Contextual and individual determinants of oral health-related quality of life among adolescents

Abstract The aim of this study was to assess the factors associated with oral health-related quality of life in adolescents (OHRQoL). Individual data on adolescents were collected from a secondary database. OHRQoL was measured using the oral impact on daily performance (OIDP) scale. Individual- and city-level variables were selected to represent the structural and intermediate determinants of health. The individual covariates analyzed were sex, age, skin color, maternal education, household income, number of people per room in the housing unit, dental attendance, self-perception of dental needs, untreated dental caries, and gingival bleeding. The contextual variables included the allocation factor, the Human Development Index (HDI), Gini coefficient, illiteracy, unemployment, income, average number of emergency dental visits per inhabitant, access to a sanitary sewer system, garbage collection, primary health care coverage, oral health team coverage, and number of tooth extractions between selected dental procedures and supervised toothbrushing. Unadjusted and adjusted multilevel Poisson regression analyses were used to evaluate the relationship between contextual and individual variables with overall OIDP scores (STATA version 16.0) - rate ratio (RR) and 95%CI. The mean OIDP score was 0.72 and the prevalence was 31.8%. There was an association between supervised toothbrushing average and the outcome (RR 0.95; 95%CI 0.91-0.99). Moreover, adolescents who lived in municipalities with the highest average number of emergency dental visits per inhabitant showed a higher OIDP. Sex, maternal education, untreated dental caries, and gingival bleeding were associated with OIDP. In addition, intersectoral public policies focusing on the reduction of social inequalities should be on the agenda of policymakers and stakeholders.

Construção e validação de instrumento para avaliação socioestrutural e comportamental associado à infecção pelo HIV em jovensa / Construcción y validación de un instrumento de evaluación sociológica y comportamental asociado con la infección por VIH en jóvenes / Construction and validity of an instrument for sociological and behavioral assessment associated with HIV infection in young peoplea

RESUMO Objetivo construir e validar conteúdo de instrumento para avaliação socioestrutural e comportamental associado à infecção pelo HIV em jovens. Método estudo metodológico, desenvolvido em duas etapas: elaboração do instrumento; e validação de conteúdo. Os itens que compuseram o instrumento foram selecionados através de revisão literária, tendo como referencial os domínios multiníveis do Modelo Social Ecológico Modificado, categorizados em componentes socioestruturais e comportamentais. O conteúdo foi avaliado por especialistas em duas rodadas conduzidas pela técnica Delphi, admitindo-se um índice de concordância de, no mínimo, 80%. Resultados a primeira versão do instrumento continha 52 itens, distribuídos em três domínios. Na primeira rodada, 19 itens (36,5%) obtiveram Índice de Validade de Conteúdo inferior a 0,80, dois itens foram excluídos e os demais foram reformulados. Na segunda rodada, 2 itens foram excluídos e 3 foram incorporados como subitem, totalizando 45 itens. O Índice de Validade de Conteúdo do Instrumento foi de 95%. Conclusão e implicações para a prática as recomendações dos especialistas contribuíram para a qualificação do instrumento Avaliação Socioestrutural e Comportamental-HIV, possibilitando a reorganização do conteúdo. O instrumento é válido para a identificação de fatores socioestruturais e comportamentais associados à infecção pelo HIV em jovens, com potencial para constituir planejamento de cuidados preventivos.

RESUMEN Objetivo construir y validar el contenido de un instrumento de evaluación socioestructural y conductual asociada a la infección por VIH en jóvenes. Método estudio metodológico, desarrollado en dos etapas: elaboración del instrumento; y validación de contenido. Los ítems que conformaron el instrumento fueron seleccionados a través de una revisión literaria, tomando como referencia los dominios multinivel del Modelo Ecológico Social Modificado, categorizados en componentes socioestructurales y conductuales. El contenido fue evaluado por expertos en dos rondas realizadas mediante la técnica Delphi, suponiendo una tasa de acuerdo de al menos el 80%. Resultados la primera versión del instrumento contuvo 52 ítems, distribuidos en tres dominios. En la primera ronda, 19 ítems (36,5%) tuvieron un Índice de Validez de Contenido inferior a 0,80, dos ítems fueron excluidos y el resto fueron reformulados. En la segunda ronda, se excluyeron 2 ítems y se incorporaron 3 como subítems, totalizando 45 ítems. El Índice de Validez de Contenido del Instrumento fue del 95%. Conclusión e implicaciones para la práctica las recomendaciones de los expertos contribuyeron para la calificación del instrumento Evaluación Socioestructural y del Comportamiento-VIH, permitiendo la reorganización del contenido. El instrumento es válido para identificar factores socioestructurales y conductuales asociados a la infección por VIH en jóvenes, con potencial para constituir una planificación de atención preventiva.

ABSTRACT Objective to construct and validate the content of an instrument for sociostructural and behavioral assessment associated with HIV infection in young people. Method a methodological study developed in two steps: instrument elaboration; and content validity. The items that made up the instrument were selected through a literary review using the Modified Social Ecological Model multilevel domains as a reference, categorized into sociostructural and behavioral components. Content was assessed by experts in two rounds conducted using the Delphi technique, assuming an agreement rate of at least 80%. Results the first version of the instrument contained 52 items, distributed across three domains. In the first round, 19 items (36.5%) had a Content Validity Index lower than 0.80, two items were excluded and the rest were reformulated. In the second round, 2 items were excluded and 3 were incorporated as subitems, totaling 45 items. The Instrument Content Validity Index was 95%. Conclusion and implications for practice experts' recommendations contributed qualifying the Sociostructural and Behavioral Assessment-HIV instrument, enabling content reorganization. The instrument is valid for identifying socio-structural and behavioral factors associated with HIV infection in young people, with the potential to constitute preventive care planning.

Fundamento y generalidades de la construcción de modelos estadísticos multinivel en el ámbito de la investigación en salud

Este trabajo tiene como objetivo presentar una mirada global de la aplicabilidad de los modelos de análisis multinivel en el ámbito de la investigación sanitaria. Ofrece información sobre los fundamentos teóricos, metodológicos y estadísticos y, además, menciona los pasos básicos para la construcción de estos modelos, y da ejemplos de su uso, según la estructura jerárquica de los datos. Cabe resaltar que, antes de utilizar estos modelos, se requiere contar con un soporte teórico sobre la necesidad de uso y una valoración estadística que dé cuenta del porcentaje de varianza explicada por el efecto de agrupación de las observaciones. Los requisitos para llevar a cabo este tipo de análisis dependen de condiciones especiales como el tipo de variables, la cantidad de unidades por nivel o el tipo de estructura jerárquica. Se concluye que los modelos de análisis multinivel son una herramienta útil para lograr la integración de información, dadas la complejidad de las relaciones y las interacciones que determinan la mayoría de las condiciones de salud, incluida la pérdida de independencia entre las unidades de observación.

This topic review aims to present a global vision of multilevel analysis models' applicability to health research, explaining its theoretical, methodological, and statistical foundations. We describe the basic steps to build these models and examples of their application according to the data hierarchical structure. It ir worth noticing that before using these models, researchers must have a rationale for needing them, and a statistical evaluation accounting for the variance percentage explained by the observations grouping effect. The requirements to conduct this type of analysis depends on special conditions such as the type of variables, the number of units per level, or the type of hierarchical structure. We conclude that multilevel analysis models are a useful tool to integrate information, considering the complexity of the relationships and interactions involved in most health conditions, including the loss of independence between observation units.

Spatial and temporal patterns of infant mortality and its components in Rio de Janeiro / Padrões espaciais e temporais da mortalidade infantil e seus componentes no Rio de Janeiro

ABSTRACT Objectives. The study aims to assess the trend of neonatal, post-neonatal, and infant mortality from 1996 to 2020 within the metropolitan region of the state of Rio de Janeiro and other regions. Methods. Ecological study using the region as analysis unity. Data were accessed from the Mortality Information System and Live Birth Information System in the capital Rio de Janeiro, in the neighboring areas of Niterói, São Gonçalo, Baixada Fluminense, and the remaining regions of the state of Rio de Janeiro State. We applied Poisson multilevel modeling, where the models' response variables were infant mortality and its neonatal and post neonatal components. Fixed effects of the adjusted models were region and death year variables. Results. During the 1996-2020 period, the Baixada Fluminense showed the highest infant mortality rate as to its neonatal and post neonatal components. All adjusted models showed that the more recent the year the lower the mortality risk. Niterói showed the lowest adjusted risk of infant mortality and its neonatal and post neonatal components. Conclusion. Baixada Fluminense showed the highest mortality risk for infant mortality and its neonatal and post-neonatal components in the metropolitan region. The stabilization in mortality rates in recent years was identified by the research.

RESUMO Objetivos. Avaliar a tendência da mortalidade neonatal, pós-neonatal e infantil de 1996 a 2020, na região metropolitana do estado do Rio de Janeiro e nas outras regiões. Métodos. Estudo ecológico utilizando regiões como unidade de análise. Os dados foram acessados no Sistema de Informações sobre Mortalidade e Sistema de Informações sobre Nascidos Vivos da Capital (Rio de Janeiro), dos territórios vizinhos (Niterói, São Gonçalo e Baixada Fluminense) e das outras regiões do Estado do Rio de Janeiro. Utilizamos a modelagem multinível de Poisson, onde as variáveis de resposta dos modelos foram mortalidade infantil e seus componentes neonatal e pós-neonatal. Os efeitos fixos dos modelos ajustados foram região e ano da morte. Resultados. No período 1996-2020, a Baixada Fluminense apresentou a maior taxa de mortalidade infantil de seus componentes neonatal e pós-natal na região metropolitana. Todos os modelos ajustados mostraram que quanto mais recente o ano, menor o risco de mortalidade. O risco ajustado da mortalidade infantil e seus componentes neonatal e pós-neonatal foi menor em Niterói. Conclusão. A Baixada Fluminense apresentou o maior risco de mortalidade infantil e de seus componentes neonatal e pós-neonatal na região metropolitana. Detectamos estabilização das taxas de mortalidade nos últimos anos.

Multilevel model in the identification of behavioral and structural risk factors for HIV: integrative review / Modelo multinivel para la identificación de factores de riesgo comportamentales y estructurales del VIH: revisión integradora / Modelo multinível na identificação de fatores de risco comportamentais e estruturais ao HIV: revisão integrativa

ABSTRACT Objectives: to investigate studies that adopted the multilevel analysis model to identify behavioral and structural risk factors associated with HIV infection. Methods: an integrative review of the literature with studies available in full, obtained from EMBASE, CINAHL, Pubmed, and Scopus, whose selected descriptors were the indexed terms: "HIV", "multilevel analysis" and "behavior". Results: the search resulted in 236 studies. Out of these, ten studies comprised the sample. Economic disadvantage, neighborhood characteristics, housing instability, incarceration, transactional sex, multiple partners, substance abuse, and age at first intercourse were classified as structural and behavioral risk factors for HIV. Reduced socioeconomic disadvantage, provision of housing stability, and condom use were associated with protective factors for HIV exposure. Conclusions: by applying the multilevel model in risk factor research studies, it was possible to identify the structural and behavioral elements of HIV risk.

RESUMEN Objetivos: investigar estudios que adoptaron el modelo del análisis multinivel para identificar los factores de riesgo comportamentales y estructurales asociados al VIH. Método: es una revisión bibliográfica integradora con estudios disponibles en su totalidad, obtenidos de las bases de datos EMBASE, CINAHL, Pubmed y Scopus, cuyos descriptores fueron los términos: "HIV", "multilevel analysis", "behavior". Resultados: diez artículos, de los 236 encontrados, formaron parte de la muestra. Desventajas económicas, características del vecindario, inestabilidad habitacional, encarcelamiento, sexo transaccional, parejas múltiples, abuso de sustancias y edad de la primera relación sexual se destacaron como factores de riesgo estructurales y comportamentales del VIH. La reducción de desventajas socioeconómicas, la provisión de estabilidad habitacional y el uso de preservativos están asociados a la protección contra el VIH. Conclusiones: al aplicar el modelo multinivel en los estudios de investigación de los factores de riesgo, fue posible identificar los elementos estructurales y comportamentales del riesgo del VIH.

RESUMO Objetivos: investigar estudos que adotaram o modelo de análise multinível na identificação de fatores de risco comportamentais e estruturais, que estão associados a infecção pelo HIV. Métodos: revisão integrativa da literatura com estudos disponíveis na íntegra, obtidos nas bases EMBASE, CINAHL, Pubmed e Scopus, cujos descritores selecionados foram os termos constantes: "HIV", "multilevel analysis", "behavior". Resultados: a pesquisa resultou em 236 artigos. Destes, dez artigos compuseram a amostra. Desvantagem econômica, características de vizinhança, instabilidade habitacional, encarceramento, sexo transacional, múltiplos parceiros, abuso de substâncias e idade da primeira relação sexual foram classificados como fatores de risco estruturais e comportamentais ao HIV. Redução da desvantagem socioeconômica, fornecimento de estabilidade habitacional e uso de preservativos foram associados a fatores de proteção à exposição ao HIV. Conclusões: com a aplicabilidade do modelo multinível nos estudos de investigação de fatores de risco, foi possível identificar os elementos estruturais e comportamentais de risco ao HIV.

Economic fluctuations and educational inequalities in premature ischemic heart disease mortality in Argentina / Variaciones económicas y desigualdades educativas en la mortalidad prematura por enfermedad isquémica en Argentina / Flutuações econômicas e desigualdades educacionais na mortalidade prematura por doença isquêmica na Argentina

Abstract: Although mortality from ischemic heart disease has declined over the past decades in Argentina, ischemic heart disease remains one of the most frequent causes of death. This study aimed to describe the role of individual and contextual factors on premature ischemic heart disease mortality and to analyze how educational differentials in premature ischemic heart disease mortality changed during economic fluctuations in two provinces of Argentina from 1990 to 2018. To test the relationship between individual (age, sex, and educational level) and contextual (urbanization, poverty, and macroeconomic variations) factors, a multilevel Poisson model was estimated. When controlling for the level of poverty at the departmental level, we observed inequalities in premature ischemic heart disease mortality according to the educational level of individuals, affecting population of low educational level. Moreover, economic expansion was related to an increase in ischemic heart disease mortality, however, expansion years were not associated with increasing educational inequalities in ischemic heart disease mortality. At the departmental level, we found no contextual association beween area-related socioeconomic level and the risk of ischemic heart disease mortality. Despite the continuing decline in ischemic heart disease mortality in Argentina, this study highlighted that social inequalities in mortality risk increased over time. Therefore, prevention policies should be more focused on populations of lower socioeconomic status in Argentina.

Resumen: Si bien la mortalidad por cardiopatía isquémica ha disminuido en las últimas décadas en Argentina, la cardiopatía isquémica sigue siendo una de las causas más frecuentes de muerte. Los objetivos de este estudio fueron describir el papel de los factores individuales y contextuales en la mortalidad prematura por cardiopatía isquémica y analizar cómo estos cambiaron las diferencias educativas en la mortalidad prematura por cardiopatía isquémica durante las variaciones económicas en dos provincias de Argentina durante el periodo 1990-2018. Para probar la relación entre los factores individuales (edad, género y nivel de educación) y contextuales (urbanización, pobreza y variaciones macroeconómicas), se estimó un modelo de Poisson multinivel. Controlando el nivel de pobreza en el ámbito departamental, se observaron desigualdades en la mortalidad prematura por cardiopatía isquémica según el nivel de educación de los individuos, lo que afecta a la población con bajo nivel de educación; la expansión económica se relacionó con el aumento de la mortalidad por cardiopatía isquémica; sin embargo, el periodo de expansión no estuvo asociado a aumentos de las desigualdades educativas en la mortalidad por cardiopatía isquémica. En el ámbito departamental no se detectó asociación entre el nivel socioeconómico de la área y el riesgo de mortalidad por cardiopatía isquémica. A pesar de la disminución continua de la mortalidad por cardiopatía isquémica en Argentina, este estudio destaca que las desigualdades sociales con relación al riesgo de mortalidad tuvieron un aumento con el tiempo. Por lo tanto, las políticas de prevención deberán dirigirse más a las poblaciones de menor nivel socioeconómico en Argentina.

Resumo: Embora a mortalidade por doença isquêmica do coração tenha diminuído nas últimas décadas na Argentina, a doença isquêmica do coração continua sendo uma das causas mais frequentes de morte. Os objetivos deste estudo foram descrever o papel de fatores individuais e contextuais na mortalidade prematura por doença isquêmica do coração e analisar como as diferenças educacionais na mortalidade prematura por doença isquêmica do coração mudaram durante as flutuações econômicas em duas províncias da Argentina durante o período 1990-2018. Para testar a relação entre fatores individuais (idade, sexo e escolaridade) e contextuais (urbanização, pobreza e variações macroeconômicas), estimou-se um modelo de Poisson multinível. Controlando o nível de pobreza no nível departamental, observaram-se desigualdades na mortalidade prematura por doença isquêmica do coração de acordo com o nível educacional dos indivíduos, afetando a população de baixa escolaridade; a expansão econômica esteve relacionada ao aumento da mortalidade por doença isquêmica do coração; no entanto, os anos de expansão não foram associados a aumentos nas desigualdades educacionais na mortalidade por doença isquêmica do coração. No nível departamental, não foi detectada uma associação contextual entre nível socioeconômico da área e risco de mortalidade por doença isquêmica do coração. Apesar do contínuo declínio da mortalidade por doença isquêmica do coração na Argentina, este estudo destaca que as desigualdades sociais em relação ao risco de mortalidade aumentaram ao longo do tempo. Portanto, as políticas de prevenção devem ser mais focadas nas populações de menor nível socioeconômico na Argentina.

Current status and future prospects of the model integrating medicine with health regimens for elderly care under the multilevel referral healthcare system / 中华老年医学杂志

Along with population aging in China, the spectrum of chronic diseases in the elderly is constantly evolving, and the demand for different types of elderly care is increasing steadily.The healthcare infrastructure constitutes the cornerstone of elderly care.In order to further improve the elderly care system and the medical service model, this paper analyzes the current status of the model integrating medicine with health regimens for elderly care under the multilevel referral healthcare system and puts forward suggestions for future development.

Longitudinal study on growth of human immunodeficiency virus-exposed uninfected children from 2013 to 2019 in Chengdu City / 中华传染病杂志

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.

Construction of multi-level medical training platform system in clinical skills simulation training center / 中华医学教育探索杂志

This study mainly introduces the exploration of the construction and management of multi-level medical training platform in clinical skills center of the Affiliated Hospital of Yangzhou University. Through the construction of a multi-level clinical skills training platform, a reasonable hierarchical training program is formulated by taking the clinical basic skills training platform and the clinical specialist skills training platform as the basic core teaching content. This program adopts various ways to improve the teaching quality, effectively promote students' ability of clinical practice step by step, meet the needs of different levels of medical personnel in different stages, scientifically and effectively cultivate the high-quality medical personals, and give full play to the role of hospital clinical skills center in medical education, which lays a good foundation for the continuous improvement of teaching quality in hospitals.

The status quo and demand analysis of multi-level pre-job training for clinical nursing teachers / 中华医学教育探索杂志

Objective:To investigate the status quo of multi-level pre-job training for clinical nursing teachers and analyze their training needs, so as to provide reference for the design of pre-job training for clinical nursing teachers.Methods:A cross-sectional survey method was used to investigate 172 clinical nursing teachers in a tertiary general hospital in Harbin from April 2020 to June 2020 with multi-level pre-job training mode. The status quo of pre-job training and the training needs of teachers were analyzed. SPSS 17.0 was used to process the original data statistically.Results:Among the 172 respondents, 138 teachers (80.2%) were under 35 years old, and 133 teachers (77.3%) had a bachelor's degree or less; 89 teachers (51.7%) confirmed that hospitals or departments would carry out pre-job training in a planned and organized way, 10 teachers (5.8%) said that hospitals or departments had never organized training, 41 teachers (23.8%) had never participated in pre-job training, and 80 teachers (46.5%) had participated in pre-job training 1-3 times. There were 5 duplicates in the first 8 training contents of in-hospital training and in-department training, including knowledge of common diseases, nursing procedures, communication skills, hospital rules and regulations, and teaching methods. The total score of training demand was (154.51± 40.35) points, and the overall demand rate was 81.3%, which was at the high level. The dimensions with the highest scoring rate were legal system and humanistic literacy, with a scoring rate of 83.0%. The dimension with the lowest score was teaching management, with a score of 74.9%. The scoring rate of training needs with the highest points won nine items respectively on students' basic quality (self-supervision, willingness to learn, professional quality, etc.) (84.7%), training of legal knowledge (84.4%), incompatibility of drugs commonly used in department (84.3%), nurse etiquette (83.3%), nursing risk prevention (83.1%), evaluation methods of student education (83.1%), nurse-patient communication skills (83.0%), nurses and patients medication observation points of commonly used drugs in the department (83.0%), and effects of commonly used drugs in department (82.9%). Among the top three training forms, 84 students (48.8%) received online learning, 74 students (43.0%) received lectures from experienced teachers in hospitals, and 72 students (41.9%) received experience exchange and sharing seminars.Conclusion:The talent structure of clinical nursing teachers in this hospital is relatively young, and the first education level is low. Therefore, the pre-job training of clinical nursing teachers should be strengthened vigorously. The awareness rate and participation rate of pre-job training are average, so we should strengthen the release of training information from various channels, improve the awareness rate of training activities, clarify the encouragement or reward measures to participate in pre-job training activities, and improve the participation rate of training activities. Pre-job training content is repeated at every level, with a gap between the training needs of teachers in clinical nursing teaching. It's suggested that the teaching hospitals combine with their training objects of training needs, take the online-offline mixed mode of training, reasonably plan training contents as a whole at all levels, avoid training content repetition and waste of teachers, and organize teachers to timely exchange and share experiences.

Preventive role of community-level social capital in the need for long-term care and impairment in instrumental activities of daily living: a multilevel analysis

BACKGROUND@#Individual-level social capital is an important determinant of older adults' long-term care needs; however, there is scant evidence regarding community-level social capital. Therefore, we investigated the association between community-level social capital and the prevalence of the need for long-term care among older adults.@*METHODS@#Between January and February 2018, a cross-sectional survey was conducted among all older adults (n = 13,558) aged 65 to 74 years in a rural municipality in Japan (total population, n = 72,833). A self-reported questionnaire was used to identify community-level social capital, comprising civic participation, social cohesion, and reciprocity. A multilevel logistic regression analysis was performed to estimate the odds ratios of the need for long-term care and a decline in social activity competence as assessed by instrumental activities of daily living. For the analysis, the community levels were divided into 76 voting districts and adjusted for daily life, lifestyle, socioeconomic status, health conditions, and the three social capital subscale scores at the individual level.@*RESULTS@#After adjusting for the covariates, we observed a tendency that a higher community level of reciprocity was associated with a lower prevalence of long-term care needs (OR: 0.86, 95% confidence interval: 0.75-1.00), whereas a high community level of social cohesion was associated with a significantly reduced decline in instrumental activities of daily living (OR per standard deviation increase: 0.87, 95% confidence interval: 0.79-0.96). No significant association was found with civic participation. Similarly, individual-level social capital was associated with the need for long-term care and decline in instrumental activities of daily living.@*CONCLUSIONS@#Our findings suggest that good community-level reciprocity or social cohesion as well as good individual social capital status may help prevent the need for long-term care among older adults.

Climas empowering y disempowering, necesidades psicológicas e intención de práctica deportiva futura en jóvenes deportistas / Empowering and disempowering climates, psychological needs and future sports practice intention in young athletes

Resumen Introducción: El objetivo principal de este trabajo es conocer la interrelación entre la percepción de los climas empowering y disempowering generados por los entrenadores (nivel equipo) con la satisfacción y frustración de las necesidades psicológicas básicas, y estas, a su vez, con las intenciones de continuar y abandonar la práctica deportiva (nivel individual) en jóvenes deportistas. Método: Participaron 251 deportistas mexicanos (M = 13.22, DT = 1.28) pertenecientes a 19 equipos. Se les aplicó una batería de cuestionarios para la recolección de datos y se realizó un análisis multinivel de ecuaciones estructuradas. Resultados: El modelo de ecuaciones estructurales reveló asociaciones positivas entre las percepciones de climas empowering desde una perspectiva grupal sobre la satisfacción de necesidades psicológicas básicas y de estas sobre las intenciones de continuar la práctica deportiva desde una perspectiva individual, así como entre las percepciones de un clima disempowering sobre la frustración de las necesidades psicológicas básicas y de estas sobre las intenciones de abandono. Conclusión: Los hallazgos de este estudio sugieren en un nivel aplicado que el clima empowering actúa como catalizador del bienestar psicológico y como protector de la aparición de frustración, mientras que el clima disempowering facilita el desarrollo de respuestas psicológicas desadaptativas en el deporte.

Abstract Introduction: The main objective of this work is to know the interrelation between the perception of empowering and disempowering climates generated by coaches (team level) with basic psychological needs satisfaction and frustration, and these in turn, with the intentions to continue and abandon sports practice (individual level) in young athletes. Method: 251 Mexican athletes participated (M = 13. 22, SD = 1.28) belonging to 19 teams. A battery of questionnaires was applied for data collection and a multilevel structured equation analysis was performed. Results: The structural equation model revealed positive associations between perceptions of empowering climates from a group perspective on the satisfaction of basic psychological needs and of these on intentions to continue practicing sports from an individual perspective; as well as between perceptions of a disempowering climate on the frustration of basic psychological needs and of these on intentions to drop out. Conclusion: The findings of this study suggest at an applied level that the empowering climate acts as a catalyst of psychological well-being and as a protector against the occurrence of frustration, while the disempowering climate facilitates the development of maladaptive psychological responses in sport.

Inequidad en el ingreso y caries de la infancia temprana en Colombia: un análisis multinivel / Income inequality and early childhood caries in Colombia: a multilevel analysis

Resumen Evaluamos la asociación entre inequidad en los ingresos y caries de la infancia temprana en Colombia, utilizando un análisis multinivel. Analizamos datos del último estudio nacional de salud bucal (2014) e información sobre ingresos en términos absolutos y relativos a nivel departamental. Los desenlaces fueron experiencia de caries y caries no tratada. Se utilizó un modelo de regresión logística multinivel con dos niveles: niños/familias (nivel 1) anidados en departamentos (nivel 2). En el nivel 1 se consideraron variables de edad, sexo, posición socioeconómica (PSE) de la vivienda, ingresos del hogar y régimen de aseguramiento en salud. Para el nivel 2 las variables fueron coeficiente Gini, Necesidades Básicas Insatisfechas (NBI) y Producto Interno Bruto (PIB). Se evaluaron datos de 5.250 niños de 1, 3 y 5 años, 36.9% tenían experiencia de caries y 33.0% caries no tratada. Los desenlaces mostraron asociaciones significativas con edad, PSE baja del hogar y pertenecer al régimen subsidiado de salud. Para caries no tratada se encontraron asociaciones con PSE baja o muy baja (OR: 1.72; IC95% 1.42, 2.07 y OR: 1.69; IC95% 1.36, 2.09 respectivamente) y régimen subsidiado de salud (OR: 1.58; IC95% 1.11, 2.24). No se encontraron asociaciones significativas con indicadores de coeficiente Gini, PIB y NBI.

Abstract The association between income inequality and dental caries on early childhood in Colombia was evaluated using a multi-level analysis. We analyzed data from the latest national oral survey (2014) and information about income in absolute and relative terms on a state-level. The outcomes were caries experience, and untreated caries. A multilevel logistic regression model was used (2 levels) with children/households nested within states. Age, gender, area-level socioeconomic position (SEP), household income and health insurance regime were the level 1 explanatory variables. For level 2, variables were the Gini coefficient, Unsatisfied Basic Needs (UBN) and Gross Domestic Product (GDP). Data from 5.250 children, aged 1, 3 and 5 years were evaluated. Prevalence of caries experience and untreated caries was 36.9% and 33.0% respectively. Both outcomes showed significant associations with age, low SEP and belonging to the subsidized health insurance regime: untreated dental caries was associated with living in low and very low SEP (OR: 1.72; 95%CI 1.42, 2.07 and OR: 1.69; 95%CI 1.36, 2.09 respectively), and subsidized health insurance scheme (OR: 1.58; 95%CI 1.11, 2.24). When the Gini, GDP and UBN indicators were included in the models, no significant associations were found.

Trayectorias de fragilidad y factores relacionados en la población de adultos mayores en México / Trajectories of frailty and related factors of elderly people in Mexico

Resumen Introducción: la fragilidad es un indicador del estado de salud en la vejez y un síndrome clínico común en adultos mayores; conlleva un elevado riesgo de resultados deficientes de salud que incluyen caídas, incidentes de discapacidad, hospitalización y mortalidad. Este estudio tuvo como objetivo identificar las diferentes trayectorias de la fragilidad y los factores relacionados con esta entre adultos mayores mexicanos a lo largo del tiempo. Metodología: los datos provienen de un panel de cuatro rondas compuesto por adultos mayores mexicanos y desarrollado de 2001 a 2015 por el Estudio Nacional de Salud y Envejecimiento en México (ENASEM). La fragilidad es la acumulación de déficits a partir de un índice de fragilidad. Se aplicó un análisis multinivel, utilizando modelos jerárquicos para conocer los cambios de trayectorias de fragilidad y qué factores se relacionan con ella. Resultados: ser mujer mayor, viuda y tener un bajo nivel educativo fueron factores de riesgo para un índice de fragilidad alto y una menor satisfacción financiera o realizar actividades en el hogar tienen efectos adversos. Conclusiones: se halló una prevalencia de la fragilidad según la proporción de déficits que poseen los individuos y sus primordiales componentes asociados. Se requiere mejorar las condiciones socioeconómicas de salud en fases previas a la vejez con miras a evitar la presencia de fragilidad en el futuro.

Abstract Introduction: Frailty is an indicator of health status in old age and a common clinical syndrome in older adults that carries an increased risk of poor health outcomes, including falls, incidents of disability, hospitalization, and mortality. This study aimed to identify the different trajectories of frailty and the factors related to frailty among Mexican older adults over time. Methods: Data are from a four-wave panel composed of older Mexican adults from 2001 to 2015 of the Mexican Health and Aging Study (MHAS). Frailty is the accumulation of deficits using a frailty index. A multilevel analysis, using hierarchical models, was applied to know the changes of frailty trajectories and what factors are related to it. Results: Being female, older, being widowhood, and having a lower level of education were risk factors for having a high frailty index and lower financial satisfaction doing activities at home have adverse effects. Conclusion: The findings of this work present information about the prevalence of frailty considering the proportion of deficits that individuals possess and their main associated components in older Mexican adults. It is necessary to improve socioeconomic health conditions in phases before old age to avoid developing frailty in the future.

Prácticas alimentarias, un fenómeno multinivel

RESUMEN El presente ensayo tiene como propósito posicionar el entender las prácticas alimentarias de las personas y de las poblaciones desde la perspectiva de curso de vida como tema relevante para generar conocimientos desde perspectivas interdisciplinarias. Así, se expondrán a las prácticas alimentarias desde una perspectiva sociohistórica, posicionándonos desde una visión que integre los diferentes niveles, dominios y temporalidades, con el fin de ampliar la perspectiva de un fenómeno esencialmente interdisciplinario. De esta manera, se abren las preguntas sobre qué niveles y dominios de la vida de las personas y las poblaciones se encuentran involucrados y cuáles son las formas temporales que se manejan en la interconexión de los diferentes elementos. Se busca posicionar a las prácticas alimentarias desde una perspectiva holística que pueda orientar la planificación e interpretación de investigaciones aplicadas para afrontar los desafíos de salud pública en el presente.

ABSTRACT The purpose of this essay is to position the understanding of food practices of individuals and populations from a life course perspective as relevant to focus in producing knowledge from an interdisciplinary perspective. So, here I discuss food practices as a sociohistorical phenomenon, acquiring a point of view that integrates different levels, domains and temporalities, with the purpose of broaden the perspective of a essentially multidisciplinary phenomenon. This opens questions about what levels and domains of the life of individuals and societies are involved, as well as what temporal forms are handled in the interconnection of the different elements. Thus, this essay seeks to position food practices from a wide perspective that can guide interpretation in empirical research necessary to face public health challenges that appear in the present.

Multilevel Survival Analysis of Factors Associated with Under-Five Mortality in Manipur

Background: Child mortality is a major public health issue. The studies on under‑five mortality that ignore the hierarchical facts mislead the interpretation of the results due to observations in the same cluster sharing common cluster‑level random effects. Objectives: The present study uses a multilevel model to analyze under‑five mortality and identify the significant factors for under‑five mortality in Manipur. Methods: National Family Health Survey‑5 (2019–21) data are used in the present study. Amultilevel mixed‑effect Weibull parameter survival model was fitted to determine the factors affecting under‑five mortality. We construct three‑level data, individual levels are nested within primary sampling units (PSUs), and PSUs are nested within districts. Results: Out of the 3225 under‑five children, 85 (2.64%) died. The three‑level mixed‑effects Weibull parametric survival model with PSUs nested within the districts, the likelihood‑ratio test with Chi‑square value = 10.98 and P = 0.004 < 0.05 indicated that the model with random‑intercept effects model with PSUs nested within the districts fits the data better than the fixed effect model. The four covariates, namely the number of birth in the last 5 years, age of mother at first birth, use of contraceptive, and size of child at birth, were found as the risk factor for under‑five mortality at a 5% level of significance. Conclusions: In the random‑intercept effect model, the two estimated variances of the random‑intercept effects for district and PSU levels are 0.27 and 0.31, respectively. The values indicate variations (unobserved heterogeneities) in the risk of death of the under‑five children between districts and PSUs levels.

Mortality by colon, lung, esophagus, prostate, cervix and breast cancers in Brazilian capitals, 2000-2015: a multilevel analysis / Mortalidade por câncer de cólon, pulmão, esôfago, próstata, colo do útero e mama nas capitais brasileiras, 2000-2015: uma análise multinível

Abstract This study aimed to analyze the role of period, geographic and socio demographic factors in cancer-related mortality by prostate, breast, cervix, colon, lung and esophagus cancer in Brazilians capitals (2000-2015). Ecological study using data of Brazilian Mortality Information. Multilevel Poisson models were used to estimate the adjusted risk of cancer mortality. Mortality rate levels were higher in males for colon, lung and esophageal cancers. Mortality rates were highest in the older. Our results showed an increased risk of colon cancer mortality in both sexes from 2000 to 2015, which was also evidenced for breast and lung cancers in women. In both genders, the highest mortality risk for lung and esophageal cancers was observed in Southern capitals. Midwestern, Southern and Southeastern capitals showed the highest mortality risk for colon cancer both for males and females. Colon cancer mortality rate increased for both genders, while breast and lung cancers mortality increased only for women. The North region showed the lowest mortality rate for breast, cervical, colon and esophageal cancers. The Midwest and Northeast regions showed the highest mortality rates for prostate cancer.

Resumo Este estudo teve como objetivo analisar o papel de fatores temporais, geográficos e sociodemográficos na mortalidade por câncer de próstata, mama, colo do útero, cólon, pulmão e esôfago nas capitais brasileiras (2000-2015). Estudo ecológico utilizando informações brasileiras de mortalidade. Modelos de Poisson multinível foram usados ​​para estimar o risco ajustado de mortalidade por câncer. Os níveis de mortalidade foram maiores em homens para câncer de cólon, pulmão e esôfago. As taxas de mortalidade foram mais altas nos idosos. Nossos resultados mostraram risco aumentado de mortalidade por câncer de cólon em ambos os sexos de 2000 a 2015, o que também foi evidenciado para câncer de mama e de pulmão em mulheres. Em ambos os sexos, o maior risco de mortalidade para câncer de pulmão e esôfago foi observado nas capitais do Sul. As capitais do Centro-Oeste, Sul e Sudeste apresentaram o maior risco de mortalidade por câncer de cólon tanto para homens quanto para mulheres. A taxa de mortalidade por câncer de cólon aumentou para ambos os sexos, enquanto a mortalidade por câncer de mama e de pulmão aumentou apenas para as mulheres. A região Norte apresentou a menor taxa de mortalidade por câncer de mama, colo do útero, cólon e esôfago. As regiões Centro-Oeste e Nordeste apresentaram as maiores taxas de mortalidade por câncer de próstata.

Cooperação internacional para o desenvolvimento e financiamento externo para o Brasil: uma macroanálise do período entre 2000 e 2020 / Cooperación internacional para el desarrollo con financiación externa para Brasil: un macroanálisis de 2000 a 2020 / International development cooperation and external financing in Brazil: a macro analysis from 2000 to 2020

Resumo Este artigo traz como objeto de análise os projetos e programas do setor público no Brasil que receberam financiamentos externos de organismos multilaterais e bilaterais em âmbito federal, estadual e municipal entre 2000 e 2020. Os dados analisados foram coletados no Painel da Comissão de Financiamentos Externos (Painel COFIEX) do Ministério da Economia do Brasil, categorizados e apresentados neste artigo de forma conjuntural, com o objetivo de representar um panorama sobre este objeto para os estudos da Administração Pública no país. Importante instrumento do Sistema de Cooperação Internacional para o Desenvolvimento (SCID), o financiamento internacional para o desenvolvimento obedece às agendas e diretrizes das organizações internacionais, as quais se modificaram ao longo dos anos. Dessa forma, além de explorar as principais fontes credoras, setores e unidades da federação de destino dos financiamentos internacionais para o desenvolvimento destinados ao Brasil, o artigo buscou verificar de que forma as características dos financiamentos internacionais recebidos entre 2000 e 2015 e pós-2015 refletem as agendas e diretrizes da Cooperação Internacional para o Desenvolvimento (CID) dos respectivos períodos, a saber: os Objetivos de Desenvolvimento do Milênio (ODM) (2000-2015) e os Objetivos do Desenvolvimento Sustentável (ODS) (2015-2030). Como resultado, além de apresentar uma pioneira análise exploratória dos dados, verificou-se uma inflexão dos financiamentos externos recebidos no pós-2015 pelo Brasil na direção da atual agenda e diretrizes da CID. Por fim, o artigo apresenta encaminhamentos para agendas futuras de pesquisa.

Resumen Este artículo ofrece un análisis de los proyectos y programas del sector público en Brasil que recibieron financiación externa de agencias multilaterales y bilaterales, a nivel federal, estatal y municipal, entre los años 2000 y 2020. Los datos analizados fueron recolectados en el Panel COFIEX del Ministerio de Economía de Brasil, categorizados y presentados en este artículo de forma coyuntural, con el objetivo de representar una visión general de este objeto para los estudios de la Administración Pública en el país. Instrumento importante del Sistema de Cooperación Internacional para el Desarrollo (SCID), la Financiación Internacional para el Desarrollo sigue las agendas y directrices de las organizaciones internacionales, que han cambiado a lo largo de los años. Así, además de explorar las principales fuentes acreedoras, sectores y unidades federales de destino de la Financiación Internacional para el Desarrollo a Brasil, el artículo buscó verificar cómo las características de la financiación internacional recibida entre 2000 y 2015 y posteriormente reflejan las agendas y directrices de la Cooperación Internacional para el Desarrollo (CID) de los respectivos períodos, a saber, los Objetivos de Desarrollo del Milenio (2000-2015) y los Objetivos de Desarrollo Sostenible (2015-2030). Como resultado, además de presentar un análisis exploratorio pionero de los datos, se verificó una inflexión de la financiación externa recibida por Brasil después de 2015 hacia la actual agenda y directrices de la Cooperación Internacional para el Desarrollo (CID). Por último, el documento presenta referencias para futuras agendas de investigación.

Abstract This article analyzes public sector projects and programs in Brazil that received external financing from multilateral and bilateral agencies at the federal, state, and municipal levels between 2000 and 2020. The analyzed data were collected in the COFIEX Panel of the Brazilian Ministry of Economy, categorized, and presented in this article in a contextual way, aiming to represent the first overview of this object for studies on Public Administration in the country. An important instrument of the International Development Cooperation System, International Financing for Development follows international organizations" agendas and guidelines that have changed throughout history. Thus, in addition to exploring the main creditor sources, sectors, and federal units of destination of International Development Financing to Brazil, the article verified how the characteristics of international financing received between 2000-2015 and post-2015 reflect the agendas and guidelines of International Development Cooperation of the respective periods, namely, the Millennium Development Goals (2000-2015) and the Sustainable Development Goals (2015-2030). As a result, in addition to presenting a pioneering exploratory analysis of the data, it was possible to verify an inflection of external financing received by Brazil after 2015 in the direction of the current agenda and guidelines of International Development Cooperation. Finally, the paper presents directions for future research agendas.

Reasonably conduct the multiple Logistic regression analysis combined with the multilevel model analysis / 四川精神卫生

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.

Provincial differentials of the effect of internal migration on teenage fertility in South Africa

This study investigated the association between internal migration and teenage fertility in South Africa. Data were from the 2007 and 2016 South African community surveys, N2007= 89800 and N2016=239733, age range 12 to 19, black teenagers= 81.5% and 89.4%, respectively. Results showed that between 2007 and 2016 internal migration levels decreased by 2% nationally, but increased for Gauteng, Western Cape and KwaZulu Natal provinces. Teenage fertility levels decreased in all provinces except the Northern Cape in the study period. In both years teenage fertility was observed at higher levels among girls that were older, heads of households, and who were in secondary schooling. Random-intercept multilevel binary logistic regression revealed that the risk of teenage fertility differed between more rural and urban provinces. In provinces that were predominantly rural the risk of teenage pregnancy increased as community-levels of internal migration increased while the risk decreased as internal migration increased in provinces that were predominantly urban. Findings suggest that the effects of internal migration on teenage pregnancy are largely dependent on the local context making it necessary to create interventions that are context-specific at sub-national levels.