Surplus degrees, scarce opportunities: profiling overqualification in Ecuador

An Explanation of the Increasing Age Premium

Understanding goals of care for terminally ill patients at the end of life is crucial to ensure that patients receive care consistent with their preferences. To investigate the patterns of goals of care among patient-caregiver dyads over the last years of the patient's life and the associations of the goals of care with patient-caregiver characteristics. This prospective cohort study of 210 patient-caregiver dyads involved surveys every 3 months from July 8, 2016, until the patient's death or February 28, 2022. Data from the last 2 years of the patients' lives were analyzed. Dyads, which comprised patients with stage IV solid cancer and their caregivers, were recruited from outpatient clinics at 2 major cancer centers in Singapore. Goals of care were examined via the tradeoffs between life extension and symptom management and between life extension and cost containment. The actor-partner interdependence framework was implemented using mixed-effects linear regressions. This study included 210 dyads (patients: mean [SD] age, 62.6 [10.5] years; 108 men [51.4%]; caregivers: mean [SD] age, 49.4 [14.6] years; 132 women [62.9%]). On average, 34% of patients (264 of 780 observations; range, 23%-42%) and 29% of caregivers (225 of 780 observations; range, 20%-43%) prioritized symptom management over life extension, whereas 24% of patients (190 of 780 observations; range, 18%-32%) and 19% of caregivers (148 of 780 observations; range, 8%-26%) prioritized life extension. Between cost containment and life extension, on average, 28% of patients (220 of 777 observations; range, 22%-38%) and 17% of caregivers (137 of 780 observations; range, 10%-25%) prioritized cost containment, whereas 26% of patients (199 of 777 observations; range, 18%-34%) and 35% of caregivers (271 of 780 observations; range, 25%-45%) prioritized life extension. Goals of care did not change as patients approached death. Patients prioritized symptom management if they experienced higher symptom burden (average marginal effect [SE], 0.04 [0.01]), worse spiritual well-being (average marginal effect [SE], -0.04 [0.01]), and accurate (vs inaccurate) prognostic awareness (average marginal effect [SE], 0.40 [0.18]) and if their caregivers reported accurate prognostic awareness (average marginal effect [SE], 0.53 [0.18]), lower impact of caregiving on finances (average marginal effect [SE], -0.28 [0.08]), and poorer caregiving self-esteem (average marginal effect [SE], -0.48 [0.16]). Compared with patients, caregivers expressed lower preferences for cost containment (average marginal effect [SE], -0.63 [0.09]). Patients prioritized cost containment if they were older (average marginal effect [SE], 0.03 [0.01]), had higher symptom burden (average marginal effect [SE], 0.04 [0.01]), had poorer spiritual well-being (average marginal effect [SE], -0.04 [0.01]), and their caregivers reported poorer caregiving self-esteem (average marginal effect [SE], -0.51 [0.16]) and more family support (average marginal effect [SE], -0.30 [0.14]). In this cohort study of patient-caregiver dyads, findings suggested the importance of interventions aimed at reducing discordance in goals of care between patients and caregivers and helping them develop realistic expectations to avoid costly, futile treatments.

ObjectivesTo establish optimal pre-pregnancy body mass index (BMI)-specific gestational weight gain (GWG) ranges for twin pregnancies and compare their association with maternal and neonatal adverse outcomes against Institute of Medicine (IOM) recommendations.DesignRetrospective cohort study. Retrospective cohort study. Adjusted ORs (aORs) with 95% CI were used to quantify associations; average marginal effects (AME) with 95% CI (in percentage points) were used to compare absolute risk differences.SettingPerinatal data from >70 obstetric institutions in Wuhan, China, collected via the Wuhan Maternal and Child Health Service Management Information System.Participants10 636 women with twin deliveries at ≥28 weeks (2011–2023). Pre-pregnancy BMI categorised using Chinese cut-offs: underweight <18.5, normal 18.5–23.9, overweight 24.0–27.9, obesity ≥28.0 kg/m².Primary and secondary outcome measuresHypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), small for gestational age (SGA) and large for gestational age.ResultsOptimal GWG ranges were: underweight 18.0–25.0 kg, normal 14.0–24.0 kg, overweight 12.2–24.0 kg, obesity 13.3–20.0 kg. Compared with IOM guidelines, study-derived ranges showed more favourable risk identification. In normal weight women, excessive GWG increased HDP risk (aOR 1.79, 95% CI 1.49 to 2.14); 13.57% versus 8.79%, AME 5.90 pp (95% CI 3.88 to 7.91 pp). In underweight women, inadequate GWG increased PROM (aOR 1.64, 95% CI 1.05 to 2.57); 14.48% versus 7.51%, AME 4.18 pp (95% CI 0.31 to 8.06 pp) and SGA (aOR 1.72, 95% CI 1.29 to 2.31); 45.58% versus 41.40%, AME 11.74 pp (95% CI 5.55 to 17.94 pp). In overweight women, excessive GWG increased HDP (aOR 1.81, 95% CI 1.21 to 2.70); 24.39% versus 16.32%, AME 9.68 pp (95% CI 2.49 to 16.88 pp) and inadequate GWG increased SGA (aOR 1.60, 95% CI 1.20 to 2.14); 35.15% versus 27.82%, AME 9.85 pp (95% CI CI 3.72 to 15.97 pp), which IOM failed to detect. In obese women, inadequate GWG increased SGA (aOR 2.76, 95% CI 1.37 to 5.53); 27.18% versus 17.16%, AME 17.95 pp (95% CI 5.74 to 30.17 pp), which was missed by IOM.ConclusionsOur findings support adopting region-specific GWG standards for twin pregnancies in Asian populations.

Young adult workers (18-24 years) in the United States have been identified as a high-risk group for smoking. This study compares changes in smoking behavior by occupational class among this group between 2005 and 2010. Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. All respondents 18-24 years who reported that they were employed during the two surveys were selected (n = 1880 in 2005; and n = 1531 in 2010). Weighted percentages and 95% confidence interval were reported. Logistic regression analyses were performed to compare smoking behavior between occupational groups (white-collar, blue-collar, and service) and between years (2005-2010), and to examine correlates of smoking, successful quit attempt, and heavy smoking. Smoking prevalence and daily smoking declined in 2010 in white-collar. Smoking prevalence and intensity decreased while age of smoking initiation increased in blue-collar workers. Young workers were more likely to smoke in 2005 than 2010. Service and blue-collar workers were more likely to smoke than white-collar workers. Older young adults, whites, individuals with a high school/or less education, those without health insurance were more likely to smoke. White workers and individuals with a high school/or less education were more likely to be heavy smokers. White-collar workers have benefited the most from tobacco control efforts. Although improvements were seen in smoking behavior among blue-collar workers, smoking prevalence remained the highest in this group. Smoking behavior among service workers did not change. Young service workers and blue-collar are priority populations for workplace tobacco control efforts. The current study examines changes in smoking behavior among young adult workers (18-24 years) by occupational class (white-collar, blue-collar, and service workers) between 2005 and 2010. Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. Smoking prevalence and daily smoking declined significantly in white-collar workers. No change in smoking behavior was observed among service workers. Positive changes in smoking behavior were observed among blue-collar workers, but smoking prevalence remained the highest in this group. Blue-collar and service workers are priority groups for future workplace tobacco control efforts.

Objectives: The aim of this study was to reveal the current state of preventive measures and lifestyle habits against heat illness in radiation decontamination workers and to examine whether young radiation decontamination workers take less preventive measures and have worse lifestyle habits than the elder workers. Methods: This was a cross-sectional study. Self-administered questionnaires were sent to 1,505 radiation decontamination workers in Fukushima, Japan. Five hundred fifty-eight men who replied and answered all questions were included in the statistical analysis. The questionnaire included age, duration of decontamination work, previous occupation, lifestyle habit, and preventive measures for heat illness. We classified age of the respondents into five groups: <30, 30-39, 40-49, 50-59, and ≥60 years and defined the workers under 30 years of age as young workers. Logistic regression analysis was used to reveal the factors associated with each lifestyle habit and preventive measures. Results: In comparison with young workers, 50-59-year-old workers were significantly associated with refraining from drinking alcohol. Workers 40 years of age or older were significantly associated with cooling their bodies with refrigerant. Furthermore, 30-39-year-old workers and 40-49-year-old workers were significantly associated with adequate consumption of water compared to young workers. Conclusion: The results of our study suggests that young decontamination workers are more likely to have worse lifestyle habits and take insufficient preventive measures for heat illness. This may be the cause of higher incidence of heat illness among young workers.

The role of patient-level factors that are unrelated to the specific clinical condition leading to an emergency department (ED) visit, such as functional status, cognitive status, social supports, and geriatric syndromes, in admission decisions is not well understood, partly because these data are not available in administrative databases. To determine the extent to which patient-level factors are associated with rates of hospital admission from the ED. This cohort study analyzed survey data collected from participants (or their proxies, such as family members) enrolled in the Health and Retirement Study (HRS) from January 1, 2000, to December 31, 2018. These HRS data were linked to Medicare fee-for-service claims data from January 1, 1999, to December 31, 2018. Information on functional status, cognitive status, social supports, and geriatric syndromes was obtained from the HRS data, whereas ED visits, subsequent hospital admission or ED discharge, and other claims-derived comorbidities and sociodemographic characteristics were obtained from Medicare data. Data were analyzed from September 2021 to April 2023. The primary outcome measure was hospital admission after an ED visit. A baseline logistic regression model was estimated, with a binary indicator of admission as the dependent variable of interest. For each primary variable of interest derived from the HRS data, the model was reestimated, including the HRS variable of interest as an independent variable. For each of these models, the odds ratio (OR) and average marginal effect (AME) of changing the value of the variable of interest were calculated. A total of 42 392 ED visits by 11 783 unique patients were included. At the time of the ED visit, patients had a mean (SD) age of 77.4 (9.6) years, and visits were predominantly for female (25 719 visits [60.7%]) and White (32 148 visits [75.8%]) individuals. The overall percentage of patients admitted was 42.5%. After controlling for ED diagnosis and demographic characteristics, functional status, cognition status, and social supports all were associated with the likelihood of admission. For instance, difficulty performing 5 activities of daily living was associated with an 8.5-percentage point (OR, 1.47; 95% CI, 1.29-1.66) AME increase in the likelihood of admission. Having dementia was associated with an AME increase in the likelihood of admission of 4.6 percentage points (OR, 1.23; 95% CI, 1.14-1.33). Living with a spouse was associated with an AME decrease in the likelihood of admission of 3.9 percentage points (OR, 0.84; 95% CI, 0.79-0.89), and having children living within 10 miles was associated with an AME decrease in the likelihood of admission of 5.0 percentage points (OR, 0.80; 95% CI, 0.71-0.89). Other common geriatric syndromes, including trouble falling asleep, waking early, trouble with vision, glaucoma or cataract, use of hearing aids or trouble with hearing, falls in past 2 years, incontinence, depression, and polypharmacy, were not meaningfully associated with the likelihood of admission. Results of this cohort study suggest that the key patient-level characteristics, including social supports, cognitive status, and functional status, were associated with the decision to admit older patients to the hospital from the ED. These factors are critical to consider when devising strategies to reduce low-value admissions among older adult patients from the ED.

Advances in diabetes detection and treatment have mitigated the risks of serious complications and death, but little is known about whether economic outcomes for people with diabetes have similarly improved. To assess whether associations between diagnosed diabetes and labor market outcomes have changed over time. This cross-sectional study analyzed data from the National Health Interview Survey from 1998 to 2018. The sample was nationally representative of the US population aged 40 to 64 years. Average marginal effects, the regression-adjusted difference in probability of outcomes between people with and without diabetes, pooled by 3-year periods (1998-2000 to 2016-2018), were estimated with controls for demographics, education, and comorbid health risks. Behavioral Risk Factor Surveillance (BRFSS) data from 1993 to 2023 were included in robustness analyses. Data were analyzed from September 2023 to November 2024. Diagnosed diabetes, defined based on respondents' self-report that they have ever been diagnosed by a medical professional. The main outcomes were labor force participation and any Supplemental Security Income or Social Security Disability Insurance income receipt. Secondary outcomes included reporting health limitations for any activities, health limitations for work, any nights in hospital, and receiving health care 10 or more times in the past year. The study included 249 712 individuals, 25 177 with diabetes. The weighted population was 50% female, 12% Hispanic, 11% non-Hispanic Black, 72% non-Hispanic White, and 5% multiracial or other race (Alaska Native or American Indian, Asian, or nonspecified). In the weighted population from 1998 to 2000, 46% of people with diabetes were 55 years and older, while 27% of people without diabetes were 55 years and older. In the weighted population from 2016 to 2018, 56% of people with diabetes were 55 years and older, while 38% of people without diabetes were 55 years and older. The average marginal effect of diabetes on probability of labor force participation was -10.9 percentage points (95% CI, -13.0 to -8.9) from 1998 to 2000 and -11.0 percentage points (95% CI, -13.0 to -9.1) from 2016 to 2018; for people who received Supplemental Security Income or Social Security Disability Insurance income, it was 4.4 percentage points (95% CI, 3.3-5.5) and 4.9 percentage points (95% CI, 3.7-6.0) from 1998 to 2000 and 2016 to 2018, respectively. During the same period, average marginal effects for all examined health outcomes significantly improved. Similar patterns were observed using BRFSS data, but with a slight improvement in labor force participation between 2017 to 2019 and 2021 to 2023. This cross-sectional study demonstrated that while people with diabetes experienced meaningful health improvements, they saw little progress in economic performance. Changing patient selection appears to play a role. Future research is needed to disentangle the paradox.

Young and low-skilled workers are the most affected groups due to the labor market disruption caused by the pandemic. One of the impacts is the transition of young workers, especially workers with low skills, or called blue-collar workers. The transition could be a change from blue-collar young workers to those Not in Education, Employment, or Training (NEET). This study aims to examine the determinants of the transition of blue-collar young workers who become Unemployed NEET or Inactive NEET during the pandemic. In this study, data from the National Labor Force Survey (SAKERNAS) with individual panel observations, observed in two survey periods, namely August 2019 and August 2020, were analyzed using multinomial logistic regression. Demographic factors, human capital, and the risk status of COVID-19 in the area where young workers live are important issues in the transition of blue-collar young workers to NEET. Optimizing gender-based employment policies, implementing policies that suit the needs of young workers in rural or urban areas, as well as intensifying the use of the internet for work that can increase worker resilience, are some of the solutions to prevent the NEET transition from blue-collar young workers during the pandemic. Keywords: Blue-Collar Worker, Multinomial logistic regression, NEET, Sakernas, Young worker

BackgroundThis study examined inter-regional emergency department (ED) utilization among critically ill patients in South Korea and identified demographic, socioeconomic, and system-level factors.MethodsA retrospective analysis of 741,701 critically ill ED visits in 2021 was conducted using the National Emergency Department Information System (NEDIS). Inter-regional utilization was defined as receiving care outside the residential emergency medical service (EMS) region. Patient characteristics were compared between inter- and intra-regional groups. Mixed-effects logistic regression, modified Poisson regression, and average marginal effects (AMEs) were applied to identify associated factors. The results were presented concurrently using odds ratios (ORs), adjusted risk ratios (aRRs), and AMEs, including 95% confidence intervals (CIs).ResultsOverall, 21.7% of critically ill patients received inter-regional care. Male patients had higher odds of inter-regional utilization (OR 1.08, 95% CI: 1.07–1.10; aRRs 1.05, 95% CI: 1.03–1.08), although their absolute probability was significantly lower (AME –8.29%p, 95% CI: –12.42 to –4.16), reflecting differences between relative and absolute measures. Adults aged 19–44 years (OR 1.35, 95% CI: 1.32–1.39) and 45–64 years (OR 1.24, 95% CI: 1.21–1.27) showed higher odds of inter-regional utilization, although corresponding AMEs were not statistically significant. Among older adults, the 65–74-year group showed a non-significant decrease in absolute probability (AME –0.90%p, 95% CI: –3.39 to 1.58), whereas the 75–84-year group demonstrated a significant reduction (AME –5.78%p, 95% CI: –7.64 to –3.92). Pediatric patients also exhibited elevated odds of inter-regional use. Medical Aid beneficiaries had lower relative odds (OR 0.65, 95% CI: 0.63–0.67), and AMEs showed no statistically significant absolute differences. Inter-hospital transfer (OR 1.20, 95% CI: 1.16–1.24) was associated with higher inter-regional use, with a statistically significant increase in absolute probability (AME + 3.74%p, 95% CI: 0.86–6.63). Arrival by ambulance or private vehicle showed positive but non-significant AMEs. High-acuity patients (KTAS 1–2) and those transferred as their final disposition also demonstrated higher relative odds of inter-regional utilization.ConclusionsInter-regional ED utilization was more likely among men, younger and middle-aged adults, high-acuity patients, and those arriving by ambulance or transferred from another hospital, while Medical Aid patients were less likely to receive such care. These findings highlight the importance of strengthening local emergency capacity, optimizing referral and transfer pathways, and implementing region-specific strategies alongside nationwide initiatives.

Background Associations of social and health disadvantages at birth with educational attainment are well-documented. Less is known about the magnitude of the associations across different historical contexts. We investigated associations between a range of early life disadvantages and higher educational attainment across three successive generations. Methods The data were from the register-based Uppsala Birth Cohort Multigenerational Study in Sweden. The study samples include three generations born in 1915-1929 (G1, n = 10 587), 1933-1972 (G2, n = 6566), and 1973-1978 (G3, n = 6684). The outcome was attainment of higher education (more than senior high school) assessed at age 30+ years. Exposures were parental socioeconomic position (SEP), mother's marital status, parity, gestational age and birth weight for gestational age. Multiple logistic regression models were fitted to evaluate the associations across three generations. Results are presented as Average Marginal Effects (AME). Results Low parental SEP was associated with lower probability of higher educational attainment in all three generations. The difference between low versus high parental SEP among men declined by 32 percentage points in G2 (AME: 0.32; 95% CI: 0.27, 0.38) and 27 percentage points in G3 (AME: 0.27; 95% CI: 0.21, 0.33) compared to G1. Among women, the corresponding declines in G2 and G3 were 35 and 28 percentage points. Mothers’ unmarried marital status and high parity were associated with lower probability of education, with no evidence of decline across generations. The association between small for gestational age and education among men persisted across generations while showing a decline in G3 women. Conclusions Associations between early life factors and education persisted across three generations. The influence of parental socioeconomic background on educational attainment appeared to level off in the youngest generation after becoming attenuated in the preceding generation. Key messages • Association between small for gestational age and educational attainment persisted across generations, with an attenuation among the youngest cohort of women. • High parity was associated with lower chance of educational attainment, with no evidence of effect attenuation across generations.

Health events may disrupt insurance coverage. We estimated the association between a child's hospitalization and insurance coverage disruption among privately insured children and caregivers. Using the MarketScan Commercial Database, we identified children (0-17years) with a hospitalization from July 2016 to June 2022. Children were matched on observable characteristics with nonhospitalized children, who were randomly assigned a "phantom" discharge date. The primary outcome was health insurance coverage disruption in the 6months post index/phantom hospitalization discharge. We examined this separately among children and caregivers via multivariable logistic regression and reported the average marginal effect (AME) of coverage disruption for the hospitalization. We performed subgroup analyses including length of stay category for children and caregiver type (primary plan-holder vs spouse), sex, and household structure (1 vs 2 insured caregivers) for caregivers. In total, 219 512 hospitalized children were matched to 715 143 nonhospitalized children, and 369 406 and 1 207 958 caregivers of hospitalized and nonhospitalized children, respectively, were identified. The predicted probability of coverage disruption was significantly higher for the hospitalized cohort of children (hospitalized percentage points 0.170; comparison group 0.156; AME, 1.3 percentage points; 95% CI, 0.011-0.014; P < .001) and their caregivers (hospitalized percentage points 0.165; comparison group 0.155; AME, 1.0 percentage points, 95% CI, 0.008-0.012; P < .001). The risk of insurance coverage disruption associated with hospitalization was higher among families of children with longer lengths of stay and with 1 insured caregiver on the insurance plan. Pediatric hospitalization is associated with an increased risk of insurance coverage disruption for the child and their caregiver among privately insured individuals. This could reflect a change in access to care for recently hospitalized children, especially those in certain subgroups.

To evaluate the impact of a virtual registered nurse (ViRN) model on safety and care outcomes. ViRN is a telemedicine intervention that enables an experienced virtual nurse to assist the in-person care team in providing care to patients. Electronic health records data were utilized from the Mayo Clinic during the intervention (December 2020-November 2021) and historical periods (December 2018-November 2019). ViRN was implemented on general medical units at the Mayo Clinic Rochester. We used general medical units at the Mayo Clinic Arizona as the comparison group. This study used a difference-in-differences design to evaluate the impact of ViRN compared to usual care on transfer to the intensive care unit (ICU), inpatient mortality, and length of stay (LOS). We used logistic regression for transfer to the ICU and inpatient mortality and negative binomial regression for LOS. We controlled for demographics, patient interaction with the health system, clinical characteristics, and admission characteristics. We clustered standard errors to account for patients who have multiple admissions during the study period. There were no significant differences for transfer to the ICU (average marginal effect (AME) -0.08 percentage point [95% confidence interval (CI): -1.34, 1.18]), inpatient mortality (AME 0.43 percentage point [95% CI: -0.33, 1.18]), or LOS (AME -0.20 days [95% CI: -0.57, 0.17]). The findings were mostly consistent across the sensitivity analyses. Our results suggest that ViRN led to similar outcomes as usual care in general medical units. These findings support the potential to develop more advanced models of ViRN at the Mayo Clinic and the dissemination of the ViRN model to other systems. In the context of staffing shortages and other disruptions to the delivery of nursing care, it is critical to understand whether new models like ViRN provide nurse staffing alternatives without negatively affecting outcomes.

Health inequities among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority populations (LGBTQ+) are driven by anti-LGBTQ+ stigma and discrimination. However, there is limited research on the manifestations of stigma and discrimination among LGBTQ+ cancer survivors. Data were collected by the North Carolina Department of Health and Human Services via the 2023 North Carolina LGBTQ+ Health Needs Assessment. Differences in outcomes (i.e., discrimination, violence, homelessness, mental health, substance use, and overdose) between LGBTQ+ individuals by cancer history were assessed using Chi-squared tests. Further, multivariable logit models were used to generate predicted probabilities, average marginal effects (AME), and 95% confidence intervals (CI) of the association of cancer with each outcome. A total of N = 3170 LGBTQ+ individuals (n = 200 cancer survivors) took part in the survey. In adjusted analyses, cancer history was associated with an 8.1 to 19.1 percentage point increase in the probability of all discrimination, violence, and homelessness outcomes. The largest AME of cancer was with accidental overdose (AME: 22.5; 95% CI, 15.2-29.8), followed by homelessness (AME: 19.1; 95% CI, 11.6-26.6), spouse or family violence (AME: 16.7; 95% CI, 9.3-24.1), LGBTQ+ violence (AME: 15.1; 95% CI, 7.8-22.5), sexual assault (AME: 14.1; 95% CI, 6.0-22.2), as well as nicotine product (AME: 9.0; 95%CI, 1.6-16.5) and cocaine use (AME: 8.9; 95% CI, 3.8-14.1). The most common barriers to mental health services were cost (36.0%) and health insurance (33.5%). The needs assessment was a convenience-based study, which limits the generalizability of our findings. LGBTQ+ cancer survivors in North Carolina experience an elevated burden of discrimination, violence, suicide attempt, substance use, and accidental overdose in comparison to LGBTQ+ individuals without a cancer history.

This study aimed to examine the association between physician sex, cesarean delivery, and neonatal complications.We analyzed the Consortium on Safe Labor database including 228,437 deliveries from 2002 to 2008. The study focused on singleton pregnancies with cephalic presentations, excluding cases with contraindications to vaginal delivery, elective cesarean deliveries, and nonobstetricians and gynecologists or maternal-fetal medicine physician management. The primary outcome of this study was cesarean delivery; secondary outcomes were cesarean delivery due to arrest of dilation or descent, cesarean delivery for nonreassuring fetal heart tracings (NRFHT), cesarean delivery for other indications, and a composite of neonatal complications. To estimate average marginal effects (AMEs) in percentage points (pp) with 95% confidence intervals (95% CI) of cesarean delivery between male and female physicians, we performed generalized estimating equations with Poisson distribution and exchange-correlation structure, adjusting for maternal, physician-level characteristics, and hospital-fixed effects.Of 108,004 individuals, 46,779 (43.3%) were attended by 183 female physicians, and 61,225 (56.7%) were attended by 250 male physicians. Female physicians were associated with a lower overall adjusted cesarean delivery proportion (11.93 vs. 13.47%; AME -1.54 pp [95% CI: -2.35, -0.73]), cesarean delivery for failure to progress (5.72 vs. 6.48%; AME -0.76 pp [95% CI: -1.24, -0.27]), and cesarean delivery for indications except for failure to progress or NRFHT (1.68 vs. 2.01%; AME -0.33 pp [95% CI: -0.56, -0.10]). There were no significant differences in cesarean outcomes for NRFHT or composite neonatal complications between male and female physicians.Compared with male physicians, female physicians had a lower rate of cesarean delivery. Further research is needed to understand the underlying mechanisms and develop targeted interventions. · Compared with male physicians, female physicians had a lower rate of cesarean delivery.. · This reduction was particularly evident for cesarean deliveries due to failure to progress.. · The reduction was not associated with an increased risk of neonatal complications..

BackgroundDespite global efforts to achieve zero hunger, food insecurity remains a critical challenge in several African countries, including Cameroon. This study aims to identify sociodemographic predictors of food insecurity across Cameroon through a comprehensive, nationwide cross-sectional analysis.MethodsData for this study were drawn from the 2018 Cameroon Demographic and Health Survey (CDHS). Food insecurity levels were evaluated using the Food Insecurity Experience Scale (FIES). To estimate the probabilities of moderate and severe food insecurity among different sociodemographic groups, logistic regression models were applied, with results expressed as average marginal effects (AME).ResultsThe findings reveal that approximately 24.86% of participants experienced moderate food insecurity, while 28.96% faced severe food insecurity. Among men, the proportion experiencing severe food insecurity was 38.8%, compared to 24.3% for women. Multivariable regression analysis showed that severe food insecurity was less likely among women [AME = 0.84, 95% CI = 0.83,0.86], Muslims [AME = 0.91, 95%CI = 0.90,0.93], individuals with higher education levels (secondary education: AME = 0.93, 95%CI = 0.90,0.95; higher education: AME = 0.87, 95%CI = 0.85,0.90), those owning land (either alone or jointly) [AME = 0.92, 95%CI = 0.89,0.96], wealthiest households (moderate food insecurity: AME = 0.91, 95%CI = 0.88,0.93; severe food insecurity: AME = 0.73, 95%CI = 0.70,0.75), female-headed households [AME = 0.97, 95%CI = 0.96,0.99], and rural residents [AME = 0.97, 95%CI = 0.95,0.98].ConclusionsThese findings underscore that food insecurity affects a substantial portion of the Cameroonian population, with certain sociodemographic groups more vulnerable than others. This study proposes targeted policy recommendations to address food insecurity in Cameroon, including social assistance programs for at-risk groups, investments in socioeconomic empowerment, improvements in agricultural productivity, and ongoing research to guide evidence-based interventions.