The unprecedented large-scale childcare facility closure during the COVID-19 pandemic led to a dramatic increase in the childcare burden at home, which is shouldered disproportionately by women more ...than men. Leveraging anonymized mobile tracking data and nationally representative time-use survey data from the USA, this study adopts a quasi-experimental approach to examine the impact of childcare facility closure on the gendered division of household childcare time. It further investigates whether this impact varies according to respondent education, family income, and employment status. Results show an expanding gender gap in parenting time on child education with young children during the pandemic. The gender gap expanded even more in places and months with more childcare facility closures, but this gendered effect is only evident among parents with lower education and family income. Our findings call for institutional support during similar public crises to mitigate the potentially negative impact on gender equality.
Aims
The New Zealand National Intestinal Failure and Rehabilitation Service (NZ‐NIFRS) was established in October 2015 to gather longitudinal data on the aetiology, clinical course and outcomes of ...children with intestinal failure (IF). One main objective is to achieve health equity for patients with IF in NZ.
Methods
Clinical outcomes (enteral autonomy, parenteral nutrition (PN) dependence, death or intestinal transplantation) for IF patients diagnosed from October 2015 to 2018 were analysed; comparisons were made by ethnicity and socio‐economic status (SES) using published ‘prioritised‐ethnicity’ health data and the NZ index of deprivation, respectively. The Cox proportional‐hazards model was used to assess time to enteral autonomy.
Results
Of the 208 patients (55.77% male, 43.75% preterm), 170 (81.73%) achieved enteral autonomy and 14 (6.73%) remained PN dependent. Pacific and Māori children accounted for 12.98% and 27.88% of the patient cohort, respectively, compared to 9.46% and 25.65% of the NZ paediatric population. More significantly, IF patients with a high NZ socio‐economic deprivation score were overrepresented, with 35.92% in the highest deprivation quintile and 10.19% in the least deprived quintile, compared to 23.53% and 20.31%, respectively, of the NZ paediatric population. There were no significant differences in primary clinical outcomes for any patients based on ethnicity or SES.
Conclusion
While disparities in ethnicity and social deprivation do exist in the incidence of IF in NZ children, clinical outcomes are similar for children regardless of ethnicity or SES. NZ‐NIFRS has achieved one of its core objectives: to achieve health equity for all patients with IF nationwide.
Introduction: Socio-demographic factors may play a pivotal role in anxious and depressed alcohol dependent patients. Identifying the patterns and impact of these factors may be important in the ...successful management of Alcohol Use Disorders (AUDs). Aim: To assess the patterns and impact of socio-demographic factors in anxious and depressed alcohol dependent patients. Materials and Methods: This cross-sectional study was conducted at Rama Medical College Hospital and Research Center Hapur, Uttar Pradesh, India, from August 2018 to January 2020. Patients with history of substance dependence, gross brain damage, severe medical complications, or evidence of drinking during the hospital stay were excluded. Severity of Alcohol Dependence Questionnaire (SADQ) was used to rate the extent of alcohol dependence and Hamilton Depression Rating Scale (HAM-D or HDRS) to rate depression. Sociodemographic data was recorded in each patient which included age, gender, background, education level, employment status, occupation, marital status, and family type. The severity of anxiety symptoms was measured on Hamilton Anxiety Rating Scale (HAM-A). Independent t-tests, Chi-square tests, oneway Analysis of Variance (ANOVA) and Pearson’s correlation analysis were used for statistical analysis. A p-value <0.05 was considered statistically significant. Results: The total of 90 alcohol dependent patients with mean age of 37.6±9.3 years and mean HDRS score was 8.5±4.3. The overall prevalence of depression cohort was. Out of these 30 (33.3%) had mild and 6 (6.7%) had moderate depression, respectively. The mean Hamilton anxiety scale score was 18.6±5.2. Patients who had a lower Socio-economic Status (SES) (p-value= 0.049 and 0.004), were martially separated (p-value<0.001 and 0.027), living in a nuclear family (p-value=0.005 and <0.001) and were unemployed (p-value<0.001 and p-value<0.001) had significantly higher depression and anxiety scores, respectively. Conclusion: In anxious and depressed alcohol dependent patients, lower SES, martial separation, living as a single family and unemployment significantly influenced depression and anxiety
Polygenic scores are a popular tool for prediction of complex traits. However, prediction estimates in samples of unrelated participants can include effects of population stratification, assortative ...mating, and environmentally mediated parental genetic effects, a form of genotype-environment correlation (rGE). Comparing genome-wide polygenic score (GPS) predictions in unrelated individuals with predictions between siblings in a within-family design is a powerful approach to identify these different sources of prediction. Here, we compared within- to between-family GPS predictions of eight outcomes (anthropometric, cognitive, personality, and health) for eight corresponding GPSs. The outcomes were assessed in up to 2,366 dizygotic (DZ) twin pairs from the Twins Early Development Study from age 12 to age 21. To account for family clustering, we used mixed-effects modeling, simultaneously estimating within- and between-family effects for target- and cross-trait GPS prediction of the outcomes. There were three main findings: (1) DZ twin GPS differences predicted DZ differences in height, BMI, intelligence, educational achievement, and ADHD symptoms; (2) target and cross-trait analyses indicated that GPS prediction estimates for cognitive traits (intelligence and educational achievement) were on average 60% greater between families than within families, but this was not the case for non-cognitive traits; and (3) much of this within- and between-family difference for cognitive traits disappeared after controlling for family socio-economic status (SES), suggesting that SES is a major source of between-family prediction through rGE mechanisms. These results provide insights into the patterns by which rGE contributes to GPS prediction, while ruling out confounding due to population stratification and assortative mating.
Enhancing the income of farmers is a national priority to address the agrarian issue of distress and improving farmers’ welfare. In this context, a network of Krishi Vigyan Kendras (KVKs) was engaged ...to make interventions on farmers’ field. This study carried out in Madhya Pradesh, presents the quantitative assessment on the impacts of KVKs’ initiatives in terms of different interventions made to contribute in farmers' income (doubling farmers income, DFI). The structured sampling method was followed using multi-stage random sampling. This has covered selecting 11 agro-climatic regions of the state and 25% of KVKs from each region. Further, 2 treatment (DFI) and 2 control (non-DFI) villages were taken. Finally, from each village, a total of 20 farm households were taken. The results indicated that average treatment effect on the treated (ATT), which is the difference between matched DFI and non- DFI households after accounting for counterfactual, was positive and significant. The value of ATT implies that net income of DFI households was more than that of non-DFI households by 111%. The net income of DFI households has increased by 156% during 2016–17 (the year of launch of KVKs' DFI scheme) to 2020–21. Households with male heads, without any other source of income, owning smaller livestock and land holdings were observed to get benefit from participation in the interventions on DFI made by the KVKs. Recognition and response to the heterogeneity treatment effect can help in optimizing resource allocation, enhancing programme effectiveness and maximizing the potential impact of the KVKs’ DFI initiatives. Agricultural diversification shifted to high value crops (e.g., like vegetables, dairying, etc.), has been crucial in enhancing income of DFI households.
China's large‐scale internal migration has stimulated ongoing debates about consequences of geographical mobility for population health. Although existing research predominantly focused on migrants' ...health in host societies, the complex relationship between migration and health throughout the full migratory cycle remains understudied. Analysing data from 2010 China General Social Survey (N = 1,660), we investigate variations in migrants' physical and mental health across four distinct migratory stages—intended, temporary, permanent, and return migration. Supporting the “healthy migrant” and “salmon” hypotheses, we found that intended migrants have better health than rural residents with no migration intention, and migrants have better health than return migrants. The health disparity between nonmigrants and migrants is largely explained by selective demographic and socio‐economic traits, but not health behaviours. Rural‐to‐urban migration is associated with adverse health outcomes, particularly among permanent migrants. The findings suggest potential health risks associated with rural‐to‐urban migration and migrant assimilation in urban China.
Globally, access to higher education has increased, but inequalities by socio‐economic background remain. This article explores the relationship between early schooling opportunities (and learning) ...and progression into higher education in four low and middle‐income countries. We analyse data from the Young Lives longitudinal study, following cohorts of young people from age 5 to 22 in four country settings: Ethiopia, Peru, Vietnam and India. We reveal wide variability in higher education participation between the four countries, with a common pattern of a very strong association between early learning and later higher education participation, even after allowing for a range of demographic characteristics. Whilst early learning is important in predicting later higher education participation, we also find that significant barriers to higher education participation remain for low socio‐economic status groups, even if they initially show good levels of learning. We track the trajectories of children who have initial good levels of learning, and hence arguably the potential to progress to higher education, and assess the extent to which socio‐economic background plays a mediating role in these trajectories. Pupils with initially good levels of learning at primary school age, but who are from poor backgrounds, fall back in terms of their relative attainment during secondary schooling years. This implies that socio‐economic status continues to be a barrier to educational attainment throughout these children’s lives. We discuss the implications of these findings for policy initiatives aimed at narrowing inequalities in higher education access in poorer countries.
Background and Aims
The path to hepatitis C virus (HCV) elimination is complicated by individuals who become lost to follow‐up (LTFU) during care, particularly before receiving effective HCV ...treatment. We aimed to determine factors contributing to LTFU and whether LTFU is associated with mortality.
Methods
In this secondary analysis, we constructed a database including individuals with HCV who were either LTFU (data from the nationwide HCV retrieval project, CELINE) or treated with directly acting antivirals (DAA) (data from Statistics Netherlands) between 2012 and 2019. This database was linked to mortality data from Statistics Netherlands. Determinants associated with being LTFU versus DAA‐treated were assessed using logistic regression, and mortality rates were compared between groups using exponential survival models. These analyses were additionally stratified on calendar periods: 2012–2014, 2015–2017 and 2018–2019.
Results
About 254 individuals, LTFU and 5547 DAA‐treated were included. Being institutionalized (OR = 5.02, 95% confidence interval (CI) = 3.29–7.65), household income below the social minimum (OR = 1.96, 95% CI = 1.25–3.06), receiving benefits (OR = 1.74, 95% CI = 1.20–2.52) and psychiatric comorbidity (OR = 1.51, 95% CI = 1.09–2.10) were associated with LTFU. Mortality rates were significantly higher in individuals LTFU compared to those DAA‐treated (2.99 vs. 1.15/100 person‐years (PY), p < .0001), while in those DAA‐treated, mortality rates slowly increased between 2012–2014 (.22/100PY) and 2018–2019 (2.25/100PY).
Conclusion
In the Netherlands, individuals who are incarcerated/institutionalized, with low household income, or with psychiatric comorbidities are prone to being LTFU, which is associated with higher mortality. HCV care needs to be adapted for these vulnerable individuals.
Summary
Previous research reported modest associations between food environments near schools and adiposity among children overall. The associations within sociodemographic subgroups have not been ...synthesized. This review assessed the evidence on the associations between food environments near schools and childhood obesity within different demographic and socio‐economic subgroups. PubMed and Scopus databases were searched to identify studies published in English between January 1, 1980, and April 25, 2019, examining the presence of fast food outlets, convenience stores, supermarkets, and grocery stores near schools and measures of overweight/obesity by race/ethnicity, gender, grade, and income level. Twelve cross‐sectional and two ecological studies were included. Fast food outlets were most commonly examined (n = 12). The associations between fast food outlets near schools and obesity were generally positive among Latino, white, and African American students and across grade levels, although the strengths of evidence varied. The directions of association were mixed among Asian children. Three studies reported generally positive associations between convenience stores and obesity among Latino and African American children and mixed associations among white and Asian children. Longitudinal studies are needed in addition to studies examining underlying mechanisms of the differential influence of food environments near schools within each subgroup.
Background
Adults with intellectual disability (ID) are prescribed high levels of medication, with polypharmacy and psychotropic polypharmacy common. However, reported rates vary between studies, and ...there has been an over‐reliance on obtaining data from convenience samples. The objective of this study was to determine the prevalence of medication use and polypharmacy in a population‐level sample of adults with IDs. Factors associated with polypharmacy and psychotropic polypharmacy are explored.
Methods
We used a total population sample of 217 adults with IDs known to services in Jersey (sampling frame n = 285). The Anatomical Therapeutic Chemical classification system was used to categorise medications that participants were currently taking on a regular basis. We examined associations of polypharmacy and psychotropic polypharmacy with socio‐economic status, health and demographic variables using univariate and multivariate analyses.
Results
A total of 83.4% of participants were prescribed medication, with high doses common. Of the participants, 38.2% were exposed to polypharmacy while 23% of participants were exposed to psychotropic polypharmacy. After controlling for demographic, health and socio‐economic characteristics, polypharmacy was significantly associated with older age, increased severity of ID, living in a residential setting and having increased comorbidities. Psychotropic polypharmacy was associated with being male, being aged 50+ years and having had a psychiatric diagnosis over the life course. Being prescribed psychotropic drugs above the defined daily dose was not associated with having had a psychiatric diagnosis over the life course, suggesting the possibility of ‘off label’ prescribing.
Conclusions
Our results indicate that medication use, in high doses, alongside polypharmacy and psychotropic polypharmacy are highly prevalent in adults with ID. The exposure to multiple medications increases the risk of developing adverse drug events, drug–drug interactions and medication‐related problems. Future population‐level, prospective cohort studies should examine the prevalence of polypharmacy and psychotropic polypharmacy using standardised definitions and consider the potential impact of adverse drug events, drug–drug interactions and medication‐related problems in this population.
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