Search

AbstractCausal discovery and causal effect estimation are two fundamental tasks in causal inference. While many methods have been developed for each task individually, statistical challenges arise when applying these methods jointly: estimating causal effects after running causal discovery algorithms on the same data leads to “double dipping,” invalidating the coverage guarantees of classical confidence intervals. To this end, we develop tools for valid post-causal-discovery inference. Across empirical studies, we show that a naive combination of causal discovery and subsequent inference algorithms leads to highly inflated miscoverage rates; on the other hand, applying our method provides reliable coverage while achieving more accurate causal discovery than data splitting. [ABSTRACT FROM AUTHOR]

Pairwise likelihood methods are commonly used for inference in parametric statistical models in cases where the full likelihood is too complex to be used, such as multivariate count data. Although pairwise likelihood methods represent a useful solution to perform inference for intractable likelihoods, several computational challenges remain. The pairwise likelihood function still requires the computation of a sum over all pairs of variables and all observations, which may be prohibitive in high dimensions. Moreover, it may be difficult to calculate confidence intervals of the resulting estimators, as they involve summing all pairs of pairs and all of the four-dimensional marginals. To alleviate these issues, we consider a randomized pairwise likelihood approach, where only summands randomly sampled across observations and pairs are used for the estimation. In addition to the usual tradeoff between statistical and computational efficiency, it is shown that, under a condition on the sampling parameter, this two-way random sampling mechanism makes the individual bivariate likelihood scores become asymptotically independent, allowing more computationally efficient confidence intervals to be constructed. The proposed approach is illustrated in tandem with copula-based models for multivariate count data in simulations, and in real data from a transcriptome study. for this article are available online. [ABSTRACT FROM AUTHOR]

This article studies the inference of the regression coefficient matrix under multivariate response linear regressions in the presence of hidden variables. A novel procedure for constructing confidence intervals of entries of the coefficient matrix is proposed. Our method first uses the multivariate nature of the responses by estimating and adjusting the hidden effect to construct an initial estimator of the coefficient matrix. By further deploying a low-dimensional projection procedure to reduce the bias introduced by the regularization in the previous step, a refined estimator is proposed and shown to be asymptotically normal. The asymptotic variance of the resulting estimator is derived with closed-form expression and can be consistently estimated. In addition, we propose a testing procedure for the existence of hidden effects and provide its theoretical justification. Both our procedures and their analyses are valid even when the feature dimension and the number of responses exceed the sample size. Our results are further backed up via extensive simulations and a real data analysis. for this article are available online. [ABSTRACT FROM AUTHOR]

Background and aims: Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay. Methods: A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed. Results: The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p <.001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40–64 years (OR 1.63 (95% CI 1.06–2.52); compared to age 18–39), age more than 64 years (OR 2.84 (95% CI 1.18–6.80); compared to age 18–39), loss of appetite (OR 2.86 (95% CI 1.64–4.98)), fever (OR 1.66 (95% CI 1.08–2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15–3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32–3.53)). Age 40–64 years (OR 2.41 (95% CI 1.50–3.88)), age more than 64 years (OR 8.79 (95% CI 2.19–35.36)), fever (OR 1.83 (95% CI 1.15–2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14–3.14)) were also risk factors for complicated appendicitis. Conclusions: Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis. [ABSTRACT FROM AUTHOR]

Objective: Many countries experience challenges in recruiting and retaining general practitioners (GPs) as supervisors for medical students in clinical placements. We aimed to investigate the opportunities, capacities and limitations of Norwegian GPs to become supervisors. Design: Web-based cross-sectional questionnaire study. Setting: Norwegian general practice. Subjects: All GPs in Norway, including locums and those on leave, both active supervisors, and GPs who are not presently supervising medical students. Main outcome measures: GPs' terms of salary, office facilities, limiting factors, capacity and needs for becoming or continuing as supervisors. Results: Among 5145 GPs, 1466 responded (29%), of whom 498 (34%) were active supervisors. Lack of a dedicated student office was the most reported limitation for both active supervisors (75%) and other GPs (81%). A high proportion (67%) of active supervisors reported that they could host more students per year, given financial support for equipped offices and higher salaries. With this kind of support, 48% (n = 461) of the GPs who were not supervisors for medical students were positive about a future supervisor role. By adjusted regression analysis, female GPs had lower likelihood of being supervisors, OR (95% CI) 0.75 (0.59–0.95) than male colleagues. GPs in the North, Mid and West regions had higher odds (OR 3.89, 3.10 and 2.42, respectively) than those in the South-East region. Teaching experience also increased the odds (2.31 (1.74–3.05). Conclusions: There seems to be capacity among both active and potential supervisors if increased salaries and financial support for office facilities are made available. KEY POINTS: Undergraduate training by clinical placements is important for the recruitment of doctors to general practice, and depends on a sufficient number of GPs as supervisors. The study shows that there is sufficient capacity among Norwegian GPs to host medical students in clinical placements. Many potential supervisors among Norwegian GPs report that they have not been approached by a university to supervise medical students. Many supervisors state that they need increased salaries and financial support for facilities and expenses in order to supervise medical students. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of an empowerment-based interprofessional lifestyle intervention program among people at risk of type 2 diabetes on knowledge, skills, and confidence in self-management, health, psychological well-being, and lifestyle characteristics, and to explore the participants' perceptions of participating in the intervention. Design and methods: In line with the Medical Research Council complex interventions research methods framework, we conducted a randomized controlled trial with embedded qualitative interviews in primary healthcare clinics in Norway between 2019–2021. Of the patients at risk (The Finnish Diabetes Risk Score Calculator (FINDRISC) ≥15 or Body Mass Index (BMI) ≥30) 142 accepted the invitation, and 14 participants from the intervention group participated in individual interviews after the 12-month follow-up. Our primary outcome was the Patient Activation Measure (PAM-13). Secondary outcomes were EQ-5D-5L, EQ-VAS, WHO-Overall health, WHO-Overall QOL, weight, height, waist circumference, and regularity of physical activity. We used thematic analysis to analyse the qualitative data. Results: There was no clinically relevant differences of neither the primary nor the secondary endpoints between intervention and control group. As to the qualitative data, we identified two distinct features: 'Meaningful perspectives on lifestyle changes' and 'Lifestyle change is not a linear process due to challenges faced along the way' putting ownership of their choices in life into picture. Conclusion: The negative results of the RCT stand in contrast to the findings given by the participants voices, perceiving the intervention as a key eye opener placing their health challenges in perspective. How to interpret these seemingly conflicting findings of participants being seen, heard, and understood, helping them to take more conscious ownership of their choices in life, and at the same time demonstrating no improvements in symptoms or measures, is a dilemma that needs further exploration. We should be careful to implement interventions that do not demonstrate any effects on the quantitative outcomes. [ABSTRACT FROM AUTHOR]

Objective: To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting: The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients: Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures: Association between self-reported BP and 10 self-report lifestyle-related variables. Results: Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion: In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension. KEY POINTS: Associations between daily home blood pressure (BP) and self-reports of lifestyle and symptoms have not been previously well explored. Self-reported higher wellbeing, lower restlessness, less stress, and higher medication adherence were significantly associated with lower same-day BP levels. Physical activity was significantly associated with same-day BP for men, but not for women. Using a hypertension management system may be a valuable tool for communication between the patient and physician. [ABSTRACT FROM AUTHOR]

Introduction: Noncommunicable diseases (NCDs) constitute a massive global burden and are the leading cause of death and disability worldwide. In Greenland, the prevalence of NCDs has historically been low. However, during the past approximately 70 years, life circumstances have changed dramatically resulting in increased life expectancy. Today, the proportion of inhabitants in Greenland ≥65 years has nearly tripled since the 1980s, and the prevalence of obesity and diabetes has increased rapidly within the past decades. The aim of this study was to describe the burden of selected NCDs in a primary care setting in Nuuk and compare it to a modern westernized suburban general practice in Denmark. Methods: The study was performed as a cross sectional register-based study using data extracted from the electronic medical records (EMR) based on diagnosis codes from inhabitants living in Nuuk, Greenland, and a suburb in Denmark. Estimates of prevalence were age-standardized to the WHO world standard population. Results: In both Nuuk and the Danish suburb, the highest prevalence was observed for hypertension (13.2% for both populations), followed by asthma (4.4 and 9.5%, respectively) and diabetes (4.3 and 2.9%, respectively). The age-standardized prevalences of diabetes, COPD, atrial fibrillation, and heart failure, were significantly higher in Nuuk, while seven NCDs including asthma, ischemic heart disease, arthritis urica, psoriasis, hyperthyreosis, hypothyreosis and osteoporosis were significantly higher in the Danish suburb. Conclusion: In contrast to the disease pattern observed in Greenland in the last century, the prevalence of diagnosed NCDs in Nuuk is no longer rare. Thus, the overall prevalence of NCDs in the population of Nuuk is now comparable to or even higher than in the suburb in Denmark. This calls for increased focus on all NCDs in the primary healthcare system in Greenland and adaption of the primary healthcare services to a changed disease spectrum. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of diabetes retinopathy and evaluate the factors influencing its occurrence both at the onset of type 2 diabetes (T2D) and three years into its duration. Design: Retrospective population-based study. Setting: Data was retrieved from Regional Healthcare Information Platform in Region Halland 2016–2020. Subjects: Patients 35-75 years old in Region Halland receiving first-time diabetes diagnosis according to ICD-code E11-14 in 2016–17. The total cohort consisted of 1659 patients. Main outcome measures: The main outcome measure of the study was the occurrence of diabetes retinopathy at onset and within three years from the diabetes diagnosis. Multivariate logistic regression analysis was conducted for diabetes retinopathy at onset and within three years, adjusted for age, gender, comorbidities, levels of HbA1c, cholesterol, kidney functional and blood pressure. Results: At onset, there were 12% with diabetes retinopathy and after three years, 32% of the patients had developed diabetes retinopathy. In the study cohort, 71 of patients who were examined with fundus photography within three years after onset, and 8% had had dietary recommendation without pharmacotherapy. High HbA1c levels, blood pressure values and impaired renal function already at onset were associated with development of diabetes retinopathy at onset and this association persisted after three years. The odds ratio for diabetes retinopathy was increased adjusted for HbA1c elevations, renal impairment, and increased blood pressure at index and when adjusted for these variables three years from index. Conclusion: These findings indicate that the risk of developing diabetes retinopathy is present early on at onset and within the first three years of diabetes diagnosis. This highlights the importance of promptly regulating glucose- and blood-pressure levels and follow up kidney dysfunction to mitigate the risk of diabetes retinopathy. KEY POINTS: Among patients with type 2 diabetes, 12% had developed diabetes retinopathy already at onset. Among patients with type 2 diabetes, one-third had developed diabetes retinopathy after three years from onset. The presence of diabetes retinopathy already at diabetes onset, was associated with elevated HbA1c levels, renal impairment and elevated blood pressure. Diabetes retinopathy three years after the onset of the disease, was associated with increased HbA1c levels, high blood pressure, and renal dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact. Design: Pragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level. Setting: PCCs in Region Västra Götaland, Sweden, with care manager organisation. Participants: Of 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder (n = 142 intervention, n = 116 control PCCs). Intervention: Cooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3 months. Regular contact with care manager was continued at the control PCCs. Main outcome measures: 12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12 months. Results: There were no significant differences between intervention and control groups after 12 months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7 days (95% confidence interval (CI) 82.6 − 138.8); control, mean = 99.1 days (95% CI 73.9 − 124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12 months. At 3 months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6 months 38% vs 32.8%, and12 months 16.9% vs 15.5%. Conclusion: Increased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation. Trial registration: ClinicalTrials.gov Identifier: NCT03250026 CO-WORK-CARE First Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017 [ABSTRACT FROM AUTHOR]

AbstractFueled in part by recent applications in neuroscience, the multivariate Hawkes process has become a popular tool for modeling the network of interactions among high-dimensional point process data. While evaluating the uncertainty of the network estimates is critical in scientific applications, existing methodological and theoretical work has primarily addressed estimation. To bridge this gap, we develop a new statistical inference procedure for high-dimensional Hawkes processes. The key ingredient for the inference procedure is a new concentration inequality on the first- and second-order statistics for integrated stochastic processes, which summarize the entire history of the process. Combining recent martingale central limit theorem with the new concentration inequality, we then characterize the convergence rate of the test statistics in a continuous time domain. Finally, to account for potential non-stationarity of the process in practice, we extend our statistical inference procedure to a flexible class of Hawkes processes with time-varying background intensities and unknown transition functions. The finite sample validity of the inferential tools is illustrated via extensive simulations and further applied to a neuron spike train data set. [ABSTRACT FROM AUTHOR]

Monte Carlo integration is a commonly used technique to compute intractable integrals and is typically thought to perform poorly for very high-dimensional integrals. To show that this is not always the case, we examine Monte Carlo integration using techniques from the high-dimensional statistics literature by allowing the dimension of the integral to increase. In doing so, we derive nonasymptotic bounds for the relative and absolute error of the approximation for some general classes of functions through concentration inequalities. We provide concrete examples in which the magnitude of the number of points sampled needed to guarantee a consistent estimate varies between polynomial to exponential, and show that in theory arbitrarily fast or slow rates are possible. This demonstrates that the behavior of Monte Carlo integration in high dimensions is not uniform. Through our methods we also obtain nonasymptotic confidence intervals which are valid regardless of the number of points sampled. [ABSTRACT FROM AUTHOR]

Melded confidence intervals were proposed as a way to combine two independent one-sample confidence intervals to obtain a two-sample confidence interval for a quantity like a difference or a ratio. Simulation-based work has suggested that melded confidence intervals always provide at least the nominal coverage. However, we show here that for the case of melded confidence intervals for a difference in population quantiles, the confidence intervals do not guarantee the nominal coverage. We derive a lower bound on the coverage for a one-sided confidence interval, and we show that there are pairs of distributions that make the coverage arbitrarily close to this lower bound. One specific example of our results is that the 95% melded upper bound on the difference between two population medians offers a guaranteed coverage of only 88.3% when both samples are of size 20. [ABSTRACT FROM AUTHOR]

The analysis of screening experiments is often done in two stages, starting with factor selection via an analysis under a main effects model. The success of this first stage is influenced by three components: (1) main effect estimators' variances and (2) bias, and (3) the estimate of the noise variance. Component (3) has only recently been given attention with design techniques that ensure an unbiased estimate of the noise variance. In this paper, we propose a design criterion based on expected confidence intervals of the first stage analysis that balances all three components. To address model misspecification, we propose a computationally-efficient all-subsets analysis and a corresponding constrained design criterion based on lack-of-fit. Scenarios found in existing design literature are revisited with our criteria and new designs are provided that improve upon existing methods. [ABSTRACT FROM AUTHOR]

Background: the aim is to investigate the risk of short-term maternal morbidity caused by the selective clinical use of episiotomy (rate < 0.02), and to compare the risk of severe perineal tears with the statewide risk. Methods: In this retrospective cohort study, we investigated the effect of selective episiotomy on the risk of severe perineal tears and blood loss in singleton term deliveries, using propensity scores with inverse probability weighting. Results: This study included 10992 women who delivered vaginally between 2008-2018. Episiotomy was performed in 171 patients (1.55%), three of whom (1.75%) experienced severe perineal tears compared to 156 (1.44%) in the control cohort. The adjusted odds ratio of severe perineal tears was 2.06 (95% confidence interval [CI]: 0.51, 8.19 with 0.3 p value). Multivariate linear regression showed that episiotomy increased blood loss by 96.3 ml (95% CI: 6.4, 186.2 with 0.03 p value). Episiotomy was performed in 23% (95% CI: 0.228, 0.23) of vaginal deliveries in the state of Hessen, with a risk of severe perineal tears of 0.0143 (95% CI: 0.0139, 0.0147) compared to 0.0145 (95% CI: 0.0123, 0.0168) in our entire cohort. Conclusions: Selective use of episiotomy does not increase the risk of higher-grade perineal tears. However, it may be associated with maternal morbidity in terms of increased blood loss. [ABSTRACT FROM AUTHOR]

We propose Narrowest Significance Pursuit (NSP), a general and flexible methodology for automatically detecting localized regions in data sequences which each must contain a change-point (understood as an abrupt change in the parameters of an underlying linear model), at a prescribed global significance level. NSP works with a wide range of distributional assumptions on the errors, and guarantees important stochastic bounds which directly yield exact desired coverage probabilities, regardless of the form or number of the regressors. In contrast to the widely studied "post-selection inference" approach, NSP paves the way for the concept of "post-inference selection." An implementation is available in the R package nsp. for this article are available online. [ABSTRACT FROM AUTHOR]

We introduce and study two new inferential challenges associated with the sequential detection of change in a high-dimensional mean vector. First, we seek a confidence interval for the changepoint, and second, we estimate the set of indices of coordinates in which the mean changes. We propose an online algorithm that produces an interval with guaranteed nominal coverage, and whose length is, with high probability, of the same order as the average detection delay, up to a logarithmic factor. The corresponding support estimate enjoys control of both false negatives and false positives. Simulations confirm the effectiveness of our methodology, and we also illustrate its applicability on the U.S. excess deaths data from 2017 to 2020. The , which contains the proofs of our theoretical results, is available online. [ABSTRACT FROM AUTHOR]

Estimation of population size using incomplete lists has a long history across many biological and social sciences. For example, human rights groups often construct partial lists of victims of armed conflicts, to estimate the total number of victims. Earlier statistical methods for this setup often use parametric assumptions, or rely on suboptimal plug-in-type nonparametric estimators; but both approaches can lead to substantial bias, the former via model misspecification and the latter via smoothing. Under an identifying assumption that two lists are conditionally independent given measured covariates, we make several contributions. First, we derive the nonparametric efficiency bound for estimating the capture probability, which indicates the best possible performance of any estimator, and sheds light on the statistical limits of capture-recapture methods. Then we present a new estimator, that has a double robustness property new to capture-recapture, and is near-optimal in a nonasymptotic sense, under relatively mild nonparametric conditions. Next, we give a confidence interval construction method for total population size from generic capture probability estimators, and prove nonasymptotic near-validity. Finally, we apply them to estimate the number of killings and disappearances in Peru during its internal armed conflict between 1980 and 2000. for this article are available online. [ABSTRACT FROM AUTHOR]

Epidemiologic screening programs often make use of tests with small, but nonzero probabilities of misdiagnosis. In this article, we assume the target population is finite with a fixed number of true cases, and that we apply an imperfect test with known sensitivity and specificity to a sample of individuals from the population. In this setting, we propose an enhanced inferential approach for use in conjunction with sampling-based bias-corrected prevalence estimation. While ignoring the finite nature of the population can yield markedly conservative estimates, direct application of a standard finite population correction (FPC) conversely leads to underestimation of variance. We uncover a way to leverage the typical FPC indirectly toward valid statistical inference. In particular, we derive a readily estimable extra variance component induced by misclassification in this specific but arguably common diagnostic testing scenario. Our approach yields a standard error estimate that properly captures the sampling variability of the usual bias-corrected maximum likelihood estimator of disease prevalence. Finally, we develop an adapted Bayesian credible interval for the true prevalence that offers improved frequentist properties (i.e., coverage and width) relative to a Wald-type confidence interval. We report the simulation results to demonstrate the enhanced performance of the proposed inferential methods. [ABSTRACT FROM AUTHOR]

Enterococcus cecorum lesion strains cause more embryonic mortality after inoculation into the albumen of embryonated eggs compared to cloaca strains. We hypothesized that these strain differences are a result of differences in sensitivity to the antimicrobial effects of the albumen. In this study, the sensitivity of 14 lesion strains and 14 cloaca strains to albumen from 12-day incubated and non-incubated eggs was assessed. A major antimicrobial protein of the albumen is lysozyme and, therefore, the lysozyme resistance of all strains was determined. Albumen from 12-day incubated and non-incubated eggs was inoculated with four cloaca strains and four lesion strains (104 CFU/tube). Based on the results, in a subsequent experiment, all 28 strains were inoculated only into albumen from non-incubated eggs. For all strains, the minimal inhibitory concentrations (MIC) of lysozyme were determined using an agar dilution method and the growth rates in broth with (500 and 2000 µg/ml) or without lysozyme were assessed. Compared to cloaca strains, lesion strains had 320 times higher odds of being reisolated from albumen (95% confidence interval: 55–3962) and had 8.5 times higher reisolation ratios (reisolation dose/inoculation dose) (95% confidence interval: 4.8–15.3). Thirteen cloaca strains had a MIC ranging from 1000 to 8000 µg/ml, while one cloaca strain and all lesion strains were resistant to the lysozyme concentrations tested. Growth rates of cloaca strains were decreased more by lysozyme compared to lesion strains. In conclusion, lesion strains had higher survival rates in egg albumen and were more resistant to lysozyme compared to cloaca strains. Egg albumen inhibits Enterococcus cecorum cloaca strains more than lesion strains. Enterococcus cecorum lesion strains are resistant to high concentrations of lysozyme. Lysozyme resistance could enhance survival in albumen and body fluids. [ABSTRACT FROM AUTHOR]

The use of donated expressed breast milk (DBM) is encouraged in South Africa, with donor milk banks and legislated policies and programmes available in hospitals serving populations with a high HIV prevalence. Concerns over poor attitudes amongst mothers towards DBM seem to persist. A cross-sectional mixed-methods approach was used in a cohort of mothers of neonates in a regional hospital. Between April 2021 and January 2022, survey data on knowledge, awareness and attitudes towards DBM was collected. Qualitative data from open-ended questions were thematically analysed. Comparative analysis using independent sample t-tests and logistic regression to determine differences in variables and to understand associations related to knowledge was conducted. A total of 163 mothers with a mean (SD) age of 27.1 ± 6.3 years were included; 49.7% of mothers had post-high-school qualifications, 82.8% were unemployed and 87.0% received social security. Some 64.4% had inadequate knowledge of DBM. Awareness of DBM had the strongest association with better knowledge concerning DBM and AdjOR (25.25 95% CI 10.60–68.40; p < 0.001). Negative attitudes towards DBM were largely driven by a lack of knowledge regarding human immunodeficiency virus (HIV) screening of donor mothers and fears of HIV transmission when using DBM. Lack of awareness concerning DBM was associated with poor knowledge of DBM, which may drive poor uptake of this critical nutritional source for at-risk neonates. Implementing targeted awareness programmes on DBM, which begin in the antenatal period and specifically address HIV screening of donor mothers, could address the poor uptake of DBM. [ABSTRACT FROM AUTHOR]

Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period. Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service's telephone records. Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected. Patients in contact with GPs and the OOH service during the outbreak and a control period. Patient contacts with GPs and the OOH service during the outbreak and a control period. There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24–4.28]). Children aged 0–4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28–1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases. The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak. [ABSTRACT FROM AUTHOR]

Objective: We opted to study how support staff operational capacity and diabetes competences may impact the timeliness of basal insulin-initiation in general practice patients with type 2 diabetes (T2D). Design/Setting/Outcomes: This was an observational and retrospective study on Norwegian primary care patients with T2D included from the ROSA4-dataset. Exposures were (1) support staff size, (2) staff size relative to number of GPs, (3) clinic access to a diabetes nurse and (4) share of staff with diabetes course (1 and 2 both relate to staff operational capacity, whereas 3 and 4 are both indicatory of staff diabetes competences). Outcomes were 'timely basal insulin-initiation' (primary) and 'attainment of HbA1c<7%' after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments. Subjects: Insulin naïve patients with 'timely' (N = 294), 'postponed' (N = 219) or 'no need of' (N = 3,781) basal insulin-initiation, respectively. Results: HbA1c [median (IQR)] increased to 8.8% (IQR, 8.0, 10.2) prior to basal insulin-initiation, which reduced HbA1c to 7.3 (6.8–8.1) % by which only 35% of the subjects reached HbA1c <7%. Adjusted risk of 'timely basal insulin-initiation' was more than twofold higher if access to a diabetes nurse (OR = 2.40, [95%CI, 1.68, 3.43]), but related only vaguely to staff size (OR = 1.01, [95%CI, 1.00, 1.03]). No other staff factors related significantly to neither the primary nor the secondary outcome. Conclusion: In Norwegian general practice, insulin initiation in people with T2D may be affected by therapeutic inertia but access to a diabetes nurse may help facilitating more timely insulin start-up. In patients with type 2 diabetes (T2D) cared for by their general practice physician (GP), insulin therapy was susceptible to therapeutic inertia. In Norwegian general practice, chance of timely basal insulin-initiation was found more than two-fold higher if the GP had access to a diabetes nurse. In contrast, the timeliness of basal insulin-initiation in general practice patients with T2D seemed unaffected by share of support staff with diabetes course and by factors indicatory of support staff overall operational capacity. In Norwegian general practice, a diabetes nurse seems to offer unique clinical benefits to the care of insulin treated patients with T2D. [ABSTRACT FROM AUTHOR]

The burden of symptoms is a subjective experience of distress. Little is known on the burden of feeling unwell in patients with persistent symptom diagnoses. The aim of this study was to assess the burden in primary care patients with persistent symptom diagnoses compared to other primary care patients. A cross-sectional study was performed in which an online survey was sent to random samples of 889 patients with persistent symptom diagnoses (>1 year) and 443 other primary care patients after a transactional identification in a Dutch primary care data registry. Validated questionnaires were used to assess the severity of symptoms (PHQ-15), Symptom Intensity and Symptom Interference questionnaires, depression (PHQ-9), anxiety (GAD-7), quality of life (SF-12 and EQ-5D-5L)) and social functioning (SPF-ILs). Overall, 243 patients completed the survey: 178 (73.3%) patients in the persistent symptom diagnoses group and 65 (26.7%) patients in the control group. In the persistent group, 65 (36.5%) patients did not have persistent symptom(s) anymore according to the survey response. Patients who still had persistent symptom diagnoses (n = 113, 63.5%) reported significantly more severe somatic symptoms (mean difference = 3.6, [95% CI: 0.24, 4.41]), depression (mean difference = 3.0 [95% CI: 1.24, 3.61]) and anxiety (mean difference = 2.3 [95% CI: 0.28, 3.10]) and significantly lower physical functioning (mean difference = − 6.8 [95% CI: −8.96, −3.92]). Patients with persistent symptom diagnoses suffer from high levels of symptoms burden. The burden in patient with persistent symptoms should not be underestimated as awareness of this burden may enhance person-centered care. [ABSTRACT FROM AUTHOR]

Swedish Physical Activity on Prescription (PAP) has been shown to increase physical activity levels, which is known to lead to positive health effects. PAP is being implemented in Swedish healthcare to various extents. However, there is a lack of knowledge about how Swedish general practitioners (GPs) work with PAP and what hinders and facilitates wider implementation. This study aimed to survey GPs' use and views of PAP, identify barriers and facilitators for implementing PAP, and explore associations to gender, practice location, and experience. The study was framed by the Normalization Process Theory. A survey was sent to 463 GPs at 69 different healthcare centres in Region Västra Götaland. Data were analysed using multiple logistic and linear regressions. A total of 143 GPs completed the survey (response rate 31%). Views on PAP were generally positive amongst respondents, but only 27% reported using PAP regularly. The most prominent reported barriers were insufficient training and resources. Positive views and willingness to collaborate in using PAP were identified as facilitators. Responding GPs in Gothenburg used PAP more often (OR 6.4; 95% CI 2.7–14.8) and were significantly more positive to the method than GPs in other areas of the region. GPs with more than 10 years of practice used PAP more often (OR 2.5; 95% CI 1.1–6.0) than less experienced GPs. Few of the investigated variables were associated with gender. The positive views amongst responding GPs are helpful, but more education, training and resources are needed for successful implementation of PAP in Swedish primary health care. Implementation of physical activity on prescription (PAP) in Swedish healthcare has been ongoing for many years, but is implemented to various extents across and within regions. Views on PAP are generally positive, but use is not widespread amongst general practitioners in Region Västra Götaland who responded to the survey. The method is more frequently used in Gothenburg, where the most extensive implementation work has been done, and amongst more experienced general practitioners. Education and training in using PAP need to increase for successful implementation. [ABSTRACT FROM AUTHOR]

To assess the cultural competence (CC) of GP trainees and GP trainers. Design and setting: A cross-sectional survey study was conducted at the GP Training Institute of Amsterdam UMC. We included 92 GP trainees and 186 GP trainers. We measured the three domains of cultural competency: 1) knowledge, 2) culturally competent attitudes and 3) culturally competent skills. Regression models were used to identify factors associated with levels of CC. Participants rated their self-perceived CC at the beginning and end of the survey, and the correlation between self-perceived and measured CC was assessed. Approximately 94% of the GP trainees and 81% of the GP trainers scored low on knowledge; 45% and 42%, respectively, scored low on culturally competent attitudes. The level of culturally competent skills was moderate (54.3%) or low (48.4%) for most GP trainees and GP trainers. The year of residency and the GP training institute were significantly associated with one or more (sub-)domains of CC in GP trainees. Having >10% migrant patients and experience as a GP trainer were positively associated with one or more (sub-) domains of cultural competence in GP trainers. The correlation between measured and self-perceived CC was positive overall but very weak (Spearman correlation coefficient ranging from −0.1–0.3). The level of cultural competence was low in both groups, especially in the knowledge scores. Cultural competence increased with experience and exposure to an ethnically diverse patient population. Our study highlights the need for cultural competence training in the GP training curricula. General practitioner (GP) trainees find cross-cultural consultations stressful due to a self-perceived lack of cultural competence (CC). The level of CC in general practice is as yet unknown. On average, the level of CC was low for the majority of GP trainees and GP trainers, especially for the scores on knowledge. CC increased with experience and exposure to an ethnically diverse patient population. GP trainees and trainers perceived a lack of covered education on various topics related to the care of migrants. Our study highlights the need for cultural competence training in the GP training curricula. [ABSTRACT FROM AUTHOR]

Federal administrative data, such as tax data, are invaluable for research, but because of privacy concerns, access to these data is typically limited to select agencies and a few individuals. An alternative to sharing microlevel data is to allow individuals to query statistics without directly accessing the confidential data. This article studies the feasibility of using differentially private (DP) methods to make certain queries while preserving privacy. We also include new methodological adaptations to existing DP regression methods for using new data types and returning standard error estimates. We define feasibility as the impact of DP methods on analyses for making public policy decisions and the queries accuracy according to several utility metrics. We evaluate the methods using Internal Revenue Service data and public-use Current Population Survey data and identify how specific data features might challenge some of these methods. Our findings show that DP methods are feasible for simple, univariate statistics but struggle to produce accurate regression estimates and confidence intervals. To the best of our knowledge, this is the first comprehensive statistical study of DP regression methodology on real, complex datasets, and the findings have significant implications for the direction of a growing research field and public policy. for this article are available online. [ABSTRACT FROM AUTHOR]

This article develops a bootstrap analogue of the well-known asymptotic expansion of the tail quantile process in extreme value theory. One application of this result is to construct confidence intervals for estimators of the extreme value index such as the Probability Weighted Moment (PWM) estimator. For the peaks-over-threshold method, we show the bootstrap consistency of the confidence intervals. By contrast, the asymptotic expansion of the quantile process of the bootstrapped block maxima does not lead to a similar consistency result for the PWM estimator using the block maxima method. For both methods, We show by simulations that the sample variance of bootstrapped estimates can be a good approximation for the asymptotic variance of the original estimator. for this article are available online. [ABSTRACT FROM AUTHOR]

The weighted nearest neighbors (WNN) estimator has been popularly used as a flexible and easy-to-implement nonparametric tool for mean regression estimation. The bagging technique is an elegant way to form WNN estimators with weights automatically generated to the nearest neighbors (Steele 2009; Biau, Cérou, and Guyader 2010); we name the resulting estimator as the distributional nearest neighbors (DNN) for easy reference. Yet, there is a lack of distributional results for such estimator, limiting its application to statistical inference. Moreover, when the mean regression function has higher-order smoothness, DNN does not achieve the optimal nonparametric convergence rate, mainly because of the bias issue. In this work, we provide an in-depth technical analysis of the DNN, based on which we suggest a bias reduction approach for the DNN estimator by linearly combining two DNN estimators with different subsampling scales, resulting in the novel two-scale DNN (TDNN) estimator. The two-scale DNN estimator has an equivalent representation of WNN with weights admitting explicit forms and some being negative. We prove that, thanks to the use of negative weights, the two-scale DNN estimator enjoys the optimal nonparametric rate of convergence in estimating the regression function under the fourth-order smoothness condition. We further go beyond estimation and establish that the DNN and two-scale DNN are both asymptotically normal as the subsampling scales and sample size diverge to infinity. For the practical implementation, we also provide variance estimators and a distribution estimator using the jackknife and bootstrap techniques for the two-scale DNN. These estimators can be exploited for constructing valid confidence intervals for nonparametric inference of the regression function. The theoretical results and appealing finite-sample performance of the suggested two-scale DNN method are illustrated with several simulation examples and a real data application. [ABSTRACT FROM AUTHOR]

This article is concerned with constructing a confidence interval for a target policy's value offline based on a pre-collected observational data in infinite horizon settings. Most of the existing works assume no unmeasured variables exist that confound the observed actions. This assumption, however, is likely to be violated in real applications such as healthcare and technological industries. In this article, we show that with some auxiliary variables that mediate the effect of actions on the system dynamics, the target policy's value is identifiable in a confounded Markov decision process. Based on this result, we develop an efficient off-policy value estimator that is robust to potential model misspecification and provide rigorous uncertainty quantification. Our method is justified by theoretical results, simulated and real datasets obtained from ridesharing companies. A Python implementation of the proposed procedure is available at. [ABSTRACT FROM AUTHOR]

Neural Bayes estimators are neural networks that approximate Bayes estimators. They are fast, likelihood-free, and amenable to rapid bootstrap-based uncertainty quantification. In this article, we aim to increase the awareness of statisticians to this relatively new inferential tool, and to facilitate its adoption by providing user-friendly open-source software. We also give attention to the ubiquitous problem of estimating parameters from replicated data, which we address using permutation-invariant neural networks. Through extensive simulation studies we demonstrate that neural Bayes estimators can be used to quickly estimate parameters in weakly identified and highly parameterized models with relative ease. We illustrate their applicability through an analysis of extreme sea-surface temperature in the Red Sea where, after training, we obtain parameter estimates and bootstrap-based confidence intervals from hundreds of spatial fields in a fraction of a second. [ABSTRACT FROM AUTHOR]

Out-of-sample prediction is the acid test of predictive models, yet an independent test dataset is often not available for assessment of the prediction error. For this reason, out-of-sample performance is commonly estimated using data splitting algorithms such as cross-validation or the bootstrap. For quantitative outcomes, the ratio of variance explained to total variance can be summarized by the coefficient of determination or in-sample R2, which is easy to interpret and to compare across different outcome variables. As opposed to in-sample R2, out-of-sample R2 has not been well defined and the variability on out-of-sample R ̂ 2 has been largely ignored. Usually only its point estimate is reported, hampering formal comparison of predictability of different outcome variables. Here we explicitly define out-of-sample R2 as a comparison of two predictive models, provide an unbiased estimator and exploit recent theoretical advances on uncertainty of data splitting estimates to provide a standard error for R ̂ 2 . The performance of the estimators for R2 and its standard error are investigated in a simulation study. We demonstrate our new method by constructing confidence intervals and comparing models for prediction of quantitative Brassica napus and Zea mays phenotypes based on gene expression data. Our method is available in the R-package oosse. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis is a major cause of mortality worldwide. Prisoners in Guiana have multiple risk factors. The primary objective of this study was to describe tuberculosis occurring in prison and after release in French Guiana between 2008 and 2020. Secondary objectives were to identify tuberculosis risk factors and determine annual incidences. Methods: A retrospective cohort study of tuberculosis cases was carried out at the Guiana prison between 2008 and 2020. Data were collected from prison registers and cross-referenced with the list of tuberculosis notifications in French Guiana. Results: A total of 36 cases of tuberculosis were studied. Incidence was high, at 263/100,000 per year, higher than elsewhere in France and comparable to that in Brazil. Despite visibly effective screening on entry, with little evidence of intra-prison circulation of tuberculosis, 39% of patients were diagnosed within two years of leaving prison (76% were symptomatic). This could be explained by the high prevalence of latent forms (LTI). Discussion: Continued screening on entry, in combination with annual radiological and clinical screening, and reinforced follow-up on release seem indicated to improve patient management and the search for possible LTI. [ABSTRACT FROM AUTHOR]

Stigma that people with HIV who inject drugs experience negatively impacts HIV and substance use care, but stigma’s association with sharing injection equipment is not known. This is a cross-sectional analysis of data from two studies of people with HIV reporting drug injection (N = 319) in St. Petersburg, Russia (September 2018-December 2020). We used logistic regression to examine associations between HIV stigma and substance use stigma scores (categorised into quartiles) and past 30-day equipment sharing, adjusting for demographic and clinical characteristics. Secondary analyses examined associations of arrest history and social support with sharing equipment. Almost half (48.6%) of participants reported sharing injection equipment. Among groups who did and did not share, mean HIV stigma (2.3 vs 2.2) and substance use stigma (32 vs 31) scores were similar. Adjusted analyses detected no significant associations between HIV stigma quartiles (global p-value = 0.85) or substance use stigma quartiles (global p-value = 0.51) and sharing equipment. Neither arrest history nor social support were significantly associated with sharing equipment. In this cohort, sharing injection equipment was common and did not vary based on stigma, arrest history, or social support. To reduce equipment sharing, investments in sterile injection equipment access in Russia should be prioritised over interventions to address stigma. [ABSTRACT FROM AUTHOR]

Orphans are at higher risk of HIV infection and several important HIV risk factors than non-orphans; however, this may be due to a combination of related social, psychological, and economic factors, as well as care environment, rather than orphan status alone. Understanding these complex relationships may aid policy makers in supporting evidence-based, cost-effective programming for this vulnerable population. This longitudinal study uses a causal effect model to examine, through decomposition, the relationship between care environment and HIV risk factors in orphaned and separated adolescents and youths (OSAY) in Uasin Gishu County, Kenya; considering resilience, social, peer, or family support, volunteering, or having one’s material needs met as potential mediators. We analysed survey responses from 1105 OSAY age 10–26 living in Charitable Children’s Institutions (CCI) (orphanages) and family-based care settings (FBS). Follow-up time was 7–36 months. Care in CCIs (vs. FBS) was associated with a decreased likelihood of engaging in forced, exchange, and consensual sex. Excess relative risks (ERR) attributable to the indirect pathway, mediation, or interaction were not significant in any model. Care environment was not statistically associated with differences in substance use. Our findings support the direct, unmediated, association between institutional care and HIV risk factors. [ABSTRACT FROM AUTHOR]

Background: Human Papillomavirus (HPV), a prevalent sexually transmitted infection carrying significant risks ranging from benign lesions to various types of malignancies, represents a matter of great public health concern. Notably, most Arab countries lack public awareness campaigns or national immunization programs. This study aims at assessing the overall knowledge on HPV and HPV vaccination among the Lebanese population, exploring the prevalent attitude on the matter, and identifying barriers and misconceptions that prevent individuals from receiving the HPV vaccine. Methods: A cross-sectional study was conducted in Beirut, on 201 participants aged between 18 and 36 years old. We performed ordinal analysis to assess the trend between Knowledge levels, attitude levels and hesitancy Levels. Results: Majority of participants (77%) demonstrated a low level of knowledge on HPV vaccination, 50% held a positive attitude, with only 18.4% being already vaccinated. Negative trend was identified between levels of knowledge, attitude and hesitancy (gamma = −0.7415, p-value < 0.01; gamma= −0.58, p-value < 0.01 respectively). Unavailability or limited access to the vaccine, and misconceptions about HPV immunization were shown to be impeding vaccination. Conclusion: Analysis of our results strongly suggests that improving knowledge and attitudes is likely to foster trust and reduce hesitancy, thereby promoting higher vaccine uptake. [ABSTRACT FROM AUTHOR]

Background: Due to the different factors affecting the maintenance of a constant supply of human blood in health facilities, this study aimed at exploring the knowledge, perceptions, and practices towards blood donation among under graduate medical students at Busitema University Faculty of Health Sciences (BUFHS). Methods: Using a convergent parallel mixed methods study design, 384 students were recruited into the study. Questionnaires and focused group discussions were used to collect the data. Stata version 15.0 and thematic analysis were used to analyze quantitative and qualitative data respectively. Results: Of the respondents, 151 (39.4%) had ever donated blood and 50.4% had good knowledge about blood donation. The commonest motivating factor towards blood donation was “to save someone’s life”. Factors associated with practices towards blood donation included: religion, year 2 of study and prior blood donation history. Being Jehovah’s Witness reduced the willingness to donate blood by 88% compared to other religions. Thematic analysis revealed four themes namely; students’ experiences and thoughts, driving forces to donate blood, fears and misconceptions, and suggestions to increase blood donors. Conclusion: The proportion of undergraduate medical students who had adequate level of knowledge about blood donation was moderately high, however, some of their perceptions towards it were unconventional. To ensure safe and adequate blood supply, design of strategies and tailored programs that promote blood donation is highly recommended.. [ABSTRACT FROM AUTHOR]

To respond to the COVID-19 pandemic, countries introduced public health and social measures that had indirect societal, economic consequences. Concerns during epidemics include continuity of routine health services. We investigate how healthcare utilisation and healthcare seeking behaviour changed during the first year of the COVID-19 pandemic among host communities in Cox’s Bazar, Bangladesh. This mixed-methods study combines quantitative analyses of routine health data and population-based findings about healthcare seeking behaviours. Trends in consultations changed according to facility level (higher-level facilities included Upazila Health Complexes and District Hospitals; lower-level facilities included Community Clinics and Union Health and Family Welfare Centers). At the pandemic’s beginning, drops were seen at higher-level health facilities for outpatient department (OPD) consultations, respiratory infections, and antenatal care. Minor reductions or increases were seen at lower-level facilities for the same services. Half of the subdistricts reported a cumulative increase in OPD and respiratory tract infection consultations. Most subdistricts reported a cumulative decrease in antenatal care. Child vaccinations dropped in all subdistricts, half of which did not catch-up, resulting in a cumulative decrease of delivered doses. Fear of contracting COVID-19 and financial constraints were the main reasons for decreased access. Drivers of healthcare seeking behaviours should be better understood to guide preparedness and service delivery modalities at primary and secondary levels. [ABSTRACT FROM AUTHOR]

Maternal depression remains under characterised in many low- and middle-income countries, especially in rural settings. We aimed to describe maternal depression and anxiety symptoms in rural and urban communities in northern Ecuador and to identify socioeconomic and demographic factors associated with these symptoms. Data from 508 mothers participating in a longitudinal cohort study were included. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist (HSCL-25), and maternal psychological functioning was assessed using a checklist of daily activities. Tobit regression models were used to examine associations with sociodemographic variables and urbanicity. The median HSCL-25 score was 1.2 (IQR: 0.4) and 14% of women scored above the threshold for clinically relevant symptoms. Rural women reported similar food insecurity, less education, younger age of first pregnancy, and lower socio-economic status compared to their urban counterparts. After adjusting for these factors, rural women reported lower HSCL-25 scores compared to women lin urban areas (β = −0.48, 95%CI:0.65, −0.31). Rural residence was also associated with lower depression and anxiety HSCL-25 sub-scale scores, and similar levels of maternal functioning, compared to urban residence. Our results suggest that both household and community-level factors are risk factors for maternal depression and anxiety in this context. [ABSTRACT FROM AUTHOR]

Tuberculosis is a global health concern n impacting communities, health systems, and economies This study assessed the TB treatment outcomes among individuals aged 15+ at Chawama first level hospital in Lusaka, Zambia, using a retrospective design focussing on individuals notified in 2020. The sample was described using descriptive statistics. The Pearson Chi-square test and logistics regression were used to analyse the characteristics of the patients influencing the treatment outcomes at 5% significant level. Out of 404 participants, 83.4% of them had successful treatment outcomes. Varied outcomes were noted in sex, patient type, TB type, HIV status, and DOT plan, but lacked significance. Odds of success were lower by 72.4% for those aged 65+ compared to those aged 15–24 years (OR (95% CI): 0.276 (0.086–0.881), p = .030). Similarly, after adjusting for other variables, the odds of success were lower by 72.9% (AOR (95% CI): 0.271 (0.083–0.882), p = .030). This study yielded an encouraging 83.4% TB success rate highlighting the potential for improvement to meet WHO targets. Notably, individuals aged 65+ showed a distinct pattern with lower treatment success odds, suggesting a need for focussed interventions. Special attention to elderly patients and targeted TB program interventions are recommended. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d’Ivoire. To address differences between harmful and non-harmful child labour, we differentiated work completed by a child by hazardous activity engagement. These groups of child labour were then modelled against educational attainment, defined by a whether or not the child needed to repeat a class. We then conducted mediation analysis to assess whether injury mediates this relationship. Our results show that hazardous child labour increases the odds of repeating a class and work-related injury compared to non-hazardous labour. The effect of hazardous child labour on academic attainment was also found to be mediated by work-related injuries by 14%. Educational attainment is associated with hazardous labour activities and the odds of injury and not the act of participation in agricultural labour alone. Programmes based on strong measures of harmful work will foster better protection for children who are most at risk and may inform global debates around the benefits versus the risks of child labour. [ABSTRACT FROM AUTHOR]

Interleukin (IL)-6 is a pro-inflammatory cytokine that plays an important role in preterm birth (PTB), Several meta-analyses investigated the association between IL-6 and PTB, but definitive conclusion has not yet been achieved. This updated meta-analysis aimed to ascertain the association between IL-6 and PTB by examining IL-6 levels in both normal birth and PTB groups. Prospective cohort studies were retrieved in PubMed, Embase, and the Cochrane library from their inception until 18 February 2020. The primary outcome was the association between IL-6 and PTB, and secondary outcomes were the association between IL-6 and spontaneous PTB. Nine studies involving 1904 patients were included. Overall, IL-6 from different sample types (maternal blood, amniotic fluid and cervicovaginal fluid) was associated with PTB (standard mean difference [SMD]: 0.86, 95% confidence interval [CI]: 0.32 to 1.39, p < 0.001). Furthermore, the association was significant for IL-6 only in amniotic fluid (SMD: 1.87, 95%CI: 0.82 to 2.93, p < 0.001) and cervicovaginal fluid (SMD: 0.46, 95%CI: 0.09 to 0.84, p = 0.022), but not significant in maternal blood (SMD: −0.11, 95%CI: −0.57 to 0.34, p = 0.623). In addition, IL-6 was also associated with spontaneous PTB (SMD: 1.57, 95% CI: 0.18 to 2.95, p < 0.001). Based on the available evidence, IL-6 in amniotic fluid and cervicovaginal fluid might be useful for predicting preterm birth. Based on the available evidence IL-6 in amniotic fluid and cervicovaginal fluid might be useful for predicting preterm birth [ABSTRACT FROM AUTHOR]

Immune-inflammatory biomarkers (IIBs) have been shown to be correlated with prognosis in patients undergoing peritoneal dialysis (PD). In this study, we aimed to evaluate the relationship between a novel comprehensive biomarker, the pan-immune-inflammation value (PIV), and the prognosis of patients undergoing PD. We retrospectively analyzed data from a multicenter, large-sample PD database. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count. The prognostic endpoints in this study were all-cause death all-cause, cardiovascular disease (CVD) and infection-related death. The Kaplan–Meier method, a Cox proportional hazards regression, Fine–Gray competing risk model, smooth curve, and subgroup analysis were used to analyze the independent relationship between PIV and the prognosis of patients undergoing PD. A total of 2796 cases of PD were included, and the study population was divided into Tertiles 1, 2, and 3, according to the tertiles of baseline PIVs. After adjusting for multiple model factors, patients in the Tertile 3 group had a significantly higher risk of all-cause death, CVD death and infection-related death compared with patients with PIV in the Tertile 1 group. Interaction tests showed no positive correlations for subgroup parameters. Regarding all-cause death, compared with the lowest tertile, the multivariable-adjusted hazard ratios (95% confidence intervals) of the highest and middle tertiles were 1.55 (1.25–1.94) and 1.77 (1.43–2.19), respectively; PIV (log2 processing) was associated with 17% excess of mortality in the continuous model. A high PIV at baseline was significantly associated with an increased risk of deaths due to all-causes, CVD and infection in patients undergoing PD. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effect of auricular acupuncture on preoperative blood pressure (BP) elevation in different age groups. Materials and methods: Auricular acupuncture treats elevated BP among patients before surgery. This prospective, randomized clinical trial was performed at Li Huili Hospital of Ningbo Medical Center, China, from January to June 2021. We prospectively enrolled 120 patients with elevated BP aged 45 to 75 and observed them in the inpatient department. Patients were randomly assigned in a 1:1 ratio to undergo auricular acupuncture or sham control groups. In addition to usual care, the study group underwent auricular acupuncture bilaterally at HX6 7i-Ear apex, TF4-Shen men, TF1-Superior triangular fossa, and CO15-Heart. Results: A total of 120 patients completed the study, 60 in the study group and 60 in the control group. Of these, 76 (63.3%) were men, and the mean (standard deviation) was 64.55 (9.48) years. The differences in systolic BP comparisons after intervention were significant (7.88 mmHg; 95% confidence interval [CI], 2.94 to 12.81; P = .002). Diastolic BP also showed statistical significance (5.85 mmHg; 95% CI, 3.05 to 8.64; P < .01. Neither AA-related adverse events nor serious adverse events occurred. Stratified by age, the differences comparisons of systolic BP (-10.13 mmHg; 95% confidence interval [CI], -16.69 to -3.57; P < .01) and diastolic BP (-7.65 mmHg; 95% confidence interval [CI], -11.17 to -4.14; P < .01) were statistically significant for participants aged 60-75 years; The differences comparison of systolic BP (-2.37 mmHg; 95% confidence interval [CI], -8.04 to 3.31; P = .40) and diastolic BP (-1.46 mmHg; 95% confidence interval [CI], -5.68 to 2.76; P = .48) were not significant aged 45-59. Conclusion: Auricular acupuncture can reduce BP before procedures. However, further research is needed on the antihypertensive effect on people aged 45-59. These findings provide clinicians with evidence of auricular acupuncture as a standard adjunctive therapy targeting this patient population. [ABSTRACT FROM AUTHOR]

Objective: Pregnancy is often described as a pivotal life stage for women, where regular contact with health professionals may play an important role in lifestyle awareness. This study explored the knowledge, practices, and beliefs of health professionals and pregnant women regarding physical activity and weight management during the antenatal period. Methods: A qualitative study was undertaken in southeastern Australia using individual interviews. Recruitment sought women of gestation >12 weeks, experiencing an uncomplicated pregnancy (n = 6), and antenatal health professionals including midwives (n = 4) and an obstetrician (n = 1). Data were analysed using Interpretive Phenomenological Analysis. Results: Three major themes emerged: (1) women rely on multiple sources of pregnancy-related healthy lifestyle information; (2) discussions around healthy lifestyle behaviours are low priority and often inconsistent; and (3) lifestyle-related topics perceived as sensitive make some conversations and actions difficult. Conclusions: Pregnant women expressed gaps in lifestyle-related knowledge and education being provided by health professionals. In turn, health professionals expressed difficulty discussing sensitive topics such as weight with pregnant women and had limited knowledge of pregnancy-specific physical activity guidelines. The themes generated by this study may form the foundation for further research to inform clinical policy and practice regarding advice in antenatal care. [ABSTRACT FROM AUTHOR]

Objective: There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. Design: A prospective one-year follow-up study. Settings and subjects: Persons aged =65years living in Eastern Finland and receiving regular home care services (n=293). Main outcome measures: Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). Results: Of the 293 patients (mean age 82.6years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62-0.86), IADL (0.75, 0.65-0.87) MMSE (0.92, 0.87-0.96), and TUG (1.02, 1.01-1.03). NHP alone was predicted by BADL (0.62, 0.50-0.78), IADL (0.57, 0.45-0.73), and MMSE (0.88, 0.82-0.94) and mortality by TUG (1.02, 1.01-1.03). Conclusion: Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year. [ABSTRACT FROM AUTHOR]

Objective: Patient education based on the patient's individual needs and circumstances is known to be associated with positive changes in clinical outcomes in chronic obstructive pulmonary disease (COPD). We aimed to assess the levels of patients' subjective needs for information about COPD before and after their general practitioners had taken part in a COPD education. Design: A secondary analysis of a cluster randomized controlled trial Setting: 22 PHCCs in Stockholm, Sweden Subjects: Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n=293) Outcome measures: Scores in the Lung Information Needs Questionnaire (LINQ) at baseline and 18months, spirometry results, and self-reported, descriptive patient data. Results: GPs' improved skills in COPD did not affect patients' self-management skills over time. In general, patients' information needs remained great in issues concerning diet, exercise and self-management. However, 43% of the patients reported reduced and 57% increased or unchanged information needs, over time. Reduced information needs were mainly associated with a high level of information needs at baseline (OR = 3.17 [95% CI 1.93-5.23], p<.01) and establishing contact with a physiotherapist (OR = 2.26 [95% CI 1.05-4.86], p=.038). Patients in a mild or stable phase of COPD with no recent exacerbations reported greater needs than those with unstable, deteriorated COPD. Conclusion: Patients' information needs are substantial in most areas of self-management of COPD, and seem to covary with the patient's current clinical status. Care providers should thus continuously be vigilant about offering all patients with COPD support and education. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities. Design and setting: A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018. Subjects: PHC patients aged 60 years or more with a T2D were included. Main outcome measures: Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR). Results: In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39-1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39-1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74-1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86-0.96]). Conclusions: In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities. [ABSTRACT FROM AUTHOR]

This article presents a Bayesian approach to multiple-output quantile regression. The prior can be elicited as ex-ante knowledge of the distance of the τ-Tukey depth contour to the Tukey median, the first prior of its kind. The parametric model is proven to be consistent and a procedure to obtain confidence intervals is proposed. A proposal for nonparametric multiple-output regression is also presented. These results add to the literature of misspecified Bayesian modeling, consistency, and prior elicitation for nonparametric multivariate modeling. The model is applied to the Tennessee Project Steps to Achieving Resilience (STAR) experiment and finds a joint increase in τ-quantile subpopulations for mathematics and reading scores given a decrease in the number of students per teacher. for this article are available online. [ABSTRACT FROM AUTHOR]

In this work, we study the transfer learning problem under high-dimensional generalized linear models (GLMs), which aim to improve the fit on target data by borrowing information from useful source data. Given which sources to transfer, we propose a transfer learning algorithm on GLM, and derive its l 1 / l 2 -estimation error bounds as well as a bound for a prediction error measure. The theoretical analysis shows that when the target and sources are sufficiently close to each other, these bounds could be improved over those of the classical penalized estimator using only target data under mild conditions. When we don't know which sources to transfer, an algorithm-free transferable source detection approach is introduced to detect informative sources. The detection consistency is proved under the high-dimensional GLM transfer learning setting. We also propose an algorithm to construct confidence intervals of each coefficient component, and the corresponding theories are provided. Extensive simulations and a real-data experiment verify the effectiveness of our algorithms. We implement the proposed GLM transfer learning algorithms in a new R package glmtrans, which is available on CRAN. for this article are available online. [ABSTRACT FROM AUTHOR]