Depression in the house: The effects of household air pollution from solid fuel use among the middle-aged and older population in China

BACKGROUND

Although the adverse health effects of ambient air pollution are well documented, evidence on the depression effects of household air pollution (HAP) are scarce.

OBJECTIVES

We investigated the effects of HAP exposure from the use of solid fuel on depression using a nationally representative dataset of middle-aged and older population in China.

METHODS

By employing the propensity score matching method, we first matched the type of household fuel based on background information, including demographic characteristics, lifestyles, health status, and household economic levels. Based on the matched data, we conducted OLS and logistic regressions with cluster standard error at community level to examine the effects of household solid fuel use on depression and adjusted for potential confounders. Heterogeneous effects for vulnerable population were also considered.

RESULTS

We found a significantly higher Center for Epidemiologic Studies Depression Scale (CES-D) score and depression risk among current household solid fuel users. After matching and adjusting for potential confounders, current solid fuel users had a higher CES-D score of 0.59 (95% confidence interval [CI]: 0.31, 0.89) than clean fuel users. The OR of depression risk were 1.26 (95% CI: 1.14, 1.41). Solid fuel users had the highest CES-D scores (β = 0.99, 95% CI: 0.62, 1.36) and depression risk (OR = 1.49, 95% CI: 1.30, 1.73) for over five years. These associations were generally higher in females, participants aged 65 years and older, with a BMI ≥ 25, with low education, with low household economic levels, and those suffer from chronic diseases, including diabetes, chronic lung diseases, and cardiovascular diseases.

CONCLUSIONS

Exposure to HAP from solid fuel combustion was linked with strong depression outcomes. Findings suggested a need to strengthen public health efforts, such as controlling the social, health, and economic costs of depression by taking the physical environment, including HAP exposure, into account.

Paternal incarceration and child-reported behavioral functioning at age 9

Within the last few decades our understanding of the importance of non-cognitive skills for socioeconomic success has grown along with our knowledge of the deleterious impacts of paternal incarceration for child wellbeing. Given the importance of early skills and that elementary-aged children constitute the majority of children with incarcerated parents, understanding the connection between paternal incarceration and the socio-emotional component of children's non-cognitive development is pressing. Using matching models, data from the newest wave of the Fragile Families and Child Wellbeing Study, and exploring a larger range of behavioral skills than previous literature, this paper provides estimates of the impact of paternal incarceration on children's behavioral functioning at age 9 using children's own self-reports. Comparisons to oft-used parent reports are made and heterogeneity by gender is explored. Findings suggest the incarceration of a father increases the antisocial behaviors children self-report, but has null effects on prosocial skill development.

Unintended Childbearing and Child Growth in Northern Malawi

Objective The study aims to assess whether unintended children experience slower growth than intended children. Methods We analysed longitudinal data linked to the Karonga Health and Demographic Surveillance Site collected over three rounds between 2008 and 2011 on women’s fertility intentions and anthropometric data of children. Using the prospective information on fertility intention we assessed whether unintended children are more likely to be stunted than intended children. We applied Propensity Score Matching technique to control for endogenous factors affecting both the probability that a family has an unwanted birth and a child with poor health outcomes. Results We found that 24 % of children from unwanted pregnancies were stunted compared with 18 % of mistimed pregnancies and 17 % of those from wanted pregnancies. However, these differences in probability of children being stunted, though in the expected direction, were not significant either for large or small families, after controlling for age. The number of children in the household was associated with stunting and boys were substantially more likely to be stunted than girls. Conclusion We found no significance difference in probability of being stunted by mother’s fertility intention.

Relationships Between Social/Emotional Support and Quality of Life, Depression and Disability in Patients With Chronic Obstructive Pulmonary Disease: An Analysis Based on Propensity Score Matching

BACKGROUND

Patients with chronic obstructive pulmonary diseases (COPD) suffer from impaired Health-Related Quality of Life (HRQoL). Having an adequate social/emotional support may improve the quality of life of COPD patients.

OBJECTIVE

To study the relationships between social/emotional support and HRQoL, depression and disability among patients with COPD.

METHODS

We applied a propensity score model using data from a large U.S. population-based health survey to match COPD patients who reported rarely/never receiving social/emotional support with those who received that support. Social/emotional support and all dependent variables were dichotomized into yes/no responses. For HRQoL domains, number of days of poor physical or mental health and activity limitations, "yes" indicated ≥14 unhealthy days in the last 30 days. McNemar's test was used to compare the matched groups.

RESULTS

Social/emotional support was rarely/never received by 37% of responders. Standardized differences between matched groups, after propensity score matching, were less than 10% indicating successful matching. COPD patients who rarely/never receive social/emotional support were more likely to report: depression (n = 321 pairs, odds ratio (OR) = 2.2, 95% confidence interval (CI): 1.56-3.14, p < .001), ≥14 poor mental HRQoL days (n = 310 pairs, OR = 3.12, 95% CI: 2.1-4.73, p < .001) and ≥14 poor physical HRQoL days (n = 307 pairs, OR = 1.5, 95% CI: 1.06-2.13, p = .02). There were no significant differences in general health, disability, or activity limitations.

CONCLUSION

Among COPD patients, lower levels of social/emotional support are associated with depression and deterioration of mental and physical HRQoL. The importance of social/emotional support should be emphasized by policy makers, healthcare providers, and family members, to improve functioning among COPD patients.

Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

The role of induction chemotherapy in nasopharyngeal carcinoma (NPC) remains controversial. The primary aim of this study was to use the National Cancer Database to evaluate the patterns of care of induction chemotherapy in NPC and its impact on overall survival (OS). Patients with NPC from 2004 to 2014 were obtained from the NCDB. Patients were considered to have received induction chemotherapy if it was started ≥43 days before the start of RT and concurrent CRT if chemotherapy started within 21 days after the start of RT. Propensity score matching was used to control for selection bias. Cox proportional hazards model was used to determine significant predictors of OS. Logistic regression model was used to determine predictors of the use of induction chemotherapy. Significance was defined as a P value <.05. A total of 4857 patients were identified: 4041 patients (87.2%) received concurrent CRT and 816 patients (16.8%) received induction chemotherapy. The use of induction therapy remained stable between 2004 and 2014. Younger patients and those with higher T- and N-stage had a higher likelihood of being treated with induction chemotherapy. The 5-year OS in patients treated with induction chemotherapy and CRT was 66.3% vs 69.1%, respectively (P = .25). There was no difference in OS when these two groups were analyzed after propensity score matching. No differences in OS existed between these treatment groups in patients with T3-T4N1 or TanyN2-3 disease (P = .76). Propensity score matching also did not reveal any difference in OS in patients with T3-T4N1 or TanyN2-3 disease. The use of induction chemotherapy has remained stable in the last decade. In this study of patients with NPC, induction chemotherapy was not associated with improved OS compared to CRT alone.

Antibiotics De-Escalation in the Treatment of Ventilator-Associated Pneumonia in Trauma Patients: A Retrospective Study on Propensity Score Matching Method

Background:

Antimicrobial de-escalation refers to starting the antimicrobial treatment with broad-spectrum antibiotics, followed by narrowing the drug spectrum according to culture results. The present study evaluated the effect of de-escalation on ventilator-associated pneumonia (VAP) in trauma patients.

Methods:

This retrospective study was conducted on trauma patients with VAP, who received de-escalation therapy (de-escalation group) or non-de-escalation therapy (non-de-escalation group). Propensity score matching method was used to balance the baseline characteristics between both groups. The 28-day mortality, length of hospitalization and Intensive Care Unit stay, and expense of antibiotics and hospitalization between both groups were compared. Multivariable analysis explored the factors that influenced the 28-day mortality and implementation of de-escalation.

Results:

Among the 156 patients, 62 patients received de-escalation therapy and 94 patients received non-de-escalation therapy. No significant difference was observed in 28-day mortality between both groups (28.6% vs. 23.8%, P = 0.620). The duration of antibiotics treatment in the de-escalation group was shorter than that in the non-de-escalation group (11 [8–13] vs. 14 [8–19] days, P = 0.045). The expenses of antibiotics and hospitalization in de-escalation group were significantly lower than that in the non-de-escalation group (6430 ± 2730 vs. 7618 ± 2568 RMB Yuan, P = 0.043 and 19,173 ± 16,861 vs. 24,184 ± 12,039 RMB Yuan, P = 0.024, respectively). Multivariate analysis showed that high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, high injury severity score, multi-drug resistant (MDR) infection, and inappropriate initial antibiotics were associated with patients' 28-day mortality, while high APACHE II score, MDR infection and inappropriate initial antibiotics were independent factors that prevented the implementation of de-escalation.

Conclusions:

De-escalation strategy in the treatment of trauma patients with VAP could reduce the duration of antibiotics treatments and expense of hospitalization, without increasing the 28-day mortality and MDR infection.

Effect of Rhubarb on Gastrointestinal Dysfunction in Critically Ill Patients: A Retrospective Study Based on Propensity Score Matching

Background:

Gastrointestinal dysfunction plays a critical role in the prognosis of critically ill patients. Previous studies showed rhubarb, a traditional Chinese herb, can protect the intestinal barrier function, prevent intestinal bacterial translocation, and promote gastrointestinal peristalsis, but the clinical studies are less. The aim of this study was to evaluate the effects of rhubarb on gastrointestinal dysfunction in critically ill patients.

Methods:

From June 2015 to May 2017, a total of 368 critically ill patients with Grade I–III acute gastrointestinal injury (AGI) were enrolled in this study. Patients were divided into two groups according to the exposure factors (whether the patients received rhubarb treatment): the rhubarb group and the usual treatment group. Clinical data were collected within the first 24 h of the Intensive Care Unit (ICU) admission and 7 days after treatment. Survival data on day 28 after ICU admission and the durations of ICU and total hospitalization were also collected. Propensity score matching (PSM) was conducted to reduce confounding bias between the groups. The logistic regression was conducted to screen the influence factors.

Results:

The eligible patients were divided into rhubarb group (n = 219, 59.5%) and usual treatment group (n = 149, 40.5%). Before PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group were 59.8% and 39.6%, respectively. After PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group was 77.9% and 30.9%, respectively. The remission rates of feeding intolerance in rhubarb group were significantly higher than those in the usual treatment group (all P < 0.05). Compared with the usual treatment group, the rhubarb group had a higher rate of AGI improvement, lower level of C-reactive protein, shorter stay in ICU before and after PSM (P < 0.05). There was no significant difference in 28-day mortality between rhubarb and usual treatment groups before and after PSM (48 vs. 33, P = 0.959; and 16 vs. 21, P = 0.335). The logistic regression analysis showed that the single factor, whether receiving rhubarb therapy, affected the proportion of patients whose enteral nutrition needs ≥83.7 kJ·kg⁻¹·d⁻¹ after 7 days of treatment (odds ratio: 7.908, 95% confidence interval: 3.661–17.083, P < 0.001). No serious adverse effects were found in two groups.

Conclusions:

The rhubarb might significantly improve feeding tolerance and relieve gastrointestinal dysfunction in critically ill patients, without serious adverse reactions. It provided proof for the treatment of gastrointestinal dysfunction with rhubarb during clinical practice.

[A pilot study to evaluate the DMP for coronary heart disease - Development of a methodology and first results]

Regarding the effectiveness of disease management programs (DMPs) in Germany, several studies have been published on the DMP for type 2 diabetes. This pilot study provides methodological insights into evaluating the DMP for coronary heart disease (CHD), which currently includes 1.7 million participants, and reveals trends in healthcare outcomes for mortality, guideline adherent prescribing and costs. Major methodological challenges that need to be considered for the development of an appropriate matching method for this indication have been identified. The results show positive trends in favor of the DMP regarding mortality, costs and medication according to guidelines. A matching design is applicable to the CHD indication; the knowledge gained regarding the quality of care can be used for a targeted development of the program.

Measuring Model Misspecification: Application to Propensity Score Methods with Complex Survey Data

Model misspecification is a potential problem for any parametric-model based analysis. However, the measurement and consequences of model misspecification have not been well formalized in the context of causal inference. A measure of model misspecification is proposed, and the consequences of model misspecification in non-experimental causal inference methods are investigated. The metric is then used to explore which estimators are more sensitive to misspecification of the outcome and/or treatment assignment model. Three frequently used estimators of the treatment effect are considered, all of which rely on the propensity score: (1) full matching, (2) 1:1 nearest neighbor matching, and (3) weighting. The performance of these estimators is evaluated under two different sampling designs: (1) simple random sampling (SRS) and (2) a two-stage stratified survey. As the degree of misspecification of either the propensity score or outcome model increases, so does the bias and the root mean square error, while the coverage decreases. Results are similar for the simple random sample and a complex survey design.

[Evidence-based medicine: opportunities of the Propensity Score Matching (PSM) method in eliminating selection bias in retrospective neurosurgical studies]

To date, a large amount of retrospectively collected data about treatment of neurosurgical pathology have been accumulated. Modern methods of medical statistics are necessary for correct interpretation of the data. The article purpose is to demonstrate application of one of the modern methods, Propensity Score Matching (PSM), in neurosurgery. The use of PSM avoids misinterpretation of retrospectively collected data and obviates errors in planning further prospective studies. For the past 10 years, the number of published international PSM-based studies has increased more than 10-fold, with the number of articles by Russian authors accounting for less than 0.2%. In line with the tendencies of international studies, application of PSM in analysis of retrospectively collected data will enable testing of a number of hypotheses and correct planning of prospective randomized studies.

The Association of Human Milk Feeding With Short-Term Health Outcomes Among Chinese Very/Extremely Low Birth Weight Infants

BACKGROUND

There is limited evidence about the influence of human milk feeding on short-term outcomes in a large preterm infant population.

RESEARCH AIMS

To explore the influences of human milk feeding on the primary outcome of necrotizing enterocolitis and secondarily sepsis, bronchial pulmonary dysplasia, severe retinopathy of prematurity, death, and the time to achieve full enteral feeding at discharge in very/extremely low-birth-weight infants.

METHODS

This study was a retrospective, longitudinal, observational two-group comparison cohort study. A total of 4470 very/extremely low-birth-weight infants from 25 neonatal intensive care units in China, between April 2015 and May 2018, were enrolled in this study. Exclusive human milk-fed and formula-fed participants were matched using propensity scores. After matching, human milk-fed participants (n = 1379) and formula-fed participants (n = 1378) were included in the analyses. The likelihood of necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, severe retinopathy of prematurity, death, and the time to achieve full enteral feeding were compared between the two groups.

RESULTS

Exclusive human milk feeding was associated with lower odds of necrotizing enterocolitis (2.90% vs. 8.42%, OR 0.33, 95% CI [0.22, 0.47]), bronchopulmonary dysplasia (15.74% vs. 20.26%, OR 0.69, 95% CI [0.56, 0.86]), severe retinopathy of prematurity (1.45% vs. 2.39%, OR 0.50, 95% CI [0.27, 0.93]), and death (6.02% vs. 10.38%, OR 0.44, 95% CI [0.32, 0.61]) compared with formula feeding. No significant differences in the time to achieve full enteral feeding or the odds of sepsis were found between the two groups.

CONCLUSION

Exclusive human milk feeding is associated with a reduction in necrotizing enterocolitis, bronchopulmonary dysplasia, severe retinopathy of prematurity, and mortality among very/extremely low-birth-weight infants.

TRIAL REGISTRATION

Clinicaltrials.gov on November 9, 2015 (NCT02600195).

A case-control study of rheumatoid arthritis revealed abdominal obesity and environmental risk factor interactions in northern China

BACKGROUND

The aim of this study was to evaluate new and previously hypothesized environmental risk factors and their interaction with rheumatoid arthritis (RA).

METHODS

Four hundred patients recently diagnosed with RA and 400 controls frequency-matched by gender and birth year using Propensity Score Matching (PSM) were selected from northern China. Investigation was performed using self-reported data from interviewer-administered surveys. Associations between exposure variables and risk of RA were evaluated using multifactor non-conditional logistic regression.

RESULTS

It showed that damp localities, draft indoor, abdominal obesity (AO), and family history of RA among first-degree relatives were independent risk factors and drinking of milk was independent protective factors for RA. Besides these risk factors, in women, infrequent delivery times, early age at menopause, and late age at menarche were also independent risk factors for RA. Both the additive model and the multiplication model suggested that there was an interaction relationship between AO and damp localities (p < .001), and only the additive model suggested that there was interaction relationship between AO and no milk drinking (p < .001) in our study population. In women, there was interaction relationship between AO and damp localities (p < .001) and between AO and age at menopause (p < .001).

CONCLUSIONS

In northern China, damp localities, draft indoor, AO, family history of RA among first-degree relatives, and no milk drinking may be important risk factors of RA patients.

Outcomes in patients with burns to the perineum, buttocks and genitalia: A retrospective cohort study

BACKGROUND

Burns that involve the perineum, buttocks and genitals (PBG) have been associated with more challenging therapeutic needs and worse clinical outcomes. We aimed to investigate whether PBG burns are an independent predictor for mortality, morbidity and complications in a large, heterogenous patient collective and in comparison to patients without PBG burns.

PATIENTS AND METHODS

Patients admitted to a level one burn center between August 2014 and July 2022 were included and stratified based on the presence of PBG burns on admission (PBG & control group = CTR). Demographic baseline data, burn aetiology, inhalation trauma (IHT), full-thickness burns (FT), number of operations (NOR), mortality, length of ICU stay (LOS-ICU), length of in-hospital stay (LOHS) and bacteraemia were assessed to compare key clinical characteristics and outcomes between the groups. Multivariate regression analyses and a 1:1 propensity score matching were conducted for key clinical outcomes.

RESULTS

A total of 1024 patients were included in the analysis (PBG: n = 227; CTR: n = 797). PBG burns were older (median (IQR) 54 (34-72) vs. 44, (30-61) years, p < 0.0001), more frequently female (35% vs. 23%, p = 0.002) presented with larger total body surface area (TBSA) burns overall (27 (32-39) vs. 10 (13-15) %, p < 0.0001) and sustained FT burns more frequently (69% vs. 26% p < 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p < 0.0001), PBG patients needed twice as many surgical procedures (Mean (SD) 2 (2.84) vs. 1 (1.6), p < 0.0001) as CTR. In multivariate analyses, a significant correlation was identified between length of ICU stay and presence of PBG burns. Following strict cohort matching to account for sex, age, cause of burn, TBSA %, presence of FT burn, inhalation trauma and bacteraemia, PBG burns were an independent predictor for mortality (p = 0.0003).

CONCLUSION

PBG burns are at risk for prolonged intensive care, hospitalization and complications during treatment. Furthermore, the presence of PBG burns appears to be a risk factor for mortality, irrespective of patient age, TBSA affected and other relevant covariates.

Effectiveness of the Ticket to Work program in supporting employment among adults with disabilities

Background

Returning to work benefits many people with disabilities, as it supports personal financial independence and provides opportunities for greater societal contributions. The U.S. Social Security Administration's Ticket to Work (TTW) program offers expanded support services to help disability beneficiaries achieve financial independence through gainful employment. SSA has continuously sought new ways to identify those who would most benefit from using a Ticket.

Objective

To identify factors contributing to TTW participation and assess its impact on benefits forgone for work.

Methods

We conducted a cohort study using SSA administrative data to predict TTW participation and its impact on benefit cessation. The study sample included beneficiaries with a physical or mental residual functional capacity assessment from 2016. We applied a frequentist propensity score matching estimate and a doubly robust Bayesian hierarchical model-based estimate.

Results

The study included 172,640 beneficiaries (52.7% male, average age 52 years) with a range of qualifying conditions: musculoskeletal disorders (45.04%), mental disorders (29.10%), neurological disorders (9.82%). Both analytic methods yielded consistent results, showing that TTW participation is effective even after controlling for confounding factors. Personal characteristics (e.g., sex, age, education, race/ethnicity), health and functional status (e.g., work cessation due to health issues, need for alternate sitting arrangements, and limitations in understanding and memory) and environmental factors (e.g., region of residence) influenced Ticket participation.

Conclusions

Our findings offer valuable insights for identifying potential TTW participants and estimating benefit savings for SSDI/SSI programs. Future research should explore available support services and barriers to access to improve TTW outcomes.

Multidisciplinary Team Meeting Significantly Enhances Disease-Free Survival in Stage II-III Rectal Cancer

BACKGROUND

Multidisciplinary team (MDT) meetings have been increasingly recognized for enhancing cancer treatment outcomes; however, their specific impact on stage II-III rectal cancer remains to be fully elucidated.

MATERIALS AND METHODS

This retrospective cohort study investigated the influence of MDT meeting on disease-free survival (DFS) and overall survival (OS) in patients with stage II-III rectal cancer. Propensity score matching (PSM) was used to minimize selection bias. Kaplan-Meier survival analysis and Cox proportional hazards models were used to compare DFS and OS between groups.

RESULTS

A total of 502 patients were included, with 176 whose cases were discussed in MDT meetings and 326 who did not undergo MDT discussions. After PSM, 173 patients were matched in each group. The MDT group exhibited a significantly improved DFS compared to the non-MDT group, both before PSM (HR = 0.618, P = .037) and after PSM (HR = 0.545, P = .012). Subgroup analysis indicated notable benefits of MDT discussions for patients with T3 to 4 tumors, low to mid tumor locations, and node-positive tumors. While there was a trend towards improved OS in the MDT group, this did not reach statistical significance. More MDT group patients received MRI staging and neoadjuvant therapy compared to non-MDT group.

CONCLUSIONS

Discussion in MDT meetings is associated with improved DFS in stage II-III rectal cancer, particularly among patients with locally advanced, low to mid rectal cancer. These findings underscore the importance of incorporating MDT discussions into routine clinical practice to optimize outcomes for rectal cancer patients.

Prevalence of depressive symptoms in nurses compared to the general population based on Propensity Score Matching: A nationwide cross-sectional study in China

BACKGROUND

Depressive symptoms have a series of negative effects and are considered especially severe among nurses, whereas there is a lack of quantitative studies comparing the risk of depressive symptoms between nurses and the general population.

METHODS

We respectively conducted a nationwide cross-sectional online survey among 17,582 Chinese nurses from July to August 2018, and 101,120 Chinese community residents from January to February 2019. The questionnaire covered social-demographic characteristics and depressive symptoms for both, work-related factors and life-related factors for nurses. Propensity Score Matching was performed to match nurses and residents by gender, age, educational level, marital status, and habitual residence.

RESULTS

Before Propensity Score Matching, the risk of depressive symptoms in nurses was higher than residents (OR, 2.16; 95% CI, 2.07-2.26). After matching, there were 15,256 nurses and residents respectively, and the risk in nurses was higher (OR, 2.14; 95% CI, 2.02-2.27). Logistic regression showed that longer years of service (OR, 1.54; 95% CI, 1.30-1.83), higher night shift frequency (OR, 1.48; 95% CI, 1.35-1.64), perceived shortage of nurses (OR, 1.98; 95% CI, 1.84-2.13), suffered verbal violence (OR, 2.43; 95% CI, 2.21-2.66) and physical violence (OR, 1.80; 95% CI, 1.64-1.98) were risk factors for depressive symptoms in nurses.

LIMITATIONS

Convenience sampling and online survey were adopted in this cross-sectional study, which may diminish the representativeness of samples.

CONCLUSIONS

Compared with the general population, nurses have a higher risk of depressive symptoms in China. Reasonable work allocation, adequate staffing, scientific shift system and violence emergency system should be implemented.

Evaluating the speed camera sites selection criteria in the UK

INTRODUCTION

Speed cameras have been implemented to improve road safety over recent decades in the UK. Although the safety impacts of the speed camera have been estimated thoroughly, the criteria for selecting camera sites have rarely been studied. This paper evaluates the current speed camera sites selection criteria in the UK based on safety performance.

METHOD

A total of 332 speed cameras and 2,513 control sites with road traffic accident data are observed from 2002 to 2010. Propensity score matching method and empirical Bayes method are employed and compared to estimate the safety effects of speed cameras under different scenarios.

RESULTS

First, the main characteristics of speed cameras meeting and not meeting the selection criteria are identified. The results indicate that the proximity to school zones and residential neighborhoods, as well as population density, are the main considerations when selecting speed camera sites. Then the official criteria used for selecting camera sites are evaluated, including site length (a stretch of road that has a fixed speed camera or has had one in the past), previous accident history, and risk value (a numerical scale of the risk level). The results suggest that a site length of 500 m should be used to achieve the optimum safety effects of speed cameras. Furthermore, speed cameras are most effective in reducing crashes when the requirement of minimum number of historical killed and seriously injured collisions (KSIs) is met. In terms of the risk value, it is found that the speed cameras can obtain optimal effectiveness with a risk value greater than or equal to 30, rather than the recommended risk value of 22.

Can Medical Consortiums Bridge the Gap in Health Inequity in China? A Propensity Score Matching Analysis

While health is a fundamental right, health inequities between urban and rural residents remain significant in China. Medical consortia aim to bridge this gap by providing equitable and affordable healthcare. However, their effectiveness in enhancing health equity remains underexplored. This study aims to explore whether medical consortia have mitigated health inequity between urban and rural residents. We employed propensity score matching to mitigate selection bias among 9,918 electronic medical records. We focused on two key areas: the effectiveness of medical consortia in reducing healthcare burdens and their influence on health equity, as indicated by the disparities in medical expenses between urban and rural residents. To obtain more detailed insights, we segmented medical expenses into low, medium, and high categories for both urban and rural residents and examined how medical consortia differentially affect health equity across these segments. Moreover, we evaluated whether the differences in referral effects on medical expenses between urban and rural residents can be explained by their varying disease structures and age distributions. We found that medical consortia can significantly reduce the medical burden on populations, but have limitations in improving health equity. The findings highlight a substantial reduction in medical expenses for urban populations. However, no significant reduction was observed in rural populations, with the low-medical-expense group experiencing an increased healthcare burden following the implementation of medical consortia. These findings are robust across various matching methods. Despite reducing healthcare burdens, medical consortia have not equalised health outcomes between urban and rural residents. Significant differences in the disease and age structures exist between urban and rural residents, which may account for the differing causal effects observed between them. Policymakers must prioritise health equity in healthcare reform and consider targeted interventions to address the distinct healthcare challenges of different socioeconomic groups.

Moving to an Activity-Friendly Community Can Increase Physical Activity

BACKGROUND

Creating activity-friendly communities (AFCs) is an important strategy to increase physical activity (PA). While cross-sectional links between community environments and PA are well documented, their causal relationships remain insufficiently explored.

METHODS

Using the accelerometer and survey data collected from adults who moved to an AFC (cases) and similar non-AFC-residing adults who did not move (comparisons), this pre-post, case-comparison study examines if moving to an AFC increases PA. Data came from 115 participants (cases = 37, comparisons = 78) from Austin, Texas, who completed 2 waves of 1-weeklong data collection. Difference-in-difference analyses and fixed-effect models were used to test the significance of the pre-post differences in moderate-to-vigorous PA (MVPA) between cases and comparisons, for the full sample and the subsample of 37 pairs matched in key covariates using the Propensity Score Matching method.

RESULTS

Average treatment effect generated based on Propensity Score Matching and difference-in-difference showed that moving to this AFC led to an average of 10.88 additional minutes of daily MVPA (76.16 weekly minutes, P = .015). Fixed-effect models echoed the result with an increase of 10.39 minutes of daily MVPA after moving to the AFC. We also found that case participants who were less active at baseline and had higher income increased their MVPA more than their counterparts.

CONCLUSIONS

This study showed that, among our study sample, moving to an AFC increased residents' PA significantly when compared to their premove level and the comparison group. This causal evidence suggests the potential of AFCs as sustainable interventions for PA promotion.

Identifying the effect of retail brands on private residential rental prices in Great Britain

This study extends our understanding of the influence of proximity to retail grocery provision on housing rental prices. To achieve this, extensive data on the size and location of retail outlets are combined with neighbourhood rental values for small areas across a two year period, together with varied contextual data for each area. In order to control the influence of many confounding variables in the determination of housing rentals, the technique of propensity score matching is applied. This provides a sophisticated means for the comparison between areas where there is substantial natural variation, rather than manageable controls. For a variety of types of retail brands, only a significant relationship is found between the proximity of a Premium retail outlet and the housing rental value. The findings of this research allow local planning officers to further understand the impact of planning applications on the potential for gentrification and the affordability of neighbouring housing.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10901-021-09904-2.

Trauma risk score matching for observational studies in orthopedic trauma dataset and code

The dataset presented was collected via retrospective review from an orthopedic trauma database approved by the institutional review board at the author's institution from patients treated at any of the four hospitals serviced by the academic orthopedic surgery department. Femoral neck and intertrochanteric hip fracture patients from low energy mechanisms admitted between October 2014 and February 2020, were selected if they were age 55 or older and had recorded sex, body mass index (BMI), Charlson Comorbidity Index (CCI), American Society of Anaesthesiologists (ASA) physical status classification, Glasgow Coma Score, Abbreviated Injury Severity score for the chest, head and neck, and extremities, and ambulation status prior to injury.

The resultant 1,590 subject dataset may be analysed via the supplied R statistical code to determine the frequency of equipoise in baseline and outcome variables from propensity matching via three matching schemes. The code implements three matching schemes including matching by (1) The Score for Trauma Triage in Geriatric and Middle-Aged (STTGMA) (2) CCI alone, or (3) a combination of sex, age, CCI and BMI. The code selects a subset of ten percent of hip fracture patients by a pseudorandom number generator (PRNG). The code matches the remaining patients 1:1 to the selected patients by propensity score generated by logistic regression of STTGMA, CCI, or a combination of sex, age, CCI and BMI using greedy nearest neighbor matching without replacement by the MatchIt package for R software. The code then compares matched cohorts by Chi-square, Fisher, or Mann-Whitney U test with significance level of 0.05 representing a 5% chance of significant differences due to random sampling of subjects.

The supplied code repeats the random selection, matching and testing process 100,000 times for each matching method. The resultant code output is the frequency of significantly different demographic or outcome parameters among matched cohorts by matching method.

This data and statistical code have reuse potential to explore alternative matching schemes. The supplied baseline variables should be robust enough to derive alternative risk scores for each patient which may be included as a matching variable for comparison. The authors also look forward to unexpected ways that this data may be used by readers.

Empowering Expecting Women to Obtain High-Quality Healthcare in Pakistan: An Evaluation of Khyber Pakhtunkhwa's Conditional Cash Transfer Program

Maternal mortality, largely stemming from complications during pregnancy and childbirth, impacts poor expecting women with limited healthcare access in rural Pakistan. Conditional Cash Transfers (CCTs), commonly implemented in developing nations, are designed to improve the well-being of vulnerable populations by focusing on health and education. A CCT initiative named Chief Minister's Special Initiative for Mother and Child Health (CM-SIMCH) was launched in Khyber Pakhtunkhwa (KP), one of the less-developed provinces of Pakistan, to empower expecting women to access quality healthcare. This study investigates the factors influencing CM-SIMCH program participation and assesses its impact on the health of expecting women by analyzing health-seeking hospital visits in KP, Pakistan. The study utilizes the Propensity Score Matching (PSM) technique to analyze cross-sectional data obtained from 303 expecting women residing in the Nowshera district of KP. The PSM allows for a balanced comparison of participants who received the CM-SIMCH transfers with those who did not, assessing its impact on maternal healthcare access and outcomes. Empirical results show that factors such as education and family system positively influence the participation of expecting women in the CM-SIMCH program, whereas travel costs exert a negative effect. The intervention leads to a notable increase in hospital visits among these women, contributing to improved health outcomes in KP. This underscores the program's potential effectiveness in addressing maternal healthcare challenges and enhancing healthcare access for vulnerable women in less-developed areas. Therefore, empirical evidence supports the CM-SIMCH program's potential to promote maternal health and improve healthcare access in KP. The study recommends government intervention in health sector as a strategic imperative to empower women and enhance infant health.

Evaluating the Risk of Comorbidity Onset in Elderly Patients After a Cancer Diagnosis

Background

Cancer is a critical disease that affects a person physically, mentally, socially, and in many other aspects. During the treatment stage of cancer, patients suffer from various health complexities, especially elderly people, which might result in the onset of other diseases development of a comorbid condition. Several studies have shown comorbidity plays a crucial role in cancer survival. However, there remains a lack of comprehensive statistical techniques at the national level studies to assess the significance of comorbidities development in cancer. Our research aims to address this gap by comparing cancer and non-cancer individuals over four years' time period.

Methods

The Health Retirement Study (HRS) data was used to extract information from 6651 participants aged more than 50. Within a 4-year time span, cross-sectional observations were created whether comorbidities or not based on the development of diseases such as high blood pressure, diabetes, heart disease, stroke, lung disease, and psychological disease.

Results

The multivariable logistic regression model, we observe higher chances of developing comorbidity (OR=1.321, p-value 0.0051) among the cancer group compared to the non-cancer group, adjusting the socio-economic factors. Moreover, the socio-economic factors were found to be significantly associated with cancer leading to applying the propensity score matching with (1:3 matching). Finally, the balanced data also showed significantly higher chances of developing comorbidity (OR=1.294, p-value 0.0207) among cancer patients.

Conclusions

The above findings demonstrated the imperative development of enhanced treatment protocols, which prioritize the overall health of cancer patients, thereby reducing their susceptibility to additional illnesses.

Differential clinical outcomes after 3 versus 5 years in a comparison of preoperative chemotherapy with and without radiotherapy in locally advanced rectal cancer: A national cohort propensity score-matched study

Background

Preoperative chemotherapy alone might be a good alternative to preoperative chemoradiotherapy for patients with locally advanced rectal cancer, yet long-term real-world data from the same cohort are lacking.

Methods

Patients diagnosed with stage II-III rectal adenocarcinoma from 2011 to 2015 were randomly sampled from the SEER-Plus database to evaluate the superiority of preoperative chemoradiotherapy versus preoperative chemotherapy alone.

Findings

A total of 1314 eligible patients were enrolled, with a median follow-up of 74.0 months. At 3-year follow-up, neither overall survival (OS) nor cancer-specific survival (CSS) was significantly different between the two treatment groups. At 5-year follow-up, CSS was similar across groups (HR 0.768, 95% CI 0.532-1.108; P = 0.156), but the 5-year OS was significantly better in the preoperative chemoradiotherapy group than in the preoperative chemotherapy group (HR 0.682, 95% CI 0.538-0.866; P = 0.002). Besides, the landmark analysis indicated a direct contrast in the CSS within 3 years (HR 1.101, 95% CI 0.598-2.029; P = 0.756) versus that at 3-5 years (HR 0.597, 95% CI 0.377-0.948; P = 0.027). The landmark analysis also showed directly contrasting OS outcomes within 3 years (HR 0.761, 95% CI 0.533-1.086; P = 0.130) versus those at 3-5 years (HR 0.621, 95% CI 0.451-0.857; P = 0.003).

Interpretation

In patients with locally advanced rectal cancer under real-world treatment practices, the addition of preoperative radiotherapy to chemotherapy improves survival outcomes at 3-5 years' follow-up but not at 3-year follow-up.

Trauma Risk Score Matching for Observational Studies in Orthopedic Trauma

OBJECTIVES

To determine if matching by trauma risk score is non-inferior to matching by chronic comorbidities and/or a combination of demographic and patient characteristics in observational studies of acute trauma in a hip fracture model.

DESIGN

Retrospective cohort study SETTING: Level-1 Trauma Center PATIENTS: 1,590 hip fracture [AO/OTA 31A and 31B] patients age 55 and over treated between October 2014 and February 2020 at 4 hospitals within a single academic medical center.

INTERVENTION

Repeatedly matching randomized subsets of patients by (1) Score for Trauma Triage in Geriatric and Middle-Aged (STTGMA), (2) Charlson Comorbidity Index (CCI), or (3) a combination of sex, age, CCI and body mass index (BMI).

MAIN OUTCOME MEASUREMENTS

"Matching failures" where rate of significant differences in variables of matched cohorts exceeds the 5% expected by chance.

RESULTS

STTGMA and combination matching resulted in no "matching failures". Matching by CCI alone resulted in "matching failures" of BMI, ASA class, STTGMA, major complications, sepsis, pneumonia, acute respiratory failure, and 90-day readmission.

CONCLUSIONS

STTGMA matching in observational cohort studies is less likely to yield significant differences of demographics and outcomes than CCI matching. STTGMA matching is noninferior to matching a combination of demographic variables optimized for each treatment cohort. STTGMA matching is apt to reflect equipoise of health at admission and outcome likelihood in observational cohort studies of orthopedic trauma, while maintaining consistent weighting of demographic and injury characteristic variables that may expand the generalizability of these studies.

LEVEL OF EVIDENCE

Level III.