Cluster-robust Standard Errors Research Articles

Triglyceride-glucose index's link to cardiovascular outcomes post-percutaneous coronary intervention in China: a meta-analysis.

Percutaneous coronary intervention (PCI) addresses myocardial ischaemia, but a significant subset of patients encounter major adverse cardiovascular events (MACE) post-treatment. This meta-analysis investigated the relationship between the post-PCI triglyceride-glucose (TyG) index and MACE. Comprehensive searches of the Embase, PubMed, Cochrane Library, and Web of Science databases were conducted up to 3 March 2023, using relevant keywords. The effect size was determined based on I2 statistic using random-effects models. Cluster-robust standard errors crafted the dose-response curve, and the GRADE Evaluation Scale was employed to rate the quality of evidence. The group with the highest TyG index had significantly higher post-PCI MACE rates than the lowest index group, with hazard ratios (HRs) of 2.04 (95% CI 1.65-2.52; I2=77%). Each unit increase in TyG index corresponded to HRs of 1.82 for MACE (95% CI 1.34-2.46; I2=92%), 2.57 for non-fatal MI (95% CI 1.49-4.41; I2=63%), and 2.06 for revascularization (95% CI 1.23-3.50; I2=90%). A linear relationship between TyG index and MACE risk was established (R2=0.6114). For all-cause mortality, the HR was 1.93 (95% CI 1.35-2.75; I2=50%), indicating a higher mortality risk with elevated TyG index. The GRADE assessment yielded high certainty for non-fatal MI but low certainty for all-cause mortality, revascularization, and MACE. The TyG index may predict risks of post-PCI MACE, all-cause mortality, non-fatal MI, and revascularization, with varied levels of certainty. A potential linear association between the TyG index and MACE post-PCI was identified. Future research should validate these findings.

The power of institutional investors: empirical evidence on their role in investment in internal audit function

PurposeInstitutional investors are major shareholders in publicly traded firms and play crucial roles in the financial and governance aspects of these firms. Despite their importance, little is known about their role in internal auditing. This study aims to fill this gap by investigating the relationship between institutional investors’ ownership and investment in the internal audit function (IAF).Design/methodology/approachThe study uses ordinary least squares regressions with two-way cluster-robust standard errors (firm and year) to estimate the relationship between institutional investors’ ownership and investment in IAF for Malaysian listed firms between 2009 and 2020.FindingsThe findings show that companies with higher levels of institutional ownership invest more in IAF, suggesting that institutional investors can effectively monitor managers due to their large holdings. Moreover, both transient and dedicated institutional investors are more likely to invest in IAF.Originality/valueThe results highlight the importance of institutional investors as a significant determinant of investment in IAF, which can aid regulators and managers in understanding the institutional investors’ role in governing and optimizing the efficient use of a firm’s resources. The findings also provide insight into institutional investors’ behavior regarding monitoring systems, which may inspire regulators and policymakers to consider increasing institutional investors’ participation to enhance governance structures.

Clinical effectiveness of robotic-assisted compared to open or video-assisted lobectomy in Germany: a real-world data analysis.

Despite robotic-assisted thoracic surgery (RATS) lobectomy being on the rise in Europe, the majority of lobectomies in Germany are still performed with an open or thoracoscopic [video-assisted thoracic surgery (VATS)] approach. Empirical evidence in favour of RATS lobectomy is inconsistent. This retrospective cohort study investigates the impact of RATS lobectomy compared with open thoracic surgery (OPEN) and VATS lobectomy on short-term outcomes in Germany using multicentre real-world data. Anonymized routine data from Germany from 2018 to 2020 were retrospectively analysed. These data were provided by 61 German hospitals. Propensity score matching with subsequent generalized linear models was performed for statistical analysis. Additionally, in order to test the robustness of the results, multivariable regression analyses with cluster-robust standard errors were used. A total of 2498 patients with lobectomy were identified: in 1345 patients OPEN, in 983 VATS and 170 a RATS lobectomy was performed. RATS-compared to OPEN and VATS-reduced length of stay (LOS) by 28% or 4.2 days [confidence interval: 2.9; 5.4] and by 13% or 1.6 days [confidence interval: 0.2; 3.0], respectively. The risk of pneumonia was reduced by 5.3 percentage points in the RATS group compared to both OPEN and VATS (P = 0.07/0.01). RATS-compared to an open approach-reduces the risk of blood transfusions by 8.8 percentage points (P < 0.001) and LOS on the intensive care unit (P < 0.001). This study provides strong support that RATS lobectomy outperforms OPEN or VATS lobectomy in terms of hospital LOS, and short-term in-hospital postoperative complications in the real-world scenario in Germany.

RESIDENTIAL SEGREGATION AND DEPRESSIVE SYMPTOMS IN OLDER CHINESE IMMIGRANTS: MEDIATING ROLE OF SOCIAL PROCESSES

Abstract Older Chinese immigrants are particularly at risk for depression due to acculturative stress and language barriers. Residential segregation with respect to language use may play an important role in mental health of historically marginalized immigrant populations. Previous research provided mixed evidence about the segregation effect among older Latino and Asian immigrants. Guided by a model of social processes, we examined the direct and indirect effects of residential segregation on depressive symptoms via multiple mechanisms of acculturation, discrimination, social network, social support, social strain, and social engagement. Four waves of depressive symptoms were assessed in the Population Study of Chinese Elderly (2011-2019, N=1,970), and linked to the 2010-2014 American Community Survey estimates of neighborhood context. Residential segregation was measured by the Index of Concentrations at the Extremes that simultaneously assesses Chinese and English language use within a given census tract. Latent growth curve models with adjusted cluster robust standard errors were estimated after controlling for individual-level factors. Residents of segregated Chinese-speaking neighborhoods had fewer baseline depressive symptoms but a slower decline rate than those living in segregated toward English-only speaking neighborhoods. Racial discrimination, social strain, and social engagement partially mediated the association between segregation and initial level; social strain and social engagement also partially mediated the association with decline in depressive symptoms. This study demonstrates the importance of residential segregation and social processes in shaping mental well-being among older Chinese immigrants and suggests potential mechanisms to alleviate mental health risks.

An investigation of the influencing factors of value added tax collection effectiveness in EU Member States

AbstractTax evasion is reducing the revenues of public budgets of many European Union (EU) Member States (MS). To improve the effectiveness of tax collection, during the last decade authorities in several MS have taken measures to reduce the value added tax (VAT) gap (i.e., revenue received as a percentage of theoretical liability). In the Central and Eastern European region, VAT gap reduction measures have been implemented effectively in Hungary and Poland, whereas in Romania the effectiveness of these measures is very low: Romania has been the worst-performing EU MS in collecting VAT for more than 10 years. Our study analyses the factors influencing this VAT gap. Our analysis relied mainly on a fixed effects panel regression model, using for a balanced panel an individual and time fixed-effects with cluster-robust standard errors model, and for the unbalanced panel the fixed-effects regression with individual-specific slopes. Our results show that the size of the VAT gap is primarily influenced by five variables: the transparency index, the tax collection ratio, the law enforcement index, the VAT revenues ratio and the digitisation index.

Day care availability and awareness of gendered economic risks: How they shape work and care norms

Family policies not only provide money, time and infrastructure to families, but also convey normative assumptions about what is considered desirable or acceptable in paid work and family care. This study conceptualises and empirically investigates how priming respondents with brief media report-like information on existing day care policy entitlements and economic consequences of maternal employment interruptions may change personal normative judgements about parental work–care arrangements. Furthermore, we analyse whether these effects differ between groups of respondents assumed to vary in their degree of affectedness by the information as well as previous knowledge. The theoretical framework builds on the concept of normative policy feedback effects combined with social norm theory and human cognition theories. The study is based on a fully randomized survey experiment combined with a vignette experiment in Wave 12 of the German Family Panel (pairfam). It applies linear and ordinal logistic regressions with cluster-robust standard errors to a sample of 5,783 respondents. Our results suggest that priming respondents with information on day care policy and long-term economic risks of maternal employment interruptions increases acceptance of intensive day care use across the full sample and especially for mothers with children below school entry age. It further increases support for longer maternal hours spent in paid work among childless women and mothers with school-aged children. Norms regarding paternal working hours are largely unaffected by the information given in this survey experiment.

Determinants of the Capital Structure of the Oil and Gas Industry in Malaysia: The Moderating Role of Earnings Volatility

This paper examines the relationship between firm-specific factors and the capital structure of the oil and gas (O&amp;G) industry in Malaysia.. In addition, this paper adds to the literature by investigating the moderating effect of earnings volatility on the relationship between firm-specific factors and capital structure. Random effect models with cluster-robust standard errors were used to analyze this relationship. Using the secondary data from 30 O&amp;G firms listed on the main market of Bursa Malaysia collected between 2010 and 2019 (10 years), the results show that profitability, asset tangibility, liquidity, and firm size significantly impact the capital structure of the O&amp;G industry in Malaysia. However, growth opportunities, non-debt tax shields, and firm age had no significant impact. In addition to this, earnings volatility significantly moderated the relationship between asset tangibility and leverage. In short, when earnings volatility acts as a moderating variable, the relationship between asset tangibility, which is otherwise positive without moderation, turns negative. This study is useful for policymakers in the O&amp;G industry in Malaysia and will help their managers to decide on capital structure for sustainable growth.

Play It Again: Differential pupillometry responses to familiar and unfamiliar music: Findings from typical and atypical Alzheimer’s disease

AbstractBackgroundMusic has gained more attention than other art forms as a potent tool in supporting cognitive, emotional and social functioning in dementia populations. Methods for measuring moment‐to‐moment responses ‐ rather than comparing pre‐ and post‐stimulus effects ‐ may enable tailoring of musical experiences for the individual. The current study investigated whether differential pupillometry responses could be established for familiar/unfamiliar music in people living with early‐mid stages of typical, memory‐led Alzheimer’s disease (tAD), atypical ‘visual variant’ of Alzheimer’s disease (posterior cortical atrophy; PCA), and healthy age‐matched controls.MethodPatient groups [tAD = 18; PCA = 21] were recruited via the Specialist Cognitive Disorders clinic at the National Hospital for Neurology and Neurosurgery, London, UK. Healthy older adults [N = 90] were recruited opportunistically via departmental research databases/Join Dementia Research. Pupillometry responses were recorded while participants listened to 30 musical excerpts [classical (N = 5); 1960s (N = 10), 1970s (N = 10), reversed ‘de novo’ tracks (N = 5)], each rated for familiarity: (a) a priori (known/unknown); (b) self‐rated by participants (not familiar‐extremely familiar); and (c) whether the excerpt evoked a memory (yes/no). Background, basic clinical and music experience information was collected, alongside additional neuropsychological assessment in the patient groups. Separate linear regression models obtaining cluster robust standard errors were run to predict pupil response from a priori predicted‐ and subjective‐ratings of music familiarity in each participant group, controlling for demographic factors including disease severity.ResultResults indicate significant within‐group effects of familiarity on pupil response in controls and the tAD group. No effects were observed within the PCA group. Preliminary between‐group analyses including diagnosis as a predictor revealed that, for each music‐pupillometry model, tAD overall pupil dilation responses did not differ significantly compared to controls, however a significant difference was observed between PCA and control pupil dilation responses.ConclusionThe results are discussed in relation to the preliminary finding of preserved differential pupillometry responses to familiar/unfamiliar music in the tAD group. Although the PCA results question the utility of pupillometry in individuals with significant oculomotor dysfunction, pupillometry may serve as a useful non‐invasive ‘biosignal’ for establishing in‐the‐moment response to music, including in post‐verbal individuals in the later stages of dementia.

Play It Again: Differential pupillometry responses to familiar and unfamiliar music: Findings from typical and atypical Alzheimer’s disease

AbstractBackgroundMusic has gained more attention than other art forms as a potent tool in supporting cognitive, emotional and social functioning in dementia populations. Methods for measuring moment‐to‐moment responses ‐ rather than comparing pre‐ and post‐stimulus effects ‐ may enable tailoring of musical experiences for the individual. The current study investigated whether differential pupillometry responses could be established for familiar/unfamiliar music in people living with early‐mid stages of typical, memory‐led Alzheimer’s disease (tAD), atypical ‘visual variant’ of Alzheimer’s disease (posterior cortical atrophy; PCA), and healthy age‐matched controls.MethodPatient groups [tAD = 18; PCA = 21] were recruited via the Specialist Cognitive Disorders clinic at the National Hospital for Neurology and Neurosurgery, London, UK. Healthy older adults [N = 90] were recruited opportunistically via departmental research databases/Join Dementia Research.Pupillometry responses were recorded while participants listened to 30 musical excerpts [classical (N = 5); 1960s (N = 10), 1970s (N = 10), reversed ‘de novo’ tracks (N = 5)], each rated for familiarity: (a) a priori (known/unknown); (b) self‐rated by participants (not familiar‐extremely familiar); and (c) whether the excerpt evoked a memory (yes/no). Background, basic clinical and music experience information was collected, alongside additional neuropsychological assessment in the patient groups.Separate linear regression models obtaining cluster robust standard errors were run to predict pupil response from a priori predicted‐ and subjective‐ratings of music familiarity in each participant group, controlling for demographic factors including disease severity.ResultResults indicate significant within‐group effects of familiarity on pupil response in controls and the tAD group. No effects were observed within the PCA group. Preliminary between‐group analyses including diagnosis as a predictor revealed that, for each music‐pupillometry model, tAD overall pupil dilation responses did not differ significantly compared to controls, however a significant difference was observed between PCA and control pupil dilation responses.ConclusionThe results are discussed in relation to the preliminary finding of preserved differential pupillometry responses to familiar/unfamiliar music in the tAD group. Although the PCA results question the utility of pupillometry in individuals with significant oculomotor dysfunction, pupillometry may serve as a useful non‐invasive ‘biosignal’ for establishing in‐the‐moment response to music, including in post‐verbal individuals in the later stages of dementia.

A longitudinal study of perceived social position and health-related quality of life

BackgroundA large body of evidence suggests that there is a social gradient in the association between perceived social position and various health outcomes. Yet only a fraction of this research uses longitudinal data, and these studies usually rely on two data points in time, consider a single health outcome measure, overlook non-linear effects of perceived social position, and come almost exclusively from the Western welfare democracies. MethodsUsing data for 1921 individuals from three waves (2008, 2013, 2018) of the Polish Panel Survey (POLPAN), we fit between- and within-individuals hybrid-effects models with cluster-robust standard errors to investigate the association between one's perceived social position (self-placement on a socioeconomic hierarchy scale varying 1 to 10) and subsequent health-related quality of life (HRQoL) measured using the Nottingham Health Profile (NHP) and its six components. ResultsWe find that the association between perceived social position and health-related quality of life is larger when estimated between individuals than within individuals, yet in fixed- and hybrid-effects models perceived social position remains significantly and negatively linked with both the aggregated NHP measure as well as with its components such as emotional reaction, physical abilities, sleep, and social isolation. We also identify that starting to perceive oneself at the lower end of the social hierarchy is associated with a deteriorating health-related quality of life but a change at the top of the perceived social hierarchy is not linked with an improvement in NHP scores. ConclusionsWe provide new evidence on the significant and non-linear links between perceived social position and health-related quality of life and highlight possible pathways linking these two aspects of individuals’ lives.

Revisiting the puzzle of capital structure determinants: an empirical study based on UK firms

PurposeThis study aims to measure impact of several firm-specific factors on alternative measures of leverage. The authors also aim to study impact of the subprime crisis on such associations.Design/methodology/approachThe authors utilized an unbalanced panel data of 973 firm-year observations on 47 UK listed non-financial firms for the years 1990–2019. Book-based and market-based long-term and total leverage measures have been used as explained variables. The explanatory variables are profitability, size, two measures of growth, asset tangibility, non-debt tax shields, firm age and product uniqueness. Fixed effect and random effect models with clustered robust standard errors have been utilized for data analysis. To find the effect of subprime crisis, original dataset was split to create pre-crisis and post-crisis datasets.FindingsThe authors find that profitability significantly reduces leverage while firms having more tangible assets use significantly more debt in capital structure. Firm size and non-debt tax shield have statistically insignificant positive impact on leverage. Having more unique products reduces use of external debt, albeit insignificantly. Growth, when measured as market-to-book ratio, has inconsistent impact, whereas capital expenditure insignificantly reduces leverage. Age is found to be an insignificant predictor of leverage. After the subprime crisis, firms started relying more on internal fund instead of external debt, more particularly short-term debt. Having more collateral is gradually becoming more important for availing external debt.Research limitations/implicationsData limitations restrict generalization of the findings.Originality/valueThis is one of the pioneering attempts to show how subprime crisis altered the theoretical domain of capital structure research in the UK.

A groupwise approach for inferring heterogeneous treatment effects in causal inference

Abstract Recently, there has been great interest in estimating the conditional average treatment effect using flexible machine learning methods. However, in practice, investigators often have working hypotheses about effect heterogeneity across pre-defined subgroups of study units, which we call the groupwise approach. The paper compares two modern ways to estimate groupwise treatment effects, a non-parametric approach and a semi-parametric approach, with the goal of better informing practice. Specifically, we compare (a) the underlying assumptions, (b) efficiency and adaption to the underlying data generating models, and (c) a way to combine the two approaches. We also discuss how to test a key assumption concerning the semi-parametric estimator and to obtain cluster-robust standard errors if study units in the same subgroups are correlated. We demonstrate our findings by conducting simulation studies and reanalysing the Early Childhood Longitudinal Study.

Associations between the COVID-19 pandemic and women’s fertility intentions: a multi-country, cross-sectional (I-SHARE) study

IntroductionThe COVID-19 pandemic, together with the subsequent social distancing measures, could lead to shifts in family and fertility planning. This study aimed to explore the associations between the COVID-19 pandemic...

Retinal main vessel calibers and systemic markers for long-term development of proliferative diabetic retinopathy.

To evaluate if retinal vascular calibers and systemic risk factors in patients with no or minimal diabetic retinopathy (DR) can predict risk of long-term progression to proliferative diabetic retinopathy (PDR). This was a matched case-control study of patients with diabetes having no or minimal DR at baseline with (cases) or without (controls) subsequent development of PDR. We collected six-field, 45-degree retinal images, demographic and clinical data from the Funen Diabetes Database. We included 52 eyes from 39 cases and 107 eyes from 89 controls matched on sex, age, type of diabetes, time from first to last screening episode and baseline DR level. Cases had higher HbA1c (73 vs. 55 mmoL/moL; p < 0.001), triglycerides (1.32 vs. 1.16 mmoL/L; p = 0.02) and longer duration of diabetes (19 vs. 14 years; p = 0.01), but the groups did not differ in calibers of retinal arterioles (229 vs. 227 μm; p = 0.49), venules (289 vs. 290 μm; p = 0.83) or the arterio-to-venule ratio (0.78 vs. 0.77; p = 0.86).In a multivariable logistic regression model with cluster robust standard error, HbA1c (OR 1.54 per 10 mmoL/moL; 95%-CI: 1.15-2.07; p = 0.004), triglyceride (OR 1.39 per 1 mmoL/L; 95%-CI: 1.03-1.86; p = 0.03) and duration of diabetes (OR 1.09 per year; 95%-CI: 1.03-1.16; p = 0.003) were independent risk factors for PDR. Retinal vascular calibers did not predict long-term development of PDR in contrast to well-established risk factors like HbA1c, triglyceride and duration of diabetes.

Impact of differentiated service delivery models on 12-month retention in HIV treatment in Mozambique: an interrupted time-series analysis

HIV treatment has been available in Mozambique since 2004, but coverage of, and retention in, antiretroviral therapy (ART) remain suboptimal. Therefore, to increase health system efficiency and reduce HIV-associated mortality, in November, 2018, the Ministry of Health launched national guidelines on implementing eight differentiated service delivery models (DSDMs) for HIV treatment. We assessed the effect of this implementation on retention in ART 12 months after initiation, and explored the associated effects of COVID-19. In this uncontrolled interrupted time-series analysis, data were extracted from the Mozambique ART database, which contains data on individuals in ART care from 1455 health facilities providing ART in Mozambique. We included individual-level data from facilities that were providing ART at the beginning of the study period (Jan 1, 2016) and at the start of DSDM implementation (Dec 1, 2018). We compared the proportion of individuals retained in ART 12 months after initiation between the periods before (Jan 1, 2017, to Nov 30, 2018) and after (Dec 1, 2019, to June 30, 2021) implementation of the DSDMs, overall and stratified by sex and age. We applied a generalised estimating equation model with a working independence correlation and cluster-robust standard errors to account for clustering at the facility level. In a secondary analysis, we assessed the effect of COVID-19 response measures during the post-intervention period on ART retention. The study included 613 facilities and 1 131 118 individuals who started ART during the inclusion period up to June 30, 2020, of whom 79 178 (7·0%) were children (age ≤14 years), 226 224 (20·0%) were adolescents and young adults (age 15-24 years), and 825 716 (73·0%) were adults (age ≥25 years). 731 623 (64·7%) were female and 399 495 (35·3%) were male. Introduction of the DSDMs was associated with an estimated increase of 24·5 percentage points (95% CI 21·1 to 28·0) in 12-month ART retention by the end of the study period, compared with the counterfactual scenario without DSDM implementation. By age, the smallest effect was estimated in children (6·1 percentage points, 1·3 to 10·9) and the largest effect in adolescents and young adults (28·8 percentage points, 24·2 to 33·4); by sex, a larger effect was estimated in males (29·7 percentage points, 25·6 to 33·7). Our analysis showed that COVID-19 had an overall negative effect on 12-month retention in ART compared with a counterfactual scenario based on the post-intervention period without COVID-19 (-10·0 percentage points, -18·2 to -1·8). The implementation of eight DSDMs for HIV treatment had a positive impact on 12-month retention in ART. COVID-19 negatively influenced this outcome. None. For the Portuguese translation of the abstract see Supplementary Materials section.

Association of Managed Medicaid Plans and Cancer Stage at Diagnosis

Managed care organizations provide insurance to many Medicare (Advantage) and Medicaid beneficiaries and seek to maintain quality while controlling provider networks, utilization, and costs. In prior research, patients with Medicare Advantage plans had restricted access to care, including at cancer centers, and had higher mortality after cancer surgery than patients with traditional Medicare. Over 80% of Medicaid patients nationally are enrolled in managed care plans; despite their prevalence, there is a paucity of evidence regarding the quality of cancer care provided by these plans. We examined associations of state-level managed Medicaid rates and cancer stage at diagnosis. Adults ages 18-64 years with Medicaid coverage diagnosed with cancer from 2007-2016 were identified from Surveillance, Epidemiology, and End Results program data covering 12 states. Note that 2016 was the last year with unsuppressed insurance status data. Year-varying state-level rates of types of managed Medicaid plans (comprehensive risk-based managed care, limited benefit plans, and primary care case management) were obtained from the Medicaid and CHIP Payment and Access Commission and categorized in quartiles. The association of state levels of each type of managed Medicaid plan with localized stage diagnoses was evaluated using multivariable linear probability models with cluster-robust standard errors (state clusters) accounting for state fixed effects, year fixed effects, age, sex, race, metropolitan residence, marital status, county-level income and education, state Medicaid expansion status, and cancer type. A total of 229,227 Medicaid patients were identified. The average state-level rates of comprehensive managed care, limited benefit, and primary care case management plans were 47%, 47%, and 5.6%, respectively. In adjusted analyses, relative to states with <20% of Medicaid recipients enrolled in comprehensive managed care plans, states with 40-80% (-2.07 percentage points, 95% CI = -3.31 to -0.83, P = .001) and >80% (-1.49, 95% CI = -2.49 to -0.50, P = .003) had fewer localized stage diagnoses. States with >2% relative to 0-1% of recipients enrolled in primary care case management plans had more localized stage diagnoses (1.02, 95% CI = 0.27 to 1.77, P = .008). States with higher levels of limited benefit plans had more localized stage diagnoses (P = .011), though associations were attenuated with increasing levels (20-40%: 1.22; 40-80%: 0.53; >80%: 0.40). Patterns were similar across most cancer types. The prevalence and type of Medicaid managed care plans are associated with early-stage cancer diagnoses. Higher levels of comprehensive managed care plans were associated with fewer early diagnoses, raising concerns about barriers to symptom evaluation and diagnostic workup. In contrast, higher levels of primary care case management plans were associated with more early diagnoses, potentially through streamlined care coordination.

Estimating prevalence and modelling correlates of HIV test positivity among female sex workers, men who have sex with men, people who inject drugs, transgender people and prison inmates in Sierra Leone, 2021

Key populations (KPs) are particularly vulnerable to HIV infection and efforts to prevent HIV infections among KPs have been less successful, largely due to existing laws and legislation that classify the groups as illegal. Understanding the HIV infection pathway and the burden of HIV infection among Female Sex Workers (FSWs), Transgender people (TG), Men who have sex with Men (MSM), People who Inject Drugs (PWID), and Prison Inmates (PIs) is critical to combatting the HIV epidemic globally. This study aims to estimate HIV prevalence and model the risk factors of HIV positivity rate among the aforementioned KPs in Sierra Leone. This study used Time Location Sampling, Respondent Driven Sampling (RDS), and Conventional cluster Sampling designs to generate a representative sample of FSWs, MSM, TG, PI, and PWID. HIV prevalence and the corresponding 95% confidence intervals among each KP were estimated by adjusting for sampling weight using the logit-transformed confidence intervals. To determine correlates of HIV test positivity among KPs, a multivariable modified Poisson regression model that adjusts for RDS survey weights was used and sensitivity analysis was conducted using a multivariable logistic regression model with cluster robust standard errors. The prevalence of HIV among FSWs in the six regional headquarter towns was estimated to be 11.8% (95% CI: 7.9–17.1); MSM was 3.4% [95% CI: 1.9–5.8]; TGs was 4.2% (95% CI: 2.9–6.1); PWIDs was 4.2% (95% CI: 2.7–6.4) and PI was 3.7% (95% CI: 1.4–9.6). The correlates of HIV test positivity among KPs and PIs include HIV-related knowledge, marital status, district, income, age and sex of KP, level of education, alcohol intake, injecting drugs, and use of lubricants. HIV prevalence is relatively high among FSWs, MSMs, PWID, and TGs as compared to the previous estimate of the general population. There is a need to scale up and strengthen evidence-based HIV prevention interventions such Pre-Exposure Prophylaxis and needle and syringe exchange programmes targeting KPs, including prison inmates. Government must scale up both non-clinical and clinical routine HIV and STI testing and counseling services at the correctional center and drop-in centers for KPs screening/testing, and ensure that services are responsive to the needs of KP.

Illicit drug use is associated with lower bone mineral density and bone strength

ObjectivesTo evaluate the association of illicit drug use with bone mineral density (BMD) and hip geometric parameters at the narrow neck. MethodsThis is a cross-sectional matched cohort study conducted in the Hong Kong Chinese population. Associations with illicit drug use were estimated using linear regression for BMD (lumbar spine and femoral neck) and hip geometrical parameters (cross-sectional area [CSA], cross-sectional moment of inertia [CSMI], section modulus [SM], average cortical thickness [ACT] and BMD at the narrow neck) after adjusting for age, body mass index (BMI), smoking status, drinking status, physical activity, and history of antipsychotic and antidepressant use. Mean difference and 95% confidence intervals (95% CI) were calculated between 108 illicit drug users and 108 controls using an adjusted linear model and cluster-robust standard errors after matching by age and sex. The false discovery rate was used to correct for multiple testing. ResultsIllicit drug users had a significantly lower BMD (g/cm2) at the lumbar spine (mean difference: −0.062; 95% CI: −0.108 to −0.015), and femoral neck (mean difference: −0.058; 95% CI: −0.106 to −0.010) in the fully adjusted model. Illicit drug users also had a significantly lower CSA (mean difference: −0.238 cm2; 95% CI: −0.462 to −0.013), ACT (mean difference: −0.018 cm; 95% CI: −0.030 to −0.006) and BMD (mean difference: −0.070 g/cm2; 95% CI: −0.128 to −0.012) at the narrow neck. ConclusionsIllicit drug use is associated with lower BMD and bone strength. Future studies evaluating the risk of illicit drug use with fragility fracture are warranted.

Socioeconomic differences in children's victimization to maternal and paternal violence: a register-based study.

To explore the potential of administrative data in assessment of the association between parental socioeconomic position (SEP) and children's violent victimization by biological parents. A longitudinal register-linkage study based on child-mother and child-father data, including all children born in Finland between 1991 and 2017. The data included 1,535,428 children, 796,335 biological mothers, and 775,966 fathers. We used logistic regression with person-years as observations and cluster-robust standard errors to predict children's violent victimization in 2009-2018 and assessed effect modification by child's age and gender. For the SEP indicators, lower maternal education (adjusted odds ratio (OR) 2.90, secondary education OR 1.99) and lower paternal education (OR 2.24, secondary education OR 1.59) were risk factors for violent victimization. Parental social assistance receipt (OR 2.4) and non-employment (OR 1.8-1.9) increased the risk of victimization to maternal and paternal violence. Income was associated with victimization in a gradient-like manner, with ORs ranging from 1.14 to 1.98 among mothers and from 1.29 to 2.56 among fathers. Children with low parental SEP were at the highest risk of parental violence, particularly paternal violence, at ages 3-8 years. All indicators of low SEP increased the risk of children experiencing both maternal and paternal physical violence, especially at ages 3-8 years. Longitudinal register data-because of large samples, no nonresponse or self-report bias, and the possibility to analyze violence committed by mother and father and age-groups separately-have great potential for comprehensive research on the risk factors of parental violence that are difficult to reliably assess with other types of data.

Organizational factors associated with primary care nurses' self-efficacy in pandemic response: a multilevel study in China.

Building primary care nurses' self-efficacy in the pandemic response has great potential to improve their well-being and work performance. We identified the organizational factors associated with their self-efficacy in pandemic response and propose potential management levers to guide primary care response for the pandemic. We conducted a cross-sectional survey with 175 nurses working in 38 community health centres varying in size and ownership in Shanghai, Shenzhen, Tianjin, and Jinan. Guided by self-efficacy theory, 4 nurse-level factors and 2 organization-level factors were selected, and a linear regression model accounting for the cluster-robust standard errors was built to examine their association with primary care nurses' self-efficacy in the pandemic response. Primary care nurses exhibited a high level of self-efficacy in responding to the pandemic (mean = 4.34, range: 0-5). For nurse-level factors, with a 1-point increase in job skill variety, job autonomy, work stress and perceived organizational support, primary care nurses' pandemic response self-efficacy increased by 0.193 points, 0.127 points, 0.156 points, and 0.107 points, respectively. Concerning organization-level factors, each point of improvement in organizational structure, representing higher mechanical organizational structure, was associated with a 0.145-point increase in nurses' self-efficacy. Our study added the knowledge of organizational factors' impact on the pandemic response self-efficacy among primary care nurses and identified the potential management levers for frontline primary care managers to build primary care nurses' self-efficacy in the pandemic response.