Wald Chi-square Test Research Articles

Comprehensive cardiac interval analysis in the WEAR-TECH study cohort by comparing the Apple Watch Series 6 against a simultaneous 12-lead ECG

Abstract Background Wearable devices capable of single-lead electrocardiograms (ECGs) are becoming increasingly prevalent. Exploring their potential for screening conditions beyond atrial fibrillation presents a compelling research opportunity. Objective This study evaluates the agreement between the Apple Watch Series 6 (APW) and simultaneous 12-lead ECG (12L) recordings in measuring PR, QRS, RR, QT, and QTc intervals in a cohort of National Health Service (NHS) cardiology patients. Methods We analysed data from the WEAR-TECH study, which included 400 simultaneous recordings from the APW and 12L ECGs. We included patients with ECGs in sinus rhythm and excluded patients with poor-quality ECGs. No exclusions were made based on underlying cardiac conditions. Measurements of the best three consecutive waveforms in leads I, II, and V5 were performed using EP Calipers (EP Studio) by a single observer. Leads I and II were compared for PR, QRS, and RR intervals, while leads I, II, and V5 were compared for QT and QTc intervals. QTc was calculated using Bazett’s formula. Differences between APW and 12L ECGs were assessed using linear mixed effects regression models with random intercepts and type II Wald chi-square tests. Clinical agreement was measured by averaging the waveforms from 12L leads and the APW and calculating the difference between the means. Results Out of 324 paired ECGs from 162 patients, 8 were excluded due to missing or uninterpretable data. The median age was 64 (IQR: 54 - 74) years, with 117 (75%) being male. PR, QRS, and RR intervals from the APW agreed best with 12L lead II, and QT and QTc intervals from APW agreed best with 12L lead V5, with no significant difference found in any of these comparisons. PR and RR intervals significantly differed between APW and 12L lead I, with the APW tending to overestimate relative to the 12L. Additionally, significant differences were found in 12L leads I and II for QT and QTc, with APW also tending to overestimate these intervals (see Table 1). Clinical agreement between the APW and all 12L leads was a minimum of 21% for a <10ms difference, 45% for a <20ms difference, and 71% for a <40ms difference (see Figure 1). Conclusions The Apple Watch Series 6 demonstrates promising potential for initial outpatient monitoring of PR, QRS, RR, QT, and QTc intervals with reasonable agreement to 12L ECG. This is especially true in lead II for PR, QRS, and RR intervals and lead V5 for QT and QTc intervals. Further reductions in variance between APW and 12L ECG measurements could enhance clinical decision-making accuracy.Table 1:The p-values of APW vs 12L leadFigure 1:Agreement of APW to 12L leads

Genomic signature for oligometastatic disease in non-small cell lung cancer patients with brain metastases.

Biomarkers for extracranial oligometastatic disease remain elusive and few studies have attempted to correlate genomic data to the presence of true oligometastatic disease. Patients with non-small cell lung cancer (NSCLC) and brain metastases were identified in our departmental database. Electronic medical records were used to identify patients for whom liquid biopsy-based comprehensive genomic profiling (Guardant Health) was available. Extracranial oligometastatic disease was defined as patients having ≤5 non-brain metastases without diffuse involvement of a single organ. Widespread disease was any spread beyond oligometastatic. Fisher's exact tests were used to screen for mutations statistically associated (p<0.1) with either oligometastatic or widespread extracranial disease. A risk score for the likelihood of oligometastatic disease was generated and correlated to the likelihood of having oligometastatic disease vs widespread disease. For oligometastatic patients, a competing risk analysis was done to assess for cumulative incidence of oligometastatic progression. Cox regression was used to determine association between oligometastatic risk score and oligoprogression. 130 patients met study criteria and were included in the analysis. 51 patients (39%) had extracranial oligometastatic disease. Genetic mutations included in the Guardant panel that were associated (p<0.1) with the presence of oligometastatic disease included ATM, JAK2, MAP2K2, and NTRK1, while ARID1A and CCNE1 were associated with widespread disease. Patients with a positive, neutral and negative risk score for oligometastatic disease had a 78%, 41% and 11.5% likelihood of having oligometastatic disease, respectively (p<0.0001). Overall survival for patients with positive, neutral and negative risk scores for oligometastatic disease was 86% vs 82% vs 64% at 6 months (p=0.2). Oligometastatic risk score was significantly associated with the likelihood of oligoprogression based on the Wald chi-square test. Patients with positive, neutral and negative risk scores for oligometastatic disease had a cumulative incidence of oligometastatic progression of 77% vs 35% vs 33% at 6 months (p=0.03). Elucidation of a genomic signature for extracranial oligometastatic disease derived from non-invasive liquid biopsy appears feasible for NSCLC patients. Patients with this signature exhibited higher rates of early oligoprogression. External validation could lead to a biomarker that has the potential to direct local therapies in oligometastatic patients.

Orofacial clefts in Costa Rica, 1996-2021: Analysis of surveillance data.

Orofacial clefts (OFCs) are among the most common birth defects (BD). In 2008, a series of improvements began in the Costa Rican Birth Defect Register Center (CREC). We aim to explore trends between 1996 and 2021. A trend analysis of OFCs from 1996 to 2021 and a descriptive analysis of OFCs from 2010 to 2021 were performed based on data from the CREC, the national BD surveillance system. Prevalence at birth was calculated according to the type: cleft palate (CP), cleft lip with or without CP (CL ± P), and presentation (isolated, multiple non-syndromic, or syndromes). We used joinpoint regression to identify if a significant change in trend occurred; the average annual percent change (AAPC) was determined. Marginal means and prevalence ratios by subperiod (1996-2009 as referent and 2010-2021) were estimated using Poisson regression and compared using Wald's chi-square tests (α ≤.05). We found a significant AAPC for OFCs prevalence of +1.4: +0.6 for isolated, +2.9 for multiple non-syndromic, and +7.7 for syndromes (p < .05). When comparing the OFC's prevalence of the subperiod 2010-2021 (11.86 per 10,000) with 1996-2009 (9.36 per 10,000) the prevalence ratio was 1.3 (p < .01): 1.1 (p < .05) for isolated, 1.6 (p < .01) for multiple non-syndromic, and 3.3 (p < .01) for syndromes. The prevalence of OFCs from 2010 to 2021 was 9.1 for CL ± P and 2.8 for CP. Seventy-one percent of the OFCs were isolated, 22% multiple non-syndromic, and 7% syndromes. The trend in OFCs' prevalence is toward increasing, mainly due to improvements in the surveillance system.

The bidirectional relationship between benign/malicious envy and subjective well-being in adolescents: The mediating effect of self-esteem.

Subjective well-being, an important index for measuring mental health, is presently declining among junior high school students. Envy, one of their common emotions, is inextricably linked to subjective well-being. Based on the Dual Envy Theory, our research explores the bidirectional relationship between benign-malicious envy and subjective well-being. The mediating role of self-esteem, as well as the related gender differences, is examined. Chinese middle school students (n = 1566, boys 50.3%, age = 13.96 ± 0.88 years old) were assessed at two time points over a 3-month interval. Structural equation modeling was used to examine the longitudinal relationships among the variables. (1) Cross-lagged analysis showed a positive bidirectional relationship between benign envy and subjective well-being and a negative bidirectional relationship between malicious envy and subjective well-being in the total sample. However, the path from T1 subjective well-being to T2 malicious envy in boys was not significant. (2) Self-esteem mediated the relationship between both benign and malicious envy and subjective well-being among both boys and girls. A Wald chi-square test showed that T2 self-esteem was a stronger predictor of T2 benign envy in boys than in girls. The results reveal a virtuous cycle of benign envy and subjective well-being, and a vicious cycle of malicious envy and subjective well-being, while emphasizing the role of self-esteem in this process. Gender differences were also noted. These findings have important implications for improving the subjective well-being of secondary school students and exploring the positive effects of envy.

Hypertension Medication and Medicare Beneficiaries: Prescription Drug Coverage Satisfaction and Medication Non-Adherence among Older Adults.

Hypertension is so prevalent and requires strict adherence to medications to prevent further disease or death, but there is no study examining factors related to prescription drug non-adherence among 65 years old and older. This study aims to assess the likelihood of medication nonadherence among patients based on factors such as age, race, and socioeconomic status, with the goal of identifying strategies to enhance medication adherence and mitigate associated health risks. Using the 2020 Medicare Current Beneficiary Survey Public Use File to represent nationwide Medicare beneficiaries (unweighted n = 3917, weighted n = 27,134,782), medication non-adherence was related to multiple independent variables (i.e., age, sex, race/ethnicity, socioeconomic status, comorbidities, insurance coverage, and satisfaction with insurance). Cross-tabulations and Wald chi-square tests were used to determine how much each variable was related to non-adherence. Multivariate logistic regression was used to examine the association between medication non-adherence and factors such as prescription drug coverage satisfaction and cost-reducing behavior. Specific trends in medication non-adherence emerged among beneficiaries. Non-adherence was higher in older adults aged 65- to 74-year-olds and those with more chronic conditions (OR = 2.24; 95% CI = 1.74-2.89). If patients were dissatisfied with the medications on the insurance formulary or struggled to find a pharmacy that accepted their medication coverage, they had worse adherence (OR = 2.63; 95% CI = 1.80-3.84). Formulary and coverage must be expanded to improve adherence to antihypertensive medications in Medicare beneficiaries. Older adults aged 65 to 74 years may be less adherent to their medications because they do not see the seriousness of the disease and could benefit from further counseling. Patients with limited activities of daily living and more comorbidities may struggle with complex treatment regimens and should use adherence assistance tools.

Co-Utilization of HIV, Substance Use, Mental Health Services Among Women With Current Substance Use: Opportunities for Integrated Care?

The syndemic of HIV, substance use (SU), and mental illness has serious implications for HIV disease progression among women. We described co-utilization of HIV care, SU treatment, and mental health treatment among women with or at risk for HIV. We included data from women with or at risk for HIV (n = 2559) enrolled in all 10 sites of the Women's Interagency HIV Study (WIHS) from 2013 to 2020. Current SU was defined as self-reported, non-medical use of drugs in the past year, excluding use of only marijuana. Tobacco and alcohol were assessed separately. We described co-utilization of SU treatment, tobacco and alcohol use treatment, HIV care, and mental health care in the past year among women who were eligible for each service. We compared service utilization by those who did/did not utilize SU treatment using Wald Chi-square tests. Among women with current SU (n = 358), 42% reported utilizing SU treatment. Among those with current SU+HIV (n = 224), 84% saw their HIV provider, and 34% saw a mental health provider. Among women with current SU+heavy alcohol use (n = 95), 18% utilized alcohol use treatment; among current SU+tobacco use (n = 276), 8% utilized tobacco use treatment. Women who utilized SU treatment had higher utilization of alcohol use treatment (59% vs. 5%; P < .001) and tobacco use treatment (12% vs. 5%; P = .028). HIV care engagement was high regardless of SU treatment. We found high engagement in SU and HIV care, but low engagement in alcohol and tobacco use treatment. Integrated SU treatment services for women, including tobacco/alcohol treatment and harm reduction, are needed to optimize treatment engagement and HIV care continuum outcomes.

Abstract WP255: Association Between Asymptomatic Intracranial Large Artery Stenosis and Neurofilament Light Chain: The Northern Manhattan Study

Introduction: The Neurofilament light chain (NfL) is a neuronal cytoplasmic protein and a reliable biomarker for assessing axonal damage in neurological diseases and traumatic brain injury. Asymptomatic intracranial large artery stenosis (ILAS) has been associated with higher risk of stroke and dementia. Although widely studied in the last few years, the role of NfL concentrations in ILAS is not well understood. Methods: We leveraged data from stroke-free participants in the population-based cohort Northern Manhattan Study (NOMAS) for a pilot study. Arterial stenosis was measured on magnetic resonance angiography in 11 intracranial large arteries and graded as 0 = no stenosis, 1 ≤ 50%, 2 = 50-69%, 3 ≥ 70% stenosis and 4 = flow gap. An asymptomatic Intracranial Large Artery Stenosis (ILAS) score was then developed to reflect the global stenotic burden, with a range of 0 to 44. We also dichotomized the ILAS score into any stenosis &gt; 50% versus none to reflect a more clinically relevant definition of ILAS. NfL concentrations were measured in plasma using Quanterix Simoa™ platform. We conducted generalized linear models adjusting for demographic and vascular risk factors and Wald Chi-Square test to analyze the association between NfL and ILAS score. Results: We included 79 stroke-free NOMAS participants (66% women, 77% Hispanic/Latino, and 75% with hypertension). The mean concentration of NFL was 0.19±0.10 pg/mL with a mean intra-assay coefficient of variation equal to 8.2%. In a model adjusted for age, sex, race/ethnicity, hypertension, diabetes, dyslipidemia and smoking, a higher ILAS score was associated with increased levels of NfL (B=0.01 ± 0.004, p=0.007). In an adjusted model, any stenosis &gt;50% was also associated with increased levels of NfL (B=0.11 ± 0.03, p&lt;0.001). Conclusions: The increased levels of plasma NfL associated with asymptomatic ILAS suggest neuronal injury that may implicate development of neurodegeneration. Confirming these results in a larger sample and longitudinal evaluation of NfL may advance the understanding of the mechanisms by which ILAS may increase the risk of dementia.

Evaluation of the genotoxicity, cytotoxicity, and bioactivity of calcium silicate-based cements

BackgroundAs calcium silicate-based cements (CSCs) have found success in various vital pulp therapy applications, several new CSC products have emerged. This study aimed to assess the genotoxicity, cytotoxicity, and bioactivity of four CSCs by comparing the newly introduced materials Bio MTA+ and MTA Cem with previously studied materials, Biodentine and NeoMTA.MethodsGenotoxicity was evaluated using the micronucleus (MN) assay in human peripheral blood lymphocyte cells, measuring MN frequency and nuclear division index (NDI). Cytotoxicity was assessed in human dental pulp stem cells through the Water-Soluble Tetrazolium Salt-1 (WST-1) colorimetric assay. Bioactivity was determined by ELISA, measuring the levels of angiogenic and odontogenic markers (BMP-2, FGF-2, VEGF, and ALP). Statistical analyses included ANOVA, Dunnet and Sidak tests, and Wald chi-square test. (p < .05).ResultsThe MN frequency in the groups was significantly lower than that in the positive control group (tetraconazole) (p < .05). NDI values decreased with increasing concentration (p < .05). Bio MTA+ and NeoMTA showed decreased cell viability at all concentrations in 7-day cultures (p < .01). All materials increased BMP-2, FGF-2, and VEGF levels, with Biodentine and NeoMTA showing the highest levels of BMP-2 and FGF-2 on day 7. Biodentine displayed the highest VEGF levels on day 7. Biodentine and NeoMTA groups exhibited significantly higher ALP activity than the Bio MTA+ and MTA Cem groups by day 7.ConclusionBio MTA+ and MTA Cem demonstrated no genotoxic or cytotoxic effects. Moreover, this study revealed bioactive potentials of Bio MTA+ and MTA Cem by enhancing the expression of angiogenic and osteogenic growth factors.

Exploring factors associated with self-rated health in individuals with diabetes and its impact on quality of life: Evidence from the Survey of Health, Ageing, and Retirement in Europe.

Self-rated health (SRH), a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including people with diabetes. Diabetes is negatively associated with SRH and quality of life (QoL). Little is known about how people with diabetes rate their health and which aspects influence the rating. Also, the predictive value of SRH on future QoL has not yet been evaluated. We analyzed data from 46 592 participants of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using linear regression, we aimed to determine which sociodemographic, socioeconomic, medical, social, mental, and health behavior factors determine SRH in people with diabetes. In addition, we analyzed the predictive value of SRH on future QoL using the generalized estimating equations procedure. We determined that country, current job situation, hospitalization, pain, polypharmacy, memory, eyesight, activities of daily living, number of chronic diseases, and depression are all linked to SRH. Together these variables explained 38% of the SRH's variance, whereas depression, pain, and memory had the greatest influence on SRH of people with diabetes. We also found that SRH independently predicted future QoL, supported by a regression coefficient of β = -1.261 (Wald chi-square test, χ2 = 22.097, df = 1, p < .05). As SRH is linked to future QoL, we conclude that incorporating SRH assessment into medical evaluations can help health care professionals gaining a more comprehensive understanding of an individual's health trajectory and supporting patients to enhance their QoL.

Effect of influenza vaccination on resting metabolic rate and c-reactive protein concentrations in healthy young adults

Objectives Chronic immune activation and severe inflammatory states are positively associated with resting metabolic rate (RMR; kcal/day), but the impacts of mild immune stimuli on metabolism are poorly understood. This study investigates the within-individual association between the inflammatory response to influenza vaccination and RMR in young adults. Methods We evaluated RMRs through indirect calorimetry and circulating c-reactive protein (CRP) concentrations (mg/L)—a direct measure of inflammation—via high-sensitivity immunoassays of dried blood spots (n = 17) at baseline and two- and seven-days post-vaccine. Wilcoxon matched-pairs signed-rank tests were used to evaluate the magnitude of the CRP and RMR responses. Type II Wald chi-square tests of linear mixed-effect models assessed whether those responses were correlated. Results Baseline CRP was 1.39 ± 1.26 mg/L. On day two post-vaccine, CRP increased by 1.47 ± 1.37 mg/L (p &lt; 0.0001), representing a 106% increase above baseline values. CRP remained higher on day seven post-vaccine, 1.32 ± 2.47 mg/L (p = 0.05) above baseline values. There were no statistically significant changes in RMR from baseline to day two (p = 0.98) or day seven (p = 0.21). Change in CRP from baseline did not predict RMR variation across days (p = 0.46). Conclusions We find no evidence that adult influenza vaccination results in a corresponding increase in RMR. These results suggest that the energetic cost of an influenza vaccine’s mild inflammatory stimulus is either too small to detect or is largely compensated by a temporary downregulation of energy allocated to other metabolic tasks.

Abstract C140: A population-based analysis of awareness and knowledge of HPV and HPV vaccine among Asian American adults by origin group, 2014-2019

Abstract Background: Awareness and knowledge of human papillomavirus (HPV) and HPV vaccine are critical antecedents of HPV vaccine uptake. While emerging literature has examined racial and ethnic differences in these areas, most either exclude Asian Americans, subsume them under the category of “other,” or aggregate all origin groups under a single category of “Asians.” To fill this gap in the literature regarding data disaggregation, we conducted an analysis of awareness and knowledge of HPV, the HPV vaccine, and HPV-related cancers among six Asian origin groups (Chinese, Filipinos, Indians, Japanese, Koreans, and Vietnamese), using nationally representative samples. Methods: We performed a pooled cross-sectional study utilizing the Health Information National Trend Survey data (HINTS-4 cycle 4 [2014], HINTS-5 cycles 1-3 [2017-2019]), a nationally representative survey administered by the National Cancer Institute. We analyzed questions about knowledge of HPV, the HPV vaccine, and the facts that HPV causes cervical, oral, anal, and penile cancers by race and/or ethnicity. The sample included those who self-reported as Chinese, Filipino, Indian, Japanese, Korean, or Vietnamese origins; non-Hispanic White (NHW) respondents were the reference group. We used survey-design adjusted Wald chi-square tests. Results: A total of 8,865 non-Hispanic White respondents and 623 Asian respondents were included in this study. Significantly lower proportions of most Asian origin groups (Chinese 45.5%; Indian 45.6%; Korean 39.7%; and Vietnamese 43.5%) had heard of HPV compared with NHW counterparts (69.4%). Significantly lower proportions of Chinese (50.9%), Filipino (47.0%) Korean (46.1%), and Vietnamese (38.8%) respondents had heard of the HPV vaccine compared with NHW respondents (68.1%). Significantly lower proportions of Chinese (41.0%), Indian (36.2%), Korean (32.9%), and Vietnamese (30.6%) respondents knew that HPV causes cervical cancer compared with NHW (55.7%). Significantly lower proportions of Chinese and Vietnamese respondents knew that HPV causes anal and oral cancers, and significantly lower proportions of Indian respondents knew that HPV causes penile cancer, when compared to NHW counterparts. Discussion: Most Asian origin groups had lower knowledge of HPV-related facts, with varying magnitudes, compared with NHW counterparts. Vietnamese and Chinese respondents had significantly lower knowledge compared with NHW respondents for 5 out of 6 questions. For most questions, Vietnamese was the group with the lowest proportions of respondents reporting knowledge. Heterogeneity in HPV-related knowledge suggests the need to culturally tailor interventions about the HPV vaccine in appropriate languages to effectively reach different Asian origin groups, with particular attention to those with low awareness. Continued monitoring of HPV-related knowledge with disaggregated data collection for Asian origin groups is critical for efforts to increase educational outreach, combat vaccine misinformation, and improve HPV vaccine uptake. Citation Format: Milkie Vu, Yenan Zhu, Duy D. Trinh, Young-Rock Hong, Ryan Suk. A population-based analysis of awareness and knowledge of HPV and HPV vaccine among Asian American adults by origin group, 2014-2019 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C140.

Abstract A074: Cancer fatalism among Asian American adults by origin group, 2014-2022

Abstract Background: Cancer fatalism encompasses beliefs about external causes of cancer and the perceived inability of humans to prevent it. Existing research suggests that individuals with higher levels of cancer fatalism are less likely to engage in cancer prevention behaviors or adhere to cancer screening practices. However, limited information exists regarding the prevalence of cancer fatalism within various Asian origin groups. Understanding whether this prevalence varies by origin group can offer valuable insights for developing strategies to enhance beliefs and knowledge about cancer among these populations, ultimately leading to improved health outcomes. To fill this gap in the literature, we conduct a disaggregated analysis of cancer fatalism among Asian origin groups (Chinese, Filipino, Indian, Vietnamese, and other Asian respondents), using nationally representative samples. Methods: We performed a pooled cross-sectional study utilizing the Health Information National Trend Survey data (HINTS-4 cycle 4 [2014], HINTS-5 cycles 1-3 [2017-2019], and HINTS-6 [2022]), a nationally representative survey administered by the National Cancer Institute. We analyzed respondents’ agreement to two items: “It seems like everything causes cancer”; and “There’s not much you can do to lower your chances of getting cancer.” We used a survey-design adjusted Wald chi-square test for bivariate analyses. Results: The sample included 234 Chinese respondents, 173 Filipino respondents, 185 Indian respondents, 97 Vietnamese respondents, and 222 other Asian respondents (e.g., Korean, Japanese). Significantly lower proportions of Indian respondents (38.9%; 95% CI 26.1 – 51.8%) endorsed the statement “It seems like everything causes cancer,” when compared with Vietnamese respondents (70.4%; 95% CI 54.9% – 86.0%) and Filipino respondents (76.2%; 95% CI 65.1% – 87.4%). Additionally, lower proportions of Indian and Chinese respondents endorsed the statement “There’s not much you can do to lower your chances of getting cancer” when compared with Vietnamese and Filipino respondents, though these differences did not reach statistical significance. Conclusions: Our study represents one of the first efforts to use nationally representative data to explore disaggregated prevalence of cancer fatalism beliefs among Asian American origin groups. Filipino adults exhibit nearly double the prevalence of one of the cancer fatalism beliefs compared to Indian adults. Vietnamese adults also have a high level of cancer fatalism beliefs. These findings highlight the heterogeneity among Asian American origin groups and emphasize the importance of culturally tailored interventions, specifically targeting those groups with higher levels of fatalism beliefs. Data collection that is disaggregated by Asian origin group should be prioritized to gain a comprehensive understanding of these beliefs and design effective interventions. Citation Format: Milkie Vu, Yenan Zhu, Ryan Suk. Cancer fatalism among Asian American adults by origin group, 2014-2022 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A074.

Debt Financing and Operational Efficiency of Companies listed at Nairobi Stock Exchange, Kenya

Background: As companies evolve, they confront a myriad of challenges, opportunities, and risks, demanding a laser focus on financial strategies. Within this landscape, the intertwined concepts of debt financing and operational efficiency emerge as critical determinants of a firm's performance and longevity. Debt financing sources presents an intricate landscape in which companies make their financial decisions. However, the existing literature often treats debt financing as a homogenous entity, lacking the granularity required to discern how the specific composition of debt, including the reliance on trade credit versus traditional short-term and long-term bank borrowings, might influence operational efficiency. Thus, this study aimed at identifying the effect of debt financing composition on operational efficiency of companies listed in NSE. Methods: The research focused on examining the link between debt financing structures and operational efficiency in 50 firms listed on the Nairobi Securities Exchange (NSE). The study collected panel data ranging between 2015 and 2022. A positivist research philosophy was employed, utilizing quantitative analysis techniques, specifically descriptive statistical analysis and random effects regression model. Findings: The regression results of the random effects model reveal the relationship between debt financing constructs and operational efficiency. The overall R-squared value for the model is 0.176, suggesting that around 17.6% of the variation in operational efficiency can be explained by the debt financing sub-variables. Furthermore, the model’s goodness of fit is assessed through the Wald chi-square test (χ² =72.61, p = 0.000), confirming its statistical significance. The coefficient for the independent variables trade credit, short-term borrowings, and long-term borrowings are (β = 0.331, p = 0.002), (β = 0.642, p = 0.001), and (β = 0.349, p = 0.001), respectively. The p-values are less than 0.05, indicating that the effects of trade credit, short-term borrowings, and long-term borrowings on the operational efficiency of firms listed at the NSE are statistically significant at the 5% level. Conclusion and Implications: The study concludes that debt financing comprising of trade credit, short-term borrowing and long-term borrowing have beneficial effects on operational efficiency. While all three sub-variables of debt financing contribute to enhanced operational efficiency, their application in corporate financing practices varies, with long-term borrowing being a common choice for funding total assets. In light of these findings, company managers should recognize debt financing as a strategic tool for improving operational efficiency. This recognition should be accompanied by a careful and thoughtful approach to utilizing the three components of debt: trade credit, short-term borrowing, and long-term borrowing.

Parenting-related positive childhood experiences, adverse childhood experiences, and mental health—Four sub-Saharan African countries

BackgroundAdverse Childhood Experiences (ACEs) are associated with poor mental health outcomes and risk-taking behaviors. Positive childhood experiences (PCEs) may mitigate these negative impacts. ObjectiveThis study 1) assessed the associations between ACEs and negative health outcomes and risk-taking behaviors among young adults, and 2) evaluated whether — and which — PCEs moderate the association between ACEs and these outcomes in sub-Saharan Africa. MethodsThis multi-country analysis combined cross-sectional representative survey data from young adults, ages 18–24 years, from the 2019 Kenya, 2018 Lesotho, 2019 Mozambique, and 2019 Namibia Violence Against Children and Youth Surveys. The association between experiencing any ACEs and each health outcome was assessed using Wald's chi-square tests. Multivariable logistic regression analyses assessed the association between each PCE and each outcome of interest. ResultsFemales who experienced any ACEs had higher odds of experiencing moderate to severe mental distress (aOR = 2.7, 95%CI: 1.9, 3.9). Males who experienced any ACEs had higher odds of experiencing suicidal/self-harm behaviors (aOR = 6.7, 95%CI: 2.8, 16.0) and substance use (aOR = 2.5, 95%CI: 1.4, 4.2). In females, strong mother-child relationship was protective against moderate to severe mental distress (aOR = 0.7, 95%CI: 0.6, 0.9), suicidal/self-harm behaviors (aOR = 0.6, 95%CI: 0.4, 0.9), and substance use (aOR = 0.6, 95%CI: 0.4, 0.9). For males, a strong mother-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.5, 95%CI: 0.2, 0.9), and a strong father-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.4, 95%CI: 0.2, 0.7) and substance use (aOR = 0.6, 95%CI: 0.4, 0.8). ConclusionsStrong parenting programs may likely play an important role in improving the psychosocial health of young adults.

Factors associated with leprosy knowledge

Introduction: Leprosy is a disease caused by Mycobacterium leprae and represents a public health challenge, with a high prevalence in Brazil. Knowledge about the disease plays a crucial role in understanding the disease and behavior in relation to prescribed medication, where social factors are linked to health literacy. The aim of this study was to assess the factors associated with knowledge about leprosy. Method: Patients from fifteen Family Health Units were interviewed using an adapted knowledge assessment tool. Associations were made between variables using crude prevalence ratios and the Wald chi-square test. The analysis included Poisson multiple regression. Results: The study revealed that approximately half of the participants had very good knowledge about leprosy, with high levels of correctness in the areas of signs/symptoms and diagnosis. In addition, the final model showed that people with an income between 2 and 3 minimum wages were 75% more likely to have good knowledge of leprosy. Conclusion: Lack of information can result in late diagnosis and treatment interruption. Therefore, health education plays a vital role in the success of leprosy treatment.

Genomic Signature for Oligometastatic Disease in Non-Small Cell Lung Cancer Patients with Brain Metastases

Biomarkers for oligometastatic disease remain elusive and few studies have attempted to correlate genomic data to the presence of true oligometastatic disease. Patients with non-small cell lung cancer (NSCLC) and brain metastases were identified in our departmental database. Electronic medical records were used to identify patients for whom liquid biopsy-based comprehensive genomic profiling (Guardant Health) was available. Oligometastatic disease was defined as patients having ≤5 non-brain metastases without diffuse involvement of a single organ. Widespread disease was any spread beyond oligometastatic. Fisher's exact tests were used to identify mutations statistically associated (p<0.1) with either oligometastatic or widespread extracranial disease. A score of +1 was assigned for every mutation present associated with oligometastatic disease, and -1 was assigned for mutations associated with widespread disease. Scores were summed for each patient to create a risk score for the likelihood of oligometastatic disease, with scores subsequently correlated to the likelihood of having oligometastatic disease vs widespread disease. For oligometastatic patients, a competing risk analysis was done to assess for cumulative incidence of oligometastatic progression accounting for the potential competing risks of widespread progression of extracranial disease or death. Cox regression was used to determine the association between oligometastatic risk score and oligometastatic progression. One hundred thirty patients met study criteria and were included in the analysis. 51 patients (39%) had oligometastatic disease. Genetic mutations included in the Guardant panel associated (p<0.1) with the presence of oligometastatic extracranial disease included ATM, JAK2, MAP2K2, and NTRK1; ARID1A and CCNE1 were associated with widespread disease. Patients with a positive, neutral and negative risk score for oligometastatic disease had a 78%, 41% and 11.5% likelihood of having oligometastatic disease, respectively (p<0.0001). Overall survival for patients with positive, neutral and negative risk scores for oligometastatic disease was 86% vs 82% vs 64% at 6 months (p = 0.2). The competing risk analysis found that the oligometastatic risk score was significantly associated with the likelihood of oligometastatic progression based on the Wald Chi-square test. Patients with positive, neutral and negative risk scores for oligometastatic disease had a cumulative incidence of oligometastatic progression of 77% vs 35% vs 33% at 6 months (p = 0.03 from competing risk model). Elucidation of a genomic signature for oligometastatic disease derived from non-invasive liquid biopsy appears feasible for NSCLC patients. Patients with the oligometastatic signature exhibited higher rates of early oligometastatic progression. Validation of this signature could lead to a biomarker that has the potential to direct local therapies in oligometastatic patients.

Clinician Champions' Influence on Social Needs Screening Volumes in Pediatric Practices.

Health systems face barriers implementing routine screening for social needs. We assessed the impact of "clinician champions" on social needs screening. Screening data were assessed at 11 pediatric primary care practices in Bronx, NY, between April 2018 and August 2021. Three intervention practices had clinician champions; 8 control practices did not. The Wald chi-square tests and Poisson regressions evaluated the relationship between screening and introduction of clinician champions. The introduction of a clinician champion was a significant predictor of screening (P < .001). Within a practice, screening after the introduction of a clinician champion was higher than before the introduction (P < .001). The rate of screening for practices with a clinician champion was 2.8 times higher per month than for practices without a clinician champion. Furthermore, practices with clinician champions had higher rates of screening during the pandemic. In summary, the presence of clinician champions increased social needs screening rates in pediatric primary care practices.

Population-based prevalence and trend of birth defects in Costa Rica from 2000 to 2019.

We aimed to analyze the prevalence and trend of birth defects (BDs) in Costa Rica, where BDs are the second leading cause of infant and under-five mortality. A descriptive analysis of selected BDs prevalence and trends from 2000 to 2019 was performed, based on data from the Costa Rican Birth Defects Register Center, the national BDs surveillance system with coverage of 98% of live births in the country. We used Joinpoint regression to identify any calendar year where a significant change in trend occurred; the annual percent change (APC) and the average annual percent change (AAPC) were determined. Marginal means and prevalence ratios by subperiod (2000-2009 as referent and 2010-2019) were estimated using Poisson regression, and compared using Wald's chi-square tests (alpha ≤0.05). From 2000 to 2019, BDs occurred in 2.3% of live births (95% CI: 2.3-2.4); 73% of which were major BDs. Males presented a significantly higher prevalence (sex ratio 1.13 males/females). The trend showed an AAPC of +3.7 (p < .05) with two joinpoints, 2005 and 2013. A significant APC (+11.3) was observed during 2005-2013, within the context of improvements in the surveillance system, such as the increase in the reporting age, and the incorporation of other data sources in addition to maternity hospitals. Most of the BDs groups presented a significant upward trend. The highest AAPC was observed for the respiratory system (+11.7), congenital heart defects (+9.5), and nervous system (+8.5). The BDs present a clear upward trend in the last two decades due, among other things, to a significant improvement in the surveillance system.

Ethnic Determinants of Health and Medication Use for Depression Among US Latinx Adults.

Medication use for depression among US Latinx adults is low (34%) and commonly associated with systems-related and individual-related cultural factors. Social determinants of health (SDH) include economic, environmental, educational, community, and healthcare systems factors. Ethnic determinants of health (EDH) are SDH factors specific to an ethnic group and described by an ethnic and disparities framework. To assess relationships between EDH factors and depression medication use among non-Latinx White (NLW) and Latinx adult populations using data from a weighted national sample for hypothesis building. Weighted responses to 2015-2018 National Survey on Drug Use and Health surveys from NLW, Latinx, and Latinx adult respondents from Puerto Rico, Mexico, and other Latinx countries were compared. Bivariate analyses were conducted using 2-way cross tabulation and a Wald chi-square test of association. EDH variables were characterized within the construct domains of systems-related geographic location, education, and economic stability, and individual-related cultural factors. Prescription medication use for depressive symptoms is 16.6% (P < 0.05) lower among a national sample of Latinx compared with NLW adults with major depressive episode (MDE). Many differences among systems-level EDH variables between Latinx and NLW populations with MDE were also found between populations with depression medication use. Of note, seeing a primary care provider or psychologist or social worker was significantly different among populations with MDE but not for those with depression medication use. Individual-related cultural EDH variables of overall health and serious psychological distress were significantly worse for Latinx than NLW populations with depression medication use. However, stigma, healing beliefs, and religious beliefs were not different between populations with MDE or depression medication use. Differences between certain Latinx populations with depression medication use were found with limited English proficiency and living in poverty. EDH variables for environment-physical characteristics or community and interpersonal levels of analysis were not represented within the NSDUH survey. Seeing a primary care provider or behavioral health specialist, depression severity, and overall health status appear to be important factors related to depression medication use among Latinx adults. Given the limitations of these analyses, multivariate analyses of EDH factors and other Latinx populations are warranted.

School Connectedness and Risk Behaviors and Experiences Among High School Students — Youth Risk Behavior Survey, United States, 2021

School connectedness, defined as students' belief that adults and peers in their school care about their learning as well as about them as persons, has been linked to positive educational, behavioral, and health outcomes in adolescence and into adulthood. Data from the 2021 nationally representative Youth Risk Behavior Survey, conducted during the COVID-19 pandemic, were used to estimate prevalence of students' perception of school connectedness and examine associations between school connectedness and seven risk behaviors and experiences: poor mental health, marijuana use, prescription opioid misuse, sexual intercourse, unprotected sex, experiencing forced sex, and missing school because of feeling unsafe. Prevalence estimates were generated and pairwise t-tests were used to detect differences among student subpopulations by sex, grade, race and ethnicity, and sexual identity; Wald chi-square tests were used to detect differences in risk behaviors by level of connectedness within a subpopulation. Logistic regression models were used to estimate prevalence ratios comparing the prevalence of risk behaviors and experiences of students with high connectedness with students with low connectedness, stratified by demographics. During 2021, 61.5% of U.S. high school students reported feeling connected to others at school. In addition, school connectedness was associated with lower prevalence of every risk behavior and experience examined in this study, although certain associations differed by race and ethnicity and sexual identity (e.g., school connectedness was associated with better mental health outcomes for youths with heterosexual, bisexual, and questioning or other sexual identities, but not for youths who identified as lesbian or gay). These findings can guide public health interventions that promote youth well-being by creating school environments where all youths have a sense of belonging and feel they are cared for and supported.