time varying covariates
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2022 ◽  
Vol 7 (2) ◽  
pp. 78-87
Author(s):  
Laura E. Michaelson ◽  
Juliette Berg ◽  
Michelle J. Boyd-Brown ◽  
Whitney Cade ◽  
Dian Yu ◽  
...  

The purpose of this study was to investigate within- and between-person associations between sleep and subsequent goal setting in adolescents. We conducted an intensive repeated measures longitudinal study to assess intra- and interindividual associations between sleep and goal setting and potential moderators of such associations. Thirty-nine seventh through 12th graders reported on their sleep quality and propensity to set goals in their daily lives several times per week for approximately four months. We used a combination of multilevel modeling with time-varying covariates and centering techniques to partition within- and between-person variance. We found significant and positive associations between sleep and goal setting within individuals, but no such associations between individuals. That is, students were more likely to set goals for their work after getting a good night’s sleep relative to their own average sleep quality, but getting good sleep on average relative to other individuals showed no association with average goal setting. These relationships were not moderated by participant age, gender, or sociodemographic status as indexed by maternal education. Differences in average sleep between adolescents matters less for their propensity to set goals than whether they experienced better- or worse-than-usual sleep the previous night given their own average. This finding represents the first evidence documenting effects of sleep on goal setting, which is an important psychological precursor to many youth behavioral and achievement outcomes. Our findings highlight the individuality of sleep needs and point to new directions for sleep-related practice and policy aimed at youth.


Author(s):  
Renpei Kato ◽  
Sei Naito ◽  
Kazuyuki Numakura ◽  
Shingo Hatakeyama ◽  
Tomoyuki Koguchi ◽  
...  

Abstract Background This retrospective multicenter study aimed to evaluate the survival benefit of upfront cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (RCC) patients stratified by International Metastatic RCC Database Consortium (IMDC) risk criteria. Methods We reviewed the medical records in the Michinoku Database between 2008 and 2019. Patients who received upfront CN, systemic therapy without CN (no CN) and CN after drug therapy (deferred CN) were analyzed. To exclude selection bias due to patient characteristics, baseline clinical data were adjusted by inverse probability of treatment weighting (IPTW). Overall survival (OS) was compared between upfront CN and non-upfront CN (no CN plus deferred CN). Associations between time-varying covariates including systemic therapies and OS stratified by IMDC risk criteria were analyzed by IPTW-adjusted Cox regression method. Results Of 259 patients who fulfilled the selection criteria, 107 were classified in upfront CN and 152 in non-upfront CN group. After IPTW-adjusted analysis, upfront CN showed survival benefit compared to non-upfront CN in patients with IMDC intermediate risk (median OS: 52.5 versus 31.3 months, p < 0.01) and in patients with IMDC poor risk (27.2 versus 11.4 months, p < 0.01). In IPTW-adjusted Cox regression analysis of time-varying covariates, upfront CN was independently associated with OS benefit in patients with IMDC intermediate risk (hazard ratio 0.52, 95% confidence interval 0.29–0.93, p = 0.03) and in patients with IMDC poor risk (0.26, 0.11–0.59, p < 0.01). Conclusions Upfront CN may confer survival benefit in RCC patients with IMDC intermediate and poor risk.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261899
Author(s):  
Alessia A. Galbussera ◽  
Sara Mandelli ◽  
Stefano Rosso ◽  
Roberto Zanetti ◽  
Marianna Rossi ◽  
...  

Background Mild anemia is a frequent although often overlooked finding in old age. Nevertheless, in recent years anemia has been linked to several adverse outcomes in the elderly population. Objective of the study was to investigate the association of mild anemia (hemoglobin concentrations: 10.0–11.9/12.9 g/dL in women/men) with all-cause mortality over 11–15 years and the effect of change in anemia status on mortality in young-old (65–84 years) and old-old (80+ years). Methods The Health and Anemia and Monzino 80-plus are two door-to-door, prospective population-based studies that included residents aged 65-plus years in Biella municipality and 80-plus years in Varese province, Italy. No exclusion criteria were used. Results Among 4,494 young-old and 1,842 old-old, mortality risk over 15/11 years was significantly higher in individuals with mild anemia compared with those without (young-old: fully-adjusted HR: 1.35, 95%CI, 1.15–1.58; old-old: fully-adjusted HR: 1.28, 95%CI, 1.14–1.44). Results were similar in the disease-free subpopulation (age, sex, education, smoking history, and alcohol consumption adjusted HR: 1.54, 95%CI, 1.02–2.34). Both age groups showed a dose-response relationship between anemia severity and mortality (P for trend <0.0001). Mortality risk was significantly associated with chronic disease and chronic kidney disease mild anemia in both age groups, and with vitamin B12/folate deficiency and unexplained mild anemia in young-old. In participants with two hemoglobin determinations, seven-year mortality risk was significantly higher in incident and persistent anemic cases compared to constant non-anemic individuals in both age groups. In participants without anemia at baseline also hemoglobin decline was significantly associated with an increased mortality risk over seven years in both young-old and old-old. Limited to the Monzino 80-plus study, the association remained significant also when the risk was further adjusted also for time-varying covariates and time-varying anemia status over time. Conclusions Findings from these two large prospective population-based studies consistently suggest an independent, long-term impact of mild anemia on survival at older ages.


2021 ◽  
pp. 003288552110693
Author(s):  
Thomas W. Wojciechowski

This study sought to understand how PTSD predicts opioid use onset rates and how subsequent exposures to violence also influence this risk following adjudication. Survival analysis was used to examine the moderating role that baseline PTSD status plays for predicting rates of opioid use onset risk following adjudication. Hazard models used to examine the role of time-varying covariates for predicting opioid onset risk following adjudication. PTSD was found to predict significantly greater odds of opioid use initiation. Hazard of introducing opioid use was greater during observation periods in which participants witnessed violence. This effect was greater for PTSD sufferers.


2021 ◽  
Vol 8 ◽  
Author(s):  
Rui Gonçalves Marques Elias ◽  
Ana Silvia Degasperi Ieker ◽  
Lucas Lopes dos Reis ◽  
Antônio Stabelini Neto ◽  
Jeffer Eidi Sasaki ◽  
...  

Background: Studies have demonstrated the positive effects of physical activity on cardiovascular risk factors. Longitudinal studies using modeled trajectories are necessary to understand patterns of physical activity and association with cardiovascular risk factors.Objective: To analyze the association between sports practice in young people and current physical activity with the trajectory of cardiovascular risk factors in workers at a public hospital.Methods: Four hundred and seventeen workers was followed for four years reporting Physical Activity, health status, lifestyle behaviors and socio-demographic characteristics. Group-based trajectory modeling identified the trajectories of PA and associations with time-stable and time-varying covariates. We considered a range of sociodemographic and health and lifestyle factors as potential covariates.Results: The results shows the association between participation in sports activities in youth and current physical activity and trajectories of cardiovascular risk, adjusted for sex and age (p &lt; 0.05). Adults who reported having played sports in their youth and are currently active have a lower risk of having a history of obesity and low HDL-c than workers who did not play sports in their youth and are currently sedentary 0.690 (0.565–0.844) obesity, 0.647 (0.500–0.837) low HDL-c.Conclusion: The practice of sports in youth and current physical activity is a protective factor against the trajectory of obesity and low HDL-c, mainly in female workers. Programs to encourage the practice of physical activity should be carried out in order to reduce cardiovascular risk factors and prevent chronic diseases in workers.


Author(s):  
Ewa Genge ◽  
Francesco Bartolucci

AbstractWe analyze the changing attitudes toward immigration in EU host countries in the last few years (2010–2018) on the basis of the European Social Survey data. These data are collected by the administration of a questionnaire made of items concerning different aspects related to the immigration phenomenon. For this analysis, we rely on a latent class approach considering a variety of models that allow for: (1) multidimensionality; (2) discreteness of the latent trait distribution; (3) time-constant and time-varying covariates; and (4) sample weights. Through these models we find latent classes of Europeans with similar levels of immigration acceptance and we study the effect of different socio-economic covariates on the probability of belonging to these classes for which we provide a specific interpretation. In this way we show which countries tend to be more or less positive toward immigration and we analyze the temporal dynamics of the phenomenon under study.


2021 ◽  
pp. 140349482110599
Author(s):  
Theodore Lytras ◽  
Sotirios Tsiodras

Aims: While healthcare services have been expanding capacity during the COVID-19 pandemic, quality of care under increasing patient loads has received less attention. We examined in-hospital mortality of intubated COVID-19 patients in Greece, in relation to total intubated patient load, intensive care unit (ICU) availability and hospital region. Methods: Anonymized surveillance data were analyzed from all intubated COVID-19 patients in Greece between 1 September 2020 and 6 May 2021. Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates. Results: Mortality was significantly increased above 400 patients, with an adjusted hazard ratio of 1.25 (95% confidence interval (CI): 1.03–1.51), rising progressively up to 1.57 (95% CI: 1.22–2.02) for 800+ patients. Hospitalization outside an ICU or away from the capital region of Attica were also independently associated with significantly increased mortality. Conclusions: Our results indicate that in-hospital mortality of severely ill COVID-19 patients is adversely affected by high patient load even without exceeding capacity, as well as by regional disparities. This highlights the need for more substantial strengthening of healthcare services, focusing on equity and quality of care besides just expanding capacity.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 115-115
Author(s):  
Tyler Bell ◽  
Jeremy Elman ◽  
Carol Franz ◽  
William Kremen

Abstract Twenty percent of older adults will experience persistent pain, the sensation of bodily harm lasting three or more months. Persistent pain doubles the risk of dementia, but we know less about the impact on earlier stages, such as mild cognitive impairment (MCI). As a step for clarification, this study leveraged data from the Vietnam Era Twin Study of Aging (VETSA) to understand how pain persistence relates to MCI in late midlife to early older adulthood. Participants (n=1,465, 100% male) were recruited across three waves at average ages 56, 62, and 68. At each wave, participants completed the SF-36 and were asked to rate their pain intensity from none (1) to very severe (6). Clinical pain was coded as pain intensity rated more than mild (&gt;3/6). As a time-varying predictor, pain persistence was then calculated as a running frequency of the total waves reporting clinical pain. MCI diagnosis was based on Jak-Bondi criteria. Age, depressive symptoms, comorbidities, and opioid use were included as time-varying covariates. Age and education were included as time-invariant covariates. General estimating equations showed that pain persistence over two waves, reported in 35% of the sample, increased MCI odds by 57% (OR=1.57, 95%CI: 1.28 to 1.94). Pain persistence over three waves, reported in 17% of the sample, increased MCI odds by 98% (OR=1.98, 95%CI: 1.44 to 2.70). The findings emphasize the role of pain in earlier stages of dementia and the potential importance of pain management in offsetting cognitive decline.


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