Objectives:This scoping review aims to methodically identify and analyse the determinants which influence maternal mortality and healthcare utilization in women of childbearing years in Nigeria.The review specifically...Objectives:This scoping review aims to methodically identify and analyse the determinants which influence maternal mortality and healthcare utilization in women of childbearing years in Nigeria.The review specifically addresses the difficulties faced in assessing medical care,and the ongoing initiatives to lower the maternal mortality ratio.Methods:Primary studies(published after year 2000)focused on maternal mortality,health determinants,and the utilization of maternal healthcare services in Nigeria were retrieved following a systematic search across multiple databases,including Scopus,PubMed,Google Scholar,and Web of Science.These were screened using defined inclusion and exclusion criteria.Data from these studies were extracted and thematically analysed to identify common themes and trends.Results:A total of 21 publications were included in this review comprising 2 qualitative,17 quantitative,and2 mixed study designs.Major health determinants identified in these studies include hypertensive disorders of pregnancy,haemorrhage,and sepsis/septicaemia,contributing as much as 29%,24%,and 14.2%of maternal deaths respectively in over 10%of the reviewed studies.Similarly,social-economic determinants including poverty,maternal education,health system issues and culture significantly impacted the utilization of maternal healthcare services,inadvertently impacting maternal mortality.Despite various maternal health interventions such as the"Abiye"Safe Motherhood Initiative,the Integrated Maternal,Newborn,and Child Health Strategy and strengthening emergency obstetric care by governmental and non-governmental agencies,early childbearing,unemployment,large family sizes,and dependence on male spouses continued to result in suboptimal utilization of services and adverse maternal outcomes.Conclusion:This scoping review comprehensively integrated existing data from published studies to provide a detailed picture of maternal mortality,its health determinants,and factors influencing care utilization among women of childbearing age in Nigeria and approaches to reduce maternal mortality in the country and possibly in the West African sub-region.展开更多
Background: Erectile dysfunction (ED) is a common, bothersome and relatively under diagnosed complication of diabetes mellitus. This study was aimed to determine the prevalence of erectile dysfunction and its determin...Background: Erectile dysfunction (ED) is a common, bothersome and relatively under diagnosed complication of diabetes mellitus. This study was aimed to determine the prevalence of erectile dysfunction and its determinants. Methods: A cross-sectional hospital-based study was carried out in the Diabetology Units of the Buea and Limbe Regional Hospitals involving 332 male patients with diabetes and aged over 21 years. Data was analyzed using Stata and R version 3.5.3. Results: The mean age of the participants was 55years. Most participants (64.46%) were married. About half (50.60%) of the participants actively consumed alcohol, 11.45% were smokers and 57.83% were sedentary. 18 participants (5.42%) recorded high risk sexual behaviour. 54.32% of participants had a comorbidity and 43.90% were overweight. The prevalence of diabetic ED was 78.92%. Age, Fasting Blood Sugar and Glycated hemoglobin were found to be positive determinants of diabetic ED (odds ratio (OR) = 0.77, 95% CI −0.1 - 0.07). Conclusion: The prevalence of diabetic ED in this hospital population study is high, and both physician and patient—initiated measures are needed to reduce this prevalence and improve awareness, recognition and care of this condition.展开更多
Objective Data on homocysteine(Hcy) status and its determinants are limited among women during pregnancy and postpartum. This cross-sectional study aimed to investigate Hcy levels during pregnancy and postpartum, and ...Objective Data on homocysteine(Hcy) status and its determinants are limited among women during pregnancy and postpartum. This cross-sectional study aimed to investigate Hcy levels during pregnancy and postpartum, and to explore the determinants like geographic factor.Methods This study was conducted in women at mid-pregnancy, late-pregnancy and postpartum from southern, central and northern China. Approximately 132 women were included in each stratum by the three phases and regions. Plasma Hcy concentrations were assessed using high-performance liquid chromatography(HPLC), with hyperhomocysteinemia defined as > 10.0 μmol/L. Quantile regression was to estimate medians and interquartile ranges(IQRs), and logistic regression to examine the determinants of hyperhomocysteinemia.Results For 1,190 women included, the median(IQR) Hcy concentration was 5.66(4.62, 7.37) μmol/L.The adjusted median in mid-pregnancy, late-pregnancy and postpartum women was 4.75(4.13, 5.54),5.72(4.81, 6.85) and 7.09(5.65, 8.75) μmol/L, respectively, showing an increasing trend(P < 0.001). This increasing trend persisted across the three regions. Higher Hcy concentrations were observed in women residing in northern region and those with younger age or lower economic status. A total of 106(8.9%)women had hyperhomocysteinemia, with a higher prevalence in those residing in northern region(16.0%), or in postpartum women(16.5%).Conclusion Hcy levels, varying with geographic region, maternal age and economic status, are increased from mid-pregnancy to late-pregnancy and postpartum, indicating a need to monitor Hcy levels in pregnant and postpartum women to control potential risks related to elevated Hcy levels.展开更多
BACKGROUND Patients with chronic obstructive pulmonary disease(COPD)frequently experience exacerbations requiring multiple hospitalizations over prolonged disease courses,which predispose them to generalized anxiety d...BACKGROUND Patients with chronic obstructive pulmonary disease(COPD)frequently experience exacerbations requiring multiple hospitalizations over prolonged disease courses,which predispose them to generalized anxiety disorder(GAD).This comorbidity exacerbates breathing difficulties,activity limitations,and social isolation.While previous studies predominantly employed the GAD 7-item scale for screening,this approach is somewhat subjective.The current literature on predictive models for GAD risk in patients with COPD is limited.AIM To construct and validate a GAD risk prediction model to aid healthcare professionals in preventing the onset of GAD.METHODS This retrospective analysis encompassed patients with COPD treated at our institution from July 2021 to February 2024.The patients were categorized into a modeling(MO)group and a validation(VA)group in a 7:3 ratio on the basis of the occurrence of GAD.Univariate and multivariate logistic regression analyses were utilized to construct the risk prediction model,which was visualized using forest plots.The model’s performance was evaluated using Hosmer-Lemeshow(H-L)goodness-of-fit test and receiver operating characteristic(ROC)curve analysis.RESULTS A total of 271 subjects were included,with 190 in the MO group and 81 in the VA group.GAD was identified in 67 patients with COPD,resulting in a prevalence rate of 24.72%(67/271),with 49 cases(18.08%)in the MO group and 18 cases(22.22%)in the VA group.Significant differences were observed between patients with and without GAD in terms of educational level,average household income,smoking history,smoking index,number of exacerbations in the past year,cardiovascular comorbidities,disease knowledge,and personality traits(P<0.05).Multivariate logistic regression analysis revealed that lower education levels,household income<3000 China yuan,smoking history,smoking index≥400 cigarettes/year,≥two exacerbations in the past year,cardiovascular comorbidities,complete lack of disease information,and introverted personality were significant risk factors for GAD in the MO group(P<0.05).ROC analysis indicated that the area under the curve for predicting GAD in the MO and VA groups was 0.978 and 0.960.The H-L test yieldedχ^(2) values of 6.511 and 5.179,with P=0.275 and 0.274.Calibration curves demonstrated good agreement between predicted and actual GAD occurrence risks.CONCLUSION The developed predictive model includes eight independent risk factors:Educational level,household income,smoking history,smoking index,number of exacerbations in the past year,presence of cardiovascular comorbidities,level of disease knowledge,and personality traits.This model effectively predicts the onset of GAD in patients with COPD,enabling early identification of high-risk individuals and providing a basis for early preventive interventions by nursing staff.展开更多
BACKGROUND The global prevalence of diabetes among adults aged 29-79 years was found to be 10.5%.It is a global public health threat with a rising trend in morbidity and mortality.Poor glycemic control(GC)among patien...BACKGROUND The global prevalence of diabetes among adults aged 29-79 years was found to be 10.5%.It is a global public health threat with a rising trend in morbidity and mortality.Poor glycemic control(GC)among patients with type 2 diabetes mellitus(T2DM)is a major determinant of diabetes-related complications.There are limited data on GC and associated factors among patients with T2DM in South West Region,Cameroon.AIM To assess GC and identify contributing factors among patients with T2DM in a regional hospital in South West Region,Cameroon.METHODS A cross-sectional study was conducted from February 2022 to July 2022 among 131 participants in Limbe Regional Hospital who were selected by convenience.Glycated hemoglobin(HbA1c)was measured by ion-exchange chromatography.Sociodemographic,clinical,and lifestyle data were collected,entered into Excel,and exported to Statistical Package for Social Sciences version 22 for analysis.A multivariate logistic regression analysis was conducted to assess the association between explanatory variables and GC.The level of significance was set at P<0.05.RESULTS The mean age was 56±5.1 years.Eighty-eight(67.2%)patients were female.The mean HbA1c was 8.8%±1.8%.Poor GC(HbA1c≥7%)was registered in 106(80.9%;95%confidence interval:73.1%-87.3%)participants.Lack of self-monitoring of blood glucose at home was associated with poor GC(adjusted odds ratio:3.858,95%confidence interval:1.262-11.800;P=0.018).CONCLUSION The majority of patients with T2DM had poor GC.Absence of self-monitoring of blood glucose at home was the main contributing factor for poor GC.展开更多
Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal inn...Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal innate,behavioral,interpersonal network,socioeconomic,and macroenvironmental characteristics.Data on cancer outcomes and health determinants from 185 countries,classified using the Human Development Index(HDI),were extracted from GLOBOCAN 2022,the World Health Organization Global Health Observatory,the Global Burden of Disease Study 2021,the United Nations,and the World Bank.A multivariate linear regression model was used to estimate the association between health determinants and cancer outcomes.Results A total of 153 countries with complete information on cancer outcomes and health determinants were enrolled in the study.A higher all-cancer age-standardized mortality rate(ASMR)was associated with current tobacco use,alcohol consumption,obesity,agricultural employment,and lag-distributed income.In women aged 15–49 years,being married or in a union was associated with a lower ASMR.Early-onset ASMR was positively associated with agricultural employment,lag-distributed income,and unsafe sanitation.Notable sex differences were observed,although tobacco use and obesity were identified as risk factors in both sexes.Conclusion We underscore the crucial need to incorporate cross-sectoral interventions within a resilient healthcare system to effectively mitigate the cancer mortality burden.展开更多
BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-incom...BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-income countries.However,the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.AIM To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.METHODS We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota,Colombia.Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included.A total of 583 patients participated in the study.We performed descriptive,bivariate,and binary logistic regression analyses,adjusting for confounding variables.RESULTS Among the 583 patients included,urban residency[odds ratio(OR)=3.05,95%confidence interval(CI):1.01-9.20]and a middle or high educational level(OR=2.33,95%CI:1.14-4.72)were associated with an increased risk of coronary artery disease.Additionally,receiving diabetes education beyond that provided by the clinic(OR=2.15,95%CI:1.14-4.05)and lack of access to spaces for physical activity(OR=4.05,95%CI:1.31-12.5)were associated with a higher risk of diabetic nephropathy and cerebrovascular disease,respectively.CONCLUSION Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs.Population-based studies are needed to guide targeted interventions and clarify causal relationships.展开更多
IPO underpricing,the tendency for newly issued shares to trade above their offer price on the first day,is a persistent global phenomenon.Empirical evidence suggests that U.S.IPOs averaged an 18.8%first-day return fro...IPO underpricing,the tendency for newly issued shares to trade above their offer price on the first day,is a persistent global phenomenon.Empirical evidence suggests that U.S.IPOs averaged an 18.8%first-day return from 1980 to 2001,imposing significant indirect costs on issuers.This paper reviews key explanations for underpricing,including information asymmetry,signaling,agency conflicts,and behavioral factors.Empirical research highlights firm characteristics,underwriter reputation,market conditions,and regulatory factors as major determinants.While underpricing facilitates liquidity and market participation,it also reflects inefficiencies.This study synthesizes theoretical perspectives and empirical findings,emphasizing the need for improved disclosure,governance,and regulatory oversight.展开更多
Background: Social determinants of health (SDOH) significantly influence diseases with environmental components, like vector-borne parasitic diseases. This study aims to examine how these factors influence vector-born...Background: Social determinants of health (SDOH) significantly influence diseases with environmental components, like vector-borne parasitic diseases. This study aims to examine how these factors influence vector-borne parasitic diseases (VBPDs) transmission in Chad and provide recommendations for policy improvements. Methods: The study adopts the WHO Conceptual Framework of SDOH to compare two regions in Southern Chad: Kouh-Est, which has an ongoing vector control program, and Grand-Sido, which lacks such a program. The study includes both nomadic and sedentary populations to provide a comprehensive understanding of the SDOH influencing VBPDs. Households were randomly selected. Data on sociodemographic characteristics, literacy, knowledge of VBPDs and protective measures, and access to education and health facilities were collected. Results: A total of 202 households from 17 villages, including 820 participants, were surveyed. Agriculture, livestock, and fishing were the main occupations, involving 84.1% of participants. Literacy was low, with 36.7% non-educated, 47.7% completing primary school, 14.5% secondary school, and only 0.3% reaching tertiary education. Most villages lacked schools beyond the primary level, and nomadic populations were significantly less educated than sedentary ones (p Conclusion: Educational deficiencies, lack of protective measures against vectors, inadequate healthcare resources, and lifestyle conditions aggravated by poor road infrastructure, limited transportation, and economic constraints contribute to worsened VBPDs outcomes in these rural populations. Addressing these systemic issues in the surveyed communities is essential for improving health equity and VBPDs outcomes in these regions specifically and in similar populations settings more broadly.展开更多
Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),...Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),RRD is a condition frequently encountered by vitreoretinal specialists.Because the fovea is responsible for central visual acuity,foveal detachment is associated with poor presenting vision and is the strongest prognostic factor predicting poor visual outcome after RRD repair(2).展开更多
Here we complete our work on the asymptotics of Hankel determinants studying the case wherein the entries are “ultrarapidly”-varying functions in the sense that their logarithms are rapidly varying. Moreover, the la...Here we complete our work on the asymptotics of Hankel determinants studying the case wherein the entries are “ultrarapidly”-varying functions in the sense that their logarithms are rapidly varying. Moreover, the last results in the paper highlight analogies between algebraic identities for Hankelians with special entries and asymptotic relations valid for large classes of entries.展开更多
Depressive symptoms in adolescents are an increasing public health issue in Sweden and in most Western countries. Aim: To explore how individual, psychosocial, and structural determinants are associated with depressiv...Depressive symptoms in adolescents are an increasing public health issue in Sweden and in most Western countries. Aim: To explore how individual, psychosocial, and structural determinants are associated with depressive symptoms in Swedish adolescents. Methods: A web-based questionnaire was answered by 1193 13- to 16-year-old boys (n = 566) and girls (n = 627). Stepwise logistic regressions were employed to analyse the association between depressive symptoms and various determinants at the individual level (self-efficacy), the psychosocial level (parental, peer, and teacher support, school demands, sexual harassment, and bullying) and the structural level (family affluence, having less money than friends, and parental foreign background). Results: Determinants at the individual, psychosocial, and structural levels were independently associated with high levels of depressive symptoms in both boys and girls. The full model explained a high proportion of the variance in depressive symptoms in both genders;34.1% in boys and 36.8% in girls. The psychosocial level contributed the most to explaining the variance in depressive symptoms in boys. In girls, when harassment variables were separated from psychosocial variables, the harassment variables contributed as much to the full model as the rest of the psychosocial variables combined. Conclusions: Addressing psychosocial determinants provides the greatest benefits for preventing depressive symptoms in adolescents. Acknowledging the association between sexual harassment and depressive symptoms for girls and having less money than their friends for boys and girls are particularly important.展开更多
Objectives: To provide references for HIV/AIDS-re-lated health education strategies through survey onHIV/AIDS-related knowledge, attitude and determi-nants of HIV/AIDS awareness. Methods: The study subjects were selec...Objectives: To provide references for HIV/AIDS-re-lated health education strategies through survey onHIV/AIDS-related knowledge, attitude and determi-nants of HIV/AIDS awareness. Methods: The study subjects were selected by ran-dom interception in a downtown street of Guangzhoucity on World AIDS Day-December 1,2002. The uni-form questionnaires were finished by means of self-administration. Results: Two hundred questionnaires were distrib-uted and 147 qualified questionnaires were collected.The results showed, the awareness rate of HIV/AIDS-related knowledge was 63.3%, and awareness rate oftransmission routes was 76.2%, whilst non-transmis-sion route was 60.5%; the awareness rate of trans-mission was 59.2%; the awareness rate of preventionwas 47.0%; the positive attitude to people living withHIV/AIDS was 65.6%. Multiple variable Logistic re-gression analysis showed the determinants of HIV/AIDS-related knowledge were education level, age,marital status and gender, of which people with highlevel of education, young age and the group of maleand married had better awareness of HIV/AIDS. Conclusion: Current HIV/AIDS-related knowledgeof urban residents is relativly low, especially for thenon-transmission route, hence further HIV/AIDS-re-lated education should be strengthened, especially fo-cusing on non-transmission route to eliminate dis-crimination over people living with HIV/AIDS.Further, education efforts also should be put on fe-male population, unmarried population and poorly edu-cated population.展开更多
Distribution of groundwater outflows(springs)is determined by a number of natural factors–the most important factor being geological structure.However,the relationship between spring location and environmental charac...Distribution of groundwater outflows(springs)is determined by a number of natural factors–the most important factor being geological structure.However,the relationship between spring location and environmental characteristics in flysch areas has not been studied extensively.The purpose of the paper is to analyze the determinants of springs location in a flysch massif based on a database of springs created in the course of detailed field mapping.展开更多
Most of the world＇s cities are concentrated in coastal areas. As a special geographical component of the coastal system, island urban spatial expansion is the outcome of interactions between city development and the ...Most of the world＇s cities are concentrated in coastal areas. As a special geographical component of the coastal system, island urban spatial expansion is the outcome of interactions between city development and the physical environment. This paper takes Xiamen Island, located in Southeastern China, as an example to analyze island urban spatial expansion and its determinants by combining an analysis of the literature on urban development policies, urban overall plans, population growth and industrial development, with geographical information analysis using historical maps and remote sensing photographs. Firstly, we reviewed the history of the Xiamen City development during the last 100 years, which can be divided into four periods： the embryonic modern city and early development from 1908 to 1949; administrative boundary expansion and infrastructure development from 1950 to 1979; special economic zone construction and rapid urbanization from 1980 to 2003; and Bay City construction since 2003. The dynamic changes to the coastline, island shape, built-up area, transportation, administrative division, and major land use type conversion which occurred during approximately the past 100 years were analyzed and the characteristics of the island urban spatial expansion were concluded： early expansion from a central point, followed by expansion along a section of coastline, and expansion from the coastline inland. Secondly, we discussed the potential determinants of island urban spatial expansion including administrative division adjustment, urban master planning revision, industrial development, topographical factors, coastal area reclamation, transportation expansion, and population growth. Finally, the effects of each potential determinant on island urban spatial expansion were concluded. Island urban spatial expansion is the result of a synthesis of natural and socio-economic factors which are not independent but interacting. Built-up area expansion is the major driver of island land cover and land use changes. By this paper, we hope to provide a scientific reference contributing to the rational understanding of island and coastal sustainable urbanization in China, and the world beyond.展开更多
Irrigation water shortage is becoming an increasingly serious problem in agricultural production. In this case, it is very important for policy makers to take measures to improve irrigation water use efficiency, espec...Irrigation water shortage is becoming an increasingly serious problem in agricultural production. In this case, it is very important for policy makers to take measures to improve irrigation water use efficiency, especially in the water-scarce areas. In this paper, the data envelopment analysis （DEA） techniques, based on the concept of input-specific technical efficiency were used to develop farm-level technical efficiency measures and sub-vector efficiencies for irrigation water use. The Tobit regression technique was then adopted to identify the factors that influence irrigation water efficiency differentials under the shortage of water resources. Based on a sample data of 432 wheat farmers in northwestern China, our experimental results of the DEA analysis showed the average technical efficiency of 0.6151. It suggested that wheat farmers could increase their production by as much as 38.49% by using inputs more efficiently. Further, the mean irrigation water efficiency of 0.3065, suggested that wheat farmers could produce the same quantity of wheat using the same quantity of inputs but with 69.35% less water. The results of the Tobit regression analysis showed that the farmer＇s age, income, education level, and the farm size tended to affect the degree of irrigation water efficiency positively, and the channel conditions and different irrigation methods made a significant impact on irrigation water use efficiency. Furthermore, the arrangements of exclusive water property rights and competitive water price mechanism have effectively encouraged the water saving behavior of farmers. These results are valuable for policy makers since it could help to guide policies towards high irrigation water use efficiency.展开更多
This cross-sectional study aimed to investigate cancer patients'cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China.In seven tertiar...This cross-sectional study aimed to investigate cancer patients'cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China.In seven tertiary hospitals across China,372 patients experiencing cancer pain were surveyed through a self-designed questionnaire to assess the factors associated with effective pain control.Patients'demographic data and pain control-related factors were recorded.Cluster sampling and binary logistic regression models were used to investigate the association between predictive factors and effective pain control.The survey showed that the majority of the patients were more than 45 years old(76.3%),and 64.4%had an average annual income of more than 20000 RMB.One-third of the patients suffered from cancer pain for more than 3 months,and 75.1%received professional guidance during medication.The barriers to pain control for patients included preference to enduring pain and refusing analgesics(62.9%),negligence towards drug usage(28.5%),concerns about the addiction(48.2%)and adverse reaction(56.4%).The average annual family income,pro fessional guidance,knowledge of pain medication,adherence to analgesics,and concerns about addiction to analgesics were significantly correlated to the effect of patients'pain control.The study presents major barriers to optimal pain control among patients with cancer in China.Our findings suggest that educational programs and medical insurance reimbursement support from the government are urgently needed to overcome the cognitive barriers toward effective pain management and to relieve the economic burden among patients with cancer pain in China.展开更多
Household CO2 emissions were increasing due to rapid economic growth and different household lifestyle. We assessed per capita household CO2 emissions（PHCEs） based on different household consuming demands（including...Household CO2 emissions were increasing due to rapid economic growth and different household lifestyle. We assessed per capita household CO2 emissions（PHCEs） based on different household consuming demands（including clothing, food, residence, transportation and service） by using provincial capital city level survey data in China. The results showed that：（1） there was a declining trend moving from eastward to westward as well as moving from northward to southward in the distribution of PHCEs.（2） PHCEs from residence demand were the largest which accounted for 44% of the total.（3） Correlation analysis and spatial analysis（Spatial Lag Model（SLM） and Spatial Error Model（SEM）） were used to evaluate the complex determinants of PHCEs. Per capita income（PI） and household size（HS） were analyzed as the key influencing factors. We concluded that PHCEs would increase by 0.2951% and decrease by 0.5114% for every 1% increase in PI and HS, respectively. According to the results, policy-makers should consider household consuming demand, income disparity and household size on the variations of PHCEs. The urgency was to improve technology and change household consuming lifestyle to reduce PHCEs.展开更多
To identify the determinant of the occurrence of IUD expulsion Materials & Methods Based on 25 733 IUD uses from the Chinese Two per Thousand Fertility Survey data, this study examines the patterns and differe...To identify the determinant of the occurrence of IUD expulsion Materials & Methods Based on 25 733 IUD uses from the Chinese Two per Thousand Fertility Survey data, this study examines the patterns and differentials of IUD expulsion rate by characteristics of women, and identifies the socio demographic determinants of IUD expulsion. A Life Table method was used to calculate the cumulative expulsion rate and a random effects discrete time survival model was employed to assess the impact of potential determinants simultaneously on the risk of expelling an IUD. Results Three major findings are observed in this study. First, IUD expulsion was the second main reason, after pregnancy during IUD use, for IUD discontinuation during the first four years of IUD insertion; the expulsion rates were 6.4%, 9.1%, 10.8 %, and 12.0% at 12, 24, 36 and 48 months, respectively. Second, there was a clustering of IUD expulsion: some women experienced repeated IUD expulsions. Third, some socio demographic characteristics and fertility history were associated with the occurrence of IUD expulsion. In particular, the expulsion rate was high among young women, among those with two or more children and among those living in rural areas. Conclusion The above mentioned factors shoald be addressed in order to decrease the IUD expulsion rate and enhance the reprocluctive he alth of women.展开更多
文摘Objectives:This scoping review aims to methodically identify and analyse the determinants which influence maternal mortality and healthcare utilization in women of childbearing years in Nigeria.The review specifically addresses the difficulties faced in assessing medical care,and the ongoing initiatives to lower the maternal mortality ratio.Methods:Primary studies(published after year 2000)focused on maternal mortality,health determinants,and the utilization of maternal healthcare services in Nigeria were retrieved following a systematic search across multiple databases,including Scopus,PubMed,Google Scholar,and Web of Science.These were screened using defined inclusion and exclusion criteria.Data from these studies were extracted and thematically analysed to identify common themes and trends.Results:A total of 21 publications were included in this review comprising 2 qualitative,17 quantitative,and2 mixed study designs.Major health determinants identified in these studies include hypertensive disorders of pregnancy,haemorrhage,and sepsis/septicaemia,contributing as much as 29%,24%,and 14.2%of maternal deaths respectively in over 10%of the reviewed studies.Similarly,social-economic determinants including poverty,maternal education,health system issues and culture significantly impacted the utilization of maternal healthcare services,inadvertently impacting maternal mortality.Despite various maternal health interventions such as the"Abiye"Safe Motherhood Initiative,the Integrated Maternal,Newborn,and Child Health Strategy and strengthening emergency obstetric care by governmental and non-governmental agencies,early childbearing,unemployment,large family sizes,and dependence on male spouses continued to result in suboptimal utilization of services and adverse maternal outcomes.Conclusion:This scoping review comprehensively integrated existing data from published studies to provide a detailed picture of maternal mortality,its health determinants,and factors influencing care utilization among women of childbearing age in Nigeria and approaches to reduce maternal mortality in the country and possibly in the West African sub-region.
文摘Background: Erectile dysfunction (ED) is a common, bothersome and relatively under diagnosed complication of diabetes mellitus. This study was aimed to determine the prevalence of erectile dysfunction and its determinants. Methods: A cross-sectional hospital-based study was carried out in the Diabetology Units of the Buea and Limbe Regional Hospitals involving 332 male patients with diabetes and aged over 21 years. Data was analyzed using Stata and R version 3.5.3. Results: The mean age of the participants was 55years. Most participants (64.46%) were married. About half (50.60%) of the participants actively consumed alcohol, 11.45% were smokers and 57.83% were sedentary. 18 participants (5.42%) recorded high risk sexual behaviour. 54.32% of participants had a comorbidity and 43.90% were overweight. The prevalence of diabetic ED was 78.92%. Age, Fasting Blood Sugar and Glycated hemoglobin were found to be positive determinants of diabetic ED (odds ratio (OR) = 0.77, 95% CI −0.1 - 0.07). Conclusion: The prevalence of diabetic ED in this hospital population study is high, and both physician and patient—initiated measures are needed to reduce this prevalence and improve awareness, recognition and care of this condition.
文摘Objective Data on homocysteine(Hcy) status and its determinants are limited among women during pregnancy and postpartum. This cross-sectional study aimed to investigate Hcy levels during pregnancy and postpartum, and to explore the determinants like geographic factor.Methods This study was conducted in women at mid-pregnancy, late-pregnancy and postpartum from southern, central and northern China. Approximately 132 women were included in each stratum by the three phases and regions. Plasma Hcy concentrations were assessed using high-performance liquid chromatography(HPLC), with hyperhomocysteinemia defined as > 10.0 μmol/L. Quantile regression was to estimate medians and interquartile ranges(IQRs), and logistic regression to examine the determinants of hyperhomocysteinemia.Results For 1,190 women included, the median(IQR) Hcy concentration was 5.66(4.62, 7.37) μmol/L.The adjusted median in mid-pregnancy, late-pregnancy and postpartum women was 4.75(4.13, 5.54),5.72(4.81, 6.85) and 7.09(5.65, 8.75) μmol/L, respectively, showing an increasing trend(P < 0.001). This increasing trend persisted across the three regions. Higher Hcy concentrations were observed in women residing in northern region and those with younger age or lower economic status. A total of 106(8.9%)women had hyperhomocysteinemia, with a higher prevalence in those residing in northern region(16.0%), or in postpartum women(16.5%).Conclusion Hcy levels, varying with geographic region, maternal age and economic status, are increased from mid-pregnancy to late-pregnancy and postpartum, indicating a need to monitor Hcy levels in pregnant and postpartum women to control potential risks related to elevated Hcy levels.
基金Supported by the Henan Provincial Health Commission,No.232102310145.
文摘BACKGROUND Patients with chronic obstructive pulmonary disease(COPD)frequently experience exacerbations requiring multiple hospitalizations over prolonged disease courses,which predispose them to generalized anxiety disorder(GAD).This comorbidity exacerbates breathing difficulties,activity limitations,and social isolation.While previous studies predominantly employed the GAD 7-item scale for screening,this approach is somewhat subjective.The current literature on predictive models for GAD risk in patients with COPD is limited.AIM To construct and validate a GAD risk prediction model to aid healthcare professionals in preventing the onset of GAD.METHODS This retrospective analysis encompassed patients with COPD treated at our institution from July 2021 to February 2024.The patients were categorized into a modeling(MO)group and a validation(VA)group in a 7:3 ratio on the basis of the occurrence of GAD.Univariate and multivariate logistic regression analyses were utilized to construct the risk prediction model,which was visualized using forest plots.The model’s performance was evaluated using Hosmer-Lemeshow(H-L)goodness-of-fit test and receiver operating characteristic(ROC)curve analysis.RESULTS A total of 271 subjects were included,with 190 in the MO group and 81 in the VA group.GAD was identified in 67 patients with COPD,resulting in a prevalence rate of 24.72%(67/271),with 49 cases(18.08%)in the MO group and 18 cases(22.22%)in the VA group.Significant differences were observed between patients with and without GAD in terms of educational level,average household income,smoking history,smoking index,number of exacerbations in the past year,cardiovascular comorbidities,disease knowledge,and personality traits(P<0.05).Multivariate logistic regression analysis revealed that lower education levels,household income<3000 China yuan,smoking history,smoking index≥400 cigarettes/year,≥two exacerbations in the past year,cardiovascular comorbidities,complete lack of disease information,and introverted personality were significant risk factors for GAD in the MO group(P<0.05).ROC analysis indicated that the area under the curve for predicting GAD in the MO and VA groups was 0.978 and 0.960.The H-L test yieldedχ^(2) values of 6.511 and 5.179,with P=0.275 and 0.274.Calibration curves demonstrated good agreement between predicted and actual GAD occurrence risks.CONCLUSION The developed predictive model includes eight independent risk factors:Educational level,household income,smoking history,smoking index,number of exacerbations in the past year,presence of cardiovascular comorbidities,level of disease knowledge,and personality traits.This model effectively predicts the onset of GAD in patients with COPD,enabling early identification of high-risk individuals and providing a basis for early preventive interventions by nursing staff.
文摘BACKGROUND The global prevalence of diabetes among adults aged 29-79 years was found to be 10.5%.It is a global public health threat with a rising trend in morbidity and mortality.Poor glycemic control(GC)among patients with type 2 diabetes mellitus(T2DM)is a major determinant of diabetes-related complications.There are limited data on GC and associated factors among patients with T2DM in South West Region,Cameroon.AIM To assess GC and identify contributing factors among patients with T2DM in a regional hospital in South West Region,Cameroon.METHODS A cross-sectional study was conducted from February 2022 to July 2022 among 131 participants in Limbe Regional Hospital who were selected by convenience.Glycated hemoglobin(HbA1c)was measured by ion-exchange chromatography.Sociodemographic,clinical,and lifestyle data were collected,entered into Excel,and exported to Statistical Package for Social Sciences version 22 for analysis.A multivariate logistic regression analysis was conducted to assess the association between explanatory variables and GC.The level of significance was set at P<0.05.RESULTS The mean age was 56±5.1 years.Eighty-eight(67.2%)patients were female.The mean HbA1c was 8.8%±1.8%.Poor GC(HbA1c≥7%)was registered in 106(80.9%;95%confidence interval:73.1%-87.3%)participants.Lack of self-monitoring of blood glucose at home was associated with poor GC(adjusted odds ratio:3.858,95%confidence interval:1.262-11.800;P=0.018).CONCLUSION The majority of patients with T2DM had poor GC.Absence of self-monitoring of blood glucose at home was the main contributing factor for poor GC.
基金supported by the National Natural Science Foundation of China(No.82273722)Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0520000)(2024ZD0520005)Central University Basic Research Fund of Peking Union Medical College(3332024216)。
文摘Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal innate,behavioral,interpersonal network,socioeconomic,and macroenvironmental characteristics.Data on cancer outcomes and health determinants from 185 countries,classified using the Human Development Index(HDI),were extracted from GLOBOCAN 2022,the World Health Organization Global Health Observatory,the Global Burden of Disease Study 2021,the United Nations,and the World Bank.A multivariate linear regression model was used to estimate the association between health determinants and cancer outcomes.Results A total of 153 countries with complete information on cancer outcomes and health determinants were enrolled in the study.A higher all-cancer age-standardized mortality rate(ASMR)was associated with current tobacco use,alcohol consumption,obesity,agricultural employment,and lag-distributed income.In women aged 15–49 years,being married or in a union was associated with a lower ASMR.Early-onset ASMR was positively associated with agricultural employment,lag-distributed income,and unsafe sanitation.Notable sex differences were observed,although tobacco use and obesity were identified as risk factors in both sexes.Conclusion We underscore the crucial need to incorporate cross-sectoral interventions within a resilient healthcare system to effectively mitigate the cancer mortality burden.
文摘BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-income countries.However,the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.AIM To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.METHODS We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota,Colombia.Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included.A total of 583 patients participated in the study.We performed descriptive,bivariate,and binary logistic regression analyses,adjusting for confounding variables.RESULTS Among the 583 patients included,urban residency[odds ratio(OR)=3.05,95%confidence interval(CI):1.01-9.20]and a middle or high educational level(OR=2.33,95%CI:1.14-4.72)were associated with an increased risk of coronary artery disease.Additionally,receiving diabetes education beyond that provided by the clinic(OR=2.15,95%CI:1.14-4.05)and lack of access to spaces for physical activity(OR=4.05,95%CI:1.31-12.5)were associated with a higher risk of diabetic nephropathy and cerebrovascular disease,respectively.CONCLUSION Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs.Population-based studies are needed to guide targeted interventions and clarify causal relationships.
文摘IPO underpricing,the tendency for newly issued shares to trade above their offer price on the first day,is a persistent global phenomenon.Empirical evidence suggests that U.S.IPOs averaged an 18.8%first-day return from 1980 to 2001,imposing significant indirect costs on issuers.This paper reviews key explanations for underpricing,including information asymmetry,signaling,agency conflicts,and behavioral factors.Empirical research highlights firm characteristics,underwriter reputation,market conditions,and regulatory factors as major determinants.While underpricing facilitates liquidity and market participation,it also reflects inefficiencies.This study synthesizes theoretical perspectives and empirical findings,emphasizing the need for improved disclosure,governance,and regulatory oversight.
文摘Background: Social determinants of health (SDOH) significantly influence diseases with environmental components, like vector-borne parasitic diseases. This study aims to examine how these factors influence vector-borne parasitic diseases (VBPDs) transmission in Chad and provide recommendations for policy improvements. Methods: The study adopts the WHO Conceptual Framework of SDOH to compare two regions in Southern Chad: Kouh-Est, which has an ongoing vector control program, and Grand-Sido, which lacks such a program. The study includes both nomadic and sedentary populations to provide a comprehensive understanding of the SDOH influencing VBPDs. Households were randomly selected. Data on sociodemographic characteristics, literacy, knowledge of VBPDs and protective measures, and access to education and health facilities were collected. Results: A total of 202 households from 17 villages, including 820 participants, were surveyed. Agriculture, livestock, and fishing were the main occupations, involving 84.1% of participants. Literacy was low, with 36.7% non-educated, 47.7% completing primary school, 14.5% secondary school, and only 0.3% reaching tertiary education. Most villages lacked schools beyond the primary level, and nomadic populations were significantly less educated than sedentary ones (p Conclusion: Educational deficiencies, lack of protective measures against vectors, inadequate healthcare resources, and lifestyle conditions aggravated by poor road infrastructure, limited transportation, and economic constraints contribute to worsened VBPDs outcomes in these rural populations. Addressing these systemic issues in the surveyed communities is essential for improving health equity and VBPDs outcomes in these regions specifically and in similar populations settings more broadly.
文摘Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),RRD is a condition frequently encountered by vitreoretinal specialists.Because the fovea is responsible for central visual acuity,foveal detachment is associated with poor presenting vision and is the strongest prognostic factor predicting poor visual outcome after RRD repair(2).
文摘Here we complete our work on the asymptotics of Hankel determinants studying the case wherein the entries are “ultrarapidly”-varying functions in the sense that their logarithms are rapidly varying. Moreover, the last results in the paper highlight analogies between algebraic identities for Hankelians with special entries and asymptotic relations valid for large classes of entries.
文摘Depressive symptoms in adolescents are an increasing public health issue in Sweden and in most Western countries. Aim: To explore how individual, psychosocial, and structural determinants are associated with depressive symptoms in Swedish adolescents. Methods: A web-based questionnaire was answered by 1193 13- to 16-year-old boys (n = 566) and girls (n = 627). Stepwise logistic regressions were employed to analyse the association between depressive symptoms and various determinants at the individual level (self-efficacy), the psychosocial level (parental, peer, and teacher support, school demands, sexual harassment, and bullying) and the structural level (family affluence, having less money than friends, and parental foreign background). Results: Determinants at the individual, psychosocial, and structural levels were independently associated with high levels of depressive symptoms in both boys and girls. The full model explained a high proportion of the variance in depressive symptoms in both genders;34.1% in boys and 36.8% in girls. The psychosocial level contributed the most to explaining the variance in depressive symptoms in boys. In girls, when harassment variables were separated from psychosocial variables, the harassment variables contributed as much to the full model as the rest of the psychosocial variables combined. Conclusions: Addressing psychosocial determinants provides the greatest benefits for preventing depressive symptoms in adolescents. Acknowledging the association between sexual harassment and depressive symptoms for girls and having less money than their friends for boys and girls are particularly important.
文摘Objectives: To provide references for HIV/AIDS-re-lated health education strategies through survey onHIV/AIDS-related knowledge, attitude and determi-nants of HIV/AIDS awareness. Methods: The study subjects were selected by ran-dom interception in a downtown street of Guangzhoucity on World AIDS Day-December 1,2002. The uni-form questionnaires were finished by means of self-administration. Results: Two hundred questionnaires were distrib-uted and 147 qualified questionnaires were collected.The results showed, the awareness rate of HIV/AIDS-related knowledge was 63.3%, and awareness rate oftransmission routes was 76.2%, whilst non-transmis-sion route was 60.5%; the awareness rate of trans-mission was 59.2%; the awareness rate of preventionwas 47.0%; the positive attitude to people living withHIV/AIDS was 65.6%. Multiple variable Logistic re-gression analysis showed the determinants of HIV/AIDS-related knowledge were education level, age,marital status and gender, of which people with highlevel of education, young age and the group of maleand married had better awareness of HIV/AIDS. Conclusion: Current HIV/AIDS-related knowledgeof urban residents is relativly low, especially for thenon-transmission route, hence further HIV/AIDS-re-lated education should be strengthened, especially fo-cusing on non-transmission route to eliminate dis-crimination over people living with HIV/AIDS.Further, education efforts also should be put on fe-male population, unmarried population and poorly edu-cated population.
文摘Distribution of groundwater outflows(springs)is determined by a number of natural factors–the most important factor being geological structure.However,the relationship between spring location and environmental characteristics in flysch areas has not been studied extensively.The purpose of the paper is to analyze the determinants of springs location in a flysch massif based on a database of springs created in the course of detailed field mapping.
基金Knowledge Innovation Programs of the Chinese Academy of Sciences, No.KZCX2-YW-450 No.0714121d10, National Natural Science Foundation of China, No.40901243 Natural Science Foundation of Fujian Province of China, No.2010J05100
文摘Most of the world＇s cities are concentrated in coastal areas. As a special geographical component of the coastal system, island urban spatial expansion is the outcome of interactions between city development and the physical environment. This paper takes Xiamen Island, located in Southeastern China, as an example to analyze island urban spatial expansion and its determinants by combining an analysis of the literature on urban development policies, urban overall plans, population growth and industrial development, with geographical information analysis using historical maps and remote sensing photographs. Firstly, we reviewed the history of the Xiamen City development during the last 100 years, which can be divided into four periods： the embryonic modern city and early development from 1908 to 1949; administrative boundary expansion and infrastructure development from 1950 to 1979; special economic zone construction and rapid urbanization from 1980 to 2003; and Bay City construction since 2003. The dynamic changes to the coastline, island shape, built-up area, transportation, administrative division, and major land use type conversion which occurred during approximately the past 100 years were analyzed and the characteristics of the island urban spatial expansion were concluded： early expansion from a central point, followed by expansion along a section of coastline, and expansion from the coastline inland. Secondly, we discussed the potential determinants of island urban spatial expansion including administrative division adjustment, urban master planning revision, industrial development, topographical factors, coastal area reclamation, transportation expansion, and population growth. Finally, the effects of each potential determinant on island urban spatial expansion were concluded. Island urban spatial expansion is the result of a synthesis of natural and socio-economic factors which are not independent but interacting. Built-up area expansion is the major driver of island land cover and land use changes. By this paper, we hope to provide a scientific reference contributing to the rational understanding of island and coastal sustainable urbanization in China, and the world beyond.
基金supported by the National Natural Sci-ence Foundation of China (70903060)the Natural Science Foundation of Zhejiang Province, China(Y6090552)
文摘Irrigation water shortage is becoming an increasingly serious problem in agricultural production. In this case, it is very important for policy makers to take measures to improve irrigation water use efficiency, especially in the water-scarce areas. In this paper, the data envelopment analysis （DEA） techniques, based on the concept of input-specific technical efficiency were used to develop farm-level technical efficiency measures and sub-vector efficiencies for irrigation water use. The Tobit regression technique was then adopted to identify the factors that influence irrigation water efficiency differentials under the shortage of water resources. Based on a sample data of 432 wheat farmers in northwestern China, our experimental results of the DEA analysis showed the average technical efficiency of 0.6151. It suggested that wheat farmers could increase their production by as much as 38.49% by using inputs more efficiently. Further, the mean irrigation water efficiency of 0.3065, suggested that wheat farmers could produce the same quantity of wheat using the same quantity of inputs but with 69.35% less water. The results of the Tobit regression analysis showed that the farmer＇s age, income, education level, and the farm size tended to affect the degree of irrigation water efficiency positively, and the channel conditions and different irrigation methods made a significant impact on irrigation water use efficiency. Furthermore, the arrangements of exclusive water property rights and competitive water price mechanism have effectively encouraged the water saving behavior of farmers. These results are valuable for policy makers since it could help to guide policies towards high irrigation water use efficiency.
基金This work was financially supported by Hubei Provincial Natural Science Foundation of China(No.2016CFB678).
文摘This cross-sectional study aimed to investigate cancer patients'cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China.In seven tertiary hospitals across China,372 patients experiencing cancer pain were surveyed through a self-designed questionnaire to assess the factors associated with effective pain control.Patients'demographic data and pain control-related factors were recorded.Cluster sampling and binary logistic regression models were used to investigate the association between predictive factors and effective pain control.The survey showed that the majority of the patients were more than 45 years old(76.3%),and 64.4%had an average annual income of more than 20000 RMB.One-third of the patients suffered from cancer pain for more than 3 months,and 75.1%received professional guidance during medication.The barriers to pain control for patients included preference to enduring pain and refusing analgesics(62.9%),negligence towards drug usage(28.5%),concerns about the addiction(48.2%)and adverse reaction(56.4%).The average annual family income,pro fessional guidance,knowledge of pain medication,adherence to analgesics,and concerns about addiction to analgesics were significantly correlated to the effect of patients'pain control.The study presents major barriers to optimal pain control among patients with cancer in China.Our findings suggest that educational programs and medical insurance reimbursement support from the government are urgently needed to overcome the cognitive barriers toward effective pain management and to relieve the economic burden among patients with cancer pain in China.
基金National Key Research and Development Program,No.2016YFA0602803National Natural Science Foundation of China,No.41371537+1 种基金The Fundamental Research Funds for the Central Universities,No.lzujbky-2016-257The Fundamental Research Funds for the Central Universities,No.lzu-jbky-2017-it106
文摘Household CO2 emissions were increasing due to rapid economic growth and different household lifestyle. We assessed per capita household CO2 emissions（PHCEs） based on different household consuming demands（including clothing, food, residence, transportation and service） by using provincial capital city level survey data in China. The results showed that：（1） there was a declining trend moving from eastward to westward as well as moving from northward to southward in the distribution of PHCEs.（2） PHCEs from residence demand were the largest which accounted for 44% of the total.（3） Correlation analysis and spatial analysis（Spatial Lag Model（SLM） and Spatial Error Model（SEM）） were used to evaluate the complex determinants of PHCEs. Per capita income（PI） and household size（HS） were analyzed as the key influencing factors. We concluded that PHCEs would increase by 0.2951% and decrease by 0.5114% for every 1% increase in PI and HS, respectively. According to the results, policy-makers should consider household consuming demand, income disparity and household size on the variations of PHCEs. The urgency was to improve technology and change household consuming lifestyle to reduce PHCEs.
文摘To identify the determinant of the occurrence of IUD expulsion Materials & Methods Based on 25 733 IUD uses from the Chinese Two per Thousand Fertility Survey data, this study examines the patterns and differentials of IUD expulsion rate by characteristics of women, and identifies the socio demographic determinants of IUD expulsion. A Life Table method was used to calculate the cumulative expulsion rate and a random effects discrete time survival model was employed to assess the impact of potential determinants simultaneously on the risk of expelling an IUD. Results Three major findings are observed in this study. First, IUD expulsion was the second main reason, after pregnancy during IUD use, for IUD discontinuation during the first four years of IUD insertion; the expulsion rates were 6.4%, 9.1%, 10.8 %, and 12.0% at 12, 24, 36 and 48 months, respectively. Second, there was a clustering of IUD expulsion: some women experienced repeated IUD expulsions. Third, some socio demographic characteristics and fertility history were associated with the occurrence of IUD expulsion. In particular, the expulsion rate was high among young women, among those with two or more children and among those living in rural areas. Conclusion The above mentioned factors shoald be addressed in order to decrease the IUD expulsion rate and enhance the reprocluctive he alth of women.
