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OBJECTIVES: Chronic pain is a highly debilitating condition that affects older adults and has the potential to increase their odds of experiencing cognitive impairment. The primary objective of this study was to examine the correlation between chronic pain and dementia. Additionally, this research endeavours to ascertain whether the association between chronic pain and dementia differs by age and gender. METHODS: Cross-sectional data were derived from the Survey of Disability, Ageing and Carers (SDAC). A total of 20,671 and 20,081 participants aged 65 years and older in 2015 and 2018, respectively, were included in this study. The pooled association between chronic pain and dementia was assessed using a multivariable logistic regression model. Furthermore, the study also examined the multiplicative interaction effects between chronic pain and age, as well as chronic pain and gender, with dementia. RESULTS: The pooled analysis demonstrated that chronic pain was associated with a heightened odds of dementia (Adjusted Odds Ratio [AOR]=1.95, 95%CI: 1.85-2.05) amongst older Australians than their counterparts without chronic pain. The interaction effect indicated that individuals with chronic pain across all age groups exhibited increased odds of living with dementia. Additionally, women with chronic pain had higher odds of dementia compared to their counterparts without chronic pain and being male. CONCLUSIONS: A continuous, coordinated, and tailored healthcare strategy is necessary to determine the pain management goals and explore early treatment options for chronic pain in older adults, particularly in groups with the greatest need.
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Hydrogen storage in solid-state materials represents a promising avenue for advancing hydrogen storage technologies, driven by their potential for high efficiency, reduced risk, and cost-effectiveness. Among the employed materials, magnesium borohydride (Mg(BH4)2) stands out for its exceptional characteristics, with a gravimetric capacity of 14.9â wt% and a volumetric hydrogen density capacity of 146â kg/m3. However, the practical application of Mg(BH4)2 is impeded by challenges such as high desorption temperatures (≥ 270 °C), sluggish kinetics, poor reversibility, and the formation of unexpected byproducts like diborane. To address these limitations, extensive research efforts have been directed towards enhancing the hydrogen storage properties of Mg(BH4)2. Various strategies have been explored, including incorporating catalysts or additives, nanoconfinement of Mg(BH4)2 within porous supports, and modifications involving metal alloys and compositional adjustments. These approaches are actively under investigation for improving the performance of Mg(BH4)2-based hydrogen storage systems. This review provides a comprehensive survey of recent advancements in Mg(BH4)2 research, focusing on experimental findings related to nanoconfined Mg(BH4)2 and modified thermodynamic processes aimed at enabling hydrogen release at lower temperatures by mitigating sluggish kinetics. Precisely, nanostructuring techniques, catalyst-mediated nanoconfinement methodologies, and alloy/compositional modifications will be elucidated, highlighting their potential to enhance hydrogen storage properties and overcome existing limitations. Furthermore, this review also discusses the challenges encountered in utilizing Mg(BH4)2 for hydrogen storage applications and offers insights into the prospects of this material. By synthesizing the latest research findings and identifying areas for further exploration, this review aims to contribute to the ongoing efforts toward realizing the full potential of Mg(BH4)2 as a viable solution for hydrogen storage in diverse applications.
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BACKGROUND: The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes. METHODS: The TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15-35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12-14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI) < 18.5 kg/m2 and MMS for others; (4) targeted BEP for those with pre-pregnancy BMI < 18.5 kg/m2, MMS for others, and women with inadequate gestational weight gain switched from MMS to BEP until the end of pregnancy. Primary outcomes include birth weight, low birth weight (< 2500 g), and small for gestational age, defined using the 10th percentile of the INTERGROWTH-21st reference, for live-born infants measured within 72 h of birth. Project-hired local female staff visit pregnant women monthly to deliver the assigned supplements, monitor adherence biweekly, and assess weight regularly during pregnancy. Trained data collectors conduct pregnancy outcome assessment and measure newborn anthropometry in the facility or home depending on the place of birth. DISCUSSION: This study will assess the effectiveness of targeted balanced energy and protein supplementation to improve birth outcomes among pregnant women in rural Bangladesh and similar settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05576207. Registered on October 5th, 2022.
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Proteínas Alimentares , Suplementos Nutricionais , Ganho de Peso na Gestação , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Feminino , Gravidez , Bangladesh/epidemiologia , Adulto , Adulto Jovem , Adolescente , Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Estado Nutricional , Recém-Nascido , Fenômenos Fisiológicos da Nutrição Materna , Peso ao Nascer , Complicações na Gravidez/prevenção & controle , Micronutrientes/administração & dosagem , Resultado do Tratamento , Idade Gestacional , Fatores de TempoRESUMO
BACKGROUND: Animal source foods are rich in multiple nutrients. Regular egg consumption may improve infant growth in low- and middle-income countries. OBJECTIVES: To assess the impact of daily egg consumption on linear growth among 6-12-mo olds in rural Bangladesh. METHODS: We conducted a 2 × 4 factorial cluster-randomized controlled trial allocating clusters (n = 566) to treatment for enteric pathogens or placebo and a daily egg, protein supplement, isocaloric supplement, or control. All arms received nutrition education. Here, we compare the effect of the egg intervention versus control on linear growth, a prespecified aim of the trial. Infants were enrolled at 3 mo. We measured length and weight at 6 and 12 mo and visited households weekly to distribute eggs and monitor compliance. We used linear regression models to compare 12-mo mean length, weight, and z-scores for length-for-age (LAZ), weight-for-length, and weight-for-age (WAZ), and log-binomial or robust Poisson regression to compare prevalence of stunting, wasting, and underweight between arms. We used generalized estimating equations to account for clustering and adjusted models for baseline measures of outcomes. RESULTS: We enrolled 3051 infants (n = 283 clusters) across arms, with complete 6 and 12 mo anthropometry data from 1228 infants (n = 142 clusters) in the egg arm and 1109 infants (n = 141 clusters) in the control. At baseline, 18.5%, 6.0%, and 16.4% were stunted, wasted, and underweight, respectively. The intervention did not have a statistically significant effect on mean LAZ (ß: 0.05, 95% confidence interval [CI]: -0.01, 0.10) or stunting prevalence (ß: 0.98, 95% CI: 0.89, 1.13) at 12 mo. Mean weight (ß: 0.07 kg, 95% CI: 0.02, 0.11) and WAZ (ß: 0.06, 95% CI: 0.02, 0.11) were significantly higher in the egg compared with control arms. CONCLUSIONS: Provision of a daily egg for 6 mo to infants in rural Bangladesh improved ponderal but not linear growth. TRIAL REGISTRATION NUMBER: NCT03683667, https://clinicaltrials.gov/ct2/show/NCT03683667.
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Ovos , População Rural , Humanos , Bangladesh/epidemiologia , Lactente , Feminino , Masculino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/prevenção & controle , Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição do Lactente , Suplementos Nutricionais , Estatura , Peso Corporal , DietaRESUMO
BACKGROUND: The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design. METHODS: Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL. RESULTS: Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (ß = - 6.527; Standard Error [SE] = 1.579), mental-component scale (ß = - 3.765; SE = 1.590) and short-form six-dimension utility index (ß = - 0.075; SE = 0.017). CONCLUSION: This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.
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População Australasiana , Multimorbidade , Qualidade de Vida , Humanos , Austrália/epidemiologia , Qualidade de Vida/psicologia , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Doença CrônicaRESUMO
Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexity of delivery. We sought to address implementation gaps in BEP interventions through a formative study designed to understand implementation outcomes. We conducted 52 in-depth interviews and 8 focus-group discussions with married women of reproductive age, family members, health care providers and pharmacists in three unions of the Gaibandha district in rural Bangladesh. Interviews were translated and transcribed in English and analysed using an analytic framework for implementation science in nutrition. BEP was viewed as an acceptable and appropriate intervention to combat undernutrition in this setting. There was a lack of clarity on who should or could be responsible for providing/distributing BEP in a way convenient to mothers. Many participants preferred door-to-door delivery and thought this approach could address social and gender inequities, but providers mentioned already being overworked and worried about adding new tasks. Participants were concerned about the affordability of BEP and opportunity costs associated with travel to proposed distribution sites such as ANC or pharmacies. Women in these communities do not always have the agency to travel without supervision or make purchasing decisions. BEP supplementation is a complex intervention; future trials seek to assess ways to overcome these implementation challenges and inform a long-term systems-owned BEP intervention.
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Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.
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Serviços de Saúde Materna , Gravidez , Criança , Feminino , Humanos , Países em Desenvolvimento , Cuidado Pré-Natal , Utilização de Instalações e Serviços , Aceitação pelo Paciente de Cuidados de Saúde , Atenção à SaúdeRESUMO
Balanced energy protein (BEP) supplementation in pregnancy is recommended in the context of undernutrition for the reduction of small-for-gestational age neonates and stillbirths. To inform an effectiveness trial, we evaluated the acceptability of a packaged, ready-to-eat fortified BEP product among women of reproductive age and their health care providers (HCPs) in rural Bangladesh and explored the feasibility of adhering to daily supplementation. We implemented a formative study using focus groups discussions with women (n = 29) and HCPs (n = 17) to introduce the product and investigate components of acceptability. A "trials of improved practice" activity was conducted in subset of women (n = 16) to evaluate adherence to BEP over a 2-week period, followed by focus group discussions to identify challenges with adherence and strategies employed. Contributors to BEP acceptability included the product's sensory attributes, such as taste, smell and texture; the attractive packaging and informative labelling; and the perceived benefits of use. Participants also identified household and community level factors influencing the adoption of BEP, such as trust in the provider, cultural beliefs on supplement use in pregnancy, and family member tasting and approval. Over the 2-week period, women consumed over 80% of the supplements provided to them and identified strategies for adherence, including visual aids and reminders from family members or providers. HCPs recommended targeted communication messages for mothers-in-law to foster a supportive home environment. Findings informed changes to the BEP product to improve acceptability and shaped the content of communication messages to optimise adherence in a forthcoming effectiveness trial.
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BACKGROUND: The exact prevalence of dementia in Australia is ambiguous. Australia is a vast continent with a small population, and 80% of the population live in five cities. This study explores recent changes in the prevalence of dementia. It also investigates geographic remoteness as a potential risk factor for developing dementia. METHODS: Survey of Disability, Ageing and Carers (SDAC), a nationally representative database, was used to conduct this study. A total of 74,862 and 65,487 individuals from 2015 and 2018, respectively, were considered for this study. A multivariable logistic regression model was used to evaluate the association between dementia and geographic remoteness for older adults aged 65 years and over. RESULTS: The results reveal that from 2015 to 2018, the prevalence of dementia among adults aged 65 years and older was higher in 2018 (5,229 per 100,000) than in 2015 (5,099 per 100,000). Significant geographical differences in the prevalence of dementia are observed among Australian adults, and this trend appears to be increasing. Furthermore, the unadjusted model revealed that, in 2015, older adults living in major cities had 1.29 (AOR: 1.29, 95% CI: 1.17-1.41) times higher odds of having dementia compared with their counterparts from outer regional and remote areas. In 2018, the adjusted model found that older adults living in major cities had 1.12 (AOR: 1.12, 95% CI: 1.01-1.25) times elevated odds of having dementia than their peers living in outer regional and remote areas. CONCLUSION: There is a rising prevalence of dementia in Australia. Further investigation is required to identify the causes of this increase. Increased public health initiatives should concentrate on behavioural characteristics and contextual environmental factors to ameliorate this trend.
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Demência , População Rural , Humanos , Idoso , Austrália/epidemiologia , Prevalência , Fatores de Risco , Demência/epidemiologiaRESUMO
INTRODUCTION: Arsenic methylation converts inorganic arsenic (iAs) to monomethyl (MMA) and dimethyl (DMA) arsenic compounds. Body mass index (BMI) has been positively associated with arsenic methylation efficiency (higher DMA%) in adults, but evidence in pregnancy is inconsistent. We estimated associations between anthropometric measures and arsenic methylation among pregnant women in rural northern Bangladesh. METHODS: We enrolled pregnant women (n = 784) (median [IQR] gestational week: 14 [13, 15]) in Gaibandha District, Bangladesh from 2018 to 2019. Anthropometric measures were BMI, subscapular and triceps skinfold thicknesses, and mid-upper arm circumference (MUAC), fat area (MUAFA), and muscle area (MUAMA). Arsenic methylation measures were urinary iAs, MMA, and DMA divided by their sum and multiplied by 100 (iAs%, MMA%, and DMA%), primary methylation index (MMA/iAs; PMI), and secondary methylation index (DMA/MMA; SMI). In complete cases (n = 765 [97.6%]), we fitted linear, beta, and Dirichlet regression models to estimate cross-sectional differences in iAs%, MMA%, DMA%, PMI, and SMI per IQR-unit difference in each anthropometric measure, adjusting for drinking water arsenic, age, gestational age, education, living standards index, and plasma folate, vitamin B12, and homocysteine. RESULTS: Median (IQR) BMI, subscapular skinfold thickness, triceps skinfold thickness, MUAC, MUAFA, and MUAMA were 21.5 (19.4, 23.8) kg/m2, 17.9 (13.2, 24.2) mm, 14.2 (10.2, 18.7) mm, 25.9 (23.8, 28.0) cm, 15.3 (10.5, 20.3) cm2, and 29.9 (25.6, 34.2) cm2, respectively. Median (IQR) iAs%, MMA%, DMA%, PMI, and SMI were 12.0 (9.3, 15.2)%, 6.6 (5.3, 8.3)%, 81.0 (77.1, 84.6)%, 0.6 (0.4, 0.7), and 12.2 (9.3, 15.7), respectively. In both unadjusted and adjusted linear models, all anthropometric measures were negatively associated with iAs%, MMA%, and PMI and positively associated with DMA% and SMI. For example, fully adjusted mean differences (95% CI) in DMA% per IQR-unit difference in BMI, subscapular skinfolds thickness, triceps skinfold thickness, MUAC, MUAFA, and MUAMA were 1.72 (1.16, 2.28), 1.58 (0.95, 2.21), 1.74 (1.11, 2.37), 1.45 (0.85, 2.06), 1.70 (1.08, 2.31), and 0.70 (0.13, 1.27) pp, respectively. CONCLUSIONS: Anthropometric measures were positively associated with arsenic methylation efficiency among pregnant women in the early second trimester.
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Arsênio , Arsenicais , Adulto , Humanos , Feminino , Gravidez , Arsênio/análise , Metilação , Gestantes , Bangladesh , Estudos Transversais , Exposição Ambiental/análiseRESUMO
BACKGROUND: Arsenic exposure and micronutrient deficiencies may alter immune reactivity to influenza vaccination in pregnant women, transplacental transfer of maternal antibodies to the foetus, and maternal and infant acute morbidity. OBJECTIVES: The Pregnancy, Arsenic, and Immune Response (PAIR) Study was designed to assess whether arsenic exposure and micronutrient deficiencies alter maternal and newborn immunity and acute morbidity following maternal seasonal influenza vaccination during pregnancy. POPULATION: The PAIR Study recruited pregnant women across a large rural study area in Gaibandha District, northern Bangladesh, 2018-2019. DESIGN: Prospective, longitudinal pregnancy and birth cohort. METHODS: We conducted home visits to enrol pregnant women in the late first or early second trimester (11-17 weeks of gestational age). Women received a quadrivalent seasonal inactivated influenza vaccine at enrolment. Follow-up included up to 13 visits between enrolment and 3 months postpartum. Arsenic was measured in drinking water and maternal urine. Micronutrient deficiencies were assessed using plasma biomarkers. Vaccine-specific antibody titres were measured in maternal and infant serum. Weekly telephone surveillance ascertained acute morbidity symptoms in women and infants. PRELIMINARY RESULTS: We enrolled 784 pregnant women between October 2018 and March 2019. Of 784 women who enrolled, 736 (93.9%) delivered live births and 551 (70.3%) completed follow-up visits to 3 months postpartum. Arsenic was detected (≥0.02 µg/L) in 99.7% of water specimens collected from participants at enrolment. The medians (interquartile ranges) of water and urinary arsenic at enrolment were 5.1 (0.5, 25.1) µg/L and 33.1 (19.6, 56.5) µg/L, respectively. Water and urinary arsenic were strongly correlated (Spearman's â´ = 0.72) among women with water arsenic ≥ median but weakly correlated (â´ = 0.17) among women with water arsenic < median. CONCLUSIONS: The PAIR Study is well positioned to examine the effects of low-moderate arsenic exposure and micronutrient deficiencies on immune outcomes in women and infants. REGISTRATION: NCT03930017.
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Arsênio , Influenza Humana , Recém-Nascido , Lactente , Gravidez , Feminino , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Estudos Prospectivos , Bangladesh/epidemiologia , Água , Micronutrientes , ImunidadeRESUMO
People who are overweight and obese suffer from significant health impacts that have increased globally. Concurrently, usage of information and communication devices such as television and mobile phones have also been growing, affecting people's weight. This study examined the association between watching television and owning a mobile phone with overweight and obesity among reproductive-aged women in low- and lower-middle-income countries (LLMICs). Data of 21 LLMICs reported between 2015 and 2020 were collected from the Demographic and Health Surveys. Multivariate logistic regression was performed to determine the association into three pooled segments: a group of 21 countries, the World Bank income classification and the regional categorisation of the countries. The all-inclusive prevalence of overweight or obesity was found at 27.1% among 175,370 reproductive-aged women, and this prevalence varied among countries. Overall, the odds of being overweight or obese were 1.20 (adjusted odds ratio [AOR]=1.20, 95% confidence interval [CI]: 1.15-1.24), 1.40 (AOR=1.40, 95% CI: 1.35-1.44) and 1.18 (AOR=1.18, 95% CI: 1.03-1.35) times higher among those who watched television less than once a week, at least once a week and almost every day, respectively, compared with those who did not watch television. Besides, women's mobile phone ownership is more likely to experience overweight or obesity (AOR=1.72, 95% CI: 1.67-1.77). Consistent results were found for the countries categorised according to the World Bank income and regional classification. Focus on sedentary behaviour, such as television watching and mobile phone use, of women and regional or country-specific innovative strategies and programs are of great immediate importance to decrease the prevalence of overweight and obesity.
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Telefone Celular , Sobrepeso , Feminino , Humanos , Adulto , Sobrepeso/epidemiologia , Sobrepeso/etiologia , Países em Desenvolvimento , Estudos Transversais , Obesidade/epidemiologia , Obesidade/etiologia , Televisão , PrevalênciaRESUMO
BACKGROUND: Any form of long-term physical or mental impairment might negatively influence health-related quality of life (HRQoL). HRQoL, as an independent concept, covers a wide range of characteristics that includes physical, mental, social, and spiritual functions. People with disabilities are continuously exposed to multiple barriers that deteriorate their HRQoL. It also creates impairment in performing physical activities. However, experts opine regular physical exercise as an intervention to help disabled people. This research aims to investigate the association between disability and physical activity with HRQoL among the adult population in Australia. DESIGN: A retrospective cohort study. METHODS: This study utilized the most recent 19 waves of data (2002-2020) from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. Component summary scores such as physical component summary (PCS) and mental component summary (MCS), and SF-6D utility scores were utilized to measure HRQoL. Random-effects GLS regression technique was fitted to estimate the association between disability and physical activity with HRQoL, after adjusting for a range of socio-demographic and health-related characteristics. RESULTS: Disability was negatively associated with the PCS (-5.95), MCS (-2.70) and SF-6D (-0.060) compared with non-disabled counterparts. However, respondents engaged in the recommended level of physical activity had substantial gain in PCS (b = 0.96), MCS (1.57), and SF-6D (0.021) scores. Besides, the results showed that performing the recommended level of physical activity in the presence of disability has lessen the negative effect of disability/ positive moderating effect of physical activity on PCS, MCS, and SF-6D scores by 1.84 points, 0.82 points, and 0.013 percentage points, respectively. CONCLUSION: This study found an inverse association between disability and HRQoL among Australian adults. However, physical activity was associated with improved HRQoL. Therefore, public health interventions, such as the orientation of physical activities, have a higher potential to dwindle the burden regarding HRQoL.
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Pessoas com Deficiência , Qualidade de Vida , Adulto , Austrália , Estudos de Coortes , Exercício Físico , Humanos , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Maternal underweight and childhood malnutrition are life-threatening public health concerns in several South and South-East Asian nations. The aim of this study was to better design interventions and prevent malnutrition of children in the region by exploring the association of maternal underweight with children's anthropometric status. METHODS: The Demographic and Health Survey's (DHS) most recent nationally representative data from eight South and South-East Asian states, collected between 2014 and 2018, were pooled for the present study. A multivariable logistic regression model was designed to explore the association between maternal underweight and child anthropometric status. Owing to the hierarchical structure of the DHS data, the study also employed the multilevel logistic regression technique. RESULTS: Among the total participants (N = 213 730), 22.66% of women were found to be underweight, whereas 39.03%, 35.88%, and 22.11% of their children had stunting, underweight, and wasting, respectively. The logistic regression model showed that the children from underweight mothers were 1.27 (95% confidence interval [CI]. 1.24-1.30), 1.69 (95% CI, 1.65-1.73), and 1.48 (95% CI, 1.45-1.52) times more likely to experience stunting, underweight, and wasting, respectively, than those with healthy-weight mothers. The significant association between maternal underweight and stunting, underweight, as well as wasting was additionally established by the multilevel logistic regression analysis. CONCLUSIONS: Findings indicate that maternal underweight is positively associated with children's anthropometric status, such as stunting, underweight, and wasting. The information from this research will guide actors and policymakers to scale up interventions with all-inclusive nutritional issues and promote healthier weight status among mothers to ensure higher odds of healthier anthropometric status in their children in the South and South-East Asian countries.
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Transtornos da Nutrição Infantil , Desnutrição , Antropometria , Caquexia/complicações , Criança , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/epidemiologia , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Lactente , Desnutrição/complicações , Desnutrição/epidemiologia , Estado Nutricional , Prevalência , Magreza/complicações , Magreza/epidemiologiaRESUMO
Silver has become a potent agent that can be effectively applied in nanostructured nanomaterials with various shapes and sizes against antibacterial applications. Silver nanoparticle (Ag NP) based-antimicrobial agents play a major role in different applications, including biomedical applications, as surface treatment and coatings, in chemical and food industries, and for agricultural productivity. Due to advancements in nanoscience and nanotechnology, different methods have been used to prepare Ag NPs with sizes and shapes reducing toxicity for antibacterial applications. Studies have shown that Ag NPs are largely dependent on basic structural parameters, such as size, shape, and chemical composition, which play a significant role in preparing the appropriate formulation for the desired applications. Therefore, this review focuses on the important parameters that affect the surface interaction/state of Ag NPs and their influence on antimicrobial activities, which are essential for designing future applications. The mode of action of Ag NPs as antibacterial agents will also be discussed.
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BACKGROUND: Obesity prevalence is increasing in many countries in the world, including Asia. Maternal obesity is highly associated with fetal and neonatal deaths. This study investigated whether maternal obesity is a risk factor of fetal death (measured in terms of miscarriage and stillbirth) and neonatal mortality in South and South-East Asian countries. METHODS: This cross-sectional study pooled the most recent Demographic and Health Surveys (DHS) from eight South and South-East Asian countries (2014-2018). Multivariate logistic regression was deployed to check the relationships between maternal obesity with fetal and neonatal deaths. Finally, multilevel logistic regression model was employed since the DHS data has a hierarchical structure. RESULTS: The pooled logistic regression model illustrated that maternal obesity is associated with higher odds of miscarriage (adjusted odds ratio [aOR]: 1.26, 95% CI: 1.20-1.33) and stillbirths (aOR: 1.46, 95% CI: 1.27-1.67) after adjustment of confounders. Children of obese mothers were at 1.18 (aOR: 1.18, 95% CI: 1.08-1.28) times greater risk of dying during the early neonatal period than mothers with a healthy weight. However, whether maternal obesity is statistically a significant risk factor for the offspring's late neonatal deaths was not confirmed. The significant association between maternal obesity with miscarriage, stillbirth and early neonatal mortality was further confirmed by multilevel logistic regression results. CONCLUSION: Maternal obesity in South and South-East Asian countries is associated with a greater risk of fetal and early neonatal deaths. This finding has substantial public health implications. Strategies to prevent and reduce obesity should be developed before planning pregnancy to reduce the fetal and neonatal death burden. Obese women need to deliver at the institutional facility centre that can offer obstetrics and early neonatal care.
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Mortalidade Infantil/tendências , Obesidade Materna/epidemiologia , Complicações na Gravidez/epidemiologia , Natimorto/epidemiologia , Adolescente , Adulto , Sudeste Asiático/epidemiologia , Índice de Massa Corporal , Estudos Transversais , Escolaridade , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Pessoa de Meia-Idade , Obesidade Materna/mortalidade , Obesidade Materna/fisiopatologia , Razão de Chances , Morte Perinatal , Gravidez , Complicações na Gravidez/fisiopatologia , Fatores de Risco , Fatores SocioeconômicosRESUMO
BACKGROUND: People with chronic conditions such as cancer, kidney disease, lung disease, diabetes, dementia, obesity, and heart conditions are at elevated risk of developing severe complications, and are thus at greater risk of death due to COVID-19. The COVID-19 vaccine is an effective measure to manage the pandemic as it prevents severe illness and death. Nevertheless, many people are hesitant to receive the COVID-19 vaccine due to fear of its side effects. The aim of this study was to identify the risk and protective factors of accepting COVID-19 vaccination among Saudi Arabian people with chronic diseases. METHODS: This study extracted data from an online cross-sectional self-reported questionnaire conducted on the acceptability of a COVID-19 vaccine in Saudi Arabia in December 2020. The study included a sample of 521 adults who self-reported that they had chronic diseases. Multivariable regression analyses were employed to identify the factors associated with accepting COVID-19 vaccination in Saudi Arabia. The estimates were adjusted for confounding variables, including socio-demographic factors. RESULTS: Among the sampled participants of Saudi adults with chronic diseases, approximately 52% indicated that they were willing to accept the COVID-19 vaccine. Participants had higher willingness to accept the vaccine if they received the seasonal influenza vaccination in the past [odds ratio (OR): 2.179; 95% confidence interval (CI): 1.222-3.888], reported high or very high levels of concern about contracting COVID-19 (OR: 2.426; 95% CI: 1.209-4.867), or believed in mandatory COVID-19 vaccination (OR: 84.848; 95% CI: 37.651-191.207). Participants had lower willingness to be vaccinated if they had a history of vaccine refusal (OR: 0.211; 95% CI: 0.088-0.504). Among the socio-demographic factors, being male (OR: 2.153; 95% CI: 1.007-4.603), having a postgraduate degree (OR: 2.408; 95% CI: 0.985-5.886), and being unemployed (OR: 2.780; 95% CI: 0.876-8.827) were associated with an increased willingness of receiving the COVID-19 vaccine. CONCLUSIONS: The findings of this study demonstrate that willingness to receive COVID-19 vaccination among Saudi Arabian adults with chronic conditions is low. Therefore, further policy measures are required to manage COVID-19-related infections and the death toll.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Adulto , Doença Crônica , Estudos Transversais , Humanos , Masculino , SARS-CoV-2 , Arábia Saudita/epidemiologia , VacinaçãoRESUMO
OBJECTIVE: Women's empowerment and its association with fertility preference are vital for central-level promotional health policy strategies. This study examines the association between women's empowerment and fertility decision-making in low and middle resource countries (LMRCs). DESIGN: This cross-sectional study uses the Demographic and Health Survey database. SETTINGS: 53 LMRCs from six different regions for the period ranging from 2006 to 2018. PARTICIPANTS: The data of women-only aged 35 years and above is used as a unit of analysis. The final sample consists of 91 070 married women. METHODS: We considered two outcome variables: women's perceived ideal number of children and their ability to achieve preferred fertility desire and the association with women empowerment. Women empowerment was measured by their participation in household decision-making and attitude towards wife-beating. The negative binomial regression model was used to assess women's perceived ideal number of children, and multivariable logistic regression was used to evaluate women's ability to achieve their preferred fertility desire. RESULTS: Our study found that empowered women have a relatively low ideal number of children irrespective of the measures used to assess women empowerment. In this study, the measures were participation in household decision-making (incidence rate ratio (IRR): 0.92, 95% CI: 0.91 to 0.93) and attitude towards wife-beating (IRR: 0.96, 95% CI: 0.95 to 0.97). In the LMRCs, household decision-making and negative attitude towards wife-beating have been found associated with 1.12 and 1.08 times greater odds of having more than their ideal number of children. CONCLUSION: Our findings suggest that women's perceived fertility desire can be achieved by enhancing their empowerment. Therefore, a modified community-based family planning programme at the national level is required, highlighting the importance of women's empowerment on reproductive healthcare as a part of the mission to assist women and couples to have only the number of children they desire.
Assuntos
Países em Desenvolvimento , Direitos da Mulher , Criança , Estudos Transversais , Tomada de Decisões , Características da Família , Feminino , Fertilidade , Inquéritos Epidemiológicos , Humanos , Poder PsicológicoRESUMO
OBJECTIVE: We estimated the cost-effectiveness of a digital health intervention package (mCARE) for community health workers, on pregnancy surveillance and care-seeking reminders compared with the existing paper-based status quo, from 2018 to 2027, in Bangladesh. INTERVENTIONS: The mCARE programme involved digitally enhanced pregnancy surveillance, individually targeted text messages and in-person home-visit to pregnant women for care-seeking reminders for antenatal care, child delivery and postnatal care. STUDY DESIGN: We developed a model to project population and service coverage increases with annual geographical expansion (from 1 million to 10 million population over 10 years) of the mCARE programme and the status quo. MAJOR OUTCOMES: For this modelling study, we used Lives Saved Tool to estimate the number of deaths and disability-adjusted life years (DALYs) that would be averted by 2027, if the coverage of health interventions was increased in mCARE programme and the status quo, respectively. Economic costs were captured from a societal perspective using an ingredients approach and expressed in 2018 US dollars. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. RESULTS: We estimated the mCARE programme to avert 3076 deaths by 2027 at an incremental cost of $43 million relative to the status quo, which is translated to $462 per DALY averted. The societal costs were estimated to be $115 million for mCARE programme (48% of which are programme costs, 35% user costs and 17% provider costs). With the continued implementation and geographical scaling-up, the mCARE programme improved its cost-effectiveness from $1152 to $462 per DALY averted from 5 to 10 years. CONCLUSION: Mobile phone-based pregnancy surveillance systems with individually scheduled text messages and home-visit reminder strategies can be highly cost-effective in Bangladesh. The cost-effectiveness may improve as it promotes facility-based child delivery and achieves greater programme cost efficiency with programme scale and sustainability.
Assuntos
Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Bangladesh/epidemiologia , Criança , Análise Custo-Benefício , Feminino , Serviços de Saúde , Humanos , GravidezRESUMO
BACKGROUND: Breast cancer is the most commonly occurring cancer among women in low-resourced countries. Reduction of its impacts is achievable with regular screening and early detection. The main aim of the study was to examine the role of wealth stratified inequality in the utilisation breast cancer screening (BCS) services and identified potential factors contribute to the observed inequalities. METHODS: A population-based cross-sectional multi-country analysis was used to study the utilisation of BCS services. Regression-based decomposition analyses were applied to examine the magnitude of the impact of inequalities on the utilisation of BCS services and to identify potential factors contributing to these outcomes. Observations from 140,974 women aged greater than or equal to 40 years were used in the analysis from 14 low-resource countries from the latest available national-level Demographic and Health Surveys (2008-09 to 2016). RESULTS: The population-weighted mean utilisation of BCS services was low at 15.41% (95% CI: 15.22, 15.60), varying from 80.82% in European countries to 25.26% in South American countries, 16.95% in North American countries, 15.06% in Asia and 13.84% in African countries. Women with higher socioeconomic status (SES) had higher utilisation of BCS services (15%) than those with lower SES (9%). A high degree of inequality in accessing and the use of BCS services existed in all study countries across geographical areas. Older women, access to limited mass media communication, being insured, rurality and low wealth score were found to be significantly associated with lower utilisation of BCS services. Together they explained approximately 60% in the total inequality in utilisation of BCS services. CONCLUSIONS: The level of wealth relates to the inequality in accessing BCS amongst reproductive women in these 14 low-resource countries. The findings may assist policymakers to develop risk-pooling financial mechanisms and design strategies to increase community awareness of BCS services. These strategies may contribute to reducing inequalities associated with achieving higher rates of the utilisation of BCS services.