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Economic evaluations often utilise individual-patient data (IPD) to calculate probabilities of events based on observed proportions. However, this approach is limited when interest is in the likelihood of extreme biomarker values that vary by observable characteristics such as blood glucose in gestational diabetes mellitus (GDM). Here, instead of directly calculating probabilities using the IPD, we utilised flexible parametric models that estimate the full conditional distribution, capturing the non-normal characteristics of biomarkers and enabling the derivation of tail probabilities for specific populations. In the case study, we used data from the Born in Bradford study (N = 10,353) to model two non-normally distributed GDM biomarkers (2-hours post-load and fasting glucose). First, we applied fully parametric maximum likelihood to estimate alternative flexible models and information criteria for model selection. We then integrated the chosen distributions in a probabilistic decision model that estimates the cost-effective diagnostic thresholds and the expected costs and quality-adjusted life years (QALYs) of the alternative strategies (‘Testing and Treating’, ‘Treat all’, ‘Do Nothing’). The model adopts the ‘payer’ perspective and expresses results in net monetary benefits (NMB). The log-logistic and Singh-Maddala distributions offered the optimal fit for the 2-hours post-load and fasting glucose biomarkers, respectively. At £13,000 per QALY, maximum NMB with ‘Test and Treat’ (−£330) was achieved for a diagnostic threshold of fasting glucose >6.6 mmol/L, 2-hours post-load glucose >9 mmol/L, identifying 2.9% of women as GDM positive. The case study demonstrated that fully parametric approaches can be implemented in healthcare modelling when interest lies in extreme biomarker values.

Postneonatal mortality (PNM), which differs from infant and perinatal mortality, has been observed in the past 25 years with respect to the health outcomes of children. While infant and perinatal mortality have been well-evaluated regarding racial differentials, there are no substantial data on PNM in this perspective. The purpose of this study was to assess whether or not social determinants of health adversely affect racial/ethnic PNM differentials in the USA.

A cross-sectional, nonexperimental epidemiologic study design was used to assess race as an exposure function of PNM using Cohort Linked Birth/Infant Death Data (2013). The outcome variable assessed PNM, while the main independent variables were race, social demographic variables (i.e. sex and age) and social determinants of health (i.e. marital status and maternal education). The chi-square statistic was used to assess the independence of variables by race, while the logistic regression model was used to assess the odds of PNM by race and other confounding variables.

During 2013, there were 4,451 children with PNM experience. The cumulative incidence of PNM was 23.6% (n = 2,795) among white infants, 24.3% (n = 1,298) among Black/African-Americans (AA) and 39.5% (n = 88) were American-Indian infants (AI), while 21.3% (n = 270) were multiracial, χ² (3) = 35.7, p < 0.001. Racial differentials in PNM were observed. Relative to White infants, PNM was two times as likely among AI, odds ratio (OR) 2.11 (95% confidence interval [CI] 1.61, 2.78). After controlling for the confounding variables, the burden of PNM persisted among AI, although slightly marginalized, adjusted odds ratio (aOR) 1.70, (99% CI 1.10, 2.65).

In a representative sample of US children, there were racial disparities in PNM infants who are AI compared to their white counterparts, illustrating excess mortality. These findings suggest the need to allocate social and health resources in transforming health equity in this direction.

This chapter shows the prevalence, trends and heterogeneity in maternal smoking around birth in the United Kingdom (UK), focussing on the war and post-war reconstruction period in which there exists surprisingly little systematic data on (maternal) smoking behaviours. Within this context, the authors highlight relevant events, the release of new information about the harms of smoking and changes in (government) policy aimed at reducing smoking prevalence. The authors show stark changes in smoking prevalence over a 30-year period, highlight the onset of the social gradient in smoking as well as genetic heterogeneities in smoking trends.

The purpose of this study is to nutritionally evaluate dams exposed to caloric restriction or cafeteria diets during the lactation period.

Twenty-four female Wistar rats (n = 8/group) and their respective litters received during lactation: Control (CTRL) – received standard chow; Caloric restriction (CR) – received 50% of the ratio of the CTRL group; Cafeteria diet (CAF) – received cafeteria diet. Weighing of the mother rats and their respective litters occurred weekly and the diets were daily. At weaning, levels of glucose, total cholesterol, high-density lipoprotein, low-density lipoprotein (LDL) and triglycerides were evaluated. Abdominal adipose tissue was removed and weighed. Liver tissue was removed to determine the lipid profile.

CR dams showed lower food (p < 0.01), caloric (p < 0.01) and all macronutrients (p < 0.01) intake. This group also observed intense weight loss (p < 0.01), in addition to low litter weight (p < 0.01). CAF dams had higher caloric intake (p < 0.05) and increased consumption of lipids (p < 0.01). The CAF group also reported greater accumulation of abdominal adipose tissue (p = 0.01), elevated levels of LDL (p < 0.01) and hepatic lipids (p < 0.01), as well as a litter with higher weaning weight (p < 0.01).

Few studies have evaluated the effects of different models of malnutrition focusing on dams. CR dams showed severe weight loss, which may have caused their pups to be underweight. On the other hand, the CAF diet during lactation led to a higher consumption of lipids and accumulation of adipose tissue, which generated a high weight of the litter.

This study aims to explore the link between prevalent risk factors for early childhood diarrhea, including hygiene, feeding, weaning practices and maternal education and the occurrence and severity of early childhood diarrhea in Saudi Arabia.

A case-control study was conducted, involving 98 mothers from the Eastern Region of Saudi Arabia (51 cases and 47 controls). Data were collected from both hospital and community sources. The collected data were statistically analyzed and depicted using descriptive statistics and frequency tables.

Demographic data revealed that 60% of mothers were housewives, 75% had normal deliveries and all babies were full term. In the study cohort, 44% of children aged one to two years. Four domains were compared: diarrheal management, hygiene, weaning and feeding practices. Diarrheal management was suboptimal in some cases: 29% increased fluid intake, 10% maintained adequate food intake, 50% sought medical advice, 58% were familiar with oral rehydration solutions and only 37% used them. Hygiene practices were deficient, with 35% using wipes or sanitizers, 64% handwashing before feeding and 52% adhering to the recommended 10-s duration. Controls exhibited better hygiene practices. Weaning practices were generally similar, with no significant differences between the two groups.

To the best of the authors’ knowledge, this is the first study to collectively report on the risk factors linked to early childhood diarrhea in Saudi Arabia. This study yields significant insights, highlighting the crucial role of managing diarrhea, educating mothers and implementing proper household practices in impacting the occurrence and severity of this perilous ailment.

This study aims to evaluate the association between ethnic minority membership and their knowledge about their human health rights in Peru.

A secondary analysis of the National Health User Satisfaction Survey 2015–2016 was conducted using an analytical cross-sectional design. Participants who spoke Quechua, Aymara, Awajun, Bora or a language other than Spanish aged 15 year were considered as a racial minority. The question “Do you know that by law you have health rights?” was applied to incorporate knowledge on health rights. Generalized linear models of the Poisson distribution were used to calculate crude prevalence ratio and adjusted prevalence ratio. A total of 3,721 responses were included in the analysis.

The average age was 38.3 year, and 26.6% were males. The prevalence of belonging to an ethnic minority was 7.7%, and 27.6% of the participants did not know about their health rights. An association was found in the adjusted regression analysis between belonging to an ethnic minority and a greater probability of not knowing human health rights.

The value of the works lies in one in four participants who did not know he had health rights by law. Belonging to an ethnic minority was associated with not knowing about having human health rights.

Since March 2020, the global COVID-19 pandemic has disproportionately impacted refugees by compounding preexisting and systemic health, social and economic inequities. In Canada, approximately 50,000 Syrian refugees arrived between 2015 and 2020 and were in the process of rebuilding their lives when the pandemic started. This study aims to explore the impact of the COVID-19 pandemic for Syrian refugees in Canada and identify supports needed.

Drawing on frameworks for refugee psychosocial adaptation and social integration and a qualitative descriptive design, the study used thematic analysis to examine semi-structured interviews with 10 Syrians.

Findings indicated four themes that provide a snapshot of impacts relatively early in the pandemic: facing ongoing development, inequity and insecurity during integration; disruption of settlement, integration and adaptation due to the pandemic; ongoing adaptation and resilience during integration in Canada; and ongoing needs and solutions for integration and adaptation.

This study builds upon growing research concerning Syrian refugees and psychosocial adaptation, particularly during the pandemic. The findings highlight the impacts of the pandemic on a population already facing inequities in a resettlement country. While the findings emphasize the resilience of the Syrian refugee community, the study also demonstrates the need for ongoing supports and justice-oriented action to fulfill resettlement commitments, especially in the face of additional stressors like the COVID-19 pandemic. Implications for policy, practice and future research are discussed.