Regression Results Research Articles

Kenyan Female Immigrants’ Creation of a Virtual Enclave: The Influence of Age and Immigration Status

ABSTRACTMuch of the research on ethnic enclaves in the United States has focussed on physical, geographic spaces or brick‐and‐mortar establishments that foster community building and provide shared resources for immigrant groups, such as those from Latin America, Asia and Europe. These studies often highlight the benefits and challenges enclaves provide, with only a limited discussion of how immigrant women use these spaces. Using survey data drawn from Kenyan women residing in the United States, this study aimed to answer two research questions: (1) Does membership in social media groups comprised of Kenyan female immigrants vary (e.g. by age, immigration status)? (2) Do age and immigration/citizenship status influence Kenyan female immigrants' reasons for joining social media groups? The bivariate results show that older women and those who migrated to the United States for school or through the Green Card lottery programme were likelier to join Tumaini and other immigrant‐specific social media groups. Regarding factors influencing their reasons for joining these groups, the regression results revealed that US citizens and permanent residents were less likely to join the group for solidarity/support. Furthermore, those who migrated for school or to join family members were likelier to join the Tumaini group for support/solidarity. This finding suggests that older women, being more likely to belong to physical social groups, have a relatively stronger attachment to such groups. Consequently, their willingness to join the Tumaini group, despite it being an online community, may be stronger than that of their younger counterparts.

The Effects of Health Insurance on Demand for Healthcare Services in Tanzania

ABSTRACT: Consistent healthcare financing systems within a particular nation or community have been regarded as vital for making universal healthcare access. This study intended to examine the influence of health insurance on the demand for healthcare services and the influence of socio-economic, demographic and hospital-related factors on demand for health care services in Tanzania context. The study employed secondary data, which were analysed by descriptive statistics and the results were presented in tables and percentages. Econometric analysis was also done using binary probit regression model to determine the factors influencing demand for health care services in Tanzania. The instrumental variable was applied to address the problem of endogeneity of health insurance. The regression results revealed that gender, education level, household size, income, treatment cost, perceived health quality and health insurance type were significant and positively linked with demand for health care services. However, marital status was also significant but negatively associated with the demand for healthcare services. The study concluded that, despite of the efforts made by the government and other stakeholders on emphasis over having health insurance, the enrolment to health insurance schemes is still low although it has been noted to significantly influence the demand for health care services. Lastly, the paper recommends that the government and other stakeholders are required to formulate or strengthen the formulated policy in practice, purposively to improve access, affordability and the quality of health care services. Governmental and non-governmental organizations (NGO`s) and other stakeholders should put more effective strategies to improve coverage but also reduce the financial burden caused by illness. Also, the government needs to subsidize the healthcare sector, especially to the poor and provide subsidies to private healthcare facilities, improvement of insurance type, specifically, the NHIF which needs to increase coverage. Furthermore, health care managers should educate other people and make a clear observation on factors that make individuals demand for health care because they have a great role in the health care sector as well as strategies to improve household`s income to meet the health needs in Tanzania.

Spatial inequality in sub-national human development index: A case study of West Bengal districts

Human Development and its regional disparity is an area of topical interest. In this paper, we consider space as an instrumental variable in understanding this disparity and explore spatial interdependence in human development across districts of West Bengal using alternate indicators of human development. This study uses both the standard United Nations Development Programme (UNDP) technique and an alternative methodology to construct a sub-national human development index. Spatial interdependence is measured using Moran's I coefficient and Local Indicators of Spatial Autocorrelation (LISA) cluster maps. Spatial regression is used to evaluate the spatial association between the Human Development Index as the dependent variable and a few independent variables. A high degree of clustering in all three dimensions of human development is observed among the southern districts of West Bengal. The pattern of cluster maps indicates the presence of both the growth pole process and the metropole-periphery process in the state. Spatial regression results indicate that the share of socially backward class population and urbanization rate are important variables affecting regional human development patterns. The findings of this study suggest policies targeted to promote social inclusion and urbanization linked with better access to economic opportunities in the lagging areas can help reduce regional imbalances.

Insight into the phase equilibrium of mycophenolic acid cocrystals

In this study, mycophenolic acid-nicotinamide (MPA-NAM) and mycophenolic acid-acetoguanamine (MPA-AGA) cocrystals were synthesized and characterized using single-crystal X-ray diffraction, Fourier transform spectroscopy and thermal analysis. Intrinsic intermolecular interactions were investigated through Hirshfeld surface and electrostatic potential surface analysis. The results indicated that MPA-NAM and MPA-AGA cocrystals possessed the same types of hydrogen bonds but different hydrogen bond connectivity. Thermodynamic studies revealed that MPA-NAM and MPA-AGA cocrystals exhibited incongruent dissolution behaviors in the chosen solvent. Model regression results indicate that the 1:1 complex formation existed during the dissolution of the MPA-NAM cocrystal, whereas 1:1 and 1:2 solution complexes presented in the MPA-AGA cocrystal. The complicated complexation in the MPA-AGA cocrystal induced all fragments of MPA-AGA to possess higher energies, facilitating MPA-AGA cocrystal precipitation from the solution, which was testified by Energy calculations.

Non-negative least-squares variance and covariance component estimation using the positive-valued function for errors-in-variables models

Abstract Although (co)variance component estimation has been widely applied in the errors-in-variables (EIV) model, the occurrence of negative variance components is still a major issue in the estimated variance components. This problem may be due to the following unfavorable factors: 1) unreasonable selection of initial variance values; 2) low redundancy in the EIV functional model; 3) improper design in the EIV stochastic model, and 4) other data quality problems. Many attempts have been made to prevent the appearance of negative variance components. In this contribution, a novel and efficient non-negative least-squares variance component estimation using the PVF (PVF-NLS-VCE) is introduced, which can simultaneously estimate the unknown (co)variance components in the EIV stochastic model and the parameters in the EIV functional model. Its principle is to implicitly impose a non-negative constraint by replacing the variance component with the positive-valued function (PVF) whose range is the set of positive real numbers. Two numerical examples using real and simulated data are presented. The numerical results of linear regression are identical to those obtained based on least-squares variance component estimation (LS-VCE) with positive initial values of variance components. The numerical results of two-dimensional affine transformation are shown to prevent negative variance components and precede those obtained by LS-VCE with a negative initial value of variance component. Both numerical examples verify the effectiveness of the PVF-NLS-VCE method whether the initial values of variance components are positive or negative. The proposed PVF-NLS-VCE is a simple, convenient and flexible method to achieve the non-negative estimates of variance components, which can reduce sensitivity to initial value selection and automatically guarantee a non-negative definite covariance matrix.

The impact of hepatitis B surface antigen seroconversion on the durability of functional cure induced by pegylated interferon alpha treatment

BackgroundHepatitis B surface antigen (HBsAg) loss is regarded as a pivotal criterion for assessing functional cure in patients diagnosed chronic hepatitis B (CHB). We conducted the research to investigate the real-world performance of HBsAg seroconversion in sustaining HBsAg loss.MethodsThis retrospective analysis confirmed 295 patients who attained HBsAg loss through combination therapy involving nucleos(t)ide analogues (NAs) and pegylated interferon alpha (peg-IFNα). Employing Kaplan–Meier estimates method to conduct survival analysis. The forest plot was used to visualize the results of multivariate Cox regression, and selected variables were included in the nomogram.ResultsHBsAg seroreversion was observed in 45 patients during follow-up periods, with a lower recurrence risk in patients with HBsAg seroconversion at the end of peg-IFNα therapy (EOT) (10.3% vs 37.3% at 96-week, P < 0.0001). Moreover, the sustainability of hepatitis B surface antibody (anti-HBs) in participants continuing therapy after HBsAg seroconversion was superior to those discontinued prematurely (72.5% vs 54.5% at 96 weeks, P = 0.012). Additionally, the former group was also relatively less likely to experience HBsAg reversion during long-term observation (8.4% vs 14.3% at 96 weeks, P = 0.280). Hepatitis B envelope antigen (HBeAg) status, anti-HBs status and consolidation treatment screened by multivariable analysis were utilized to construct a predictive model for HBsAg reversion. The concordance index(C-index = 0.77) and calibration plots indicated satisfactory discrimination and consistency of nomogram.ConclusionsHBsAg seroconversion was beneficial for sustaining functional cure in patients treated with peg-IFNα. Continuing consolidation therapy after HBsAg seroconversion also contributed to maintain HBsAg seroconversion and improve the durability of HBsAg loss. The nomogram illustrated its efficacy as a valuable instrument in showcasing survival probability of functional cure.

Development and validation of a web-based nomogram for acute kidney injury in acute non-variceal upper gastrointestinal bleeding patients.

Acute kidney injury (AKI) is a common and serious complication in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB). Early prediction and intervention are crucial for improving patient outcomes. Data for patients presenting with acute NVUGIB in this retrospective study were sourced from the MIMC-IV database. Patients were randomly allocated into training and validation cohorts for further analysis. Independent predictors for AKI were identified using least absolute shrinkage and selection operator regression and multivariable logistic regression analyses in the training cohort. Based on the logistic regression results, a nomogram was developed to predict early AKI onset in acute NVUGIB patients, and implemented as a web-based calculator for clinical application. The nomogram's performance was evaluated through discrimination, using the C-index, calibration curves, and decision curve analysis (DCA) to assess its clinical value. The study involved 1082 acute NVUGIB patients, with 406 developing AKI. A multivariable logistic regression identified five key AKI predictors: CKD, use of human albumin, chronic liver disease, glucose, and blood urea nitrogen. The nomogram was constructed based on independent predictors. The nomogram exhibited robust accuracy, evidenced by a C-index of 0.73 in the training cohort and 0.72 in the validation cohort. Calibration curves demonstrated satisfactory concordance between predicted and observed AKI occurrences. DCA revealed that the nomogram offered considerable clinical benefit within a threshold probability range of 7% to 54%. Our nomogram is a valuable tool for predicting AKI risk in patients with acute NVUGIB, offering potential for early intervention and improved clinical outcomes.

Clinical and prognostic significance of FBXL6 expression in ovarian cancer

ObjectiveGrowing evidence indicates that F-box and leucine-rich repeat protein 6 (FBXL6) is associated with the progression of various cancers, including gastric cancer, hepatocellular carcinoma, and colorectal cancer. This study focuses on the prognostic significance of FBXL6 in OC. MethodsDifferential levels of FBXL6 in multiple cancers were evaluated using the TCGA and GSE26712 databases. We screened FBXL6-related differentially expressed genes using the GSE63885 dataset and conducted Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways analysis. The genes that associate with FBXL6 were screened using the “limma” package, the STRING database, and Cytoscape software, and the association was validated through Gene Expression Profiling Interactive Analysis. The potential substrates of FBXL6 were predicted using UbiBrowser2.0 database. FBXL6 protein levels in 84 OC samples were evaluated using immunohistochemistry. The prognostic significance of FBXL6 was explored using Kaplan–Meier and Cox regression analyses. Based on the Cox regression results, an FBXL6-based nomogram that can predict the overall survival (OS) rate were constructed. Moreover, we examined the net benefits and discriminative ability of the nomogram using the decision curve analysis (DCA), calibration plots, and receiver operating characteristic (ROC) curve. ResultsFBXL6 was elevated in OC tissues, and the overexpression of FBXL6 was linked to poor prognosis in OC patients. The ROC and DCA curves indicated that the prognostic value of the FBXL6-based nomogram model was superior to that of FBXL6, age, and FIGO stage alone. ConclusionsElevated FBXL6 expression was an independent factor for OC, and an easily applied nomogram was developed to predict OS in OC patients.

The value of international standards certification: Evidence on export and firm performance from a security enforcement on borders

Globally, economic growth is promoted through regional economic integration, and governments actively try to improve the security and efficiency of international trade and border management by optimizing the conditions for international trade. The World Trade Organization (WTO) introduced the Authorized Economic Operator (AEO) certification system to improve the efficiency of customs clearance and to ensure the security of the global supply chain. Using a sample of Taiwanese-listed firms that attained AEO certification from 2009 to 2018, this study investigates the influence of AEO certification on their export sales and corporate performance. The empirical results show that AEO-certified firms increase their ratio of export sales and the scope of export destination regions. However, AEO-certified firms can not improve their operating and market performance significantly, except for low-performance firms in the accreditation year. This study also uses the two-stage least square regressions (2SLS) method and the propensity score matching method to conduct the regression analysis. The regression results are consistent with the main findings. The findings can be used for reference by firms seeking to expand international trade and by governments to promote the country’s international trading.

Prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania: evidence from a national survey

BackgroundTimely initiation of breastfeeding is crucial for positive health outcomes for babies and mothers. Understanding the factors influencing timely initiation of breastfeeding is vital for reducing child morbidities and mortalities in Mauritania. This study, therefore, assessed the prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania, providing significant insights for improving maternal and child health in the country.MethodsWe performed a secondary analysis of the 2019–2021 Mauritania Demographic and Health Survey data. A weighted sample of 4,114 mother-child pairs was included in the study. We used percentage to present the prevalence of early initiation of breastfeeding. A four-modelled multilevel binary logistic regression was used to examine the factors associated with early initiation of breastfeeding. The regression results were presented using adjusted odds ratio (aOR) with their respective 95% confidence interval (CI). Stata software version 17.0 was used to perform all the analyses.ResultsThe prevalence of early initiation of breastfeeding was 57.3% (95% CI 54.5, 60.00). Birth order was associated with early initiation of breastfeeding with the highest odds among those in the fourth birth order (aOR 1.61; 95% CI 1.08, 2.39). Mothers who practiced skin-to-skin contact were more likely to initiate breastfeeding early than those who did not (aOR 1.46; 95% CI 1.14, 1.87). There were regional disparities in the early initiation of breastfeeding. The odds of timely initiation of breastfeeding was lower among women who were delivered by caesarean section (aOR 0.22; 95%CI 0.14, 0.36), those who were working (aOR 0.57; 95% CI 0.45, 0.73), those who had four or more antenatal care visits (aOR 0.67; 95%CI 0.47, 0.94)], and those in the richest wealth quintile (aOR 0.61; 95% CI 0.38, 0.98) compared to those who had normal delivery, those who were not working, those who had zero antenatal care visits, and those in the poorest wealth quintile households, respectively.ConclusionOur study found a relatively low prevalence of early initiation of breastfeeding among women in Mauritania. Factor such as birth order, region of residence, mother and newborn skin-to-skin contact after birth, antenatal care visits, caesarean delivery, employment status, and wealth index were associated with early initiation of breastfeeding. Improving optimal breastfeeding practices, such as early initiation of breastfeeding in Mauritania, should be given adequate attention. There is a need for interventions such as baby-friendly facilities, providing an enabling environment for mothers to breastfeed their newborns early. Addressing regional health access disparities is important to improve early initiation of breastfeeding and other maternal, newborn, and child health interventions.

Analysis of risk factors for intraoperative bleeding in patients with Siewert type II esophagogastric junction adenocarcinoma treated by two minimally invasive surgeries and its influence on prognosis: a retrospective study.

The present study aimed to analyze the independent risk factors for intraoperative bleeding in Siewert II adenocarcinoma of the esophagogastric junction (AEG) using two minimally invasive surgical approaches, namely, the laparoscopy-assisted abdominal trans-hiatal (LTH) method and transthoracic-laparoscopic esophagectomy (TLE). The clinical data of 100 patients with SiewertII AEG admitted to our hospital from October 2017 to October 2020 were retrospectively analyzed. According to the type of surgery, the patients were divided into LTH approach group and TLE approach group. The differences between the clinical characteristics of the patients in different groups and the differences in the intraoperative bleeding and prognosis between different surgical procedures were analyzed and compared using the t-test and chi-squared test. Multiple linear regression was used to identify the independent risk factors affecting the amount of intraoperative bleeding in patients. The results of this study showed that patients in the LTH group had significantly less intraoperative bleeding and operative time and significantly better postoperative recovery than the TLE group. The results of multivariate linear regression showed that the combined trans-thoracic-abdominal approach (P=0.000), advanced age (P=0.014), larger BMI (P=0.000), and larger tumor diameter (P=0.001) were the independent risk factors influencing the increase in intraoperative bleeding. In addition to the conventional factors that affect intraoperative bleeding, such as the patient's general condition, operation time, and tumor size, LTH surgery is another way to avoid intraoperative bleeding for Siewert type II AEG patients and can significantly improve postoperative recovery.

The relationship between thigh circumference and sarcopenia in Chinese community-dwelling elderly aged ≥60 years

BackgroundThere has been a growing body of research demonstrating that thigh circumference is closely associated with the development of various chronic disease. However, limited evidence has been obtained regarding the relationship between thigh circumference and sarcopenia. ObjectiveThe aim of this study was to investigate the relationship between thigh circumference and sarcopenia, and explore the potential role of thigh circumference for sarcopenia screening among community-dwelling older adults. MethodsThe investigation was carried out in six rural communities located in northwestern China with participants aged ≥60 years old. We collected variables related to sarcopenia, including function, muscle mass, and strength. The thigh circumference was categorized into four groups based on quartiles, with the first quartile (≤46.65cm); the second quartile (46.66-48.50cm); the third quartile (48.51-50.55cm); and the fourth quartile (>50.55cm). The associations and screening effect were estimated with multivariate logistics regression and ROC curves. ResultsOf the 1000 participants aged 70.72 ± 4.68 years. Compared with the first quartile (≤46.65cm), the odds ratios for the second, third, and fourth quartiles of thigh circumference were 0.465 (95%CI: 0.281–0.770, p=0.003), 0.199 (95%CI: 0.097–0.407, p<0.001), and 0.059 (95%CI: 0.016–0.220, p<0.001), respectively. The regression results were consistent across different sexes. The AUC and cutoff values of thigh circumference for sarcopenia were 0.873 (95% CI 0.836–0.909, p<0.001) and 48.83 cm for men and 0.861 (95% CI 0.822–0.900, p<0.001) and 46.78 cm for women. There was a positive correlation between thigh circumference and skeletal muscle mass (r=0.747, p<0.001), hand grip strength (r=0.337, p<0.001), and gait speed (r=0.142, p<0.001), while a negative correlation was observed with five-times-sit-to-stand test (r=-0.073, p=0.021). ConclusionThere was a negative correlation between thigh circumference and sarcopenia, suggesting that thigh circumference may serve as a potential useful indicator for sarcopenia screening in the elderly.

Can employee training facilitate production repurposing in crises? An ability-motivation-opportunity perspective

Production repurposing is an initiative for firms to alter their manufacturing capabilities and outputs to meet new demands, particularly during times of crisis. This initiative is crucial for businesses to remain resilient to unexpected changes in the market. Despite its importance, the specific factors that drive production repurposing during crises, especially from the perspective of human capital development, are not well understood. Drawing upon the ability, motivation, and opportunity (AMO) framework, this study aims to examine the impact of pre-pandemic employee training, an ability-enhancing practice, on production repurposing during the pandemic. Based on a dataset of 4,679 firm-year observations from 32 countries sourced from the World Bank, our regression results indicate that firms that engaged in pre-pandemic employee training are more likely to initiate production repurposing during the pandemic. Furthermore, we delve into the moderating roles of government wage subsides, a motivation factor, and labor shortages, an opportunity constraint. The results reveal that government wage subsidies amplify the positive effect of pre-pandemic training on production repurposing, whereas labor shortages dampen this impact. Our heterogeneity analysis further suggests that national socioeconomic features can influence these relationships. This study underscores the role of employee training in preparing firms to actively adapt during crises. It also highlights the necessity of providing adequate motivations and creating conducive opportunities to facilitate human capital. These insights are valuable for managers and policymakers aiming to enhance firm adaptability and ensure resilient operations during crises.

Clinical Diagnostic Significance of Combined Measurement of Lipoprotein(a) and Neck Circumference in Patients with Coronary Heart Disease.

The study aimed to explore the clinical diagnostic significance of lipoprotein(a) [Lp(a)] and neck circumference (NC) in patients with coronary heart disease (CHD). This cross-sectional study was conducted at Chengde Central Hospital from September 2021 to June 2023, enrolling 791 patients with suspected CHD who underwent selective coronary angiography (CAG). Patients were categorized into CHD and non-CHD groups based on the severity of arterial narrowing. Subsequently, the diagnostic value of Lp(a) combined with NC in patients with CHD was assessed using receiver operating characteristic (ROC) curves. Based on the results of multivariate logistic regression, a nomogram was constructed, and its clinical applicability was validated using decision curve analysis (DCA) and clinical impact curve (CIC). Multivariate logistic regression proved that high Lp(a) and high NC are risk factors for CHD, with OR of 1.836 (95% CI: 1.282-2.630) and 1.383 (1.0.978-1.955), respectively. Patients in the high NC or Lp(a) group exhibited a higher prevalence of multi-vessel disease. The area under the ROC curve (AUC) of the predictive model combining high Lp(a) and high NC was 0.710 (95% CI: 0.670-0.751) and also demonstrated good calibration (Hosmer-Lemeshow goodness-of-fit test P value=0.494). The DCA and CIC confirmed the clinical utility of the nomogram developed to predict CHD based on the combination of high Lp(a) and high NC. The levels of Lp(a) and NC exhibit a significant correlation with the presence of CHD, and their combined assessment holds specific clinical value in the diagnosis of CHD.

Is it possible to detect women at higher risk of intrapartum stillbirth? An area-based prospective cohort study.

The aim of the study is to perform an overview of intrapartum stillbirth (SB) at term, assessing risk factors, causes of death and quality of pregnancy care. This is an area-based, prospective cohort study on pregnant women at ≥37 weeks from 2014 to 2021. We compared intrapartum SB' information to alive birth and to antepartum deaths of the same period. Results of logistic regression are reported as the Odds Ratio (OR) with 95% confidence interval (95% CI) and the P value. A descriptive analysis about the causes of death and quality of pregnancy care is performed. The overall rate of SB at term in Emilia-Romagna was 1.06 ‰ births. Among the 260 cases, 27 (10.4%) occurred during labor, with an intrapartum SB rate of 0.11‰. This SB rate was stable during years. SGA newborn (P=0.005, 95% CI 1.47-9.04, OR 3.63), low level of education (P<0.0001, 95% CI 2.98-16.11, OR 6.93), pre pregnancy BMI ≥ 25 kg/m2 (P<0.0001, 95% CI 6.61-31.74, OR 14.50) are independent risk factors for intrapartum SB when compared to alive newborns. Compared with antepartum SB, excessive weight gain in pregnancy (RR 2.91, 1.43-3.98, P=0.001) represents a risk factor for intrapartum ones. Preventing intrapartum SB at term in developed country should be based on both the appropriate antenatal management of fetal growth and the avoidance of maternal excessive weight gain. An effort toward pre conceptional intervention of improving maternal shape could be of value.

Effect of pyrolysis parameters on the biochar reactivity in the N-absorption reaction of chemical looping ammonia generation

Biochar from slow pyrolysis was applied to Chemical Looping Ammonia Generation (CLAG) to avoid the preparation of ammonia from fossil fuels and relatively expensive H2. The effects of pyrolysis atmosphere, temperature, heating rate, and residence time on the biochar reactivity in the N-adsorption reaction were investigated. The relationship between specific surface area, average pore diameter, micropore percentage, and disorder degree of biochar on reactivity was evaluated by simple and multiple linear regression and Analysis of Variance (ANOVA). The results showed that the biochar prepared in a CO2 atmosphere with a pyrolysis temperature of 700 °C, a heating rate of 10 °C/min, and a resident time of 30 min had the highest conversion rate of 57.79 % in the N-absorption reaction. When the pyrolysis temperature was increased from 600 °C to 700 °C, the biochar conversion in the N-adsorption reaction was significantly increased due to the Boudouard reaction during biomass pyrolysis. The linear regression and ANOVA results show that the micropore percentage and disorder degree of biochar significantly positively affected the reactivity, guiding feedstock selection and optimization of the preparation method of the carbon source used for CLAG.

Trajectory and predictors of post-stroke depression among patients with newly diagnosed stroke: A prospective longitudinal study

BackgroundPost-stroke depression (PSD) is the most prevalent neuropsychological disorder among stroke patients, affecting approximately one-third of stroke survivors at any one time after a stroke. We identified between-person associations between post-stroke depression trajectories across 3 timepoints and predictors affecting trajectory classification among stroke patients. MethodsThis is a prospective longitudinal study using a convenience sample of 119 participants from 2 tertiary hospitals from March 2022 to September 2022. Clinical assessments and data collection were performed at diagnosis (T1), 3 months (T2), and 6 months (T3) after diagnosis. The instruments were Demographic and Disease Information Sheet and PROMIS-Depression 8a. Data were analyzed using SPSS 27.0 for descriptive statistics, logistic regression, and the Mplus program for growth mixture model analysis. ResultsTwo stroke survivors depression trajectory classes (Class 1, moderate level decreasing- [37.8 %], and Class 2, high level increasing- [62.2%]) were delineated. Class 1 experienced moderate depression post-stroke, with a smooth diminishing pattern at T2 and T3, while Class 2 had a higher baseline depressive score and a significant increase at T2 and T3. The best growth mixture model was Class 2 model (LMR, p=0.010, BLRT, p≤0.01, AIC=2611.934, BIC=2650.842, aBIC=2606.583, Entropy= 0.944). The logistic regression results revealed that Class 2 of depression trajectory had a significant association with a lower score on cognitive function (B=-5.29, 95%CI: -8.80, -1.78, p <0.05) compared with Class 1. The stroke type, marital status, and monthly income were predictors of the Class 2 depression trajectory group among stroke patients. Precisely, ischemic stroke is associated with lower risk of class 2 trajectory. ConclusionThe trajectory of post-stroke depression changes over time. This research has the potential to serve as a foundation for the assessment of high-risk stroke patients, the development of precise management programs, the implementation of risk stratification, and the enhancement of prognosis.

Does Mobile Payment Raise the Poverty‐Alleviation Resilience of Chinese Households?

ABSTRACTConsidering the complex environment facing the future poverty reduction process in China, and it is increasingly urgent to shift the conversation from the poverty vulnerability to poverty‐alleviation resilience of households. Coinciding with poverty‐alleviation progress, mobile payment has experienced explosive growth, resulting in significant and far‐reaching influences on production and lifestyle. This study constructs a theoretical framework to analyze the impact of mobile payment on poverty‐alleviation resilience (splitting into poverty‐eradication resilience and development resilience). Meanwhile, the impact is empirically investigated using the China Household Finance Survey for 2017 and 2019. The findings reveal that, first, mobile payment significantly increases both poverty‐eradication resilience and development resilience. According to the quantile regression results, mobile payment has a larger contribution to households with a lower poverty‐alleviation resilience, with the contribution diminishing as poverty‐alleviation resilience improves; second, mobile payment significantly increases poverty‐alleviation resilience by increasing self‐insurance capacity and participation in commercial insurance (ex ante), alleviating financial exclusion (ex interim), and promoting entrepreneurship and improving entrepreneurial performance (ex post); and third, social trust significantly improves the effect of mobile payment on poverty‐alleviation resilience, whereas the age of the household head has the reverse effect. Since risk and shocks play a more pronounced role in the persistence of poverty, our research helps to understand poverty alleviation and offers insights into how to eradicate poverty in all its forms and dimensions, thus realizing the 2030 Agenda for Sustainable Development.

Comprehensive Risk Analysis of Emergency Medical Response Systems in Serbian Healthcare: Assessing Systemic Vulnerabilities in Disaster Preparedness and Response.

Emergency Medical Response Systems (EMRSs) play a vital role in delivering medical aid during natural and man-made disasters. This quantitative research delves into the analysis of risk and effectiveness within Serbia's Emergency Medical Services (EMS), with a special emphasis on how work organization, resource distribution, and preparedness for mass casualty events contribute to overall disaster preparedness. The study was conducted using a questionnaire consisting of 7 sections and a total of 88 variables, distributed to and collected from 172 healthcare institutions (Public Health Centers and Hospitals). Statistical methods, including Pearson's correlation, multivariate regression analysis, and chi-square tests, were rigorously applied to analyze and interpret the data. The results from the multivariate regression analysis revealed that the organization of working hours (β = 0.035) and shift work (β = 0.042) were significant predictors of EMS organization, explaining 1.9% of the variance (R2 = 0.019). Furthermore, shift work (β = -0.045) and working hours (β = -0.037) accounted for 2.0% of the variance in the number of EMS points performed (R2 = 0.020). Also, the availability of ambulance vehicles (β = 0.075) and financial resources (β = 0.033) explained 4.1% of the variance in mass casualty preparedness (R2 = 0.041). When it comes to service area coverage, the regression results suggest that none of the predictors were statistically significant. Based on Pearson's correlation results, there is a statistically significant correlation between the EMS organization and several key variables such as the number of EMS doctors (p = 0.000), emergency medicine specialists (p = 0.000), etc. Moreover, the Chi-square test results reveal statistically significant correlations between EMS organization and how EMS activities are conducted (p = 0.001), the number of activity locations (p = 0.005), and the structure of working hours (p = 0.001). Additionally, the results underscore the necessity for increased financial support, standardized protocols, and enhanced intersectoral collaboration to strengthen Serbia's EMRS and improve overall disaster response effectiveness. Based on these findings, a clear roadmap is provided for policymakers, healthcare administrators, and EMS personnel to prioritize strategic interventions and build a robust emergency medical response system.

Resource allocation efficiency in 68 county-level traditional Chinese medicine hospitals in China: a data envelopment analysis.

Analysing and evaluating how efficiently health resources are allocated to county-level Traditional Chinese Medicine (TCM) hospitals in Zhejiang Province, this study aims to provide empirical evidence for improving operational efficiency and optimising resource allocation in these hospitals. The study employed a three-stage Data Envelopment Analysis (DEA) model to assess efficiency, using data from 68 county-level TCM hospitals. Four input and five output variables related to TCM services were selected for the analysis. The first-stage DEA results indicated that in 2022, the technical efficiency (TE) of TCM hospitals in Zhejiang Province was 0.788, the pure technical efficiency (PTE) was 0.876 and the scale efficiency (SE) was 0.903. The classification of hospitals into four groups based on the bed size showed statistically significant differences in returns to scale (p<0.001). The Stochastic Frontier Analysis regression results were significant at the 1% level across four regressions, showing that environmental variables such as per capita GDP, population density and the number of hospitals impacted efficiency. In the third stage DEA, after adjusting the input variables, the TE, PTE and SE improved to 0.809, 0.833 and 0.917, respectively. The adjusted mean TE rankings by region were West (0.860) > East (0.844) > South (0.805) > North (0.796) > Central (0.731). There is an imbalance between the inputs and outputs of county-level TCM hospitals. Each region must consider factors such as the local economy, population and medical service levels, along with the specific development characteristics of hospitals, to reasonably determine the scale of county-level TCM hospital construction. Emphasis should be placed on improving hospital management and technical capabilities, coordinating regional development, promoting the rational allocation and efficient use of TCM resources and enhancing the efficiency of resource allocation in county-level TCM hospitals.