Robust Variance Estimation Research Articles

Cardiorespiratory fitness, body mass index and mortality: a systematic review and meta-analysis

ObjectiveThe purpose of this review was to assess the joint relationship of cardiorespiratory fitness (CRF) and Body Mass Index (BMI) on both cardiovascular disease (CVD) and all-cause mortality risk.DesignA systematic review and meta-analysis was conducted. Pooled HR and 95% CI were calculated using a three-level restricted maximum likelihood estimation random-effects model with robust variance estimation. The reference group was normal weight-fit and was compared with normal weight-unfit, overweight-unfit and fit, and obese-unfit and fit.Data sourcesElectronic databases (PubMed/MEDLINE, Web of Science and SportDiscus) were searched following registration on PROSPERO.Eligibility criteriaArticles meeting the following criteria were included: (1) published between January 1980 and February 2023, (2) prospective cohort study, (3) CRF assessed using a maximal or VO2peak exercise test, (4) BMI reported and directly measured, (5) joint impact of CRF and BMI on all-cause mortality or CVD mortality were analysed, and (6) the reference group was normal weight, fit individuals.Results20 articles were included in the analysis resulting in a total of 398 716 observations. Compared with the reference group, overweight-fit (CVD HR (95% CI): 1.50 (0.82–2.76), all-cause HR: 0.96 (0.61–1.50)) and obese-fit (CVD: 1.62 (0.87–3.01), all-cause: 1.11 (0.88–1.40)) did not have a statistically different risk of mortality. Normal weight-unfit (CVD: 2.04 (1.32–3.14), all-cause: 1.92 (1.43–2.57)), overweight-unfit (CVD: 2.58 (1.48–4.52), all-cause: 1.82 (1.47–2.24)) and obese-unfit (CVD: 3.35 (1.17–9.61), all-cause: 2.04 (1.54–2.71)) demonstrated 2–3-fold greater mortality risks.ConclusionsCRF is a strong predictor of CVD and all-cause mortality and attenuates risks associated with overweight and obesity. These data have implications for public health and risk mitigation strategies.

Advancing Interpretable Regression Analysis for Binary Data: A Novel Distributed Algorithm Approach.

Sparse data bias, where there is a lack of sufficient cases, is a common problem in data analysis, particularly when studying rare binary outcomes. Although a two-step meta-analysis approach may be used to lessen the bias by combining the summary statistics to increase the number of cases from multiple studies, this method does not completely eliminate bias in effect estimation. In this paper, we propose a one-shot distributed algorithm for estimating relative risk using a modified Poisson regression for binary data, named ODAP-B. We evaluate the performance of our method through both simulation studies and real-world case analyses of postacute sequelae of SARS-CoV-2 infection in children using data from 184 501 children across eight national academic medical centers. Compared with the meta-analysis method, our method provides closer estimates of the relative risk for all outcomes considered including syndromic and systemic outcomes. Our method is communication-efficient and privacy-preserving, requiring only aggregated data to obtain relatively unbiased effect estimates compared with two-step meta-analysis methods. Overall, ODAP-B is an effective distributed learning algorithm for Poisson regression to study rare binary outcomes. The method provides inference on adjusted relative risk with a robust variance estimator.

Faecal biomarkers in children with coeliac disease: A way forward?

Novel markers to reflect the intestinal damage in coeliac disease are needed. We studied the potential of faecal and serum neopterin, and faecal myeloperoxidase, human β-defensin-2, and lipocalin-2 in a case-control study. Data were collected from medical records and a biobank including newly diagnosed coeliac disease patients, potential coeliac disease patients and non-coeliac controls. Commercially available ELISA assays were used for measuring the biomarkers. Altogether 19 patients with coeliac disease (median age 9.0 years), 8 with potential coeliac disease (4.0 years) and 18 controls (6.5 years) were included. The highest faecal neopterin levels were seen in potential coeliac disease, followed by controls and coeliac disease (median 513 vs. 372 vs. 255 nmol/L, respectively, p = 0.016). Also, serum neopterin was highest in the potential coeliac disease group (9.8 vs. 5.5 vs. 5.9 nmol/L, p = 0.022). After age adjustment and robust variance estimation, only differences in serum neopterin remained significant. Other markers did not differ between the groups. None of the markers were significantly associated with serum transglutaminase-2 antibody levels. Differences in neopterin levels amongst patients with potential coeliac disease, coeliac disease, and controls suggest that neopterin might serve as an early disease marker.

Who am I? A second-order meta-analytic review of correlates of the self in childhood and adolescence.

People's subjective beliefs about themselves affect what people think and, consequently, what they do. Positive self-beliefs are important for many life outcomes, from academic success to well-being, especially during K-12 education as a crucial developmental period. Many empirical studies and meta-analyses have examined correlates of self-beliefs. The present second-order meta-analytic review integrates this large and diverse body of research, addressing two research aims: First, we examined the comparative strength of different variables related to self-beliefs. Second, we provide a methodological review of meta-analyses in this area, thereby facilitating readers' ability to assess the risk of bias when interpreting the results. We summarized 105 first-order meta-analyses published before July 2023 that investigated variables associated with self-beliefs during K-12 education, comprising 493 first-order effect sizes based on more than 8,500 primary studies and more than 16 million children and adolescents. We computed second-order standardized mean differences (SMD) using two-level meta-analyses with robust variance estimation. Personal characteristics (SMD = 0.50) showed stronger relations with self-beliefs than interventions (SMD = 0.27). Achievement (SMD = 0.66) and noncognitive variables (SMD = 0.67) were the personal characteristics most strongly related to self-beliefs compared to cognitive abilities (SMD = 0.30) and background variables (SMD = 0.21). Interventions targeting individual characteristics (SMD = 0.35) and especially self-beliefs (SMD = 0.52) showed larger effect sizes than interventions that focused on improving teaching and classroom structure (SMD = 0.20). Few meta-analyses investigated situational aspects, such as the geographical origin of the sample, in association with children's and adolescents' self-beliefs. Overall, this second-order meta-analytic review provides a comprehensive map of correlates of the self, highlighting pathways for future research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of dose, dietary nutrient composition, and supplementation period on the efficacy of methane mitigation strategies in dairy cows: A meta-analysis

The objective of this meta-analysis was to quantify the potential of CH4-mitigating strategies in dairy cattle when accounting for the effects of treatment dose, dietary nutrient composition, and supplementation period. Data from 218 studies with dairy cattle published between 1963 to 2022 were reviewed. Individual CH4 mitigation strategies selected for the analysis were algae (Asparagopsis spp.), 3-nitrooxypropanol, nitrate, lipids, plant secondary compounds, and direct-fed microbials (DFM). Response variables evaluated were daily CH4 emission (g/d), CH4 yield (g CH4/kg DMI), and CH4 intensity (g CH4/kg milk yield [MY] and ECM). Relative mean difference between treatment and control means reported in the studies were calculated and used in the statistical analysis. Robust variance estimation method was used to analyze the effects of CH4 mitigation strategies. Dose, forage-to-concentrate ratio (F:C), dietary concentrations of CP, ether extract (EE), NDF, ADF, and starch, and supplementation period were used as continuous explanatory variables. Data for algae supplementation were limited and responses to studied species were contrasting but, overall, Asparagopsis spp. effectively decreased daily CH4 emission, CH4 yield, and CH4 intensities by 29.8 ± 4.6%, 23.0 ± 5.3%, 34.0 ± 4.3%, and 22.6 ± 7.3%, respectively. Supplementation of 3-nitrooxypropanol decreased daily CH4 emission, yield, and intensity (per kg MY and ECM) by 28.2 ± 3.6%, 28.7 ± 2.8%, 29.2 ± 3.1%, and 31.8 ± 2.8%, respectively, compared with control. Decreasing dietary fiber (i.e., F:C, NDF, and ADF), whereas increasing dietary starch concentration increased the efficacy of 3-nitrooxypropanol at mitigating enteric CH4 emission. Nitrate supplementation decreased CH4 emission, yield, and intensity (per kg ECM) by 18.5% ± 1.9%, 17.6 ± 1.6%, and 13.0 ± 0.2%, respectively, compared with control. Efficacy of nitrate at mitigating enteric CH4 yield and CH4 intensity was positively associated with dose, and efficacy of nitrate at mitigating CH4 yield was positively associated with dietary starch concentration. Lipid supplementation decreased CH4 emission, yield, and intensities by up to 14.8 ± 2.3%, respectively, compared with control. Efficacy of lipids supplementation was positively associated with dietary EE, starch, and supplementation period, but negatively associated with dietary ADF concentration. Free oil supplementation tended to increase lipid efficacy by 31% at decreasing CH4 emission, compared with control. Condensed tannins and plant-derived bioactive compounds decreased CH4 yield by 11.3 ± 2.9% and 5.7 ± 2.5%, respectively, but oregano did not affect enteric CH4 emission metrics in the current meta-analysis. Direct-fed microbials were not effective in mitigating enteric CH4 emission variables. Data were limited to determine the effects of dietary nutrients and duration of supplementation on efficacy of Asparagopsis spp., plant secondary compounds and DFM. Overall, supplementation of the diet with Asparagopsis spp., 3-nitrooxypropanol, nitrate, and lipids were the most effective strategies for decreasing enteric CH4 emission in dairy cattle. Variability in the efficacy of most CH4 mitigation strategies can be partially explained by differences in treatment dose, dietary nutrient composition, and supplementation period.

Association between SMOFlipid and impaired brain development on term-equivalent age brain magnetic resonance imaging in very preterm infants

Soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid) is used without evidence of benefits. We investigated the relationship between lipid emulsions and brain injury in term-equivalent age magnetic resonance imaging (MRI) in 148 very preterm infants with a birth weight of < 1500 g at ≤ 32 gestational weeks in a neonatal intensive care unit. Infants who received soybean-based lipid emulsions between January 2015 and December 2018 were compared with those who received SMOFlipids between January 2019 and December 2022. A negative binomial generalized linear model was applied for bivariate analysis. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber–White) were applied to adjust for potential confounders. The Kidokoro score was used to determine if lipid emulsion type would affect brain morphology and growth at term-equivalent age. Eighty-six (58.9%) received SMOFlipid. SMOFlipid was associated with lower focal signal abnormality, myelination delay, increased extracerebral space, and cerebellar volume reduction (P = 0.02, P = 0.007, P = 0.01, P = 0.02, respectively). SMOFlipidis are associated with brain insult, especially in white matter, cortical gray matter, and the cerebellum. Well-designed studies are needed to investigate the effect of lipid emulsions on the central nervous system.

A Meta-Analytic Review of Personality and Teacher-Student Relationships.

This meta-analysis provides the first comprehensive synthesis of associations between student and teacher personality traits and the quality of teacher-student relationships. Fifty-five studies met the eligibility criteria, contributing a total of 238 effect sizes. We used multivariate meta-analysis with robust variance estimation (RVE) to model the dependency of effect sizes. Student prosocial behavior (ρ = 0.59) and proactive personality (ρ = 0.48) were the strongest predictors of positive teacher-student relationship quality. All Big Five traits of students, except neuroticism, showed significant positive associations, with all correlations exceeding 0.4 when holding constant with all other moderators. Teacher agreeableness (ρ = 0.31) and conscientiousness (ρ = 0.29) yielded modest associations. Students with less emotional stability or aggressive behaviors were more likely to experience negative teacher-student relationships, such as conflict and dependency. Our findings highlight the critical role of student personality in explaining the quality of teacher-student interactions. Multiple traits appear equally important, as indicated by comparable effect sizes. The literature is relatively limited when it comes to teacher personality. We were unable to examine teacher traits in relation to teacher-student conflict and dependency, but, overall, agreeable and conscientious teacher behaviors appeared to be important for favorable interactions, whereas teacher neuroticism may undermine the quality of such interactions.

Population trends and demographic disparities in sexual identity in Stockholm County, 2010 to 2021

Abstract Background Sexual identity, linked to experiences of disadvantage and discrimination, is crucial in equality monitoring. Sweden’s gender-neutral marriage laws, introduced in 2009, provide a unique context. This study examines the population trends and demographic disparities in sexual identity over time. Methods We analyzed three population surveys (2010, 2014, 2021) from the Stockholm Public Health Cohort, including around 50,000 individuals per survey. Sexual identity was assessed via self-administered questionnaires. Demographic data were sourced from Swedish national registers. Weighted multivariate Poisson regression with robust variance estimators was used to identify demographic disparities in sexual identity. Results were presented as proportion ratio (PR) with 95% confidence interval (CI). Results Overall, 29,607 (2010), 20,249 (2014), and 22,558 (2021) individuals reported sexual identity. Heterosexual identity decreased from 95.7% (95% CI 95.4-96.0%) in 2010 to 89.0% (88.5-89.4%) in 2021, while bisexual identity increased from 1.4% (1.2-1.6%) in 2010 to 2.0% (1.8-2.3%) in 2014, and further up to 2.7% (2.4-2.9%) in 2021. Homosexual identity increased slightly from 1.5% (1.4-1.7%) in 2010 to 1.8% (1.6-2.0%) in 2021. Multivariate analyses showed that female, older age, and lower education were inversely associated, while never-married status and living alone were positively associated, with homosexual identity. In contrast, female, younger age, lower income (100 SEK/year) ( &amp;lt; =2,500 vs &amp;gt; 4,500: 2010: PR 3.32 [95% CI 1.92-5.75]; 2014: 1.83 [1.28-2.60]; 2021: 1.51 [1.14-2.01]), and never-married status (never vs currently married: 2010: 2.03 [1.47-2.80]; 2014: 1.92 [1.39-2.65]; 2021: 1.50 [1.15-1.95]) were positively associated with bisexual identity. Conclusions Heterosexual identity decreased while homosexual/bisexual identities increased in Stockholm County during 2010-2021. Socioeconomic disparities persist in sexual minorities and vary by sexual identity. Key messages • Marked socioeconomic disparities persist in sexual minorities and vary by sexual identity in Stockholm County, although income and marital status disparities in bisexual group seem narrowing. • Future studies are warranted to investigate the social dynamics that continue to produce sexual minority disadvantages.

Individual fluidity of sexual identity in Stockholm County, 2010 to 2021

Abstract Background Sexual fluidity is key to understanding the size of sexual minority populations and analyzing the socioeconomic disparities these populations face. This study explores the stability and changes in sexual identity over time, and identifies key demographic factors that predict shifts in sexual identity. Methods We analyzed longitudinal data from the Stockholm Public Health Cohort, following 36,398 participants from 2010 to 2021. Sexual identity was measured using a self-administered questionnaire in 2010, 2014, and 2021. Demographic data from 2010 were collected from the Swedish national registers. Multivariate Poisson regression with robust variance estimators was used to identify demographic factors that predicted identity changes. Results were presented as proportion or risk ratio (RR) with 95% confidence interval (CI). Results Overall, 12.1% (95% CI 11.8%-12.5%) changed sexual identity at least once in 2010-2021, including 10.4% (10.0%-10.7%) among those initially identifying as heterosexual in 2010, 41.3% (37.1%-45.6%) as homosexual, 59.6% (55.0%-64.0%) as bisexual, and 65.0% (59.4%-70.3%) as uncertain. Multivariate analyses showed that sexual minorities (homosexual: RR 5.00, 95% CI 4.45-5.61; bisexual: 6.68, 6.04-7.38; uncertain: 3.88, 3.30-4.55), females (1.28, 1.21-1.35), younger (18-29 years: 1.49, 1.30-1.70) and older ( &amp;gt; =60 years: 2.07, 1.92-2.22) ages, born outside Sweden (Europe: 1.21, 1.11-1.32; Outside Europe: 2.90, 2.62-3.21), and lower education ( &amp;lt; =9 years: 2.14, 1.98-2.31; 10-12 years: 1.43, 1.34-1.53) and income (100 SEK/year) ( &amp;lt; =2,500: 1.83, 1.66-2.02; (2,500, 3,500]: 1.32, 1.19-1.46) independently predicted a higher probability of identity changes. Conclusions This study provides the first insights into sexual identity fluidity in a large general population sample in Sweden, highlighting its fluid nature. Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity. Key messages • This study provides the first insights into sexual identity fluidity in Sweden, highlighting its fluid nature. • Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity.

Long-term outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in women with severe coronary artery disease

Abstract Background The optimal revascularization strategy for severe coronary artery disease (CAD) in women remains controversial. Despite differences between women and men in the development of CAD, there remains a paucity of comparative real-world observational evidence comparing percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in women. Purpose We evaluated short and long-term outcomes of PCI and CABG in women with severe CAD. Methods We conducted a propensity score-matched retrospective cohort study using linked clinical and administrative databases in Ontario, Canada to obtain records of women with left main, 3-vessel disease, or 2-vessel disease with proximal left anterior descending artery involvement undergoing PCI or CABG from April 1st, 2012 to December 31st, 2021. Patients who were &amp;gt;80 years of age and patients who underwent urgent or emergent procedures were excluded for the primary analysis. The primary outcome was a composite of myocardial infarction, stroke, repeat revascularization, and death (MACCE). Secondary outcomes included the individual components of MACCE and a composite of readmission for MI, heart failure, and stroke. Following multiple imputation and propensity score-matching, the Cox proportional hazards model and Fine-Gray sub-distribution hazard model with robust variance estimators accounting for death as a competing risk were used to evaluate long-term outcomes. Results In the primary cohort, 2469 patients underwent PCI and 3,721 patients underwent CABG. After propensity score matching, including by coronary disease territory, 2,033 well-balanced pairs were identified, with standardized mean differences &amp;lt;0.10 for all covariates. In-hospital death and stroke were significantly lower with PCI than with CABG (0.7% vs 1.5%, p=0.036) and (&amp;lt;0.2% vs 1.4%, p&amp;lt;0.001), respectively, and there was no difference in perioperative MI between PCI and CABG (1.1% vs 0.6%, p=0.121). At a median (IQR) of 5.1 (2.9-7.5) years, major adverse cardiac and cerebrovascular events (MACCE) was higher with PCI compared with CABG (37.7% vs 23.3%, HR 1.79, [95% CI: 1.66-1.91], p&amp;lt;0.001) (Figure 1). All-cause mortality was higher with PCI compared with CABG (17.8% vs 13.4%, HR 1.33, [95% CI: 1.21-1.45], p&amp;lt;0.001) (Figure 2). The composite readmission outcome (MI, heart failure, stroke) was higher with PCI compared with CABG (16.2% vs 11.2%, HR 1.42, [95% CI: 1.37-1.48], p&amp;lt;0.001). Conclusion In women with severe CAD, CABG appears to be associated with a long-term reduction in MACCE and mortality compared with PCI. Our findings provide evidence to suggest women with severe CAD may derive greater long-term benefit from CABG compared to PCI and suggest that the treatment recommendation should shift towards CABG in appropriately selected women.Figure 1.MACCE free survivalFigure 2.Overall survival

Social Relationships and Tooth Loss in Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis.

To systematically assess current evidence on the extent to which social relationships are associated with tooth loss in adults aged 60 years and older. A systematic literature search was conducted on PubMed, Embase, Web of Science, CINAHL and The Cochrane Library databases to identify relevant studies published from 1966 up to March 2024. Cross-sectional or cohort studies investigating the association between structural, functional and/or combined (structural and functional) components of social relationships and the number of remaining teeth or edentulism among community-dwelling or institutionalised older adults were included. Data were extracted on participants' and study characteristics, including study design, the type of measures used to assess social relationships (structural, functional, and combined), outcome measures and association estimates. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the adapted NOS for cross-sectional studies. The reported association between social relationships and the number of remaining teeth or edentulism was summarised using meta-analysis with robust variance estimation. Twenty studies were included in the review and 12 studies (125 553 participants) in the meta-analysis. Across the 12 studies, the average odds ratio (95% confidence interval) was 1.15 (1.01-1.32), indicating a 15% higher likelihood of having a lower number of teeth or edentulism for those with weaker social relationships. The GRADE certainty of the body of evidence was low. Weak social relationships were associated with a lower number of teeth or edentulism in older adults. Our findings may inform potential public health approaches that target and modify social relationships to prevent and address older adults' oral diseases. Still, the directionality and the underlying mechanisms connecting social relationships and tooth loss need to be further explored by longitudinal studies with follow-up long enough for oral health outcomes or changes in social relationships to occur. Protocol Registration: PROSPERO (CRD42023417845).

Group-based versus individual parenting programs: A meta-analysis of effects on parents.

Parenting programs aim to motivate change in parents' behaviors, perceptions, and knowledge to promote desirable changes in children's adjustment and behavior. Parenting programs are typically delivered in a group-based or individual format, and it is unknown which format most effectively supports parents. On the one hand, group-based programs may be more effective since they provide access to peer-based support. On the other hand, individual programs may be more successful since they offer a tailored approach. Therefore, this meta-analysis investigated which delivery format is most effective in optimizing child behavior management (i.e., positive reinforcement and nonviolent discipline), parenting stress, and parental depressive symptoms. Studies were selected from the systematic review by Backhaus et al. (2023). Our sample included evaluations of 121 group-based and 41 individual programs based on social learning theory principles. Robust variance estimation indicated that parents' child behavior management and parenting stress improved in both delivery formats. In contrast, parental depressive symptoms improved only in group-based programs. Our findings suggest that whether parents benefit more from a group-based or individual program in part depends on the outcome examined. Therefore, it is important for clinicians to understand parents' goals to effectively guide them toward the most appropriate parenting program delivery format. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The link between digital gaming and creativity: a meta analysis

ABSTRACT This study explored the relationship between digital gaming and creativity by conducting a meta-analysis of effect sizes using data from 78 effect sizes in 19 studies encompassing 3,172 samples. We employed a two-level multivariate model with a robust variance estimator and conducted separate analyses for between-subject and within-subject designs. For the between-subject designs, the mean effect size was r = .109, 95% [−0.036, 0.249], indicating non-significance. We conducted moderator analyses to explore potential sources of variation in the observed effects, including creativity test modality, creativity test type, divergent thinking index, analytical approach, age, gender, and year of publication. None of the examined moderators were found to be statistically significant. In contrast, we observed a significant mean effect size for within-subject designs based on 29 effects from seven studies (r = .772, 95% CI [0.595, 0.878]). Variation in mean effects by study design warrants caution when making inferences about the impact of digital gaming on creativity. The implications and limitations of the findings are discussed.

Understanding the mechanisms of change in social norms around tobacco use: A systematic review and meta-analysis of interventions.

Tobacco use spreads through social networks influencing social norms around tobacco use. However, the social norms scholarship is extremely diverse and occasionally conflicting, complicating efforts to understand how best to leverage social norms to reduce tobacco use. This study systematically reviewed and meta-analyzed this vast terrain by focusing on social norms measurement and mechanism, and intervention effectiveness and modality aimed at changing social norms around tobacco use and actual tobacco use. We searched Scopus, PubMed, PsycInfo, Clinicaltrials.gov, ProQuest Dissertations, the Cochrane Trial Registry, as well as the websites of the Society for Research on Nicotine and Tobacco, the Open Science Framework, medrXiv and the Truth Initiative for experimental and quasi-experimental evaluation studies of interventions designed to shift tobacco use. We included studies written in English from inception to 30 May 2024. We only included studies which noted social norms or social influence as part of the intervention design or set of measured variables. We excluded studies with only one time point, without an intervention being evaluatedand those not published in English. Study screening followed the PRISMA 2020 guidelines, and was conducted by at least two independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analyzed in a narrative synthesis, and those providing sufficient statistics for tobacco and social norms outcomes were included in meta-analyses, which were performed separately for tobacco outcomes and social norms outcomes. Study outcomes were transformed into a standardized mean difference (Hedges' g) and several meta-regressions were fit to explore sources of heterogeneity using a robust variance estimation specification to handle effect size dependency. A total of 95 studies met inclusion criteria for the narrative synthesis, 200 effect sizes from 86 studies were included in the tobacco outcomes meta-analysis, and 66 effect sizes from 29 studies were included in the social norms outcomes meta-analysis. Nearly 90% of included studies were conducted in high-income settings, with the remainder conducted in middle-income settings. No studies were conducted in Latin America or on the African continent. Social norms change interventions had a statistically significant effect on reducing tobacco use and pro-tobacco social normative perceptions [g = 0.233, 95% confidence interval (CI) = 0.166, 0.301, P < 0.001 and g = 0.292, 95% CI = 0.090, 0.494, P = 0.007, respectively]. Interventions were commonly conducted among schoolchildren in classrooms through multicomponent education sessions, often coupled with regular 'booster' sessions over time. Among adult populations, motivational interviewing and other counselling approaches were used in some cases, and few interventions leveraged digital technologies to change social norms. Social norms change interventions appear to be effective for reducing tobacco use and pro-tobacco social normative perceptions. In particular, leveraging role models appears to be the most effective social norms change mechanisms for tobacco control.

Impact of Refeeding Syndrome on the Short-Term Clinical Outcomes of Very-Premature Infants.

Refeeding syndrome (RFS) is a potentially life-threatening condition that can occur in preterm infants if nutritional support is initiated or increased after a period of starvation or malnutrition. The current study aimed to examine the short-term clinical outcomes of RFS in preterm infants born at ≤32 weeks of gestation. Infants with a gestational age of ≤32 weeks and a birth weight of <1500 g who were born and admitted to the level III neonatal intensive care unit and received parenteral nutrition upon admission were retrospectively evaluated. The modified log Poisson regression with generalized linear models and a robust variance estimator was applied to adjust the outcomes of infants. In total, 760 infants met this study's inclusion criteria. Of them, 289 (38%) developed RFS. RFS was significantly associated with a composite outcome of mortality and intraventricular hemorrhage. Based on the multivariate Cox regression analysis adjusted for significant potential confounders, RFS was significantly associated with increased mortality risk, with a hazard ratio for death in infants with RFS being 1.74-fold higher compared to those without RFS. Preterm infants born at ≤32 weeks of gestation who develop RFS within the first week of life are at increased risk for both intraventricular hemorrhage and mortality. This study underscores the need for standardized clinical approaches for managing RFS in the neonatal intensive care unit to improve outcomes. Future research should establish a unified RFS definition and conduct clinical trials to optimize parenteral nutrition strategies for this vulnerable population.

Association of early dysglycemia with intraventricular hemorrhage and mortality in very low birth weight infants.

To investigate the combined effect of hyperglycemia and hypoglycemia on intraventricular hemorrhage (IVH) and mortality recognizing that previous research has predominantly focused on examining these conditions independently. This study included very preterm infants who were born at King Saud Medical City, a tertiary referral center, and admitted to a level 3 neonatal intensive care unit between January 2020 and January 2024. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber-White) were used to adjust for potential confounding factors. A total of 554 infants met the inclusion criteria. Hyperglycemia and/or hypoglycemia developed in 75.5% (418) patients within the first postnatal week. During the study period, IVH occurred in 28.5% (N = 158), and severe IVH occurred in 13% (72) infants. In addition, 13.7% (76) of infants died during the study period. The multivariate regression revealed an association between the isolated hyperglycemia, combined exposure of hypo- and hyperglycemia, and development of IVH (relative risk [RR], 2.10; 95% confidence interval [CI], 1.36, 3.25; RR, 2.33; 95% CI, 1.34, 4.06, respectively). Severe IVH was significantly associated with isolated hyperglycemia (adjusted relative risk [aRR], 2.46; 95% CI, 1.16, 5.23). Death was associated with combined hypo- and hyperglycemia (adjusted hazardous ratio [aHR], 3.19; 95% CI, 1.23, 8.26).Conclusion: Combined hyper- and hypoglycemia in the first week of life of premature babies increases the risk and severity of IVH and neonatal mortality.

The Effects of Morphological Instruction on Literacy Outcomes for Children in English-Speaking Countries: A Systematic Review and Meta-Analysis

In this pre-registered meta-analysis, we investigated the effectiveness of morphology instruction on literacy outcomes for primary school children in English-speaking countries. We were interested in overall reading and spelling outcomes, but we also looked separately at results for trained and untrained words in order to determine whether there was evidence of transfer to untrained words. Further, we were interested in whether results transferred beyond the word level to reading comprehension outcomes. Our screening process revealed 28 eligible studies, which contributed 177 effect sizes to the analyses. Robust variance estimation methods were used to account for dependence between effect sizes. Overall, effect sizes on reading and spelling outcomes were small to moderate. Effect sizes were larger for trained words than untrained words. There was evidence of transfer to untrained words for spelling outcomes, but not for reading outcomes. There was also no clear evidence of effects on reading comprehension outcomes. In general, the evidence was characterised by large amounts of heterogeneity and imprecision, which was reflective of the wide variety within and between studies in terms of intervention content, outcome measures, intervention dosage and type of control group. We discuss the limitations of the current literature and make recommendations for future research and practice in the field of morphology instruction. (207 words – max 250).

Children's Selective Teaching and Informing: A Meta-Analysis.

Empirical studies on selective teaching and informing indicate that children may vary what they teach depending on whom they are teaching, taking into account how helpful the information is for a given audience. The current meta-analysis quantifies the effect of selective informing and teaching in 2-7-year-olds by examining the relationship between the helpfulness of the information and the frequency of information transmission. Through a systematic search that yielded 1483 results, 28 studies (104 effect sizes, N=2716) met the inclusion criteria. Using robust variance estimation, we found a medium average effect, Hedges' g=0.578, 95% CI (0.331, 0.825), suggesting that children selectively share information based on its perceived helpfulness to the listener. Moderator analyses revealed that age and communicative context were significant factors. Children were more informative in their communication when asked to teach compared to other nonpedagogical prompts. This finding supports and extends natural pedagogy theory-young children not only interpret pedagogical information differently than information acquired through other means, but they are more selective in their informing when teaching. Additionally, we observed a key developmental progression at age 4. Four- to 7-year-olds, but not 2-3-year-olds, selectively shared information that was most helpful for a given learner. This coincides with the development of false-belief understanding, which undergoes significant development at around age 4. Taken together, the present synthesis suggests that young children actively engage in selective social learning from both sides, that of beneficiaries and benefactors of valuable information.

Trends and determinants of clustering for non-communicable disease risk factors in women of reproductive age in Nepal.

Understanding the clustering of two or more risk factors of non-communicable disease, such as smoking, overweight/obesity, and hypertension, among women of reproductive age could facilitate the design and implementation of strategies for prevention and control measures. This study examined the factors associated with smoking, overweight/obesity, and hypertension among Nepalese women of reproductive age (15-49 years). This study used the Nepal Demographic and Health Surveys (NDHS) 2016 (6,079 women for smoking and overweight/obesity, 6076 for hypertension) and 2022 (6,957 women for overweight/obesity and smoking status and 3,749 women for hypertension) for comparison of trends of NCD risk factors among women aged 15-49 years. Additionally, for each participant, risk factors score (range of 0 to 3) was created by summing individual risk factors. We assessed the determinants of risk factor clustering using multivariable Poisson regression models with robust sandwich variance estimator to calculate adjusted prevalence ratios using NDHS 2022. The national prevalence of overweight/obesity increased from 22.2% in 2016 to 29.2% in 2022 among women of reproductive age. In 2022, the prevalence for smoking, overweight/obesity, and hypertension were 3.8%, 29.2%, and 9.6%, respectively. More than one in four women (28.7%) had one NCD risk factor, while 6.5% had two such risk factors. Higher aged women (40-49 years) were more likely to have multiple NCD risk factors than those aged 15-29 years (APR: 3.19; 95% CI: 2.68-3.80). Those in the richest wealth quintile (APR: 1.52; 95% CI: 1.24-1.85), as well as married (APR: 3.02; 95% CI: 2.43-3.76) and widowed/divorced (APR: 2.85; 95% CI: 2.14-3.80) were more likely to have multiple NCD risk factors. Women from Koshi province (APR: 1.74; 95% CI: 1.41-2.15) had more NCD risk factors than those from the Sudurpaschim province. Working women also had a higher prevalence of NCD risk factors compared to non-working women (APR: 1.23; 95% CI: 1.06-1.43). Additionally, Hill Janajatis (APR: 1.44; 95% CI: 1.21-1.72) and Dalits (APR: 1.42; 95% CI: 1.15-1.75) women were more likely to have NCD risk factors compared to women of Brahmin hill origin. Clustering of two or more NCD risk factors was higher among women aged ≥30 years, those who are currently married or widowed/divorced/separated, working women, and individuals from the wealthiest socioeconomic groups. A higher burden of risk factors underscores the importance of targeted public health interventions, particularly among women from advantaged socio-economic groups, those of affluent regions, and in the workplace.

Firth-Type Penalized Methods of the Modified Poisson and Least-Squares Regression Analyses for Binary Outcomes.

The modified Poisson and least-squares regression analyses for binary outcomes have been widely used as effective multivariable analysis methods to provide risk ratio and risk difference estimates in clinical and epidemiological studies. However, there is no certain evidence that assessed their operating characteristics under small and sparse data settings and no effective methods have been proposed for these regression analyses to address this issue. In this article, we show that the modified Poisson regression provides seriously biased estimates under small and sparse data settings. In addition, the modified least-squares regression provides unbiased estimates under these settings. We further show that the ordinary robust variance estimators for both of the methods have certain biases under situations that involve small or moderate sample sizes. To address these issues, we propose the Firth-type penalized methods for the modified Poisson and least-squares regressions. The adjustment methods lead to a more accurate and stable risk ratio estimator under small and sparse data settings, although the risk difference estimator is not invariant. In addition, to improve the inferences of the effect measures, we provide an improved robust variance estimator for these regression analyses. We conducted extensive simulation studies to assess the performances of the proposed methods under real-world conditions and found that the accuracies of the point and interval estimations were markedly improved by the proposed methods. We illustrate the effectiveness of these methods by applying them to a clinical study of epilepsy.