A Review of Digital Health Strategies in 10 Countries With Young Populations: Do They Serve the Health and Wellbeing of Children and Youth in a Digital Age?

Children and youth merit special attention from digital health policymakers and practitioners because of the great potential for digital transformations to both enhance and undermine their health and wellbeing. However, an analysis of digital health strategies from 10 African countries with young populations suggest that national approaches to digital health are overlooking young people's specific health needs and unique risks in relation to digital technologies and data. To better serve the needs of children and youth in a digital age, future digital health strategies-and the global guidance that many strategies are based upon-should consider the ways in which digital transformations can positively or negatively impact the health and wellbeing of different populations, and the forms of cross-sectoral and multi-stakeholder collaboration required to amplify or mitigate them. Future strategies should be developed through inclusive processes that support young people's right to participate in decision-making that affects their lives.

Ventricular Arrhythmia Burden in Patients With Heart Failure and Cardiac Resynchronization Devices: The Importance of Renal Function.

BACKGROUND: Chronic kidney disease (CKD) is a risk factor for arrhythmias in patients with heart failure (HF). However, the effects of CKD on ventricular arrhythmia (VA) burden in patients with cardiac resynchronization therapy and defibrillator (CRT-D) devices in a primary prevention setting are unknown. OBJECTIVE: To determine whether baseline CKD is associated with increased risk of VA in patients implanted with primary prevention CRT-D devices. METHODS AND RESULTS: In this retrospective study, 199 consecutive primary prevention CRT-D recipients (2005-2010) were stratified by estimated glomerular filtration rate (eGFR) levels prior to device implantation with 106 (53.2%) ≥CKD III (eGFR < 60 mL/min/1.73 m2 ) (CKD group). CKD group patients were significantly older (70.0 ± 10 years vs. 61.3 ± 12 years, P < 0.05) with higher prevalence of ischemic cardiomyopathy (56.2% vs. 40.2%, P < 0.05). Detected ventricular tachycardia (VT)/ventricular fibrillation (VF) episodes resulting in device therapy occurred significantly more frequently in the CKD group [40/106(37.8%)] than controls [24/93(25.8%)], (odd ratio [OR] = 1.74, 95% confidence interval [CI] = 1.01-3.2, P = 0.05). At 5-year follow-up, interval censored data analysis showed 41% VT/VF incidence in the CKD group compared to 24% incidence in controls (P < 0.05). Cox proportional hazards model identified CKD > III as the only predictor of sustained VA in this group (adjusted hazard ratio [HR] 2.92, CI = 1.39-6.1, P = 0.004). CONCLUSION: Baseline CKD is a strong independent risk factor for VA in primary prevention CRT-D recipients. Further understanding of the underlying arrhythmogenic mechanisms relating to CKD may be of interest to allow appropriate correction and prevention. Device programming in this cohort may need to reflect this increased risk.

Hard to Believe : Produced by Ken Stone and Irene Silber, 2015, Swoop Films and Stone Soup Productions (New York, 56 minutes, unrated).

This article presents a review of Hard to Believe, a compelling documentary reporting the forced organ procurement and death of Chinese prisoners of conscience. The documentary is targeted to ignite political and public pressure to stop these practices that are thought to be motivated by financial and political gain. Narrated by journalist and author Ethan Gutmann, the documentary pricks at the collective conscience, as credible witnesses provide evidence that point to an abrogation of every ethical principle ascribed to legitimate organ procurement.

Identification of chromosomal locations associated with tail biting and being a victim of tail-biting behaviour in the domestic pig (Sus scrofa domesticus).

The objective of this study was to identify loci associated with tail biting or being a victim of tail biting in Norwegian crossbred pigs using a genome-wide association study with PLINK case-control analysis. DNA was extracted from hair or blood samples collected from 98 trios of crossbred pigs located across Norway. Each trio came from the same pen and consisted of one pig observed to initiate tail biting, one pig which was the victim of tail biting and a control pig which was not involved in either behaviour. DNA was genotyped using the Illumina PorcineSNP60 BeadChip whole-genome single-nucleotide polymorphism (SNP) assay. After quality assurance filtering, 53,952 SNPs remained comprising 74 animals (37 pairs) for the tail biter versus control comparison and 53,419 SNPs remained comprising 80 animals (40 pairs) for the victim of tail biting versus control comparison. An association with being a tail biter was observed on Sus scrofa chromosome 16 (SSC16; p = 1.6 × 10(-5)) and an unassigned chromosome (p = 3.9 × 10(-5)). An association with being the victim of tail biting was observed on Sus scrofa chromosomes 1 (SSC1; p = 4.7 × 10(-5)), 9 (SSC9; p = 3.9 × 10(-5)), 18 (SSC18; p = 7 × 10(-5) for 9,602,511 bp, p = 3.4 × 10(-5) for 9,653,881 bp and p = 5.3 × 10(-5) for 29,577,783 bp) and an unassigned chromosome (p = 6.1 × 10(-5)). An r(2) = 0.96 and a D' = 1 between the two SNPs at 9 Mb on SSC18 indicated extremely high linkage disequilibrium, suggesting that these two markers represent a single locus. These results provide evidence of a moderate genetic association between the propensity to participate in tail-biting behaviour and the likelihood of becoming a victim of this behaviour.

Do larger studies find smaller effects? The example of studies for the prevention of conduct disorder.

INTRODUCTION: There is some emerging evidence in medicine that larger clinical trials tend to be associated with smaller effect sizes. Much of the evidence-base currently informing practice in Child Psychiatry relies on relatively small trials. We therefore investigated the relationship between trial size and effect size in research within a key area of child mental health. METHOD: A recent systematic review of 20 trials of prevention of conduct disorder was subjected to meta-regression, to examine the relationship between study size and effect size, and to explore hypothesised confounding variables. RESULTS: In this sample of studies, reported effect size was inversely related to sample size. This effect is not explained by year of publication, intervention type or quality of methodology in the study. DISCUSSION: Our finding is consistent with other reports in the literature. The origin of this effect is not yet clear. However if replicated it clearly has significant implications for the way trials in child mental health are interpreted.