Stratified Sampling Design Research Articles

Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17)

Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and inter-regional variations. The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines. A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1. The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India. Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners.

Building trust and therapeutic relationships between healthcare providers and patients are crucial for delivering high-quality, comprehensive sexual and reproductive health (SRH) services. Yet, while patients face substantial SRH disparities in Tanzania, little is known about health care professionals' [HCPs] SRH history-taking practices and experiences. This paper describes HCPs' interdisciplinary practices, experience in conducting SRH taking, and the critical lessons learned to optimize quality SRH care. We conducted 18 focus group discussions in June 2019 in Dar es Salaam, Tanzania, with 60 healthcare practitioners and 61 students in midwifery, nursing, and medicine. We implemented a purposive, stratified sampling design to explore the experiences and perspectives of HCPs regarding providing sexual health services. We employed a grounded theory approach to perform the analysis. We provided seven scenarios to participants to discuss how they would manage SRH health problems. The scenarios helped us evaluate the practice and experience of SRH in Tanzania. Four broad themes and sub-themes emerged during the discussion; 1) SRH history-taking practices and experiences in the health care facilities; 2) the perceived benefit of effective SRH history-taking; 3) Factors hindering the SRH history-taking process; 4) The power of confidence. These findings have implications for strengthening a sexual health curriculum for medical students and continuing education programs for practicing health professionals designed to address the observed health disparities in Tanzania. These findings affirm that proper SRH history-taking requires a conducive environment, knowledge of relevant SRH-related laws and regulations; application of evidence-based techniques; and giving patients autonomy to make decisions for their health while making recommendations regarding standard care. Comprehensive SRH history-taking identifies critical data for illness diagnosis, provides foundational information for risk-reduction behavioural change counselling, and reduces medical costs. Therefore, the primary goal is to optimize health professional training on SRH issues and history-taking skills within the medical interview.

Melanoma literacy and predictors for skin self-examination in three western U.S. states: A population-based survey.

10558 Background: Melanoma is a leading cause of skin cancer deaths, despite being easily treated when detected early. The objective of this study is to investigate the relationship between melanoma knowledge and beliefs, and the performance of skin self-examination (SSE) in three US states with high incidence rates of melanoma. Understanding the barriers to behaviors such as SSE can aid in the development of interventions aimed at increasing the frequency of early detection and reducing melanoma-related deaths. Methods: A total of 15,000 surveys were distributed to households in the states of Oregon, Washington, and Utah using a stratified two-stage sampling design. The survey responses were weighted to resemble the gender and age distributions of the US census. Rural areas were oversampled to ensure sufficient representation. The first objective of this study was to assess melanoma literacy, including knowledge about melanoma risks, attitudes, and preventive behaviors. Our second objective was to investigate the relationship between self-reported SSE and melanoma literacy, self-efficacy, and belief in the benefits of performing SSE. Results: Among 2,326 respondents, characteristics were similar across states (weighted by census-based population percentages), including demographics, baseline knowledge, performance of SSE, and self-efficacy in performing SSE. Rural respondents had a higher frequency of personal history of melanoma (16.2%) compared to urban respondents (9.9%). Only 21.2% of the respondents demonstrated high knowledge of melanoma. 62.8% of respondents reported having performed a SSE at some point in their lives, with only 24.6% of respondents having done so in the past 2 months. Most respondents (84.8%) believed in the effectiveness of SSE in detecting skin cancer, but only 38.3% and 7.3% reported being "fairly" or "very" confident in performing SSE, respectively. The performance of SSE was most strongly correlated with higher melanoma knowledge, higher self-efficacy, and a personal history of melanoma. Conclusions: The results of the survey indicate that melanoma literacy among respondents in 3 high-risk Western states is limited. A higher level of literacy was associated with a higher likelihood of reported early detection behaviors. This study provides a baseline assessment and serves as a foundation for the development of public health campaigns aimed at promoting prevention and early detection of this deadly cancer.

20-Year Trends in Metabolic Syndrome Among Korean Adults From 2001 to 2020

BackgroundThe number of people with metabolic syndrome (MetS) is increasing worldwide, and many socioeconomic and environmental factors contribute to this. ObjectivesThe authors investigated tangible trends in the prevalence of MetS using the 2001 to 2020 versions of the Korea National Health and Nutrition Examination Survey (KNHANES). MethodsIn these surveys, stratified multistage sampling designs were used to approximate the entire population. Blood pressure, waist circumference, and lifestyle variables were examined in a standardized fashion. Metabolic biomarkers were measured in a central laboratory operated by the Korean government. ResultsThe age-adjusted prevalence of MetS increased significantly from 27.1% in 2001 to 33.2% in 2020. It was more prevalent in men (25.8%→40.0%) but did not change in women (28.2%→26.2%). Among the 5 MetS components, the proportions of high glucose level and large waist circumference increased substantially by 17.9% and 12.2% over 20 years, while high-density lipoprotein cholesterol levels increased significantly, resulting in a decrease in low high-density lipoprotein cholesterol by 20.4%. Caloric intake derived from carbohydrates decreased from 68.1% to 61.3%, while fat consumption increased from 16.7% to 23.0%. Notably, sugar-sweetened beverage consumption showed an almost 4-fold increase from 2007 to 2020, while physical activity levels decreased by 12.2% from 2014 to 2020. ConclusionsGlycemic dysregulation and abdominal obesity were key features contributing to the increased prevalence of MetS observed in Korean men during the past 20 years. Rapid economic and socioenvironmental changes in this period may be involved in this phenomenon. Understanding these changes in MetS could be valuable for other countries undergoing such socioeconomic transformation.

A statistical approach on distribution and seasonal habitat use of waterfowl and shorebirds in Çıldır Lake (Ardahan, Türkiye).

Wetlands are crucial habitats for both migrant and resident bird assemblages. The distribution and habitat preferences of birds in aquatic ecosystems are significantly influenced by environmental and ecological factors that critically impact the relevant habitats. In order to reveal the distribution and habitat preferences of the birds, many statistical models and methodologies are employed in ecology and conservation biology. Herein, we investigated the effects of year, season, habitat, and species variables on the distribution and population dynamics of waterfowls and shorebirds associated with the wetland. In this regard, field surveys were carried out in and around Çıldır Lake (Ardahan, Türkiye) between April 2017 and September 2018 to examine the distribution of waterfowls and shorebirds and variations in population sizes. As an experimental design, a stratified random sampling design was used to assess bird fauna in the four dominant habitat types (open water surface, reeds, grasslands, and agricultural areas) in the study area. Accordingly, a total of 51 waterfowl and shorebird species were identified during the study period. Of the identified families, Anatidae (n = 18), Scolopacidae (n = 8), and Ardeidae (n = 8) were the most common families. Considering bird species, common coot Fulica atra and mallard Anas platyrhynchos were the most abundant species. The dependent variable (bird populations) was compared with the independent variables (year, season, habitat, and species). The population in 2018 decreased by 13% in comparison to the population in 2017 (p < 0.05). Once the reed area was considered as the reference, the population density in the water surface habitat increased by 65% (p < 0.001). In relation to seasonal reference, a 65% increase in population growth in spring was recorded in comparison to the growth in fall (p < 0.001). On the other hand, no statistical differences were noted in population growth in winter and summer ((p > 0.05). With respect to the reference species (Anas crecca), critical differences in species fluctuation were observed among species (p < 0.001). Consequently, the findings of the present study suggest that seasonal factor might be of the substantial factors linked to the habitat composition. However, more descriptive and predictive analytical methods are needed beyond classical regression approaches in habitat use and selection studies at bird ecology.

Assessing the Integration of 21st Century Skills in Purposive Communication: Basis for a Skill-Based Module

The study aimed to assess the integration of 21st century skills in Purposive Communication, specifically communication, creativity, critical thinking, and collaboration skills or the 4Cs. The study used a descriptive correlational research design in which the respondents were chosen using the stratified probability sampling design. A total of 480 became the final number of respondents based on the data retrieved from the online survey. The data collected were tabulated and processed using the Statistical Packages for Social Sciences (SPSS) Version 23 and Graph Pad InStat Version 3. Data were analyzed and interpreted using Frequency and Percentage Distribution, Mean Score and Descriptive Interpretation, One-Way Analysis of Variance and Independent T-Test. Results of the study revealed that there was a significant difference with regard to the 21st century skills integration in Purposive Communication when grouped according to respondents’ category profiles. The findings of the study paved the way for the development of the module titled “21st Century Skills-Integrated Module in Purposive Communication”. The module was designed to highlight authentic materials and real-life tasks to make learning relevant and experiential. With these activities, students are expected to develop the life skills necessary to prepare them for future careers and thrive in the workplace.

The effects of green space and physical activity on muscle strength: a national cross-sectional survey with 128,759 Chinese adults.

Muscle strength is closely related to chronic noncommunicable diseases; specifically, a decline in handgrip strength (HS) is predominant globally. Exposure to green space-built environment components used for health intervention-reportedly decreases the risk of certain diseases and all-cause mortality. However, evidence in this area is limited. We aimed to explore the association between green space exposure and muscle strength and ascertain the combined effect of physical activity and green space exposure on muscle strength. Data from 128,759 participants (aged 20-79 years) were obtained using a complex stratified multistage probability cluster sampling design. The green space was assessed as normalized difference vegetation index (NDVI) data for a 500-m buffer zone based on the geolocation information of sampling sites. We used a questionnaire to investigate transportation, occupation, physical activity, leisure-time exercise behaviors, and sedentary time within a usual week of the preceding year. The outcome was low relative HS, defined as HS-to-body weight ratio, and the percentage of men and women with relative HS in the lower third. We defined adequate physical activity as 150 min of moderate-intensity or 75 min of vigorous physical activity per week and calculated the weighted proportion of participants with insufficient physical activity. Categorical variables of NDVI and physical activity were used as exposure variables and their interrelationship was evaluated in a generalized linear mixed model (GLMM) to estimate the odds ratios (ORs) and 95% confidence intervals (95% CI). We measured interaction on an additive or multiplicative scale using a GLMM to test the interaction between green space exposure and physical activity. All analyses were performed for the total sample and subgroups (urban and rural). The high NDVI group had a lower risk of low relative HS than the low NDVI group (OR [95% CI]: 0.92 [0.88-0.95]). The sufficient physical activity group had a lower risk of low relative HS than the insufficient physical activity group (OR [95% CI]: 0.85 [0.81-0.88]). There was an interactive effect on the additive scale (relative excess risk owing to interaction: 0.29, 95% CI 0.22-0.36, p < 0.001) between green space exposure and physical activity. High NDVI and adequate physical activity were protective factors against low relative HS in Chinese adults. Increasing green space exposure and physical activity together may have a greater potentiating effect on muscle strength improvement than these two protective factors individually. Green spaces should be incorporated into city design or built environments.

Effect of Stakeholder Participation in Planning on Performance of Kenyan Alcohol Manufacturing Firms

Manufacturing companies have a direct impact on national governments and value addition at large. Manufacturing, like other sectors, has felt the effects of a variety of stakeholder engagement factors. Although many companies engage their stakeholders in day-to-day business activities, studies have reported a challenge for them in managing diverse operations in dispersed markets. An examination of the effect of stakeholder participation in planning on the performance of Kenyan alcohol manufacturing firms, namely East African Breweries Limited, Kenya Wine Agencies Limited, and Keroche, was undertaken. The study concentrated on the performance of these firms for five years (2017–2021). Guided by stakeholder theory, the study adopted the descriptive cross-sectional research design. The target population was 608 stakeholders (senior management, middle management, and lower management) working in various employment cadres. The stratified random sampling design was used to sample 241 respondents from various departments. Data was collected through questionnaires and analysed descriptively and inferentially. Descriptive statistics involved means, standard deviations, frequencies, and percentages, while inferential statistics involved Pearson correlation and simple regression analysis. The Shapiro-Wilk test of normality was conducted, and since the p-values were above 0.05, the data was normal. The study found that stakeholder participation had a significant effect on organizational performance in selected alcohol manufacturing entities (t = -6.958, p&lt;0.05). The study therefore rejected the null hypothesis formulated. The study recommends frequent engagement of stakeholders at work by firm management to enhance performance.

Trends and determinants of acute respiratory infection symptoms among under-five children in Cambodia: Analysis of 2000 to 2014 Cambodia demographic and health surveys.

Acute Respiratory Infections (ARIs) are the leading cause of mortality and morbidity among children under 5 years old and about 1.3 million annually worldwide. Account for 33% of deaths among children under 5 years that occurred in developing countries. In Cambodia, ARIs prevalence in children under 5 years old was 20% in 2000, and 6% in 2014. Hence, the aimed to describe the trends of ARI symptoms among children aged 0-59 months over time using the 2000, 2005, 2010, and 2014 Cambodia Demographic and Health Survey (CDHS) and determined the relationships between socio-demographic, behavioral, and environmental factors with ARI symptoms. We analyzed existing children's data from 2000, 2005, 2010 and 2014 of Cambodia Demographic and Health Survey (CDHS) that used a two-stage stratified cluster sampling design. We limited our analysis to children born in the last five years prior to the surveys, alive and living in households during interview time. Data were pooled across the four survey years for 29,171 children aged 0-59 months. All statistics were carried out using STATA V16, and survey weights were taken into account for the survey design of the CDHS. We used multiple logistic regression to determine the main predictors of ARI symptoms among children under 5 years. ARI symptoms in the previous two weeks in children aged 0-59 months in Cambodia were 19.9% in 2000 to 8.6% in 2005 to 6.4% in 2010, and 5.5% in 2014. Factors independently associated with increased odds of ARI symptoms were children ages 6-11 months with adjusted odds ratio [AOR = 1.91; 95% CI: 1.53-2.38], 12-23 months [AOR = 1.79; 95% CI: 1.46-2.20], and 24-35 months [AOR = 1.41; 95% CI: 1.13-1.76], smoking mother [AOR = 1.61; 95% CI: 1.27-2.05], and using non-improved toilets in households [AOR = 1.20; 95% CI: 0.99-1.46]. However, the following factors were found to be associated with decreased odds of having ARI symptoms: Mothers with higher education [AOR = 0.45; 95% CI: 0.21-0.94], breastfeeding children [AOR = 0.87; 95% CI: 0.77-0.98], and children born into richest wealth quantile [AOR = 0.73; 95% CI: 0.56-0.95], respectively. Survey 2005 [AOR = 0.36; 95% CI: 0.31-0.42], 2010 [AOR = 0.27; 95% CI: 0.22-0.33], 2014 [AOR = 0.24; 95% CI: 0.19-0.30]. The trends of ARI symptoms among children under five in Cambodia significantly decreased from 2000-2014. Smoking mothers, young children ages (0-35 months), and using non-improved toilet in household are factors that independently increased the likelihood that children would develop ARI symptoms. Inversely, factors were found to be associated with decreased odds of having ARI symptoms: Mothers with higher education, breastfeeding children, and children born into the richest wealth quantile and Survey years. Therefore, government and child family programs must promote maternal education, particularly infant breastfeeding. The government ought to support maternal education and infant breastfeeding in the interest of early childhood care.

Standardized Data to Improve Understanding and Modeling of Soil Nitrogen at Continental Scale

AbstractNitrogen (N) is a key limiting nutrient in terrestrial ecosystems, but there remain critical gaps in our ability to predict and model controls on soil N cycling. This may be in part due to lack of standardized sampling across broad spatial–temporal scales. Here, we introduce a continentally distributed, publicly available data set collected by the National Ecological Observatory Network (NEON) that can help fill these gaps. First, we detail the sampling design and methods used to collect and analyze soil inorganic N pool and net flux rate data from 47 terrestrial sites. We address methodological challenges in generating a standardized data set, even for a network using uniform protocols. Then, we evaluate sources of variation within the sampling design and compare measured net N mineralization to simulated fluxes from the Community Earth System Model 2 (CESM2). We observed wide spatiotemporal variation in inorganic N pool sizes and net transformation rates. Site explained the most variation in NEON’s stratified sampling design, followed by plots within sites. Organic horizons had larger pools and net N transformation rates than mineral horizons on a sample weight basis. The majority of sites showed some degree of seasonality in N dynamics, but overall these temporal patterns were not matched by CESM2, leading to poor correspondence between observed and modeled data. Looking forward, these data can reveal new insights into controls on soil N cycling, especially in the context of other environmental data sets provided by NEON, and should be leveraged to improve predictive modeling of the soil N cycle.

Sex-based differences in risk of cardiovascular disease development and cardiovascular risk factors among individuals with hypertension: A cross-sectional study from primary care facilities

BackgroundOver the last two decades, the understanding of cardiovascular disease (CVD) has expanded in Asian countries. Despite this progress, there have been limited investigations into sex-based differences in the development of CVD and cardiovascular risk factors (CVRFs). AimWe investigated whether males and females with hypertension had different risks of developing CVD and CVRFs. MethodsWe used a stratified multi-stage sampling design involving 15 primary care centers in Thailand. We recruited 1,448 individuals aged 35–74 years old. The Framingham cardiovascular risk algorithm was used to determine the risk of CVD development. ResultsFemale patients were overall more likely to have lower CVD risk scores. However, they demonstrated higher scores in the moderate-risk (p < 0.001) and high-risk (p < 0.001) groups as compared with males. One in four females was at a high risk of developing CVD. Females had higher rates of all CVRFs against males across sub-risk groups, with the highest odds ratio observed in the high-risk group, which persisted after adjusting for covariations. Overall, female patients had higher rates of diabetes, hyperlipidemia, obesity, and abdominal obesity as compared with males. Females in the overall group had a lower prevalence of uncontrolled hypertension than males, in contrast to the high-risk group. Female patients also had a lower prevalence of cigarette smoking and alcohol consumption than males. ConclusionThere is evidence of sex-based differences in the risk of CVD development in hypertensive individuals. The interaction of CVRFs with a high risk of developing CVD was noted in females.

Generation and comprehensive validation of 30 m conterminous United States Landsat percent tree cover and forest cover loss annual products

This study describes the generation and comprehensive validation of 30 m Landsat-based annual percent tree cover and forest cover loss products for the conterminous United States (CONUS). The products define (i) forest status with respect to three thematic classes: stable forest, stable non-forest, forest cover loss, (ii) percent tree cover (PTC, 0–100%), (iii) percent tree cover decrease (ΔPTC), and (iv) the Landsat acquisition dates bounding mapped forest cover loss occurrence. Forest was defined, based on the U.S. federal government forested land definition, as 30 m pixels with mapped PTC >10%. Annual products were derived using temporally overlapping 9-year periods (mapping within each central 5-year period) of USGS Landsat Analysis Ready Data (ARD) with reconciliation of the results between periods. The products for 2013 are presented and were validated rigorously by comparison with 1910 30 m independent reference data interpreted from bi-temporal <1 m resolution aerial imagery selected using a Stage 3 CONUS stratified random sampling design. The stable forest, stable non-forest, and forest cover loss results were validated using standard accuracy metrics derived from the confusion matrix. The overall accuracy was high (0.92), and class-specific user's accuracy (UA) and producer's accuracy (PA) metrics were also high for the stable forest (UA = 0.94, PA = 0.84) and stable non-forest (UA = 0.90, PA = 0.97) classes. The forest cover loss class had similarly high UA (0.89) but significantly lower PA (0.61) indicating non-negligible omission errors. All standard errors were <5%. The total area of stable forest over CONUS for year 2013 was estimated as 3,049,380 ± 114,392 km2 and the total area of forest cover loss was estimated as 31,382 ± 4751 km2, with 95% confidence interval. The PTC and ΔPTC products were validated by linear regression with the reference data, indicating good PTC precision reflected by a high coefficient of determination (R2 = 0.79), and accuracy with a regression slope close to unity (0.86) and small intercept (3.48). The regression between mapped ΔPTC and the reference data had a high coefficient of determination (R2 = 0.74) but a regression slope further away from unity (0.78) and small intercept (1.68) consistent with the forest cover loss omission errors revealed by the confusion matrix. State-level comparison of the stable forest mapped area with forest land area statistics published by the U.S. federal government for the 48 CONUS states indicated reasonable correspondence (R2 = 0.97) but with a 1.15 regression line slope indicating relative over estimation of the mapped stable forest area, likely related to forest land reporting differences.

The Association Between Cannabis Use and Subsequent Nicotine Electronic Cigarette Use Among US Adolescents

PurposeThe current study assessed the association between cannabis use among youth never e-cigarette users and subsequent e-cigarette use. MethodsThe Population Assessment of Tobacco and Health Study is a nationally representative cohort study. Participants aged 12 years and older were selected using a 4-stage, stratified probability sample design from the US civilian, noninstitutionalized population. We included adolescents who participated in both wave 4.5 (2017–2018) and wave 5 (2018–2019) of Population Assessment of Tobacco and Health, and were never e-cigarette users at baseline (N = 9,925). Through multivariable logistic regressions, we examined the prospective association between cannabis use and subsequent e-cigarette use. ResultsE-cigarette use at wave five was significantly more common among youth cannabis users at wave 4.5. The adjusted relative risks between ever cannabis use and subsequent past 12-month, past 30-day, and frequent e-cigarette use (≥20 days per month) were 1.53 (95% CI, 1.26–1.81), 1.70 (95% CI, 1.25–2.15), and 2.10 (95% CI, 1.17–3.03), respectively. The adjusted relative risks between past 30-day cannabis use and subsequent past 12-month, past 30-day, and frequent e-cigarette use were 1.54 (95% CI, 1.04–2.28), 2.01 (95% CI, 1.23–3.29), and 2.87 (95% CI, 1.44–5.71), respectively. We also found significant associations between ever cannabis vaping with subsequent e-cigarette use. DiscussionWhile previous research associates e-cigarette use with subsequent onset of cannabis use, we identify a reverse directional effect, where adolescent cannabis use is associated with increased likelihood of future e-cigarette use.

Age, period and cohort effects on time trends in monthly cannabis use in adult population: 1996-2019.

With changes in norms related to cannabis use and in the regulation of cannabis, understanding trends in cannabis use is important, especially differentiating between trends that affect cohorts of all ages similarly, versus trends that disproportionately affect a younger generation. The present study examined the age-period-cohort (APC) effects on monthly cannabis use among adults in Ontario, Canada over a 24-year period. Data were utilised from the Centre for Addiction and Mental Health Monitor Survey, an annual repeated cross-sectional survey of adults 18 years of age and older. The present analyses focused on the 1996 to 2019 surveys, which employed a regionally stratified sampling design using computer-assisted telephone interviews (N = 60,171). Monthly use of cannabis stratified by sex were examined. There was about a five-fold increase in monthly cannabis use from 1996 (3.1%) to 2019 (16.6%). The youngest adults use cannabis monthly more, but the patterns of monthly cannabis use appeared to be increasing among older adults. Adults born in the 1950s had higher prevalence of cannabis use (1.25 times more likely to use) compared to those born in 1964, with strongest period effect in 2019. The subgroup analysis of monthly cannabis use by sex showed little variation in APC effects. There is a change in patterns of cannabis use among older adults and inclusion of birth cohort dimension improves the explanation of cannabis use trends. Adults in the 1950s birth cohort and increases in the normalisation of cannabis use could also be the key to explaining increasing monthly cannabis use.

Acceptability of mandatory vaccination against influenza, measles, pertussis and varicella by workers in healthcare facilities: a national cross-sectional study, France, 2019

BackgroundVaccination of healthcare workers (HCW) aims to protect them and to reduce transmission to susceptible patients. Influenza, measles, pertussis, and varicella vaccinations are recommended but not mandatory for HCW in France. Insufficient vaccine coverage for these diseases in HCW has raised the question of introducing mandatory vaccination. We conducted a survey to estimate acceptability of mandatory vaccination for these four vaccines by HCW working in healthcare facilities (HCF) in France, and to identify associated determinants.MethodsIn 2019, we performed a cross-sectional survey of physicians, nurses, midwives and nursing assistants working in HCF in France using a randomised stratified three-stage sampling design (HCF type, ward category, HCW category). Data were collected in face-to-face interviews using a tablet computer. We investigated the possible determinants of acceptability of mandatory vaccination using univariate and multivariate Poisson regressions, and estimated prevalence ratios (PR).ResultsA total of 8594 HCW in 167 HCF were included. For measles, pertussis, and varicella, self-reported acceptability of mandatory vaccination (very or quite favourable) was 73.1% [CI95%: 70.9–75.1], 72.1% [69.8–74.3], and 57.5% [54.5–57.7], respectively. Acceptability varied according to i) HCW and ward category for these three vaccinations, ii) age group for measles and pertussis, and iii) sex for varicella. For mandatory influenza vaccination, acceptability was lower (42.7% [40.6–44.9]), and varied greatly between HCW categories (from 77.2% for physicians to 32.0% for nursing assistants).ConclusionHCW acceptability of mandatory vaccination was high for measles, pertussis and varicella but not as high for influenza. Vaccination for COVID-19 is mandatory for HCW in France. Replication of this study after the end of the COVID-19 crisis would help assess whether the pandemic had an impact on their acceptability of mandatory vaccination, in particular for influenza.

Age-related disparities and trends in national healthcare spending formanagement of appendicitis in the United States: A retrospective cost-analysis.

Changes in clinical care for appendicitis have impacted healthcare use associated with treatment. We evaluated national trends and assessed factors associated with healthcare costs for appendicitis in the United States. The Disease Expenditure Project, the Global Burden of Disease study, and the National Inpatient Sample were used to estimate total national expenditures, per-capita costs for incident cases, and factors associated with inpatient costs for appendicitis management, respectively. The national estimates of appendicitis costs were obtained from 1996 to 2016. Appendicitis incidence was estimated to calculate per-capita costs. After application of survey weights for the stratified sample design, 191,180 weighted discharges for appendicitis from the 2016 National Inpatient Sample study were evaluated. The Disease Expenditure Project and the Global Burden of Disease study were used to estimate total and per-capita spending. Temporal trends were evaluated using joinpoint regression, expressed as annual percent change. Multivariable linear regression was used to evaluate patient factors associated with total hospital charges. In 2016, total spending on appendicitis was $9.3 billion (95% confidence interval: $8.0-$10.8], a 2-fold increase from $4.7 billion ($4.0-$5.3) in 1996. Per-capita spending decreased significantly after 2011 (annual percent change -3.7% [-4.4% to -2.9%]). Patients ≥65 years accounted for 64.1% (61.1%-67.3%) of total spending for appendicitis. The hospital charges for older patients were significantly higher among those undergoing appendectomy. Overall healthcare spending for appendicitis has doubled from 1996 to 2016, but per capita spending has decreased since 2011, driven by improved efficiency of inpatient care. Nearly two-thirds of spending is on patients ≥65 years, with significantly higher costs associated with surgical management in this population.

Overweight and obesity among women at reproductive age in Cambodia: Data analysis of Cambodia Demographic and Health Survey 2014.

Overweight and obesity increase the risk of cardiovascular disease, type 2 diabetes mellitus, hypertension, stroke, and some type of cancers, and maternal health globally. In Cambodia, the prevalence of overweight and obesity among women aged 15-49 years increased from 6% in 2000 to 18% in 2014, becoming a public health burden. We examined socio-demographic and behavioral factors associated with overweight and/or obesity among women of reproductive age (WRA) in Cambodia. We analyzed data from the 2014 Cambodia Demographic and Health Survey (CDHS) that used a two-stage stratified cluster sampling design. Data analysis was restricted to non-pregnant women, resulting in an analytic sample of 10,818 women. Multivariable logistic regressions were performed using STATA V16 to examine factors associated with overweight and obesity. Prevalence of overweight and obesity among non-pregnant women of reproductive age were 15.2% and 2.8% respectively. Factors independently associated with increased odds of overweight and/or obesity including women aged 20-29 years with adjusted odds ratio [AOR = 2.4; 95% CI: 1.6-3.6], 30-39 years [AOR = 4.6; 95% CI: 3.0-6.9], and 40-49 years [AOR = 6.6; 95% CI: 4.3-10.1], married women [AOR = 1.8; 95% CI: 1.3-2.7], urban residence [AOR = 1.3; 95% CI: 1.1-1.5], and women having at least 4 children [AOR = 1.7; 95% CI: 1.2-2.5]. The factors were associated with decreased odds of overweight and obesity: completed at least secondary education [AOR = 0.7; 95% CI: 0.6-0.8], agricultural work [AOR = 0.7; 95% CI: 0.5-0.8], and manual labor work [AOR = 0.7; 95% CI: 0.6-0.9]. Increased age, married women, living in urban residence, and having at least four children were the main risk factors associated with overweight and/or obesity. Conversely, higher education, working in agriculture, and working in manual labor were negatively associated with overweight and/or obesity. Cambodia's non-communicable disease (NCD) public health programs should consider these characteristic for targeting interventions to further reduce overweight and/or obesity in the coming years.

Calibration Approach Ratio Estimators of Population Median in Stratified Random Sampling Design

Median as a measure of location gives a more robust estimate than the mean when dealing with heavy tailed or skewed distributions. It can also be used in cases of qualitative variables and open end intervals. Calibration, an approach that adjusts the original design weight by incorporating auxiliary information is employed using the chi square distance measure on a ratio median estimator under stratified random sampling to propose some estimators of population median. These proposed estimators are: the regression and ratio-type calibrated estimators with one constraint and the regression and ratio-type calibrated estimators with two constraints. The estimators of variance of these proposed estimators are also obtained. Empirical investigations on the performance of these estimators are carried out using R software simulated data set under underlying distributional assumptions of Cauchy and Lognormal, for sample sizes of 10%, 20% and 25%. The results showed that the proposed regression and ratio-type calibrated estimators with one constraint and the regression-type calibrated estimator with two constraints were more efficient than the existing ratio estimator and the proposed ratio-type calibrated estimator under two constraints for both Cauchy and the lognormal distributions.

Association Of Burnout And Depression Symptoms And Their Prevalence Among Medical Students In Karachi, Pakistan

Background — The mental health of medical students has long been a concern. Symptoms of depression and burnout are common among medical students, but the overlap of symptoms of both diseases with risk factors remains unclear. The goal of this study was to determine the prevalence of burnout and depression symptoms’ overlap in medical students. Methods — This cross-sectional study was conducted among students of the clinical course (3rd, 4th and 5th years). A multistage stratified random sampling design was used to select 284students that were offered a validated and structured questionnaire that included a modified Oldenburg Burnout Inventory and Patient Health Questionnaire-9 to assess their emotional burnout and depression, respectively. Chi-square and multinomial regression analyses were done to identify overlapping symptoms of burnout and depression with association of risk factors with dependent variable. Results — Out of 284 students, 13% had symptoms of severe depression, 24% had high burnout symptoms, and 32% had overlapping symptoms of burnout and depression. In regression analysis, higher academic year more than 2 times (5th year, OR 2.03, 95% CI 1.42-7.96, p-value 0.004) and living at dormitory more than 3 times (OR 3.97, 95% CI 1.97-5.01, p-value 0.003) were more likely associated with more extensive overlap of burnout and depression symptoms. Conclusion — There is a high prevalence of burnout and depression symptoms among medical students, with a strong association between the two disorders. Early burnout detection and psychiatric therapies given to affected students and these disorders management training at medical school, may help reduce negative consequences of these conditions.

The combined consumption of fresh/minimally processed food and ultra-processed food on food insecurity: COVID Inconfidentes, a population-based survey.

To investigate whether the combined consumption of fresh/minimally processed and ultra-processed food is associated with food insecurity (FI) during the COVID-19 pandemic. Cross-sectional observational study was derived from a survey using a population-based search of a complex sample. FI was assessed using the validated Brazilian Food Insecurity Scale. Food consumption was assessed using a qualitative FFQ and the NOVA classification for fresh/minimally processed food and ultra-processed food. A scoring system was used to evaluate combined food consumption according to the extent and purpose of processing, considering the weekly consumption of the two groups (according to the NOVA classification). Higher punctuation reflects worse diet quality (higher consumption of ultra-processed foods and lower consumption of fresh/minimally processed foods). A theoretical causality model was constructed using a directed acyclic graph, and multivariate analysis was performed using Poisson regression to test the association between FI and food consumption. Ouro Preto and Mariana, Brazil, between October and December 2020. An epidemiological household survey was conducted with 1753 individuals selected through a stratified and clustered sampling design in three stages. Those with food consumption scores in the fourth quartile had a 60 % higher prevalence ratio (PR) for FI (PR: 1·60 and 95 % CI: 1·06 - 2·40). Also, the increased consumption of fresh/minimally processed foods and low consumption of ultra-processed foods presented a 45 % lower prevalence ratio of FI (PR: 0·55 and 95 % CI: 0·40 - 0·80). These results indicate an inverse association between FI and diet quality.