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Objective:To assess the early physical growth and development of human immunodeficiency virus-exposed uninfected (HEU) children by longitudinally comparing the differences of growth and development between HEU group and the healthy human immunodeficiency virus-unexposed uninfected (HUU) control group of children aged 0 to 18 months.Methods:A retrospective cohort study was designed.Maternal information of the human immunodeficiency virus (HIV) infected mothers and follow-up information at 0, 1, 3, 6, 9, 12, and 18 months postpartum of their children (born between January 2013 and December 2019 in Chengdu City) were collected from the Information System of Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus Management. The HUU control group was matched with HEU group by maternal age, gestational age at birth, and infant gender at a ratio of 1∶1. There were 385 children each included in the HEU and HUU groups. Matched samples t-test and the multilevel models were used to compared the physical developmental differences between the two groups. Results:Weight for age Z scores (WAZ) at 0, 3, 6 months of HEU group were -0.72±1.03, -0.09±1.18 and 0.05±1.09, respectively, which were all lower than WAZ of HUU group (-0.21±1.04, 0.42±1.19 and 0.41±1.16, respectively), which were all significantly different ( t=8.41, 7.47 and 5.18, respectively, all P<0.001). Length for age Z scores (LAZ) at 3, 6, 12, 18 months of HEU group were -0.23±1.36, -0.01±1.48, -0.18±1.20 and -0.32±1.13, respectively, which were all lower than LAZ of HUU group (0.24±1.26, 0.30±1.26, 0.07±1.11 and 0.04±1.05, respectively), which were all significantly different ( t=6.14, 4.04, 2.72 and 4.30, respectively, all P<0.01). Weight for length Z scores (WLZ) at 0, 3, 6 months of HEU group were -1.05±1.18, 0.23±1.03 and 0.22±0.95, respectively, which were all lower than WLZ of HUU group (-0.20±0.98, 0.44±1.03 and 0.45±1.00, respectively), which were all significantly different ( t=10.90, 2.95 and 2.96, respectively, all P<0.01). After possible confounding factors were corrected, the WAZ of HEU children at 0, 3, 6 months were still lower than those of HUU children, the LAZ of 3, 6, 12, 18 months were still lower than those of HUU children, and the WLZ of 0, 3, 6 months were still lower than those of HUU children. Conclusions:The differences between HEU and HUU children in Chengdu City mainly occur within six months of age, but the differences of body length persist until 18 months of age.Prenatal exposure to HIV infection affects both fetal and postnatal body growth and development.
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The purpose of this paper was to introduce how to reasonably analyze the multiple Logistic regression models in combination with the multilevel model analysis. Firstly， four basic concepts related to the multilevel model analysis were introduced. Secondly， three steps for building a multilevel model were given. Thirdly， through an example of a multicenter drug clinical trial， the whole process of how to use SAS software for the analysis was presented. The contests were as follows： ① testing whether the odds ratios of each center were homogenous； ② building the multiple Logistic regression model after generating dummy variables for the trial center； ③ constructing a multiple Logistic regression model with the trial center as a stratified variable； ④ building a random intercept multilevel multiple Logistic regression model； ⑤ constructing a random intercept and random slope multilevel multiple Logistic regression model. The conclusion was that when there were differences among the data at different hierarchies with binary outcome variables， the most appropriate approach was to build a multilevel multiple Logistic regression model.
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Background Nursing staff are often exposed to a variety of occupational risk factors in the working environment, such as long working hours and heavy workload, which associated with adverse mental health outcomes. And these factors may not be randomly distributed across different levels. Objective To explore mental health risk factors of nursing staff by multilevel analysis. Methods A cross-sectional survey of nursing staff in Shanghai Municipality, Zhejiang Province, Guangxi Zhuang Autonomous Region, and Xinjiang Uygur Autonomous Region was conducted through convenience sampling from 2018 to 2021. Data were collected by self-report questionnaires. The mental component summaries of 12-Iitem Short Form Health Survey were used to evaluate the mental health status of nursing staff, and related factors were collected atindividual level, including gender, body mass index (BMI), smoking status, drinking status, working years, pain intensity of musculoskeletal disorders, and working hours per week, and at regional level, including gross domestic product (GDP) level of each province. A two-level model was established by incorporating both individual and regional factors, and deviance was used to test the goodness of fit of the model. A traditional generalized linear model was also established, and then compared with the multilevel model. Results A total of 567 nurses participated in this study, and the valid rate of questionnaire was 80.08%. The results of the multilevel model showed that the regional factor contributed 12.1% to the mental component summaries. As to the regional factor, GDP was negatively correlated with mental health of nursing staff, the adjusted OR (AOR) was −0.53 (95%CI: −0.66-−0.28). Among the factors at individual level, the mental component summaries of females were lower than those of males (AOR=−3.25, 95%CI: −4.73-−0.35); the longer the working years, the higher the mental health score (AOR=0.11, 95%CI: 0.06-0.20); working hours per week (AOR=−0.10, 95%CI: −0.14-−0.03) and pain intensity of musculoskeletal disorders (AOR=−0.05, 95%CI: −0.06-−0.03) were negatively correlated with mental component summaries. The results of the generalized linear model included the same factors as the multilevel model, but the 95%CIs of AOR of the factors in the multilevel model were narrower, and the deviation value of the multilevel model was the smallest, indicating that the goodness of fit of the multilevel model was better than that of the traditional linear model. Conclusion The mental health of nursing staff is not only affected by individual level factors, but also affected by regional level factors. It suggests that combining different levels of intervention measures can upscale the effect of improving mental health in nursing staff.
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ObjectiveTo analyze the influencing factors of health-related behaviors for schistosomiasis prevention and control among primary and secondary school students in Sichuan Province using a multilevel and multivariate logistic model, so as to provide the theoretical evidence for developing the schistosomiasis prevention and control strategy among primary and secondary school students in Sichuan Province. MethodsA multi-stage sampling was conducted among 63 schistosomiasis-endemic counties (districts) in Sichuan Province. Five endemic townships were sampled from each county (district), and 100 Grade 4 to 6 students in each primary school and 100 Grade 1 to 3 students in each secondary school were sampled from each township as the study subjects. The health-related behaviors for schistosomiasis prevention and control were investigated using a questionnaire survey, and factors affecting infested water contact behaviors were identified using univariate and multilevel logistic analyses. Results Among the 62 200 questionnaires distributed, there were 59 134 recovered, and 56 510 were qualified. The qualified 56 510 respondents included 22 955 secondary school students and 33 555 primary school students, and 28 297 male students and 28 213 females. A higher proportion of infested water contacts was seen in male students than in females (P < 0.001), and the students living in heavily endemic areas had a higher proportion of infested water contacts than those in mildly endemic areas (P < 0.001). In addition, there was no significant difference in the proportion of infested water contacts between primary and secondary school students (P >0.05). Multilevel and multivariate logistic analyses revealed a lower proportion of infested water contacts with the increase of knowledge, belief and self-efficacy levels (P < 0.001), and there was a cluster of infested water contacts among students at a county scale (P < 0.001). Conclusions There is a cluster of infested-water contact behaviors among primary and secondary school students at a county scale in Sichuan Province. Individual and environmental factors should be considered during the formulation of health education strategy and interventions for schistosomiasis among primary and secondary school students.
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Objective@#To investigate the prevalence, awareness, treatment and control of hypertension in adult residents in Jiangsu province and provide evidence for the prevention and control of hypertension.@*Methods@#A population-based cardiovascular disease screening project was conducted during 2015-2018 in Jiangsu, a total of 95 348 community-dwelling adults aged 35-75 years from 6 project areas were included in the study. The prevalence rate of hypertension and rates of awareness, treatment and control of hypertension in the adults with different characteristics were analyzed. Multilevel model was applied to identify the influencing factors.@*Results@#Among 95 348 adults surveyed, 54 407 were hypertensive, the standardized prevalence rate was 48.1%. The prevalence rate was significantly higher in males than in females (62.1% vs. 54.0%, P<0.05). Among the hypertension patients, the rates of awareness, treatment and control of hypertension were 56.6%, 45.3% and 12.0% (standardized rates: 52.2%, 41.0% and 11.2%), respectively, and all the rates were positively associated with age (all P<0.05). Multilevel model analysis showed that those who were males, at older age, lived in rural area, suffered from diabetes, had frequent alcohol drinking and those who were overweight/obese had higher risk for hypertension (all P<0.05). Among people with hypertension, those who had younger age, lower education level, lower household income level and those who had frequent alcohol drinking had lower awareness, treatment and control rates of hypertension (all P<0.05).@*Conclusions@#The prevalence rate of hypertension was high, but related awareness, treatment and control rates were low in adult residents in Jiangsu province. Comprehensive measures should be taken to improve awareness, treatment and control of hypertension in whole population, especially in young adults, and those with low education or income levels.
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Objective@#To explore the patient and hospital related determinants of adherence to early antithrombotic therapy among patients with acute ischemic stroke (AIS).@*Methods@#AIS patients aged 50 years old or above who were eligible for early antithrombotic therapy, were included from the China National Stroke Registry Ⅱ (CNSR Ⅱ) project. Characteristics related to patients and hospitals were collected. Univariate analysis method was conducted to explore the correlation between hospital or patient-related determinants and early antithrombotic therapy. A 2-level logistic regression model was set up to identify patient and hospital-related variables that were associated with the adherence to early antithrombotic therapy, with patient as level 1 and hospital as level 2.@*Results@#A total of 16 910 patients were included in the study, with 14 332 (84.75%) of them having received early antithrombotic therapy. Results from the univariate analysis showed that the patient determinants to early antithrombotic therapy would include age, type of health insurance, average income and history of dyslipidemia. Hospital determinants would include factors as: level and region of the hospital, academic status, with/without stroke unit, quality control on single disease and the percentage of neurological beds in total beds (P<0.05). Data on multilevel model showed that the patient-related determinants on early antithrombotic therapy would include age, gender, average income, history of hypertension, National Institutes of Health Stroke Scale (NIHSS) score at admission while hospital related determinants would include percentage of neurological beds in total beds, and region of the hospital (P<0.05).@*Conclusions@#The quality of a hospital was associated with the adherence to early antithrombotic therapy. AIS patients at advanced age or with high NIHSS score at admission should be paid more attention.
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Objective To determine the awareness, treatment and control of hypertension and its determinants in the elderly hypertensive patients of Dean nationality so as to explore the associated determinants. Methods This was a cross-sectional, population-based survey. A total of 939 persons aged 60 years and older sampled by stratified sampling method from the elderly population of Dean nationality were examined from July to September 2016. Meanwhile, the data of medical history and examination were collected. Results There were 353 elderly patients with hypertension in the 939 subjects. The awareness, treatment and control of hypertension in the elderly hypertensive patients (EHP), which was 47.3％, 36.5％and 22.1％respectively, were higher than the results of previous national study and had the upward trends with the increasing age (<0.05) . In comparison with the reference group, EHP living in middle economic level area had the higher awareness, treatment and control of hypertension (<0.05) . The results of covariate-adjusted multilevel logistic regression model indicated that there was a cross-level interaction effect between middle economic level area and dyslipidemia on the awareness and treatment of hypertension respectively, and a cross-level interaction effect between middle economic level area and low fat diet on the control of hypertension ( <0.05) . The individual level covariates, age (OR=1.3412, 1.3144, 95％ CI 1.0217-1.7609, 1.0030-1.7225) and diabetes ( OR=2.6735, 2.3078, 95％ CI 1.0721-6.6672, 1.0240-5.2007), had the positive association with the awareness and treatment of hypertension;age (OR=1.4740, 95％CI 1.0034-2.1654), non-drinking (OR=3.2056, 95％CI 1.5554-6.6066) and low salt diet (OR=3.6969, 95％CI 1.7996-7.5946) had the positive association with the control of hypertension. Conclusion The awareness, treatment and control of hypertension in the EHP of Dean nationality were higher than those of the national level, and the dominant factors were economic level, age, dyslipidemia, diabetes, non-drinking, low fat diet and low salt diet, etc.
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O objetivo do presente artigo consiste em apresentar um modelo reducionista e o modelo multinível com relação à explicação etiológica dos transtornos mentais, a partir do exemplar da esquizofrenia, considerando-se os alcances e limites destes modelos. Ao final do artigo, são extraídas algumas implicações ético-políticas para a psiquiatria.
The aim of this paper is to present a reductionist model and the multilevel model for the etiological explanation of mental disorders, based on the example of schizophrenia and by taking into account the scope and limits of those models. To conclude, some ethical and political implications for psychiatry are singled out.
Le but de cet article est de présenter un modèle réductionniste et le modèle à multi-niveaux pour l’explication étiologique des troubles mentaux, illustrés par l’exemple de la schizophrénie et en tenant compte de la portée et des restrictions que ces modèles présentent. Quelques implications éthiques et politiques pour la psychiatrie en sont extraites en guise de conclusion.
El propósito de este artículo consiste en presentar el modelo reduccionista y el modelo multinivel con respecto a la explicación etiológica de los trastornos mentales desde el ejemplo de la esquizofrenia, teniendo en cuenta los alcances y los límites de estos modelos. Al final del artículo, se extraen algunas implicaciones éticas y políticas para la psiquiatría.
Dieser Artikel beschreibt ein reduktionistisches Modell und das Mehrebenenmodell für die ätiologische Erklärung psychischer Störungen und benutzt als Beispiel die Schizophrenie, unter Berücksichtigung der Anwendungsbereiche und Begrenzungen dieser Modelle. Abschließend werden ethische und politische Schlussfolgerungen für die Psychiatrie erläutert.
本文章的目的是提供一个还原模式和多层次的模型解释精神障碍的病因，尤其精神分裂症，并考虑其范围和界限。在文章结束时提取精神病学一些伦理和政治影响。.
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To compare two commonly used statistical approaches:the multilevel model and the latent growth curve model in analyzing longitudinal data. A longitudinal data set,obtained from the quality of life in patients with colorectal cancer after operation,was used to illustrate the similarities and differences between the two methods. Results from the study indicated that the latent growth curve modeling was equivalent to multilevel modeling with regards to longitudinal data which could yield identical results for the estimates of parameters. Multilevel model approach seemed easier for model specification. However,latent growth curve model had the advantage of providing model evaluation and was more flexible in statistical modeling by allowing the incorporation of latent variables. Both multilevel and latent growth curve models were suitable for analyzing longitudinal data with advantages on their own,they conld be chosen by researchers under different situation to be chosen accordingly by researchers under different situation.
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To compare two commonly used statistical approaches:the multilevel model and the latent growth curve model in analyzing longitudinal data. A longitudinal data set,obtained from the quality of life in patients with colorectal cancer after operation,was used to illustrate the similarities and differences between the two methods. Results from the study indicated that the latent growth curve modeling was equivalent to multilevel modeling with regards to longitudinal data which could yield identical results for the estimates of parameters. Multilevel model approach seemed easier for model specification. However,latent growth curve model had the advantage of providing model evaluation and was more flexible in statistical modeling by allowing the incorporation of latent variables. Both multilevel and latent growth curve models were suitable for analyzing longitudinal data with advantages on their own,they conld be chosen by researchers under different situation to be chosen accordingly by researchers under different situation.
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Objective To assess prevalence and risk factors of illness within the past 2 weeks among rural residents in Menglian,under the background of essential public health service implemented generally. Methods In February 2012, the questionnaire method was employed to investigate the two-week morbidity in 2011 rural residents sampled by multistage stratified random sampling from Menglian population. Results The prevalence, that of illness within two-week among 2011 rural residents in Menglian, was 97.5‰ (95%CI 84.5‰-110.5‰) . It was lower than that of the rural region IV in China (149.6‰, <0.05) .Its age trend was the same as that of the rural region IV in China,the prevalence in 0-14 years old children,however,was higher than the counterpart in the rural region IV in China. The diseases, which two-week morbidity ranked the top five, were acute upper respiratory infection, acute gastroenteritis, hyperostosis, acute tracheobronchitis and rheumatoid arthritis. The results of multilevel logistic regression model fitted by group-level explanatory variable mountainous area, individual-level random slopes variable gender and other individual background variables indicated that there were across-level interactions between mountainous area and gender ( <0.05), the family income lower than RMB 15000 (odds ration 3.2378, 95%CI 1.9014-5.5130) and age (odds ration 1.0163, 95%CI 1.0002-1.0327) had a positive effect to two-week morbidity, and contrasting to unmarried, married had a negative effect to two-week morbidity (odds ratio 0.4727, 95%CI 0.2534-0.8819) . Conclusions Comparing with that of the rural region IV in China before implementing essential public health service, the two-week morbidity in Menglian was lower. For further elevating the health level of population, the strategies, such as intensifying material and child hygiene in the mountain area, improving sanitary conditions of low income family, and updating health consciousness in single population,would be implemented.
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Objective To analyze the awareness on health among high school students and its influencing factors in Guangdong. Methods Multi-stage sampling and questionnairs "2009 health awareness survey of the Chinese citizens" developed by our Department of Health, were used. Data were analyzed by multivariate multilevel model under MLwinN 2.19 software. Results The mean scores on knowledge and ideas, behaviors and related skills among 1606 high school students of Guangdong province, were 69.08 ± 14.81,60.05 ± 16.85 and 74.99 ± 21.17 respectively. Three items on health showed that they all related to each other and relations between grades (0.972,0.715 and 0.855) were greater than the individuals (0.565,0.426 and 0.438). Conclusion Factors as students from outside the Pearl River Delta region or from the rural areas, being male, at general secondary schools, at grade one, with poor academic performance and more pocket money etc., had lower levels on those related information of health.
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Objective To explore the association between psychiatric disorders and socioeconomic status such as education,income,employment and area of community settings in Zhejiang province.Methods Data were from the epidemiological survey of mental illnesses aged 15 and older in 2001(n=14 632).Psychiatric disorders were measured by GHQ-12 with a cut-point 4.Logistic multilevel analysis was the main statistical method being used.Results The overall prevalence of psychiatric disorders was 18.5%(95% confidence intervals,17.9% to 19.1%),higher than the data from Hebei province(u=4.39,P＜0.001).Annual household income and employment were strongly associated with psychiatric disorders especially for those with low income(odds ratio 3.45,95%CI:1.72-6.67)and unemployment(odds ratio 2.03,95%CI:1.73-2.40).Factors as regional effect and education level showed weak or inconsistent association with psychiatric disorders after controlling on other indicators.Conclusion Inverse gradient relation between psychiatric disorders and SES seemed as the main result of low SES individual characteristics and some minor effects at the county level.
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The main purpose of this paper is to explore the applicability of multivariate multilevel models for bioequivalence evaluation. Using an example of a 4×4 cross-over test design in evaluating bioequivalence of homemade and imported rosiglitazone maleate tablets,this paper illustrated the multivariate-model-based method for partitioning total variances of In (AUC) and In (C_(max)) in the framework of multilevel models. It examined the feasibility of multivariate multilevel models in directly evaluating average bioequivalence (ABE),population bioequivalence (PBE) and individual bioequivalenc (IBE). Taking into account the correlation between In (AUC) and In (C_(max)) of rosiglitazone maleate tablets,the proposed models suggested no statistical difference between the two effect measures in their ABE bioequivalence via joint tests,whilst a contradictive conclusion was derived based on univariate multilevel models. Furthermore,the PBE and IBE for both In (AUG) and In(C_(max)) of the two types of tablets were assessed with no statistical difference based on estimates of variance components from the proposed models. Multivariate multilevel models could be used to analyze bioequivalence of multiple effect measures simultaneously and they provided a new way of statistical analysis to evaluate bioequivalence.
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Objective To provide evidence for setting up violence intervention programs in rural middle schools, through studying the influential factors. Methods Taking variables including emotional, physical and sexual violence in the past year as the multi-dependent variables before multivariate multilevel model logistic regression model was adopted to analyze the correlations among the three kinds of violence and the influential factors. Results Among 3620 respondents, the incidence rates of emotional, physical and sexual violence weres 21.5%, 24.3% and 2.0% respectively. The correlation coefficients between emotional violence vs. physical violence, emotional violence vs. sexual violence, physical violence vs. sexual violence were 0.337,0.133, 0.131 respectively when the random effect of class difference was separated by multivariate multilevel model. There was an internal aggregation of the incidence rate on physical violence in different grades (X2=4.286, P=0.038) and an internal relevant between emotional violence vs. sexual violence (X2=4.239, P=0,039), physical violence vs. sexual violence (X2=4.482, P=0.034). The influential factors on the incidence rates of violence would include:sex, smoking status, family without harmony, tendency of bullying others and the level on self-esteem etc. Conclusion When the random effect of class difference was separated by multivariate multilevel model, the estimated results would be more precise. Other than paying more attention to both individual and family influential factors when taking measures to reduce the incidence rate of violence in high school students, the effect of environment in the class should not be ignored.