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Health-related quality-of-life associated with Chagas disease in Argentina and Spain
Get PDFObjectives Evidence on health-related quality of life (HRQoL) in Chagas disease is essential for understanding its burden and informing interventions. However, studies on HRQoL variation during disease progression and treatment are limited. This study provides new estimates of perceived HRQoL levels among individuals with T.cruzi infection, patients with Chagas disease, and at-risk populations, using a preference-based measure relevant for economic evaluations. Methods HRQoL data were collected from 1383 individuals in Argentina and 157 in Spain using the EQ-5D-3L questionnaire. We estimated utility scores and examined clinical subgroups, adjusting for sociodemographic factors. Overall HRQoL determinants were analyzed with truncated inflated beta regression models; domain-specific determinants with seemingly unrelated ordered probit models. Results Chagas disease significantly reduces HRQoL, with lower scores among older individuals and women. Chronic cardiac disease and symptoms were key determinants. Higher HRQoL was linked to being male, more educated, and asymptomatic. Urban residents, particularly in San Juan, Argentina, reported lower HRQoL. In Spain, HRQoL declined by 0.01 per month during treatment, likely due to side effects. Conclusion This first large EQ-5D-3L study on Chagas disease in endemic and non-endemic settings enables QALY estimation and can inform economic evaluations to guide healthcare priorities
The decline of child stunting in 122 countries: a systematic review of child growth studies since the nineteenth century
Get PDFIntroduction Child stunting, a measure of malnutrition, is a major global health challenge affecting 148.1 million children in 2022. Global stunting rates have declined from 47.2% in 1985 to 22.3% in 2022; however, trends before the mid-1980s are unclear, including whether child stunting was previously prevalent in current high-income countries (HICs). We conducted a systematic review of child growth studies before 1990 to reconstruct historical rates of child stunting. Methods We included reports of mean height by age and sex for children up to age 10.99 years. We excluded studies that were not representative of the targeted population and data for children under age 2. Stunting rates were computed by converting the means and SDs of height to height-for-age Z-scores (HAZ) using the WHO standard/reference, combining the HAZ distributions for all ages and measuring the share of the combined distribution below the stunting threshold. Results We found 923 child growth studies at the community, regional and national level covering 122 countries from 1814 to 2016. We supplemented these historical studies with stunting estimates from the 1990s onward from the Joint Malnutrition Estimates database. Many current HICs had high levels of child stunting in the early 20th century, similar to low- and middle-income countries (LMICs) today. However, there was heterogeneity: stunting rates were low in Scandinavia, the European settler colonies and in the Caribbean, higher in Western Europe and exceptionally high in Japan and South Korea. Child stunting declined across the 20th century. Conclusion The global child stunting rate was substantially higher in the early 20th century than in 1985, and the reduction of child stunting was a central feature of the health transition. The high stunting rates and subsequent reduction of stunting in HICs suggest that current HICs provide lessons for eradicating child stunting and that all LMICs can eliminate stunting
Beyond prototypicality: identity leadership is about shaping and embedding a sense of social identity, not just representing it
Get PDFResearch inspired by the social identity theory of leadership has focused predominantly on the importance of a leader being seen to be representative of the groups they lead. However, beyond this, research suggests that leaders also need to create, advance, and embed a sense of shared social identity in those groups. In the present research, we explore how these different facets of identity leadership combine to form distinct leader profiles. We draw on two heterogeneous independent samples from the Global Identity Leadership Development project (N = 7682; N = 7855) to explore profiles of leaders’ engagement in identity leadership. In both studies, a latent profile analysis of the results of a CFA using a bifactor-(S − 1) model was conducted. In each case, the analysis identified two different predominant identity leadership profiles: ‘engaged identity leaders’ and ‘moderate-inconsistent identity leaders’. Employees working with engaged identity leaders reported substantially more positive job-related attitudes. The results were very similar across the two studies and suggest that this profile analysis is generalizable. The findings support suggestions that identity leadership is multidimensional rather than solely a matter of identity prototypicality
Physical attractiveness and the general factor of personality: replication and extension
No full textA significant positive correlation between physical attractiveness and the general factor of personality (GFP) has been found. This association was replicated in the current study with longitudinal analyses revealing that physical attractiveness in both childhood and adolescence is predictive of the GFP in adulthood. It is posited that the results are due to mediated pleiotropy with attractive individuals responding positively to preferential treatment. The results may extend our understanding of the development of individual differences in the GFP. However, future research in which both attractiveness and personality are measured at several points is needed to disentangle the dynamics effects between the two variables
Tertiary patents on drugs approved by the FDA
Get PDFImportance: Manufacturers of drug-device combinations, such as inhalers and injectable medications, often obtain patents not just on the active pharmaceutical ingredients of these products (primary patents) but also on other features, such as their formulations and methods of use (secondary patents) and delivery devices (tertiary patents). Courts, policymakers, and regulators have recently begun scrutinizing whether manufacturers may be improperly listing tertiary patents with the Food and Drug Administration (FDA) that lack claims on active pharmaceutical ingredients and whether such patents may be delaying generic competition. However, the full scope of patenting practices on drug-device combinations remains unknown. Objective: To analyze patent protection on small-molecule drugs approved by the FDA from 1986 to 2023 with 1 or more tertiary patents. Design, Setting, and Participants: In this retrospective cohort study of patenting practices on drug-device combinations, all patents listed in the FDA's Approved Drug Products With Therapeutic Equivalence Evaluations (Orange Book) were categorized (primary, secondary, or tertiary), and products with at least 1 tertiary patent were included. Analyses were performed between May 2024 and October 2025. Main Outcomes and Measures: The primary outcome of the study was the duration of expected patent protection on each product, measured from the time of approval until expiration of the last-to-expire patent. Added protection from tertiary patents that went beyond protection afforded by primary or secondary patents was also analyzed. Results: The FDA approved 331 products from 1986 to 2023 with 1 or more tertiary patents; 137 of 3241 patents (4.2%) listed on these products were primary patents, 1353 of 3241 were secondary patents (41.7%), and 1751 of 3241 were tertiary patents (54.0%). Among tertiary patents, 1047 of 1751 (59.8%) lacked claims making any mention of active pharmaceutical ingredients. The median (IQR) duration of expected patent protection among products in the cohort was 17.6 (14.4-21.2) years. There were 180 products (54.4%) that had tertiary patents extending periods of expected protection beyond other patents, and the median (IQR) duration of added protection was 7.5 (2.8-13.9) years. Conclusions and Relevance: The findings of this cohort study suggest that policymakers and regulators should take steps to ensure that tertiary patents are not improperly listed in the Orange Book and that generic competition occurs in a timely fashion
Effectiveness of an integrated prevention programme (“JoyAge”) for depressive symptoms, anxiety, and loneliness in older adults in Hong Kong: a pragmatic quasi-experimental trial
No full textBackground With population ageing and insufficient mental health workforce, there are huge treatment gaps for late-life depression. Real-world evidence of scalable preventive services is scarce. This study examines the effectiveness of an integrated selective and indicated prevention programme for late-life depression in a large group of older adults in Hong Kong. Methods This was a pragmatic quasi-experimental trial of a new service (“JoyAge”) for older people with risk factors for late-life depression or subsyndromal depressive symptoms. Participants were recruited and allocated, based on their district of residence, to receive JoyAge ( N = 2975) or usual care ( N = 441). The primary outcome was depressive symptoms (PHQ-9) at 12-month follow-up; secondary outcomes were anxiety symptoms (GAD-7) and loneliness (UCLA-3). Analyses were conducted in an intention-to-treat framework using mixed modelling, with subgroup analyses based on baseline depressive symptoms, and sensitivity analyses in a 1:1 ( N = 422 each group) propensity score-matched sample. Results The JoyAge participants had a greater reduction in depressive symptoms over the 12-month period compared to those assigned to usual care (adjusted mean difference [AMD] = 1.65, 95% CI = 1.24–2.07, p < .001), similarly in anxiety symptoms (AMD = 1.47, 95% CI = 1.01–1.93, p < .001), and loneliness (AMD = 1.29, 95% CI = 0.98–1.60, p < .001). Results were similar in propensity-score matched analyses. Subgroup analysis showed that JoyAge was particularly effective among people with moderate to moderately severe symptoms and those with risk factors only. Conclusions Integrated late-life depression prevention can be effectively implemented at scale in rapidly ageing settings with a limited specialist mental health workforce. Economic analyses are needed to support further implementation
Sequential knockoffs for variable selection in reinforcement learning
No full textIn real-world applications of reinforcement learning, it is often challenging to obtain a state representation that is parsimonious and satisfies the Markov property without prior knowledge. Consequently, it is common practice to construct a state larger than necessary, e.g., by concatenating measurements over contiguous time points. However, needlessly increasing the dimension of the state may slow learning and obfuscate the learned policy. We introduce the notion of a minimal sufficient state in a Markov decision process (MDP) as the subvector of the original state under which the process remains an MDP and shares the same reward function as the original process. We propose a novel sequential knockoffs (SEEK) algorithm that estimates the minimal sufficient state in a system with high-dimensional complex nonlinear dynamics. In large samples, the proposed method achieves selection consistency. As the method is agnostic to the reinforcement learning algorithm being applied, it benefits downstream tasks such as policy learning. Empirical experiments verify theoretical results and show that the proposed approach outperforms several competing methods regarding variable selection accuracy and the suboptimality gap of the learned policy. A Python implementation of SEEK is provided at https://github.com/Mamba413/see
AI and robotics as drivers of China’s urban innovation
No full textFew studies have examined the economic consequences of deploying artificial intelligence (AI) and robotics in less-developed cities, where policies have often failed. To address this gap, we analyse a panel of 270 Chinese cities (2009–2019) using ordinary least squares (OLS), instrumental variable two-stage least squares (IV-2SLS) and quantile regression techniques. We find that AI and robotics significantly promote technological innovation in China, with especially pronounced implications for cities at or below the technological frontier. These technologies also enhance the returns to science and technology (S&T) investment. Its novelty lies in framing AI and robotics as policy substitutes and tools for narrowing innovation divides among Chinese cities
The extra costs of disability in Chile: regional heterogeneity and policy implications
No full textDisabled people and their households face greater vulnerability to poverty and deprivation due to both lower incomes and higher resource needs. Research on this topic remains limited in developing countries, where disability prevalence is higher and social protection systems are less developed. This study estimates the direct extra costs of disability for Chilean households and examines their implications for poverty and inequality measurement. Using the Standard of Living (SoL) approach with data from a nationally and regionally representative household survey, I find that households with a disabled member would require an additional 46% of their monthly disposable income to achieve the same living standards as households without disabled members. These extra costs are larger in urban areas, exhibit significant regional variations, and are particularly pronounced among households with members experiencing severe or multiple disabilities. Accounting for these extra costs reveals increased levels of poverty and inequality. These findings point to inadequacies in Chile’s current social benefit system and underscore the need for enhanced disability benefits, disability-adjusted poverty measurement, and social policies to reduce the social exclusion and economic vulnerability experienced by disabled individuals and their households