Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys.

BackgroundInequalities in neonatal mortality rates (NMRs) in low- and middle-income countries show key disparities at the detriment of disadvantaged population subgroups. There is a lack of scholarly evidence on the extent and reasons for the inequalities in NMRs in Angola.ObjectiveThe aim of this study was to assess the socio-economic, place of residence, region and gender inequalities in the NMRs in Angola.MethodsThe World Health Organization Health Equity Assessment Toolkit software was used to analyse data from the 2015 Angola Demographic and Health Survey. Five equity stratifiers: subnational regions, education, wealth, residence and sex were used to disaggregate NMR inequality. Absolute and relative inequality measures, namely, difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio, were calculated to provide a broader understanding of the inequalities in NMR. Statistical significance was calculated at corresponding 95% uncertainty intervals.FindingsWe found significant wealth-driven [PAR = -14.16, 95% corresponding interval (CI): -15.12, -13.19], education-related (PAF = -22.5%, 95% CI: -25.93, -19.23), urban-rural (PAF = -14.5%, 95% CI: -16.38, -12.74), sex-based (PAR = -5.6%, 95% CI: -6.17, -5.10) and subnational regional (PAF = -82.2%, 95% CI: -90.14, -74.41) disparities in NMRs, with higher burden among deprived population subgroups.ConclusionsHigh NMRs were found among male neonates and those born to mothers with no formal education, poor mothers and those living in rural areas and the Benguela region. Interventions aimed at reducing NMRs, should be designed with specific focus on disadvantaged subpopulations

The nature and impact of oral disease of systemic sclerosis

Systemic Sclerosis (SSc) is a multisystem immune-mediated disorder that by virtue of its many possible orofacial features has the potential to adversely affect oral function, impact on oral health care and lessen the quality of life. This thesis has sought to determine the oral and dental consequences of SSc upon a substantial group of affected individuals in the UK. A retrospective analysis of 138 patients with SSc found that the most frequent extra-oral feature was facial skin fibrosis followed by perioral skin tightening, 37% and 35% respectively. Intra-oral features were common, as 73% of patients had microstomia and 47% had xerostomia and generalised chronic periodontitis. An assessment of the online information regarding the treatment of the oral manifestations of SSc found that there are general scarcity of websites providing relevant content with most sites being of poor quality and difficult to read. A cross-sectional observational questionnaire study of the implications of SSc upon the access to dental care services and oral health-related quality of life (OHRQoL) indicated that SSc has a negative impact on general and OHRQoL with a high level of psychological disability that included pain, anxiety and depression. A detailed study of the psychometric properties of the only specific patient-reported outcome measure Mouth Handicap in Systemic Sclerosis (MHISS) in a large group of patients with SSc found that this instrument had good levels of validity and reliability with respect to patients resident in the UK. The results of this thesis indicate that many patients with SSc may have oral manifestations that can potentially impact adversely upon their oral function, ability to maintain good oral health and lessen OHRQoL. They will not be able to obtain reliable, understandable information from the world wide web concerning oral aspects of SSc – although their OHRQoL can be assessed well using the MHISS

It Takes Time:Vigilance and Sustained Attention Assessment in Adults with ADHD

Objectives: The present study compares the utility of eight different tests of vigilance and sustained attention in the neuropsychological examination of adults with Attention-deficit/hyperactivity disorder (ADHD). Methods: Thirty-one adults diagnosed with ADHD performed eight tests for vigilance and sustained attention, spread over three assessment days. Results: Adults with ADHD showed cognitive impairments in most tests and test variables, even though their sensitivity differed greatly. No specific type of test variable stands out to be the most sensitive, and no evidence for a differential deterioration of performance over time was observed. Conclusion: This study underscores the role of vigilance and sustained attention tests in the assessment of adult ADHD. It is further concluded that summary scores over the entire test duration are sufficient, but that all variables of a test should be considered. Finally, we hypothesize that reassessment on a different day may benefit a more accurate clinical assessment of adults with ADHD, in order to adequately take intraindividual fluctuations and limitations regarding test reliability into account

Falsification of Cyber-Physical Systems with Robustness-Guided Black-Box Checking

For exhaustive formal verification, industrial-scale cyber-physical systems (CPSs) are often too large and complex, and lightweight alternatives (e.g., monitoring and testing) have attracted the attention of both industrial practitioners and academic researchers. Falsification is one popular testing method of CPSs utilizing stochastic optimization. In state-of-the-art falsification methods, the result of the previous falsification trials is discarded, and we always try to falsify without any prior knowledge. To concisely memorize such prior information on the CPS model and exploit it, we employ Black-box checking (BBC), which is a combination of automata learning and model checking. Moreover, we enhance BBC using the robust semantics of STL formulas, which is the essential gadget in falsification. Our experiment results suggest that our robustness-guided BBC outperforms a state-of-the-art falsification tool.Comment: Accepted to HSCC 202

Toward a Dimensional Assessment of Externalizing Disorders in Children: Reliability and Validity of a Semi-Structured Parent Interview

Objective This study assesses the reliability and validity of the DSM-5-based, semi-structured Clinical Parent Interview for Externalizing Disorders in Children and Adolescents (ILF-EXTERNAL). Method Participant data were drawn from the ongoing ESCAschool intervention study. The ILF-EXTERNAL was evaluated in a clinical sample of 474 children and adolescents (aged 6-12 years, 92 females) with symptoms of attention-deficit/hyperactivity disorder (ADHD). To obtain interrater reliability, the one-way random-effects, absolute agreement models of the intraclass correlation (ICC) for single ICC(1,1) and average measurements ICC(1,3) were computed between the interviewers and two independent raters for 45 randomly selected interviews involving ten interviewers. Overall agreement on DSM-5 diagnoses was assessed using Fleiss' kappa. Further analyses evaluated internal consistencies, item-total correlations as well as correlations between symptom severity and the degree of functional impairment. Additionally, parents completed the German version of the Child Behavior Checklist (CBCL) and two DSM-5-based parent questionnaires for the assessment of ADHD symptoms and symptoms of disruptive behavior disorders (FBB-ADHS; FBB-SSV), which were used to evaluate convergent and divergent validity. Results ICC coefficients demonstrated very good to excellent interrater reliability on the item and scale level of the ILF-EXTERNAL [scale level: ICC(1,1) = 0.83-0.95; ICC(1,3) = 0.94-0.98]. Overall kappa agreement on DSM-5 diagnoses was substantial to almost perfect for most disorders (0.38 ≤ κ ≤ 0.94). With some exceptions, internal consistencies (0.60 ≤ α ≤ 0.86) and item-total correlations (0.21 ≤ r$_{it}$ ≤ 0.71) were generally satisfactory to good. Furthermore, higher symptom severity was associated with a higher degree of functional impairment. The evaluation of convergent validity revealed positive results regarding clinical judgment and parent ratings (FBB-ADHS; FBB-SSV). Correlations between the ILF-EXTERNAL scales and the CBCL Externalizing Problems were moderate to high. Finally, the ILF-EXTERNAL scales were significantly more strongly associated with the CBCL Externalizing Problems than with the Internalizing Problems, indicating divergent validity. Conclusion In clinically referred, school-age children, the ILF-EXTERNAL demonstrates sound psychometric properties. The ILF-EXTERNAL is a promising clinical interview and contributes to high-quality diagnostics of externalizing disorders in children and adolescents

The importance of familial risk factors in children with ADHD: direct and indirect effects of family adversity, parental psychopathology and parenting practices on externalizing symptoms

Background Children experiencing unfavorable family circumstances have an increased risk of developing externalizing symptoms. The present study examines the direct, indirect and total effects of family adversity, parental psychopathology, and positive and negative parenting practices on symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in children with ADHD. Methods Data from 555 children (M = 8.9 years old, 80.5% boys) who participated in a multicenter study on the treatment of ADHD (ESCAschool) were analyzed using structural equation modeling (SEM). Results The SEM analyses revealed that (a) family adversity and parental psychopathology are associated with both child ADHD and ODD symptoms while negative parenting practices are only related to child ODD symptoms; (b) family adversity is only indirectly associated with child ADHD and ODD symptoms, via parental psychopathology and negative parenting practices; (c) the detrimental effect of negative parenting practices on child ADHD and ODD symptoms is stronger in girls than in boys (multi-sample SEM); (d) there are no significant associations between positive parenting practices and child ADHD or ODD symptoms. Conclusions Family adversity, parental psychopathology, and negative parenting practices should be routinely assessed by clinicians and considered in treatment planning. Trial registration (18th December 2015): German Clinical Trials Register (DRKS) DRKS00008973

The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG)

ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems

Familial Factors in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder (ADHD): Associations With Symptom Severity and Comorbid Symptoms

As the primary, immediate environment of children and adolescents, the family is associated with protective and risk factors for child development, especially child mental health. This familial impact on children’s mental health may be attributable to the transmission of genetic material, the parental shaping of the child’s environment, and the interaction of genetic and environmental factors. One of the most common mental disorders in childhood and adolescence is attention-deficit/hyperactivity disorder (ADHD). This cumulative dissertation presents two studies that examined the associations between several family characteristics and (a) the severity of ADHD symptoms as well as (b) the presence of comorbid oppositional symptoms in children and adolescents with a clinical diagnosis of ADHD. In the first study, a meta-analysis was conducted. A systematic search was run for primary studies that examined associations between various familial factors and child ADHD symptom severity. Suitable primary studies were then quantitatively summarized in a meta-analysis and also qualitatively summarized in a supplemental review. The second study analyzed data from a multicenter intervention study of school-aged children with ADHD (ESCAschool), using structural equation modeling (SEM) to examine the relationships among four familial factors and their respective effects on ADHD and comorbid oppositional symptoms in children. Both studies identified family characteristics that were associated with increased severity of child ADHD symptoms. Additionally, the findings of the second study support the hypothesis that the economic or (psycho-)social burden of families is associated with parental mental health problems and impairments in parenting, and that these adverse family characteristics are in turn related to increased externalizing behaviors in children. The findings of the cumulative dissertation emphasize the importance of familial factors for the mental health of children and adolescents