 2020 (n = 22,087) and for respiratory diseases in 2019 (n = 7,586). Socio-economic data from the social security database were linked to clinical data from the hospital registry. We analyzed the socio-demographic and clinical factors associated with COVID-19 hospitalization (control group, wave 1, and wave 2) using multinomial regressions and logistic regression models and the length of stay during hospitalization using binomial negative regressions.ResultsA social health gradient was observed in both the COVID-19 and control groups, with a significant increase across waves for COVID-19 (p-trend < 0.0001). Men, people over the age of 45, those with comorbidities, high population density, lower income, lower socio-economic status, and people living in Brussels capital were at higher risk of COVID-19 hospitalization and longer length of stay compared to the control group. Except for sub-Saharan Africans, all patients of foreign nationality had a significantly increased risk of hospitalization (p < 0.001), but a shorter length of stay compared to Belgians.ConclusionThe socio-health gradient for COVID-19 followed the same pattern as that observed in pre-pandemic respiratory diseases, intensifying in the second wave and among the most deprived groups. This study emphasizes the importance of collecting social data alongside clinical data for a better understanding of social health inequalities and for tailoring health prevention policies.

Correlates of food insecurity among university students in a low socioeconomic area

Abstract Background The prevalence of food insecurity (FI) is high and suggested to be growing among university students, with potential detrimental effects on their health status and academic performances. This cross-sectional study aims to identify the socioeconomic, demographic and lifestyle factors associated with FI among university students in a disadvantaged area. Methods An anonymous online survey was conducted from Nov 2022 to Jan 2023 among students enrolled at University Sorbonne Paris Nord, located in a low socioeconomic area in France. FI was assessed with one question distinguishing 2 levels of FI: quantitative (i.e. not having enough to eat) and qualitative (i.e. not having the desired food). This abstract focused on quantitative FI. To improve the representativeness of the sample compared to the total student population of the university, sample weights were used according to gender, study level and speciality, whether they were undergoing initial training or not, or obtained their baccalaureate abroad or not. Multivariable multinomial logistic regression models were used to identify factors associated with FI. Results A total of 5068 students provided valid answers (20% of the target population), 66% of whom were women, and 12% and 36% reported quantitative and qualitative FI, respectively. Being a man, an undergraduate, having obtained a baccalaureate abroad, not living in the family home, not receiving food from family, having no household food-heating facilities, reporting financial difficulties, relying on food charity and eating alone on a regular basis were positively associated with quantitative FI (P < 0.0001). Those reporting quantitative FI were more likely to report academic difficulties. Conclusions This study shows a high prevalence of FI in this student population and identifies several associated factors. Identifying students at greater risk of FI is an important first step to design and evaluate public health interventions. Key messages • The different socio-economic backgrounds of university students imply important food insecurity disparities among them. • University students present several factors associated with food insecurity, which should be considered when addressing food insecurity in this population.

Green and blue spaces residential exposure over childhood and multimorbidity in adolescence

Abstract Background Previous studies have explored associations of exposure to natural spaces with specific adverse health outcomes over childhood. However, knowledge is lacking on its effects on multimorbidity, defined as the co-occurrence of two or more diseases in the same individual. We aimed to assess the associations between exposure to green and blue spaces, at multiple time points and through trajectories over childhood, with multimorbidity in early adolescence. Methods In 2388 children from the Generation XXI birth cohort, we assessed, at birth, 4, 7 and 10 years, the residential greenness through the Normalized Difference Vegetation Index (NDVI), the distance from the child’s residence to the closest green and blue space, and the presence of green and blue space (>5,000m²) within 300m distance from the child’s residence. We identified, from birth to 10 years, longitudinal trajectories of exposure to green and blue spaces, using latent class mixed models. At 13 years, participants were classified as having 0, 1 or ≥ 2 cardiometabolic, respiratory and/or neurodevelopmental adverse health outcomes. Adjusted multinomial logistic regression models were used. Results The prevalence of multimorbidity at 13 years was 43%, with overweight/obesity (35%), allergies and asthma (30%), and dyslipidemia (26%) as the most common adverse health outcomes. We observed that the presence of green spaces > 5,000m² within a distance of 300m at birth, 4, 7, and 10 years was associated with lower odds of developing multimorbidity (Odds Ratio (OR) [95% CI] 0.55 [0.32-0.95]; 0.52 [0.32-0.84]; 0.51 [0.32-0.82]; 0.51 [0.32-0.80], respectively). No other significant associations were observed. Conclusions Green spaces around the child’s residence seem to have a protective effect on the development of multimorbidity at 13 years. These findings reinforce the importance of urban design, and the creation of green spaces close to residential areas to optimize health across childhood and adolescence. Key messages • The prevalence of multimorbidity at 13 years is high and worrying. • Increasing accessibility to green spaces might decrease the risk of multimorbidity in adolescence.

Uncovering Prognostic Clinical Phenotypes in Children and Adolescents with SARS-CoV-2 Infection

Abstract Background Characterizing clinical phenotypes is important for classifying patients, predicting disease outcomes, and adapting treatment. We aimed to identify distinct clinical phenotypes among hospitalized children and adolescents with SARS-CoV-2 infection and to evaluate variations in prognosis across these phenotypes. Methods The DGPI (German Society of Pediatric Infectious Diseases) registry serves as a nationwide, prospective registry for children and adolescents hospitalized with a SARS-CoV-2 infection in Germany. We applied hierarchical clustering and integrated variables such as sex, SARS-CoV-2-related symptoms, pre-existing comorbidities, clinically relevant coinfection, and SARS-CoV-2 risk factors to describe distinct clinical phenotypes. Subsequently, we applied a multinomial logistic regression model to examine the association between these phenotypes and discharge status. Results The DGPI registry encompassed 6983 patients and facilitated the identification of six distinct phenotypes for children and adolescents with SARS-CoV-2. Phenotype A had a similar symptom pattern as the total sample. Predominant symptoms of patients with other phenotypes were gastrointestinal (95.9%, B), asymptomatic (95.9%, C), lower respiratory tract (49.8%, D), lower respiratory tract and ear, nose and throat (86.2% and 41.7%, E), and neurological (99.2%, F). Patients with phenotype C had lower odds of residual symptoms (OR: 0.10 [0.06, 0.15]) than those with phenotype A, whereas patients with phenotype D and E had higher odds of residual symptoms (OR: 1.33 [1.11, 1.59] and 1.91 [1.65, 2.21], respectively) than those with phenotype A. Patients with phenotype D were significantly more likely (OR: 4.00 [1.95, 8.19]) to have an unfavorable outcome, compared to patients with phenotype A. Conclusions We could show that the identified phenotypes could facilitate early risk assessment and aid in tailoring individualized patient management strategies. Key messages • Six distinct clinical phenotypes existed in children and adolescents with SARS-CoV-2 infection. • Phenotypes could assist in risk evaluation and help personalize patient care.

Machine Learning-Based Crop Suitability Prediction: An Emerging Technique for Sustainable Agricultural Production in the Desert Region of India

ABSTRACT Machine learning (ML) algorithms can be applied to predict the suitability of soil for crop cultivation based on digital soil mapping. We used three distinct models viz. Multinomial Logistic Regression (MnLR), Random Forest (RF), and Extreme Gradient Boosting (XGBoost) to predict the suitability of wheat and pearl millet in the Barmer district of the Thar Desert. After the computation of crop suitability classes, ML techniques were used to develop suitability maps of wheat and pearl millet in the study area. The study found that the RF and XGBoost models worked well to classify crop suitability. The RF model showed that 11.9% of the total area was highly suitable, 1.6% was moderately suitable, 14.9% was marginally suitable, and 71.6% was not suitable for wheat crop. RF model for pearl millet showed that 15.5% of the area is highly suitable. Soil suitability mapping for wheat showed a Kappa index ranging from 0.23 to 0.57 and an overall accuracy ranging from 0.79 to 0.86, whereas the prediction of suitability for pearl millet showed a moderate range of Kappa index from 0.31 to 0.58 and accuracy from 0.63 to 0.77. The area under curve (AUC) for wheat crop was 0.72, 0.88, and 0.91 for MnLR, RF, and XGBoost models, respectively. Overall, the RF model performed better than the MnLR model, showing a 16% increase in accuracy. Therefore, the developed suitability maps using ML provide valuable details on agricultural potential in the Indian desert region while harmonizing its impact on the environment and the economy.

Comparison of depressive symptoms among emergency physicians and the general population in China: a cross-sectional study based on national data

BackgroundWhile physicians are considered to be more susceptible to developing depressive symptoms, empirical data are lacking. The study aims to compare the risk of depressive symptoms between emergency physicians and the general population in China based on national data.MethodsThis was a national cross-sectional study. 10 457 emergency physicians and 101 120 participants from the general population were investigated from July 2018 to August 2018 and January 2019 to February 2019, respectively. PHQ-9 was used to measure depressive symptoms, and a score ≥ 10 indicates major depression. Propensity score matching was adopted to balance the characteristics between emergency physicians and the general population. Multinomial logistic regression model was used to examine the association between occupational groups and the severity of depressive symptoms. Binary logistic regression model was performed to explore the risk factors of major depression among emergency physicians.ResultsThe prevalence of major depression among emergency physicians was 35.7%, whereas among the general population was 13.9%. Emergency physicians had a 3.65 times higher risk of major depression than the general population. And emergency physician was significantly associated with mild (OR: 3.12, 95% CI 2.95–3.30), moderate (OR: 4.94, 95% CI 4.60–5.30), moderately severe (OR: 9.48, 95% CI 8.61–10.44), and severe depressive symptoms (OR: 14.18, 95% CI 12.47–16.13) compared with none depressive symptoms. Even after matching, the results remained consistent. Factors associated with major depression among emergency physicians included bachelor degree or above (OR: 1.22, 95% CI 1.06–1.40), worked long years (OR: 1.26, 95% CI 1.08–1.46 for 1–5 years; OR: 1.56, 95% CI 1.32–1.84 for ≥ 6 years), experienced workplace violence (OR: 2.51, 95% CI 2.16–2.94), worked more night shifts per month (OR: 1.33, 95% CI 1.16–1.51 for 6–10 times; OR: 1.83, 95% CI 1.58–2.11 for ≥ 11 times), smoked (OR: 1.64, 95% CI 1.47–1.84), and effort-reward imbalance (OR: 4.18, 95% CI 3.62–4.85).ConclusionsEmergency physicians had a higher risk of depressive symptoms than the general population. There is a need for greater awareness of the mental health issues faced by emergency physicians.

Sexual identity differences in the association between psychological distress and cardiometabolic health among women: 2013-2018 National Health Interview Survey.

Poor psychological health has been consistently documented for sexually minoritized women. However, little is known about the association between poor psychological health and physical health. This study examined associations between psychological distress and cardiometabolic health, including cardiovascular disease risk conditions (hypertension, high cholesterol, and diabetes) and diagnoses (stroke, coronary heart disease, myocardial infarction, and angina), by sexual identity among women. Data are from the 2013-2018 National Health Interview Survey and included 102,279 women, who were straight (n = 97,909), lesbian/gay (n = 1,424), bisexual (n = 1,235), something else (n = 360), did not know (n = 712), and refused to disclose (n = 639). Multivariable multinomial logistic regression models were fit to estimate associations between psychological distress (measured with Kessler-6) and cardiometabolic health (self-reported diagnosis) and to examine sexual-identity differences in these associations. Covariates included sociodemographic characteristics. Overall, severe psychological distress was associated with significantly higher odds of having a cardiometabolic health condition (OR = 2.66). These associations generally did not statistically significantly differ based on sexual identity. However, potential substantive differences in the magnitude of the association existed among lesbian/gay (OR = 4.00) compared to straight women (OR = 2.73). Moreover, women who identified as gay/lesbian, bisexual, "something else," or "I don't know" all reported significantly higher prevalence of severe psychological distress than straight women. Given the overall positive association between psychological distress and cardiometabolic health as well as the higher prevalence of severe psychological distress among sexual minority women, more work is needed to longitudinally examine the effects of psychological distress on health among sexually minoritized women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Enhanced multinomial logistic regression analysis of determinants influencing technical and vocational education and training (TVET) choices among Ghanaian youth: Implications for policy development

In Ghana, youth unemployment remains significant challenges, with technical and vocational education and training (TVET) emerging as a potential solution to equip young people with practical skills for the job market. However, the uptake of TVET programmes among Ghanaian youth remains low, particularly among females. This study therefore explores the determinants that influence TVET choices among Ghanaian youth, with the goal of informing policy development to enhance participation in vocational education. Applying an enhanced multinomial logistic regression (MLR) model, this research examines the influence of socio-economic, demographic, and attitudinal factors on career decisions. The enhanced model accounts for class imbalances in the dataset and improves classification accuracy, making it a robust tool for understanding the drivers behind TVET choices. A sample of 1600 Ghanaian youth engaged in vocational careers was used, ensuring diverse representation of the population. Key findings reveal that males are approximately three times more likely to choose TVET programs than females, despite females making up 50.13% of Ghana’s population. Specific determinants influencing TVET choices include financial constraints, parental influence, peer influence, teacher influence, self-motivation, and vocational limitations. In regions with limited vocational options, youth often pursue careers based on availability rather than preference, which highlights a gap in vocational opportunities. Parental and teacher influences were found to play a dominant role in steering youth towards specific careers. The study concludes with recommendations for policymakers, instructors, and stakeholders to increase the accessibility, relevance, and quality of TVET programmes to meet the socio-economic needs of Ghanaian youth.

Dual HIV risk and vulnerabilities among people who inject drugs in Iran: Findings from a nationwide study in 2020

IntroductionPeople who inject drugs (PWID) are a key population at risk of HIV in Iran. We measured the prevalence and covariates of HIV-related risk behaviours among PWID in Iran.MethodsWe conducted a respondent-driven bio-behavioural surveillance survey among PWID from July 2019 to March 2020 in 11 major cities. We assessed PWID’s recent (i.e., last three months) HIV-related risk behaviours using a four-level categorical variable: Only unsafe injection (i.e., sharing needles/syringes or injecting equipment), only unsafe sex (i.e., unprotected sex), dual HIV risk (i.e., both unsafe injection and unprotected sex), and safe injection and sex. Data were summarized using RDS-weighted analysis. Multinomial logistic regression models were built to characterize HIV-related risk behaviours and relative risk ratio (RRR) with 95% confidence interval (CI) were reported.ResultsOverall, 2562 men who inject drugs (MWID) were included in the regression analysis. The RDS-weighted prevalence of dual HIV risk was 1.3% (95% CI: 0.8, 1.9), only unsafe injection was 4.5%, and only unsafe sex was 11.8%. Compared to the safe injection and sex group, dual HIV risk was significantly and positively associated with multiple partnership (RRR = 15.06; 3.30, 68.73). Only unsafe injection was significantly associated with homelessness in the last 12 months (RRR: 3.02; 95% CI: 1.34, 6.80). Only unsafe sex was significantly associated with multiple partnership (RRR = 6.66; 4.27, 10.38), receiving free condoms (RRR = 1.71; 1.01, 2.89), receiving free needles (RRR = 2.18; 1.22, 3.90), and self-received risk for HIV (RRR = 2.51; 1.36, 4.66). Moreover, history of HIV-testing in the last three months was significantly associated with only unsafe injection (RRR = 2.71; 1.84, 3.80). Among the 90 women who injected drugs, none reported dual HIV risk behaviours.Discussion and conclusionsWhile the low prevalence of dual HIV risk among PWID is encouraging, unprotected sexual practices among PWID is concerning. Expanding sexual health education and care services as well as tailored interventions aimed at reducing high-risk sexual activities among PWID are warranted. Additionally, tackling potential misperceptions about risk of HIV transmission among PWID in Iran is warranted.

Profiling patterns of patient experiences of access and continuity at team-based primary healthcare clinics (Canada): a latent class analysis

BackgroundAccess to primary healthcare services is a core lever for reducing health inequalities. Population groups living with certain individual social characteristics are disproportionately more likely to experience barriers accessing care. This study identified profiles of access and continuity experiences of patients registered with a family physician working in team-based primary healthcare clinics and explored the associations of these profiles with individual and organizational characteristics.MethodsA cross-sectional e-survey was conducted between September 2022 and April 2023. All registered adult patients with an email address at 104 team-based primary healthcare clinics in Quebec were invited to participate. Latent class analysis was used to identify patient profiles based on nine components of access to care and continuity experiences. Multinomial logistic regression models were fit to analyze each profile’s association with ten characteristics related to individual sociodemographics, perceived heath status, chronic conditions and two related to clinic area and size.ResultsBased on 87,155 patients who reported on their experience, four profiles were identified. “Easy access and continuity” (42% of respondents) was characterized by ease in almost all access and continuity components. Three profiles were characterized by diverging access and/or continuity difficulties. “Challenging booking” (32%) was characterized by patients having to try several times to obtain an appointment at their clinic. “Challenging continuity” (9%) was characterized by patients having to repeat information that should have been in their file. “Access and continuity barriers” (16%) was characterized by difficulties with all access and continuity components. Female gender and poor perceived health significantly increased the risk of belonging to the three profiles associated with difficulties by 1.5. Being a recently arrived immigrant (p = 0.036), having less than a high school education (p = 0.002) and being registered at a large clinic (p < 0.001) were associated with experiencing booking difficulties. Having at least one chronic condition (p = 0.004) or poor perceived mental health (p = 0.048) were associated with experiencing continuity difficulties.ConclusionsThese results highlight individual social and health characteristics associated with increased risk of experiencing healthcare access difficulties, such as immigration status and education level and/or continuity difficulties when having a chronic condition and poor perceived mental health. Facilitating appointment booking for recently arrived immigrants and patients with low education, integrating interprofessional collaboration practices for patients with chronic conditions and improving care coordination and communication for patients with mental health needs are recommended.

Relationships between working from home, sitting postures and low back pain during COVID-19: A survey of frequent computer users.

To investigate the effects of working from home on musculoskeletal pain. An e-survey of computer workers was conducted. Multinomial logistic regression modelling examined relationships between work location (work or home office desk, dining table, other), sitting posture (diagrams with descriptors), depressive symptoms (CESD -10), sleep quality (good/average vs poor) and pain (low back pain [LBP]), other pain without LBP, asymptomatic). Of 634 respondents, most (91%, n = 578) worked partially at home and had pain (91%, n = 576; 342 LBP, 234 other pain, 58 asymptomatic). Sitting posture ("trunk a little bent forward" vs "straight up, back against back rest": OR = 2.9; 95% CI 1.3-6.5, p = .008), being female (2.2; 1.2-4.1, p = .008), and depressive symptoms (3.4; 1.7-6.6; p < .001) were associated with LBP. Poor sleep quality related to LBP but correlated with depressive symptoms. Working from home and location were not associated with pain. Sitting postures, but not working from home, are associated with LBP.

Determinants of Prevalence and Factors Associated with Anemia among Pregnant Women in Gambia: A Multivariate Analysis using DHS Data

Background Anemia is a prevalent public health concern in The Gambia and other developing nations. While previous studies relied on binary logistic regression, the Multinomial Survey Logistic Regression Model was developed to address complexities in survey design, including sampling weights, stratification, and clustering. Multiple Imputation with Chained Equations (MICE) was employed to address missing data in variables such as anemia level, contraceptive use, and malaria drug intake during pregnancy. Aim/Objective This study aims to determine the prevalence and factors of anemia among pregnant women across eight local government areas in The Gambia. The research focuses on Kanifing, Kuntaur, Mansakonko, Kerewan, Janjanbureh, Basse, Brikama, and Banjul. Given the limited research on anemia among pregnant women in The Gambia, there is a need for further investigation into this topic. Methods MICE were utilized to address missing data due to their validity in handling uncertainty. This method generates multiple reasonable datasets for imputation and analyzes them accurately. A survey logistic regression model was employed to assess data fitness, considering the complex sample design. Anemia levels were measured among 11,865 pregnant women aged 15 to 49 using a systematic questionnaire. The multinomial survey logistic regression model was utilized to account for sampling weights, stratification, and clustering, relaxing the premise of observation independence violated by conventional logistic regression. Results The study involved 11,865 expectant mothers, revealing mild, moderate, and severe cases of anemia with a prevalence of 44.6%. Factors associated with anemia included place of residence, local government area, contraceptive use, age, literacy level, and current pregnancy status. Conclusion Socio-economic, demographic, and environmental factors significantly impact anemia levels among reproductive women in The Gambia. Addressing factors such as place of residence, local government areas, contraceptive use, literacy level, and current pregnancy status is crucial in mitigating anemia risk. Government initiatives, such as improving access to sanitation facilities and offering free check-ups, could effectively address this public health concern.

Parents’ Attitudes Toward School Choice Change in Chile: The Role of Information in an Unequal Context

ABSTRACT The School Admission System (SAE, the Spanish acronym for “Sistema de Admisión Escolar”) was recently implemented in Chile to mitigate the market logic in school admission. This system represents a drastic change in how families select schools. The following study analyzes the relationship between the sociodemographic characteristics of parents, their consumption of information, and their attitudes toward the SAE. A latent class analysis and a multinomial logistic regression model used data from a survey administered to parents. Three attitudes toward the SAE were identified: positive, neutral, and hostile; those attitudes have been influenced by several factors, including region of residence, socioeconomic group, and the quantity and objectivity of consumed information.

Total dietary antioxidant capacity and food groups and their relationship with the sleep time of Brazilian graduates (CUME Study)

ABSTRACT To investigate the association between the Dietary Total Antioxidant Capacity (dTAC) and the Total Antioxidant Capacity of food groups (fgTAC) with the sleep time of Brazilian graduates participating in the Cohort of Universities of Minas Gerais (CUME Study). This cross-sectional study analyzed 6,387 graduates (2,052 men, 4,335 women, 35.3 ± 9.3 years old) from the CUME Study. Data was collected online, and dTAC was obtained by the Ferric Reduction Antioxidant Power (FRAP) method. Daily sleep time was classified as short sleep, normal sleep, and long sleep (≤6, 7–8, and ≥9 h, respectively). Multinomial logistic regression models were used to estimate the Odds Ratio (OR) and its 95% Confidence Interval (95% CI) between short sleep and long sleep with quartiles of dTAC and the fgTAC. Lower odds of short sleep was observed for the third quartile of dTAC and for fourth quartile of fgTAC of fruits, beans, and lentils, and for the third quartile of fgTAC of vegetables and oils and fats. Higher odds of short sleep for the fourth quartile of fgTAC of teas and coffees. For long sleep, inverse associations were observed for the fourth quartile of fgTAC of oilseeds and the third quartile of fgTAC of teas and coffees. Higher odds of long sleep were observed for the third quartile of artificial juices and sodas. We cannot independently assert an association between higher dTAC and sleep time. In turn, the associations between sleep time and fgTAC show the importance of the food matrix that antioxidants are inserted, requiring longitudinal studies to observe the direction of associations.

Travel mode choice behavior analysis using multinomial logit models towards creating sustainable college campus: a case study of the University of Toledo, Ohio

By employing descriptive statistics and multinomial logistic regression models, the paper investigates factors that affect the travel mode choice behavior of a college community for both commuting to the campus from their residences and commuting on campus from one facility to another. Results show that car ownership, travel distance, age, gender, academic status, income, perception of safety, number of weekly trips, and weather conditions affect people’s mode choice decisions significantly. The study finds that increasing travel distance, age, and being a staff member positively impact car mode choice, faculty members are more likely to bike and walk compared to undergraduate students, and unlike the authors’ predictions, the higher-income people are more likely to walk on campus. Results also reveal that car users change travel modes more often than active transport mode users based on semesters and that although women are less likely to bike to the campus, they are more likely to walk and bike on campus. If the number of trips increases, people prefer cars to walk, bike, and ride a bus to commute to the campus while they prefer walking to driving a car on campus. The study contributes to help create pollution-free and healthy urban college campuses that, on larger scales, will further contribute to developing sustainable cities to achieve the Sustainable Development Goals as described by the United Nations, particularly goal number 11, “to make cities and human settlements inclusive, safe, resilient and sustainable,” and thereby contribute to improving urban living conditions.

Diabetes Control Status and Severity of Depression: Insights from NHANES 2005-2020.

Background/Objectives: Examining the risk of depression among patients with diabetes is crucial for understanding the mental health burden of this chronic condition. This study examined the likelihood of depression severity among participants in the National Health And Nutrition Examination Survey (NHANES) from 2005 to 2020, based on glycemic control status. Methods: Depression severity was categorized into three levels using the Patient Health Questionnaire-9 (PHQ-9), and glycemic control status was categorized into five groups based on prior diabetes diagnoses and hemoglobin A1c (HbA1c) levels. Using multinomial logistic regression models, the odds ratio (OR) and 95% confidence intervals (95%CIs) of various severities of depression by glycemic control status were calculated after comprehensive adjustments. Results: Out of 76,496 NHANES participants from 2005 to 2020, 37,037 individuals who met our inclusion criteria were analyzed. The likelihood of depression in individuals with prediabetes was not significantly different from those with normoglycemia. In contrast, participants with diabetes had a higher likelihood of having depression versus individuals with normoglycemia even when they kept their HbA1c within the normal range (lower than 5.7%). Among individuals with diabetes, those with HbA1c < 5.7% had a higher likelihood of mild depression (OR: 1.54, 95%CI: 1.02-2.34), while having HbA1c ≥ 10.0% was significantly associated with a greater likelihood of moderate to severe depression (OR: 1.53, 95%CI: 1.07-2.19) compared to those with HbA1c levels of 5.7-10.0%. Conclusions: Our findings highlight the need for a holistic approach to diabetes care that includes mental health considerations, especially for those who are at the extremes of the HbA1c spectrum.

Factors associated with essential newborn care practices among non-institutional births in urban Bangladesh: evidence from Bangladesh Urban Health Survey 2021

ABSTRACT Background Non-institutional births remain prevalent in low- and middle-income countries, associated with a majority of adverse maternal and child health outcomes, including maternal and child mortality. Ensuring essential newborn care (ENC) practices for these non-institutional births is crucial for reducing these adverse outcomes. This study aimed to identify the prevalence, and factors associated with the adoption of ENC practices among non-institutional births in urban Bangladesh. Methods A total of 2,165 children’s data were analyzed, extracted from the 35,186 ever-married women interviewed in the 2021 Bangladesh Urban Health Survey. Six ENC components and their level (lowest/none, moderate, and highest) were considered as the outcome variables. Several socio-demographic factors were considered as the explanatory variables. Multivariate binary and multinomial logistic regression model were used to explore the association between outcome and explanatory variables. Results Approximately 49% of all mothers reported practicing the highest level of ENC. Among the individual components, the highest adherence was observed for the use of a disinfected instrument to cut the umbilical cord (90%). The likelihood of adopting the highest level of ENC practices was higher among mothers with relatively higher education and wealth quintiles and lower among those residing in slum and other urban areas of city corporations compared to non-slum areas. Mothers living in the Khulna and Sylhet divisions had a lower likelihood of adopting the highest level of ENC practices. Conclusion Awareness building programs are needed to educate the population, particularly mothers, about the importance of practicing ENC for improving maternal and child health outcomes.