Applying Machine Learning Approach to Explore Childhood Circumstances and Self-Rated Health in Old Age - China and the US, 2020-2021.

Introduction: Childhood circumstances impact senior health, prompting the introduction of machine learning methods to assess their individual and collective contributions to senior health. Methods: Using health and retirement study (HRS) and China Health and Retirement Longitudinal Study (CHARLS), we analyzed 2,434 American and 5,612 Chinese participants aged 60 and above. Conditional inference trees and forests were employed to estimate the influence of childhood circumstances on self-rated health (SRH). Results: The conventional method estimated higher inequality of opportunity (IOP) values in both China (0.039, accounting for 22.67% of the total Gini coefficient 0.172) and the US (0.067, accounting for 35.08% of the total Gini coefficient 0.191). In contrast, the conditional inference tree yielded lower estimates (China: 0.022, accounting for 12.79% of 0.172; US: 0.044, accounting for 23.04% of 0.191), as did the forest (China: 0.035, accounting for 20.35% of 0.172; US: 0.054, accounting for 28.27% of 0.191). Childhood health, financial status, and regional differences were key determinants of senior health. The conditional inference forest consistently outperformed others in predictive accuracy, as demonstrated by lower out-of-sample mean squared error (MSE). Discussion: The findings emphasize the need for early-life interventions to promote health equity in aging populations. Machine learning showcases the potential in identifying contributing factors.

Preterm births among male and female conception cohorts in France during initial COVID-19 societal restrictions.

PURPOSE: A recent meta-analysis finds reduced risk of preterm birth (PTB; <37 weeks gestational age) during the initial stage of COVID-19 in which infection rates remained relatively low but many societies imposed restrictions on movement. None of this work, however, examines sex-specific responses despite much literature on other ambient "shocks" which would predict male sensitivity. We use a conception cohort approach to explore potential sex-specific PTB responses in France, a country which imposed a lockdown in Spring 2020. METHODS: We applied interrupted time series methods using national data in France for 207 weeks among 1403,284 males and 1341,359 females conceived from 19 Jan 2016 to 6 Jan 2020. RESULTS: For males in utero, the 1st COVID-19 societal lockdown corresponds with a - 0.60 per 100 conception reduction in PTB cases per week, for 12 consecutive weeks (95% confidence interval [CI]: -.36, -.84). For females in utero, the PTB reduction is smaller (-0.40 reduction per 100 conceptions, for 10 consecutive weeks, 95% CI: -.15, -.61). A formal test of sex differences in the PTB response indicates a stronger reduction in male (vs. female) PTB during the lockdown (p = .001). CONCLUSIONS: Explanations for the counterintuitive reduction in PTB during COVID-19 among cohorts in utero during Spring 2020 should consider mechanisms that disproportionately affect males.

Antidepressant Prescription Behavior Among Primary Care Clinician Providers After an Interprofessional Primary Care Psychiatric Training Program.

Primary care providers (PCPs) are increasingly called upon to screen for and treat depression. However, PCPs often lack the training to diagnose and treat depression. We designed an innovative 12-month evidence and mentorship-based primary care psychiatric training program entitled the University of California, Irvine (UCI) School of Medicine Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship and examined whether this training impacted clinician prescription rates for antidepressants. We retrieved information on 18,844 patients and 192 PCPs from a publicly insured health program in Southern California receiving care between 2017 and 2021. Of the 192 PCPs, 42 received TNT training and 150 did not. We considered a patient as exposed to the provider's TNT treatment if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of antidepressant prescriptions per patient, per quarter-year as the dependent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification. After PCPs completed TNT training, "exposed" patients received 0.154 more antidepressant prescriptions per quarter-year relative to expected levels (p < 0.01). Clustering of standard errors by provider characteristics reduced precision of the estimate (p < 0.10) but the direction and magnitude of the results were unchanged. Early results from the UCI TNT PCP Fellowship demonstrate enhanced antidepressant prescription behavior in PCPs who have undergone TNT training. A novel, and relatively low-cost, clinician training program holds the potential to empower PCPs to optimally deliver depression treatment.

Psychiatric Emergencies in Los Angeles County During, and After, Initial COVID-19 Societal Restrictions: An Interrupted Time-Series Analysis.

Emergency department (ED) visits for psychiatric care in the US reportedly declined during the COVID-19 pandemic. This work, however, does not control for strong temporal patterning in visits before the pandemic and does not examine a potential "rebound" in demand for psychiatric care following the relaxation of initial societal restrictions. Here, we examine COVID-19-related perturbations in psychiatric care during and after the 1st stage of societal restrictions in the largest safety-net hospital in Los Angeles. We retrieved psychiatric ED visit data (98,888 total over 156 weeks, Jan 2018 to Dec 2020) from Los Angeles County + USC Medical Center. We applied interrupted time series methods to identify and control for autocorrelation in psychiatric ED visits before examining their relation with the 1st stage of societal restrictions (i.e., March 13 to May 8, 2020), as well as the subsequent "rebound" period of relaxed restrictions (i.e., after May 8, 2020). Psychiatric ED visits fell by 78.13 per week (i.e., 12%) during the 1st stage of societal restrictions (SD = 23.99, p < 0.01). Reductions in ED visits for alcohol use, substance use, and (to a lesser extent) anxiety disorders accounted for the overall decline. After the 1st stage of societal restrictions, however, we observe no "rebound" above expected values in psychiatric ED visits overall (coef = - 16.89, SD = 20.58, p = 0.41) or by diagnostic subtype. This pattern of results does not support speculation that, at the population level, foregoing ED care during initial societal restrictions subsequently induced a psychiatric "pandemic" of urgent visits.

Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program.

BACKGROUND: The issue of malnutrition in the Democratic Republic of Congo is severe. Meanwhile, the Water, Sanitation, and Hygiene program has been demonstrated to be effective in reducing the rates of growth stunting among children. OBJECTIVE: We aimed to explore the association between maternal exposure to mass media and stunting in children through water, sanitation, and hygiene behaviors. METHODS: Mediation analysis was conducted using data from the 2018 Multiple Indicators Cluster Surveys. RESULTS: Mothers' exposures to television and the internet in the Democratic Republic of Congo significantly decreases the risk of stunting in children by 5% and 10%, respectively, mediated by household water, sanitation, and hygiene facilities and practices. CONCLUSIONS: These findings could inform interventions and policies to reduce the rate of stunting rate children by promoting water, sanitation, and hygiene through mass media, especially through the internet and television.

Does integrated medical insurance system alleviate the difficulty of using cross-region health Care for the Migrant Parents in China-- evidence from the China migrants dynamic survey.

BACKGROUND: Many internal migrants during the urbanization process in China are Migrant Parents, the aging group who move to urban areas to support their family involuntarily. They are more vulnerable economically and physically than the younger migrants. However, the fragmentation of rural and urban health insurance schemes divided by "hukou" household registration system limit migrant's access to healthcare services in their resident location. Some counties have started to consolidate the Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NRCMS) as one Integrated Medical Insurance Schemes (IMIS) from 2008. The consolidation aimed to reduce the disparity between different schemes and increase the health care utilization of migrants. RESULTS: Using the inpatient sample of migrant parents from China Migrants Dynamic Survey in 2015, we used Ordinary Least Squares (OLS) for regression models. We found that the migrant parents covered by the IMIS are more likely to choose inpatient services and seek medical treatment in the migrant destination. We further subdivide Non-IMISs into NCMSs and URBMIs in the regression to alleviate the doubt about endogenous. The results revealed that the migrant parents in IMIS use more local medical services than both of them in URBMI and NCMS. CONCLUSIONS: The potential mechanisms of our results could be that IMIS alleviates the difficulty of seeking medical care in migrant destinations by improving the convenience of medical expense reimbursement and enhancing health insurance benefits.