Calculating risk and prevalence ratios and differences in R: Developing intuition with a hands-on tutorial and code.

Epidemiologic research questions often focus on evaluating binary outcomes, yet curricula and scientific literature do not always provide clear guidance or examples on selecting and calculating an appropriate measure of association in these scenarios. Reporting inappropriate measures may lead to misleading statistical conclusions. We present a hands-on tutorial that includes annotated code written in an open-source statistical programming language (R) showing readers how to apply, compare, and understand four methods used to estimate a risk or prevalence ratio (or difference), rather than presenting an odds ratio.

Calculating risk and prevalence ratios and differences in R: developing intuition with a hands-on tutorial and code.

Epidemiologic research questions often focus on evaluating binary outcomes, yet curricula and scientific literature do not always provide clear guidance or examples on selecting and calculating an appropriate measure of association in these scenarios. Reporting inappropriate measures may lead to misleading statistical conclusions. We present a hands-on tutorial that includes annotated code written in an open-source statistical programming language (R) showing readers how to apply, compare, and understand four methods used to estimate a risk or prevalence ratio (or difference), rather than presenting an odds ratio.

Statewide Policy to Increase Provision of Take-Home Naloxone at Emergency Department Visits for Opioid Overdose, Rhode Island, 2018‒2019.

In 2017, Rhode Island responded to rising overdose deaths by establishing statewide emergency department (ED) treatment standards for opioid overdose and opioid use disorder. One requirement of the policy is that providers prescribe or provide take-home naloxone to anyone presenting to EDs with opioid overdose. Among adults presenting to EDs with opioid overdose from 2018 to 2019, approximately half received take-home naloxone.

Spurious early ecological association suggesting BCG vaccination effectiveness for COVID-19.

Background: Several ecologic studies have suggested that the bacillus Calmette-Guérin (BCG) vaccine may be protective against SARS-CoV-2 infection including a highly-cited published pre-print by Miller et al., finding that middle/high- and high-income countries that never had a universal BCG policy experienced higher COVID-19 burden compared to countries that currently have universal BCG vaccination policies. We provide a case study of the limitations of ecologic analyses by evaluating whether these early ecologic findings persisted as the pandemic progressed.

Validity of Self-Report for Ascertaining HIV Status Among Circular Migrants and Permanent Residents in South Africa: A Cross-Sectional, Population-Based Analysis.

While expanded HIV testing is needed in South Africa, increasing accurate self-report of HIV status is an essential parallel goal in this highly mobile population. If self-report can ascertain true HIV-positive status, persons with HIV (PWH) could be linked to life-saving care without the existing delays required by producing medical records or undergoing confirmatory testing, which are especially burdensome for the country's high prevalence of circular migrants. We used Wave 1 data from The Migration and Health Follow-Up Study, a representative adult cohort, including circular migrants and permanent residents, randomly sampled from the Agincourt Health and Demographic Surveillance System in a rural area of Mpumalanga Province.

The Macroeconomic Consequences Of Firearm-Related Fatalities In OECD Countries, 2018-30: A Value-Of-Lost-Output Analysis.

We modeled gross domestic product (GDP) losses attributable to firearm-related fatalities in each of thirty-six Organization for Economic Cooperation and Development (OECD) countries using the value-of-lost-output approach from 2018 to 2030. There are three categories of firearm-related fatalities: physical violence, self-harm, and unintentional injury. We project that the thirty-six OECD countries will lose $239.

'We are all serving the same Ugandans': A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda.

Introduction: Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda.

Methods: A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals.

Implementation of an international standardized set of outcome indicators in pregnancy and childbirth in Kenya: Utilizing mobile technology to collect patient-reported outcomes.

Background: Limited data exist on health outcomes during pregnancy and childbirth in low- and middle-income countries. This is a pilot of an innovative data collection tool using mobile technology to collect patient-reported outcome measures (PROMs) selected from the International Consortium of Health Outcomes Measurement (ICHOM) Pregnancy and Childbirth Standard Set in Nairobi, Kenya.

Methods: Pregnant women in the third trimester were recruited at three primary care facilities in Nairobi and followed prospectively throughout delivery and until six weeks postpartum.

The global surgery blood drought: frontline provider data on barriers and solutions in Bihar, India.

Background: Limited access to safe, timely banked blood is a critical barrier to providing basic surgical care in resource-limited settings globally. Contextual, locally driven data are required to elucidate country needs, develop effective interventions, and guide policy decisions.

Objective: We employ qualitative methodology to describe barriers faced and solutions proposed by front-line obstetric providers in Bihar - a poor, populous Indian state where maternal mortality exceeds the national average.

Latent class analysis of the social determinants of health-seeking behaviour for delivery among pregnant women in Malawi.

Introduction: In the era of Sustainable Development Goals, reducing maternal and neonatal mortality is a priority. With one of the highest maternal mortality ratios in the world, Malawi has a significant opportunity for improvement. One effort to improve maternal outcomes involves increasing access to high-quality health facilities for delivery.

Long-Term Functional Upper-Extremity Outcomes in Adults with Apert Syndrome.

Background: The goal of this study was to determine upper-extremity function and health-related quality of life in a cohort of adults with Apert syndrome.

Methods: Twenty-two adults with Apert syndrome completed the Disabilities of the Arm, Shoulder, and Hand survey; the 36-Item Short-Form Health Survey; and a semistructured interview. One surgeon administered the Jebsen Hand Function Test and measured sensation, joint motion, and strength.

Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis.

Introduction: Commission on Global Surgery proposed the perioperative mortality rate (POMR) as one of the six key indicators of the strength of a country's surgical system. Despite its widespread use in high-income settings, few studies have described procedure-specific POMR across low-income and middle-income countries (LMICs). We aimed to estimate POMR across a wide range of surgical procedures in LMICs.

You pray to your God: A qualitative analysis of challenges in the provision of safe, timely, and affordable surgical care in Uganda.

Background: Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception.

Evaluation of Andrews' Analysis as a Predictor of Ideal Sagittal Maxillary Positioning in Orthognathic Surgery.

Purpose: There is no universally accepted method for determining the ideal sagittal position of the maxilla in orthognathic surgery. In "Element II" of "The Six Elements of Orofacial Harmony," Andrews used the forehead to define the goal maxillary position. The purpose of this study was to compare how well this analysis correlated with postoperative findings in patients who underwent bimaxillary orthognathic surgery planned using other guidelines.

Provision of surgical care in Ethiopia: Challenges and solutions.

Unlabelled: With the lowest measured rate of surgery in the world, Ethiopia is faced with a number of challenges in providing surgical care. The aim of this study was to elucidate challenges in providing safe surgical care in Ethiopia, and solutions providers have created to overcome them. Semi-structured interviews were conducted with 10 practicing surgeons in Ethiopia.

Fingertip Injuries in Children: Epidemiology, Financial Burden, and Implications for Prevention.

Background: Although fingertip injuries are common, there is limited literature on the epidemiology and hospital charges for fingertip injuries in children. This descriptive study reports the clinical features of and hospital charges for fingertip injuries in a large pediatric population treated at a tertiary medical center.

Methods: Our hospital database was queried using International Classification of Diseases, Revision 9 (ICD-9) codes, and medical records were reviewed.

The How Project: understanding contextual challenges to global surgical care provision in low-resource settings.

Introduction: 5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges-the specific circumstances-faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges.

Methods: From January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries.

Physician Courtesy and Patient Satisfaction in a Pediatric Plastic and Oral Surgery Department.

Hospitals in the United States have started collecting information related to the patient experience with the objective of improving overall patient satisfaction. Between 2012 and 2015, the authors collected data from 2,875 patient satisfaction surveys. The purpose of this study was to analyze the effects of several variables-wait time, physician courtesy, administrative staff courtesy, patients' opportunity to ask questions, and patients' understanding of the answers-on a patient satisfaction score.

Focusing Quality Improvement Initiatives in Pediatric Plastic Surgery: A Descriptive Study Using the Pediatric National Surgical Quality Improvement Program.

Background: The American College of Surgeons National Surgical Quality Improvement Program - Pediatrics uses a risk-adjusted, case-mix-adjusted methodology to compare quality of hospital-level surgical performance. This paper aims to focus quality improvement efforts on diagnoses that have large patient volume and high morbidity for pediatric plastic surgery.

Methods: Frequency statistics were generated for a cohort of patients under age 18 who underwent plastic surgery procedures at participating National Surgical Quality Improvement Program - Pediatrics hospitals from January 1, 2011 to December 31, 2012.