Complex Interaction Of Various Factors Research Articles

Predictive Models for Suicide Attempts in Major Depressive Disorder and the Contribution of EPHX2: A Pilot Integrative Machine Learning Study

Suicide is a major public health problem caused by a complex interaction of various factors. Major depressive disorder (MDD) is the most prevalent psychiatric disorder associated with suicide; therefore, it is essential to prioritize suicide prediction and prevention within this population. Integrated information from different dimensions, including personality, cognitive function, and social and genetic factors, is necessary to improve the performance of predictive models. Besides, recent studies have indicated the critical roles for EPHX2/P2X2 in the pathophysiology of MDD. Our previous studies found an association of EPHX2 and P2X2 with suicide in MDD. This study is aimed at (1) establishing predictive models with integrated information to distinguish MDD from healthy volunteers, (2) estimating the suicide risk of MDD, and (3) determining the contribution of EPHX2/P2X2. This cross-sectional study was conducted on 472 prospectively collected participants. The machine learning (ML) technique using Extreme Gradient Boosting (XGBoost) classifier was employed to evaluate the performance and relative importance of the extracted characteristics in recognising patients with MDD and depressed suicide attempters (DSA). In independent validation set, the model with clinical and cognitive information could recognise MDD with an area under the receiver operating characteristic curve (AUC) of 0.938 (95% confidence interval (CI), 0.898–0.977), and genetic information did not improve classification performance. The model with clinical, cognitive, and genetic information resulted in a significantly higher AUC of 0.801 (95% CI, 0.719–0.884) for identifying DSA than the model with only clinical information, in which the three single nucleotide polymorphisms of EPHX2 showed important roles. This study successfully established step-by-step predictive ML models to estimate the risk of suicide attempts in MDD. We found that EPHX2 can help improve the performance of suicidal predictive models. This trial is registered with NCT05575713.

Why Chinese “Society” is So Called: How Social and Managerial Discourse Caused the Choice of the Word at the Turn of the 19th and 20th Centuries

Introduction. The purpose of this article is to investigate the reasons for the choice of the term “shehui” to designate the concept of “society” in China at the turn of the 19th and 20th centuries. The research novelty of the work is manifested in the complex analysis of social and managerial discourse of that time and in the identification of factors that influenced the terminological choice. The relevance of the study is conditioned by the necessity to understand the processes of formation of social sciences in China, which is important for the interpretation of modern socio-political processes in the country, including in the context of modern sociology of management. This is especially important for Russian sociology, since its area of interest includes the search for mutually beneficial strategies of interaction between Russian and Chinese societies. And this is impossible without studying China's approaches to managing the country's development processes, its internal and external social relations. Methodology and sources. The study applies a system-historical approach, as well as discursive, terminological, etymographic and factor analysis. The paper analyzes classical Chinese texts and works of Chinese enlighteners of the late 19th and early 20th centuries, and also uses some materials collected by modern researchers, in particular, by N.M. Kalyuzhnaya. Results and discussion. The main results of the study were the identification and analysis of factors (including internal political, social, foreign policy and linguistic factors) that determined the social and managerial discourse of the period under study and the choice in favor of “shehui” among the main terms competing for the right to designate the concept of “society”. Author pointed out that the process of formation of social and managerial discourse was in line with the gradual decline in the influence of traditionalism and strengthening of the ideas of anti-monarchism, people's power and self-government. Conclusion. Author emphasized that the term “shehui” became one of the key terms in the social and managerial discourse of China at the turn of the century, reflecting global socio[1]political trends. The choice of this term is the result of a complex interaction of various factors in the formation of discursive practices, which themselves were further modified under the influence of the term and its derivatives.

Navigating accent bias in German: children's social preferences for a second-language accent over a first-language regional accent

Spoken language conveys rich sociolinguistic information about a speaker's language background. Previous research indicates that both monolingual and bilingual children use this information when making social decisions. They prefer local speakers whose accent or variety matches their own over speakers of foreign languages or second-language speakers. What remains unclear is how exposure to diverse linguistic communities affects children's preferences for non-local accents. This study examines social preferences for a regional and a second-language accent as a function of prior exposure to diverse accents and languages, measured on a continuous scale. German-speaking primary-school children (aged 7–10) were asked to choose stickers in a forced-choice task using animated cartoon characters. We replicated the observed social preferences for one's local accent. Interestingly, when the local accent was absent, children socially preferred a second-language accent (American) over a first-language regional accent (Bavarian), even though both accents were equally intelligible and relatively unfamiliar to the children, as determined through a sentence repetition task and a geographical classification task. Children's choices were not explained by continuous measures of accent or bilingual exposure. The results suggest a complex interaction of various factors not limited to the speakers' first- or second-language status.

Genetic Diversity in Bronchial Asthma Susceptibility: Exploring the Role of Vitamin D Receptor Gene Polymorphisms in Varied Geographic Contexts.

Bronchial asthma (BA) exhibits varying prevalence across global populations, prompting a comprehensive investigation into genetic and environmental determinants. Vitamin D is a potent immunomodulator capable of suppressing inflammatory signals in several cell types involved in the asthmatic response; it exerts effects on the immune system by binding to the nuclear vitamin D receptor (VDR). VDR gene genetic variations are affecting serum vitamin D levels with a possible role in the BA risk. The current study aimed to examine the complex interaction of various factors (genetic background, serum vitamin D levels, and geographic location) to identify differences in the influence of these factors on the susceptibility to asthma between populations at different latitudes. Focusing on Eastern European cohorts from Latvia and Lithuania and comparing them with published data on East Asian populations, we explore the impact of VDR gene polymorphisms on BA susceptibility. Genotyping four key VDR SNPs and assessing their association with 25-hydroxyvitamin D levels, our study unveils significant associations of the studied loci with the risk of asthma-both risk-reducing and increasing effects, differently distributed between Baltic and East Asian populations. The functional effects of in silico VDR gene genetic variations are also identified and discussed.

Assessing crash severity of urban roads with data mining techniques using big data from in-vehicle dashcam

<abstract> <p>The factors that affect the severity of crashes must be identified for pedestrian and traffic safety in urban roads. Specifically, in the case of urban road crashes, these crashes occur due to the complex interaction of various factors. Therefore, it is necessary to collect high-quality data that can derive these various factors. Accordingly, this study collected crash data, which included detailed crash factor data on the huge urban and mid-level roads. Using this, various crash factors including driver, vehicle, road, environment, and crash characteristics are constructed to develop a crash severity prediction model. Through this, this study identified more detailed factors affecting the severity of urban road crashes. The crash severity model was developed using both machine learning and statistical models because the insights that can be obtained from the latest technology and traditional methods are different. Therefore, the binary logit model, a support vector machine, and extreme gradient boosting were developed using key variables derived from the multiple correspondence analysis and Boruta-SHapley Additive exPlanations. The main result of this study shows that the crash severity decreased at four-street intersections and when traffic segregation facilities were installed. The findings of this study can be used to establish a traffic safety management strategy to reduce the severity of crashes on urban roads.</p> </abstract>

Perkembangan Terkini Perilaku Bunuh Diri pada Orang dengan Depresi

Suicide is one of the leading causes of injury and death worldwide. Suicide is the fourth most common cause of death among young people worldwide. Suicidal behavior is caused by a complex interaction of several risk factors. One of the most common risk factors is psychiatric disorders, especially in people with depression. Depressive conditions are describedasmooddisordersthat causepersistentfeelingsof sadness and lossof interest that can affect daily life and trigger suicidal thoughts. Several efforts can be made to treat depression and suicide prevention, starting with screening, pharmacological treatment, and non-pharmacological. However, there has been no significant effect in reducing the incidence of suicide. This is because the association of suicidal behavior in individuals with depression is not only caused by a simple etiology but is the result of a complex interaction of various factors

Description of the technology for forming students' ethnic identity in the modern context: research results

In modern conditions of the development of the information society, there is a tendency to complicate the content and structure of the identity of the individual, which is the result of his free choice. Simple identification with cultural patterns becomes impossible due to the blurring of value orientations, unified, standardized norms and values imposed by mass culture, the media and communications, virtual reality technologies. Children, adolescents and young people have problems identifying themselves as a person in society due to the multiplicity of self-images that can coexist and conflict at the same time. Actualization of the problem of ethnic identity is especially acute for the pedagogical community: along with the need to educate a citizen and a patriot in the implementation of state policy in the field of education, this problem is no less relevant for vocational education that trains teachers. Appeal to the problem of the formation of ethnic identity is connected, first, with the socio-cultural changes taking place in society, the processes of modernization of education. The ethnic identity of a developing personality is determined by a complex interaction of various factors (historical, geographical, religious, and sociocultural). The declared priorities of the state policy in the field of culture and education, national policy, first, aim at the formation of civic identity in a multicultural and multi-confessional society, a component of which is ethnic identity. The purpose of the article is to refine the concept of ethnic identity in the context of the study, to describe the technology of forming the ethnic identity of students by means of extracurricular activities, and to present the results of an empirical study. The article discusses the possibilities of extracurricular activities for the formation of ethnic identity, taking into account the regional context at the level of primary general education. An interpretation of the results of the empirical study and conclusions are presented.

Phase synchronization of chlorophyll and total phosphorus oscillations as an indicator of the transformation of a lake ecosystem

The ecosystem of the Naroch Lakes (Belarus) includes three water bodies, Lake Batorino, Lake Myastro and Lake Naroch. These lakes have a common catchment area. At the end of the 80 s, the ecosystem of the Naroch Lakes underwent a transformation, during which the nutrient load on the catchment area decreased, and the concentration of phosphorus as a limiting factor in these water bodies decreased significantly. At the same time, the Naroch Lakes were exposed to zebra mussel (Dreissena polymorpha Pallas) invasion. In the mid-90 s, the biological and hydrochemical characteristics of the ecosystem of the Naroch Lakes stabilized. We show here that complex processes associated with the transformation of the lake ecosystem and affecting both trophic interactions in the Naroch Lakes and the influence of environmental factors on them can be represented using a single parameter, the phase-locking index, PLI. In this case, a statistically significant numerical value of PLI characterizes the phase synchronization of two processes, oscillations of the concentration of total phosphorus, TP, and oscillations of the concentration of chlorophyll, Chl. We show that the phase synchronization of these processes occurs only after the stabilization of the ecosystem of the Naroch Lakes. In the period preceding the transformation of the lake ecosystem, there was no synchronization. Numerical evaluation of PLI as a holistic parameter allows us to characterize the transformation of the lake ecosystem as a whole without resorting to study of complex interactions of various factors involved in this transformation.

Conditionals in written L2 English: Form and function

This paper examines the form and functions of English conditionals in L2 English, focusing on the differences between NS and NNS writers and across proficiency levels. Our analysis of NS and NNS argumentative essays has revealed that the NNS, compared to the NS, produced more tokens of conditionals and initial if-clauses but less tokens of atypical conditionals. The NNS preferred the future predictive condition over the factual condition, which was preferred by the NS. The NNS utilized the initial if-clause to offer a contrast to previous claims as opposed to the NS utilizing it to repeat previous claims. The developmental trajectory from the lowest to highest levels was not linear, but exhibited a rather irregular pattern. The results evidence that the use of conditionals is an outcome of the complex interaction of various factors including L2 proficiency, L1 structure, textual features, and possibly classroom instruction.

Knowledge, Attitude, Perceptions, and Concerns of Pregnant Women Regarding the Influenza Vaccination in Kocaeli, Turkey.

IntroductionIn order to better understand the barriers to influenza vaccination, we have designed a study to investigate pregnant women's knowledge, attitude, perceptions, and concerns towards the inactivated influenza vaccine.Materials and methodsIn this prospective study, carried out between July 1, 2019, and December 31, 2019, 252 pregnant women (≥12 weeks of gestational age), who had consented to be enrolled in the study, were asked to complete an interviewer-administered questionnaire during their stay in the hospital ward.ResultsThe lack of information about influenza vaccines (59.4%) was in the first rank among the reasons for personal and parental vaccine rejection. Most (65.1%) pregnant women either did not believe in or had doubts about the efficiency of the influenza vaccine during gestation. Most of them (80.9%) either were not sure about or did not have much confidence in the prenatally inoculated vaccine's ability to protect their babies postnatally. Some (25.6%) participants attributed their vaccinal unwillingness to fear of adverse effects, and some (11.5%) deemed gestational influenza immunization unnecessary because of their tendency to underestimate the grave consequences of influenza contracted by infants within the first six months of life. The higher the education level, the higher was the knowledge of and the willingness to be immunized against influenza.DiscussionIt is known that about one-third of pregnant women in Turkey have never heard of the influenza vaccine. Unawareness of influenza vaccination in pregnancy is significantly related to vaccine uptake in Japan. Patient education on knowledge of influenza and influenza vaccination has a booster effect on vaccination rates. Had the influenza vaccine been routinely administered to pregnant women in Turkey, the lives of the majority of the women who died of influenza in the influenza A (H1N1) pandemic in 2009 would have been saved. Low-risk perception is quoted as one of the main reasons for influenza vaccine refusal during pregnancy, which was also the case in our study. Concordant with the current literature, the education level and household income were correlated with the level of influenza vaccination uptake. Pregnant women's fear of adverse effects of the influenza vaccine might extend to the fear of birth defects.ConclusionThe acceptance of influenza vaccines by pregnant women is a consequence of complex interactions of various factors. Giving necessary information to pregnant women is one of the most important factors that can increase influenza vaccine uptake. For this reason, it should be ensured that the efficacy and safety data of the influenza vaccine are more widely included in vocational training activities of health personnel and in prenatal care textbooks and guidelines.

Experimental Study on True Triaxial Mechanical Properties of Frozen Calcareous Clay under the Influence of Multiple Factors

To investigate the mechanical properties of frozen saline soil, the deep calcareous clay in the Huanghuai mining area was chosen as the research object, and an orthogonal test was carried out to study the true triaxial mechanical properties of frozen saline calcareous clay under the influence of multiple factors. The stress–strain characteristics, strength, and influence trend of salted frozen calcareous clay with different salt content, stress paths, and water content, and the relationships among the above-mentioned factors, were investigated. The analysis of the test results by an orthogonal test revealed the order of importance of the factors that influenced strength. The primary and secondary order of influence σ1 is as follows: confining pressure σ3, water content ω, temperature T, medium principal stress coefficient b, and salt content φ. Under the influence of multiple factors, the strength of frozen soil in the real state is not the result of single factors with independent influences that are then simply superimposed. Instead, the complex interactions of various factors affect strength. The stress path significantly influences the stress–strain relationship of frozen calcareous clay. As the coefficient of the intermediate principal stress b increases, its influence on the strength of salted frozen calcareous clay diminishes, and the optimal principal stress coefficient b = 0.33 maximizes the strength of the specimen. The influence of the moisture content on the strength of the sample is negatively correlated. The effect of different moisture contents on the deformation and failure characteristics of unsaturated saline calcareous clay is not significantly different, and this difference does not exceed 5%.

Relation of expressed emotions and burden of care in primary caregivers to severity of illness in schizophrenia patients: A cross-sectional, hospital based study

Background: Negative expressed emotions are a significant characteristic of the family milieu that has been found to predict symptom relapse in schizophrenia and may be related to severity of illness and burden of care. Aim: The aim of this article is to study the expressed emotions and burden of care in primary caregiver of patients suffering from schizophrenia, with relation to severity of illness. Methods: This cross-sectional, hospital-based study included 60 schizophrenia patients and their primary caregivers. Positive and Negative Syndrome Scale (PANSS), modified Global Assessment of Functioning scale (mGAF), and Family Emotional Involvement and Criticism Scale (FEICS) were applied on the patients. Burden Assessment Schedule (BAS) was applied on the caregivers. Results: Patients were mostly male, symptomatic, diagnosed as paranoid schizophrenia and aged between 20 and 50 years. Caregivers were predominantly married and employed. Expressed emotions and burden of care were significantly related to caregiver and patient education, gender, employment, marital status, type of family, diagnosis, duration of illness, caregiver relation, duration of care giving, and severity of schizophrenia symptoms. Burden of care showed significant variations according to patient and caregiver economic status, domicile, religion, and age. Both expressed emotions and burden of care had moderately positive and statistically significant correlation with severity of the disease. Conclusion: Both expressed emotions and burden of care in primary caregiver of patients suffering from schizophrenia are influenced by a number of sociodemographic, clinical, and disease-related factors. Thus increase or decrease in expressed emotions and burden of care is caused by the complex interaction of various factors that the patients and caregivers experience.

Peer assessment in EFL teacher preparation: A longitudinal study of student perception

Peer assessment has been found to have many advantages in learning particularly when viewing it through a socio-cultural lens. This study explored peer assessment across language teacher education coursework, following 15 teacher candidates through three semesters of TEFL coursework. This longitudinal approach is rare with peer assessment research. Surveys and interviews were collected to understand the students’ perception of peer assessment, including how it contributed to their learning and its summative use. Results indicated that repeatedly practicing peer assessment in coursework led to increased positive perception about its usefulness in learning and enhanced trust in peers as qualified assessors, but with a complex interaction of various factors in students’ perception, such as perceived task difficulty, interpersonal relationships, mode of feedback, etc. The participants’ hesitant attitudes about summative use of peer assessment (PA) was interpreted as largely based on their socio-culturally shaped perspectives of authority and academic achievement. Implications for using peer assessment in language teacher education are offered.

Do Unmet Health Needs Drive Pediatric Emergency Department Utilization?: A Population-Based Assessment.

Lack of access to basic health services is thought to increase emergency department (ED) utilization. This study assessed the relationship between unmet health care needs and pediatric ED utilization in the United States. The National Survey of Children's Health was used (2016-2017; n = 71,360). Parent/guardians reported number of ED visits and the presence of unmet health needs (medical, dental, mental health, vision, hearing, other) in the last 12 months. Associations were analyzed using multinomial logistic regression modeling and accounted for the weighting and complex survey design of the National Survey of Children's Health. Children with 2 or more unmet health needs had 3.72 times (95% confidence interval, 2.25-6.16) risk of ≥2 ED visits when compared with those with 0 unmet health needs. This risk became nonsignificant when adjusted for race, ethnicity, age, insurance, having asthma, current medication status, health description, number of preventative health visits, and place to go for preventative health (aRR, 1.77; 95% confidence interval, 0.96-3.27). The adjusted association was also nonsignificant for specific types of unmet needs. Race, insurance status, age 0 to 3 years, current medication status, having asthma, ≥2 preventative visits, and poorer health were associated with ≥2 ED visits. Unmet health needs were not found to be a significant driving force for ED utilization. Other factors were found to be more strongly associated with it. Future studies to understand the perception, motives, and complex interaction of various factors leading to ED use in high-risk populations may optimize care for these children.

Androgen and Anti-Mullerian Hormone Concentrations at Term in Newborns and Their Mothers with and without Polycystic Ovary Syndrome.

Objectives: The aetiology of polycystic ovary syndrome (PCOS) is not particularly mapped; however, a complex interaction of various factors, such as genetic, environmental and intrauterine factors, can be assumed. Experimental animal studies and clinical observations support the hypothesis that developmental programming by excess intrauterine steroid is relevant. The aim of the study was to investigate whether mothers with and without PCOS exhibit different androgen and anti-Mullerian hormone (AMH) levels at the end of pregnancy and how maternal hormone levels are reflected in their offspring. Methods: Between March 2013 and December 2015, we performed a prospective cross-sectional study at the Medical University of Graz. We included 79 women with PCOS according to the ESHRE/ASRM 2003 definition and 354 women without PCOS, both with an ongoing pregnancy ≥37 + 0 weeks of gestation, who gave birth in our institution. Primary outcome parameters were the levels of maternal and neonatal androgens (testosterone, free testosterone, androstenedione) and AMH at delivery. Results: Androgen levels in female offspring of PCOS and non-PCOS women at birth did not differ, while maternal hormone levels differed significantly. Androgen levels in PCOS boys were significantly higher when compared to levels in PCOS girls. Discussion: Our findings do not support the hypothesis that maternal androgen excess contributes to elevated androgen concentrations in the female offspring. Nevertheless, the effects of the increased androgen concentrations in mothers on their offspring have to be investigated in future studies.

Milestones of the Formation of Islamic Tradition in the North-Eastern Caucasus

The purpose of this article is to show the dynamics of Islam using the history of Islam in the North-East Caucasusas an example. The Islamic tradition has never remained static; it has historically changed in accordance with the requirements of the time and rational expediency. Using the example of the history of Islam in the Caucasus and especially in Dagestan, we can trace the logic of the complex interaction of various factors of history, primarily political, ethnic and religious, which have most influenced the multiple social transformations in this region. The question of the cultural complexity of socio-political and ethno-confessional processes in heterogeneous societies that have experienced numerous influences at various stages of Islamization, starting from the period of early Islam, is connected with the question of the political expediency of disseminating certain ideological and worldview interpretations of the Muslim religion.

Novel ensembles of COPRAS multi-criteria decision-making with logistic regression, boosted regression tree, and random forest for spatial prediction of gully erosion susceptibility

Gully erosion is considered as a severe environmental problem in many areas of the world which causes huge damages to agricultural lands and infrastructures (i.e. roads, buildings, and bridges); however, gully erosion modeling and prediction with high accuracy are still difficult due to the complex interactions of various factors. The objective of this research was to develop and introduce three new ensemble models, which were based on Complex Proportional Assessment of Alternatives (COPRAS), Logistic Regression (LR), Boosted Regression Tree (BRT), Random Forest (RF), and Frequency Ratio (FR) for spatial prediction of gully erosion with a case study at the Najafabad watershed (Iran). For this purpose, a total of 290 head-cut of gullies and 17 conditioning factors were collected and used to establish a geospatial database. Subsequently, FR was used to determine the spatial relationship between the conditioning factors and the head-cut of gullies, whereas RF, BRT, and LR were used to quantify the relative importance of these factors. In the next step, three ensemble gully erosion models, named COPRAS-FR-RF, COPRAS-FR-BRT, and COPRAS-FR-LR were developed and verified. The Success Rate Curve (SRC), and the Prediction Rate Curve (PRC) and their areas under the curves (AUC) were used to check the performance of the three proposed models. The result showed that Soil group, geomorphology, and drainage density factors played the key role on the occurrence of the gully erosion. All the three models have very high degree-of-fit and the prediction performance, the COPRAS-FR-RF model (AUC-SRC = 0.974 and AUC-PRC = 0.929), the COPRAS-FR-BRT model (AUC-SRC = 0.973 and AUC-PRC = 0.928), and the COPRAS-FR-LR model (AUC-SRC = 0.972 and AUC-PRC = 0.926); therefore, it is concluded that they are efficient and new powerful tools which could be used for predicting gully erosion in prone-areas.

Maintenance performance evaluation using an integrated approach of graph theory, ISM and matrix method

Operational performance of a plant and its competitiveness are dependent on reliability and maintainability of its equipment, which in turn are dependent on how these are designed and how effectively the maintenance activities are carried out. This paper proposes an integrated approach based on graph theory, interpretive structural modelling (ISM) and matrix method to quantitatively evaluate the maintenance performance leading to a numerical index, called as maintenance performance index (IMP). The approach is premised based on the fact that, the effectiveness of maintenance performance is a complex interaction of various factors prevailing in the plant. The index evaluates the maintenance performance by assessment of the individual maintenance functions, which the system is expected to fulfil. IMP is obtained from the Maintenance Performance Matrix by substituting the performance index, (IFP), of the individual maintenance functions and maintenance function’s interdependence values. Performance index of each individual maintenance function is obtained from the corresponding Function Performance Matrix, by substituting indicator characteristic values and indicator causal interrelationship values. This matrix is obtained by extracting the relationships among the indicators using the ISM approach. The ISM presents a hierarchy based model of the interrelated indicators and their significance in the measurement of maintenance performance. The methodology is demonstrated using a case study. The approach is premised based on the fact that, the effectiveness of maintenance performance is a complex interaction of various factors prevailing in the plant. The suggested methodology is convenient for the industry to hierarchically classify both subjective and objective performance parameters and in quantifying maintenance performance.

P26.07: Androgen levels in female offspring of PCOS and non‐PCOS women

The etiology of polycystic ovary syndrome (PCOS) is not particularly mapped, but a complex interaction of various factors can be assumed. Experimental studies in non-humans and clinical observations in humans raise the hypothesis that developmental programming by androgen excess in utero plays a role in the development of PCOS. Our study aimed to evaluate whether the female offspring of PCOS women already show higher androgen levels compared to the female offspring of non-PCOS women. Androgen levels were determined in maternal serum and umbilical cord blood from PCOS and non-PCOS women and the respective offspring at the Medical University of Graz, Austria, between 2012 and 2015. A total of 79 PCOS and 354 non-PCOS women were recruited. The main results are shown in table 1. The comparison revealed that androgen levels in female offspring of PCOS and non-PCOS women do not differ although maternal hormone levels differ significantly. P26.07: Table 1.

Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia

BackgroundInhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma. However, underutilization of ICSs is common and little is known about factors contributing toward this undesirable use.MethodsA cross-sectional study was conducted through interview and chart review among persistent asthmatic patients attending chest clinic of Tikur Anbessa Specialized Hospital from 1 May to 31 September 2014. A total of 131 eligible patients who attended the clinic during study period were included in the study. A multivariate logistic regression was used to examine the association between independent and dependent variables.ResultsOverall, extent of underutilization of ICSs was found to be 68%. Monthly income, comorbidity and types of ICSs products prescribed showed significant association with reported underutilization. Patients’ reported reasons for underutilization includes; unaffordability (44%), using only when symptoms exacerbate (21%), fear of side effects (10%), practitioners’ recommendation (10%) and unavailability of ICSs in the local market (7%). Physicians also stated unaffordability, fear of side effects and dependency, lack of local guideline for asthma management and unavailability of ICSs as the contributing factors.ConclusionIn this setting, extent of underutilization of ICSs was found to be high and seems the result of complex interaction of various factors. Financial problem combined with inconsistent availability of ICSs in the local market, patients’ poor knowledge of asthma and ICSs, negative attitude toward ICSs, absence of local guidelines for asthma management are found to be essential elements dictating an extent of ICSs use.