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BACKGROUND: Psychological distress (PD) is a major risk factor for mental health among middle-aged and older adults and affects their quality of life and well-being. This study aimed to examine the evolution of PD with age and the relative importance of its determinants, issues that have been insufficiently studied. METHODS: We used longitudinal data obtained from 17-wave social surveys conducted in Japan from 2005 to 2021, to track 34,128 individuals (16,555 men and 17,573 women) born between 1946 and 1955. We defined PD as a Kessler 6 score (range: 0-24) ≥ 5 and estimated fixed-effects regression models to examine the evolution of its proportion with age. We also conducted a mediation analysis to examine the relative importance of specific mediators such as self-rated health (SRH), activities of daily living (ADL), and social participation, in the association between age and PD. RESULTS: Regression model results confirmed an increase in PD with age. Poor SRH, issues with ADL, and no social participation were key mediators of aging on PD, accounting for 34.2% (95% confidence interval [CI]: 21.0-47.3%), 13.7% (95% CI: 8.2-19.3%), and 10.5% (95% CI: 8.0-13.0%), respectively; consequently increasing PD between 50 and 75 years. CONCLUSION: The results suggest the need for policy support to encourage middle-aged and older adults to promote health and increase social participation in order to prevent depression while aging.

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This study evaluates the impact of results-based financing (RBF) on maternal health outcomes and the inequality of opportunity (IOP) in these outcomes in Zimbabwe. We employ a difference-in-differences approach that leverages the staggered implementation of the programme across 60 districts, exploiting temporal variation in the introduction of RBF and individual-level variation in birth timing. Our analysis uses nationally representative, pooled cross-sectional data from the 2005/2006, 2010/2011, and 2015 Zimbabwe demographic and health surveys. Employing the extended two-way fixed effects (ETWFE) estimator to address biases associated with staggered rollouts, we find significant positive effects of RBF on maternal health outcomes. The programme is associated with an increase in the number of prenatal care visits by 0.185 units (p < 0.01), first-trimester care by 7.7 percentage points (pp) (p < 0.01), facility births by 8.6 pp (p < 0.01), and professional delivery assistance by 3.4 pp (p < 0.01), while reducing C-section rates by 1.3 pp (p < 0.01). Additionally, RBF is associated with reductions in IOP in prenatal care visits, early prenatal care, facility births, and professional delivery assistance by 3.8, 1.3, 8.4, and 4.9 pp (p < 0.01), respectively. These findings underscore the potential of RBF to enhance maternal health outcomes and promote health equity. Integrating equity considerations into health system strengthening initiatives is essential. Policymakers should ensure that health interventions improve access and balance opportunities across various socio-economic and demographic groups. This evidence suggests that RBF schemes can improve access to and equity in healthcare services, particularly in low-income settings such as Zimbabwe.

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RATIONALE: Despite the existing literature connecting depressive symptoms with cognitive function in adulthood, there is limited knowledge about the longitudinal association between depressive symptoms in adolescence and memory function in adulthood, as well as the mechanisms underlying this relationship. OBJECTIVES: This study aims to determine whether depressive symptoms in adolescence are associated with memory function in young adulthood. To explore the underlying mechanisms of this association, it employs a life course approach, testing the critical period, accumulation, and pathway models. METHODS: Utilizing data from the sibling sample of the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study employed sibling fixed effects models to control for unobserved heterogeneity at the family level. To test various life course models, the analysis incorporated adult depressive symptoms, as well as an array of behavioral, psychosocial, and educational mechanism variables. RESULTS: Sibling fixed effects estimates indicated a longitudinal association between depressive symptoms in adolescence and memory function in young adulthood (b = -0.084, p < 0.01). Depressive symptoms in adulthood neither explained nor intensified this association. Mediation analysis revealed that educational attainment modestly accounted for about 11% of the relationship between adolescent depressive symptoms and adult memory function. Combined, these findings lend support to the life course approach, with a specific focus on the critical period model. CONCLUSIONS: This study's findings suggest that depressive symptoms in adolescence are an independent risk factor for memory function in adulthood. The empirical support for the critical period model underscores the importance of implementing early intervention programs and targeted strategies to support adolescents experiencing depressive symptoms.

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Despite the growing evidence on the influence of neighborhood safety on physical activity, few studies have specifically focused on preschool-aged children and differentiated the various domains of neighborhood safety. This study investigates the relationship between parental perceptions of neighborhood safety and preschool children's time spent outdoors and explores potential sex differences in this relationship. This study analyzed nationally representative data from 1656 Korean children (848 boys and 808 girls) aged 3, 5, 6 years collected over the course of three waves of the Panel Study on Korean Children (PSKC). Outdoor playtime was measured by maternal reports of the time their children spent playing outdoors on a typical weekday. Parental perceptions of neighborhood safety were assessed using two items that inquired about neighborhood safety in terms of crime and accidents, respectively. Fixed effects estimates revealed that parental perceptions of social safety were associated with an increase in children's outdoor physical activity (b = 3.778, p < 0.05), whereas perceptions of physical safety were not. Sex-stratified models showed that the association between parental perceptions of social safety and children's outdoor play was driven largely by boys (b = 8.498, p < 0.001), with no association observed for girls. The findings of this study underscore the importance of addressing the social safety of neighborhood environments to promote outdoor play in preschool children. Moreover, sex differences should be considered when developing interventions aimed at increasing physical activity among young children.

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BACKGROUND: Ensuring that the scale and hierarchical structure of health human resources are rational, and that medical services are efficient and fair, is an important task of practical significance. On this basis, examining the impact of health human resources on the level of medical services presents a new and formidable challenge. This study aims to delve into how the scale and hierarchical structure of health human resources in China's four major economic regions affect the fairness and efficiency of medical services, and to identify optimization strategies. METHODS: This study utilizes provincial panel data from China's four major economic regions spanning the years 2009 to 2021. Initially, it provides a statistical description of the current state of health human resources and the level of medical services. Subsequently, it employs a fixed-effects model to analyze the impact of the scale and hierarchical structure of health human resources, as well as their interactive effects, on the fairness and efficiency of medical services, and discusses the interactive mechanisms between medical service fairness and medical service efficiency. Furthermore, after conducting a comprehensive evaluation of the level of medical services using the entropy weight method, it explores the regional heterogeneity and temporal dynamics in the influence of the scale and hierarchical structure of health human resources on the level of medical services. Finally, the study examines the scientific validity and rationality of the research findings through various robustness checks, including the substitution of research variables and models. RESULTS: The study found that the scale of health human resources has a promoting effect on the equity of medical services (ß ≤ 0.643, p ≤ 0.01), but exhibits an inhibitory effect on the efficiency of medical services (ß ≥ -0.079, p ≤ 0.1); the hierarchical structure of health human resources shows a positive impact on both the equity and efficiency of medical services (ßequity ≤ 0.160, p ≤ 0.01; ßefficiency ≤ 0.341, p ≤ 0.05); at the same time, the results indicate that the interactive effect of the scale and hierarchical structure of health human resources promotes equity in medical services (ß = 0.067, p ≤ 0.01), but restricts the efficiency of medical services (ß ≥ -0.039, p ≤ 0.01); the mechanism by which health human resources affect the level of medical services in China's western and northeastern regions is more pronounced than in the central and eastern regions; after the implementation of the "Healthy China 2030" Planning Outline, the role of health human resources in the level of medical services has been strengthened; in the robustness tests, the model remains robust after replacing the core explanatory variables, with R2 maintained between 0.869 and 0.972, and the dynamic GMM model test shows a significant second-order lag in the level of medical services (ßequity ≤ 0.149, p ≤ 0.01; ßefficiency ≤ 0.461, p ≤ 0.01); the channel test results prove that managerial personnel and other technical personnel are key pathways in regulating the impact of medical staff on the level of medical services. CONCLUSION: This study provides an in-depth analysis of the impact of health human resources on the level of medical services, revealing that both the scale and hierarchical structure of health human resources significantly affect the equity and efficiency of medical services. Furthermore, the influence of health human resources on the level of medical services exhibits regional heterogeneity and temporal characteristics. Robustness tests ensure the scientific validity and robustness of the research conclusions. This provides effective references for optimizing the allocation of health human resources and improving the level of medical services.

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There has been growing research interest in developing methodology to evaluate the health care providers' performance with respect to a patient outcome. Random and fixed effects models are traditionally used for such a purpose. We propose a new method, using a fusion penalty to cluster health care providers based on quasi-likelihood. Without any priori knowledge of grouping information, our method provides a desirable data-driven approach for automatically clustering health care providers into different groups based on their performance. Further, the quasi-likelihood is more flexible and robust than the regular likelihood in that no distributional assumption is needed. An efficient alternating direction method of multipliers algorithm is developed to implement the proposed method. We show that the proposed method enjoys the oracle properties; namely, it performs as well as if the true group structure were known in advance. The consistency and asymptotic normality of the estimators are established. Simulation studies and analysis of the national kidney transplant registry data demonstrate the utility and validity of our method.

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Despite the negative externalities on the environment and human health, today's economies still produce excessive carbon dioxide emissions. As a result, governments are trying to shift production and consumption to more sustainable models that reduce the environmental impact of carbon dioxide emissions. The European Union, in particular, has implemented an innovative policy to reduce carbon dioxide emissions by creating a market for emission rights, the emissions trading system. The objective of this paper is to perform a counterfactual analysis to measure the impact of the emissions trading system on the reduction of carbon dioxide emissions. For this purpose, a recently-developed statistical machine learning method called matrix completion with fixed effects estimation is used and compared to traditional econometric techniques. We apply matrix completion with fixed effects estimation to the prediction of missing counterfactual entries of a carbon dioxide emissions matrix whose elements (indexed row-wise by country and column-wise by year) represent emissions without the emissions trading system for country-year pairs. The results obtained, confirmed by robust diagnostic tests, show a significant effect of the emissions trading system on the reduction of carbon dioxide emissions: the majority of European Union countries included in our analysis reduced their total carbon dioxide emissions (associated with selected industries) by about 15.4% during the emissions trading system treatment period 2005-2020, compared to the total carbon dioxide emissions (associated with the same industries) that would have been achieved in the absence of the emissions trading system policy. Finally, several managerial/practical implications of the study are discussed, together with its possible extensions.

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Meta-analysis is a statistical method for combining quantitative results across studies. A fundamental decision in undertaking a meta-analysis is choosing an appropriate model for analysis. This is the second of two companion articles which have the joint aim of describing the different meta-analysis models. In the first article, we focused on the common-effect (also known as fixed-effect [singular]) model, and in this article, we focus on the random-effects model. We describe the key assumptions underlying the random-effects model, how it is related to the common-effect and fixed-effects [plural] models, and present some of the arguments for selecting one model over another. We outline some of the methods for fitting a random-effects model. Finally, we present an illustrative example to demonstrate how the results can differ depending on the chosen model and method. Understanding the assumptions of the different meta-analysis models, and the questions they address, is critical for meta-analysis model selection and interpretation.

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Meta-analysis (MA) is a fundamental statistical tool for combining the results of different studies to obtain potentially high-level evidence that can be implemented in clinical practice. Although its use in clinical research is increasing, MAs are still relatively rare in hand surgery. Therefore, it should be important for every hand surgeon to not only know how to interpret a MA, but also how to perform one. The purpose of this first of a two-part article is to introduce the principles of MA and describe the main models and methods used to pool effect estimates.

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This debate article discusses the use of fixed effects models for causal analysis, with reference to an article recently published in Scandinavian Journal of Public Health.

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The results-based financing (RBF) program, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilisation of health services. This study leverages the staggered rollout of the program as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilising pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section, and family planning. Specifically, the RBF program is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, p < 0.01), first-trimester prenatal care (-0.033, p < 0.01), delivery by caesarean section (-0.028, p < 0.005), and family planning (-0.033, p < 0.005). Additionally, the program is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, p < 0.01). These effects are more pronounced among lower socioeconomic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritising expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

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This paper studies the interrelation between birth order and emigration adopting a family fixed-effects approach. We use register data on all persons in full-siblings groups born 1970-2002 in the entire Finnish-born population, and observe their first move abroad since age 18 in the period 1987-2020. The total number of siblings is 1,352,908, the total number of sibling groups 549,842, and the total number of first moves abroad 31,192. By comparing siblings in the same family, we effectively adjust for all time-invariant confounding from unobserved or unmeasured time-invariant variables. Emigration is found to be positively associated with birth order. The hazard of emigration for second-born siblings is 1.05 that of first borns, that of third borns 1.07, and that of fourth borns 1.11. The pattern is particularly marked for emigration to countries where there is free mobility, and the association is similar for both genders. Potential explanations to the birth order pattern may be variation in personality traits, risk-taking behaviours and aspirations between siblings, or differential allocation of resources and opportunities within families. The results highlight the importance of considering birth order within the context of family dynamics and individual mobility patterns, and they need to be extended to broader settings.

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The pollutant emissions of diesel-powered heavy-duty trucks (HDTs) seriously damage the air quality. The promotion of hydrogen fuel cell HDTs through purchase subsidy policy to reduce emissions has become an important approach to control air pollution. This study focuses on the impact of hydrogen fuel cell HDT purchase subsidies on air quality in the context of China, covering the panel data of 31 Chinese cities from 2014 to 2021 and applying a two-way fixed effects model to analyze the contribution of purchase subsidies and hydrogen refueling station construction subsidies to air quality. Results show that (1) the increase in purchase subsidies could improve the air quality by around 6.1% and there is a lag effect. (2) Purchase subsidies make a larger contribution to air quality compared with construction subsidies. (3) Purchase subsidies can improve air quality by reducing carbon emissions in transport industry. In sight of these results, policy makers should emphasize the implementation of purchase subsidies and hydrogen refueling station construction subsidies and stimulate manufacturers to improve the performance of hydrogen fuel cell so as to contribute more to the environment.

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This study investigates gender gaps in digital skills among youth (15-24 years old) in 32 low- and middle-income economies using data from UNICEF-supported and internationally comparable Multiple Indicator Cluster Surveys (MICS). Utilizing a household fixed effects approach, we aim to isolate gender-based disparities from household-level variations. The intra-household analysis reveals significant inequalities, with biases against young women in possessing digital skills, including the very basic ones. Supplementary analysis using a mixed-effects model, which accounts separately for within- and between-household variation, highlights that wealthier households exhibit larger gender gaps in digital skills, disadvantaging young women primarily due to a floor effect in the poorest households. The paper concludes with policy implications aimed at reducing gender gaps in digital skills.

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BACKGROUND: Viral hepatitis imposes a heavy disease burden worldwide and is also one of the most serious public health problems in China. We aimed to describe the epidemiological characteristics of hepatitis in China and to investigate the influencing factors. METHODS: We first used the JoinPoint model to analyze the percentage change (APC) and average annual percentage change (AAPC) of hepatitis in Chinese provinces from 2002 to 2021. We then explored the influencing factors by using the time-series global principal component analysis (GPCA) and the panel fixed-effects model. RESULTS: The disease burden varied across different provinces from 2002 to 2021. The AAPC of the total HAV incidence decreased by 10.39% (95% CI: [-12.70%, -8.02%]) from 2002 to 2021. Yet the AAPC of HBV, HCV, and HEV increased by 1.50% (95% CI: [0.23%, 2.79%]), 13.99% (95% CI: [11.28%, 16.77%]), and 7.10% (95% CI: [0.90%, 13.69%]), respectively. The hotspots of HAV, HBV, HCV, and HEV moved from the west to the center, from the northwest to the southeast, from the northeast to the whole country, and from the northeast to the southeast, respectively. Different types of viral hepatitis infections were associated with hygiene, pollutant, and meteorological factors. Their roles in spatial-temporal incidence were expressed by panel regression functions. CONCLUSIONS: Viral hepatitis infection in China showed spatiotemporal heterogeneity. Interventions should be tailored to its epidemiological characteristics and determinants of viral hepatitis.

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Although a large body of research has documented the negative effects of insecure employment for adult workers, less is known about the consequences for their children's well-being. Our understanding of the mechanisms through which insecure maternal employment may affect children is particularly limited. This study examines the relationship between insecure maternal employment and child behaviour difficulties from the age of 4-16 using seven waves of data for nearly 5000 families from Growing Up in Australia: The Longitudinal Study of Australian Children. Employing fixed effects models to account for unobserved time-invariant heterogeneity, we found that children whose mothers were casual contract employees or economically inactive had greater behaviour difficulties, on average, than their peers whose mothers were permanent employees. Maternal mental health and parenting, rather than household financial strain, contributed to explaining the association between insecure maternal employment and child behaviour difficulties. These results were more pronounced for younger children (up to the age of 12). This study contributes to the literature on the consequences of maternal employment insecurity for child mental health in high-income countries by clarifying the mechanisms behind this association.

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Gene pathways and gene-regulatory networks are used to describe the causal relationship between genes, based on biological experiments. However, many genes are still to be studied to define novel pathways. To address this, a gene-clustering algorithm has been used to group correlated genes together, based on the similarity of their gene expression level. The existing methods cluster genes based on only one type of omics data, which ignores the information from other types. A large sample size is required to achieve an accurate clustering structure for thousands of genes, which can be challenging due to the cost of multi-omics data. Meta-analysis has been used to aggregate the data from multiple studies and improve the analysis results. We propose a computationally efficient meta-analytic gene-clustering algorithm that combines multi-omics datasets from multiple studies, using the fixed effects linear models and a modified weighted correlation network analysis framework. The simulation study shows that the proposed method outperforms existing single omic-based clustering approaches when multi-omics data and/or multiple studies are available. A real data example demonstrates that our meta-analytic method outperforms single-study based methods.

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Agriculture is a significant source of carbon emissions, which have a substantial environmental impact. The digital economy plays a vital role in mitigating these emissions through innovative digital solutions. As a leading agricultural nation, China faces substantial pressure to reduce its agricultural carbon emissions(ACE). This paper aims to thoroughly examine the relationship between the growth of the rural digital economy and ACE. To achieve this, we utilize an extensive panel dataset covering China's provinces from 2011 to 2020, analyzing the dynamic and spatial effects of digital economy development on ACE. The key findings of this research are as follows: (1) The rapid expansion of the digital economy significantly reduces ACE. (2) The impact of digital economic development on lowering ACE varies spatially, with a clear progression from eastern to western regions. (3) The digital economy helps reduce ACE through three specific channels: fostering technological innovation, enhancing scale efficiency management, and providing agricultural financial incentives. Based on these findings, this study proposes policy recommendations to improve digital infrastructure, promote balanced regional development in the digital economy, and optimize the management of agricultural science and technology. These policy insights aim to transform agriculture and achieve the goal of reducing ACE, thereby contributing to broader environmental sustainability.

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It is well-established that unstructured unsupervised socializing with peers (UUS) motivates deviance while in that specific context. In this article, we extend this situational view by arguing that repeated UUS may also gradually shape adolescents' norms and decision making beyond the situation. Specifically, we argue that UUS promotes short-term mindsets, i.e., an increased focus on present rewards at the expense of considering future consequences. We test this hypothesis with fixed-effects models, using longitudinal data from a representative sample of 1,675 adolescents from Zurich, Switzerland. Consistent with our preregistered predictions, more frequent UUS is associated with increased short-term mindsets. Thus, our finding suggests that the effects of UUS on later deviance might be driven by becoming more present-oriented. This link offers new insights into the developmental pathways toward adolescent delinquency and offers a potential target for intervention. Supplementary Information: The online version contains supplementary material available at 10.1007/s40865-024-00249-2.