Poor Research Articles

Income-Based Disparities in Outcomes Following Pediatric Appendectomy: A National Analysis.

Appendectomy remains a common pediatric surgical procedure with an estimated 80,000 operations performed each year. While prior work has reported the existence of racial disparities in postoperative outcomes, we sought to characterize potential income-based inequalities using a national cohort. All non-elective pediatric (<18years) hospitalizations for appendectomy were tabulated in the 2016-2020 National Inpatient Sample. Only those in the highest (HI) and lowest income (LI) quartiles were considered for analysis. Multivariable regression models were developed to assess the independent association of income and postoperative major adverse events (MAE). Of an estimated 87,830 patients, 36,845 (42.0%) were HI and 50,985 (58.0%) were LI. On average, LI patients were younger (11 [7-14] vs 12 [8-15] years, P < .001), more frequently insured by Medicaid (70.7 vs 27.3%, P < .05), and more commonly of Hispanic ethnicity (50.8 vs 23.4%, P < .001). Following risk adjustment, the LI cohort was associated with greater odds of MAE (adjusted odds ratio [AOR] 1.30 95% confidence interval [CI] 1.06-1.64). Specifically, low-income status was linked with increased odds of infectious (AOR 1.65, 95% CI 1.12-2.42) and respiratory (AOR 1.67, 95% CI 1.06-2.62) complications. Further, LI was associated with a $1670 decrement in costs ([2220-$1120]) and a +.32-day increase in duration of stay (95% CI [.21-.44]). Pediatric patients of the lowest income quartile faced increased risk of major adverse events following appendectomy compared to those of highest income. Novel risk stratification methods and standardized care pathways are needed to ameliorate socioeconomic disparities in postoperative outcomes.

Medication Literacy Test for Older Adults: psychometric analysis and standardization of the new instrument.

Low medication literacy is prevalent among older adults and is associated with adverse drug events. The Medication Literacy Test for Older Adults (TELUMI) was developed and content validated in a previously published study. To evaluate the psychometric properties and provide norms for TELUMI scores. This was a cross-sectional methodological study with older adults selected from the community and from two outpatient services. Descriptive item-analysis, exploratory factor analysis (EFA), item response theory (IRT), reliability, and validity analysis with schooling and health literacy were performed to test the psychometric properties of the TELUMI. The classification of the TELUMI scores was performed using percentile norms. A total of 344 participants, with a mean age of 68.7years (standard deviation = 6.7), were included; most were female (66.6%), black/brown (61.8%), had low schooling level (60.2%) and low income (55.2%). The EFA pointed to the one-dimensional structure of TELUMI. A three-parameter logistic model was adopted for IRT. All items had an adequate difficulty index. One item had discrimination < 0.65, and three items had an unacceptable guessing index (< 0.35) and were excluded. The 29-item version of TELUMI had excellent internal consistency (KR20 = 0.89). There was a positive and strong association between TELUMI scores and health literacy and education level. The scores were classified as inadequate medication literacy (≤ 10.0 points), medium medication literacy (11-20 points), and adequate medication literacy (≥ 21 points). The results suggest that the 29-item version of TELUMI is psychometrically adequate for measuring medication literacy in older adults.

Inter-Nation Equity And The Regulation of Tax Competition via the Global Minimum Tax Rule: A Case for Improvement

The Organization for Economic Co-operation and Development (OECD) is an institution that influences policymaking in international tax law, and it is changing the international tax architecture to deal with tax competition by encouraging countries to adopt a global minimum tax rule. This emerging rule – called Pillar Two in international tax circles – is inadequate for dealing with poverty and inequality in an asymmetrical global context. The rule is premised on the notion and argument that tax competition is a problem for international tax law. Notwithstanding, there is existing research and evidence to show that tax competition can also be a solution to the enormous challenge of poverty and inequality as it can have a redistributive effect. This is a valuable factor amid the inefficiently asymmetrical global society with extreme poverty in many countries and enormous wealth in a few others.This article submits that the Pillar Two minimum tax rule – the Global Anti-Base Erosion (GloBE) Rules encompassing the income inclusion rule (IIR), undertaxed payment/profit rule (UTPR), and qualified domestic minimum top-up tax (QDMTT) – should incorporate inter-nation equity to prevent exacerbating global inequality and poverty. Pillar Two intensifies these for at least two reasons: (1) it restricts the positive redistributive effects of tax competition on an inefficiently asymmetrical global society, and (2) it encourages tax competition more suited for high-income countries (HICs) and less suited for those that are low-income countries (LICs). There is latitude to incorporate a differentiated principle deriving from inter-nation equity into this new Pillar Two rule designed to regulate tax competition globally. This proposal requires that the emerging rule be disenabled in certain circumstances to enable LICs to choose whether to apply the rule without being worse off. The article’s proposal seeks to allow LICs room for effective tax competition needed to attain sustainable development goals.

Application of waste gypsum as novel selective depressant in the flotation separation of apatite from dolomite

The accumulation of gypsum slag not only causes resource wastage, but also poses serious environmental hazards, therefore, utilizing the resources of the main components in gypsum slag is an imperative task. In this study, gypsum was used as an inorganic depressant for the flotation separation of apatite from dolomite through the selective adsorption of gypsum on the surface of dolomite. Micro-flotation experiments showed that sodium oleate exhibited a good ability to collect apatite and dolomite, but poor ability to collect gypsum. At pH 9.5, when 3.75 g/L gypsum was added to the slurry, the recovery of dolomite decreased from 76.77 % to 18.34 %, whereas that of apatite was 86.45 %. Atomic force microscopy, scanning electron microscopy, and X-ray photoelectron spectroscopy were employed to elucidate the adsorption characteristics of gypsum on the apatite and dolomite surfaces. The results showed that gypsum was selectively adsorbed on the raised particles on the dolomite surface and combined with the active sites of Ca and Mg metal ions. However, the adsorption of gypsum on the surface of apatite was weak and had little effect on the flotation performance. Density functional theory calculations showed that the O in gypsum reacted easily with Ca and Mg metal ions on the mineral surface. The adsorption energies of gypsum at the Ca and Mg sites on the dolomite surface were −81.97 and −86.18 kJ/mol, respectively, whereas the adsorption energy on the apatite surface was only −34.20 kJ/mol. Gypsum is the main component of gypsum slag, and this study provides a potential recycling method for gypsum slag resources.

Monosodium glutamate disrupts zebrafish sleep-like state likely through activation of peripheral nervous system glutamate receptors

Monosodium glutamate (MSG), a widely used flavor enhancer, has raised concerns about its effects on behavior and sleep. This study investigates how MSG influences zebrafish sleep-like state (SLS) and interacts with other substances affecting neurobehavioral responses. Adult zebrafish were exposed to MSG at concentrations of 50, 100, and 150 mg/L, and their swimming speeds and SLS durations were recorded over a 14-hour night period. The results indicated that higher MSG concentrations increased swimming speeds and decreased SLS duration, suggesting heightened excitability and reduced sleep recovery. The study further evaluated how MSG impacts anesthesia sensitivity induced by 2-phenoxyethanol (POE) compared to alcohol and nicotine. Zebrafish were pre-treated with 50 mg/L MSG, 0.5% alcohol, or 0.5 mg/L nicotine before being anesthetized with POE. Nicotine decreased anesthesia sensitivity in a concentration-dependent manner by enhancing neurotransmitter release. In contrast, MSG and alcohol had minimal effects on anesthesia. The limited impact of MSG on anesthesia sensitivity suggests that MSG primarily affects peripheral nervous system functions rather than central nervous system functions, likely due to its poor ability to cross the blood-brain barrier. Overall, the findings demonstrate that MSG disrupts zebrafish behavior through peripheral mechanisms, affecting both swimming activity and sleep patterns. Nicotine, on the other hand, influences behavior through central nervous system interactions. These results highlight the need for further research to better understand how dietary additives like MSG impact neurobehavioral functions in aquatic models, offering insights into their broader implications for sleep and behavior.

A lifesaving improvised peritoneal dialysis on a toddler with acute kidney injury following a swarm of bees’ sting at Iringa Regional Referral Hospital, Southern Highland—Tanzania: a case report

BackgroundPeritoneal dialysis as one of the nephrology services in children with acute kidney injury is a safe and cost-effective modality of treatment in low and lower-middle income countries. Despite evidence of its effectiveness in limited resource settings, the service is still provided only in tertiary level healthcare facilities in Tanzania.Case presentationIn this case report, we narrate the survival of a 22-month-old male patient of African descent with an acute kidney injury following a swarm of bees’ stings at home. A lifesaving, although low-quality and high-risk, peritoneal dialysis was performed for 5 days at Iringa Regional Referral Hospital, a secondary level health facility in rural Tanzania with lack of standard and recommended expertise, laboratory investigations, and equipment.ConclusionLower- and middle-income countries in collaboration with stake holders should ensure that this service is available, accessible, and safe in the lower-level health facilities, given that access to the tertiary-level facilities is inadequate and time limited, hence serving a larger population.

Abstract A040: Effects of food environment, income inequality, and racial segregation on obesity- related cancer mortality

Abstract BACKGROUND: Rural areas experience 7-12% higher risk of obesity-related cancer mortality compared to their urban counterparts. Complex interactions between social and structural factors in rural areas, combined with limited access to healthy foods and lower income, warrant further study to understand drivers of this disparity. Methods: County-level rates of age-adjusted obesity-related cancer mortality per 100,000 (2009-2020 were obtained from the Centers for Disease Control and Prevention’s Wide-Ranging ONline Data for Epidemiologic Research database. Based on data from the Food Environment Atlas, we calculated food swamp using the modified Retail Food Environment Index (mRFEI) as the ratio of fast-food restaurants and convenience stores to grocery and specialized food stores, supercenters, and farmers markets. Food swamp scores were then divided into quartiles. Next, we used Global G and local Gi statistics to identify the presence of spatial autocorrelation in food swamp and subsequently calculated a spatial moving average (SMA) across counties. Measures of economic segregation, racial segregation, and racialized economic segregation were calculated using the Index of Concentration at the Extremes (ICE) using population and demographic estimates from the 2005- 2009 American Community Survey. Larger values reflect concentrated extremes of disadvantage. Poisson regression was used to assess the impact of food swamp, urban-rural status, economic segregation, racial segregation, and racialized economic segregation on rates of obesity-related cancer mortality. Results: Among the 3014 counties included, median food swamp score was 3.6 (interquartile range=2.6-4.9), and counties in the 2nd, 3rd, and 4th quartiles for food swamp had 2%, 4%, and 6% higher rates (respectively) of obesity-related cancer mortality than those in the 1st quartile. Incidence rate ratios for the association of food swamp quartile with obesity-related cancer mortality were 1-3% smaller after control for food swamp SMA and for racialized economic Urban-rural differences in obesity-related cancer mortality varied with all ICE measures. Rural counties had 5% higher rates of obesity-related cancer mortality (IRR=1.05, 95%CI=1.04-1.06), even after controlling for food swamp and food swamp SMA, but there was no longer an association after controlling for economic segregation (IRR=0.99, 95%CI=0.98-1.00). Rural counties had 5% higher rates of obesity-related cancer mortality (IRR=1.05, 95%CI=1.04-1.07) when controlling for racial segregation and 2% higher rates when controlling for racialized economic segregation (IRR=1.02, 95%CI=1.01-1.03). Thus, we stratified our models by urban-rural status and found that each ICE measure had larger effects on obesity-related cancer mortality in rural counties than in urban. CONCLUSION: While food swamp is important, the socioeconomic environment of a county has a larger impact on obesity- related cancer mortality. Individuals may have access to healthy food stores, but whether they can afford the healthy food is more important. Citation Format: Elizabeth S. Davis, Sara Myers, Jeffrey A. Franks, Michael R. Poulson, Julie R. Palmer, Kelly M. Kenzik. Effects of food environment, income inequality, and racial segregation on obesity- related cancer mortality [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A040.

The Price of Foods, Beverages, and Diets in Australia: An Updated Systematic Review

Abstract Context The price and affordability of food are priorities for public health and health equity; however, Australia lacks a consistent method to evaluate healthy versus unhealthy diets, creating a gap in routine food price reporting. Objective This review aimed to identify and summarize recent methods used to assess and monitor the price and/or affordability of food and beverages in Australia using a health lens. Data Sources Four academic databases (MEDLINE Complete, Global Health, CINAHL Complete, and Business Source Complete) were searched in English from 2016 to 2022. Relevant gray literature was searched through Google Scholar and government websites. Data Extraction Five reviewers screened titles and abstracts, and full-text screening was conducted by 1 reviewer, with eligibility confirmed by a second reviewer. The quality of studies was assessed using the Joanna Briggs Institute “Checklist for Analytical Cross-Sectional Studies.” Data Analysis Twenty-five eligible studies were identified. Eleven studies used a version of the Healthy Diets Australian Standardized Affordability and Pricing protocol to collect prices for a “healthy” diet modelled on dietary guidelines and an “unhealthy” diet based on a habitual Australian diet. These studies consistently found unhealthy diets to be more expensive than healthy diets. Other identified methods included assessing the price of household diets across healthy baskets (n = 6), store types (n = 5), a planetary health diet (n = 1), packaged foods according to their Health Star Rating (n = 1), a fruit and vegetable basket (n = 1), school canteen foods against a traffic light system (n = 1), and weekly healthy meal plans (n = 1). Healthy diets tended to be less costly than less healthy diets, but both diets were often unaffordable in regional areas, for people on low incomes, and for First Nations peoples. Conclusion Consistent country-wide application of methods for monitoring the price and affordability of foods and diets in Australia is needed—including tailored approaches for priority groups. Systematic Review Registration PROSPERO registration no. CRD42022333531.

Spelling abilities of Dutch children with developmental language disorder on words differing in complexity

AbstractChildren with developmental language disorder (DLD) often have spelling difficulties. Previous research has established that children with DLD, especially those with additional reading problems, perform below typically developing (TD) children on spelling, but it is unknown if they struggle with certain types of words. We compared the spelling dictation outcomes of 152 Dutch children with DLD attending special education in Grades 5/6, to that of 129 TD children in Grades 4/5, and 108 TD children in Grades 2/3. The dictation task included transparent words (spaarpot ‘piggy bank’), analogy-based words (maaien ‘to mow’), rule-based words (takken ‘branches’), and visual imprint words (cactus ‘cactus’). Within the group of children with DLD, we compared the performance of children with average-to-good reading abilities (n = 62) to that of children with poor reading abilities (n = 82). Children with DLD spelled significantly fewer words correctly than TD children in Grades 4/5, but performed similarly on mean spelling correct to TD children in Grades 2/3. When comparing word categories within groups, all three groups of children performed best on analogy-based words. A difference in spelling patterns on the complex word categories emerged between the groups: Children with DLD in Grades 5/6 and TD children in Grades 4/5 performed similarly on rule-based and visual imprint words, whereas TD children in Grades 2/3 performed better on rule-based than on visual imprint words. Finally, average-to-good readers with DLD outperformed poor readers with DLD on spelling. Children with DLD are delayed in their spelling development. Their spelling pattern on complex word categories is comparable to that of TD children slightly younger than them. A more substantial delay emerges for children with DLD with word reading difficulties compared to children with DLD-only, though their spelling patterns are similar. The results suggest that children with DLD still require continued intensive spelling instruction for all word categories at the end of elementary school.

Are there lasting impacts of China’s anti-poverty program? A synthetic control analysis

ABSTRACT China’s National Poor Counties (NPCs) program represents one of the largest anti-poverty efforts ever undertaken in a developing country. In spite of this, no causal analysis has been undertaken to examine whether regions in poverty at the end of the program actually achieve sustainable growth after support is removed. This paper provides the first long-term analysis of China’s NPCs (National Poor Counties) program on local development, investigating whether poor regions continue to develop economically after exiting the anti-poverty program. Focusing on the period 1986 to 2010, I construct plausible counterfactuals for counties that participated and graduated from the NPCs registry using the synthetic control method. This exercise reveals several new insights. First, on average, graduates of China’s anti-poverty program exhibit roughly the same growth outcomes as those still receiving support from the program. Second, I show that focusing on the average impact masks sizable heterogeneity when disaggregating to a case by case analysis of counties. Importantly, for the subset of counties which graduated from the first wave of the poverty reduction program in 1993, there is a demonstrably faster expansion post-graduation. For more recent county’s graduating from the program, however, I find significantly lower income growth of NPCs program completion in the long run.

Investigation of Depression and Post-Traumatic Growth in Renal Transplant Recipients via Self-Assessment

Objective: In this study, we aimed to determine post-traumatic growth and depression levels in renal transplant recipients and the relationship between these two variables. Design and Methods: The study was conducted with a descriptive, cross-sectional, and correlational design. The data for the study were collected at the organ transplant unit of a research and training hospital located in the west of Turkey. The sample of the study included 122 kidney transplant recipients (n = 122). A Sociodemographic Information Form, the Post-Traumatic Growth (PTG) Inventory, and the Beck Depression Inventory (BDI) were employed to collect data. In the analyses of the data, descriptive statistics, ANOVA, an independent-samples t-test, post hoc tests, and Pearson correlation tests were used. Results: As the ages of the renal transplant recipients increased, their depression scores decreased, while their PTG scores increased. Higher depression levels were identified in the female participants compared to the male participants and in those with a low income compared to other income groups. The lowest PTG levels were found in the recipients who received their kidney transplants from third-degree relatives. Age, gender, economic status, and time of transplant were predictors of depression. The identity of the donor was the most significant predictor of PTG (62% explanation rate). A strong and inverse correlation was found between depression and PTG (p &lt; 0.05). Conclusions: Post-traumatic growth was found to decrease depression. However, while poor economic status led to depression, high economic status did not lead to a significant change in PTG. As education levels increased, PTG decreased, but education status did not have any significant effect on depression. On the other hand, there was a negative correlation between PTG and depression. The results obtained in this study are valuable and important in terms of understanding depression better and determining PTG as a significant factor that could alleviate it.

Obstetric care provider’s knowledge about the use of low dose aspirin for preeclampsia prevention in low and middle income countries: a systematic review and meta-analysis

Introduction: Preeclampsia can elevate the likelihood of unfavorable consequences for a mother, such as severe morbidity and mortality. World Health Organization recommends low dose acetylsalicylic acid (aspirin, 75 mg per day) for the prevention of preeclampsia in women at moderate or high risk of developing the condition. The use of low dose aspirin is dependent on the knowledge of health care providers working in the antenatal care units. We found inconsistent figures regarding the knowledge level of health care providers on low dose aspirin for preeclampsia prevention around different low and middle income countries in the world. Thus, determining the pooled knowledge level of health care providers is very important.MethodsThis systematic review and meta-analysis (SRMA) was conducted on the knowledge level of among obstetric care providers towards preeclampsia prevention in low and middle income countries. We identified relevant literature in the English language only. A comprehensive search was conducted on databases such as PubMed, Google Scholar, HINARI, and Scopus. Subsequently, all datasets were exported to Mendeley reference manager and transferred to a Microsoft Excel spreadsheet to eliminate duplicate data during the review process. The extracted Microsoft Excel spreadsheet format data was imported to STATA software version 17 (STATA corporation, Texas, USA) for analysis. Then random effect model was used to estimate the pooled level of knowledge of health care providers on low dose aspirin for preeclampsia prevention in low income countries. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among all the studies included in this SRMA.ResultA total of 1231 articles were identified through our search strategies, including Google Scholar, PubMed, Hinari and Scopus. Ultimately, six articles met the eligibility criteria for inclusion in the final SRMA. The pooled knowledge level of healthcare providers regarding the use of low-dose aspirin for preeclampsia prevention in low-income countries was found to be 16.38% (95% CI: 4.36–28.40). The Cochrane heterogeneity index, with a substantial I2 value of 98.89% and a significant P-value of 0.01, indicated significant heterogeneity among the primary studies included.Conclusionthe knowledge level of obstetric care providers in low and middle income countries is found very low and all the governmental and non-governmental organizations should strive to enhance the knowledge of obstetric care providers on the use of low dose aspirin for preeclampsia prevention in low and middle income countries.

Validation of the minimum dietary diversity for women as a predictor of micronutrient adequacy among lactating women in Ethiopia

BackgroundThe Minimum Dietary Diversity for Women (MDD-W) indicator is used as a proxy indicator for assessing micronutrient adequacy among women of the reproductive age group. Variations were observed in studies, and there was also a lack of evidence regarding the performance of this proxy indicator in Ethiopia, a country with diverse dietary consumption practices. This study aimed to validate the performance of the MDD-W in predicting micronutrient intake adequacy among lactating women in Ethiopia.Methods and materialsA community-based cross-sectional study was conducted among randomly selected 457 lactating women in Northwest Ethiopia from February 2 to 18, 2023. A multistage sampling technique was used to select 457 study participants. A single multiphasic interactive 24-h dietary recall was used to collect dietary intake data. Ten food groups were used to compute the Minimum Dietary Diversity for Women, and the Mean Adequacy Ratio was used to assess nutrient intake adequacy. Spearman’s rank correlation test, Cohen’s kappa statistics, and ROC curve analysis were conducted. The optimal cutoff points for Minimum Dietary Diversity for Women were determined by selecting the points that maximized the Youden index.ResultsMDD-W had poor positive correlation (ρ = 0.19, p &amp;lt; 0.001) and poor predictive ability (AUC = 0.62, 95% CI: 0.56, 0.67) (p &amp;lt; 0.001) with the Mean Adequacy Ratio in determining micronutrient intake adequacy. The sensitivity and specificity of the MDD-W in the ≥5 food groups standard cutoff were 25.2 and 82.3%, respectively. The optimal cutoff point for MDD-W to predict micronutrient intake adequacy was ≥3 food groups.ConclusionMinimum Dietary Diversity for Women had a poor correlation and poor predictive ability in predicting micronutrient intake adequacy. The variations noted in studies and differences from the Food and Agriculture Organization recommendations regarding the cutoff and level of performance of MDD-W in defining micronutrient adequacy warrant further investigation.

Pathways from education to mortality, mediated through income.

Lower levels of education are associated with higher mortality. Lower levels of education are also associated with lower income, which is also associated with higher mortality. We investigate the impact of education on mortality and the extent to which this is mediated through income over the life course. We account for both selective educational attainment and selective income over the life course, through inverse propensity weighting (IPW) of the mortality hazard. We decompose the educational gain, that is, the decrease in mortality from more education, in the hazard into an indirect effect of education, running through changes in income and a direct effect of education, running through other factors. We use Swedish conscription data (men only), linked to parental information and individual annual income for the period 1968 till 2012. Our empirical results indicate large educational gains in mortality. We also find that this educational gradient runs through changes in income, especially for the more educated, and does not run through other factors related to education. We conduct several robustness and sensitivity checks that indicate that the results are robust.

The Impact of the Opportunity Zone Program on Residential Real Estate

Problem definition: Opportunity zones (OZs) are designated census tracts in which real estate investments can gain tax benefits. Introduced by the U.S. Tax Cuts and Jobs Act of 2017, the goal of the OZ program is to foster economic development in distressed neighborhoods. In this paper, we investigate and optimize the OZ selection process and examine the impact of OZs by exploiting two data sets: a proprietary real estate data set that includes 36.1 million residential transactions spanning all 50 U.S. states and census-tract demographics data between 2010 and 2019. Methodology/results: We show that census tracts with higher poverty and unemployment rates were more likely to be selected. Counterintuitively, however, tracts with a higher average real estate price were also more likely to be selected. We then apply difference-in-differences, synthetic control, and matching techniques to rigorously assess the impact of the OZ program on two key real estate metrics: price and transaction volume. We find that the OZ program increased real estate prices by 4.03%–6.13% but do not observe a significant effect on the transaction volume. We also find that investors primarily targeted the high-end real estate market, namely, exhibiting a cherry-picking behavior. To better fulfill its intended societal and economic goals, we propose an optimization framework with fairness considerations for OZ assignment decisions. We show that the OZs assigned from our fairness-aware optimization formulation can better serve distressed communities and mitigate investors’ cherry-picking behavior. Managerial implications: Our paper underscores the importance of incorporating fairness in OZ designation to achieve a desirable real estate market reaction. Our large-scale empirical analysis provides a comprehensive assessment of the current government OZ assignment, and our fairness-aware optimization framework provides concrete recommendations for policy makers. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2024.0746 .

Cumulative risk predicting differential effectiveness of the incredible years parent-training

The evidence on whether socioeconomic status moderates the effectiveness of parent-training programs for disruptive child behaviors is inconclusive. These varied results may stem from differences in the programs or the studies themselves. We applied an equivalence test paradigm to test the hypothesis of equal benefit from the Incredible Years Parent-Training (IYPT) across family risk on disruptive child behaviors. During the Danish roll-out of the IYPT, 1203 families were recruited across 20 different municipalities. The isolated and cumulative effect of five markers of low socioeconomic status, specifically single parent household, parental unemployment, low family income, low parental educational level, and teen parenthood, were analyzed as predictors of pre-to-post treatment response. Results showed equal benefit among families experiencing from zero to four accumulated socioeconomic risks (99 % of our sample). Our findings suggest that the IYPT brings equal benefit across socioeconomic backgrounds and risk levels in Danish community settings.

Financial Stress Amongst People Who Self-Harm in Sri Lanka

Objective Socioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka. Methods Data on non-fatal self-harm presentations were collected from an ongoing surveillance project in 52 hospitals in Sri Lanka. A questionnaire captured data on two forms of financial stress: unmet need (i.e., costs and bills that cannot be paid) and required support (i.e., steps taken to cover costs, such as selling belongings). Additional data on demographic, economic and clinical characteristics were also collected. Results The sample included 2516 individuals. Both forms of financial stress were very common, with pawning/selling items (47%) and asking family or friends for money (46%) in order to pay bills or cover costs being commonly reported. Greater financial stress was associated with being aged 26-55 years, limited education, and low socioeconomic position. Financial stress was greater in women than men after adjusting for other factors. Conclusion The results indicate that financial stress is commonly reported amongst individuals presenting to hospital with non-fatal self-harm in Sri Lanka, especially women. The research highlights a need to attend to financial stress both within self-harm prevention and aftercare.

Geospatial determinants of urban poverty in Nigeria: an analysis of locally weighted factors

ABSTRACT Determining the factors that influence poverty has been seen as one of the ways of identifying appropriate poverty alleviation strategies in cities. This has been done, in most cases, through the application of ordinary least squares (OLS), which assumes homogeneous influence without considering the spatial heterogeneity that may occur in this influence. This study aims to determine the spatial heterogeneity in the influence of public infrastructure, economic, environmental, and social factors on poverty, by carrying out comparison analysis using OLS and Geographically Weighted Regression (GWR) in ArcGIS Pro 3.0.1, with a view of proffering poverty alleviation strategies for each section of an urban area. A questionnaire in Geographic Open Data Kit (GeoODK) was administered to 366 urban residents across the twenty wards in the selected city in Nigeria. The results reveal that factors that influence income poverty are spatially varying in direction and weight across a city. Spatial heterogeneity of poverty’s determinants should be considered in the formulation and implementation of effective poverty alleviation policies and programs.

The Affordable Care Act Dependent Coverage Provision and Unintended Pregnancy.

Background: Nearly half of all pregnancies in the United States are considered unintended (mistimed or unwanted), and this rate is even higher among younger and lower income women. The Affordable Care Act (ACA) dependent coverage provision may have influenced the frequency of unintended pregnancies by increasing accessibility to and affordability of family planning services among young adults. Furthermore, the impact of this provision may differ by young adult income level as those with lower income are less likely to be insured and thus more likely to benefit from this provision. Our objective was to estimate the association between the ACA dependent coverage provision and unintended pregnancy, overall, and by young adult income level. Methods: We applied a difference-in-differences approach to data from multiple cycles of the National Survey of Family Growth (n = 10,104) and compared trends in unintended pregnancy between those who were eligible to benefit (ages 18-25 years) and those who were ineligible to benefit (ages 26-33 years) from the provision, overall, and among income subgroups. Results: We found evidence that the dependent coverage provision was associated with a -7.4 percentage point reduction (95% CI: -13.5, -1.3) in the prevalence of unintended pregnancy among young adults with lower income (<100% of the federal poverty level). There was limited evidence, however, that the provision was associated with unintended pregnancy among young adults with higher income levels. Conclusions: These findings suggest the ACA dependent coverage provision may have reduced unintended pregnancy among a particularly high-risk group (i.e., young adults with lower income).

Prevalence, mortality and risk factors for self-reported COPD among smokers and never smokers, NHANES 1999-2018.

Cigarette smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), but 25% to 50% of cases occur in non-smokers. In the US, limited recent national data compare COPD prevalence between smokers and never smokers. Furthermore, our study seeks to explore the prevalence and mortality of self-reported COPD among smokers (including current smokers and ex-smokers) and never smokers in the US from 1999 to 2018, and to identify the risk factors and differences. This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Age-standardized prevalence of self-reported COPD among current smokers, ex-smokers, and never smokers was calculated using sample weights and 2010 US Census estimates. Risk factors were evaluated through weighted logistic regression models. Subsequently, participants who enrolled in the study cohort were followed until 31 December 2019, to determine all-cause mortality rates. Between 1999 and 2018, the weighted prevalence of COPD among current smokers, ex-smokers, and never smokers in the U.S. was 12.6%, 9.6%, and 4.1%, respectively. The mortality rates observed were 21.1% among current smokers with COPD, 29% among ex-smokers with COPD, and 12% among never smokers with COPD. Over this period, among the general population in the U.S., the proportion of current smokers has declined, the proportion of never smokers has increased, and the proportion of ex-smokers has remained relatively stable. From 1999 to 2018, COPD prevalence rose from 13.7% to 21.9% among current smokers, stayed at 10.1% among ex-smokers, and dropped from 4.9% to 3.3% among never smokers. Independent risk factors for COPD across all groups included being female, older, and lower income. In particular, US citizens and non-Hispanic Whites (among ex-smokers and never smokers) were at higher risk compared to their counterparts. The prevalence and all-cause mortality of COPD among current smokers and ex-smokers remain elevated. Although the prevalence of COPD among never smokers is gradually declining, it continues to be significant, thereby maintaining a substantial burden of disease. Furthermore, common independent risk factors for COPD across current smokers, ex-smokers, and never smokers include female gender, advanced age, lower income, and deviations from normal body weight whether overweight or underweight.