National Dataset Research Articles

Assessing the excess costs of the in-hospital adverse events covered by the AHRQ's Patient Safety Indicators in Switzerland.

There currently exists no comprehensive and up-to date overview on the financial impact of the different adverse events covered by the Patient Safety Indicators (PSIs) from the Agency for Healthcare Research and Quality. We conducted a retrospective case-control study using propensity score matching on a national administrative data set of 1 million inpatients in Switzerland to compare excess costs associated with 16 different adverse events both individually and on a nationally aggregated level. After matching 8,986 cases with adverse events across the investigated PSIs to 26,931 controls, we used regression analyses to determine the excess costs associated with the adverse events and to control for other cost-related influences. The average excess costs associated with the PSI-related adverse events ranged from CHF 1,211 (PSI 18, obstetric trauma with instrument) to CHF 137,967 (PSI 10, postoperative acute kidney injuries) with an average of CHF 27,409 across all PSIs. In addition, adverse events were associated with 7.8-day longer stays, 2.5 times more early readmissions (within 18 days), and 4.1 times higher mortality rates on average. At a national level, the PSIs were associated with CHF 347 million higher inpatient costs in 2019, which corresponds to about 2.2% of the annual inpatient costs in Switzerland. By comparing the excess costs of different PSIs on a nationally aggregated level, we offer a financial perspective on the implications of in-hospital adverse events and provide recommendations for policymakers regarding specific investments in patient safety to reduce costs and suffering.

Changes in diagnostic patterns and resource utilisation in Swiss adult ICUs during the first two COVID-19 waves: an exploratory study.

The coronavirus disease 2019 (COVID-19) outbreak deeply affected intensive care units (ICUs). We aimed to explore the main changes in the distribution and characteristics of Swiss ICU patients during the first two COVID-19 waves and to relate these figures with those of the preceding two years. Using the national ICU registry, we conducted an exploratory study to assess the number of ICU admissions in Switzerland and their changes over time, characteristics of the admissions, the length of stay (LOS) and its trend over time, ICU mortality and changes in therapeutic nursing workload and hospital resources in 2020 and compare them with the average figures in 2018 and 2019. After analysing 242,935 patient records from all 84 certified Swiss ICUs, we found a significant decrease in admissions (-9.6%, corresponding to -8005 patients) in 2020 compared to 2018/2019, with an increase in the proportion of men admitted (61.3% vs 59.6%; p <0.001). This reduction occurred in all Swiss regions except Ticino. Planned admissions decreased from 25,020 to 22,021 in 2020 and mainly affected the neurological/neurosurgical (-14.9%), gastrointestinal (-13.9%) and cardiovascular (-9.3%) pathologies. Unplanned admissions due to respiratory diagnoses increased by 1971 (+25.2%), and those of patients with acute respiratory distress syndrome (ARDS) requiring isolation reached 9973 (+109.9%). The LOS increased by 20.8% from 2.55 ± 4.92 days (median 1.05) in 2018/2019 to 3.08 ± 5.87 days (median 1.11 days; p <0.001), resulting in an additional 19,753 inpatient days. The nine equivalents of nursing manpower use score (NEMS) of the first nursing shift (21.6 ± 9.0 vs 20.8 ± 9.4; p <0.001), the total NEMS per patient (251.0 ± 526.8 vs 198.9 ± 413.8; p <0.01) and mortality (5.7% vs 4.7%; p <0.001) increased in 2020. The number of ICU beds increased from 979 to 1012 (+3.4%), as did the number of beds equipped with mechanical ventilators (from 773 to 821; +6.2%). Based on a comprehensive national data set, our report describes the profound changes triggered by COVID-19 over one year in Swiss ICUs. We observed an overall decrease in admissions and a shift in admission types, with fewer planned hospitalisations, suggesting the loss of approximately 3000 elective interventions. We found a substantial increase in unplanned admissions due to respiratory diagnoses, a doubling of ARDS cases requiring isolation, an increase in ICU LOS associated with substantial nationwide growth in ICU days, an augmented need for life-sustaining therapies and specific therapeutic resources and worse outcomes.

Antimicrobial use and appropriateness in neutropenic fever: a study of the Hospital National Antimicrobial Prescribing Survey data.

Neutropenic fever (NF) is a common complication in patients receiving chemotherapy. Judicious antimicrobial use is paramount to minimize morbidity and mortality and to avoid antimicrobial-related harms. To use an Australian national dataset of antimicrobial prescriptions for the treatment of NF to describe antimicrobial use, prescription guideline compliance and appropriateness; and to compare these findings across different healthcare settings and patient demographics. We also aimed to identify trends and practice changes over time. Data were extracted from the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) database from August 2013 to May 2022. Antimicrobial prescriptions with a NF indication were analysed for antimicrobial use, guideline compliance and appropriateness according to the Hospital NAPS methodology. Demographic factors, hospital classifications and disease characteristics were compared. A total of 2887 (n = 2441 adults, n = 441 paediatric) NF prescriptions from 254 health facilities were included. Piperacillin-tazobactam was the most prescribed antimicrobial. Overall, 87.4% of prescriptions were appropriate. Piperacillin-tazobactam and cefepime had the highest appropriateness though incorrect piperacillin-tazobactam dosing was observed. Lower appropriateness was identified for meropenem, vancomycin, and gentamicin prescribing particularly in the private hospital and paediatric cohorts. The most common reasons for inappropriate prescribing were spectrum too broad, incorrect dosing or frequency, and incorrect duration. This study provides insights into antimicrobial prescribing practices for NF in Australia. We have identified three key areas for improvement: piperacillin-tazobactam dosing, paediatric NF prescribing and private hospital NF prescribing. Findings from this study will inform the updated Australian and New Zealand consensus guidelines for the management of neutropenic fever in patients with cancer.

Development of delivery indicators and delivery enablers for cardiovascular disease in the UK: a modified Delphi study

IntroductionStandards to define and measure quality in healthcare for cardiovascular disease risk reduction and secondary prevention are available, but there is a paucity of indicators that could serve as facilitators...

Threats of dams to the persistence of the world's freshwater fishes

AbstractHabitat fragmentation due to dams is a well‐known threat to freshwater fish. Yet, the global consequences of fragmentation for the viability of freshwater fish populations are unknown. Here, we provide the first global assessment of the threats of dams to the persistence of freshwater fish species. We developed a global macroecological relationship between freshwater fish range size and body size and used this relationship to assess whether isolated range fragments are too small to support a species. Our assessment includes 7369 freshwater fish species and considers the effects of 31,780 dams globally. Furthermore, we performed a more detailed analysis of the threats of dams in Brazil, the greater Mekong region and the United States, using complementary national and regional data sets. Globally, more than half of the species analysed face extirpation in a part of their geographic range, with an average potential range loss of 3.3% (95%‐range: 0%–31.8%) across all species analysed. For 74 fish species, occurring in Brazil, China, India, the Mekong basin, the United States, South‐Africa and the East Adriatic Coast, more than 50% of their range is potentially lost. This includes 18 species threatened with extinction across their whole range. Our complementary regional analysis revealed that the potentially lost range increases by a factor of 2–4 when considering both large and small dams compared with considering only large dams (≥15 m), highlighting the need to establish more comprehensive global dam inventories. Our novel approach and global analysis identifies species at risk of extirpation as well as geographic hotspots of extirpation threat by dams, which can aid in establishing more effective strategies for global hydropower development and barrier removal efforts to optimise the trade‐offs between biodiversity conservation and the socio‐economic benefits of dams.

Analysis of water, sanitation, and hygiene facilities using the WASH-FIT approach and its relation to patient satisfaction and maternal mortality at hospitals in Indonesia.

The provision of Water, Sanitation, and Hygiene (WASH) is critical to reducing infection and enhancing the quality of health care services. The study aims to assess WASH facilities in Indonesian hospitals using the Water, Sanitation, and Hygiene Facility Improvement Tool (WASH-FIT) approach and examine their association with customer satisfaction and maternal mortality owing to infection. We utilized the national scale Health Facilities Research dataset in Indonesian hospitals in 2019. WASH status is determined using WASH-FIT indicators, i.e., water, sanitation, waste management, hand hygiene, environmental cleaning, and management services, and then divided into three levels: poor, adequate, and good categories. The majority of hospitals in Indonesia had a good category, i.e., the range of hospitals with a good category was 79-97% nationally, in 6 aspects: water, sanitation, hand hygiene, environmental cleaning, and management services, except for waste management services (13%). Good WASH service facilities are more frequently found in government hospitals than in private and specialized hospitals, while lower-level hospitals tend to have poor levels of all WASH-FIT indicators. There are significant relationships between adequate sanitation services (β = 0.724), adequate and good categories of hand hygiene services (β = 0.712 and 0.866, respectively), environmental cleaning (β = -0.501 and -0.503, respectively), and management (β = -0.645 and 0.446, respectively), with the proportion of maternal mortality owing to infection. Furthermore, there was no relationship between WASH-FIT indicators and patient satisfaction, except for good hand hygiene services (β = 0.453). Despite good conditions in almost all WASH-FIT indicators, the improvement of waste management is urgently needed to improve the WASH services in hospitals in Indonesia, as also found in other developing countries.

Relationship Between Sleep Duration and Cognitive Function in Older Adults: Analysis of NHANES and UK Biobank GWAS Data.

To explore the relationship between sleep duration and cognitive functions in older adults using NHANES, a national US population study dataset, and to explore the causal association with Mendelian randomization (MR) using the UK Biobank. First, an observational study was conducted with the NHANES database with participants ≥60 years. Sleep duration was measured with accelerometers for 7 consecutive days. Participants were divided into habitual short sleep (<7h) and long sleep (>9h) groups. Cognitive functions were measured with the CERAD Word Learning sub-set, Animal Fluency, and Digit Symbol Substitution test (DSST). Multivariate regression models were used to explore relationships between sleep duration and cognitive functions. Second, bidirectional MR was conducted with data for self-reported sleep duration, which came from a genome-wide association study (GWAS) comprising 446,118 adults from the UK Biobank, and general cognitive performance, which was obtained from a recent GWAS study (N = 257,841). Inverse-variance weighted (IVW) was used as the primary estimation of the outcome. In the observational study, 2687 participants were included. Sleep duration was associated with cognitive functions in a non-linear way. Habitual long sleep (>9°h) was associated with lower scores on DSST (OR = 0.01, p = .003) in the fully-adjusted model. The association between habitual short sleep and cognitive functions was insignificant. For the MR, genetically predicted lower general cognitive performance was causally associated with a higher prevalence of habitual short sleep (OR = 0.97, p = 5.1 × 10-7) and long sleep (OR = 0.97, p = 8.87 × 10-16). Short and long sleep duration might be both causally associated with worse outcomes of cognitive functions in older adults, highlighting the importance of maintaining sleep health.

The risk of acute disseminated encephalomyelitis (ADEM) following covid-19 vaccination in England: A self-controlled case-series analysis

ABSTRACT Acute disseminated encephalomyelitis (ADEM) has been identified as an Adverse Event of Special Interest in the COVID-19 vaccine programme due to its long-standing temporal association with a wide range of other vaccines. Case reports of ADEM shortly following COVID−19 vaccination have now been documented. There were 217 ADEM admissions in 215 individuals in the period 8th December 2020 to 31st March 2023. An increased risk of ADEM following the first dose of ChAdOx1 vaccine was observed (relative incidence (RI) = 3.13, 95% Confidence Interval (CI) [1.56–6.25]) with a vaccine attributable risk of 0.39 per million doses. When doses 1 and 2 were combined this increased risk remained just significant (1.96 [95%CI 1.01–3.82]). No significant increased risk was observed with any other vaccine or dose. This small, elevated risk after the first dose of ChAdOx1-S vaccine demonstrates how large national electronic datasets can be used to identify very rare risks and provides reassurance that any risk of ADEM following the ChAdOx1-S COVID-19 vaccination is extremely small. Given the rarity of this risk, further studies in settings with access to data on large populations should be carried out to verify these findings.

Abstract WP66: Increases in Emergency Department Utilization of CT Angiography Brain and CT Perfusion in the Transferred Patient Population Across the Endovascular Therapy Era

Background: With the advent of endovascular therapy as a treatment modality for LVO stroke, the importance of stroke networks has become increasingly clear. We sought to understand the way advanced neuroimaging is utilized in transferred emergency department (ED) encounters using a large national dataset. Methods: Retrospective cohort study of adult ED encounters, comparing ED transfers (to other acute care hospitals) to discharged patients. Data from the 2013-2018 National Emergency Department Sample (NEDS), an AHRQ dataset containing a weighted 20% sample of US ED encounters were analyzed. CTA Head, CTP, MRI Brain, and Non-contrast CT Head imaging use was determined from Common Procedural Terminology (CPT) codes. ICD10 Codes I60-I69 were used to indicate cerebrovascular disease. Statistical comparisons used 95% CI for rate per 100,000 ED visits. Results: ED utilization of advanced neuroimaging was higher in transferred patients than discharged patients in all years studied (Fig). Between 2013 and 2018, utilization of CTA and CTP increased 8-fold and 20-fold, respectively in the transferred population. Noncontrast head CT and MRI were relatively stable but more frequent in transferred encounters. Between 2013 and 2018, encounters associated with a transfer came disproportionately from smaller hospitals (45% from hospitals with &lt;=20,000 ED visits per year, and 24% from ED visits at hospitals with between 20,000 and 40,000 ED visits per year). In 2018 transferred encounters with a CTA Head or CTP, 75% (72-77) and 76%(70-83), respectively had a diagnosis code associated with cerebrovascular disease. Conclusions: Utilization of CTA and CTP increased substantially between 2013-2018 in the ED transfer population, and most of these encounters are associated with a cerebrovascular disease diagnosis. Detailed diagnosis and hospital demographic data to be presented. These results have implications for the design and optimization of stroke systems of care.

Exploration of enfortumab vedotin (EV)–related cutaneous events by race in two real-world cohorts.

544 Background: EV is an antibody drug conjugate, approved in advanced urothelial cancer (UC). The Nectin-4 target of EV is present in tumor and normal skin, and EV-related cutaneous events (EVCEs) are common. EVCEs often appear early with variable grade presentation. Continuation of EV is typically safe with supportive management, but rare life-threatening manifestations have occurred. Dermatologic conditions, including medication-related skin events are often underdiagnosed or under-staged in Black patients (pts). Black pts are also frequently under-represented in UC trials, and it is unknown whether EVCE incidence varies by skin tone. We explored whether EVCE frequency varies between Black and White pts in an urban cohort and a large community-based national dataset. Methods: This retrospective cohort analysis used data from Johns Hopkins Hospital (JH) and Flatiron Health (FH), a de-identified electronic health record (EHR)-derived database of community-based oncology clinics across the U.S. Pts treated with EV monotherapy at JH and in the FH database who self-identified as Black or White race were included. In the JH cohort, chart review was used to extract demographics, treatment details, and EVCEs. EVCEs were defined as any grade, new or exacerbated dermatologic event after EV initiation, not attributed to other cause. In the FH cohort, EVCEs were identified through pre-defined skin-related ICD-10 codes identified by the study authors. Odds ratios (OR) with 95% confidence intervals of EVCE incidence between Black and White pts were calculated separately for each cohort. Results: 78 toxicity-evaluable pts were identified in the JH cohort and 316 in the FH cohort. 12 were Black (15.4%) in the JH Cohort vs. 24 Black (7.6%) in the FH cohort. Median age was 71 years (IQR: 64-78), 20 (25.6%) were female, 50 (64.1%) pts had a primary site in the bladder, and 13 (16.7%) had EV as second-line and 49 (62.8%) as third-line treatment in the JH cohort, vs. 71 years (IQR: 65-77), 84 females (26.6%), 226 (71.5%) with bladder primary site, and 122 (38.6%) and 108 (34.2%) receiving EV as second-and-third-line treatment respectively in the FH Cohort. In the JH Cohort 8 of 12 Black pts (66.7%) as compared to 32 of 58 (55.2%) White pts experienced an EVCE (Table, OR 1.63, 95% CI [0.44, 6.0]). In the FH cohort, 6/24 Black pts (25%) compared to 46 /292 White pts (15.8%) experienced an EVCE (Table, OR 1.78, 95% CI [0.67, 4.73]). Conclusions: In this hypothesis-generating analysis of EV treated pts, the largest reported cohort of Black EV treated pts to date, we observed an increased EVCE frequency in Black pts relative to White, though statistical significance was not demonstrated. Future prospective EV studies should aim to recruit Black patients to better characterize this finding. [Table: see text]

Post-Menarcheal Growth Patterns in a Contemporary Cohort of Latino Girls

Introduction: Menarche is the last stage of pubertal development, which coincides with the completion of longitudinal growth. As a consequence of the lack of national and up-to-date data related to post-menarcheal (PM) growth, the aim of our work was to evaluate PM growth in a group of contemporary healthy Chilean girls followed, prospectively, until 4 years PM. Methods: This study was nested within the GOCS cohort, in a prospective fashion. The girls were followed yearly after menarche for at least for 4 years. We modeled each girl’s growth using a SuperImposition by Translation and Rotation (SITAR) model. Results: A total of 534 girls were evaluated prospectively; 399 girls had height measured 2 years after menarche, 421 after 3 years, and 364 of 534 had height measured at 4 years PM. Expected height gained PM in the complete study group was 6.6 ± 2.5 cm. We observed that the largest gain in height occurred after the first year PM (3.8 ± 1.5 cm). According to the age of menarche, the group with earlier menarche (p Conclusion: In a national and updated dataset, we observed that girls grew until 4 years PM an average of 6.6 ± 2.5 cm, with greatest gain occurring in the first year PM (3.8 ± 1.5 cm). Age at menarche was associated with menarche growth patterns.

Establishment of a Latin American dataset to enable the construction of gestational weight gain charts for adolescents.

Gestational weight gain is an important indicator for monitoring nutritional status during pregnancy. However, there are no gestational weight gain references created for adolescents or national datasets to enable the construction of such graphs up to date. This manuscript aims to describe the creation of a Latin American dataset to construct gestational weight gain references for adolescents aged 10-19 years old. Gestational weight gain data from studies conducted in nine countries (Argentina, Brazil, Chile, Colombia, Mexico, Panama, Paraguay, Peru, and Uruguay) collected between 2003 and 2021 were harmonized. Data on height, weight, and gestational age in at least two gestational trimesters were included. Pregnant adolescents should be free of diseases that could affect weight, and newborns should weigh between 2,500-4,000 g and be free of congenital malformations. The final dataset included 6,414 individuals after data cleaning. Heterogeneity between the countries was assessed by calculating standardized site differences for GWG and z scores of height-for-age. Several imputation procedures were tested, and approximately 10% of the first-trimester weights were imputed. The prevalence of individuals with underweight (1.5%) and obesity (5.3%) was low, which may lead to problems when modeling the curves for such BMI categories. Maternal height and gestational weight gain did not show significant differences by country, according to the standardized site differences. A harmonized dataset of nine countries with imputed data in the first trimester of pregnancy was prepared to construct Latin American gestational weight gain curves for adolescents.

Revealing the hidden carbon in forested wetland soils

Inland wetlands are critical carbon reservoirs storing 30% of global soil organic carbon (SOC) within 6% of the land surface. However, forested regions contain SOC-rich wetlands that are not included in current maps, which we refer to as ‘cryptic carbon’. Here, to demonstrate the magnitude and distribution of cryptic carbon, we measure and map SOC stocks as a function of a continuous, upland-to-wetland gradient across the Hoh River Watershed (HRW) in the Pacific Northwest of the U.S., comprising 68,145 ha. Total catchment SOC at 30 cm depth (5.0 TgC) is between estimates from global SOC maps (GSOC: 3.9 TgC; SoilGrids: 7.8 TgC). For wetland SOC, our 1 m stock estimates are substantially higher (Mean: 259 MgC ha−1; Total: 1.7 TgC) compared to current wetland-specific SOC maps derived from a combination of U.S. national datasets (Mean: 184 MgC ha−1; Total: 0.3 TgC). We show that total unmapped or cryptic carbon is 1.5 TgC and when added to current estimates, increases the estimated wetland SOC stock to 1.8 TgC or by 482%, which highlights the vast stores of SOC that are not mapped and contained in unprotected and vulnerable wetlands.

Predictive cut-off values for the triglyceride-to-high-density lipoprotein cholesterol ratio to predict metabolic syndrome in the middle-aged Korean population

Background and aimsThe triglyceride-to-high density lipoprotein cholesterol (TG/HDL) ratio is associated with insulin resistance related diseases, including metabolic syndrome (MetS). However, specific TG/HDL values that can predict MetS have not been well identified. In this study, we analyzed both cross-sectional and longitudinal data from two national Korean datasets to obtain TG/HDL cut-off values that can identify MetS and predict its occurrence. Methods and resultsTo distinguish the presence and occurrence of MetS, the cut-off values were determined using the maximum F-score calculated through a logistic regression analysis. To predict new-onset MetS within 10 years, Cox proportional hazard models were used to consider the time of occurrence. The TG/HDL cut-off values of 3.97, 3.24, and 3.24 were optimal for identifying current MetS and predicting new-onset MetS within 10 years and five years, respectively, in Korean men. In Korean women, the optimal values for each task were 3.18, 2.38, and 2.26, respectively. ConclusionsWe suggest the TG/HDL ratio as a potential candidate predictor for MetS. Therefore, we anticipate that future studies will apply individual lipid levels as well as their combinatory values to establish models that predict the prevalence and occurrence of MetS, diabetes, and cardiovascular disease.

Association of ethnicity with unintentional injury-related hospitalisation and mortality among older people residing in two regions of Aotearoa New Zealand.

To characterise unintentional injury-related hospitalisation and mortality amongst older adults (aged 50+ years) in the Lakes and Bay of Plenty District Health Boards of Aotearoa New Zealand and to examine whether hospitalisation patterns differed by ethnicity. This observational study analysed unintentional injury-related hospitalisations and deaths among older adults between 2014 and 2018. Routinely collected national data sets were used to calculate annualised, age-standardised injury rates. The independent variable of interest was ethnicity (Māori or non-Māori). There were 11,834 unintentional injury-related hospitalisations in the study period (n = 1444 for Māori). Overall, there was no significant difference in the age-standardised hospitalisation rate between Māori and non-Māori (Standardised Rate Ratio [SRR] = 0.96 [95% CI 0.90, 1.02]). Falls were the most common mechanism of injury among Māori and non-Māori overall (50% and 71%) and relative risks of falls increased with age. Non-Māori were 57% less likely to be hospitalised for unintentional poisoning than Māori (SRR = 0.43, [0.34, 0.59]). The mechanisms of injury, and variation in unintentional injury-related hospitalisation rates between Māori and non-Māori, change throughout older age, and incidence increase0073 with age. Falls cause significant injury-related hospitalisations for older Māori and responsive injury prevention and rehabilitation efforts are warranted to achieve equitable health outcomes.

Deep evolutionary fusion neural network: a new prediction standard for infectious disease incidence rates

BackgroundPreviously, many methods have been used to predict the incidence trends of infectious diseases. There are numerous methods for predicting the incidence trends of infectious diseases, and they have exhibited varying degrees of success. However, there are a lack of prediction benchmarks that integrate linear and nonlinear methods and effectively use internet data. The aim of this paper is to develop a prediction model of the incidence rate of infectious diseases that integrates multiple methods and multisource data, realizing ground-breaking research.ResultsThe infectious disease dataset is from an official release and includes four national and three regional datasets. The Baidu index platform provides internet data. We choose a single model (seasonal autoregressive integrated moving average (SARIMA), nonlinear autoregressive neural network (NAR), and long short-term memory (LSTM)) and a deep evolutionary fusion neural network (DEFNN). The DEFNN is built using the idea of neural evolution and fusion, and the DEFNN + is built using multisource data. We compare the model accuracy on reference group data and validate the model generalizability on external data. (1) The loss of SA-LSTM in the reference group dataset is 0.4919, which is significantly better than that of other single models. (2) The loss values of SA-LSTM on the national and regional external datasets are 0.9666, 1.2437, 0.2472, 0.7239, 1.4026, and 0.6868. (3) When multisource indices are added to the national dataset, the loss of the DEFNN + increases to 0.4212, 0.8218, 1.0331, and 0.8575.ConclusionsWe propose an SA-LSTM optimization model with good accuracy and generalizability based on the concept of multiple methods and multiple data fusion. DEFNN enriches and supplements infectious disease prediction methodologies, can serve as a new benchmark for future infectious disease predictions and provides a reference for the prediction of the incidence rates of various infectious diseases.

Analysis of England's incident and mental health nursing workforce data 2015-2022.

INTRODUCTION: There is a paucity of empirical data examining incidents and mental health nurses and the relationship between the two remains uncertain. Comparison of English national data for incidents and nursing workforce to examine recent trends. Descriptive analysis of two national datasets of incidents and workforce data for England between 2015 and 2022. A 46% increase in incidents was found; the leading causes are self-harm and aggressive behaviour. Despite the rise in adverse incident reporting, a 6% increase in mental health nurses was found, with more nurses in community settings than hospitals. Current services are incident reporting at greater concentrations than in previous years. Patient-related behaviour continues to be most prominently reported, rather than possible antecedent health services issues that may contribute to reporting. Whilst staffing has increased, this does not seem to have kept pace with the implied workload evident in the increase in incident reports. Greater emphasis should be placed on health service behaviour in reporting mechanisms. Self-harm and aggression should continue to be considered adverse outcomes, but causal health service factors, such as missed care, should be present in pooled reporting to help reduce the occurrence of adverse outcomes.

Computerized adaptive testing to screen pre-school children for emotional and behavioral problems.

Questionnaires to detect emotional and behavioral (EB) problems in preventive child healthcare (PCH) should be short; this potentially affects their validity and reliability. Computerized adaptive testing (CAT) could overcome this weakness. The aim of this study was to (1) develop a CAT to measure EB problems among pre-school children and (2) assess the efficiency and validity of this CAT. We used a Dutch national dataset obtained from parents of pre-school children undergoing a well-child care assessment by PCH (n = 2192, response 70%). Data regarded 197 items on EB problems, based on four questionnaires, the Strengths and Difficulties Questionnaire (SDQ), the Child Behavior Checklist (CBCL), the Ages and Stages Questionnaire: Social Emotional (ASQ:SE), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Using 80% of the sample, we calculated item parameters necessary for a CAT and defined a cutoff for EB problems. With the remaining part of the sample, we used simulation techniques to determine the validity and efficiency of this CAT, using as criterion a total clinical score on the CBCL. Item criteria were met by 193 items. This CAT needed, on average, 16 items to identify children with EB problems. Sensitivity and specificity compared to a clinical score on the CBCL were 0.89 and 0.91, respectively, for total problems; 0.80 and 0.93 for emotional problems; and 0.94 and 0.91 for behavioral problems. Conclusion: A CAT is very promising for the identification of EB problems in pre-school children, as it seems to yield an efficient, yet high-quality identification. This conclusion should be confirmed by real-life administration of this CAT. What is Known: • Studies indicate the validity of using computerized adaptive test (CAT) applications to identify emotional and behavioral problems in school-aged children. • Evidence is as yet limited on whether CAT applications can also be used with pre-school children. What is New: • The results of this study show that a computerized adaptive test is very promising for the identification of emotional and behavior problems in pre-school children, as it appears to yield an efficient and high-quality identification.

Examining the impacts of urban, work and social environments on residents’ subjective wellbeing: a cross-regional analysis in China

Introduction: Urbanization has affected the quality of the living environments. It is important to improve residents’ living environments and promote their happiness.Methods: We use a national and representative dataset targeting the labor force in China, collecting basic information about the work environments, the social environments, and the urban environments. This work employed a linear regression model to investigate the influencing factors of residents’ SWB.Results: The three major findings are as follows: 1) At the national level, residents’ SWB exhibits a notable spatial variability, being higher in the northern regions and lower in the southern areas. 2) The dimensions of the urban environments (housing prices, POI density, NPP, land development intensity and the number of tertiary hospitals), the work environments (work pressure and job satisfaction), and the social environments (community trust, social justice and sense of security), along with sociodemographic characteristics, significantly influence SWB. 3) In China, the impacts on SWB exhibit pronounced regional heterogeneity. The relationship between environmental pollution and SWB is characterized by an inverted U-shaped pattern. Intriguingly, while housing prices negatively affect SWB in the eastern and central regions, the enforcement of housing purchase limits has been observed to enhance residents’ SWB in the western region.Discussion: First, this work show the overall spatial level of SWB in China geographically. And second, this research found the SWB heterogeneity on a regional level (eastern, central, and western regions). Furthermore, this methodological framework provides a novel perspective among the urban, work and social environments on SWB. This work also contributes to inform policy to improve residents’ SWB in China.

Investigating the academic attainment and progress of children in receipt of individual counselling: A matched comparison study of primary school age children in England

AbstractIntroductionIn 2016, the UK government identified the need for counselling services in schools to be evidence‐based (Department for Education, 2016). While there is more empirical evidence on counselling and improvement in mental health (Daniunaite et al., Counselling and Psychotherapy Research, 2015, 15, 251; Finning et al., European Child &amp; Adolescent Psychiatry, 2022, 31, 1591), less is known about the associations of counselling with children's academic attainment and progress.MethodThe aim of the paper was to provide more pieces of evidence on the possible associations between school‐based individual counselling and the academic attainment and progress of primary school–aged children. The academic outcomes of children receiving one‐to‐one counselling were compared with those of children who did not receive counselling, but who had similar background characteristics. Coarsened exact matching method was used to match similar children for these comparisons based on national data sets available in England. Data were analysed with inferential statistics and multilinear regression.FindingsBefore matching the samples, analyses revealed children attending Place2Be's counselling services were significantly more likely to be boys (56.6% vs. 51.1%), of ethnic minority origin (46.4% vs. 21.5%), eligible for free school meals (FSM; 52.7% vs. 16.9%) and have special educational needs and disabilities (SEND) status (43.1% vs. 21.1%) than the comparison group. They also had lower academic attainment than children who were not in counselling. However, after a coarsened exact matching on relevant background characteristics, the Place2Be sample was found to have similar levels of academic progress to the matched national sample, suggesting they did not fall behind similar children.ConclusionsFindings indicate that individual school‐based counselling may be helpful as a potential intervention for supporting vulnerable children's (defined as those identified by schools or parents as in need of individual counselling) academic progress in primary schools, as well as socio‐emotional outcomes; however, further research is needed.