Adequacy Indices Research Articles

Research progress on measurement methods and evaluation of the hemodialysis adequacy index Kt/V.

The most common form of replacement therapy for end-stage renal disease (ESRD) is hemodialysis, and the adequacy of hemodialysis is strongly associated with the quality of life and long-term survival of patients. Kt/V is currently one of the most important indicators for evaluating the adequacy of hemodialysis. There are many methods for measuring Kt/V, such as blood collection and measurement, dialysate measurement, bioresistive resistance, WinNonlin software analysis, and artificial intelligence. There are different views on the importance of Kt/V as an indicator of the adequacy of hemodialysis. This article provides a literature review of the various methods of measuring Kt/V and on different perspectives on Kt/V as an evaluation of hemodialysis adequacy.

Diet quality and blood lead levels in Uruguayan first graders

ObjectiveFoods are a potential source of lead but also contain nutrients that counteract the intestinal absorption of lead. Translatable evidence is needed to better understand the relationship between whole diets and blood lead levels (BLLs) in children. In this cross-sectional study we investigated the association between dietary variety, adequacy, moderation, and overall diet quality with children's BLLs. MethodsFirst graders (~ 7 years) from Montevideo, Uruguay were evaluated in years 2009–13 (Phase I, n = 303) and 2015–19 (Phase II, n = 443). Lead was measured in fasting blood via atomic absorption spectrometry and primary caregivers completed two non-consecutive 24-h recalls. Indices of dietary variety (maximum score of 20), adequacy (maximum 40), moderation (maximum 30), and overall diet quality were calculated from food and nutrient intakes averaged over two recall days. The indices were adapted from the Diet Quality Index-International based on dietary recommendations for children. Missing covariate data were imputed. The associations between diet quality measures and BLLs were modeled separately in Phase I and II with multivariable linear models, testing for sex differences via interaction terms and stratified models. ResultsThe median[IQR] BLLs were 3.8[2.6, 4.9] and 1.3[0.7, 3.6] μg/dL in study Phases I and II, respectively. All diet quality scores were <60 % of the maximum values and daily intakes of key food groups fell below recommended levels. There was little evidence of an association between measures of diet quality and children's BLLs overall. On the other hand, higher diet variety, adequacy, and overall diet quality were associated with slightly higher BLLs among girls in Phase I only. ConclusionsIn the context of low lead exposure and food consumption patterns that fall short of recommended levels, the relation of diet quality to children's BLLs may depend on lead exposure levels.

Validation of the HIV/AIDS-Targeted Quality of Life (HAT-QOL) for Evaluation of Health-related Quality of Life in People Living with HIV/AIDS in Brazil.

HIV/AIDS-Targeted Quality of Life (HAT-QOL) is an instrument for evaluating health-related quality of life (HRQOL) in people living with HIV (PLWHIV). This has been adapted into Brazilian Portuguese, but its dimensional structure has not been analyzed. This study evaluated the psychometric properties of the Brazilian Portuguese version of the HAT-QOL, using a sample of 319 PLWHIV in Salvador, Brazil. The study performed Exploratory Factor Analysis (EFA) to assess the HAT-QOL dimensional structure. The analysis used a polychoric correlation matrix, Robust Diagonally Weighted Least Squares (RDWLS) as an extraction method, Parallel Analysis for factor retention, robust promin as oblique rotation, and Generalized H-index (G-H) for construct replicability of each factor. Model adequacy was assessed using the Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). Concurrent validity was evaluated with the 36-item Short Form Health Survey, version 2 (SF-36v2). EFA identified a HAT-QOL six-factor solution: Financial Worries, Sexual Function, Medication Concerns, Life Satisfaction, Health Worries, and Overall Function. This solution showed high G-H indexes, concurrent validity, and satisfactory adequacy indexes (X2 = 231.345, df = 291, p < 0,001; RMSEA = 0.001, CFI = 0.999, TLI = 1.028). HIV Mastery, Disclosure Worries, and Provider Trust domains were not retained in EFA and did not have evidence of concurrent validity. This study proposed a HAT-QOL six-factor model for measuring HRQOL in the Brazilian PLWHIV. Future research could help identify another latent construct from not-included domains.

Population dietary-metabolic characteristics and mortality from major cardiovascular disease subtypes: the Seven Contries Study 60-year follow-up

Background and aimDuring the last few years, the Seven Countries Study of Cardiovascular Diseases (SCS) produced some new analyses dealing with the relationships of a dietary score, the pool of dietary fatty acids and serum cholesterol with major types of cardiovascular disease (CVD) mortality in 10 cohorts of 6 countries made of middle-aged men followed-up for 60 years until extinction. This sparse evidence is condensed here to provide a coherent view. Methods and resultsThe Mediterranean Adequacy Index (MAI, a dietary score whose high levels depict the characteristics of the Mediterranean Diet), was highly and significantly associated in an inverse way, at country levels, with the Atherogenicity (ATI) and the Thrombogenicity (THI) indexes that included a series of dietary fatty acids. These indexes were highly and significantly associated in a direct way with country baseline serum cholesterol levels. Countries with high serum cholesterol had largely higher death rates from coronary heart disease (CHD) and lower rates from other heart diseases of uncertain etiology and stroke. The reverse was observed in countries with low serum cholesterol. ConclusionThe chain of diet, dietary fatty acids and serum cholesterol seems to be responsible in various ways for the different distribution of major CVD mortality subtypes in extincted cohorts.

The efficacy of sacubitril/valsartan in patients receiving peritoneal dialysis with diabetes and heart failure with preserved ejection fraction.

To investigate the efficacy of sacubitril/valsartan in the treatment of peritoneal dialysis (PD) in patients with diabetes and heart failure with preserved ejection fraction (HFpEF). Patients with diabetes who underwent PD and had HFpEF (n = 64) were divided into two groups: the experimental group (n = 31), which was administered sacubitril/valsartan, and the control group (n = 33), administered valsartan alone. Data were collected before and after treatment to compare the inter-group changes in cardiac function indexes, residual renal function (RRF), and PD adequacy indexes. Compared with the control group, the N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were lower in the experimental group after treatment (Wilcoxon test, p < 0.05). The descent ranges of NT-proBNP, left ventricular end-systolic dimension, and left ventricular fraction shortening, as well as increases in the amplitude of left ventricular ejection fraction after treatment were better in the experimental group than in the control group (t-test, p < 0.05). The descent ranges of residual renal glomerular filtration rate, residual renal Kt/Vurea, and residual renal creatinine clearance, as well as increases in the amplitude of β2-microglobulin, were lower in the experimental group than in the control group (Wilcoxon test, p < 0.05). However, there were no significant differences between the two groups in the descent ranges of the PD adequacy indexes (Wilcoxon test, p > 0.05). Hyperkalemia occurred in 8 cases (25.81%) in the experimental group and 13 cases (39.39%) in the control group, while hypotension occurred in 2 cases (6.45%) and 1 case (3.03%), respectively. No other adverse effects were observed in either group. The findings suggest that sacubitril/valsartan can safely and effectively improve RRF and cardiac function in patients with diabetes combined with HFpEF receiving PD, but it has little effect on PD adequacy.

New Electric Power System Stability Evaluation Based on Game Theory Combination Weighting and Improved Cloud Model

The development of new electric power system is a requirement for China to realize its “carbon peaking and carbon neutrality goals”, so it is of great importance that we assess the stability of a new electric power system under certain conditions. Firstly, according to the factors affecting the stability of the new power system, the characteristics of the new electric power system are analyzed in depth, so as to establish a stability evaluation index system including four first-level indices of safety, adequacy, flexibility, and adaptability. Secondly, a stability evaluation model is proposed. Based on the game theory, the entropy weight method, criteria importance though intercrieria correlation (CRITIC) method, and coefficient of variation method are combined and assigned, and the cloud model is improved through the combination of weights, which is used for evaluating the stability of the new electric power system. Finally, the applicability of the proposed evaluation model is verified by an arithmetic example analysis, which can identify the vulnerability of the new electric power system and provide suggestions for improving its stability. The model can provide a theoretical basis for promoting energy transition and sustainable development.

Real-World Treatment of Hypertension on Hemodialyses Data from a Large Polish Database.

The prevalence of hypertension among patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD) ranges from 72 to 88% depending on applied diagnostic criteria and the chosen method of blood pressure measurement. Despite the guidelines recommending the widespread use of renin-angiotensin system blockers (RASBs) in patients with kidney disease, their utilization in patients on HD may be suboptimal, especially in patients with preserved diuresis. This hesitance that often steams from concern is often due to fear of a decrease in eGFR and a subsequent decrease in diuresis. The aim of this study was to compare clinical characteristics, blood pressure, safety, and HD adequacy indices in hypertensive HD patients on multiple antihypertensive drug regimens, including diuretic treated with RASB (RASB group) or without RASB (no-RASB) with preserved residual diuresis. We sought to examine the real-life use of RASB in HD patients in relation to their clinical characteristics, blood pressure, safety, and HD adequacy. From a database of 5,879 patients receiving HD (mean age 65.2 ± 14.2 years, 60% of males) of the largest provider of HD in the country, we selected the subgroup treated with at least three antihypertensive medications including diuretics. We compared patients treated with RASB to counterparts without RASB (no-RASB). The RASB group has similar age and gender proportions as well as BMI and bioimpedance compared to counterparts. However, dry body mass was significantly lower in the RASB group (78.1 ± 18.3 kg vs. 80.0 ± 18.2 kg, p &lt; 0.017). Prevalence of diabetes mellitus was similar in both groups, but RASB-treated patients have cardiovascular diseases more frequently (70.1 vs. 60.8%; p &lt; 0.001). Systolic blood pressure and the number of antihypertensive drugs used were significantly higher in RASB patients than in counterparts (146 ± 16 mm Hg vs. 144 ± 15 mm Hg; p &lt; 0.001 and 4.1 ± 0.9 vs. 3.5 ± 0.5; p &lt; 0001, respectively). RASB-treated patients have significantly longer dialysis vintage (52.7 ± 44.4 months vs. 40.2 ± 40.9 months; p &lt; 0.001) and dialysis time (722 ± 87.1 min/week vs. 713 ± 93.4 min/week; p &lt; 0.017) than counterparts. Serum potassium was slightly but significantly higher in RASB (5.3 ± 0.8 mmol/L vs. 5.1 ± 0.7 mmol/L; p &lt; 0.01). In the real world setting, RASB can be safely used in HD patients treated with diuretics with preserved residual diuresis. Given that many HD patients present numerous multimorbidities, RASB should not only be considered as an additional hypotensive drug in poorly controlled hypertension but also in other compelling indications in HD patients. The tendency toward hyperkalemia in HD patients could be effectively managed with appropriate diet and HD prescription adjustments.

Adequacy of Dialysis and Incidence of Atrial Fibrillation in Patients Undergoing Hemodialysis.

Atrial fibrillation (AF) can lead to stroke, heart failure, and mortality and has a greater prevalence in dialysis patients than in the general population. Several studies have suggested that uremic toxins may contribute to the development of AF. However, the association between dialysis adequacy and incident AF has not been well established. In this retrospective nationwide cohort study, we analyzed data from the Korean National Periodic Hemodialysis Quality Assessment from 2013 to 2015 of patients who received outpatient maintenance hemodialysis 3× a week. The main exposure was single pooled Kt/V (spKt/V), which is the dialysis adequacy index, and the primary outcome was the development of AF. For the primary analysis, patients were categorized into quartiles according to baseline spKt/V. The lowest quartile, representing the lowest adequacy, was used as the reference group. Fine-Gray subdistribution hazard models were used, treating all-cause mortality as a competing risk. Of 25 173 patients, the mean age was 60 (51-69) years, and 14 772 (58.7%) were men. During a median follow-up of 5.7 years, incident AF occurred in a total of 3883 (15.4%) patients. Participants with a higher spKt/V tended to have lower AF incidence. In survival analysis, a graded association was observed between the risk of incident AF and spKt/V quartiles: subdistribution hazard ratios and 95% CIs for the second, third, and the highest quartile compared with the lowest quartile were 0.90 (95% CI, 0.82-0.98), 0.84 (95% CI, 0.77-0.93), and 0.79 (95% CI, 0.72-0.88), respectively. This nationwide cohort study showed that a higher spKt/V is associated with a reduced risk of incident AF. These findings suggests that reducing uremic toxin burden through enhanced dialysis clearance may be associated with a lower risk of AF development in patients undergoing maintenance hemodialysis.

Association between self-reported functional capacity measures and postoperative myocardial injury in patients undergoing noncardiac surgeries.

Self-reported functional capacity measures have an uncertain role in the pre-operative cardiovascular risk stratification. This substudy aimed to evaluate whether self-reported metabolic equivalent (MET) could improve the prediction of postoperative myocardial injury (MI) over other well-established cardiovascular risk factors. This is a post hoc analysis of an international multicenter prospective cohort study. We recruited patients ≥45 years old who had elective elevated-risk noncardiac surgery in 45 centers across 17 countries between June 2017 and April 2020. The primary outcome was MI defined according to the Fourth Universal Definition of Myocardial Infarction. We measured the proportion of new prognostic information added by self-reported MET using multivariable logistic regression. In total, 860 (41.3%) patients suffered MI. In patients without systematic troponin surveillance, the odds ratio for MI with each 1-point increment in MET equaled 1.03 (95% confidence interval [CI], 0.99-1.07). The new prognostic information, according to the likelihood ratio adequacy index, accounted for 1.5%. Sensitivity analysis, including centers with >90% of patients with routine high-sensitivity troponin T monitoring, showed that MET added 21.8% of new information to the baseline model, and each additional point was associated with a lower risk of MI (odds ratio, 0.86; 95% CI, 0.81-0.91). In elevated-risk noncardiac surgery, self-reported functional capacity measures do not significantly improve the prediction of MI; however, they add new prognostic information in centers with routine perioperative troponin monitoring.

Dietary atherogenicity and thrombogenicity indexes predicting cardiovascular mortality: 50-year follow-up of the Seven Countries Study

Background and aimTo study the relationships of an Atherogenicity Index (ATI) and a Thrombogenicity Index (THI), with 50-year mortality from coronary heart disease (CHD), other heart diseases of uncertain etiology (HDUE) and cerebrovascular disease or stroke (STR), in 16 international cohorts of middle-aged men. Methods and resultsFoods from a dietary survey in subsamples of men in each cohort of the Seven Countries Study (SCS) were chemically analyzed for several types of fatty acids that were converted into ATI and THI identifying each of 16 cohorts. Ecological correlations of the ATI and THI were calculated with the three fatal CVD conditions and with all-cause mortality at 25 and 50 years. Correlation coefficients (Rs) were positive and highly significant between ATI and THI versus CHD mortality, with levels ranging from 0.79 to 0.97, depending on the duration of follow-up and the choice of 10 or of 16 cohorts. This was not the case for HDUE and STR mortality for which Rs were variable and not significant. A strong direct association was also found with all-causes deaths at 25 and 50-years. ATI and THI were also directly related with dietary saturated fat and cholesterol levels and inversely with the Mediterranean Adequacy Index (a score identifying the Mediterranean diet). ConclusionThese findings indicate that CHD has a different relationship with dietary lipids intake than HDUE and STR. This suggests that HDUE and STR have different underlying pathways or are different diseases.

Association between Socioecological Status, Nutrient Intake, and Cancer Screening Behaviors in Adults Aged 40 and Over: Insights from the Eighth Korea National Health and Nutrition Examination Survey (KNHANES, 2019).

Cancer screening is pivotal for early detection and improved survival rates. While socio-ecological factors are known to influence screening uptake, the role of lifestyle, dietary habits, and general health in shaping these decisions remains underexplored. Utilizing the 2019 Korea National Health and Nutrition Examination Survey (KNHANES), this study examined the myriad of factors impacting cancer screening utilization. Data from 274,872 adults aged 40 years or older were scrutinized, highlighting demographics, income, lifestyle behaviors, health-related variables, nutrient intake, and dietary quality. A combination of descriptive statistics and logistic regression helped us ascertain influential determinants. Higher educational attainment and income quartiles were positively correlated with cancer screening rates. Regular walkers, those engaged in moderate physical activity, and individuals with a previous cancer diagnosis were more likely to get screened. High-risk drinkers and smokers were less inclined towards screening. Dietary habits also influenced screening decisions. Notably, participants with healthier eating behaviors, indicated by factors such as regular breakfasts and fewer meals out, were more likely to undergo screening. Additionally, nutrient intake analysis revealed that those who had undergone screening consumed greater quantities of most nutrients, bar a few exceptions. For individuals aged 50-64, nutritional assessment indicators highlighted a higher mean adequacy ratio (MAR) and index of nutritional quality (INQ) value among those who participated in screening, suggesting better nutritional quality. This study elucidates the complex socio-ecological and nutritional landscape influencing cancer screening decisions. The results underscore the importance of a holistic approach, emphasizing lifestyle, dietary habits, and socio-economic considerations. It provides a roadmap for policymakers to craft more inclusive screening programs, ensuring equal access and promoting early detection.

Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis

BackgroundAlthough sociodemographic characteristics are associated with health disparities, the relative predictive value of different social and demographic factors remains largely unknown. This study aimed to describe the sociodemographic characteristics of All of Us participants and evaluate the predictive value of each factor for chronic diseases associated with high morbidity and mortality.MethodsWe performed a cross-sectional analysis using de-identified survey data from the All of Us Research Program, which has collected social, demographic, and health information from adults living in the United States since May 2018. Sociodemographic data included self-reported age, sex, gender, sexual orientation, race/ethnicity, income, education, health insurance, primary care provider (PCP) status, and health literacy scores. We analyzed the self-reported prevalence of hypertension, coronary artery disease, any cancer, skin cancer, lung disease, diabetes, obesity, and chronic kidney disease. Finally, we assessed the relative importance of each sociodemographic factor for predicting each chronic disease using the adequacy index for each predictor from logistic regression.ResultsAmong the 372,050 participants in this analysis, the median age was 53 years, 59.8% reported female sex, and the most common racial/ethnic categories were White (54.0%), Black (19.9%), and Hispanic/Latino (16.7%). Participants who identified as Asian, Middle Eastern/North African, and White were the most likely to report annual incomes greater than $200,000, advanced degrees, and employer or union insurance, while participants who identified as Black, Hispanic, and Native Hawaiian/Pacific Islander were the most likely to report annual incomes less than $10,000, less than a high school education, and Medicaid insurance. We found that age was most predictive of hypertension, coronary artery disease, any cancer, skin cancer, diabetes, obesity, and chronic kidney disease. Insurance type was most predictive of lung disease. Notably, no two health conditions had the same order of importance for sociodemographic factors.ConclusionsAge was the best predictor for the assessed chronic diseases, but the relative predictive value of income, education, health insurance, PCP status, race/ethnicity, and sexual orientation was highly variable across health conditions. Identifying the sociodemographic groups with the largest disparities in a specific disease can guide future interventions to promote health equity.

Impact analysis of electricity pricing on the reliability of integrated Nepal power system

Abstract Time of Use of Electricity Pricing (TOU) strategy is adopted by many countries to reduce the peak load and minimize the cost of Electricity. In this research, the effect of the TOU tariff system on the reliability of the Integrated Nepal Power System (INPS) has been investigated. Implemented TOU is based on three time periods: Peak time, Flat time, and Valley time (PFV). The moving variable method is used to find the optimal PFV period in a day. Particle swarm optimization (PSO) is used to find optimal prices corresponding to the given periods, where two objective functions are converted to a single objective function. Prices are modeled with the demand response and a new load pattern of consumers after TOU has been obtained. Power plants of INPS are modeled into four states model and the Monte-Carlo simulation is used to find the generation adequacy indices like Loss of Load Probability (LOLP), Loss of Load Expected (LOLE), and Loss of Energy Expected (LOEE) before and after the implementation of the TOU. The risk level of INPS is reduced by 37% and peak load is reduced by 4.2% after the implementation of TOU. It is found that the reliability of INPS can be improved with the help of TOU

Sex-dependent differences in patients treated with regular hemodialysis

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction.&amp;lt;/strong&amp;gt; The aims of the study were to find out sex differences among patients starting regular hemodialysis (HD) in 2014 and to check whether these differences change over a five-year period.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; The retrospective five-year study included 35 patients (24 men; 11 women) starting HD in HD centers in Leskovac and Pirot in 2014. Demographic data, clinical data, laboratory findings, and medication used for examined patients were taken from medical records.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results.&amp;lt;/strong&amp;gt; A comparison of patients of different sexes at the beginning of the study showed that women were significantly older (70.55 &amp;amp;plusmn; 13.27 vs. 58.88 &amp;amp;plusmn; 15.27 years), but diabetes and hypertension were more frequent causes of chronic kidney disease in men. Women had significantly lower body mass index and serum creatinine level than men in the first year of the study. During all five years, the HD adequacy index spKt/V was higher in women than in men, but the difference reached statistical significance only in the third year (1.4 &amp;amp;plusmn; 0.2 vs. 1.2 &amp;amp;plusmn; 0.2). Serum iPTH level was higher in women than in men in almost the entire study period. There was no significant sex difference in blood pressure, type of vascular access, number of HD hours per week, in the percentage of patients who used erythropoiesis-stimulating agents or phosphate binders. During the study period 10 (42.7%) men and five (45.5%) women died and the most frequent causes of death were cerebrovascular and cardiovascular diseases.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion. &amp;lt;/strong&amp;gt;The study revealed several differences between men and women on regular HD, but no treatment inequality was found.&amp;amp;nbsp;&amp;lt;/p&amp;gt;

Family Vulnerability Scale: validity evidence in primary health care.

Investigate evidence of validity of the Family Vulnerability Scale (EVFAM-BR) as an instrument to support population-based management in primary health care (PHC), in the scope of Health Care Planning (PAS). This is a psychometric study to assess any additional evidence of the internal structure of EVFAM-BR using confirmatory factor analysis (CFA) and network analysis (NA). A preliminary version of the scale with 38 items was submitted to patients of PHC facilities that use the PAS methodology, distributed across the five regions of Brazil. For the primary CFA data, factor loadings and predictive power (R2) of the item were used. Seven model adjustment indices were adopted and reliability was measured by three indicators, using Bayesian estimation. The preliminary version of the scale was applied to 1,255 patients. Using the AFC, factor loadings ranged from 0.66 to 0.90 and R2 from 0.44 to 0.81. Both the primary indicators and the model adequacy indices presented satisfactory and consistent levels. According to the NA, the items were appropriately associated with their peers, respecting the established dimensions, thus demonstrating sustainability and stability of the proposed model. The evidence of validity presented by EVFAM-BR indicates, for the first time in Brazil, a concise instrument that is able to assertively measure family vulnerability, potentially supporting population-based management.

Brazilian Scale for Evaluation of Mental Health Care Needs: Additional Evidence.

To investigate validity evidence of the Brazilian Scale for Evaluation of Mental Health Care Needs (CuidaSM). This is a psychometric study, which seeks additional evidence of internal structure. Data collection was carried out in 11 Primary Health Care (PHC) services , which implement the Health Care Planning (HCP) methodology, distributed across the five Brazilian regions. The preliminary version of CuidaSM, containing a block self-referred by the user and another block evaluated by PHC professionals, was applied to users aged 18 or over who attended the PHC services for consultation with a higher education professional. The techniques of confirmatory factor analysis and network analysis were used to investigate validity evidence. For the primary data of the confirmatory factor analysis, the factorial loads and the item's predictive power (R2) were used. Six model adjustment indices were adopted and reliability was measured by three indicators using Bayesian estimation. A total of 879 users participated in the study. By confirmatory factor analysis, factorial loads ranged from 0.43 to 0.99 and R2 from 0.19 to 0.98. Both the primary indicators and the model adequacy indices were established at satisfactory and consistent levels. The network analysis showed that the items were appropriately associated with their peers, respecting the established dimensions, which again indicates the sustainability and stability of the proposed model. The study findings confirm a consistent and reliable model of the instrument, through a combination of techniques. Considering the importance of using solid instruments in clinical practice, CuidaSM is a promising tool for population-based management and network care organization, aligned with HCP proposals.

Indicators of Accounting Measurement of Insurance Awareness and its Impact on Risk Reduction in the Light of the International Financial Reporting Standard (Insurance Contracts)

This study aims to provide some indicators for the accounting measurement to spread insurance awareness and determine its impact on avoiding financial risks in the light of the International Financial Reporting Standard "Insurance Contracts". To achieve this study, the researcher presented the problem of the study and some previous studies related to insurance awareness and accounting for insurance contracts. The researcher presented the main concepts of insurance awareness and its deficiency factors. In addition accounting for insurance contracts, with a focus on testing the adequacy of obligations and displaying the impact on risk reduction. The researcher reached out to provide some indicators to measure insurance awareness. These indicators help to increase the income of insurance companies and avoid the risks arising from insurance contracts. The researcher relied on designing a survey list to test the hypothesis of the study. It was distributed among various groups. The first group consisted of some employees of some insurance companies. The second group consisted of some faculty members in the accounting and insurance departments. The third group consisted of some workers in accounting and auditing offices. The study hypothesis was tested using the SPSS statistical program. The study concluded that the indicators proposed by the researcher to measure the dissemination of insurance awareness can help to avoid the financial risks of the liability adequacy index in insurance companies.

Evaluation of the Turkey Nutrition and Health Surveys according to the mediterranean adequacy index and sustainability through water footprints.

Sustainable diet is one of the main factors that support food security, and the Mediterranean diet (MD) one of the sustainable diet models associated with low ecological impact and optimum health results has come to the fore. It was aimed to compare the results of the 2010 and 2017 Turkey Nutrition and Health Studies (TNHS) according to the Mediterranean Adequacy Index (MAI) and in order to evaluate the environmental impact of the current nutritional status in Turkey through water footprints (WF). The MAI score was calculated using the published results of the 2010 and 2017 TNHS, and the WF have been calculated as indicators of environmental impact. Turkey. There are no participants. In the TNHS, there was an increase in the amount of energy provided by foods non-MD in 2017 compared to 2010, with a decrease in the total MAI score. The group with the lowest adherence to the MD in both years was the adult group (MAI20102·74 and MAI20172·31), while the group with the highest adherence was the adolescent group (MAI20103·21 and MAI20172·53). The MAI scores of females were higher than those of males in both years. The males aged 19-64 years had the largest (841 m3/year) WF and the females aged 65+ years had the smallest (483 m3/year). The food group that contributed the most to WF was meat and meat products (21·0-35·0 %). Adherence to the MD has decreased due to the increase in the consumption of the Western-type diet in Turkey.

Translation, Cultural Adaptation and Validation of Perceived Physical Literacy Instrument-Spanish Version (PPLI-Sp) for Adults

To translate and culturally adapt the Perceived Physical Literacy Instrument (PPLI) questionnaire, as well as to evaluate the factor structure. A single-measure cross-sectional study was conducted. For the first phase of the study, a translation and cultural adaptation of the PPLI questionnaire was carried out, as well as an interview, with the aim of assessing the understanding of the instrument. In the second part of the study, exploratory (EFA) and confirmatory (CFA) factorial analyses were conducted. A total of 213 Spanish adults with a mean age of 27.40 (10.58) participated. EFA was performed because of the good results offered by the sampling adequacy indices (Bartlett test = 1081.848; df = 153; p &lt; 0.001; and KMO test = 0.825). The factor solution comprised three correlated factors:1) physical competence, 2) motivation and confidence, and 3) knowledge and understanding. After the EFA, items 7, 9, 10, 11, 12, 13, 14, 15 and 17 were excluded. Therefore, through CFA, a factor structure of 9 items grouped into three dimensions was extracted. The PPLI-Sp version for adults, obtained from the back-translation process as well as after individual interviews, proved to be valid and reliable after the EFA and CFA analyses, obtaining an instrument of nine items, divided into three dimensions. This instrument can be used to determine the perception of physical literacy among different Spanish adult populations.

Translation, Cultural Adaptation and Validation of Perceived Physical Literacy Instrument-Spanish Version (PPLI-Sp) for Adults.

To translate and culturally adapt the Perceived Physical Literacy Instrument (PPLI) questionnaire, as well as to evaluate the factor structure. A single-measure cross-sectional study was conducted. For the first phase of the study, a translation and cultural adaptation of the PPLI questionnaire was carried out, as well as an interview, with the aim of assessing the understanding of the instrument. In the second part of the study, exploratory (EFA) and confirmatory (CFA) factorial analyses were conducted. A total of 213 Spanish adults with a mean age of 27.40 (10.58) participated. EFA was performed because of the good results offered by the sampling adequacy indices (Bartlett test = 1081.848; df = 153; p < 0.001; and KMO test = 0.825). The factor solution comprised three correlated factors:1) physical competence, 2) motivation and confidence, and 3) knowledge and understanding. After the EFA, items 7, 9, 10, 11, 12, 13, 14, 15 and 17 were excluded. Therefore, through CFA, a factor structure of 9 items grouped into three dimensions was extracted. The PPLI-Sp version for adults, obtained from the back-translation process as well as after individual interviews, proved to be valid and reliable after the EFA and CFA analyses, obtaining an instrument of nine items, divided into three dimensions. This instrument can be used to determine the perception of physical literacy among different Spanish adult populations.