Limited Evidence Research Articles

Determinants of short birth interval among married multiparous women in Chinaksen district, eastern Ethiopia: a case-control study.

The short birth interval is a common public health issue that affects women's and children's health in sub-Saharan Africa. Despite a higher burden of short birth intervals reported in Ethiopia, there is limited evidence to indicate the primary risk factors, particularly in rural eastern Ethiopia. Therefore, this study assessed the determinants of the short birth interval among married multiparous women in Chinaksen district, Eastern Ethiopia. A community-based case-control study was conducted among randomly selected 210 cases and 210 controls from April 01 to June 30, 2019. The total sample size (219 cases and 219 controls) were calculated using Epi-Info software version 7.2. Data were entered using EpiData version 3.1 and analyzed using SPSS version 27, and multivariable logistic regression analyses conducted to identify the determinants of short birth intervals. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the strength of association and statistical significance declared at p-value < 0.05. The women in the young age group (AOR = 2.33, 95% CI: 1.03, 5.26), missed their antenatal care visits (AOR = 2.23, 95% CI: 1.18, 4.21), failed to utilize postpartum contraceptives (AOR = 5.98, 95% CI: 3.62, 9.89), did not attend postnatal care visit (AOR = 1.86, 95% CI: 1.13, 3.05), nonexclusive breastfed (AOR = 4.05, 95% CI: 2.18, 7.52), short and medium period of breastfeeding (AOR = 4.00, 95% CI: 1.34, 12.10) and (AOR = 3.56, 95% CI: 1.62, 7.82), respectively and female sex of preceding child (AOR = 1.92, 95% CI: 1.18, 3.12) were the important risk factors of short birth interval. Women's age, antenatal care visits, postnatal care attendance, utilization of postpartum contraceptives, exclusive breastfeeding practice, duration of breastfeeding, and sex of the preceding child were the primary predictors of short birth intervals. Improving the utilization of maternal healthcare services in health facilities would be imperative to prevent and reduce short birth intervals, and its negative consequences.

Eco-Efficiency of Olive Farms across Diversified Ecological Farming Approaches

Eco-efficiency is commonly used as an indicator of sustainability since it expresses the efficiency with which natural resources are utilized to meet people’s needs. Agriculture relies heavily on these ecological resources and by-produces significant environmental burdens, shifting the interest of researchers and policymakers toward the promotion of ecological practices. However, limited evidence exists regarding eco-efficiency across various ecological approaches like low input, conservation, and organic farming. This paper contributes to the existing literature and provides insight into the eco-efficiency of Cretan olive farms managed under different ecological approaches. Olive oil production is vital for the socio-economic sustainability of Mediterranean agriculture, a significant element of the region’s culture, and the basis of the well-known “Mediterranean diet”; therefore, it is crucial to investigate eco-efficient management options for olive farmers. Data Envelopment Analysis (DEA) and a second-stage statistical analysis are employed to estimate the eco-efficiency of olive farms and investigate factors affecting it. Composite indicators for biodiversity, soil, and input management are incorporated in the eco-efficiency model. The results indicate that organic farms achieve the highest eco-efficiency scores, followed by other ecological approaches. Additionally, eco-efficiency seems to be explained by farmers’ dependency on subsidies, commitment to farming activity, and environmental awareness.

In Silico and In Vitro Studies of Antibacterial Activity of Cow Urine Distillate (CUD).

Cow urine distillate (CUD) is a traditional Indian medicine used to treat various diseases, including bacterial infections. However, there is limited evidence to support its use as a medicine, and its safety and efficacy have not been thoroughly studied. In this study, we evaluated the antibacterial activity of CUD against five bacterial strains using in vitro and in silico approaches. In vitro experiments showed that CUD has significant antibacterial activity against all tested strains with a zone of inhibition (ZOI) ranging from 13 to 24 mm and minimum inhibitory concentration (MIC) values ranging from 12.5 to 50 µg/ml. The results indicated that the 15% concentration of CUD displayed the highest antibacterial activity against Staphylococcus aureus and Salmonella typhi. To further investigate the antibacterial mechanism of CUD, we performed in silico docking studies of the active compounds of CUD with bacterial proteins involved in protein synthesis. Our results showed that 2-hydroxycinnamic acid (ΔG = -6.9 kcal/mol) and ferulic acid (ΔG = -6.8 kcal/mol) exhibited the best docking scores with the targeted proteins (DNA gyrase, PDBID: 4KFG). The hydrogen bonding interaction with amino acids Val71 and Asp73 was found to be crucial for their antibacterial activity.

Investigating chromosomal instability in long-term survivors with glioblastoma and grade 4 astrocytoma.

Only a small group of patients with glioblastoma multiforme (GBM) survives more than 36 months, so-called long-term survivors. Recent studies have shown that chromosomal instability (CIN) plays a prognostic and predictive role among different cancer types. Here, we compared histological (chromosome missegregation) and bioinformatic metrics (CIN signatures) of CIN in tumors of GBM typical survivors (≤36 months overall survival), GBM long-term survivors and isocitrate dehydrogenase (IDH)-mutant grade 4 astrocytomas. Tumor sections of all gliomas were examined for anaphases and chromosome missegregation. Further CIN signature activity analysis in the The Cancer Genome Atlas (TCGA)-GBM cohort was performed. Our data show that chromosome missegregation is pervasive in high grade gliomas and is not different between the 3 groups. We find only limited evidence of altered CIN levels in tumors of GBM long-term survivors relative to the other groups, since a significant depletion in CIN signature 11 relative to GBM typical survivors was the only alteration detected. In contrast, within IDH-mutant grade 4 astrocytomas we detected a significant enrichment of CIN signature 5 and 10 activities and a depletion of CIN signature 1 activity relative to tumors of GBM typical survivors. Our data suggest that CIN is pervasive in high grade gliomas, however this is unlikely to be a major contributor to the phenomenon of long-term survivorship in GBM. Nevertheless, further evaluation of specific types of CIN (signatures) could have prognostic value in patients suffering from grade 4 gliomas.

Gas cooking indoors and respiratory symptoms in the ECRHS cohort

BackgroundGas cooking is an important source of indoor air pollutants, and there is some limited evidence that it might adversely be associated with respiratory health. Using repeated cross-sectional data from the multi-centre international European Community Respiratory Health Survey, we assessed whether adults using gas cookers have increased risk of respiratory symptoms compared to those using electric cookers and tested whether there was effect modification by a priori selected factors. MethodsData on respiratory symptoms and gas cooking were collected from participants at 26–55 and 38–67 years (median time between examinations 11.4 years) from interviewer-led questionnaires. Repeated associations between gas cooking (versus electric) and respiratory symptoms were estimated using multivariable mixed-effects logistic regression models adjusted for age, sex, study arm, smoking status, education level, and included random intercepts for participants within study centres. Analyses were repeated using a 3-level variable for type of cooker and gas source. Effect modification by ventilation habits, cooking duration, sex, age atopy, asthma, and study arm were examined. ResultsThe sample included 4337 adults (43.7% males) from 19 centres in 9 countries. Gas cooking increased the risk of “shortness of breath whilst at rest” (OR = 1.38; 95%CI: 1.06–1.79) and “wheeze with breathlessness” (1.32; 1.00–1.74). For several other symptoms, effect estimates were larger in those who used both gas hobs and ovens, had a bottled gas source and cooked for over 60 min per day. Stratifying results by sex and age found stronger associations in females and younger adults. ConclusionThis multi-centre international study, using repeat data, suggested using gas cookers in the home was more strongly associated than electric cookers with certain respiratory symptoms in adults. As gas cooking is common, these results may play an important role in population respiratory health.

Management of Multifocal Squamous Dysplasia: Role of Esophagectomy

Squamous dysplasia precedes invasive squamous cell carcinoma of the esophagus, but there is limited evidence on its surgical management. The “field change effect” further complicates matters, causing multifocal or second primary neoplasms in the esophagus and upper aerodigestive tract. While endoscopic procedures are the primary treatment, surgical resection, either alone or in combination with endoscopy, must be considered given the extent of the disease and organ involvement. This chapter summarizes multifocal squamous dysplasia scenarios and highlights the role of esophagectomy or surgical resection.

Comparative Study of Ropivacaine Alone Versus Combination of Ropivacaine with Either Dexmedetomidine or Dexamethasone for Ultrasound Guided Supraclavicular Brachial Plexus Block

Background: Ropivacaine is a common choice for supraclavicular brachial plexus block. Dexmedetomidine and Dexamethasone are frequently added to local anesthetics for improved effects. With limited comparative evidence, this study aimed to assess Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in ultrasound-guided supraclavicular brachial plexus block.Methods: This prospective double-blind study enrolled patients aged 18-60, scheduled for elective upper limb surgery below mid-humeral level. They were randomly assigned into three groups: Ropivacaine alone, Ropivacaine with Dexmedetomidine (1 mcg/kg), or Ropivacaine with Dexamethasone (8 mg). The study aimed to compare sensory and motor blockade onset and duration, postoperative analgesia duration, and adverse event occurrence among the groups.Results: Ninety-eight patients participated in the study. All three groups showed similar characteristics in terms of age, weight, gender, ASA grade, and surgery duration. The onset and duration of sensory and motor block were comparable between the Dexamethasone and Dexmedetomidine groups. A significant difference was observed when comparing the Ropivacaine only group to either of the other two groups or when comparing all three groups. Similarly, postoperative analgesia duration was comparable between the Dexamethasone and Dexmedetomidine groups while it differed significantly when comparing all three groups or when comparing the Ropivacaine only group to either of the other groups. Ropivacaine with Dexmedetomidine group experienced notable occurrence of bradycardia.Conclusion: Dexamethasone and Dexmedetomidine as adjuvants to 0.5% Ropivacaine for ultrasound-guided supraclavicular brachial plexus blockade have comparable effects on sensory and motor blockade onset and duration, along with postoperative analgesia duration. Dexmedetomidine, however, is linked to more bradycardia compared to Dexamethasone.

Social cognition, emotion regulation and social competence in classical galactosemia patients without intellectual disability.

Classical galactosemia (CG) is an inborn error of galactose metabolism. Many CG patients suffer from long-term complications including poor cognitive functioning. There are indications of social dysfunction but limited evidence in the literature. Therefore, this study aims to improve our understanding of social competence in CG by investigating social cognition, neurocognition and emotion regulation. A comprehensive (neuro)psychological test battery, including self and proxy questionnaires, was administered to CG patients without intellectual disability. Social cognition was assessed by facial emotion recognition, Theory of Mind and self-reported empathy. Standardised results were compared to normative data of the general population. Data from 23 patients (aged 8-52) were included in the study. On a group level, CG patients reported satisfaction with social roles and no social dysfunction despite the self-report of lower social skills. They showed deficits in all aspects of social cognition on both performance tests (emotion recognition and Theory of Mind) and self-report questionnaires (empathy). Adults had a lower social participation than the general population. Parents reported lower social functioning, less adaptive emotion regulation and communication difficulties in their children. Individual differences in scores were present. This study shows that CG patients without intellectual disability are satisfied with their social competence, especially social functioning. Nevertheless, deficits in social cognition are present in a large proportion of CG patients. Due to the large variability in scores and discrepancies between self- and proxy-report, an individually tailored, comprehensive neuropsychological assessment including social cognition is advised in all CG patients. Treatment plans need to be customised to the individual patient.

Impact of health system strengthening interventions on child survival in sub-Saharan Africa: a systematic review protocol

BackgroundStrengthening healthcare systems is a practical approach to enhance healthcare delivery and services. Although there has been a rise in the number of health systems strengthening (HSS) interventions in sub-Saharan Africa (SSA), there is limited evidence on the causal effect of these activities on child survival. Furthermore, the findings reported so far have been varied, and how they relate to each other remains unclear. This systematic review study aims to assess all available evidence to understand the impact of HSS activities on child survival in SSA.MethodsWe developed a search strategy to retrieve all relevant studies from electronic databases such as PubMed/MEDLINE, Web of Science, and African Journals Online. We will use a combination of search terms such as “under-five mortality,” “child mortality,” “infant mortality,” “neonatal mortality,” “child survival,” and “health systems strengthening.” The review will include studies that establish a causal relationship between HSS interventions and child survival. This will include studies with designs such as randomized controlled trials and quasi-experimental and methods like difference-in-difference. Two reviewers will independently screen all citations, abstracts, and full-text data and a third reviewer will act as a tiebreaker in case of disagreements. The primary outcome of interest is the impact of HSS activities on under-five survival. We will evaluate the quality of each study using the Bradford Hill criteria for causation.DiscussionOur systematic review will identify and evaluate all relevant evidence that establishes a causal relationship between HSS activities and the survival of children under five years in SSA. The review’s findings regarding the impact of HSS activities on child survival could be of significant interest to the donor community and policy actors in the region. We also anticipate that the review’s conclusions could serve as a valuable guide for the development of future health system interventions and strategies in SSA.Systematic review registrationPROSPERO CRD42022333913.

Multisite clinical cross-validation and variant interpretation of a next generation sequencing panel for lymphoid cancer prognostication

AimsGenomic sequencing of lymphomas is under-represented in routine clinical testing despite having prognostic and predictive value. Clinical implementation is challenging due to a lack of consensus on reportable targets and...

Incidence and predictors of chronic kidney disease among patients with diabetes treated at governmental hospitals of Harari Region, eastern Ethiopia, 2022.

Chronic kidney disease (CKD) is the leading cause of morbidity and mortality in diabetic patients. However, limited evidence is available about its incidence and predictors in Ethiopia, specifically in the Harari region. A retrospective follow-up study was conducted among 520 diabetes patients who followed their treatment at governmental hospitals in the Harari region between 1 September 2012, and 30 May 2022. The risk of developing CKD was calculated with a 95% CI, and the risk was stratified by type of diabetes mellitus. Predictors of CKD were determined using the Gompertz regression model with the baseline Cox model. Data from 494 patients were included in the final analysis with 26 (5%) excluded. A total of 51 patients (10.32%) developed CKD over the 10-year follow-up period with an incidence rate of 2.16 cases (95% CI 1.64-2.84) per 100 person-years of observation. The risk of CKD was increased by three times (AHR: 3.09, 45 95% CI: 1.56, 6.14) among patients older than 60 years and by more than three times (AHR: 3.53, 95% CI: 1.43, 8.71) among patients with diabetes mellitus for longer than 5 years of stay with the diabetes mellitus. Moreover, the risk of CKD was increased four-fold among patients with high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL (AHR: 3.84, 95% CI, 1.80-8.18) and those with positive baseline proteinuria (AHR: 3.77, 95% CI: 1.43-8.71). We found that one in ten diabetic patients had developed CKD within 10 years of the diabetes mellitus diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level, and proteinuria had increased the hazards of developing CKD. We recommend a more focused follow-up of older adult patients with advanced disease status at baseline for optimal control of diabetes mellitus that prevents its furthering to CKD.

How educational leaders can maximise the social capital benefits of inter-school networks: findings from a systematic review

PurposeEducators need to engage in continuous learning to ensure that their knowledge and practice responds to the changing needs of society and students. Collaborative approaches, in which social capital resource is exchanged, can serve as an effective way of facilitating such learning. With this systematic review, the authors identify the opportunities and benefits inter-school social capital networks might bring by exploring: (1) what inter-school networks are available internationally for primary and secondary schools, (2) the features and activities present within inter-school networks and (3) evidence of impact of inter-school network activities.Design/methodology/approachFor this study, the authors employed a systematic review methodology. The review comprised the five stages of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: PRISMA, 2021) protocol. The study findings derived from 111 research outputs (from a total of 1,221 originally identified).FindingsThe review highlights a number of different inter-school networks and their diverse purposes as well as key network features, such as the actors present in networks and the activities network participants engage with. At the same time, however, the authors only identify limited reliable evidence of the impact of inter-school networks.Originality/valueThe study fills a knowledge gap by exploring, for the first time, the presence, features of inter-school social capital networks available to school leaders as well as investigating the impact of these networks.

Risk factors for COVID-19 in-hospital mortality in Argentina: A competing risk survival analysis.

COVID-19 poses dire threats for low and middle-income countries (LMICs). Yet, there remains limited rigorous evidence describing the characteristics and outcomes of hospitalized patients for LMICs, and often the evidence was based on small samples and/or unicentric. The objective of this study was to examine risk factors of COVID-19 mortality in Argentina, a hard-hit middle-income Latin American country. We analyze data on 5,146 COVID-19 patients from 11 centers across 10 cities in Argentina, making this one of the largest multi-centric retrospective observational descriptive studies in the LMICs. Information on demographics and co-morbidities was extracted from medical records. Outcomes of relevance consisted of whether the patient was discharged or deceased (as established in medical records), along with date of each event. We use survival models that account for competing risks. Median age was 60 years (IQR: 48-72), there were fewer women (40.8%) hospitalized than men (59.2%), and the most prevalent comorbidities were hypertension (40.9%), diabetes (20.0%) and obesity (19.1%). Patients were hospitalized for a median duration of 8 days (IQR: 5-13), and in-hospital mortality was 18.1%, though it varied substantially across health centers (95%CI: 17.1%-19.2%). Baseline characteristics most associated with in-hospital mortality were respiratory rate (adjusted HR = 3.6, 95%CI: 2.5-5.4 for ≥ 26 breathes/min), older age (adjusted HR = 2.5, 95%CI: 2.0-3.3 for the 80+ age group), and chronic kidney disease (adjusted HR = 2.2, 95%CI: 1.8-2.8). Associations were attenuated when survival models did not account for the competing risk of being discharged. We document lower mortality rates than those in prior studies, likely due to a lower prevalence of comorbidities amongst patients in our sample. Compared with standard Cox models, we find that, when using competing risk models, risk factors have a larger role in explaining COVID-19 mortality. Overall, we provide rigorous evidence describing the characteristics and outcomes of hospitalized patients for LMICs. Thus, our findings are useful to conduct a more accurate in-hospital monitoring of patient subgroups who may be at greater risk. They also provide valuable guidance for public health and policy efforts in Argentina and other developing countries.

Formal designation of Brazilian indigenous lands linked to small but consistent reductions in deforestation

Indigenous territories in Brazil have existed since the pre-European discovery of the continent. Yet, many of them remain without formal recognition by the state. While numerous studies discuss the social implications of indigenous land (IL) designation, limited empirical evidence exists regarding its role in forest conservation. To address this gap, the present study employs a quasi-experimental design and causal-inference methods to estimate the effects of formal IL designation on deforestation across Brazil and its biomes, from 1986 to 2021. Estimates indicate an average impact of −0.05% on deforestation due to the formal designation of ILs nationwide, with variations ranging from −0.21% to 0.04% across different evaluation periods and biomes. Notably, designated ILs in the Cerrado biome had the highest avoided deforestation impacts (−0.12%, on average). No evidence of deforestation leakage was observed. The findings from this study suggest that while the promotion of formal IL designation can lead to consistent reductions in deforestation, the magnitude of its effect is relatively small to be promoted on the sole basis of an effective strategy to mitigate tropical deforestation and climate change. Nevertheless, the potential positive socioeconomic impacts of formal IL designation on indigenous peoples cannot be undermined.

Neonatal hypoglycemia and neurodevelopmental outcomes: Yesterday, today, tomorrow.

Neonatal hypoglycemia is a major source of concern for pediatricians since it has commonly been related to poor neurodevelopmental outcomes. Diagnosis is challenging, considering the different operational thresholds provided by each guideline. Screening of infants at risk plays a crucial role, considering that most hypoglycemic infants show no clinical signs. New opportunities for prevention and treatment are provided by the use of oral dextrose gel. Continuous glucose monitoring systems could be a feasible tool in the next future. Furthermore, there is still limited evidence to underpin the current clinical practice of administering, in case of hypoglycemia, an intravenous "mini-bolus" of 10% dextrose before starting a continuous dextrose infusion. This brief review provides an overview of the latest advances in this field and neurodevelopmental outcomes according to different approaches. Conclusion:To adequately define if a more permissive approach is risk-free for neurodevelopmental outcomes, more researchon continuous glucose monitoring and long-term follow-up is still needed. What is Known: •Neonatal hypoglycemia (NH) is a well-known cause of brain injury that could be prevented to avoidneurodevelopmental impairment. • Diagnosis is challenging, considering the different suggested operational thresholds for NH (<36, <40, <45, <47or <50 mg/dl). What is New: •A 36 mg/dl threshold seems to be not associated with a worse psychomotor development at 18 months of lifewhen compared to the "traditional" threshold (47 mg/dl). •Further studies on long-term neurodevelopmental outcomes are required before suggesting a more permissivemanagement of NH.

Integrative non-pharmacological care for individuals at risk of rheumatoid arthritis.

There is increasing knowledge in the recognition of individuals at risk for progression to rheumatoid arthritis (RA) before the clinical manifestation of the disease. This prodromal phase preceding the manifestation of RA may represent a "window of opportunity" for preventive interventions that may transform the clinical approach to this disease. However, limited evidence exists in support of effective interventions to delay the onset or even halt the manifestation of RA. Given the multifactorial nature of RA development and disease progression, the latest guidelines for established RA stress the use of integrative interventions and multidisciplinary care strategies, combining pharmacologic treatment with non-pharmacological approaches. Accordingly, individuals at risk of RA could be offered an integrative, multifactorial intervention approach. Current data point toward pharmacological intervention reverting the subclinical inflammation and delay in the disease onset. In addition, targeting life style modifiable factors (smoking cessation, dental health, physical activity, and diet) may presumably improve RA prognosis in individuals at risk, mainly by changes in epigenetics, autoantibodies, cytokines profiles, and microbiome. Nonetheless, the benefits of multidisciplinary interventions to halt the manifestation of RA in at-risk individuals remain unknown. As there is a growing knowledge of possible pharmacological intervention in the preclinical phase, this narrative review aims to provide a comprehensive overview of non-pharmacological treatments in individuals at risk of RA. Considering the mechanisms preceding the clinical manifestation of RA we explored all aspects that would be worth modifying and that would represent an integrative non-pharmacological care for individuals at risk of RA.

Incidence, risk factors for active tuberculosis infection and changes of IGRA in patients with Takayasu arteritis: a prospective cohort study

ABSTRACT There is limited evidence to support the association between tuberculosis (TB) and the occurrence of Takayasu arteritis (TAK). To investigate the incidence of active TB (ATB) in TAK and explore the impact of anti-rheumatic therapy on the occurrence of ATB or reactivation of Latent TB infection (LTBI) and their effect on interferon-γ release assay (IGRA) results, we conducted a prospective study based on the Chinese Registry for Systemic Vasculitis cohort. The standard incidence ratio (SIR) was calculated and stratified by age. Kaplan–Meier analysis was used to determine the effect of variables on ATB or LTBI reactivation in patients with TAK. Data from 825 patients with TAK in the registry were analysed. During a median follow-up of 5 years, 5 patients developed ATB with a crude incidence of 154 (95%CI:57–381) person-years/100,000. The SIR was 5.59 (95%CI:1.81–13.04). Glucocorticoids and conventional disease-modifying anti-rheumatic drugs (cDMARDs) did not increase the risk of ATB or LTBI reactivation (P > 0.05). However, the use of tumour necrosis factor inhibitor (TNFi) increased the risk of ATB in patients with LTBI (P < 0.001). Furthermore, the value of the IGRA assay decreased after treatment (P < 0.05). In conclusion, the incidence of TB infection is markedly increased in patients with TAK and patients with TAK are at high risk of developing ATB. Treatment with glucocorticoids and cDMARDs does not significantly increase the risk for ATB in patients with TAK. Moreover, IGRA may have limited effectiveness in monitoring ATB infection or LTBI reactivation in patients with TAK.

Momentary measures of emotions during technology-enhanced learning prospectively predict standardized test scores in two large samples

BackgroundStudent emotions play a vital role in learning and have been linked to achievement outcomes, but research on the relationship between emotions (other than anxiety) and high-stakes standardized tests is sparse. AimsWe investigated whether emotions experienced during learning predict later performance on a high-stakes, mandatory, standardized test. SampleWe used two cohorts comprising a total of 102,007 grade 7–9 U.S. students. MethodsWe used experience sampling methods to measure 14 emotions (e.g., boredom, confusion, hope) as students engaged in technologically-enhanced learning as part of their math classroom instruction. ResultsStudents’ self-reported positive and negative emotions, positively and negatively predicted test scores, respectively, after covarying prior achievement and sociodemographics. However, there was limited evidence for indirect paths between prior achievement, emotions, and subsequent achievement. ConclusionsOur findings corroborate central predictions of major theories on emotions and learning that highlight the importance of emotions to learning processes and outcomes.

Joint developmental trajectories of internalizing and externalizing problems from mid-childhood to late adolescence and childhood risk factors: Findings from a prospective pre-birth cohort.

There is limited evidence on heterogenous co-developmental trajectories of internalizing (INT) and externalizing (EXT) problems from childhood to adolescence and predictors of these joint trajectories. We utilized longitudinal data from Raine Study participants (n = 2393) to identify these joint trajectories from 5 to 17 years using parallel-process latent class growth analysis and analyze childhood individual and family risk factors predicting these joint trajectories using multinomial logistic regression. Five trajectory classes were identified: Low-problems (Low-INT/Low-EXT, 29%), Moderate Externalizing (Moderate-EXT/Low-INT, 26.5%), Primary Internalizing (Moderate High-INT/Low-EXT, 17.5%), Co-occurring (High-INT/High-EXT, 17%), High Co-occurring (Very High-EXT/High-INT, 10%). Children classified in Co-occurring and High Co-occurring trajectories (27% of the sample) exhibited clinically meaningful co-occurring problem behaviors and experienced more adverse childhood risk-factors than other three trajectories. Compared with Low-problems: parental marital problems, low family income, and absent father predicted Co-occurring and High Co-occurring trajectories; maternal mental health problems commonly predicted Primary Internalizing, Co-occurring, and High Co-occurring trajectories; male sex and parental tobacco-smoking uniquely predicted High Co-occurring membership; other substance smoking uniquely predicted Co-occurring membership; speech difficulty uniquely predicted Primary Internalizing membership; child's temper-tantrums predicted all four trajectories, with increased odds ratios for High Co-occurring (OR = 8.95) and Co-occurring (OR = 6.07). Finding two co-occurring trajectories emphasizes the importance of early childhood interventions addressing comorbidity.

Impact of terror on international trade in financial services: Does the development of financial institutions matter?

AbstractWe examine the impact of terror on international trade in financial services and the role of financial institutions in alleviating this impact. Using a sample of 67 countries from 2000 to 2020, we find that a 10% increase in the number of terrorist incidents in the importer and/or the exporter results, on average, in a 1.77–2.05% annual reduction in their bilateral financial service trade which is more economically significant than what has been documented for trade in commodities. Top exporters and importers of financial services, however, are less affected by the incidence of terrorism. Confirming the critically important role of systemic stability, we further find that financial institutions' stability (measured by the Z score) is the most powerful factor in mitigating the detrimental impact of terrorism on trade. There is also some limited evidence that exporting countries where financial institutions exhibit more efficiency (measured as the ratio of overhead costs to total assets) cope better with terrorism.