Is educational attainment associated with the onset and outcomes of low back pain? a systematic review and meta-analysis.

BACKGROUND: Low back pain (LBP) is the leading global cause of years lived with disability. Of the biopsychosocial domains of health, social determinants of LBP remain under-researched. Socioeconomic status (SES) may be associated with the onset of new LBP or outcomes of acute LBP, with educational attainment (EA) being a key component of SES. The association between EA and LBP has yet to be the subject of a dedicated review and meta-analysis. PURPOSE: To review evidence of the association between EA and a) onset or b) outcomes of acute and subacute LBP in the adult general population and to conduct statistical pooling of data where possible. METHODS: An electronic search was conducted in MEDLINE, Embase, CINAHL, and ProQuest from inception to 2nd November 2023 including reference lists to identify relevant prospective studies. Risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool. Where adequate data were available, estimates were pooled using a random-effects meta-analysis. Overall evidence for each outcome was graded using an adapted GRADE. RESULTS: After screening 8498 studies, 29 were included in the review. Study confounding and attrition were common biases. Data from 19 studies were statistically pooled to explore EA as a predictor of new LBP onset or as prognostic for outcomes of acute or subacute LBP. Pooled results showed no association between EA and the onset of new LBP (OR: 0.927, 95%CI: 0.747 to 1.150; I2 = 0%). For predicting outcomes of acute LBP, compared to those with no more than secondary-level education, post-secondary education or higher was associated with better outcomes of pain (OR: 0.538, 95%CI: 0.432 to 0.671; I2 = 35%) or disability (OR: 0.565, 95%CI: 0.420 to 0.759; I2 = 44%). High heterogeneity (I2>80%) prevented meaningful pooling of estimates for subacute LBP outcomes. CONCLUSION: We found no consistent evidence that lower EA increases the risk of LBP onset. Lower EA shows a consistent association with worse LBP outcomes measured at least 3 months later after acute onset with inconclusive findings in subacute LBP. Causation cannot be supported owing to study designs. High-quality research is needed on potential mechanisms to explain these effects.

Grandparents' educational attainment is associated with grandchildren's epigenetic-based age acceleration in the National Growth and Health Study.

We examined three generations (grandparents, mothers, and grandchildren) to assess the association between grandparents' educational attainment and their grandchildren's epigenetic-based age acceleration and whether the association was mediated by parental educational attainment and mothers' life course health-related factors. Mothers were recruited to the NHLBI Growth and Health Study at 9-10 years and followed for 10 years (1987-1998). Mothers were then re-contacted three decades later (ages 37-42) to participate in the National Growth and Health Study (NGHS), and health information from their youngest child (i.e., grandchildren; N = 241, ages 2-17) was collected, including their saliva samples to calculate epigenetic age. Five epigenetic-based age acceleration measures were included in this analysis, including four epigenetic clock age accelerations (Horvath, Hannum, GrimAge, and PhenoAge) and DunedinPACE. Grandparents reported their highest education during the initial enrollment interviews. Parental educational attainment and mothers' life course health-related factors (childhood BMI trajectories, adult cardiovascular health behavioral risk score, and adult c-reactive protein) are included as mediators. Grandparents' education was significantly associated with Horvath age acceleration (b = -0.32, SE = 0.14, p = 0.021). Grandchildren with college-degree grandparents showed significantly slower Horvath age accelerations than those without college degrees. This association was partially mediated by parental education and mothers' health-related factors, especially adult cardiovascular health behavioral risk score and CRP, but not mothers' childhood BMI trajectory. This ability to conserve the speed of biological aging may have considerable consequences in shaping health trajectories across the lifespan.

Exploring the state and influential factors of dental caries in preschool children aged 3-6 years in Xingtai City.

OBJECTIVE: To explore the main factors affecting early dental caries among preschool children aged 3-6 years in Xingtai City to formulate effective preventive measures. METHODS: A cross-sectional study was conducted on 570 preschool children aged 3-6 years in Xingtai City through questionnaire surveys and oral examinations to understand their dental caries situation. Multifactorial logistic regression analysis was used to analyse the main influencing factors for the occurrence of dental caries in preschool children. RESULTS: Univariate analysis showed statistically significant differences in age (χ2 = 2.636, p = 0.008), father's education level (χ2 = 4.207, p < 0.001), mother's education level (χ2 = 4.217, p < 0.001), daily tooth brushing frequency (χ2 = 3.160, p = 0.002), age of starting tooth brushing (χ2 = 8.756, p < 0.001), mouth rinsing after meals (χ2 = 89.401, p < 0.001), Streptococcus mutans positivity (χ2 = 133.503, p < 0.001), non-sweet snack consumption frequency (χ2 = 5.962, p < 0.001), snack flavour preference (χ2 = 116.119, p < 0.001), use of fluoridated toothpaste (χ2 = 75.639, p < 0.001), regular oral examinations (χ2 = 98.711, p < 0.001), sugary drink consumption frequency (χ2 = 10.370, p < 0.001) and sweet food consumption frequency (χ2 = 9.261, p < 0.001) between the caries and non-caries groups. Multifactorial analysis revealed that older age (odds ratio [OR] = 5.342, 95% confidence interval [CI]: 1.434-6.631), later initiation of tooth brushing (OR = 3.244, 95% CI: 2.413-5.424), S. mutans positivity (OR = 5.357, 95% CI: 4.529-8.563), high snack consumption frequency (OR = 3.452, 95% CI: 2.634-5.442), high sugary drink consumption frequency (OR = 4.414, 95% CI: 2.534-6.451) and high sweet food consumption frequency (OR = 4.531, 95% CI: 3.421-6.354) were risk factors for dental caries. Higher father's educational level (OR = 0.724, 95% CI: 0.564-0.891), higher mother's educational level (OR = 0.641, 95% CI: 0.601-0.813), high daily tooth brushing frequency (OR = 0.572, 95% CI: 0.423-0.864), mouth rinsing after meals (OR = 0.743, 95% CI: 0.643-0.813), use of fluoridated toothpaste (OR = 0.657, 95% CI: 0.553-0.931) and regular oral examinations (OR = 0.443, 95% CI: 0.352-0.747) were protective factors against dental caries (all p < 0.05). CONCLUSION: Multiple factors result in early dental caries in preschool children aged 3-6 years; however, the most influential factors are older age and high snack consumption, as well as high sugary and sweet food/drink consumption.

Caesarean section and associated factors in Nigeria: assessing inequalities between rural and urban areas-insights from the Nigeria Demographic and Health Survey 2018.

INTRODUCTION: When medically indicated, caesarean section (CS) can be a life-saving intervention for mothers and their newborns. This study assesses the prevalence of CS and its associated factors, focussing on inequalities between rural and urban areas in Nigeria. METHODS: We disaggregated the Nigeria Demographic and Health Survey 2018 and performed analyses separately for Nigeria's overall, rural, and urban residences. We summarised data using frequency tabulations and identified factors associated with CS through multivariable logistic regression analysis. RESULTS: CS prevalence was 2.7% in Nigeria (overall), 5.2% in urban and 1.2% in rural areas. The North-West region had the lowest prevalence of 0.7%, 1.5% and 0.4% for the overall, urban and rural areas, respectively. Mothers with higher education demonstrated a greater CS prevalence of 14.0% overall, 15.3% in urban and 9.7% in rural residences. Frequent internet use increased CS prevalence nationally (14.3%) and in urban (15.1%) and rural (10.1%) residences. The southern regions showed higher CS prevalence, with the South-West leading overall (7.0%) and in rural areas (3.3%), and the South-South highest in urban areas (8.5%). Across all residences, rich wealth index, maternal age ≥ 35, lower birth order, and ≥ eight antenatal (ANC) contacts increased the odds of a CS. In rural Nigeria, husbands' education, spouses' joint healthcare decisions, birth size, and unplanned pregnancy increased CS odds. In urban Nigeria, multiple births, Christianity, frequent internet use, and ease of getting permission to visit healthcare facilities were associated with higher likelihood of CS. CONCLUSION: CS utilisation remains low in Nigeria and varies across rural-urban, regional, and socioeconomic divides. Targeted interventions are imperative for uneducated and socioeconomically disadvantaged mothers across all regions, as well as for mothers in urban areas who adhere to Islam, traditional, or 'other' religions. Comprehensive intervention measures should prioritise educational opportunities and resources, especially for rural areas, awareness campaigns on the benefits of medically indicated CS, and engagement with community and religious leaders to promote acceptance using culturally and religiously sensitive approaches. Other practical strategies include promoting optimal ANC contacts, expanding internet access and digital literacy, especially for rural women (e.g., through community Wi-Fi programs), improving healthcare infrastructure and accessibility in regions with low CS prevalence, particularly in the North-West, and implementing socioeconomic empowerment programs, especially for women in rural areas.

Prevalence of Dental Erosive Wear and Possible Risk Factors among Adolescents and Adults in Poland - A National Survey.

PURPOSE: To investigate the prevalence and severity of erosive tooth wear (ETW) and evaluate the determinants of ETW among adolescents and adults in Poland. MATERIALS AND METHODS: The study covered three age groups of patients: 15 years old, 18 years old, and adults aged 35-44 years. Calibrated examiners measured ETW according to the Basic Erosive Wear Examination (BEWE) scoring system in 6091 patients. The clinical examination of patients was preceded by a socio-medical study based on a questionnaire consisting of items identifying potential risk factors for ETW. RESULTS: In all age groups, erosive lesions were most common in the form of initial enamel damage; more advanced lesions (BEWE 2 and 3) were rarely observed among 15-year-olds, while in the group of older adolescents and adults, the percentages were 13% and 20%, respectively. Acidic diet, gender, level of education, and medical conditions were statistically significantly associated with ETW in the examined population. The analysis showed that, depending on age, multiple and statistically significant risk factors for ETW become most apparent in the 35-44 age group, especially with regard to general health. This suggests that the long-term impact of factors and their cumulative effects are critical to the development of ETW. CONCLUSIONS: This is the first large, representative study of ETW in Central and Eastern Europe among adolescents and adults, which indicates the relatively rare occurrence and severity of erosive lesions. The present findings support other longitudinal studies supporting the use of the BEWE system as a valuable standard for assessing erosive lesions and related risk factors among different populations at different ages.

Educational and occupational aspirations of adolescent and young adult cancer survivors: a qualitative analysis.

PURPOSE: Adolescent and young adult cancer survivors (AYACS) are patients diagnosed with cancer between 15 and 39 years of age. AYACS are often derailed from planned educational and occupational endeavors due to disruption from cancer treatment and its consequences. The study objective was to examine how a personal cancer diagnosis impacted AYACS' experiences related to these endeavors. METHODS: Semi-structured interviews were conducted as part of a larger study assessing psychosocial challenges among a younger AYACS subset aged 15-25 years old at the time of cancer diagnosis. Interviews were coded based on responses and were used to develop themes related to educational and occupational endeavors. RESULTS: Data were collected from 35 participants. Five themes emerged: (1) Pauses in educational attainment had a detrimental effect on educational goals for some participants, but further solidified and sculpted educational plans for others; (2) Although participants experienced challenges accomplishing educational goals, supportive school environments helped surmount these challenges; (3) Participants reflected on rethinking career aspirations, though some desired to pursue the same occupation planned before cancer diagnosis; (4) Participants experienced challenges, including physical and cognitive limitations, upon returning to work; and (5) Participants valued autonomy and normalcy through work and appreciated supportive and flexible work environments. CONCLUSIONS: AYACS prioritize professional achievement, yet encounter challenges in achieving professional goals. Our findings create a foundation for developing and testing prospective interventions to promote continuance of school and work during cancer treatment when feasible, and proactive reintegration strategies for those who paused professional goals due to cancer treatment.

Risk factors for breast cancer among women in Freetown, Sierra Leone, 2017: a case-control study.

Introduction: breast cancer is the most commonly diagnosed malignancy and an important cause of cancer death among females worldwide. The disease accounted for 25% (1.67 million) of new cancer cases and the fifth cause of cancer deaths. Incidence of all types of cancers is approximately 25% in Sierra Leone. However, there was no documented evidence on risk factors for breast cancer among women in the country. The main aim of this study was to assess risk factors associated with breast cancer among women screened for breast cancer in Freetown Sierra Leone. Methods: we conducted a case-control study on breast cancer involving 116 confirmed breast cancer cases and 116 controls. Questionnaire was designed to collect data on socio-demographic, reproductive and behavioral risk factors. Analysis was carried using logistic regression to assess the associations between breast cancer and the risk factors. Results: in the final multiple logistic regression, had formal educational level, (aOR 0.1, 0.03-0.26, p= 0.001) physical activity for more than 30 minutes per week (aOR 0.5 (0.9- 0.7, p=0.001). Cigarette smoking (aOR 4.8, 1.2-18.5, p=0.023) and family history of breast cancer (aOR 9.9 cigarette smoking (OR 4.4, 1.2-18.5, p=0.023) and family history of breast cancer (OR 9.9, 2.7-36.45, p=0.040) were identified as the main risk factors for breast cancer. This study did not find any statistically significant associations between reproductive risk factors and breast cancer. Conclusion: risk factors for breast cancer among women in Sierra Leone include educational level, physical activity, cigarette smoking and family history of breast cancer. We recommended screening program for women above 40 years and had history of breast cancer. Also, to establish breast cancer registry.

Public perception and acceptance of coypu Myocastor coypus removal in urban areas: influences of age and education.

Monitoring and management of alien coypu (Myocastor coypus) is a key issue in Europe since this species has been included in the EU Invasive Alien Species Regulation 1143/2014. Thus, controlling the population of this rodent is considered as imperative by wildlife managers. Coypu management in urban areas is crucial considering potential conflicts with human activities. The aim of this study is to investigate citizens' knowledge, perceptions and opinions towards the presence and management of coypu in a case study in Central Italy (the Serravalle urban park, Tuscany). The survey was administered to a subset of municipal residents and garnered responses from 281 park visitors. The outcomes showed a high level of knowledge of respondents: 99.3% of total respondents had heard of coypu before this survey, and 93.9% were able to distinguish the coypu from the Eurasian beaver (Castor fiber). Despite the importance of coypu control in invaded countries, our results highlight that most respondents are against the removal of coypu, with the exception of most young, highly-educated and upperclass men, but favouring sterilization over capture and population control. Findings of this study could assist managers in enhancing the efficacy of management efforts via an information initiative involving the general public. Achieving this goal may entail improved communication by wildlife managers, which is imperative for optimizing management strategies regarding alien species.

Health literacy and its associated factors among the population in two schistosomiasis-endemic villages in Jiangxi Province, China.

This cross-sectional study aimed to assess the levels of health literacy and the associated factors among the general population living in 2 schistosomiasis-endemic villages in Jiangxi Province, China. Multistage stratified random sampling was used to select participants, and a face-to-face survey was conducted from July to August 2021 to collect participants' socio-demographic characteristics and levels of overall health literacy (HL) and its 3 subscales: health literacy of basic knowledge and concepts (HL-BKC), health literacy of behavior and lifestyle (HL-BAL), and health literacy of health-related skills (HL-HRS). The Chi-square test and logistic regression models were used to assess the association between socio-demographic characteristics and low HL levels. The prevalence rates of low overall HL, HL-BKC, HL-BAL, and HL-HRS were 84.3%, 61.8%, 82.6%, and 86%, respectively. In addition, no significant differences (P > .05) were noted between the 2 villages regarding overall HL scores and the 3 subscales of health literacy scores. Older age (P < .001), occupation (P < .001), lower educational level (P < .001), and lower annual household income (P < .05) were associated with an increased risk of low HL. Multivariate logistic regression revealed that occupation as a student (OR = 32.289, 95% CI:1.965-530.462, P < .05) and fishermen (OR = 27.902, 95%CI:1.91-407.642, P < .05), lower education level (OR = 0.384, 95%CI:0.149-0.99, P < .05), older age (OR = 5.228, 95%CI:1.458-18.75, P < .001), and lower annual household income (OR = 0.452, 95%CI:0.24-0.851, P < .05) were independently associated with low HL. The prevalence of low HL is high among the population in the schistosomiasis-endemic villages of Jiangxi Province, China. Age, education level, occupation, and annual household income were all independent factors associated with HL levels. Health educational interventions to improve HL should be simultaneously conducted in health promotion work to reduce risky habits.

Unmasking caries risk: a multi-regional study in Saudi Arabia.

BACKGROUND: Dental caries are common and troublesome and may affect individuals' health conditions. It is crucial to comprehend the caries experience for prevention, management, and enhancing oral health. Techniques such as CAMBRA can help assess an individual's risk factors for caries lesions. This study aims to assess the caries risk in five distinct regions of Saudi Arabia, utilizing the CAMBRA methodology. METHODS: This multiregional cross-sectional study was conducted at university dental clinics across the five regions of Saudi Arabia, using a Caries Management by Risk Assessment (CAMBRA) tool. This study used binary logistic regression analysis, the Pearson Chi-square test, and descriptive analysis as statistical methods. RESULTS: A total of 551 respondents participated in the study, with 59.7% being male and 40.3% being female. The age group with the highest proportion was 20-29, making up 31.6% of the participants. All participants exhibited at least one caries lesion (100%), with white spots (66.4%) and enamel lesions (56.1%) being the most prevalent. The moderate-risk category encompassed the largest proportion of participants, accounting for 60% of the total. High caries risk had a significant association with age group (P < 0.001), education (P < 0.001), profession (P < 0.001), and socio-economic status (P < 0.001). Furthermore, only age and socio-economic status showed a significant relationship with high caries risk in the multiple logistic regression. CONCLUSION: The CAMBRA tool indicates a high prevalence of moderate risk across the five regions of Saudi Arabia, identifying age and socio-economic status as significant predictors of caries risk.

The impact of multiple discrimination on labor misallocation of China: Based on fsQCA method.

Discrimination in the labor market hinders efficient labor allocation, impeding socio-economic health. With the rapid population aging in China, addressing multifaceted discrimination to enhance labor allocation efficiency emerges as a crucial area of research. To explore the relationship between five types of discrimination (age, gender, hukou, educational background, and occupation) and labor misallocation, this paper based on intersectionality theory, employs the fuzzy-set Qualitative Comparative Analysis (fsQCA) method to conduct a configurational analysis of data from China. The research findings indicate that none of the five forms of discrimination can be deemed a necessary condition for achieving high-level labor misallocation. The study identifies five distinct pathways of multiple discrimination to form high-level labor misallocation, which can be classified into four interaction modes: age-hukou, gender-hukou, gender-occupation, and age-gender-educational background. Meanwhile, there are four configuration paths for the absence of labor misallocation. This study reveals the intricate mechanisms by which multiple forms of discrimination contribute to labor misallocation in China's labor market, and provides valuable insights for addressing employment discrimination and improving the efficiency of labor allocation.

Work-related socioeconomic determinants of health: evidence from educational mismatch in Italy.

Introduction: An educational mismatch is defined as the situation where the education qualifications of an employee do not match the qualifications required for the job they do. A mismatch can be vertical where the level of the employee's qualification is not the one required by the job. This study contributes to the literature on work-related social determinants of health, by carrying out the first assessment of the relationship between educational mismatch and health in Italy. Methods: Data come from PLUS, a national survey of labor supply. The risk of suffering from bad or very bad health associated with educational mismatch is investigated through a logistic regression model accounting for the socioeconomic context and occupation. Results: Our findings show women are at greater risk of suffering from bad or very bad health than men, especially if under-educated. Discussion: Our results show the need to address more research on work-related social determinants of health, which can represent a barrier to achieving health equity.

Gender Disparities in the Association Between Educational Attainment and Cardiovascular-Kidney-Metabolic Syndrome: Cross-Sectional Study.

Background: Cardiovascular-kidney-metabolic (CKM) health is affected by social determinants of health, especially education. CKM syndrome has not been evaluated in Chinese population, and the association of education with CKM syndrome in different sexes and its intertwined relation with lifestyles have not been explored. Objective: We aimed to explore the association between educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women as well as the potential role of health behavior based on Life's Essential 8 construct. Methods: This study used data from the nationwide, community-based REACTION (Risk Evaluation of Cancers in Chinese diabetic individuals: a longitudinal study). A total of 132,085 participants with complete information to determine CKM syndrome stage and education level were included. Educational attainment was assessed by the self-reported highest educational level achieved by the participants and recategorized as low (elementary school or no formal education) or high (middle school, high school, technical school/college, or above). CKM syndrome was ascertained and classified into 5 stages according to the American Heart Association presidential advisory released in 2023. Results: Among 132,085 participants (mean age 56.95, SD 9.19 years; n=86,675, 65.62% women) included, most had moderate-risk CKM syndrome (stages 1 and 2), and a lower proportion were at higher risk of CKM (stages 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (odds ratio 1.36, 95% CI 1.23-1.49) with a significant sex disparity, but was positively correlated with high-risk CKM for both sexes. The association between low education and high-risk CKM was more evident in women with poor health behavior but not in men, which was also interactive with and partly mediated by behavior. Conclusions: Low education was associated with adverse CKM health for both sexes but was especially detrimental to women. Such sex-specific educational disparity was closely correlated with health behavior but could not be completely attenuated by behavior modification. These findings highlight the disadvantage faced by women in CKM health ascribed to low education, underscoring the need for public health support to address this inequality.

Factors related to early weaning in babies born at term in a public maternity. / Fatores relacionados ao desmame precoce em bebês nascidos a termo em uma maternidade pública.

PURPOSE: to analyze how socioeconomic, pregnancy and childbirth factors relate to the feeding situation in the sixth month of life of full-term babies. METHODS: longitudinal observational study, with 98 mothers of full-term babies. Data collection was structured by capturing information regarding the clinical history and moment of birth in the babies' medical records, followed by the application of two questionnaires to the postpartum women, with questions regarding sociodemographic data, pre- and post-pregnancy data and the baby's nutrition. baby, the first being answered during hospital stay and the second, by telephone, in the 6th month of life. A descriptive analysis of the data was performed, using the frequency distribution of categorical variables, inferential analysis using Pearson's Chi-square test and multivariate analysis using binary logistic regression, adopting, for inclusion in the final model, the significance level of 5%. RESULTS: there was an association between exclusive breastfeeding in the 6th month and maternal education and between the period of food introduction and family income. Mothers with higher education were 4.82 times more likely to breastfeed their children exclusively until the sixth month. Families with lower income (up to one minimum wage) were 2.54 times more likely to start food introduction before the sixth month than families with higher income. CONCLUSION: higher maternal education was a predictive factor for exclusive breastfeeding at the 6th month and higher military income was a predictive factor for introducing food after the 6th month.

OBJETIVO: analisar como os fatores socioeconômicos, da gestação e do parto se relacionam com a situação da alimentação no sexto mês de vida de bebês nascidos a termo. MÉTODO: estudo observacional longitudinal, com 98 mães de bebês termos. A coleta de dados foi estruturada pela captação das informações referentes à história clínica e ao momento do parto nos prontuários dos bebês, seguida da aplicação de dois questionários, com questões referentes a dados sociodemográficos, dados pré e pós-gestacionais e da alimentação do bebê, sendo o primeiro respondido durante a internação hospitalar e o segundo, por contato telefônico, no 6° mês de vida. Foi realizada análise descritiva dos dados, por meio da distribuição de frequência das variáveis categóricas, análise inferencial utilizando o teste Qui-quadrado de Pearson e análise multivariada por regressão logística binária, adotando-se, para inclusão no modelo final, o nível de significância de 5%. RESULTADOS: houve associação entre aleitamento materno exclusivo no 6º mês e escolaridade materna e entre o início da introdução alimentar e a renda familiar. Mães com ensino superior apresentaram 4,82 vezes mais chances de amamentarem os filhos de forma exclusiva até o sexto mês. Famílias de menor renda (até um salário mínimo) tiveram 2,54 vezes mais chances de iniciarem a introdução alimentar antes do sexto mês do que as famílias de maior renda. CONCLUSÃO: maior escolaridade materna foi fator preditor para o aleitamento materno exclusivo ao 6º mês e maior renda familiar foi fator preditor para introdução alimentar após o 6º mês.

Factors affecting COVID-19 vaccine uptake in populations with higher education: insights from a cross-sectional study among university students in Malawi.

BACKGROUND: The Coronavirus disease-2019 (COVID-19) vaccines were rolled out in many countries; however, sub-optimal COVID-19 vaccine uptake remains a major public health concern globally. This study aimed at assessing the factors that affected the uptake, hesitancy, and resistance of the COVID-19 vaccine among university undergraduate students in Malawi, a least developed country in Africa. METHODS: A descriptive cross-sectional study design was conducted using an online semi-structured questionnaire. A total of 343 University undergraduate students in Blantyre participated in this study after obtaining ethical clearance. Data was exported from Survey Monkey to Microsoft Excel version-21 for cleaning and was analysed using SPSS version-29. Descriptive statistics, including percentages, were performed to define the sample characteristics. Pearson Chi-square and Fisher's exact test were performed to identify significant relationships between vaccine uptake and demographics. A 95% confidence interval was set, and a p-value of < 0.05 was considered statistically significant. RESULTS: Of the 343 participants, 43% were vaccinated. Among the vaccinated, the majority (47.3%, n = 69/146) received Johnson & Johnson vaccine followed by AstraZeneca (46.6%, n = 68/146). The commonly reported reason for vaccine acceptance was 'to protect me against getting COVID-19' (49%); whereas vaccine hesitancy was attributed to 'lack of knowledge (34%), and concerns about vaccine safety (25%). CONCLUSIONS: This study found that adequate knowledge about benefits and safety of COVID-19 vaccine could potentially increase uptake. Lack of credible information or misinformation contributed to vaccine hesitancy. The findings provide insights for design of strategies to increase future vaccine uptake and reduce determinants of vaccine hesitancy. To reduce vaccination hesitancy in any population with or without higher education, we recommend that institutions entrusted with vaccine management must optimise health messaging, and reduce mis-information and dis-information.

Comparison of univariate and bivariate Poisson regression methods in the analysis of determinants of female schooling and fertility in Malawi.

Recent research has established existence of a correlation between women's education and fertility, suggesting that they share similar risk factors. However, in many studies, the two variables were analysed separately, which could bias the conclusions by undermining the apparent correlations of such paired outcomes. In this article, the univariate and bivariate Poisson regression models were applied to nationally representative sample of 24,562 women from the 2015-16 Malawi demographic and health survey to examine the risk factors of women's education levels and fertility. The R software version 4.1.2 was used for the analyses. The results showed that estimates from the bivariate Poisson model were consistent with those obtained from the separate univariate Poisson models. The sizes of estimates of coefficients, their standard errors, p-values, and directions were comparable in both bivariate and univariate Poisson models. Using either the univariate or bivariate Poisson model, it was found that the age of a woman at first sexual experience, her current age, household wealth index, and contraceptive usage were significantly associated with both the woman's schooling and fertility. The study further revealed that ethnicity, religion, and region of residence impacted education level only and not fertility. Similarly, marital status and occupation impacted fertility only and not education. The study also found that higher education levels were linked to a lower number of children, with a strong negative correlation of -0.62 between the two variables. The study recommends using bivariate Poisson regression for analysing paired count response data, when there is an apparent covariance between the outcome variables. The results suggest that efforts by policymakers to achieve the desired women's sexual and reproductive health in sub-Saharan Africa should be intertwined with improving women's and girls' education attainment in the region.

Factors associated with postnatal care utilization in Afghanistan.

Afghanistan has one of the highest maternal mortality rates in the world. Inadequate postnatal care (PNC) increases the risk of maternal mortality. This study aimed to analyze the socioeconomic and demographic factors that affect postnatal care utilization. A secondary analysis was conducted in 2019 based on the data from the 2015 Afghanistan Demographic and Health Survey. The sample included 29,461 married women aged 15-49 interviewed during the survey. This was a cross-sectional study in which a frequency distribution of independent variables for the study sample was carried out, Pearson's chi-square test was conducted for association, and the strength of association was measured using binary logistic regression. The study found that 39.9% of married women used postnatal care services. The findings of this study suggest that place of delivery and women who gave birth at health facilities were more likely to use PNC than women who delivered at home. Women age 30-39 and 20-29 positively associated with PNC use compared with mothers aged < 20 years. Each level of women's educational attainment increased their use of PNC, and women with higher education were more likely to use PNC than those without education. Furthermore, women who visited 1-3 and more than four ANC visits were more likely to use PNC than women who did not visited ANC. Moreover, women exposed to mass media were more likely to use PNC than those who were not exposed to mass media. Finally, women who lived in the northern and western regions were more likely to use PNC than those who lived in the central region, while women who lived in the southern and southeastern regions were less likely to use PNC than those who lived in the central region. Therefore, strengthening the provision of information, education, and communication could be a communication channel to further improve PNC utilization. Meanwhile further studies are needed to focus on the quality of maternal health care and PNC services in Afghanistan in order to obtain more precise information.

Childhood Health and Educational outcomes afteR perinatal Brain injury (CHERuB): protocol for a population-matched cohort study.

INTRODUCTION: Over 3000 infants suffer a brain injury around the time of birth every year in England. Although these injuries can have important implications for children and their families, our understanding of how these injuries affect children's lives is limited. METHODS AND ANALYSIS: The aim of the CHERuB study (Childhood Health and Educational outcomes afteR perinatal Brain injury) is to investigate longitudinal childhood health and educational outcomes after perinatal brain injury through the creation of a population-matched cohort study. This study will use the Department of Health and Social Care definition of perinatal brain injury which includes infants with intracranial haemorrhage, preterm white matter injury, hypoxic ischaemic encephalopathy, perinatal stroke, central nervous system infections, seizures and kernicterus. All children born with a perinatal brain injury in England between 2008 and 2019 will be included (n=54 176) and two matched comparator groups of infants without brain injury will be created: a preterm control group identified from the National Neonatal Research Data Set and a term/late preterm control group identified using birth records. The national health, education and social care records of these infants will be linked to ascertain their longitudinal childhood outcomes between 2008 and 2023. This cohort will include approximately 170 000 children. The associations between perinatal brain injuries and survival without neurosensory impairment, neurodevelopmental impairments, chronic health conditions and mental health conditions throughout childhood will be examined using regression methods and time-to-event analyses. ETHICS AND DISSEMINATION: This study has West London Research Ethics Committee and Confidential Advisory Group approval (20/LO/1023 and 22/CAG/0068 issued 20/10/2022). Findings will be published in open-access journals and publicised via the CHERuB study website, social media accounts and our charity partners.

Childhood family socioeconomic status is linked to adult brain electrophysiology.

A large body of research has linked childhood family socioeconomic status (SES) to neurodevelopment in childhood and adolescence. However, it remains unclear to what extent childhood family SES relates to brain functioning in adulthood. To address this gap, the present study investigated the associations between retrospective accounts of objective and subjective childhood family SES and two well-established electrophysiological indices of brain functioning in adulthood-the MMN and P3b event-related potentials (ERP) components, as neural correlates of automatic change detection and cognitive control respectively. Higher objective childhood family SES, as proxied by parent educational attainment in childhood, was associated with larger (more positive) P3b amplitudes in adulthood. In contrast, there was no association between childhood parent educational attainment and the magnitude of MMN. Adult reports of subjective family SES during childhood were not related to the magnitude of MMN or P3b. These findings suggest that the links between childhood parent educational attainment and brain functioning may extend into adulthood, especially for brain functions supporting cognitive control. These results also imply that, when using retrospective accounts of childhood family SES, objective and subjective reports likely proxy different childhood experiences that have distinct links with specific neurodevelopmental outcomes, and that some of these links may not persist into adulthood. Our findings lay the groundwork for future investigations on how and why childhood family SES relates to brain functioning in adulthood.