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The purpose of this paper is to examine the available peer-reviewed research regarding literacy achievement in deaf children with cochlear implants. A related goal is to identify gaps in the empirical literature and suggest directions for future research. Included in this review are studies that exclusively report reading and writing outcomes for groups of students. A total of 21 studies were identified, representing those published over approximately a 20-year time period (1997-2016) and collectively reporting the literacy outcomes for over 1,000 cochlear implant users. Overall findings of the studies of reading comprehension suggest that the majority of participants achieved scores in the average range, although a wide-range of variability was reported. Only 3 studies of writing were available for review, with 2 reporting lower achievement in this area as compared to reading. Factors impacting outcomes achieved such as age at implantation, presence of additional disabilities, consistency of device use, and communication modality are explored and summarized. [ABSTRACT FROM AUTHOR]

Background: the complex management for patients presenting to hospital with vertebral fragility fractures provides justification for the development of specific services for them. A systematic review was undertaken to determine the incidence of hospital admission, patient characteristics and health outcomes of vertebral fragility fracture patients to inform the development of such a service. Methods: non-randomised studies of vertebral fragility fracture in hospital were included. Searches were conducted using electronic databases and citation searching of the included papers. Results: a total of 19 studies were included. The incidence of hospital admission varied from 2.8 to 19.3 per 10,000/year. The average patient age was 81 years, the majority having presented with a fall. A diagnosis of osteoporosis or previous fragility fracture was reported in around one-third of patients. Most patients (75% men and 78% women) had five or more copathologies. Most patients were managed non-operatively with a median hospital length of stay of 10 days. One-third of patients were started on osteoporosis treatment. Inpatient and 1-year mortality was between 0.9 and 3.5%, and 20 and 27%, respectively, between 34 and 50% were discharged from hospital to a care facility. Many patients were more dependent with activities of daily living on discharge compared to their pre-admission level. Older age and increasing comorbidities was associated with longer hospital stay and higher mortality. Conclusion: these findings indicate that specific hospital services for patients with vertebral fragility fractures should take into consideration local hospitalisation rates for the condition, and should be multifaceted-providing access to diagnostic, therapeutic, surgical and rehabilitation interventions. [ABSTRACT FROM AUTHOR]

Background The Nordic countries represent a unique case study for the COVID-19 pandemic due to socioeconomic and cultural similarities, high-quality comparable administrative register data and notable differences in mitigation policies during the pandemic. We aimed to compare weekly excess mortality in the Nordic countries across the three full pandemic years 2020–2022. Methods Using data on weekly all-cause mortality from official administrative registers in Denmark, Finland, Norway and Sweden, we employed time series regression models to assess mortality developments within each pandemic year, with the period 2010–2019 used as reference period. We then compared excess mortality across the countries in 2020–2022, taking differences in population size and age- and sex-distribution into account. Results were age- and sex-standardized to the Danish population of 2020. Robustness was examined with a variety of sensitivity analyses. Results While Sweden experienced excess mortality in 2020 [75 excess deaths per 100 000 population (95% prediction interval 29–122)], Denmark, Finland and Norway experienced excess mortality in 2022 [52 (14–90), 130 (83–177) and 88 (48–128), respectively]. Weekly death data reveal how mortality started to increase in mid-2021 in Denmark, Finland and Norway, and continued above the expected level through 2022. Conclusion Although the Nordic countries experienced relatively low pandemic excess mortality, the impact and timing of excess mortality differed substantially. These estimates—arguably the most accurate available for any region in capturing pandemic-related excess deaths—may inform future research and policy regarding the complex mortality dynamics in times of a health crisis such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background Although the global chronic morbidity indicator (GCMI) of the Minimum European Health Module (MEHM) was not specifically designed to monitor chronic disease in the population, it is increasingly used for this purpose in Europe and elsewhere. However, its metrological characteristics have seldom been examined, with various sensitivity issues being raised. The present study investigated the metrological performances of the GCMI and analyzed its implications in terms of prevalence and demographic and socioeconomic gradients of chronic conditions in the population. Methods We used data from two large French nationwide representative surveys with cross-sectional and longitudinal data conducted between 2010 and 2021. The surveys used MEHM and collected data on numerous chronic conditions and socioeconomic indicators. Criterion and predictive validity of the GCMI regarding chronic conditions and the resultant socioeconomic gradients were compared with indicators based on reports of individual chronic conditions. Results GCMI sensitivity to capture chronic conditions varied from <20 to 80% depending on the chronic condition. Number of chronic conditions, gender, age and education were also associated with GCMI endorsement. However, the GCMI was predictive of mortality and activity limitations independently of individual conditions. Conclusion The varying lack of sensitivity depending on the chronic condition and the respondent's sociodemographic status may bias estimates of demographic and socioeconomic gradients compared with indicators based on reports of individual chronic conditions. Differences between GCMI and list-based approaches should be more cautiously considered when monitoring chronic conditions in the population. These approaches should be viewed as complementary rather than contradictory or interchangeable. [ABSTRACT FROM AUTHOR]

Background Resilience of national health systems in Europe remains a major concern in times of multiple crises and as more evidence is emerging relating to the indirect effects of the COVID-19 pandemic on health care utilization (HCU), resulting from de-prioritization of regular, non-pandemic healthcare services. Most extant studies focus on regional, disease specific or early pandemic HCU creating difficulties in comparing across multiple countries. We provide a comparatively broad definition of HCU across multiple countries, with potential to expand across regions and timeframes. Methods Using a cross-country federated research infrastructure (FRI), we examined HCU for acute cardiovascular events, elective surgeries and serious trauma. Aggregated data were used in forecast modelling to identify changes from predicted European age-standardized counts via fitted regressions (2017–19), compared against post-pandemic data. Results We found that elective surgeries were most affected, universally falling below predicted levels in 2020. For cardiovascular HCU, we found lower-than-expected cases in every region for heart attacks and displayed large sex differences. Serious trauma was the least impacted by the COVID-19 pandemic. Conclusion The strength of this study comes from the use of the European Population Health Information Research Infrastructure's (PHIRI) FRI, allowing for rapid analysis of regional differences to assess indirect impacts of events such as pandemics. There are marked differences in the capacity of services to return to normal in terms of elective surgery; additionally, we found considerable differences between men and women which requires further research on potential sex or gender patterns of HCU during crises. [ABSTRACT FROM AUTHOR]

Objective This study compared adults with peripheral vestibular hypofunction (VH) to healthy controls and assessed the sensitivity and specificity of the Cervical Torsion Test (CTT) and the Head-Neck Differentiation Test (HNDT). This study aimed to determine whether neck problems affected primary outcomes. Methods This cross-sectional study included adults from a specialist consultation for dizziness. VH had been diagnosed with the video Head Impulse Test. Exclusion criteria were conditions following head or neck trauma and diseases of the central nervous system. The sensitivity and specificity of the index tests were calculated, and regression analyses were performed to test for contributing factors. Results A total of 19 patients with VH and a historical cohort of 19 matched healthy controls were included. Most patients with VH (84.2%) experienced symptoms in at least 1 test component, compared to 5.2% of the control group. Of patients with VH, 78.9% had symptoms during the HNDT "en bloc" (en bloc = head and trunk rotated together), whereas only 26.3% reported symptoms during the CTT en bloc. The best discriminatory validity was found for the HNDT en bloc, with a sensitivity of 0.79 (95% CI = 0.54–0.94), a specificity of 0.86 (95% CI = 0.65–0.97), and a positive likelihood ratio of 5.79 (95% CI = 1.97–17.00). The number of symptoms of CTT "in torsion" (in torsion = trunk rotated actively with fixed head) was increased by a factor of 1.13 (95% CI = 1.01–1.27) for every additional point on the Neck Disability Index. Conclusion The CTT and HNDT can serve as non-laboratory tests for patients with dizziness. The HNDT en bloc has the best discriminatory validity, finding those with and those without VH. Symptom reproduction during torsion may help to identify when neck problems may contribute to dizziness. Impact The HNDT en bloc may be useful for ruling VH in or out in patients with dizziness. Positive CTT and HNDT in torsion components may verify the likelihood of additional neck involvement. [ABSTRACT FROM AUTHOR]

This study investigated the acquisition of early expressive vocabulary among young children who are deaf and hard-of-hearing (DHH; n  = 68) using auditory technology (hearing aids and cochlear implants). Parents completed a standardized vocabulary checklist, which allowed analyses of (i) the size of their child's spoken vocabulary; (ii) composition of the expressive lexicon (e.g. parts of speech such as nouns and verbs; semantic categories such as routines and body parts); and (iii) demographic and audiologic factors (e.g. chronologic age, degree of hearing access) potentially associated with these metrics. Young children who are DHH and use auditory technology acquired fewer spoken words than peers with typical hearing (TH) matched for chronologic age but more spoken words than peers with TH matched for listening experience. Action verbs—not nouns—significantly increased the odds of a child who is DHH achieving a vocabulary quotient within the normative range. These findings support the exploration of early expressive vocabulary size and composition—especially the number of active verbs—to guide clinical management and decision-making for young children who are DHH. [ABSTRACT FROM AUTHOR]

Background Although biobanks have become fundamental to many research centers and contribute to medical development, they generate many ethical and legal issues that may discourage patients from donating. Materials and Methods To understand patients' perception of ethical and legal issues related to biobanks we conducted a survey among 548 Polish patients with cancer. Results While 93.1% of patients with cancer declared themselves willing to donate biospecimens left over after a medical procedure to a biobank, most opted for one-time consent or study-specific consent, blanket consent being less frequently preferred. Many patients believed that future use of previously collected tissues require second contact. Most patients preferred pseudonymization over anonymization of the data, and supported donors' right to withdraw informed consent at any given moment. Finally, while personal health information was the most expected form of compensation for donation, most patients suggested that all parties, including the biobank concerned, the sponsors of the research, and the donors, should own the rights to cancer tissues donated and profit from the biobank research. Patients' opinions on the ethical and legal issues related to biobank research were associated with age, sex, religiosity, education level, and place of residence. Conclusions Since biobanks generate ethical and legal issues related to informed consent, data protection and storage, as well as the sharing of biosamples, tissue ownership, and profit sharing, that may discourage patients from donation, when asking a patient for a donation, healthcare professionals should communicate in a donor-centered manner and address patients' ethical and moral concerns related to donation and offer resources to help manage these concerns. [ABSTRACT FROM AUTHOR]

Background Complementary feeding has long-term effects on health but there is heterogeneity in recommendations across Europe. Recommendations include responsive feeding practices and nutritional needs but there is a debate in primary paediatricians as to which one should be the main criterion for complementary feeding. This pilot study investigated (i) the factors affecting the recommendations of paediatricians in Cyprus for starting complementary feeding, (ii) whether their main criterion is the developmental readiness or the nutritional needs of the infant and (iii) how this priority influences recommendations. Methods The 11-item questionnaire was completed by 73 Cypriot paediatricians. Results Approximately 66% of paediatricians recommended starting complementary feeding between 5 and 6 months, 29% between 4 and 5 and 3% between 6 and 7 months. Predefined schemes were recommended by ∼25% of paediatricians, baby-led weaning by 14% and 58% of paediatricians recommended either modality depending on the family circumstances whilst 4% involve the mother in the decision process. Approximately 64% of paediatricians recommended the introduction of parent's diet after the first year of life. Approximately 55% of paediatricians chose developmental readiness and 45% nutritional needs of the infant as their primary criterion for starting complementary feeding. Paediatricians who prioritized developmental readiness were more likely to be younger, less likely to advice on meat quantity and less likely to follow good nutritional practice. Conclusions The younger the paediatrician the more likely they are to prioritize developmental readiness over nutritional needs of the infant for complementary feeding. Paediatricians who prioritized developmental readiness were also less likely to provide nutritional advice. [ABSTRACT FROM AUTHOR]

Background Socioeconomic inequalities constitute an important focus area for public health, and it has long been established that higher educational level and longer lifespan are correlated. Little is known about decennial time trends in poor self-rated health and mental distress. Methods This study linked decennial cross-sectional survey data on self-rated health and mental distress from the Trøndelag Health Study (HUNT) from 1984 to 2019 with educational registry data using personal identification numbers. Survey participation ranged from 50 807 to 77 212. Slope index of inequality (SII) and relative index of inequality (RII) were calculated using generalized linear models in Stata. Analyses were stratified by sex and age, using the age categories of 30–59 years and 60–80 years. Results Absolute inequalities in self-rated health and mental distress between educational groups have stayed relatively stable throughout all rounds of HUNT. Relative inequalities in self-rated health and mental distress have generally increased, and both men and women with the lowest education level were more likely to experience poor self-rated health and mental distress relative to those with the highest education level. RII in self-rated health increased over time for both sexes and both age groups. RII for mental distress increased in both sexes and both age groups, except for men and women aged 60–80. Discussion This study shows that relative inequalities in self-rated and mental health in the Norwegian population are still persistent and have increased. Further knowledge about groups with a disadvantageous health situation should have implications for health care resource allocation. [ABSTRACT FROM AUTHOR]

In the UK, foster families are the most common form of care for looked after children. Research in this area has mainly concentrated on foster mothers and looked after children but little is known about the experiences of biological children in these families. This paper reports on the findings of a qualitative study that was conducted with the biological children of foster-carers within an independent foster-care agency. Using semi-structured interviews, the paper considers the perspectives of biological children and asks how they adapt to the fostering experience. Generally, they appear to view the fostering experience in a positive light. A number of strategies were adopted by the children and their families in adapting to the changing family structure and dynamics. It was evident that the existing attachment relationship between biological children and their parents formed a key context within which these adaptive functions develop. The paper emphasises the importance of recognising the role of biological children as part of the fostering team and the value of their active inclusion in training, support groups and decision making. [ABSTRACT FROM AUTHOR]

Osteoarthritis is a chronic degenerative disorder characterised by cartilage loss. It is extremely prevalent in society and is a major cause of disability. It is important to treat osteoarthritis effectively using a multidisciplinary approach tailored to the patient's needs. This paper reviews current thinking on the aetiology, pathogenesis, investigations, and management of osteoarthritis. The paper also discusses the challenges for developing good quality outcome measures for use in large scale multicentre clinical trials for new osteoarthritis treatments, especially disease modifying osteoarthritis drugs. [ABSTRACT FROM AUTHOR]

Background: Although there is an ever increasing literature on older drivers, there is no comprehensive up-to-date presentation of how older drivers are impacted by traffic safety, and how they impact the road safety of others.Methods: This paper uses 1994-1996 US data to determine how many rates related to traffic safety depend on the age and sex of road users (fatalities, fatalities per licensed driver, etc.) Threats drivers pose to other road users are estimated by driver involvement in pedestrian fatality crashes.Results: It is found that renewing the licence of a 70-year-old male driver for another year poses, on average, 40% less threat to other road users than renewing the license of a 40-year-old male driver. The fatality risks drivers themselves face generally increase as they age, with the increased risk of death in the same severity crash being a major contributor. If this factor is removed, crash risks for 70-year-old male drivers are not materially higher than for 40-year-old male drivers; for female drivers they are.Conclusions: Most driver rates increase substantially by age 80, in many cases to values higher than those for 20-year-olds. Given that a death occurs, the probability that it is a traffic fatality declines steeply with age, from well over 20% for late teens through mid twenties, to under one per cent at age 65, and under half a per cent at age 80. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores, from the patients' perspective, the likely impact of the Australian after-hours house-call (AHHC) medical services on emergency department (ED) presentations. This has become imperative given the significant cost difference between patient presentations to either the AHHC or ED and their practical implications for health care funding.Design, setting and participants: A cross-sectional, self-reported survey of all 10 838 patients in Australia known to have patronized AHHC services over the last week of January 2016.Main outcome measure: The study used a validated, self-completion questionnaire, dispatched through a mixture of online and postal methods.Results: A total of 1228 questionnaires were returned, of which 1211 included all relevant sections of the survey (11.2% response rate). Four hundred and eighty-six patients (40.1%) indicated that they would have gone to the ED on the same day or night of their illness had the AHHC not been available, with the elderly (≥65) and children (<16) accounting for nearly two-thirds of these (64.6%). Following their AHHC consultations, 103 (8.5%) patients eventually attended the ED, meaning that the service prevented 383 patients from attending the ED, a decrease of 78.8%. Stratification based on location showed that this impact was seen across all states and territories in Australia where AHHC services exist, ranging from a reduction of 73.9% in Western Australia to 85.0% in Tasmania. Similarly, the impact cuts across all patient demographics, including age ranges, gender and social divides.Conclusions: Based on our respondents' reports, AHHC services appear to be associated with a reduction in ED visits in Australia, with the impact cutting across all regions and patient demographics. [ABSTRACT FROM AUTHOR]

Study Question: Can the diagnosis of common diseases before menopause influence age at natural menopause (ANM) onset?Summary Answer: Polycystic ovary syndrome (PCOS) and depression were observed to delay menopause.What Is Known Already: It has been observed that women who undergo early menopause experience a higher burden of health problems related to metabolic syndromes, heart disease and depression, but whether ANM can be influenced by common adult diseases has not been studied extensively.Study Design, Size, Duration: All women attending mammography screening or clinical mammography at four hospitals in Sweden were invited to participate in the Karolinska Mammography Project for Risk Prediction of Breast Cancer (KARMA) study. Between January 2011 and March 2013, 70 877 women were recruited. Information from the baseline questionnaire filled out upon enrollment was used in this cross-sectional analysis on predictors of ANM onset.Participants/materials, Setting, Methods: We limited our analyses to 61 936 women with complete data on ANM and covariates and a follow-up time (from birth to menopause or censoring) of at least 35 years. Premenopausal diagnoses of depression, anorexia, bulimia, PCOS, ovarian cyst, heart failure, myocardial infarction, angina pectoris, stroke, preeclampsia, diabetes, hypertension and hyperlipidemia were examined as time-dependent variables in multivariable Cox regression analyses, adjusting for reproductive factors (age at menarche, menstrual cycle regularity in adult life, number of children and premenopausal oral contraceptive use) and risk factors of common diseases (education, physical activity at 18 years and information at the time of questionnaire including BMI, ever smoking and alcohol consumption).Main Results and the Role Of Chance: Women with PCOS and depression were independently associated with later menopause (hazard ratio (95% CI): 0.44 (0.28-0.71) and 0.95 (0.91-1.00), respectively), compared to women with no such histories. The associations remained significant in a subset of women who had never received gynecological surgery or hormone treatment (n = 32313, 0.21 (0.08-0.50) and 0.91 (0.85-0.98), respectively). None of the other diseases examined were significantly associated with ANM.Limitations, Reasons For Caution: Information from the questionnaire was self-reported, making recall possible, but it is unlikely that any bias was different in the strata of different factors considered. Misclassification could also have occurred in cases where the diagnoses of common diseases were close to age at last follow-up. In addition, observational studies cannot establish that the associations identified represent cause-and-effect relationships.Wider Implications Of the Findings: Our study is the first in examining multiple common diseases simultaneously as determinants of ANM. Contrary to previous reports, we did not find any significant accelerating effect of hypertension, cardiovascular disease and diabetes on ANM.Study Funding/competing Interests: KARMA was financed by the Märit and Hans Rausing's Initiative Against Breast Cancer. K.R.W. is supported by the Swedish Society of Medicine and by Stockholm County Council. J.L. is a recipient of an Alex and Eva Wallström Foundation award. The authors declare that there is no conflict of interest regarding the publication of this paper. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to conduct a systematic and comprehensive review of qualitative research to examine the physical and psychological needs, as well as work experiences, of patients undergoing total knee replacement and total hip replacement surgeries during their process of returning to work. Methods A systematic review and meta-synthesis of qualitative literature was conducted. A systematic search was conducted across 8 databases to identify qualitative or mixed-methods research on the needs and experiences of individuals with total knee replacement and total hip replacement who have returned to work. The search period extended from the inception of each database to March 2023. Two researchers independently utilized a predetermined search strategy to retrieve relevant English-language studies published in any year. The included studies were assessed for quality using the Critical Appraisal Skills Program appraisal tool. Findings from the studies were then summarized and integrated using the pooled integration method. Results There were 10 studies in total. Three key themes were identified from the original research: needs during the return to work process and rehabilitation training, faith and support to return to work, and constraints and challenges at work. Conclusion Health care professionals and employers should conscientiously consider the physical and psychological requirements of patients who have undergone total knee replacement and total hip replacement when they are resuming work, taking into account the specific constraints and challenges that may arise in the workplace. To ensure a seamless transition back to work, it is essential to develop tailored occupational interventions, implement comprehensive return to work programs, and offer patients sufficient understanding and support. Impact The findings of this study offer valuable insights into the physical and psychological needs, as well as the work experiences, of patients who have undergone total knee replacement and total hip replacement during their reintegration into the workforce. These findings have the potential to assist health care professionals and employers in providing enhanced support to facilitate successful return-to-work outcomes for patients. [ABSTRACT FROM AUTHOR]

Motivation Major improvements in sequencing technologies and genome sequence assembly have led to a huge increase in the number of available genome sequences. In turn, these genome sequences form an invaluable source for evolutionary, ecological, and comparative studies. One kind of analysis that has become routine is the search for traces of ancient polyploidy, particularly for plant genomes, where whole-genome duplication (WGD) is rampant. Results Here, we present a major update of a previously developed tool wgd, namely wgd v2, to look for remnants of ancient polyploidy, or WGD. We implemented novel and improved previously developed tools to (a) construct K S age distributions for the whole-paranome (collection of all duplicated genes in a genome), (b) unravel intragenomic and intergenomic collinearity resulting from WGDs, (c) fit mixture models to age distributions of gene duplicates, (d) correct substitution rate variation for phylogenetic placement of WGDs, and (e) date ancient WGDs via phylogenetic dating of WGD-retained gene duplicates. The applicability and feasibility of wgd v2 for the identification and the relative and absolute dating of ancient WGDs is demonstrated using different plant genomes. Availability and implementation wgd v2 is open source and available at https://github.com/heche-psb/wgd. [ABSTRACT FROM AUTHOR]

Background: Transport injuries are a major cause of mortality among adolescents. Our aim was to evaluate the circumstances and trauma associated with fatal accidents involving adolescents and two-wheeled vehicles. Methods: We analyzed retrospective data from the Finnish Crash Data Institute from 2008 to 2019 involving 10- to 24-year-old victims of fatal traffic accidents who were injured while riding a bicycle, moped or motorcycle. We collected data on patient characteristics, accident circumstances and possible treatment. These fatalities were compared with national mortality rates among the respective age groups. Results: We identified 147 fatalities over the 12-year period involving 20 bicycle, 50 moped and 77 motorcycle riders. Most accidents involved males (n=121, 82%). Less than half of vehicles were in good condition (46%); motorized vehicles were often illegally tuned (37%) or had tire problems (31%). Most of the accidents were collisions with another vehicle (n=99, 67%) or other objects (n=35, 24%). In 94% of cases, the Injury Severity Score was >25. Head injury was the most common cause of death (62%). Among 15-year-olds, every fifth death was due to accidents on two-wheeled vehicles. Conclusions: Fatal transport accidents among adolescents comprise several elements that should be incorporated into driver's education and in case of minors, also communicated to parents. These include the condition of the vehicle, proper helmet use and effects of speed on both control of the vehicle and the consequences of a possible collision. [ABSTRACT FROM AUTHOR]

Background: Research has shown that individual socio-economic circumstances throughout life affect health in older ages. However, little attention has been paid to the broad economic context affecting individual's life-chances. This paper examines whether economic downturns experienced during young and mid-adulthood have long-run effects on physical health. Methods: We exploit data on economic fluctuations in the period 1945-2010 in 11 European countries, linked to longitudinal data from three waves of the Survey of Health, Ageing and Retirement in Europe. We estimate a country fixed effect model assessing whether downturns experienced at 5-year intervals between ages 25 and 54 are associated with levels and onset of new limitations with Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older age (55-80). Results: Experiencing an economic downturn at ages 45-59 is associated with increased risk of having at least one disability limitation in later-life (odds ratio [OR] for ADL = 1.66, 95% CI [Confidence Interval] 1.24, 2.22; OR for IADL = 1.46, 95% CI 1.10, 1.94). Economic downturns at ages 40-44 and 45-49 also increase the risk of a new functional limitation in later-life (OR for IADL ages 40-44 = 1.20, 95% CI 1.03, 1.40; OR for IADL ages 45-49 = 1.44, CI 1.10-1.88). Economic downturns experienced around these ages are also associated with significantly greater risks of smoking and excessive alcohol consumption as well as lower incomes in older age. Conclusions: Exposure to an economic downturn at ages 40-49 is associated with poorer health in older ages, possibly by increasing risk of unhealthy behaviours and low incomes persisting into older age. [ABSTRACT FROM AUTHOR]

Background: We have found no papers evaluating nonadherence to guidelines for the treatment of atrial fibrillation (AF), taking into account the two risk scales [C, congestive heart failure; H, hypertension; A, age; D, diabetes mellitus; S, stroke (CHADS2) and C, congestive heart failure; H, hypertension; A, age; D, diabetes mellitus; S, stroke; V, vascular disease; A, age; Sc, sex category (CHA2DS2-VASc)] and the two types of treatment that are recommended (antiplatelet/anticoagulant therapy).Objective: To determine the extent of lack of adherence when prescribing anticoagulant and antiplatelet therapy to patients with AF and associated factors.Methods: Cross-sectional, observational study of 144 patients with AF who visited the emergency department of Elda Hospital in 2013-14 (Spain). Main variable: the patient was prescribed a therapy different from that indicated by the guidelines (nonadherence) or not prescribed any therapy. Secondary variables: CHADS2, CHA2DS2-VASc, HAS-BLED, type of AF and symptoms related to AF. Multivariate models were constructed to identify the associated factors by calculating the adjusted odds ratios (OR).Results: Nonadherence occurred in 90 patients [62.5%, 95% confidence interval (CI): 54.6-70.4%]. Associated factors were higher CHADS2 (OR = 1.30, 95% CI: 0.96-1.75, P = 0.091) and CHA2DS2-VASc (OR = 1.23, 95% CI: 1.02-1.47, P = 0.027), and lower HAS-BLED (OR = 0.67, 95% CI: 0.49-0.91, P = 0.011).Conclusions: Nonadherence to guidelines was found in three out of every five patients. A greater cerebrovascular risk and a lower haemorrhagic risk were associated with this behaviour. Qualitative studies are needed to determine the causes. [ABSTRACT FROM AUTHOR]

Based on the underlying principle that all children have the right to be cared for by their birth family wherever it is safe to do so, this practitioner research study examined what works in family reunification practices for abused and neglected looked after children. The research used a case-file audit to explore the characteristics of forty-three children successfully returned home in one metropolitan local authority, and how social work practice contributed to this success. This paper considers how assessment, decision making and planning inform the types of support and monitoring provided, and how this affects outcomes for reunified children. The study found that certain factors characterise successful reunions. Children tend to be young in age, have short, stable care experiences and have consistent family contact prior to return. Whilst assessment and planning prior to reunification were inconsistent, the provision of services was generally good, successfully supporting children to remain at home. Areas for improvement were identified in the provision of therapeutic and culturally specific services for families, and in addressing under and over-representations of certain groups of children within reunification policy and practice. The findings of the study are being directly implemented through a pilot reunification panel in the study authority. [ABSTRACT FROM AUTHOR]

Background Following hip fracture surgery, patients from residential care are frequently excluded from inpatient rehabilitation. We aimed to assess the impact of place of residence and other factors such as frailty on rehabilitation outcomes after hip fracture surgery. Methods Retrospective cohort study. Outcome measures included Functional Independence Measure efficiency, discharge destination and recovery of pre-fracture mobility. Univariable and multivariable linear or logistic regression analyses were performed. Setting One general rehabilitation and two geriatric evaluation and management wards in a large public tertiary teaching hospital. Participants A total of 844 patients who underwent inpatient rehabilitation after hip fracture surgery from 2010 to 2018. Results There were 139 (16%) patients from residential care. Being from residential care was not an independent predictor of poor outcomes. Premorbid frailty (Clinical Frailty Scale) was the strongest independent predictor of poorer Functional Independence Measure efficiency, inability to recover pre-fracture mobility and return to community dwelling. Dementia and delirium were also independently predictive of poor outcomes across all measures. Age > 90 years was independently predictive of inability to recover pre-fracture mobility and return to community dwelling. Conclusion Being from residential care is not independently associated with poor outcomes following inpatient rehabilitation after hip fracture surgery and should not be the basis for excluding these patients from rehabilitation. Major predictors of poorer outcomes include premorbid frailty, dementia, delirium and age > 90 years. If able and motivated, those with potentially reversible functional limitations should be given the opportunity to participate in inpatient rehabilitation as even small gains can have a significant impact on quality of life. [ABSTRACT FROM AUTHOR]

Background Community environment might play an important role in supporting ageing in place. This paper aims to explore relocation at older age and its associations with individual and community level factors. Methods The postcodes of the 2424 people in the year-10 interview of the Cognitive Function and Ageing Study (CFAS) in England were mapped onto Enumeration Districts and linked to their corresponding Townsend deprivation score and the 2011 rural/urban categories. Multilevel logistic regression was conducted to examine the influence of the baseline individual (age, gender, education and social class) and community (rural/urban categories and area deprivation) level factors on relocation over 10 years. Results One-third of people moved residence after the age of 65 years and over. Older age, low education, low social class and living in rural areas at baseline were associated with higher probability of moving later in life. The likelihood of relocation in later life increased from least to most deprived areas (odds ratio: 2.0, 95% confidence interval: 1.4, 2.8). Conclusions Urban/rural contexts and area deprivation are associated with relocation at older age and indicate that community environment may be relevant to ageing in place. [ABSTRACT FROM AUTHOR]

Increasingly often in epidemiologic research, associations between survival time and predictors of interest are measured by differences between distribution functions rather than hazard functions. For example, differences in percentiles of survival time, expressed in absolute time units (e.g., weeks), may complement the popular risk ratios, which are unitless measures. When analyzing time to an event of interest (e.g., death) in prospective cohort studies, the time scale can be set to start at birth or at study entry. The advantages of one time origin over the other have been thoroughly explored for the estimation of risks but not for the estimation of survival percentiles. In this paper, we analyze the use of different time scales in the estimation of survival percentiles with Laplace regression. Using this regression method, investigators can estimate percentiles of survival time over levels of an exposure of interest while adjusting for potential confounders. Our findings may help to improve modeling strategies and ease interpretation in the estimation of survival percentiles in prospective cohort studies. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the agreement between deaf children's and adolescents' self-ratings of health-related quality of life (HRQoL) and their parents' proxy reports. This observational cross-sectional study included 114 deaf 8- to 18-years-old students and proxy family members. HRQoL was measured using the KIDSCREEN-27 questionnaire, which was adapted to Spanish sign language for children, with a written version for parents. Respondents completed a selfadministered paper questionnaire. Parents' and children's mean scores differences were not significant, except for the “Autonomy and Parents” and “Peers and Social Support” dimensions. Children aged 8-11 years scored higher in some domains of QoL compared to those aged 12-18 years. The level of agreement between children/adolescents' and parents/ proxies' responses was acceptable, except for the dimension “Autonomy and Parents.” Overall, deaf children/adolescents' self-ratings of HRQoL did not differ from their parents' proxy reports; however, differences were found in the dimensions that explored the quality of the interaction of children/adolescents and parents, the perceived level of autonomy, and social relations and support. [ABSTRACT FROM AUTHOR]

Objective The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) project relies on the identification of modulators to improve characterization and classification of acute pain conditions. In the frame of the AAAPT effort, this paper presents an overview of common biological modulators of acute pain. Methods Nonsystematic overview. Results Females may experience more acute pain than males, but the clinical significance may be modest. Increasing age is associated with decreasing analgesic requirement and decreasing pain intensity after surgery and with higher risk of acute low back pain. Racial and ethnic minorities have worse pain, function, and perceived well-being. Patients with preexisting chronic pain and opioid use are at higher risk of severe acute pain and high opioid consumption. The OPRM1 gene A118G polymorphism is associated with pain severity and opioid consumption, with modest quantitative impact. Most studies have found positive associations between pain sensitivity and intensity of acute clinical pain. However, the strength of the association is unclear. Surgical techniques, approaches, and complications influence postoperative pain. Conclusions Sex, age, race, ethnicity, preexisting chronic pain and opioid use, surgical approaches, genetic factors, and pain sensitivity are biological modulators of acute pain. Large studies with multisite replication will quantify accurately the association between modulators and acute pain and establish the value of modulators for characterization and classification of acute pain conditions, as well as their ability to identify patients at risk of uncontrolled pain. The development and validation of quick, bed-side pain sensitivity tests would allow their implementation as clinical screening tools. Acute nonsurgical pain requires more investigation. [ABSTRACT FROM AUTHOR]

Background and Objectives Older adults' self-perceptions of aging and being older can influence well-being and quality of life. This systematic scoping review aimed to map out current research on older adults' self-perceptions of aging and being older. Research Design and Methods The scoping review followed Arksey and O'Malley's methodological framework. A total of 5,037 records were identified (duplicates removed). After screening, a final 148 papers were included. Descriptives, including year of publication, methodology, age, gender, and location of participants, were calculated. Thematic analyses were conducted examining ways in which the topic was conceptualized. Results The most frequent method used in the research was quantitative. Participants were from 38 different countries. There were more female participants than male. Seven themes representing the main research emphasis emerged: attitudes towards one's own aging (n = 48), aging well (n = 23), aging stereotypes, self-stigma (n = 23), construction of aging identities (n = 22), subjective age (n = 18), the aging body (n = 8), and future self-views (n = 6). Discussion and Implications The research within these themes approach self-perceptions of aging using varying points of reference for what participants compare their age to. The methods used to illicit aging perspectives held their own assumptions about aging. [ABSTRACT FROM AUTHOR]

Background and Objectives Transnationalism, defined as migrants having ties to the country of origin and the destination country, is mostly explored with qualitative data. Quantitative studies only use a small number of indicators. This is one of only a few studies to examine transnationalism based on multiple indicators and elaborate classes of transnationalism. The research questions are: What are the forms of transnationalism in which older migrants engage? And how do age, gender, income, and country of origin affect these forms? Research Design and Methods The paper used the Vivre/Leben/Vivere (2011/2012) subsample of migrants in Switzerland, aged 65–82 years. Transnationalism was measured using 11 indicators, including nationality, having family abroad, and sending remittances. Latent class analysis was used to distinguish between several forms of transnationalism. Latent class regression models subsequently explore the effect of age, gender, income and country of origin on these transnationalism forms. Results Four different forms of transnationalism were found among older migrants: least transnational , distant transnational , active transnational , and returning transnational. The models suggest that country of origin and income are important predictors, while age is less important and gender has no effect on falling in these transnationalism classes. Discussion and Implications The results confirm that our measure of transnationalism is an innovative approach toward exploring the different forms older migrants engage in. The method has several advantages over usual methods and can be used in future studies to analyze, for example, how different forms of transnationalism emerge as a consequence of policies relevant for older migrants, like care arrangements and pensions. [ABSTRACT FROM AUTHOR]

Background Fatigue is common in patients undergoing radiotherapy (RT) and can significantly impact quality of life. Melatonin, a safe inexpensive natural supplement, may improve symptoms and attenuate the side effects of RT. The purpose of this randomized double-blind placebo-controlled phase III trial was to assess the effects of melatonin for preventing fatigue and other symptoms in patients with breast cancer undergoing RT. Methods Female early stage or Ductal carcinoma in situ patients with breast cancer ≥18 years of age with Eastern Cooperative Oncology Group (ECOG) performance status <3, hemoglobin ≥9 g/dL, planned for outpatient RT treatment with curative intent, were randomized 1:1 to melatonin 20 mg or placebo, orally, starting the night before RT initiation until 2 weeks post-RT. Randomization was stratified according to treatment duration (<3 weeks, ≥3 weeks) and prior chemotherapy. The primary endpoint was the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue scale), and secondary endpoints were FACIT-F subscales, Edmonton Symptom Assessment Scale (ESAS), and Patient-Reported Outcomes Measurement Information System (PROMIS) scores obtained at baseline, and 2 and 8 weeks post-RT. A 2-sided ANOVA F -test at a 4.5% significance level for the primary endpoint was used. Secondary analyses were reported using an F -test at a 5% significance level. The goal was to recruit approximately 140 patients with interim analysis planned mid-recruitment. Results Eighty-five patients were screened for eligibility; 79 patients were randomized: 40 to melatonin and 39 to placebo; 78 patients were treated and included in the interim analysis at the mid-recruitment point. Baseline patient characteristics of age, race, and ECOG performance status were similar in both arms. The treatment effect was studied using a longitudinal mixed effects model with the effect of treatment over time (treatment × time) as the primary outcome parameter. The treatment × time for FACIT-Fatigue did not demonstrate statistical significance (P -value.83) in the melatonin group compared to placebo. In addition, secondary analyses of FACIT physical, social, emotional, and functional well-being scores did not demonstrate statistical significance (P -values of.35,.06,.62, and.71, respectively). Total PROMIS scores, collected as secondary outcome reported by patients, did not demonstrate statistically significant change over time either (P -value is.34). The other secondary scale, ESAS, was analyzed for each individual item and found to be nonsignificant, anxiety (P  = .56), well-being (.82), drowsiness (.83), lack of appetite (.35), nausea (.79), pain (.50), shortness of breath (.77), sleep (.45), and tiredness (.56). Depression was the only item demonstrating statistical significance with a decrease of 0.01 unit in the placebo group, a change not considered clinically significant. Melatonin was well-tolerated with no grade 3 or 4 adverse events reported. The most common side effects were headache, somnolence, and abdominal pain. No patients died while participating in this study. Two patients died within a year of study completion from breast cancer recurrence. Sixteen patients withdrew prior to study completion for various reasons including adverse events, hospitalizations unrelated to study drug, RT discontinuation, and COVID-19 precautions. Conclusions In this double-blind placebo-controlled phase III trial, melatonin did not prevent or significantly improve fatigue and other symptoms in patients with early stage breast cancer undergoing RT. The analysis, showing little evidence of an effect, at mid-recruitment, assured early termination of the trial. [ABSTRACT FROM AUTHOR]

Background Missed opportunities constitute a main driver of suboptimal seasonal influenza vaccination (SIV) coverage in older adults. Vaccine co-administration is a way to reduce these missed opportunities. In this study, we quantified missed opportunities for SIV, identified some of their socio-structural correlates and documented SIV co-administration patterns. Methods In this registry-based retrospective cohort study, we verified the SIV status of all subjects aged ≥65 years who received at least one dose of coronavirus disease 2019 (COVID-19), pneumococcal or herpes zoster vaccines during the 2022/23 influenza season. The frequency of concomitant same-day administration of SIV with other target vaccines was also assessed. Results Among 41 112, 5482 and 3432 older adults who received ≥1 dose of COVID-19, pneumococcal and herpes zoster vaccines, missed opportunities for SIV accounted for 23.3%, 5.0% and 13.2%, respectively. Younger, male and foreign-born individuals were generally more prone to missing SIV. The co-administration of SIV with other recommended vaccines was relatively low, being 11.0%, 53.1% and 17.1% in COVID-19, pneumococcal and herpes zoster cohorts, respectively. Conclusions A sizeable proportion of older adults who received other recommended vaccines during the last influenza season did not receive SIV. This share of missed opportunities, which are subject to some social inequalities, may be addressed by increasing vaccine co-administration rates and implementing tailored health promotion interventions. [ABSTRACT FROM AUTHOR]

We believe that our analyses of ICONA cohort data, which focused specifically on the association between sex and response to DTG-containing regimens, cannot be directly compared to those of the Ciccullo study. We do not know how the reasons for discontinuation were collected by the Ciccullo cohort; in particular, it is unclear whether discontinuations due to simplification were counted as events in the analysis with outcome treatment failure. Long-term outcome of dolutegravir-containing regimens according to sex: data from the ICONA Study-authors' response. [Extracted from the article]

Background: concern over the sustainability of the National Health Service (NHS) is often focussed on rising numbers of hospital admissions, particularly among older people. Hospital admissions are enumerated routinely by the Hospital Episode Statistics (HES) Service, but published data do not allow individual-level service use to be explored. This study linked information on Hertfordshire Cohort Study (HCS) participants with HES inpatient data, with the objective of describing patterns and predictors of admissions among individuals.Methods: 2,997 community-dwelling men and women aged 59–73 years completed a baseline HCS assessment between 1998 and 2004; HES and mortality data to 31 March 2010 were linked with the HCS database. This paper describes patterns of hospital use among the cohort at both the admission and individual person level.Results: the cohort experienced 8,741 admissions; rates were 391 per 1,000 person-years among men (95% CI: 380, 402) and 327 among women (95% CI: 316, 338), P < 0.0001 for gender difference. A total of 1,187 men (75%) and 981 women (69%) were admitted to hospital at least once; among these, median numbers of admissions were 3 in men (inter-quartile range, (IQR): 1, 6) and 2 in women (IQR: 1, 5). Forty-eight percent of those ever admitted had experienced an emergency admission and 70% had been admitted overnight.Discussion: It is possible to link routinely collected HES data with detailed information from a cohort study. Hospital admission is common among community-dwelling ‘young-old’ men and women. These linked datasets will facilitate research into lifecourse determinants of hospital admission and inform strategies to manage demand on the NHS. [ABSTRACT FROM AUTHOR]

Ozone is associated with adverse health; however, less is known about vulnerable/sensitive populations, which we refer to as sensitive populations. We systematically reviewed epidemiologic evidence (1988-2013) regarding sensitivity to mortality or hospital admission from short-term ozone exposure. We performed meta-analysis for overall associations by age and sex; assessed publication bias; and qualitatively assessed sensitivity to socioeconomic indicators, race/ethnicity, and air conditioning. The search identified 2,091 unique papers, with 167 meeting inclusion criteria (73 on mortality and 96 on hospitalizations and emergency department visits, including 2 examining both mortality and hospitalizations). The strongest evidence for ozone sensitivity was forage. Per 10-parts per billion increase in daily 8-hour ozone concentration, mortality risk for younger persons, at 0.60% (95% confidence interval (Cl): 0.40, 0.80), was statistically lower than that for older persons, at 1.27% (95% Cl: 0.76,1.78). Findings adjusted for publication bias were similar. Limited/suggestive evidence was found for higher associations among women; mortality risks were 0.39% (95% Cl: -0.22,1.00) higher than those for men. We identified strong evidence for higher associations with unemployment or lower occupational status and weak evidence of sensitivity for racial/ethnic minorities and persons with low education, in poverty, or without central air conditioning. Findings show that some populations, especially the elderly, are particularly sensitive to short-term ozone exposure. [ABSTRACT FROM AUTHOR]

Mumps is a potentially severe viral infection. The incidence of mumps has declined dramatically in high-income countries since the introduction of mumps antigen-containing vaccines. However, recent large outbreaks of mumps in highly vaccinated populations suggest waning of vaccine-induced immunity and primary vaccine failure. In this paper we present a simple method for identifying geographic regions with high outbreak potential, demonstrated using 2006 mumps seroprevalence data from Belgium and Belgian vaccination coverage data. Predictions of the outbreak potential in terms of the effective reproduction number in future years signal an increased risk of new mumps outbreaks. Literature reviews on serological information for both primary vaccine failure and waning immunity provide essential information for our predictions. Tailor-made additional vaccination campaigns would be valuable for decreasing local pockets of susceptibility, thereby reducing the risk of future large-scale mumps outbreaks. [ABSTRACT FROM PUBLISHER]

Child protection social work's current concern remains largely with offline harm and injury and separate from the focus on child protection in relation to risks online and children's use of computer-mediated communication and the internet. This paper draws on original research reporting children's methods for assessing who they are talking to online, as part of a wider study designed to develop software tools for improved online child safety. It finds that children use similar methods to detect identity online as they do offline, reinforcing the interconnections between mediated and unmediated communication and an ontology of childhood in a digital world that is neither online nor offline, but both. Drawing on the concept of cyborg youth and understanding contemporary child protection in this context allows a re-visioning of the social work role that demands attention to computer-mediated literacy in the assessment of all vulnerable children and in the support of their parents and carers. [ABSTRACT FROM PUBLISHER]

To investigate the cross-national relevance of community health promotion, this paper compared community variation in alcohol use and risk and protective factors for adolescents in Australia (State of Victoria, 2009) and the Netherlands (2007/2008). Multi-level analyses examined community variation in heavy episodic (binge) alcohol use [≥5 drinks in a session ≥once in the prior fortnight (>63 ml of ethanol)] and associations with predictors. Representative community samples of adolescents (12–17 years) were recruited. The participants were 7812 students from 36 Australian communities and 15 082 adolescents from 124 Dutch communities. Predictors included adolescent reports of family, school, peer and neighbourhood environments and community predictors (rural, disadvantage). The overall prevalence of alcohol use prevalence was similar in both nations. Australia had higher use at younger ages and no difference between genders. In the Netherlands older adolescents and males used alcohol at significantly higher rates. Although individual predictors were mostly similar, binge drinking was more strongly associated with poor family management, friends' use of drugs and community disorganization in Australia. Significant community variation in adolescent heavy alcohol use was observed in both countries, but was higher in the Netherlands [inter class correlation 6.1%, (95% CI: 4.5–8.3%)] than Australia (ICC 2.4%, 1.3–4.5%). Youth from rural areas drank at a higher level, especially in the Netherlands. Targeting community level adolescent alcohol use appears feasible in both countries. Although behavioural patterns and risk and protective influences are similar in the Netherlands and Australia, important differences should be taken into account in tailoring community interventions. [ABSTRACT FROM AUTHOR]

The author comments on a research paper on the prevalence, incidence and mortality of delirium in the COVID-19 disease, which references a study by S. C. Shao et al., published in a 2021 issue of "Age Ageing". Topics discussed include the characteristics of delirium, the challenges facing health professionals in managing delirium in patients with COVID-19, findings on its prevalence on admission and during hospitalization, and the study's implications for care for patients with delirium.

Although there is strong evidence that short-term exposure to particulate matter is associated with health risks, less is known about whether some subpopulations face higher risks. We identified 108 papers published after 1995 and summarized the scientific evidence regarding effect modification of associations between short-term exposure to particulate matter and the risk of death or hospitalization. We performed a meta-analysis of estimated mortality associations by age and sex. We found strong, consistent evidence that the elderly experience higher risk of particular matter-associated hospitalization and death, weak evidence that women have higher risks of hospitalization and death, and suggestive evidence that those with lower education, income, or employment status have higher risk of death. Meta-analysis showed a statistically higher risk of death of 0.64% (95% confidence interval (Cl): 0.50, 0.78) for older populations compared with 0.34% (95% Cl: 0.25, 0.42) for younger populations per 10 ng/m³ increase of particulate matter with aerodynamic diameter ≤10 µm. Women had a slightly higher risk of death of 0.55% (95% Cl: 0.41,0.70) compared with 0.50% (95% Cl: 0.34, 0.54) for men, but these 2 risks were not statistically different. Our synthesis on modifiers for risks associated with particulate matter can aid the design of air quality policies and suggest directions for future research. Studies of biological mechanisms could be informed by evidence of differential risks by population, such as by sex and preexisting conditions. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a systematic review of qualitative studies from high-income (OECD) countries relating to sun protection and skin cancer, with a focus on barriers and facilitators for the following interventions: resource provision; environmental change; and multi-component interventions. Twenty-three study reports were included in the review. Data were analysed using a thematic analysis methodology with the Health Belief Model as a framework. The risk and potential severity of skin cancer are not seen as important concerns, and tanning which is not deliberate is seen as less dangerous. There are a number of social and practical barriers to the use of sun protection resources, including cost, inconvenience and social norms. There are important differences between age groups and between men and women in attitudes. [ABSTRACT FROM AUTHOR]

Social work students are being educated during a time of major socio-economic change with the financial relationship between the university and society currently being reconfigured. This is occurring alongside a rapid expansion in the availability of technological mediums that offer the opportunity for alternative methods of teaching delivery. Moving towards technologically enhanced methods of teaching delivery may be sought as one way of improving student learning whilst reducing staffing costs in a time of financial austerity. Podcasting, for example, is becoming a more commonplace activity within higher educational institutions (HEIs) and used for a variety of different reasons, although the evaluation of using such methods of delivery and its impact on student learning is in its infancy. This paper outlines some of the current issues involved and begins to explore them via an evaluation of the use of podcast lectures on one social work programme. Current findings highlight the importance of appreciating the socio-emotional as well as the cognitive aspects of student learning. This study suggests that podcasts have potential benefit educationally but their use within HEIs needs to be appreciated within a broader context where contra-indicators for the use of such technology are also considered in relation to professional practice. [ABSTRACT FROM AUTHOR]

In this paper, we propose new methods for investigating the extent of heterogeneity in effective contact rates relevant to the transmission of infections. These methods exploit the correlations between ages at infection for different infections within individuals. The methods are developed for serological surveys, which provide accessible individual data on several infections, and are applied to a wide range of infections. We find that childhood infections are often highly correlated within individuals in early childhood, with the correlations persisting into adulthood only for infections sharing a transmission route. We discuss 2 applications of the methods: 1) to making inferences about routes of transmission when these are unknown or uncertain and 2) to estimating epidemiologic parameters such as the basic reproduction number and the critical immunization threshold. Two examples of such applications are presented: elucidating the transmission route of polyomaviruses BK and JC and estimating the basic reproduction number and critical immunization coverage of varicella-zoster infection in Belgium, Italy, Poland, and England and Wales. We speculate that childhood correlations stem from confounding of different transmission routes and represent heterogeneity in childhood circumstances, notably nursery-school attendance. In contrast, it is suggested that correlations in adulthood are route-specific. [ABSTRACT FROM PUBLISHER]

Background: Hearing impairment is a leading cause of disease burden, yet population-based studies that measure hearing impairment are rare. We estimate regional and global hearing impairment prevalence from sparse data and calculate corresponding uncertainty intervals. Methods: We accessed papers from a published literature review and obtained additional detailed data tabulations from investigators. We estimated the prevalence of hearing impairment by region, sex, age and hearing level using a Bayesian hierarchical model, a method that is effective for sparse data. As the primary objective of modelling was to produce regional and global prevalence estimates, including for those regions with scarce to no data, models were evaluated using cross-validation. Results: We used data from 42 studies, carried out between 1973 and 2010 in 29 countries. Hearing impairment was positively related to age, male sex and middle- and low-income regions. We estimated that the global prevalence of hearing impairment (defined as an average hearing level of 35 decibels or more in the better ear) in 2008 was 1.4% (95% uncertainty interval 1.0–2.2%) for children aged 5–14 years, 9.8% (7.7–13.2%) for females >15 years of age and 12.2% (9.7–16.2%) for males >15 years of age. The model exhibited good external validity in the cross-validation analysis, with 87% of survey estimates falling within our final model's 95% uncertainty intervals. Conclusion: Our results suggest that the prevalence of child and adult hearing impairment is substantially higher in middle- and low-income countries than in high-income countries, demonstrating the global need for attention to hearing impairment. [ABSTRACT FROM PUBLISHER]

There are several measures that summarize the mortality experience of a population. Of these measures, life expectancies are generally preferred based on their simpler interpretation and direct age standardization, which makes them directly comparable between different populations. However, traditional life expectancy estimations are highly inaccurate for smaller populations and consequently are seldom used in small-area applications. In this paper, the authors compare the relative performance of traditional life expectancy estimation with a Bayesian random-effects approach that uses correlations (i.e., borrows strength) between different age groups, geographic areas, and sexes to improve the small-area life expectancy estimations. In the presented Monte Carlo simulations, the Bayesian random-effects approach outperforms the traditional approach in terms of bias, root mean square error, and coverage of the 95% confidence intervals. Moreover, the Bayesian random-effects approach is found to be usable for populations as small as 2,000 person-years at risk, which is considerably smaller than the minimum of 5,000 person-years at risk recommended for the traditional approach. As such, the proposed Bayesian random-effects approach is well-suited for estimation of life expectancies in small areas. [ABSTRACT FROM AUTHOR]

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program provides a rich source of data stratified according to tumor biomarkers that play an important role in cancer surveillance research. These data are useful for analyzing trends in cancer incidence and survival. These tumor markers, however, are often prone to missing observations. To address the problem of missing data, the authors employed sequential regression multivariate imputation for breast cancer variables, with a particular focus on estrogen receptor status, using data from 13 SEER registries covering the period 1992–2007. In this paper, they present an approach to accounting for missing information through the creation of imputed data sets that can be analyzed using existing software (e.g., SEER*Stat) developed for analyzing cancer registry data. Bias in age-adjusted trends in female breast cancer incidence is shown graphically before and after imputation of estrogen receptor status, stratified by age and race. The imputed data set will be made available in SEER*Stat (http://seer.cancer.gov/analysis/index.html) to facilitate accurate estimation of breast cancer incidence trends. To ensure that the imputed data set is used correctly, the authors provide detailed, step-by-step instructions for conducting analyses. This is the first time that a nationally representative, population-based cancer registry data set has been imputed and made available to researchers for conducting a variety of analyses of breast cancer incidence trends. [ABSTRACT FROM PUBLISHER]

Drawing on a qualitative study exploring the stories of twenty-four women involved in sex work in the UK, this paper discusses whether it is possible to identify key risk and protective factors influencing involvement. It argues that, although age at first involvement is an important factor in influencing outcome, so also are experiences of childhood and adult adversity. Early damaging experiences, which may increase the likelihood of involvement, also affect the ability to deal with the experience of sex work and simultaneously ‘manage’ other life experiences. What is crucial in identifying who is likely to be the most vulnerable are the accumulation of risk factors in early childhood and the personal and ecological resources available to individuals across the lifespan to manage that pathway. How these factors are managed determines the degree of victimhood or agency, vulnerability or resilience individuals perceive they have and the route taken through sex work as a consequence. The study identified three different groups of women who reported different pathways, reflecting different sources of support and coping strategies. This analysis suggests that there is a need to facilitate the provision of ‘secure base’ interventions for women involved in sex work, whatever their age, which have meaning for them. [ABSTRACT FROM PUBLISHER]

The authors conducted a meta-analysis of the association between smoking before a first pregnancy, when undifferentiated breast tissue may be vulnerable to tobacco carcinogens, and the risk of breast cancer. A search of the published literature through August 2010 identified 23 papers reporting on associations between smoking before a first pregnancy and breast cancer. Odds ratios or hazard ratios and 95% confidence intervals, adjusted for known or suspected breast cancer risk factors, were abstracted from each study. Data were pooled using both fixed- and random-effects models. The fixed-effect summary risk ratio for breast cancer among the women who smoked before their first pregnancy versus women who had never smoked was 1.10 (95% confidence interval: 1.07, 1.14); the random-effects estimate was similar. The separate fixed-effect risk ratios for smoking only before the first pregnancy (5 studies) or only after the first pregnancy (16 studies) were both 1.07, providing no evidence that breast tissue is more susceptible to malignant transformation from smoking before the first pregnancy. While these small summary risk ratios may represent causal effects, residual confounding could readily produce estimates of this size in the absence of any causal effect. [ABSTRACT FROM AUTHOR]

The Life Journeys of Young Women Project is the first population-based study to examine the role of economic uncertainty throughout early adulthood on age at first childbirth. A retrospective cross-sectional component was added to an existing cohort study that is based on a birth cohort of women born during 1973–1975 in Adelaide, South Australia (n ˜ 1,000). An event history calendar instrument was used to obtain data regarding a range of life domains including partnering, educational attainment, home ownership, higher education debt, employment, and pregnancies over a 20-year period (sometimes as detailed as at monthly intervals). Interviews were conducted between 2007 and 2009. An analysis framework applying time-varying and time-constant survival analysis techniques within a life-course framework was developed that will guide analyses to examine the role of duration and life-course timing of economic uncertainty on age at first childbirth. This paper discusses study objectives and design, fieldwork procedures, planned statistical analyses, and recruitment outcomes, focusing on novel features that would facilitate analogous epidemiologic research. [ABSTRACT FROM AUTHOR]

In this paper, the authors describe a simple method for making longitudinal comparisons of alternative markers of a subsequent event. The method is based on the aggregate prediction gain from knowing whether or not a marker has occurred at any particular age. An attractive feature of the method is the exact decomposition of the measure into 2 components: 1) discriminatory ability, which is the difference in the mean time to the subsequent event for individuals for whom the marker has and has not occurred, and 2) prevalence factor, which is related to the proportion of individuals who are positive for the marker at a particular age. Development of the method was motivated by a study that evaluated proposed markers of the menopausal transition, where the markers are measures based on successive menstrual cycles and the subsequent event is the final menstrual period. Here, results from application of the method to 4 alternative proposed markers of the menopausal transition are compared with previous findings. [ABSTRACT FROM PUBLISHER]

The ability to access and understand the meaning of multi-morphemic words is essential for age-appropriate literacy growth as well as for achievement in other participants, such as science and social studies, which are so print-dependent. This paper provides a theoretical basis for focusing on the morphology of English when teaching students who are deaf or hard of hearing to read through a review of the literature on the role of morphology in reading for both hearing students and those with a hearing loss. In addition, the authors review the empirical literature on Signing Exact English (SEE), a system of signing English constructed in which the morphology of words is made visible to children who might not be able to hear them. The authors propose that students’ use of SEE can provide a bridge to developing the morphemic awareness so necessary for age-appropriate reading development and achievement. [ABSTRACT FROM PUBLISHER]

This paper has contributed to confirming the link between education and health in developed countries. The analysis is based on 11 European Union countries. We estimate country-specific health functions, where the dependent variable is self-reported health status and the education attainment is one of the main inputs. All eight waves (1994–2001) of the European Community Household Panel are deployed. A random effects ordered probit is estimated in order to control, to a given extent, for unobserved heterogeneity. Explanatory variables are both time invariant (education attainment and gender) and time varying (gross wages, hours of work, age and living alone). Results confirm the positive impact of secondary education on health in most cases and tertiary education in all cases, even after controlling for other inputs in the health function and taking unobserved heterogeneity into account. Secondary education has an impact on health in all countries in the sample except for The Netherlands and UK. The effect does not differ between secondary and tertiary education in France, Ireland and Greece. The correlation between education and health is interpreted in different but complementary ways by diverse approaches and we may not disentangle the precise mechanism that connects health with education from our results. Anyway, it seems clear that better coordination is needed between education and health policies to effectively improve health literacy. Other relevant results from our study are that women register poorer health than men, age contributes to worsening health status and wages contribute positively to health. [ABSTRACT FROM AUTHOR]