The impact of uncertain precipitation data on insurance loss estimates using a flood catastrophe model

Catastrophe risk models used by the insurance industry are likely subject to significant uncertainty, but due to their proprietary nature and strict licensing conditions they are not available for experimentation. In addition, even if such experiments were conducted, these would not be repeatable by other researchers because commercial confidentiality issues prevent the details of proprietary catastrophe model structures from being described in public domain documents. However, such experimentation is urgently required to improve decision making in both insurance and reinsurance markets. In this paper we therefore construct our own catastrophe risk model for flooding in Dublin, Ireland, in order to assess the impact of typical precipitation data uncertainty on loss predictions. As we consider only a city region rather than a whole territory and have access to detailed data and computing resources typically unavailable to industry modellers, our model is significantly more detailed than most commercial products. The model consists of four components, a stochastic rainfall module, a hydrological and hydraulic flood hazard module, a vulnerability module, and a financial loss module. Using these we undertake a series of simulations to test the impact of driving the stochastic event generator with four different rainfall data sets: ground gauge data, gauge-corrected rainfall radar, meteorological reanalysis data (European Centre for Medium-Range Weather Forecasts Reanalysis-Interim; ERA-Interim) and a satellite rainfall product (The Climate Prediction Center morphing method; CMORPH). Catastrophe models are unusual because they use the upper three components of the modelling chain to generate a large synthetic database of unobserved and severe loss-driving events for which estimated losses are calculated. We find the loss estimates to be more sensitive to uncertainties propagated from the driving precipitation data sets than to other uncertainties in the hazard and vulnerability modules, suggesting that the range of uncertainty within catastrophe model structures may be greater than commonly believed

Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: Systematic review and meta-regression

Objective: To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings. Methods: The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa-Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates. Results: Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. Conclusions: The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented

The effectiveness of public health interventions to reduce the health impact of climate change:a systematic review of systematic reviews

Climate change is likely to be one of the most important threats to public health in the coming years. Yet despite the large number of papers considering the health impact of climate change, few have considered what public health interventions may be of most value in reducing the disease burden. We aimed to evaluate the effectiveness of public health interventions to reduce the disease burden of high priority climate sensitive diseases

Death within 8 years after childhood convulsive status epilepticus:a population-based study

The risk of long-term mortality and its predictors following convulsive status epilepticus in childhood are uncertain. We report mortality within 8 years after an episode of convulsive status epilepticus, and investigate its predictors from a paediatric, prospective, population-based study from north London, UK. In the current study, we followed-up a cohort previously ascertained during a surveillance study of convulsive status epilepticus in childhood. After determining the survival status of the cohort members, we defined cause of death as that listed on their death certificates. We estimated a standardized mortality ratio to compare mortality in our cohort with that expected in the reference population. Multivariable Cox regression analysis was used to investigate any association between the clinical and demographic factors at the time of status epilepticus and subsequent risk of death. The overall case fatality was 11% (95% confidence interval 7.5–16.2%); seven children died within 30 days of their episode of convulsive status epilepticus and 16 during follow-up. The overall mortality in our cohort was 46 times greater than expected in the reference population, and was predominantly due to higher mortality in children who had pre-existing clinically significant neurological impairments when they had their acute episode of convulsive status epilepticus. Children without prior neurological impairment who survived their acute episode of convulsive status epilepticus were not at a significantly increased risk of death during follow-up. There were no deaths in children following prolonged febrile convulsions and idiopathic convulsive status epilepticus. A quarter of deaths during follow-up were associated with intractable seizures/convulsive status epilepticus, and the rest died as a complication of their underlying medical condition. On regression analysis, presence of clinically significant neurological impairments prior to convulsive status epilepticus was the only independent risk factor for mortality. In conclusion, there is a high risk of death within 8 years following childhood convulsive status epilepticus but most deaths are not seizure related. Presence of pre-existing clinically significant neurological impairments at the time of convulsive status epilepticus is the main risk factor for mortality within 8 years after the acute episode. The attributable role of convulsive status epilepticus on mortality remains uncertain, but appears less than is generally perceived

Quality and Safety Aspects of Infant Nutrition

Quality and safety aspects of infant nutrition are of key importance for child health, but oftentimes they do not get much attention by health care professionals whose interest tends to focus on functional benefits of early nutrition. Unbalanced diets and harmful food components induce particularly high risks for untoward effects in infants because of their rapid growth, high nutrient needs, and their typical dependence on only one or few foods during the first months of life. The concepts, standards and practices that relate to infant food quality and safety were discussed at a scientific workshop organized by the Child Health Foundation and the Early Nutrition Academy jointly with the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, and a summary is provided here. The participants reviewed past and current issues on quality and safety, the role of different stakeholders, and recommendations to avert future issues. It was concluded that a high level of quality and safety is currently achieved, but this is no reason for complacency. The food industry carries the primary responsibility for the safety and suitability of their products, including the quality of composition, raw materials and production processes. Introduction of new or modified products should be preceded by a thorough science based review of suitability and safety by an independent authority. Food safety events should be managed on an international basis. Global collaboration of food producers, food-safety authorities, paediatricians and scientists is needed to efficiently exchange information and to best protect public health. Copyright (C) 2012 S. Karger AG, Base

Sudden sex hormone withdrawal and the effects on body composition in late pubertal adolescents with gender dysphoria

Background: Sex hormones initiate profound physical and physiological changes during the pubertal process, but to what extent are they responsible for continuing the body composition changes of late adolescence and what happens to body composition on sudden sex hormone withdrawal? / Methods: Thirty-six healthy, phenotypically and chromosomally normal late and post-pubertal individuals aged 15–17 years with gender dysphoria (transgirls – birth-registered males identifying as female n = 11; and transboys – birth-registered females identifying as male n = 25) underwent Tanita body composition analysis at 0, 6 and 12 months during reproductive hormone suppression with Triptorelin as part of the standard therapeutic protocol. / Results and conclusions: In the transgirl cohort, paired t-test analysis demonstrated a significant decrease in height and lean mass standard deviation scores over the 12-month period, going against an expected trajectory over that time. In contrast, oestrogen suppression appeared not to affect the body composition of transboys; their measurements were not significantly different at baseline and after 12 months of treatment. The withdrawal of sex hormone secretion does not appear to have a significant impact on female post-pubertal body composition, in contrast to that seen at the menopause. This suggests that other factors may preserve normal body balance in adolescents in the absence of sex steroids

Interventions to Improve Breastfeeding Outcomes in Late Preterm and Early Term Infants

BACKGROUND: Late preterm infants (LPIs; born at 340/7 to 366/7 gestational weeks) and early term infants (ETIs; 370/7 to 386/7 gestational weeks) are at higher risk of morbidity and mortality compared with more mature infants. Breastfeeding can reduce these risks, but feeding difficulties are common among these infants and breastfeeding rates are low. We conducted a systematic review to identify the interventions available to improve any breastfeeding, exclusive breastfeeding, or breast milk yield. METHODS: A literature search was performed up to February 23, 2022, using MEDLINE, CINAHL, Embase, and Google Scholar, and nine articles were included. Only one article was a randomized controlled trial, and only one included ETIs. The remaining articles were quasi-experimental and included only LPIs. Outcomes included breastfeeding duration, breastfeeding exclusivity, and/or breast milk production (volume) before 6 months actual age. RESULTS: Professional support significantly improved exclusive breastfeeding rates. A breastfeeding education program delivered at the hospital with weekly telephone follow-up postdischarge significantly increased breastfeeding rates. Neither cup feeding nor early discharge (with in-home lactation support) improved breastfeeding rates, whereas rooming-in (versus direct admission to the neonatal intensive care unit) worsened exclusive breastfeeding rates. DISCUSSION: This is the first systematic review to identify interventions available for both LPIs and ETIs. Overall, there are limited studies that investigate interventions promoting breastfeeding in these populations. However, breastfeeding support delivered by health care professionals seems to improve breastfeeding rates. The main limitations are the lack of randomization, blinding, and adjustment for confounding variables. Experimental studies with robust methodological design are needed

Human milk feeding and cognitive outcome in preterm infants: the role of infection and NEC reduction

BACKGROUND: Breast milk has been associated with lower risk of infection and necrotising enterocolitis (NEC) and improved long-term cognitive outcomes in preterm infants but, if unsupplemented, does not meet the nutritional requirements of preterm infants. METHODS: Preterm infants were randomised to receive a high nutrient intervention diet: preterm formula (PTF) or the standard diet: term formula (TF) or banked donor breast milk (BBM), either as their sole diet or as supplement to maternal breast milk (MBM). IQ tests were performed at ages 7, 15, 20, and 30 years. RESULTS: An increase in MBM and BBM intake was associated with a lower chance of neonatal infection/NEC. Neonatal infection/NEC was associated with lower Full Scale IQ (FSIQ) and Performance IQ (PIQ) score at ages 7 and 30 years. The relationship between higher intake of MBM and PIQ at age 7 years was partly mediated by neonatal infection/NEC. The intervention diet was associated with higher Verbal IQ (VIQ) scores compared to the standard diet. There was no evidence that these effects changed from childhood through to adulthood. CONCLUSIONS: Neonatal diet is an important modifiable factor that can affect long-term cognitive outcome through a 'human milk' factor, protecting against infection/NEC, and a 'nutrient content' factor. IMPACT: This is the first study to demonstrate the effects of neonatal infection/necrotising enterocolitis (NEC) on IQ in the same cohort in childhood and adulthood. Diet can be a key factor in long-term cognitive outcome in people born preterm by preventing neonatal infection/NEC and providing adequate nutrients. Human milk, whether MBM or BBM, is associated with a reduced risk of infection/NEC. A higher nutrient diet is associated with better cognitive outcome in childhood. Performance IQ is particularly vulnerable to the effects of infection/NEC and verbal IQ to the quantity of (macro)nutrients in the diet

Staff satisfaction and organisational performance : evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data

Background: The search for causal links between human resource management (HRM) and organisational performance has dominated academic and practitioner debates for many years. However, much of this work comes from contexts outside health care and/or the UK. Objectives: This study tested the later stages of a well-established HRM model, testing whether or not there was evidence of causal links between staff experience and intermediate (staff) and final (patient and organisational) outcomes, and whether or not these differed in parts of the NHS. We used large-scale longitudinal secondary data sets in order to answer these questions in a thorough way. Data sources: Searches were conducted using Health Management Information Consortium, MEDLINE, PsycINFO, Social Sciences Citation Index and EBSCOhost (from inception to May 2012). Methods: Staff experience data came from the national NHS staff surveys of 2009, 2010 and 2011, with trust-level measures of staff absenteeism, turnover, patient satisfaction, mortality and infection rates gathered from the same NHS years. Several analytical methods were used, including multilevel analysis, mediated regression, latent growth curve modelling and cross-lagged correlation analysis. Results: In general, the pattern was that better staff experiences are associated with better outcomes for employees and patients. Multilevel analysis found that the positive effects of staff perceiving equal opportunities on employee outcomes were especially strong, as were the negative effects of aggression and discrimination. Organisational-level analysis showed that better staff experiences (particularly those associated with better well-being and better job design, and more positive attitudes about the organisation generally) were linked to lower levels of absenteeism and greater patient satisfaction. There was some evidence that the relationship with absenteeism is causal, although the causal link with patient satisfaction was less clear-cut. Some relationships between staff experience and turnover, and some between staff experience and patient mortality, were also found (and a few with infection rates), with longitudinal analysis comparatively unclear about the direction of causality. Although many staff experiences were associated with absenteeism and patient satisfaction, these effects were not mediated and the reason staff experiences are linked to patient satisfaction appears to be separate from the link with absenteeism. In general, there is no single group of staff (or geographical region) for which staff experiences are the most important. However, nurses’ experiences generally had the strongest effects on absenteeism, followed by medical/dental staff. Few clear or explainable patterns for other staff group effects were found. Absenteeism was most readily predicted by staff experience in the West Midlands. Two Action Learning Sets of managers, and patient and public involvement representatives broadly supported the emerging findings of the factors that seemed to be important indicators of staff satisfaction and organisational outcomes. Limitations: The relatively blunt nature of the data used meant that conclusions about the direction of causality were less clear. More specific limitations included that we had to limit outcome variables to those that were available already, that many variables were available for acute trusts, and that we could not break down data further within trusts or years. Conclusions: Overall, the research confirmed many expected links between staff experiences and outcomes, providing support for that part of the overall HRM model in the NHS. However, conclusions about the direction of causality were less clear (except for absenteeism). This is probably due in part to the relatively blunt nature of the data used. Future research may involve the careful evaluation of interventions designed to improve staff experience on more specific groups of staff, and the continued use of secondary data sources, such as those used in this report, to answer more specific, theoretically driven questions