Analysis of count data using poisson regression

Providing elevated structures in the pullet rearing environment affects behavior during initial acclimation to a layer aviary

Spatial abilities of hens are particularly sensitive to development during early life. Experiences in pullet housing may have lasting consequences on adult hens' movements in cage-free environments. We tested whether opportunities to access elevated spaces during rearing improved hens' use of a multitiered aviary. Female Dekalb White pullets were reared in either floor pens (FL), single-tiered aviaries (ST), or 2-tiered aviaries (TT; n = 5 pens/environment) through 16 wk of age. Rearing structures were replaced with identical multitiered aviaries at 17 wk. The distribution of the flock within the aviary and the vertical transitions of 10 focal hens/pen across the aviary were determined from videos recorded during their first (D1) and seventh (D7) day of aviary access, as well as at 19, 23, and 27 wk of age. Prevalence of floor eggs was recorded weekly from 17 to 28 wk of age. On D1, more ST and TT hens utilized the aviary during the daytime (P = 0.0077), made more vertical transitions when searching for a roosting spot in the evening (P = 0.0021), and maintained a consistent distance traveled during transitions compared to FL hens (P = 0.02). These differences disappeared by D7, except that ST and TT hens continued to roost on the highest perches of the aviary more (P < 0.0001) than FL hens through 27 wk of age. FL hens laid more floor eggs than ST and TT hens for the first 2 wk of lay (P < 0.0001). The majority (97.9%) of vertical transitions was controlled. Uncontrolled transitions were highest at D1 and decreased by D7 (P = 0.0009) and were not affected by rearing (P = 0.33). The results suggest that hens reared with minimal height are hesitant to use the laying hen aviaries when they are first transferred. They acclimate within 1 to 2 wk, but continue to roost less in the highest accessible level.

Identifying spatial heterogeneity of COVID-19 transmission clusters and their built-environment features at the neighbourhood scale

The identification of high-risk areas for infectious disease transmission and its built-environment features are crucial for targeted surveillance and early prevention efforts. While previous research has explored the association between infectious disease incidence and urban built environment, the investigation of spatial heterogeneity of built-environment features in high-risk areas has been insufficient. This paper aims to address this gap by analysing the spatial heterogeneity of COVID-19 clusters in Shanghai at the neighbourhood scale and examining associated built-environment features. Using a spatiotemporal clustering algorithm, the study analysed 1395 reported cases in Shanghai from March 6 to March 17, 2022. Both global Poisson regression (GPR) and geographically weighted Poisson regression (GWPR) models were applied to examine the association between built-environment variables and the size of COVID-19 clusters. Our findings suggest that larger COVID-19 clusters emerging in the suburbs compared with the downtown and multiple built-environment features are significantly associated with this pattern. Specifically, neighbourhoods with a higher proportion of commercial, public service and industrial land, higher centrality of metro stations, and proximity to hospitals are positively associated with larger COVID-19 clusters, while neighbourhoods with higher land use mix and green/open spaces density are associated with smaller COVID-19 clusters. Moreover, we identified that metro stations with high centrality present the highest risk in the downtown, while commercial and public service places exhibit the highest risk in the suburbs. By highlighting the overlooked spatial heterogeneity of built-environment features for high-risk areas, this study aims to provide valuable guidance for public health departments in implementing place-based interventions to effectively prevent the spread of potential epidemics.

Childhood adversities and rate of adulthood all-cause hospitalization in the general population: A retrospective cohort study

OBJECTIVE

The study examined the association between specific childhood adversities and rate of all-cause hospitalization in adulthood in a large sample of the general population and assessed whether adult socioeconomic and health-related factors mediate those associations.

METHODS

We used linked data available from Statistics Canada i.e., the Canadian Community Health Survey (CCHS-2005) linked to Discharge Abstract Database (DAD 2005-2017) and Canadian Vital Statistics Database (CVSD 2005-2017). CCHS-2005 measured self-reported exposure to childhood adversities, namely prolonged hospitalization, parental divorce, parental unemployment, prolonged trauma, parental substance use, physical abuse, and being sent away from home for wrongdoing, from a sample of household residents aged 18 years and above (n = 11,340). The number and causes of hospitalization were derived from linkage with DAD. Negative binomial regression was used to characterize the association between childhood adversities and the rate of hospitalization and to identify potential mediators between them.

RESULTS

During the 12-year follow-up, 37,080 hospitalizations occurred among the respondents, and there were 2,030 deaths. Exposure to at least one childhood adversity and specific adversities (except parental divorce) were significantly associated with the hospitalization rate among people below 65 years. The associations (except for physical abuse) were attenuated when adjusted for one or more of the adulthood factors such as depression, restriction of activity, smoking, chronic conditions, poor perceived health, obesity, unmet health care needs, poor education, and unemployment, observations that are consistent with mediation effects. The associations were not significant among those aged 65 and above.

CONCLUSION

Childhood adversities significantly increased the rate of hospitalization in young and middle adulthood, and the effect was potentially mediated by adulthood socioeconomic status and health and health care access related factors. Health care overutilization may be reduced through primary prevention of childhood adversities and intervention on those potentially mediating pathways such as improving adulthood socioeconomic circumstances and lifestyle modifications.

The Impact of Police Response on Intimate Partner Violence Victims' Social, Emotional, and Physical Well-Being: Results From the National Crime Victimization Survey

This study examined whether police involvement in intimate partner violence (IPV) incidents is associated with victims' socio-emotional problems, and emotional and physical toll symptoms for 1 month or longer post-victimization. Data from the 2010-2019 National Crime Victimization Survey suggest that police investigational effort, later contact with the police, suffering severe injury during victimization, and repeated victimization were positively associated with experiencing socio-emotional problems. Later contact with police and severe injury were positively associated with both emotional and physical toll symptoms, while the female sex was positively associated with emotional toll symptoms. The arrest of the abuser was negatively associated with physical toll symptoms. Findings highlight the need for policies and practices in response to IPV that consider the diverse needs of survivors of partner abuse to help reduce IPV-related trauma.

The association between receipt of home care rehabilitation services and acute care hospital utilization in clients with multimorbidity following an acute care unit discharge: a retrospective cohort study

BACKGROUND

Individuals experiencing multimorbidity have more complex healthcare needs, use more healthcare services, and access multiple service providers across the healthcare continuum. They also experience higher rates of functional decline. Rehabilitation therapists are well positioned to address these functional needs; however, little is known about the influence of rehabilitation therapy on patient outcomes, and subsequent unplanned healthcare utilization for people with multimorbidity. The aims of this study were to: 1) describe and compare the characteristics of people with multimorbidity receiving: home care rehabilitation therapy alone, other home care services without rehabilitation therapy, and the combination of home care rehabilitation therapy and other home care services, and 2) determine the association between home care rehabilitation therapy and subsequent healthcare utilization among those recently discharged from an acute care unit.

METHODS

This retrospective cohort study used linked health administrative data housed within ICES, Ontario, Canada. The cohort included long-stay home care clients experiencing multimorbidity who were discharged from acute care settings between 2007-2015 (N = 43,145). Descriptive statistics, ANOVA's, t-tests, and chi-square analyses were used to describe and compare cohort characteristics. Multivariable logistic regression was used to understand the association between receipt of rehabilitation therapy and healthcare utilization.

RESULTS

Of those with multimorbidity receiving long-stay home care services, 45.5% had five or more chronic conditions and 46.3% required some assistance with ADLs. Compared to people receiving other home care services, those receiving home care rehabilitation therapy only were less likely to be readmitted to the hospital (OR = 0.78; 95% CI: 0.73-0.83) and use emergency department services (OR = 0.73; 95% CI: 0.69-0.78) within the first 3-months following hospital discharge.

CONCLUSIONS

Receipt of rehabilitation therapy was associated with less unplanned healthcare service use when transitioning from hospital to home among persons with multimorbidity. These findings suggest rehabilitation therapy may help to reduce the healthcare burden for individuals and health systems. Future research should evaluate the potential cost savings and health outcomes associated with providing rehabilitation therapy services for people with multimorbidity.

Temporomandibular disorders and associated comorbidities among brazilian dental students during COVID-19

Aim: This study aimed to assess the prevalence of temporomandibular disorders (TMD) and psychosocial comorbidities in undergraduate dental students in a southern Brazilian university, during the COVID-19 pandemic. Also, it aimed to verify the association between psychosocial factors and TMD. Methods: Fonseca Anamnestic Index, Depression Anxiety Stress Scale (DASS-21), a socioeconomic questionnaire, and questions about academic performance and social distancing were applied. Poisson regression analysis was used to assess the association of predictive variables with TMD. Results: The prevalence of TMD was found to be 82.4%, and more than half of the students had some degree of stress, anxiety, and depression. Students who had symptoms of stress (RR 1.11; 95% CI 1.04-1.19), anxiety (RR 1.19; 95% CI 1.12-1.27) and reported academic performance worsening (RR 1.12; 95% CI 1.07-1.19) had higher TMD scores. Conclusion: The findings suggest that TMD was highly prevalent among dental students at a federal university in southern Brazil during the pandemic, being associated with high levels of stress, anxiety, poor academic performance, and greater social distancing.

Social status predicts different mating and reproductive success for men and women in China: evidence from the 2010–2017 CGSS data

Abstract

Evolutionary psychological theories posit that higher social status is conducive to men’s reproductive success. Extant research from historical records, small scale societies, as well as industrialized societies, support this hypothesis. However, the relationship between status difference between spouses and reproductive success has been investigated less. Moreover, even fewer studies have directly compared the effect of status and status difference between spouses on reproductive success in men and women. Using data from the Chinese General Social Survey (CGSS) conducted between 2010 and 2017 (N = 55,875; 28,931 women) and operationalizing social status as standardized income and educational level (compared with same-sex peers), we examined how social status and relative status between spouses impact men’s and women’s mating and reproductive success. We found that (1) men with higher social status were more likely to have long-term mating (being in a marriage and/or not going through marriage disruption) and reproductive success, mainly through having a lower risk of childlessness; (2) women with higher social status were less likely to have mating and reproductive success; and (3) relative status between spouses had an impact on the couple’s reproductive success so that couples, where the husband had higher status compared to the wife, had higher reproductive success. Thus, social status positively impacted men’s reproductive success, but relative status between spouses also affected mating and impacted childbearing decisions.

Significance statement

In terms of standardized educational level and income among peers, social status positively predicts men’s mating and reproductive success in contemporary China. However, while a higher social status increases the probability of having at least one child, it does not predict a greater number of children for men. A status difference between spouses, on the other hand, consistently predicts having children. Thus, the higher the husband’s status relative to his wife, the greater the likelihood of having the first, second, and third children. The current results suggest that when examining the effect of status on mating and reproduction, social status and status within a family should be considered. We also stress the importance of exploring the potential proximate mechanisms by which a status difference influences childbearing decisions.

Infants later diagnosed with autism have lower canonical babbling ratios in the first year of life

BACKGROUND

Canonical babbling-producing syllables with a mature consonant, full vowel, and smooth transition-is an important developmental milestone that typically occurs in the first year of life. Some studies indicate delayed or reduced canonical babbling in infants at high familial likelihood for autism spectrum disorder (ASD) or who later receive an ASD diagnosis, but evidence is mixed. More refined characterization of babbling in the first year of life in infants with high likelihood for ASD is needed.

METHODS

Vocalizations produced at 6 and 12 months by infants (n = 267) taking part in a longitudinal study were coded for canonical and non-canonical syllables. Infants were categorized as low familial likelihood (LL), high familial likelihood diagnosed with ASD at 24 months (HL-ASD) or not diagnosed (HL-Neg). Language delay was assessed based on 24-month expressive and receptive language scores. Canonical babble ratio (CBR) was calculated by dividing the number of canonical syllables by the number of total syllables. Generalized linear (mixed) models were used to assess the relationship between group membership and CBR, controlling for site, sex, and maternal education. Logistic regression was used to assess whether canonical babbling ratios at 6 and 12 months predict 24-month diagnostic outcome.

RESULTS

No diagnostic group differences in CBR were detected at 6 months, but HL-ASD infants produced significantly lower CBR than both the HL-Neg and LL groups at 12 months. HL-Neg infants with language delay also showed reduced CBR at 12 months. Neither 6- nor 12-month CBR was significant predictors of 24-month diagnostic outcome (ASD versus no ASD) in logistic regression.

LIMITATIONS

Small numbers of vocalizations produced by infants at 6 months may limit the reliability of CBR estimates. It is not known if results generalize to infants who are not at high familial likelihood, or infants from more diverse racial and socioeconomic backgrounds.

CONCLUSIONS

Lower canonical babbling ratios are apparent by the end of the first year of life in ASD regardless of later language delay, but are also observed for infants with later language delay without ASD. Canonical babbling may lack specificity as an early marker when used on its own.

The Geographically Weighted Multivariate Poisson Inverse Gaussian Regression Model and Its Applications

This study aims to develop a method for multivariate spatial overdispersion count data with mixed Poisson distribution, namely the Geographically Weighted Multivariate Poisson Inverse Gaussian Regression (GWMPIGR) model. The parameters of the GWMPIGR model are estimated locally using the maximum likelihood estimation (MLE) method by considering spatial effects. Therefore, the significance of the regression parameter differs for each location. In this study, four GWMPIGR models are evaluated based on the exposure variable and the spatial weighting function. We compare the performance of those four models in real-world application using data on the number of infant, under-5 and maternal deaths in East Java in 2019 using five predictor variables. In this study, the GWMPIGR model uses one exposure variable and three exposure variables. Compared to the fixed kernel Gaussian weighting function, the GWMPIGR model with the fixed kernel bisquare weighting function and one exposure variable has a better fit based on the AICc value. Furthermore, according to the best GWMPIGR model, there are several regional groups formed based on predictors that significantly affected each event in East Java in 2019.

Anxiety in Geoffroy's spider monkeys (Ateles geoffroyi): Can scratching be used as an indicator?

Self-directed behavior, such as self-scratching (hereafter, scratching), occurs in several taxa across the animal kingdom, including nonhuman primates. There is substantial evidence that scratching is an indicator of anxiety-like emotions in a variety of nonhuman primate species. Despite its importance as a window into emotional states, few studies have investigated scratching in Platyrrhines. We investigated scratching patterns of 24 Geoffroy's spider monkeys (Ateles geoffroyi) belonging to a group living in the Otoch Ma'ax Yetel Kooh protected area in the Yucatàn peninsula (Mexico). We assessed whether scratching could be used as an indicator of anxiety levels in this species by testing predictions based on contexts and behaviors associated with risk and uncertainty. We found no effect of the subject's sex and age, subgroup size, male presence, and the occurrence of fusions between subgroups on scratching rates. Similarly, we found no effect of infant proximity on their mother's scratching rates. Supporting our prediction, we found evidence that isolation from conspecifics affected scratching rates as individuals scratched more frequently the more time they spent isolated. Being in proximity with a partner with a relationship characterized by uncertainty affected scratching rates as individuals scratched more frequently when in proximity with a partner with whom they engaged in embraces (an indicator of uncertainty) than when in proximity with a partner with whom they did not exchange embraces. Our study provides insight into the factors affecting scratching in Geoffroy's spider monkeys, suggesting that scratching may indicate anxiety in this species at least in some contexts and thus opening a window into the emotional experience of another Platyrrhine monkey species.

Re-referrals to Child Protective Services for children born to young parents

BACKGROUND

Children of teenage parents are at increased risk for child maltreatment but there is limited information about the risks teenage parenthood poses for maltreatment recurrence after prior Child Protective Service (CPS) involvement.

OBJECTIVE

Determine whether children born to teenage parents are at increased risk of maltreatment re-referral to CPS compared to children born to older parents.

PARTICIPANTS AND SETTING

Children under 6 years with substantiated reports of parental maltreatment between 2002 and 2018 were identified from National Child Abuse and Neglect Data System (NCANDS) data.

METHODS

Youngest known parental age at child's birth, in years, was categorized as <20, 20-24, 25-29, or ≥30 (referent group). The number of re-referrals within 5 years was the outcome of interest. Negative binomial regression analyses assessed whether being born to a teen parent was associated with a greater risk of re-referral.

RESULTS

In a study population of 2,680,961 children, having a teen parent, one aged 20-24 years, or 25-29 years at birth was associated with 19% (95% CI 1.18-1.19), 16% (95% CI 1.16-1.17), and 11% (95% CI 1.11-1.12) greater risk of re-referral compared to having a parent aged 30 years or older adjusting for child age, gender, race-ethnicity, state, and initial maltreatment type.

CONCLUSION

The small, but significant increased risk for re-referral to CPS for child maltreatment in young children with at least one teenage or young parent at the time of birth compared to children with older parents suggests that specifically targeting young parents with appropriate services when initially referred to CPS may help reduce the risk of maltreatment recurrence.

Aha! under pressure: The Aha! experience is not constrained by cognitive load

The Aha! moment- the sudden insight sometimes reached when solving a vexing problem- entails a different problem-solving experience than solution retrieval reached by an analytical, multistep strategy (i.e., non-insight). To date, the (un)conscious nature of insight remains debated. We addressed this by studying insight under cognitive load. If insight and non-insight problem solving rely on conscious, effortful processes, they should both be influenced by a concurrent cognitive load. However, if unconscious processes characterize insight, cognitive load might not affect it at all. Using a dual-task paradigm, young, healthy adults (N = 106) solved 70 word puzzles under different cognitive loads. We confirmed that insight solutions were more often correct and received higher solution confidence. Importantly, as cognitive load increased, non-insight solutions became less frequent and required more solution time, whereas insightful ones remained mostly unaffected. This implies that insight problem solving did not compete for limited cognitive resources.

Pre-deployment personality traits predict prescription opioid receipt over 2-year post-deployment period in a longitudinal cohort of deployed National Guard soldiers

BACKGROUND

While military service members are at risk forpain conditions, receipt of prescribed opioids is associated with a range of serious adverse outcomes. The goal of this study is to examine the association between pre-deployment personality traits and receipt of prescription opioids after return from deployment.

METHOD

Data were drawn from the Readiness and Resilience in National Guard Soldiers (RINGS) cohort study, an ongoing study of post-deployment health. Participants (N = 522) completed baseline assessments one month prior to deploying to Iraq (2006-2007). At baseline, we assessed personality traits using abbreviated versions of the Personality Psychopathology Five scales from the Minnesota Multiphasic Personality Inventory-2. Follow-up assessments were conducted three months, one year, and two years post-deployment. The primary outcome was total amount of prescribed opioids dispensed from Department of Veterans Affairs outpatient pharmacies in the two-year period following soldiers' return from deployment. Unadjusted and adjusted negative binomial regression models examined the relationships of pre-deployment personality traits, demographics (age, gender, and rank), baseline trauma symptoms, deployment related risk factors (difficult living/working environment, deployment injury, combat exposure), and post-deployment trauma symptoms with post-deployment opioid prescribing.

RESULTS

Disconstraint, negative emotionality, and introversion/low positive emotionality were associated with receipt of more prescribed opioids over the two years after return from deployment. Personality traits measured at baseline remained statistically significantly after adjusting for all eight baseline and deployment risk factors of interest.

CONCLUSIONS

Understanding how pre-deployment personality traits contribute to post-deployment prescription opioid use could inform efforts to improve veterans' health.

Investigating the Association Between Self-Reported Comorbid Anxiety and Depression and Health Service Use in Cancer Survivors

BACKGROUND

Anxiety and depression have a higher prevalence in cancer survivors than in the general population and are associated with lower quality of life, poorer survival and an increased risk of suicide. Anxiety and depression are also highly comorbid among cancer survivors and associated with increased health service use. As such, it is important to consider both anxiety and depression and health service use in cancer survivors.

OBJECTIVE

Our objective was to explore the association between anxiety and depression and health service utilisation, both cancer-specific and general doctor visits, in cancer survivors.

METHODS

Data from a Dutch cancer registry were analysed to determine the association between anxiety and depression (measured using the Hospital Anxiety and Depression Scale) and health service use. Negative binomial regression models, controlling for patient demographics, comorbidities and cancer-related variables were estimated.

RESULTS

Cancer survivors (n = 2538), with a mean age of 61.1 years and between 0.7 and 10.9 years since diagnosis, were included in the analysis. Increasing levels of anxiety and depression were associated with increased health service use. Having severe levels of anxiety was associated with more frequent visits to the general practitioner (p < 0.001). Severe depression in cancer survivors was associated with more frequent visits to the specialist (p < 0.001).

CONCLUSION

Anxiety and depression in cancer survivors, particularly severe anxiety and depression, were associated with increased health service use. Treatment of anxiety and depression in cancer survivors has the potential to reduce overall health service use and associated costs and improve health outcomes for cancer survivors.

Epidemiology of cardiac or orthopedic procedures in gout versus rheumatoid arthritis: a national time-trends study

Aims

To examine the secular trends in the number and rates of in-hospital cardiac and orthopedic procedures in people with gout and rheumatoid arthritis (RA), and the United States (US) general population, from 1998 to 2014.

Methods

We examined the frequency of seven common cardiac and orthopedic procedures in hospitalized people with gout, RA, or the general population using the 1998-2014 US National Inpatient Sample (NIS). Poisson regression evaluated the differences in frequencies in 1998 versus 2014, between gout and RA, and within each cohort.

Results

Both in-hospital cardiac and orthopedic procedures increased in gout and RA with time, in contrast with declining cardiac procedures in the general US population. Cardiac procedures were significantly higher in gout versus RA in 1998 (59% higher) and 2014 (92% higher). The rate of cardiac procedures increased from 36.6 to 82.8 in gout and from 20.1 to 33.1 in RA per 100,000 NIS claims from 1998 to 2014. Orthopedic procedures became more common than cardiac procedures in gout and RA by 2014. In RA, the cardiac-orthopedic procedure volume difference was significant in 1998 and 2014. We noted no significant difference between cardiac versus orthopedic procedures in 1998 in gout, but the difference was significant in 2014. Orthopedic procedures in gout were significantly lower than RA in 1998 (33% lower), but were significantly higher than RA in 2014 (5% higher).

Conclusion

Increasing in-hospital cardiac procedures in gout and RA contrasting with declining general US population rates indicated that optimal management of systemic inflammation and an early diagnosis of gout and RA are needed. The rate of increase in orthopedic procedures exceeded that in cardiac procedures. A much greater volume and rate of increase in common in-hospital cardiac and orthopedic procedures in gout compared to RA indicates that an aggressive approach to treat-to-target in gout is needed to potentially reduce the associated healthcare burden and cost.

Plain language summary

Cardiac and orthopedic procedures rising faster for gout compared to rheumatoid arthritis in the United States We performed a national US study of the most common cardiac versus orthopedic procedures from 1998 to 2014. We found that over time, the number and the rate of cardiac procedures increased in people with gout (2.2-fold higher) or rheumatoid arthritis (1.6-fold higher). This was surprising, since during the same time, we noted a decrease in cardiac procedures in the general U.S. population. The rate of cardiac procedures in gout was 2.5-fold higher than that in rheumatoid arthritis, 82.8 vs. 33.1 per 100,000 NIS claims in 2014. Interestingly, orthopedic procedures were more common than cardiac procedures in both gout and RA in all periods. Also, the difference in the numbers of cardiac vs. orthopedic procedures increased over time in both gout and RA. Gout outpaced rheumatoid arthritis for both the total number and the rate of cardiac or orthopedic procedures over time. Therefore, our study provides an understanding of an increasing procedure burden in gout compared to rheumatoid arthritis, and to the general U.S. people with these conditions.

Line-transect versus point-transect sampling: the effects of survey area and survey effort on method efficiency for Geoffroy’s spider monkeys

Abstract ContextLine-transect sampling is considered to be a more efficient survey method than point-transect sampling to estimate population densities and abundance of many animal species. AimsIn the present study, we tested whether this claim holds true when surveying arboreal fast-moving primate species occurring at low densities, and whether the potential difference in efficiency can be explained by the difference in the size of the survey area between the methods. We further examined the impact of survey effort for point-transect sampling. MethodsWe conducted line- and point-transect sampling for Geoffroy’s spider monkeys (Ateles geoffroyi) in the same locations and compared the numbers of detected individual monkeys and the probability of their occurrence per survey between the two methods. We further compared the data from point-transect sampling gathered within three different waiting periods. Key resultsWe found a higher probability to detect monkeys and a higher number of monkeys during line-transect sampling than during point-transect sampling, but more spider monkeys were detected at point transects when controlling for the size of the survey area. More monkey detections were made during the first 10 min than during the second and third 10-min periods of point-transect surveys. ConclusionsWe showed that line-transect sampling is more efficient than point-transect sampling when surveying Geoffroy’s spider monkeys in a flat landscape of tropical forest with homogenous visibility. We discuss factors influencing survey results and recommend 20 min as the maximum waiting time at point transects when surveying arboreal mammals. ImplicationsOur study has provided a quantitative approach to compare efficiency across survey methods for fast-moving arboreal animals that occur at low densities, and supports the use of point-transect sampling in sites where line-transect sampling is not feasible, such as in human-modified landscapes.

Facebook-Based Social Marketing to Reduce Smoking in Australia's First Nations Communities: An Analysis of Reach, Shares, and Likes

BACKGROUND

Facebook is widely used by Australia's First Nations people and has significant potential to promote health. However, evidence-based guidelines for its use in health promotion are lacking. Smoking prevalence among Australia's First Nations people is nearly 3 times higher than other Australians. Locally designed programs in Aboriginal Community Controlled Health Services (ACCHOs) to reduce smoking often use Facebook.

OBJECTIVE

This study reports on an analysis of the reach and engagement of Facebook posts with smoking prevention and cessation messages posted by ACCHOs in the Northern Territory, Australia.

METHODS

Each service posted tobacco control content at least weekly for approximately 6 months. Posts were coded for the following variables: service posted, tailored First Nations Australian content, local or nonlocally produced content, video or nonvideo, communication technique, and emotional appeal. The overall reach, shares, and reactions were calculated.

RESULTS

Compared with posts developed by the health services, posts with content created by other sources had greater reach (adjusted incident rate ratio [IRR] 1.92, 95% CI 1.03-3.59). Similarly, reactions to posts (IRR 1.89, 95% CI 1.40-2.56) and shared posts (IRR 2.17, 95% CI 1.31-3.61) with content created by other sources also had more reactions, after controlling for reach, as did posts with local First Nations content compared with posts with no First Nations content (IRR 1.71, 95% CI 1.21-2.34).

CONCLUSIONS

Facebook posts with nonlocally produced content can be an important component of a social media campaign run by local health organizations. With the exception of nonlocally produced content, we did not find a definitive set of characteristics that were clearly associated with reach, shares, and reactions. Beyond reach, shares, and likes, further research is needed to understand the extent that social media content can influence health behavior.

Endometriosis Lowers the Cumulative Live Birth Rates in IVF by Decreasing the Number of Embryos but Not Their Quality

Endometriosis and infertility are closely linked, but the underlying mechanisms are still poorly understood. This study aimed to evaluate the impact of endometriosis on in vitro fertilization (IVF) parameters, especially on embryo quality and IVF outcomes. A total of 1124 cycles with intracytoplasmic sperm injection were retrospectively evaluated, including 155 cycles with endometriosis and 969 cycles without endometriosis. Women with endometriosis had significantly lower ovarian reserve markers (AMH and AFC), regardless of previous ovarian surgery. Despite receiving significantly higher doses of exogenous gonadotropins, they had significantly fewer oocytes, mature oocytes, embryos, and top-quality embryos than women in the control group. Multivariate analysis did not reveal any association between endometriosis and the proportion of top-quality embryo (OR = 0.87; 95% CI [0.66-1.12]; p = 0.3). The implantation rate and the live birth rate per cycle were comparable between the two groups (p = 0.05), but the cumulative live births rate was significantly lower in in the endometriosis group (32.1% versus 50.7%, p = 0.001), as a consequence of the lower number of frozen embryos. In conclusion, endometriosis lowers the cumulative live birth rates by decreasing the number of embryos available to transfer, but not their quality.

Examining the Role of Weight Status and Individual Attributes on Adolescent Social Relations

PURPOSE

Weight stigmatization during adolescence may compromise the development of social relations important for the development. This study examined the associations between weight status and likelihood of nomination (indegree) for five different social network types-friendship, romantic, admiration, succeed, and popularity.

METHODS

Data for the study were from 1,110 tenth grade students (aged 11-19 years) from four high schools in one Los Angeles school district in 2010. Multiple Poisson regression analyses using generalized linear model were conducted to examine the relationship between weight status (underweight/normal weight/overweight measured with body mass index calculated from self-reported height and weight) and adolescents' indegree for the five different networks.

RESULTS

Obese adolescents were significantly less likely to be nominated as romantic interest (odds ratio [OR]: .29, 95% confidence interval [CI]: .19-42), admired (OR: .80, 95% CI: .65-.97), or popular (OR: .71, 95% CI: .57-.88) compared with their normal weight peers. Overweight adolescents were also less likely to be nominated as a romantic interest (OR: .57, 95% CI: .42-.78) or popular (OR: .67, 95% CI: .53-.84) compared with those who were normal weight. Underweight adolescents were also less likely to be nominated as friends (OR: .76, 95% CI: .60-98), someone admired (OR: .61, 95% CI: .42-.89), likely to succeed (OR: .62, 95% CI: .44-.87), or popular (OR: .40, 95% CI: .25-.64).

CONCLUSIONS

Our results suggest weight status is associated with being selected by peers into different types of adolescent networks. Underweight, overweight, and obese adolescents are at an increased risk for social isolation because of their weight. This may have a negative impact on their peer relations important for social development, self-esteem, and mental health.

Activation in bed nucleus of the stria terminalis (BNST) corresponds to everyday helping

Everyday prosociality includes helping behaviors such as holding doors or giving directions that are spontaneous and low-cost and are performed frequently by the average person. Such behaviors promote a wide array of positive outcomes that include increased well-being, trust, and social capital, but the cognitive and neural mechanisms that support these behaviors are not yet well understood. Whereas costly altruistic responding to others' distress is associated with elevated reactivity in the amygdala, we hypothesized that everyday prosociality would be more closely associated with activation in the bed nucleus of the stria terminalis (BNST), a region of the extended amygdala known for its roles in maintaining vigilance for relevant socio-affective environmental cues and in supporting parental care. One previous study of the neural correlates of everyday prosociality highlighted a functional cluster identified as the septal area but which overlapped with established coordinates of BNST. We used an anatomical mask of BNST (Torrisi et al., 2015) to evaluate the association of BNST activation and daily helping in a sample of 25 adults recruited from the community as well as 23 adults who had engaged in acts of extraordinary altruism. Results found that activation in left BNST during an empathy task predicted everyday helping over a subsequent 14-day period in both samples. BNST activation most strongly predicted helping strangers and proactive helping. We conclude that beyond facilitating care for offspring, activation in BNST may provide a basis for the motivation to engage in a broad array of everyday helping behaviors.

A Scientometric Study on Depression among University Students in East Asia: Research and System Insufficiencies?

Given that mental health issues are acute in Asian countries, particularly Japan and Korea, and university students are more vulnerable to depression than the general population, this study aims to examine the landscapes of scientific research regarding depressive disorders among university students and evaluate the effectiveness of international collaboration and funding provision on the scientific impact in Korea, Japan, and China. Based on articles retrieved from the Web of Science database during the period 1992–2018, we found that the number of scientific publications, international collaborations, and allocated funds regarding depressive disorder among university students in China (97 articles, 43 international collaborations, and 52 funds provided, respectively) overwhelmingly surpassed the case of Korea (37 articles, 12 international collaborations, and 15 funds provided, respectively) and Japan (24 articles, 5 international collaborations, and 6 funds provided, respectively). The differences in collaboration patterns (p-value < 0.05) and the proportion of allocated funds (p-value < 0.05) among Korea, Japan, and China were also noted using Fisher’s exact test. Based on the Poisson regression analysis, China’s associations of scientific impact with international collaboration (β = −0.322, p-value < 0.01) and funding provision (β = −0.397, p-value < 0.01) are negative, while associations of the scientific impact and scientific quality with funding provision and international collaboration were statistically insignificant. These findings hint that Korea and Japan lacked scientific output, diversity in research targets, international collaboration, and funding provision, compared to China, but the quality of either China’s internationally collaborated or funded articles was contentious. As a result, policymakers in Korea and Japan are suggested to raise the importance of mental health problems in their future policy planning and resource distribution. Moreover, it would be advisable to establish a rigorous system of evaluation for the quality of internationally collaborated and funded studies in order to increase scientific impact and maintain public trust, especially in China.

Inflammation, depression, and anxiety disorder: A population-based study examining the association between Interleukin-6 and the experiencing of depressive and anxiety symptoms

The uncovering of a positive association between inflammatory cytokine levels - Interkleukin-6 (IL-6) in particular - and the experiencing of depressive and anxiety symptoms is one of the most promising and enthusiastically-discussed finding in recent years. Despite considerable ambiguity in the directionality and underpinnings of this association, anti-inflammatory drugs are already being tested on mental health patients who present no physical symptoms of inflammation, risking potential adverse side effects. Researchers have thus urgently called for more rigorous empirical elucidations of this association. Based on a large, longitudinal, nationally representative sample of middle-aged adults in the United States (N = 1255), IL-6 was observed to be significantly associated with one's present experiencing of depressive and anxiety symptoms. However, IL-6 was predictive of only prospective depressive (not anxiety) symptoms measured six years later, and only when baseline number of symptoms was not accounted for. Further, evidence for IL-6's postulated role as being either a biological cause itself (augmenting HPA stress reactivity) or a biological consequence of a psychological cause (psychological stress) for depression and anxiety was not found. These findings underscore the imperativeness of more rigorous studies to be conducted in this area, and caution practitioners against the premature consideration of IL-6 levels in clinical practice.

What Levels the Association Between Income and Mortality in Later Life: Age or Health Decline?

OBJECTIVES

Researchers frequently use the "age-as-leveler" hypothesis to explain decreasing inequality and a weakened relationship between socioeconomic position and health in old age. This study examined whether health status can explain the age pattern in the association between income and mortality as predicted by the age-as-leveler hypothesis.

METHOD

This study used longitudinal (1991-2002) data from the SWEOLD and LNU surveys. The analytical sample consisted of 2,619 people aged 54-92 in 2003. Mortality (2003-2014) and income (1991-2000) was collected from Swedish national registers. Poisson regression was used to estimate associations between mortality, income, age, and health status. Average marginal effects were used to visualize interaction effects between income and age.

RESULTS

The association between income and mortality weakened in those aged 84 and older. However, health status explained a large part of the effect that age had on the association between income and mortality. Analyses done after stratifying the sample by health status showed that the association between income and mortality was strong in people who reported good health and weak or nonexistent in those who reported poor health.

DISCUSSION

Age leveled the income-mortality association; however, health status, not age, explained most of the leveling.

Evolutionary costs and benefits of infection with diverse strains of Spiroplasma in pea aphids

The heritable endosymbiont Spiroplasma infects many insects and has repeatedly evolved the ability to protect its hosts against different parasites. Defenses do not come for free to the host, and theory predicts that more costly symbionts need to provide stronger benefits to persist in host populations. We investigated the costs and benefits of Spiroplasma infections in pea aphids (Acyrthosiphon pisum), testing 12 bacterial strains from three different clades. Virtually all strains decreased aphid lifespan and reproduction, but only two had a (weak) protective effect against the parasitoid Aphidius ervi, an important natural enemy of pea aphids. Spiroplasma-induced fitness costs were variable, with strains from the most slowly evolving clade reaching higher titers and curtailing aphid lifespan more strongly than other strains. Some Spiroplasma strains shared their host with a second endosymbiont, Regiella insecticola. Although the result of an unfortunate handling error, these co-infections proved instructive, because they showed that the cost of infection with Spiroplasma may be attenuated in the presence of Regiella. These results suggest that mechanisms other than protection against A. ervi maintain pea aphid infections with diverse strains of Spiroplasma, and that studying them in isolation will not provide a complete picture of their effects on host fitness.

Generating Engagement on the Make Healthy Normal Campaign Facebook Page: Analysis of Facebook Analytics

Background

Facebook is increasingly being used as part of mass media campaigns in public health, including the Make Healthy Normal (MHN) campaign in New South Wales, Australia. Therefore, it is important to understand what role Facebook can play in mass media campaigns and how best to use it to augment or amplify campaign effects. However, few studies have explored this.

Objective

This study aimed to investigate usage of and engagement with the MHN Facebook page and to identify influential factors in driving engagement with the page.

Methods

We examined both post-level and page-level analytic data from Facebook from the campaign’s launch in June 2015 to September 2017. For post-level data, we conducted a series of negative binomial regressions with four different outcome measures (likes, shares, comments, post consumers), including some characteristics of Facebook posts as predictors. We also conducted time series analyses to examine associations between page-level outcomes (new page likes or “fans” and number of engaged users) and different measures of exposure to the page (number of unique users reached and total count of impressions) and to television advertising.

Results

Of the 392 posts reviewed, 20.7% (n=81) received a paid boost and 58.9% (n=231) were photo posts. We found that posts that received a paid boost reached significantly more users and subsequently received significantly more engagement than organic (unpaid) posts (P<.001). After adjusting for reach, we found the effect of being paid was incremental for all outcome measures for photos and links, but not videos. There were also associations between day of the week and time of post and engagement, with Mondays generally receiving less engagement and posts on a Friday and those made between 8 AM and 5 PM receiving more. At the page level, our time series analyses found that organic impressions predicted a higher number of new fans and engaged users, compared to paid impressions, especially for women. We also found no association between television advertising and engagement with the Facebook page.

Conclusions

Our study shows that paying for posts is important for increasing their reach, but that page administrators should look to maximize organic reach because it is associated with significantly higher engagement. Once reach is accounted for, video posts do not benefit from being paid, unlike the other post types. This suggests that page administrators should carefully consider how they use videos as part of a Facebook campaign. Additionally, the lack of association between television advertising and engagement suggests that future campaigns consider how best to link different channels to amplify effects. These results highlight the need for ongoing evaluation of Facebook pages if administrators are to maximize engagement.

Health Consequences of an Armed Conflict in Zamboanga, Philippines Using a Syndromic Surveillance Database

The Zamboanga armed conflict was a 19-day long encounter in the Philippines in 2013 that displaced 119,000 people from their homes. This study describes the health consequences of this complex emergency in different age groups, time periods, and health facilities using data from Surveillance in Post Extreme Emergencies and Disasters (SPEED). This is a descriptive study of the SPEED database spanning 196 days of observation post-disaster and 1065 SPEED reports from 49 health facilities. Evacuation centers and village health centers, both primary care facilities, had the highest number of consults. Common infections and noncommunicable diseases were the most common reasons for consultations, namely, acute respiratory infections, fever, watery diarrhea, skin disease, and hypertension. Infections can be associated with environmental conditions in displaced populations, while hypertension has a high prevalence in the country and implies long-term care. Conflict-related injuries and deaths were not frequently observed due to the volatile situation that influenced health-seeking behavior as well as possible reporting gaps. In conclusion, in complex emergencies, as in natural disasters, wherein early alert and warning for potential outbreaks is crucial, SPEED can assist decision makers on response and recovery interventions. Linkages between SPEED and other surveillance and reporting systems need to be explored.

Higher intake of medications for digestive disorders in children prenatally exposed to drugs with atropinic properties

Childhood digestive disorders are a common occurrence and are sometimes unexplained. Maternal medication during the development of the foetus' digestive system may contribute to the increase in childhood digestive disorders, especially with drugs acting on the cholinergic system. This study investigated the association between prenatal exposure to drugs with atropinic properties and the use of digestive disorder medications in childhood (0-3 years). Children from POMME (PrescriptiOn Médicaments Mères Enfants), a French database of reimbursed drugs for pregnant women and their children, were included (N = 8 372). Each drug prescribed during antenatal life was assigned an atropinic score (0 = null, 1 = low, 3 = strong). The prenatal atropinic burden was calculated as the sum of atropinic scores of drugs prescribed. More than 30% (N = 2 652) of the children were prenatally exposed to atropinic drugs. They used significantly more digestive disorder medications than unexposed children (RRa = 1.11 [1.06; 1.16]). The strength of the association increased with the prenatal atropinic burden. Our results suggest long-term digestive effects after prenatal exposure to atropinic drugs.

Effect of Schooling on Age-Disparate Relationships and Number of Sexual Partners Among Young Women in Rural South Africa Enrolled in HPTN 068

BACKGROUND

Attending school may have a strong preventative association with sexually transmitted infections among young women, but the mechanism for this relationship is unknown. One hypothesis is that students who attend school practice safer sex with fewer partners, establishing safer sexual networks that make them less exposed to infection.

SETTING

We used longitudinal data from a randomized controlled trial of young women aged 13-20 years in the Bushbuckridge district, South Africa, to determine whether the percentage of school days attended, school dropout, and grade repetition are associated with having a partner 5 or more years older (age-disparate) and with the number of sexual partners in the previous 12 months.

METHODS

Risks of having an age-disparate relationship and number of sexual partners were compared using inverse probability of exposure weighted Poisson regression models. Generalized estimating equations were used to account for repeated measures.

RESULTS

Young women who attended fewer school days (<80%) and who dropped out of school were more likely to have an age-disparate relationship (risk difference 9.9%, 95% confidence interval [CI]: 3.9% to 16.0%; risk difference (%) dropout 17.2%, 95% CI: 5.4% to 29.0%) and those who dropped out reported having fewer partners (count difference dropout 0.343, 95% CI: 0.192 to 0.495). Grade repetition was not associated with either behavior.

CONCLUSION

Young women who less frequently attend school or who drop out are more likely to have an age-disparate relationship. Young women who drop out have overall more partners. These behaviors may increase the risk of exposure to HIV infection in young women out of school.

The Impact of Demographic, Clinical, Symptom and Psychological Characteristics on the Trajectories of Acute Postoperative Pain After Total Knee Arthroplasty

Objective

Total knee arthroplasty is a painful procedure. No studies have evaluated modifiable predictors of acute postoperative pain trajectories during hospitalization.

Methods

Consecutive patients (N = 188) were enrolled in a longitudinal cohort study and completed a demographic questionnaire, as well as the Brief Pain Inventory, Hospital Depression and Anxiety Scale, Lee Fatigue Scale, Fatigue Severity Scale, and Brief Illness Perception Questionnaire on the day before surgery. Clinical data were extracted from medical records.

Setting and Patients

Each patient completed a pain diary that assessed pain at rest and with activity, and hours per day in pain every evening from day of surgery until postoperative day 3. Using hierarchical linear modeling, we investigated which demographic, clinical, symptom, and psychological characteristics predicted initial levels as well as the trajectories of acute pain at rest and with activity, and hours per day in pain.

Results

Higher levels of all three acute pain characteristics on the day of surgery resulted in worse trajectories. Higher pain scores with rest and with activity on the day of surgery were associated with more days with femoral block, higher average dose of opioids, and higher emotional response to osteoarthritis. Higher number of comorbidities, higher average dose of opioids, and lower perceived control predicted more hours per day in pain on the day of surgery.

Conclusions

This study identified several potentially modifiable predictors of worsening pain trajectories following total knee arthroplasty. Optimal pain management warrants identification of these high-risk patients and treatment of modifiable risk factors.

ECG-derived Cheyne-Stokes respiration and periodic breathing in healthy and hospitalized populations

BACKGROUND

Cheyne-Stokes respiration (CSR) has been investigated primarily in outpatients with heart failure. In this study we compare CSR and periodic breathing (PB) between healthy and cardiac groups.

METHODS

We compared CSR and PB, measured during 24 hr of continuous 12-lead electrocardiographic (ECG) Holter recording, in a group of 90 hospitalized patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome (ACS) to a group of 100 healthy ambulatory participants. We also examined CSR and PB in the 90 patients presenting with ACS symptoms, divided into a group of 39 (43%) with confirmed ACS, and 51 (57%) with a cardiac diagnosis but non-ACS. SuperECG software was used to derive respiration and then calculate CSR and PB episodes from the ECG Holter data. Regression analyses were used to analyze the data. We hypothesized SuperECG software would differentiate between the groups by detecting less CSR and PB in the healthy group than the group of patients presenting to the emergency department with ACS symptoms.

RESULTS

Hospitalized patients with suspected ACS had 7.3 times more CSR episodes and 1.6 times more PB episodes than healthy ambulatory participants. Patients with confirmed ACS had 6.0 times more CSR episodes and 1.3 times more PB episodes than cardiac non-ACS patients.

CONCLUSION

Continuous 12-lead ECG derived CSR and PB appear to differentiate between healthy participants and hospitalized patients.

Do the same risk and protective factors influence aggression toward partners and same-sex others?

The current studies examined whether several risk and protective factors operate similarly for intimate partner violence (IPV) and same-sex aggression (SSA) in the same sample, and to assess whether they show similar associations for men and women. Study 1 (N = 345) tested perceived benefits and costs, and instrumental and expressive beliefs about aggression: perceived costs predicted IPV and SSA for both men and women. Expressive beliefs predicted IPV (more strongly for women), and instrumental beliefs predicted SSA. Study 2 (N = 395) investigated self-control, anxiety and empathy, finding that self-control strongly predicted both types of aggression in both sexes. Study 3 (N = 364) found that primary psychopathy (involving lack of anxiety) was associated with IPV for men and SSA in both sexes, whereas secondary psychopathy (involving lack of self-control) was associated with IPV and SSA in both sexes. Overall there were both similarities and differences in the risk factors associated with IPV and SSA, and for men and women. The implications of the findings for theoretical debates about the study of IPV are discussed. Aggr. Behav. 43:163-175, 2017. © 2016 Wiley Periodicals, Inc.

N-Terminal Pro-B-Type Natriuretic Peptide-Guided Therapy in Chronic Heart Failure Reduces Repeated Hospitalizations-Results From TIME-CHF

BACKGROUND

Although heart failure (HF) patients are known to experience repeated hospitalizations, most studies evaluated only time to first event. N-Terminal B-type natriuretic peptide (NT-proBNP)-guided therapy has not convincingly been shown to improve HF-specific outcomes, and effects on recurrent all-cause hospitalization are uncertain. Therefore, we investigated the effect of NT-proBNP-guided therapy on recurrent events in HF with the use of a time-between-events approach in a hypothesis-generating analysis.

METHODS AND RESULTS

The Trial of Intensified Versus Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) randomized 499 HF patients, aged ≥60 years, left ventricular ejection fraction ≤45%, New York Heart Association functional class ≥I,I to NT-proBNP-guided versus symptom-guided therapy for 18 months, with further follow-up for 5.5 years. The effect of NT-proBNP-guided therapy on recurrent HF-related and all-cause hospitalizations and/or all-cause death was explored. One hundred four patients (49 NT-proBNP-guided, 55 symptom-guided) experienced 1 and 275 patients (133 NT-proBNP-guided, 142 symptom-guided) experienced ≥2 all-cause hospitalization events. Regarding HF hospitalization, 132 patients (57 NT-proBNP-guided, 75 symptom-guided) experienced 1 and 122 patients (57 NT-proBNP-guided, 65 symptom-guided) experienced ≥2 events. NT-proBNP-guided therapy was significant in preventing 2nd all-cause hospitalizations (hazard ratio [HR] 0.83; P = .01), in contrast to nonsignificant results in preventing 1st all-cause hospitalization events (HR 0.91; P = .35). This was not the case regarding HF hospitalization events (HR 0.85 [P = .14] vs HR 0.73 [P = .01]) The beneficial effect of NT-proBNP-guided therapy was seen only in patients aged <75 years, and not in those aged ≥75 years (interaction terms with P = .01 and P = .03 for all-cause hospitalization and HF hospitalization events, respectively).

CONCLUSION

NT-proBNP-guided therapy reduces the risk of recurrent events in patients <75 years of age. This included all-cause hospitalization by mainly reducing later events, adding knowledge to the neutral effect on this end point when shown using time-to-first-event analysis only.

CLINICAL TRIAL REGISTRATION

isrctn.org, identifier: ISRCTN43596477.

Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh

AbstractUnderstanding illness costs associated with diarrhea and acute respiratory infections (ARI) could guide prevention and treatment strategies. This study aimed to determine incidence of childhood diarrhea and ARI and costs of homecare, hospitalization, and outpatient treatment by practitioner type in rural Bangladesh. From each of 100 randomly selected population clusters we sampled 17 households with at least one child < 5 years of age. Childhood diarrhea incidence was 3,451 and ARI incidence was 5,849/1,000 child-years. For diarrhea and ARI outpatient care per 1,000 child-years, parents spent more on unqualified ($2,361 and $4,822) than qualified health-care practitioners ($113 and $947). For outpatient care, visits to unqualified health-care practitioners were at least five times more common than visits to qualified practitioners. Costs for outpatient care treatment by unqualified health-care practitioners per episode of illness were similar to those for qualified health-care practitioners. Homecare costs were similar for diarrhea and ARI ($0.16 and $0.24) as were similar hospitalization costs per episode of diarrhea and ARI ($35.40 and $37.76). On average, rural Bangladeshi households with children < 5 years of age spent 1.3% ($12 of $915) of their annual income managing diarrhea and ARI for those children. The majority of childhood illness management cost comprised visits to unqualified health-care practitioners. Policy makers should consider strategies to increase the skills of unqualified health-care practitioners, use community health workers to provide referral, and promote homecare for diarrhea and ARI. Incentives to motivate existing qualified physicians who are interested to work in rural Bangladesh could also be considered.

Understanding Women's Awareness and Access to Preconception Health Care in a Rural Population: A Cross Sectional Study

Despite evidence of the benefits of preconception health care (PCHC), little is known about awareness and access to PCHC for rural, reproductive-aged women. This study aimed to assess the prevalence of PCHC conversations between rural reproductive-age women and health care providers, PCHC interventions received in the past year, and ascertain predictors of PCHC conversations and interventions. Women (n = 868; 18-45 years) completed a questionnaire including reproductive history, health care services utilization, and interest in PCHC. The prevalence of health care providers' PCHC conversations was 53.9 %, and the mean number of interventions reported was 2.6 ± 2.7 (±SD). Significant predictors of PCHC conversation based on adjusted odds ratios from logistic regression were race (Native American 76 % greater than White), health care provider type (non-physician 63 % greater than physician), visits to a health care provider (3+ times 32 % greater than 1-2 times), and pregnancy planning (considering in next 1-5 years 51 % greater than no plans). Significant predictors of PCHC interventions received in the past 12 months based on adjusted risk ratios from negative binomial regression were race (Native American 22 % greater than White), PCHC conversation with a health care provider (yes 52 % lower than no), reporting PCHC as beneficial (yes 32 % greater than don't know), and visits to a health care provider in the past year (3+ times 90 % greater than 1-2 times). Increasing conversations about PCHC between health care providers and their reproductive-aged patients can improve awareness and increase their likelihood of receiving all of the recommended interventions.

Please Like Me: Facebook and Public Health Communication

Facebook, the most widely used social media platform, has been adopted by public health organisations for health promotion and behaviour change campaigns and activities. However, limited information is available on the most effective and efficient use of Facebook for this purpose. This study sought to identify the features of Facebook posts that are associated with higher user engagement on Australian public health organisations' Facebook pages. We selected 20 eligible pages through a systematic search and coded 360-days of posts for each page. Posts were coded by: post type (e.g., photo, text only etc.), communication technique employed (e.g. testimonial, informative etc.) and use of marketing elements (e.g., branding, use of mascots). A series of negative binomial regressions were used to assess associations between post characteristics and user engagement as measured by the number of likes, shares and comments. Our results showed that video posts attracted the greatest amount of user engagement, although an analysis of a subset of the data suggested this may be a reflection of the Facebook algorithm, which governs what is and is not shown in user newsfeeds and appear to preference videos over other post types. Posts that featured a positive emotional appeal or provided factual information attracted higher levels of user engagement, while conventional marketing elements, such as sponsorships and the use of persons of authority, generally discouraged user engagement, with the exception of posts that included a celebrity or sportsperson. Our results give insight into post content that maximises user engagement and begins to fill the knowledge gap on effective use of Facebook by public health organisations.

The neonatal preventable harm index: a high reliability tool

OBJECTIVE

The aim of this study is to identify, quantify and disseminate a novel set of safety indicators for monitoring the occurrence of preventable harm in the neonatal intensive care unit (NICU).

STUDY DESIGN

Literature review and experiences in an academic, level IV NICU identified prevalent, preventable safety events: hospital-acquired infections (catheter-associated bloodstream infection, ventilator-associated pneumonia), unscheduled extubations, intravenous infiltrates requiring intervention, first week readmissions, serious adverse drug events and miscellaneous events (unanticipated harm or serious near misses). Negative binominal regression evaluated the event incidence trends.

RESULTS

Of 226 preventable harm events occurring between March 2013 and January 2015, the most common were unscheduled extubations (98; 2/100 ventilator days) and intravenous infiltrates (62; 2.7/100 admissions). No trends were detected (rate ratio: 0.99; confidence limits: 0.96 to 1.01; P=0.38).

CONCLUSION

The Neonatal Preventable Harm Index represents a novel and transparent means to monitor serious safety events and direct harm prevention strategies in the NICU.

Impact of endometriosis on in vitro fertilization outcomes: an evaluation of the Society for Assisted Reproductive Technologies Database

OBJECTIVE

To assess the impact of endometriosis, alone or in combination with other infertility diagnoses, on IVF outcomes.

DESIGN

Population-based retrospective cohort study of cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database.

SETTING

Not applicable.

PATIENT(S)

A total of 347,185 autologous fresh and frozen assisted reproductive technology cycles from the period 2008-2010.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Oocyte yield, implantation rate, live birth rate.

RESULT(S)

Although cycles of patients with endometriosis constituted 11% of the study sample, the majority (64%) reported a concomitant diagnosis, with male factor (42%), tubal factor (29%), and diminished ovarian reserve (22%) being the most common. Endometriosis, when isolated or with concomitant diagnoses, was associated with lower oocyte yield compared with those with unexplained infertility, tubal factor, and all other infertility diagnoses combined. Women with isolated endometriosis had similar or higher live birth rates compared with those in other diagnostic groups. However, women with endometriosis with concomitant diagnoses had lower implantation rates and live birth rates compared with unexplained infertility, tubal factor, and all other diagnostic groups.

CONCLUSION(S)

Endometriosis is associated with lower oocyte yield, lower implantation rates, and lower pregnancy rates after IVF. However, the association of endometriosis and IVF outcomes is confounded by other infertility diagnoses. Endometriosis, when associated with other alterations in the reproductive tract, has the lowest chance of live birth. In contrast, for the minority of women who have endometriosis in isolation, the live birth rate is similar or slightly higher compared with other infertility diagnoses.

Regular exercise and related factors in patients with Parkinson's disease: Applying zero-inflated negative binomial modeling of exercise count data

PURPOSE

This study was conducted to identify risk factors that influence regular exercise among patients with Parkinson's disease in Korea. Parkinson's disease is prevalent in the elderly, and may lead to a sedentary lifestyle. Exercise can enhance physical and psychological health. However, patients with Parkinson's disease are less likely to exercise than are other populations due to physical disability.

METHODS

A secondary data analysis and cross-sectional descriptive study were conducted. A convenience sample of 106 patients with Parkinson's disease was recruited at an outpatient neurology clinic of a tertiary hospital in Korea. Demographic characteristics, disease-related characteristics (including disease duration and motor symptoms), self-efficacy for exercise, balance, and exercise level were investigated. Negative binomial regression and zero-inflated negative binomial regression for exercise count data were utilized to determine factors involved in exercise.

RESULTS

The mean age of participants was 65.85 ± 8.77 years, and the mean duration of Parkinson's disease was 7.23 ± 6.02 years. Most participants indicated that they engaged in regular exercise (80.19%). Approximately half of participants exercised at least 5 days per week for 30 min, as recommended (51.9%). Motor symptoms were a significant predictor of exercise in the count model, and self-efficacy for exercise was a significant predictor of exercise in the zero model.

CONCLUSION

Severity of motor symptoms was related to frequency of exercise. Self-efficacy contributed to the probability of exercise. Symptom management and improvement of self-efficacy for exercise are important to encourage regular exercise in patients with Parkinson's disease.

Healthcare use and voluntary health insurance after retirement in Thailand

BACKGROUND

The dramatic changes occurring in the age structure of the Thai population make providing healthcare services for the elderly a major challenge for decision makers. Because the number of the elderly will be increasing, together with the number of retired workers, under the Social Health Insurance (SHI) scheme, there will be the unmet needs for healthcare use after retirement. The SHI scheme does not cover workers after retirement unless they could use free healthcare for the elderly. In addition, the government budget is tight regarding the support of universal healthcare and long-term care services for all of the elderly. Therefore, the government could support retired workers who have the ability to pay by facilitating voluntary health insurance.

OBJECTIVE

The main objectives of the present study are to analyze the characteristics of workers that need health insurance after retirement and to identify the factors explaining healthcare use to offer healthcare services to meet the workers' needs and expectations.

METHODS

Four hundred insured workers under the Social Health Insurance (SHI) Scheme in Thailand were interviewed using a structured questionnaire. The Anderson-Newman model of healthcare use is the conceptual framework used in this study to understand the factors that explain healthcare use patterns of workers. Multiple regressions are employed extensively to evaluate the variables that predict healthcare use.

RESULTS

According to the survey, a person that purchases voluntary health insurance is likely to be female, have a higher personal income, and healthy. The characteristics related to healthcare use were poor health status, a high personal income, and peeople afflicted by chronic illness.

CONCLUSIONS

There is a gap between healthcare service use and the demand for voluntary health insurance. People that have a high income are more likely to purchase voluntary health insurance, while people in worse health and afflicted by chronic illness may have greater difficulty purchasing voluntary health insurance because they face higher premiums or are denied coverage by insurers.

Effect of Methadone Dose on Maintenance Treatment and Health Consequences Among Heroin Addicts in South China

A retrospective cross-sectional study was conducted with a convenience sample of 197 adults receiving methadone maintenance treatment in Kunming city, South China, in 2010. The aim of the study was to determine the association of methadone maintenance dose on a variety of treatment outcomes. Treatment modalities, the adverse reactions to methadone treatment, the physical and mental outcomes of the treatment, and risk behavior changes were assessed. Multilevel negative and logistic binomial regression analyses were carried out, which demonstrated that methadone maintenance dose in this sample was not associated with improved treatment adherence or with quality of life. We concluded that dose had a small, if negligible, influence on the changes in adverse effects of methadone. Further research in dose differences between the genders should be conducted.

Testing predictions from the male control theory of men's partner violence

The aim of this study was to test predictions from the male control theory of intimate partner violence (IPV) and Johnson's [Johnson, M. P. (1995). Journal of Marriage and the Family, 57, 282-294] typology. A student sample (N = 1,104) reported on their use of physical aggression and controlling behavior, to partners and to same-sex non-intimates. Contrary to the male control theory, women were found to be more physically aggressive to their partners than men were, and the reverse pattern was found for aggression to same-sex non-intimates. Furthermore, there were no substantial sex differences in controlling behavior, which significantly predicted physical aggression in both sexes. IPV was found to be associated with physical aggression to same-sex non-intimates, thereby demonstrating a link with aggression outside the family. Using Johnson's typology, women were more likely than men to be classed as "intimate terrorists," which was counter to earlier findings. Overall, these results do not support the male control theory of IPV. Instead, they fit the view that IPV does not have a special etiology, and is better studied within the context of other forms of aggression.

Development and confirmatory factor analysis of the non-violent and violent offending behavior scale (NVOBS)

The purpose of this research was to develop a psychometrically sound measure of violent and non-violent offending, suitable for both male and female participants in general (non-forensic) samples. Potential items were selected from existing measures. A sample of 653 British university students completed all items, and their responses were analyzed using exploratory factor analysis and validated with confirmatory factor analysis. There were five separate factors (general violence, drug-related offenses, partner violence, theft, and criminal damage), which were confirmed with acceptable fit indices. The five-factor model applied to both males and females. Each subscale demonstrated good internal consistency, with alphas for each factor ranging from moderate to good. This new measure is a potentially valuable research tool for investigating people's involvement in violent and non-violent offending. The importance of examining the psychometric properties of scales, and confirming the category groupings using CFA of the items is outlined.