Making the most of world talent for science? The Nobel Prize and Fields Medal experience

Opportunities in science largely affect the accumulation of scientific knowledge and, therefore, technological change. However, there is little evidence of how much of people’s talent is actually wasted. Here we focus on scientists with the highest performance, the recipients of the Nobel Prize and Fields Medal. We found that the average age of scientists at the time of the breakthrough was higher for researchers from less developed countries. Moreover, individual opportunities in the world were extremely unequal by country of birth, gender significantly conditioned any participation in research, and the probability of becoming a top researcher more than doubled for individuals with parents belonging to the most favoured occupational categories. Thus, inequality of opportunity in science at the highest level was higher than in sports excellence (Olympic medals) and educational attainment. These findings would not be so negative if opportunities in science at the highest level had increased over time. Contrary to the expectations, our results show that opportunities in science, in contrast with humanities, have stagnated.

A Meta-analysis on the Effect of Kangaroo Mother Care on Preterm Mortality

Background. Kangaroo mother care (KMC) is a low-cost but high-impact intervention for preterm and low birth weight (LBW) infants. Objectives. To determine the effect of KMC on in-hospital mortality among preterm and LBW infants, taking into consideration their gestational age, birth weight, income category of the country of birth, and medical stability. Materials and Methods. A comprehensive search of several databases, as well as local listings of research papers, was performed to look for randomized controlled studies with KMC as intervention, and mortality and length of hospitalization as outcome measures. The risk of bias and publication bias was assessed. We did subgroup analyses based on income category of the country of birth, gestational age, birth weight, and medical stability of the infants. Results. Sixteen randomized controlled trials (RCTs) with 1738 infants in the KMC group and 1674 infants in the control group were included. Based on the GRADE approach, although all the studies were RCTs, the evidence is assessed as moderate certainty due to the nature of the intervention (KMC) that prevented blinding. There was a 41% reduction in risk of dying among preterm and low birth weight infants who received KMC compared to conventional medical care (3.86%% vs 6.87%; RR = 0.59, 95% CI 0.44, 0.79; I2 = 0%; number needed to treat for additional benefit (NNTB) = 34; 16 RCTs; 3,412 infants). Furthermore, there were also reductions in the risk of dying among infants who were <34 weeks AOG (KMC: 4.32% vs CMC: 8.17%, RR = 0.55, 95% CI 0.38, 0.79; I2 = 0%; NNTB = 26; 10 RCTs; 1795 infants), with birthweight of >1500 g (KMC: 3.97% vs CMC: 6.83%, RR = 0.60; 95% CI 0.45, 0.82; I2 = 0%; NNTB = 35; 10 RCTs; 2960 infants), and born in low- and middle income countries (LMIC) (3.77% vs 6.95%; RR = 0.57, 95% CI 0.43, 0.77; I2 = 0%; NNTB = 32; 14 RCTs; 3281 infants). There was a significant reduction in mortality (KMC: 11.05% vs CMC: 20.94%; RR = 0.54; 95% CI 0.34, 0.87; I2 = 0%; NNTB = 11; 5 RCTs; 387 infants) even among medically unstable infants who received KMC compared to those who did not. The length of hospitalization did not significantly differ between the KMC and the control groups. Due to high heterogeneity, subgroup analyses were performed, which showed a trend towards a shorter length of hospital stay among preterm infants <34 weeks AOG, with birthweight ≥1500 g, medically unstable during admission, and belonging to LMIC but did not reach statistical significance. Conclusion. There was moderate certainty evidence that KMC can decrease mortality among preterm and LBW infants. Furthermore, KMC was beneficial among relatively more premature, bigger, medically unstable preterm infants and born in low to middle-income countries.

Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK

International migrants comprised 14% of the UK’s population in 2020; however, their health is rarely studied at a population level using primary care electronic health records due to difficulties in their identification. We developed a migration phenotype using country of birth, visa status, non-English main/first language and non-UK-origin codes and applied it to the Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country-of-birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997 to 2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified: 178,749 (1.11%) had foreign-country-of-birth or visa -status codes, 216,731 (1.35%) non-English-main/first-language codes, and 8288 (0.05%) non-UK-origin codes. The cohort was similarly distributed versus ONS data by sex and region of birth. Migration recording improved over time and younger migrants were better represented than those aged ≥50. The validated phenotype identified a large migrant cohort for use in migration health research in CPRD GOLD to inform healthcare policy and practice. The under-recording of migration status in earlier years and older ages necessitates cautious interpretation of future studies in these groups.

Resilience and Change in Opera Theatres: Travelling the Edge of Tradition and Contemporaneity

ABSTRACTOver the last century, the opera has changed dramatically and on several levels. This chapter maps out the major changes of the opera since its origin in its country of birth, Italy, discussing whether this evolution displays a form of transformative resilience. As a theoretical contribution, this case allows to challenge the resilience framework presented in Chapter 1, by raising several prominent questions for the conceptual advancement and empirical grounding of resilience. We ask: To what extent can an entity change in order to be considered a persisting entity and not a different entity? Or in other words: How much continuity is necessary to recognize resilience in the same entity? We add: How are different levels of resilience (institutional, organizational and individual) nested one into another, and therefore, how is the ‘agency of resilience’ played out? As an empirical contribution, this chapter sketches an empirical reconstruction of the history of the opera in a holistic longitudinal perspective.

Associations between Physical Activity Patterns, Screen Time and Cardiovascular Fitness Levels in Swedish Adolescents

Cardiovascular fitness (CVF) has been associated with cardiovascular risk factors in adolescents. CVF levels are determined by non-modifiable and modifiable factors; one modifiable factor is physical activity (PA). There is a lack of studies investigating the associations between PA patterns and CVF and how gender, parental education, BMI status and country of birth are associated with CVF. The aim of this study was to explore the cross-sectional associations between PA patterns and CVF in Swedish 13–14-year-old adolescents. CVF was estimated using the Ekblom-Bak submaximal test, data on PA patterns were collected using hip-worn accelerometers and a questionnaire. The mean CVF was 44.8 mL/kg/min in girls (n = 569) and 55.5 mL/kg/min in boys (n = 451) p < 0.01. The results showed a significant association between participation in organised sports (β = 3.32 CI: 2.14, 4.51, β = 4.38, CI: 2.80, 5.96), MVPA (β = 0.07, CI: 0.04, 0.11, β = 0.07, CI: 0.03, 0.11), a high proportion of SED (β = −0.47, CI: −0.70, −0.25, β = −0.41, CI: −0.64, −0.18) and CVF in girls and boys, respectively. More than five hours of screen time on weekdays was associated with lower CVF (β = −2.32 CI: −3.92, −0.71 in girls and boys β = −2.82, CI: −5.14, −0.50). While causal relations remain unknown, these findings could be relevant when designing future interventions with the aim to improve CVF.

Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK

International migrants comprised 14% of the UK population in 2020, but migrant health in the UK has rarely been studied at a population level using primary care electronic health records (EHRs). Given the difficulty of determining migration status using EHRs, this study developed a migration phenotype and assessed its validity. We developed a phenotyping algorithm using codes for country of birth, visa status, non-English main/first language and non-UK origin. It was applied to a Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country of birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997-2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified using the phenotype. 178,749 (1.11%) of these migrants were identified by codes indicating foreign country of birth or visa status, 216,731 (1.35%) a non-English main/first language, and 8,288 (0.05%) non-UK origin. The cohort was similarly distributed compared to ONS migration statistics in terms of sex and region of birth. Recording of migration improved from identifying approximately one-tenth of the expected proportion of migrants according to the ONS in 2004 to a quarter in 2018. Younger migrants were better represented than those aged 50 and over. The migration phenotype identified a large number of migrants and can be used to undertake large-scale migration health research in CPRD GOLD to inform healthcare policy, practice and action. While the cohort was representative of the UK migrant population in terms of sex and region of birth, migration status was under-recorded in earlier years and older ages, and future studies for these groups should therefore be interpreted with caution.

Maternal body mass index and country of birth in relation to the adverse outcomes of large for gestational age and gestational diabetes mellitus in a retrospective cohort of Australian pregnant women

Background The prevalence of gestational diabetes mellitus in Australia has been rising in line with the increased incidence of maternal overweight and obesity. Women with gestational diabetes mellitus, high body mass index or both are at an elevated risk of birthing a large for gestational age infant. The aim was to explore the relationship between country of birth, maternal body mass index with large for gestational age, and gestational diabetes mellitus. In addition to provide additional information for clinicians when making a risk assessment for large for gestational age babies. Method A retrospective cohort study of 27,814 women residing in Australia but born in other countries, who gave birth to a singleton infant between 2008 and 2017 was undertaken. Logistic regression analysis was used to examine the association between the aforementioned variables. Results A significantly higher proportion of large for gestational age infants was born to overweight and obese women compared to those who were classified as underweight and healthy weight. Asian-born women residing in Australia, with a body mass index of ≥40 kg/m2, had an adjusted odds ratio of 9.926 (3.859–25.535) for birthing a large for gestational age infant. Conversely, Australian-born women with a body mass index of ≥40 kg/m2 had an adjusted odds ratio of 2.661 (2.256–3.139) for the same outcome. Women born in Australia were at high risk of birthing a large for gestational age infant in the presence of insulin-requiring gestational diabetes mellitus, but this risk was not significant for those with the diet-controlled type. Asian-born women did not present an elevated risk of birthing a large for gestational age infant, in either the diet controlled, or insulin requiring gestational diabetes mellitus groups. Conclusions Women who are overweight or obese, and considering a pregnancy, are encouraged to seek culturally appropriate nutrition and weight management advice during the periconception period to reduce their risk of adverse outcomes.

COVID-19 vaccination rates among health care workers by immigrant background. A nation-wide registry study from Norway

BackgroundStudies have suggested that some minority groups tend to have lower vaccination rates than the overall population. This study aims to examine COVID-19 vaccination rates among health care workers (HCWs) in Norway, according to immigrant background.MethodsWe used individual-level, nation-wide registry data from Norway to identify all HCWs employed full-time at 1 December 2020. We examined the relationship between country of birth and COVID-19 vaccination from December 2020 to August 2021, both crude and adjusted for e.g. age, sex, municipality of residence, and detailed occupation codes in logistic regression models.ResultsAmong all HCWs in Norway, immigrants had a 9 percentage point lower vaccination rate (85%) than HCWs without an immigrant background (94%) at 31 August 2021. The overall vaccination rate varied by country of birth, with immigrants born in Russia (71%), Serbia (72%), Lithuania (72%), Romania (75%), Poland (76%), Eritrea (77%), and Somalia (78%) having the lowest crude vaccination rates. When we adjusted for demographics and detailed occupational codes, immigrant groups that more often worked as health care assistants, such as immigrants from Eritrea and Somalia, increased their vaccination rates.ConclusionSubstantial differences in vaccination rates among immigrant groups employed in the health care sector in Norway indicate that measures to improve vaccine uptake should focus specific immigrant groups rather than all immigrants together. Lower vaccination rates in some immigrant groups appears to be largely driven by the occupational composition, suggesting that some of the differences in vaccine rates can be attributed to variation in vaccine access.

Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden

BackgroundThe backdrop of the ubiquitous social inequalities has increasingly come into foreground in research on the COVID-19 pandemic, but the lack of high-quality population-based studies limits our understanding of the inequitable outcomes of the disease. The present study seeks to estimate social gradients in COVID-19 hospitalisations, intensive care admissions and death by education, income and country of birth, while taking into account disparities in comorbidities.MethodsWe used a register-based retrospective open cohort design enrolling all 74 659 confirmed SARS-CoV-2-positive cases aged >25 years in Sweden during the first wave of the pandemic (until 14 September 2020). Information was retrieved from multiple registers and linked by the unique Swedish personal identity number concerning COVID-19 case identification; COVID-19 hospitalisations, intensive care admissions and death; comorbidities as measured by the Charlson Comorbidity Index; and sociodemographic information. Social gradients were estimated by the Relative Index of Inequality (RII) using Cox regression.ResultsAdjusted analyses showed significant social gradients in COVID-19 hospitalisation, intensive care admission, across education, income and country of birth, which were unaffected by adjustment for comorbidities. Education and country of birth gradients were stronger for hospitalisation and intensive care admissions but small to non-existent for death. In contrast, income gradients were consistent across all three COVID-19 outcomes.ConclusionSocial gradients in severe COVID-19 outcomes are widespread in Sweden, but appear to be unrelated to pre-existing health disparities. Inequitable outcomes of SARS-CoV-2 infection may therefore be at least partially avoidable and could rely on equitable management of confirmed COVID-19 cases.