Demographic Strata Research Articles

Effect of an In-Home Palivizumab Administration Program for Children with Medical Complexity.

In-home palivizumab administration programs (PH) have shown promise in reducing RSV-associated infections. These programs may be particularly beneficial for children with medical complexity (CMC) by limiting their exposure to healthcare-associated infections (HAIs) from non-RSV-related pathogens during transportation and visits to medical facilities. In this prospective study, 41 children with CMC less than 2 years of age were randomized by their health insurance to receive PH or in the clinic (PC) during the RSV season (October 2018-April 2019). Patients were stratified by home ventilation. The primary outcome was the total number of face-to-face encounters. Secondary outcomes were unscheduled clinic visits and hospitalizations secondary to the non-RSV LRTIs. Standard frequentist and Bayesian analyses were performed. All demographic factors and strata were matched between PH ("n" = 13, mean age 22 mo. SD ± 1), and PC ("n" = 28, mean age: 18 mo. SD ± 1). There was a decrease in the number of total face-to-face encounters (adjusted for mechanical ventilation and baseline diagnosis) [(4.5 vs. 8.8), (RR: 1.8, 95% CI: 1.3-2.5, p = 0.001)], and hospitalizations [(0.3 vs. 1.25), (RR: 3.8, 95% CI: 1.3-11.3, p = 0.016)], in the PH vs PC groups. Bayesian analysis showed a 93% probability of benefit in favor of fewer face-to-face encounters in the PH group. This study suggests that PH administration may reduce healthcare utilization in CMC. Minimizing exposure to healthcare facilities and supporting home-based interventions are promising strategies for this population.

Sex-Dependent Effects of Cardiometabolic Health and APOE4 on Brain Age: A Longitudinal Cohort Study.

The aging population is growing faster than all other demographic strata. With older age comes a greater risk of health conditions such as obesity and high blood pressure (BP). These cardiometabolic risk factors (CMRs) exhibit prominent sex differences in midlife and aging, yet their influence on brain health in females vs males is largely unexplored. In this study, we investigated sex differences in relationships between BP, body mass index (BMI), and brain age over time and tested for interactions with APOE ε4 genotype (APOE4), a known genetic risk factor of Alzheimer disease. The sample included participants from 2 United Kingdom-based longitudinal birth cohorts, the Lothian Birth Cohort (1936) and Insight 46 (1946). Participants with MRI data from at least 1 time point were included to evaluate sex differences in associations between CMRs and brain age. The open-access software package brainageR 2.1 was used to estimate brain age for each participant. Linear mixed-effects models were used to assess the relationships between brain age, BMI, BP, and APOE4 status (i.e., carrier vs noncarrier) in males and females over time. The combined sample comprised 1,120 participants (48% female) with a mean age (SD) of 73 (0.72) years in the Lothian Birth Cohort and 71 (0.68) years in Insight 46 at the time point 1 assessment. Approximately 30% of participants were APOE4 carriers. Higher systolic and diastolic BP was significantly associated with older brain age in females only (β = 0.43-0.56, p < 0.05). Among males, higher BMI was associated with older brain age across time points and APOE4 groups (β = 0.72-0.77, p < 0.05). In females, higher BMI was linked to older brain age among APOE4 noncarriers (β = 0.68-0.99, p < 0.05), whereas higher BMI was linked to younger brain age among carriers, particularly at the last time point (β = -1.75, p < 0.05). This study indicates sex-dependent and time-dependent relationships between CMRs, APOE4 status, and brain age. Our findings highlight the necessity of sex-stratified analyses to elucidate the role of CMRs in individual aging trajectories, providing a basis for developing personalized preventive interventions.

Household Firearm Ownership and Firearm Mortality

Causal associations between household firearm ownership rates (HFRs) and firearm mortality rates are not well understood. To assess the population-level temporal sequencing of firearm death rates and HFRs. This cohort study used autoregressive cross-lagged models to analyze HFRs, firearm suicide rates, and firearm homicide rates in the US from 1990 to 2018. The suicide analyses included 16 demographic subgroups of adults, defined by study year, state, sex, race and ethnicity, marital status, and urbanicity. The homicide analyses consisted of adult subgroups living in urban or rural areas. Data analysis was conducted from March to December 2023. Firearm mortality rates and HFRs. Firearm homicide and suicide rates with HFRs as the exposure, and HFR with mortality as the exposure. A total of 10 416 observations of 16 demographic subgroups by state and 2-year periods were included in the suicide analyses, while 1302 observations from 2 demographic subgroups by state and 2-year period were included in the homicide analysis. At baseline, the mean (SD) rate per 100 000 population across strata was 7.46 (7.21) for firearm suicides and 3.32 (2.13) for firearm homicides. The mean (SD) baseline HFR was 36.9% (20.2%) for firearm suicides and 36.9% (14.8%) for firearm homicides. Higher HFR preceded increases in suicide rates: demographic strata with equal firearm suicide rates but which differ by 18.6 percentage points on HFR (1 SD) would be expected to have firearm suicide rates that diverged by 0.19 (95% CI, 0.15-0.23) deaths per 100 000 population per period. With these differences accumulated over 8 years, firearm suicide rates in subgroups with the highest decile HFR would be expected to have 1.93 (95% CI, 1.64-2.36) more suicides per 100 000 population than strata with lowest decile HFR, a difference of 25.7% of the overall firearm suicide rate in 2018 and 2019. Firearm suicide rates had a smaller magnitude of association with subsequent changes in HFR: strata with equal HFRs but which differ by 1 SD in firearm suicide rates had minimal subsequent change in HFRs (-0.02 [95% CI, -0.04 to 0.01] percentage points). A 1-SD difference in HFRs was associated with little difference in next-period overall firearm homicides rates (0.03 [95% CI, -0.02 to 0.08] per 100 000 population), but a 1-SD difference in homicide rates was associated with a decrease in HFR (-0.09 [95% CI, -0.16 to -0.04] percentage points). This cohort study found an association between high HFRs and subsequent increases in rates of firearm suicide. In contrast, higher firearm homicide rates preceded decreases in HFRs. By demonstrating the temporal sequencing of firearm ownership and mortality, this study may help to rule out some theories of why gun ownership and firearm mortality are associated at the population level.

Consequences of age and education correction of cognitive screening tests - A simulation study of the MoCA test in Italy.

Cognitive screening tools are widely used in clinical practice to screen for age-related cognitive impairment and dementia. These tools' test scores are known to be influenced by age and education, leading to routine correction of raw scores for these factors. Despite these corrections being common practice, there is evidence suggesting that corrected scores may perform worse in terms of discrimination than raw scores. To address the ongoing debate in the field of dementia research, we assessed the impact of the corrections on discrimination, specificity, and sensitivity of the Montreal Cognitive Assessment test in Italy, both for the overall population and across age and education strata. We created a realistic model of the resident population in Italy in terms of age, education, cognitive impairment and test scores, and performed a simulation study. We confirmed that the discrimination performance was higher for raw scores than for corrected scores in discriminating patients with cognitive impairment from individuals without (areas under the curve of 0.947 and 0.923 respectively). With thresholds determined on the overall population, raw scores showed higher sensitivities for higher-risk age-education groups and higher specificities for lower-risk groups. Conversely, corrected scores showed uniform sensitivity and specificity across demographic strata, and thus better performance for certain age-education groups. Raw and corrected scores show different performances due to the underlying causal relationships between the variables. Each approach has advantages and disadvantages, the optimal choice between raw and corrected scores depends on the aims and preferences of practitioners and policymakers.

A health economics perspective on behavioural responses to climate change across geographic, socio-economic and demographic strata

This perspective examines the relationship between climate change, health outcomes, and behavioural responses across the life course. It identifies three primary channels through which climate change impacts behaviours which in turn affect health: increased morbidity driving healthcare demand and accessibility, reduced productivity and income affecting health care investments, and combined health and economic risks shaping migration patterns, dietary choices and human capital investment across the life course and generations. Climate-induced changes in behaviours exacerbate existing health-related and socio-economic vulnerabilities. While climate-related shocks elevate demand for healthcare services, disruptions in infrastructure hinder access, especially for the poorest, widening health inequities. Loss of income and disrupted employment further compound health and economic risks, pushing vulnerable communities towards informal care options and impoverishment tied to health expenditures. Increased health and economic risks are associated with migration affecting healthcare access and health outcomes. They also influence dietary choices, with health consequences. Finally, deteriorating prospects of leading a long, prosperous and healthy life may induce individuals to reduce their time horizon and assign lower values to long-term survival, impacting human capital investments across the life course and generations. Again, these impacts are prone to exhibit a social gradient with vulnerable individuals being more likely to give up on striving for a healthier life. Effective policies must integrate climate, health, and socioeconomic factors, considering long-term behavioural responses and their health and socio-economic implications. Adapting health financing mechanisms to account for climate risks and incentivise resilience-building behaviours within health and social care systems is essential for protecting health across the life course, and avoiding widening inequities.

Prevalence of intimate partner violence among Indian women and their determinants: a cross-sectional study from national family health survey – 5

IntroductionIntimate partner violence (IPV) can be described as a violation of human rights that results from gender inequality. It has arisen as a contemporary issue in societies from both developing and industrialized countries and an impediment to long-term development. This study evaluates the prevalence of IPV and its variants among the empowerment status of women and identify the associated sociodemographic parameters, linked to IPV.MethodsThis study is based on data from the National Family Health Survey (NFHS) of India, 2019-21 a nationwide survey that provides scientific data on health and family welfare. Prevalence of IPV were estimated among variouss social and demographic strata. Pearson chi-square test was used to estimate the strength of association between each possible covariate and IPV. Significantly associated covariates (from univariate logistic regression) were further analyzed through separate bivariate logistic models for each of the components of IPV, viz-a-viz sexual, emotional, physical and severe violence of the partners.ResultsThe prevalence of IPV among empowered women was found to be 26.21%. Among those who had experienced IPV, two-thirds (60%) were faced the physical violence. When compared to highly empowered women, less empowered women were 74% more likely to face emotional abuse. Alcohol consumption by a partner was established to be attributing immensely for any kind of violence, including sexual violence [AOR: 3.28 (2.83–3.81)].ConclusionsOur research found that less empowered women experience all forms of IPV compared to more empowered women. More efforts should to taken by government and other stakeholders to promote women empowerment by improving education, autonomy and decision-making ability.

Impact of the pandemic on leisure physical activity and alcohol consumption

BackgroundThe COVID-19 pandemic precipitated heightened morbidity and elevated mortality attributed to the SARS-CoV-2 infection. The pandemic also influenced health behaviors such as physical activity (PA) and alcohol consumption. The aim of this study was to examine changes in leisure PA and alcohol consumption in Sweden during the pandemic, and elucidate potential discrepancies in changes across demographic strata and socioeconomic status (SES).MethodsData were retrieved from two waves of the longitudinal cohort study Life conditions, Stress and Health (LSH) (n = 2,523). Two measures of change were used; longitudinal change relative to baseline (2012–2015) and reported change compared to before the pandemic. For these two change measures, differences between sex, age group and SES were analyzed using multinomial logistic regression.ResultsRegardless of the change measure, the proportion of individuals with diminished PA was notably higher among females compared to males. Furthermore, relative to baseline, females were less likely to have increased their PA, however according to the reported change they were more likely to have increased PA. Longitudinal change in PA compared to baseline followed a reversed age gradient, while, according to reported change, a decrease in PA during the pandemic was most prevalent in respondents 45 years of age at baseline (OR = 1.8, CI: 1.2–2.5) and respondents 50 years of age at baseline (OR = 1.7, CI: 1.2–2.4). High SES was associated with a greater variability in PA. Alcohol consumption was generally reduced during the pandemic. However, individuals aged 40 or 45 years at baseline were more likely than others to have initiated risky alcohol consumption.ConclusionsFemales exhibited a greater propensity to alter their PA levels during the pandemic, with the most profound decreases observed among individuals of working ages. Despite a general downturn in alcohol consumption, individuals aged 40 and 45 had a heightened likelihood of having initiated risky alcohol consumption compared to individuals in other age cohorts. In conclusion, societal restrictions during a pandemic render a dual impact on PA levels. While posing a risk for decreased PA among individuals in working ages, the restrictions also present a potential window of opportunity to increase PA, particularly among females.

Associations of systemic immune‐inflammation index with high risk for prostate cancer in middle‐aged and older US males: A population‐based study

AbstractBackgroundSystemic immune‐inflammation index (SII) provides convincing evaluation of systemic immune and inflammatory condition in human body. Its correlation with prostate cancer (PCa) risk remains uncharted. The principal objective of this investigation was to elucidate the association between SII and the risk for PCa in middle‐aged and elderly males.Materials and MethodsAnalysis entailed multivariate linear and logistic regression, generalized additive model, and smoothing curve fitting using resource from 2007 to 2010 National Health and Nutrition Examination Survey (NHANES). To ascertain robustness and consistency of this association across different demographic strata, we conducted rigorous subgroup analyses and interaction tests.ResultsAmong 3359 participants, those with elevated SII displayed higher total prostate‐specific antigen (tPSA) levels, higher risk for PCa, and lower free/total PSA (f/t PSA) ratio. Specifically, each unit increase of log2 (SII) was associated with a 0.22 ng/mL increase in tPSA (β: 0.22, 95% confidence intervals [CI] 0.05–0.38), a 2.22% decline in f/t PSA ratio (β: −2.22, 95% CI −3.20 to −1.23), and a 52% increased odds of being at high risk for PCa (odds ratio [OR]: 1.52, 95% CI 1.13–2.04). People in the top quartile of log2 (SII) exhibited 0.55 ng/mL increased tPSA (β: 0.55, 95% CI 0.19–0.90), 4.39% reduced f/t PSA ratio (β: −4.39, 95% CI −6.50 to −2.27), and 168% increased odds of being at high risk for PCa (OR: 2.68, 95% CI 1.32–5.46) compared to those in the bottom quartile.ConclusionSystemic immune and inflammatory condition, as represented by SII, is independently and positively associated with tPSA levels and the risk for PCa, as well as independently and negatively associated with f/t PSA ratio among middle‐aged and older US males. These findings may enhance the effectiveness of PCa screening in predicting positive biopsy results.

The case for metacognition support in a flipped STEM course

The metacognitive strategies of planning, monitoring, and evaluating can be promoted through systematic reflection to drive self-directed, lifelong learning. This article reports on a three-year study on systematic written reflection within an undergraduate Fluid Mechanics course to promote planning, monitoring, and evaluation. Students were prompted weekly to reflect on their in-class problem-solving, classroom and exam preparation, performance, behaviors, and learning in a flipped classroom at a large southeastern U.S. university. In addition, they received intentional instruction on how to plan, monitor, and evaluate their problem-solving during class. To enable a comparative assessment, a flipped classroom without these interventions was also implemented as a non-experimental cohort. The cohorts were compared using a final exam, concept inventory, and the Metacognitive Activities Inventory (MCAI). The MCAI indicated a significantly higher positive change (pre- to post-course) in self-regulatory behavior for the experimental cohort ( p = 0.037). The weekly reflections were studied using an inductive content analysis to assess students’ self-regulatory behaviors. They were also used to investigate statistical associations between reflection content and course outcomes. This revealed that academic self-discipline via planning, monitoring one's work, or being careful and diligent may be as aligned with course performance in STEM as is practice with the problem-solving itself. The effects for the final exam in the experimental cohort were positive overall as well as statistically or practically significant for various demographic strata. These results provided evidence for the potential enhancement of course performance with metacognition support. A positive shift in students’ perspectives regarding the value of the reflection questions was observed throughout the study. Therefore, as an implementation guide for other educators, the reflection questions and any changes made in posing them to students are discussed chronologically. Overall, the study points to the desirability of providing metacognition support in a STEM course.

The Prevalence of Anemia Among Vietnamese Children: A Systematic Review and Meta-Analysis.

While anemia constitutes a prevalent health issue among children in Vietnam, comprehensive aggregate data remain scarce. Consequently, the objective of this meta-analysis is to establish the pooled prevalence of anemia in the pediatric population of Vietnam. A comprehensive systematic search of existing prevalence studies was conducted up until June 2022, encompassing databases such as PubMed, Scopus, and the Cochrane Library, as well as reference list analysis. Pooled prevalence estimates, along with 95% confidence intervals (CIs), were calculated using a random-effects model. Publication bias was assessed using the Egger regression test and funnel plot inspection. Subgroup analyses were performed to identify potential variations in anemia prevalence across study groups. The pooled prevalence estimate for anemia among children under 10-year-olds amounted to 35.5% (95% CI = [23.9, 49.1]). Notably, gender-specific analyses unveiled distinct prevalence rates, with 37.8% among males and 33.4% among females. Furthermore, variations in anemia prevalence among Vietnamese children were evident across different demographic strata, encompassing gender, age groups, and rural or poor rural residency. The calculated pooled prevalence of anemia among children in Vietnam revealed a significant burden. Addressing this issue necessitates targeted interventions within specific regions and the implementation of government policies aligned with global targets for the eradication of childhood anemia.

Challenges in reducing maternal and neonatal mortality in Niger: an in-depth case study

IntroductionRecent modelled estimates suggest that Niger made progress in maternal mortality since 2000. However, neonatal mortality has not declined since 2012 and maternal mortality estimates were based on limited data....

Tracking Cancer: Exploring Heart Rate Variability Patterns by Cancer Location and Progression.

Reduced heart rate variability (HRV) is an autonomic nervous system (ANS) response that may indicate dysfunction in the human body. Consistent evidence shows cancer patients elicit lower HRV; however, only select cancer locations were previously evaluated. Thus, the aim of the current study was to explore HRV patterns in patients diagnosed with and in varying stages of the most prevalent cancers. At a single tertiary academic medical center, 798 patients were recruited. HRV was measured via an armband monitor (Warfighter MonitorTM, Tiger Tech Solutions, Inc., Miami, FL, USA) equipped with electrocardiographic capabilities and was recorded for 5 to 7 min with patients seated in an upright position. Three time-domain metrics were calculated: SDNN (standard deviation of the NN interval), rMSSD (the root mean square of successive differences of NN intervals), and the percentage of time in which the change in successive NN intervals exceeds 50ms within a measurement (pNN50). Of the 798 patients, 399 were diagnosed with cancer. Cancer diagnoses were obtained via medical records one week following the measurement. Analysis of variance models were performed comparing the HRV patterns between different cancers, cancer stages (I-IV), and demographic strata. A total of 85% of the cancer patients had breast, gastrointestinal, genitourinary, or respiratory cancer. The cancer patients were compared to a control non-cancer patient population with similar patient size and distributions for sex, age, body mass index, and co-morbidities. For all HRV metrics, non-cancer patients exhibited significantly higher rMSSDs (11.1 to 13.9 ms, p < 0.0001), SDNNs (22.8 to 27.7 ms, p < 0.0001), and pNN50s (6.2 to 8.1%, p < 0.0001) compared to stage I or II cancer patients. This significant trend was consistently observed across each cancer location. Similarly, compared to patients with stage III or IV cancer, non-cancer patients possessed lower HRs (-11.8 to -14.0 bpm, p < 0.0001) and higher rMSSDs (+31.7 to +32.8 ms, p < 0.0001), SDNNs (+45.2 to +45.8 ms), p < 0.0001, and pNN50s (19.2 to 21.6%, p < 0.0001). The HR and HRV patterns observed did not significantly differ between cancer locations (p = 0.96 to 1.00). The depressed HRVs observed uniformly across the most prevalent cancer locations and stages appeared to occur independent of patients' co-morbidities. This finding highlights the potentially effective use of HRV as a non-invasive tool for determining common cancer locations and their respective stages. More studies are needed to delineate the HRV patterns across different ages, between sexes and race/ethnic groups.

The Necessity of Cybersecurity for Community Safety The Proposal of the Safe Family Program for Educating the Gulf Arab Community on Information Security for Both Students and Parents

The contemporary landscape of electronic communication technologies is marked by rapid advancement, diverse modalities, and intuitive interfaces, rendering them widely accessible across demographic strata. Notably, the youth cohort, including school students, exhibits a discernible proclivity towards the utilization of social media networks. Regrettably, this escalating adoptionlacks the concomitant implementation of requisite competencies for judicious technological engagement. Furthermore, a perceptible dearth of cognizance is observed among students regarding the gravity of information security and the attendant repercussions of its neglect. This lacuna has precipitated a proliferation of cybersecurity issues, including hacking and electronic coercion. Despite instances of adept technological acumen among some students, they remain susceptible to exploitation by cyber adversaries. This discourse underscores the imperative for comprehensive educational initiatives aimed at fostering responsible and secure digital practices among the burgeoning generation of technology users. This study conducted a survey among diverse groups of male and female students in the Kingdom of Saudi Arabia to identify the primary issues leading to their vulnerability to cyber intrusions. The objective was to derive necessary recommendations for their protection while engaging in social network activities. The study elucidated the importance of educating students about the ramifications of unsafe technology use, emphasizing the preservation of their electronic privacy. Furthermore, this study addressed the exploration of the role of parents in safeguarding their offspring from the perils of cyber intrusion and extortion. The study conducted a comparative analysis between numerous families wherein parents and children had the opportunity for appropriate training in the use of these technologies and those families lacking such training. This comparative approach aimed to elucidate the role of parents in shielding their children from electronic intrusions. The findings of the study underscored a critically significant role for parents in protecting their children from electronic threats, even in cases where the offspring possessed a sufficient educational background in handling these new technologies. The researcher proposed an educational initiative aimed at preserving electronic privacy forstudents, encompassing all categories of public and private education. In addition, a program for parental education was introduced, targeting both mothers and fathers. The objective of this program is to contribute to the elevation of societal security awareness and the protection of children from the imminent dangers posed by electronic threats.

Developing Topics.

APOE*2 and APOE*4 are respectively the strongest protective and risk-increasing genetic variants for late-onset Alzheimer's disease (AD), making APOE status highly relevant towards clinical trial design and AD research broadly. The associations of APOE genotypes with AD are importantly modulated by age, sex, race, ethnicity, and ancestry, but these associations remain unclear, particularly in historically understudied non-white samples. The study overview is shown in Figure.1. Various case-control, family-based, and longitudinal AD genetic cohorts were available through public repositories and underwent extensive genotype and phenotype quality control. These cohorts contributed data for Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB), and Hispanics (HISP). Global ancestry was determined using SNPweights v2.1. Case-control logistic regression models evaluated the AD risk associations of APOE*2 dosage, APOE*4 dosage, and APOE genotype, with regard to APOE*33 as the reference, while adjusting for sex, array/batch/center, and global European, African, and Amerindian ancestry. Different stratified analyses, interaction models, and race/ethnicity heterogeneity tests were evaluated. APOE associations in East-Asians (EAS) were obtained through meta-analyses of published AD genetic studies, given the relative paucity of EAS in publicly available genetic cohorts. Compared to prior literature, we made several novel observations (Figure.2). Notably, the associations of APOE genotypes with AD risk were least pronounced in HISP, which was not explained by global ancestry. Further, not just APOE*4, but also APOE*2 followed a reduced association strength with AD risk according to the pattern of EAS > NHW > NHB > HISP (with the exception of APOE*2 in EAS, which showed no significant association). The sex-by-age-specific association of APOE*34 in NHW, which was shown to be stronger in women, was reproduced here at ages 60-70 years, and additionally replicated in NHB and HISP. There were no other significant sex-by-APOE interactions. Merited by recent advances in AD genetic cohorts, we provide the largest-to-date overview of APOE's associations with AD risk across important biological and demographic strata. We expect these insights to be critical to guide AD research and clinical trial design. With increased diversity and phenotype harmonization efforts in AD genetics, future extensions on this work are expected to provide additional insights.

Air Pollution and Meteorological Conditions Significantly Associated With Vernal Keratoconjunctivitis Exacerbations.

Vernal keratoconjunctivitis (VKC) is a severe chronic allergic inflammation of the ocular surface with episodes of acute exacerbations, that primarily affects children and young adults. Although the etiology and pathogenesis of VKC remain unclear, studies have suggested that environmental factors may be involved. This study aims to investigate the association between exposure to meteorological and environmental factors and the incidence of VKC exacerbations. This study was conducted in southern Israel, which is a semi-arid, hot, and dry climate with frequent dust storms. Patients diagnosed with VKC were recruited for the study. VKC exacerbations were identified as the need for medical intervention. Pollutants measured included nitrogen dioxide (NO2), ozone (O3), particulate matter (PM10 and PM2.5), sulfur dioxide (SO2), relative humidity (RH), temperature, and solar radiation (SR). To assess the association between VKC exacerbations and exposure to different pollutants, a case-crossover analysis was conducted. We also stratified the analysis by sex, age, ethnicity, immigration status, and social state score. Our results demonstrated that the pollutants NO2, O3, and PM10 were associated with VKC exacerbations with odds ratio (OR) = 2.17 (95% confidence interval [CI] =1.40 to 3.04), OR = 2.28 (95% CI = 1.30 to 3.39), and OR = 1.89 (95% CI = 1.06 to 2.74). Other pollutants PM2.5, temperature, and solar radiation were also independently associated with incidence of exacerbations with OR = 1.15 (95% CI = 0.87 to 1.50), OR = 1.75 (95% CI = 1.16 to 2.65), and OR = 1.37 (95% CI = 1.01 to 1.63) and had varying effects in different demographic strata. The environmental parameters, NO2, O3, PM10, PM2.5, temperature, and solar radiation were found to be significantly associated with VKC exacerbations, with NO2, O3, and PM10 showing the strongest associations. Our findings suggest that environmental factors should be considered when developing strategies to prevent and manage VKC exacerbations.

The influence of demographic, health and psychosocial factors on patient uptake of the English NHS diabetes prevention programme

BackgroundThe prevention of type 2 diabetes (T2DM) is a major concern for health services around the world. The English NHS Diabetes Prevention Programme (NHS-DPP) offers a group face-to-face behaviour change intervention, based around exercise and diet, to adults with non-diabetic hyperglycaemia (NDH), referred from primary care. Previous analysis of the first 100,000 referrals revealed just over half of those referred to the NHS-DPP took up a place. This study aimed to identify the demographic, health and psychosocial factors associated with NHS-DPP uptake to help inform the development of interventions to improve uptake and address inequities between population groups.MethodsDrawing on the Behavioral Model of Health Services Utilization we developed a survey questionnaire to collect data on a wide range of demographic, health and psychosocial factors that might influence uptake of the NHS-DPP. We distributed this questionnaire to a cross-sectional random sample of 597 patients referred to the NHS-DPP across 17 general practices, chosen for variation. Multivariable regression analysis was used to identify factors associated with NHS-DPP uptake.Results325 out of 597 questionnaires were completed (54%). Only a third of responders took up the offer of a place. The best performing model for uptake (AUC = 0.78) consisted of four factors: older age; beliefs concerning personal vulnerability to T2DM; self-efficacy for reducing T2DM risk; and the efficacy of the NHS-DPP. After accounting for these, demographic and health-related factors played only a minor role.ConclusionUnlike fixed demographic characteristics, psychosocial perceptions may be amenable to change. NHS-DPP uptake rates may be improved by targeting the beliefs of patients about their risk of developing T2DM, their ability to carry out and sustain behaviours to reduce this risk, and the efficacy of the NHS-DPP in providing the necessary understanding and skills required. The recently introduced digital version of the NHS DPP could help address the even lower uptake amongst younger adults. Such changes could facilitate proportional access from across different demographic strata.

D ‐Dimer Level After Endovascular Treatment Can Help Predict Outcome of Acute Ischemic Stroke

Background d ‐Dimer level is a marker of hypercoagulability, which is associated with thrombus formation and resolution. We investigated the value of d ‐dimer levels in predicting outcomes of acute ischemic stroke in patients who underwent endovascular treatment (EVT). Methods We analyzed data of patients who underwent only EVT from the SECRET (Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy) registry. d ‐Dimer levels were routinely measured in 10 of 15 participating hospitals. Patients were grouped into tertiles (tertile 1, tertile 2, and tertile 3) according to d ‐dimer levels (lowest, moderate, and highest, respectively). We compared serial scores on the National Institutes of Health Stroke Scale at baseline, on day 1 of hospitalization, and at discharge; functional outcome 3 months after EVT; and rate of mortality within 6 months after EVT. Results In the 170 patients, the median d ‐dimer level was 477 ng/mL (interquartile range, 249–988 ng/mL). In tertile 3, the National Institutes of Health Stroke Scale score was higher at discharge than on day 1 of hospitalization. Poor outcome 3 months after EVT (modified Rankin Scale score, ≥3) was more common with high d ‐dimer levels (26.3% of tertile 1, 57.1% of tertile 2, and 76.4% of tertile 3; P &lt;0.001). Multivariable analysis showed that a high d ‐dimer level was independently associated with poor outcome 3 months after EVT (odds ratio [OR], 4.399 [95% CI, 1.594–12.135]). Kaplan–Meier survival analysis showed that a high d ‐dimer level was independently associated with death within 6 months after EVT (OR, 5.441 [95% CI, 1.560–18.978]; log‐rank test, P &lt;0.001). The d ‐dimer effect showed no heterogeneity across the subgroups for poor outcome 3 months after EVT or death within 6 months after EVT. The direction of effect was unfavorable for tertile 3 across all demographic strata. Conclusions High plasma d ‐dimer levels were predictive of early neurologic worsening, poor functional outcome 3 months after EVT, and death within 6 months after EVT. Registration URL: http://www.clinicaltrials.gov ; Unique identifier: NCT02964052.

Orthopaedic and trauma surgeons’ prioritisation of app quality principles based on their demographic background

BackgroundAlthough apps are becoming increasingly relevant in healthcare, there is limited knowledge about how healthcare professionals perceive “quality” in this context and how quality principles that can aid them in assessing health-related apps may be prioritised.The objective was to investigate physicians’ views of predefined (general) quality principles for health apps and to determine whether a ranking algorithm applied to the acquired data can provide stable results against various demographic influences and may thus be appropriate for prioritisation.MethodsParticipants of an online survey of members of two German professional orthopaedics associations conducted between 02/12/2019 and 02/01/2020 were asked about their perception of a set of quality principles for health apps (i.e., “practicality,” “risk adequacy,” “ethical soundness,” “legal conformity,” “content validity,” “technical adequacy,” “usability,” “resource efficiency,” and “transparency”). Structured as a Kano survey, for each principle, there were questions about its perceived relevance and opinions regarding the presence or absence of corresponding characteristics. The available data were evaluated descriptively, and a newly developed method for prioritisation of the principles was applied overall and to different demographic strata (for validation).ResultsThree hundred eighty-two datasets from 9503 participants were evaluated. Legal conformity, content validity, and risk adequacy filled ranks one to three, followed by practicability, ethical soundness, and usability (ranks 4 to 6). Technical adequacy, transparency, and resource efficiency ranked last (ranks 7 to 9). The ranking based on the proposed method was relatively stable, irrespective of demographic factors. The principles were seen as essential, with one exception (“resource efficiency”). Only those with little to no interest in digitisation (22/382, 5.8%) rated the nine principles indifferently.ConclusionsThe specified quality principles and their prioritisation can lay a foundation for future assessments of apps in the medical field. Professional societies build upon this to highlight opportunities for digital transformations in medicine and encourage their members to participate.

Measuring what gets done: Using goal attainment scaling in a vocational counseling program for survivors of childhood cancer.

Childhood cancer survivors face education and employment challenges due to physical, cognitive, and psychosocial effects of the disease and treatments, with few established programs to assist them. The objectives of this study were to describe the implementation of Goal Attainment Scaling (GAS) to evaluate an educational and vocational counseling program established for survivors of childhood cancer, and analyze patterns of program engagement and client outcomes, stratified by demographic and diagnostic characteristics. A population-based retrospective cohort study of childhood cancer survivors who were engaged with the Pediatric Oncology Group of Ontario's School and Work Transitions Program (SWTP) between January 2015 and December 2018 was utilized. Survivors were followed from SWTP engagement until May 30, 2019 to capture goal attainment. Individual goals were summarized across various demographic, disease, and treatment strata. In total, 470 childhood cancer survivors (median age=17.9, 58% male) set 4,208 goals in the SWTP during the study period. The mean length of observation was 130.8 weeks (SD=56.9). Overall, 68% of the goals were achieved. Eighty-three percent of the goals related to further education. Clients diagnosed with a solid tumor set the most goals on average, followed by those with central nervous system tumors and leukemia/lymphoma. The SWTP assists childhood cancer survivors in realizing their academic and vocational goals. Application of GAS in this setting is a feasible way to evaluate program outcomes. From the volume and breadth of the GAS goals set and achieved, the overall success of the SWTP appears strong.

Measurement Invariance Across Sex and Language Background of a Self-Report Social-Emotional Learning Questionnaire for Middle Childhood

This study investigates the measurement invariance of a brief self-report measure of childhood social-emotional competencies, the Middle Childhood Survey: Social-Emotional Learning (MCS-SEL), across demographic subgroups. Invariance was tested simultaneously among subgroups of children aged 11–12 years that were differentiated by sex (male, female) and main language spoken at home (English, not English). Multi-group confirmatory factor analysis evaluated structural and item-level invariance using two random, independent samples of 2,000 students (500 per demographic strata) selected by disproportionate sampling from the New South Wales Child Development Study (NSW-CDS) population cohort. The measure achieved full configural, metric, scalar, and residual invariance across all demographic subgroups, validating its utility for assessing middle childhood social-emotional competencies at a population-level.