Community Influences on Schooling and Work Activity of Youth in Pakistan

The schooling and work activities of youth remain fundamental to their human capital development. Yet we have limited understanding of factors influencing these activities in Pakistan and elsewhere. The bulk of research on children’s work and schooling looks primarily to household-level factors to explain current rates. As such, activities’ of youth are viewed as a product of family strategies for confronting poverty. On the other hand, the influences at the community level on work and schooling of youth have received relatively little attention and remain largely undeveloped in the literature. Further, work and schooling activities remain are usually investigated separately in the analyses. Most studies focus on either the work activities or schooling of youth, despite recent appeals to examine these activities simultaneously [DeGraff, Bilsborrow and Herrin (1993); Mahmood, Javaid and Baig (1994) and Weiner and Noman (1997)]. The purpose of this paper is to assess the participation of youth in work and schooling activities and the way household and community factors shape these activities. I address two central research questions in this paper. First, what is the distribution of Pakistani youth in work and schooling activities? Second, what factors influence the likelihood that youth engage in work and/or schooling? Particularly, what is the influence of community-level factors (specifically, availability of schools, wage returns to education, and infrastructure development) on the activities of youth?

Greater investments in children through women\u27s empowerment: A key to demographic change in Pakistan?

Women’s status has received considerable attention as a significant factor in demographic behavior and outcomes in South Asia however, little research has addressed the links between women’s status and their investments in children. In this paper, we empirically investigate how women’s status on multiple levels is associated with demographic outcomes. Using data from the Pakistan Status of Women and Fertility Survey in rural Punjab, we confirm that empowered women, or those with higher status, are better able to make positive investments in their children, thus increasing their children’s chances of survival during infancy and increasing their likelihood of ever attending school. It is in examining these two outcomes in combination that the multiple dimensions of women’s status at the micro and macro levels become most apparent. Overall, the data support our hypotheses that improvements in women’s status at the individual level, particularly in terms of improvement of women’s position within the household, will enhance child survival, whereas improvements in women’s status at the more general community level will improve the schooling chances of children, especially girls. Specifically, higher levels of women’s status at the individual level, particularly in terms of access to financial resources and the absence of purdah restriction and physical abuse by husbands, are associated with a lower likelihood of infant mortality. On the other hand, higher mean levels of women’s mobility and lower levels of fear of disagreeing with husbands in a community are associated with a higher likelihood that children, especially girls, will ever attend school

In silico validation of the autoinflammatory disease damage index

Introduction Autoinflammatory diseases can cause irreversible tissue damage due to systemic inflammation. Recently, the Autoinflammatory Disease Damage Index (ADDI) was developed. The ADDI is the first instrument to quantify damage in familial Mediterranean fever, cryopyrin-associated periodic syndromes, mevalonate kinase deficiency and tumour necrosis factor receptor-associated periodic syndrome. The aim of this study was to validate this tool for its intended use in a clinical/research setting. Methods The ADDI was scored on paper clinical cases by at least three physicians per case, independently of each other. Face and content validity were assessed by requesting comments on the ADDI. Reliability was tested by calculating the intraclass correlation coefficient (ICC) using an â observer-nested-within-subject\u27 design. Construct validity was determined by correlating the ADDI score to the Physician Global Assessment (PGA) of damage and disease activity. Redundancy of individual items was determined with Cronbach\u27s alpha. Results The ADDI was validated on a total of 110 paper clinical cases by 37 experts in autoinflammatory diseases. This yielded an ICC of 0.84 (95% CI 0.78 to 0.89). The ADDI score correlated strongly with PGA-damage (r=0.92, 95% CI 0.88 to 0.95) and was not strongly influenced by disease activity (r=0.395, 95% CI 0.21 to 0.55). After comments from disease experts, some item definitions were refined. The interitem correlation in all different categories was lower than 0.7, indicating that there was no redundancy between individual damage items. Conclusion The ADDI is a reliable and valid instrument to quantify damage in individual patients and can be used to compare disease outcomes in clinical studies

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Leveraging longitudinal data in developing countries /

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In silico validation of the autoinflammatory disease damage index

Introduction Autoinflammatory diseases can cause irreversible tissue damage due to systemic inflammation. Recently, the Autoinflammatory Disease Damage Index (ADDI) was developed. The ADDI is the first instrument to quantify damage in familial Mediterranean fever, cryopyrin-associated periodic syndromes, mevalonate kinase deficiency and tumour necrosis factor receptor-associated periodic syndrome. The aim of this study was to validate this tool for its intended use in a clinical/research setting. Methods The ADDI was scored on paper clinical cases by at least three physicians per case, independently of each other. Face and content validity were assessed by requesting comments on the ADDI. Reliability was tested by calculating the intraclass correlation coefficient (ICC) using an â observer-nested-within-subject' design. Construct validity was determined by correlating the ADDI score to the Physician Global Assessment (PGA) of damage and disease activity. Redundancy of individual items was determined with Cronbach's alpha. Results The ADDI was validated on a total of 110 paper clinical cases by 37 experts in autoinflammatory diseases. This yielded an ICC of 0.84 (95% CI 0.78 to 0.89). The ADDI score correlated strongly with PGA-damage (r=0.92, 95% CI 0.88 to 0.95) and was not strongly influenced by disease activity (r=0.395, 95% CI 0.21 to 0.55). After comments from disease experts, some item definitions were refined. The interitem correlation in all different categories was lower than 0.7, indicating that there was no redundancy between individual damage items. Conclusion The ADDI is a reliable and valid instrument to quantify damage in individual patients and can be used to compare disease outcomes in clinical studies. © 2018 Author(s) (or their employer(s)