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The model moss species Physcomitrium patens has long been used for studying divergence of land plants spanning from bryophytes to angiosperms. In addition to its phylogenetic relationships, the limited number of differential tissues, and comparable morphology to the earliest embryophytes provide a system to represent basic plant architecture. Based on plant-fungal interactions today, it is hypothesized these kingdoms have a long-standing relationship, predating plant terrestrialization. Mortierellaceae have origins diverging from other land fungi paralleling bryophyte divergence, are related to arbuscular mycorrhizal fungi but are free-living, observed to interact with plants, and can be found in moss microbiomes globally. Due to their parallel origins, we assess here how two Mortierellaceae species, Linnemannia elongata and Benniella erionia, interact with P. patens in coculture. We also assess how Mollicute-related or Burkholderia-related endobacterial symbionts (MRE or BRE) of these fungi impact plant response. Coculture interactions are investigated through high-throughput phenomics, microscopy, RNA-sequencing, differential expression profiling, gene ontology enrichment, and comparisons among 99 other P. patens transcriptomic studies. Here we present new high-throughput approaches for measuring P. patens growth, identify novel expression of over 800 genes that are not expressed on traditional agar media, identify subtle interactions between P. patens and Mortierellaceae, and observe changes to plant-fungal interactions dependent on whether MRE or BRE are present. Our study provides insights into how plants and fungal partners may have interacted based on their communications observed today as well as identifying L. elongata and B. erionia as modern fungal endophytes with P. patens.

Background: Early marriage and motherhood have long been prevalent in India, with 44.5% of women aged 20–24 reporting marriage before 18 in NFHS 3 (2005–2006), dropping to 26.8% in NFHS 4 (2015–2016). Early motherhood has also seen a significant decline, with first births by age 18 decreasing from 34.3% in NFHS I to 8.2% in NFHS V. Despite these improvements, significant regional disparities persist due to social, normative, and legal factors. This study investigates the spatial heterogeneity of early marriage and motherhood across Indian districts, offering a multilevel analysis that reveals critical local variations often obscured at broader levels. Understanding these patterns is crucial for targeted policy interventions and addressing the root causes of early marriage and motherhood. Methods: Utilizing data from the fifth round of National Family Health Survey, this study employs multilevel logistic regression and geospatial analysis to assess the determinants and spatial distribution of early marriage and early motherhood among ever-married women in India. The analysis incorporates individual, household, and community-level variables, complemented by spatial analysis techniques, including Empirical Bayes Bivariate Moran's I values and LISA cluster maps, to identify regional patterns and hotspots. Results: This study revealed that educational attainment emerged as a critical determinant, with uneducated women significantly more likely to marry early. Socioeconomic factors, such as poverty and limited mass media exposure, also heightened the risk of early marriage and motherhood. Caste and religion were significantly associated with these events, with marginalized groups facing higher prevalence. Spatial analysis revealed significant geographic disparities, with central and eastern regions showing higher concentrations of early marriage and motherhood. District-level characteristics and the influence of neighboring districts were also significant, highlighting the importance of localized interventions. Conclusions: The findings underscore the critical role of education, economic empowerment, and media literacy in mitigating early marriage and motherhood risks. The study calls for multi-sectoral interventions in geographical hotspots to break the cycle of early family formation and promote reproductive health. Policies enhancing educational opportunities, addressing economic disadvantages, and considering district-specific factors are essential. Comprehensive strategies are necessary to empower women, foster reproductive health, and address the multifaceted nature of early marriage and motherhood in India. [ABSTRACT FROM AUTHOR]

Introduction: Human rights violations and violence against women are serious public health issues that have numerous detrimental repercussions on one's physical, emotional, sexual, and reproductive health. According to studies, women's perceptions and traits of violence are highly predictive of their likelihood of seeking help against violence. Even though intimate partner violence is a huge challenge nowadays in Africa, there is a low level of helpseeking behavior. Conducting this study at the East African level on help-seeking behavior can provide a clue for policy-makers. Therefore, this study aimed to reveal the prevalence of help-seeking behavior against intimate partner violence and determinant factors among women in East Africa. Method: Multilevel logistic regression analysis was carried out among East Africans using recent demographic and health survey data. A total of 7,387 participants aged 15 to 49 years were included in this study from East African countries. Individual- and community-level variables were considered to determine the associated factors with help-seeking behaviors against intimate partner violence with 95% CI and AOR. Results: The prevalence of help-seeking behavior against intimate partner violence among women was 38.07% with 95% CI (36.96%, 39.18%). Husbands drink alcohol [AOR = 1.46: 95% CI (1.33, 1.61)], women who have work [AOR = 1.33: 95% CI (1.19, 1.50)], and women with higher educational status [AOR = 1.36: 95% CI (1.16, 1.59)] were factors associated with help-seeking behavior against intimate partner violence. Conclusion: Approximately four out of 10 women were seeking help for intimate partner violence in East Africa. Husbands drinking alcohol, women's high educational status, and women having occupations were the factors that were associated with help-seeking behaviors against intimate partner violence. [ABSTRACT FROM AUTHOR]

Background: Regional variations in SARS-CoV-2 infection were observed in Canada and other countries. Studies have used multilevel analyses to examine how a context, such as a neighbourhood, can affect the SARS-CoV-2 infection rates of the people within it. However, few multilevel studies have quantified the magnitude of the general contextual effect (GCE) in SARS-CoV-2 infection rates and assessed how it may be associated with individual- and area-level characteristics. To address this gap, we will illustrate the application of the median rate ratio (MRR) in a multilevel Poisson analysis for quantifying the GCE in SARS-CoV-2 infection rates in Ontario, Canada. Methods: We conducted a population-based, two-level multilevel observational study where individuals were nested into regions (i.e., forward sortation areas [FSAs]). The study population included community-dwelling adults in Ontario, Canada, between March 1, 2020, and May 1, 2021. The model included seven individual-level variables (age, sex, asthma, diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease) and four FSA census-based variables (household size, household income, employment, and driving to work). The MRR is a median value of the rate ratios comparing two patients with identical characteristics randomly selected from two different regions ordered by rate. We examined the attenuation of the MRR after including individual-level and FSA census-based variables to assess their role in explaining the variation in rates between regions. Results: Of the 11 789 128 Ontario adult community-dwelling residents, 343 787 had at least one SARS-CoV-2 infection during the study period. After adjusting for individual-level and FSA census-based variables, the MRR was attenuated to 1.67 (39% reduction from unadjusted MRR). The strongest FSA census-based associations were household size (RR = 1.88, 95% CI: 1.71–1.97) and driving to work (RR = 0.68, 95% CI: 0.65–0.71). Conclusions: The individual- and area-level characteristics in our study accounted for approximately 40% of the between-region variation in SARS-CoV-2 infection rates measured by MRR in Ontario, Canada. These findings suggest that population-based policies to address social determinants of health that attenuate the MRR may reduce the observed between-region heterogeneity in SARS-CoV-2 infection rates. [ABSTRACT FROM AUTHOR]

Background Aims Sample Methods Results Conclusions Teachers' and parents' judgements of pupils' cognitive abilities influence pupils' daily learning opportunities and experiences, as these judgements affect the difficulty level of materials and instruction that teachers and parents provide. Over time, these judgements thus significantly shape educational success. However, pupils' characteristics, such as special educational needs (SEN), giftedness and socioeconomic status (SES) can influence and bias judgement accuracy.The present study aimed to investigate the relation between pupils' cognitive abilities and their teachers' and parents' judgements of these abilities, and potential bias in these judgements related to SEN, giftedness, and SES.The sample consisted of 1073 primary school pupils from grades 4–6 from 77 classes in 16 schools, and their teachers and parents.Teachers and parents rated their pupils' cognitive abilities. Pupils completed the COVAT‐3, a cognitive ability test.Multilevel analyses revealed that parent judgements were significantly higher than teacher judgements, but both informants' judgements were equally strong related to the cognitive ability scores. When controlling for pupils' assessed cognitive abilities, the results revealed small judgement biases: negative for SEN, positive for giftedness, and finally positive for high SES, but only in teachers.Overall, the results indicated that teachers and parents can judge their pupils abilities to a moderate degree, but they also hold judgement biases related to SEN, giftedness and SES. As these biases can affect pupils' opportunities, it is important to increase teachers' and parents' awareness. [ABSTRACT FROM AUTHOR]

Immigration in Africa has increased significantly in the past two decades, with a record number of people moving to Africa from other non-African countries as well as Africans moving to other countries on the continent. This increase in immigration requires an empirical exploration to understand how Africans feel and think about immigrants. Therefore, the purpose of the current study is to explore Africans' willingness to accept immigrants and foreign workers into their neighbourhoods. Analyzing large-scale data from more than 45,000 citizens across 34 countries, we examined individual- and country-level factors using a multilevel hierarchical linear approach. At the individual level, our analysis revealed that gender, religious affiliation, nationalism, fear of extremism, and security are important indicators of Africans' willingness to live with immigrants in their neighbourhoods. While we did not observe any effect for country-level economic variables, it was revealed that regional location was a vital consideration. These observations are helpful in understanding immigration in Africa as well as offering insights for policy development. [ABSTRACT FROM AUTHOR]

Growing care dependencies among the elderly due to population ageing in Europe challenge the labour-market participation of informal caregivers. While familiarized care regimes incentivize family caregiving by providing many cash-for-care-benefits, resulting in reduced labour supply, defamiliarized care regimes allocate more public spending to care infrastructure, alleviating the care responsibilities placed on family members. At the same time, care provision on the micro-level is distributed unequally across gender, age, and socioeconomic status. The question then emerges: Does the labour-market participation of informal caregivers vary between and within countries depending on the social-expenditure policy of welfare states? To answer this research question, a multilevel design was used, employing SHARE data and macro-indicators from OECD and Eurostat databases. The results reveal higher probabilities of labour-market participation for informal caregivers in general when social expenditures on formal care infrastructure are higher. However, labour-market participation was observed as being unequally distributed among the heterogeneous group of persons with and without caregiving duties. Women and individuals of lower socioeconomic status did not benefit from social expenditures in the same way as their counterparts, leading to lower levels of labour-market participation. [ABSTRACT FROM AUTHOR]

According to the healthy context paradox, the negative effects of peer victimization on core self-evaluation and depressive symptoms may vary in different levels of classroom-level victimization. However, previous studies have not investigated this issue using a longitudinal study design. The present study used a longitudinal design to examine why and under what conditions peer victimization was associated with adolescents' depressive symptoms. A large number of Chinese adolescents (Time 1: N = 4164, 50.3 % girls, M age = 12.89, SD age = 0.77; Time 2: N = 4001, 50.4 % girls, M age = 14.39, SD age = 0.75) were followed for one and a half years. Results showed that adolescents who were victimized in healthy contexts were more depressed and were at an increased risk of reporting more negative core self-evaluation than those victimized in unhealthy contexts. Moreover, core self-evaluation served as a mediator between peer victimization and depressive symptoms. This study included two waves of data, which limited the exploration of dynamic relationships between peer victimization and depressive symptoms. In addition, the self-reported data weakened the objectivity of the results. Finally, this study neglected the effects of different dimensions of peer victimization on depressive symptoms. The healthy context paradox of peer victimization is identified in China, highlighting that future interventions of peer victimization should pay more attention to specific remaining victimized and self-devaluing individuals in healthy contexts. • Core self-evaluation mediated the path between peer victimization and depression. • The negative influence of peer victimization differed in varied contexts. • Victimized adolescents displayed more depressive symptoms in healthier contexts. [ABSTRACT FROM AUTHOR]

Background: Sexual violence is a violation of women's rights, resulting in significant physical and psychological challenges and adverse reproductive health outcomes. Addressing these issues demands urgent public health interventions and support systems to mitigate the profound impact on individuals and societies. Thus, this study aimed to assess sexual violence against ever-married reproductive-age women in East Africa. Methods: Data retrieved from the recent Demographic and Health Survey (DHS) of East African countries was used, and a weighted sample of 40,740 ever-married reproductive-age women was included. To identify factors associated with sexual violence, multilevel mixed-effects models utilizing robust Poisson regression were applied. Akaike's and Bayesian information criteria, as well as deviance, were utilized to compare the models. In the multivariable regression model, adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were used to estimate the strength of association, with statistical significance set at a p-value < 0.05. Result: The pooled proportion of sexual violence among ever-married reproductive-age women in East Africa was 13.05% (95% CI: 12.74–13.36). The multivariable multilevel robust Poisson regression revealed that age at first cohabitation/marriage, having a primary educational level, being employed, residing in a female-headed household, having a husband/partner who drinks alcohol, and living in rural areas were positively associated with sexual violence. On the contrary, having secondary and higher educational levels and living in communities with a high proportion of uneducated women were negatively associated with sexual violence. Conclusion: Empowering girls and women through education reduces their vulnerability. Effective programs should prioritize workplace safety, financial independence, and robust legal protections against harassment and abuse. Raising awareness about the impact of alcohol abuse on relationships and the heightened risk of sexual violence is crucial. Moreover, enhancing access to support services and community networks, especially in rural areas, is essential for preventing and responding to sexual violence. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) in older adults with hypertension, diabetes, and hyperlipidemia increases the risks of cardiovascular diseases by 2.5 times and type 2 diabetes by five times. This study aimed to explain the multilevel relationships between health service system factors and individual-level factors influencing the control of MetS among older adults with NCDs receiving health care services at the NCD Plus clinics of hospitals in 1 year. Methods: This cross-sectional analytical study employed a systematic sampling method to have two groups of samples from 4 regions of Thailand: (1) 600 older adults having at least one diagnosis of NCDs receiving services at NCD Plus clinics and (2) 12 nurses in charge of the NCD Plus clinics at the hospitals providing services to these patient samples. Data were analyzed using multilevel logistic regression analysis. Results: 24% of older adults with NCDs can control MetS within one year. The MetS escalation from the initial assessment to 1-year follow-up varied according to the level of the hospitals. The transition from MetS to non-MetS status was rare in older adults with NCDs. Among health service system factors, complete screening for MetS influenced 1-year MetS control (95% CI [1.06, 2.92]). Older adults who were female and who had polypharmacy had a 66% (95% CI [0.22, 0.53]) and a 54% (95% CI [0.29 − 0.71]) reduction chance in MetS control. Older adults, who were ≥ 80 years old, labor-employed, healthy dietary patterns, and medication adherence increased chances of controlling MetS by 2.38 times (95% CI [1.12, 5.05]), 2.14 times (95% CI [1.03, 4.42]), 1.61 times (95% CI [1.06–2.46]), and 3.18 times (95% CI [1.51, 6.70]), respectively. Conclusions: NCDs Plus clinics that provide complete screening for MetS significantly enhance their effectiveness in reducing the proportion of older adults with MetS. In addition, the service should pay attention to older adults who are female, are retired, and take multiple medications to achieve MetS control better. The insights gained from such an analysis could be instrumental in pinpointing the resources necessary to bolster the efficacy of NCD Plus clinics. [ABSTRACT FROM AUTHOR]

Background: One of the reasons for the high rates of maternal and child morbidity and mortality in Sub-Saharan Africa is the rising proportion of teenage pregnancy. Preventing teenage pregnancy is critical to meeting sustainable development goal number three which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. To support the achievement of this goal, this study aimed to assess the spatial variation and factors associated with teenage pregnancy in Ethiopia using the recent nationally representative data. Methods: A secondary data analysis of the 2019 Ethiopian mini Demographic and Health Survey was conducted with a total weighted sample of 2211 (unweighted 2100) teenagers. The Bernoulli model was fitted using SaTScan version 9.6 to identify hotspot areas and the geospatial pattern and prediction of teenage pregnancy were mapped using ArcGIS version 10.7. A multilevel logistic regression model was fitted to identify factors associated with teenage pregnancy among teenagers. Adjusted OR with 95% CI was calculated and variables having a p-value less than 0.05 were statistically significant factors of teenage pregnancy. Result: The prevalence of teenage pregnancy among adolescents aged 15–19 years in Ethiopia was 12.89% (95% CI: 11.56%, 14.36%). The SaTScan analysis identified a primary cluster in the Gambella region of Ethiopia (log-likelihood ratio = 14.02, p < 0.001). A high prevalence of teenage pregnancy was observed in Somalia, Afar, Gambella, and the southern part of the Oromia regions of Ethiopia. Age, educational status- primary and secondary, religion- protestant, having television, contraceptive knowledge, household head-female, and region- Small peripheral were significant determinants of teenage pregnancy. Conclusion: The spatial distribution of teenage pregnancy in Ethiopia was nonrandom. Age, educational status, religion, having television, contraceptive knowledge, sex of household head, and region were significant determinants of teenage pregnancy. Therefore, concerned government bodies and other stakeholders should organize periodic educational campaigns and youth-friendly reproductive health services. Collaboration between healthcare professionals, and religious and community leaders could also form a strategic partnership that makes interventions more comprehensive, culturally sensitive, and effective in reducing teenage pregnancy. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Hospital‐level and international variations exist in the management strategies of bronchopulmonary dysplasia (BPD). However, studies evaluating hospital‐level variations in the respiratory outcomes of pre‐term infants associated with differing management strategies of BPD are lacking.Herein, we aimed to assess inter‐hospital variations in the respiratory outcomes of BPD in very pre‐term and extremely pre‐term infants.In this cohort study, the administrative claims and discharge summary data were extracted from 276 hospitals in Japan between April 2014 and March 2016. This study assessed neonates of a gestational age of 22–31 weeks old, who had been hospitalised for ≥7 days.The primary outcome was a BPD defined using any respiratory support, such as supplemental oxygen, high‐flow nasal cannula, CPAP, or mechanical ventilation at 36 weeks PMA. The median odds ratio (MOR) was calculated using a multilevel logistic regression model, including baseline characteristics, comorbidities, and treatment as covariates, to evaluate the inter‐hospital variation of the outcome.Of the 8143 neonates from across 132 hospitals, 53.7% were male, with a mean gestational age (standard deviation) of 28.0 (2.5)‐weeks‐old and birthweight of 1086 (386) g. Among these patients, BPD occurred in 2737 (33.6%). The MOR was 2.49, representing the median value of odds ratios when comparing two neonates with identical covariates from hospitals with high and low propensity for the outcomes to occur.Outcome variations in the BPD were observed among hospitals in Japan, even after adjusting for individual factors, including gestational age, birthweight, comorbidities, and treatments. Thus, in Japan, developing strategies is essential to decrease the BPD rates, while minimising inter‐hospital heterogeneity, to improve the healthcare quality for pre‐term neonates. [ABSTRACT FROM AUTHOR]

Introduction: Antenatal Care (ANC) services provide essential interventions that effectively educate pregnant women regarding safe delivery, healthy pregnancy and postpartum family planning. This study assessed the individual and community factors associated with ANC utilisation among women aged 15-49 in Indonesia. Materials and methods: Data from the Indonesia Demographic and Health Survey 2017 were used with a sample size of 15,021 women aged 15-49 who gave birth five years before the survey. Multilevel mixed-effect logistic regression analysis was fitted to analyse the predictors of ANC utilisation after potential confounders made adjustments. A 95% confidence interval with adjusted odds ratio was reported. The community factor is the place of residence. Results: About 90% of women visited ANC services at least four times. Birth order one or two (AOR=1.69, 95% CI:1.47-1.94), women aged 20-34 (AOR=2.41, 95% CI:1.82-3.20), and women aged 35 or older (AOR=2.68, 95% CI:1.97-3.65) were factors positively associated with ANC utilisation. Higher household status, including middle-class wealth women (AOR=1.62, 95% CI:1.38-1.90) and wealthy women (AOR=2.51, 95% CI:2.10-2.99) were four times more likely to use ANC services compared to their counterparts. Secondary (AOR=1.77, 95% CI:1.56-2.02) and higher (AOR=2.70, 95% CI:2.09-3.48) educated women were associated with increased odds of ANC utilisation than primary or less educated women. Conclusion: Maternal age, birth order, maternal education, and household wealth status significantly impact ANC service utilisation. Exploring women's and healthcare providers' views on ANC services, especially the quality of ANC services, may be beneficial for further studies. [ABSTRACT FROM AUTHOR]

Understanding and accepting climate change is crucial for individuals to adopt environmentally responsible behaviors and support political actions aimed at mitigating greenhouse gas emissions. In this cross-national comparative study, we explore factors associated with both climate change denial and awareness. We analyze data from the European Social Survey (Wave 8) and additional country-level data to identify factors associated with each of these outcomes. We measure awareness as a composite index that aggregates multiple indicators, including beliefs about the existence of climate change, concern, causes, impact, and responsibility. Our findings indicate that climate change denial and awareness do not exist on a single scale. Climate change awareness is strongly influenced by individuals' socio-demographic characteristics, values, and political orientation. Higher levels of awareness are found among those who are more receptive to educational efforts that promote scientific knowledge. In contrast, climate change denial is weakly related to socio-demographic and political factors and is more influenced by individuals' worldviews and detachment from mainstream society. European post-socialist countries demonstrate distinct attitudes towards environmental issues, with lower average climate change awareness and a higher proportion of individuals denying climate change. [ABSTRACT FROM AUTHOR]

Background: There have been limited studies with statistically sufficient sample sizes for assessment of suitable bone defect morphology for combination therapy with enamel matrix derivative (EMD) and bone grafting. The aim of this study was to investigate the appropriate feature of intrabony defects, such as bone defect angle (DA) and the containment by bony wall, for yielding the additional benefit of bone grafting in combination with periodontal regenerative therapy using EMD. Methods: Following periodontal regenerative therapy using EMD with or without autologous bone grafting, 282 intrabony defects of 177 participants were maintained for 3 years. Multilevel linear regression analysis was performed to evaluate the radiographic bony defect depth (RBD) reduction after adjusting for confounders. Results: The baseline parameters, except for the proportion of contained bony defects and tooth mobility, did not differ significantly between the groups with and without bone grafts. There was no significant difference in the improvement of clinical parameters between the groups. The 1‐ and 3‐year reduction of RBD showed significant inverse correlations with preoperative DA only in the group without bone graft. Furthermore, multivariate analysis showed a significant interaction between DA at baseline ≥40° and adjunctive bone grafting in the reduction of RBD, regardless of the number of bony walls. Conclusion: Adjunctive autologous bone grafting with enamel matrix derivative might be significantly beneficial for defect depth improvement in the case of DA at baseline ≥40°. [ABSTRACT FROM AUTHOR]

This paper answers how changes in social media activity influence customers to visit nationally known, brick-and-mortar retail stores. We consider seven measures of social media activity within a Social Impact Theory framework and test under what context does online chatter about a brand lead to higher foot traffic to those brand stores. We use hierarchical linear regression to account for the random effects of brand and store heterogeneity, which is superior to ordinary linear regression. Despite wide variation, when brand mentions increase by one standard deviation—either in likes or disagreement—then next-day foot traffic to stores of that brand will increase by 0.04 standard deviations (3–4%). This modest but meaningful effect, however, fully dissipates within 1 week. The weak cross-brand effects show that social media has distinct and larger influence on brands individually rather than universally. Our approach is novel due to (1) the large scale of data, (2) the breadth of analysis, (3) the multi-level specification, and (4) in estimating global elasticities between changes in electronic word-of-mouth (WoM) communication about brands and changes in store visits of those brands. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the results of and conditions for systemic large-scale school improvement. Through a multi-level analysis and a theoretical framework inspired by organization- and sensemaking-oriented theories, the study examines how a Swedish large-scale school improvement program, "Collaboration for the Best School Possible," played out in two Swedish municipalities. School actors at four organizational levels (at the National Education Agency, Local Education Authority, school leader, and teacher levels) in the two municipalities were interviewed. Because these school actors' sensemaking is linked to different aspects of the national largescale improvement program, the analysis shows a variation in the strengthening of the couplings between these organizational levels. The different nature of the couplings affected the implementation process and the results of the program. While the national large-scale program seemed to have contributed to an improvement in the schools' quality assurance systems and leadership practices, there were difficulties in maintaining general and sustainable changes in schools' instructional practices. The conclusion of the study was that, even if a national large-scale school improvement program is well designed and backed up with many resources, it must be perceived as legitimate among the local school actors at the different organizational levels. This points to the importance of managing the balance between top-down efforts and visions and local professional knowledge and experience. [ABSTRACT FROM AUTHOR]

Objective: This study sought to determine the risk-adjusted (controlled for patient characteristics) trend in pressure injury (PI) incidence in Switzerland. Method: A secondary data analysis was conducted. The data originated from the national PI quality measurement based on a multicentre cross-sectional design with repeated annual measurements. Descriptive statistics, a Cochran–Armitage trend test and logistic (multilevel) regression modelling were applied. Results: The analysis sample comprised 123,715 patients from 230 hospitals over 10 survey years (2011–2019 and 2022). The incidence of descriptive PI varied in Switzerland between 3.7% and 5.6% over the survey years. No linear trend could be found when patient characteristics were not considered. A non-linear trend was detected when controlling for patient characteristics and the time effect (repeated measurement). This was also reflected in the plotted risk-adjusted incidence, which revealed a decrease followed by a levelling off. When only considering the incidence of PIs rated category 2 and higher, there was also a non-linear decreasing trend when controlling for patient characteristics and time effects. If the incidence per survey year were estimated on the basis of patient characteristics, an increase in the incidence would have been expected. Conclusion: Although patients' risk of developing a PI increased between 2011–2022, the incidence of PIs in Switzerland first decreased and then levelled off. The results indicated that care quality in Swiss hospitals has improved regarding PIs. Nevertheless, in view of demographic trends and increasing staff shortages, it is important to continue to monitor PI incidence and to invest in PI prevention. [ABSTRACT FROM AUTHOR]

The research examined how different profiles of emotional intelligence (attention, clarity, and emotional regulation) act as protective or risk factors against cyber-victimization, taking into account individual and behavioral variables such as gender, sexual orientation, self-esteem, social anxiety, Internet risk, and parental control among high school students (11–18 years). A simulated sample was used, which was derived from an experimental sample of 1908 subjects (50.7% girls). Statistical equivalence was ensured between the two samples, and a multilevel analysis was conducted using the emotional intelligence profiles as the grouping variable. The results showed that the variability in emotional intelligence profiles predicted 96.7% of the variability of cyber-victimization. Factors that increase this likelihood include excessive interpersonal attention and low emotional regulation, higher social anxiety, offline victimization, older age, high parental supervision, and low self-esteem. In addition, being male and heterosexual is associated with a lower risk of cyber-victimization than being female and non-heterosexual. In general, it is suggested that protective measures against cyber-victimization should warn about the risk of Internet use, avoid paternalistic behavior by adults, and reduce rumination or excessive attention to the opinions of others. [ABSTRACT FROM AUTHOR]

This study adopts the multidimensional concept of workplace age-friendliness as reflecting the extent to which organizations maintain age-related organizational values, policies, practices, and climates that support the employability needs of older workers. Using responses from 1,893 employees working in 32 organizations from seven economic sectors in Israel who evaluated their organizations, we examine a novel conceptual model of the joint role of organizational ageism, inter-age contact, and organizational values in the formation of workplace age-friendliness. Multilevel multivariate analysis using a general linear mixed model demonstrated differential involvement of these variables in the formation of workplace age-friendliness: A significant negative association was found between organizational ageism and all dimensions of workplace age-friendliness, while inter-age contact was found to have a positive albeit a moderate association with part of its dimensions. Of the types of organizational cultures examined, a significant positive linkage was found between clan culture and all dimensions of workplace age-friendliness, whereas its associations with other cultural environments were less prominent or comprehensive. The theoretical and practical implications of these findings discussed here may serve policymakers and enrich both age-related organizational research and approaches with an evolving positive organizational perspective towards work in older age. [ABSTRACT FROM AUTHOR]

The Human Development Index (HDI) is a proxy for the social and economic level of countries, which is related to the health and well-being of older adults. This study aimed to examine the moderating effect of the HDI on the relationship between frailty and health-related quality of life among European older adults. Participants were 23,972 older adults (53.2% female, M = 74.2 years old, SD = 6.75 years old) from 24 European countries, joining wave 8 (2020) of the Survey of Health, Aging, and Retirement in Europe (SHARE). Multilevel modeling was used to analyze nested data. Significant differences in health-related quality of life among the several European Union countries were observed (intraclass correlation coefficient [ICC] = 0.18, LRT (1) = 5568.07, p < .001). The HDI has been shown to moderate the relationship between frailty and health-related quality of life among older adults, buffering the impact of frailty on the health-related quality of life. Since healthy aging is a priority for the European Union, policies mitigating the impact of HDI on the relationship between frailty and health-related quality of life should be implemented. [ABSTRACT FROM AUTHOR]

Background: Contraceptive usage in Ethiopia is significantly influenced by the decision-maker at the household level. Joint decision-making involving both women and their husbands/partners is considered ideal for improving contraceptive uptake among women and for managing health outcomes related to contraceptive side effects. However, there is a lack of substantial evidence regarding the prevalence and impact of joint decision-making on contraceptive use in Ethiopia. Therefore, the current study aimed to assess the magnitude of joint decision-making on contraceptive use and its determinant factors among married, contraceptive-using, reproductive-age women in Ethiopia. Methods: This study was conducted based on the Ethiopian Demographic and Health Survey (EDHS) 2016 data. A total weighted sample of 3,669 married, contraceptive-using, reproductive-age women were included in the study. Multilevel logistic regression was employed due to the hierarchical nature of the data. Variables with a p-value of ≤ 0.2 in the bivariate multilevel analysis were included in the multivariable multilevel analysis. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine the direction and strength of associations. Variables with a p-value of < 0.05 in the multivariable multilevel analysis were considered statistically significant for joint decision-making on contraceptive use. Results: The prevalence of joint decision-making on contraceptive use in Ethiopia was 78.81% [95% CI: 71.35-74.23%]. Several factors were found to be statistically significant in relation to joint decision-making on contraceptive use: Women educational level primary, secondary, and higher (Adjusted odds' ratio (AOR = 1.5; CI 1.2–1.9), (AOR = 1.9; CI 1.3–2.9), and (AOR = 2.1; CI 1.2–3.5) respectively, protestant in religion (AOR = 1.7; CI 1.7–2.5), wealth status rich (AOR = 1.4; CI 1.1–1.9), media exposure (AOR = 1.4; CI 1.1–1.9), and community poverty high (AOR = 0.6; CI 0.6–0.9). Conclusions: In Ethiopia, the majority of contraceptive users are married, reproductive-age women, and their decision to use contraceptives is typically made jointly with their husbands or partners. Factors positively associated with joint decision-making on contraceptive use include women's educational level (primary, secondary, and higher), being Protestant, having a higher wealth status, and media exposure. Conversely, women living in communities with high poverty levels are less likely to make joint decisions about contraceptive use. Health care providers, health care programmers and policy makers should be focused on these determinant factors to enhance joint decision-making in women's contraceptive use in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Despite the intended 50% reduction in anemia in women of reproductive age, this tendency has only worsened. Even though iron deficiency is the most prevalent cause of anemia, anemia and chronic illnesses like HIV are closely associated; in fact, 48.6% of people living with HIV who were 15 years of age or older had anemia. However, the burden of anemia among HIV-positive women in sub-Saharan African (SSA) countries is not well documented. Therefore, the goal of our research was to investigate anemia and the factors that are linked to it in SSA women who had HIV infections. Methods: A cross-sectional study was conducted using demographic and health survey datasets from 18 SSA countries. A total of 7823 weighted samples were included. STATA version 16 software was used for analysis. A multilevel logistic regression model was fitted. An adjusted odds ratio with a 95% CI and a p-value < 0.05 was used to declare significantly associated factors. Result: The overall prevalence of anemia was found to be 45.1% [95% CI: 43.97–46.18%]. Of those 5.05%, 37.97%, and 56.97% were severely, moderately, and mildly anemic, respectively. Education level of primary [AOR = 0.74, 95% CI: 0.62, 0.89], secondary [AOR = 0.81, 95% CI: 0.68, 0.98], and higher [AOR = 0.74, 95% CI: 0.55, 0.99], as well as current contraceptive use [AOR = 0.74, 95% CI: 0.63, 0.87] were negatively associated with anemia. While pregnancy [AOR = 1.51, 95% CI: 1.17, 1.94], breast feeding [AOR = 1.38, 95% CI: 1.17, 1.64], health insurance [AOR = 1.50, 95% CI: 1.25, 1.80], and menstruation within six weeks prior to data collection [AOR = 1.36, 95% CI: 1.20, 1.54] had a significant positive relation with anemia among HIV-infected women in SSA countries. Conclusion: Anemia is a serious public health problem among HIV-infected women in SSA countries. Pregnancy, breast feeding, health insurance, and menstruation within six weeks prior to data collection were significant risk factors. On the other education and current contraceptive use were significant protective factors for anemia among HIV-infected women in SSA countries. Therefore, strategies aimed at early identification of anemia may lead to an improvement in the health of HIV-infected women. [ABSTRACT FROM AUTHOR]

The bidirectional relationship between physical health (PH) and depressive symptoms (DS) remains unclear. Data were extracted from the Health and Retirement Study in the United States. PH was measured with a composite of chronic diseases, functional limitations and difficulties in basic and instrumental activities of daily living, and DS with a modified Center for Epidemiological Studies of Depression. Latent growth curve models (LGCM) were employed to examine how the change in PH or DS affected their mutual trajectories in later life. In addition, multilevel models were utilized. There were 6144 participants included, with an average age of 69.82 ± 6.85 years at baseline, of whom 3686 (59.99 %) were women. PH scores increased from 5.65 in 2010 to 7.72 in 2018, while depression scores increased from 1.14 to 1.31. LGCM results showed that the initial levels of PH and DS were associated (β = 0.558, P <.001), and the initial level of PH could predict the trajectory of DS (β = 0.089, P <.001). Likewise, the initial level of DS was also related to initial PH (β = −0.563, P <.001) but couldn't predict the trajectory of PH. Furthermore, the slopes of PH and DS were predicted bidirectionally by each other. Two-level logistic models further demonstrated the bidirectional association between PH and DS. There was a bidirectional association between physical health and depressive symptoms, which highlights the necessity of comprehensive health management for older adults with poor physical health or depression symptoms. • The study examineed the reciprocal association between physical health and depressive symptoms among older adults. • There is a bidirectional relationship between physical health and depressive symptoms. • Highlighting the importance of health management for older adults with poor physical health or depression symptoms. [ABSTRACT FROM AUTHOR]

Background: Many married women of reproductive age with husbands or partners are less cooperative in using contraceptives, often resulting in unintended pregnancies or secret contraceptive use. This private use of contraceptives causes women to suffer from side effects without proper support, and many women in Ethiopia die due to unintended pregnancies. However, the involvement of husbands or partners in the contraceptive decision-making process in Ethiopia is often neglected. There is also a lack of evidence regarding the determinants of husbands' or partners' decision-making power on contraceptive use in Ethiopia. Objective: This study aimed to assess the determinants of low involvement of husbands/partners in women's contraceptive use decision-making processes in Ethiopia. Methods: This study was based on Ethiopian Demographic and Health Survey data, collected from January 18 to June 27, 2016. Weighted samples of 3,669 reproductive-age women were included. Husbands'/partners' independent decision-making was measured by whether the husband/partner decided independently or alone about contraceptive use, categorized as "Yes" or "No". A multilevel logistic regression model was fitted, and ICC (Intra-class Correlation Coefficient), MOR (Median Odds Ratio), PCV (Proportion Change in Variance), and deviance were used to assess model fitness and comparison. Variables with a p-value of ≤ 0.2 in the bivariate analysis were considered candidates for multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval was used to determine both the direction and strength of the association, and a p-value of < 0.05 was used to declare statistical significance. Results: Husbands'/partners' independent decision-making in women's contraceptive use was found to be 5.41% [4.72-6.19%]. Significant factors associated with this included: Husbands/partners aged 31–59 years (Adjusted Odds Ratio (AOR) = 1.3; Confidence Interval (CI) 2.3–5.4) and over 59 years (AOR = 2.3; CI 1.2–4.3), Educational level of husbands/partners: primary education (AOR = 3.2; CI 2.9–4.3), secondary education (AOR = 3.9; CI 2.7–4.4), and higher education (AOR = 4.3; CI 2.8-5.0), Media exposure (AOR = 4.5; CI 2.2–5.4), History of pregnancy termination (AOR = 3.3; CI 2.6–4.1), Perception that distance to health facilities is not a significant problem (AOR = 3.0; CI 1.7–4.7) and Urban residency (AOR = 3.5; CI 1.6–4.2). Conclusions: In Ethiopia, the involvement of husbands/partners in the contraceptive use decision-making process is low. To increase their decision-making power, attention should be given to factors such as age, educational level, media exposure, history of pregnancy termination, distance to health facilities, and urban residency. [ABSTRACT FROM AUTHOR]

AbstractWe examine the impact of alcohol consumption on children’s educational achievement using the Vietnam Household Living Standard Surveys from 2012 to 2018. We find that alcohol consumption negatively impacts children’s schooling years and their likelihood of tertiary and higher education, while also positively affecting the lag in their school achievement. The impact is more severe in rural areas, while urban areas show no evidence. The influence of alcohol consumption varies among regions, with southern areas having a stronger effect on children’s education. Female students appear to be more affected than male students when their households consume the same amount of alcohol. [ABSTRACT FROM AUTHOR]

Bipolar disorder (BD) is a chronic psychiatric condition characterized by large episodic changes in mood and energy. Recently, BD has been proposed to be conceptualized as chronic cyclical mood instability, as opposed to the traditional view of alternating discrete episodes with stable periods in-between. Recognizing this mood instability may improve care and call for high-frequency measures coupled with advanced statistical models. To uncover empirically derived mood states, a multilevel hidden Markov model (HMM) was applied to 4-month ecological momentary assessment data in 20 patients with BD, yielding ∼9,820 assessments in total. Ecological momentary assessment data comprised self-report questionnaires (5 × daily) measuring manic and depressive constructs. Manic and depressive symptoms were also assessed weekly using the Altman Self-Rating Mania Scale and the Quick Inventory for Depressive Symptomatology Self-Report. Alignment between HMM-uncovered momentary mood states and weekly questionnaires was assessed with a multilevel linear model. HMM uncovered four mood states: neutral, elevated, mixed, and lowered, which aligned with weekly symptom scores. On average, patients remained <25 hr in one state. In almost half of the patients, mood instability was observed. Switching between mood states, three patterns were identified: patients switching predominantly between (a) neutral and lowered states, (b) neutral and elevated states, and (c) mixed, elevated, and lowered states. In all, elevated and lowered mood states were interspersed by mixed states. The results indicate that chronic mood instability is a key feature of BD, even in "relatively" euthymic periods. This should be considered in theoretical and clinical conceptualizations of the disorder. General Scientific Summary: The article investigates bipolar disorder with advanced statistical methods and adds evidence challenging the traditional view of alternating discrete mood episodes with stable periods in-between. Instead, it suggests that chronic mood instability may be a significant aspect of bipolar disorder and calls for high-frequency assessments using advanced statistical models to better understand and improve care for individuals with the disorder. [ABSTRACT FROM AUTHOR]

The current study aims to examine predictors of subjective health, including its relation with happiness, at the individual and family levels. For this purpose, we analyzed data collected from spouses representing each family (9,634 families, N = 19,268). A multilevel analysis was conducted to examine both individual- and family-level variables associated with subjective health evaluations. Individual-level variables were gender, age, education, employment, presence of chronic illness, smoking, alcohol use, and individual happiness. Family-level variables were socioeconomic status, number of children, household size, length of the marriage (in a year), presence of an elderly person who needs care in the household, presence of a disabled person who needs care in the household, and family happiness. The results showed that subjective health is enhanced by being man, younger, employed, highly educated, free from chronic illness, and experiencing greater levels of happiness at the individual level. In addition, poorer subjective health is associated with caring for an elderly or disabled family member and having a higher number of children in the household at the family level. However, individuals had better subjective health at the family level when socioeconomic status was higher, greater family happiness, and greater household size existed. The current study is important since research that simultaneously considers individual- and family-level happiness has been scarce in the literature. Thus, the findings would enhance the current understanding of the link between happiness and health. [ABSTRACT FROM AUTHOR]

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This study investigated multilevel models of homework time management involving Chinese middle school students. At the individual level, homework time management was positively associated with arranging the environment, monitoring motivation, time on homework, and teacher and parent autonomy support. Additionally, homework time management was positively related to teacher autonomy support at the class level. Taken together, this study extended previous research, by indicating that homework time management was positively related to teacher and parent autonomy support when accounting for other theoretically pertinent variables. Implications of these results are explored with respect to homework practices and potential avenues for future investigation. [ABSTRACT FROM AUTHOR]

Abstract Background Early marriage and motherhood have long been prevalent in India, with 44.5% of women aged 20–24 reporting marriage before 18 in NFHS 3 (2005–2006), dropping to 26.8% in NFHS 4 (2015–2016). Early motherhood has also seen a significant decline, with first births by age 18 decreasing from 34.3% in NFHS I to 8.2% in NFHS V. Despite these improvements, significant regional disparities persist due to social, normative, and legal factors. This study investigates the spatial heterogeneity of early marriage and motherhood across Indian districts, offering a multilevel analysis that reveals critical local variations often obscured at broader levels. Understanding these patterns is crucial for targeted policy interventions and addressing the root causes of early marriage and motherhood. Methods Utilizing data from the fifth round of National Family Health Survey, this study employs multilevel logistic regression and geospatial analysis to assess the determinants and spatial distribution of early marriage and early motherhood among ever-married women in India. The analysis incorporates individual, household, and community-level variables, complemented by spatial analysis techniques, including Empirical Bayes Bivariate Moran’s I values and LISA cluster maps, to identify regional patterns and hotspots. Results This study revealed that educational attainment emerged as a critical determinant, with uneducated women significantly more likely to marry early. Socioeconomic factors, such as poverty and limited mass media exposure, also heightened the risk of early marriage and motherhood. Caste and religion were significantly associated with these events, with marginalized groups facing higher prevalence. Spatial analysis revealed significant geographic disparities, with central and eastern regions showing higher concentrations of early marriage and motherhood. District-level characteristics and the influence of neighboring districts were also significant, highlighting the importance of localized interventions. Conclusions The findings underscore the critical role of education, economic empowerment, and media literacy in mitigating early marriage and motherhood risks. The study calls for multi-sectoral interventions in geographical hotspots to break the cycle of early family formation and promote reproductive health. Policies enhancing educational opportunities, addressing economic disadvantages, and considering district-specific factors are essential. Comprehensive strategies are necessary to empower women, foster reproductive health, and address the multifaceted nature of early marriage and motherhood in India.

Abstract Background Regional variations in SARS-CoV-2 infection were observed in Canada and other countries. Studies have used multilevel analyses to examine how a context, such as a neighbourhood, can affect the SARS-CoV-2 infection rates of the people within it. However, few multilevel studies have quantified the magnitude of the general contextual effect (GCE) in SARS-CoV-2 infection rates and assessed how it may be associated with individual- and area-level characteristics. To address this gap, we will illustrate the application of the median rate ratio (MRR) in a multilevel Poisson analysis for quantifying the GCE in SARS-CoV-2 infection rates in Ontario, Canada. Methods We conducted a population-based, two-level multilevel observational study where individuals were nested into regions (i.e., forward sortation areas [FSAs]). The study population included community-dwelling adults in Ontario, Canada, between March 1, 2020, and May 1, 2021. The model included seven individual-level variables (age, sex, asthma, diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease) and four FSA census-based variables (household size, household income, employment, and driving to work). The MRR is a median value of the rate ratios comparing two patients with identical characteristics randomly selected from two different regions ordered by rate. We examined the attenuation of the MRR after including individual-level and FSA census-based variables to assess their role in explaining the variation in rates between regions. Results Of the 11 789 128 Ontario adult community-dwelling residents, 343 787 had at least one SARS-CoV-2 infection during the study period. After adjusting for individual-level and FSA census-based variables, the MRR was attenuated to 1.67 (39% reduction from unadjusted MRR). The strongest FSA census-based associations were household size (RR = 1.88, 95% CI: 1.71–1.97) and driving to work (RR = 0.68, 95% CI: 0.65–0.71). Conclusions The individual- and area-level characteristics in our study accounted for approximately 40% of the between-region variation in SARS-CoV-2 infection rates measured by MRR in Ontario, Canada. These findings suggest that population-based policies to address social determinants of health that attenuate the MRR may reduce the observed between-region heterogeneity in SARS-CoV-2 infection rates.

Purpose : The authors aimed to identify the factors affecting interhospital transfer (“transfer”) of severe pediatric patients who visited to an emergency department (ED). Methods : Using the Korean National ED Information System, we analyzed high-acuity patients aged 18 years or younger who visited EDs of local or regional emergency centers nationwide. The high acuity was defined as a Korean Triage and Acuity Scale 1-2. To investigate the factors associated with transfer, a multilevel modeling was selected, examining independent variables at both individual- and hospital-levels with transfer as a dependent variable. Results : A model consisting of variables at individual- and hospital-levels showed the factors as follows: mode of arrival(self-transport: odds ratio, 0.48 [95% confidence interval, 0.38-0.61]; other ambulances: 0.41 [0.24-0.71]; compared with firehouse ambulance), visit at 18:00-07:59 (0.75 [0.64-0.88]), intentional injury (1.59 [1.03-2.47]; compared with non-injury), decreased level of consciousness (drowsy: 1.94 [1.33-2.84]; stupor: 4.08 [2.99-5.57]; coma: 1.81 [1.26-2.60]; compared with alert), severe illness diagnosis (1.49 [1.12-1.98]), the number of all beds in EDs (1.02 [1.01-1.04]), and acceptance for treatment (0.92 [0.87-0.98]; with increment of 1%). Conclusion : This study confirms that both individual-level and hospital-level factors affect the transfer risk of severe pediatric patients in EDs. The study suggests the needs for direct transportation to specialized pediatric treatment facilities, and concentrated support for the pediatric emergency medical centers and pediatric trauma centers.

Abstract Background Sexual violence is a violation of women’s rights, resulting in significant physical and psychological challenges and adverse reproductive health outcomes. Addressing these issues demands urgent public health interventions and support systems to mitigate the profound impact on individuals and societies. Thus, this study aimed to assess sexual violence against ever-married reproductive-age women in East Africa. Methods Data retrieved from the recent Demographic and Health Survey (DHS) of East African countries was used, and a weighted sample of 40,740 ever-married reproductive-age women was included. To identify factors associated with sexual violence, multilevel mixed-effects models utilizing robust Poisson regression were applied. Akaike’s and Bayesian information criteria, as well as deviance, were utilized to compare the models. In the multivariable regression model, adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were used to estimate the strength of association, with statistical significance set at a p-value

Abstract Background One of the reasons for the high rates of maternal and child morbidity and mortality in Sub-Saharan Africa is the rising proportion of teenage pregnancy. Preventing teenage pregnancy is critical to meeting sustainable development goal number three which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. To support the achievement of this goal, this study aimed to assess the spatial variation and factors associated with teenage pregnancy in Ethiopia using the recent nationally representative data. Methods A secondary data analysis of the 2019 Ethiopian mini Demographic and Health Survey was conducted with a total weighted sample of 2211 (unweighted 2100) teenagers. The Bernoulli model was fitted using SaTScan version 9.6 to identify hotspot areas and the geospatial pattern and prediction of teenage pregnancy were mapped using ArcGIS version 10.7. A multilevel logistic regression model was fitted to identify factors associated with teenage pregnancy among teenagers. Adjusted OR with 95% CI was calculated and variables having a p-value less than 0.05 were statistically significant factors of teenage pregnancy. Result The prevalence of teenage pregnancy among adolescents aged 15–19 years in Ethiopia was 12.89% (95% CI: 11.56%, 14.36%). The SaTScan analysis identified a primary cluster in the Gambella region of Ethiopia (log-likelihood ratio = 14.02, p

Abstract Background Worldwide, sexual and reproductive health remains a prominent public health concern for women of reproductive age. Modern contraceptive methods play a crucial role in enabling individuals and families to regulate fertility, thereby reducing unintended pregnancies, abortions, pregnancy-related complications, and mortality. Due to the scarcity of reliable and current data regarding the factors affecting the adoption of modern contraceptives among women of reproductive age at the national level in Ghana, this research aimed to explore the determinants of modern contraceptive usage among reproductive age women. Methods The study analyzed data from the 2022 Ghana Demographic and Health Survey, including a weighted sample of 6,839 reproductive-age women. By employing a multilevel logistic regression model, the study sought to determine factors associated with the utilization of modern contraceptives. Associations between explanatory variables and the outcome were evaluated using adjusted odds ratios (AORs) along with 95% confidence intervals (CIs). Statistical significance was established using a p-value threshold of less than 0.05. All statistical analyses were conducted using STATA version 17 software. Results The study found that 26.36% (95% CI: 25.33-27.34%) of women of reproductive age in Ghana used modern contraceptives. Secondary education (AOR = 1.26, 95% CI = 1.03–1.53), poorer household (AOR = 1.30, 95% CI = 1.05–1.61), women’s marital status, i.e. married (AOR = 1.46, 95% CI = 1.16–1.83), living with a partner (AOR = 1.65, 95% CI = 1.32–2.06), divorced (AOR = 2.53, 95% CI = 1.48–4.31), and separated (AOR = 1.70, 95% CI = 1.21–2.37), multipara (AOR = 1.39, 95% CI = 1.04–1.87), were the factors that promote modern contraceptive utilization. Women’s age in years, i.e. 35–39 (AOR = 0.71, 95% CI = 0.52–0.97), 40–44 (AOR = 0.63, 95% CI = 0.44–0.90), and 45–49 (AOR = 0.45, 95% CI = 0.25–0.79), history of pregnancy loss (AOR = 0.86, 95% CI = 0.76–0.98), region, i.e. Greater Accra (95% CI = 0.42–0.92), Bono East (95% CI = 0.32–0.81), Northern (95% CI = 0.28–0.67), Savannah (95% CI = 0.28–0.81), and North East (95% CI = 0.20–0.63), were all associated with a lower use of modern contraceptives. Conclusions Modern contraceptive utilization was low in this study. Factors such as women’s education, socioeconomic status, and marital status were associated with increased modern contraceptive utilization, whereas women’s age and regional disparities were linked to lower usage rates. These findings emphasize the need for targeted interventions to address socioeconomic barriers and regional disparities in access to family planning services across Ghana.

Abstract Background Contraceptive usage in Ethiopia is significantly influenced by the decision-maker at the household level. Joint decision-making involving both women and their husbands/partners is considered ideal for improving contraceptive uptake among women and for managing health outcomes related to contraceptive side effects. However, there is a lack of substantial evidence regarding the prevalence and impact of joint decision-making on contraceptive use in Ethiopia. Therefore, the current study aimed to assess the magnitude of joint decision-making on contraceptive use and its determinant factors among married, contraceptive-using, reproductive-age women in Ethiopia. Methods This study was conducted based on the Ethiopian Demographic and Health Survey (EDHS) 2016 data. A total weighted sample of 3,669 married, contraceptive-using, reproductive-age women were included in the study. Multilevel logistic regression was employed due to the hierarchical nature of the data. Variables with a p-value of ≤ 0.2 in the bivariate multilevel analysis were included in the multivariable multilevel analysis. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine the direction and strength of associations. Variables with a p-value of

Abstract Background Despite the intended 50% reduction in anemia in women of reproductive age, this tendency has only worsened. Even though iron deficiency is the most prevalent cause of anemia, anemia and chronic illnesses like HIV are closely associated; in fact, 48.6% of people living with HIV who were 15 years of age or older had anemia. However, the burden of anemia among HIV-positive women in sub-Saharan African (SSA) countries is not well documented. Therefore, the goal of our research was to investigate anemia and the factors that are linked to it in SSA women who had HIV infections. Methods A cross-sectional study was conducted using demographic and health survey datasets from 18 SSA countries. A total of 7823 weighted samples were included. STATA version 16 software was used for analysis. A multilevel logistic regression model was fitted. An adjusted odds ratio with a 95% CI and a p-value

Abstract Background Many married women of reproductive age with husbands or partners are less cooperative in using contraceptives, often resulting in unintended pregnancies or secret contraceptive use. This private use of contraceptives causes women to suffer from side effects without proper support, and many women in Ethiopia die due to unintended pregnancies. However, the involvement of husbands or partners in the contraceptive decision-making process in Ethiopia is often neglected. There is also a lack of evidence regarding the determinants of husbands’ or partners’ decision-making power on contraceptive use in Ethiopia. Objective This study aimed to assess the determinants of low involvement of husbands/partners in women’s contraceptive use decision-making processes in Ethiopia. Methods This study was based on Ethiopian Demographic and Health Survey data, collected from January 18 to June 27, 2016. Weighted samples of 3,669 reproductive-age women were included. Husbands’/partners’ independent decision-making was measured by whether the husband/partner decided independently or alone about contraceptive use, categorized as “Yes” or “No”. A multilevel logistic regression model was fitted, and ICC (Intra-class Correlation Coefficient), MOR (Median Odds Ratio), PCV (Proportion Change in Variance), and deviance were used to assess model fitness and comparison. Variables with a p-value of ≤ 0.2 in the bivariate analysis were considered candidates for multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval was used to determine both the direction and strength of the association, and a p-value of

Purpose: Although immediate-loading implant (ILI) treatment is a general treatment strategy for fully edentulous maxillae, long-term evidence is required. The purpose of this study was to evaluate the long-term clinical results of, and risk factors for, ILI treatment in fully edentulous maxillae. Materials and Methods: ILI treatments of maxillae using 526 implants in 117 patients were reviewed retrospectively. The longest and mean observation periods were 15 years and 9.2 years, respectively. Kaplan-Meier survival curve analysis, log-rank tests, and multilevel mixed-effects parametric survival analysis were used for statistical analyses. Results: Overall, 38 of 526 implants failed in 23 patients, and the estimated 15-year cumulative implant-level and patient-level survival rates were 90.7% and 73.7%, respectively. The cumulative implant survival rate was significantly higher in female patients than in male patients. Sex, implant length, and implant diameter were significantly associated with implant survival. Conclusion: ILI treatment of completely edentulous maxillae demonstrated viable long-term clinical outcomes. Male sex, shorter implant length, and narrow implant diameter negatively affected implant survival. [ABSTRACT FROM AUTHOR]

Abstract Background Underweight is a prevalent health issue in children. This study aimed to identify factors associated with underweight in children aged 1–2 years in Hamadan city. Unlike the studies conducted in this field, which are cross-sectional and do not provide information on the effect of age changes on underweight, our longitudinal approach provides insights into weight changes over time. On the other hand, this study focuses on the high-risk age group of 1 to 2 years, which has only been addressed in a few studies. Methods In this longitudinal study, 414 mothers with 1 to 2 year-old children referred to the health centers of Hamadan city, whose information is in the SIB system, a comprehensive electronic system, were examined to identify factors related to underweight. The response variable was weight-for-age criteria classified into three categories: underweight, normal weight, and overweight. A two-level longitudinal ordinal model was used to determine the factors associated with underweight. Results Of the children studied, 201 (48.6%) were girls and 213 (51.4%) were boys. Significant risk factors for underweight included low maternal education (AOR = 3.56, 95% CI: 1.10–11.47), maternal unemployment (AOR = 3.38, 95% CI: 1.05–10.91), maternal height (AOR = 0.85, 95% CI: 0.79–0.92), lack of health insurance (AOR = 2.85, 95% CI: 1.04–7.84), gestational age less than 24 years (AOR = 3.17, 95% CI: 16.28–0.97), child age 12–15 months (AOR = 2.27, 95% CI: 1.37–3.74), and child's birth weight (AOR = 0.63, 95% CI: 0.70–0.58). Conclusion Based on the results of the present study, it seems that the possibility of being underweight among children is more related to the characteristics of mothers; therefore, taking care of mothers can control some of the weight loss of children.

Abstract Background We aimed to measure the variance due to examination conditions during the first sessions of objective structured clinical examinations (OSCEs) performed at a French medical school and identify factors associated with student success. Methods We conducted a retrospective, observational study using data from the first three OSCEs sessions performed at Paris-Saclay medical school in 2021 and 2022. For all sessions (each organized in 5 parallel circuits), we tested a circuit effect using a linear mixed-effects model adjusted for sex and the average academic level of students (according to written tests). Then, we studied the factors associated with student success at one station using a multivariate linear mixed-effects model, including the characteristics of students, assessors, and standardized patients. Results The study included three OSCEs sessions, with 122, 175, and 197 students and a mean (± SD) session score of 13.7(± 1.5)/20, 12.7(± 1.7)/20 and 12.7(± 1.9)/20, respectively. The percentage of variance due to the circuit was 6.5%, 18.2% (statistically significant), and 3.8%, respectively. For all sessions, the student’s average level and station scenario were significantly associated with the score obtained in a station. Still, specific characteristics of assessors or standardized patients were only associated with the student’s score in April 2021 (first session). Conclusion The percentage of the variance of students’ performance due to the examination conditions was significant in one out of three of the first OSCE sessions performed at Paris-Saclay medical school. This result seems more related to individual behaviors rather than specific characteristics of assessors or standardized patients, highlighting the need to continue training teaching teams. National clinical trial number Not applicable.

Abstract Background Poor infant and child feeding practices, in combination with increased rates of infectious diseases, are the main immediate causes of malnutrition during the first two years of life. Non-breastfed children require milk and other dairy products, as they are rich sources of calcium and other nutrients. As far as our search is concerned, there is no evidence on the pooled magnitude and determinants of minimum milk feeding frequency among non-breastfed children in sub-Saharan Africa conducted using the most recent indicators for assessing infant and young child feeding practices published in 2021. Therefore, this study is intended to determine the magnitude and associated factors of minimum milk feeding frequency among non-breastfed children aged 6–23 months in sub-Saharan Africa using the most recent guideline and demographic and health survey dataset. Methods Data from the most recent health and demographic surveys, which were carried out between 2015 and 2022 in 20 sub-Saharan African countries, were used. The study comprised a weighted sample consisting of 13,315 non-breastfed children between the ages of 6 and 23 months. STATA/SE version 14.0 statistical software was used to clean, recode, and analyze data that had been taken from DHS data sets. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Model comparison and fitness were assessed using deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Finally, variables with a p-value

Abstract Objective In view of the increasing number of people with (multiple) chronic conditions, the Organisation for Economic Co-operation and Development (OECD) initiated the International Survey of People Living with Chronic Conditions (PaRIS survey), which aims to provide insight in patient-reported outcomes and experiences of chronic care provided by primary care practices to support policy development. The objective of this research note is to describe the structure of the data, collected in the PaRIS survey and how the data will be analysed in a multilevel approach for cross-country comparison. Analysis plan The data structure of the PaRIS survey represents three levels: countries/health systems, primary care practices and patients. Multilevel analysis is used because of its accuracy in estimating country-level outcomes, its flexibility in modelling relationships, and its opportunities in connecting to relevant policy questions. Country-level outcomes will be estimated to facilitate cross-country comparison and (future) within-country comparison over time. Characteristics of patients that potentially explain variation in patient-reported outcomes and experiences can be linked to primary care practice and country/health system characteristics. This makes it possible to address policy-relevant questions relating, e.g., to the impact of chronic care management on patients with a specific chronic condition.

Abstract Background Patients who receive invasive mechanical ventilation (IMV) in the intensive care unit (ICU) have exhibited lower in-hospital mortality rates than those who are treated outside. However, the patient-, hospital-, and regional factors influencing the ICU admission of patients with IMV have not been quantitatively examined. Methods This retrospective cohort study used data from the nationwide Japanese inpatient administrative database and medical facility statistics. We included patients aged ≥ 15 years who underwent IMV between April 2018 and March 2019. The primary outcome was ICU admission on the day of IMV initiation. Multilevel logistic regression analyses incorporating patient-, hospital-, or regional-level variables were used to assess cluster effects by calculating the intraclass correlation coefficient (ICC), median odds ratio (MOR), and proportional change in variance (PCV). Results Among 83,346 eligible patients from 546 hospitals across 140 areas, 40.4% were treated in ICUs on their IMV start day. ICU admission rates varied widely between hospitals (median 0.7%, interquartile range 0–44.5%) and regions (median 28.7%, interquartile range 0.9–46.2%). Multilevel analyses revealed significant effects of hospital cluster (ICC 82.2% and MOR 41.4) and regional cluster (ICC 67.3% and MOR 12.0). Including patient-level variables did not change these ICCs and MORs, with a PCV of 2.3% and − 1.0%, respectively. Further adjustment for hospital- and regional-level variables decreased the ICC and MOR, with a PCV of 95.2% and 85.6%, respectively. Among the hospital- and regional-level variables, hospitals with ICU beds and regions with ICU beds had a statistically significant and strong association with ICU admission. Conclusions Our results revealed that primarily hospital and regional factors, rather than patient-related ones, opposed ICU admissions for patients with IMV. This has important implications for healthcare policymakers planning interventions for optimal ICU resource allocation.

Abstract Hazardous drinking, defined as the consumption of homemade, unofficially made alcohol and non-beverages, is prevalent and accounts for a high proportion of alcohol-related deaths in Russia. Individual-level characteristics are important explanations of hazardous drinking, but they are unlikely to explain spatial variation in this type of alcohol consumption. Areas that attracted insufficient attention in the research of hazardous drinking are the legacy of industrialization and the speed of economic reforms, mainly through the privatization policy of major enterprises in the 1990s. Applying mixed-effects logistic regressions to a unique dataset from 30 industrial towns in the European part of Russia, we find that in addition to individual-level characteristics such as gender, age, marital status, education, social isolation, labor market status, and material deprivation, the types of towns where informants’ relatives resided such as industrial structure and speed of privatization also accounted for the variance in hazardous alcohol consumption among both male and female populations of the analyzed towns.

Abstract Background Knowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya. Methods The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data. Results The overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women’s age, women’s education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period. Conclusion As per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.