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Background: Electronic data collection is increasingly being used for discrete choice experiments (DCEs).Objectives: To study whether paper or electronic administration results in measurement effects.Methods: Respondents were drawn from the same sample frame (an Internet panel) and completed a nearly identical DCE survey either online or on paper during the same period. A DCE on preferences for basic health insurance served as a case study. We used panel mixed logit models for the analysis.Results: In total, 898 respondents completed the survey: 533 respondents completed the survey online, whereas 365 respondents returned the paper survey. There were no significant differences with respect to sociodemographic characteristics between the respondents in both samples. The median response time was shorter for the online sample than for the paper sample, and a smaller proportion of respondents from the online sample were satisfied with the number of choice sets. Although some willingness- to-pay estimates were higher for the online sample, the elicited preferences for basic health insurance characteristics were similar between both modes of administration.Conclusions: We find no indication that online surveys yield inferior results compared with paper-based surveys, whereas the price per respondent is lower for online surveys. Researchers might want to include fewer choice sets per respondent when collecting DCE data online. Because our findings are based on a nonrandomized DCE that covers one health domain only, research in other domains is needed to support our findings. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyse the risk factors for unplanned readmissions within 1 month after hospital discharge to develop a seamless support system from discharge to home care. Background: With shorter hospital stay lengths, understanding the characteristics of patients with multiple risk factors is important to prevent rehospitalization. Design: This is a single‐centre retrospective descriptive study. Methods: Logistic regression and decision tree analyses were performed using eight items from the records of 3117 patients discharged from a university hospital between April–September 2017 as risk factors. Results: Unplanned readmission risk was significantly associated with emergency hospitalization (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.04–4.77), malignancy (OR: 2.16, 95% CI: 1.44–3.24), non‐surgical admission (OR: 1.76, 95% CI: 1.07–2.88), hospital stay of ≥ 15 days (OR: 1.66, 95% CI: 1.14–2.43) and decline in activities of daily living owing to hospitalization (OR: 1.68, 95% CI: 1.06–2.64). The highest risk combinations for rehospitalization were as follows: emergency hospitalization and malignancy; emergency admission, non‐malignancy and a hospital stay of ≥15 days; and scheduled hospitalization, no surgery and a hospital stay of ≥15 days. Conclusions: Patients with multiple risks for unplanned readmission should be accurately screened and provided with optimal home care. Summary statement: What is already known about this topic? Although the characteristics of patients at high risk of rehospitalization include malignancy, heart failure, conditions such as chronic obstructive pulmonary disease and other diseases prone to recurrence, old age, reduced activities of daily living and emergency hospitalization, few studies have reported on cases with multiple risks. What this paper adds? The most frequent risk types for unplanned readmissions within a month were emergency admissions for malignant tumours, emergency admissions for non‐malignant tumours with a hospital stay of 2 weeks or more and scheduled admissions for non‐surgical purposes with a length of stay of 2 weeks or more. The implications of this paper: The risk of unplanned readmission within 1 month of discharge increased due to a combination of multiple risks.This study helps us identify patients who are at high risk for readmission early in the hospitalization process and in providing nursing support for transition to their homes. [ABSTRACT FROM AUTHOR]

Background: The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption.Objective: We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows.Methods: Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score.Results: A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger.Conclusion: At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians. [ABSTRACT FROM AUTHOR]

Background: Vaccination is a crucial protective intervention to prevent adult mortality and morbidity. Personal perceptions and resources have an important place in the vaccination decision. Aim: This study aimed to modify the Public Attitude Towards Vaccination–Health Belief Model scale for adult vaccines and evaluate its psychometric properties. Methods: Overall, 626 people participated in this methodological study. Content validity index, confirmatory factor analysis, internal consistency and item‐total score correlation were used for validity and reliability. The independent samples t test, logistic regression analysis and ROC analysis were used for criterion and concurrent validity. Results: In confirmatory factor analysis, values of fit indices were excellent or acceptable. The Cronbach alpha value was between 0.83 and 0.92. According to criterion validity, the susceptibility, severity, benefit, and health motivation scores of those with the vaccine were higher than those without, whereas their barrier score was lower. The barrier subscale was a risk factor, whereas the benefit score was a protective factor that increased the likelihood of vaccination. The concurrent validity of the scale was tested with the COVID‐19 vaccine. While the barrier subscale's ability to distinguish between vaccinated (specificity) and unvaccinated (sensitivity) individuals is excellent, it is acceptable for the other subscales. Conclusion: Modified PAVS‐HBM is valid and reliable for adult vaccines. This scale was associated with vaccination behaviour and distinguished between vaccinated and unvaccinated individuals. Summary statement: What is already known about this topic? Vaccination rates are low in many countries due to issues of access, economy and infrastructure and in countries that provide vaccines.Low vaccination rates in adults are associated with mortality and morbidity.Vaccination management success is enhanced by orientation towards individual perceptions. What this paper adds? The modified Public Attitude Towards Vaccination Scale–Health Belief Model (PAVS‐HBM) was demonstrated as a reliable and valid scale.This scale explains the vaccination behaviour for different adult vaccines.This scale's ability to distinguish between vaccinated (specificity) and unvaccinated (sensitivity) individuals is acceptable to excellent. The implications of this paper for practice: The scale can be used as a tool for researchers to evaluate the probability of individuals being vaccinated and to determine risk groups for vaccine refusal.It can be integrated with many models focused on behaviour change, and when used with a health model, the scale's explanation of individuals' vaccination behaviour can guide the structuring of nursing interventions for vaccination. [ABSTRACT FROM AUTHOR]

Despite increased access to and improvements in contraceptives, unintended pregnancy continues to be a problem globally and is associated with adverse outcomes for mothers and infants. This paper seeks to unravel the mediators of intended versus unintended pregnancies among Black women living with HIV. The paper draws on survey data from a broader multi-country mixed methods study that used a community-based participatory research approach to investigate the psychosocial experiences of Black mothers living with HIV. The study participants were Black mothers living with HIV drawn through venue-based sampling from Ottawa, Canada (n = 89), Port Harcourt, Nigeria (n = 400), and Miami, Florida, United States (n = 201). We used Hierarchical Binary Logistic Regression Modelling (HBLM) to estimate the independent associations of pregnancy intention (intended versus unintended) with blocks of predictor variables (sociodemographic, sociocultural, and psychosocial predictors) at alpha level of 0.5. Specifically, 44.2%, 67.3%, and 17.7% of the women had unintended pregnancies in Ottawa, Miami, and Port Harcourt, respectively. There were important results from the HBLM. The odds of intended relative to unintended pregnancies were (i) reduced in larger households (OR = 0.56, 95% CI = 0.36/0.87), but increased with employment (OR = 7.84, 95% CI = 1.52/40.54) and HIV knowledge (OR = 3.13, 95% CI = 1.42/6.90) in Ottawa; (ii) reduced with age (OR = 0.93, 95% CI = 0.88/0.98), but increased with marriage (OR = 2.90, 95% CI = 1.43/5.88) and social support (pregnancy (OR = 3.77, 95% CI = 1.98/7.19) in Port Harcourt; (iii) reduced with social support (OR = 0.95, 95% CI = 0.91/1.00) but increased with HIV status disclosure (OR = 1.73, 95% CI = 1.01/2.97) and the influence of specific referent (OR = 1.68, 95% CI = 1.13/2.52) in Miami-FL. The incidence of unintended pregnancy is more prevalent among Black women living with HIV in the North American cities relative to the African city. Also, unique combinations of sociodemographic, sociocultural, and psychosocial factors influence pregnancy intention in each city. This implies that policy and practices to address reproductive health needs of WLHIV must consider these contextual issues. [ABSTRACT FROM AUTHOR]

Aims: This exploratory study, using mixed methods research, aimed to (1) examine the associations among self‐efficacy, social support and regular leisure‐time physical activity of nursing staff, and (2) identify motivators and barriers to leisure‐time physical activity. Background: It is important to engage nursing staff in regular leisure‐time physical activity as a countermeasure against high occupational stress and poor health. Limited research has examined nursing staff's participation in leisure‐time physical activity and associated factors. Methods: Nursing staff employed at a community hospital in the northeastern United States were invited to participate in this cross‐sectional survey with close‐ and open‐ended questions in March 2016. Results: A total of 363 nurses and nursing assistants responded, among whom, 59.8% reported regular leisure‐time physical activity. Poisson regression models suggested that self‐efficacy and social support had an interactive association with increased prevalence of regular leisure‐time physical activity. Conclusion: Self‐efficacy and social support have an important synergistic association with regular leisure‐time physical activity of nursing staff. Effective interventions intending to facilitate nursing staff's leisure‐time physical activity should consider improving their self‐efficacy and social support. Qualitative comments suggested that work‐out areas in the workplace with release time and organized activity may promote regular leisure‐time physical activity of nursing staff. Summary statement: What is already known about this topic? Leisure‐time physical activity is beneficial to both physical and mental health.Self‐efficacy and social support have been reported as independent predictors of leisure‐time physical activity in the general population.There is limited evidence regarding nursing staff's level of participation in leisure‐time physical activity and associated factors. What this paper adds? There is a higher level of participation in leisure‐time physical activity among nursing staff than the general population.Exercise self‐efficacy and social support have a synergistic association with regular leisure‐time physical activity among nursing staff.Support and promoting physical and mental fitness are motivators, whereas lack of time and energy and physical illnesses are barriers to regular leisure‐time physical activity reported by nursing staff. The implications of this paper: Findings indicate effective interventions designed to improve both self‐efficacy and social support might help facilitate nursing staff's participation in regular leisure‐time physical activity.Findings suggest organizational support through installing work‐out areas in the workplace with release time and organized activity might enhance nursing staff's capacity to engage in leisure‐time physical activity. [ABSTRACT FROM AUTHOR]

Background: Traditional approaches to identify missing mechanisms are usually based on the hypothesis test and confronted with both theoretical and practical challenges. It has been proved that the Bayesian network is powerful in integrating, analyzing and visualizing information, and some previous researches have verified the promising features of Bayesian network to deal with the aforementioned challenges in missing mechanism identification. Based on the above reasons, this paper explores the application of Bayesian network to the identification of missing mechanisms for the first time, and proposes a new method, the Bayesian network-based missing mechanism identification (BN-MMI) method, to identify missing mechanism in medical research.Methods: The procedure of BN-MMI method consists three easy-to-implement steps: estimating the missing data structure by the Bayesian network; assessing the credibility of the estimated missing data structure; and identifying the missing mechanism from the estimated missing data structure. The BN-MMI method is verified by simulation research and empirical research.Results: The simulation study verified the validity, consistency and robustness of BN-MMI method, and indicated its outperformance in contrast to the traditional logistic regression method. In addition, the empirical study illustrated the applicability of BN-MMI method in the real world by an example of medical record data.Conclusions: It was confirmed that the BN-MMI method itself, together with human knowledge and expertise, could identify the missing mechanisms according to the probabilistic dependence/independence relations among variables of interest. At the same time, our research shed light upon the potential application of BN-MMI method to a broader range of missing data issues in medical studies. [ABSTRACT FROM AUTHOR]

Background: Several attitude scales have been developed to measure students' attitudes toward computer programming, including the prominent one developed by Cetin and Ozden. The development of these scales stemmed from the elusive nature of attitude and the lack of specific constructs to measure attitude. These instruments measure students' attitudes based on one‐dimensional perspective, thus, making it difficult to interpret the meaning of some attitude evaluations such as the meaning of neutral points in a 10‐point scale (for example). Objectives: The computer programming attitude scale was modified to measure ambivalence. The study also investigate attitude differences across demographic variables and used these variables to predict ambivalence. Methods: The study was conducted in two phases. In the first phase, the instrument was validated using exploratory factor analysis and confirmatory factor analysis. In the second phase, the revised scale was administered to another 547 students in four research universities for empirical investigation. Results: Results show that the instrument is valid and suitable for measuring students' programming attitudes. Participants' attitudes skewed toward the negative attitude dimension. Lastly, we found that both attitude and ambivalence are factors of programming experience. Conclusions: We discussed the findings, recommend the instrument to programming tutors, and strongly emphasise the evaluation of students' ambivalent attitudes. Lay Description: What is currently known: There are numerous scales developed to measure students' attitude toward computer programming, such as the computer programming attitude scale (CPAS).The development of these inventories stemmed from the elusive nature of attitude and the lack of specific construct to measure attitude.These instruments measure students' attitude based on one dimensional perspective, thus, making it difficult to interpret the meaning of some attitude evaluations such as the meaning of neutral points in a 10‐point scale (for example). What this paper adds: The present research brings a novel approach to instrument development by acknowledging the presence of attitude toward computer programming.This novel approach advances the knowledge of instrument development in the field of attitude measurement by introducing a paradigm shift from conventional attitude evaluation to a more diverse approach.The study has introduced new items to the existing CPAS, and subsequently, indicates the possibility of validating an attitude inventory using data obtained from ambivalence evaluation.By using this instrument, students' attitude is measured accurately rather than adopting the conventional measures that ignored the presence of negative and positive evaluations. Implication to practitioners: Through the findings of the study, computer science and programming educators would come to know that many positive and negative attitude elements are occasionally subsumed toward an attitude object, thereby leading to an ambivalence attitude.The instrument can be used by the practitioners to accurately measure students' positive and negative attitude toward programming across all levels of education.Using the instrument, practitioners can predict the identified attitude using wide range of variables such as gender, age, computational thinking skills, programming proficiency levels, among others. [ABSTRACT FROM AUTHOR]

Background: Confounding bias is a common concern in epidemiological research. Its presence is often determined by comparing exposure effects between univariable- and multivariable regression models, using an arbitrary threshold of a 10% difference to indicate confounding bias. However, many clinical researchers are not aware that the use of this change-in-estimate criterion may lead to wrong conclusions when applied to logistic regression coefficients. This is due to a statistical phenomenon called noncollapsibility, which manifests itself in logistic regression models. This paper aims to clarify the role of noncollapsibility in logistic regression and to provide guidance in determining the presence of confounding bias.Methods: A Monte Carlo simulation study was designed to uncover patterns of confounding bias and noncollapsibility effects in logistic regression. An empirical data example was used to illustrate the inability of the change-in-estimate criterion to distinguish confounding bias from noncollapsibility effects.Results: The simulation study showed that, depending on the sign and magnitude of the confounding bias and the noncollapsibility effect, the difference between the effect estimates from univariable- and multivariable regression models may underestimate or overestimate the magnitude of the confounding bias. Because of the noncollapsibility effect, multivariable regression analysis and inverse probability weighting provided different but valid estimates of the confounder-adjusted exposure effect. In our data example, confounding bias was underestimated by the change in estimate due to the presence of a noncollapsibility effect.Conclusion: In logistic regression, the difference between the univariable- and multivariable effect estimate might not only reflect confounding bias but also a noncollapsibility effect. Ideally, the set of confounders is determined at the study design phase and based on subject matter knowledge. To quantify confounding bias, one could compare the unadjusted exposure effect estimate and the estimate from an inverse probability weighted model. [ABSTRACT FROM AUTHOR]

When developing prediction models for application in clinical practice, health practitioners usually categorise clinical variables that are continuous in nature. Although categorisation is not regarded as advisable from a statistical point of view, due to loss of information and power, it is a common practice in medical research. Consequently, providing researchers with a useful and valid categorisation method could be a relevant issue when developing prediction models. Without recommending categorisation of continuous predictors, our aim is to propose a valid way to do it whenever it is considered necessary by clinical researchers. This paper focuses on categorising a continuous predictor within a logistic regression model, in such a way that the best discriminative ability is obtained in terms of the highest area under the receiver operating characteristic curve (AUC). The proposed methodology is validated when the optimal cut points' location is known in theory or in practice. In addition, the proposed method is applied to a real data-set of patients with an exacerbation of chronic obstructive pulmonary disease, in the context of the IRYSS-COPD study where a clinical prediction rule for severe evolution was being developed. The clinical variable PCO2 was categorised in a univariable and a multivariable setting. [ABSTRACT FROM AUTHOR]

Clinical prediction models (CPMs) can predict clinically relevant outcomes or events. Typically, prognostic CPMs are derived to predict the risk of a single future outcome. However, there are many medical applications where two or more outcomes are of interest, meaning this should be more widely reflected in CPMs so they can accurately estimate the joint risk of multiple outcomes simultaneously. A potentially naïve approach to multi-outcome risk prediction is to derive a CPM for each outcome separately, then multiply the predicted risks. This approach is only valid if the outcomes are conditionally independent given the covariates, and it fails to exploit the potential relationships between the outcomes. This paper outlines several approaches that could be used to develop CPMs for multiple binary outcomes. We consider four methods, ranging in complexity and conditional independence assumptions: namely, probabilistic classifier chain, multinomial logistic regression, multivariate logistic regression, and a Bayesian probit model. These are compared with methods that rely on conditional independence: separate univariate CPMs and stacked regression. Employing a simulation study and real-world example, we illustrate that CPMs for joint risk prediction of multiple outcomes should only be derived using methods that model the residual correlation between outcomes. In such a situation, our results suggest that probabilistic classification chains, multinomial logistic regression or the Bayesian probit model are all appropriate choices. We call into question the development of CPMs for each outcome in isolation when multiple correlated or structurally related outcomes are of interest and recommend more multivariate approaches to risk prediction. [ABSTRACT FROM AUTHOR]

Aim: To describe trends in gastrostomy tube insertion in children with developmental or acquired disorders in Sweden and assess their demographic characteristics.Method: Children aged 0 to 18 years with gastrostomy tube insertions recorded between 1998 and 2014 were identified in the Swedish National Patient Register. Associations between disorder type and year of surgery, as well as age at surgery, were analysed using linear regression analyses. The association between disorder type and mortality 2 years from gastrostomy tube insertion was also analysed using logistic regression analysis.Results: The data for 4112 children (2182 males, 1930 females), with a median age of 2 years (interquartile range=1-8y), were analysed. Children who presented with developmental disorders were the largest group (n=3501, 85%). The most common diagnosis in children with developmental disorders was cerebral palsy (n=165, 4%). In children with acquired disorders, acute lymphoblastic leukaemia (n=117, 3%) was the most common diagnosis. Gastrostomy tube insertions increased from 1998 to 2014, with the greatest increase in children with developmental disorders, who were younger than children with acquired disorders when the gastrostomy tube was first inserted. Age at tube insertion decreased in both groups during the study period. Mortality was higher in children with acquired disorders, suggesting that gastrostomy tube insertion should be part of a palliative care approach.Interpretation: Child characteristics differed depending on whether the underlying disorder was developmental or acquired, suggesting a need for clinical health care guidelines related to the specific goals of gastrostomy tube insertion.What This Paper Adds: Gastrostomy tube insertions increased by 140% from 1998 to 2014 in Sweden. The age of children with developmental disorders decreased by 1 month per year during the study period. Children presenting with developmental disorders were younger than children with acquired disorders when the gastrostomy tube was first inserted. Mortality was higher in children with acquired disorders. [ABSTRACT FROM AUTHOR]

Background: Trachoma is a neglected tropical disease which is the leading infectious cause of blindness in the world. Trachoma is one of the major health problems in Tigray Region, Northern Ethiopia. However, knowledge, attitudes, and practices about trachoma are not yet studied in depth. The objective of the study was to assess knowledge, attitudes, and practices on trachoma and its associated factors among rural communities in two districts of Tigay Region, Northern Ethiopia.Methods: A cross-sectional study was conducted in two districts of Tigray Region, Northern Ethiopia, from May 7-24, 2017. Data were collected on paper based, were entered into Epi Info version 3.5.1, and then exported to SPSS version 21 for analysis. Logistic regression analysis was done to identify factors associated with knowledge, attitudes, and practices.Results: In this study, a total of 194 respondents were included. The overall level of good knowledge, attitudes, and practices on trachoma was 51%, 49.5%, and 35.6%, respectively. Having ever received health education was significantly associated with good knowledge (adjusted odds ratio (AOR) = 4.10; 95% confidence interval (CI): 1.91-8.79) and attitudes (AOR = 2.10; 95% CI: 1.02-4.25). Moreover, good knowledge was associated with good practices on trachoma prevention and control (AOR = 2.86; 95% CI: 1.46-5.62).Conclusion: Our study implies that areas with high burden of trachoma need to improve communities' knowledge, attitudes, and practices towards trachoma prevention and control in order to eliminate trachoma as a public health problem. Therefore, health education focused on SAFE strategy should be provided to increase knowledge and changing attitudes that contribute for good practices towards trachoma prevention and control among communities. [ABSTRACT FROM AUTHOR]

This paper presents two new model-based goodness-of-fit tests for the ordered stereotype model applied to an ordinal response variable. The proposed tests are based on the Lipsitz test, which partitions the subjects into G groups following the popular Hosmer-Lemeshow test for binary data. The tests construct an alternative model where group effects are added into the null model. If the model fits the data well then the null model is correct, and there should be no group effects. One of the main advantages of the ordered stereotype model is that it allows us to determine a new uneven spacing of the ordinal response categories, dictated by the data. The two proposed tests use this new adjusted spacing. One test uses the form of the original ordered stereotype model, and the other uses an ordinary linear model. We demonstrate the performance of both tests under a variety of scenarios. Finally, the results of the application in three examples are presented. [ABSTRACT FROM AUTHOR]

Aim: To compare the rate of falls between adults with and without cerebral palsy (CP).Method: We used primary care data on 1705 adults with CP and 5115 adults without CP matched for age, sex, and general practice attended. We compared odds of experiencing a fall between adults with and without CP using conditional logistic regression. We compared the rate of falls using a negative binomial model.Results: Participants were 3628 males (53%) and 3192 females (47%) (median age 29y, interquartile range 20-42y) at the start of follow-up. Follow-up was 14 617 person-years for adults with CP and 56 816 person-years for adults without CP. Of adults with CP, 15.3% experienced at least one fall compared to 5.7% of adults without CP. Adults with CP had 3.64 times (95% confidence interval [CI] 2.98-4.45) the odds of experiencing a fall compared to adults without CP. The rate of falls was 30.5 per 1000 person-years and 6.7 per 1000 person-years for adults with and without CP respectively (rate ratio 5.83, 95% CI 4.84-7.02) INTERPRETATION: Adults with CP are more likely to fall, and fall more often, than adults without CP. The causes and consequences of falls in adults with CP need examination.What This Paper Adds: Twenty adults with CP and 5.3 adults without CP experienced at least one fall per 1000 person-years. Adults with CP experienced 30.5 falls per 1000 person-years compared to 6.7 falls per 1000 person-years among adults without CP. Adults with CP had 3.64 times the odds of experiencing a fall compared to adults without CP. Adults with CP experienced 5.83 times more falls than adults without CP. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) programme has been scaled up to three provinces in South Africa. This paper explores associations between women's engagement in the intervention, intimate partner violence (IPV) and factors associated with IPV and partner abuse. We enrolled women receiving group-based microfinance loans plus gender training into the scaled-up IMAGE cohort study (n = 860). We present cross-sectional analysis on participants' characteristics and intervention engagement and use multivariate logistic regression to explore associations. 17% of women reported lifetime (95% CI 15 to 20%) and 7% past year (95% CI 5 to 9%) IPV, 9% past-year economic (95% CI 7 to 11%) and 11% past-year emotional (95% CI 9 to 14%) abuse. Women under 35 years had higher levels of IPV and emotional abuse. 53% of women attended all the trainings, 83% continuously borrowed and 98% agreed the training had a major impact on their life. Attendance was associated with improved partner relationships (χ2p < 0.001), but not lower IPV risk. Odds of past-year IPV decreased the more types of support (e.g. advice) women received from group members (aOR 0.27, p < 0.001 among those reporting all support versus none or some). A similar pattern was seen for economic, but not emotional, abuse. The scaled-up IMAGE intervention is widely acceptable and may support improvements in partner relationships, but younger women need to be targeted. Group support appears to be a potentially important component of the intervention. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Chronic rhinosinusitis (CRS) is defined as a condition of inflammation in the paranasal sinus mucosa persisting for more than 12 weeks. We previously reported that the prevalence of CRS was about 8 % in China. Here, we aim to investigate the occupational and environmental risk factors associated with CRS.Methods: Data were collected from seven Chinese cities: Urumqi, Changchun, Beijing, Wuhan, Chengdu, Huaian and Guangzhou. CRS was diagnosed according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP(3)OS) document. Participants were asked to complete a standardized questionnaire, which was developed by the Global Allergy and Asthma European Network (GA(2)LEN) project and covered sociodemographic characteristics, CRS-related symptoms and occupational and environmental exposures. We evaluated the association between CRS and various occupational and environmental factors using odds ratios (ORs) and 95 % confidence intervals (95 % CIs).Results: The total study population consisted of 10,633 subjects, 850 (7.99 %) of whom were defined as having CRS according to the EP(3)OS criteria. We found that there were significant associations between occupational and environmental factors and CRS. Specifically, having a clearance-related job, occupational exposure to dust, occupational exposure to poisonous gas, a pet at home or carpet at home or at the workplace were risk factors for CRS. Additionally, the method used to keep warm in winter, the duration of time spent using air conditioning in summer and the frequency of exposure to mouldy or damp environments were significantly different in subjects with and without CRS.Conclusions: Our data showed that some occupational and environmental exposures are strongly associated with CRS, which aids in understanding the epidemiology of CRS. [ABSTRACT FROM AUTHOR]

Epidemiologic research often aims to estimate the association between a binary exposure and a binary outcome, while adjusting for a set of covariates (eg, confounders). When data are clustered, as in, for instance, matched case-control studies and co-twin-control studies, it is common to use conditional logistic regression. In this model, all cluster-constant covariates are absorbed into a cluster-specific intercept, whereas cluster-varying covariates are adjusted for by explicitly adding these as explanatory variables to the model. In this paper, we propose a doubly robust estimator of the exposure-outcome odds ratio in conditional logistic regression models. This estimator protects against bias in the odds ratio estimator due to misspecification of the part of the model that contains the cluster-varying covariates. The doubly robust estimator uses two conditional logistic regression models for the odds ratio, one prospective and one retrospective, and is consistent for the exposure-outcome odds ratio if at least one of these models is correctly specified, not necessarily both. We demonstrate the properties of the proposed method by simulations and by re-analyzing a publicly available dataset from a matched case-control study on induced abortion and infertility. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to survey the prevalence of exposure to workplace violence (WPV) including physical violence, verbal abuse, bullying as well as its related factors among physicians and medical students attending teaching hospitals of Kurdistan University of Medical Sciences (KUMS).Design/methodology/approach This is a descriptive analytic as well as a cross-sectional study which was carried out on all physicians (general and specialists) and medical students attending teaching hospitals of KUMS in 2014. Overall, 400 participated in this study and data were gathered using a standard questionnaire. Then, data were analyzed using SPSS 20, χ2 and Fisher's exact tests as well as univariate and adjusted logistic regression.Findings The prevalence of physical violence, verbal abuse and bullying among medical students was reported 4.5, 59 and 0.8 percent, respectively. In addition, the prevalence of these violence among general practitioners was 6.9, 72.4 and 0 percent, respectively. Moreover, 11.5, 42.3 and 3.8 percent of specialists had experienced physical violence, verbal abuse and bullying, respectively. Patients and their relatives were the main sources of the violence. Based on the results of multivariate logistic regression, male sex (AOR=2.60, CI: 1.56–4.32) and having shift work (AOR=3.13, CI: 1.67–5.84) were the most significant risk factors for total WPV.Originality/value The WPV experienced by physicians and medical students attending teaching hospitals of MUK is high. Health sector authorities should develop and implement proper strategies and interventions aiming at reducing or preventing from incidence of WPV. [ABSTRACT FROM AUTHOR]

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Purpose: This study aimed to investigate the influencing factors of breast cancer recurrence by comparing the risk factors and lifestyle patterns related to breast cancer in Korean women with and without recurrence. Methods: This cross-sectional survey comprised 241 Korean women diagnosed with breast cancer who had received follow-up treatment. Participants were recruited from a university hospital in Seoul and an online social media platform for breast cancer patients. Data were collected either via online or a paper survey, using a structured questionnaire that included general and disease-related characteristics and lifestyle behaviors. Data were analyzed using descriptive statistics, univariate analysis, and logistic regression. Results: Recurrence of breast cancer was influenced by four factors; childbirth experience, consumption of green/yellow vegetables, drinking behavior, and recovery from fatigue after sleep. Prevalence of recurrent breast cancer was associated with no childbirth experience (OR=2.29, p=.010), fewer green/yellow vegetables (OR=0.71, p=.008), drinking behavior (OR=0.24, p=.001), and a lower level of recovery from fatigue after sleep (OR=0.51, p<.001). Conclusion: Aside from having experienced childbirth, this study identified several modifiable factors that influence breast cancer recurrence. Increasing green/ yellow vegetable intake, alleviating fatigue, and reducing alcohol intake are important. Intervention strategies in clinical research and practice can be applied to address risk factors and reduce the prevalence of recurrent breast cancer. [ABSTRACT FROM AUTHOR]

Asymptotic tests are commonly used for comparing two binomial proportions when the sample size is sufficiently large. However, there is no consensus on the most powerful test. In this paper, we clarify this issue by comparing the power functions of three popular asymptotic tests: the Pearson's χ2 test, the likelihood-ratio test and the odds-ratio based test. Considering Taylor decompositions under local alternatives, the comparisons lead to recommendations on which test to use in view of both the experimental design and the nature of the investigated signal. We show that when the design is balanced between the two binomials, the three tests are equivalent in terms of power. However, when the design is unbalanced, differences in power can be substantial and the choice of the most powerful test also depends on the value of the parameters of the two compared binomials. We further investigated situations where the two binomials are not compared directly but through tag binomials. In these cases of indirect association, we show that the differences in power between the three tests are enhanced with decreasing values of the parameters of the tag binomials. Our results are illustrated in the context of genetic epidemiology where the analysis of genome-wide association studies provides insights regarding the low power for detecting rare variants. [ABSTRACT FROM AUTHOR]

Background: Knowledge of HIV status can be important in reducing the risk of HIV exposure. In a European sample of men-who-have-sex-with-men (MSM), we aimed to identify factors associated with HIV serostatus disclosure to the most recent anal intercourse (AI) partner. We also aimed to describe the impact of HIV serostatus disclosure on HIV exposure risks.Methods: During 2013 and 2014, 4901 participants were recruited for the bio-behavioural Sialon-II study in 13 European cities. Behavioural data were collected with a self-administered paper questionnaire. Biological specimens were tested for HIV antibodies. Factors associated with HIV serostatus disclosure with the most recent AI partner were examined using bivariate and multilevel multivariate logistic regression analysis. We also describe the role of serostatus disclosure for HIV exposure of the most recent AI partner.Results: Thirty-five percent (n = 1450) of the study participants reported mutual serostatus disclosure with their most recent AI partner or disclosed having HIV to their partner. Most of these disclosures occurred between steady partners (74%, n = 1077). In addition to the type of partner and HIV diagnosis status, other factors positively associated with HIV serostatus disclosure in the multilevel multivariate logistic regression model were recent testing, no condom use, and outness regarding sexual orientation. Disclosure rates were lowest in three south-eastern European cities. Following condom use (51%, n = 2099), HIV serostatus disclosure (20%, n = 807) was the second most common prevention approach with the most recent AI partner, usually resulting in serosorting. A potential HIV exposure risk for the partner was reported by 26% (111/432) of HIV antibody positive study participants. In 18% (20/111) of exposure episodes, an incorrect HIV serostatus was unknowingly communicated. Partner exposures were equally distributed between steady and non-steady partners.Conclusions: The probability of HIV exposure through condomless AI is substantially lower after serostatus disclosure compared to non-disclosure. Incorrect knowledge of one's HIV status contributes to a large proportion of HIV exposures amongst European MSM. Maintaining or improving condom use for anal intercourse with non-steady partners, frequent testing to update HIV serostatus awareness, and increased serostatus disclosure particularly between steady partners are confirmed as key aspects for reducing HIV exposures amongst European MSM. [ABSTRACT FROM AUTHOR]

Objective Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. Methods This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (<150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. Results At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97–6.06), obesity (odds ratio = 1.79; 95% CI = 1.26–2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20–8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17–2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48–0.90), and student status (odds ratio = 0.58; 95% CI = 0.37–0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46–0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01–2.13). Conclusions This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. Impact In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity. [ABSTRACT FROM AUTHOR]

Simple Summary: A 90-day mortality predictive model for curative gastric cancer resection based on the Spanish EURECCA Esophagogastric Cancer database was externally validated using the GASTRODATA registry. The externally validated model showed a modestly worse performance compared to the original model, nevertheless maintaining its discriminating ability in clinical practice. Background: Radical gastrectomy remains the main treatment for gastric cancer, despite its high mortality. A clinical predictive model of 90-day mortality (90DM) risk after gastric cancer surgery based on the Spanish EURECCA registry database was developed using a matching learning algorithm. We performed an external validation of this model based on data from an international multicenter cohort of patients. Methods: A cohort of patients from the European GASTRODATA database was selected. Demographic, clinical, and treatment variables in the original and validation cohorts were compared. The performance of the model was evaluated using the area under the curve (AUC) for a random forest model. Results: The validation cohort included 2546 patients from 24 European hospitals. The advanced clinical T- and N-category, neoadjuvant therapy, open procedures, total gastrectomy rates, and mean volume of the centers were significantly higher in the validation cohort. The 90DM rate was also higher in the validation cohort (5.6%) vs. the original cohort (3.7%). The AUC in the validation model was 0.716. Conclusion: The externally validated model for predicting the 90DM risk in gastric cancer patients undergoing gastrectomy with curative intent continues to be as useful as the original model in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Recently, trials have supported changes in deep caries management. However, reporting might lack details, affecting interpretation and implementation. Thus, we aimed to evaluate the adherence to the CONSORT statement and the risk of bias of randomized controlled trials (RCTs) on deep caries management published in pediatric dental journals. Methods: We searched PubMed for RCTs in six pediatric dental journals between 2010 and 2022, focusing on deep caries lesion management. Adherence to the CONSORT guideline and the risk of bias were assessed using a modified tool with 19 items; each scored from 0 to 2 (maximum of 38 points), and the Cochrane risk-of-bias (RoB 2) tool. We performed descriptive and regression analyses (α = 5%). Results: We analyzed 127 RCTs. The mean (standard deviation) CONSORT adherence score was 21.1 (6.7). Notably, 96.1% of the studies received a score of 2 for the "intervention" item, whereas 83.5% scored 0 for the "estimated effect size". The risk of bias assessment revealed that 40.2% of the RCTs were at high risk, 59% were at low risk, and 0.8% were at low risk. RCTs with a high risk of bias had lower CONSORT scores (p<0.001) than those with low or some concerns. RCTs published in journals without the endorsement of the CONSORT statement had lower scores than those in journals with the endorsement of the CONSORT statement. Older RCTs (6-10 years old and more than 10 years old) showed significantly lower CONSORT statement compliance than trials published recently within 5 years. Conclusion: Adherence to the CONSORT was relatively low among the investigated RCTs. Moreover, lower adherence to the CONSORT was associated with a higher risk of bias. Trial Registration: This study protocol was prospectively registered on the Open Science Framework - DOI (10.17605/OSF.IO/V6SYZ). [ABSTRACT FROM AUTHOR]

Background: The integration of mental health into primary care—i.e., the process by which a range of essential mental health care and services are made available in existing multipurpose health care settings that did not previously provide them—can be facilitated or hindered by several health system factors that are still poorly understood. This study aimed to identify health system facilitators and barriers to the integration of mental health services into primary care in the Democratic Republic of the Congo (DRC) to improve the success rate of integration programs. Methods: We conducted a multimethod, cross-sectional exploratory study. Stakeholders (managers, health service providers, service users, etc.) from sixteen of the twenty-six provinces of the DRC participated. We collected qualitative data through 31 individual, semistructured, face-to-face key informant interviews. We then collected quantitative data through a population-based survey of 413 respondents. We analyzed the interviews via thematic analysis, assigning verbatims to predefined themes and subthemes. For the survey responses, we performed descriptive analysis followed by binomial logistic regression to explore the associations between the variables of interest. Results: Strong leadership commitment, positive attitudes toward mental health care, the availability of care protocols, mental health task sharing (p < 0.001), and sufficient numbers of primary care providers (PCPs) (p < 0.001) were identified as key health system facilitators of successful integration. However, barriers to integration are mainly related to a poor understanding of what integration is and what it is not, as well as to the poor functionality and performance of health facilities. In addition, stigma, low prioritization of mental health, lack of mental health referents, low retention rate of trained health professionals, lack of reporting tools, lack of standardized national guidelines for integration (p < 0.001), lack of funding (p < 0.001), shortage of mental health specialists to coach PCPs (p < 0.001), and lack of psychotropic medications (p < 0.001) were identified as health system barriers to integration. Conclusion: Improving the functionality of primary care settings before integrating mental health care would be beneficial for greater success. In addition, addressing identified barriers, such as lack of funding and mental health-related stigma, requires multistakeholder action across all building blocks of the health system. [ABSTRACT FROM AUTHOR]

Background: The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes.Methods: As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites in the passive group received the guideline excluding treatment protocols. As part of a process evaluation, nurses, and occupational and physical therapists, blinded to study hypotheses, were asked to record their implementation of 18 recommended treatments targeting motor function, postural control and mobility using individualized patient checklists after treatment sessions for 2 weeks pre- and post-intervention. The percentage of patients receiving each treatment pre- and post-intervention and between groups was compared after adjusting for clustering and covariates in a random-effects logistic regression analysis.Results: Data on treatment implementation from nine and eight sites in the facilitated and passive KT group, respectively, were available for analysis. The facilitated KT intervention was associated with improved implementation of sit-to-stand (p = 0.028) and walking (p = 0.043) training while the passive KT intervention was associated with improved implementation of standing balance training (p = 0.037), after adjusting for clustering at patient and provider levels and covariates.Conclusions: Despite multiple strategies and resources, the facilitated KT intervention was unsuccessful in improving integration of 18 treatments concurrently. The facilitated approach may not have adequately addressed barriers to integrating numerous treatments simultaneously and complex treatments that were unfamiliar to providers.Trial Registration: Unique identifier- NCT00359593. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Quality of Life Inventory™ 4.0 Short Form 15 Generic Core Scales (hereafter the PedsQL) and the Child Health Utility-9 Dimensions (CHU9D) are two generic instruments designed to measure health-related quality of life in children and adolescents in the general population and paediatric patient groups living with specific health conditions. Although the PedsQL is widely used among paediatric patient populations, presently it is not possible to directly use the scores from the instrument to calculate quality-adjusted life-years (QALYs) for application in economic evaluation because it produces summary scores which are not preference-based.Objective: This paper examines different econometric mapping techniques for estimating CHU9D utility scores from the PedsQL for the purpose of calculating QALYs for cost-utility analysis.Methods: The PedsQL and the CHU9D were completed by a community sample of 755 Australian adolescents aged 15-17 years. Seven regression models were estimated: ordinary least squares estimator, generalised linear model, robust MM estimator, multivariate factorial polynomial estimator, beta-binomial estimator, finite mixture model and multinomial logistic model. The mean absolute error (MAE) and the mean squared error (MSE) were used to assess predictive ability of the models.Results: The MM estimator with stepwise-selected PedsQL dimension scores as explanatory variables had the best predictive accuracy using MAE and the equivalent beta-binomial model had the best predictive accuracy using MSE.Conclusions: Our mapping algorithm facilitates the estimation of health-state utilities for use within economic evaluations where only PedsQL data is available and is suitable for use in community-based adolescents aged 15-17 years. Applicability of the algorithm in younger populations should be assessed in further research. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the design and cohort characteristics of the Social Spectrum Study: a clinical cohort study that used a two-phase sampling design to identify children at risk for ASD. After screening 1281 children aged 2.5-10 years who had been consecutively referred to one of six mental health services in the Netherlands, children who screened positive for ASD (n = 428) and a random selection of screen negatives (n = 240) were invited to participate in diagnostic assessments and questionnaires regarding the child, family and society. A 1-year follow-up was also conducted. Results from this study may contribute to knowledge of the identification and characterization of children with ASD, family processes, and the impact of ASD on the family and society. [ABSTRACT FROM AUTHOR]

Background: Men use health services less often than women and frequently delay seeking help even if experiencing serious health problems. This may put men at higher risk for developing serious health problems which, in part, may explain men's higher rates of some serious illnesses and shorter life span relative to women. This paper identifies factors that contribute to health care utilisation in a cohort of Australian men by exploring associations between socio-economic, health and lifestyle factors and the use of general practitioner (GP) services.Methods: We used data from Ten to Men, the Australian Longitudinal Study on Male Health. Health care utilisation was defined in two ways: at least one GP visit in the past 12 months and having at least yearly health check-ups with a doctor. Associations between these two measures and a range of contextual socio demographic factors (education, location, marital status, country of birth, employment, financial problems etc.) as well as individual health and lifestyle factors (self-rated health, smoking, drinking, healthy weight, pain medication) were examined using logistic regression analysis. The sample included 13,763 adult men aged 18 to 55 years. Analysis was stratified by age (18 to 34 year versus 35 to 55 years).Results: Overall, 81 % (95 % CI: 80.3-81.6) of men saw a GP for consultation in the 12 months prior to the study. The odds of visiting a GP increased with increasing age (p < 0.01), but decreased with increasing remoteness of residence (p < 0.01). Older men, smokers and those who rate their health as excellent were less likely to visit a GP in the last 12 months, but those on daily pain medication or with co-morbidities were more likely to have visited a GP. However, these factors were not associated with consulting a GP in the last 12 months among young men. Overall, 39 % (95 % CI: 38.3-39.9) reported having an annual health check. The odds of having an annual health check increased with increasing age (p < 0.01), but showed no association with area of residence (p = 0.60). Across both age groups, the odds of a regular health check increased with obesity and daily pain medication, but decreased with harmful levels of alcohol consumption.Conclusion: The majority of men (61 %) did not engage in regular health check-up visits, representing a missed opportunity for preventative health care discussions. Lower consultation rates may translate into lost opportunities to detect and intervene with problems early and this is where men may be missing out compared to women. [ABSTRACT FROM AUTHOR]

Snoring is the most direct symptom of obstructive sleep apnea hypopnea syndrome (OSAHS) and implies a lot of information about OSAHS symptoms. This paper aimed to identify OSAHS patients by analyzing acoustic features derived from overnight snoring sounds. Mel-frequency cepstral coefficients, 800 Hz power ratio, spectral entropy and other 10 acoustic features were extracted from snores, and Top-6 features were selected from the extracted 10 acoustic features by a feature selection algorithm based on random forest, then 5 kinds of machine learning models were applied to validate the effectiveness of Top-6 features on identifying OSAHS patients. The results showed that when the classification performance and computing efficiency were taken into account, the combination of logistic regression model and Top-6 features performed best and could successfully distinguish OSAHS patients from simple snorers. The proposed method provides a higher accuracy for evaluating OSAHS with lower computational complexity. The method has great potential prospect for the development of a portable sleep snore monitoring device. [ABSTRACT FROM AUTHOR]

Issue addressed Tobacco consumption contributes to health disparities among Aboriginal Australians who experience a greater burden of smoking-related death and diseases. This paper reports findings from a baseline survey on factors associated with smoking, cessation behaviours and attitudes towards smoke-free homes among the Aboriginal population in inner and south-western Sydney. Methods A baseline survey was conducted in inner and south-western Sydney from October 2010 to July 2011. The survey applied both interviewer-administered and self-administered data collection methods. Multiple logistic regression was performed to determine the factors associated with smoking. Results Six hundred and sixty-three participants completed the survey. The majority were female (67.5%), below the age of 50 (66.6%) and more than half were employed (54.7%). Almost half were current smokers (48.4%) with the majority intending to quit in the next 6 months (79.0%) and living in a smoke-free home (70.4%). Those aged 30-39 years (AOR 3.28; 95% CI: 2.06-5.23) and the unemployed (AOR 1.67; 95% CI: 1.11-2.51) had higher odds for current smoking. Participants who had a more positive attitude towards smoke-free homes were less likely to smoke (AOR 0.79; 95% CI: 0.74-.85). Conclusions A high proportion of participants were current smokers among whom intention to quit was high. Age, work status and attitudes towards smoke-free home were factors associated with smoking. So what? The findings address the scarcity of local evidence crucial for promoting cessation among Aboriginal tobacco smokers. Targeted promotions for socio-demographic subgroups and of attitudes towards smoke-free homes could be meaningful strategies for future smoking-cessation initiatives. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to study the prevalence of a regular source of primary care for Victorian children attending one of four emergency departments (EDs) and to determine associated characteristics, including ED use.Methods: Responses were collected via an electronic survey from parents attending EDs with their child (≤9 years of age) for a lower-urgency condition. Single, multiple choice, and Likert scale responses were analysed using bivariate and logistic regression tests.Results: Of the 1146 parents who provided responses, 80% stated their child has a regular source of primary care. Of these, care is mostly received by a general practitioner (GP) (95%) in GP group practices (71%). Approximately 20% have changed where their child receives primary care in the last year. No associations were observed between having a regular source of primary care and frequency of ED attendance in the past 12 months, although parents whose child did not have a regular source of primary care were more likely to view the ED as a more convenient place to receive care than the primary care provider (39% without regular source vs. 18% with regular source; P < 0.0001). Children were less likely to have a regular source of primary care if their parents were younger, had a lower household income, lower education, and were visiting a hospital in a lower socio-economic indexes for areas rank.Conclusions: Policy options to improve continuity of care for children may require investigation. Increasing the prevalence of regular source of primary care for children may in turn reduce ED visits. [ABSTRACT FROM AUTHOR]

Background: This paper explores the importance of electronic medical records (EMR) for predicting 30-day all-cause non-elective readmission risk of patients and presents a comparison of prediction performance of commonly used methods.Methods: The data are extracted from eight Advocate Health Care hospitals. Index admissions are excluded from the cohort if they are observation, inpatient admissions for psychiatry, skilled nursing, hospice, rehabilitation, maternal and newborn visits, or if the patient expires during the index admission. Data are randomly and repeatedly divided into fitting and validating sets for cross validations. Approaches including LACE, STEPWISE logistic, LASSO logistic, and AdaBoost, are compared with sample sizes varying from 2,500 to 80,000.Results: Our results confirm that LACE has moderate discrimination power with the area under receiver operating characteristic curve (AUC) around 0.65-0.66, which can be improved to 0.73-0.74 when additional variables from EMR are considered. These variables include Inpatient in the last six months, Number of emergency room visits or inpatients in the last year, Braden score, Polypharmacy, Employment status, Discharge disposition, Albumin level, and medical condition variables such as Leukemia, Malignancy, Renal failure with hemodialysis, History of alcohol substance abuse, Dementia and Trauma. When sample size is small (≤5000), LASSO is the best; when sample size is large (≥20,000), the predictive performance is similar. The STEPWISE method has a slightly lower AUC (0.734) comparing to LASSO (0.737) and AdaBoost (0.737). More than one half of the selected predictors can be false positives when using a single method and a single division of fitting/validating data.Conclusions: True predictors can be identified by repeatedly dividing data into fitting/validating subsets and referring the final model based on summarizing results. LASSO is a better alternative to the STEPWISE logistic regression, especially when sample size is not large. The evidence for adequate sample size can be explored by fitting models on gradually reduced samples. Our model comparison strategy is not only good for 30-day all-cause non-elective readmission risk predictions, but also applicable to other types of predictive models in clinical studies. [ABSTRACT FROM AUTHOR]

Objective: Melanoma is on the rise, especially in Caucasian populations exposed to high ultraviolet radiation such as in Australia. This paper examined the psychological components facilitating change in skin cancer prevention or early detection behaviours following a text message intervention.Methods: The Queensland-based participants were 18 to 42 years old, from the Healthy Text study (N = 546). Overall, 512 (94%) participants completed the 12-month follow-up questionnaires. Following the social cognitive model, potential mediators of skin self-examination (SSE) and sun protection behaviour change were examined using stepwise logistic regression models.Results: At 12-month follow-up, odds of performing an SSE in the past 12 months were mediated by baseline confidence in finding time to check skin (an outcome expectation), with a change in odds ratio of 11.9% in the SSE group versus the control group when including the mediator. Odds of greater than average sun protective habits index at 12-month follow-up were mediated by (a) an attempt to get a suntan at baseline (an outcome expectation) and (b) baseline sun protective habits index, with a change in odds ratio of 10.0% and 11.8%, respectively in the SSE group versus the control group.Conclusions: Few of the suspected mediation pathways were confirmed with the exception of outcome expectations and past behaviours. Future intervention programmes could use alternative theoretical models to elucidate how improvements in health behaviours can optimally be facilitated. [ABSTRACT FROM AUTHOR]

Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare".Background: Hospital readmissions raise healthcare costs and cause significant distress to providers and patients. It is, therefore, of great interest to healthcare organizations to predict what patients are at risk to be readmitted to their hospitals. However, current logistic regression based risk prediction models have limited prediction power when applied to hospital administrative data. Meanwhile, although decision trees and random forests have been applied, they tend to be too complex to understand among the hospital practitioners.Objectives: Explore the use of conditional logistic regression to increase the prediction accuracy.Methods: We analyzed an HCUP statewide inpatient discharge record dataset, which includes patient demographics, clinical and care utilization data from California. We extracted records of heart failure Medicare beneficiaries who had inpatient experience during an 11-month period. We corrected the data imbalance issue with under-sampling. In our study, we first applied standard logistic regression and decision tree to obtain influential variables and derive practically meaning decision rules. We then stratified the original data set accordingly and applied logistic regression on each data stratum. We further explored the effect of interacting variables in the logistic regression modeling. We conducted cross validation to assess the overall prediction performance of conditional logistic regression (CLR) and compared it with standard classification models.Results: The developed CLR models outperformed several standard classification models (e.g., straightforward logistic regression, stepwise logistic regression, random forest, support vector machine). For example, the best CLR model improved the classification accuracy by nearly 20% over the straightforward logistic regression model. Furthermore, the developed CLR models tend to achieve better sensitivity of more than 10% over the standard classification models, which can be translated to correct labeling of additional 400 - 500 readmissions for heart failure patients in the state of California over a year. Lastly, several key predictor identified from the HCUP data include the disposition location from discharge, the number of chronic conditions, and the number of acute procedures.Conclusions: It would be beneficial to apply simple decision rules obtained from the decision tree in an ad-hoc manner to guide the cohort stratification. It could be potentially beneficial to explore the effect of pairwise interactions between influential predictors when building the logistic regression models for different data strata. Judicious use of the ad-hoc CLR models developed offers insights into future development of prediction models for hospital readmissions, which can lead to better intuition in identifying high-risk patients and developing effective post-discharge care strategies. Lastly, this paper is expected to raise the awareness of collecting data on additional markers and developing necessary database infrastructure for larger-scale exploratory studies on readmission risk prediction. [ABSTRACT FROM AUTHOR]

Background: Metabolic risk factors, low cognitive function and history of depression are known risk factors for future depressive episodes. This paper aims to evaluate the potential interactions between these factors on the risk of a major depressive episodes in middle-age.Methods: Baseline and follow-up data from a population-based study of Quebec, Canada were used. The sample consisted of 1788 adults between 40 and 69 years of age without diabetes. Cognitive function and metabolic risk factors were assessed at baseline. Three cognitive domains were assessed: processing speed, episodic memory and executive function. History of depression was assessed five years later by a clinical interview. Logistic regression analysis was conducted to evaluate interactions between individual metabolic factors, low cognitive function, and depression history.Results: Participants with a comorbidity of at least one metabolic factor, history of depression and low cognitive function had the highest risk of experiencing a depressive episode in middle age. The highest risk was observed in individuals with abdominal obesity, low cognitive function, and a history of depression (OR= 8.66, 95% CI 3.83-19.59). The risks for those with abdominal obesity only, depression history only, and low cognitive function were 1.20 (95%CI 0.71-2.02), 3.10 (95%CI 1.81-5.24), and 1.39 (95%CI 0.72-2.67), respectively.Limitations: Depression was only assessed at follow-up.Conclusion: Metabolic risk factors comorbid with low cognitive function in middle-aged individuals with a history of depression were associated with an increased risk of a future depressive episode. This study highlights the importance of screening for metabolic and cognitive comorbidities in patients with a history of depression. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores education-, income- and occupational class-related inequalities in risky health behaviours including into models all three factors together as well as their interactions, which has not been undertaken by previous studies analysing socioeconomic status (SES) related differences in risky health behaviours.Methods: Our data source is the special module "Social Inequalities in Health" included into the European Social Survey Round 7 (ESS R7) and conducted in 20 European countries. We run nine separate multilevel binomial logistic regression analyses for all the risky health behaviours with all our independent and control variables including country as the second level random intercept. Into all the models we also included interaction terms to consider possible moderating effects of separate independent variables.Results: Education and income emerged as factors most consistently related to risky health behaviours, but occupational class differences were also found to be significant: eating vegetables or salad less than once a day and being daily smoker is positively related to lower SES as measured by all three indicators; eating fruits less than once a day is related to lower income and occupational class, while drinking alcohol at least several times a week is positively related to higher education and higher income; being physically active for less than 3 days per week is positively related to lower education; patterns of heavy smoking and binge drinking are inconsistently related to SES variables. We also found considerable regional variation, especially in fruit and vegetable consumption, being physically active and alcohol consumption patterns.Conclusions: Without careful theoretical consideration linking SES and risky health behaviours, education, income and occupational class cannot substitute each other in the study of SES-related differences of health behaviours, as assumed in the larger part of research on the subject. [ABSTRACT FROM AUTHOR]

Background: Postpartum anxiety (PPA) and postpartum depression (PPD) are associated with immediate and long-term health risks for both mothers and babies. The purpose of this paper was to evaluate relationships between sociodemographic, perinatal variables, and PPA and PPD symptoms of parturients 6 weeks postpartum.Methods: A cross-sectional survey with 1204 women who had a healthy and term birth in a baby-friendly hospital, Shanghai, China. PPA and PPD symptoms were measured by using the Self-Rating Anxiety Scale (SAS) and the Edinburgh Postnatal Depression Scale (EPDS).Results: The mean score of SAS and EPDS was 40.79 ± 8.48 and 8.18 ± 5.80, respectively. The estimated prevalence of PPA and PPD symptoms was 15.2% and 23.2%, respectively. Multivariable logistic regression analysis showed that the presence of fatigue and PPD symptoms were risk factors for PPA symptoms, whereas having support from family and being satisfied with labor experience were protective factors. In terms of PPD symptoms, its risk factors included smoking before pregnancy, maternal separation from baby, fatigue, encountering difficulties in breastfeeding, and the presence of PPA symptoms. In contrast, the protective factors for PPD symptoms were having support from family and having support from colleagues or friends.Limitations: Convenience sampling and voluntary participation may have led to a selection bias.Conclusion: PPA and PPD symptoms occur commonly among parturients in Shanghai, China. The findings from this research provide a better understanding of factors associated with PPA and PPD symptoms and will help guide personalized approaches to the management of postpartum anxiety and depression. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral skills of people living with HIV/AIDS (PLWHA) in consuming antiretrovirals (ARV) can reduce their morbidity and mortality; however, behavioral skills in ARV therapy are still low. Motivational factor is considered to have an effect on behavior skills. The purpose of this study was to explain the influence of motivational factors on behavioral skills of PLWHA. Material and methods: Descriptive correlational cross-sectional approach was applied as study design. One hundred respondents, who met inclusion criteria were selected through simple random sampling method, and were requested to fill out a questionnaire. Results were analyzed using descriptive analysis and logistic regression test, with a significance value of p = 0.05. Results: In general, there is a significant effect of personal motivation (p = 0.000) and social motivation (p = 0.016) on behavioral skills. Personal motivation is based on attitudes towards preventive behavior, perceptions of disease susceptibility, benefits, and barriers to preventive behavior, while social motivation is a support provided by family and/ or friends as an assistance during treatment. Conclusions: Behavioral skills of PLWHA consisting of taking medication skills and managing information, are influenced by personal and social motivation. Support from family and friends is an important value that can play a role in achieving optimal motivation for treatment. [ABSTRACT FROM AUTHOR]

Background: The Weight-Specific Adolescent Instrument for Economic Evaluation (WAItE) is a new condition-specific patient reported outcome measure that incorporates the views of adolescents in assessing the impact of above healthy weight status on key aspects of their lives. Presently it is not possible to use the WAItE to calculate quality adjusted life years (QALYs) for cost-utility analysis (CUA), given that utility scores are not available for health states described by the WAItE.Objective: This paper examines different regression models for estimating Child Health Utility 9 Dimension (CHU-9D) utility scores from the WAItE for the purpose of calculating QALYs to inform CUA.Methods: The WAItE and CHU-9D were completed by a sample of 975 adolescents. Nine regression models were estimated: ordinary least squares, Tobit, censored least absolute deviations, two-part, generalized linear model, robust MM-estimator, beta-binomial, finite mixture models, and ordered logistic regression. The mean absolute error (MAE) and mean squared error (MSE) were used to assess the predictive ability of the models.Results: The robust MM-estimator with stepwise-selected WAItE item scores as explanatory variables had the best predictive accuracy.Conclusions: Condition-specific tools have been shown to be more sensitive to changes that are important to the population for which they have been developed for. The mapping algorithm developed in this study facilitates the estimation of health-state utilities necessary for undertaking CUA within clinical studies that have only collected the WAItE. [ABSTRACT FROM AUTHOR]

Background: Visitation restrictions due to COVID‐19 kept parents from being with their children who were hospitalized in the PICU and from meeting with professional staff. Aim: This study examined the moderating effect of COVID‐19‐induced visitation restrictions on the relationship between stress and post‐traumatic stress disorder in parents of children admitted to the paediatric intensive care unit. Study Design: We conducted a descriptive, exploratory study involving 93 parents of children hospitalized in the paediatric intensive care unit using the Korean version of the Parental Stressor Scale: Paediatric Intensive Care Unit and the Revised Impact of Events Scale. Descriptive, Pearson's correlation, and logistic regression analyses were used to investigate the data. Self‐reported survey questionnaires were provided for parents to complete in a separate area of the outpatient clinic when they visited for follow‐up care after their children were discharged from the paediatric intensive care unit. Results: Mothers showed significantly higher post‐traumatic stress disorder scores than fathers. The relationship between all the sub‐domains of perceived stress and post‐traumatic stress disorder was statistically significant. Visitation restrictions because of the COVID‐19 pandemic had significant moderating effects on the relationship between perceived parental stress and post‐traumatic stress disorder. Moreover, the moderating effects of COVID‐19 were exhibited when the two sub‐domains—hyperarousal and intrusion—were investigated. Conclusions: Paediatric intensive care unit visitation may be an important intervention for parental post‐traumatic stress disorder. Parental visitation should be enabled, and alternative interventions should be developed in situations where visitation is prohibited. Relevance to Clinical Practice: It is necessary to develop and apply various and effective alternatives visitation that can prepare hospitals for visiting restrictions during pandemic situations which could emerge in the future. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to assess the prevalence of orthostatic hypotension (OH) in a sample of late life depression (LLD) patients and to determine the validity of a standardized questionnaire, the Orthostatic Hypotension Questionnaire (OHQ). Secondarily, we wished to assess variables associated with OH.Methods: We conducted a cross-sectional study on 82 consecutive geriatric outpatients presenting with LLD. OH was defined as a fall in systolic blood pressure of greater than 20 mm Hg and/or 10 mm Hg on diastolic blood pressure on an orthostatic stress test from sitting to standing. Logistic regressions were used to identify factors associated with OH.Results: The prevalence of OH as measured on the orthostatic stress test and on the OHQ was 28% and 57%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the OHQ were 69.6% (95% CI 47%-87%), 47.5% (95%CI 34%-61%), 0.54 (95% CI: 0.43-0.64), 34% (95%CI 21%-49%), and 80% (95%CI 63%-92%), respectively. Females were more likely to have OH (OR: 3.96, 95%CI 1.06-14.89, P = .041), and those married or in a common-law relationship were less likely to have OH (OR: 0.25, 95% CI 0.08-0.72, P = .011).Conclusions: OH is common in patients with LLD conferring them a risk of gait instability and falls. Females had a higher risk of having OH while participants who were married or in a common-law relationship were less likely to have OH. Although the OHQ is a quick to administer paper-based screening test, it did not show adequate diagnostic accuracy in patients with LLD seen in a routine psychiatry clinic. [ABSTRACT FROM AUTHOR]

Objectives: Suicide among nursing home residents is a growing public health concern, currently lacking in empirical research. This study aims to describe the frequency and nature of suicide among nursing home residents in Australia.Methods: This research comprised a national population-based retrospective analysis of suicide deaths among nursing home residents in Australia reported to the Coroner between July 2000 and December 2013. Cases were identified using the National Coronial Information System, and data collected from paper-based coroners' records on individual, incident, and organizational factors, as well as details of the medico-legal death investigation. Data analysis comprised univariate and bivariate descriptive statistical techniques; ecological analysis of incidence rates using population denominators; and comparison of age and sex of suicide cases to deaths from other causes using logistic regression.Results: The study identified 141 suicides among nursing home residents, occurring at a rate of 0.02 deaths per 100 000 resident bed days. The ratio of deaths from suicide to deaths from any other cause was higher in males than females (OR = 3.56, 95%CI = 2.48-5.12, P = <0.001). Over half of the residents who died from suicide had a diagnosis of depression (n = 93, 66.0%) and had resided in the nursing home for less than 12 months (n = 71, 50.3%). Common major life stressors identified in suicide cases included the following: health deterioration (n = 112, 79.4%); isolation and loneliness (n = 60, 42.6%); and maladjustment to nursing home life (n = 42, 29.8%).Conclusions: This research provides a foundational understanding of suicide among nursing home residents in Australia and contributes important new information to the international knowledge base. [ABSTRACT FROM AUTHOR]

Background: Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). Objectives: To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. Design: Observational, cross‐sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day‐care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. Methods: Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. Results: Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0–8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). Conclusions: Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. Patient contribution Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life. [ABSTRACT FROM AUTHOR]

Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 vaccination uptake of a sample of patient-facing healthcare workers (HCWs). A web-based questionnaire—measuring beliefs about vaccinations (the BMQ), perceptions of COVID-19 (the BIPQ), vaccine hesitancy, and vaccine uptake—was targeted to HCWs via social media platforms between May–July 2022. Open text responses allowed participants to provide explanations for any delay in vaccine uptake. A total of 91 participants completed the questionnaire. Most respondents (77.1%, n = 64) had received three doses of the COVID-19 vaccination, and vaccination uptake (number of doses received) was predicted by Vaccine Concerns, Vaccine Hesitancy, and their Necessity–Concerns Differential score. Vaccine Hesitancy was predicted by Necessity, Concerns, and Overuse scores, as well as Necessity–Concerns Differential scores. Delay in Vaccine Uptake could only be predicted for Dose 3 (Booster). Qualitative data revealed that hesitant respondents were "unable to take time off work" for vaccination and that some had concerns over vaccine safety. In conclusion, illness and medication beliefs have potential value in predicting vaccine hesitancy and uptake in healthcare workers. Interventions to improve vaccination uptake in this population should address concerns about vaccine safety and releasing staff for vaccination booster appointments should be prioritised. Future research should further investigate the relationship between illness and medication beliefs and COVID-19 vaccine uptake in a larger sample of healthcare workers. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic disproportionately impacted Latinos across the United States though data on emerging immigrant communities is lacking. The purpose of this study is to better understand how Latino immigrants were impacted by the COVID-19 pandemic, allowing a community health clinic in Charlotte, North Carolina to quickly respond to their needs. Design/methodology/approach: A mixed method, rapid appraisal using community-based participatory research approaches conducted in February to April 2021 by a team of bilingual researchers. Project consisted of a Spanish, electronic survey distributed through community leaders and in-person interviews conducted in Spanish at COVID-19 vaccine clinics. SPSS Version 26 was used for quantitative analysis. Ordinal and binary logistic regression tests were performed to assess the associations among several outcome and four predictor variables: documentation status, status of health insurance, level of trust in the vaccine and place of birth. Qualitative analysis used rapid appraisal and grounded theory approaches. Findings: Latino immigrants experienced job and income loss, resulting in difficulty paying for food, housing and health care. Participants experienced emotional and financial stress and isolation from family. Undocumented immigrants were more likely to experience detrimental impacts than documented immigrants. Most wanted the vaccine but felt barriers like trust and insurance may prevent them. Research limitations/implications: Findings from this study are locally relevant to Latino immigrants living in the Charlotte area of North Carolina and findings may not be generalizable to other Latinos. Participants were recruited through faith networks and those who are not connected may not be represented. In addition, interview participants were sampled during vaccination clinics and likely had positive views of the vaccine. Practical implications: As a direct result of this project, community health clinic (CHC) held vaccination clinics to instill more confidence in the vaccination process. Spanish-speaking staff were available to assist with paperwork and answer questions onsite. The importance of familismo in decision-making and the reported presence of misinformation about the vaccine prompted CHC to continue providing accurate information about the vaccine in Spanish, and to strategize marketing materials to reflect a family-centric approach to better appeal to Latinos. Findings were used to obtain funding for expansion of clinical and behavioral health services in the community through mobile units, increasing accessibility for Latino immigrants. Originality/value: To the best of the authors' knowledge, this was the first study to examine the effects of the pandemic on a growing and disproportionately underrepresented group in an emerging immigrant state. Findings informed culturally competent COVID-19 vaccine clinics, marketing strategies and the expansion of medical and behavioral health services for a local community clinic. [ABSTRACT FROM AUTHOR]