Handling missing data in a composite outcome with partially observed components: simulation study based on clustered paediatric routine data

Composite scores are useful in providing insights and trends about complex and multidimensional quality of care processes. However, missing data in subcomponents may hinder the overall reliability of a composite measure. In this study, strategies for handling missing data in Paediatric Admission Quality of Care (PAQC) score, an ordinal composite outcome, were explored through a simulation study. Specifically, the implications of the conventional method employed in addressing missing PAQC score subcomponents, consisting of scoring missing PAQC score components with a zero, and a multiple imputation (MI)-based strategy, were assessed. The latent normal joint modelling MI approach was used for the latter. Across simulation scenarios, MI of missing PAQC score elements at item level produced minimally biased estimates compared to the conventional method. Moreover, regression coefficients were more prone to bias compared to standards errors. Magnitude of bias was dependent on the proportion of missingness and the missing data generating mechanism. Therefore, incomplete composite outcome subcomponents should be handled carefully to alleviate potential for biased estimates and misleading inferences. Further research on other strategies of imputing at the component and composite outcome level and imputing compatibly with the substantive model in this setting, is needed.KEYWORDS: Composite outcome, multiple imputation, paediatrics, PAQC score, pneumonia     

On the Relationship Between Carcinogenicity and Acute Toxicity

Parodi et al. ⁽¹⁾ and Zeise et al. ⁽²⁾ found a surprising statistical correlation (or association) between acute toxicity and carcinogenic potency. In order to shed light on the questions of whether or not it is a causal correlation, and whether or not it is a statistical or tautological artifact, we have compared the correlations for the NCI/NTP data set with those for chemicals not in this set. Carcinogenic potencies were taken from the Gold et al. database. We find a weak correlation with an average value of TD₅₀/LD₅₀= 0.04 for the non-NCI data set, compared with TD₅₀/LD₅₀= 0.15 for the NCI data set. We conclude that it is not easy to distinguish types of carcinogens on the basis of whether or not they are acutely toxic.     

Emergency contraception: the politics of post-coital contraception

The literature and events related to the politicization of emergency contraceptive pills (ECPs) in the United States is reviewed. The basis of opposition to the regimen, rooted in the mode of action of ECPs, the confusion with mifepristone, and the challenges this presents for ECP advocates is also discussed. Legislative actions that impact the availability of ECPs are described, as well as efforts to increase access and availability through innovative programs, legislation, and changes in medical practice. Recommendations for future research, service delivery, and public policy are also presented .     

Management of medically fragile infants and children

Medically fragile infants and children present a host of challenges. The neonatal intensive care unit (NICU) is initially the mainstay of care for these infants, but it does not meet the critical developmental interactive needs of the child and parents to ensure positive psychosocial bonding. The care of these infants is further complicated by high daily costs (ranging from $1,000 to $2,500 per neonatal intensive care bed day) and lengthy, expensive inpatient stays (typically ranging from one week to five months or more). FHP Utah, a managed care organization, met these challenges through an innovative case management-oriented home care program called "Welcome Home." The program has produced a major impact on the quality and the cost of care for medically fragile infants. This article summarizes the first year's experience in implementing and operating the program.     

Different ways of knowing a child and their relations to mother‐reported autonomy support

We considered how different forms of child knowledge (i.e., mothers’ reports of taking their child's perspective, their accurate knowledge in the form of precise predictions of their child's ratings regarding distress/comforting and compliance/discipline situations, and their perceived knowledge) are differentially associated with mother‐reported autonomy support (i.e., providing meaningful rationales, providing choice, and acknowledging feelings; Koestner, Ryan, Bernieri, & Holt, 1984 ). Mothers and their children (141 dyads, M = 11 years old at Time 1) participated in a two‐wave longitudinal study with assessments made two years apart. The only form of knowledge that predicted changes in autonomy support was perspective‐taking. Autonomy support, in turn, indirectly predicted changes in distress/comforting accuracy through child‐reported self‐disclosure and directly predicted changes in perceived knowledge. These findings underline the importance of differentiating among forms of child knowledge in the study of socialization processes.