Alyce Raybould, Karen Dennison, Orla McBride
et al.
Public engagement is an important mechanism for ensuring that the voices of the public are integrated into study design and data use. The commissioning of a new UK-wide birth cohort study by the UKRI Economic and Social Research Council (ESRC), the Early Life Cohort Feasibility Study (ELC-FS), necessitated renewed dialogue with the public about the acceptability of conducting a large-scale study of this kind. The ELC-FS recruited several thousand children in their first year of life, using an administrative data sampling frame, an `opt-out' recruitment approach, and embedded linkages to education, health and social care administrative data. The study faced many complexities and challenges to achieve this: the sampling frame had not been used for this purpose before, required negotiation with different data holders in the four UK nations, and the study needed to ensure transparency around how participants' administrative and survey data would be used. Conducting public engagement projects with parents of young children prior to the study's fieldwork was essential to understanding more about the public acceptability of data use in ELC-FS. Evidence from these projects was used to support negotiations with data holders, as well as in guiding best practice for informing participants about their data use and data linkage. This paper summarises the evidence from these public engagement projects relating to data transparency and enacting participant choice and control of the use of their data in the study. We describe how this evidence was implemented in three key study design areas: sampling and recruitment, the collection and use of survey data, and seeking participant consent to link administrative records to individual-level survey data. We also present evidence from the study's fieldwork about participants' acceptability of the survey design and transparency around data use, from recruitment to data collection and processing.
Intraoperative monitoring and prediction of vital signs are critical for ensuring patient safety and improving surgical outcomes. Despite recent advances in deep learning models for medical time-series forecasting, several challenges persist, including the lack of standardized benchmarks, incomplete data, and limited cross-center validation. To address these challenges, we introduce VitalBench, a novel benchmark specifically designed for intraoperative vital sign prediction. VitalBench includes data from over 4,000 surgeries across two independent medical centers, offering three evaluation tracks: complete data, incomplete data, and cross-center generalization. This framework reflects the real-world complexities of clinical practice, minimizing reliance on extensive preprocessing and incorporating masked loss techniques for robust and unbiased model evaluation. By providing a standardized and unified platform for model development and comparison, VitalBench enables researchers to focus on architectural innovation while ensuring consistency in data handling. This work lays the foundation for advancing predictive models for intraoperative vital sign forecasting, ensuring that these models are not only accurate but also robust and adaptable across diverse clinical environments. Our code and data are available at https://github.com/XiudingCai/VitalBench.
Signe Svallfors, Mónica L. Caudillo, Orsola Torrisi
This study examines the relationship between community violence and the use and provision of contraception in Mexico, where family planning is a long-standing policy priority and the "war on drugs" has led to chronically high levels of violence. We adopt a two-step approach. First, we investigate the association between women's exposure to violence and first contraceptive use. Combining individual-level data (n = 86,219) from two waves of the National Survey of Demographic Dynamics (ENADID) with information on monthly municipality-level homicides in event-history models, we analyze the timing and method of women's first contraceptive use and the source of first contraception. Second, leveraging rare data from Mexico's Ministry of Health in clinic fixed-effects models, we study the association between homicides and contraceptive provision from public clinics. Results show strong positive associations between community violence and both the transition to first contraceptive use and the contraceptive provision of reversible methods. These relationships are stronger in the long term; one more homicide per 10,000 population during the past five years is associated with triple the risk of initiating contraceptive use and two to three more reversible contraception users served in each public clinic per month. The findings suggest increasing contraceptive vigilance and fertility regulation preferences-but also healthcare system resilience-in times of insecurity.
The COVID-19 pandemic has reshaped our daily lives and the way we interact with urban green–blue spaces (UGBS), particularly in the economically challenged regions of Northwest China. Our study, utilizing surveys and social media, delves into the pandemic’s impact on UGBS engagement in this area, offering critical insights for urban planning amidst a global health crisis. We found a gender-balanced but preference-specific engagement in UGBS, with women and married couples in the Chengguan District of Lanzhou city showing affinity. Moreover, educational levels and proximity to academic institutions emerged as key factors influencing UGBS use, pointing to the importance of educational attainment in engagement diversity. Enhancing safety, creating child-friendly and leisure facilities for families, and designing vibrant spaces for socializing are vital, and placing UGBS near educational districts could also promote environmental awareness and scientific learning. Furthermore, the pandemic has reshaped public priorities, elevating the value of accessible, safe UGBS. This shift is evidenced by varied motivations for UGBS visits, with an emphasis on health, nature connectivity, and leisure. Women, older adults, and families, each with their distinct reasons, were drawn to UGBS for activities ranging from recreation to relaxation. Our findings advocate for the creation of multifunctional UGBS that cater to these varied interests, incorporating features such as air-purifying plants, scenic pathways, and zones for family activities, all underpinned by enhanced safety and accessibility. The study also highlights distinct transportation preferences among residents of Chengguan’s northern and southern parts, suggesting a tailored approach to urban infrastructure that accommodates pedestrian access and public transit use. To prevent overcrowding, adjusting facility hours and event timings based on peak visitation times is recommended. Moreover, improving walkways and public transport connectivity is essential not just for convenience but also for ensuring that these green spaces are equitable and financially accessible, fostering inclusive access to these essential urban areas. During the pandemic, social media revealed a growing search for spiritual fulfillment within UGBS, highlighting their importance in societal well-being and coping mechanisms. In response, there’s a compelling opportunity for UGBS to evolve by incorporating designated areas for spiritual relaxation, along with mental health support services. By actively monitoring social media feedback and trends, these spaces can adapt and refine their offerings, ensuring that they meet the community’s changing needs more effectively. Our study highlights the importance of tailoring UGBS to meet diverse community needs, especially during crises. It emphasizes creating multifunctional, accessible UGBS that reflect demographic trends, transportation habits, and public preferences, aiming to boost community resilience and well-being. Drawing from research conducted amidst a worldwide crisis, our study provides key recommendations for the future evolution of UGBS, urging the creation of inclusive environments that bolster the health and well-being of urban populations.
Objective and Approach
Caesarean delivery (CD) rates are increasing globally. Over one-third of babies born in Northern Ireland (NI) during 2021-22 were via CD. Reducing the CD rate was cited as an important public health priority in the Strategy for Maternity Care in Northern Ireland (2012-2018). In 2015, WHO advocated that the Robson Ten Group Classification System (TGCS) be used to audit, analyse, and compare CD rates across countries. TGCS is currently not implemented in NI.
Results
Analysis of NI’s administrative maternity system (NIMATS) is on-going (accessed via Honest Broker Service Project P045) to address this study’s objectives, which will be completed for presentation: (1) describe the characteristics (maternal, obstetric practice, and fetal/infant features) of all deliveries during 2011-2019; (2) group all births over this period into TGCS categories and calculate the relative size of each group and the absolute contribution of each group to the overall CD rate; (3) compare the NI population distribution of TGCS group-specific CD rates against WHO-recommended benchmarks; (4) test for temporal trends in CD rates here over time; and (5) estimate the ability of a range of maternal, infant, and obstetric factors in predicting the overall CD rate and by TGCS group in NI over time.
Conclusions
Application of the Robson TGCS to NIMATS data has potential to address a critical knowledge gap relating to the use of CD in NI.
Implications
Avenues to extend this work to investigate longer-term outcomes (via possible linkage to the NI Child Health System) will be considered.
BACKGROUND: Although most countries show a general convergence in men’s and women’s investment in domestic labor, women continue doing more housework, especially among couples with children. However, cross-national descriptive estimates have focused exclusively on routine tasks, thus overlooking potential change in gender inequality in non-routine tasks, as well as the total housework investment, which varies significantly across countries. OBJECTIVE: Our aims are twofold: (1) to provide the most recent estimates of housework investments from time-use diaries across all tasks, (2) to describe the relationships between total housework investment, gender inequality, and gender task segregation. METHODS: Using the Harmonized European Time Use Survey (HETUS), we focus on different-sex couples living with children under the age of 18 across 15 European countries (n = 74,630). We measure housework across six primary tasks: cooking, cleaning, laundry, maintenance, gardening and pet care, and household administration. RESULTS: Mothers continue doing more housework than fathers across all 15 countries. The gender gap in housework is higher in countries with higher levels of total housework investment. However, we also find descriptive evidence that non-routine ‘male-typed’ tasks might be becoming gender-neutral. CONCLUSIONS: Housework scholars should re-visit the typology of task segregation and focus on a comparative investigation of the meaning and standards of housework and their relationship with gender inequality. CONTRIBUTION: This note draws attention to the role of the total housework investment in driving cross-national variation in gender inequality, and the importance of a comparative perspective within gender for understanding task segregation.
Robin Alexander, Holger Unger, Swetha Bhaskar
et al.
Breech presentation is a risk factor for poor birth outcomes. Guidance for safest mode of delivery in breech presenting full term pregnancies is available but there is a lack of evidence on the optimal mode of delivery in breech presenting preterm spontaneous births. The aim of this study is to evaluate the causal effect of mode of delivery on extended perinatal death (EPD) in this population using a trial emulation.
Randomized experiments are the gold standard for estimating causal effects; however, previous attempts to conduct them in this context has resulted in recruitment challenges. Causal inference methods provide a framework for drawing causal conclusions from observational data.
A trial emulation aims to overcome limitations common to observational studies by specifying core components of a randomized trial using observational data. Our trial emulation uses national Scottish health data to identify an eligible study sample and adjust for confounding characteristics between groups undergoing caesarean and vaginal deliveries to simulate randomized assignment of mode of delivery. We were able to estimate the per-protocol impact of caesarean delivery on EPD.
Our data, containing all recorded potentially eligible births in Scotland between 1997 and 2019, was provided by eDRIS in a trusted research environment. After applying our eligibility criteria, our data contained 3,457 birth records, (2,361 c-section and 1,096 vaginal deliveries). There were 212 EPDs (1.7% (39) of c-sections and 16% (173) of vaginal deliveries).
Our preliminary results suggest that caesarean delivery reduces the odds of EPD by 73% among breech presenting spontaneous preterm births.
Estimates of future migration patterns are of broad interest in demography. Forced migration, including refugee and asylum seekers, plays an important role in overall migration patterns, but is notoriously difficult to forecast. Focusing on refugees and asylum seekers, we propose a modeling pipeline based on Bayesian hierarchical time-series modeling for projecting refugee population official statistics by country of origin using data from the United Nations High Commissioner for Refugees (UNHCR). Our approach is based on a conceptual model of refugee and asylum seeker populations following growth and decline phases, separated by a peak. The growth and decline phases are modeled by logistic growth and decline through an interrupted logistic process model. We evaluate our method through a set of validation exercises that show it has good performance for forecasts at 1, 5, and 10 year horizons, and we present projections for 35 countries of origin of large refugee and asylum seeker population.
How to find memory safety bugs efficiently when navigating a symbolic execution tree that suffers from path explosion? Existing solutions either adopt path search heuristics to maximize coverage rate or chopped symbolic execution to skip uninteresting code (i.e., manually labeled as vulnerability-unrelated) during path exploration. However, most existing search heuristics are not vulnerability-oriented, and manual labeling of irrelevant code-to-be-skipped relies heavily on prior expert knowledge, making it hard to detect vulnerabilities effectively in practice. This paper proposes Vital, a new vulnerability-oriented path exploration for symbolic execution with two innovations. First, a new indicator (i.e., type-unsafe pointers) is suggested to approximate vulnerable paths. A pointer that is type-unsafe cannot be statically proven to be safely dereferenced without memory corruption. Our key hypothesis is that a path with more type-unsafe pointers is more likely to be vulnerable. Second, a new type-unsafe pointer-guided Monte Carlo Tree Search algorithm is implemented to guide the path exploration towards the areas that contain more unsafe pointers, aiming to increase the likelihood of detecting vulnerabilities. We built Vital on top of KLEE and compared it with existing path searching strategies and chopped symbolic execution. In the former, the results demonstrate that Vital could cover up to 90.03% more unsafe pointers and detect up to 57.14% more unique memory errors. In the latter, the results show that Vital could achieve a speedup of up to 30x execution time and a reduction of up to 20x memory consumption to detect known vulnerabilities without prior expert knowledge automatically. In practice, Vital also detected one previously unknown vulnerability (a new CVE ID is assigned), which has been fixed by developers.
Christoffer H Hilde, Marlène Gamelon, B. Sæther
et al.
In (st)age-structured populations, the long-run population growth rate is negatively affected by temporal variation in vital rates. In most cases, natural selection should minimize temporal variation in the vital rates to which the long-run population growth is most sensitive, resulting in demographic buffering. By reviewing empirical studies on demographic buffering in wild populations, we found overall support for this hypothesis. However, we also identified issues when testing for demographic buffering. In particular, solving scaling problems for decomposing, measuring, and comparing stochastic variation in vital rates and accounting for density dependence are required in future tests of demographic buffering. In the current context of climate change, demographic buffering may mitigate the negative impact of environmental variation and help populations to persist in an increasingly variable environment.
<b>Background</b>: Although women's empowerment is one of the key concepts in development, it has proven challenging to measure it. Empirical studies have tended to focus on a cause-and-effect analysis of empowerment and using composite measures to compare different national contexts. More recent works suggest new conceptual and methodological approaches to women's empowerment that better reflect contextual factors, intersectionality, and life course perspectives. <b>Objective</b>: We conduct cross-national comparative research on women's empowerment using a new approach: by examining how women's household decision-making power, education, and work - major components of empowerment - relate to each other across 28 low- and middle-income countries. Through this, we explore what the different relationships might imply for women's empowerment in different contexts and circumstances. <b>Methods</b>: We utilize latent class analysis, a person-centered approach, to identify an unobserved class membership structure that classifies women into typologies to account for the different contexts and multidimensionality of women's empowerment within and between countries. <b>Results</b>: We find substantial within-country differences in household decision-making power and how this aligns with women's education and work. Across countries, we find work and education are not always positively associated with each other or with decision-making power, which suggests a need to contextualize the associations within the different dimensions of women's empowerment. <b>Contribution</b>: Our analysis provides a nuanced examination of empowerment and reveals a spectrum of women differently situated in each country and across different countries, which is often obscured in previous research.
Within minutes of birth a newborn gnu or giraffe works to stand and walk, asserting postural balance and organised animate behaviour in an apparently goal-directed manner. In contrast, robots learning to stand and walk from scratch begin with random flailing, the behaviour cohering over time as the robot internalises some reward or value signal. How does the newborn gnu innately know what goal to aim for, and decide to work towards it? How could similar goal-directed balance learning be implemented in robots? Currently, animate balance inherits its axiomatic definition from the Newtonian formulation for inanimate balance - static mechanical equilibrium. This is arguably inappropriate for animate balance, because animals need to move and are never in static mechanical equilibrium, giving rise to the posture-movement paradox. The present perspective article proposes a more fluid, dynamical axiomatic task definition and goal which (a) isolates resisting gravity, (b) admits and enables movement, and (c) subsumes static mechanical equilibrium as a special case. This novel definition is founded upon inevitable biophysical requirements and observable developmental process. The article explains how animals apprehend and embed this goal through prenatal development suspended in equidense amniotic fluid, and then are challenged to self-maintain it by the perinatal transition. The account entails a paradigmatic shift in putative physiological organisation and associated conceptual framework for balance from a subsidiary sensorimotor control task, to a vital mechano-regulation task organisationally akin to thermo-regulation. This vital mechano-regulation model of balance has practical implications and implies a range of predictions.
Shuaifeng Jiang, Ahmed Alkhateeb, Daniel W. Bliss
et al.
Radar as a remote sensing technology has been used to analyze human activity for decades. Despite all the great features such as motion sensitivity, privacy preservation, penetrability, and more, radar has limited spatial degrees of freedom compared to optical sensors and thus makes it challenging to sense crowded environments without prior information. In this paper, we develop a novel dual-sensing system, in which a vision sensor is leveraged to guide digital beamforming in a multiple-input multiple-output (MIMO) radar. Also, we develop a calibration algorithm to align the two types of sensors and show that the calibrated dual system achieves about two centimeters precision in three-dimensional space within a field of view of $75^\circ$ by $65^\circ$ and for a range of two meters. Finally, we show that the proposed approach is capable of detecting the vital signs simultaneously for a group of closely spaced subjects, sitting and standing, in a cluttered environment, which highlights a promising direction for vital signs detection in realistic environments.
<p><strong>Background</strong></p> <p>As global climate change transforms average temperature and rainfall, species distributions may meet, increasing the potential for hybridization and altering individual fitness and population growth. Altered rainfall specifically may shift the strength and direction of selection, also manipulating population trajectories. Here, we investigated the role of interspecific hybridization and selection imposed by rainfall on the evolution of weedy life-history in non-hybrid (<em>Raphanus raphanistrum</em>) and hybrid (<em>R. raphanistrum x R. sativus</em>) populations using a life table response experiment.</p> <p><strong>Results</strong></p> <p>In documenting long-term population dynamics, we determined intrinsic (<em>r</em>) and asymptotic (<em>λ</em>) population growth rates and sensitivities, a measure of selection imposed on demographic rates. Hybrid populations experienced 8.7-10.3 times stronger selection than wild populations for increased seedling survival. Whereas crop populations generally exhibit little dormancy and wild populations often exhibit dormancy, non-hybrid populations experienced 10% stronger selection than hybrid populations for exhibiting seed dormancy. Selection on survival-to-flowering in wild, not hybrid, populations declined marginally with increasing soil moisture. Hybrid populations exhibited greater <em>r</em>, but not <em>λ</em>, than wild populations regardless of moisture environment. In general, fecundity contributed most to differences in λ but fecundity only contributed positively to hybrid λ relative to wild λ when precipitation was altered (either higher or lower than control) and not under control watering conditions.</p> <p><strong>Conclusions</strong></p> <p>Selection on key demographic traits may not change dramatically in response to rainfall, and hybridization may more strongly influence the demography of these weedy species than rainfall. If hybrid populations can respond to selection for increased dormancy, this may make it more difficult to deplete weed seed banks and increase the persistence of crop genes in weed populations.</p>
Due to its nature, the population is quite a dynamic and mobile phenomenon, which is manifested in its natural and mechanical movement. It is significantly influenced by many factors. It is significantly influenced by many factors. The influence of some of them is reflected in a short period of time when the balance of a number of indicators of the socio-economic structure of the population is disturbed. But there are such vital indicators, which in certain periods of time develop with similar tendencies based on existing and developed demographic events in previous years. Both the absolute and relative birth rates of the population remind us of the same basic, sharply defined signs during the formation of each new and subsequent generation. The result of its influence is not visible in the current statistical data of each year, but periodically, in an equal period of time, in the appropriate time and space, these traits are transmitted to the new generation without reduction (due to low birth rates, increase in migration processes, relatively less number of births due to severe social conditions in the reproductive age have fewer children throughout the country…) Due to this qualitative nature, the study of the factors affecting birth rates and demographic analysis is always a field of special interest for those interested in the study of demographic processes. It can be safely said that demographers make a "recipe" about the future sex-age structure of the population based on the natural movement of the population during such analysis. This feature of population mobility is a very important vector for the future programs and forecasts of the state. General birth rates are an approximate measure of the birth level, as the number of births is divided by the total population, which includes the population that is physiologically, due to youth or old age, unable to bear children, and the population that does. Therefore, the quantity of general birth rates depends on the age structure, i.e. On the number and share of young women of reproductive age (15-49 years) in the population. In order to more accurately describe the birth rate, demographers calculate a special birth rate. The special birth rate for 2021 was 57.5, which means that on average there are 57.5 newborns for every 1,000 women during the year. The birth rate of the population is determined by the demographic structure (sex, age, marriage and family structure) and reproductive behavior. Birth rate is a mass demographic process of the population. It is influenced by various kinds of external factors: natural-biological, socio-economic, psychological, existential-cultural, religious and others. It is interesting what trends characterize the main indicators of the population dynamics of today's Georgia. The National Statistical Service of Georgia published an official report on the main indicators of the natural and mechanical movement of the country's population. In our opinion, special attention is paid to a number of internal and external factors, which have a direct impact on the gender-age structure of the population. At the beginning of 2023, the population of the country has increased by 1.3% compared to the previous year and is equal to 3, 736,4 thousand people. The increase in the population of Georgia did not occur as a result of natural increase, it was caused by the factor of the Russia-Ukraine war and the wave of immigration. There was no real increase in the total population of the country. Moreover, the demographic situation created since the beginning of the 90s of the 20th century started and continues to intensively affect the reproduction of the country's population: decrease in the birth rate, decrease in the reproductive age population in the sex-age structure, demographic aging, increase in migration processes. Next to the negative tendencies of the natural movement of the population, migration is an equally important problem in the country. Especially in the last 5 years, the number of population in almost all regions of Georgia has significantly decreased as a result of migration outside the country. It is a pity that the main causes of the aggravation and complication of the demographic situation have been neglected for years, and the issue has become the subject of discussion only in a narrow circle of demographers and small groups of people interested in these issues. Very soon, along with such large and intensive migration processes in the country, the flow of immigrants will definitely begin to increase. Accordingly, an equally important problem arises - the alienation of Georgian lands. The study of the mentioned problems and the complex development of relevant measures should be done as soon as possible and necessarily at the governmental level, because stopping the current demographic situation and turning it towards positive trends is unthinkable without the state program of demographic development. There are two most important and vital problems facing Georgia and the Georgian nation. Reduction of birth rate and migration should become the main concern of the state.
J. Margalef‐Marrase, R. Molowny‐Horas, L. Jaime
et al.
In recent decades, die-off events in Pinus sylvestris populations have increased. The causes of these phenomena, which are usually related to local and regional extreme hot droughts, have been extensively investigated from a physiological viewpoint. However, the consequences of die-off process in terms of demography and vegetation dynamics have been less thoroughly addressed. Here, we projected P. sylvestris plot dynamics after a die-off event, under climate change scenarios, considering also their early demographic stages (i.e., seedlings, saplings and ingrowth from the sapling to adult class), to assess the resilience of P. sylvestris populations after such events. We used Integral Projection Models (IPMs) to project future plot structure under current climate, and under RCP4.5 and RCP8.0 climate scenarios, using climatic suitability - extracted from Species Distribution Models - as a covariable in the estimations of vital rates over time. Field data feeding IPMs were obtained from two successive surveys, at the end of the die-off event (2013) and four years later (2017), undertaken on populations situated across the P. sylvestris range of distribution in Catalonia (NE Spain). Plots affected by die-off experienced a loss of large trees, which causes that basal area, tree diameter and tree density will remain lower for decades relative to unaffected plots. After the event, this situation is partially counterbalanced in affected plots by a greater increase in basal area and seedling recruitment into tree stage, thus promoting resilience. However, resilience is delayed under the climate-change scenarios with warmer and drier conditions involving additional physiological stress, due to a reduced abundance of seedlings and a smaller plot basal area. The study shows lagged effect of drought-induced die-off events on forest structure, also revealing stabilizing mechanisms, such as recruitment and tree growth release, which enhance resilience. However, these mechanisms would be jeopardized by oncoming regional warming.
Emma J. Talis, Christian Che‐Castaldo, Bilgecan Şen
et al.
1. The population dynamics of many colonially breeding seabirds are characterized by large inter-annual fluctuations that cannot be explained by environmental conditions alone. This variation may be particularly confounded by the use of skipped breeding by seabirds as a life history strategy, which directly impacts the number of breeding pairs and may affect the accuracy of breeding abundance as a metric of population health. Additionally, large fluctuations in time series may suggest that the underlying population dynamics are heavy tailed, allowing for a higher likelihood of extreme events than expected under Gaussian dynamics. 2. Here, we investigated the effect of demography on time series for abundance of the Adélie penguin (Pygoscelis adeliae) and explored the occurrence of heavy-tailed dynamics in observed Adélie time series. We focus this study on the Adélie penguin as it is an important bellwether species long used to track the impacts of climate change and fishing on the Southern Ocean ecosystem and shares life history traits with many colonial seabirds. 3. We quantified the impacts of demographic rates, including skipped breeding, on time series of Adélie abundance simulated using an age-structured model. We also used observed time series of Adélie breeding abundance at all known Antarctic colonies to classify distributions for abundance as Gaussian or non-Gaussian heavy-tailed. We then identified the cause of such heavy-tailed dynamics in simulated time series and linked these to spatial patterns in Adélie food resource variability. 4. We found that breeding propensity drives observed breeding fluctuations more than any other vital rate, with high variability in skipped breeding decoupling true abundance from observed breeding abundance. We also found several Antarctic regions characterized by heavy-tailed dynamics in abundance. These regions were often also characterized by high variability in zooplankton availability. In simulated time series, heavy-tailed dynamics were strongly linked to high variability in adult survival. 5. Our results illustrate that stochastic variability in abundance dynamics, particularly the presence of variable rates of skipped breeding, can challenge our interpretation of fluctuations in abundance through time and obscure the relationship between key environmental drivers and population abundance.
Valuation of sons over daughters introduces sex-biased health, economic, and socio-demographic inequalities in many societies. This study aims to examine fetus-sex differences in maternity services and sex differences in medical care for terminally ill neonates in Bangladesh, using secondary data from the Matlab Health and Demographic Surveillance System (HDSS), maintained by icddr,b since 1966 along with data from the Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016. The HDSS follows a well-defined rural population (0.24 million in 2018) to register vital events and migrations and records the use of maternity services for the index birth and medical care-seeking during the terminal illness of each death in verbal autopsy. The BMMS 2016 recorded maternity care and maternal complications for the last live birth of mothers in the same population (weighted n = 27,133; unweighted n = 26,939). Bivariate analyses estimated the use (in %) of maternity services for the index live births and medical services for terminally ill neonates for each socio-demographic variable. Logistic regression models estimated odds ratios (AORs) adjusted for socio-demographic variables and clustering of births to the same mothers. The HDSS registered 49,827 live births and 1,049 neonatal deaths during 2009–2018. We found similar prenatal care-seeking for male and female fetuses but higher facility delivery (AOR = 1.17, 95% CI: 1.12–1.23) and C-sections (AOR = 1.20, 95% CI: 1.15–1.25) for male fetus pregnancies, differences that remain after adjusting for maternal complications. Sex differences persisted in seeking care for terminally ill neonates. Trained provider consultation (AOR = 1.46, CI: 1.00–2.12); hospital admissions (AOR = 1.43, CI: 1.01–2.03); and dying in hospital (AOR = 1.91, CI: 1.31–2.78) were all higher for male neonates. Other variables positively associated with delivery care and medical care-seeking were lower birth order of the child, higher maternal education, and higher household wealth status. Policy and decision-makers need to be aware of gender disparities in maternity care and care of sick neonates and plan remedial actions.
Rebecca Cannings-John, Fiona Lugg-Widger, Michael Robling
et al.
Objectives
Domiciliary care workers (DCWs) continued to provide social care to vulnerable adults in their own homes throughout the COVID-19 pandemic. However, evidence of pandemic impact upon DCWs’ health is mixed. The OSCAR study aimed to quantify the impact of COVID-19 upon health outcomes of DCWs in Wales, and explore causes of variation.
Approach
Data for all registered DCWs in Wales are newly available via the SAIL Databank using a secured, privacy-protecting encrypted anonymisation process. Occupational registration data for DCWs working during the pandemic was combined with electronic health records data to describe health outcomes within the first two years of the pandemic. Rates of confirmed COVID-19 infections and health outcomes including mental health contacts, fit notes, respiratory infections, and mortality will be reported and explore variation (by factors such as age, sex, ethnicity, deprivation quintile, employer). We will also explore changes over time (pre- and post- onset of COVID-19 pandemic) in outcomes.
Results
The OSCAR study used anonymised health records for 15,727 registered DCWs in Wales. PCR-confirmed infection rates in the first full year of the pandemic (March20-February21) were 12% although lower in males (9%) than for females (12%). However, 28% of care workers received care for mental health with large differences observed between males (20%) and females (29%), and between workers from different health board regions (range 22% to 33%). The extent to which these represent pre-pandemic rates overall and how they compare to the broader community will be explored in our remaining work. A qualitative sub-study involving interviews with DCWs has informed our approach to modelling and to interpretation of findings.
Conclusion
Using novel anonymised occupational records at a national level and existing linked EHR data and qualitative interviews, the OSCAR study will quantify the risk of COVID-19 on DCWs' health and explore sources of variation. This will provide a secure base for informing public health policy and occupational guidance.