Dynamic inference of healthcare expenditure on economic growth in Sub-Saharan Africa: a dynamic heterogenous panel data analysis

PurposeThis article investigates the dynamic implication of healthcare expenditure on economic growth in the selected ten Sub-Saharan African countries over the period 2000–2018.Design/methodology/approachThe study methodology included dynamic heterogenous panel, using mean group and pooled mean group estimators. The investigation of the healthcare expenditure and economic growth nexus was achieved while controlling the effects of investment, savings, labor force and life expectancy via interaction terms.FindingsThe results from linear healthcare expenditure have a significant positive impact on economic growth, while the nonlinear estimates through the interaction terms between healthcare expenditure and investment have a negative statistically significant impact on growth. The marginal effect of healthcare expenditure evaluated at the minimum and maximum level of investment is positive, suggesting the impact of health expenditure on growth does not vary with the level of investments. This result responds to the primary objective of the article.Research limitations/implicationsIn policy terms, the impact of investment on healthcare is essential to addressing future health crises. The impact of coronavirus disease 2019 (COVID-19) can never be separated from the shortages or low prioritization of health against other sectors of the economy. The article also provides an insight to policymakers on the demand for policy reform that will boost and make the health sector attractive to both domestic and foreign direct investment.Originality/valueGiven the vulnerability of SSA to the health crisis, there are limited studies to examine this phenomenon and first to address the needed investment priorities to the health sector infrastructure in SSA.

Better COVID-19 Intensive Care Unit survival in females, independent of age, disease severity, comorbidities, and treatment

Although male Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients have higher Intensive Care Unit (ICU) admission rates and a worse disease course, a comprehensive analysis of female and male ICU survival and underlying factors such as comorbidities, risk factors, and/or anti-infection/inflammatory therapy administration is currently lacking. Therefore, we investigated the association between sex and ICU survival, adjusting for these and other variables. In this multicenter observational cohort study, all patients with SARS-CoV-2 pneumonia admitted to seven ICUs in one region across Belgium, The Netherlands, and Germany, and requiring vital organ support during the first pandemic wave were included. With a random intercept for a center, mixed-effects logistic regression was used to investigate the association between sex and ICU survival. Models were adjusted for age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, comorbidities, and anti-infection/inflammatory therapy. Interaction terms were added to investigate effect modifications by sex with country and sex with obesity. A total of 551 patients (29% were females) were included. Mean age was 65.4 ± 11.2 years. Females were more often obese and smoked less frequently than males (p-value 0.001 and 0.042, respectively). APACHE II scores of females and males were comparable. Overall, ICU mortality was 12% lower in females than males (27% vs 39% respectively, p-value < 0.01) with an odds ratio (OR) of 0.62 (95%CI 0.39–0.96, p-value 0.032) after adjustment for age and APACHE II score, 0.63 (95%CI 0.40–0.99, p-value 0.044) after additional adjustment for comorbidities, and 0.63 (95%CI 0.39–0.99, p-value 0.047) after adjustment for anti-infection/inflammatory therapy. No effect modifications by sex with country and sex with obesity were found (p-values for interaction > 0.23 and 0.84, respectively). ICU survival in female SARS-CoV-2 patients was higher than in male patients, independent of age, disease severity, smoking, obesity, comorbidities, anti-infection/inflammatory therapy, and country. Sex-specific biological mechanisms may play a role, emphasizing the need to address diversity, such as more sex-specific prediction, prognostic, and therapeutic approach strategies.

Differential impact of the Canadian point-of-sale tobacco display bans on quit attempts and smoking cessation outcomes by sex, income and education: longitudinal findings from the ITC Canada Survey

SignificanceThis study examines the differential effects of Canadian point-of-sale (POS) tobacco display bans across provinces on quit attempts and smoking cessation, by sex, education and income.MethodsWe analysed survey data from five waves (waves 4–8) of the International Tobacco Control Canada Survey, a population-based, longitudinal survey, where provinces implemented display bans between 2004 and 2010. Primary outcomes were quit attempts and successful cessation. We used generalised estimating equation Poisson regression models to estimate associations between living in a province with or without a POS ban (with a 24-month threshold) and smoking outcomes. We tested whether these associations varied by sex, education and income by including interaction terms.ResultsAcross survey waves, the percentage of participants in provinces with POS bans established for more than 24 months increased from 5.0% to 95.8%. There was no association between POS bans and quit attempts for provinces with bans in place for 0–24 months or more than 24 months, respectively (adjusted relative risk (aRR)=0.99, 95% CI: 0.89 to 1.10; 1.03, 95% CI: 0.88 to 1.20). However, we found a differential impact of POS bans on quit attempts by sex, whereby bans were more effective for women than men for bans of 0–24 months. Participants living in a province with a POS ban for at least 24 months had a higher chance of successful cessation (aRR=1.49; 95% CI: 1.08 to 2.05) compared with those in a province without a ban. We found no differences in the association between POS bans and quit attempts or cessation by education or income, and no differences by sex for cessation.ConclusionPOS bans are associated with increased smoking cessation overall and more quit attempts among women than men.

Heterogeneity of the Relative Benefits of TICI 2c/3 over TICI 2b50/2b67

Purpose Incomplete reperfusion after mechanical thrombectomy (MT) is associated with a poor outcome. Rescue therapy would potentially benefit some patients with an expanded treatment in cerebral ischemia score (eTICI) 2b50/2b67 reperfusion but also harbors increased risks. The relative benefits of eTICI 2c/3 over eTICI 2b50/67 in clinically important subpopulations were analyzed. Methods Retrospective analysis of our institutional database for all patients with occlusion of the intracranial internal carotid artery (ICA) or the M1/M2 segment undergoing MT and final reperfusion of ≥eTICI 2b50 (903 patients). The heterogeneity in subgroups of different time metrics, age, National Institutes of Health Stroke Scale (NIHSS), number of retrieval attempts, Alberta Stroke Programme Early CT Score (ASPECTS) and site of occlusion using interaction terms (pi) was analyzed. Results The presence of eTICI 2c/3 was associated with better outcomes in most subgroups. Time metrics showed no interaction of eTICI 2c/3 over eTICI 2b50/2b67 and clinical outcomes (onset to reperfusion pi = 0.77, puncture to reperfusion pi = 0.65, onset to puncture pi = 0.63). An eTICI 2c/3 had less consistent association with mRS ≤2 in older patients (>82 years, pi = 0.038) and patients with either lower NIHSS (≤9) or very high NIHSS (>19, pi = 0.01). Regarding occlusion sites, the beneficial effect of eTICI 2c/3 was absent for occlusions in the M2 segments (aOR 0.73, 95% confidence interval [CI] 0.33–1.59, pi = 0.018). Conclusion Beneficial effect of eTICI 2c/3 over eTICI 2b50/2b67 only decreased in older patients, M2-occlusions and patients with either low or very high NIHSS. Improving eTICI 2b50/2b67 to eTICI 2c/3 in those subgroups may be more often futile.

Bayesian Genomic Linear Regression

The Bayesian paradigm for parameter estimation is introduced and linked to the main problem of genomic-enabled prediction to predict the trait of interest of the non-phenotyped individuals from genotypic information, environment variables, or other information (covariates). In this situation, a convenient practice is to include the individuals to be predicted in the posterior distribution to be sampled. We explained how the Bayesian Ridge regression method is derived and exemplified with data from plant breeding genomic selection. Other Bayesian methods (Bayes A, Bayes B, Bayes C, and Bayesian Lasso) were also described and exemplified for genome-based prediction. The chapter presented several examples that were implemented in the Bayesian generalized linear regression (BGLR) library for continuous response variables. The predictor under all these Bayesian methods includes main effects (of environments and genotypes) as well as interaction terms related to genotype × environment interaction.

US Medical Expense Analysis Through Frequency and Severity Bootstrapping and Regression Model

For the purpose of control health expenditures, there are some papers investigating the characteristics of patients who may incur high expenditures. However fewer papers are found which are based on the overall medical conditions, so this chapter was to find a relationship among the prevalence of medical conditions, utilization of healthcare services, and average expenses per person. The authors used bootstrapping simulation for data preprocessing and then used linear regression and random forest methods to train several models. The metrics root mean square error (RMSE), mean absolute percent error (MAPE), mean absolute error (MAE) all showed that the selected linear regression model performs slightly better than the selected random forest regression model, and the linear model used medical conditions, type of services, and their interaction terms as predictors.

Social Isolation and Falls Risk: Lack of Social Contacts Decreases the Likelihood of Bathroom Modification Among Older Adults With Fear of Falling

Fall prevention strategies exist, but little is known about factors that influence whether they are used. We assessed whether social isolation modifies the association between fear of falling (FOF) and bathroom environmental modification. Data were included from 2858 Medicare beneficiaries in the National Health and Aging Trends Study. FOF and social isolation were assessed at baseline (2011); new bathroom modifications were assessed 1-year post-baseline. Social network size was dichotomized as any versus no social contacts. Logistic regression assessed associations between FOF and bathroom modification. Effect modification between FOF and social isolation was assessed with multiplicative interaction terms. FOF was associated with increased odds of bathroom modification. We observed a statistically significant interaction between FOF and social isolation ( p = 0.03). Among those with no social contacts, FOF was associated with reduced odds bathroom modification that did not reach statistical significance (OR 0.5, 95% CI 0.2–1.3).

Parents’ Perceptions of Education and Culture as a Context of Parental Stress: A Study of Parents of Preschool Children in Hong Kong

This study examines how cultural context mediates the association between parents’ perceptions of education and parental stress under the ABC-X model. The analysis was based on a sample of 6454 parents of preschool children in Hong Kong. Exploratory and confirmatory factor analysis detected two major dimensions of parents’ perceptions of children’s education. Ordinary least squares regression models with interaction terms were used to analyze the identified dimensions’ associations with parental stress. The study found preschool parents with an assertive perception of children’s cognitive skills, discipline, coercion, and competition were more stressed than parents with a responsive perception of children’s non-cognitive skills, self-management, autonomy, and cooperation in education. Parents paradoxically caught between these two types of perceptions were the most stressed. Native residents and earlier immigrant parents also had a higher level of stress than recent immigrants.

Hyperglycemia on Admission Predicts Acute Kidney Failure and Renal Functional Recovery among Inpatients

Background: Hyperglycemia is associated with adverse outcomes in hospitalized patients. We aimed to assess the impact of glucose levels upon admission on the subsequent deterioration or improvement of kidney function in inpatients with a focus on diabetes or reduced baseline kidney function as possible modifiers of this effect. Methods: Running a retrospective cohort analysis, we compared patients with normal vs. high glucose levels upon admission. We applied multivariable logistic regression models to study the association between baseline glucose levels with subsequent renal and clinical outcomes. Interaction terms were used to study a possible modifier effect of diabetes. Results: Among 95,556 inpatients (52% males, mean age 61 years), 15,675 (16.5%) had plasma glucose higher than 180 mg/dL, and 72% of them were diabetics. Patients with higher glucose at presentation were older, with a higher proportion of co-morbid conditions. Rates of acute kidney injury (AKI), acute kidney functional recovery (AKR), and mortality were proportional to reduced renal function. AKI, AKR, and mortality were almost doubled in patients with high baseline glucose upon admission. Multivariable analysis with interaction terms demonstrated an increasing adjusted probability of all events as glucose increased, yet this association was observed principally in non-diabetic patients. Conclusions: Hyperglycemia is associated with AKI, AKR, and mortality in non-diabetic inpatients in proportion to the severity of their acute illness. This association diminishes in diabetic patients, suggesting a possible impact of treatable and easily reversible renal derangement in this population.

The Centrality of Education for Indigenous Income Mobility in Canada

In this article, we employ a multinomial logistic regression model to determine which factors predict middle- and upper income class belonging among Indigenous and non-Indigenous people. We examine the impact of identity, education, occupation, and urbanization on income status. The positive impact of higher education is captured by the model; however, post-secondary education has a greater impact on some Indigenous groups than others. We present interaction terms between education and identity to show that investment in higher education is crucial to Indigenous people’s income attainment; however, some identity groups benefit more than others.