The Relationship between Participation in Extracurricular Arts and Sports Activities and Adolescents' Social and Emotional Skills: An Empirical Analysis Based on the OECD Social and Emotional Skills Survey.

In light of the 'double reduction' policy, which affords adolescents increased time for extracurricular pursuits, the strategic organization of these activities' form and content is imperative. Prior research has established a robust correlation between adolescent participation in extracurricular arts and sports and the enhancement in their social and emotional skills. Nevertheless, the relationship between extracurricular arts and sports activities and the various dimensions of social and emotional skills, as well as the connection between participation in different types of these activities and the enhancement in social and emotional skills, requires further investigation. Utilizing the Theory of Multiple Intelligence and data from the OECD-SSES2019 Suzhou (China) student survey, this study employs Ordinary Least Squares (OLS) and coarsened exact matching (CEM) methodologies to address these gaps. In China, participation in extracurricular arts and sports activities is significantly positively associated with various dimensions of social and emotional skills, with a synergistic effect observed between these activities in enhancing these skills. Additionally, this study finds age-related heterogeneity in the relationship between participation in extracurricular arts and sports activities and the improvement in social and emotional skills.

Statistical methods to control for confounders in rare disease settings that use external control.

In the drug development for rare disease, the number of treated subjects in the clinical trial is often very small, whereas the number of external controls can be relatively large. There is no clear guidance on choosing an appropriate statistical method to control baseline confounding in this situation. To fill this gap, we conduct extensive simulations to evaluate the performance of commonly used matching and weighting methods as well as the more recently developed targeted maximum likelihood estimation (TMLE) and cardinality matching in small sample settings, mimicking the motivating data from a pediatric rare disease. Among the methods examined, the performance of coarsened exact matching (CEM) and TMLE are relatively robust under various model specifications. CEM is only feasible when the number of controls far exceeds the number of treated, whereas TMLE has better performance with less extreme treatment allocation ratios. Our simulations suggest bootstrap is useful for variance estimation in small samples after matching.

Unraveling determinants of integrated farming systems adoption for sustainable livelihood and dietary diversity.

Introduction: Over the years, smallholder farmers have faced more vulnerability to risk and uncertainty in India due to their dependence on cereal crops. One way to reduce this risk is through diversified agriculture, integrating different practices for efficient resource utilization, and adopting a farming systems approach. An integrated farming system (IFS) is one such technique that provides year-round income from different components of enterprises. However, the decision to adopt IFS may be determined by several characteristics of farmers, which needs to be delineated through impact analysis to harness the benefits of a systems approach. Methods: This study analyzes the economic effects of integrated farming systems and assesses their determinants, as well as the dietary diversity patterns of farmers in two states of southern India, i.e., Kerala and Tamil Nadu. A multistage sampling technique was used to obtain cross-sectional data from 367 farmers randomly chosen from one district in Kerala and two districts in Tamil Nadu. The participants have Crop + Horticulture + Animal husbandry (45.45%) as their major system, whereas non-participants have Crop + Animal husbandry (44.35%) as their predominant system. Coarsened exact matching and logit regression methods were used to evaluate the economic impacts of IFS and its influencing factors. Results: The findings of the study indicate that age, education, livestock holding, access to credit, and plantation area have a positive and significant effect on participation by farmers in the program. The matching results show that adoption of IFS resulted in a significant economic impact, generating an additional gross income of Rs. 36,165 ha-1 and a net income of Rs. 35,852 ha-1 and improving the dietary diversity of farm households by 8.6% as compared to non-adopters. Discussion: This study suggests that IFS is a promising approach for improving farmers' livelihoods, economic gains, and nutritional security. Therefore, the integrated farming systems models need to be upscaled through the convergence of government schemes in other regions of India to support smallholder farmers' farming.

Relationship Between Comorbidity Burden and Short-Term Outcomes Across 4680 Consecutive Spinal Fusions.

OBJECTIVE: Preoperative management requires the identification and optimization of modifiable medical comorbidities, though few studies isolate comorbid status from related patient-level variables. This study evaluates Charlson Comorbidity Index (CCI)-an easily derived measure of aggregate medical comorbidity-to predict outcomes from spinal fusion surgery. Coarsened exact matching is employed to control for key patient characteristics and isolate CCI. METHODS: We retrospectively assessed 4680 consecutive patients undergoing single-level, posterior-only lumbar fusion at a single academic center. Logistic regression evaluated the univariate relationship between CCI and patient outcomes. Coarsened exact matching generated exact demographic matches between patients with high comorbid status (CCI >6) or no medical comorbidities (matched n = 524). Patients were matched 1:1 on factors associated with surgical outcomes, and outcomes were compared between matched cohorts. Primary outcomes included surgical complications, discharge status, 30- and 90-day risk of readmission, emergency department (ED) visits, reoperation, and mortality. RESULTS: Univariate regression of increasing CCI was significantly associated with non-home discharge, as well as 30- and 90-day readmission, ED visits, and mortality (all P < 0.05). Subsequent isolation of comorbidity between otherwise exact-matched cohorts found comorbid status did not affect readmissions, reoperations, or mortality; high CCI score was significantly associated with non-home discharge (OR = 2.50, P < 0.001) and 30-day (OR = 2.44, P = 0.02) and 90-day (OR = 2.29, P = 0.008) ED evaluation. CONCLUSIONS: Comorbidity, measured by CCI, did not increase the risk of readmission, reoperation, or mortality. Single-level, posterior lumbar fusions may be safe in appropriately selected patients regardless of comorbid status. Future studies should determine whether CCI can guide discharge planning and postoperative optimization.

Impacts of Caregiving on Health of New Spousal Caregivers to Older Adults in the United States: A Coarsened Exact Matching Analysis.

OBJECTIVES: Spousal caregivers of older adults, especially new spousal caregivers, face increased risks of negative health outcomes due to the demands of caregiving and their own health decline. Estimating the impacts of caregiving on health without controlling for caregivers' own aging-related health decline could exaggerate the negative health consequences of caregiving, while focusing solely on caregivers could result in selection bias where healthier individuals enter and/or remain in caregiving. This study aims to estimate the impacts of caregiving on health of new spousal caregivers while controlling for observable confounders. METHODS: We utilized coarsened exact matching analysis to compare health outcomes between new spousal caregivers and spousal noncaregivers using pooled panel data from 2006 to 2018 in the Health and Retirement Study. We analyzed 242,123 person-wave observations from 42,180 unique individuals, among whom 3,927 were new spousal caregivers. Variables used for matching were classified into 3 categories: care needs, willingness to provide care, and ability to provide care. Two-year outcomes assessed are spouse's self-rated health, depressive symptoms, and cognitive functioning. RESULTS: A total of 3,417 (87.01%) new spousal caregivers were matched with 129,798 observations of spousal noncaregivers. Regression analysis indicated being a new spousal caregiver was associated with a 0.18- (standard error = 0.05) unit increase in number of depressive symptoms. No statistically significant results were identified for self-rated health and cognitive functioning. DISCUSSION: Our results highlighted the needs to address mental health among new spousal caregivers and emphasized the importance of addressing mental health in long-term care programs and policies.

In search of experimental evidence on Scratch programming and students' achievements in the first-year college computing class? Consider these datasets.

This article presents datasets representing the demographics and achievements of computer science students in their first programming courses (CS1). They were collected from a research project comparing the effects of a constructionist Scratch programming and the conventional instructions on the achievements of CS1 students from selected Nigerian public colleges. The project consisted of two consecutive quasi-experiments. In both cases, we adopted a non-equivalent pretest-posttest control group design and multistage sampling. Institutions were selected following purposive sampling, and those selected were randomly assigned to the Scratch programming class (experimental) and the conventional (comparison) class. A questionnaire and pre- and post-introductory programming achievement tests were used to collect data. To strengthen the research design, we used the Coarsened Exact Matching (CEM) algorithm to create matched samples from the unmatched data obtained from both experiments. Future studies can use these data to identify the factors influencing CS1 students' performance, investigate how programming pedagogies or tools affect CS1 students' achievements in higher education, identify important trends using machine learning techniques, and address additional research ideas.

Amelioration and deterioration: Social network typologies and mental health among female domestic workers in China.

Previous quantitative studies on the effects of social network types on mental health have obtained inconsistent or conflicting results, due to problems such as sample selection bias or crude measurement of variables. In this study, we avoided these problems by using appropriate statistical methodology to examine the effect of various forms of social network on the mental health of a sample of 987 Chinese female domestic workers. Thus, we measured social network types in terms of both network attributes (friend networks and family networks) and interaction channels (face-to-face, telephone, and WeChat/QQ channels, where the latter are two popular online messaging platforms in China), and used the coarsened exact matching method to obtain a balanced sample. The results showed that social network typologies had positive and negative effects on the mental health of this sample of domestic workers, as evidenced by (1) In terms of network attributes, family networks were associated with improved mental health and friend networks were associated with worsened mental health; (2) In terms of interaction channels, the significant amelioration in mental health from family networks came from face-to-face interactions, the significant deterioration in mental health from friends networks came from telephone interactions, and in terms of other interaction channels, family networks and friends networks had no significant effect on mental health. Robustness tests indicated that these conclusions are reliable. We discuss the possible mechanisms of which different types of social networks influence mental health.

Behavioral Outcomes of Children with Same-Sex Parents in The Netherlands.

Same-sex parents face substantial stressors due to their sexual orientation, such as experiences of prejudice and prohibitive legal environments. This added stress is likely to lead to reduced physical and mental health in same-sex parents that, in turn, may translate into problematic behavioral outcomes in their children. To date, there are only a few nationally representative studies that investigate the well-being of children with same-sex parents. The current study takes a closer look at children's behavioral outcomes, reported by a parent, using an adapted version of the emotional, conduct, hyperactivity, pro-social, and peer problems subscales of the Strengths and Difficulties Questionnaire (SDQ). We take advantage of unique data from the Netherlands based on a probability sample from population registers, whereby findings can be inferred to same-sex and different-sex parent households with parents between the ages of 30 and 65, and with children between the ages of 6 and 16 years (62 children with same-sex, and 72 children with different-sex parents). The findings obtained by coarsened exact matching suggest no significant disadvantages for children with same-sex parents compared to different-sex parents. We contextualize these findings in their wider cultural context, and recommend a renewed focus in future research away from deficit-driven comparisons.

Association of pulmonary vein isolation and major cardiovascular events in patients with atrial fibrillation.

BACKGROUND: Patients with atrial fibrillation (AF) face an increased risk of adverse cardiovascular events. Evidence suggests that early rhythm control including AF ablation may reduce this risk. METHODS: To compare the risks for cardiovascular events in AF patients with and without pulmonary vein isolation (PVI), we analysed data from two prospective cohort studies in Switzerland (n = 3968). A total of 325 patients who had undergone PVI during a 1-year observational period were assigned to the PVI group. Using coarsened exact matching, 2193 patients were assigned to the non-PVI group. Outcomes were all-cause mortality, hospital admission for acute heart failure, a composite of stroke, transient ischemic attack and systemic embolism (Stroke/TIA/SE), myocardial infarction (MI), and bleedings. We calculated multivariable adjusted Cox proportional-hazards models. RESULTS: Overall, 2518 patients were included, median age was 66 years [IQR 61.0, 71.0], 25.8% were female. After a median follow-up time of 3.9 years, fewer patients in the PVI group died from any cause (incidence per 100 patient-years 0.64 versus 1.87, HR 0.39, 95%CI 0.19-0.79, p = 0.009) or were admitted to hospital for acute heart failure (incidence per 100 patient-years 0.52 versus 1.72, HR 0.44, 95%CI 0.21-0.95, p = 0.035). There was no significant association between PVI and Stroke/TIA/SE (HR 0.94, 95%CI 0.52-1.69, p = 0.80), MI (HR 0.43, 95%CI 0.11-1.63, p = 0.20) or bleeding (HR 0.75, 95% CI 0.50-1.12, p = 0.20). CONCLUSIONS: In our matched comparison, patients in the PVI group had a lower incidence rate of all-cause mortality and hospital admission for acute heart failure compared to the non-PVI group. GOV IDENTIFIER: NCT02105844, April 7th 2014.

Matched Analysis of the Risk Assessment and Prediction Tool for Discharge Planning Following Single-Level Posterior Lumbar Fusion.

OBJECTIVES: Predicting patient needs for extended care after spinal fusion remains challenging. The Risk Assessment and Prediction Tool (RAPT) was externally developed to predict discharge disposition after nonspine orthopedic surgery but remains scarcely used in neurosurgery. The present study is the first to use coarsened exact matching-which incorporated patient characteristics known to independently affect outcomes-for 1:1 matching across a large population of single-level, posterior lumbar fusions, to isolate the predictive value of preoperative RAPT score on postoperative discharge disposition. METHODS: Preoperative RAPT scores were prospectively calculated for 1066 patients undergoing consecutive single-level, posterior-only lumbar fusion within a single, university healthcare system. The primary outcome was discharge disposition. Logistic regression was executed across all patients, evaluating the RAPT score as a continuous variable to predict home discharge. Subsequently, patients were retrospectively clustered into predicted risk cohorts-validated within prior orthopedic joint research-based on the RAPT score (Lowest, Intermediate, and Highest Risk). Coarsened exact matching was performed among predicted risk cohorts, and outcomes were compared between exact-matched groups. RESULTS: Among all patients, single-point increases in the RAPT score (i.e., decrease in predicted risk) were associated a 75% increased odds of home discharge (P < 0.001). Exact-matched analysis demonstrated increased odds of home discharge by 400% when comparing the Lowest versus Highest Risk cohorts (P = 0.004), by 750% when comparing the Intermediate versus Highest Risk cohorts (P < 0.001), and by 200% when comparing the Lowest versus Intermediate Risk cohorts (P < 0.001). CONCLUSIONS: The RAPT score, captured in preoperative evaluations, can be highly predictive of discharge disposition following single-level, posterior lumbar fusion.

Employment and child support outcomes among noncustodial fathers: An evaluation of the Fathers Advancing Community Together program.

Prior research underscores the importance of fathers' involvement in their children's lives. However, there is mixed evidence about the degree to which fatherhood programs improve economic stability and child support outcomes among noncustodial fathers. We attempted to address some of these gaps in the literature by evaluating the Fathers Advancing Community Together (FACT) program. FACT was implemented by Rubicon Programs, a community-based nonprofit organization in the Bay Area, California known for providing services to help move people out of poverty. The program provided parents economic stability, responsible parenting, and healthy relationship workshops, as well as support services and intensive case management. We relied on data from the Department of Child Support Services to assess whether FACT increased the likelihood of employment, child support modifications, and child support payments among noncustodial fathers during a 6-month post-enrollment period. Using 3:1 coarsened exact matching procedures, the total sample resulted in 744 fathers (186 in the intervention group and 558 in the comparison group). Results from logistic regression models indicate that FACT participants were more likely to be employed and more likely to receive a child support modification during the post-enrollment period than their comparison counterparts, though we found no significant relationship between FACT participation and whether fathers made a child support payment.

Investigaciones previas subrayan la importancia de la participación de los padres en las vidas de sus hijos. Sin embargo, hay datos contradictorios acerca del grado en el cual los programas sobre la paternidad mejoran los resultados en la estabilidad económica y la manutención infantil entre los padres que no tienen la custodia de sus hijos. Intentamos abordar algunos de estos vacíos en las publicaciones evaluando el programa "Padres que fomentan la comunidad juntos" (Fathers Advancing Community Together, FACT). El programa FACT fue implementado por Rubicon Programs, una organización comunitaria sin fines de lucro en el Área de la Bahía de California, conocida por prestar servicios para ayudar a las personas a salir de la pobreza. El programa ofreció talleres de estabilidad económica para los padres, crianza responsable y relaciones sanas, así como servicios de apoyo y gestión intensiva de casos. Utilizamos datos del Departamento de Servicios de Manutención Infantil (Department of Child Support Services) para evaluar si el FACT aumentó la probabilidad de empleo, las modificaciones en la manutención infantil y los pagos de la manutención infantil entre padres sin la custodia de sus hijos durante un periodo de seis meses posterior a la inscripción. Utilizando métodos de emparejamiento exacto 3:1, la muestra total dio como resultado 744 padres (186 en el grupo de intervención y 558 en el grupo de comparación). Los resultados de los modelos de regresión logística indican que los participantes del FACT tuvieron más probabilidades de ser empleados y de recibir una modificación en la manutención infantil durante el periodo posterior a la inscripción que sus homólogos del grupo de de comparación, aunque no encontramos una relación significativa entre la participación en el FACT y si los padres hicieron un pago de manutención infantil.

Adolescent electronic cigarette use and tobacco smoking in the Millennium Cohort Study.

AIMS: To evaluate the catalyst, diversion and common liability hypotheses by examining associations between e-cigarette use and tobacco cigarette smoking at modal ages 14 and 17 years, controlling for adolescent and infancy risk factors. DESIGN: Intergenerational, prospective cohort data from the Millennium Cohort Study (MCS). Nationally representative sample of infants born September 2000 to January, 2002. SETTING: United Kingdom. PARTICIPANTS: Parent and child data from 10 625 youth assessed in infancy and modal ages 11, 14 and 17 years. MEASUREMENTS: Age 14 and 17 e-cigarette and combustible cigarette use (recency, frequency). Potential confounders were age 11 risk factors (e.g. alcohol use, externalizing behaviors, parental tobacco use, permissiveness), infancy risk factors (e.g. maternal smoking during pregnancy, smoke exposure in infancy) and demographic characteristics. FINDINGS: Among youth who had not smoked tobacco by age 14 (n = 9046), logistic regressions estimated that teenagers who used e-cigarettes by age 14 compared with non-e-cigarette users, had more than five times higher odds of initiating tobacco smoking by age 17 [odds ratio (OR) = 5.25, 95% confidence interval (CI) = 3.28-8.38] and nearly triple the odds of being a frequent tobacco smoker at age 17 (OR = 2.91, 95% CI = 1.56-5.41), net of risk factors and demographics. Among youth who had not used e-cigarettes by age 14 (n = 9078), teenagers who had smoked tobacco cigarettes by age 14 had three times higher odds of initiating e-cigarettes by age 17 (OR = 2.98, 95% CI = 1.74-5.09) compared with non-tobacco smokers and nearly three times higher odds of frequently using e-cigarettes at age 17 (OR = 2.90, 95% CI = 1.21-6.95), net of confounders. Similar links between e-cigarette and tobacco cigarette use were observed in regressions following coarsened exact matching. CONCLUSIONS: E-cigarette use by age 14 is associated with increased odds of tobacco cigarette initiation and frequent smoking at age 17 among British youth. Similarly, tobacco smoking at age 14 is associated with increased odds of both e-cigarette initiation and frequent use at age 17.

Comparing the pelvis of Tibetan and Chinese Han women in rural areas of China: two population-based studies using coarsened exact matching.

This study aims to investigate the difference of pelvic size and shape between Tibetan and Chinese Han women. Data on pelvic dimension measures including interspinous diameter (IS), intercrestal diameter (IC), external conjugate (EC) and transverse outlet (TO) were acquired from two population-based studies amongst Tibetan women in Lhasa, and Chinese Han women in Shaanxi province in China. After coarsened exact matching, there was no statistical difference between any characteristics amongst Tibetan and Chinese Han women (p>.05). The generalised estimating equation models showed Tibetan women had significantly lower IS and IC means than Chinese Han women (IS: 24.39 cm vs. 24.77 cm, p<.001; IC: 26.35 cm vs. 26.93 cm, p<.001) but statistically higher in TO mean (9.12 cm vs. 9.03 cm, p<.001). This study showed Tibetan women have smaller pelvis compared to Chinese Han women. This should offer a useful literature on the comparison of pelvis between Tibetan and Chinese Han women although the difference is small.Impact StatementWhat is already known on this subject? Previous studies in China indicated different populations have different dimensions of pelvis, with the pelvis of Uighur women being bigger than Chinese Han women, and that of Zhuang and Tu women being smaller than Chinese Han women. Little research reports the specific size of Tibetan women's pelvis. Living at high altitude, the Tibetan population have differentiated demographics and show local adaptions, such as unelevated haemoglobin, and significant catch-up growth for infants compared with Chinese Han infants. Therefore, there is a strong rationale for better understanding pelvic characteristics amongst this population.What the results of this study add? This study showed Tibetan women have smaller pelvises compared to Chinese Han women. Tibetan women have a smaller interspinous diameter and intercrestal diameter than Chinese Han women, which leads to relatively narrow hip.What the implications are of these findings for clinical practice and/or further research? This study provides useful comparative information on pelvic features between Tibetan and Chinese Han women although the findings of differences were small. In addition, during the formulation of women's health policy, the results of this study can provide data to support the selection of appropriate indicators of obstetrics and gynaecology for different populations of pregnant women during antenatal care and delivery.

Debunking Lesbian Bed Death: Using Coarsened Exact Matching to Compare Sexual Practices and Satisfaction of Lesbian and Heterosexual Women.

The current study examined the prevalence and correlates of over 50 sexual practices in a national survey of heterosexual and lesbian women in relationships. Coarsened exact matching was used to create comparable samples of heterosexual (n = 2510) and lesbian (n = 283) women on six demographic factors, including relationship length. Heterosexual and lesbian women were equally likely to be sexually satisfied (66% heterosexual women vs. 68% lesbian women). Compared to heterosexuals, lesbians were more likely to report having sex 0-1 times per month (11% vs. 23%) and were less likely to report having sex greater than once per month (89% vs. 77%). Among women who had been in relationships for longer than 5 years, heterosexual women were less likely than lesbian women to report having sex 0-1 times per month (15%; 42%). This steeper drop in sexual frequency among lesbian women than heterosexual women has pejoratively been labeled lesbian bed death. Rather than accept the label "lesbian bed death" as characterizing these sexual relationships, we turn our attention to what we call lesbian bed intimacies: the myriad ways that lesbian women incorporate behaviors promoting emotional connection, romance, and mood setting, as well as relying on a wide variety of specific sexual acts (e.g., use of sex toys) and sexual communication. Compared to heterosexual women, lesbian women were more likely to usually to always receive oral sex during sex in the past month (28%; 47%) and to use sex toys in the past year (40%; 62%). In their last sexual encounter, lesbian women were more likely to say "I love you" (67%; 80%), have sex longer than 30 min (48%; 72%), and engage in gentle kissing (80%; 92%). These intimacies likely help explain why sexual satisfaction was similar in these groups despite notable differences in sexual frequency.

Bowling alone or distancing together? The role of social capital in excess death rates from COVID19.

Much attention on the spread and impact of the ongoing pandemic has focused on institutional factors such as government capacity along with population-level characteristics such as race, income, and age. This paper draws on a growing body of evidence that bonding, bridging, and linking social capital - the horizontal and vertical ties that bind societies together - impact public health to explain why some U.S. counties have seen higher (or lower) excess deaths during the COVID19 pandemic than others. Drawing on county-level reports from the Centers for Disease Control and Prevention (CDC) since February 2020, we calculated the number of excess deaths per county compared to 2018. Starting with a panel dataset of county observations over time, we used coarsened exact matching to create smaller but more similar sets of communities that differ primarily in social capital. Controlling for several factors, including politics and governance, health care quality, and demographic characteristics, we find that bonding and linking social capital reduce the toll of COVID-19 on communities. Public health officials and community organizations should prioritize building and maintaining strong social ties and trust in government to help combat the pandemic.

Propensity score matching versus coarsened exact matching in observational comparative effectiveness research.

Aim & methods: We compared propensity score matching (PSM) and coarsened exact matching (CEM) in balancing baseline characteristics between treatment groups using observational data obtained from a pan-Canadian prostate cancer radiotherapy database. Changes in effect estimates were evaluated as a function of improvements in balance, using results from randomized clinical trials to guide interpretation. Results: CEM and PSM improved balance between groups in both comparisons, while retaining the majority of original data. Improvements in balance were associated with effect estimates closer to those obtained in randomized clinical trials. Conclusion: CEM and PSM led to substantial improvements in balance between comparison groups, while retaining a considerable proportion of original data. This could lead to improved accuracy in effect estimates obtained using observational data in a variety of clinical situations.

Ultra-Fast-Track Extubation in Adult Congenital Heart Surgery.

Background In pediatric cardiac surgery, perioperative management has evolved from slow weaning of mechanical ventilation in the intensive care unit to "ultra-fast-track" anesthesia with early extubation (EE) in theater to promote a faster recovery. The strategy of EE has not been assessed in adults with congenital heart disease, a growing population of patients who often require surgery. Methods And Results Data were collected retrospectively on all patients >16 years of age who underwent adult congenital heart surgery in our tertiary center between December 2012 and January 2020. Coarsened exact matching was performed for relevant baseline variables. Overall, 711 procedures were performed: 133 (18.7%) patients underwent EE and 578 (81.3%) patients received conventional extubation. After matching, patients who received EE required less inotropic or vasopressor support in the early postoperative period (median Vasoactive-inotropic score 0.5 [0.0-2.0] versus 2.0 [0.0-3.5]; P<0.0001) and had a lower total net fluid balance than patients after conventional extubation (1168±723 versus 847±733 mL; P=0.0002). The overall reintubation rate was low at 0.3%. EE was associated with a significantly shorter postoperative length of stay in higher dependency care units before a "step-down" to ward-based care (48 [45-50] versus 50 [47-69] hours; P=0.004). Lower combined intensive care unit and high dependency unit costs were incurred by patients who received EE compared with patients who received conventional extubation (£3949 [3430-4222] versus £4166 [3893-5603]; P<0.0001). Conclusions In adult patients undergoing surgery for congenital heart disease, EE is associated with a reduced need for postoperative hemodynamic support, a shorter intensive care unit stay, and lower health-care-related costs.

Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents.

BACKGROUND: Patient experience is a key measure widely used to evaluate quality of healthcare, yet there is little discussion about it in China using national survey data. This study aimed to explore rural and urban differences in patient experience in China. METHODS: Data regarding this study were drawn from Chinese General Social Survey (CGSS) 2015, with a sample size of 9604. Patient experience was measured by the evaluation on healthcare services. Coarsened exact matching (CEM) method was used to balance covariates between the rural and urban respondents. Three thousand three hundred seventy-two participants finally comprised the matched cohort, including 1592 rural residents and 1780 urban residents. Rural and urban differences in patient experience were tested by ordinary least-squares regression and ordered logistic regression. RESULTS: The mean (SD) score of patient experience for rural and urban residents was 72.35(17.32) and 69.45(17.00), respectively. Urban residents reported worse patient experience than rural counterparts (Crude analysis: Coef. = - 2.897, 95%CI: - 4.434, - 1.361; OR = 0.706, 95%CI: 0.595, 0.838; Multivariate analysis: Coef. = - 3.040, 95%CI: - 4.473, - 1.607; OR = 0.675, 95%CI: 0.569, 0.801). Older (Coef. = 2.029, 95%CI: 0.338, 3.719) and healthier (Coef. = 2.287, 95%CI: 0.729, 3.845; OR = 1.217, 95%CI: 1.008, 1.469) rural residents living in western area (Coef. = 2.098, 95%CI: 0.464, 3.732; OR = 1.276, 95%CI: 1.044, 1.560) with higher social status (Coef. = 1.158, 95%CI: 0.756, 1.561; OR = 1.145, 95%CI: 1.090, 1.204), evaluation on adequacy (Coef. = 7.018, 95%CI: 5.045, 8.992; OR = 2.163, 95%CI: 1.719, 2.721), distribution (Coef. = 4.464, 95%CI: 2.471, 6.456; OR = 1.658, 95%CI: 1.312, 2.096) and accessibility (Coef. = 2.995, 95%CI: 0.963, 5.026; OR = 1.525, 95%CI: 1.217, 1.911) of healthcare resources had better patient experience. In addition, urban peers with lower education (OR = 0.763, 95%CI: 0.625, 0.931) and higher family economic status (Coef. = 2.990, 95%CI: 0.959, 5.021; OR = 1.371, 95%CI: 1.090,1.723) reported better patient experience. CONCLUSIONS: Differences in patient experience for rural and urban residents were observed in this study. It is necessary to not only encourage residents to form a habit of seeking healthcare services in local primary healthcare institutions first and then go to large hospitals in urban areas when necessary, but also endeavor to reduce the disparity of healthcare resources between rural and urban areas by improving quality and capacity of rural healthcare institutions and primary healthcare system of China.

Comparison of inequity in health-related quality of life among unemployed and employed individuals in China.

BACKGROUND: In China, achieving health equity has been regarded as a key issue for health reform and development in the current context. It is well known that unemployment has a negative effect on health. However, few studies have addressed the association between unemployment and inequity in health-related quality of life (HRQOL). This study aims to compare the inequality and inequity in HRQOL between the unemployed and employed in China. METHODS: The material regarding this study was derived from the Chinese National Health Services Survey of Shaanxi Province for 2013. We controlled for confounding factors by utilizing the coarsened exact matching method. Finally, 7524 employed individuals and 283 unemployed individuals who were 15 to 64 years old in urban areas were included in this study. We used HRQOL as the outcome variable, which was evaluated by using the Chinese version of EQ-5D-3L. The health concentration index, decomposition analysis based on the Tobit model, and the horizontal inequity index were employed to compute the socioeconomic-related equity between the unemployed and employed and the contribution of various factors. RESULTS: After matching, unemployed people tended to have poorer EQ-5D utility scores than employed people. There were statistically pro-rich inequalities in HRQOL among both employed and unemployed people, and the pro-rich health inequity of unemployed people was substantially higher than that of employed people. Economic status, age, education, smoking and health insurance were the factors influencing inequality in HRQOL between employed and unemployed individuals. Education status and basic health insurance have reduced the pro-rich inequity in HRQOL for unemployed people. CONCLUSION: It is suggested that unemployment intensifies inequality and inequity in HRQOL. According to policymakers, basic health insurance is still a critical health policy for improving health equity for the unemployed. Intervention initiatives aiming to tackle long-term unemployment through active labour market programmes, narrow economic gaps, improve educational equity and promote the health status of the unemployed should be considered by the government to achieve health equity.

The impact of output price support on smallholder farmers' income: evidence from maize farmers in Ghana.

Instability in smallholder farmers' income in developing countries due to unstable farm prices has been a challenge for farmers and agricultural policymakers over the years. Sustained price stabilization mechanisms are mostly lacking. In some countries, output price support has been initiated to stabilize incomes and as an incentive to enhance farmer investment and boost production. This paper investigates the impacts of output price support on smallholder farmers' income in Ghana, using a household and farm-level data from 252 beneficiaries and 268 non-beneficiaries of buffer stock operations in Ghana. We applied the Coarsened Exact Matching and Propensity Score Matching methods to balance the data among the two groups. We estimate the smallholder farmer income effect from participating in buffer stock operations by combining the matching methods in a regression framework. The results affirm that buffer stock operations increase the incomes of participating smallholder farming households by at least 12%, providing evidence that output price support via buffer stocks is a critical tool for improving incomes and alleviating poverty among farmers in Ghana. The results further indicate that age, gender, access to market, and use of extension services, as well as transport and packaging costs, drive the participation of smallholder farmers in the buffer stock operations in Ghana. The findings are relevant to local policymakers and development partners who develop tailored interventions to stabilize and increase income for smallholder maize farmers in Ghana.