Linear modeling of zonal level crop production in Ethiopia.

Accounting for zonal-level variations and identifying factors that have linear effects on crop production help to make better decisions and plan new policies for effective crop production and food security. The main objective of this study is to identify potential subsets of covariates and estimate their linear effects on crop production. A linear mixed effects model (random--intercept) is used on agricultural sample survey data for Meher seasons from 2012/13 to 2019/20 to explore and identify the best variance-covariance structure for the longitudinal data on 90 zones with eight repeated observations and different sampling weights. The minimum, mean, and maximum crop production by farmers across the country are 1.616, 8.693, and 147.843 quintals, respectively, and about 98 % of farmers produced less than 25 quintals. There is a small rate of increase in mean and median crop production by farmers across the years, and the variability between zones is highest in the year 2019/20 and in the Somali region. The histogram, kernel density, and P-P plots suggested a common logarithm transformation on the crop production variable. Results from the data exploration and variance-covariance structure selection methods suggested a heterogeneous compound symmetry (CSH) structure. Covariates region, year, proportion of farmers who practice pure-agriculture and other-agriculture types, proportion of farmers who use any type of fertilizer, farmer's age, area used, farmer association crop production, indigenous seed used, improved seed used, UREA fertilizer used, other fertilizers used, and percentage of crop damaged are significant in linearly explaining/affecting log crop production, and among these area used, farmers association crop production, UREA fertilizer used, and indigenous seed used have relatively highest effect on log crop production. Zones Wolayita, North-Shewa (Am), West-Arsi, West-Welega, Dawro, and Guji are top/good performers while zones Southwest-Shewa, Waghimra, Guraghe, South-Omo, Keffa, North-Wello, South-Wello, and Eastern Tigray are bottom/poor performers in crop production. Model assumptions and influence diagnostics results suggested the linearity of the model and normality of random effects and residuals are not violated, even though some zones have influences on either model parameters, precisions of estimates of these parameters, and predicted values.

Improving the Efficiency of Inferences From Hybrid Samples for Effective Health Surveillance Surveys: Comprehensive Review of Quantitative Methods.

BACKGROUND: Increasingly, survey researchers rely on hybrid samples to improve coverage and increase the number of respondents by combining independent samples. For instance, it is possible to combine 2 probability samples with one relying on telephone and another on mail. More commonly, however, researchers are now supplementing probability samples with those from online panels that are less costly. Setting aside ad hoc approaches that are void of rigor, traditionally, the method of composite estimation has been used to blend results from different sample surveys. This means individual point estimates from different surveys are pooled together, 1 estimate at a time. Given that for a typical study many estimates must be produced, this piecemeal approach is computationally burdensome and subject to the inferential limitations of the individual surveys that are used in this process. OBJECTIVE: In this paper, we will provide a comprehensive review of the traditional method of composite estimation. Subsequently, the method of composite weighting is introduced, which is significantly more efficient, both computationally and inferentially when pooling data from multiple surveys. With the growing interest in hybrid sampling alternatives, we hope to offer an accessible methodology for improving the efficiency of inferences from such sample surveys without sacrificing rigor. METHODS: Specifically, we will illustrate why the many ad hoc procedures for blending survey data from multiple surveys are void of scientific integrity and subject to misleading inferences. Moreover, we will demonstrate how the traditional approach of composite estimation fails to offer a pragmatic and scalable solution in practice. By relying on theoretical and empirical justifications, in contrast, we will show how our proposed methodology of composite weighting is both scientifically sound and inferentially and computationally superior to the old method of composite estimation. RESULTS: Using data from 3 large surveys that have relied on hybrid samples composed of probability-based and supplemental sample components from online panels, we illustrate that our proposed method of composite weighting is superior to the traditional method of composite estimation in 2 distinct ways. Computationally, it is vastly less demanding and hence more accessible for practitioners. Inferentially, it produces more efficient estimates with higher levels of external validity when pooling data from multiple surveys. CONCLUSIONS: The new realities of the digital age have brought about a number of resilient challenges for survey researchers, which in turn have exposed some of the inefficiencies associated with the traditional methods this community has relied upon for decades. The resilience of such challenges suggests that piecemeal approaches that may have limited applicability or restricted accessibility will prove to be inadequate and transient. It is from this perspective that our proposed method of composite weighting has aimed to introduce a durable and accessible solution for hybrid sample surveys.

Characteristics of Maine and Massachusetts nurses interested in advanced nursing degrees.

BACKGROUND: Maine (ME) and Massachusetts (MA) nursing programs aim to develop collaborative training programs, but need to identify which nurses have interest in such programs. PURPOSE: We sought to determine sociodemographics of nurses seeking advanced nursing degrees nationally, and in ME and MA using the 2018 publicly available, National Sample Survey of Registered Nurses (NSSRN). METHODS: Weighted multivariable logistic regression for advanced degree-seeking, adjusted for sociodemographics. RESULTS: Of the n = 47,274 nurses (weighted n [Wn] = 3,608,633), 90.7 % were female, 74.1 % were white, and 15.8 % sought an advanced nursing degree on average 12.7 (SD 0.2) years after their first. Females vs. males had lower odds (OR 0.63, 95%CI [0.44-0.90]) and Black vs. White race had higher odds (OR 1.30, 95%CI [1.05-1.60]) of seeking doctorates. In Maine (Wn = 20,389), age 24-29 had higher odds (OR 2.98 (95%CI [1.06-3.74]), but in Massachusetts (Wn = 101,984), age 30+ had lower odds (OR 0.32, 95%CI [0.13-0.78]) of degree-seeking vs. <24 years. Initial nursing degrees earned between 1980 and 1989 had higher odds (OR 1.99, 95%CI [1.06-3.74]) in Maine, but between 2010 and 2014 had lower odds (OR 0.32, 95%CI [0.14-0.72]) in Massachusetts of degree-seeking, vs. before 1980. CONCLUSIONS: Targets for advanced nursing training programs may vary by state and sociodemographic profile.

Progress towards universal health coverage in the context of mental disorders in India: evidence from national sample survey data.

BACKGROUND: Universal health coverage (UHC) has emerged as one of the important health policy discourses under the current sustainable development goals in the world. UHC in individual disease conditions is a must for attaining overall UHC. This study measures progress towards UHC in terms of access to health care and financial protection among individuals with mental disorders in India. METHODS: Data from the 75th Round National Sample Survey (NSS), 2017-18, was used, which is the latest round on health in India. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232), from randomly selected 8077 villages and 6181 urban areas, included 283 outpatient and 374 hospitalization cases due to mental disorders in India. Logistic regression models were used for analyses. RESULTS: Self-reporting of mental disorders was considerably lower than the actual disease burden in India. However, self-reporting of ailment was 1.73 times higher (95% CI: 1.18-2.52, p < 0.05) among the richest income group population compared to the poorest in India. The private sector was a major service provider of mental health services with a larger share for outpatient (66.1%) than inpatient care (59.2%). Over 63% of individuals with a mental disorder who reported private sector hospitalization noted unavailability or poor service quality at public facilities. Only 23% of individuals hospitalized had health insurance coverage at All India level. However, health insurance coverage among poorest economic class was a meagre 3.4%. Average out-of-pocket expenditure during hospitalization (public: 123 USD; private: 576 USD) and outpatient care (public: 8 USD; private: 37 USD) was significantly higher in the private sector than in the public sector. Chances of facing catastrophic health expenditure at 10% threshold were 23.33 times (95% CI: 10.85-50.17; p < 0.001) higher under private sector than public sector during hospitalization. Expenditure on medicine, as the share of total medical expenditure, was highest for hospitalization (public: 45%, private:39.5%) and outpatient care (public: 74.1%, private:39.7%). CONCLUSIONS: Social determinants play a vital role in access to healthcare and financial protection among individuals with mental disorders in India. For achieving UHC in mental disorders, India needs to address the gaps in access and financial protection for individuals with mental disorders. TRIAL REGISTRATION: Not applicable.

New nurses' quality and safety education: An analysis of the 2018 National Sample Survey of Registered Nurses.

BACKGROUND: The integration of the Nursing Quality and Safety Education (QSEN) competencies into American Association of College of Nursing - The Essentials: Core Competencies for Professional Nursing Education warrants continued assessment of the new nurses' QSEN competencies preparedness. PURPOSE: The purpose of this study was to analyze quality and safety education needs of nurses who graduated in 2016, 2017, and 2018 and have responded to the most recent National Sample Survey of Registered Nurses. METHODS: This is a retrospective correlational design study using analysis of publicly available data from the 2018 National Sample Survey of Registered Nurses. A logistic regression model was used to assess correlations between 21 quality and safety education variables and nursing degree type. RESULTS: When adjusting for differences in demographic and work characteristics, there were no significant differences in quality and safety training needs by the nursing degree type. New nurses, regardless of the nursing degree type reported additional training needs in patient-centered care (50%), evidence-based practice and team-based care (40%), quality improvement (30%). CONCLUSIONS: This study provides new, national data on new nurses' quality and safety education preparedness and provides evidence for the need for continued investment and integration of QSEN competencies in all nursing degree programs.

Public health nursing workforce and learning needs: A national sample survey analysis.

OBJECTIVES: Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States. DESIGN: Secondary data analysis of the 2018 National Sample Survey of Registered Nurses. SAMPLE: Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce. MEASUREMENTS: Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed. RESULTS: Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting. CONCLUSIONS: Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice.

Prevalence and Correlational Factors of Suicidal Ideation and Suicide Attempts Among Chinese Adolescents.

This study's purpose was to (1) determine the prevalence of suicidality (i.e., suicidal ideation or suicide attempts) among adolescents in a city in Northeast China and (2) identify the correlational factors among adolescents with suicidality. A total of 69,519 adolescents from grades 5 to 12 in a city in Northeast China participated in the online investigation. Students completed a structured questionnaire to report their demographic information, psychological characteristics, and suicidality. Univariable and multivariable logistic regressions were applied to determine significant correlational factors associated with suicidal ideation (SI) and suicide attempts (SA). The prevalence of SI and SA among adolescents in the past 12 months was 13 and 4.8%, respectively. Multivariable logistic regression analyses found that the potential risk factors for SI and SA included female, non-nuclear family, higher subjective socioeconomic status, meaningless in life, depression, bullying perpetrator, negative parental rearing styles, lower self-esteem scores, hopelessness, and stressful life events. In order to improve the accuracy of suicide risk identification, a cumulative risk index was used. With the increase in the number of cumulative risks, the risk of SI and SA also increased. So the cumulative risk index was very valuable. The total prevalence of SI and SA among primary and middle school students was high. Preventive measures could be implemented according to the risk factors.

Certification alignment of nurse practitioners in acute care.

BACKGROUND: The Consensus Model specifies distinct education preparations for acute care and primary care nurse practitioners (NP), but incomplete implementation and employer hiring practices risk misalignment of certification and practice. PURPOSE: Report the prevalence of acute care certification among NPs working in acute care, investigate the factors associated with alignment, and explore the impact of alignment on nurse outcomes. METHODS: Using the 2018 National Sample Survey of Registered Nurses, we selected NPs practicing acute care and compared employment, education, and nurse outcomes by certification alignment. FINDINGS: A minority of NPs (44.5%) held acute care certification. Controlling for NP characteristics, those practicing in states that restrict a NP's practice to their area of certification had 47% higher odds of acute care certification. DISCUSSION: Understanding patterns of alignment in the NP workforce and the factors that produce them is critical to an appropriate regulatory framework for advanced practice nursing.

A comparison of approaches to measuring maternal mortality in Bangladesh, Mozambique, and Bolivia.

BACKGROUND: Many low- and middle-income countries cannot measure maternal mortality to monitor progress against global and country-specific targets. While the ultimate goal for these countries is to have complete civil registrations systems, other interim strategies are needed to provide timely estimates of maternal mortality. OBJECTIVE: The objective is to inform on potential options for measuring maternal mortality. METHODS: This paper uses a case study approach to compare methodologies and estimates of pregnancy-related mortality ratio (PRMR)/maternal mortality ratio (MMR) obtained from four different data sources from similar time periods in Bangladesh, Mozambique, and Bolivia-national population census; post-census mortality survey; household sample survey; and sample vital registration system (SVRS). RESULTS: For Bangladesh, PRMR from the 2011 census falls closely in line with the 2010 household survey and SVRS estimates, while SVRS' MMR estimates are closer to the PRMR estimates obtained from the household survey. Mozambique's PRMR from household survey method is comparable and shows an upward trend between 1994 and 2011, whereas the post-census mortality survey estimated a higher MMR for 2007. Bolivia's DHS and post-census mortality survey also estimated comparable MMR during 1998-2003. CONCLUSIONS: Overall all these data sources presented in this paper have provided valuable information on maternal mortality in Bangladesh, Mozambique, and Bolivia. It also outlines recommendations to estimate maternal mortality based on the advantages and disadvantages of several approaches. CONTRIBUTION: Recommendations in this paper can help health administrators and policy planners in prioritizing investment for collecting reliable and contemporaneous estimates of maternal mortality while progressing toward a complete civil registration system.

The Economic and Psychological Impacts of COVID-19 Pandemic on Indian Migrant Workers in the Kingdom of Saudi Arabia.

The ongoing Coronavirus disease 2019 (COVID-19) pandemic has changed the working environment, occupation, and living style of billions of people around the world. The severest impact of the coronavirus is on migrant communities; hence, it is relevant to assess the economic impact and mental status of the Indian migrants. This study is quantitative in nature and based on a sample survey of 180 migrant workers. Descriptive statistics, chi-square test, dependent sample t-test, and Pearson's correlation coefficient were utilized to analyze the surveyed data. The findings of the study reveal, through the working experience of the migrants, that new international migration has reduced due to lockdown and international travel restrictions. It was also reported that the majority of the migrants worked less than the normal working hours during the lockdown, causing a reduction of salary and remittances. Chi-square test confirms that the perceptions of migrants towards the COVID-19 management by the government were significantly different in opinion by different occupation/profession. Majority of the sampled migrants reported the problem of nervousness, anxiety, and depression; however, they were also hopeful about the future. The psychological problem was severe for the migrants above the age of 40, not educated, and with a higher number of family members. Subsequently, the policy implications from the findings of the research can draw attention of the policy makers towards protective measures which need to be implemented to support migrants during the ongoing pandemic. The government should take some necessary steps, such as a financial benefit scheme, to overcome the problems in the reduction of migrant earnings and remittances. The government should not focus only on vaccination and physical fitness of the migrants but also need to find out the cure of the psychological impact arising during the pandemic.

Is there an association between public spending on health and choice of healthcare providers across socioeconomic groups in India? - Evidence from a national sample.

The role of public spending on health in reducing socioeconomic inequalities in healthcare is an emerging area of research, little supporting empirical evidence is available from low- and middle-income countries. This study examined: (1) the relationship between public spending on health per capita and the decision whether to seek healthcare or not, (2) the relationships between public spending on health per capita and choice of medical provider, and (3) whether these relationships varied by socioeconomic groups in India. Our study utilized the nationally representative 71st National Sample Survey of India, using 26,142 people who had been ailing in the past 15 days, the survey took place between the 1st of January and June 30, 2014. Two regression-based approaches were used to examine the association between public spending and choice of medical providers: (1) Multilevel multinomial regression; and (2) Instrumental variable regression. We examined the differential impacts of public spending on healthcare utilisation by socioeconomic groups. Increased public spending on health was not associated with changes in ailing people's decision whether to seek care or not (p > 0.05 in all analyses). However, increased public spending on health was associated with reductions in patients choosing private medical providers [adjusted odds ratio = 0.88 (95%CI 0.85-0.91) for outpatient private clinics] compared to outpatient government clinics. These associations may be greater among the lower economic groups compared with their counterparts. Across India, higher levels of government investment in health services are recognised by healthcare users and shown in their pattern of healthcare utilisation. That an increase in public spending on health results in a decrease in the use of private providers, particularly outpatient facilities with no inpatient capabilities, provides strong evidence for the effectiveness of 'regulation by competition'. This is a strong argument for focusing health system strengthening, and strategies for achieving universal healthcare on public investment.

Factors influencing household pulse consumption in India: A multilevel model analysis.

Pulses (also known as legumes) are important in achieving nutrient adequacy in India due to their quality protein content. This study compared district-level pulse production and consumption across India, and household and district-level determinants of pulse intake, including availability, accessibility and affordability, using multi-level models in nationally representative datasets for 2011-12. The per capita consumption was about 50% of recommended intake (80 g/day), even in high-producing districts. District-level pulse production was associated with household pulse intake (2.73 × 10-8 [5.19 × 10-9, 4.94 × 10-8]) and market accessibility (-0.0077 [-0.0133, -0.0021]). Affordability (absolute price of pulse) was also associated with household intake. While agricultural policies relating to pulses have been oriented towards improving pulse output and productivity, forward-looking policies to improve pulse intake should focus on demand-side factors, such as improved market accessibility and the affordability of pulses relative to other foods.

Rising healthcare expenditure on tuberculosis: Can India achieve the End TB goal?

OBJECTIVE: To examine the out-of-pocket expenditure (OOPE), healthcare burden, catastrophic health expenditure, hardship financing and impoverishment effects of TB treatment in India. METHODS: Data of three rounds of National Statistic Surveys 60th 2004-05, 71st 2013-14 and 75th 2017-18. Descriptive statistics, bivariate estimates and multivariate models were performed to calculate the OOPE, healthcare burden, catastrophic health expenditure, hardship financing and impoverishment using standard definitions at December 2019 price values. RESULTS: More than two-thirds of the TB cases are seen in the economically productive age group (14-59 years). Illiterate patients had a higher healthcare burden and OOPE. The healthcare burden, hardship financing and catastrophic health expenditure are considerably higher for those utilising private hospitals. Male patients have a higher exposure to hardship financing than female patients. Impoverishment effects are higher among Hindus and illiterate populations due to utilisation of hospitalisation services. CONCLUSION: The present analysis helps to understand the trends in the financial burden of TB on households over last 15 years, thus providing evidence to policymakers for more effective channelling of resources in order to achieve a TB-free India by 2025.

Fitting marginalized two-part models to semicontinuous survey data arising from complex samples.

OBJECTIVE: To accurately model semicontinuous data from complex surveys, we extend marginalized two-part models to a design-based inferential framework and provide guidance on incorporating complex sample designs. DATA SOURCES: 2014 Medical Expenditure Panel Survey (MEPS). STUDY DESIGN: We describe the use of pseudo-Maximum Likelihood Estimation and Jackknife Repeated Replication for estimating model parameters and sampling variance, respectively. We illustrate our approach using MEPS, modeling total healthcare expenditures in 2014 as a function of respondents' age and family income. We provide SAS and R code for implementing the extension, assessing model-fit indices, and evaluating the need to incorporate complex sampling features. DATA EXTRACTION METHODS: Data obtained from www.meps.ahrq.gov. PRINCIPLE FINDINGS: A 100 percentage-point increase in family income as a percent of the federal poverty level was associated with a 5%-6% increase in healthcare spending. People over 65 had an increase of 4-5 times compared to those younger. Accounting for complex sampling in the models led to different parameter estimates and wider confidence intervals than the unweighted models. Ignoring complex sampling could lead to inaccurate finite population inference. CONCLUSION: Researchers should account for complex sampling features when analyzing semicontinuous data from surveys.

Rising Catastrophic Expenditure on Households Due to Tuberculosis: Is India Moving Away From the END-TB Goal?

Introduction: One of the targets of the END-TB strategy is to ensure zero catastrophic expenditure on households due to TB. The information about household catastrophic expenditure is limited in India and, therefore difficult to monitor. The objective is to estimate household and catastrophic expenditure for Tuberculosis using national sample survey data. Methods: For arriving at out-of-pocket expenditure due to tuberculosis and its impact on households the study analyzed four rounds of National Sample Survey data (52nd round-1995-1996, 60th round-2004-2005, 71st round-2014-15, and 75th round 2017-2018). The household interview survey data had a recall period of 365 days for inpatient/ hospitalization and 15 days for out-patient care expenditure. Expenditure amounting to >20% of annual household consumption expenditure was termed as catastrophic. Results: A 5-fold increase in median outpatient care cost in 75th round is observed compared to previous rounds and increase has been maximum while accessing public sector. The overall expense ratio of public v/s private is 1:3, 1:4, 1:5, and 1:5, respectively across four rounds for hospitalization. The prevalence of catastrophic expenditure due to hospitalization increased from 16.5% (52nd round) to 43% (71st round), followed by a decline to 18% in the recent 75th round. Conclusion: Despite free diagnostic and treatment services offered under the national program, households are exposed to catastrophic financial expenditure due to tuberculosis. We strongly advocate for risk protection mechanisms such as cash transfer or health insurance schemes targeting the patients of tuberculosis, especially among the poor.

Horizontal inequity in self-reported morbidity and untreated morbidity in India: Evidence from National Sample Survey Data.

BACKGROUND: Health outcomes in India are characterized by pervasive inequities due to deeply entrenched socio-economic gradients amongst the population. Therefore, it is imperative to investigate these systematic disparities in health, however, evidence of inequities does not commensurate with its policy objectives in India. Thus, our paper aims to examine the magnitude of and trends in horizontal inequities in self-reported morbidity and untreated morbidity in India over the period of 2004 to 2017-18. METHODS: The study used cross-sectional data from nationwide healthcare surveys conducted in 2004, 2014 and 2017-18 encompassing sample size of 3,85,055; 3,35,499 and 5,57,887 individuals respectively. Erreygers concentration indices were employed to discern the magnitude and trend in horizontal inequities in self-reported morbidity and untreated morbidity. Need standardized concentration indices were further used to unravel the inter-regional and intra-regional income related inequities in outcomes of interest. Additionally, regression based decomposition approach was applied to ascertain the contributions of both legitimate and illegitimate factors in the measured inequalities. RESULTS: Estimates were indicative of profound inequities in self-reported morbidity as inequity indices were positive and significant for all study years, connoting better-off reporting more morbidity, given their needs. These inequities however, declined marginally from 2004(HI: 0.049, p< 0.01) to 2017-18(HI: 0.045, P< 0.01). Untreated morbidity exhibited pro-poor inequities with negative concentration indices. Albeit, significant reduction in horizontal inequity was found from 2004(HI= - 0.103, p< 0.01) to 2017-18(HI = - 0.048, p< 0.01) in treatment seeking over the years. The largest contribution of inequality for both outcomes stemmed from illegitimate variables in all the study years. Our findings also elucidated inter-state heterogeneities in inequities with high-income states like Andhra Pradesh, Kerala and West Bengal evincing inequities greater than all India estimates and Northeastern states divulged equity in reporting morbidity. Inequities in untreated morbidity converged for most states except in Punjab, Chhattisgarh and Himachal Pradesh where widening of inequities were observed from 2004 to 2017-18. CONCLUSIONS: Pro-rich and pro-poor inequities in reported and untreated morbidities respectively persisted from 2004 to 2017-18 despite reforms in Indian healthcare. Magnitude of these inequities declined marginally over the years. Health policy in India should strive for targeted interventions closing inequity gap.

Tools for Selecting Working Correlation Structures When Using Weighted GEE to Model Longitudinal Survey Data.

Weighted generalized estimating equations (GEE) are popular for the marginal analysis of longitudinal survey data. This popularity is due to the ability of these estimating equations to provide consistent regression parameter estimates and corresponding standard error estimates as long as the population mean and survey weights are correctly specified. Although the data analyst must incorporate a working correlation structure within the weighted GEE, this structure need not be correctly specified. However, accurate modeling of this structure has the potential to improve regression parameter estimation, i.e. reduce standard errors, and therefore the selection of a working correlation structure for use within GEE has received considerable attention in standard longitudinal data analysis settings. In this manuscript, we describe how correlation selection criteria can be extended for use with weighted GEE in the context of analyzing longitudinal survey data. Importantly, we provide and demonstrate an R function that we have created for such analyses. Furthermore, we discuss correlation selection in the context of using existing software which does not have this explicit capability. The methods are demonstrated via the use of data from a real survey in which we are interested in the mean number of falls that elderly individuals in a specific subpopulation experience over time.

Prevalence of SARS-CoV-2, Verona, Italy, April-May 2020.

We used random sampling to estimate the prevalence of severe acute respiratory syndrome coronavirus 2 infection in Verona, Italy. Of 1,515 participants, 2.6% tested positive by serologic assay and 0.7% by reverse transcription PCR. We used latent class analysis to estimate a 3.0% probability of infection and 2.0% death rate.

Children's education and parental old-age health: Evidence from a population-based, nationally representative study in India.

Previous research has documented intergenerational transmission of human capital from children to parents. Less is known, however, about heterogeneity in this 'upward transmission' in low-resource settings. We examine whether co-resident adult children's education is associated with improved health among older parents in India, using nationally representative data from the 2014 Indian National Sample Survey. Parents of children with tertiary education had a lower probability of reporting poor health than parents of children with less than primary education. The benefits of children's education persisted after controlling for economic factors, suggesting that non-pecuniary pathways-such as health knowledge or skills-may play an important role. The association was more pronounced among economically dependent parents and those living in the North and West regions. Taken together, our results point to a strong positive association between children's education and parental health, the role of non-pecuniary pathways, and the importance of subnational heterogeneity in India.

Changes in the prevalence and profile of users of contraception in Britain 2000-2010: evidence from two National Surveys of Sexual Attitudes and Lifestyles.

AIM: To describe prevalence and trends in contraceptive method use in Britain through a comparison of the second and third National Surveys of Sexual Attitudes and Lifestyles (Natsal-2 and Natsal-3). METHODS: Cross-sectional probability sample surveys. General population sample of women aged 16-44 years, resident in Britain, with ever-experience of vaginal sex and, for analysis by sociodemographic characteristics, vaginal sex in the last year. Main outcome measure was current contraceptive method use ('usual these days'), categorised by effectiveness. RESULTS: Prevalence of current contraceptive use among women who had ever had vaginal sex declined between Natsal-2 and Natsal-3, 83.5% (95% CI 82.4 to 84.5) and 76.4% (95% CI 75.0 to 77.7), respectively. The condom and oral contraceptive pill remain the most commonly used methods. One in five women reported use of a most effective method. While no difference was found between surveys in use of most effective methods, a decline in sterilisation use was compensated by an increase in long-acting reversible contraceptive (LARC) use. Increased LARC use was particularly evident among under-25s compared with women aged 40-44 years (OR 11.35, 95% CI 3.23 to 39.87) and a decline was observed among those with two or more children relative to those with none (OR 0.21, 95% CI 0.13 to 0.35). CONCLUSIONS: Strategies to improve access to LARC methods have been particularly successful in increasing uptake among young people in the first decade of the 21st century. Whether this trajectory is maintained given changing sociodemographic characteristics and more recent financial cuts to sexual health service provision will warrant investigation.