Zero-inflated Negative Binomial Analysis Research Articles

Discrimination and manic symptoms in early adolescence: A prospective cohort study

PurposeThis study aims to investigate the prospective associations between four types of perceived discrimination (country of origin, race and ethnicity, sexual orientation, and weight) and the development of manic symptoms in a diverse, nationwide sample of adolescents aged 9–14 years in the U.S. MethodsWe analyzed prospective cohort data from the Adolescent Brain Cognitive Development Study (N = 7466; ages 9–14 years at Year 1 or 2 in 2017–2020; 49.1 % female; 42.1 % racial/ethnic minority). Multiple zero-inflated negative binomial analyses were conducted to examine the associations between Year 1 or 2 discrimination (by country of origin, race/ethnicity, sexual orientation, weight, sum score), and Year 3 manic symptoms (7 Up Mania scale), adjusting for covariates (age, sex, race/ethnicity, household income, parental education, sipping alcohol, puffing tobacco, anxiety symptoms, depressive symptoms, Year 1 manic symptoms, and study site). ResultsAfter adjusting for covariates, perceived discrimination based on country of origin (incidence rate ratio [IRR] = 1.46; 95 % confidence interval [CI] 1.15–1.86), sexual orientation (IRR = 1.36; 95 % CI 1.21–1.53), race/ethnicity (IRR = 1.28; 95 % CI 1.13–1.46), weight (IRR = 1.21 95 % CI 1.09–1.34), and sum scores (IRR = 1.18 5 % CI 1.12–1.24), were significantly associated with higher manic symptoms. ConclusionPerceived discrimination based on country of origin, race/ethnicity, sexual orientation, weight, and sum scores, are prospectively associated with greater manic symptoms in adolescents. These findings underscore the need for targeted interventions to address discrimination and associated psychological impacts. Efforts to reduce discrimination and to support affected adolescents are important components of comprehensive mental health care and public health strategies.

Do improvements in motivational language predict alcohol use in motivational interviewing? Ambivalence matters.

Motivational Interviewing (MI) is described as a method for improving clinical outcomes by reducing client ambivalence. If this is true, MI's focus on improving clients' motivational language should be most useful for clients with ambivalence about change and less valuable for those who are ready to implement new behaviors or are opposed to change. To address this hypothesis and potentially add precision to MI delivery in clinical settings, we tested whether the relationship between clients' in-session motivational language and posttreatment alcohol use depended on their baseline motivation to change. Client speech from 149 sessions from Project MATCH were analyzed. A cluster analysis of the percent change talk during the first decile of the session identified three motivational groups: opposed, ambivalent, and ready. The change in percent change talk (C-PCT) across the session was calculated for each group. Zero-inflated negative binomial analysis was used to test whether the effect of C-PCT on end-of-treatment drinking varied between motivational groups. The count part of the model revealed a significant interaction between C-PCT and membership in the ambivalent group (b = -17.710, 95% CI [-25.775, -9.645], p < .001), only for those who received MI. Favorable C-PCT was associated with less drinking (b = -15.735, p = .004). Only baseline drinking was a significant predictor of abstinence at follow-up (b = .032, 95% CI [0.012, 0.051], p = .001). A putative MI mechanism-improved client motivational language-appears most important for clients who express ambivalence in the opening minutes of the session, with minimal value for those who do not. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pocket money and the risk of dental caries and oral pain in children

BackgroundTooth decay affects 40–90 % of children in low- and middle-income countries (LMICs), contributing to adverse consequences, including oral pain, difficulty focusing in school, lifelong dental problems, and overall lower quality of life. Few studies have examined the relationship between pocket money given to children, their purchase of sugary snacks and drinks with that money, and the risk for tooth decay. MethodsThis secondary cross-sectional analysis utilized data which were collected in 2014 as part of an oral health promotion program in rural El Salvador. A convenience sample of 279 children and their mothers who participated in the program were recruited to complete an interview with trained community health workers, and children received a dental examination from trained and licensed Salvadoran and U.S. dentists. Only children with teeth (primary, mixed, or permanent dentition) were included in this analysis; as such, children ranged in age from 6 months through 14 years. Descriptive, multivariate logistic regression, and Zero-Inflated Negative Binomial analyses were used to identify associations between pocket money given to children and three oral health outcomes: number of decayed, missing/extracted due to decay, and filled teeth (dmft for primary teeth and DMFT for permanent teeth); presence of deep decay; and occurrence of oral pain. ResultsOverall, almost two-thirds of children received daily pocket money with which over 70 % purchased unhealthy snacks/drinks; 83 % of children had tooth decay, with a mean dmft/DMFT of 6.0. After adjusting for covariates, receiving pocket money was associated with 0.18 (95 % CI: 0.05–0.54) times the odds of having zero-dmft/DMFT (i.e., being cavity-free) (p = 0.002). Among children with at least one decayed tooth, receiving pocket money was associated with 1.22 (95 % CI: 1.01–1.53) times the expected dmft/DMFT count (p = 0.04), 3.39 (95 % CI: 1.59–7.22) times the odds of deep decay (p < 0.001), and 2.66 (95 % CI: 1.24–5.70) times the odds of oral pain (p = 0.007) compared to children who did not receive pocket money. ConclusionInterventions to reduce the prevalence and severity of tooth decay should include nutrition and oral health education for children and families—including addressing pocket money and healthy vs. unhealthy purchases—in schools, communities, and primary health clinics; school programs to provide healthy foods and beverages for children; and enforcement of policies to prohibit the sale of ultra-processed foods and sugary drinks in and around schools.

Development of verb argument constructions in L2 English learners: A close replication of research question 3 in Römer and Berger (2019)

Abstract This study closely replicates the analyses of the third research question in Römer and Berger (2019), which reported that the associations between verbs and verb argument constructions (VACs) used by German and Spanish learners of English move closer to a native usage norm as the learners’ proficiency increases. This study conducted the same correlation analyses from the original study but with a substantially expanded version of the learner corpus used therein. Additionally, we conducted zero-inflated negative binomial analyses to estimate the relationship between the frequencies of verb-VAC combinations in the British National Corpus (BNC) and in the learner subcorpora representing different proficiency levels. Our findings were consistent with the original study in showing significant positive correlations between frequencies of the verb-VAC combinations in the BNC and in the learner subcorpora but further revealed the potential effect of topic on the learners’ VAC usage. Implications for future studies are discussed.

Environmental dynamics and seasonal wing physiological changes of coastal mosquito vectors (Diptera: Culicidae) in Central Thailand

Mosquitoes (Diptera: Culicidae) are small hematophagous insects that serve as disease vectors by transmitting pathogens to humans and animals. This study was conducted on the coastline of Samut Songkhram Province in Thailand's central region to evaluate the impact of environmental factors on coastal mosquitoes, namely Anopheles epiroticus and Culex sitiens. A zero-inflated negative binomial (ZINB) regression was employed to assess the relationship between the density of larval mosquitoes and water quality factors. Spearman's rank correlation was used to examine the relationship between the number of adult mosquitoes and meteorological factors, and the geometric morphometric (GM) technique was used to study the wing size and shape of adult mosquitoes throughout different seasons. The ZINB analysis revealed a significant negative relationship (p < 0.05) between dissolved oxygen, high-range phosphate, and the number of An. epiroticus larvae. Conversely, in the case of Cx. sitiens, there was a significant positive relationship between nitrate-nitrogen and larval density (p < 0.01), while dissolved oxygen exhibited a significant negative relationship (p < 0.05). Regarding adult mosquitoes, relative humidity was positively correlated with the abundance of adult Cx. sitiens (r = 0.85, p < 0.01), whereas each meteorological parameter—temperature, relative humidity, rainfall, wind speed, and atmospheric pressure—was negatively correlated with adult An. epiroticus abundance (p < 0.05 for each). The GM analysis revealed statistically significant seasonal variations in wing shapes for both species (p < 0.05 for all seasonal comparisons), underscoring their adaptation to seasonal environmental conditions in coastal habitats.

Early COVID-Related pandemic impacts and subsequent opioid outcomes among persons receiving medication for opioid use disorder: a secondary data analysis of a Type-3 hybrid trial

BackgroundOpioid overdoses have continued to increase since the start of the COVID-19 pandemic. The pathways through which the COVID-19 pandemic has affected trajectories of opioid use and opioid-related problems are largely unknown. Using the Epidemic-Pandemic Impacts Inventory (EPII), a novel instrument that assess pandemic-related impacts across multiple life domains, we tested the hypothesis that COVID-related impacts (on e.g., interpersonal conflict, employment, infection exposure, and emotional health) experienced in the early months of the pandemic would predict changes in opioid use and opioid-related problems at follow-up.MethodsThis analysis was embedded within a cluster randomized type 3 implementation-effectiveness hybrid trial that had enrolled 188 patients across eight opioid treatments prior to the start of the pandemic. Participants had all been recently inducted on medication for opioid use disorder and were actively receiving treatment. Participants reported on their opioid use and opioid-related problems at baseline and 3-, 6-, and 9-month post-baseline assessments. Between May and August 2020, participants were sent an optional invitation to complete the EPII.ResultsOne hundred thirty-three respondents completed the EPII and 129 had sufficient data to analyze the EPII and at least one subsequent follow-up. In logistic and zero-inflated negative binomial analyses adjusting for covariates, each endorsed pandemic impact in the interpersonal conflict domain was associated with 67% increased odds of endorsement of any opioid use, and each impact in the employment and infection exposure-domains was associated with 25% and 75% increases in number of endorsed opioid-related problems, respectively.ConclusionsMitigating the effect of the pandemic on patients’ interpersonal relationships and employment, and promoting greater infection control in opioid treatment programs, could be protective against negative opioid-related outcomes.Trial registration The present study describes secondary data analysis on a previously registered clinical trial: clinicaltrials.gov/ct2/show/NCT03931174.

Abstract 15002: Real-World Healthcare Resource Utilization Among US Patients With Atrial Fibrillation Receiving Dronedarone versus Ablation as 1st-Line Therapy

Introduction: Catheter ablation is used increasingly as a 1st-line (1L) alternative to antiarrhythmic drugs (AAD) including dronedarone in patients with atrial fibrillation (AF). Healthcare resource utilization (HCRU)-related costs with dronedarone vs 1L ablation are unknown. Methods: We conducted a retrospective, observational cohort study using Optum Clinformatics Data Mart® from Jan 2012-Jan 2022 among US adults with AF and no prior rhythm control therapy who received new AAD therapy with dronedarone (index: date of incident dronedarone fill) vs those who received 1L ablation, or a non-dronedarone AAD followed by ablation within 3 mo (index: date of first recorded ablation or AAD). Patients were required to have ≥24 mo of pre-index data, and ≥3 mo follow-up. Patients in the 1L ablation cohort were propensity score matched 2:1 to the dronedarone cohort. Mean payer costs per patient per month (PPPM) during the 24-mo post-index period were calculated for total HCRU, inpatient visits, emergency room (ER) visits, outpatient physicians’ office visits, and all outpatient visits, and compared by zero-inflated negative binomial (ZINB) regression model. Results: Post-matching, the dronedarone (n=1440) and 1L ablation (n=2253) cohorts had similar baseline characteristics (mean age at index: 68.4 vs 67.7 years; male: 57.7% vs 59.3%; mean time from AF diagnosis to index: 80.2 vs 91.6 days; Charlson comorbidity index: 2.3 vs 2.2; CHADS2-VASc score: 3.4 vs 3.2). Mean PPPM costs were lower with dronedarone vs 1L ablation for all-cause total HCRU, inpatient visits, any outpatient visit, ER visit, and outpatient office visit (Table). ZINB analyses showed significant cost differences for all-cause total HCRU and any outpatient visit events. Conclusion: In patients with AF and no prior rhythm control therapy, 1L dronedarone was associated with lower total HCRU and outpatient visit costs during 24-mo follow-up vs 1L ablation; future studies will assess cost-effectiveness.

The Role of Ideology in Terrorist Attack Intentions and Outcomes

ABSTRACT This study seeks to investigate whether ideological elements, namely that of audience and othering, are related to attack-level objectives and effects. Prior research has established a strong connection between ideological subscription and violent attack outcomes, but few studies have sought to examine the full spectrum of ideologies. Moreover, little empirical attention has been given to examining how ideological affiliation may correlate with violent intentions in terrorist attacks; namely, an actor’s intention to kill or commit a mass casualty incident. To address these research gaps, we pose the question: Is a U.S. terrorist attack’s ideological component correlated with its both intentions and outcomes? Utilizing a sample of 2,275 terrorist incidents from the Global Terrorism Database (GTD), we examine our research question through a series of models with sensitivity checks using logistic regression and zero-inflated negative binomial analyses. In sum, our results are consistent with the premise that ideology does matter, particularly if this ideology involves a defined other.

Basic psychological needs in gambling and gaming problems

Background and AimsStudies on self-determination theory (SDT) have placed satisfaction of basic psychological needs (autonomy, relatedness, and competence) at the core of well-being, whereas frustration of these needs results in multiple potentially unhealthy mental and behavioral patterns. This study analyzed how need satisfaction and frustration relate to the severity of gambling and gaming problems. MethodsA survey study with 18–75-year-old Finnish participants (N = 1530; 50.33% male) was conducted in April 2021. Basic psychological needs were measured with the Basic Psychological Need Satisfaction and Frustration Scale, mental health issues with the five-item Mental Health Inventory, gambling problems with the Problem Gambling Severity Index, and gaming problems with the Internet Gaming Disorder Test. Zero-inflated negative binomial analyses were conducted to examine how satisfaction and frustration of basic psychological needs, together with mental health issues, are associated with gaming and gambling problems. ResultsMental health issues were associated with gambling and gaming problems, but this association became nonsignificant when basic psychological needs were added to the model. However, better mental health still was associated with the absence of gaming problems. While need satisfaction had no association with the absence of gaming or gambling problems, need frustration was associated with increases in the severity of both gaming and gambling problems. DiscussionFrustration of basic psychological needs for autonomy, relatedness, and competence is associated with both gambling and gaming problems and should be considered when developing treatment and support for those who experience such problems.

Precarious Employment and Increased Incidence of Musculoskeletal Pain among Wage Workers in Korea: A Cross-Sectional Study.

The number of precarious workers is increasing globally, and precarious employment is becoming a public concern in terms of workers’ health. However, sufficient research on precarious employment and its impact on musculoskeletal pain (MSP) is lacking. This study aimed to investigate the relationship between precarious employment and the risk of MSP among Korean wage workers. After merging the data from the 4th and 5th Korean Working Conditions Surveys, 59,644 wage workers were analyzed. The control group comprised full-time permanent workers, and precarious employment was defined as workers involved in temporary or daily employment, or part-time workers. The outcome variable was the summed number of MSP in three anatomical sites (back, neck and upper limb, lower limb). Zero-inflated negative binomial analyses were selected to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) between precarious employment and MSP. In adjusted models with age, sex, educational level, income level, weekly working hours, and occupation, precarious employment was significantly associated with an increased risk of both MSP (OR 1.66 95% CI 1.56–1.77) and work-related MSP (OR 1.18 95% CI 1.11–1.25). Given the job insecurity and health inequity associated with precarious employment, special attention on precarious workers’ health is needed.

Insufficient Rest Breaks at Workplace and Musculoskeletal Disorders Among Korean Kitchen Workers.

BackgroundThe socioeconomic burden of musculoskeletal disorders (MSDs) is significant, and kitchen work is a high-risk occupation for MSDs due to the intensive manual workload and repetitive movements that are involved. However, there are very few studies on MSDs and rest breaks as a workplace intervention among kitchen workers. This study examined the relationship between insufficient rest breaks and increased MSD risk among Korean kitchen workers.MethodsSociodemographic and occupational factors of 1,909 kitchen workers were collected from the 3rd–4th Korean Working Conditions Survey data. Five items on rest breaks at work were categorized into two groups, “sufficient” and “insufficient.” The number of MSDs and work-related MSDs (WMSDs), an outcome variable, was obtained from the sum of MSDs/WMSDs in three anatomical sites (back, neck, and upper limb, lower limb). The association between rest breaks and MSDs was estimated using zero-inflated negative binomial analyses, with adjustments for age, education level, and weekly working hours, and the analyses were stratified by sex.ResultsAfter adjustment, significant associations were found between insufficient rest breaks and an increased risk of MSDs (odds ratio [OR] 1.68 95% confidence interval [CI] 1.11–2.54) and WMSDs (OR 1.40 95% CI 1.01–1.96) among female kitchen workers. Insufficient rest breaks were significantly associated with MSDs in female kitchen workers in all three anatomical sites.ConclusionThis study emphasizes the need for rest breaks as a workplace intervention for preventing MSDs in kitchen workers. Further studies to reveal the causality of this relationship are required.

Patient-Reported Symptom Burden in Routine Oncology Care: Examining Racial and Ethnic Disparities

Racial and ethnic disparities are well-documented in cancer outcomes such as disease progression and survival, but less is known regarding potential disparities in self-reported symptom burden. The goal of this retrospective study was to examine differences in symptom burden by race and ethnicity in a large sample of cancer patients. We hypothesized that racial and ethnic minority patients would report greater symptom burden than non-Hispanic whites. Cancer patients completed the Edmonton Symptom Assessment Scale – revised (ESAS-r-CSS) at least once as part of clinical care in our center’s Radiation Oncology and/or Supportive Care Medicine clinics. Two indicators of symptom burden were evaluated: 1) total ESAS-r-CSS score (i.e., overall symptom burden), and 2) number of severe symptoms (i.e., severe symptomatology, defined as symptoms scores of 7 or higher). Among patients completing the ESAS-r-CSS on multiple occasions, the highest score for each indicator was used. Zero-inflated negative binomial analyses were conducted, adjusting for other sociodemographic and clinical characteristics. Included were 19,642 symptom reports made by 5,798 patients between January 2015 and June 2018. Patients who self-identified as black reported significantly higher symptom burden and more severe symptoms than self-identified white patients (p for each<0.02). Patients self-identifying their race as “other” also reported significantly more severe symptoms than white patients (p=0.03). No other racial or ethnic differences in symptom burden were observed. This study advances our understanding of racial disparities in patient-reported symptom burden during routine oncology care. Clinic-based electronic symptom monitoring may be useful to detect high symptom burden, particularly in patients who self-identify their race as black or other. Future research is needed to reduce symptom burden in racially-diverse cancer populations.

Enamel and Dentin Caries Risk Factors of Adolescents in the Context of the International Caries Detection and Assessment System (ICDAS): A Longitudinal Study.

Objective: The objective of this study was to identify risk factors for enamel and dentin caries in adolescents.Method: This 1-year longitudinal study was conducted in 2018 and 2019; 13- to 14-year-old adolescents were recruited. The merged International Caries Detection and Assessment System (ICDAS) was used to identify caries. The relationships between the caries increment and variables were analyzed with a zero-inflated negative binomial (ZINB) regression model.Results: A total of 1,016 participants completed the assessment. The ZINB analysis found that individuals with caries at baseline were more likely to develop new dentin caries. Females, or individuals who had a high cariostat score had an increased likelihood of having a high ΔD4-6MFT score. Among the caries-free adolescents at baseline, females, or individuals who consumed snacks once or more than once a day were more likely to develop caries. Individuals from one-child families, who used fluoride toothpaste, and who had a high saliva buffering capability (pH≥4.25) had an increased likelihood of a low ΔD1-6MFT score.Conclusion: The results suggest that there are some specific risk factors of initiating of enamel caries in adolescents, including the frequency of snack consumption, sex, saliva buffering capability, fluoride toothpaste usage and belonging to a one-child family. In all adolescents, most of whom have enamel caries, the dentin caries risk factors were past caries experience, cariostat score and sex.

Assessment of Voice Outcomes Following Surgery for Thyroid Cancer

An increasing number of surgeries are being performed for differentiated thyroid cancer (DTC). Long-term voice abnormalities are a known risk of thyroid surgery; however, few studies have used validated scales to quantify voice outcomes after surgery. To identify the prevalence, severity, and factors associated with poor voice outcomes following surgery for DTC. A cross-sectional, population-based survey was distributed via a modified Dillman method to 4185 eligible patients and linked to Surveillance, Epidemiology and End Results (SEER) data from SEER sites in Georgia and Los Angeles, California, from February 1, 2017, to October 31, 2018. Multivariable logistic regression and zero-inflated negative binomial analysis were performed to determine factors associated with abnormal voice. Participants included patients undergoing surgery for DTC between January 1, 2014, and December 31, 2015, excluding those with voice abnormalities before surgery. Abnormal Voice Handicap Index (VHI-10) score, defined as greater than 11. The VHI-10 is designed to quantify 10 psychosocial consequences of voice disorders on a Likert scale (0, never; to 4, always). A total of 2632 patients (63%) responded to the survey and 2325 met the inclusion criteria. With data reported as unweighted number and weighted percentage, 1792 were women (77.4%); weighted mean (SD) age was 49.4 (14.4) years. Of these, 599 patients (25.8%) reported voice changes lasting more than 3 months following surgery, 272 patients (12.7%) were identified as having an abnormal VHI-10 score, and 105 patients (4.7%) reported vocal fold motion impairment diagnosed by laryngoscopy. In multivariable analysis, factors associated with an abnormal VHI-10 score included age 45 to 54 years (reference, ≤44 years; odds ratio [OR], 1.49; 95% CI, 1.05-2.11), black race (OR, 1.73; 95% CI, 1.14-2.62), Asian race (OR, 1.66; 95% CI, 1.08-2.54), gastroesophageal reflux disease (OR, 1.67; 95% CI, 1.15-2.43), and lateral neck dissection (OR, 1.99; 95% CI, 1.11-3.56). A high prevalence of abnormal voice per validation with the VHI-10 emphasizes the need for heightened awareness of voice abnormalities following surgery and warrants consideration in the preoperative risk-benefit discussion, planned extent of surgery, and postoperative rehabilitation.

Social-ecological correlates of cyberbullying victimization and perpetration among African American youth: Negative binomial and zero-inflated negative binomial analyses

Due to the technical advancement and popularity of social media in adolescent lives, there is a growing social and policy concern about cyberbullying and victimization. However, research about cyberbullying victimization and perpetration among African American youth is limited. The current study focuses on a nationally representative sample of 2560 African American youths. Data were drawn from the 2009–2010 Health Behavior in School-aged Children, negative binomial and zero-inflated negative binomial analyses were incorporated, and the social-ecological approach was applied to examine the correlates of cyberbullying victimization and perpetration among African Americans. Results revealed that fathers' monitoring and unstructured activities with peers had a significant effect on the probability of being cyberbullied or engaging in cyberbullying in both analyses. Also, youth who talked more about their problems with friends were less likely to be cyberbullied. Further, youth who spent less time using computers had an significanlty lower likelihood of engaging in cyberbullying. The significance and implications of the social-ecological approach for African American youth cyberbullying perpetration and victimization are also discussed.

Real-World Risk Indicators of Severe Hypoglycemia in T2D—Results of the InHypo-DM Study

Insight into the self-reported frequency of third-party assisted severe hypoglycemia (SH) is critical for the therapeutic optimization of type 2 diabetes (T2D). This study presents real-world epidemiological evidence on the self-reported incidence and related risk indicators of SH. A validated questionnaire (InHypo-DMPQ) was administered to a population-based panel of adult Canadians with T2D treated with insulin and/or secretagogues. Questions pertained to respondents’ past hypoglycemia events as well as socio-demographic and clinical characteristics, including hypoglycemia unawareness. Univariable analyses (p≤0.20) followed by a multivariable zero-inflated negative binomial (ZINB) analysis were performed to explore the influence of potential risk indicators on the occurrence of any and repeated SH events. The current evaluation is based on a cohort of 436 respondents (mean age: 53 years; male: 54%). Among these individuals, 37.8% (95% CI: 33.3%-42.4%) self-reported at least one SH event in the past year; the incidence rate was 2.4 events (95% CI: 2.26-2.55) per person-year. Based on the ZINB analysis, only non-severe (NH) hypoglycemia was independently associated with SH, holding other indicators constant. Among respondents who reported ≥1 (vs. zero) NH events, the odds of never experiencing an SH event decreased by 82% (95% CI: 39.3%-94.7%, p=0.006). Likewise, a history of NH, among those who had a chance of experiencing SH, increased the expected rate of SH by a factor of 4.29 (95% CI: 2.25-8.17, p&amp;lt;0.001). Real-world estimates of SH in T2D are often limited by sub-optimal reporting and gaps in clinical practice. To help clarify the true frequency of SH, this large, population-based study leveraged the value and clinical relevance of self-reported hypoglycemia data. The results of this study suggest that the burden of third-party assisted SH is substantial in people with T2D. Clinical strategies to prevent NH may reduce the risk of any/repeated SH events and resulting sequelae. Disclosure A. Ratzki-Leewing: None. S. Harris: Advisory Panel; Self; Novo Nordisk A/S, Sanofi, Merck, AstraZeneca, Amgen Inc., Lilly/Boehringer Ingelheim, Abbott, Janssen. Consultant; Self; Novo Nordisk A/S, Sanofi, Merck, AstraZeneca, Lilly/Boehringer Ingelheim, Abbott, Janssen. Research Support; Self; Novo Nordisk A/S, Sanofi, Merck, Abbott, AstraZeneca, Janssen. Other Relationship; Self; CIHR, CDA, The Lawson Foundation. S. Mequanint: None. N.H. Au: None. J.E. Black: None. S.M. Reichert: Other Relationship; Self; Novo Nordisk Inc., Sanofi, Abbott, AstraZeneca. Advisory Panel; Self; Servier. Speaker's Bureau; Self; Eli Lilly and Company. Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Speaker's Bureau; Self; Merck &amp; Co., Inc., Janssen Pharmaceuticals, Inc.. J.B. Brown: None. B.L. Ryan: None.

Valuing Treatment With Infliximab for Ankylosing Spondylitis Using a Willingness-to-Pay Approach.

ObjectiveTo investigate willingness to pay (WTP) for treatment with infliximab by patients with ankylosing spondylitis (AS) and explore factors associated with WTP.MethodsData from 85 patients participating in the European AS Infliximab Cohort (EASIC) open‐label extension of the AS Study for the Evaluation of Recombinant Infliximab Therapy (ASSERT) were used. WTP was included at baseline in EASIC and comprised a hypothetical scenario exploring whether the patient would be willing to pay for beneficial effects of infliximab and, if so, what amount they would be willing to pay per administration. Factors associated with WTP were explored using zero‐inflated negative binomial (ZINB) regressions.ResultsOf the 85 patients, 63 (74.1%) were willing to pay, and among these, the mean amount they were willing to pay per administration was €275 (median €100 [interquartile range €50–200]). Multivariable ZINB analysis showed that Assessment of SpondyloArthritis international Society criteria for 20% improvement (ASAS20) response was associated with a 7‐fold lower likelihood to pay 0 euros (odds ratio [OR] 0.14 [95% confidence interval (95% CI) 0.03–0.71]) and a 3‐fold increase in the amount willing to pay (exp(β) = 3.32 [95% CI 1.44–7.69]). In addition, the country of residence was associated with a lower likelihood to pay 0 euros (OR 0.07 [95% CI 0.02–0.36]), while increased age was associated with the amount willing to pay (exp(β) = 1.05 [95% CI 1.01–1.09]).ConclusionIn a hypothetical scenario, three‐quarters of patients with AS receiving long‐term infliximab stated that they were willing to pay an out‐of‐pocket contribution for this treatment. Treatment response contributed to the willingness as well as to the amount patients were willing to pay.

Dental caries status and its associated factors among 5-year-old Hong Kong children: a cross-sectional study

BackgroundThis study investigated dental caries status and its associated factors among 5-year-old children in Hong Kong.MethodThis cross-sectional survey was conducted in 2016. It comprised a questionnaire survey and a clinical examination. Kindergarten children aged 5 were recruited using a multistage sampling method. Parents of the participating children were asked about their children’s demographic information, sugary snacking behaviours, and oral health–related behaviours and about their own oral health knowledge. One trained dentist performed oral examinations on the children. Caries experience was measured using the dmft index. The relationships between the dmft scores and background information, sugary snacking behaviours, oral health–related behaviours and parental dental knowledge were studied using a zero-inflated negative binomial (ZINB) regression analysis.ResultsA total of 570 children were invited to participate, and 501 completed the oral examination (response rate: 88%). The prevalence of dental caries was 55%, and the mean dmft score was 2.7 ± 3.7. Decayed teeth (dt) constituted 93% of caries experience. ZINB analysis found that children who visited a dentist, who were taken care of primarily by grandparents and whose parental dental knowledge levels were moderate had higher dmft scores. Children who ate sugary snacks more than twice daily, had irregular dental attendance and lived in low-income families had a significantly higher chance of having dental caries.ConclusionsDental caries was prevalent among 5-year-old Hong Kong children, and most of the decayed teeth were untreated. The caries prevalence of the children was related to their frequency of sugary snack intake, dental attendance and socio-economic background.

Substance Use, Depression and Sociodemographic Determinants of HIV Sexual Risk Behavior in Outpatient Substance Abuse Treatment Patients.

The NIDA Clinical Trials Network trial of rapid HIV testing/counseling in 1281 patients was a unique opportunity to examine relationships among substance use, depressive symptoms, and sex risk behavior. Past 6-month substance use; substance use severity (Drug Abuse Screening Test - 10); depressive symptoms (Quick Inventory of Depressive Symptomatology); and three types of sex risk behavior (unprotected sex occasions [USOs] with primary partners; USOs with nonprimary partners; and USOs while high/drunk) were assessed. Zero-inflated negative binomial analyses provided: probability and rate of sex risk behavior (in risk behavior subsample). Levels of sexual risk behavior were high, while variable across the three types of sex risk behaviors. Among the patients, 50.4% had engaged in USOs with primary partners, 42% in sex while drunk or high, and 23.8% in USOs with nonprimary partners. Similar factors were significantly associated with all three types of sex risk behaviors. For all types, problem drinking, cocaine use, and substance use severity had an exacerbating effect. Older age was associated with lower risk behavior; other relationship categories (eg, married, separated/divorced, cohabitating) were associated with greater risk behavior than was single status. Depressive symptoms were associated with decreased likelihood of USOs with a primary partner. Sexual risk behavior is common among individuals in outpatient substance abuse treatment. Results highlight problem drinking (eg, up to three-fold) and cocaine (eg, up to twice) in increasing sex risk behavior. They demonstrate the utility of distinguishing between partner types and presence/absence of alcohol/drugs during sex. Findings argue for the need to integrate sex risk reduction into drug treatment.

In-hospital outcomes and costs of surgical stabilization versus nonoperative management of severe rib fractures

One factor that has precluded the wide adoption of surgical stabilization of rib fractures (SSRF) is the perception that it is too expensive to surgically repair an injury that will eventually heal without intervention. The purpose of this study was to compare in-hospital outcomes, costs, and charges for SSRF patients with a series of propensity-matched, nonoperatively managed rib fracture (NON-OP) patients at a single Level 1 trauma center. All patients admitted with rib fractures between January 2009 and June 2013 were identified. Patient demographics, injury, cost, and charge data were collected. Two-to-one propensity score matching was used to identify NON-OP patients who were similar to the SSRF patients. Zero-inflated negative binomial regression was conducted to assess the relationship among SSRF, intensive care unit (ICU) length of stay (LOS), and ventilator days. Cost and charge information was compared using Wilcoxon rank-sum tests. A total of 411 patients (137 SSRF, 274 NON-OP) were included in the analysis. Ventilator days and ICU LOS in days were not different between the SSRF and NON-OP groups when compared using the Wilcoxon rank-sum test. Ventilator and ICU days were less for SSRF by 2.24 days and 1.62 days, respectively, using zero-inflated negative binomial analysis to exclude the large number of patients who had 0 day on the ventilator and/or in the ICU. SSRF patients had higher hospital costs and total relevant charges compared with the NON-OP patients. Subgroup analysis of patients requiring mechanical ventilation who did not have head injury showed decreased ventilator days (median, 3 days vs. 5 days; p = 0.03) and need for tracheostomy (5% vs. 23%, p = 0.02) in SSRF versus NON-OP, respectively. In this subgroup, there was no difference in hospital costs and charges between SSRF and NON-OP. SSRF patients have shorter ICU LOS and less ventilator days than NON-OP across a diverse group of patients. Hospital costs and charges for SSRF patients are higher. In mechanically ventilated patients who do not have head injury, in-hospital outcomes are better, and there is no difference in hospital costs and charges. Further prospective cost-effectiveness research will determine whether improved quality of life and ability to return to meaningful activity sooner outweighs the increased costs of the acute care episode for SSRF patients. Epidemiologic study, level III.