Contribution of Tinnitus and Hearing Loss to Depression: NHANES Population Study.

OBJECTIVES: Hearing loss affects the emotional well-being of adults and is sometimes associated with clinical depression. Chronic tinnitus is highly comorbid with hearing loss and separately linked with depression. In this article, the authors investigated the combined effects of hearing loss and tinnitus on depression in the presence of other moderating influences such as demographic, lifestyle, and health factors. DESIGN: The authors used the National Health and Nutrition Examination Survey data (2011-2012 and 2015-2016) to determine the effects of hearing loss and tinnitus on depression in a population of US adults (20 to 69 years). The dataset included the Patient Health Questionnaire-9 for depression screening, hearing testing using pure-tone audiometry, and information related to multiple demographic, lifestyle, and health factors (n = 5845). RESULTS: The statistical analysis showed moderate to high associations between depression and hearing loss, tinnitus, and demographic, lifestyle, and health factors, separately. Results of logistic regression analysis revealed that depression was significantly influenced by hearing loss (adjusted odds ratios [OR] = 3.0), the functional impact of tinnitus (adjusted OR = 2.4), and their interaction, both in the absence or presence of the moderating influences. The effect of bothersome tinnitus on depression was amplified in the presence of hearing loss (adjusted OR = 2.4 in the absence of hearing loss to adjusted OR = 14.9 in the presence of hearing loss). Conversely, the effect of hearing loss on depression decreased when bothersome tinnitus was present (adjusted OR = 3.0 when no tinnitus problem was present to adjusted OR = 0.7 in the presence of bothersome tinnitus). CONCLUSIONS: Together, hearing loss and bothersome tinnitus had a significant effect on self-reported depression symptoms, but their relative effect when comorbid differed. Tinnitus remained more salient than hearing loss and the latter's contribution to depression was reduced in the presence of tinnitus, but the presence of hearing loss significantly increased the effects of tinnitus on depression, even when the effects of the relevant demographic, lifestyle, or health factors were controlled. Treatment strategies that target depression should screen for hearing loss and bothersome tinnitus and provide management options for the conditions.

What Is the Linear Accuracy of Regional Voxel-Based Registration for Orthognathic Surgery Landmarks?

PURPOSE: While regional voxel-based registration (R-VBR) has been shown to have excellent reproducibility and angular accuracy, there are limited data on the linear accuracy of R-VBR for common orthognathic surgery landmarks, or on whether angular accuracy correlates with linear accuracy. The purpose of this study was to estimate the linear accuracy of R-VBR for several skeletal landmarks commonly used in orthognathic surgical planning, and to measure the correlation between angular and linear discrepancies. MATERIALS AND METHODS: This is a retrospective cross-sectional study of consecutive patients treated at a single center with nonsegmental LeFort I and bilateral sagittal split osteotomy surgery from January 2019 to November 2020. Cone beam computed tomography at the preoperative (T0) and immediate postoperative (T1) stages were analyzed to measure the postoperative positional changes of 11 orthognathic landmarks in 4 regions of interest (ROI) using R-VBR performed twice by two examiners. Pairwise correlation analysis and canonical correlation analysis were performed for the angular discrepancies (primary predictor variable) and the linear discrepancies (primary outcome variable) to measure the correlation between the two. RESULTS: In cone beam computed tomography analysis of 28 eligible subjects (16 males, 12 females; mean age 18.9 years, range 15 to 25), the mean absolute (MA) angular discrepancies ranged from 0.15° to 0.55°, while the corresponding MA linear discrepancies ranged from 0.05 to 0.41 mm. There was a strong correlation between angular and linear discrepancies that was statistically significant (P = .001 to .04, Spearman's rank correlation coefficient 0.38 to 0.87). CONCLUSIONS: For nonsegmental LeFort I osteotomies and bilateral sagittal split osteotomy, R-VBR has excellent linear accuracy within a single voxel size (0.3 mm) for commonly used orthognathic landmarks in the maxillary and distal mandibular ROI. The MA linear discrepancy for the proximal mandibular segment ROI was greater than a single voxel size, with a maximum of 0.41 mm.

Double burden of malnutrition among ever-married women in Bangladesh: a pooled analysis.

BACKGROUND: Evidences show that the burden of overweight and obesity is escalating in developing countries with predominant burden of underweight. The coexistence of underweight and overweight/obesity is known as double burden of malnutrition. Recent scanty studies confirmed that Bangladesh is currently experiencing augmented overweight and obesity as well as abating underweight. The present study aimed at assessing the changes of prevalence of overweight/obesity and underweight from 2004 to 2014 and investigated the socio-demographic correlates of being overweight/obese and underweight among ever-married women age 15-49 years. METHODS: Data were collected from four consecutive Demographic and Health Surveys conducted in Bangladesh in 2004 (N = 11,173), 2007 (N = 10,993), 2011 (N = 17,749), 2014 (N = 17,690). Multinomial logistic regression model has been used to determine association between different socio-demographic predictors with overweight/obesity and underweight among ever-married women age 15-49 years considering normal weight as reference category. RESULTS: The prevalence of underweight decreased by 43.2% (from 32.2% in 2004 to 18.3% in 2014) and 130.5% increase in overweight and obesity (from 10.5% in 2004 to 24.2% in 2014) were found over the ten years period. Age, educational status, wealth index and year were positively associated with overweight and obesity and negatively associated with underweight. Also, 'not being married' status for rural women were positively associated with underweight and negatively associated with overweight and obesity. Rural women were less likely to be overweight and obese (OR = 0.7, 95% CI: 0.7-0.8) while more likely to be underweight (OR = 1.1, 95% CI: 1.1-1.2) relative to urban women respectively. The likelihood of being overweight and obese was 4.5 times (95% CI: 4.1-4.9) higher among women who were in richest quintile compared to poorest women. They were also less likely to be underweight (OR = 0.4, 95% CI: 0.3-0.4) relative to same reference category. CONCLUSION: The double burden of malnutrition is evidently prevailing in Bangladesh. Over the ten years period, overweight and obesity has been raised tremendously but underweight did not fall significantly. This study suggests that strategies for preventing both underweight and overweight/obesity simultaneously among reproductive women need to be implemented considering regional context and their socioeconomic status (SES).

Socioeconomic correlates of overweight and obesity among ever-married urban women in Bangladesh.

BACKGROUND: The escalating prevalence of overweight and obesity globally is reflected amongst urban women in many low-to-middle income countries. Evidence also shows that overweight and obesity is an increasing trend in Bangladesh. The present study assessed the prevalence and socioeconomic determinants of overweight and obesity among urban women in Bangladesh. METHODS: Data were extracted from Bangladesh Demographic and Health Survey (BDHS) 2014. A two-stage stratified sampling technique has been used for data collection in this cross-sectional survey. A sample of 1701 ever-married non-pregnant urban women aged 15-49 years was selected for statistical analysis. Descriptive analysis, multiple binomial logistic regression analysis were executed in this study. RESULTS: The prevalence of overweight and obesity was 34% (95% CI, 0.30-0.38) among urban Bangladeshi women. The probability of being overweight and obese increased with increasing age and wealth index. The likelihood of being overweight and obese among the oldest women surveyed (40-49 years) was 4.3 times (OR = 4.3, 95% CI: 2.1-8.8) higher relative to the youngest women (15-19 years). The wealthiest women had 4.1 times (OR = 4.1, 95% CI: 2.5-6.7) higher likelihood of being overweight and obese compared to the reference group of poorest women. Women having higher education (OR = 1.7, 95% CI: 1.0-2.6) were more likely to be overweight and obese. However, women who were no longer living with their husband or separated from their husband were (OR = 0.4, 95% CI: 0.2-0.8) less likely to be overweight and obese. CONCLUSION: This study provides evidence that a large number of urban women were overweight and obese in Bangladesh. Women having higher levels of education, being older and belonging in both poorer and richest wealth quintile were at risk of being overweight and obese. Appropriate health promoting interventions based on these factors should be envisaged to reduce this problem.

Socio-economic risk factors for early childhood underweight in Bangladesh.

BACKGROUND: Underweight is a major cause of global disease burden. It is associated with child mortality and morbidity, and its adverse impact on human performance and child survival is well recognized. Underweight is a major public health problem in Bangladesh, which is amongst the highest underweight prevalent countries in the world. The objectives of our study were to determine the national and regional prevalence rates of underweight and severe underweight in Bangladesh, and to investigate the association of socioeconomic and demographic factors with child underweight and severely underweight among children under the age of five living in Bangladesh. METHODS: We performed a cross sectional study using Multiple Indicators Cluster Survey 2012-13, Bangladesh data on 17,133 children under 5 years of age. Weight-for-age Z scores based upon World Health Organization (WHO) guidelines were used to define child underweight and severe underweight. The association of underweight and severe underweight with household socioeconomic factors and demographic characteristics was investigated using binary logistic regression model. RESULTS: An estimated 31.67% children were underweight and 8.81% children were severely underweight. Children of mothers with incomplete secondary education [Odds Ratio (OR) = 0.84, 95% CI: 0.75, 0.94] and mothers with completed secondary education [Odds Ratio (OR) = 0.77, 95% CI: 0.64, 0.93] were less likely to be underweight than children of uneducated mothers who had no formal schooling. A similar association exists for father's education, children from households in the highest wealth index quintile had lower likelihood of underweight [Odds Ratio (OR) = 0.44, 95% CI: 0.37, 0.53] than children from households in the lowest quintile. Consumption of non-iodized salt had higher risk of severe underweight for children aged between 24 and 35 months [Odds Ratio (OR) = 2.32, 95% CI: 1.80, 3.00]. Other risk factors of child severe underweight included living in Sylhet division and increases in the number of children under the age of five in a household. CONCLUSION: Underweight was associated with lower parental education, household position in lower wealth index, living in Sylhet division and consumption of non-iodized salt. Strategies are discussed considering the relative importance of risk factors for child underweight.

Cost of illness for outpatients attending public and private hospitals in Bangladesh.

BACKGROUND: A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient's total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh. METHODS: The study used face to face interviews at three hospitals (one public and two private) to elicit cost data from presenting outpatients. Other socio-economic and demographic data was also collected. A sample of 252 outpatients were randomly selected and interviewed. The total cost of outpatients comprises direct medical costs, non-medical costs and the indirect costs of patients and caregivers. Indirect costs comprise travel and waiting times and income losses associated with treatment. RESULTS: The costs of illness are significant for many of Bangladesh citizens. The direct costs are relatively minor compared to the large indirect cost burden that illness places on households. These indirect costs are mainly the result of time off work and foregone wages. Private hospital patients have higher average direct costs than public hospital patients. However, average indirect costs are higher for public hospital patients than private hospital patients by a factor of almost two. Total costs of outpatients are higher in public hospitals compared to private hospitals regardless of patient's income, gender, age or illness. CONCLUSION: Overall, public hospital patients, who tend to be the poorest, bear a larger economic burden of illness and treatment than relatively wealthier private hospital patients. The large economic impacts of illness need a public policy response which at a minimum should include a national health insurance scheme as a matter of urgency.

Assessing willingness to pay for health care quality improvements.

BACKGROUND: Contingent valuation (CV) is used to estimate the willingness to pay (WTP) of consumers for specific attributes to improve the quality of health care they received in three hospitals in Bangladesh. METHODS: Random sample of 252 patients were interviewed to measure their willingness to pay for seven specified improvements in the quality of delivered medical care. Partial tobit regression and corresponding marginal effects analysis were used to analyze the data and obtain WTP estimates. RESULTS: Patients are willing to pay more if their satisfaction with three attributes of care are increased. These are: a closer doctor-patient relationship, increased drug availability and increased chances of recovery. The doctor patient relationship is considered most important by patients and exhibited the highest willingness to pay. CONCLUSIONS: This study provides important information to policy makers about the monetary valuation of patients for improvements in certain attributes of health care in Bangladesh.

Risk factors for child stunting in Bangladesh: an analysis using MICS 2019 data.

BACKGROUND: Malnutrition is considered a major public health challenge and is associated with a range of health issues, including childhood stunting. Stunting is a reliable and well-recognized indicator of chronic childhood malnutrition. The objective of this study is to determine the risk factors associated with stunting among 17,490 children below five years of age in Bangladesh. METHODS: Correlates of child stunting were examined using data generated by a cross-sectional cluster survey conducted in Bangladesh in 2019. The data includes a total of 17,490 children (aged < 5 years) from 64,400 households. Multiple logistic regressions were used to determine the risk factors associated with child stunting and severe stunting. RESULTS: The prevalence of stunting and severe stunting for children was 25.96% and 7.97%, respectively. Children aged 24 to < 36 months [Odds Ratio (OR) = 2.65, 95% CI: 2.30, 3.05] and aged 36 to < 48 months [OR = 2.33, 95% CI: 2.02, 2.69] had more risk of stunting compared to the children aged < 6 months. Children from Sylhet division had the greatest risk of stunting of all the eight divisions [OR = 1.26, 95% CI: 1.09, 1.46]. Children of secondary complete or higher educated mothers were less likely to develop stunting [OR = 0.66, 95% CI: 0.56, 0.79] compared with children of mothers having no education at all. Similarly, children of secondary complete or higher educated father [OR = 0.74, 95% CI: 0.63, 0.87] were found to have lower risk of stunting compared with children whose father hadn't any education. Substantially lower risk of stunting was observed among children whose mother and father both completed secondary education or above [OR = 0.59, 95% CI: 0.52, 0.69]. Children from the richest households [OR = 0.49, 95% CI: 0.41, 0.58] had 51% lower odds of stunting compared to children from the poorest households. CONCLUSIONS: After controlling for socioeconomic and demographic factors, parental education and household position in the wealth index were found to be the most important determinants of child stunting in Bangladesh.

Dietary habits, physical activity, and sedentary behaviour of children of employed mothers: A systematic review.

Since approximately 40% of the global workforce are women, a comprehensive understanding of association of maternal employment with child dietary patterns, physical activity and sedentary behaviour needs more focus. This systematic review aims to identify the association between maternal employment and dietary patterns (DP), physical activity (PA) and sedentary behaviour (SB) of children and adolescents (6 to 18 years). Searches were performed using electronic databases and manual searches. Peer reviewed journal articles, conference papers, theses at masters/doctoral levels in English were included. A total 42 studies met selection criteria, which indicated associations between maternal employment and at least one of the domains of interest: DP, PA and/or SB. Using individual samples of analysis, it was found that, 9 samples of DP, 11 samples of PA and 12 samples of SB were positively correlated with maternal employment, whereas 25 samples of DP, 5 samples of PA and 5 samples of SB showed an opposite association. Results suggest that PA and SB were positively related with maternal employment, whereas DP had an inverse relationship. Findings from this review provide evidence that children of employed mothers had poorer DP and greater prevalence of SB, however, their children are more physically active. Future interventions need to create a positive environment at the workplace and for families to support employed mothers and improve children's dietary patterns and decrease sedentary behaviours. Future studies should prioritise the domains of DP, PA and SB that have been studied inadequately and have inconsistent results.

Factors associated with stunting and wasting in children under 2 years in Bangladesh.

Child undernutrition has been a major concern for Bangladesh as it is amongst the highest stunting and wasting prevalent countries in the world. The objective of our study was to explore the socioeconomic determinants of stunting and wasting in children under two years. This study explored nationally representative sample of 7,230 children ranging in age from 0 to <24 months using two separate binary logistic regression models to determine the risk factors associated with child stunting and wasting. Our study estimated approximately 33 percent children to be stunted and 11 percent to be wasted. Our analysis found that, 12 to <24 months old children's height-for-age-z-score and weight-for-height-z-score deteriorated in comparison to those of below 6 months. Female children had significantly lower odds of stunting and wasting compared with male children. Study revealed that children from wealthier families were at lower risk of being stunted and wasted compared to children from poorer households. Parental education was determined as a significant predictor of stunting. Children who lived in Sylhet division were 1.26 times more likely to be stunted than the children of Dhaka division [OR = 1.26; 95% CI: 1.02-1.55]. Our study revealed age, gender, geographic distribution, and household's position in wealth index as common determinants of child stunting and wasting in Bangladesh. While parental education was significant predictor for child stunting, type of toilet facility was found as statistically significant determinant of child wasting in children of less than two years age.

Waste management in the meat processing industry: Conversion of paunch and DAF sludge into solid fuel.

This article addresses the novel dewatering process of immersion-frying of paunch and dissolved air flotation (DAF) sludge to produce high energy pellets. Literature have been analysed to address the feasibility of replacing conventional boiler fuel at meat processing facilities with high energy paunch-DAF sludge pellets (capsules). The value proposition of pelleting and frying this mixture into energy pellets is based on a Cost-Benefit Analysis (CBA). The CBA is based on information derived from the literature and consultation with the Australian Meat Processing Industry. The calorific properties of a mixture of paunch cake solids and DAF sludge were predicted from literature and industry consultation to validate the product. This study shows that the concept of pelletizing and frying paunch is economically feasible. The complete frying and dewatering of the paunch and DAF sludge mixture produces pellets with energy content per kilogram equivalent to coal. The estimated cost of this new product is half the price of coal and the payback period is estimated to be between 1.8 and 3.2years. Further research is required for proof of concept, and to identify the technical challenges associated with integrating this technology into existing meat processing plants.