Statewide Data Research Articles

Liver stiffness (Fibroscan®) is a predictor of all-cause mortality in people with non-alcoholic fatty liver disease.

Progressive liver fibrosis related to non-alcoholic fatty liver disease (NAFLD) is associated with all-cause and liver-related mortality. We assessed vibration-controlled transient elastography (VCTE) as a predictor of mortality. Data from patients who underwent VCTE for NAFLD at four large health services in Victoria, Australia between the years 2008 and 2019 were linked to state-wide data registries. Cause of death (COD) and predictors of all-cause mortality were subsequently analysed using descriptive statistics and Cox-proportional regression analysis. Of 7079 VCTE records submitted for data linkage, 6341 were matched via data registry linkage. There were 217 deaths over a 22 653 person-year follow-up. COD included malignancies other than hepatocellular carcinoma (HCC) (18.0%, n= 39), sepsis (16.1%, n= 35), decompensated liver disease (15.2%, n= 33), cardiac disease (15.2%, n= 33) and HCC 6.0% (n= 13). Controlled attenuation parameter (CAP) was not associated with mortality in univariable analysis (HR=1.00, CI 1.0-1.0, p= .488). Increased liver stiffness measurement (LSM) (HR 1.02 per kiloPascal, CI 1.01-1.03, p < .001), Charlson comorbidity index (CCI) (HR 1.32 for each point, CI 1.27-1.38, p < .001) and age (HR 1.05 per annum, CI 1.03-1.07, p < .001) were each associated with higher rates of all-cause mortality in multivariable analysis. LSM ≥10kPa suggestive of compensated advanced chronic liver disease (cACLD) was associated with mortality in multivariable analysis (HR 2.31, CI 1.73-3.09, p< .001). VCTE LSM, in addition to age and CCI, is independently associated with increased all-cause mortality in a large cohort with NAFLD.

Evaluation of Telehealth in Child Behavioral Health Services Delivery During the COVID-19 Pandemic.

The authors quantified the impact of the use of telehealth services on patient-level clinical outcomes among children with complex behavioral and emotional needs in Idaho during the COVID-19 pandemic by comparing data collected in 2020 with data for the same months in 2019. Longitudinal statewide data of Child and Adolescent Needs and Strengths (CANS) assessments were extracted from Idaho's mental and behavioral health system. Prepandemic assessments were matched to midpandemic assessments. A linear mixed-effect model was used to explore four child-level outcomes: psychosocial strengths-building rate, rate of need resolution within a life-functioning domain, rate of need resolution within a behavior-emotional domain, and rate of need resolution within a high-risk behaviors domain. The number of new patients admitted to Idaho's state-funded mental and behavioral health program decreased almost twofold from April-December 2019 to April-December 2020 (N=4,458 vs. 2,794). For most children with complex needs, the use of telehealth was as effective in terms of strengths building and needs resolution as in-person services; for children whose caregivers had issues with access to transportation, availability of telehealth services improved outcomes for the children. The COVID-19 pandemic in 2020 was associated with a dramatic drop in the number of children served by Idaho's mental health program. Telehealth may effectively bridge mental health service delivery while patients and providers work toward the resolution of transportation issues or may serve as a more acceptable permanent format of service delivery for some populations.

School Age Developmental Outcomes of Children Conceived by IVF Compared with Controls: A Population Linkage Study

Background: There has been increasing interest in assessing longer term developmental and health outcomes in IVF-conceived offspring compared with those born after natural conception. So far, the findings have been conflicting. The Australian Early Developmental Consensus (AEDC) assesses children in their first year of primary school across five domains; physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Aim: To compare school entry (5-7 years of age) outcomes in IVF-conceived children in Victoria with naturally conceived controls. Method: We undertook a statewide data linkage study, with perinatal data (births 2005-2014) linked to data from major IVF providers in Victoria and the AEDC. Our approach to analysis included: complete case analysis, multiple imputation of missing data, consideration of clustering (siblings) and inverse probability weighted modeling to adjust for covariates. Our primary outcome was an AEDC score indicative of developmental vulnerability in two or more domains. We adjusted for the child’s age at assessment, sex, highest level of maternal education, maternal age, parity, SEIFA (Socio-Economic Indexes for Areas) quintile, language background other than English, and Aboriginal and Torres Strait Islander (ATSI) status. Results: The linked dataset comprised 163,418 children, including 4,441 IVF-conceived children. The IVF conceived population had older, more highly educated mothers who lived in more affluent areas and were less likely to be from non-English speaking backgrounds or identify as ATSI. IVF-conceived children were less likely to be developmentally vulnerable, in both unadjusted (RR 0.59, 95%CI: 0.52-0.67, p&lt;0.001) and adjusted analyses (aRR 0.72, 95%CI: 0.58-0.88, p&lt;0.001). Conclusion: Children conceived by IVF were less likely to be developmentally vulnerable in their first year of schooling, compared with peers conceived naturally. Further research should aim to understand if similar patterns are seen in other education and health domains and the potential mechanisms for these differences.

The National Centre for Healthy Ageing data platform: establishing an Electronic Health Record derived linked geographic cohort.

ObjectivesElectronic Health Record (EHR) data have created unique opportunities for research. However, these data are: not curated, siloed and poorly integrated. We describe linkage of EHR data from an entire health service with government datasets to establish a linked geographic cohort within the Australian National Centre for Healthy Ageing (NCHA). ApproachResearch suitable EHR items were identified from Peninsula Health (NCHA partner) data systems based on: published research, availability and quality. Items underwent end-user Delphi processes to identify core research items (consensus=70%). Approvals were obtained from the Australian Institute of Health and Welfare (AIHW) for linkage with: Medicare, medication dispensings, Aged Care and death registry data through the AIHW spine, created using identifiers from the Medicare Consumer Directory (MCD); and from the Centre for Victorian Data Linkage for linkage to state-wide hospital data. Identifiers for local residents aged ≥60 years who attended Peninsula Health were submitted for probabilistic data linkage. ResultsDelphi participants included 10 researchers from 8 fields/departments and 13 clinicians from 11 clinical areas. To date 7 of the 11 datasets have been reviewed. N=107 potentially suitable data items were identified and 96 gained consensus for inclusion in the core dataset. Of the 49,767 Health Service users (episodes: Jan 2010-Dec May 2021) submitted for linkage, 98.4% were successfully linked to the MCD (Median age 72.2 years, 52.2% female, 1.8% regional residence). An additional 172,290 individuals living within the geographic region but not contained within the EHR dataset were identified in the MCD for linkage to the government datasets. Linkage accuracy was impacted by inaccurate/incomplete address fields (~30%) and lack of adherence to naming conventions within the EHR data. ConclusionLinking with EHR data is complex. Having an established EHR research dataset will improve the feasibility of data linkage and potential for future expansion of linkages within the NCHA. Once merged, the data will be used to underpin a range of research activities related to ageing and dementia.

Systematic Approaches for Telemedicine and Data Coordination for COVID-19 in Baja California, Mexico

Background In 2019, the State of Baja California had a total population of 3,682,063 inhabitants; in the city of Tijuana, there were only 13 Red Cross ambulances and 1 fire department ambulance to attend to the prehospital emergencies of almost 2 million inhabitants. Objective This study aimed to provide information to the public; evaluate COVID-19 in real time; and track regional, municipal, and state-wide data in real time that inform supply chains and resource allocation with the anticipation of a surge in COVID-19 cases. Methods Our model is based on human-centric design factors and cross-disciplinary collaborations for the scalable, data-driven enablement of smartphone teleconsultation technologies to link hospitals, clinics, and emergency medical services for point-of-care assessments of COVID-19 testing and subsequent treatment and quarantine decisions. Results The Telehealth System handled 28,964 telephone calls in the period from April 1, 2020, to January 30, 2022, and accumulated 20,287 working hours. In total, 13,721 follow-up calls were made to quarantined patients, providing medical and psychological counseling, and 12,643 calls were received and transferred from the 911 system, of which 4964 calls from patients with respiratory symptoms required urgent ambulance dispatch. Conclusions Telehealth offers capabilities for remote detection, care, and treatment to help with supervision, surveillance, discovery, and prevention, as well as to mitigate the effects of health care indirectly related to COVID-19.

Exploring financial stress and resource deprivation as barriers to preferred contraceptive use in Wisconsin in 2021

ObjectiveThis study assessed a broad array of socioeconomic barriers in relation to preferred contraceptive use during a time of exacerbated personal and social financial strain (the COVID-19 pandemic). Study DesignUsing statewide data collected in early 2021 through the Survey of the Health of Wisconsin, we conducted bivariate analyses exploring the relationship between socioeconomic resources and preferred contraceptive use among Wisconsin women. ResultsThe survey garnered 1889 responses, with a response rate of 34%. The sample for the current study (N = 247) included only adult women of reproductive age who reported current contraceptive use. Nearly one-third (32.8%) of contraceptive users reported that they were not using their preferred method. We found that greater resource deprivation, including housing instability (had to relocate: p = 0.004; unable to pay rent and/or mortgage: p = 0.008), food insecurity (ran out of food: p = 0.003; worried about running out of food: p = 0.008), and greater financial stress (p < 0.001), were significantly associated with lowered likelihood of using one's preferred contraceptive method. ConclusionsFindings indicated that people lacking socioeconomic resources, including adequate food and housing, may be unable to access their preferred contraceptive method(s). Amidst competing demands on time and resources, the inability to obtain preferred contraceptive method(s) may represent system-wide barriers as well as people's lowered ability to prioritize and access care in light of socioeconomic struggles. ImplicationsHealth care providers and health systems should work to address structural barriers to care and bolster community resources in ways that promote patients’ reproductive autonomy. There is also a need for continued research on specific socioeconomic determinants of preferred contraceptive use and potential solutions that bolster community resources.

Association of multiple sclerosis with mortality in sepsis: a population-level analysis

BackgroundMultiple sclerosis (MS) is associated with increased risk of sepsis and higher sepsis-related mortality, compared to the general population. However, the evidence on the prognostic impact of MS in sepsis has been scarce. We aimed to evaluate the population-level association of MS with short-term mortality in sepsis.MethodsWe performed a retrospective population-based cohort study using a statewide data set to identify hospitalizations aged ≥ 18 years in Texas with sepsis, with and without MS during 2010–2017. Multilevel logistic models were fit to estimate the association of MS with short-term mortality among all sepsis hospitalizations, and for sensitivity analyses among hospitalizations with septic shock and those admitted to ICU.ResultsAmong 283,025 sepsis hospitalizations, 1687 (0.6%) had MS. Compared to sepsis hospitalizations without MS, those with MS were younger (aged ≥ 65 years 35.0% vs 56.8%), less commonly racial/ethnic minority (36.2% vs 48.1%), and had lower mean Deyo comorbidity index (1.6 vs 2.7). The rates of septic shock and ICU admission were similar for sepsis hospitalizations with and without MS (58.7% vs 59.6% and 46.7% vs 46.0%, respectively). The unadjusted short-term mortality among sepsis hospitalizations with and without MS for the whole cohort, among those with septic shock, and among ICU admissions were 20.2% vs 31.3%, 25.6% vs 40.0%, and 24.0% vs 34.8%, respectively. On adjusted analyses, MS was associated with 17% lower odds of short-term mortality (adjusted odds ratio [aOR] 0.828 [95% CI 0.723–0.947]). Similar findings were observed on sensitivity analyses of patients with septic shock (aOR 0.764 [95% CI 0.651–0.896]), but MS was not associated with mortality among sepsis hospitalizations admitted to ICU (aOR 0.914 [95% CI 0.759–1.101]).ConclusionsMS was associated with lower short-term mortality among septic patients, with findings consistent among the subset with septic shock. Among septic patients admitted to ICU, MS was not associated with mortality.

Trauma-Specific Performance Improvement Activities for Emergency Medical Services Providers: A Statewide Perspective

IntroductionTrauma-specific performance improvement (PI) activities are highly variable among Emergency Medical Services (EMS) providers. This study assesses the perception of the trauma PI activities of EMS providers in the state of Ohio and identifies potential barriers to conducting a successful program. MethodsAn institutional review board–approved, voluntary, and anonymous Qualtrics survey was disseminated to all EMS agencies registered under the Ohio Department of Public Safety throughout the 88 counties of Ohio. It included questions regarding what agencies considered trauma-specific PI activities, how frequently they completed those activities, and barriers related to conducting such PI activities. There were both open-ended and closed-ended questions in the survey, along with a follow-up interview. The data were descriptively and thematically analyzed. ResultsFrom the recorded responses (341), most the respondents (98.5%) either agreed or strongly agreed that trauma-specific PI activities improve performance of EMS providers, while only 63.8% (218) of the agencies performed them. Some activities considered as trauma PI and conducted at least once a month included (1) record keeping (74.6%), (2) confirmation on the use of correct triage protocols (66.9%), (3) measuring response time on trauma calls (60.0%), (4) PI reviews of trauma cases (56.9%), and (5) obtaining feedback from the receiving facility and or authorizing physicians (48.5%). Primary barriers to performing trauma PI activities included a lack of interest and financial resources, followed by system-level reasons such as unavailability of training centers and a lack of regional/state support. Thematic analysis of the data suggested that improved communication and awareness of trauma PI, sharing statewide data on trauma PI, better synchronization among EMS agencies and trauma centers, and enhanced EMS funding could potentially improve trauma-specific PI programs at the EMS level. ConclusionsOur results showed variability in the perception, execution, and availability of trauma-specific PI activities among EMS agencies in the state. Common barriers could potentially be mitigated by collaboration between agencies, trauma centers, and state-led initiatives. With the increased frequency of mass shootings and other large-scale trauma disasters, it is imperative from a state and regional level to address these inconsistencies and further elucidate effective measures of trauma PI for the EMS community.

Monitoring of coercive measures and compulsory treatment in Germany

Epidemiological registers on the burden of disease and adverse events (deaths, serious side effects, etc.) play an important role in the management, evaluation, and improvement of healthcare treatment for the population. This also applies to coercive measures in the psychiatric healthcare system. Such registers only became feasible on abroad basis due to the availability of electronic medical records and steadily increasing computing capacities; however, in most German states, registers have not been implemented. Data protection problems must be taken into account in the collation of person-related data but can be solved by appropriate pseudonymization procedures taking the prerequisites of data parsimony into account. Extensive data are now available from the Baden-Wuerttemberg register for coercive measures, which has been in existence since 2015 and which enabled, for instance, evaluating the consequences of the changes to the law following the 2018 ruling of the Federal Constitutional Court on mechanical restraint and the consequences of the coronavirus pandemic. In the meantime, there are also state-wide data collections in some other German states; however, unlike in Baden-Wuerttemberg, these registers do not include measures under guardianship law. Anationwide register for coercive measures, compulsory treatment and involuntary detention has justifiably repeatedly been demanded for a long time. Amajor obstacle is the historically developed separation between the responsibility of the German states for the detention regulated by public law and the Federal State for the scope of application of the guardianship law.

The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study

BackgroundThe use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth.MethodsThis was a population-based cohort study of singleton livebirths at ≥37 weeks’ gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed.ResultsIn total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86–0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome.ConclusionCommon intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.

Methodology for Monitoring Work Zones Traffic Operations Using Connected Vehicle Data

The National Work Zone Safety Information Clearinghouse estimated there were approximately 115,000 work zone crashes with 842 fatalities in 2019. There is broad consensus that it is important for agencies to develop near real-time risk assessment of work zone traffic operations to proactively identify improvement opportunities. Due to the huge spatial distribution and relatively low frequency of crashes, legacy techniques of monitoring crash locations do not scale well for identifying all but the most severe construction zone operational problems. Past research identified hard braking and congestion as strong predictors for crashes in and around work zones. This paper presents scalable methodologies that can be used to systematically analyze hard-braking and speed data obtained from connected vehicles. These techniques have been applied to over 205 billion records in Indiana since 2019. These statewide data analytics are fused into concise graphics to identify work zones with emerging anomalies in congestion and/or hard braking. Weekly screening reports, institutionalized in Indiana for the past two years, provide information for agile agency monitoring and response. Case studies show quantitative changes in work zone performance measures, and corresponding surveillance video images illustrate the significance of these changes. During this period of near real-time monitoring and agile agency response, Indiana interstate crash rates have been reduced by 31% from 2019 to 2021, even though most 2021 interstate traffic volumes have rebounded to pre-pandemic 2019 volumes.

Use of a Victorian statewide surveillance programme to evaluate the burden of healthcare-associated Staphylococcus aureus bacteraemia and Clostridioides difficile infection in patients with cancer.

Patients with cancer are at high risk for infection, but the epidemiology of healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) and Clostridioides difficile infection (HA-CDI) in Australian cancer patients has not previously been reported. To compare the cumulative aggregate incidence and time trends of HA-SAB and HA-CDI in a predefined cancer cohort with a mixed statewide patient population in Victoria, Australia. All SAB and CDI events in patients admitted to Victorian healthcare facilities between 1 July 2010 and 31 December 2018 were submitted to the Victorian Healthcare Associated Infection Surveillance System Coordinating Centre. Descriptive analyses and multilevel mixed-effects Poisson regression modelling were applied to a standardised data extract. In total, 10 608 and 13 118 SAB and CDI events were reported across 139 Victorian healthcare facilities, respectively. Of these, 89 (85%) and 279 (88%) were healthcare-associated in the cancer cohort compared with 34% (3561/10 503) and 66% (8403/12 802) in the statewide cohort. The aggregate incidence was more than twofold higher in the cancer cohort compared with the statewide cohort for HA-SAB (2.25 (95% confidence interval (CI): 1.74-2.77) vs 1.11 (95% CI: 1.07-1.15) HA-SAB/10 000 occupied bed-days) and threefold higher for HA-CDI (6.26 (95% CI: 5.12-7.41) vs 2.31 (95% CI: 2.21-2.42) HA-CDI/10 000 occupied bed-days). Higher quarterly diminishing rates were observed in the cancer cohort than the statewide data for both infections. Our findings demonstrate a higher burden of HA-SAB and HA-CDI in a cancer cohort when compared with state data and highlight the need for cancer-specific targets and benchmarks to meaningfully support quality improvement.

Exploring SWPBIS Implementation Outcomes in Rural and Urban Schools in Florida

Rural schools experience unique challenges, including teacher quality and teacher retention, limited resources, and availability of funding. Furthermore, access to professional development and, subsequently, implementation of evidence-based practices may also be limited in rural settings. One evidence-based framework for implementing evidence-based practices, School-Wide Positive Behavioral Interventions and Supports (SWPBIS), has been widely implemented, including in rural and urban schools. Yet, very little research has explicitly compared rural and urban schools implementing SWPBIS with regard to implementation and discipline. Therefore, we examined statewide data to evaluate differences between rural and urban schools implementing SWPBIS in Florida. We found that both rural and urban schools were equally likely to implement all the components of SWPBIS. When comparing schools, we found that rural schools implementing SWPBIS had more out-of-school suspensions than nonimplementing rural schools, while the opposite was true for urban schools. Limitations and future research are discussed.

Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019.

Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019.

Distribution and Fractionation of Zinc and Copper in Poultry Litters Across North Carolina

ABSTRACT Zinc (Zn) and copper (Cu) are necessary micronutrients for crop production. However, excess Zn and Cu applied through land application of manures can result in Zn and Cu toxicity, reducing yields. With many integrators and little information on the formulation of poultry feeds in North Carolina (NC), it is difficult to predict the fractionation of Zn and Cu in litters generated at facilities, as the form of Zn and Cu determines mobility and bioavailability. Therefore, statewide data from the NC Department of Agriculture and Consumer Services was analyzed to determine regional variation of total Zn and Cu. The results showed a significant effect of the region on the total Zn and Cu among the three production regions in the state. Additionally, 11 broilers and broiler breeder litter samples were analyzed to determine the distribution of Zn and Cu in acid soluble, reducible, oxidizable, and residual fractions. Total Zn and Cu averaged 675 mg/kg and 629 mg/kg, respectively. There was a significant interaction between the region and Zn concentration in the fractions. However, there was no region interaction when converted to a percentage of the sum of the fractions, indicating Zn partitions similarly across a wide range of concentrations and 37%, 40%, 21%, and 0.6% was found in the acid soluble, reducible, oxidizable, and residual fractions, respectively. Region did not have an effect on Cu fractionation, with 26%, 8%, 67%, and 2% of Cu in the acid-soluble, reducible, oxidizable, and residual fractions, respectively. Results indicate greater bioavailability and mobility potential for Zn as compared to Cu.

School Climate in Rural and Urban Schools and the Impact of SWPBIS

Positive school climate is associated with myriad positive student, staff, and school outcomes, including increased achievement and decreased problem behavior. Hence, universal evidence-based practices are necessary to increase school climate. One universal approach with evidence of effects on school climate is School-Wide Positive Behavior Interventions and Supports (SWPBIS). However, little research exists evaluating the effects of SWPBIS on school climate focus on student perceptions. Furthermore, researchers have rarely examined differences in students’ perceptions of school climate in rural and urban schools and differences of SWPBIS effectiveness in rural and urban schools. Therefore, we used state-wide school climate data for elementary students in the U.S. state of Georgia and examined differences between rural and urban locale and SWPBIS implementation. Using multilevel structural equation modeling, we found that rural schools implementing SWPBIS with high levels of fidelity had significantly higher positive school climate than urban schools. Implications and limitations are discussed.

Determinants of purchase likelihood for partially and fully automated vehicles: Insights from mixed logit model with heterogeneity in means and variances

Determining the likelihood of consumers purchasing automated vehicles (AVs) is extremely important for policymakers, researchers, and automobile manufacturers. Successful penetration of AVs into the market depends on the end-user’s perception and their affinity towards these vehicles. In this study, a comprehensive state-wide data has been used to determine the factors affecting the purchase likelihood of AVs. A wide range of potential factors are evaluated, including attributes related to safety and consumer’s perception, socio-economic and demographic factors, carsharing and ridesharing habits, types of housing and parking, types of owned and future vehicles, consumers’ preferences for buying or leasing a vehicle, and their residential region. A random parameters logit model with three outcomes of consumer’s affinity (i.e., agree, neither agree nor disagree, disagree) towards purchasing either partially (Levels 3 and 4) or fully (Level 5) AVs is considered. Moreover, to account for different layers of unobserved heterogeneity and to obtain a better statistical fit, the means and variances of random parameters are allowed to vary across the observations. The estimations results reveal significant differences between the determinants of consumer’s affinity towards partially and fully AVs. For partially AVs, the effect of certain variables related to the status of owing hybrid vehicles, education level, parking type, gender, and consumer’s opinion about the future of carsharing and ridesharing programs represented significant degrees of heterogeneity. For fully AVs, however, variables related to education level, parking type, housing type, and ethnicity were found to produce random parameters. The findings from this study can be used to estimate AV penetration and promote AV adoption.

Application of a risk-guided strategy to secondary prevention of coronary heart disease: analysis from a state-wide data linkage in Queensland, Australia

ObjectiveThis study sought whether higher risk patients with coronary heart disease (CHD) benefit more from intensive disease management.DesignLongitudinal cohort study.SettingState-wide public hospitals (Queensland, Australia).ParticipantsThis longitudinal study included 20 426 patients...

Racial/ethnic disparities in childhood obesity: The role of school segregation.

Recent studies have observed that racial or ethnic adult health disparities revealed in national data dissipate in racially integrated communities, supporting the theory that "place, not race" shapes the nature and magnitude of racial/ethnic health disparities. This study tested this theory among children. In 2020, the racial/ethnic childhood obesity disparities within integrated schools and between segregated schools were estimated using statewide cross-sectional data collected in 2019 on fifth, seventh, and ninth grade students from California public schools. School segregation accounted for a large part of the obesity disparities between White children and children of color (Latino, Black, and Filipino children). In racially integrated schools, obesity disparities were much smaller than those in statewide data, whereas racial or ethnic childhood obesity disparities were larger when comparing children in majority-White schools with those attending schools with a majority enrollment of children of color, except for Asian children, who generally had lower obesity rates than their White peers. School-level racial segregation is a salient contributor to racial/ethnic childhood obesity disparities. Reducing obesity disparities may be particularly effective if place-level interventions target socioeconomically disadvantaged integrated schools and segregated schools attended primarily by children of color.

Association between screening for antenatal depressive symptoms and delivery outcomes: The Born in Queensland Study.

Evidence shows that depressive symptoms during pregnancy increase the risk of an intervention during delivery (induction, the use of forceps or vacuum, and caesarean sections (CS)). Many women with depression during pregnancy are not identified and therefore will not receive appropriate follow up of their symptoms. We hypothesised that routine screening for depressive symptoms during pregnancy could reduce detrimental consequences of depressive symptoms on delivery outcomes. We explored the association between screening for depressive symptoms during pregnancy and delivery outcomes. A cross-sectional analysis of state-wide administrative data sets. The population included all women who delivered a singleton in Queensland between the July and December of 2015. Logistic regression analyses were run in 27 501 women (93.1% of the total population) with information in all variables. The following were the main outcomes: onset of labour, CS, instrumental vaginal delivery, and all operative deliveries (including both CS and instrumental vaginal deliveries). Women who completed the screening had increased odds of a spontaneous onset of labour (adjusted odds ratio (aOR) 1.18; 95% CI 1.09-1.27) and decreased odds of an operative delivery (instrumental or CS) (aOR 0.88; 95% CI 0.81-0.96). Among women who had a vaginal delivery, those who completed the screening had decreased odds of having an instrumental delivery (aOR 0.84; 95% CI 0.74-0.97). Sensitivity analyses in women who did not have a formal diagnosis of depression showed similar results. Our findings suggest that screening may decrease interventions during delivery in women with depressive symptoms.