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1.
Front Public Health ; 12: 1390107, 2024.
Article in English | MEDLINE | ID: mdl-38962774

ABSTRACT

Early childhood is foundational for optimal and inclusive lifelong learning, health and well-being. Young children with disabilities face substantial risks of sub-optimal early childhood development (ECD), requiring targeted support to ensure equitable access to lifelong learning opportunities, especially in low- and middle-income countries. Although the Sustainable Development Goals, 2015-2030 (SDGs) emphasise inclusive education for children under 5 years with disabilities, there is no global strategy for achieving this goal since the launch of the SDGs. This paper explores a global ECD framework for children with disabilities based on a review of national ECD programmes from different world regions and relevant global ECD reports published since 2015. Available evidence suggests that any ECD strategy for young children with disabilities should consists of a twin-track approach, strong legislative support, guidelines for early intervention, family involvement, designated coordinating agencies, performance indicators, workforce recruitment and training, as well as explicit funding mechanisms and monitoring systems. This approach reinforces parental rights and liberty to choose appropriate support pathway for their children. We conclude that without a global disability-focussed ECD strategy that incorporates these key features under a dedicated global leadership, the SDGs vision and commitment for the world's children with disabilities are unlikely to be realised.


Subject(s)
Child Development , Disabled Children , Humans , Child, Preschool , Global Health , Sustainable Development , Developing Countries , Infant , Child , Early Intervention, Educational
2.
Memory ; : 1-13, 2024 Jul 04.
Article in English | MEDLINE | ID: mdl-38963910

ABSTRACT

Wang and Conway (2006, Autobiographical memory, self, and culture. In L.-G. Nilsson, & N. Ohta (Eds.), Memory and society: Psychological perspectives (pp. 9-27). Psychology Press) posit that remembering takes place in a culturally modulated self-memory system in which working self-goals are shaped by society and, in turn, influence the encoding and construction of memories in a culturally canonical fashion. The current research examined the self-goal of competence, which manifests through self-enhancement versus self-improvement motivations, in influencing remembering in different cultural contexts. We conducted two cross-cultural studies to examine memories for personal successes and failures (Study 1) and autobiographical and vicarious experiences (Study 2) in connection with individuals' positive self-views. European Americans recalled a greater number of success than failure memories (Study 1) and US participants recalled a greater number of autobiographical than vicarious memories (Study 2), which was further associated with positive self-views at the individual level. In contrast, Asian (Study 1) and Chinese participants (Study 2) recalled even-handedly the different types of memories, and the memory retrieval was unrelated to individuals' self-views. We discuss the findings in light of the different manifestations of the competence goal in shaping memory in the culturally modulated self-memory system.

3.
Article in English | MEDLINE | ID: mdl-38981962

ABSTRACT

This study examines the connection between economic policy uncertainty (EPU), CO2 emissions, and financial inclusion in developed and developing countries. Using the data from 2004 to 2021, advanced statistical techniques are employed, including Sobel test, to explore the mediating effect of financial inclusion on the relationship between economic policy uncertainty (EPU) and CO2 emissions. There is a dearth of research examining these three variables together in a single study. Similarly, using financial inclusion as a mediator in the relation of EPU and CO2 emissions is a novel concept. This article employs a multi-indicator approach to measure key variables like CO2 emissions and financial inclusion. The results indicate that uncertainties in economic policies contribute in practices that lead to higher CO2 emissions in overall panel data of 44 countries. In addition, when considering the relationship between EPU and FI, the results indicate a significant and negative relationship between EPU and FI. If there is uncertainty in economic policies, it may lead toward challenges and hurdles in financial inclusion. When the mediating affect was checked, it was found financial inclusion acts as a significant mediator in the relationship between EPU and CO2 emissions, depicting that financial inclusion fosters the environmental quality and mitigates the potential harmful effects of environmental aspects of economic policy uncertainty. Therefore, policies that promote financial inclusion should be given top priority by governments, particularly in emerging nations. Financial literacy and bank service accessibility should be promoted. These measures would lessen the impact of staggering economic policies on CO2 emissions. It is necessary for policymakers to include environmental factors, specifically those relating to carbon emissions, into economic strategies. This requires encouraging industries to adopt eco-friendly practices and coordinating economic strategies with sustainability objectives.

5.
AIDS Care ; : 1-8, 2024 Jul 03.
Article in English | MEDLINE | ID: mdl-38958153

ABSTRACT

ABSTRACTJustice-impacted persons may inconsistently access HIV testing. This cross-sectional secondary analysis investigates lifetime HIV testing prevalence among adults with prior histories of incarceration in Southern California, United States, participating in health-focused programming (n = 3 studies). Self-reported demographic and lifetime HIV testing data were collected between 2017-2023; descriptive analyses were conducted. Across the three samples, at least 74% of participants were male; Latino and African American individuals accounted for nearly two-thirds of participants. Lifetime HIV testing ranged from 72.8% to 84.2%. Males were significantly more likely than females to report never being tested in two samples and accounted for >95% of those never tested. No statistically significant differences in testing were observed by race/ethnicity. Single young adults (ages 18-26) were less likely than their partnered peers to report testing. HIV testing is critical for ensuring that individuals access prevention and treatment. HIV testing among justice-impacted adults in this study was higher than in the general population, potentially due to opt-out testing in correctional settings. Nevertheless, these findings underscore the importance of implementing targeted interventions to reduce structural (e.g., health insurance, access to self-testing kits) and social barriers (e.g., HIV stigma) to increase HIV testing among justice-impacted males and single young adults.

6.
J Youth Adolesc ; 2024 Jul 04.
Article in English | MEDLINE | ID: mdl-38963580

ABSTRACT

Numerous studies have sought to determine whether low self-esteem acts as a risk factor for depressive symptoms (i.e., a vulnerability model) or whether depressive symptoms lead to a decrease in self-esteem (i.e., a scar model). Although both models have received some support, very little research has: (a) addressed this question across critical life transitions likely to modify this pattern of associations, such as the transition to adulthood; (b) sought to identify the psychological mechanisms (i.e., mediators) underpinning these associations. The present study was designed to address these two limitations, focusing on the directionality of the associations between depressive symptoms and self-esteem from mid-adolescence to early adulthood while considering the role of motivational factors, namely mastery (intrinsic/extrinsic) and performance (approach/avoidance) goals as conceptualized in achievement goal theory. A sample of 707 Finnish adolescents aged 15-16 (52.1% boys) was surveyed six times up to the age of 25. Results from a cross-lagged panel model (CLPM) revealed that depressed individuals were more likely to have low self-esteem, although self-esteem protected against depressive symptoms between ages 16-17 to 20-21. Moreover, while self-esteem promoted mastery-extrinsic goals which in turn reinforced self-esteem, depressive symptoms promoted performance-avoidance goals which led to more depressive symptoms and lower self-esteem. Overall, these findings highlight (1) the long-lasting negative consequences of depressive symptoms on self-esteem and (2) the crucial role played by academic motivation in explaining the development of depressive symptoms and self-esteem over time. In turn, these results help refine the vulnerability and scar models, and suggest that motivational factors should be considered in prevention and intervention efforts among young populations.

7.
Sci Rep ; 14(1): 15221, 2024 Jul 02.
Article in English | MEDLINE | ID: mdl-38956104

ABSTRACT

Municipal wastewater treatment systems use the chemical oxygen demand test (COD) to identify organic contaminants in industrial effluents that impede treatment due to their high concentration. This study reduced the COD levels in tannery wastewater using a multistage treatment process that included Fenton oxidation, chemical coagulation, and nanotechnology based on a synthetic soluble COD standard solution. At an acidic pH of 5, Fenton oxidation reduces the COD concentration by approximately 79%. It achieves this by combining 10 mL/L of H2O2 and 0.1 g/L of FeCl2. Furthermore, the author selected the FeCl3 coagulant for the coagulation process based on the best results of comparisons between different coagulants. At pH 8.5, the coagulation dose of 0.15 g/L achieved the maximum COD removal efficiency of approximately 56.7%. Finally, nano bimetallic Fe/Cu was used to complete the degradation and adsorption of the remaining organic pollutants. The XRD, SEM, and EDX analyses proved the formation of Fe/Cu nanoparticles. A dose of 0.09 g/L Fe/Cu NPs, 30 min of contact time, and a stirring rate of 200 rpm achieve a maximum removal efficiency of about 93% of COD at pH 7.5. The kinetics studies were analyzed using pseudo-first-order P.F.O., pseudo-second-order P.S.O., and intraparticle diffusion models. The P.S.O. showed the best fit among the kinetic models, with an R2 of 0.998. Finally, the authors recommended that technique for highly contaminated industrial effluents treatment for agriculture or industrial purposes.

8.
AIDS Care ; : 1-8, 2024 Jul 11.
Article in English | MEDLINE | ID: mdl-38991109

ABSTRACT

Antiretroviral therapy (ART) has been adopted as a form of HIV treatment and prevention. This study assesses rapid ART initiation using clinical outcomes such as viral load (VL) and CD4+ T lymphocytes count. Over the course of one year, the progress of newly diagnosed people living with HIV who started ART early in a hospital in Panama City was followed. The evaluation of early initiation of ART in achieving viral suppression (VL <200 copies/ml) was analyzed using descriptive statistics. Additionally, the cost difference between early (first 7 days) and late initiation of ART was evaluated from the perspective of the service provider. In total, 209 people were followed up during the study; 85% were male, 70% started ART on same day from hospital arrival, 80% had suppressed viral load at 6 months, and the median count of CD4 increased from 285 (IQR: 166-429) to 509 (IQR: 373-696) over 12 months. Starting ART early led to a 42% increase for the provider in terms of staffing costs; however, the clients had the opportunity to decrease absenteeism in daily activities. The results reveal that early initiation of ART generates clinical and economic benefits for the person in treatment.

9.
Alzheimers Dement (N Y) ; 10(3): e12493, 2024.
Article in English | MEDLINE | ID: mdl-39011459

ABSTRACT

Introduction: Person-centered goals capture individual priorities in personal contexts. Goal Attainment Scaling (GAS) has been used in drug trials involving people living with dementia (PLWD) but GAS has been characterized as difficult to incorporate into trials and clinical practice. We used GAS in a trial of New Interventions for Independence in Dementia Study (NIDUS)-family, a manualized care and support intervention, as the primary outcome and to tailor the interventions to goals set. We aimed to assess the feasibility and content of baseline goal-setting. Methods: We developed training for nonclinical facilitators to set individualized GAS goals remotely with PLWD and family carer dyads, or carers alone, in the intervention trial, during the COVID-19 pandemic. A qualitative content analysis of the goals set explored participants' priorities and unmet needs, to consider how existing GAS goal domains might be extended in a psychosocial intervention trial context. Results: Eleven facilitators were successfully trained to set and score GAS goals. A total of 313/328 (95%) participants were able to collaboratively set three to five goals with the facilitators. Of these, 302 randomized participating dyads set 1043 (mean 3.5, range 3 to 5) goals. We deductively coded 719 (69%) goals into five existing GAS domains (mood, behavior, self-care, cognition, and instrumental activities of daily living); 324 (31%) goals were inductively coded into four new domains: carer break, carer mood, carer behavior, and carer sleep. The most frequently set goals pertained to social support. There was little variation in types of goals set based on the context of who set them or level of pandemic restrictions in place. Discussion: It is feasible for people without clinical training to set GAS holistic goals for PLWD and family carers in the community. GAS has potential to facilitate personalization of care and support interventions, such as NIDUS-family, and facilitate the roll out of more personalized care. Highlights: Goal Attainment Scaling (GAS) can capture meaningful priorities of people with dementia and their family carers.A psychosocial intervention RCT used GAS as the primary outcome measure and goals were set collaboratively by non-clinically trained facilitators.The findings underscore the feasibility of using GAS as an outcome measure with this population.The content analysis findings unveiled the diversity in experiences and priorities of the study participants.GAS has the potential to support the implementation of more person-centred approaches to dementia care.

10.
Prog Neurobiol ; 240: 102653, 2024 Jul 02.
Article in English | MEDLINE | ID: mdl-38960002

ABSTRACT

We present here a view of the firing patterns of hippocampal cells that is contrary, both functionally and anatomically, to conventional wisdom. We argue that the hippocampus responds to efference copies of goals encoded elsewhere; and that it uses these to detect and resolve conflict or interference between goals in general. While goals can involve space, hippocampal cells do not encode spatial (or other special types of) memory, as such. We also argue that the transverse circuits of the hippocampus operate in an essentially homogeneous way along its length. The apparently different functions of different parts (e.g. memory retrieval versus anxiety) result from the different (situational/motivational) inputs on which those parts perform the same fundamental computational operations. On this view, the key role of the hippocampus is the iterative adjustment, via Papez-like circuits, of synaptic weights in cell assemblies elsewhere.

11.
BMC Public Health ; 24(1): 1855, 2024 Jul 11.
Article in English | MEDLINE | ID: mdl-38992642

ABSTRACT

INTRODUCTION: The United Nations established the Sustainable Development Goals (SDGs) in 2015 to enhance global development. In this study, we examine an SDG indicator: the percentage of women aged 15-49 whose family planning needs are met by modern contraception (mDFPS). We evaluate both the factors influencing its coverage and its progress since 2015. METHODS: We used nationally representative surveys data (Demographic and Health Surveys (DHS) and Performance Monitoring for Action (PMA)) from Ethiopia, Kenya, and Nigeria. We assessed predictors of mDFPS. We also computed mDFPS coverage across countries and subnational areas, assessing coverage changes from the SDGs onset to the most recent period, using a Bayesian model-based geostatistical approach. We assessed whether the subnational areas exceeded the minimum recommended WHO mDFPS coverage of 75%. RESULTS: Varied individual and community-level determinants emerged, highlighting the countries' uniqueness. Factors such as being part of a female-headed household, and low household wealth, lowered the odds of mDFPS, while rural-residence had low odds only in Ethiopia and Nigeria. The results indicate mDFPS stagnation in most administrative areas across the three countries. Geographic disparities persisted over time, favouring affluent regions. The predicted posterior proportion of mDFPS and exceedance probability (EP) for WHO target for Ethiopia was 39.85% (95% CI: [4.51, 83.01], EP = 0.08) in 2016 and 46.28% (95% CI: [7.15, 85.99], EP = 0.13) in 2019. In Kenya, the adjusted predicted proportion for 2014 was 30.19% (95% CI: [2.59, 80.24], EP = 0.06) and 44.16% (95%CI: [9.35, 80.24], EP = 0.13) in 2022. In Nigeria, the predicted posterior proportion of mDFPS was 17.91% (95% CI: [1.24, 61.29], EP = 0.00) in 2013, and it was 23.08% (95% CI: [1.80, 56.24], EP = 0.00) in 2018. None of the sub-national areas in Ethiopia and Nigeria exceeded the WHO target. While 9 out of 47 counties in Kenya in 2022 exceeded the WHO mDFPS target. CONCLUSION: The study unveils demographic, geographic, and socioeconomic mDFPS disparities, signalling progress and stagnation across administrative areas. The findings offer policymakers and governments insights into targeting interventions for enhanced mDFPS coverage. Context-specific strategies can address local needs, aiding SDG attainment.


Subject(s)
Family Planning Services , Humans , Female , Adolescent , Adult , Nigeria , Young Adult , Middle Aged , Ethiopia , Kenya , Family Planning Services/statistics & numerical data , Contraception/statistics & numerical data , Bayes Theorem , Health Services Needs and Demand , Socioeconomic Factors , Health Surveys , Sustainable Development
12.
Front Psychol ; 15: 1355213, 2024.
Article in English | MEDLINE | ID: mdl-38993339

ABSTRACT

Introduction: Across various cultural contexts, success in goal realization relates to individuals' well-being. Moreover, commitment to and successful pursuance of goals are crucial when searching for a meaningful identity in adolescence. However, individuals' goals differ in how much they match their implicit motive dispositions. We hypothesized that successful pursuance of affiliation goals positively relates to commitment-related dimensions of interpersonal identity development (domain: close friends) that, in turn, predict adolescents' level of well-being. However, we further assumed that the links between goal success and identity commitment are particularly pronounced among adolescents who are characterized by a high implicit affiliation motive. Methods: To scrutinize the generalizability of the assumed relationships, data were assessed among adolescents in individualistic (Germany) and collectivistic (Zambia) cultural contexts. Results: Regardless of adolescents' cultural background, we found that commitment-related dimensions of interpersonal identity development mediate the link between successful attainment of affiliation goals and well-being, particularly among adolescents with a pronounced implicit affiliation motive; that is, the strength of the implicit affiliation motive moderates the association between goal success and identity commitment. Conclusion: We discuss findings concerning universal effects of implicit motives on identity commitment and well-being.

13.
Front Psychol ; 15: 1362920, 2024.
Article in English | MEDLINE | ID: mdl-38993334

ABSTRACT

Objective: This study aims to investigate the mediating role of achievement goals in the relationship between teachers' zest for work and teaching motivation. Method: The research was designed using the relational survey model. The research sample consisted of 518 teachers working in various cities in Turkey in 2023-2024 academic year fall semester. A convenience sampling method was used in sampling. Three Likert-type scales were used as data collection tools. In the data analysis, firstly, the data suitability to normal distributions was examined. As a result of the analysis, kurtosis and skewness values were examined and it was assumed that the data were normally distributed. SPSS Process extension was used to analyze the data. Results and discussion: According to the research results, teachers' zest for work positively and significantly predicted strong and positive achievement goals. In addition, teachers' achievement goals significantly and positively predicted their teaching motivation. Additionally, teachers' zest for work positively and significantly predicted their teaching motivation. Moreover, it can be inferred that achievement goals for students have a mediating role in the relationship between teachers' zest for work and teaching motivation. In this context, it is suggested that policies that increase teachers' teaching motivation should be prioritized.

14.
EClinicalMedicine ; 73: 102682, 2024 Jul.
Article in English | MEDLINE | ID: mdl-39007064

ABSTRACT

Background: Sub-Saharan Africa (SSA) has the highest burden of neonatal mortality in the world. Identifying the most critical modifiable risk factors is imperative for reducing neonatal mortality rates. This study is the first to calculate population-attributable fractions (PAFs) for modifiable risk factors of neonatal mortality in SSA. Methods: We analysed the most recent Demographic and Health Surveys data sets from 35 SSA countries conducted between 2010 and 2022. Generalized linear latent and mixed models were used to estimate odds ratios (ORs) along with 95% confidence intervals (CIs). PAFs adjusted for communality were calculated using ORs and prevalence estimates for key modifiable risk factors. Subregional analyses were conducted to examine variations in modifiable risk factors for neonatal mortality across Central, Eastern, Southern, and Western SSA regions. Findings: In this study, we included 255,891 live births in the five years before the survey. The highest PAFs of neonatal mortality among singleton children were attributed to delayed initiation of breastfeeding (>1 h after birth: PAF = 23.88%; 95% CI: 15.91, 24.86), uncleaned cooking fuel (PAF = 5.27%; 95% CI: 1.41, 8.73), mother's lacking formal education (PAF = 4.34%; 95% CI: 1.15, 6.31), mother's lacking tetanus vaccination (PAF = 3.54%; 95% CI: 1.55, 4.92), and infrequent antenatal care (ANC) visits (PAF = 2.45; 95% CI: 0.76, 3.63). Together, these five modifiable risk factors were associated with 39.49% (95% CI: 21.13, 48.44) of neonatal deaths among singleton children in SSA. Our subregional analyses revealed some variations in modifiable risk factors for neonatal mortality. Notably, delayed initiation of breastfeeding consistently contributed to the highest PAFs of neonatal mortality across all four regions of SSA: Central, Eastern, Southern, and Western SSA. Interpretation: The PAF estimates in the present study indicate that a considerable proportion of neonatal deaths in SSA are preventable. We identified five modifiable risk factors that accounted for approximately 40% of neonatal deaths in SSA. The findings have policy implications. Funding: None.

16.
Glob Public Health ; 19(1): 2371389, 2024 Jan.
Article in English | MEDLINE | ID: mdl-39003749

ABSTRACT

Sexual violence in humanitarian contexts is a global public health issue. Yet, evidence suggests that humanitarian organisations may not always be inclusive of cisgender, heterosexual men and LGBTIQ+ survivors in their responses. This scoping review examines the extent to which global organisations focusing on sexual and gender-based violence (SGBV) address the needs of cisgender, heterosexual men and LGBTIQ+ survivors in service delivery and funding priorities. We examined grey literature published from 2013-2023 on SGBV service delivery and funding priorities in humanitarian contexts. Forty-seven documents were included in the final analyses, which comprised content and thematic analyses. Many of the documents acknowledged cisgender, heterosexual men or LGBTIQ+ individuals as at-risk groups; however, there was a lack of comprehensive discussion of these groups. Documents on LGBTIQ+ individuals referred to the group as a monolith, making little distinction among the LGBTIQ+ experience and the need to tailor responses to meet intersectional needs. Documents on men emphasised their role as perpetrators and allies, while overlooking that they also experience sexual violence. Findings support the critical need to address gaps in humanitarian programme and donor priorities to better ensure inclusion of cisgender, heterosexual men and LGBTIQ+ individuals without ignoring the needs of women and girls.


Subject(s)
Altruism , Sex Offenses , Sexual and Gender Minorities , Survivors , Humans , Male , Female , Heterosexuality , Delivery of Health Care
17.
Front Sports Act Living ; 6: 1348983, 2024.
Article in English | MEDLINE | ID: mdl-38947867

ABSTRACT

This study employs Bayesian methodologies to explore the influence of player or positional factors in predicting the probability of a shot resulting in a goal, measured by the expected goals (xG) metric. Utilising publicly available data from StatsBomb, Bayesian hierarchical logistic regressions are constructed, analysing approximately 10,000 shots from the English Premier League (for the years of 2003 and 2015) to ascertain whether positional or player-level effects impact xG. The findings reveal positional effects in a basic model that includes only distance to goal and shot angle as predictors, highlighting that strikers and attacking midfielders exhibit a higher likelihood of scoring. However, these effects diminish when more informative predictors are introduced. Nevertheless, even with additional predictors, player-level effects persist, indicating that certain players possess notable positive or negative xG adjustments, influencing their likelihood of scoring a given chance. The study extends its analysis to data from Spain's La Liga ( ≈ 20 K shots from 1973 and 2004 to 2020) and Germany's Bundesliga ( ≈ 7.5 K shots from 2015), yielding comparable results. Additionally, the paper assesses the impact of prior distribution choices on outcomes, concluding that the priors employed in the models provide sound results but could be refined to enhance sampling efficiency for constructing more complex and extensive models feasibly.

18.
Aggress Behav ; 50(4): e22163, 2024 06.
Article in English | MEDLINE | ID: mdl-38949228

ABSTRACT

Whereas research on aggression and status motivation in youth has predominantly looked at a promotion focus (striving for popularity), a prevention focus (wanting to avoid low popularity) could also be an important determinant of aggression, as youth who fear low popularity may use strategic aggression to secure their position. The aim of the current study was to develop reliable measures for both popularity motivations, and examine how both motivations are uniquely and jointly related to aggression. Participants were 1123 Dutch secondary school students (M age = 14.4 years, 48% girls), who completed a 3-item measure of striving for high popularity based on existing questionnaires (Li & Wright, 2014; Ojanen et al., 2005), and a 3-item measure of avoiding low popularity consisting of an adapted version of the high popularity items. Aggressive behavior was measured through peer nominations. Motivations were moderately correlated (r = .51), but did not always co-occur within the same person, as 17% of the sample belonged to a cluster that scored low on striving for popularity, but moderately high on avoiding low popularity. When considered simultaneously, striving for high popularity was not related to any type of aggression, whereas avoiding affiliation with unpopular peers was related to strategic aggression. For physical and verbal aggression, gossiping, excluding and bullying, the association of avoiding low popularity with aggression was strongest when youth also strived for high popularity. Future work should take both popularity motivations into account to better understand, predict and intervene on youth's aggression toward peers.


Subject(s)
Adolescent Behavior , Aggression , Motivation , Humans , Aggression/psychology , Female , Adolescent , Male , Adolescent Behavior/psychology , Peer Group , Social Desirability , Students/psychology , Netherlands , Bullying/psychology , Surveys and Questionnaires
19.
Article in English | MEDLINE | ID: mdl-38951318

ABSTRACT

This study considers a hypothetical global pediatric vaccine market where multiple coordinating entities make optimal procurement decisions on behalf of countries with different purchasing power. Each entity aims to improve affordability for its countries while maintaining a profitable market for vaccine producers. This study analyzes the effect of several factors on affordability and profitability, including the number of non-cooperative coordinating entities making procuring decisions, the number of market segments in which countries are grouped for tiered pricing purposes, how producers recover fixed production costs, and the procuring order of the coordinating entities. The study relies on a framework where entities negotiate sequentially with vaccine producers using a three-stage optimization process that solves a MIP and two LP problems to determine the optimal procurement plans and prices per dose that maximize savings for the entities' countries and profit for the vaccine producers. The study's results challenge current vaccine market dynamics and contribute novel alternative strategies to orchestrate the interaction of buyers, producers, and coordinating entities for enhancing affordability in a non-cooperative market. Key results show that the order in which the coordinating entities negotiate with vaccine producers and how the latter recuperate their fixed cost investments can significantly affect profitability and affordability. Furthermore, low-income countries can meet their demands more affordably by procuring vaccines through tiered pricing via entities coordinating many market segments. In contrast, upper-middle and high-income countries increase their affordability by procuring through entities with fewer and more extensive market segments. A procurement order that prioritizes entities based on the descending income level of their countries offers higher opportunities to increase affordability and profit when producers offer volume discounts.

20.
BMC Pediatr ; 24(1): 429, 2024 Jul 04.
Article in English | MEDLINE | ID: mdl-38965471

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) is a significant public health problem. The burden of CKD in children and adolescents in India is not well described. We used data from the recent Comprehensive National Nutrition Survey (CNNS) to estimate the prevalence of impaired kidney function (IKF) and its determinants in children and adolescents between the ages of 5 and 19. METHODS: CNNS 2016-18 adopted a multi-stage sampling design using probability proportional to size sampling procedure after geographical stratification of urban and rural areas. Serum creatinine was tested once in 24,690 children and adolescents aged 5-19 years. The estimated glomerular filtration rate (eGFR) was derived using the revised Schwartz equation. The eGFR value below 60 ml/min/1.73 m2 is defined as IKF. Bivariate analysis was done to depict the weighted prevalence, and multivariable logistic regression examined the predictors of IKF. RESULTS: The mean eGFR in the study population was 113.3 + 41.4 mL/min/1.73 m2. The overall prevalence of IKF was 4.9%. The prevalence in the 5-9, 10-14, and 15-19 year age groups was 5.6%, 3.4% and 5.2%, respectively. Regression analysis showed age, rural residence, non-reserved social caste, less educated mothers, Islam religion, children with severe stunting or being overweight/obese, and residence in Southern India to be predictors of IKF. CONCLUSIONS: The prevalence of IKF among children and adolescents in India is high compared to available global estimates. In the absence of repeated eGFR-based estimates, these nationally representative estimates are intriguing and call for further assessment of socio-demographic disparities, genetics, and risk behaviours to have better clinical insights and public health preparedness.


Subject(s)
Glomerular Filtration Rate , Nutrition Surveys , Renal Insufficiency, Chronic , Humans , Adolescent , India/epidemiology , Child , Female , Prevalence , Male , Child, Preschool , Young Adult , Renal Insufficiency, Chronic/epidemiology , Risk Factors , Cross-Sectional Studies , Creatinine/blood
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