Two-level Logistic Regression Models Research Articles

Induced abortion among adolescent girls and young women: should geography matter in Ghana?

Globally, there has been a slight reduction in abortion rates. However, abortion rates have increased in other major regions, including sub-Saharan Africa. Induced abortion rates vary by ecological zone and place of residence, and it is prevalent among women aged 15–24. This study examined the predictors of induced abortion in ecological zones by place of residence among adolescent girls and young women aged 15–24. The 2017 Ghana Maternal and Health Survey, which is a nationally representative household survey dataset, was used for this study. This analysis is restricted to 3194 Adolescent Girls and Young Women (AGYW) aged 15–24 years. A two-level multilevel binary logistic regression model was used to analyze the individual and contextual level characteristics associated with induced abortion. The results show that the prevalence rate of induced abortion among adolescent girls and young women is 26.0%. After adjusting for individual and community level factors, ecological zones and place of residence predicted induced abortion among AGYW. More importantly, the results demonstrate that AGYW residing in urban areas of the forest zones were statistically significant to report induced abortion compared to those in the rural areas. In conclusion, there is a strong association between place of residence, ecological zones and induced abortion in Ghana. Primarily, urban-dwelling women in the forest zone are more likely to report induced abortion. There is, therefore, a need to prioritize women residing in urban areas and the forest zone of Ghana. AGYW in these high-risk ecological zones should be reached with sufficient health education and sensitization about induced abortion. Given the protective factor of contraceptive use, it is recommended that the government and its health agencies strengthen campaigns to improve contraceptive use among AGYW across the country, particularly in the urban forest ecological zone.

Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia

ABSTRACT Objectives Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations. Methods We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination. Results We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds. Conclusion Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.

Current situation of family doctor contracting program: A survey of the perspective of general practitioners

BackgroundResearch on family doctor contract services has predominantly focused on residents, with limited attention to the general practitioners (GPs) regarding the current situation of family doctor team contracting. ObjectiveThis study aims to assess the current status of family doctor contract services in primary health care facilities in Guangdong Province from the GPs' perspective and to identify factors influencing the number of people contracting with family doctor teams. MethodsA multi-stage stratified cluster sampling method was used to select GPs from primary health care facilities in Guangdong Province from July 5 to July 31, 2021. A self-developed survey questionnaire was used to collect data. The number of people contracted with family doctor teams under different characteristics of GPs and their teams was compared, and a two-level Logistic regression model was developed using R 4.2.2 software to determine the factors that influence whether enrollment numbers in family doctor teams exceed 2,000. ResultsA total of 3,252 valid responses were collected from family doctor teams with a contracting count above 100. In 2020, the median number of contracts per family doctor team, as reported by GPs, was 1,400(IQR = 2,499). Comparisons of the number of people contracted with family doctor teams among GPs of different genders, ages, educational levels, managerial positions, employment forms, years of professional experience, working facilities, practicing regions, training received, and annual income showed statistically significant differences (P < 0.05). Variables including the number of team members, the population under jurisdiction, the intention for specialist doctors within the health group to join the team, the availability of hospital beds, and guidance from higher-level hospitals also exhibited significant variations (P < 0.05). Zero model fitting results highlighted that the distribution of contracted individuals was regionally clustered among the practicing regions of GPs (P < 0.05). The comprehensive analysis using a two-level Logistic regression model revealed several key findings: GPs holding a college diploma [OR (95 %CI) = 2.79 (1.84, 3.74)] or a vocational school/high school certificate [OR (95 %CI) = 2.83 (1.80, 3.86)] were more likely to manage teams with over 2,000 contracted individuals, compared to those with a master's degree or higher. GPs in managerial positions were less likely [OR (95 %CI) = 0.66 (0.33, 0.99)] to oversee teams exceeding 2,000 contracted individuals, in contrast to those without any managerial role. Formal employment status was associated with a higher likelihood [OR (95 %CI) = 2.02 (1.53, 2.51)] of managing larger numbers of contracted individuals compared to temporary employment. Team size showed a positive correlation with contracting capacity; teams with 4–6 members [OR (95 %CI) = 1.31 (1.05, 1.57)], 7–10 members [OR (95 %CI) = 2.06 (1.75, 2.37)], 11–19 members [OR (95 %CI) = 3.67 (3.31, 4.03)], and ≥20 members [OR (95 %CI) = 3.46 (2.74, 4.18)] were increasingly likely to surpass 2,000 contracted individuals. Teams managing larger populations—2,001–9,999 [OR (95 %CI) = 2.37 (2.12, 2.62)], 10,000–29,999 [OR (95 %CI) = 2.92 (2.65, 3.19)], and ≥30,000 [OR (95 %CI) = 2.86 (2.55, 3.17)]—were more likely to exceed 2,000 contracts compared to those managing ≤2,000 people. The absence of hospital bed resources within a team was positively associated [OR (95 %CI) = 1.38 (1.14, 1.62)] with surpassing the 2,000 contracted individuals threshold. ConclusionThe study findings suggest that a larger family doctor team size and larger population size of jurisdiction positively impact the capacity for contracting with family doctor teams. GPs with higher educational levels, managerial roles, and access to hospital bed resources possess a more profound understanding and control over family doctor contract service policies, leading to optimized management of contracted individuals. Compared to their temporarily employed counterparts, formally employed GPs within family doctor teams are more likely to engage in contracting activities.

Food Insecurity and Outpatient Care Utilization Among Indonesian Older Adults.

This study aims to examine the complex relationship between household food insecurity and outpatient care utilization among Indonesian older adults. Individual-level data from the 2020 National Socioeconomic Survey (SUSENAS; n = 29 950 older adults aged 60 and over in poor self-rated health who are unable to do daily activities) and environmental-level data (n = 84 096 villages in a data aggregation across 514 municipalities) from the 2021 Village Potential Data Census Collection Survey (PODES) are used in a two-level binary logistic regression model. Older adults who live in severely food insecure households (odds ratio [OR] 1.963; CI [1.658, 2.319]) and lack of health insurance (OR 1.654; CI [1.556, 1.747]) are more likely of not utilizing outpatient care. The interclass correlation coefficient value is 0.162, indicating that primary health care services in every village improve outpatient care utilization. Food insecurity is the major determinant of reduced likelihood of outpatient care utilization, which can be explained by household resource constraints.

Association of child marriage and nutritional status of mothers and their under-five children in Bangladesh: a cross-sectional study with a nationally representative sample

BackgroundChild marriage remains an important problem around the world with young mothers and their under-five children often experiencing under-nutrition. The problem is rarely studied in the Bangladeshi population. This paper was designed to identify the association between child marriage and nutritional status of mothers and their under-five children in Bangladesh.MethodsNationally representative secondary data was used for this study, data was extracted from the Bangladesh Demographic and Health Survey (BDHS) 2017–18. The sample consisted of 7235 mothers aged 18–49 years and their under-five children. The mothers were classified into two classes according to their age at first marriage: (i) child marriage (marriage at < 18 years) and (ii) not child marriage (marriage at ≥ 18 years). The nutritional status of mothers was measured by body mass index (BMI), and under-five children’s nutritional status was measured by (i) height-for-age (z-score) (stunting), (ii) weight-for-age (z-score) (underweight), and (iii) weight-for-height (z-score) (wasting). The chi-square test and two-level logistic regression model were used for data analysis using SPSS software (IBM version 20).ResultsThe prevalence of child marriage among Bangladeshi women was 69.0%, with the mean and median of age at the first marriage being 16.57 ± 2.83 years and 16 years, respectively. Of the mothers, 15.2% suffered from chronic energy deficiency (underweight), and 72.8% were married at < 18 years. The prevalence of stunting, underweight, and wasting among under-five children in Bangladesh was 31.0%, 22.0%, and 8.5%, respectively. Compared to women married at the age of ≥ 18 years, there was a significantly higher likelihood of chronic energy deficiency among women who married at < 18 years [Adjusted OR = 1.27, CI: 1.05–1.82; p < 0.05]. Under-five children of mothers married before the age of 18 were more likely to have stunting [Adjusted OR = 1.201, CI: 1.11–1.72; p < 0.05], wasting [Adjusted OR = 1.519, CI: 1.15-2.00; p < 0.01], and underweight [Adjusted OR = 1.150, CI: 1.09–1.82; p < 0.05] compared to children of mothers who married at age ≥ 18.ConclusionThe rate of child marriage among Bangladeshi women is high, and it is significantly associated with malnutrition among mothers and their under-five children. The Bangladesh government can use the findings of this study to prevent and reduce child marriage and malnutrition among mothers and their under-five children to achieve sustainable development goals by 2030.

Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study

ObjectivesThis study aimed to investigate whether a significant trend regarding inpatient falls in Swiss acute care hospitals between 2011 and 2019 could be confirmed on a national level, and whether...

Analysis of prevalence status and influencing factors of e-cigarette use among secondary school students in Heilongjiang Province

Objective: To describe the current situation and influencing factors of e-cigarette use among secondary school students in Heilongjiang Province to provide evidence for formulating provincial youth e-cigarette prevention and control strategies. Methods: A multi-stage stratified cluster probability sampling method was adopted in 2021, with 8 340 students in 180 classes from 56 primary and high schools in 10 monitoring districts and counties in Heilongjiang Province. The students in the selected classes filled out a unified questionnaire by themselves. SAS 9.4 software was used for data cleansing, sample weighting, and analysis. Chi-squared tests were used to compare the differences between groups, and a two-level logistic regression model was used to analyze the influencing factors of e-cigarette use among secondary school students. Results: A total of 8 329 survey questionnaires were included in the analysis. The prevalence rates of ever and current e-cigarette use among secondary school students in Heilongjiang Province were 18.27% and 5.46%, respectively. In terms of ever e-cigarette use, the rate of boys (23.94%) was higher than that of girls (12.35%). The rate of vocational high school students (39.18%) was higher than that of general high school students (24.11%) and than that of junior school students (11.27%). In terms of current e-cigarette use, the rate of boys (7.08%) was higher than that of girls (3.76%). The rate of vocational high school students (14.56%) was higher than that of general high school students (7.70%) and than that of junior school students (2.67%). The rates of ever and current e-cigarette use were relatively higher in each subgroup, including "weekly allowance more than 40 Yuan" "one of the student's parents, friends or teachers was smoker" "smoked cigarettes now" and "saw e-cigarette advertisements". A two-level logistic regression model showed that the following factors were the influencing factors of current use of e-cigarettes among secondary school students, including gender, whether they were current cigarette smokers, the smoking status of their close friends, if they saw teachers smoked in the school, noticed e-cigarette advertisements, and e-cigarette addictive cognition. Conclusions: The prevalence rates of ever and current e-cigarette use among secondary school students in Heilongjiang Province were high. E-cigarette advertisements, the smoking status of their close friends, and whether they saw teachers smoking in the school were the main factors affecting e-cigarette use among secondary school students in Heilongjiang Province. It is necessary to focus on constructing smoke-free environments and increase health education related to e-cigarette knowledge on risk in developing a smoke-free campus in the whole province.

Particulate matter 2.5 exposure during pregnancy and birth outcomes: Evidence from Colombia

Particulate matter is a type of air pollution that consists of fine particles with a diameter <2.5 μm (PM2.5), which can easily penetrate the respiratory system and enter the bloodstream, increasing health risks for pregnant women and their unborn babies. Recent reports have suggested that there is a positive association between PM2.5 exposure and adverse pregnancy outcomes. However, most evidence of this relationship comes from Western countries. Thus, the objective of this study was to evaluate the association between PM2.5 exposure during pregnancy and birth outcomes among pregnant women in Colombia. This study included 542,800 singletons born in 2019 to Colombian women, aged 15+ years, residing in 981 municipalities. Data on parental, child and birth characteristics were extracted from anonymized live birth records. Satellite-based estimates of monthly PM2.5 concentrations at the surface level were extracted for each municipality from the Atmospheric Composition Analysis Group (ACAG). PM2.5 exposure during pregnancy was indicated by the monthly average of PM2.5 concentrations across the pregnancy duration for the municipality where the child was born. The associations of municipality-level PM2.5 concentration during pregnancy with pre-term birth (PTB) and low birth weight (LBW) were tested in separate two-level logistic regression models, with babies nested within municipalities. The prevalence of PTB and LBW were 8.6 % and 8.3 %, respectively. The mean PM2.5 concentration across the 981 municipalities was 18.26 ± 3.30 μg/m3, ranging from 9.11 to 31.44 μg/m3. Greater PM2.5 concentration at municipality level was associated with greater odds of PTB (1.05; 95%CI: 1.04–1.06) and LBW (1.04; 95%CI: 1.03–1.05), after adjustment for confounders. Our findings provide new evidence on the association between PM2.5 on adverse pregnancy outcomes from a middle-income country.

Individual and community level factors associated with modern contraceptive utilization among women in Ethiopia: Multilevel modeling analysis.

Modern contraceptive utilization is the most effective intervention to tackle unintended pregnancy and thereby reduce abortion and improve maternal, child, and newborn health. However, multilevel factors related to low modern contraceptive utilization and the robust analysis required for decision-making were scarce in Ethiopia. To investigate the individual and community-level predictors of modern contraceptive utilization among reproductive-age women in Ethiopia. We utilized data from a cross-sectional 2019 Performance Monitoring for Action Ethiopia survey. The survey employed a stratified two-stage cluster sampling method to select households for inclusion. In Stata version 16.0, the data underwent cleaning, aggregation, and survey weighting, following which a descriptive analysis was performed utilizing the "svy" command. Subsequently, the primary analysis was executed using R software version 4.1.3. We fitted a two-level mixed effects logistic regression model on 6,117 reproductive-age women nested within 265 enumeration areas (clusters). The fixed effect models were fitted. The measures of variation were explained by intra-cluster correlation, median odds ratio, and proportional change in variance. The shrinkage factor was calculated to estimate the effects of cluster variables using the Interval odds ratio and proportion opposed odds ratio. Finally, the independent variables with a significance level of (P<0.05) and their corresponding Adjusted Odds ratios and 95% confidence intervals were described for the explanatory factors in the final model. In Ethiopia, the prevalence of modern contraceptive utilization was only 37.% (34.3 to 39.8). Women who attained primary, secondary, and above secondary levels of education were more likely to report modern contraceptive utilization with AOR of 1.47, 1.73, and 1.58, respectively. Divorced/widowed women were less likely to report modern contraceptive utilization (AOR:0.18, 95% CI 0.13,0.23) compared to never-married women. Discussions between women and healthcare providers at the health facility about family planning were positively associated with modern contraceptive utilization (AOR:1.84, 95% CI: 1.52, 2.23). Community-level factors have a significant influence on modern contraceptive utilization, which is attributed to 21.9% of the total variance in the odds of using modern contraceptives (ICC = 0.219). Clusters with a higher proportion of agrarian (AOR: 2.27, 95% CI 1.5, 3.44), clusters with higher literacy (AOR: 1.46, 95% CI 1.09, 1.94), clusters with empowered women and girls about FP (AOR: 1.47, 95% CI 1.11, 1.93) and clusters with high supportive attitudes and norms toward FP (AOR: 1.37, 95% CI 1.04, 1.81) had better modern contraceptive utilization than their counterparts. In Ethiopia, understanding the factors related to modern contraceptive use among women of reproductive age requires consideration of both individual and community characteristics. Hence, to enhance family planning intervention programs, it is essential to focus on the empowerment of women and girls, foster supportive attitudes towards family planning within communities, collaborate with education authorities to enhance overall community literacy, pay special attention to pastoralist communities, and ensure that reproductive-age women as a whole are targeted rather than solely focusing on married women.

The impact of co-occurring mental health problems on referral to and initiation of treatment among youth under probation supervision: Findings from a cluster randomized trial

IntroductionMany youth under community supervision have substance use and co-occurring mental health issues. Yet, access to treatment is limited, and many programs cannot address co-occurring disorders. This study examines how co-occurring symptoms among youth on probation affect referral to and initiation of treatment. We hypothesize that both referral and initiation rates will be lower for youth with any co-occurring indicators. MethodsThis study collected administrative data from 14 sites in three states between March 2014 and November 2017 using JJ-TRIALS, a cluster randomized trial. Among 8552 youth in need of treatment (screened as having a substance use problem, drug possession arrest, positive drug test, etc.), 2069 received a referral to treatment and 1630 initiated treatment among those referred. A co-occurring indicator (n = 2828) was based on symptoms of an internalizing and/or externalizing issue. Descriptive analyses compared referral and initiation by behavioral health status. Two-level mixed effects logistic regression models estimated effects of site-level variables. ResultsAmong youth in need with co-occurring internal, external, or both indicators, only 16 %, 18 %, and 20 % were referred to treatment and of those referred, 63 %, 69 %, and 57 % initiated treatment, respectively. Comparatively, 27 % and 83 % of youth with a substance use only indicator were referred and initiated treatment respectively. Multi-level multivariate models found that, contrary to our hypothesis, co-occurring-both (p = 0.00, OR 1.44) and co-occurring-internal indicators (p = 0.06, OR 1.25) predicted higher referral but there were no differences in initiation rates. However, there was substantial site-level variation. ConclusionsYouth on probation in need of substance use treatment with co-occurring issues have low referral rates. Behavioral health status may influence youth referral to treatment depending on where a youth is located. Depending on the site, there may be a lack of community programs that can adequately treat youth with co-occurring issues and reduce unmet service needs.

What are the determinants of variation in caretaker satisfaction with sick child consultations? A cross-sectional analysis in five low-income and middle-income countries

ObjectivesThe objective of this study was to explore determinants of variation in overall caretaker satisfaction with curative care for sick children under the age of 5 in five low-income and...

Prevalence, awareness, treatment and control of dyslipidaemia and their determinants: results from a population-based survey of 60 283 residents in eastern China

ObjectivesTo investigate the prevalence, awareness, treatment and control of dyslipidaemia and its associated factors in eastern China.DesignCross-sectional study.SettingData were collected from the 2017 Nanjing Chronic Disease and Risk Factor Surveillance.ParticipantsThis...

Prevalence and determinants of anemia among school going children in the state of Tamil Nadu, India: applications of two-level logistic regression model

Background: Anemia still remains as one of the major public health problems in India despite implementing preventive measures. The objective was to find the prevalence and determinants of anemia among school going children in Tamil Nadu. Methods: We used the data from the fourth round of district level household survey (DLHS-4) for Tamil Nadu pertaining to the year 2012-13. Our analysis included 23997 children. Descriptive statistics, Random intercept and empty models of two-level logistic regression analysis were used. Results: The overall prevalence of anemia was found to be 41.4% (95% CI: 40.77%-42.02%). We observed a district level variation on anemia (District level variance=0.1, p&lt;0.001) and the intra class correlation coefficient was 0.0295. The prevalence of anemia was more in coastal districts as compared to non-coastal districts (43.85% vs. 40.18%, p&lt;0.001). Variables that are found to have significant association with anemia on multilevel analysis were younger age (Adjusted odds ratio (AOR)=1.343, 95% CI: 1.270-1.420), female children (AOR=1.462, 95% CI: 1.387-1.541), more than eight family members in the household (AOR=1.120, 95% CI: 1.008-1.245), rural residence (AOR=1.103, 95% CI: 1.038-1.172) and lower standard of living (AOR=1.203, 95% CI: 1.084-1.334). Conclusions: Half of school going children were anemic in the state. Geospatial distribution of anemia varied significantly. Governments and regional health centres should take adequate measures to avert the consequences of anemia in school going children considering these factors.

Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure.

There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity. Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas. The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.

Association of land urbanization and type 2 diabetes mellitus prevalence and mediation of greenness and physical activity in Chinese adults

The prevalence of type 2 diabetes (T2D) is higher in urban than in rural areas. Limited information is available on the association between T2D and Land urbanization (LU) while LU influences not only greenness and Particulate Matter 2.5 (PM2.5) but also inhabitant behavior. We aimed to explore the association between the LU level and T2D prevalence, as well as whether greenness, PM2.5, or conscious physical activity mediated any of the observed associations. This study encompassed 27,633 adult participants from Shandong Province who completed the sixth National Health Service Survey in 2018. Ambient LU exposure was estimated by spatial characteristics, including the existing impervious surface area (ISA), road density (RD), and annual night light (NL). Exposures were estimated using satellite images and OpenStreetMap, with 1000 m used as the main analysis buffer. Two-level logistic regression models were used to investigate the association between the LU metrics and T2D. Additionally, we explored potential mechanisms of the association through mediation analysis. The prevalence of T2D among participants was 5.14%, with average exposures to ISA_1000m of 1.441 km2, RD_1000m of 3.856 km/km2, and NL_1000m of 9.821 nW/cm2/sr. Higher levels of LU exposure were associated with higher T2D ORs [for each interquartile of ISA_1000m, RD_1000m, and NL_1000m, the adjusted OR (95% CI) for the T2D prevalence were 1.29 (1.19–1.4), 1.25 (1.15–1.36), and 1.25 (1.15–1.36), respectively]. This relationship persisted in several sensitivity analyses including use of different buffer sizes. We observed stronger associations among participants younger than 65 years or in men. Greenness mediated a 20.78%–65.36% of the estimated associations, conscious physical activity mediated a 10.35%–15.85%, while PM2.5 mediated insignificantly. These results suggest a deleterious association between higher levels of LU and T2D among adult residents in a developing country. Greenness and conscious physical activity mediate the association.

A life course perspective on determinants of discontinuance of active participation in sports activities

Physical inactivity remains a global public health challenge today. Determining why people stop regularly participating in sports is significant to develop targeted intervention strategies for sports promotion and healthy living. As sports participation is dynamic throughout life, a life-course perspective is needed to provide a more comprehensive understanding. This study adopts a life-course perspective to explore the determinants of the change from active participation in sports to becoming inactive. Based on online retrospective survey data collected in the Netherlands, a two-level binary logistic regression model is estimated to capture the effects of socio-demographics, sports motivations, life transitions, and neighborhood characteristics on sports dropout over the lifespan. Results show that dropout from sports is age-specific, and that people are less likely to discontinue sports participation when they have health and weight loss goals. Life transitions have different effects. The cessation of living with physically active people appears to be the most important event to make people stop sporting, followed by having a baby, and then owning the first car. Compared with education-related events, work-related events are more likely to cause people to stop sporting. Moreover, the probability of sports discontinuance may increase when residents feel unsafe doing physical activities in their neighborhoods or when the neighborhood has sufficient greenspace for walking. The findings have implications for supporting sports participants to continue exercising by addressing the barriers.

Perceived problematic alcohol use in the family and adolescents’ stress-related complaints: examining the buffering role of the school’s degree of student focus as rated by its teachers

BackgroundA non-negligible proportion of children grow up with problematic alcohol use in the family. Problematic familial drinking can be regarded as a stressor, and prior studies have consistently reported poorer mental health among adolescents who are exposed. However, it is also of relevance to identify modifiable protective factors which may buffer against stress-related ill-health in this group of adolescents. One context where such factors may be present is the school. The aim of this study is to examine the relationship between perceived problematic familial alcohol use and students’ stress-related complaints, and specifically to explore if the school’s degree of student focus can buffer against any such negative health consequences of problem drinking at home.MethodsData were drawn from four separate surveys, the Stockholm School Survey (SSS) and the Stockholm Teacher Survey (STS) conducted in 2014 and 2016 among 7,944 students (~ 15–16 years) and 2,024 teachers in 147 Stockholm senior-level school units. Perceived problematic familial alcohol use was measured by one item in the SSS. Stress-related complaints were captured by co-occurring somatic complaints and psychological distress, and reported by students in the SSS. The school’s student focus was measured by an index based on teachers’ ratings of four items in the STS. A set of covariates at the student and the school level were also included. Two-level binary logistic and linear regression models were performed.ResultsPerceived problematic familial alcohol use was linked with an increased likelihood of reporting co-occurring somatic complaints as well as psychological distress. Cross-level interactions revealed that the association between perceived problematic familial alcohol use and co-occurring somatic complaints was weaker among students attending schools with stronger teacher-rated student focus. Regarding psychological distress, the association was weaker for students attending schools with intermediate or strong teacher-rated student focus, compared with those attending schools with weaker teacher-rated student focus.ConclusionsThe findings provide support for the assumption that favourable conditions in schools can buffer against negative health consequences of problematic conditions in the family, thus serving a compensatory role.

Association between different obesity measurement indexes and serum C-reactive protein in adult women

Objective: To explore the association of different obesity measurement indexes on serum C-reactive protein (CRP) in Chinese adult women. Methods: The data were obtained from baseline and follow-up surveys of the urban Breast Cancer Screening Program in Shuangliu District, Chengdu. A total of 441 adult women were included in the study. A questionnaire survey, physical examination, and laboratory testing were conducted on the subjects. Multivariate logistic regression model, two-level mixed effects logistic regression model, and restricted cubic spline method were used to investigate the linear and nonlinear correlation between different obesity measurement indexes and serum CRP in adult women. Results: For every 1 unit increase in BMI, waist circumference (WC), and adiposity, the risk of elevated serum CRP or exacerbation of chronic low-grade inflammation in adult women increased by 16.5%, 5.0%, and 11.1% (P<0.05), respectively. Both BMI and adiposity were nonlinear correlated with serum CRP. Using BMI=24.0 kg/m2 as the reference point, serum CRP level increased with the increase of BMI when BMI >24.0 kg/m2. Using adiposity=30% as the reference point, serum CRP level increased with the increase of adiposity when adiposity >30%. Conclusions: Overall, obesity reflected by BMI had the strongest association with serum CRP in adult women, followed by body fat content reflected by adiposity, and central obesity reflected by WC had the weakest association with CRP. Adult women with BMI >24.0 kg/m2 or adiposity >30% are at high risk for obesity-related inflammatory manifestations.

Risk factors for colonization with multidrug-resistant Gram-negative bacteria and Clostridioides difficile in Long Term Care Facilities (LTCFs) residents: the evidence from 27 facilities in a high endemic setting.

Residency in LTCFs increases the likelihood of colonization with multidrug resistant Gram-negative bacteria (MDR-GNB). We assessed the prevalence and risk factors for enteric colonization by III-generation cephalosporins-resistant and carbapenem-resistant (CR) GNB in a large group of LTCFs in a high endemic setting. We also assessed the prevalence and risk factors for C. difficile colonization. A point prevalence survey with rectal screening (RS) was conducted in 27 LTCFs in north Italy. Epidemiological and clinical variables on the survey day, history of hospitalization and surgery within one year, and antibiotics within three months, were collected. The presence of III-generation cephalosporin resistant and CR GNB was assessed using a selective culture on chromogenic medium and PCR for carbapenemase detection. The presence of C. difficile was assessed using ELISA for GDH and RT-PCR to identify toxigenic strains. Multi-variable analyses were performed using two-level logistic regression models. In the study period 1947 RSs were performed. The prevalence of colonization by at least one GNB resistant to III-generation cephalosporin was 51% (E. coli 65%, K. pneumoniae 14% of isolates). The prevalence of colonization by CR GNB was 6%. 6% of all isolates (1150 strains) resulted in a carbapenem-resistant K. pneumoniae, and 3% in a carbapenem-resistant E. coli. KPC was the most frequent carbapenemase (73%) identified by PCR, followed by VIM (23%). The prevalence of colonization by C. difficile was 11.7%. The presence of a medical device (OR 2.67) and previous antibiotic use (OR 1.48) were significantly associated with III-generation cephalosporin resistant GNB colonization. The presence of a medical device (OR 2.67) and previous hospitalization (OR 1.80) were significantly associated with CR GNB. The presence of a medical device (OR 2.30) was significantly associated with C. difficile colonization. Main previously used antibiotic classes were fluoroquinolones (32% of previously treated subjects), III-generation cephalosporins (21%), and penicillins (19%). Antimicrobial stewardship in LTCFs is a critical issue, being previous antibiotic treatment a risk factor for colonization by MDR-GNB. The prevalence of colonization by III-generation cephalosporin and CR GNB among LTCF residents also underlines the importance to adhere to hand hygiene indications, infection prevention and control measures, and environmental hygiene protocols, more achievable than rigorous contact precautions in this type of social setting.

A multilevel analysis to determine the factors affecting WHO recommended quantity antenatal care utilizations of pregnant women in Bangladesh

Antenatal Care utilizations have become an essential phenomenon to all pregnant women as a means of disease preclusion during pregnancy and safe live birth. To lessen maternal death and disease, proper (minimum eight) antenatal care (ANC) contacts are necessary according to World Health Organization (WHO) new guideline. The aim of this study is to assess the factors affecting proper antenatal care utilization of pregnant Bangladeshi women. The study used data from the most recent Bangladesh Demographic and Health Survey 2017–18 for conducting a two-level binary logistic regression model. A weighted sample of 4866 women and 675 clusters were considered as individual and community level respectively. The results exhibited only 11.6% women took proper antenatal care during pregnancy. The study found 23.9% variability in utilizations of Antenatal care belongs to community-level factors. At individual-level, mother’s occupation, body mass index, birth-order, pregnancy intention, education, delivery place, and media access and at community-level, rural communities (AOR = 0.70, 95% C.I = 0.542–0.920), and communities having media access (AOR = 1.38, 95% C.I = 0.979–1.96) had significant relationship with proper antenatal care utilizations of pregnant women. After testing random slopes of individual-level variables, only education of women covariate was found to be varied from community to community. This study suggests that uptake of proper antenatal care depend on both individual and community level covariates and there lies extensive variation among them. Future studies on wider aspect are therefore suggested to determine obstacles in making proper Antenatal care utilizations.