Analyzing Obesity Trends in American Children and Adolescents: Comprehensive Examination Using the National Center for Health Statistics (NCHS) Database.

Background In the USA, obesity in children and adolescents has become a major public health concern. Childhood obesity has been linked to various cardiometabolic comorbidities all through one's life. Owing to the significant increment in childhood obesity rates, there has been an urgent need for the identification of the correlates and antecedents of adiposity and the cardiometabolic risk to enable early prevention of obesity. As such, the objective of this study is to analyze obesity trends in American children and adolescents from 1999 to 2018 using the National Center for Health Statistics (NCHS) database, as this will enable the identification of various risk factors and early prevention of childhood obesity. Objective This study aimed to comprehensively examine demographic factors impacting obesity prevalence, including gender, age groups (two to five, six to 11, and 12-19 years), race/ethnicity, and poverty level. Methods The study conducted a retrospective analysis using the NCHS database from 1999 to 2018. Utilizing NCHS data, we examined the evolution of obesity prevalence among children and adolescents. The analysis focused on demographic variations, including gender, age, race/ethnicity, and percentage of poverty level. SPSS version 24, a statistical software by IBM Corp. (Chicago, IL, USA), was used for database summarization, graphical representation, and presenting prevalence trends across all participants. Results Temporal trends in obesity prevalence exhibited notable fluctuations from 1999 to 2018. Utilizing NCHS data, the study revealed demographic disparities in age groups, genders, race/ethnicities, and socioeconomic status categories. Gender-based obesity variations persist, with boys consistently surpassing girls in prevalence (17.5% vs. 16%, p = 0.0231). Varied age group patterns emerged, peaking at 18.7% in 12-19 years, 17.7% in six to 11 years, and 11.2% in two to five years. Racially, Hispanic individuals had the highest prevalence (22.8%), followed by Mexican (22.0%) and Black or African American-only individuals (20.6%). White-only individuals showed 14.4%, and Asian-only individuals exhibited the lowest (9.4%). Lower socioeconomic brackets correlate with higher obesity instances, particularly below the 100% poverty level (20%). The 100-199%, 200-399%, and 400% or more categories contributed 18.6%, 16.6%, and 11.6%, respectively. Conclusion Our extensive examination of obesity trends among American children and adolescents from 1999 to 2018, utilizing the NCHS database, provides valuable insights into the complex interplay of demographic factors influencing this public health concern. The study reveals age-specific variations, emphasizing unique challenges during adolescence. Gender disparities, socioeconomic influences, and racial/ethnic impacts are evident, underscoring the need for further study. Our findings present several policy implications regarding the development of interventions aimed at reducing childhood obesity rates in the USA. For instance, the findings indicate the need for policymakers to develop policy interventions aimed at enabling the prevention of obesity during early infancy stages. The findings highlight the need for interventions aimed at reducing the obesity disparities observed between genders and races/ethnic groups. Developing and executing the interventions is prone to considerably reduce the obesity prevalence rates among children and adolescents in the USA.

Atlas 2022 of African health Statistics: Key results towards achieving the health-related SDGs targets.

Introduction: The Atlas 2022 of African Health Statistics is a comprehensive tool that gives an overview of the health ecosystem in the African region. As such, it tracks progress towards globally agreed objectives, such as Sustainable Development Goals (SDGs), assesses the capacity of African countries to achieve them, and helps policymakers identify gaps and areas requiring substantial reinforcement. Methods: We analyzed health-related SDGs' key indicators in the Atlas 2022 of African Health Statistics. This platform is a nexus for consistent and comparable data sources across countries. A review of studies addressing the evolution of health-related SDG indicators in Africa was also considered for discussion and recommendations. Results: Hunger and different forms of malnutrition remain prevalent in the Region. Maternal and neonatal mortality is still high compared to other regions, with increasing incidences of non-communicable diseases and poor mechanisms to address mental health issues. Many inequalities are noted in violence against women, access to health services, or access to water and basic sanitation, which is exacerbated in rural areas. Regarding achieving the SDGs, the trend of most indicators shows they will be challenging to perform at the Regional level. However, a few countries are on track to achieve some goals. These results clearly show that countries have different experiences and, therefore, different progress in achieving sustainable development goals. The delays experienced by many countries in terms of development in other sectors, such as climate and the environment, poverty reduction and economic growth, equity and justice, etc., will make it even more difficult to achieve the health-related SDGs. Achieving these goals should, therefore, be seen as a transdisciplinary and inclusive process. Conclusion: Beyond the COVID-19 pandemic that has recently challenged health systems worldwide, the African Region is also dealing with several threats, jeopardizing its progress toward achieving the SDGs by 2030. Given the Region's particular context, a readjustment of the regional targets and/or deadlines would be advisable to ensure they are achievable.

The problem and probability of marriage for alumnae in Progressive Era United States.

When Bryn Mawr College opened in 1885, then-president James Rhoads highlighted the precautions taken to ensure that the young women students would remain healthy, in reaction to the publicized warnings of Scottish physician Thomas S. Clouston, M.D. Dr. Clouston's concern that girls' higher education would damage their health epitomized a growing anxiety around the status of wives and mothers at a time of increased educational opportunities for the so-called 'fairer sex'. To counter these opinions, college alumnae and administrators turned to statistics. Through a combination of published statistics and informal anecdotes, this article provides an in-depth study of how marriage data were solicited, tabulated, and framed at Bryn Mawr College during the Progressive Era, contributing a detailed case-study to the historiography on the period's debates over educated women. The tension between marriage and a career in research was acutely apparent to the women in academia who were at once responsible for the statistical analysis and among the subjects under investigation. While the survey design and published results emphasized the desired outcome of marriage after graduation, these same documents also offered space for emerging professional trajectories.

Attention-Deficit Hyperactivity Disorder Among American Youth: A Comprehensive 20-Year Analysis of National Center for Health Statistics (NCHS) Data.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that has a significant impact on the lives of children and adolescents. This study conducts a comprehensive 20-year analysis of data from the National Center for Health Statistics (NCHS) to investigate the prevalence of ADHD among American youth, as well as its demographic patterns and socioeconomic determinants. METHODS: A retrospective analysis of NCHS data spanning from 1997 to 2018 was carried out. The dataset included information on ADHD diagnoses, demographic characteristics (such as age, gender, and race/ethnicity), socioeconomic indicators (including poverty level and health insurance status), and temporal variables. A range of statistical analyses were performed, encompassing temporal trend analysis, demographic assessments, and socioeconomic examinations. RESULTS: It was consistently observed that boys had a higher prevalence of ADHD (12.93% compared to 5.61%), aligning with established trends. Among adolescents aged 10-17, the prevalence was the highest at 11.09%, while for the 5-9 age group, it stood at 6.57%. In terms of racial and ethnic groups, individuals identifying as two or more races exhibited the highest prevalence at 12.36%, followed by white (9.83%), black or African American (10.09%), Hispanic or Latino (5.36%), and non-Hispanic or Latino (10.64%). Socioeconomic disparities were evident, with a prevalence of 11.41% among those living below the poverty line, compared to 10.6% (100%-199% of the poverty line), 8.6% (200%-399%), and 8.39% (400% or more). Medicaid beneficiaries had the highest prevalence at 12.57%, followed by those with private insurance (9.65%), insured (8.11%), and uninsured (5.83%). CONCLUSION: These findings underscore the intricate relationship between ADHD prevalence and demographic and socioeconomic factors. It is imperative to address these disparities to ensure equitable assessment and intervention for ADHD, taking into account cultural influences, determinants of health tied to socioeconomic status, and access to healthcare for all children. This analysis by the NCHS provides essential insights into ADHD among American youth, emphasizing the necessity for tailored interventions, equitable healthcare access, and further research to comprehensively address this complex neurodevelopmental disorder.

A Comprehensive 16-Year Analysis of National Center for Health Statistics Data on the Top Three Causes of Death Before Age 75 by Sex, Race, and Hispanic Origin.

OBJECTIVE:  This study aimed to conduct a comprehensive 16-year analysis of years of potential life lost (YPLL) due to leading causes of death in the United States, focusing on disparities by sex, race/ethnicity, and specific causes of death using the National Center for Health Statistics (NCHS) data. METHODS:  Data from the NCHS spanning 2000-2016 were included. Age-adjusted YPLL rates per 100,000 population were analyzed, stratified by sex, race/ethnicity, and leading causes of death, including malignant neoplasms, heart disease, and cerebrovascular diseases. RESULTS:  Over 16 years, the total YPLL rate was 7,036.2 per 100,000 population. Males had a higher YPLL rate (8,852.5 per 100,000) than females (5,259.9 per 100,000). Among racial/ethnic groups, Black/African Americans had the highest YPLL rate (10,896.8 per 100,000), followed by American Indian/Alaska Natives (7,310.0 per 100,000), Hispanics/Latinos (5,256.8 per 100,000), and Asians/Pacific Islanders (3,279.7 per 100,000). Leading causes included malignant neoplasms (1,451.6 per 100,000), heart diseases (1,055.4 per 100,000), and cerebrovascular diseases (182.3 per 100,000). CONCLUSION: This analysis spanning 16 years highlights notable disparities in YPLL rates among different demographic groups. These differences are evident in the YPLL rates for males, which are higher than those for females. The YPLL rate is most pronounced among Black/African Americans, followed by American Indian/Alaska Natives, Hispanics/Latinos, and Asians/Pacific Islanders. The primary contributors to YPLL are malignant neoplasms, heart diseases, and cerebrovascular diseases. These findings emphasize the importance of addressing these disparities to enhance public health outcomes and mitigate the premature loss of life. Despite progress, disparities persist, highlighting the need for targeted interventions and further research.

Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data.

Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5-11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3-24.4) but not among lesbian and bisexual women (3.5; CI: 0.9-13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.

A novel comorbidity index in Italy based on diseases detected by the surveillance system PASSI and the Global Burden of Diseases disability weights.

BACKGROUND: Understanding comorbidity and its burden characteristics is essential for policymakers and healthcare providers to allocate resources accordingly. However, several definitions of comorbidity burden can be found in the literature. The main reason for these differences lies in the available information about the analyzed diseases (i.e., the target population studied), how to define the burden of diseases, and how to aggregate the occurrence of the detected health conditions. METHODS: In this manuscript, we focus on data from the Italian surveillance system PASSI, proposing an index of comorbidity burden based on the disability weights from the Global Burden of Disease (GBD) project. We then analyzed the co-presence of ten non-communicable diseases, weighting their burden thanks to the GBD disability weights extracted by a multi-step procedure. The first step selects a set of GBD weights for each disease detected in PASSI using text mining. The second step utilizes an additional variable from PASSI (i.e., the perceived health variable) to associate a single disability weight for each disease detected in PASSI. Finally, the disability weights are combined to form the comorbidity burden index using three approaches common in the literature. RESULTS: The comorbidity index (i.e., combined disability weights) proposed allows an exploration of the magnitude of the comorbidity burden in several Italian sub-populations characterized by different socioeconomic characteristics. Thanks to that, we noted that the level of comorbidity burden is greater in the sub-population characterized by low educational qualifications and economic difficulties than in the rich sub-population characterized by a high level of education. In addition, we found no substantial differences in terms of predictive values of comorbidity burden adopting different approaches in combining the disability weights (i.e., additive, maximum, and multiplicative approaches), making the Italian comorbidity index proposed quite robust and general.

Dashboard With Bump Charts to Visualize the Changes in the Rankings of Leading Causes of Death According to Two Lists: National Population-Based Time-Series Cross-Sectional Study.

BACKGROUND: Health advocates and the media often use the rankings of the leading causes of death (CODs) to draw attention to health issues with relatively high mortality burdens in a population. The National Center for Health Statistics (NCHS) publishes "Deaths: leading causes" annually. The ranking list used by the NCHS and statistical offices in several countries includes broad categories such as cancer, heart disease, and accidents. However, the list used by the World Health Organization (WHO) subdivides broad categories (17 for cancer, 8 for heart disease, and 6 for accidents) and classifies Alzheimer disease and related dementias and hypertensive diseases more comprehensively compared to the NCHS list. Regarding the data visualization of the rankings of leading CODs, the bar chart is the most commonly used graph; nevertheless, bar charts may not effectively reveal the changes in the rankings over time. OBJECTIVE: The aim of this study is to use a dashboard with bump charts to visualize the changes in the rankings of the leading CODs in the United States by sex and age from 1999 to 2021, according to 2 lists (NCHS vs WHO). METHODS: Data on the number of deaths in each category from each list for each year were obtained from the Wide-ranging Online Data for Epidemiologic Research system, maintained by the Center for Disease Control and Prevention. Rankings were based on the absolute number of deaths. The dashboard enables users to filter by list (NCHS or WHO) and demographic characteristics (sex and age) and highlight a particular COD. RESULTS: Several CODs that were only on the WHO list, including brain, breast, colon, hematopoietic, lung, pancreas, prostate, and uterus cancer (all classified as cancer on the NCHS list); unintentional transport injury; poisoning; drowning; and falls (all classified as accidents on the NCHS list), were among the 10 leading CODs in several sex and age subgroups. In contrast, several CODs that appeared among the 10 leading CODs according to the NCHS list, such as pneumonia, kidney disease, cirrhosis, and sepsis, were excluded from the 10 leading CODs if the WHO list was used. The rank of Alzheimer disease and related dementias and hypertensive diseases according to the WHO list was higher than their ranks according to the NCHS list. A marked increase in the ranking of unintentional poisoning among men aged 45-64 years was noted from 2008 to 2021. CONCLUSIONS: A dashboard with bump charts can be used to improve the visualization of the changes in the rankings of leading CODs according to the WHO and NCHS lists as well as demographic characteristics; the visualization can help users make informed decisions regarding the most appropriate ranking list for their needs.

Ranking of Alzheimer's disease and related dementia among the leading causes of death in the US varies depending on NCHS or WHO definitions.

INTRODUCTION: We compared the ranking of Alzheimer's disease and related dementia (ADRD) among the leading causes of death (LCODs) between those according to the National Center for Health Statistics (NCHS) and the World Health Organization (WHO) lists by sex. METHOD: The number of deaths in each LCOD category was obtained from CDC WONDER. RESULTS: According to the WHO list, ADRD was the second LCOD from 2005 to 2013, the first from 2014 to 2020, and the third in 2021, respectively, for women and was the second in 2018 and 2019, the third in 2020, and the fourth in 2021, respectively, for men. According to the NCHS list, Alzheimer's disease was the fourth in 2019 and 2020 for women and was the seventh from 2016 to 2019 for men. DISCUSSION: The ranking of ADRD among the LCODs according to the WHO list was higher than those according to the NCHS list.

[Geographic information in National Cancer Registry data: Overseas examples and challenges in Japan].

Worldwide, research based on geographic information of official statistical data, including cancer registries, is utilized for cancer control and public health policies. The National Cancer Registry of Japan was launched in 2016, making it possible to use data on cancer incidence systematically. Given the nature of this comprehensive survey, the usefulness of the National Cancer Registry would be further enhanced when it is utilized at small-regional levels, such as in municipalities or even smaller geographical units. It is essential to maintain a balance between privacy protection and data usability. Currently, the national and prefectural councils determine the availability of the data from the National Cancer Registry at the small-regional level on an individual application basis. Under this framework, use of the data is often restricted or declined. This paper showcases three model countries where geographic information obtained from cancer registry data are widely utilized: the United States, Canada, and the United Kingdom. It further discusses measures to ensure that data are effectively used, without compromising data privacy. In the three countries, data-providing systems have been established to compile the necessary data from the cancer registry and other linked databases, in accordance with the purpose of use. The relationships between healthcare access and various outcomes are elaborately examined at the small-regional level. In Japan, similar utilization of data has not been fully implemented, and there remain many hurdles to the application of the data use. For the National Cancer Registry to promote research and further enhance cancer control, it is necessary to establish a system that enables effective and safe utilization of the data from the National Cancer Registry, including linkage with other data and on-site use.

Challenges in Collecting and Reporting Health Statistics in Kosovo.

Background: Statistical data play a crucial role in research, planning and decision making in the health system, especially in the formulation and implementation of health policies. Health policy, adequate health legislation and sustainable financing of the health system remain serious challenges for countries in transition and especially for the Republic of Kosovo. Objective: To analyze the challenges of collection, accuracy and accurate reporting and the impact of the accuracy of these health statistics on the creation of appropriate public health policies in Kosovo. Methods: This research is mainly based on a combination of qualitative, quantitative, deductive, analytical and comparative methods conducted by health workers at all three levels of the health organization and IT experts who were actively involved in some of the important components of our research. Results: It is interesting to note that respondents gave typical scores for the security and confidentiality of medical data and statistics during the cycle of their collection and processing, with one score being 3 and the other 5, and 50% of respondents gave a score of 5 for the successful fulfilment of the mission and tasks established by the Law on the rational use of medical data and statistics to support public health policy. Conclusion: The research and findings provide sufficient evidence that Kosovar health data and statistics system suffers from serious deficiencies ranging from the legal framework, organizational structure, functional organization, segregation of duties and responsibilities, to a pronounced lack of human resources, professional profiles in the health statistics service and the necessary technology to perform the basic tasks in a timely and high quality manner.

Low sodium intake and cardiovascular disease mortality among adults with hypertension.

Background: Though high sodium intake is linked to an increased risk of hypertension and cardiovascular diseases, the relationship between sodium intake and mortality remains controversial. Given that medications used to treat hypertension can potentially lower blood sodium levels and alter electrolyte balance, it begs the question whether a further reduction in dietary sodium below the recommended daily intake of 2300 mg is beneficial among adults with hypertension. Objective: To evaluate the effect of low sodium intake on cardiovascular disease (CVD) mortality and all-cause mortality among adults with hypertension. Design: A retrospective cohort study was conducted using data from the Continuous NHANES (1999-2010) linked to mortality files from the National Death Index. Using sodium intake categorized as low <2300 mg/day and high ≥2300 mg/day, the baseline demographic and health characteristics of participants were determined. Hazard ratios (HR) for CVD and all-cause mortality were determined through cox proportional hazard regression analysis adjusted for age, sex, race, total dietary calories, body mass index, physical activity, smoking, diabetes, alcohol consumption, and total serum cholesterol while considering the complex survey design. Results: Of the 8542 adults with hypertension, 71.01% consumed sodium higher than the recommended daily intake of 2300 mg. The mean age was 54 years, 52.3% were female and 73.1% were white. Over 12.7 years of follow-up, there were 971 deaths, with 232 deaths from CVD. The low sodium intake group had a nonsignificant 5% higher risk of CVD mortality, [Adjusted HR 1.05,95% CI (0.7-1.6), p-value 0.82]. Similarly, there was a nonsignificant 17% higher risk for all-cause mortality for the low sodium intake group, [Adjusted HR 1.17,95% CI (1.0-1.4), p-value 0.10]. There was no effect modification by age, race, or sex. Conclusion: The findings of an inverse association between sodium intake and mortality among adults with hypertension seen here, though not statistically significant warrant further investigation.

The association between dietary fiber and infertility among US women: The National Health and Nutrition Examination Survey, 2013-2018 / La relación entre la fibra dietética y la infertilidad femenina en los Estados unidos: encuesta nacional de salud y nutrición, 2013-2018

Background: studies have shown that dietary factors are linked to female infertility, but the relation between dietary fiber consumption and infertility has not been proven. The purpose of this research was to investigate whether there is an independent association between dietary fiber intake and infertility in American women. Material and methods: a secondary analysis of the National Health and NUTRITION Examination Survey (NHANES) dataset has been conducted, covering three cycles from 2013 to 2018. A total of 3,497 participants were included in the data analysis. The independent and dependent variables of interest were dietary fiber intake and infertility. Covariates included sociodemographic, questionnaire, diet, and physical examination data. Multiple logistic regression and sensitivity analyses were performed to investigate the relationship of dietary fiber intake with infertility. Results: each additional increase in log10 dietary fiber consumption was associated with a 32 % lower risk of infertility (OR, 0.68; 95 % CI, 0.48-0.96). The outcome is still robust in the minimally as well as the fully adjusted model. The possibility of a nonlinear association between dietary fiber intake and infertility was ruled out by the GAM model and smooth curve fitting. The RESULTS showed that there is an inverse linear correlation between dietary fiber intake and infertility. Conclusions: the association between intake of dietary fiber and infertility is linear, and increasing dietary fiber intake may be beneficial for lower infertility. (AU)

Antecedentes: el consumo de fibra dietética es un factor importante en la infertilidad femenina. El objetivo del estudio fue investigar si existe una relación independiente entre el consumo de fibra dietética y la infertilidad en las mujeres estadounidenses. Material y métodos: se realizó un análisis secundario del conjunto de datos de la encuesta nacional de salud y nutrición (NHANES), que abarcó tres ciclos entre 2013 y 2018. Se incluyeron 3497 participantes para el análisis de datos. Las variables independientes y dependientes asociadas fueron la ingesta de fibra dietética y la infertilidad. Las covariables incluyeron datos sociodemográficos, de los cuestionarios, dietéticos y médicos. Se realizó un análisis de regresión logística multivariada y un análisis de sensibilidad para determinar la relación entre el consumo de fibra dietética y la infertilidad. Resultados: cada aumento log10 en el consumo de fibra dietética se asoció con una reducción del 32 % en el riesgo de infertilidad (OR: 0,68; intervalo de confianza del 95 %: 0,48-0,96). En el modelo mínimo y totalmente ajustado, los resultados siguen siendo robustos. El modelo GAM y el ajuste de curvas suavizadas descartaron la posibilidad de una relación no lineal entre la ingesta de fibra dietética y la infertilidad. Los resultados muestran una correlación lineal negativa entre la ingesta de fibra dietética y la infertilidad. Conclusiones: se observó una relación lineal entre la ingesta de fibra dietética y la infertilidad. El aumento de la ingesta de fibra dietética redujo la incidencia de la infertilidad. (AU)

Maternal and neonatal characteristics associated with clinical outcomes of TOLAC from 2012-20 in the USA: Evidence from a retrospective cohort study.

Background: The risks of a few maternal and/or neonatal morbidities are higher with the trial of labour after caesarean (TOLAC) owing to unplanned caesarean delivery. Thus, it is imperative to consider the trade-off between the risk of side effects and the potential benefits before TOLAC utilisation and whether TOLAC should be provided to women with specific characteristics related to previous caesarean delivery. We aimed to investigate maternal and neonatal characteristics associated with TOLAC utilisation, compare maternal and/or neonatal morbidities in TOLAC women with women who chose planned caesarean deliveries, and assess specific characteristics related to maternal and/or neonatal morbidities in women with TOLAC utilisation. Methods: In this retrospective cohort study, we used nationwide, linked birth and infant death data in the United States between 2012 and 2020, which covers all 50 states in the US. Poisson regression models using generalised estimating equations yielded adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) of TOLAC utilisation and unsuccessful TOLAC by maternal and neonatal characteristics. Logistic regression models using generalised estimating equations yielded adjusted odds ratios (aORs) with 95% CIs of maternal and neonatal morbidities. Statistical analysis was performed from February 2022 to July 2022. Findings: The sample included 4,898,441 women with mean (SD) maternal age years (5.4 years; range 13-50). Several specific maternal and neonatal characteristics were significantly associated with unsuccessful TOLAC, although women with TOLAC utilisation were associated with significantly lower risks of maternal unplanned hysterectomy (aOR, 0.60; 95% CI, 0.60-0.61), admission to intensive care (aOR, 0.84; 95% CI, 0.84-0.85), and neonatal seizures (aOR, 0.80; 95% CI, 0.74-0.84). In women who attempted TOLAC, advanced maternal age, higher maternal body mass index, more than 2 previous caesarean deliveries, having maternal co-morbidities and fetal malpresentation increased the likelihood of maternal and neonatal morbidities. Interpretation: When utilising TOLAC, specific maternal and neonatal characteristics in pregnant women should be considered in conjunction with the potential benefits of TOLAC in preventing maternal and neonatal morbidities. Funding: This study is funded by the Clinical Medicine Plus X - Young Scholars Project, Peking University, the Fundamental Research Funds for the Central Universities (No: PKU2022LCXQ008).

When does morbidity start? An analysis of changes in morbidity between 2013 and 2019 in Italy.

Morbidity is one of the key aspects for assessing populations' well-being. In particular, chronic diseases negatively affect the quality of life in the old age and the risk that more years added to lives are years of disability and illness. Novel analysis, interventions and policies are required to understand and potentially mitigate this issue. In this article, we focus on investigating whether in Italy the compression of morbidity is in act in the recent years, parallely to an increase of life expectancy. Our analysis rely on large repeated cross-sectional data from the national surveillance system passi, providing deep insights on the evolution of morbidity together with other socio-demographical variables. In addition, we investigate differences in morbidity across subgroups, focusing on disparities by gender, level of education and economic difficulties, and assessing the evolution of these differences across the period 2013-2019.

Legal Regulations of the Health Statistics System and Reflections on the Creation and Implementation of Health Policy in Kosovo.

Background: Health professionals and health institutions document their professional activities with patients based on health policy and legal framework. This creates valuable medical records not only for health institutions at the three levels, but also for scientific research purposes and government agencies that design policies, laws and strategies and implement and monitor these policies based on the health statistics that form the basis of these policies, as well as for the health system not only at the national level, but also at the regional and local levels. Objective: To analyze the impact of the legal framework for health statistics in Kosovo on the planning of health system needs, human and financial resources and other components related to the collection, analysis and processing of data and health statistics, and on the basis of these statistics, to develop sectoral strategies, but also other key strategic documents for decision-making in the health system of Kosovo. Methods: Decision-makers and stakeholders, as well as other staff involved in the system of health statistics at the three organization levels of the health system in Kosovo, including inspectors from the Health Inspectorate, were interviewed through specific questionnaires. Results: The analysis of the laws, bylaws and other provisions that regulate and directly influence the data system and health statistics in Kosovo revealed that the institutional role is unclear, the legislation is insufficient and in many cases regulations are missing, which are an essential prerequisite for the implementation of the legislation and consequently influence the insufficient decision-making process. Conclusion: The research and findings provide sufficient evidence that the Kosovo's system for health data and statistics has serious shortcomings, starting with the legal framework, organizational structure, functional organization, segregation of duties and responsibilities, pronounced lack of staff, professional profiles and required technology, which in turn affects unreliable decision-making and health policy.

Psychological distress and the risk of drug overdose death.

BACKGROUND: Previous research has shown an association between psychological distress and overdose death among specific populations. However, few studies have examined this relationship in a large US population-based cohort. METHODS: Data from the 2010-2018 NHIS were linked to mortality data from the National Death Index through 2019. Psychological distress was measured using the Kessler 6 scale. Drug overdose deaths were examined, and deaths from all other causes were included as a comparison group. Cox proportional hazards regression was used to estimate mortality risk by psychological distress level. RESULTS: The study population included 272,561 adults. Adjusting for demographic covariates and using no psychological distress as the reference, distress level was positively associated with the risk of overdose death: low (HR = 1.8, 95 % CI = 1.1-2.8), moderate (HR = 4.1, 95 % CI = 2.5-6.7), high (HR = 10.3, 95 % CI = 6.5-16.1). A similar pattern was observed for deaths from all other causes: low (HR = 1.2, 95 % CI = 1.1-1.2), moderate (HR = 1.9, 95 % CI = 1.7-2.0), high (HR = 2.6, 95 % CI = 2.4-2.8). LIMITATIONS: Limited substance use information prevented adjustment for this potentially important covariate. DISCUSSION: Adults with psychological distress were at greater risk of drug overdose death, relative to those without psychological distress. Adults with psychological distress were also at increased risk of death due to other causes, though the association was not as strong.

Significancia Estadística en Ciencias de la Salud: Limitaciones y Alternativas / Statistical significance in the field of health sciences: limitations and alternatives

Introducción. La prueba de significancia de la hipótesis nula (PSHN) constituye la herramienta más usada para evaluar hipótesis científicas y tomar decisiones al respecto, en especial en ciencias de la salud. Sin embargo, por décadas ha estado en el centro del debate, ya que se han identificado varios problemas conceptuales y de interpretación. Se realizó una revisión de artículos científicos que ilustran las críticas de esta controversia y su relevancia en el ámbito de la investigación en salud. Algunas alternativas para la PSHN son una adecuada interpretación del valor p, uso de intervalos de confianza, incluir el tamaño del efecto y adoptar un marco de inferencia bayesiana. En todos los casos en que se utilice PSHN, su uso debe ser claramente justificado.

Background. Null hypothesis significance testing (NSHT) constitutes the most widely applied tool for the evaluation of scientific hypotheses and decision making in health sciences. However, the method has been the centre of a heated debate where various criticisms related to conceptual and interpretational problems. A review of scientific articles that illustrate the criticisms of this controversy and its relevance in the field of health research was carried out. Some alternatives for the NSHT are an adequate interpretation of the p-value, use of confidence intervals, including the effect size and adopting a Bayesian inference framework. In all cases where NSHT is used, its use should be clearly justified.