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  • Configurations of attitudes toward immigration in Europe: evidence of polarization, ambivalence, and multidimensionality

    Ronald Kwon; William J. Scarborough; Roberto Gallardo (SpringerOpen, 2024-04-01)
    Abstract Scholarship on immigrant stereotypes suggest that individuals’ viewpoints toward immigration may be differentiated across the dimensions of culture and economics. In this study, we use latent class analysis, which avoids the assumption that attitudes are unidimensional, scalar, and polarized, to examine configurations of immigration attitudes in Europe from 2002 through 2010, a period of time leading up to and within the Great Recession. Analyzing a set of items capturing different aspects of immigration attitudes, we discover that although there are substantial segments of the European population who hold polarized anti- or pro-immigration attitudes, the most common viewpoint is ambivalence. Specifically, those with ambivalent attitudes feel that immigration enriches national culture but also believe that immigration has less benefits for the economy. Using an interrupted time series design, we explore how attitudinal configurations shifted with the onset of the Great Recession. The crisis coincided with a rise in ambivalent attitudes as economic threat grew more than concerns about culture.
  • De-migranticizing as methodology: rethinking migration studies through immobility and liminality

    Parvati Raghuram; Markus Roos Breines; Ashley Gunter (SpringerOpen, 2024-04-01)
    Abstract De-migranticization is becoming a core strategy for overcoming the fetishization of migrants in migration studies. However, this shift in perspectives raises questions about what categories to use instead. This paper contributes to these debates by considering the potential of studying immobility as a tool for de-migranticization. It looks at immobility through the lens of liminality: as a transitory phase, as a transformative stage and as one which enables epistemological subversion. In doing so, it goes beyond other border spanning terms to offer methodological insights into using immobility and liminality to de-migranticize. The paper suggests that these qualities of reading immobility through theories of liminality has implications for when, where and how to study migration. The empirical case draws on 165 semi-structured interviews with distance education students from Zimbabwe, Namibia and Nigeria studying at the University of South Africa (UNISA).
  • “There’s No Connection Plugging Me Into This System”: Citizenship as Non‐Participation and Voicelessness

    Erika Anne Hayfield (Cogitatio, 2024-04-01)
    The small and remote island community, the Faroe Islands, has experienced a vast increase in immigration recently. In the space of a decade, immigration has risen from 1.5% of the population to 5.5%. The island community, previously ethnically and culturally homogenous, is now facing growing diversity. The Faroese context is characterised by its small size and a micro‐administration that is ill‐equipped for the complexities of immigration. Previous research has found that underlying the Faroese language and identity is a pervasive ideology of who is considered to “authentically belong.” Furthermore, the small population is strongly connected through multiple relations, and navigating formal and informal life depends on social/family networks. In this small island community context, this article examines immigrant citizenship experiences, drawing on qualitative data collated between 2016 and 2023. Citizenship is here understood as everyday relational and spatial experiences at various levels of society. From the analysis, two central values of citizenship emerged as key to entangled citizenship experiences: (non)participation and (mis)recognition. The analysis finds that Faroese society, both formally and informally, is highly inaccessible to immigrants, rendering them voiceless and marginalised. Furthermore, immigrants experience misrecognition for the resources they bring and find themselves on the margins of the labour market and society in general.
  • Becoming Active Agents Through Practices of Volunteering: Immigrants’ Experiences in Rural Germany

    Tobias Weidinger; David Spenger; Stefan Kordel (Cogitatio, 2024-03-01)
    Volunteering is an important way to include immigrants at a local scale, especially in small towns and municipalities with limited arrival infrastructure. With the recent increase in immigrants, including in rural areas, volunteering practices for this target group have been much discussed, albeit with an emphasis on immigrants as vulnerable beneficiaries. There are few studies that focus on immigrants’ volunteering practices, or their function for the individual and receiving community, while empirical evidence for rural areas is explicitly lacking. In this article, we address immigrants as active agents with recourse to the concept of agency and unravel, firstly, the meanings they attribute to volunteering and reasons for their mobilisation; secondly, their access to volunteering in the German countryside; and thirdly their reflecting, practising, and sharing of agency through volunteering with an impact on themselves and their rural communities. Drawing on a qualitative, biographical‐narrative study of 72 immigrants in rural Germany, we show how cultures of volunteering—or how it is practised in different contexts—inform immigrants’ current activities, ranging from leisure practices to neighbourly help and supporting the inclusion of new arrivals. We illustrate the importance of opportunity structures and social networks for accessing volunteering and reveal individual and altruistic reasons for doing it, such as facilitating language acquisition and enhancing one’s participation, showing solidarity with immigrants, or gratitude towards the receiving society, often coinciding with expected outcomes. Volunteering allows immigrants to “perform agency” and fosters both belonging and responsibility taking for the dwelling place.
  • Immigrants’ Experiences of Settling in a Rural Community in Norway: Inclusion and Exclusion Through “Being Seen”

    Turid Sætermo; Angelina Penner Gjertsen; Guro Korsnes Kristensen (Cogitatio, 2024-03-01)
    This article sets out from two dominant and contradictive narratives about immigrant integration in rural areas in Norway. The first holds that rural areas are “better at integration” as relations in these communities are more tight‐knit and personal. The other holds that integration in rural areas is more difficult due to the homogeneity and closed‐mindedness of rural communities. Based on ethnographic in‐depth interviews with individuals with different immigration backgrounds living in a rural coastal community, the article explores their perceptions of rural integration and their experiences of inclusion and exclusion in the local community. By using the notion of “being seen” as an analytical lens, the article shows that both narratives of rural integration are engaged and that experiences of inclusion and exclusion are interwoven and complex. On the one hand, “being seen” points to more personalised relations and support; on the other, it points to concerns by immigrants that they are seen by locals as “others.” The lens of visibility and “being seen” allows for a more nuanced understanding of immigrants’ experiences with settling in and finding their place in rural areas, and strengthens the argument for studying rural areas as a particular context for inclusion.
  • Migrants’ Inclusion in Rural Communities

    Unnur Dís Skaptadóttir; Pamela Innes; Anna Wojtyńska (Cogitatio, 2024-05-01)
    This thematic issue examines migrants’ inclusion in rural communities, contributing to a deeper understanding of the complex realities informing migrant experiences and processes of inclusion and exclusion in rural localities. The studies presented apply different theoretical approaches, all using various qualitative methods, to shed light on daily life experiences and views in rural locations. This editorial discusses the questions raised in the studies and outlines the main arguments of the different contributions assembled in this thematic issue.
  • Differentiated Borders of Belonging and Exclusion: European Migrants in Rural Areas in Iceland

    Unnur Dís Skaptadóttir; Anna Wojtyńska; Pamela Innes (Cogitatio, 2024-03-01)
    This article addresses questions of difference, positionality, and belonging from the perspectives of international migrants living and working in rural communities in Iceland. With the recent integration of rural areas into the global economy, small villages and towns have undergone rapid social transformation. The development of new industries and growing tourism in these localities has attracted many international migrants. The share of migrants in the local populations oscillates between 10% to 50%, depending on the town, with the majority coming from Europe. Commonly, they make up the greater part of workers in service jobs and manual labour in rural towns and villages. This article builds on data from ethnographic field research over 15 months in five parts of Iceland located outside of the capital region. Based on the analysis of interviews with migrants, we examine different perceptions of affinity and belonging and explore their experiences of inclusion and exclusion. To what extent do migrants see themselves as part of local communities? How do they narrate their social positions in those places? The discussion highlights how social stratification and hierarchy affect migrants’ experiences of inclusion as commonly displayed in the interviews. Furthermore, we elaborate on how notions of relatedness and otherness reflect inherited ideas of Europe and contemporary divergent geopolitical positions.
  • Social Relations Among Diverse Rural Residents in the Scottish Highlands

    Emilia Pietka-Nykaza (Cogitatio, 2024-04-01)
    This article focuses on the development and the limitations of convivial, instrumental, and intimate family relations among diverse rural residents in the Inner Moray Firth area of the Scottish Highlands. Drawing on 22 semi‐structured interviews with international migrants (EU nationals), internal migrants (UK nationals), and participants who were born there and never left, this article identifies and critically discusses how different types of social relations develop, or not, within and between these groups of rural residents. This article indicates that while all participants experienced convivial relations, these encounters did not always transfer into close, meaningful relations. The instrumental and meaningful relations, however, were more ambivalent in practice and related to internal divisions within rural communities defined along the lines of who is perceived to be “local” or “not local.” The instrumental ties were developed among participants with common interests, similar life stages, and experiences and varied in terms of ethnic and national composition. Similarly, while family ties were crucial for a sense of belonging, their ethnic and national composition differed. By illustrating the complex composition of convivial, instrumental, and family ties in rural Highlands, this article highlights that meaningful social relations supporting social integration should not be understood via social encounters with “local” residents only, but also intimate and instrumental social relations within and between migrant populations.
  • The Role of Leisure Practices and Local Identity in Migrants’ Inclusion in Two Rural Norwegian Municipalities

    Brit Lynnebakke (Cogitatio, 2024-04-01)
    This article discusses the role of local identity and local leisure practices in migrants’ inclusion processes in two rural Norwegian localities. The discussed study was conducted in municipalities that had experienced increased international migration following the EU expansion in 2004 and had a long history of internal in‐migration. In the study, individuals’ social inclusion and belonging processes are treated as inseparable from a locality’s dominant local narratives, practices, and norms—drawing on theories on inclusion/exclusion processes in places. Based on findings from semi‐structured interviews with local natives, internal migrants, and international migrants, the study found that different leisure practices were central to local identity in the two localities, which had implications for what was expected of migrants in order for them to be accepted locally. These findings align with what is commonly conceived as outdated community study research findings. The findings indicate the continued relevance of the local for people’s identification and migrants’ inclusion processes and support a need for closer theoretical and methodological integration of internal and international migration research. Another central finding was that in one of the localities, national narratives about civic engagement were evoked by some majority Norwegians as additional arguments for the importance of migrants’ involvement in local leisure activities. These interviewees’ main concern appeared to be ensuring local—rather than national—cultural continuity and cohesion. Finally, the different inclusion grammars in the two localities illustrate that inclusion processes in one locality should not by default be seen as representative of what is transpiring in a nation‐state.
  • The Bosnian House: Trajectories of (Non‐)Return Among Bosnian Roma in a Roman Shanty

    Marco Solimene (Cogitatio, 2024-04-01)
    This article draws on materials collected during ethnographic fieldwork among Bosnian Roma refugees who reconstructed homes in an urban shanty at the periphery of Rome (Italy). In the last two decades, many of these Roma started building or refurbishing houses in villages in the Federation of Bosnia and Herzegovina, close to the Serbian Republic (where their former home village is now situated). The construction, refurbishing, and maintenance of these houses played (and still play) a role in the local economy; they also changed the local landscape and became the mark of a new but intermittent presence in post‐Dayton Bosnia. The houses and the transnational practices connected to them have become tokens of economic success and aspirations that revolve around both the Bosnian context and the Roman one. They also express nostalgic attachments to a lost homeland radically transformed by war, foreign interventions, and the advent of the market economy and eventually turned into an unfamiliar place. This article builds on the literature on transnational migration and material culture and explores the ambivalence and complexity of transnational trajectories that stretch between an urban context in the EU and a rural one in non‐EU and reveals complex scenarios of identity, movements, and unlikely returns.
  • Migrant Agricultural Workers’ Experiences of Support in Three Migrant‐Intensive Communities in Canada

    Glynis George; Kristin Lozanski; Stephanie Mayell; Susana Caxaj (Cogitatio, 2024-03-01)
    Canada has intensified its reliance on temporary foreign workers, including migrant agricultural workers (MAWs) who have contributed to its agriculture sector, rural economies, and food security for decades. These workers live and work in rural communities across Canada for up to two years. Thousands of MAWs engage in recurring cyclical migration, often returning to the same rural communities in Canada for decades, while others are undocumented. Yet MAWs do not have access to the supports and services provided for immigrant newcomers and pathways for permanent residence. The exclusion of these workers from such entitlements, including labour mobility, reinforces their precarity, inhibits their sense of belonging, and reflects the stratification built into Canada’s migration regime. This article draws on interviews with 98 MAWs in three migrant‐intensive regions in southwestern Ontario to examine how workers construct and describe support in relation to co‐workers, employers, residents, and community organizations. Drawing on conceptualizations of support as an important vehicle for social connection and inclusion that comprises social and citizenship belonging, we document how the strategies MAWs employ to forge connections are enabled or undermined by Canada’s Temporary Foreign Worker Program, community dynamics, and the broader forces of racialization, gender, and exclusion. This article contributes to the limited scholarship on the support landscape for MAWs, whose experiences foreground the contested nature of belonging and inclusion among migrant populations across smaller cities and rural areas.
  • Invisibility and (Dis)Integration: Examining the Meaning of Migrant Inclusion in Everyday Lived Experience in Rural Areas

    Leila Giannetto; Shirley van der Maarel (Cogitatio, 2024-04-01)
    The settlement of migrants in rural areas that are facing population decline has gained increased attention in recent years as an economic, social, and political issue, as well as an opportunity for development for local communities. Studies have primarily focused on investigating whether and how migrants are integrated and included within these areas. This article adopts a fresh perspective by examining how the meaning of “integration” and “inclusion” is given shape by residents and migrant workers themselves. Our research centres on a small rural town in Sardinia, where individuals from Romania and West Africa have relocated to fill job positions traditionally held by Italians. Based on participant observation and in‐depth interviews, we examine the everyday experiences of residents and migrants to develop an understanding of the lived realities of integration and inclusion. In doing so, the article calls into question the perceived value of these processes for the very individuals that are supposed to benefit from them.
  • Inclusion or Exclusion? The Spatial Habitus of Rural Gentrifiers

    Kyra Tomay; Viktor Berger (Cogitatio, 2024-03-01)
    Several rural areas all over the world have experienced the inflow of the urban better‐off. This rural gentrification takes various temporary and permanent forms, i.e., lifestyle migration, second‐home ownership, or short‐term visitors. Scholarly interest in rural gentrification is evidenced by the growing body of literature. Based on 105 semi‐structured in‐depth interviews conducted in two rural areas in Hungary, this article aims to explore the perceptions, motivations, preferences, and lived experiences of rural newcomers, their position within the community, as well as processes of inclusion and exclusion. We rely on Pierre Bourdieu’s concept of habitus and argue that it includes distinct spatial dispositions forming a “spatial habitus.” The interviews show that the middle‐class rural gentrifiers’ (spatial) habitus is entangled with their cultural capital and represents a mixture of urban and “ruralising” dispositions. Their spatial practices are interpreted as the result of middle‐class (spatial) habitus and middle‐class symbolic distinction. At the same time, middle‐class rural gentrifiers are active local agents who defy common notions of newcomers having to integrate into their communities of choice.
  • Network meta-analysis of the intervention effects of different exercise measures on Sarcopenia in cancer patients

    Rui Liu; XY Gao; Li Wang (BMC, 2024-05-01)
    Abstract Purpose This study aims to investigate the impact of four exercise modes (aerobic exercise, resistance exercise, aerobic combined with resistance multimodal exercise, and stretching) on the physical performance of cancer patients. Methods Randomized controlled trials (RCTs) were exclusively collected from PubMed, EMBASE, Web of Science, and The Cochrane Library, with a search deadline of April 30, 2023. Different exercise interventions on the physical performance of cancer patients were studied, and the Cochrane risk of bias assessment tool was employed to evaluate the quality of the included literature. Data analysis was conducted using STATA 15.1 software. Results This study included ten randomized controlled trials with a combined sample size of 503 participants. Network meta-analysis results revealed that aerobic combined with resistance multimodal exercise could reduce fat mass in cancer patients (SUCRA: 92.3%). Resistance exercise could improve lean mass in cancer patients (SUCRA: 95.7%). Furthermore, resistance exercise could enhance leg extension functionality in cancer patients with sarcopenia (SUCRA: 83.0%). Conclusion This study suggests that resistance exercise may be more beneficial for cancer-related sarcopenia.In clinical practice, exercise interventions should be tailored to the individual patients’ circumstances. Registration number This review was registered on INPLASY2023110025; DOI number is https://doi.org/10.37766/inplasy2023.11.0025 .
  • Age at death during the Covid-19 lockdown in French metropolitan regions: a non parametric quantile regression approach

    Jonathan Roux; Marlène Faisant; Diane François; Olivier Retel; Alain Le Tertre (BMC, 2024-05-01)
    Abstract Background Lockdowns have been implemented to limit the number of hospitalisations and deaths during the first wave of 2019 coronavirus disease. These measures may have affected differently death characteristics, such age and sex. France was one of the hardest hit countries in Europe with a decreasing east–west gradient in excess mortality. This study aimed at describing the evolution of age at death quantiles during the lockdown in spring 2020 (17 March—11 May 2020) in the French metropolitan regions focusing on 3 representatives of the epidemic variations in the country: Bretagne, Ile-de-France (IDF) and Bourgogne-Franche-Comté (BFC). Methods Data were extracted from the French public mortality database from 1 January 2011 to 31 August 2020. The age distribution of mortality observed during the lockdown period (based on each decile, plus quantiles 1, 5, 95 and 99) was compared with the expected one using Bayesian non-parametric quantile regression. Results During the lockdown, 5457, 5917 and 22 346 deaths were reported in Bretagne, BFC and IDF, respectively. An excess mortality from + 3% in Bretagne to + 102% in IDF was observed during lockdown compared to the 3 previous years. Lockdown led to an important increase in the first quantiles of age at death, irrespective of the region, while the increase was more gradual for older age groups. It corresponded to fewer young people, mainly males, dying during the lockdown, with an increase in the age at death in the first quantile of about 7 years across regions. In females, a less significant shift in the first quantiles and a greater heterogeneity between regions were shown. A greater shift was observed in eastern region and IDF, which may also represent excess mortality among the elderly. Conclusions This study focused on the innovative outcome of the age distribution at death. It shows the first quantiles of age at death increased differentially according to sex during the lockdown period, overall shift seems to depend on prior epidemic intensity before lockdown and complements studies on excess mortality during lockdowns.
  • Twenty-four-hour physical activity patterns associated with depressive symptoms: a cross-sectional study using big data-machine learning approach

    Saida Salima Nawrin; Hitoshi Inada; Haruki Momma; Ryoichi Nagatomi (BMC, 2024-05-01)
    Abstract Background Depression is a global burden with profound personal and economic consequences. Previous studies have reported that the amount of physical activity is associated with depression. However, the relationship between the temporal patterns of physical activity and depressive symptoms is poorly understood. In this exploratory study, we hypothesize that a particular temporal pattern of daily physical activity could be associated with depressive symptoms and might be a better marker than the total amount of physical activity. Methods To address the hypothesis, we investigated the association between depressive symptoms and daily dominant activity behaviors based on 24-h temporal patterns of physical activity. We conducted a cross-sectional study on NHANES 2011–2012 data collected from the noninstitutionalized civilian resident population of the United States. The number of participants that had the whole set of physical activity data collected by the accelerometer is 6613. Among 6613 participants, 4242 participants had complete demography and Patient Health Questionnaire-9 (PHQ-9) questionnaire, a tool to quantify depressive symptoms. The association between activity-count behaviors and depressive symptoms was analyzed using multivariable logistic regression to adjust for confounding factors in sequential models. Results We identified four physical activity-count behaviors based on five physical activity-counting patterns classified by unsupervised machine learning. Regarding PHQ-9 scores, we found that evening dominant behavior was positively associated with depressive symptoms compared to morning dominant behavior as the control group. Conclusions Our results might contribute to monitoring and identifying individuals with latent depressive symptoms, emphasizing the importance of nuanced activity patterns and their probability of assessing depressive symptoms effectively.
  • SARS-CoV-2 vaccine breakthrough infection and the evaluation of safety precaution practice before and after vaccination among healthcare workers in South West, Nigeria

    Oluwatosin Idowu Oni; Patrick Olanrewaju Osho; Tayelolu Mary Odesanmi; Habeebat Motunrayo Raji; Faith Titilayo Oluranti; Demian Ibina (BMC, 2024-05-01)
    Abstract Introduction Worldwide, it has been reported that fully vaccinated people still die of COVID-19-associated symptoms, generating public uncertainty about the safety and effectiveness of the vaccines. Hence, this research is aimed at assessing the incidence of COVID-19 breakthrough infection among vaccinated Health Workers and the possible effect of changes in the practice of post-vaccination safety precautions. Method This was a Health facility-based descriptive cross-sectional study. Data were collected using self-administered questionnaires distributed at the participant’s work unit across the selected health facilities. The nasopharyngeal specimen was also obtained from the participants and analysed using STANDARD Q COVID-19 Ag Test rapid chromatographic immunoassay for the detection of antigens to SARS-CoV-2. All data were input and analyzed using SPSS version 20. Results There was a statistically significant relationship between the vaccination status of respondents and the post-vaccination test result (χ2 = 6.816, df = 1, p = 0.009). The incidence of COVID-19 infection among the vaccinated and unvaccinated HCWs was 2% and 8% respectively. 5 of the 15 respondents who tested positive for COVID-19 had been fully vaccinated. However, all 5 of them did not practice safety measures after vaccination. None of the respondents who practised safety measures after vaccination tested positive for COVID-19. The remaining 10 respondents that tested positive for COVID-19 had not been vaccinated though they practised safety precautions. Conclusion Vaccination and the practice of safety precautions will go a long way to preventing future COVID-19 breakthrough infections.
  • Predictors of male loneliness across life stages: an Australian study of longitudinal data

    Ferdi Botha; Marlee Bower (BMC, 2024-05-01)
    Abstract Background Despite growing recognition of loneliness as a global public health concern, research on its occurrence and precipitants among men across different life stages remains limited and inconclusive. This study aims to address this gap by investigating the prevalence and predictors of loneliness among a large, representative data set of Australian adult men. Methods The study used longitudinal data from waves 2–21 of the Household, Income and Labour Dynamics in Australia (HILDA) Survey, including men aged 15–98. Estimating linear fixed effects regressions that account for unobserved time-invariant individual heterogeneity, a single-item measure of loneliness was regressed on a set of selected explanatory variables over different parts of the life course. Results Increased social isolation, romantic partnership dissolution, having a long-term disability, and stronger beliefs that the man, rather than the woman, should be the breadwinner of the household, are associated with greater loneliness. Frequent social connection, having a romantic partner, and high neighbourhood satisfaction are protective against loneliness. The findings also reveal several differences in the predictors of loneliness over the life course. Job security is especially important for younger men, whereas for older men volunteering and less conservative gender role attitudes are important factors that can decrease loneliness. Conclusions The results emphasise the need to consider age-specific factors and societal expectations in understanding and addressing loneliness amongst men. Additionally, the findings underscore the importance of raising awareness about the impact of societal norms and expectations on men's mental health. The results offer valuable insights for policymakers, healthcare providers, and researchers to develop effective strategies and support systems to combat loneliness and promote well-being among men.
  • Need for informed providers: exploring LA-PrEP access in focus groups with PrEP-indicated communities in Baltimore, Maryland

    Rose Pollard Kaptchuk; Amber M. Thomas; Amit “Mickey” Dhir; Sunil S. Solomon; Steven J. Clipman (BMC, 2024-05-01)
    Abstract Background The approval of long-acting pre-exposure prophylaxis PrEP (LA-PrEP) in the United States brings opportunities to overcome barriers of oral PrEP, particularly among sexual and gender minority communities who bear a higher HIV burden. Little is known about real-time decision-making among potential PrEP users of LA-PrEP post-licensure. Methods We held focus group discussions with people assigned male at birth who have sex with men in Baltimore, Maryland to explore decision-making, values, and priorities surrounding PrEP usage. A sexual and gender minority-affirming health center that provides PrEP services supported recruitment. Discussions included a pile-sorting activity and were audio-recorded. Recordings were transcribed and analyzed iteratively, combining an inductive and deductive approach. Results We held five focus groups from Jan-June 2023 with 23 participants (21 cisgender men who have sex with men, two transgender women who have sex with men; mean age 37). Among participants, 21 were on oral PrEP, one was on injectable PrEP, and one had never taken PrEP. Most had never heard about LA-PrEP. When making decisions about PrEP, participants particularly valued efficacy in preventing HIV, side effects, feeling a sense of security, and ease of use. Perceptions varied between whether oral or injectable PrEP was more convenient, but participants valued the new opportunity for a choice in modality. Factors influencing PrEP access included cost, individual awareness, provider awareness, and level of comfort in a healthcare environment. Participants emphasized how few providers are informed about PrEP, placing the burden of being informed about PrEP on them. Comfort and trust in a provider superseded proximity as considerations for if and where to access PrEP. Conclusions There is still low awareness about LA-PrEP among sexual and gender minority communities; thus, healthcare providers have a critical role in influencing access to LA-PrEP. Despite this, providers are still vastly underinformed about PrEP and underprepared to support clients in contextualized ways. Clients are more likely to engage in care with affirming providers who offer non-judgmental conversations about sex and life experiences. Provider education in the United States is urgently needed to better support clients in choosing a PrEP modality that is right for them and supporting adherence for effective HIV prevention.
  • Bayesian network analysis of factors influencing type 2 diabetes, coronary heart disease, and their comorbidities

    Danli Kong; Rong Chen; Yongze Chen; Le Zhao; Ruixian Huang; Ling Luo; Fengxia Lai; Zihua Yang; Shuang Wang; Jingjing Zhang (BMC, 2024-05-01)
    Abstract Objective Bayesian network (BN) models were developed to explore the specific relationships between influencing factors and type 2 diabetes mellitus (T2DM), coronary heart disease (CAD), and their comorbidities. The aim was to predict disease occurrence and diagnose etiology using these models, thereby informing the development of effective prevention and control strategies for T2DM, CAD, and their comorbidities. Method Employing a case-control design, the study compared individuals with T2DM, CAD, and their comorbidities (case group) with healthy counterparts (control group). Univariate and multivariate Logistic regression analyses were conducted to identify disease-influencing factors. The BN structure was learned using the Tabu search algorithm, with parameter estimation achieved through maximum likelihood estimation. The predictive performance of the BN model was assessed using the confusion matrix, and Netica software was utilized for visual prediction and diagnosis. Result The study involved 3,824 participants, including 1,175 controls, 1,163 T2DM cases, 982 CAD cases, and 504 comorbidity cases. The BN model unveiled factors directly and indirectly impacting T2DM, such as age, region, education level, and family history (FH). Variables like exercise, LDL-C, TC, fruit, and sweet food intake exhibited direct effects, while smoking, alcohol consumption, occupation, heart rate, HDL-C, meat, and staple food intake had indirect effects. Similarly, for CAD, factors with direct and indirect effects included age, smoking, SBP, exercise, meat, and fruit intake, while sleeping time and heart rate showed direct effects. Regarding T2DM and CAD comorbidities, age, FBG, SBP, fruit, and sweet intake demonstrated both direct and indirect effects, whereas exercise and HDL-C exhibited direct effects, and region, education level, DBP, and TC showed indirect effects. Conclusion The BN model constructed using the Tabu search algorithm showcased robust predictive performance, reliability, and applicability in forecasting disease probabilities for T2DM, CAD, and their comorbidities. These findings offer valuable insights for enhancing prevention and control strategies and exploring the application of BN in predicting and diagnosing chronic diseases.

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