How prevalent are adverse academic outcomes following a school threat assessment?

Modest reduction in adverse birth outcomes following the COVID-19 lockdown

The postnatal period is defined as the first six weeks after birth; it is critical to the health and survival. The study was conducted to determine the key factors of maternal postnatal care using Bayesian multilevel analysis using 7,192 mothers aged between 15-49 of EDHS 2016 data. Descriptive statistics revealed that 675 (9.4%) women received postnatal care. The Bayesian multilevel model used to analyze postnatal care utilization of woman. The predictor variables like mother's age, region, place of residence, media exposure, religion, wealth index, parents' education level, and mothers' occupation were found to be significant determinants of variation in women postnatal care utilization in Ethiopia. The Bayesian multilevel logistic regression analysis also estimates the variance of random effect at the regional level. Thus, the value of var (u0j) = δ2= 0.127 is significant at the 5% level of significance. In order to convey policies, it is important not only to comprehend the effect of reforms on the issues, but also on the how it diverges with demographic and economic characteristics.

There is a dearth of information on induced abortion in Ghana, possibly owing to the sensitive nature of the subject. In this study, we examine the effect of socioeconomic and contextual factors on induced abortion in Ghana. This study draws on data from the 2017 Ghana Maternal Health Survey. The study used a Bayesian multilevel logistic regression analysis to estimate both individual- and contextual-level factors affecting induced abortion levels in Ghana. The results show a total induced abortion prevalence of 19.6% coupled with considerable district-level disparities. Induced abortion is significantly associated with socioeconomic factors such as educational attainment, wealth status, and marital status at the individual-level. The risk of induced abortion is considerably higher among the educated, wealthy, and cohabiting women. The current age of women, age at first sex, religious affiliation, parity, and type of residence are the demographic factors having an association with induced abortion levels. At the contextual-level, district health insurance coverage and poverty rate have a significant association with induced abortion. Induced abortion appears to be prevalent in Ghana and is underpinned by both individual-level socioeconomic and aggregate-level factors. Addressing induced abortion levels in Ghana may require policies that take a multilevel approach by focusing on the socioeconomic status of women and district-level contextual factors.

Prolonged time to pregnancy is associated with a greater risk of adverse outcomes

The widespread adoption of behavioral threat assessment across the United States has raised concerns about equity in exclusionary school discipline. This study examined out-of-school suspension (OSS), placement change, and expulsion rates for a statewide sample of approximately 19,000 students who received a threat assessment in 1,700 Florida schools using the Comprehensive School Threat Assessment Guidelines. Bayesian multilevel logistic regression indicated that disciplinary outcomes were strongly associated with team determination of threat seriousness, but not school-level characteristics other than greater exclusionary discipline in secondary schools. Student-level disability and low income were associated with lower rates of exclusionary discipline. Black and Hispanic students had slightly higher suspension rates, but expulsion and placement change rates were not different than White students. In contrast to the disparities typically observed in school discipline, threat assessment was associated with only small or no disparities, supporting the equity of threat assessment for groups typically disadvantaged by disproportionate exclusionary discipline. Impact Statement A Best Practices statement by the National Association of School Psychologists described behavioral threat assessment and management as a critical component of efforts to prevent violence by students, but cautioned that the process must be properly implemented so that it does not lead to the overuse of exclusionary discipline for students of color and students with disabilities. This statewide study of 19,000 threat assessments in 1,700 Florida public schools found largely equitable outcomes in out-of-school suspension, expulsion, and school transfer for students grouped by race/ethnicity, disability, and low-income status.

The influence of hours worked prior to delivery on maternal and neonatal outcomes: a retrospective cohort study

Students with attention-deficit/hyperactivity disorder (ADHD) experience significant academic difficulties that can lead to numerous negative academic consequences. With a focus on adverse academic outcomes, this study seeks to disentangle variance attributable to ADHD from variance attributable to salient personal and contextual covariates. Responses from 136 students with ADHD and 3,779 non-ADHD peers from 9 high schools were analyzed using logistic regression. Dependent measures included academic failure, grade repetition, school refusal, changing classes and school, school exclusion, and schoolwork noncompletion. Covariates comprised personal (e.g., sociodemographics, personality, prior achievement, specific learning disabilities, motivation) and contextual (e.g., school size, school socioeconomic status, school average achievement) factors. Findings indicated that, after accounting for personal and contextual covariates, ADHD explained significant variance in numerous adversities (schoolwork noncompletion, school suspension, school expulsion, changing schools, grade repetition). Thus, beyond the effects of numerous personal and contextual covariates, ADHD has a distinct presence in students' academic adversity. Also interesting, after accounting for other personal and contextual factors, was academic adversity with which ADHD was not associated. Findings provide direction for educational intervention targeting ADHD and associated factors found to be significant in the study.

Threat assessment involves evaluating and intervening with individuals who make threats of violence. This study examined the resulting actions and outcomes of threat assessment cases in three Colorado school districts. A particular focus of the study was on potential disparities. The sample consisted of 253 threat assessment cases reported by participating school districts for the 2014–2015 academic year. In addition to disciplining students, schools implemented a variety of nondisciplinary actions in response to threat assessment, including mental health services, behavior support plans, and referrals for a special education evaluation. Analyses found no disparities in any outcomes, including disciplinary actions among Black, Hispanic, and White students receiving a threat assessment. There were also no significant differences between students with and without disabilities. These findings are promising in light of documented exclusionary discipline disparities and have implications for both the use of threat assessment as a violence prevention strategy and school discipline reform. Impact Statement Findings of the current study indicate that more than half of Colorado students who received a threat assessment were subsequently disciplined in some way. Most students also received nondisciplinary actions such as mental health counseling. No differences in threat assessment outcomes were observed based on race/ethnicity or disability status.

BackgroundWomen's malnutrition, particularly undernutrition, remains an important public health challenge in Ethiopia. Although various studies examined the levels and determinants of women's nutritional status, the influence of living close to an international border on women's nutrition has not been investigated. Yet, Ethiopian borders are regularly affected by conflict and refugee flows, which might ultimately impact health.ObjectiveTo investigate the impact of living close to borders in the nutritional status of women in Ethiopia, while considering other important covariates.DesignOur analysis was based on the body mass index (BMI) of 6,334 adult women aged 20–49 years, obtained from the 2011 Ethiopian Demographic and Health Survey (EDHS). A Bayesian multilevel multinomial logistic regression analysis was used to capture the clustered structure of the data and the possible correlation that may exist within and between clusters.ResultsAfter controlling for potential confounders, women living close to borders (i.e. ≤100 km) in Ethiopia were 59% more likely to be underweight (posterior odds ratio [OR]=1.59; 95% credible interval [CrI]: 1.32–1.90) than their counterparts living far from the borders. This result was robust to different choices of border delineation (i.e. ≤50, ≤75, ≤125, and ≤150 km). Women from poor families, those who have no access to improved toilets, reside in lowland areas, and are Muslim, were independently associated with underweight. In contrast, more wealth, higher education, older age, access to improved toilets, being married, and living in urban or lowlands were independently associated with overweight.ConclusionsThe problem of undernutrition among women in Ethiopia is most worrisome in the border areas. Targeted interventions to improve nutritional status in these areas, such as improved access to sanitation, economic and livelihood support, are recommended.

Stroke represents a prominent global health issue, exhibiting the third highest incidence of disability and a significant burden on both healthcare and the economy. Stress hyperglycemia, an acute reaction of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, leading to adverse outcomes and mortality. Several previous studies have indicated that stress hyperglycemia, as evaluated by the stress hyperglycemia ratio (SHR), significantly increases the risk of adverse outcomes and mortality in stroke patients. However, there is a lack of further investigation into the influence of dynamic changes in stress hyperglycemia on the clinical outcomes of acute ischemic stroke (AIS) patients. Consequently, we performed a meticulous analysis, considering dose-response relationships from existing studies, to ascertain the correlation between dynamic changes in stress hyperglycemia and the susceptibility to adverse outcomes in patients with AIS. This investigation was prospectively registered in PROSPERO and adhered to the PRISMA guidelines. A comprehensive search was performed across English and Chinese databases. A two-sided random-effects model was employed to consolidate the odds ratios (ORs) of the highest vs. lowest categories of SHR. Restricted cubic spline (RCS) models were employed to estimate potential non-linear trends between SHR and the risk of adverse outcomes in AIS patients. Egger's test was utilized to assess publication bias. Heterogeneity was evaluated using Cochran's Q-test. The Newcastle-Ottawa Scale (NOS) tool was employed to evaluate the risk of bias of the included studies. The final analysis incorporated a total of thirteen studies, which were published between 2019 and 2023, encompassing a participant cohort of 184,179 individuals. The SHR exhibited a significant association with the risk of various adverse outcomes. Specifically, a higher SHR was correlated with a 2.64-fold increased risk of 3-month poor functional outcomes (OR: 2.64, 95% CI 2.05-3.41, I2 = 52.3%, P < 0.001), a 3.11-fold increased risk of 3-month mortality (OR: 3.11, 95% CI 2.10-4.59, I2 = 38.6%, P < 0.001), a 2.80-fold increased risk of 1-year mortality (OR: 2.80, 95% CI 1.81-4.31, I2 = 88%, P < 0.001), a 3.90-fold increased risk of intracerebral hemorrhage (ICH) and 4.57-fold increased risk of symptomatic ICH (sICH) (ICH-OR: 3.90, 95% CI 1.52-10.02, I2 = 84.3%, P = 0.005; sICH-OR: 4.57, 95% CI 2.05-10.10, I2 = 47.3%, P < 0.001), a 1.73-fold increased risk of neurological deficits (OR: 1.73, 95 CI 1.44-2.08, I2 = 0%, P < 0.001), and a 2.84-fold increased risk of stroke recurrence (OR: 2.84, 95 CI 1.48-5.45, I2 = 50.3%, P = 0.002). It is noteworthy that, except for hemorrhagic transformation (HT) and stroke recurrence, the remaining adverse outcomes exhibited a "J-shaped" non-linear dose-response relationship. In summary, our findings collectively suggest that increased exposure to elevated SHR is robustly linked to a heightened risk of adverse outcomes and mortality in individuals with AIS, exhibiting a non-linear dose-response relationship. These results underscore the significance of SHR as a predictive factor for stroke prognosis. Therefore, further investigations are warranted to explore the role of SHR in relation to adverse outcomes in stroke patients from diverse ethnic populations. Furthermore, there is a need to explore the potential benefits of stress hyperglycemia control in alleviating the physical health burdens associated with AIS. Maintaining a lower SHR level may potentially reduce the risk of adverse stroke outcomes. https://www.crd.york.ac.uk/prospero/, identifier: CRD42023424852.

BackgroundAlthough treatment decisions for localized prostate cancer (LPC) are preference-sensitive, the extent to which individuals with LPC receive preference-concordant treatment is unclear. In a sample of individuals with LPC, the purpose of this study was to (a) assess concordance between the influence of potential adverse treatment outcomes and treatment choice; (b) determine whether receipt of a decision aid predicts higher odds of concordance; and (c) identify predictors of concordance from a set of participant characteristics and influential personal factors.MethodsParticipants reported the influence of potential adverse treatment outcomes and personal factors on treatment decisions at baseline. Preference-concordant treatment was defined as (a) any treatment if risk of adverse outcomes did not have a lot of influence, (b) active surveillance if risk of adverse outcomes had a lot of influence, or (c) radical prostatectomy or active surveillance if risk of adverse bowel outcomes had a lot of influence and risk of other adverse outcomes did not have a lot of influence. Data were analyzed using descriptive statistics and logistic regression.ResultsOf 224 participants, 137 (61%) pursued treatment concordant with preferences related to adverse treatment outcomes. Receipt of a decision aid did not predict higher odds of concordance. Low tumor risk and age ≥ 60 years predicted higher odds of concordance, while attributing a lot of influence to the impact of treatment on recreation predicted lower odds of concordance.ConclusionsRisk of potential adverse treatment outcomes may not be the foremost consideration of some patients with LPC. Assessment of the relative importance of patients’ stated values and preferences is warranted in the setting of LPC treatment decision making.Clinical trial registration: NCT01844999 (www.clinicaltrials.gov).

BackgroundUrbanization and population aging may affect prevalence of chronic pain from various causes. This cross-sectional study aimed to investigate the prevalence of chronic musculoskeletal pain, including some subtypes, in independent Japanese older people, and whether population density and population aging rate explained prevalence and differences in pain levels between municipalities.MethodsWe analyzed data from 12,883 independent older people living in 58 municipalities who completed mailed questionnaires and did not need support for daily living. We identified three types of pain: “chronic musculoskeletal pain” lasting ≥ 3 months (overall and in each part of the body), “chronic widespread-type pain” in the spinal and peripheral area, and “chronic multisite pain” in at least three sites. The latter two were measured using new definitions. These types of pain are correlated with depressive symptoms and we therefore examined the construct validity of the definitions by comparing the Geriatric Depression Scale score. We also used analysis of covariance to compare the prevalence of these three types of pain between municipalities. Odds ratios, median odds ratios, and the municipal variance in prevalence of chronic musculoskeletal pain were estimated by Bayesian multilevel logistic regression analysis using the Markov Chain Monte Carlo method.ResultsThe construct validity of the definitions of chronic widespread-type pain and chronic multisite pain was confirmed. The prevalence of the three types of pain (chronic musculoskeletal, widespread, and multisite pain) was 39.0%, 13.9%, and 10.3%, respectively. Chronic musculoskeletal pain showed a higher prevalence among older people and women. Individuals in underpopulated, suburban, or metropolitan areas tended to have more pain than those in urban areas, but this was not statistically significant (odds ratio [95% credible interval] 1.15 [0.86–1.51], 1.17 [0.93–1.43], 1.17 [0.94–1.46]). Population density and population aging rate did not explain the differences between municipalities.ConclusionsThe prevalence of chronic musculoskeletal pain was consistent with previous global reports. Areas with overpopulation and depopulation tended to have higher pain prevalence, but population density and population aging rate did not explain municipal variance. Further research is needed to identify other factors that contribute to regional variance.

Cystic echinococcosis (CE) is mainly described as a food/waterborne zoonosis. However, evidence about matrices contamination is scarce. Identifying main transmission routes could optimize health messages aiming to prevent ingestion of parasite eggs. We evaluated Echinococcus granulosus contamination of matrices in two areas of Chile and Peru. In stage 1, areas with high active CE prevalence were identified through cross-sectional ultrasound surveys. Stage 2 was a case-control study encompassing matrices sampling in public places and households with and without CE cases in these areas, followed by (stage 3), matrices processing by sequential sieving and E. granulosus detection by PCR. Bayesian multilevel mixed-effects logistic regression analysis was used to identify factors associated with risk of contamination. In households, soil (19%-42%); dogs' fur (10%-30%); shoes' soles (5%-33%); and dogs' feces (0-50%) were highly contaminated. In public areas, ~ 30% of fecal and soil samples were contaminated. Overall, matrices from public areas were more contaminated than those from households. When examining households, there was no difference in risk of contamination according to presence of CE cases, while CE-free households had lower risk when considering households and public areas. There was no difference in risk of contamination according to matrix. Vegetables were PCR-negative. Results suggest the need for a paradigm-shift towards considering CE an environmental-borne infection with a "community risk" to which people are exposed.

Global variations and time trends in the prevalence of childhood myopia: a systematic review and meta-analysis

How we perceive a visual form not only depends on the currently presented shape, but also on the temporal context in which it is shown. Earlier research found both attractive and repulsive context effects in perception. Tendencies to see the current stimulus similar to how the previous stimulus was seen (i.e., hysteresis, attraction) co-exist with tendencies that repel the current percept away from the organization for which there was most evidence in the previous stimulus (i.e., adaptation, repulsion). While previous research focused on group-level effects of temporal context, this study investigated whether everyone shows effects of the previous percept and the previous stimulus in the expected direction, and whether possible individual differences in these attractive and repulsive temporal context effects are consistent. Participants (N=209) conducted a perceptual categorization task with two series of abstract morph figures as stimuli, for which average temporal context effects were identified before. A Bayesian multilevel logistic regression analysis on the current percept was conducted to get estimates for the size of the hysteresis and adaptation effect per participant. Results indicate that almost everyone showed an attractive effect of what was perceived in the previous trial, while a repulsive effect of the previously shown stimulus was less universal. The size of the individual hysteresis and adaptation effects were strongly correlated: participants with a more outspoken attractive effect of the previous percept also showed a stronger repulsive effect of the previous stimulus. Furthermore, individual differences in the strength of the adaptation effect were heavily correlated with individual differences in the sensitivity to perceptual differences between the different morph levels. The study provides evidence for different percepts in different individuals even when presented with the same stimulus in the same context and thereby increases insight in how different individuals differentially combine previous and current input in their perception.