The Importance of Thinking Multivariately When Setting Subscale Cutoff Scores

Setting cutoff scores is one of the most common practices when using scales to aid in classification purposes. This process is usually done univariately where each optimal cutoff value is decided sequentially, subscale by subscale. While it is widely known that this process necessarily reduces the probability of “passing” such a test, what is not properly recognized is that such a test loses power to meaningfully discriminate between target groups with each new subscale that is introduced. We quantify and describe this property via an analytical exposition highlighting the counterintuitive geometry implied by marginal threshold-setting in multiple dimensions. Recommendations are presented that encourage applied researchers to think jointly, rather than marginally, when setting cutoff scores to ensure an informative test.     

Higher socioeconomic status is related to healthier levels of fatness and fitness already at 3 to 5 years of age: The PREFIT project

This study aimed to analyse the association between socioeconomic status (SES) and fatness and fitness in preschoolers. 2,638 preschoolers (3–5 years old; 47.2% girls) participated. SES was estimated from the parental educational and occupational levels, and the marital status. Fatness was assessed by body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Physical fitness components were assessed using the PREFIT battery. Preschoolers whose parents had higher educational levels had lower fatness (P < 0.05). BMI significantly differed across occupational levels of each parent (P < 0.05) and WHtR across paternal levels (P = 0.004). Musculoskeletal fitness was different across any SES factor (P < 0.05), except handgrip across paternal occupational levels (P ≥ 0.05). Preschoolers with high paternal occupation had higher speed/agility (P = 0.005), and those with high or low maternal education had higher VO₂max (P = 0.046). Odds of being obese and having low musculoskeletal fitness was lower as SES was higher (P < 0.05). Those with married parents had higher cardiorespiratory fitness than single-parent ones (P = 0.010). School-based interventions should be aware of that children with low SES are at a higher risk of obesity and low fitness already in the first years of life.     

Environmental correlates of total and domain-specific sedentary behaviour in young people. The UP&DOWN study

This study investigated the associations between the characteristics of the nearby physical environment with the total and domain-specific leisure-time sedentary behaviour (SB) in young people. The study included 1578 youth (9–18 years) from the UP&DOWN study. Total leisure-time SB was objectively-assessed by accelerometers. Participants self-reported the time spent during leisure-time in different domains of SB (i.e. screen-based, educational-based, social-based, and other-based SB). Information regarding the basic characteristics of the house, the perceived neighbourhood environment, the amount of physical activity facilities, equipment and materials attainable at home, and the media equipment available at home and in the own bedroom was collected. Linear mixed models were performed, including school and city as random effects. The availability of yard was related to lower total SB and time spent surfing the Internet in boys, but not in girls. More favourable perceived neighbourhood environment was associated with lower total SB and time spent playing video games in girls, but not in boys. The amount of physical activity materials at home was negatively associated with screen-based SB, while the availability of a computer in the own bedroom was positively related to the time spent surfing the Internet in boys and girls. The number of televisions at home and having a computer in the own bedroom was associated with lower time in educational-based SB in boys and girls, respectively. Increasing the number of PA materials at home and decreasing the number of TVs at home and the availability of a computer in the bedroom could improve SB profiles of youth.     

Social correlates of sedentary behavior in young people:The UP&DOWN study

Purpose:The aim of the present study was to analyze the associations of youths' sedentary behavior(SB) with parents' and siblings' SB and physical activity(PA),as well as the associations of youths' coparticipation with parents,siblings,and friends in PA and SB with youths' SB.Methods:The sample consisted of 1543 youths(12.02±2.51 years;788 boys) enrolled in the baseline cohort of the UP&DOWN study.SB was assessed by accelerometry and questionnaire.Participants reported the time spent by their parents and siblings watching television,playing videogames,surfing the Internet,sitting/resting,and doing PA.Further,participants reported coparticipation with parents,siblings,and friends in these activities.Linear mixed models,including school and city as random effects,were performed.Results:Parents' television time was positively associated with youths' screen-based SB.Coparticipation with friends in playing videogames(in boys) and in surfing the Internet(in girls) showed a positive association with screen-based SB and a negative association with educational-based SB.Moreover,coparticipation with siblings and friends in PA was inversely associated with accelerometer-based SB in boys and girls.Conclusion:Our results emphasize the important role of social modeling in the development of sedentary lifestyles in youths.Interventions aimed at reducing health risk behaviors in youths could be more effective if they are oriented from a social perspective that involves their families and networks of their closest friends.     

Associations of total sedentary time,screen time and non-screen sedentary time with adiposity and physical fitness in youth: the mediating effect of physical activity

The aims of the present study were: i) to examine the associations of total accelerometer-based sedentary time (ST) and specific-domain self-reported ST (i.e., screen-based, educational-based, social-based, and other-based ST) with adiposity and physical fitness in youth; and ii) to analyse the mediation effect of physical activity (PA) on associations.

This study was conducted with 415 children (9.1 ± 0.4 years) and 853 adolescents (13.6 ± 1.6 years) in Spain during 2011–2012. Total ST and PA were assessed by accelerometry. Leisure-time spent in twelve sedentary behaviours was self-reported. Adiposity and physical fitness was measured following the ALPHA battery for youth.

Total accelerometer-based ST was positively associated with global adiposity score in children, and negatively associated with global physical fitness score in children and adolescents; but relationships were not independent of PA. PA mediated all associations of accelerometer-based and self-reported ST with adiposity or physical fitness in children. Conversely, screen-, educational-, social-, and other-based ST were negatively related to physical fitness in adolescents, independently of PA.

These findings give an impetus to developing effective strategies for specifically promoting PA in children and for increasing PA while reducing ST in adolescents in order to produce improvements on adiposity and physical fitness.     

Price-effectiveness: pharmacoeconomics,value and the right price for HPV vaccines

ABSTRACT

Drawing on a pragmatist approach to pricing, this article discusses the impact of cost-effectiveness analysis (CEA) in the pricing strategies of pharmaceutical companies. Through an analysis of the human papillomavirus (HPV) vaccination, this article illustrates the strategic appropriation of evidence-based medicine (narratives and practices) that pharmaceutical companies have undertaken to enhance the value of their products. While governments are concentrated on the measurement of costs and efficiency (cost-effectiveness), companies attempt to find the threshold of effectiveness that supports their estimation of value. I have called such mode of calculation, price-effectiveness. Pharmaceutical companies engage in different ways with CEA in devising their own price strategies. First, CEA is used as an instrument to raise HPV vaccines as a matter of interest for health authorities. Second, companies produce models to maximise the effectiveness of their products. Third, the expense side of CEA has opened an opportunity to represent some conditions as diseases in order to increase the potential value of the vaccine, expressed in a higher price. Debates and practices of pricing offer a unique opportunity to trace how particular forms of quantification have become the common ground in the demonstration of value in healthcare and the adaptation of companies.     

Activity-related typologies and longitudinal change in physical activity and sedentary time in children and adolescents: The UP&DOWN Study

Background: Children and adolescents can be distinguished by different typologies (clusters) of physical activity and sedentary behavior. How physical activity ...     

Engaging rational discrimination: exploring reasons for placing regulatory constraints on decision support systems

In the future systems of ambient intelligence will include decision support systems that will automate the process of discrimination among people that seek entry into environments and to engage in search of the opportunities that are available there. This article argues that these systems must be subject to active and continuous assessment and regulation because of the ways in which they are likely to contribute to economic and social inequality. This regulatory constraint must involve limitations on the collection and use of information about individuals and groups. The article explores a variety of rationales or justifications for establishing these limits. It emphasizes the unintended consequences that flow from the use of these systems as the most compelling rationale.