Statistical review of Hydroxychloroquine in patients with COVID-19 : an open-label, randomized, controlled trial

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Environmental and developmental determinants of obesity in Cebu, Philippines

Obesity is now recognized as a serious challenge to global public health. Obesity is often viewed as a problem that results from a deficiency in a person's character; that obesity is the consequence of gluttony and sloth. However, obesity is impacted by a variety of factors that are largely exogenous to human choices. We investigated both how shared environment and individual level socio-economic status influence obesity risk, as well as how prenatal characteristics can increase human susceptibility to the obesogenic effects of modern environments before we are even born. Analyses were conducted using data from the Cebu Longitudinal Health and Nutrition Survey, a community based study of a one year birth cohort (1983) followed up until young adulthood (2005). Using the spatial scan statistic we found that measures of overweight and obesity were spatially clustered in the study area Metro Cebu. The locations of these clusters coincided with the urban core of Cebu, but also extended into peri-urban and rural areas as well. Clustering in the males was largely explained by the spatial distribution of individual level socio-economic status. We then used multivariable linear models to explore the joint impact of community level urbanicity and multiple indicators of individual level socio-economic status on multiple measures of overweight and obesity. We found that socioeconomic status was positively associated with obesity in males but not females. Lastly, we tested the mismatch hypothesis, which generally posits that maternal constraint of fetal growth can lead to developmental changes in utero that increase an individual's susceptibility to obesogenic environments. More specifically, we found that that the positive association between socio-economic status and central adiposity in male study participants was amplified in firstborns. This research helps fill an important gap in understanding how socio-environmental conditions can influence obesity in a lower-income, rapidly developing context. We also provide one of the earliest explicit tests of the mismatch hypothesis with respect to birth order. The public health consequences of these associations could become critical as obesogenic environments become more common, and the proportion of lower order pregnancies among humans increases

Statistical review of Remdesivir in adults with severe COVID-19 : a randomised, double-blind, placebo-controlled, multicentre trial

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Adverse childhood experiences (ACEs) and later-life depression: perceived social support as a potential protective factor.

OBJECTIVE: To investigate associations between adverse childhood experiences (ACEs) and later-life depressive symptoms; and to explore whether perceived social support (PSS) moderates these. METHOD: We analysed baseline data from the Mitchelstown (Ireland) 2010-2011 cohort of 2047 men and women aged 50-69 years. Self-reported measures included ACEs (Centre for Disease Control ACE questionnaire), PSS (Oslo Social Support Scale) and depressive symptoms (CES-D). The primary exposure was self-report of at least one ACE. We also investigated the effects of ACE exposure by ACE scores and ACE subtypes abuse, neglect and household dysfunction. Associations between each of these exposures and depressive symptoms were estimated using logistic regression, adjusted for socio-demographic factors. We tested whether the estimated associations varied across levels of PSS (poor, moderate and strong). RESULTS: 23.7% of participants reported at least one ACE (95% CI 21.9% to 25.6%). ACE exposures (overall, subtype or ACE scores) were associated with a higher odds of depressive symptoms, but only among individuals with poor PSS. Exposure to any ACE (vs none) was associated with almost three times the odds of depressive symptoms (adjusted OR 2.85; 95% CI 1.64 to 4.95) among individuals reporting poor PSS, while among those reporting moderate and strong PSS, the adjusted ORs were 2.21 (95% CI 1.52 to 3.22) and 1.39 (95% CI 0.85 to 2.29), respectively. This pattern of results was similar when exposures were based on ACE subtype and ACE scores, though the interaction was clearly strongest among those reporting abuse. CONCLUSIONS: ACEs are common among older adults in Ireland and are associated with higher odds of later-life depressive symptoms, particularly among those with poor PSS. Interventions that enhance social support, or possibly perceptions of social support, may help reduce the burden of depression in older populations with ACE exposure, particularly in those reporting abuse

Quantifying the urban environment: A scale measure of urbanicity outperforms the urban–rural dichotomy

The rapid urbanization of the developing world has important consequences for human health. Although several authorities have called for better research on the relationships between urbanicity and health, most researchers still use a poor measurement of urbanicity, the urban-rural dichotomy. Our goal was to construct a scale of urbanicity using community level data from the Cebu Longitudinal Health and Nutrition Survey. We used established scale development methods to validate the new measure and tested its performance against the dichotomy. The new scale illustrated misclassification by the urban-rural dichotomy, and was able to detect differences in urbanicity, both between communities and across time, that were not apparent before. Furthermore, using a continuous measure of urbanicity allowed for better illustrations of the relationships between urbanicity and health. The new scale is a better measure of urbanicity than the traditionally used urban-rural dichotomy

Positive lifestyle changes around the time of pregnancy:a cross-sectional study

OBJECTIVES: To examine the prevalence of positive lifestyle behaviours before and during pregnancy in Ireland. DESIGN: Cross-sectional study. SETTING: Population-based study in Ireland. PARTICIPANTS: A total of 718 women of predominantly Caucasian origin from the Pregnancy Risk Assessment Monitoring System (PRAMS), Ireland, were included. PRIMARY AND SECONDARY OUTCOME MEASURES Positive lifestyle behaviour changes before and during pregnancy in Ireland on alcohol consumption, smoking, folate use and nutrition. RESULTS: Of 1212 women surveyed, 718 (59%) responded. 26% were adherent to all three recommendations on alcohol consumption, smoking and folate use before pregnancy. This increased to 39% for the same three behaviours during pregnancy, with greater increases in adherence observed among women with the lowest adherence before pregnancy. Age, education and ethnicity gaps in adherence before pregnancy appeared to narrow during pregnancy. Adherence to all seven food pyramid guidelines was less than 1% overall, and less than 1% of participants met all four micronutrient guidelines on vitamin D, folate, calcium and iron intake around the time of pregnancy. CONCLUSIONS: Low levels of healthy lifestyle behaviours before pregnancy and low levels of positive lifestyle behaviours during pregnancy demonstrate an urgent need for increased clinical and public health efforts to target deleterious health behaviours before, during and after pregnancy

Embedding key word sign prompts in a shared book reading activity: The impact on communication between children with Down syndrome and their parents

Background: Children with Down syndrome have speech and language difficulties that are disproportionate to their overall intellectual ability and relative strengths in the use of gesture. Shared book reading between parents and their children provides an effective context in which language development can be facilitated. However, children with Down syndrome often take a passive role in shared book reading and the use of key word signing (KWS) as a shared book reading technique has never been investigated. Aims: This study aimed to compare children with Down syndrome's participation and use of KWS across two methods of shared book reading – one in which a book had key-word sign prompts embedded (signed condition) and the other in which a book was read as normal (unsigned condition). Measures of child and parent communicative behaviour were taken in each condition to establish if differences emerged. Methods & Procedures: A total of 36 children with Down syndrome (aged between 18 and 61 months) and their mothers took part in the study. Parent–child dyads were videoed at home reading two books, one in a signed and one in an unsigned condition. Child measures included total number of signs produced in each condition and levels of attention and initiation as measured by the Pivotal Behaviour Rating Scale. Parent measures included total number of utterances, mean length of utterance (MLU) in morphemes and vocabulary diversity (VOCD). Parental measures were transcribed using the Codes for Human Analysis Transcripts (CHAT) software and analysed by the Computerised Language Analysis software (CLAN). Contrasts in outcomes between the signed and unsigned conditions were estimated using Poisson and linear mixed-effects models, determined by the type of data. Outcomes & Results: Results showed that children attempted to sign significantly more in the signed than unsigned condition, as well as showing significant increases in their levels of attention and initiation. There was also a significant increase in the total number of utterances used by parents in the signed versus unsigned condition and a decrease in MLU. VOCD was similar in both conditions. Conclusions & Implications: This study shows that the simple act of embedding key word signs into commercially available books, during shared book reading between parents and young children with Down syndrome, positively affects children's participation (initiation and attention) and use of KWS. The use of KWS as a core shared book reading technique may therefore be a fruitful avenue to facilitate growth in the language abilities of young children with Down syndrome

A person-centred analysis of the time-use, daily activities and health-related quality of life of Irish school-going late adolescents

Purpose: The health, well-being and quality of life of the world’s 1.2 billion adolescents are global priorities. A focus on their patterns or profiles of time-use and how these relate to health-related quality of life (HRQoL) may help to enhance their well-being and address the increasing burden of non-communicable diseases in adulthood. This study sought to establish whether distinct profiles of adolescent 24-h time-use exist and to examine the relationship of any identified profiles to self-reported HRQoL.Method: This cross-sectional study gathered data from a random sample of 731 adolescents (response rate 52 %) from 28 schools (response rate 76 %) across Cork city and county. A person-centred approach, latent profile analysis, was used to examine adolescent 24-h time-use and relate the identified profiles to HRQoL.Results: Three male profiles emerged, namely productive, high leisure and all-rounder. Two female profiles, higher study/lower leisure and moderate study/higher leisure, were identified. The quantitative and qualitative differences in male and female profiles support the gendered nature of adolescent time-use. No unifying trends emerged in the analysis of probable responses in the HRQoL domains across profiles. Females in the moderate study/higher leisure group were twice as likely to have above-average global HRQoL.Conclusion: Distinct time-use profiles can be identified amongst adolescents, but their relationship with HRQoL is complex. Rich mixed-method research is required to illuminate our understanding of how quantities and qualities of time-use shape lifestyle patterns and how these can enhance the HRQoL of adolescents in the twenty-first century

Happy Talk: A pilot effectiveness study of a targeted-selective speechâ language and communication intervention for children from areas of social disadvantage

Background: Despite the public health implications of language difficulties associated with social disadvantage, there is a dearth of effectiveness studies investigating the effects of targeted speech and language programmes in this area. Aims: To determine the effects of a targeted selective community-based child language intervention programme (Happy Talk), which simultaneously engaged with parents and early childhood educators, in the Republic of Ireland. Methods & Procedures: A mixed methods methodology was applied with quantitative outcome and qualitative process data collected. Effectiveness was examined using a quasi-experimental single blind study design comparing Happy Talk with ‘usual care’ across four preschools. Qualitative process data were also gathered to examine the acceptability and feasibility of the Happy Talk approach in practice, and to identify factors to improve the probability of successful wider implementation. Child language (PLS-5) and quality-of-life measures were administered pre- and immediately post- the 11-week intervention. Responsiveness was assessed as the parental outcome, and the oral language environment of preschools was measured using the Communication Supporting Classroom Observation Tool (CSCOT). Retrospective acceptability was analysed with reference to the theoretical framework of acceptability (v 2). Outcomes & Results: Pre-/post-expressive and composite language scores were collected for 58 children, and receptive scores for 54 children. Multiple linear regression revealed significant intervention effects for comprehension and total language with large and moderate effect sizes, respectively (0.60 and 0.46 SD). No significant effect was shown for parental responsiveness. No effects were found for the preschool environment or children's quality of life. Preschool staff deemed the programme to be an acceptable method of enhancing children's speech and language skills and rated the intervention positively. Conclusions & Implications: The Happy Talk pilot effectiveness trial shows that comprehension can be improved (with a large effect) in preschool children from areas of social disadvantage, following an 11-week intervention, in which parents and preschool staff are simultaneously engaged. The ecological validity of the programme, as well as feasibility and acceptability to staff, make it a suitable programme to be delivered at scale

Predicting 1‐year mortality in older hospitalized patients: external validation of the HOMR Model

Objectives: Accurate prognostic information can enable patients and physicians to make better healthcare decisions. The Hospital‐patient One‐year Mortality Risk (HOMR) model accurately predicted mortality risk (concordance [C] statistic = .92) in adult hospitalized patients in a recent study in North America. We evaluated the performance of the HOMR model in a population of older inpatients in a large teaching hospital in Ireland. Design: Retrospective cohort study. Setting: Acute hospital. Participants: Patients aged 65 years or older cared for by inpatient geriatric medicine services from January 1, 2013, to March 6, 2015 (n = 1654). After excluding those who died during the index hospitalization (n = 206) and those with missing data (n = 39), the analytical sample included 1409 patients. Measurements: Administrative data and information abstracted from hospital discharge reports were used to determine covariate values for each patient. One‐year mortality was determined from the hospital information system, local registries, or by contacting the patient's general practitioner. The linear predictor for each patient was calculated, and performance of the model was evaluated in terms of its overall performance, discrimination, and calibration. Recalibrated and revised models were also estimated and evaluated. Results: One‐year mortality rate after hospital discharge in this patient cohort was 18.6%. The unadjusted HOMR model had good discrimination (C statistic = .78; 95% confidence interval = .76‐.81) but was poorly calibrated and consistently overestimated mortality prediction. The model's performance was modestly improved by recalibration and revision (optimism corrected C statistic = .8). Conclusion: The superior discriminative performance of the HOMR model reported previously was substantially attenuated in its application to our cohort of older hospitalized patients, who represent a specific subset of the original derivation cohort. Updating methods improved its performance in our cohort, but further validation, refinement, and clinical impact studies are required before use in routine clinical practice