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Using Multivariate Statistics

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Part I: AN INTRODUCTION TO INQUIRY. 1. Human Inquiry and Science. 2. Paradigms, Theory, and Research. 3. The Ethics and Politics of Social Research. Part II: THE STRUCTURING OF INQUIRY: QUANTITATIVE AND QUALITATIVE. 4. Research Design. 5. Conceptualization, Operationalization, and Measurement. 6. Indexes, Scales, and Typologies. 7. The Logic of Sampling. Part III: MODES OF OBSERVATION: QUANTITATIVE AND QUALITATIVE. 8. Experiments. 9. Survey Research. 10. Qualitative Field Research. 11. Unobtrusive Research. 12. Evaluation Research. Part IV: ANALYSIS OF DATA:QUANTITATIVE AND QUALITATIVE . 13. Qualitative Data Analysis. 14. Quantitative Data Analysis. 15. Reading and Writing Social Research. Appendix A. Using the Library. Appendix B. Random Numbers. Appendix C. Distribution of Chi Square. Appendix D. Normal Curve Areas. Appendix E. Estimated Sampling Error.

社会研究方法基础 = The Basics of Social Research

List of Figures List of Tables Foreword Introduction Robin P. Fawcett, M.A.K. Halliday, Sydney M. Lamb and Adam Makkai 1 Language as Code and Language as Behaviour: A Systemic-Functional Interpretation of the Nature and Ontogenesis of Dialogue M.A.K. Halliday 2 Metaphors of Information John Regan 3 How Universal is a Localist Hypothesis? A Linguistic Contribution to the Study of 'Semantic Styles' of Language Yoshihiko Ikegami 4 Some Speculations on Language Contact in a Wider Setting Jeffrey Ellis 5 Ways of Saying: Ways of Meaning Ruqaiya Hasan Index

Language as social semiotic

Public Health in Germany: a new “Golden Age”?

Few studies have assessed whether refugees health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on number of inhabitants, degree of housing deterioration and remoteness (distance to amenities) and assess the association with health in multivariate analyses. Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and general anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Our findings inform policymakers on layout and location of refugee collective accommodation centres.

Type of refugee accommodation and health of residents: cross-sectional cluster analysis in German federal state

TheWest is entangled in a seeming paradox: it abhors the war in Ukraine but continues to fund it by buying oil and gas from Russia (with Germany as the main Western buyer) and giving billions of dollars in weapon aid to Ukraine (with the United States as the main donor). Although “severe” sanctions have been imposed, they are yet to significantly affect Russia’s ability to continue the war. Presently, Russia’s lower sales volume is compensated by the soaring prices. The Russia-Ukraine war is “global” due to its adverse “cluster and scattered” effects (like the cluster bombs and “scatterable” munitions allegedly used by Russia in Ukraine). The sanctions adversely affect less well-off Westerners through increasing energy and food prices [1, 2] which some governments alleviate through tax reductions and other support measures. Unfortunately, the vulnerable populations of the Global South, with very little leverage to end the war, bear the greater brunt of the sanctions’ adverse effects. War has been described as a man-made public health problem [3]. Russia’s invasion of Ukraine is a typical example of a catastrophe in the globalized world. It is also an example of manufactured risk; sadly, risk-sharing is unavoidable. The sociologists Ulrich Beck and Anthony Giddens described the world as a risk society [4, 5]. Since the world is socio-spatially compressed, most high-level events will have global consequences. As Beck observed, unequal distribution of risk is a reality as risk often settles at the lower rung of society. Russia’s war in Ukraine is a global event with considerable adverse consequences impacting disproportionately on vulnerable populations, mostly in the Global South. The primary war victims comprise the deceased, injured and displaced in Ukraine and Russia. Many of the secondary victims or casualties are in the Global South, groaning about the concomitant war-related rise in food and energy costs, weakening the already fragile livelihood system and thus, upsurging the poverty and hunger counts. For instance, the warrelated inflation shock will push over one million more Nigerians into poverty [6]. Significant inflation and supply disruption mean that “the world’s poor could be forced to do without (food)” [7]. Worse still, there are limited or no social security benefits to protect the vulnerable populations in the Global South. For instance, only 18% of Africa’s population has adequate access to at least one form of social protection [8]. While there are apparent adverse effects on economic growth and poverty reduction, it is early to estimate the other multiplier effects on education, employment, crime, social unrest, social amenities and well-being, including morbidity, mortality and access to healthcare. Consequently, as the war lingers and the West imposes sanctions, we all feel the pain—not only or even mainly populations of the West [7]. For the Global South, the war is like a spanner thrown in the wheel of progress toward the Sustainable Development Goals. It is a massive global health concern. War is always a path of inhumanity. Although the greater responsibility rests on Russia to end the invasion, it takes all stakeholders, including NATO and the United States, to stop the war. Edited by: Olaf Von Dem Knesebeck, University Medical Center HamburgEppendorf, Germany

The War in Europe Viewed From the South: A Global Health Concern

Abstract Almost a third of all people who entered Germany to seek protection since 2010 were under the age of 18. Asylum-seeking and refugee (ASR) adolescents in Germany face reduced entitlements to healthcare and experience barriers in accessing mental healthcare, despite documented mental health needs. This mixed-methods study aims to describe the mental health needs and service use of ASR adolescents in Germany and identify the predictors of their help-seeking patterns. Here we report findings of cross-sectional data collected between February 2019 and November 2020 in schools and refugee accommodations in three German federal states. Our subsample consists of ASR between the ages of 11 and 18, coming from Syria, Afghanistan, and Iraq ( N = 216). Cross-sectional data are supplemented by semi-structured interviews with nine mental health professionals in one region of the study. Our findings reveal an underutilization of mental health services relative to the emotional difficulties reported. Perceived and experienced access barriers, age, and externalizing and internalizing symptoms predict different help-seeking patterns. Psychotherapy-related social resources, as well as reporting of emotional difficulties, are predictors of actual or intended psychotherapeutic service utilization. Based on our quantitative and qualitative findings, we highlight the need for widespread, accessible, and low-threshold mental health initiatives designed to work with ASR adolescents, for additional assistance in navigating the mental healthcare system, as well as for support to important people in ASR adolescents’ lives who fill the gap between mental health needs and accessible mental healthcare services. 

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Asylum seeking and refugee adolescents’ mental health service use and help-seeking patterns: a mixed-methods study

Angesichts der Masernausbruche wird fur Deutschland der Einsatz von Masernimpfkampagnen („supplementary immunization activities“ [SIAs]) diskutiert. Eine Evidenzbasis fur einen Einsatz in den Zielgruppen Deutschlands fehlt bislang. 1. Welche Informationen zur Durchfuhrung von SIAs sind verfugbar? 2. Lassen sich auf Basis der Informationen Trends erkennen, welche Merkmale von SIAs mit einer Inzidenzreduktion einhergehen? Anhand eines Scoping Reviews wurden Informationen zu Masern-SIAs recherchiert. „Least developed countries“ wurden ausgeschlossen. Erganzend wurden Inzidenzveranderungen zwischen den Jahren vor und nach der SIA in den betrachteten Landern und Jahren berechnet. Es wurden 82 SIAs aus 82 Landern (20 Artikel) eingeschlossen. Informationen zur Umsetzung beschranken sich meist auf die veroffentlichten Daten der WHO. In 90 % der niedriginzidenten Lander blieben die Masernneuerkrankungsraten nach SIAs niedrig. Die Neuerkrankungsraten der 27 mittelinzidenten Lander entwickelten sich unterschiedlich. In 5 Landern (19 %) stieg die Inzidenz, in 11 (41 %) blieb sie konstant und in 11 (41 %) sank sie. In 87 % der hochinzidenten Lander reduzierten sich die Inzidenzen. Die Dokumentation ist nicht ausreichend, um gesicherte Empfehlungen fur entsprechende Zielgruppen oder konkrete Umsetzungsstrategien in Deutschland zu geben. Trotz der unterschiedlichen Voraussetzungen in den Landern war der Einsatz von SIAs meist mit einem Ruckgang oder einer Stabilisierung der Inzidenzraten verbunden. In nur jedem zweiten Land sank die Inzidenz nach Durchfuhrung einer SIA. Es werden sechs Handlungsempfehlungen fur zukunftige SIA-Planungen gegeben.

Oliver Razum

Papers

Public Health in Germany: a new “Golden Age”?

Type of refugee accommodation and health of residents: cross-sectional cluster analysis in German federal state

The War in Europe Viewed From the South: A Global Health Concern

Asylum seeking and refugee adolescents’ mental health service use and help-seeking patterns: a mixed-methods study

Masernimpfkampagnen – internationale Erfahrungen