A Core Outcome Set for Pediatric Critical Care

Objectives: More children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs.Design: A two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% “critical” and less than 15% “not important” advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components.Setting: Multinational survey.Patients: Stakeholder participants from six continents representing clinicians, researchers, and family/advocates.Measurements and Main Results: Overall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% “critical” and less than 15% “not important” and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set—extended.Conclusions: The PICU core outcome set and PICU core outcome set—extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families

Health and Financial Fragility: Evidence from Car Crashes and Consumer Bankruptcy

This paper assesses the importance of adverse health shocks as triggers of bankruptcy filings. We view car crashes as a proxy for health shocks and draw on a large sample of police crash reports linked to hospital admission records and bankruptcy case files. We report two findings: (i) there is a strong positive correlation between an individual\u27s pre-shock financial condition and his or her likelihood of suffering a health shock, an example of behavioral consistency; and (ii) after accounting for this simultaneity, we are unable to identify a causal effect of health shocks on bankruptcy filing rates. These findings emphasize the importance of risk heterogeneity in determining financial fragility, raise questions about prior studies of medical bankruptcy, and point to important challenges in identifying the triggers of consumer bankruptcy

Health and Financial Fragility: Evidence from Car Crashes and Consumer Bankruptcy

This paper assesses the importance of adverse health shocks as triggers of bankruptcy filings. We view car crashes as a proxy for health shocks and draw on a large sample of police crash reports linked to hospital admission records and bankruptcy case files. We report two findings: (i) there is a strong positive correlation between an individual\u27s pre-shock financial condition and his or her likelihood of suffering a health shock, an example of behavioral consistency; and (ii) after accounting for this simultaneity, we are unable to identify a causal effect of health shocks on bankruptcy filing rates. These findings emphasize the importance of risk heterogeneity in determining financial fragility, raise questions about prior studies of medical bankruptcy, and point to important challenges in identifying the triggers of consumer bankruptcy

Suicides and Suicide Attempts Following Homicide Victim–Suspect Relationship, Weapon Type, and Presence of Antidepressants

This study used linked, official data for population-based surveillance of homicides, suicides, and homicide–suicides in four U.S. states and four counties. Among 1,503 homicide incidents, less than 5% ( n = 74) were followed by the perpetrator's suicide and 1% ( n = 18) by a nonfatal suicide attempt. However, among men who killed their female intimate partner with a firearm, 59% also took their own life. Homicide–suicide perpetrators did not test positive for an antidepressant more often than other male suicide decedents (15% vs. 19%). Most (54%) perpetrators of nonfirearm homicides who attempted suicide lived; nearly all (93%) firearm perpetrators who attempted suicide died. Among men who killed their female intimate partner with a firearm, homicide–suicide was the norm. Better enforcement of existing laws designed to protect abuse victims by removing firearms from domestic abusers may also prevent abusers' suicides

Rape Myth Acceptance Among College Students in the United States, Japan, and India

Rape myth acceptance is an important determinant of sexual assault behaviors. This study explored country and gender differences in rape myth acceptance among undergraduate students in the United States, Japan, and India. Male and female college students (N = 637) in these three countries participated in a self-administered survey in the fall of 2012 (the United States, n = 206; Japan, n = 215; and India, n = 216). The order of the countries arranged in increasing order of likelihood of disbelieving rape claim was as follows: the United States, Japan, and India. U.S. and Japanese students were less likely to disbelieve rape claims (p < .01) while U.S. students also were less likely to believe that victims are responsible for rape (p < .01). Overall, female participants were less likely to believe in the rape myth acceptance, disbelief of rape claim and victims are responsible for rape (p < .05). Acceptance of rape myth also varied by whether a participant knew about an organization or who do not believe they would seek help for sexual assault. Non-help seeking is associated with rape myth acceptance. This study, which used the same survey and data collection methods, provides comparative information on rape myth acceptance among college students in the United States, Japan, and India, which is not otherwise available, and contributes to providing fundamental knowledge to develop country-specific prevention programs

Incentive delivery timing and follow-up survey completion in a prospective cohort study of injured children: a randomized experiment comparing prepaid and postpaid incentives.

BACKGROUND: Retaining participants over time is a frequent challenge in research studies evaluating long-term health outcomes. This study’s objective was to compare the impact of prepaid and postpaid incentives on response to a six-month follow-up survey. METHODS: We conducted an experiment to compare response between participants randomized to receive either prepaid or postpaid cash card incentives within a multisite study of children under 15 years in age who were hospitalized for a serious, severe, or critical injury. Participants were parents or guardians of enrolled children. The primary outcome was survey response. We also examined whether demographic characteristics were associated with response and if incentive timing influenced the relationship between demographic characteristics and response. We evaluated whether incentive timing was associated with the number of calls needed for contact. RESULTS: The study enrolled 427 children, and parents of 420 children were included in this analysis. Follow-up survey response did not differ according to the assigned treatment arm, with the percentage of parents responding to the survey being 68.1% for the prepaid incentive and 66.7% with the postpaid incentive. Likelihood of response varied by demographics. Spanish-speaking parents and parents with lower income and lower educational attainment were less likely to respond. Parents of Hispanic/Latino children and children with Medicaid insurance were also less likely to respond. We found no relationship between the assigned incentive treatment and the demographics of respondents compared to non-respondents. CONCLUSIONS: Prepaid and postpaid incentives can obtain similar participation in longitudinal pediatric critical care outcomes research. Incentives alone do not ensure retention of all demographic subgroups. Strategies for improving representation of hard-to-reach populations are needed to address health disparities and ensure the generalizability of studies using these results. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12874-021-01421-8