The Revolution Will Be Hard to Evaluate: How Co-Occurring Policy Changes Affect Research on the Health Effects of Social Policies

Extensive empirical health research leverages variation in the timing and location of policy changes as quasi-experiments. Multiple social policies may be adopted simultaneously in the same locations, creating co-occurrence which must be addressed analytically for valid inferences. The pervasiveness and consequences of co-occurring policies have received limited attention. We analyzed a systematic sample of 13 social policy databases covering diverse domains including poverty, paid family leave, and tobacco. We quantified policy co-occurrence in each database as the fraction of variation in each policy measure across different jurisdictions and times that could be explained by co-variation with other policies (R2). We used simulations to estimate the ratio of the variance of effect estimates under the observed policy co-occurrence to variance if policies were independent. Policy co-occurrence ranged from very high for state-level cannabis policies to low for country-level sexual minority rights policies. For 65% of policies, greater than 90% of the place-time variation was explained by other policies. Policy co-occurrence increased the variance of effect estimates by a median of 57-fold. Co-occurring policies are common and pose a major methodological challenge to rigorously evaluating health effects of individual social policies. When uncontrolled, co-occurring policies confound one another, and when controlled, resulting positivity violations may substantially inflate the variance of estimated effects. Tools to enhance validity and precision for evaluating co-occurring policies are needed.

Start of the Green Season and Normalized Difference Vegetation Index in Alaska’s Arctic National Parks

Daily Normalized Difference Vegetation Index (NDVI) values from the MODIS Aqua and Terra satellites were compared with on-the-ground camera observations at five locations in northern Alaska. Over half of the spring rise in NDVI was due to the transition from the snow-covered landscape to the snow-free surface prior to the deciduous leaf-out. In the fall after the green season, NDVI fluctuated between an intermediate level representing senesced vegetation and lower values representing clouds and intermittent snow, and then dropped to constant low levels after establishment of the permanent winter snow cover. The NDVI value of snow-free surfaces after fall leaf senescence was estimated from multi-year data using a 90th percentile smoothing spline curve fit to a plot of daily NDVI values vs. ordinal date. This curve typically showed a flat region of intermediate NDVI values in the fall that represent cloud- and snow-free days with senesced vegetation. This “fall plateau” was readily identified in a large systematic sample of MODIS NDVI values across the study area, in typical tundra, shrub, and boreal forest environments. The NDVI level of the fall plateau can be extrapolated to the spring rising leg of the annual NDVI curve to approximate the true start of green season.

Ophthalmic pathologies in an older HIV-positive Tanzanian population and their association with neurological morbidity and evaluation of a low-resource screening strategy

Background Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Objectives To evaluate clinical utility of HIV-retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. Methods A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Results Of 129 individuals assessed, 69.8% were visually impairment. Six had suspected HIV retinopathy. HAND prevalence was 66.7%. HIV retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of HIV-retinopathy for HAND was poor (AUROC 0.545–0.617) but specificity and positive predictive value were high. Conclusions Ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.

Using Isotopic and Hydrochemical Indicators to Identify Sources of Sulfate in Karst Groundwater of the Niangziguan Spring Field, China

Karst groundwater in the Niangziguan spring fields is the main source to supply domestic and industrial water demands in Yangquan City, China. However, the safety of water supply in this region has recently suffered from deteriorating quality levels. Therefore, identifying pollution sources and causes is crucial for maintaining a reliable water supply. In this study, a systematic sample collection for the karst groundwater in the Niangziguan spring fields was implemented to identify hydrochemical characteristics of the karst groundwater through comprehensive analyses of hydrochemistry (piper diagram, and ion ratios,) and stable isotopes (S and H-O). The results show that the karst groundwater in the Niangziguan spring fields was categorized as SO4·HCO3-Ca·Mg, HCO3·SO4-Ca·Mg, and SO4-Ca types. K+, Cl-, and Na+ are mainly sourced from urban sewage and coal mine drainage. In addition, SO42− was mainly supplied by the dissolution of gypsum and the oxidation of FeS2 in coal-bearing strata. It is noteworthy that, based on H-O and S isotopes, 75% of the karst groundwater was contaminated by acidic water in coal mines at different degrees. In the groundwater of the Niangziguan spring field, the proportions of SO42− derived from FeS2 oxidation were 60.6% (N50, Chengxi spring), 30.3% (N51, Wulong spring), and 26.0% (N52, Four springs mixed with water). Acid mine drainage directly recharges and pollutes karst groundwater through faults or abandoned boreholes, or discharges to rivers, and indirectly pollutes karst groundwater through river infiltration in carbonate exposed areas. The main source of rapid increase of sulfate in karst groundwater is acid water from abandoned coal mines.

The acceptability to women of techniques for managing an impacted fetal head at caesarean section and of randomised trials evaluating those techniques: a qualitative study

Background This study aimed to explore women’s views on the acceptability of different techniques for managing an impacted fetal head at caesarean; and the feasibility and acceptability of conducting a trial in this area. Methods Qualitative semi-structured interviews with a systematic sample of women who experienced second stage emergency caesarean section at a tertiary National Health Service (NHS) hospital in England, UK. Thematic analysis was used to extract women’s views. Results Women varied in their perceptions of the acceptability of different techniques for managing impacted fetal head. Trust in medical expertise and prioritising the safety of the baby were important contextual factors. Greater consensus was found around informed choice in trials where subthemes considered the timing of invitation, reduced capacity to give consent in emergency situations, and the importance of birth outcomes and having good rapport with healthcare professionals who invite women into trials. Finally, women reflected on the importance of supportive antenatal and postpartum education for impacted fetal head. Conclusions This research provides information on the acceptability of techniques and any trial to evaluate these techniques. Findings illustrate the importance of context and quality of care to both acceptability and approaching women to take part in a future trial.

Review of Recent Research about Parenting Generation Z Pre-Teen Children

The purpose of this scoping review is to provide a timely update of available research describing parents’ perspectives of parenting pre-teen children of Generation Z (born 1997 through 2012). The databases of Ovid MEDLINE, CIHAHL, SCOPUS, Web of Science, JUSTOR, and PsyINFO were searched using a combination of key words for manuscripts published in English. A limited collection of scientific literature documented experiences of parents, practices of parenting, styles of parenting, and interventions that influence parenting of Generation Z pre-teen children among various groups of parents. Although an emerging body of literature on parenting pre-teen children of Generation Z was identified, future research should consider systematic sample selection to further explore the roles of cultural and psychosocial factors that influence parents’ perspectives of parenting “digital natives” in homes around the world.

Demographics of Vaccine Hesitancy in Chandigarh, India

The impact of vaccine hesitancy on childhood immunization in low- and middle-income countries remains largely uncharacterized. This study describes the sociodemographic patterns of vaccine hesitancy in Chandigarh, India. Mothers of children <5 years old were sampled from a two-stage cluster, systematic sample based on Anganwadi child care centers in Chandigarh. Vaccine hesitancy was measured using a 10-item Vaccine Hesitancy Scale, which was dichotomized. A multivariable logistic regression assessed the association between socioeconomic factors and vaccine hesitancy score. Among 305 mothers, >97% of mothers thought childhood vaccines were important, effective, and were a good way to protect against disease. However, many preferred their child to receive fewer co-administered vaccines (69%), and were concerned about side effects (39%). Compared to the “other caste” group, scheduled castes or scheduled tribes had 3.48 times greater odds of vaccine hesitancy (95% CI: 1.52, 7.99). Those with a high school education had 0.10 times the odds of vaccine hesitancy compared to those with less education (95% CI: 0.02, 0.61). Finally, those having more antenatal care visits were less vaccine hesitant (≥4 vs. <4 visits OR: 0.028, 95% CI: 0.1, 0.76). As India adds more vaccines to its Universal Immunization Program, consideration should be given to addressing maternal concerns about vaccination, in particular about adverse events and co-administration of multiple vaccines.

The impact of the management model on the principal’s leadership: the Portuguese case

ABSTRACT The Principal is a central actor in schools and their formal leader. The public school management model (PSMM) influences his/her leadership style and behaviours. This study intended to analyse Principal’s performance as a leader under the current PSMM, as well as the positive and negative aspects of the model. The data were collected through exploratory interviews with a random systematic sample of 30 Principals with a management experience of at least 4 years. The results showed that Principals seek to find a balance between their role as leaders and managers, privileging delegation and collegiality in team coordination, disagreeing with the current General Council configuration, and underlining the importance of values and ethics in school management. They demand more time for pedagogical management and monitoring, greater autonomy and less bureaucracy and denounce the lack of resources for the management of people, facilities, equipment and services.

Birds from northeastern Bogotá Savannah, Cundinamarca, Colombia

The northeast area of the Bogotá Savannah (Cundinamarca, Colombia) is a region where biodiversity requires research because of few records in the current literature. We present a list of birds from the northeast area of the Bogotá Savannah. A systematic sample was conducted in the Ecoparque Sabana Nature Reserve (Tocancipá) to record the frequency of occurrence of bird species, while opportunistic observations were made at Parque Jaime Duque Nature Reserve (Tocancipá) and Aguablanca wetland (Sesquilé). A total of 820 h of sampling was done between February 2016 and June 2019. We provide a list with 128 species belonging to 37 families. Of these species, eight are newly recorded from the Bogotá Savannah; one species is considered Endangered and three are Near Threatened according to the Red List of the International Union for Conservation of Nature. The species richness found in our study supports the importance of protected areas in the northeast area of the Bogotá Savannah. Protected areas here help conserve the biodiversity of birds of the Andean region.