Identifying climatic and non-climatic determinants of malnutrition prevalence in Bangladesh: A country-wide cross-sectional spatial analysis.

Child malnutrition is indisputably a multi-faceted phenomenon. Comprehending the aforesaid crucial issue this paper intended to identify climatic and non-climatic factors for the spatial variation of malnutrition prevalence in Bangladesh. The climatic data on temperature and rainfall are obtained from the WorldClim dataset. We obtained a set of global climate layers that included monthly data on minimum temperature, maximum temperature, mean temperature, and rainfall for the period 1960-1990, at a spatial resolution up to 30 'onds (~ 1 × 1 km at the equator). The data are extracted at the district level using the zonal-statistics in QGIS. This study performed a spatial lag regression to evaluate association of malnutrition with climate characteristics and other factors. The prevalence of malnutrition exhibited substantial association with temperature and precipitation. Food production, water access, improved sanitation, literacy, road density, solvency ratio and GDP had a significant association with the spatial variation of malnutrition in Bangladesh.

Determinants of Medical Practice Variation Among Primary Care Physicians: Protocol for a Three Phase Study.

BACKGROUND: One of the greatest challenges of modern health systems is the choice and use of resources needed to diagnose and treat patients. Medical practice variation (MPV) is a broad term which entails the differences between health care providers inclusive of both the overuse and underuse. In this paper, we describe a 3-phase research protocol examining MPV in primary care. OBJECTIVE: We aim to identify the potential targets for behavioral modification interventions to reduce the variation in practice patterns and thus improve health care, decrease costs, and prevent disparities in care. METHODS: The first phase will delineate the variation in primary care practice over a wide range of services and long follow-up period (2003-2017), the second will examine the 3 determinants of variation (ie, patient, physician, and clinic characteristics), and attempt to derive the unexplained variance. In the third phase, we will assess a novel component that might contribute to the previously unexplained variance - the physicians' personal behavioral characteristics (such as risk aversion, fear of malpractice, stress from uncertainty, empathy, and burnout). RESULTS: This work was supported by the research grant from Israel National Institute for Health Policy Research (Grant No. 2014/134). Soroka University Medical Center Institutional Ethics Committee has approved the updated version of the study protocol (SOR-14-0063) in February 2019. All relevant data for phases 1 and 2, including patient, physician, and clinic, were collected from the Clalit Health Services data set in 2019 and are currently being analyzed. The evaluation of the individual physician characteristics (eg, risk aversion) by the face-to-face questionnaires was started on 2018 and remains in progress. We intend to publish the results during 2020-2021. CONCLUSIONS: Based on the results of our study, we aim to propose a list of potential targets for focused behavioral intervention. Identifying new targets for such an intervention can potentially lead to a decrease in the unwarranted variation in the medical practice. We suggest that such an intervention will result in optimization of the health system, improvement of health outcomes, reduction of disparities in care and savings in cost. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18673.

Temperature and the seasonality of births.

PIP: The relationship between temperature and seasonal fluctuations in births is presented cross nationally. Previous literature which give some credence to this relationship is reviewed, but the authors caution that there is no singular reason for birth seasonality. The summary conclusion is that the evidence is inconclusive; the most consistent hypothesis is that summer heat depresses conceptions. The next section is concerned with a selected set of estimates for birth seasonality. The data description and methods are published elsewhere. Tests of statistical significance at the 1% level reject the null hypothesis of no seasonality. In the US birth seasonality if reflected in a September peak and an April/May trough with variation between states in amplitude. The southern state's pattern is compared to 3 regions in India and Israel, and found to be similar. A European pattern is discerned with a spring peak, a local September peak, and a trough during late fall and early winter. The September peak is the only similarity to the US The explanation for variations is difficult, particularly when the birth seasonality between Sweden and the US is different and the seasonal temperature patterns are the same. 2 explanations are posited and discussed: 1) temperature operates in a more complicated manner than by simply depressing conceptions during the period of summer heat; and 2) 1 other factor, in addition to temperature explains the observed seasonal patterns. An estimation strategy is outlined which utilizes a variety of temperature effects, such as the effect of temperature on coital frequency. The equations also allow for the possibility that temperature has no effect at moderature temperature, a negative effect an high temperatures, or that hot or cold temperatures suppress fecundity. The results strongly reject the null hypothesis, but are mixed in the monthly temperature explanation with significance at the 5% level for Georgia, New York, Kerala, Maharashtra, England, and France, at the 10% level in California, Israel, and New Zealand, and insignificant for the Punjab, Canada, Sweden and Australia. The trends show that there is a spring trough in births in warm climate populations (hot summers reduce conceptions); that there is a pattern without temperature explanation for a persistent September peak in births and a spring peak in births in northern populations. High temperatures reduce conceptions in a wide variety of populations, but the explanation is not apparent.^ieng

Seasonal variation in human reproduction: environmental factors.

Almost all human populations exhibit seasonal variation in births, owing mostly to seasonal variation in the frequency of conception. This review focuses on the degree to which environmental factors like nutrition, temperature and photoperiod contribute to these seasonal patterns by acting directly on the reproductive axis. The reproductive strategy of humans is basically that of the apes: Humans have the capacity to reproduce continuously, albeit slowly, unless inhibited by environmental influences. Two, and perhaps three, environmental factors probably act routinely as seasonal inhibitors in some human populations. First, it seems likely that ovulation is regulated seasonally in populations experiencing seasonal variation in food availability. More specifically, it seems likely that inadequate food intake or the increased energy expenditure required to obtain food, or both, can delay menarche, suppress the frequency of ovulation in the nonlactating adult, and prolong lactational amenorrhea in these populations on a seasonal basis. This action is most easily seen in tropical subsistence societies where food availability often varies greatly owing to seasonal variation in rainfall; hence births in these populations often correlate with rainfall. Second, it seems likely that seasonally high temperatures suppress spermatogenesis enough to influence the incidence of fertilization in hotter latitudes, but possibly only in males wearing clothing that diminishes scrotal cooling. Since most of our knowledge about this phenomenon comes from temperate latitudes, the sensitivity of spermatogenesis in both human and nonhuman primates to heat in the tropics needs further study. It is quite possible that high temperatures suppress ovulation and early embryo survival seasonally in some of these same populations. Since we know less than desired about the effect of heat stress on ovulation and early pregnancy in nonhuman mammals, and nothing at all about it in humans or any of the other primates, this is an important area for future research. Third, correlational data suggest that there may be some degree of regulation of reproduction by photoperiod in humans at middle to higher latitudes. Populations at these latitudes often show a peak in presumed conceptions associated with the vernal equinox. On the other hand, evidence gathered by neuroendocrinologists tends to argue against reproductive photoresponsiveness in humans.