How financial incentives in parenting skills programs affect engagement and outcomes: a systematic review and meta-analysis protocol.

OBJECTIVE: This systematic review will investigate the effects of financial incentives on engagement with and outcomes of evidence-based parenting skills programs to prevent and treat disruptive behavior disorders. INTRODUCTION: Evidence-based parenting skills programs are a first-line treatment in disruptive behavior disorders (ie, oppositional defiant disorder, conduct disorder, and attention-deficit/hyperactivity disorder), but fewer than half of referred parents complete these programs. When untreated, children affected by disruptive behavior disorders are at elevated risk of incarceration, drug misuse, and educational under-performance. Financial incentives can improve parents' engagement with parenting skills programs, and are increasingly popular strategies in public health policy to increase rates of compliance with health interventions. However, no previous systematic review or meta-analysis of financial incentives in parenting skills programs has been conducted. INCLUSION CRITERIA: Randomized controlled trials or quasi-experimental studies (ie, studies with a control group allocated through a non-random process) testing the effects of financial incentives on engagement will be included. Study participants must be in a guardian role to a person under 18 years of age. There will be no restrictions on country setting. Only English-language publications will be included. METHODS: We will search PubMed, CINAHL, Sociological Abstracts, Cochrane Trials, and PsycINFO databases for relevant articles. Two independent reviewers will screen abstracts for eligibility. Data will be extracted from eligible articles by 2 researchers and results will be presented in tabular and narrative format, along with a meta-analysis using a random effects model and assessment of heterogeneity. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022336210.

Methods to Establish Race or Ethnicity of Twitter Users: Scoping Review.

BACKGROUND: A growing amount of health research uses social media data. Those critical of social media research often cite that it may be unrepresentative of the population; however, the suitability of social media data in digital epidemiology is more nuanced. Identifying the demographics of social media users can help establish representativeness. OBJECTIVE: This study aims to identify the different approaches or combination of approaches to extract race or ethnicity from social media and report on the challenges of using these methods. METHODS: We present a scoping review to identify methods used to extract the race or ethnicity of Twitter users from Twitter data sets. We searched 17 electronic databases from the date of inception to May 15, 2021, and carried out reference checking and hand searching to identify relevant studies. Sifting of each record was performed independently by at least two researchers, with any disagreement discussed. Studies were required to extract the race or ethnicity of Twitter users using either manual or computational methods or a combination of both. RESULTS: Of the 1249 records sifted, we identified 67 (5.36%) that met our inclusion criteria. Most studies (51/67, 76%) have focused on US-based users and English language tweets (52/67, 78%). A range of data was used, including Twitter profile metadata, such as names, pictures, information from bios (including self-declarations), or location or content of the tweets. A range of methodologies was used, including manual inference, linkage to census data, commercial software, language or dialect recognition, or machine learning or natural language processing. However, not all studies have evaluated these methods. Those that evaluated these methods found accuracy to vary from 45% to 93% with significantly lower accuracy in identifying categories of people of color. The inference of race or ethnicity raises important ethical questions, which can be exacerbated by the data and methods used. The comparative accuracies of the different methods are also largely unknown. CONCLUSIONS: There is no standard accepted approach or current guidelines for extracting or inferring the race or ethnicity of Twitter users. Social media researchers must carefully interpret race or ethnicity and not overpromise what can be achieved, as even manual screening is a subjective, imperfect method. Future research should establish the accuracy of methods to inform evidence-based best practice guidelines for social media researchers and be guided by concerns of equity and social justice.

Identifying facilitators, barriers, and strategies to implement social determinants of health screening, referral, and follow-up in the US: a scoping review protocol.

OBJECTIVE: This review will assess the literature exploring facilitators, barriers, and strategies for the implementation of social determinants of health and social needs screening, referral to community resources, and follow-up in clinical settings and clinical training curricula in the United States. INTRODUCTION: Social determinants of health and social needs are a central cause of health inequity and poor health outcomes in the United States. Existing research primarily focuses on theoretical implications of social determinants of health on health outcomes, with a growing secondary focus on the development of screening tools that identify patients' specific unmet social needs. However, summative research has not yet focused on the barriers, facilitators, and strategies relating to the implementation of social determinants of health and social need screenings into routine clinical care. This scoping review aims to examine literature on the implementation of social determinants of health and social needs screening in clinical settings and clinical training curricula while also identifying gaps that require further exploration. INCLUSION CRITERIA: This review will include relevant studies examining the facilitators, barriers, and strategies for the implementation of social determinants of health and social needs screening, referral, and follow-up as they relate to human subjects. The literature must be in English from 2010 and focus on United States clinical health settings and curricula. METHODS: We will search PubMed, CINAHL, and Embase databases for relevant articles. Two independent reviewers will screen abstracts for eligibility. Data will be extracted from eligible articles and results will be presented in narrative and tabular format in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Multi-level social organization and nest-drifting behaviour in a eusocial insect.

Stable social groups usually consist of families. However, recent studies have revealed higher level social structure, with interactions between family groups across different levels of social organization in multiple species. The explanations for why this apparently paradoxical behaviour arises appear to be varied and remain untested. Here, we use automated radio-tagging data from over 1000 wasps from 93 nests and social network analyses of over 30 000 nest visitation records to describe and explain interactions across levels of social organization in the eusocial paper wasp Polistes canadensis. We detected three levels of social organization (nest, aggregation and community) which exchange 'drifter' individuals within and between levels. The highest level (community) may be influenced by the patchiness of high-quality nesting habitats in which these insects exist. Networks of drifter movements were explained by the distance between nests, the group size of donor nests and the worker-to-brood ratios on donor and recipient nests. These findings provide some explanation for the multi-level social interactions, which may otherwise seem paradoxical. Fitness benefits across multiple levels of social organization should be considered when trying to understand animal societies.

Multiplexed Functional Assessment of Genetic Variants in CARD11.

Genetic testing has increased the number of variants identified in disease genes, but the diagnostic utility is limited by lack of understanding variant function. CARD11 encodes an adaptor protein that expresses dominant-negative and gain-of-function variants associated with distinct immunodeficiencies. Here, we used a "cloning-free" saturation genome editing approach in a diploid cell line to simultaneously score 2,542 variants for decreased or increased function in the region of CARD11 associated with immunodeficiency. We also described an exon-skipping mechanism for CARD11 dominant-negative activity. The classification of reported clinical variants was sensitive (94.6%) and specific (88.9%), which rendered the data immediately useful for interpretation of seven coding and splicing variants implicated in immunodeficiency found in our clinic. This approach is generalizable for variant interpretation in many other clinically actionable genes, in any relevant cell type.

Late Presentation HIV/AIDS Is Still a Challenge in Brazil and Worldwide.

Despite all the efforts to contain the HIV/AIDS epidemics, there still are individuals of unknown diagnosis. These present high risk of mortality and after diagnosis respond very poorly to treatment. Late testing also represents a reduced opportunity in controlling the transmission of HIV and causes an indirect increase in the transmission rates of other diseases, such as tuberculosis. In European countries, as well as in the United States, a great number of people, represented especially by illegal immigrants, black individuals, and women, markedly present at a later state of infection. In 1996, Brazil was the very first developing country to offer free and universal access to antiretroviral therapy, as well as easy access to HIV testing and care. Nonetheless, there is still a significant number of young and adult subjects who look for HIV/AIDS services and hospitals at later stage of infection by HIV (late presenters). Here we discuss important aspects related to the late diagnosis of HIV in Brazil and worldwide.

Are scientific research outputs aligned with national policy makers' priorities? A case study of tuberculosis in Cambodia.

With funding for tuberculosis (TB) research decreasing, and the high global disease burden persisting, there are calls for increased investment in TB research. However, justification of such investments is questionable, when translation of research outputs into policy and health care improvements remains a challenge for TB and other diseases. Using TB in Cambodia as a case study, we investigate how evidence needs of national policy makers are addressed by topics covered in research publications. We first conducted a systematic review to compile all studies on TB in Cambodia published since 2000. We then identified priority areas in which evidence for policy and programme planning are required from the perspective of key national TB control stakeholders. Finally, results from the literature review were analysed in relation to the priority research areas for national policy makers to assess overlap and highlight gaps in evidence. Priority research areas were: TB-HIV co-infection; childhood TB; multidrug resistant TB (MDR-TB); and universal and equitable access to quality diagnosis and treatment. On screening 1687 unique papers retrieved from our literature search, 253 were eligible publications focusing on TB in Cambodia. Of these, only 73 (29%) addressed one of the four priority research areas. Overall, 30 (11%), five (2%), seven (2%) and 37 (14%) studies reported findings relevant to TB-HIV, childhood TB, MDR-TB and access to quality diagnosis and treatment respectively. Our analysis shows that a small proportion of the research outputs in Cambodia address priority areas for informing policy and programme planning. This case study illustrates that there is substantial room for improvement in alignment between research outputs and evidence gaps that national policy makers would like to see addressed; better coordination between researchers, funders and policy makers' on identifying priority research topics may increase the relevance of research findings to health policies and programmes.

A strong TB programme embedded in a developing primary healthcare system is a lose-lose situation: insights from patient and community perspectives in Cambodia.

As exemplified by the situation in Cambodia, disease specific (vertical) health programmes are often favoured when the health system is fragile. The potential of such an approach to impede strengthening of primary healthcare services has been studied from a health systems perspective in terms of access and quality of care. In this bottom-up, qualitative study we investigate patient and community member experiences of health services when a strong tuberculosis (TB) programme is embedded into a relatively underutilized primary healthcare system. We conducted six gender-stratified community focus group discussions (n = 49) and seven mixed-gender focus group discussions with TB patients (n = 45) in three provinces located in urban, peri-urban and rural areas of Cambodia. Our analysis of health-seeking behaviour and experiences for TB and TB-like illness indicates that building a strong vertical TB control programme has had numerous benefits, including awareness of typical symptoms and need to seek care early; confidence in free TB services at public facilities; and willingness to complete treatment. However, there was a clear dichotomy in experiences and behaviour with respect to care-seeking for less severe illness at primary health services, which were generally avoided owing to access barriers and perceived poor quality. The tendency to delay seeking health care until the development of severe symptoms clearly indicative of TB is a major barrier to early diagnosis and treatment of TB. Our study indicates that an imbalance in the strength of vertical and primary health services could be a lose-lose situation as this impedes improvements in health system functioning and constrains progress of vertical disease control programmes.

Tuberculosis active case finding in Cambodia: a pragmatic, cost-effectiveness comparison of three implementation models.

BACKGROUND: Globally, almost 40% of tuberculosis (TB) patients remain undiagnosed, and those that are diagnosed often experience prolonged delays before initiating correct treatment, leading to ongoing transmission. While there is a push for active case finding (ACF) to improve early detection and treatment of TB, there is extremely limited evidence about the relative cost-effectiveness of different ACF implementation models. Cambodia presents a unique opportunity for addressing this gap in evidence as ACF has been implemented using different models, but no comparisons have been conducted. The objective of our study is to contribute to knowledge and methodology on comparing cost-effectiveness of alternative ACF implementation models from the health service perspective, using programmatic data, in order to inform national policy and practice. METHODS: We retrospectively compared three distinct ACF implementation models - door to door symptom screening in urban slums, checking contacts of TB patients, and door to door symptom screening focusing on rural populations aged above 55 - in terms of the number of new bacteriologically-positive pulmonary TB cases diagnosed and the cost of implementation assuming activities are conducted by the national TB program of Cambodia. We calculated the cost per additional case detected using the alternative ACF models. RESULTS: Our analysis, which is the first of its kind for TB, revealed that the ACF model based on door to door screening in poor urban areas of Phnom Penh was the most cost-effective (249 USD per case detected, 737 cases diagnosed), followed by the model based on testing contacts of TB patients (308 USD per case detected, 807 cases diagnosed), and symptomatic screening of older rural populations (316 USD per case detected, 397 cases diagnosed). CONCLUSIONS: Our study provides new evidence on the relative effectiveness and economics of three implementation models for enhanced TB case finding, in line with calls for data from 'routine conditions' to be included in disease control program strategic planning. Such cost-effectiveness comparisons are essential to inform resource allocation decisions of national policy makers in resource constraint settings. We applied a novel, pragmatic methodological approach, which was designed to provide results that are directly relevant to policy makers, costing the interventions from Cambodia's national TB program's perspective and using case finding data from implementation activities, rather than experimental settings.

Less research on tuberculosis than HIV and malaria when research agendas are poorly coordinated: a systematic review of research outputs from Cambodia.

OBJECTIVE: Coordination of health interventions and research is often weak during periods of political transition and unprecedented aid inflows, which Cambodia has recently experienced. Although HIV, tuberculosis (TB), and malaria have been a focus of international funding, TB has received much less. This study compares the numbers and methodologies of studies conducted on TB, malaria, and HIV in Cambodia, identifying evidence gaps and future research needs. METHODS: Three electronic databases and the grey literature were searched for studies on HIV, TB, and malaria published between January 2000 and October 2015. Information about the disease focus and methodology was extracted from the studies included. RESULTS: A total of 2581 unique studies were screened and 712 were included in the analysis. The results of this review demonstrated that despite increasing numbers of publications, there have been fewer studies on TB (16%) than HIV (43%) and malaria (41%). Observational epidemiological studies outnumbered other methodologies (44%) for all three diseases. CONCLUSIONS: Despite substantial investments, important research areas appear to have been neglected in Cambodia; specifically, studies on TB and studies involving economic, qualitative, interventional, and genomics methods. The inter-disease disparity in published research in Cambodia identified, considered alongside disease burden, suggests that an increase in TB research may be needed to inform control strategies.

Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities.

BACKGROUND: The ongoing west Africa Ebola-virus-disease epidemic has disrupted the entire health-care system in affected countries. Because of the overlap of symptoms of Ebola virus disease and malaria, the care delivery of malaria is particularly sensitive to the indirect effects of the current Ebola-virus-disease epidemic. We therefore characterise malaria case management in the context of the Ebola-virus-disease epidemic and document the effect of the Ebola-virus-disease epidemic on malaria case management. METHODS: We did a cross-sectional survey of public health facilities in Guinea in December, 2014. We selected the four prefectures most affected by Ebola virus disease and selected four randomly from prefectures without any reported cases of the disease. 60 health facilities were sampled in Ebola-affected and 60 in Ebola-unaffected prefectures. Study teams abstracted malaria case management indicators from registers for January to November for 2013 and 2014 and interviewed health-care workers. Nationwide weekly surveillance data for suspect malaria cases reported between 2011 and 2014 were analysed independently. Data for malaria indicators in 2014 were compared with previous years. FINDINGS: We noted substantial reductions in all-cause outpatient visits (by 23 103 [11%] of 214 899), cases of fever (by 20249 [15%] of 131 330), and patients treated with oral (by 22 655 [24%] of 94 785) and injectable (by 5219 [30%] of 17 684) antimalarial drugs in surveyed health facilities. In Ebola-affected prefectures, 73 of 98 interviewed community health workers were operational (74%, 95% CI 65-83) and 35 of 73 were actively treating malaria cases (48%, 36-60) compared with 106 of 112 (95%, 89-98) and 102 of 106 (96%, 91-99), respectively, in Ebola-unaffected prefectures. Nationwide, the Ebola-virus-disease epidemic was estimated to have resulted in 74 000 (71 000-77 000) fewer malaria cases seen at health facilities in 2014. INTERPRETATION: The reduction in the delivery of malaria care because of the Ebola-virus-disease epidemic threatens malaria control in Guinea. Untreated and inappropriately treated malaria cases lead to excess malaria mortality and more fever cases in the community, impeding the Ebola-virus-disease response. FUNDING: Global Fund to Fight AIDS, Tuberculosis and Malaria, and President's Malaria Initiative.

Social support and the consequences of heart failure compared with other cardiac diseases: The contribution of support received within an attachment relationship.

BACKGROUND: Interpersonal support is protective in heart disease, but sources of support and the quality of support may change over time, especially with aging and disease progression. AIMS: To determine if support received within an attachment relationship with a spouse is more protective than other types. METHODS: Subjects were sex- and age-matched cardiac outpatients with (n=40) or without (n=43) heart failure; they were studied with an observer-rated measure of attachment and self-report measures of other variables. RESULTS: Having heart failure was associated with more depressive symptoms and illness intrusiveness. Although perceived social support did not differ in people with or without heart failure, those with heart failure had a spouse as the primary source of attachment functions less frequently than those without heart failure (50% vs 79%; P=0.006). Not having a spouse as the main provider of attachment functions was a partial mediator of the relationship between disease type (heart failure or no heart failure) and depressive symptoms (ß=-0.24, t=-2.2; P=0.03) and deficits in non-attachment support made a further independent contribution (ß=-0.24, t=-2.4; P=0.02). Neither perceived social support nor having a spouse serving attachment needs made a significant contribution to illness intrusiveness. CONCLUSION: Having someone other than a spouse to provide attachment support is more common in cardiac patients who have heart failure and is associated with an increased risk of depressive symptoms.

Initiators, leaders, and recruitment mechanisms in the collective movements of damselfish.

Explaining how individual behavior and social interactions give rise to group-level outcomes and affect issues such as leadership is fundamental to the understanding of collective behavior. Here we examined individual and collective behavioral dynamics in groups of humbug damselfish both before and during a collective movement. During the predeparture phase, group activity increased until the collective movement occurred. Although such movements were precipitated by one individual, the success or failure of any attempt to instigate a collective movement was not solely dependent on this initiator's behavior but on the behavior of the group as a whole. Specifically, groups were more active and less cohesive before a successful initiation attempt than before a failed attempt. Individuals who made the most attempts to initiate a collective movement during each trial were ultimately most likely to lead the collective movement. Leadership was not related to dominance but was consistent between trials. The probability of fish recruiting to a group movement initiative was an approximately linear function of the number of fish already recruited. Overall, these results are consistent with nonselective local mimetism, with the decision to leave based on a group's, rather than any particular individual's, readiness to leave.

Exploring the Link between Genetic Relatedness r and Social Contact Structure k in Animal Social Networks.

Our understanding of how cooperation can arise in a population of selfish individuals has been greatly advanced by theory. More than one approach has been used to explore the effect of population structure. Inclusive fitness theory uses genetic relatedness r to express the role of population structure. Evolutionary graph theory models the evolution of cooperation on network structures and focuses on the number of interacting partners k as a quantity of interest. Here we use empirical data from a hierarchically structured animal contact network to examine the interplay between independent, measurable proxies for these key parameters. We find strong inverse correlations between estimates of r and k over three levels of social organization, suggesting that genetic relatedness and social contact structure capture similar structural information in a real population.

In a quasi-simultaneous assessment, imprecise cholesterol monitoring and screening tests were improved.

OBJECTIVE: To calibrate Reflotron-measured capillary total cholesterol (cTC) relative to a laboratory-measured venous total cholesterol (vTC) criterion standard for monitoring and screening hypercholesterolemia. STUDY DESIGN AND SETTING: Quasi-simultaneous assessment in 1999-2002 of Reflotron cTC and laboratory vTC in a random sample of 4,269 adult residents of Geneva, Switzerland (calibration development subsample n=3,067; validation subsample n=1,172), by means of bias, precision, correlation, sensitivity, and false positive percentage (calculated as 100-specificity) analyses of Reflotron cTC vs. laboratory vTC measures for predicting hypercholesterolemia. RESULTS: Total bias was small (-0.26 mmol/L), but there was substantial negative drift in Reflotron cTC (annual biases +0.08, -0.17, -0.27, and -0.60 mmol/L in 1999-2002). Overall, 57% of Reflotron cTC measurements for 894 hypercholesterolemic patients underestimated laboratory vTC (2%, 57%, 71%, and 98% in 1999-2002). Prior to calibration, sensitivity was 73% for the development and 35% for the validation subsample, with false positive at 4% (development) and 0.1% (validation). After calibration, sensitivity was 78% for the development and 37% for the validation subsample, with false positive at 5% (development) and 0.2% (validation). Using 95% upper prediction limits (UPL) for individual vTC values increased sensitivity to 99% and 83% and false positive percentage to 30% and 7% for the development and validation subsamples, respectively. CONCLUSION: Crude results of Reflotron-measured cTC have poor sensitivity. Instead, 95% UPL can be used for monitoring and screening. Simply adding 0.8 mmol/L to a patient's observed Reflotron cTC value provides a very good approximation to the 95% UPL.