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A cause-specific cumulative incidence function (CIF) is the probability of failure from a specific cause as a function of time. In randomized trials, a difference of cause-specific CIFs (treatment minus control) represents a treatment effect. Cause-specific CIF in each intervention arm can be estimated based on the usual non-parametric Aalen-Johansen estimator which generalizes the Kaplan-Meier estimator of CIF in the presence of competing risks. Under random censoring, asymptotically valid Wald-type confidence intervals (CIs) for a difference of cause-specific CIFs at a specific time point can be constructed using one of the published variance estimators. Unfortunately, these intervals can suffer from substantial under-coverage when the outcome of interest is a rare event, as may be the case for example in the analysis of uncommon adverse events. We propose two new approximate interval estimators for a difference of cause-specific CIFs estimated in the presence of competing risks and random censoring. Theoretical analysis and simulations indicate that the new interval estimators are superior to the Wald CIs in the sense of avoiding substantial under-coverage with rare events, while being equivalent to the Wald CIs asymptotically. In the absence of censoring, one of the two proposed interval estimators reduces to the well-known Agresti-Caffo CI for a difference of two binomial parameters. The new methods can be easily implemented with any software package producing point and variance estimates for the Aalen-Johansen estimator, as illustrated in a real data example., (© 2020 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Little is known regarding the overall health of youth elite athletes. Our aim was to describe the prevalence and severity of health problems in a cohort of youth elite athletes representing a variety of endurance, team, and technical sports. Elite sport athletes (N = 260, 16.2 years) from different Sport Academy High Schools in Norway, and a group of their teammates (N = 60, 16.4 years) attending regular high schools, were included in the study. The Oslo Sports Trauma Research Centre (OSTRC) questionnaire on health problems was used to self‐report injuries and illnesses for 26 weeks. At any given time, an average of 43% [95% CI: 37%‐49%] of the elite sport athletes had some form of health problem and 25% [20%‐31%] had substantial health problems. The prevalence of health problems was similar between the elite team sport athletes and their teammates, except for substantial injuries (22% [16%‐30%] vs 10% [5%‐20%]). Endurance sport athletes reported more illnesses (23% [15%‐35%]) than technical and team sport athletes (10% [5%‐20%] and 8% [4%‐14%]). In contrast, technical and team sport athletes reported more injuries (36% [95% CI: 25‐48] and 37% [95% CI 29‐45]) compared to endurance sport athletes (15% [8%‐25%]). The total impact of health problems was roughly split in thirds between overuse injuries (37%), acute injuries (34%), and illnesses (30%). This is the first prospective study to present self‐reported injury and illness data in a large heterogeneous group of youth elite athletes, documenting a substantial impact of both injuries and illnesses on the health of this population. [ABSTRACT FROM AUTHOR]

Early childhood development (ECD) is crucial for better health and well‐being throughout life, but few studies have examined how ECD relates to child malnutrition. This is mainly due to lack of reliable and disaggregated data on ECD. We estimated the prevalence of ECD delays (communication, fine motor, gross motor, problem‐solving and personal–social) and examined how different ECD domains were associated with child nutritional status in urban Ethiopia. Using a community‐based cross‐sectional survey design, 627 mother–child (12–36 months old) pairs were included in the study. The ECD was assessed using the Age and Stage Questionnaire (ASQ‐3), and the nutritional status was assessed using anthropometric measurements. The association between the ECD domains and nutritional status was analysed using ordinal logistic regression, adjusting for confounding variables. Delays in ECD domains were common, especially in fine motor domain (41.9%); and more than half of the children were stunted (52.8%). Stunting and underweight were associated with ECD delays, while wasting was not. Accordingly, stunted children were more likely to have worst ECD delays in fine motor (odds ratios [OR] = 1.54; 95% confidence interval [CI]: 1.11; 2.15), gross motor (OR = 1.47; 95% CI: 1.05; 2.04) and problem‐solving (OR = 1.41; 95% CI: 1.02; 1.96) domains compared to non‐stunted children. Similarly, underweight children were more likely to have worse ECD delays in gross motor (OR = 1.91; 95% CI: 1.20; 3.04) and fine motor (OR = 1.90; 95% CI: 1.15; 3.15) domains compared to normal children. Coordinated and targeted ECD interventions, such as nurturing care, should be promoted and implemented widely to improve ECD outcomes and child nutrition. Key messages: Studies examining early childhood development (ECD) and child nutrition are scarce in Ethiopia, mainly due to lack of reliable and disaggregated ECD data.We estimated the prevalence of ECD delays and examined how different ECD domains were associated with child nutrition in urban Ethiopia using a direct ECD measure.Our study revealed that stunted and underweight children had a higher likelihood of ECD delays. To address these issues, we recommend coordinated efforts across key sectors, such as health, education, women's affairs and social protection, to promote and implement ECD interventions, such as nurturing care. [ABSTRACT FROM AUTHOR]

Aim(s): To assess the effectiveness of sub‐epidermal moisture (SEM) assessment technology in the detection of early‐stage pressure damage in a critical care unit (CCU) and dark skin tone patients and its impact on hospital‐acquired pressure injury (HAPI) incidence. Design: Quality improvement study employing Kurt Lewin's change model emphasizing planning, implementation, evaluation and sustainable change. Methods: The study evaluated 140 adult patients admitted to the CCU over a 24‐week period, from July to December 2022. Retrospective analysis of standard PI care pathways was performed in 90 patients admitted during a 12‐week pre‐implementation period. Fifty patients were admitted through the subsequent 12‐week implementation period. SEM assessments were performed daily at the sacrum and heels and interventions were applied based on SEM assessments; SEM delta ≥0.6 indicating localized oedema or persistent focal oedema. Statistical analyses were performed on anonymized data. Results: Pre‐implementation HAPI incidence was 8.9% (N = 8/90). All eight patients were African American with varying skin tones. A 100% reduction in HAPI incidence was achieved in the implementation period which included 35 African American patients. The relative risk of HAPI incidence was 1.6 times higher in the pre‐implementation group. Conclusion: Implementing SEM assessment technology enabled equitable PI care for all population types and resulted in a 100% reduction of PIs in our CCU. Objective SEM assessments detected early‐stage PIs, regardless of skin tone and enabled providing interventions to specific anatomies developing tissue damage as opposed to universal preventive interventions. Implications: PI care pathways relying on visual and tactile skin assessments are inherently biased in providing equitable care for dark skin tone patients. Implementing SEM assessments empowers healthcare practitioners in driving objective clinical interventions, eliminates bias and enables positive PI health outcomes. Impact: Implementing SEM assessment technology had three main effects: it detected early tissue damage regardless of skin tone (detection effect), enabled anatomy‐specific interventions (treatment effect) and prevented PIs across all population types (prevention effect). The authors have adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. Patient or Public Contribution: No patient or public contribution. What does this paper contribute to the wider global clinical community? Addressing health inequities in pressure injury prevention; Demonstrated effectiveness across patient populations; Resource optimization and enhanced patient safety. [ABSTRACT FROM AUTHOR]

Objective. Evaluate the mortality risk of childhood-onset type 1 diabetes compared to the general population. Research Design and Methods. The study population, identified from the Australasian Paediatric Endocrinology Group diabetes register, was diagnosed with type 1 diabetes at age < 16 in New South Wales (NSW), Australia, from 1990 to 2010. The register was linked to National Death Index registrations to ascertain timing and cause of death up to 31/12/2022. Risk factors for mortality were assessed using multivariable Cox regression models and observed mortality rate compared to "expected" rates in the Australian general population using indirect-standardized mortality ratios (SMR), overall and by sex and age at diagnosis. Diabetes-related cause of death categories were identified. Results. Of 5,417 children diagnosed with type 1 diabetes, 157 subsequently died, with all-cause mortality of 1.37/1,000 person years. Increased mortality risk was associated with living in most disadvantaged areas (aHR 1.81 (1.05, 3.11)) but not living in a rural area. Overall SMR was 2.83 (95% CI 2.40, 3.33) with females having higher SMR than males (4.18 vs. 2.19). Most common causes of death recorded were acute diabetes complications (26%), including diabetes ketoacidosis, accident/misadventure (21%), and chronic diabetes complications (15%). Alcohol and/or drug use contributed to 17% of deaths. Conclusion. Compared to the general population, higher risk of mortality in people with type 1 diabetes was associated with female sex and living in area of socioeconomic disadvantage. Education about minimizing risk-taking behaviors should be communicated to young adults with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluates three different language sample elicitation strategies to determine a valid elicitation strategy for early language learners who speak using augmentative and alternative communication (AAC). Method: Ten children who speak using AAC participated in this study. Language samples were elicited from each participant using three strategies: the Communication and Symbolic Behavior Scales (CSBS), a generic play-based elicitation strategy, and automatic data logging. Samples were transcribed and coded. Additionally, each participant's school speech-language pathologist completed a Communication Matrix. Data from coded language samples were correlated with Communication Matrix results to determine the elicitation strategy that yielded the most valid language sample in comparison to Communication Matrix results. Results: Both the CSBS and the play-based strategy yielded clinically relevant information. Because the log lacked communicative context, resulting data from the log was limited. An analysis of variance revealed significant differences in the amount of information elicited from each elicitation strategy. The CSBS repeatedly elicited the most data, followed by the play-based strategy and then the log. Generic play-based strategy results yielded the most correlations with Communication Matrix data. Conclusions: This preliminary data suggest that the play-based elicitation strategy elicited the most valid language sample when compared to the Communication Matrix from early language learners who speak using AAC. Additionally, results suggest that the CSBS may be an effective tool to measure the limits of this population's expressive language abilities. [ABSTRACT FROM AUTHOR]

In a matched pairs experiment, two binary variables are typically observed on all subjects in the experiment. However, when one of the variables is missing on some subjects, we have so called the partially observed binary data that consist of two parts: a multinomial from the subjects with a pair of observed variables and two independent binomials from the subjects with only one observed variable. The goal of this paper is to construct exact confidence intervals for the difference of two (success) proportions of the two binary variables. We first derive a new test by combining two score tests for the two parts of the data and invert it to an asymptotic confidence interval. Since asymptotic intervals do not achieve the nominal level, this interval and three other existing intervals are improved to be exact by the general h$$ h $$‐function method. We compare the infimum coverage probability and average interval length of these intervals and recommend the exact intervals that are improved from the newly proposed interval. Two real data sets are used to illustrate the intervals. [ABSTRACT FROM AUTHOR]

For ordered categorical data from randomized clinical trials, the relative effect, the probability that observations in one group tend to be larger, has been considered appropriate for a measure of an effect size. Although the Wilcoxon–Mann–Whitney test is widely used to compare two groups, the null hypothesis is not just the relative effect of 50%, but the identical distribution between groups. The null hypothesis of the Brunner–Munzel test, another rank-based method used for arbitrary types of data, is just the relative effect of 50%. In this study, we compared actual type I error rates (or 1 – coverage probability) of the profile-likelihood-based confidence intervals for the relative effect and other rank-based methods in simulation studies at the relative effect of 50%. The profile-likelihood method, as with the Brunner– Munzel test, does not require any assumptions on distributions. Actual type I error rates of the profile-likelihood method and the Brunner–Munzel test were close to the nominal level in large or medium samples, even under unequal distributions. Those of the Wilcoxon–Mann–Whitney test largely differed from the nominal level under unequal distributions, especially under unequal sample sizes. In small samples, the actual type I error rates of Brunner–Munzel test were slightly larger than the nominal level and those of the profile-likelihood method were even larger. We provide a paradoxical numerical example: only the Wilcoxon–Mann–Whitney test was significant under equal sample sizes, but by changing only the allocation ratio, it was not significant but the profile-likelihood method and the Brunner–Munzel test were significant. This phenomenon might reflect the nature of the Wilcoxon–Mann–Whitney test in the simulation study, that is, the actual type I error rates become over and under the nominal level depending on the allocation ratio. [ABSTRACT FROM AUTHOR]

Background. Adolescents with type 1 diabetes (T1D) are particularly vulnerable to poor psychosocial outcomes—high rates of diabetes distress and poor quality of life are common among this cohort. Previous work in the general population demonstrated positive associations between quality of life and increases in moderate-to-vigorous physical activity (MVPA), as well as decreased sedentary behavior. While survey-based assessments of young adults with T1D observed similar trends, these studies were limited by their use of subjective assessments of MVPA and sedentary behavior. The use of direct activity monitoring is needed to establish the association between psychosocial outcomes and MVPA and sedentary behavior among adolescents with T1D. Objective. To explore the association between objectively measured MVPA and sedentary behavior on psychosocial outcomes among adolescents with T1D. Subjects and Methods. The current study is a secondary analysis of baseline data collected for a pilot trial of sleep-promoting intervention for adolescents with T1D. Participants (n = 29, with a mean age of 15.9 ± 1.3 years) completed baseline surveys and wore an actigraph for a week following the baseline visit. We examined minutes per week of MVPA and proportion of awake time spent sedentary in relation to adolescents' diabetes distress, depressive symptoms, and diabetes-related quality of life. Results. Participants engaged in a mean of 19.6 ± 22.4 minutes of MVPA per day and spent 68.6 ± 9.9% of their awake time sedentary. MVPA was associated with lower diabetes distress in unadjusted (−3.6; 95% CI: −6.4 to −0.8) and adjusted (−2.6; 95% CI: −5.0–−0.3) analyses. Sedentary time was associated with higher diabetes distress in adjusted (6.3; 95% CI: 1.3–11.2) but not unadjusted (6.0; 95% CI: −5.6–12.6) analyses. In secondary analyses, we did not observe significant associations between quality of life or depressive symptoms with either MVPA or sedentary behavior. Discussion. Our findings extend previous survey-based work demonstrating an association between decreased diabetes distress with greater weekly MVPA and lower sedentary time. The current study highlights the multifaceted benefits of physical activity in this population and provides preliminary evidence for developing interventions to reduce sedentary time as an alternative method to improve psychosocial outcomes in this at-risk population. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the association between sedentary behaviour (SB), physical activity (PA), and frailty and frailty subdomains in community‐dwelling older women. Background: Frailty is associated with numerous adverse health outcomes in older people, and women had a higher prevalence than men. However, older adults may face different health risks due to different combinations of frailty subdomains; therefore, specific studies on frailty subdomains are needed. Design: A cross‐sectional study guided by the STROBE. Methods: In total, 1099 community‐dwelling older Chinese women (60–70 years) were included. SB and PA were objectively obtained using a validated triaxial accelerometer. Frailty was defined using the Fried Phenotype (FP) Model. Results: After adjusting for confounders, a significant association was found between SB, PA and the prevalence of frailty. The optimal cut‐off values of total SB time, light PA (LPA) time, and moderate‐to‐vigorous PA (MVPA) time to discriminate between frailty and non‐frailty were 625.4 min/day, 379.3 min/day and 20.1 min/day, respectively. For frailty subdomains, total SB time was positively associated with low PA. When it comes to total LPA time, the association with low PA was negative. Total MVPA time was significantly and negatively associated with exhaustion, weakness, slowness and low PA, and the optimal cutoff value was 24.4 min/day, 26 min/day, 29.5 min/day and 20.8 min/day, respectively. Conclusions: Effective management of frailty requires consideration of different combinations of frailty subdomains. Increasing MVPA and limiting SB may help deal with frailty for community‐dwelling older Chinese women. Additional research is needed to determine whether PA are useful for prevention of frailty. Relevance to clinical practice: The results of this study could help caregivers provide professional and specific physical activity guidance for order women, who are on a risk of or already suffered frailty. [ABSTRACT FROM AUTHOR]

The relative risk and odds ratio are widely used in many fields, including biomedical research, to compare two treatments. Extensive research has been done to infer the two parameters through approximate or exact confidence intervals. However, these intervals may be liberal or conservative. A natural question is whether the intervals can be further improved in maintaining the correct confidence coefficient of an approximate interval or shortening an exact but conservative interval. In this article, when two independent binomials are observed we offer an effort to improve any of the existing intervals by applying the h$$ h $$‐function method. In particular, if the given interval is approximate, then the improved interval is exact; if the given interval is exact, then the improved interval is a subset of the given interval. This method is also applied multiple times to the improved intervals until the final resultant interval cannot be shortened any further. To demonstrate the effectiveness of the method, we use three real datasets to illustrate in detail how several good intervals in practice are improved. Two exact intervals are then recommended for estimating each of the two parameters in different scenarios. [ABSTRACT FROM AUTHOR]

Child welfare (CW) agencies are charged with ensuring children's safety; when children live with families impacted by intimate partner violence (IPV), this task can be complex. To better understand how U.S. CW agencies identify and make decisions about child maltreatment (CM) in the presence of IPV, this mixed-methods study used national data (N = 248,654) to investigate whether IPV was more likely to be documented as co-occurring with certain types of CM. This study also explored the intersection of IPV and CM using 19 semi-structured interviews with child welfare stakeholders to gain insight into the mechanisms underpinning reporting processes. Multinomial logistical regression showed that after controlling for other risk factors, children living in a household with IPV were more likely to be determined to be physically abused and emotionally maltreated than neglected, and less likely to be determined to be sexually abused than neglected, compared with children who did not live in a household with IPV. Those children were also more likely to be determined to be emotionally maltreated than physically abused, and less likely to be determined to be sexually abused than physically abused, compared with children who did not live in a household with IPV (all results, p <.0001). Qualitative results revealed IPV and children's exposure to IPV may be categorized as different types of CM by CW agencies and staff, and that this categorization can vary by agency and staff level. Participants also described challenges to addressing IPV within CW systems. Findings suggest national CW data may obscure when IPV and CM co-occur versus when a given type of CM is serving as a proxy for the presence of or children's exposure to IPV, presenting challenges to interpreting child welfare data. Recommendations are presented to improve CW data accuracy and ensure the safety of children and families impacted by IPV. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine whether interventions that use the Specific Thematic Nursing Care Action Modules (STNC‐AM) platform improve patients' psychological health over a two‐month period. Background: Stroke survivors often are left with a disability after a stroke, which can have an impact on their physical and mental health. Therefore, it is necessary for stroke patients to have tailored programmes in the face of post‐stroke mental health concerns and the need for care information. Design: A non‐randomised controlled pilot study was conducted. Methods: Participants included 44 post‐stroke patients at a medical university hospital, between 1 August 2019–28 February 2021, of whom 24 were assigned to the control group and 20 were assigned to the intervention (STNC‐AM). Data were analysed on an intention‐to‐treat basis. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist (case–control studies) for this study. Results: There were no statistical differences between the two groups at baseline. At the end of two months, however, the scores for resilience, depression and positive factors illness representation were statistically different between the two groups (p <.05). The results of the generalised estimating equation model analysis indicated that resilience and anxiety remained more significant in decreasing depression in the intervention group than in the control group. Conclusion: This preliminary trial suggests that, although action modules may be associated with a decrease in depression post‐stroke, part of this effect was likely associated with an increase in resilience and a decrease in anxiety of the patients. Relevance to clinical practice: The STNC‐AM platform provides a coaching platform that helps patients and caregivers to be effective and accessible. [ABSTRACT FROM AUTHOR]

The purpose of the study was to clarify the independent association between sedentary behavior and physical activity with multiple chronic diseases and medicine intake in older individuals. Sedentary behavior and physical activity were measured by questionnaires. Diseases and medication use were self-reported. Poisson's regression was adopted for main analysis, through crude and adjusted prevalence ratio and confidence interval of 95%. For men, sedentary time >4 hr/day presented a 76% higher prevalence of ≥2 chronic diseases, while physical inactivity increases the likelihood of using ≥2 medicines in 95%. For women, sedentary behavior >4 hr/day presented an 82% and 43% greater prevalence for ≥2 chronic diseases and the intake of ≥2 medicines, respectively. Sedentary behavior represents an independent associated factor of multiple chronic diseases in older men and women. In addition, inactivity for men and sedentarism for women are associated with the amount of medicine intake. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to analyse the social and gender-related factors influencing sedentariness in women, including occupation and family size (FS). We included women aged 45–70 years participating in the Breast Cancer Screening Programme of the Valencia Region (BCSP-VR) between November 2018 and October 2019 (n = 121,988). The response variable was sedentariness measured by sitting time in hours/day (h/day) (<3 h/day and ≥3 h/day). The explanatory variables were age, educational level, country of origin, living alone, childcare responsibilities, FS, disability, body mass index (BMI) and smoking status. Logistic regression models were adjusted for the whole sample and were stratified by occupation and FS. The variables that increased the odds of sedentariness were age ≥65 years (OR = 1.28; CI = 1.20–1.36), high educational level (OR = 1.39; CI = 1.31–1.47), non-manual occupation (OR = 2.38; CI = 2.27–2.48), living alone (OR = 1.11; CI = 1.05–1.17), disability (OR = 1.37; CI = 1.20–1.56) and BMI ≥ 30 (OR = 1.33; CI = 1.28–1.38). The variables decreasing the odds were large (OR = 0.90; CI = 0.87–0.96) and medium FS (OR = 0.93; CI = 0.90–0.97). Older age, high educational level and high BMI conferred a higher odd of sedentary lifestyle, independently of occupation and FS with statistical differences. Protective factors were childcare responsibilities in non-working women (OR = 0.86; CI = 0.74–0.99), large FS in women with manual occupations (OR = 0.88; CI = 0.80–0.97) and medium FS in housewives (OR = 0.91; CI = 0.86–0.97). This study identified social and gender-related inequalities in the factors influencing sedentariness, which were related to the type of occupation and FS. Highlights There are social and gender inequalities in the factors influencing sedentariness Non-manual occupation increases the risk of sedentary lifestyle Belonging to a medium or large family decreases the risk of sedentary behaviour Childcare responsibilities are related to lower sitting time throughout the day [ABSTRACT FROM AUTHOR]

Background: Frequent use of screen-based devices could be a modifiable risk factor for adolescent depression, but findings have been inconsistent and mostly from cross-sectional studies. We examined prospective associations of video gaming, social media, and internet use with depressive symptoms in adolescents. Methods: A total of 11 341 adolescents from the Millennium Cohort Study, a representative, UK population-based. The main outcome was depressive symptoms from a Moods and Feelings Questionnaire (age 14). Exposures were frequency of video game, social media, and internet use (age 11). Physical activity (effect modifier) was measured by self-report. Results: The fully adjusted models indicated that boys playing video games most days, at least once a week, and at least once a month at age 11 had lower depression scores at age 14 by 24.2% (IRR = 0.77, 95% CI 0.66–0.91), 25.1% (IRR = 0.75, 95% CI 0.62–0.90), and 31.2% (IRR = 0.69, 95% CI 0.57–0.83), compared with playing less than once a month/never. In girls, compared with less than once a month/never, using social media most days at age 11 was associated with 13% higher depression scores at age 14 (IRR = 1.13, 95% CI 1.05–1.22). We found some evidence of associations between using the internet most days and depressive symptoms compared with less than once a month/never in boys (IRR = 0.86, 95% CI 0.75–1.00). More frequent video game use was consistently associated with fewer depressive symptoms in boys with low physical activity, but not in those with high physical activity. Conclusions: Different types of screen-time may have contrasting associations with depressive symptoms during adolescence. Initiatives to address adolescents' screen-time may require targeted approaches. [ABSTRACT FROM AUTHOR]

We used logistic regression to investigate the joint associations of physical activity level (high: ≥3000 MET-min/week, moderate: ≥600 MET-min/week, low: not meeting either criteria) and TV viewing time (low: ≤1 h/day, moderate: 2–3 h/day, high: ≥4 h/day) with COVID-19 mortality risk in UK Biobank. Additional models were performed with adjustment for body mass index (BMI) and waist circumference. Within the 373, 523 included participants, there were 940 COVID-19 deaths between 16 March 2020 and 12 November 2021. Compared to highly active individuals with a low TV viewing time, highly active individuals with a high TV viewing time were at significantly higher risk of COVID-19 mortality (odds ratio = 1.54, 95% confidence interval = 1.11–2.15). However, the greatest risk was observed for the combination of a low physical activity level and a high TV viewing time (2.29, 1.63–3.21). After adjusting for either BMI or waist circumference, only this latter combination remained at a significantly higher risk, although the effect estimate was attenuated by 43% and 48%, respectively. In sum, a high TV viewing time may be a risk factor for COVID-19 mortality even amongst highly active individuals. Higher adiposity appears to partly explain the elevated risk associated with a low physical activity level and a high TV viewing time. [ABSTRACT FROM AUTHOR]

Objective: There is some controversy about the beneficial effects of occupational physical activity (OPA) on cardiovascular risk (CVR). The main aim of this study was to explore the effect of the combination of different frequencies of leisure-time physical activity (LTPA) and two types of OPA on CVR and body composition, and whether the association between physical activity (PA) and CVR was mediated by visceral adipose tissue (VAT). Methods: This cross-sectional study included data from 2516 couriers living in Spain, delivering either by motorbike or foot, and practicing LTPA never, occasionally, or regularly. Couriers were classified into six categories according to LTPA and OPA; body composition was assessed by Bioelectrical Impedance, and CVR by the Framingham equation. General linear models were performed to explore the association between different categories with each outcome (CVR and body composition) and the possible role of VAT as a mediator between PA and CVR. Results: Compared with the most sedentary group (motorbike couriers that never practice PA), walking couriers who practice regular PA presented the lowest CVR [β −1.58 (95% CI −2.31; −0.85)] and the lowest VAT [β −2.86 (95% CI −3.74; −1.98) followed by the motorbike couriers who practiced regular PA [β −0.51 (95% CI −1.00; −0.03) for CVR and β −2.33 (95% CI −2.91; −1.75) for VAT]. The association between PA and CVR was partially mediated by VAT. Conclusion: The present results indicated that both OPA and LTPA are protective factors for CVR and play an important role on VAT accumulation. [ABSTRACT FROM AUTHOR]

The problems of constructing confidence intervals (CIs) for the proportions and functions of proportions in finite populations are considered. For estimating the proportion in a finite population, we propose a CI based on the generalized fiducial method and compare it with an exact CI and score CI. For the two-sample problems, we consider interval estimating the difference between two proportions, the ratio of two proportions and the ratio of odds. Our solutions for the two-sample problems are based on the fiducial approach and the method of variance estimate recovery. All the CIs are evaluated on the basis of their exact coverage probabilities and expected widths. The methods are illustrated using some practical examples. [ABSTRACT FROM AUTHOR]

Background: Physical activity health benefits are widely known. However, the association between physical activity, physical fitness, executive function, and academic performance need further investigation. Additionally, one of the literature gaps reveals scarce and mixed findings on what mediators of physical activity may affect academic achievement. Purpose: This investigation aims to provide knowledge about the mediation role of physical fitness and executive function in the association of physical activity with academic achievement in a cohort of Spanish schoolchildren using a structural equation modelling approach. Methods: The data for this cross-sectional study were collected from a convenience sample of children from Spain (Balearic Islands) aged between 9 and 13 years. Physical activity levels were self-reported with the Physical Activity Questionnaire for Children; physical fitness was assessed using the International Fitness Scale; executive function was assessed with the Trail Making Test, and children's achievements were collected from the school records. Structural equation modelling was used to explore the relationship between physical activity, physical fitness, executive function, and academic achievement. Findings: Statistically significant positive direct associations were observed between physical activity and physical fitness (β = 0.46, 95% CI [0.29, 0.64]), physical fitness and executive function (β = 0.28, 95% CI [0.04, 0.52]), and executive function and academic achievement (β = 0.46, 95% CI [0.28, 0.65]), while adjusting for the confounding effects of sex and body mass index. Furthermore, indirect associations were observed between physical activity and executive function mediated by physical fitness (β = 0.13, bias-corrected 95% CI [0.02, 0.31]) and between physical fitness and academic achievement through executive function (β = 0.13, bias-corrected 95% CI [0.03, 0.32]). Conclusions: This investigation adds to the literature with evidence supporting the idea that regular PA leads to improvements in physical fitness and may support cognitive skills and academic performance in children. [ABSTRACT FROM AUTHOR]

Confidence interval (CI) for a proportion has been a topic discussed repeatedly in the literature because of its omnipresence in applications. A wide variety of CIs have been proposed since the Wald CI for a proportion performs quite poorly. Among them, the Wilson score interval is widely recommended. However, the Wilson score method suffers from the so-called "downward spikes" when the proportion is close to 0 or 1. Except for the exact methods which ensure the coverage probability be at least the nominal size, the performances of existing proposed methods are similar to the Wilson score CI or its slightly improved version at the cost of increased interval width or computational complexity. In this study, we propose a simple CI which has very good performance in the coverage probability, confidence width, and the location. Especially when the proportion is <20% or >80% the CI proposed has a shorter confidence width than the Wilson score method. In combination our new method with the Newcombe's hybrid way to construct CI for the difference of two independent proportions, we also get a better CI. [ABSTRACT FROM AUTHOR]

Aim: We aimed to identify the risk factors for delayed discharge in a day surgery centre in west China. Background: Delayed discharge affected by various factors is a key indicator for healthcare quality of day surgery. However, few studies have focused on this issue in developing countries where the day surgery started much later. Design A retrospective case–control design. Method: A random sample of 169 delayed discharge cases and 514 normal discharge cases was randomly selected from 38,021 day surgery cases from May 2011 to May 2019 in a tertiary teaching hospital in west China. Socio‐demographic and clinical characteristics of patients were collected through the hospital electronic database and a chart review. A multivariate logistic regression was conducted to identify the risk factors for delayed discharge. Results: The urban employee basic medical insurance, comorbidity, general anaesthesia, pain, fever, bleeding and metabolic disorder were identified as the risk factors for delayed discharge. Living in the city where the hospital located was a protective factor for delayed discharge. Conclusion: Post‐operative complications including fever, pain, bleeding and metabolic disorder were the most important risk factors for delayed discharge. The pre‐operative prevention, careful monitoring and rapid reactions to post‐operative complications may reduce delayed discharge. Summary statement: What is already known about this topic? Day surgery is conducted worldwide due to its time‐saving, cost‐effectiveness and low risk for post‐operative infection.Delayed discharge is considered as one of the most important indicators for healthcare quality of a day surgery centre.Most of the identified risk factors for delayed discharge are from the developed countries' experience of day surgery and remain controversial. What this paper adds? The insurance reimbursement rate influenced patients' willingness for discharge.Living in the same city where the hospital is located was a protective factor for delayed discharge.Post‐operative metabolic disorder was a risk factor for delayed discharge. The implications of this paper: Reducing the insurance reimbursement rate of patients who meet discharge criteria but ask for longer hospital stays may be helpful to reduce delayed discharge.Careful monitoring and rapid response to post‐operative complications may be simple but useful measures to reduce the risk of delayed discharge. [ABSTRACT FROM AUTHOR]

This paper aims to verify the association between the combined relationship of physical inactivity and sedentary behaviour (SB) at leisure-time and the prevalence of noncommunicable chronic diseases (NCDs) in Brazilian adults and elderly. This is a cross-sectional study, derived from the VIGITEL system, with individuals ≥18 years old (n = 52,675). The presence of NCDs (diabetes, hypertension, and obesity) and the independent variables were defined by self-report. Binary logistic regression was used. While adults with the presence of, at least, one risky behaviour had a higher odds to have obesity (OR active + high SB: 1.25; 95%CI: 1.01;1.54; OR inactive + low SB: 1.47; 95%CI: 1.25;1.73; OR inactive + high SB: 1.77; 95%CI: 1.47;2.12), the elderly had an increased risk for this outcome only when classified as inactive (OR inactive + low SB: 1.43; 95%CI: 1.17;1.75; OR inactive + high SB: 1.87; 95%CI: 1.47;2.38). Inactive adults with low SB were more likely to have diabetes (OR inactive + low SB: 1.31; 95%CI: 1.00;1.71) and hypertension (OR inactive + low SB: 1.26; 95%CI: 1.08;1.46), while physical inactivity was again more strongly associated with these outcomes in the elderly, for diabetes (OR inactive + low SB: 1.23; 95%CI: 1.02;1.48; OR inactive + high SB: 1.75; 95%CI: 1.39;2.19), and hypertension (OR inactive + low SB: 1.22; 95%CI: 1.05;1.41; OR inactive + high SB: 1.60; 95%CI: 1.33;1.94) Both leisure-time behaviours carry a high risk of the prevalence of different NCDs, however, physical inactivity, isolated or combined, showed a greater association with the evaluated outcomes. Highlights This cross-national survey included representative sample of people ≥18 years old. Adults with at least one evident risky behavior had a higher chance of obesity. Inactive adults with low sedentary behavior had higher chances for diabetes and hypertension. Physical inactivity was more strongly associated with all diseases in the elderly. [ABSTRACT FROM AUTHOR]

Two-tailed asymptotic inferences for the ratio R=p2/p1 of two independent proportions have been well covered in the published literature. However, not very much has been written about one-tailed asymptotic inferences. This paper evaluates 63 different methods for realizing such inferences (hypothesis tests and confidence intervals). In general it is noted that: (a) the one-tailed inferences require at least 80 observations per sample, compared to the 40 observations necessary for two-tailed inferences; (b) the traditional methods do not perform well; (c) the methods selected for each case are not always the same; and (d) the optimal method is the 'approximate adjusted score' method (ZA1 in this paper), which is not always reliable, or 'Peskun´s score' method (ZP0 in theis paper), which is always reliable but is very conservative. The two selected methods provide an confidence interval that is obtained through an explicit formula. [ABSTRACT FROM AUTHOR]

Background: Many American workers spend over 7 hours a day at work in primarily sedentary office work. Physical activity is a key aspect of optimizing health and preventing disease; yet, 80% of American adults do not meet the recommended guidelines for physical activity. In this systematic review, the relationship between physical work environment and physical activity among office workers was explored. Methods: Of the 321 studies screened, 26 studies met the eligibility criteria and were included for evaluation in this systematic review. Results: Of the 26 studies, four were cross-sectional studies, 14 were quasi-experimental studies, and eight were randomized control trials. Physical activity during the workday was measured using self-report surveys and electromechanical devices such as accelerometers. Physical work environments examined by the studies included different types of desks (n = 16), office arrangements (n = 5), and building design (n = 5). In nine studies, office environments and building work environments designed to promote activity using active design principles such as stairs and flexible workspaces were associated with increased physical activity. Sit–stand desks reduced overall sitting time, but had a minimal effect on physical activity. Conclusion/Application to practice: Offices and buildings designed for activity had the largest impact on physical activity among office workers. To increase physical activity in office workers, focus should be placed on opportunities to increase incidental movement that can increase physical activity throughout the workday. Occupational health nurses should advocate workspace designs that can increase physical activity in workers. [ABSTRACT FROM AUTHOR]

Background and purpose -- Intraoperative periprosthetic femoral fractures (IPFFs) can occur during primary total hip arthroplasty (THA). We describe the incidence of IPFFs during THA in Norway and estimate potential risk factors that could be associated with IPFF Patients and methods -- Data from the Norwegian Arthoplasty Register (1987--2020) was used: 2,268 IPFFs from 218,423 primary THAs in 172,598 patients. The following factors were analyzed: sex, age, diagnosis, previous operation on the same hip, surgical approach, and stem fixation technique. Association of these factors with IPFF risk was assessed using multivariable Poisson regression. Results -- IPFF occurred during 2,268 operations with an incidence of 1.0% among all primary THAs. The risk of IPFF was associated with female sex (relative risk 1.8; 99% CI 1.5--2.1), age 80--90 years and age over 90 years (compared with age 60--70 years: 1.3; CI 1.0--1.6 and 2.6; CI 1.6--4.3, respectively), non-osteoarthritis diagnoses (2.2; CI 1.9--2.6), previous surgery to the same hip (1.8; CI 1.5--2.2), lateral approach (compared with the posterior approach: 1.5; CI 1.1--2.0), and cementless stem fixation (2.7; CI 2.0--3.6). Interpretation -- Surgeons should be aware of the factors associated with an increased risk of IPFF: female sex, age above 80 years, non-osteoarthritis diagnoses, and previous surgery to the same hip. Cemented stem fixation and posterior approach should be favored in high-risk patients, such as elderly women. [ABSTRACT FROM AUTHOR]

This paper proposes two new approximate confidence limit methods for the common odds ratio from multiple 2 × 2 tables. The two new procedures, based on the asymptotic distribution of Woolf estimator and Mantel-Haenszel estimator, associate with inverse sinh transformation. We employ three pseudo-frequency methods to calculate confidence intervals in order to avoid the interval failure caused by the presence of zero cells in multiple 2 × 2 tables. We develop the modified inverse sinh intervals for the common odds ratio which add one pseudo-frequency (c1) to all the cells before computing the point estimate of common odds ratio and another pseudo-frequency (c2) to all the cells before computing the standard error estimate. The simulation is to evaluate the 22 confidence intervals, including Woolf, Mantel-Haenszel, their inverse sinh intervals, and their pseudo-frequency modified inverse sinh intervals, in terms of their coverage probabilities and average log lengths. Simulation results demonstrate that the adjusted inverse sinh intervals by two different pseudo-frequencies perform quite well when c2 is slightly greater than c1 since the coverage probabilities of them are closer to confidence level of 95%. Larger values of c2 lead to narrow intervals and low coverage probabilities. We also find that inverse sinh intervals are shorter than untransformed intervals based on Woolf estimator and Mantel-Haenszel estimator, respectively. These procedures were illustrated with two clinical trials. [ABSTRACT FROM AUTHOR]

To describe all health problems (injuries and illnesses) in relation to type, location, incidence, prevalence, time loss, severity, and burden, in competitive adolescent distance runners in England. Prospective observational study: 136 competitive adolescent distance runners (73 female athletes) self-reported all health problems for 24-weeks between May and October 2019. Athletes self-reported health problems using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. The incidence of running-related injury per 1,000 hours of exposure was markedly higher, compared to previous research. At any time, 24% [95% Confidence Intervals (CI): 21-26%] of athletes reported a health problem, with 11% [95% CI: 9-12%] having experienced a health problem that had substantial negative impact on training and performance. Female athletes reported noticeably more illnesses, compared to male athletes, including higher prevalence, incidence, time loss, and severity. The most burdensome health problems, irrespective of sex, included lower leg, knee, and foot/toes injuries, alongside upper respiratory illnesses. [ABSTRACT FROM AUTHOR]

Aims: To examine the relationship between leisure‐time physical activity, sitting time and prefrailty in community‐dwelling older adults. Design: Cross‐sectional study. Methods: Between February and July 2019, 539 individuals over age 60 were recruited in northern Taiwan. Demographic, medical history, physical activity and frailty data were analysed using descriptive statistics, chi‐square tests and logistic regression. Results: The prevalence of prefrailty was 24.4%; 33.2% had regular leisure‐time physical activity, and 14.7% reported >6 hrs daily sitting time. Compared with individuals having regular leisure‐time physical activity and shorter sitting times (daily average ≤6 hrs), those having no regular leisure‐time physical activity and also shorter sitting times (adjusted OR, 1.80; 95% CI, 1.12, 2.92), or those also having regular leisure‐time physical activity but longer sitting times (adjusted OR, 4.42; 95% CI, 2.22, 8.79) had an increased prefrailty risk. Conclusions: Having no regular leisure‐time physical activity or longer sitting times is associated with a higher risk of prefrailty. For sedentary older adults to prevent prefrailty, they can become more active, sit less or better yet, commit to both. [ABSTRACT FROM AUTHOR]

This manuscript has two objectives: (1) operationalise and measure the fit of two theory-based measures of social norms and (2) examine the relationship between a social and behaviour change communication (SBCC) initiative, social norms, and menstrual health and hygiene management (MHM) among rural adolescent girls in Uttar Pradesh, India. A population-based, case-comparison design was utilised. Interviews were conducted (n = 2212) using quantitative questionnaires. Social norms were operationalised in two ways: (1) a composite additive measure of self-approval, perception of other girls' approval and perception of other girls' practice of the desired MHM behaviour; (2) based on social restrictions. The composite measure had a better model fit, suggesting that social norms should be examined as a multi-dimensional construct with a two-way relationship between personal beliefs and injunctive and descriptive norms. Bivariate and multivariate analysis assessed the relationship between the SBCC intervention, social norms, and adequate MHM. Adolescent girls in the intervention group had more positive social norms (43.99% versus 21.11%) and those reporting positive social norms had 1.66 (95% CI: 1.33–2.09) times greater odds of being in the 'high' MHM practice group, indicating that SBCC interventions promoting positive social norms can impact practice of MHM. [ABSTRACT FROM AUTHOR]

The effects of breaking up sitting with resistance exercise on cardiometabolic health and cognitive function in young healthy adults are unknown. This study evaluated the acute effects of breaking up sitting with bodyweight resistance exercise on postprandial glucose, lipids, blood pressure and cognitive function. A randomised crossover design was used. Twelve normal-weight participants aged 25 ± 6 years took part in two, 5 h conditions: (1) uninterrupted sitting (SIT), and (2) sitting with 3 min of bodyweight resistance exercise breaks every 30 min (REX). Dietary intake was standardised across conditions. Linear mixed models were used to compare outcomes between conditions. Postprandial glucose was significantly higher in the REX condition than in SIT (incremental area under the curve 346.3 [95% confidence interval: 233.9, 458.7] and 256.9 [144.4, 369.3] mmol/L∙5 h, respectively, p = 0.045). Blood pressure, lipids and cognitive function outcomes were not different between conditions (p ≥ 0.05). This study suggests that breaking up sitting with bodyweight resistance exercise does not benefit cardiometabolic health or cognitive function acutely in young healthy adults. The longer-term effects of breaking up sitting with resistance exercise warrants investigation to appropriately inform public health guidelines. [ABSTRACT FROM AUTHOR]

Various asymptotic methods of obtaining a confidence interval (CI) for the odds ratio (OR) have been proposed. Surprisingly, insofar as we know, the behavior of these methods has not been evaluated for data proceeding from a cross-sectional study (multinomial sampling), but only for data that originate in a prospective or retrospective study (two independent binomials sampling). The paper evaluates 15 different methods (10 classic ones and 5 new ones). Because the CI is obtained by inversion in θ of the two-tailed test for H0(θ): OR = (null hypothesis), this paper evaluates the tests for various values of θ, more than the CIs that are obtained. The following statements are valid only for the two-tailed inferences based on 20 ≤ n ≤ 200 and 0.05≤ OR≤20, since these are the limitations of the study. The two best methods are the classic Cornfield chi-squared method for 0.2≤ OR≤5 and, in other cases, the new method of Sterne for chi-squared; but the adjusted likelihood ratio method is a good alternative to the two previous methods, especially to the first when the sample size is large. The three methods require iterative calculations to obtain the CI. If one is looking for methods that are simple to apply (that is, ones that admit a simple, explicit solution), the best option is the Gart logit method for 1/3≤ OR≤3 and, if in other cases, the Agresti logit method. The Cornfield chi-squared and Gart logit methods should not be used outside the specified interval OR. The paper also selects the best methods for realizing the classic independence test (θ = 1). [ABSTRACT FROM AUTHOR]

Background and Purpose: Understanding how both active and sedentary time is accumulated in people after stroke may help to better target interventions to reduce stroke recurrence. This study aimed to determine the difference between stroke and healthy controls in (a) time spent in sedentary and active behaviour, (b) frequency of short and long active and sedentary bouts and (c) time spent in short and long active and sedentary bouts. Methods: Analysis of secondary outcomes from a cross‐sectional study. Participants were 42 community‐dwelling people after stroke and 21 age‐matched healthy controls. An activity monitor was used to collect free‐living active and sedentary behaviour. Total active (standing and walking) and sedentary (lying, reclining and sitting) time was calculated in minutes per day. Bouts were categorized as short (<5 min, 5–15 min, 15–30 min) or long (>30 min). The frequency of and time spent in each bout were calculated. Results: Relative to wear time, the stroke group spent 10% (95% confidence interval [CI] 3 to 17) more time in sedentary behaviour and had fewer long active bouts than the healthy controls. The stroke group spent 7% (95% CI 1–13) less time in long active bouts and 11% (95% CI 2–20) more time in long sedentary bouts than the healthy controls. Conclusions: Community‐dwelling people after stroke spent less time in active behaviour and accumulated more sedentary time in bouts longer than 30 min compared with healthy controls. Increasing active time and breaking up long sedentary time warrants investigation in people after stroke. [ABSTRACT FROM AUTHOR]

Objective: Despite the growing research on the effectiveness of specialty courts, including drug treatment courts (DTCs) and veterans treatment courts (VTCs), little is known about the unique treatment needs of individuals with co-occurring mental health and substance use disorders (COD) who are commonly served by these courts. This pilot study examines individuals with COD across two DTCs and two VTCs in Massachusetts to understand the characteristics and treatment needs of these unique populations. Methods: Baseline data for 112 individuals enrolled in a community-based COD treatment program within two DTCs (N = 86) and two VTCs (N = 26) with a Monte Carlo simulation of 10,000 samples were analyzed to assess differences in treatment needs. Results: DTC participants experienced more lifetime convictions (p =.000), months incarcerated (p =.000), and had a longer lifetime history of illicit drug use (p =.004). Meanwhile, a higher proportion of VTC participants experienced trauma (p <.002) and chronic medical problems (p <.001), and VTC participants experienced more severe acute behavioral health symptoms as measured by the BASIS-32 (p =.021). Conclusions: Given the unique differences in treatment needs between DTC and VTC participants, these findings have implications for specialty court management such as treatment planning, referrals to meet participants' service needs, and even docket sizes. [ABSTRACT FROM AUTHOR]

Objective: Regular screening for colorectal cancer (CRC) can substantially improve outcomes. This study investigated how measuring regret expected from failing to screen might lead to stronger screening intentions. Five potential moderators were evaluated: perceived threat, psychological reactance, prior screening participation, concurrently measuring faecal aversion (FA) and anticipated regret (AR). Design: A 2 (AR measured pre/post intention) × 2 (FA measured pre/post intention) single blind parallel randomised controlled trial was used. Australians aged 45 and over completed an online survey measuring AR, FA, intention, theory of planned behaviour variables and potential moderators. Main outcome measures: The primary outcome was CRC screening intention. Results: Eight hundred and three participants were randomised, with 666 analysed. Measuring AR prior to intention unexpectedly resulted in a significantly lower intention to screen (d = 0.18, 95% CI [0.03, 0.33]) compared to measuring after intention. Trait reactance predicted a significantly lower intention when it was at least 0.52 SD above the mean; other moderators were not supported. Conclusion: The processes underlying anticipated regret manipulations must be better understood in order to have practical value in health promotion. More research is required to determine how to minimise or avoid the apparent negative effects of psychological reactance in CRC screening communication. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12618001098224 [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between simultaneity of leisure-time physical inactivity and high television time with the presence of chronic diseases in adults and older adults in Brazil. We analyzed secondary data from Vigitel 2013 database, a cross-sectional national survey. It was included 37 947 adults (18–59 years) and 14 982 older adults (≥60 years) living in Brazilian state capitals. The association was between simultaneity of risk behaviors considering leisure-time physical inactivity (<10 min/day) and high television time (≥2 h/day), with the presence of chronic diseases (diabetes, dyslipidemia, hypertension and obesity), measured according to the age group. We performed a binary logistic regression, crude and adjusted analysis, using weighted to reflect population estimates. In adults, there was an association between leisure-time physical inactivity and television time with the presence of diseases. In practice, the simultaneity of risk behaviors when compared with those without risk behavior had higher odds for diabetes (OR = 1.83), dyslipidemia (OR = 1.17), hypertension (OR = 1.54) and obesity (OR = 1.60). In older adults, the simultaneity was associated with diabetes (OR = 1.61), hypertension (OR = 1.33) and obesity (OR = 1.81). We concluded that for adults and older adults the simultaneity of leisure-time physical inactivity and high television time increased the odds for the presence of chronic disease, especially for diabetes and obesity. [ABSTRACT FROM AUTHOR]

Summary: Less is known about the impact of non-hip non-vertebral fractures (NHNV) on early death. This study demonstrated increased risk of dying following hip and NHNV fractures which was further increased by a subsequent fracture. This highlights the importance of early intervention to prevent both initial and subsequent fractures and improve survival. Introduction: Osteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures. Methods: The Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables. Results: Of 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73–2.42 in women and 2.49, 95% CI 2.00–3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21–1.84 and 1.81, 95% CI 1.37–2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52–2.35 and 1.77, 95% CI 1.16–2.71), respectively. Conclusion: Hip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention. [ABSTRACT FROM AUTHOR]

The present study utilized a large, multi-country sample and aimed to examine the correlates of sedentary behavior in university students with depression in 22 low- and middle-income countries. In a cross-sectional survey, university students (median age 20 years, interquartile range = 3) from 22 countries in the Americas, Africa, and Asia responded to self-reported measures of sedentary behavior and health indicators. Overall, among 1693 university students with depression, 36.3% engaged in 8 or more hours a day sedentary time. In the final logistic regression model, residing in a low-income or lower middle-income country and inadequate fruit and vegetable consumption were positively and having sustained an injury in the past year was negatively associated with high sedentary behavior. Findings suggest that sedentary behavior interventions in university students with depression could target at-risk groups identified in this study. [ABSTRACT FROM AUTHOR]

Performing physical activity is considered health promoting but may induce a need for subsequent rest periods. This study aimed to determine the within-day interactions between vigorous physical activity (VPA) and sedentary behaviour (SB) in participants with low cardiorespiratory fitness. We tested the hypothesis that VPA is associated with a temporary subsequent increase in SB. One week of accelerometer data containing a minimum of one 10-min bout of VPA from 62 participants with low cardiorespiratory fitness (31–50 years old) were obtained from the MILE study. A comparison of SB was made between days with a bout of VPA and days without (control). Due to a positive association between VPA and number and duration of sedentary bouts, the time accumulated in both uninterrupted and total sedentary bouts were 27 (95% CI, 10–45) min and 29 (95% CI, 9–50) min higher on VPA days compared to control days (P < 0.05). Our results indicate that in participants with low cardiovascular fitness, unprompted VPA is positively associated with an increase in subsequent sedentary time. We propose that such VPA-associated sedentary time may be viewed as part of a healthy activity pattern. [ABSTRACT FROM AUTHOR]

Background. Prostate cancer (PCa) is the ninth most common cause of cancer death globally. Many studies have investigated aspirin exposure and mortality risk among PCa patients, returning inconsistent results. We conducted a comprehensive meta-analysis to explore the association between aspirin exposure and mortality risk among PCa patients and to investigate potential dose/duration/frequency-response relationships. Methods and Results. Studies published from 1980 to 2018 of PubMed and EMBASE databases were searched. We included 14 studies with 110,000 participants. Multivariate-adjusted odds ratios (ORs) were pooled using random-effect models. Potential dose/duration/frequency-response relationships were evaluated for aspirin exposure and prostate cancer-specific mortality (PCSM) risk. We did not detect an association between the highest aspirin exposure and mortality risk (PCSM of prediagnostic aspirin exposure, OR: 0.96, 95% confidence interval [CI]: 0.87-1. 07, I2 = 0%; PCSM of postdiagnostic aspirin exposure, OR:0.92, 95% CI: 0.77-1.10, I2 = 56.9%; all-cause mortality [ACM] of prediagnostic aspirin exposure, OR: 0.96, 95% CI: 0.88-1.04, I2 = 9.4%; ACM of postdiagnostic aspirin exposure, OR: 0.95, 95% CI: 0.73-1.23, I2 = 88.9%). There was no significant dose/frequency-response association observed for aspirin exposure and PCSM risk. On duration-response analysis, we found that short-term postdiagnostic aspirin exposure (shorter than 2.5 years) increased the risk of PCSM. Conclusions. Our meta-analysis suggests that there is no association between aspirin exposure and PCSM risk. Nor is there an association between the highest aspirin exposure and ACM risk among PCa patients. More studies are needed for a further dose/duration/frequency-response meta-analysis. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional, exploratory study was to explore associations between sitting time and (1) participation, (2) fear of falling, and (3) upper limb impairment after stroke. High sitting time was associated with less participation in meaningful activities involving standing or walking (ρ = −0.519, p = 0.023). A greater fear of falling (ρ = 0.579, p = 0.012) and having an impaired upper limb (mean difference 18.7%, 95% CI: 5.3–32.1, p = 0.012) were associated with greater sitting time. Providing support for stroke survivors to participate in meaningful activities while reducing sitting time is an important consideration when planning occupational therapy interventions, particularly for individuals with an arm impairment and/or those with a fear of falling. [ABSTRACT FROM AUTHOR]

Background: Sedentary behavior, defined as lying or sitting, is a global health concern. As researchers continue to identify modern-day risk factors for sedentary behavior, few have explored the role of illicit drug use. Objective: To examine the association between leisure-time sedentary behavior and cannabis use, in adolescents and adults. Methods: We conducted a cross-sectional study relating cannabis use to total leisure-time sedentary behavior (hr/wk using the computer, playing video games, watching television or videos, and reading for leisure) using data from the 2011–2012 Canadian Community Health Survey (CCHS), a population-based survey of Canadians age ≥12 years. Analyses were possible for 48,240 respondents in Saskatchewan, Ontario, and Nunavut who reported on sedentary behavior. We used logistic regression modeling to relate frequency of cannabis use (never, occasional, heavy) to high-risk sedentary behavior (<35 versus ≥35 hr/wk) overall and stratified by sex, age, and rural location. Results: Approximately 80% of respondents were ≥25 years old. In the fully-adjusted model, the odds of ≥35 hr/wk of sedentary behavior were 80% higher for heavy cannabis users versus never users (OR = 1.8, 95% CI: 1.4–2.3); in occasional cannabis users, the odds were 30% higher (OR = 1.3, 95% CI: 1.1–1.5). In stratified analyses, odds ratios were statistically significant among adults age 25–44 years and people living in nonrural settings. Conclusions/Importance: Our findings support dual lifestyle interventions targeting heavy cannabis use and excessive sedentary behavior simultaneously. Moreover, leisure-time sedentary behavior should be considered as a covariate in future epidemiologic models relating cannabis to health. [ABSTRACT FROM AUTHOR]

Objective: To identify major patterns of physical activity (PA), sedentary behavior (SB) and sleeping (all self-reported), and their association with long-term mortality. Methods: Cohort of 2,851 individuals aged ≥ 60 from Spain. Mortality was ascertain from 2003 up to July 2013. Patterns of PA, SB and sleeping were identified by factor analysis. Results: During follow-up, 1,145 deaths occurred. The first pattern, named "sedentary and non-active pattern", was characterized by long sleeping or lying time, and not doing even light PA (household chores or walking). The second pattern was named "active and non-sedentary pattern", and was characterized long time devoted to vigorous activities, long walking time, and short seating time. Compared to those in the first quartile of the "sedentary and non-active pattern", those in the highest quartile showed a 71% higher mortality (HR: 1.71; 95%CI: 1.42-2.07; p-trend:<0.001); it corresponds to being 6-year older. By contrast, being in the highest versus the lowest quartile of the "active and non-sedentary pattern" was associated with a 32% lower mortality (HR: 0.68: 0.57-0.82; p-trend:<0.001); it corresponds to being 4-year younger. Conclusion: The "sedentary and non-active" pattern had a large impact on mortality. The "active and non-sedentary" pattern showed an opposite and slightly lower association. [ABSTRACT FROM AUTHOR]

The book "Confidence Intervals for Discrete Data in Clinical Research" by Vivek Pradhan, Ashis K. Gangopadhyay, Sandeep M. Menon, Cynthia Basu, and Tathagata Banerjee argues that significance testing is overemphasized and that data analysts should focus more on analyses using confidence intervals. The book provides a comprehensive overview of various methods for calculating confidence intervals for discrete data, including those based on asymptotic versions of tests, exact versions using small-sample discrete distributions, and small-sample methods with conditional and unconditional approaches. The authors also discuss frequentist and Bayesian approaches and provide examples and instructions for obtaining results using software such as SAS and StatXact. However, the book has some limitations, such as the lack of detail in certain methods and the omission of the odds ratio. Overall, it is a valuable resource for researchers interested in analyzing contingency tables and comparing the performance of different methods. [Extracted from the article]

Two-tailed asymptotic inferences for the difference d = p2 − p1 with independent proportions have been widely studied in the literature. Nevertheless, the case of one tail has received less attention, despite its great practical importance (superiority studies and noninferiority studies). This paper assesses 97 methods to make these inferences (test and confidence intervals [CIs]), although it also alludes to many others. The conclusions obtained are (1) the optimal method in general (and particularly for errors α = 1% and 5%) is based on arcsine transformation, with the maximum likelihood estimator restricted to the null hypothesis and increasing the successes and failures by 3/8; (2) the optimal method for α = 10% is a modification of the classic model of Peskun; (3) a more simple and acceptable option for large sample sizes and values of d not near to ±1 is the classic method of Peskun; and (4) in the particular case of the superiority and inferiority tests, the optimal method is the classic Wald method (with continuity correction) when the successes and failures are increased by one. We additionally select the optimal methods to make compatible the conclusions of the homogeneity test and the CI for d, both for one tail and for two (methods which are related to arcsine transformation and the Wald method). [ABSTRACT FROM AUTHOR]

In addition to point estimate for the probability of response in a two-stage design (e.g. Simon's two-stage design for binary endpoints), confidence limits should be computed and reported. The current method of inverting the p-value function to compute the confidence interval does not guarantee coverage probability in a two-stage setting. The existing exact approach to calculate one-sided limits is based on the overall number of responses to order the sample space. This approach could be conservative because many sample points have the same limits. We propose a new exact one-sided interval based on p-value for the sample space ordering. Exact intervals are computed by using binomial distributions directly, instead of a normal approximation. Both exact intervals preserve the nominal confidence level. The proposed exact interval based on the p-value generally performs better than the other exact interval with regard to expected length and simple average length of confidence intervals. [ABSTRACT FROM AUTHOR]

Previous nationally-representative research in Scotland found a j-shaped relationship between age and leisure sedentary time (ST): a decrease from young to middle-age, before rising steeply in older-age. This study investigated the effects of age and sex on weekday (including work) ST for all adults and stratified by work-status, and on weekend day ST. Differences in the relative contributions of component behaviours were also investigated. Responses from 14,367 adult (≥16 years) 2012–14 Scottish Health Survey participants were analysed using linear regressions. We found no j-shaped relationship between age and weekday ST. Instead, only 16–24 year olds reported lower levels than those over 75 years (6.6 (95% CI: 6.3–6.9) compared to 7.4 (95% CI: 7.2–7.6) hours/day; p < 0001). The j-shape was only evident in the stratified analysis amongst women not in work, and for weekend day ST for all groups. For those in work, work ST accounted for 45% of weekday ST. Television/screen ST made up over half of leisure ST on weekdays and weekend days, regardless of sex, age, or work-status. These results challenge our understanding of how ST varies by age. Interventions to reduce ST should consider differences in the relative contributions of ST behaviours by age and work-status. [ABSTRACT FROM AUTHOR]

Background: Physical activity in children is associated with better physical and mental health but many children do not meet physical activity guidelines. Friendship groups are potentially an important influence on children's physical activity and sedentary time. This paper examines the association between children of physical activity and sedentary time in school-based same-sex friendship networks, for both moderate-to-vigorous intensity physical activity (MVPA) and sedentary time. Moreover, considering the methodological challenges of conducting and interpreting these analyses, we provide examples of how to analyse these data and interpret results to encourage further work in the area. Methods: Accelerometer data for 1223 children, aged 8-9 years, were collected in 2015-2016 and analysed in 2017. Mean accelerometer minutes of MVPA and sedentary time were calculated. Children named up to four school friends and same-sex school-based friendship networks were constructed. Network models, which include correlation between friends, were fitted by sex. Results: Both MVPA and sedentary time were found to be associated via the friendship networks, for both boys and girls. The network autocorrelation was 0.21 (95% CI: 0.15 to 0.26) for boys' MVPA, and 0.14 (95% CI: 0.07 to 0.21) for sedentary time. Network autocorrelation between girls was weaker, with 0.13 (95% CI: 0.06 to 0.19) for MVPA and 0.11 (95% CI: 0.05 to 0.17) for sedentary time. Conclusions: Physical activity and sedentary time of boys and girls are associated with the physical activity and sedentary time respectively of others within same-sex friendship networks, and these associations are comparable to other known factors. In this study, the correlation between friends was stronger for boys than girls, and stronger for MVPA than for sedentary time. These findings suggest that friendship networks play a part in understanding children's physical activity and sedentary time and could play a valuable role in developing effective interventions. [ABSTRACT FROM AUTHOR]

Research on youth in foster care has focused on those placed for reasons of maltreatment rather than delinquency, yet most states provide foster care services to youth under probation supervision. This analysis generated knowledge about youth in probation-supervised foster care (PSFC) in California by examining the relationship between past child protective services (CPS) involvement and exit type. CPS records were extracted to identify 17-year-old youths in PSFC between 2008 and 2012 (N = 11,188). The relationship between allegations of maltreatment and exit type was assessed using regression models. Of the PSFC youth, 64.6% had previous allegations of maltreatment and a quarter had been reported at least 6 times. Youth with a history of placement in CPS foster care were more likely to age out relative to achieving permanency in comparison to PSFC youth with no maltreatment history (relative risk ratio = 2.20; 95% confidence interval [1.90, 2.55]). As the number of reports increased, the likelihood of exiting care by aging out increased relative to achieving permanency (p < .001). The findings suggest a majority of PSFC youth had maltreatment histories, the overlap between CPS and probation was constant, and maltreatment records may characterize youth in PSFC at risk of negative exits from care. [ABSTRACT FROM AUTHOR]

Interval estimation is an important objective of most experimental and observational studies. Knowing at the design stage of the study how wide the confidence interval (CI) is expected to be and where its limits are expected to fall can be very informative. Asymptotic distribution of the confidence limits can also be used to answer complex questions of power analysis by computing power as probability that a CI will exclude a given parameter value. The CI-based approach to power and methods of calculating the expected size and location of asymptotic CIs as a measure of expected precision of estimation are reviewed in the present paper. The theory is illustrated with commonly used estimators, including unadjusted risk differences, odds ratios and rate ratios, as well as more complex estimators based on multivariable linear, logistic and Cox regression models. It is noted that in applications with the non-linear models, some care must be exercised when selecting the appropriate variance expression. In particular, the well-known 'short-cut' variance formula for the Cox model can be very inaccurate under unequal allocation of subjects to comparison groups. A more accurate expression is derived analytically and validated in simulations. Applications with 'exact' CIs are also considered. [ABSTRACT FROM AUTHOR]