Public Health Commons^™

Integrated Profiling Identifies Itgb3bp As Prognostic Biomarker For Hepatocellular Carcinoma, Qiuli Liang, Chao Tan, Feifei Xiao, Fuqiang Yin, Meiliang Liu, Lei Lei, Liuyu Wu, Yu Yang, Jennifer Hui Juan Tan, Shun Liu, Xiaoyun Zeng

Faculty Publications

Hepatocellular carcinoma (HCC) is a highly malignant tumor. In this study, we sought to identify a novel biomarker for HCC by analyzing transcriptome and clinical data. The R software was used to analyze the differentially expressed genes (DEGs) in the datasets GSE74656 and GSE84598 downloaded from the Gene Expression Omnibus database, followed by a functional annotation. A total of 138 shared DEGs were screened from two datasets. They were mainly enriched in the “Metabolic pathways” pathway (Padj = 8.21E-08) and involved in the carboxylic acid metabolic process (Padj = 0.0004). The top 10 hub genes were found by protein-protein interaction …

Impact Of Adverse Childhood Events On The Psychosocial Functioning Of Children Affected By Parental Hiv In Rural China, Jordan Ezell, Sayward E. Harrison, Yanping Jiang, Xiaoming Li Ph.D.

Faculty Publications

Introduction: Children affected by parental HIV are more likely than unaffected peers to experience trauma and are at-risk for negative psychological and social outcomes. This study aimed to examine the relationship between adverse childhood events and psychosocial functioning among children affected by parental HIV.

Methods: A total of 790 children ages 6–17 from Henan, China were enrolled in a longitudinal, randomized controlled trial of a resilience-based psychosocial intervention. At baseline, children reported on numerous psychosocial factors, including trauma exposure, symptoms of anxiety and depression, and peer social functioning. We used linear regression analysis to test the direct effect of trauma …

Time-Varying Insomnia Symptoms And Incidence Of Cognitive Impairment And Dementia Among Older Us Adults, Nicholas V. Resciniti, Valerie Yelverton, Bezawit Eyob Kase, Jiajia Zhang, Matthew C. Lohman

Faculty Publications

There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms which were compiled in an insomnia severity index, ranging from 0 to 4. In analysis, participants’ symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive …

Effects Of Moderate Sleep Restriction During 8-Week Calorie Restriction On Lipoprotein Particles And Glucose Metabolism, Joshua R. Sparks, Ryan R. Porter, Shawn D. Youngstedt, Kimberly P. Bowyer, J. Larry Durstine, Xuewen Wang

Faculty Publications

Study Objectives

This study examined how glucose, glucose regulatory hormones, insulin sensitivity, and lipoprotein subclass particle concentrations and sizes change with sleep restriction during weight loss elicited by calorie restriction.

Methods

Overweight or obese adults were randomized into an 8-week calorie restriction intervention alone (CR, n = 12; 75% female; body mass index = 31.4 ± 2.9 kg/m2) or combined with sleep restriction (CR+SR, n = 16; 75% female; body mass index = 34.5 ± 3.1 kg/m2). Participants in both groups were given the same instructions to reduce calorie intake. Those in the CR+SR group were instructed to reduce their …

Semantics Of The Black-Box: Can Knowledge Graphs Help Make Deep Learning Systems More Interpretable And Explainable?, Manas Gaur, Keyur Faldu, Amit Sheth

Publications

The recent series of innovations in deep learning (DL) have shown enormous potential to impact individuals and society, both positively and negatively. The DL models utilizing massive computing power and enormous datasets have significantly outperformed prior historical benchmarks on increasingly difficult, well-defined research tasks across technology domains such as computer vision, natural language processing, signal processing, and human-computer interactions. However, the Black-Box nature of DL models and their over-reliance on massive amounts of data condensed into labels and dense representations poses challenges for interpretability and explainability of the system. Furthermore, DLs have not yet been proven in their ability to …

Analysis Of Contraceptive Use Among Immigrant Women Following Expansion Of Medicaid Coverage For Postpartum Care, Maria I. Rodriguez, Megan Skye, Stephan Lindner, Aaron B. Caughey, Ana Lopez-Defede

Publications

Importance: Access to postpartum care is restricted for low-income women who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective: To examine the association of a policy extending postpartum coverage to Emergency Medicaid recipients with attendance at postpartum visits and use of postpartum contraception. Design, setting, and participants: This cohort study linked Medicaid claims and birth certificate data from 2010 to 2019 to examine changes in postpartum care coverage on postpartum care and contraception use. A difference-in-difference design was used to compare the rollout of postpartum coverage in Oregon with a comparison state, South Carolina, which did not cover …

Deep Brain Stimulation For Obsessive-Compulsive Disorder: Real World Experience Post-Fda-Humanitarian Use Device Approval, Lora Kahn, Brianne Sutton, Helena R. Winston, Aviva Abosch, John A. Thompson, Rachel E. Davis

Faculty Publications

While case series have established the efficacy of deep brain stimulation (DBS) in treating obsessive-compulsive disorder (OCD), it has been our experience that few OCD patients present without comorbidities that affect outcomes associated with DBS treatment. Here we present our experience with DBS therapy for OCD in patients who all have comorbid disease, together with the results of our programming strategies. For this case series, we assessed five patients who underwent ventral capsule/ventral striatum (VC/VS) DBS for OCD between 2015 and 2019 at the University of Colorado Hospital. Every patient in this cohort exhibited comorbidities, including substance use disorders, eating …

Validity Of A Four-Item Household Water Insecurity Experiences Scale For Assessing Water Issues Related To Health And Well-Being, Sera L. Young, Joshua D. Miller, Edward A. Frongillo Jr., Godfred O. Boateng, Zeina Jamaluddine, Torsten B. Neilands

Faculty Publications

We sought to determine whether a shortened version of the 12-item Household Water Insecurity Experiences (HWISE) Scale, which measures water insecurity equivalently in low- and middle-income countries (LMICs), is valid for broad use. Using data from 9,261 households in 25 LMICs, subsets of candidate items were evaluated on their predictive accuracy, criterion validity, and sensitivity-specificity. A subset with items assessing "worry," "changing plans," "limited drinking water," and "inability to wash hands" because of problems with water (range: 0-12) were highly correlated with full HWISE Scale scores (correlation coefficient: 0.949-0.980) and introduced minimal additional error (root mean square error: 2.13-2.68). Criterion …

Moving Beyond Giving Free Food: Specific Targeting And Tailoring In Response To Child Food Insecurity, Maryah Stella Fram, Edward A. Frongillo Jr.

Faculty Publications

No abstract provided.

Megf10 Deficiency Impairs Skeletal Muscle Stem Cell Migration And Muscle Regeneration, Chengcheng Li, Dorianmarie Vargas-Franco, Madhurima Saha, Rachel M. Davis, Kelsey A. Manko, Isabelle Draper, Christina A. Pacak, Peter B. Kang

Faculty Publications

Biallelic loss-of-function MEGF10 mutations lead to MEGF10 myopathy, also known as early onset myopathy with areflexia, respiratory distress, and dysphagia (EMARDD). MEGF10 is expressed in muscle satellite cells, but the contribution of satellite cell dysfunction to MEGF10 myopathy is unclear. Myofibers and satellite cells were isolated and examined from Megf10 and wild-type mice. A separate set of mice underwent repeated intramuscular barium chloride injections. Megf10 muscle satellite cells showed reduced proliferation and migration, while Megf10 mouse skeletal muscles showed impaired regeneration. Megf10 deficiency is associated with impaired muscle regeneration, due in part to defects in satellite cell function. Efforts to …

Association Of Expanded Prenatal Care Coverage For Immigrant Women With Postpartum Contraception And Short Interpregnancy Interval Births, Maria I. Rodriguez, Menolly Kaufman, Stephan Lindner, Aaron B. Caughey, Ana Lopez-De Fede

Publications

Importance Access to prenatal and postpartum care is restricted among women with low income who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective To examine the association of extending prenatal care coverage to Emergency Medicaid enrollees with postpartum contraception and short interpregnancy interval births. Design, Setting, and Participants This cohort study used a difference-in-differences design to compare the staggered rollout of prenatal care in Oregon with South Carolina, a state that does not cover prenatal or postpartum care. Linked Medicaid claims and birth certificate data from 2010 to 2016 were examined for an association between prenatal care coverage …

Disparities In Postpartum Contraceptive Use Among Immigrant Women With Restricted Medicaid Benefits, Maria I. Rodriguez, K. John Mcconnell, Megan Skye, Menolly Kaufman, Aaron B. Caughey, Ana Lopez-De Fede

Publications

BACKGROUND: The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina. OBJECTIVE: We assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 …

Genetic Risk Factors For Alzheimer’S Disease In Racial/Ethnic Minority Populations In The U.S.: A Scoping Review, Lindsey Rubin, Lucy Annang Ingram Phd, Nicholas V. Resciniti, Brianna Ashford-Carroll, Katherine Henrietta Leith, Aubrey Rose, Stephanie Ureña, Quentin Mccollum, Daniela B. Friedman

Faculty Publications

As the United States (U.S.) population rapidly ages, the incidence of Alzheimer's Disease and Related Dementias (ADRDs) is rising, with racial/ethnic minorities affected at disproportionate rates. Much research has been undertaken to test, sequence, and analyze genetic risk factors for ADRDs in Caucasian populations, but comparatively little has been done with racial/ethnic minority populations. We conducted a scoping review to examine the nature and extent of the research that has been published about the genetic factors of ADRDs among racial/ethnic minorities in the U.S. Using an established scoping review methodological framework, we searched electronic databases for articles describing peer-reviewed empirical …

Restriction Of Access To Deep Brain Stimulation For Refractory Ocd: Failure To Apply The Federal Parity Act, Rachel Davis, James Giordano, D Brian Hufford, Sameer A. Sheth, Peter Warnke, Alik S. Widge, R Mark Richardson, Joshua M. Rosenow, Peter Justin Rossi, Eric A. Storch, Helena Winston, Joanne Zboyan, Darin D. Dougherty, Kelly D. Foote, Wayne K. Goodman, Nicole C. Mclaughlin, Steven Ojemann, Steven Rasmussen, Aviva Abosch, Michael S. Okun

Faculty Publications

No abstract provided.

A Method For Cultivation, Fractionation, And Metal Determination To Evaluate Metal Removal By The Combination Of Nps And Bacteria, Xiufeng Cao, Liang Xu, Alan W. Decho, Jamie Lead

Faculty Publications

Metals being released into the environment are posing an increasing risk to both environments and public health. Developing improved approaches to remove these metals from the environment is urgent. A current publication discovered that metal bioremediation was significantly improved by nanoparticles (NPs), and the remediation duration was shortened. However, there is no relevant method for the preparation and evaluation of this novel idea. Hence, we developed this method for bacteria -EPS (Extracellular Polymeric Substances) cultivation, bacteria sub-cellular fractionation, and metal determinations in cultivating solution, EPS and different fractions of bacteria to evaluate metal removal by the combination of NPs and …

Responding To The Call: Building A Training Program To Diversify The Academy In Alzheimer’S Disease Research, Lucy Annang Ingram Phd, Marvella E. Ford, Christiana L. Johnson, Brianna Ashford-Carroll, Quentin Mccollum, Daniela B. Friedman, Sue E. Levkoff

Faculty Publications

Alzheimer's disease and related dementias (ADRD) are at the forefront of the United States (US) public health agenda due to their tremendous human and financial burden. Further, disproportionately high ADRD rates among racial/ethnic minorities require incorporating the unique perspectives of racially and ethnically diverse scientists, which will necessitate diversifying the scientific workforce that investigates disparities in aging. The purpose of this paper is to describe the training and mentorship initiatives of the National Institute on Aging (NIA)-funded Carolina Center on Alzheimer's Disease and Minority Research, emphasizing lessons learned from our engagement with underrepresented minority and minoritized (URM) Scientists. We highlight …

Nutritional Approach For Increasing Public Health During Pandemic Of Covid-19: A Comprehensive Review Of Antiviral Nutrients And Nutraceuticals, Vahideh Ebrahimzadeh-Attari, Ghodratollah Panahi, James R. Hébert Scd, Alireza Ostadrahimi, Maryam Saghafi-Asl, Neda Lotfi-Yaghin, Behzad Baradaran

Faculty Publications

Background: The novel coronavirus (COVID-19) is considered as the most life-threatening pandemic disease during the last decade. The individual nutritional status, though usually ignored in the management of COVID-19, plays a critical role in the immune function and pathogenesis of infection. Accordingly, the present review article aimed to report the effects of nutrients and nutraceuticals on respiratory viral infections including COVID-19, with a focus on their mechanisms of action.

Methods: Studies were identified via systematic searches of the databases including PubMed/ MEDLINE, ScienceDirect, Scopus, and Google Scholar from 2000 until April 2020, using keywords. All relevant clinical and experimental studies …

Evaluating A Technology-Mediated Hpv Vaccination Awareness Intervention: A Controlled, Quasi-Experimental, Mixed Methods Study, Heather M. Brandt, Beth Sundstrom, Courtney M. Monroe, Gabrielle Turner-Mcgrievy, Chelsea Larsen, Melissa Stansbury, Karen Magradey, Andrea Gibson, Delia Smith West

Faculty Publications

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes ( = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight …

Information Uncertainty: A Correlate For Acute Stress Disorder During The Covid-19 Outbreak In China, Danhua Lin, Daniela B. Friedman Ph.D., Shan Qiao Ph.D., Cheuk Chi Tam, Xiaoyan Li, Xiaoming Li Ph.D.

Faculty Publications

Background: Individuals’ stress in responding to the current COVID-19 pandemic may be exacerbated by information uncertainty driven by inconsistent, unverified, and conflicting news from various sources. The current study aims to test if information uncertainty during the COVID-19 outbreak was related to acute stress disorder (ASD) over and above other psychosocial stressors.

Methods: An anonymous online survey was conducted with 7800 college students throughout China from January 31 through February 11, 2020. Existing scales were modified to measure ASD and six potential stressors including information uncertainty during the COVID-19 outbreak. Hierarchical regression analysis was conducted to assess the unique association …

Integrating Health Technologies In Health Services For Syrian Refugees In Lebanon: Qualitative Study, Reem Talhouk, Chaza Akik, Vera Araujo-Soares, Balsam Ahmad, Sandra Mesmar, Patrick Olivier, Madeline Balaam, Kyle Montague, Andrew Garbett, Hala Ghattas Ph.D.

Faculty Publications

Background:

Lebanon currently hosts around one million Syrian refugees. There has been an increasing interest in integrating eHealth and mHealth technologies into the provision of primary health care to refugees and Lebanese citizens.

Objective:

We aimed to gain a deeper understanding of the potential for technology integration in primary health care provision in the context of the protracted Syrian refugee crisis in Lebanon.

Methods:

A total of 17 face-to-face semistructured interviews were conducted with key informants (n=8) and health care providers (n=9) involved in the provision of health care to the Syrian refugee population in Lebanon. Interviews were audio recorded …

Lc-Ms/Ms Quantification Of Nevirapine And Its Metabolites In Hair For Assessing Long-Term Adherence, Haoran Yang, Liuxi Chu, Yan Wu, Wei Wang, Jin Yang, Quan Zhang, Shan Qiao Ph.D., Xiaoming Li Ph. D., Zhiyong Shen, Yuejiao Zhou, Shuaifeng Liu, Huihua Deng

Faculty Publications

The adherence assessment based on the combination of nevirapine (NVP) and its two metabolites (2-hydroxynevirapine and 3-hydroxynevirapine) would more comprehensively and accurately reflect long-term adherence than that of a single prototype. This study aimed to develop a specific, sensitive and selective method for simultaneous detection of the three compounds in hair and explore whether there was consistency among the three compounds in assessing long-term adherence. Furthermore, 75 HIV-positive patients who were taking the NVP drug were randomly recruited and divided into two groups (high-and low-adherence group). All participants self-reported their days of oral drug administration per month and provided their …

External Stoma Diversion: A Palliative Measure For Peristomal Wound Healing In Resource-Limited Settings, Rachel W. Davis, Youmna A. Sherif, Catherine Anne Morrison

Faculty Publications

The provision of intestinal stoma care is challenging in austere settings due to limitations in surgical and wound care access as well as the high cost and sparsity of ostomy supplies. As a result, many surgical patients suffer from ostomy-related complications such as peristomal wounds and are unable to find relief for these complications from standard treatments and measures. This article describes the external stoma diversion, a cost-effective palliative surgical procedure that assists in the healing of peristomal wounds in resource-limited settings.

Parkindex: Validation And Application Of A Pragmatic Measure Of Park Access And Use, Andrew T. Kaczynski, S. Morgan Hughey, Ellen W. Stowe, Marilyn E. Wende, J. Aaron Hipp, Elizabeth L. Oliphant, Jasper Schipperijn

Faculty Publications

Composite metrics integrating park availability, features, and quality for a given address or neighborhood are lacking. The purposes of this study were to describe the validation, application, and demonstration of ParkIndex in four diverse communities. This study occurred in Fall 2018 in 128 census block groups within Seattle(WA), Brooklyn(NY), Raleigh(NC), and Greenville County(SC). All parks within a half-mile buffer were audited to calculate a composite park quality score, and select households provided data about use of proximal parks via an online, map-based survey. For each household, the number of parks, total park acreage, and average park quality score within one …

Monitoring The Spatial Spread Of Covid-19 And Effectiveness Of Control Measures Through Human Movement Data: Proposal For A Predictive Model Using Big Data Analytics, Zhenlong Li, Xiaoming Li, Dwayne Porter Ph.D., Jiajia Zhang Ph.D., Yuqin Jiang, Bankole Olatosi Ph.D., Sharon Weissman

Faculty Publications

Background: Human movement is one of the forces that drive the spatial spread of infectious diseases. To date, reducing and tracking human movement during the COVID-19 pandemic has proven effective in limiting the spread of the virus. Existing methods for monitoring and modeling the spatial spread of infectious diseases rely on various data sources as proxies of human movement, such as airline travel data, mobile phone data, and banknote tracking. However, intrinsic limitations of these data sources prevent us from systematic monitoring and analyses of human movement on different spatial scales (from local to global). Objective: Big data from social …

Association Between Appendicular Skeletal Muscle Index And Leukocyte Telomere Length In Adults: A Study From National Health And Nutrition Examination Survey (Nhanes) 1999-2002, Lingzhi Chen, Nitin Shivaooa, Xiuxun Dong, Jingjing Ming

Faculty Publications

Background A higher body mass index (BMI) is associated with shorter telomeres. The loss of muscle mass with aging is associated with adverse outcomes. The appendicular skeletal muscle index (ASMI) is currently used to quantify muscle mass. Objective We investigated the association of the ASMI with leukocyte telomere length in adult Americans. Methods This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) 1999–2002 dataset. Body composition was measured by dual-energy X-ray absorptiometry. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). The telomere-to-single-copy gene ratio (T/S ratio) was converted to …

The Role Of Mental Health On The Relationship Between Food Insecurity And Immunologic Outcome Among People Living With Hiv In Guangxi, China, Cheng Chen, Xueying Yang, Chengbo Zeng, Xiaoming Li Ph.D., Shan Qiao Ph.D., Yuejiao Zhou

Faculty Publications

BACKGROUND

Previous studies showed that food insecurity could adversely affect clinical outcomes of people living with HIV (PLWH). The mental health pathways of such effects are suggested in existing literature, but empirical data are limited in resource-limited settings.

METHODS

This cross-sectional study aims to explore the role of depressive symptoms and anxiety on the association between food insecurity and CD4 counts among a sample of 2,987 PLWH in Guangxi, China. Path analysis was used to examine a hypothetical model and delta ztest was used to assess the indirect effects of food insecurity on CD4 counts through depressive symptoms and …

Development Of A Comprehensive Measure Of Organizational Readiness (Motivation × Capacity) For Implementation: A Study Protocol, Timothy J. Walker, Heather M. Brandt, Abraham Wandersman, Jonathan Scaccia, Andrea Lamont, Lauren Workman, Emanuelle Dias, Pamela M. Diamond, Derek W. Craig, Maria E. Fernandez

Faculty Publications

BACKGROUND: Organizational readiness is important for the implementation of evidence-based interventions. Currently, there is a critical need for a comprehensive, valid, reliable, and pragmatic measure of organizational readiness that can be used throughout the implementation process. This study aims to develop a readiness measure that can be used to support implementation in two critical public health settings: federally qualified health centers (FQHCs) and schools. The measure is informed by the Interactive Systems Framework for Dissemination and Implementation and R = MC heuristic (readiness = motivation × innovation-specific capacity × general capacity). The study aims are to adapt and further develop …

A Community-Based School Nutrition Intervention Improves Diet Diversity And School Attendance In Palestinian Refugee Schoolchildren In Lebanon, Zeina Jamaluddine, Jowel Choufani, Amelia Reese Masterson, Reem Hoteit, Nadine R. Sahyoun, Hala Ghattas Ph.D.

Faculty Publications

Background:

School feeding programs have the potential to supply children with healthy school food, alleviate short-term hunger, and improve children's educational outcomes.

Objectives:

We linked community kitchens to a subsidized school snack intervention and assessed the impact of this intervention on nutritional (diet diversity, hemoglobin, and anthropometry) and educational (attendance and academic performance) outcomes of Palestinian refugee schoolchildren.

Methods:

We collected data from 1362 students (aged 5-15 y) and their parents at baseline, and at an 8-mo follow-up in 2 control and 2 intervention schools. We conducted linear, logistic, and negative binomial regression analyses to assess changes in outcomes of …

Building Capacity In Dissemination And Implementation Science: A Systematic Review Of The Academic Literature On Teaching And Training Initiatives, Rachel E. Davis, Danielle D'Lima

Faculty Publications

BACKGROUND: The field of dissemination and implementation (D&I) science has grown significantly over recent years. Alongside this, an increased demand for training in D&I from researchers and implementers has been seen. Research describing and evaluating D&I training opportunities, referred to here as 'capacity building initiatives' (CBIs), can help provide an understanding of different methods of training as well as training successes and challenges. However, to gain a more detailed understanding of the evidence-base and how D&I CBIs are being reported in publications, a field-wide examination of the academic literature is required. METHODS: Systematic review to identify the type and range …

Association Between Dietary Inflammatory Index And Type 2 Diabetes Mellitus In Xinjiang Uyghur Autonomous Region, China, Wenhui Fu, Hualian Pei, Nitin Shivaooa, James R. Hébert, Tao Luo, Tian Tian, Dilibaier Alimu, Zewen Zhang, Jianghong Dai

Faculty Publications

Background Diet and inflammation have both been studied in relation to type 2 diabetes mellitus (T2DM). The aim of this cross-sectional study was to examine the association between the Dietary Inflammatory Index (DII®) and T2DM. Methods Subjects were adults enrolled in the baseline study of the Xinjiang multi-ethnic natural population cohort and health follow-up study from January to May 2019. The study involved 5,105 subjects (58.7% men) between 35 and 74 years of age. The DII score was calculated from a data obtained via a food frequency questionnaire consisting of 127 food items. Results Logistic regression analyses were used to …