Having a disability increases the likelihood of food insecurity despite federal programs to prevent this hardship

In 2016, more than 41 million people living in the United States were food insecure. Food insecurity is more pronounced among individuals with disabilities. Work-limiting disability is associated with food insecurity in multiple ways. This research brief shows how such high rates of food insecurity among the disabled population stems from ineffective national policies the many ways in which disabilities increase risk of food insecurity

Global Patterns in Overweight Among Children and Mothers in Less Developed Countries

Objective: Past research has identified increases in national income and urbanization as key drivers of the global obesity epidemic. That work further identified educational attainment and urban residence as important moderators of the effects of national income. However, such work has tended to assume that children and adults respond in the same way to these factors. In the present paper, we evaluate how the socio-economic and country-level factors associated with obesity differ between children and their mothers. Design: We modelled the associations between maternal education, country-level income and urban residence with mother\u27s and children\u27s weight status. Setting We analysed ninety-five nationally representative health and nutrition surveys conducted between 1990 and 2008 from thirty-three less developed countries. Subjects Our sample included children aged 2-4 years (n 253 442) and their mothers (n 228 655). Results Consistent with prior research, we found that mothers\u27 risk of overweight was positively associated with economic development, urban residence and maternal education. Additionally, economic development was associated with steeper increases in mothers\u27 risk of overweight among those with low (v. high) levels of education and among those living in rural (v. urban) areas. However, these associations were different for children. Child overweight was not associated with maternal education and urban residence, and negatively associated with national income. Conclusions: We speculate that the distinctive patterns for children may arise from conditions in low- and middle-income developing countries that increase the risk of child underweight and poor nutrition. © The Authors 2012

The Link Between Health Insurance Coverage and Citizenship Among Immigrants: Bayesian Unit-Level Regression Modeling of Categorical Survey Data Observed with Measurement Error

Social scientists are interested in studying the impact that citizenship status has on health insurance coverage among immigrants in the United States. This can be done using data from the Survey of Income and Program Participation (SIPP); however, two primary challenges emerge. First, statistical models must account for the survey design in some fashion to reduce the risk of bias due to informative sampling. Second, it has been observed that survey respondents misreport citizenship status at nontrivial rates. This too can induce bias within a statistical model. Thus, we propose the use of a weighted pseudo-likelihood mixture of categorical distributions, where the mixture component is determined by the latent true response variable, in order to model the misreported data. We illustrate through an empirical simulation study that this approach can mitigate the two sources of bias attributable to the sample design and misreporting. Importantly, our misreporting model can be further used as a component in a deeper hierarchical model. With this in mind, we conduct an analysis of the relationship between health insurance coverage and citizenship status using data from the SIPP

Legal status and health disparities: An examination of health insurance coverage among the foreign-born

Objective: This paper employs a statistical matching procedure to impute the legal status of foreign-born adults in US Census surveys in order to estimate migration status disparities in health insurance coverage. Methods: Using data from the Survey of Income and Program Participation, we impute the legal/citizenship (migration) status of immigrants in the National Health Interview Survey. Results: Results from the pooled data document disparities in health insurance coverage among four citizen/legal status groups: naturalized citizens, lawful permanent residents, legal nonimmigrants, and unauthorized immigrants. Naturalized citizens had the highest rate of health insurance coverage, followed by legal immigrants, legal nonimmigrants, and unauthorized immigrants. Contribution: The paper presents revised pre-Affordable Care Act (ACA) estimates of health insurance coverage among the foreign-born that are crucial for evaluating the impact of the ACA on reducing or exacerbating disparities in health coverage among migration status groups

Centile charts for birthweight for gestational age for Scottish singleton births

<p>Abstract</p> <p>Background</p> <p>Centile charts of birthweight for gestational age are used to identify low birthweight babies. The charts currently used in Scotland are based on data from the 1970s and require updating given changes in birthweight and in the measurement of gestational age since then.</p> <p>Methods</p> <p>Routinely collected data of 100,133 singleton births occurring in Scotland from 1998–2003 were used to construct new centile charts using the LMS method.</p> <p>Results</p> <p>Centile charts for birthweight for sex and parity groupings were constructed for singleton birth and compared to existing charts used in Scottish hospitals.</p> <p>Conclusion</p> <p>Mean birthweight has been shown to have increased over recent decades. The differences shown between the new and currently used centiles confirm the need for more up-to-date centiles for birthweight for gestational age.</p

Prediction Tools for Unfavourable Outcomes in Clostridium difficile Infection: A Systematic Review

CONTEXT: Identifying patients at risk for adverse outcomes of Clostridium difficile infection (CDI), including recurrence and death, will become increasingly important as novel therapies emerge, which are more effective than traditional approaches but very expensive. Clinical prediction rules (CPRs) can improve the accuracy of medical decision-making. Several CPRs have been developed for CDI, but none has gained a widespread acceptance. METHODS: We systematically reviewed studies describing the derivation or validation of CPRs for unfavourable outcomes of CDI, in medical databases (Medline, Embase, PubMed, Web of Science and Cochrane) and abstracts of conferences. RESULTS: Of 2945 titles and abstracts screened, 13 studies on the derivation of a CPR were identified: two on recurrences, five on complications (including mortality), five on mortality alone and one on response to treatment. Two studies on the validation of different severity indices were also retrieved. Most CPRs were developed as secondary analyses using cohorts assembled for other purposes. CPRs presented several methodological limitations that could explain their limited use in clinical practice. Except for leukocytosis, albumin and age, there was much heterogeneity in the variables used, and most studies were limited by small sample sizes. Eight models used a retrospective design. Only four studies reported the incidence of the outcome of interest, even if this is essential to evaluate the potential usefulness of a model in other populations. Only five studies performed multivariate analyses to adjust for confounders. CONCLUSIONS: The lack of weighing variables, of validation, calibration and measures of reproducibility, the weak validities and performances when assessed, and the absence of sensitivity analyses, all led to suboptimal quality and debatable utility of those CPRs. Evidence-based tools developed through appropriate prospective cohorts would be more valuable for clinicians than empirically-developed CPRs

Early fibrinogen concentrate therapy for major haemorrhage in trauma (E-FIT 1): results from a UK multi-centre, randomised, double blind, placebo-controlled pilot trial.

BACKGROUND: There is increasing interest in the timely administration of concentrated sources of fibrinogen to patients with major traumatic bleeding. Following evaluation of early cryoprecipitate in the CRYOSTAT 1 trial, we explored the use of fibrinogen concentrate, which may have advantages of more rapid administration in acute haemorrhage. The aims of this pragmatic study were to assess the feasibility of fibrinogen concentrate administration within 45 minutes of hospital admission and to quantify efficacy in maintaining fibrinogen levels ≥ 2 g/L during active haemorrhage. METHODS: We conducted a blinded, randomised, placebo-controlled trial at five UK major trauma centres with adult trauma patients with active bleeding who required activation of the major haemorrhage protocol. Participants were randomised to standard major haemorrhage therapy plus 6 g of fibrinogen concentrate or placebo. RESULTS: Twenty-seven of 39 participants (69%; 95% CI, 52-83%) across both arms received the study intervention within 45 minutes of admission. There was some evidence of a difference in the proportion of participants with fibrinogen levels ≥ 2 g/L between arms (p = 0.10). Fibrinogen levels in the fibrinogen concentrate (FgC) arm rose by a mean of 0.9 g/L (SD, 0.5) compared with a reduction of 0.2 g/L (SD, 0.5) in the placebo arm and were significantly higher in the FgC arm (p < 0.0001) at 2 hours. Fibrinogen levels were not different at day 7. Transfusion use and thromboembolic events were similar between arms. All-cause mortality at 28 days was 35.5% (95% CI, 23.8-50.8%) overall, with no difference between arms. CONCLUSIONS: In this trial, early delivery of fibrinogen concentrate within 45 minutes of admission was not feasible. Although evidence points to a key role for fibrinogen in the treatment of major bleeding, researchers need to recognise the challenges of timely delivery in the emergency setting. Future studies must explore barriers to rapid fibrinogen therapy, focusing on methods to reduce time to randomisation, using 'off-the-shelf' fibrinogen therapies (such as extended shelf-life cryoprecipitate held in the emergency department or fibrinogen concentrates with very rapid reconstitution times) and limiting the need for coagulation test-based transfusion triggers. TRIAL REGISTRATION: ISRCTN67540073 . Registered on 5 August 2015