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Background The pilot use of a smartphone platform for electronic informed consent (e- consent) in large vessel occlusion acute stroke (LVOS) trials has recently been reported. The degree of satisfaction from legal authorized representatives (LARS) with regard to this process remains to be established. Methods A single- center study evaluating the experience of lars with the use of e- consent in a LVOS randomized trial of an investigational drug administered within 12 hours of last known normal was carried out. a structured survey was used to evaluate the experience of the lars with the e- consenting process. Results From February to november 2018, 60 consecutive patients were e- consented. Of these, 53 lars completed the survey. The median (IQR) age of the patients was 63 (53--70) years, baseline/discharge national institutes of health stroke scale score was 17 (12--20)/3(1--12), and 45% were independent at discharge. The survey was applied in person in 43% of cases and via telephone in 57%. Median LAR age was 48 (39--59) years, 64% were female, and a multi- ethnic composition was observed. Forty percent of LARS had less than tertiary level of education (high- school or less). regarding the e- consent, 98% of LARS reported to be 'clear' and 83% felt 'very comfortable' in signing. The overall experience was 'excellent/good' in 91%. Despite the positive general impression regarding the use of e- consent, 12 lars (22%) would have preferred paper consent. Multivariable regression indicated that lower educational status (tertiary education or less: Or 5.09, 95% CI 1.02 to 25.48; p=0.04) and lower baseline ASPECTS score (Or 0.63, 95% CI 0.41 to 0.96; p=0.03) were independently associated with preference for paper consent. Conclusions e- consent was overall very well perceived by lars in a randomized clinical trial of lVOs. a minority of proxies, who were more commonly less formally educated, would have preferred paper consenting. [ABSTRACT FROM AUTHOR]

Background Replication is a vital part of the research process and has recently received considerable attention. Analyses using publicly available data should, if adequately described, be reproducible without assistance from the original investigators. Using data from the US National Health and Nutrition Examination Survey (NHANES), a recent study reported a statistically significant difference in cardiovascular disease risk comparing subgroups of sexual minority men. We attempted to reproduce these findings and assessed whether the results were robust to alternative analytic strategies and assumptions. Methods We used the exclusion criteria and coding strategy described in the original paper to construct our analytical data set. Sampling weights were constructed in accordance with NHANES analytical guidelines. We estimated crude and covariate-adjusted associations between sexual orientation and vascular age using the regression models specified in the original report. We also conducted a series of sensitivity analyses to improve on the original findings. Results Our replication attempt was partially successful: we replicated the general trends reported in the original analysis, but not identical effect estimates. Importantly, we identified a potential misapplication of the Framingham Risk Score; correcting for this increased the probability that the reported null hypothesis test was a type I error. Conclusions This paper supports the recent calls for greater transparency and improved reporting in research. Even with a publicly available and well-documented data source, we were unable to exactly replicate another study's original findings. Our sensitivity analyses revealed key issues in the original analysis and demonstrate the scientific importance of research replication. [ABSTRACT FROM AUTHOR]

Background: Being married is associated with healthier lifestyle behaviours and lower mortality and may reduce risk for dementia due to life-course factors. We conducted a systematic review and meta-analysis of studies of the association between marital status and the risk of developing dementia.Methods: We searched medical databases and contacted experts in the field for relevant studies reporting the relationship, adjusted for age and sex, between marital status and dementia. We rated methodological quality and conducted random-effects meta-analyses to summarise relative risks of being widowed, divorced or lifelong single, compared with being married. Secondary stratified analyses with meta-regression examined the impact of clinical and social context and study methodology on findings.Results: We included 15 studies with 812 047 participants. Compared with those who are married, lifelong single (relative risk=1.42 (95% CI 1.07 to 1.90)) and widowed (1.20 (1.02 to 1.41)) people have elevated risk of dementia. We did not find an association in divorced people.Further analyses showed that less education partially confounds the risk in widowhood and worse physical health the elevated risk in lifelong single people. Compared with studies that used clinical registers for ascertaining dementia diagnoses, those which clinically examined all participants found higher risk for being unmarried.Conclusions: Being married is associated with reduced risk of dementia than widowed and lifelong single people, who are also underdiagnosed in routine clinical practice. Dementia prevention in unmarried people should focus on education and physical health and should consider the possible effect of social engagement as a modifiable risk factor. [ABSTRACT FROM AUTHOR]

Background Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010. Methods Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30-79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities. Results We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In al countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities. Conclusions Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed. [ABSTRACT FROM AUTHOR]

Background: Successful injury prevention requires identification and targeting of particularly vulnerable groups. Little is known about injury vulnerability patterns in Sudan. This paper aimed to fill this gap using survey data. Methods: Data from the Sudan Household Health Survey were used. This was a national cross-sectional interview survey of 83 510 individuals selected by multistage cluster random sampling. Multivariable Poisson regression was used to investigate the association of cause-specific injury that received care by traditional healers, outpatient care and inpatient care, and those that received only inpatient care, with age, gender, area of residence (urban or rural), socioeconomic status and education. Relevant interactions were tested. Results: Independent of other sociodemographic variables, men were at higher risk of road traffic injury (prevalence ratio (PR): 3.3 95% CI 2.4 to 4.7), falls (PR: 1.5, 95% CI 1.3 to 1.9), assault (PR: 3.0 95% CI 1.8–5) and mechanical injury (PR: 2.0 95% CI 1.2 to 3.1) that received any form of healthcare. Those aged 65 years and over also had the highest risk of those injury causes, while children under 5 years were the most likely to suffer burn injuries. Socioeconomic status was associated with assault (PR for the richest group 0.4 95% CI 0.2 to 0.8). Vulnerability patterns for injury that received inpatient care were fairly similar for some causes. Conclusions: In Sudan, existing disease prevention and health promotion programmes should expand to target men, children under 5 years, elderly people and those of low socioeconomic status with injury prevention interventions. Further research is needed to investigate the context-specific proximal risk factors that shape the various vulnerability patterns observed. [ABSTRACT FROM AUTHOR]

Background Diabetes prevalence is high worldwide, affecting entire populations. Yet some population groups are more susceptible than others. In contemporary western societies, socioeconomically disadvantaged groups are disproportionally affected. The pattern is less clear for diabetes mortality. Researchers argue increasingly in favour of looking beyond individual socioeconomic position (SEP). In light of the above, this paper looks at the relationship between individual-based and household-based SEP measures and diabetes mortality. Methods Data consisted of the Belgian 2001 census for the Flanders region linked to register data on causespecific mortality during the period 2001–2010. The study population included all 35-year-old to 74-year-old official inhabitants of Flanders married or cohabiting at the 2001 census. Age-standardised death rates (direct standardisation) and mortality rate ratios (MRRs; Poisson regression) were computed for the different SEP groups. Results Inverse gradients were observed by own education, partner’s education and housing status (combination of housing tenure and quality). For example, among 55-year-olds to 74-year-olds, MRRs according to partner’s education were 3.0 (95% CI 2.4 to 3.8) for women with a lower-educated partner and 1.6 (95% CI 1.2 to 2.0) for women with a higher secondary-educated partner, relative to women with a higher-educated partner. As for housing status, diabetesrelated mortality was particularly high among tenants and low-quality owners. The association between each of the SEP measures and diabetes-related mortality remained after adjusting for the other measures. Conclusions There were large differences in diabetesrelated mortality according to both individual-based and household-based SEP measures, indicating the importance of the individual and household levels for understanding socioeconomic inequalities in diabetes mortality. [ABSTRACT FROM AUTHOR]

Background Socioeconomic development has been considered as a solution to the problem of sex differentials at birth and under-five mortality. This paper analyses longitudinal data from the Ballabgarh Health and Demographic Surveillance System (HDSS) site in north India to check its veracity.Methods A cohort of children born between 1 January 2006 and 31 December 2011 at Ballabgarh HDSS were followed till death, emigration, 3 years of age or end of the study. Socioeconomic status (SES) was measured by caste, parental combined years of schooling and wealth index and divided into low, mid and high strata for each of them. Sex ratio at birth (SRB) was reported as the number of girls per 1000 boys. The Kaplan-Meier survival curves were drawn and a Cox Proportional HR of girls over boys was estimated. Results A total of 12 517 native born children (25 797 child years) were enrolled of which 710 died (death rate of 56.7/1000-live births and 27.5/1000 child-years. Socioeconomically advantaged children had significantly lower death rates. The SRB (10–16% lower) and neonatal death rate were consistently adverse for girls in the advantaged groups by all the three indicators of SES. The first month survival rates were better for girls in the lower SES categories (significant only in caste (HR 0.58; 0.37 to 0.91). High SES categories consistently showed adverse survival rates for girls (HR of 1.22 to 1.59). Conclusions Better socioeconomic situation worsened the sex differentials, especially at birth. Therefore,specific interventions targeting gender issues are required, at least as a short-term measure. [ABSTRACT FROM AUTHOR]

Several authors have suggested that dementia screening tests may be biased against low levels of education, whereas others find that a low level of education is a genuine risk factor for dementia. The present paper attempts to reconcile these conflicting views by examining item bias and test bias indices of the mini mental state examination (MMSE). Psychometric calculations and receiver operating characteristics (ROC) analyses of sensitivity and specificity as performed by earlier studies were replicated and extended from the database of the Amsterdam Study of the Elderly. This is a population survey on cognitive decline and dementia (age range 65-84). Subjects with a low level of education (primary school) were compared with better educated subjects (at least some secondary education). Cases were matched by age and sex. The results indicate that the MMSE is not educationally biased as far as item characteristics, reliability, and construct validity are concerned. Yet its predictive validity as a screening test for dementia is educationally biased. This bias will effectively be eliminated with a two point higher cut off score for the subjects whose education extends beyond primary school. Even after such score correction, a low level of education probably remains a genuine risk factor for dementia. [ABSTRACT FROM AUTHOR]

Objective: Early life adversity has been associated with increased risk of inflammation and inflammation-related diseases in adulthood. This study aimed to examine the association of childhood socioeconomic conditions with chronic low-grade inflammation over adolescence.Methods: We used information on 2942 members (1507 girls and 1435 boys) of the EPITeen (Epidemiological Health Investigation of Teenagers in Porto) cohort that was established in 2003 in Porto, Portugal, and included 13-year-old adolescents were further evaluated at 17 and 21 years. Mother' and father's education and occupation were used as indicators of childhood socioeconomic conditions. High-sensitivity C reactive protein (hs-CRP) was measured at three points in time (13, 17 and 21 years). hs-CRP levels were categorised in tertiles separately for each wave; chronic low-grade inflammation in adolescence was defined as having hs-CRP levels in the highest tertile in at least two waves and never in the lowest tertile.Results: Prevalence of chronic low-grade inflammation during adolescence was significantly higher among participants with low parental socioeconomic position. Low parental socioeconomic position was associated with chronic low-grade inflammation in adolescence, after adjustment for sex, perinatal and physical environment factors, health-related behaviours and health status in adolescence OR=1.6; 95% CI: 1.1 to 2.4 for lowest versus highest mother's education and OR=1.6; 95% CI: 1.1 to 2.3 for lowest versus highest father's occupation.Conclusion: Low childhood socioeconomic conditions are associated with chronic low-grade inflammation during adolescence. Our results suggest that the early life socioeconomic environment has an impact on inflammatory processes over adolescence. [ABSTRACT FROM AUTHOR]

Background The global financial crisis of 2008 is likely to have repercussions on public health in Europe, not least through escalating mass unemployment, fiscal austerity measures and inadequate social protection systems. The purpose of this study is to analyse the role of unemployment insurance for deteriorating self-rated health in the working age population at the onset of the fiscal crisis in Europe. Methods Multilevel logistic conditional change models linking institutional-level data on coverage and income replacement in unemployment insurance to individual-level panel data on self-rated health in 23 European countries at two repeated occasions, 2006 and 2009. Results Unemployment insurance significantly reduces transitions into self-rated ill-health and, particularly, programme coverage is important in this respect. Unemployment insurance is also of relevance for the socioeconomic gradients of health at individual level, where programme coverage significantly reduces health risks attached to educational attainment. Conclusions Unemployment insurance mitigated adverse health effects both at individual and country-level during the financial crisis. Due to the centrality of programme coverage, reforms to unemployment insurance should focus on extending the number of insured people in the labour force. [ABSTRACT FROM AUTHOR]

Objective To analyse the prevalence and correlates of smoking in cars as well as attitudes towards the extension of smoking bans in private vehicles among Italian adults. Methods We used data from two surveys conducted in 2011 and 2012 on an overall sample of 6167 individuals representative of the Italian population aged ≥15 years. Results The prevalence of smoking while driving was 65.5% among adult smokers. There was a negative trend with age and a positive one with education level. Smoking while driving was more prevalent among men, heavy smokers and smokers who believe there is little or no increased risk of accidents from smoking while driving. Among smokers who smoke while driving, 20.9% smoke in cars carrying children. Overall, 79.6% of Italians (88.2% non-smokers and 48.8% current smokers) support a ban on smoking in cars, and 92.5% (95.0% non-smokers and 83.5% current smokers) support such a ban in cars carrying children. Conclusions Despite the high percentage of smokers who smoke in private vehicles, the majority of the Italian population (including smokers) support the introduction of a smoking ban in cars, particularly in cars carrying children. Smoke-free laws should therefore be extended to private vehicles, particularly if they are carrying children. Moreover, warning labels on cigarette packages should include information on the increased risk of accidents when smoking while driving. Mass media campaigns should also consider targeting this topic. [ABSTRACT FROM AUTHOR]