Comprehensive Measures Research Articles

Individual risk preference as a predictor of health behaviour: evidence from the use of condoms against HIV/AIDS in Ghana

BackgroundIt is evident that public health education interventions to promote the use of condoms against HIV infections in Ghana have yielded modest results. However, existing studies in the field of sexual and reproductive health in Ghana have failed to account for differences in risk preferences of individuals. This study fills the gap by investigating how individuals' risk preferences predict their behaviour toward using condoms against HIV in Ghana.MethodConceptually, the study followed the Grossman health capital theoretical model for risk preference and health behaviour nexus. Data were obtained from the most recent Ghana Living Standards Survey Round 7 (GLSS 7), conducted in 2017. Using data from GLSS 7, a probit regression model was estimated to show how the risk preferences of individuals that did not abstain from sex predicted their use of condoms against HIV. To ensure robustness, two scenarios of declared risk preferences were used to predict the use of condom behaviour against HIV.ResultsProbit regression estimation shows that the risk preferences of individuals that did not abstain from sex significantly predicted their use of condoms against HIV in Ghana. Even though the study found that the predicted probability of using a condom reduces among risk-averse individuals that do not abstain from sex, not using a condom against HIV was found to be worse among risk lovers.ConclusionThe study provides empirical evidence that public health education against HIV/AIDS in Ghana cannot continue to ignore the risk preference of individuals. The results of this study have immediate implications, first for a comprehensive and continuous measurement of risk preferences among Ghanaians in major household surveys going forward. At the moment, the latest round of the GLSS is just about the only household survey in Ghana that has attempted to collect some data on individual time and risk preferences using only hypothetical monetary rewards. Second is the immediate consideration of individual risk preferences in public health education campaigns against HIV/AIDS in Ghana.

Developing the 15-Minute City: A comprehensive assessment of the status in Hong Kong

The 15-minute city concept has been incorporated into the planning doctrines of an increasing number of cities in different parts of the world. It serves as a guide for creating a compact and livable urban living environment where residents can reach locations of essential urban functions within 15-minute active travel. Nonetheless, there is a lack of comprehensive measures and an overall understanding of the 15-minute city status. By using the latest population census data and POI data in Hong Kong, this study proposes a 15-minute city index that holistically measures the 15-minute city status by incorporating the accessibility, which is measured by a modified two-step floating catchment area (2SFCA) method, to five categories of POI locations related to living, healthcare, education, public transit and entertainment. Our results show that the historical population centers of Kowloon and Hong Kong Island, which have experienced the earliest urban development in Hong Kong, generally rank the highest on the 15-minute city index. The neighborhoods in the new towns around the New Territories, especially those that are not near the transit hubs in the new town centers, largely lag behind on the 15-minute city index.

Paving the way to the future: Mapping historical patterns and future trends of road material stock in Japan

Roads are a fundamental component of societal infrastructure, whose decades-long lifespan has far-reaching implications for developmental decisions. The road construction and development have profound impacts on economic growth, social dynamics, and environmental sustainability. Therefore, comprehensive measurement of the current road material stock (MS) and the projection of expected future road scale based on regional socio-economic scenarios that can reflect unique local conditions are necessary. This study examined the historical changes and progression patterns of the road network across Japan from 1965 to 2020 through material flow and material stock analysis. By using the road MS time series, along with explanatory socioeconomic variables, several models including Autoregressive Integrated Moving Average with explanatory variables (ARIMAX), Support Vector Regression (SVR), hybrid ARIMAX-SVR, Multiple Linear Regression (MLR), Artificial Neural Networks (ANN), and Random Forest (RF) were compared. After comparison analysis, ARIMAX and hybrid ARIMAX-SVR models were employed to forecast expected road MS in each prefecture of Japan by 2050 based on national shared socioeconomic pathways (SSP) scenarios. The study found that the total road MS of Japan increased 5.5-fold over 55 years. Aggregate was the dominant material, comprising over 70 % among the four materials of the total road MS. The forecast results for each prefecture were classified into three different patterns. Expected MS in most prefectures still displayed increasing trends in the five scenarios, but the projection of road MS in eight prefectures revealed a notable downward trend across each SSP scenario. For most prefectures, SSP5 displayed the highest expected road MS, followed by SSP1. SSP3 was the scenario with the lowest MS. This approach provided a more thorough understanding of the likely evolution of road MS across different SSP scenarios and could help inform decisions for resource allocation and policy formulation concerning road infrastructure management.

Design of an Urban Domestic Waste Landfill Based on Aerial Image Segmentation and Ecological Restoration Theory

Properly managed urban household waste landfills play a crucial role in achieving sustainable development and ecological civilization. This paper proposes an innovative design method that aims to overcome the limitations and extensive challenges of traditional urban domestic waste landfill design by combining aerial image segmentation with ecological restoration theory. We suggest an enhanced SEVnet, a combination of the basic vnet network and the sequence-and-excitation module, for precise and efficient garbage dump identification. Through this module, the network can independently analyze the significance of each feature channel and provide weights, leading to enhanced image detail recovery and more precise segmentation. We implemented the proposed SEVnet model based on an aerial photography database of urban garbage dumps. Following precise urban garbage disposal site division, we adopt ecological restoration theory to achieve sustainable design. This article presents the Saihanba area in China as a case study, collects pertinent data, and conducts image segmentation and GIS-assisted analysis. This paper examines the landscape application and design of the landfill site based on an analysis and planning of land use in its vicinity. The intervention of landscape ecology imbues the landfill site with new functions. We propose comprehensive planning and landscape restoration design measures from four perspectives, encompassing disadvantages, threats, opportunities, and strengths, using SWOT analysis to better integrate the Hebei Saihanba landfill site with the surrounding environment. This paper introduces a groundbreaking design scheme for a landfill that aligns with the principles of current green and sustainable development.

Development and validation of the Socioeconomic Status Composite Scale (SES-C).

Socioeconomic status (SES) is a critical multifactorial determinant of health and plays a significant role in shaping an individual's health outcomes. While a composite scale has been proposed to measure SES in children, to our knowledge, limited composite scales were developed for adults in different contexts, highlighting the need for a comprehensive and valid SES measure to elucidate the relationship between SES and health in this population. This study aimed to develop and validate a composite scale that measures the socioeconomic status in Lebanon and assess its correlates in a socioeconomic crisis context. An online study was carried out between October and November 2022 across all Lebanese regions. Snowball sampling was used to enroll 448 adults living in Lebanon through a questionnaire created on Google Forms and shared by WhatsApp to a first sample from all geographic areas. The developed composite scale (SES-C) was found to be reliable and valid. It was based on several aspects of socioeconomic status, i.e., participant education level, family head education level, perceived social class, not being in debt, not receiving financial help, crowding index, participant work status, family head work status, monthly household income, and financial well-being. Furthermore, high SES was significantly associated with married status, older age, alcohol consumption, the absence of chronic disease, easy access to healthcare, private insurance coverage, and the number of rooms in the house in the bivariate analysis. In the multivariable analysis, high SES was significantly associated with age (ORa-1.13; p = 0.011) and easy access to healthcare (ORa = 7.81; p = 0.001) and inversely associated with chronic disease (ORa = 0.17; p = 0.002). Similar results with lower magnitude were found for moderate SES. The study successfully developed and validated a composite scale (SES-C) for measuring the socioeconomic status in Lebanon, taking into account the complexities of the Lebanese context. The scale was found to be reliable and valid, and its results showed significant correlations with various factors such as older age, lower risk of chronic disease, and easy access to healthcare.

Incorporating a new landscape intensity indicator into landscape metrics to better understand controls of water quality and optimal width of riparian buffer zone

River water quality plays a crucial role in numerous industries, necessitating the precise delineation of riparian buffer zones and the implementation of comprehensive management measures to preserve water quality. Determining the optimal riparian buffer zone through the impact of landscape metrics on water quality has been widely applied to river management. However, failure to differentiate the same indicators in areas with different anthropogenic activities could lead to inaccuracies in identifying the optimal riparian buffer zone, particularly in regions with notable gradient in anthropogenic activities. Here, we incorporated a new landscape intensity (NLI) indicator into the landscape metrics to better understand controls of water quality and optimal width of riparian buffer zone, considering the differences between areas with different anthropogenic activities. Based on water quality monitoring data from June 2010 to April 2013 in a typical agricultural-urban gradient with different anthropogenic activities, we adopted redundancy analysis (RDA) to quantify the spatial scale effects and seasonal dependence of various landscape metrics impact on river water quality, and then to reveal the importance of landscape metrics in explaining water quality by variance partitioning analysis (VPA). Results showed that landscape metrics were more effective at explaining the water quality variations during the dry season than the wet season (56.48% ∼ 68.99% vs 53.28% ∼ 58.91%). The 1000 m riparian buffer zone was found to be optimal for explaining water quality changes during the dry season, while the 200 m riparian buffer zone was optimal during the wet season. In addition, we found that NLI was the most important landscape metric in our study and could explain 26% to 52% of the variation in water quality. This study provides a new insight for developing a landscape metric that considers differences in anthropogenic activities, which can help us to better understand water quality changes and preserve aquatic ecosystems.

Water quality improvement project for initial rainwater pollution and its performance evaluation

Efficiently addressing initial rainwater pollution is crucial for mitigating urban water pollution. However, the performance evaluation of initial rainwater pollution control project is rarely introduced. In this study, the architecture of effective comprehensive engineering measures for improving the water quality of initial rainwater in Anhui Province, China, was described. Three water quality indicators, ammonia nitrogen (NH3–N), chemical oxygen demand (COD), and total phosphorus (TP), were selected to explore the severity of urban pollution caused by initial rainwater under various rainfall scenarios. A single-factor evaluation method was used to contrast and assess the benefits of the initial rainfall interception project in terms of water quality enhancement. Results showed that initial rainfall pollution was gentler under light rainfall conditions but more prominent under moderate and heavy conditions. The percentages of NH3–N, COD, and TP in Lotus Pond that met the tertiary drinking water standard were 100%, 74.91%, and 100% with great improvement, and the average concentrations of NH3–N, COD, and TP in Fushan Road Drainage have decreased by 91.43%, 10.49%, and 57.33% respectively, after the construction of the interception project. These indicated that the nitrogen and phosphorus pollution were successfully controlled by the control techniques in both locations, but COD concentration has to be addressed with more specialized strategies. Overall, the water quality improvement project for initial rainwater pollution plays a great role in effectively governing initial rainwater pollution and improving river water quality, and provides an effective technical reference for urban water ecological environment management.

Benchmarking nursing homes using the Order Rated Effectiveness model

Benchmarking, a critical process to compare relative performance of nursing homes, was implemented in an earlier study applying multicriteria measures of operational and quality of care efficiencies. In that study those measures were aggregated and optimized using Data Envelopment Analysis (Shimshak et al., 2009) [1]. The authors concluded that while providing useful analysis, the DEA results did not discriminate well among the nursing homes. In this paper we apply the Order Rated Effectiveness (ORE) model (Klimberg and Ratick, 2018; Klimberg and Ratick, 2020a; Klimberg and Ratick, 2020b) [2,3,4], to the Shimshak et al. data set to address that issue. The ORE model utilizes Order Weighted Averaging (OWA) to aggregate operational and quality performance measures, providing a range of relative performance measures for each nursing home. These aggregates are then used within a Data Envelopment Analysis (DEA) optimization framework. The use of OWA helps capture the implied preferences of multiple decision makers within the different nursing homes. We compare and evaluate the ORE results to those obtained in the original Shimshak et al. study. The ORE process provided aggregate comprehensive measures of relative performance that addressed both the multi-objective and multi-decision-maker character of this decision problem essential to making effective and actionable comparisons of nursing home performance.

Structured Ethical Review for Wastewater-Based Testing in Support of Public Health.

Wastewater-based testing (WBT) for SARS-CoV-2 has rapidly expanded over the past three years due to its ability to provide a comprehensive measurement of disease prevalence independent of clinical testing. The development and simultaneous application of WBT measured biomarkers for research activities and for the pursuit of public health goals, both areas with well-established ethical frameworks. Currently, WBT practitioners do not employ a standardized ethical review process, introducing the potential for adverse outcomes for WBT professionals and community members. To address this deficiency, an interdisciplinary workshop developed a framework for a structured ethical review of WBT. The workshop employed a consensus approach to create this framework as a set of 11 questions derived from primarily public health guidance. This study retrospectively applied these questions to SARS-CoV-2 monitoring programs covering the emergent phase of the pandemic (3/2020-2/2022 (n = 53)). Of note, 43% of answers highlight a lack of reported information to assess. Therefore, a systematic framework would at a minimum structure the communication of ethical considerations for applications of WBT. Consistent application of an ethical review will also assist in developing a practice of updating approaches and techniques to reflect the concerns held by both those practicing and those being monitored by WBT supported programs.

Evaluating the effects of different pollution reduction scenarios on the total phosphorus concentration of a mountainous river basin in southwest China using SWAT model: a case study of the Donghe River in Baoshan, Yunnan

Abstract Water quality has become a significant concern in many river basins in China due to both point and non-point source pollution. The SWAT model assessed pollution reduction scenarios and their effects on Donghe River basin water quality in southwest China. The calibrated model evaluated existing point and non-point emissions. Three schemes reduced point sources by 30, 60, and 90% and non-point sources by 25, 50, and 75%, respectively. Simulations analyzed annual and monthly total phosphorus (TP) concentrations under the scenarios. Results showed that the scenarios effectively improved water quality, meeting Class IV TP standards annually. However, TP exceeded standards in dry months (January–April, December) under all scenarios. A certain degree of negative correlation (R = −0.52, P = 0.11) between TP and rainfall suggests rainfall that influences TP. Comprehensive measures are needed to achieve standards year-round. In summary, the study found that reducing emissions improved Donghe water quality overall but more work is required to meet standards during dry periods. Rainfall correlates with and may affect TP. The work emphasizes implementing comprehensive approaches for year-round water quality improvements in the basin.

The Application of Industrial Robot and the High-Quality Development of Manufacturing Industry: From a Sustainability Perspective

Proposing a comprehensive evaluation measure of the high-quality development of manufacturing industry (HQDMI), the purpose of this paper is to explore whether the high-quality development of manufacturing industry (HQDMI) promotes the application of industrial robots (AIR). Evidence shows that, first, the index of HQDMI across regions shows an upward trend from 2008 to 2020. Furthermore, the application of industrial robots significantly increases the high-quality development of manufacturing industry. Our heterogeneity analysis further infers that the positive effect of AIR on HQDMI is more pronounced in wealthy and eastern regions. The mechanism analysis shows that the application of industrial robots can generate the “value-added effect of informatization” and the “resource allocation effect”. The findings provide important theoretical support for the use of industrial robots and the promotion of high-quality development.

Disorders of the hemostasis system in the stage of burn shock in patients with burn injuries

Burn injury is a serious medical, social and economic problem. In case of burn injuries, the burn consists in the study of disorders in the hemostasis system in the shock phase.The object of the study was patients admitted to the Burn department RSCUMA in the period from 2016 to 2019. In the phase of burn shock with deep burns from 10 to 35% of the body surface 95 (out of 112 main groups). The age of the patients ranged from 18 to 75 years, the average age was 54.3 ± 0.7. There were 142 (65.43%) men and 75 (34.56%) women. There was a poorly developed increase in the coagulation system (tolerance to heparin 253.4 ± 21.3 seconds, thrombotest - 4.06 ± 0.2 degrees), PTI decreased to 87.6 ± 3.1% (R <0.05). there was a constant decrease in fibrinolytic activity. However, a sharp decrease in fibrinolytic activity was observed, amounting to 6.58 ± 0.69% (P <0.05). When all patients are hospitalized, comprehensive anti-shock measures should be taken to improve the water-salt balance, acid-base balance and disruption of homeostasis.

Validation of a community-based application of the Portuguese version of the survey on Social and Emotional Skills - Child/Youth Form.

Children and adolescents' social and emotional skills have been gaining attention in diverse settings. With over 100 conceptual frameworks available, there is now a common move toward framing these skills as social and emotional learning (SEL), assuming that they are not only amiable to development, but also malleable to change as a product of intervention. As such, there is a strong need for a comprehensive measure to effectively evaluate such skills, validated for different age groups in children and young people, and applicable to both educational contexts and community settings. This paper presents the validation of the Portuguese adaptation of the Child/Youth form of the Survey on Social and Emotional Skills (SSES), in the scope of the Gulbenkian Academies for Knowledge initiative with a sample of 7,831 participants between 8 and 17 years old (M = 11.79, SD = 2.94). Results show that the measure has good internal consistency and sensitivity, while also being sensitive to change over time. Preliminary factor analysis shows promise, although further research is necessary. Discussion reflects on the value of the Child/Youth form of the SSES as a comprehensive measure to be used by community and educational professionals to monitor skill development and improve their work on SEL.

Effects of organic amendments on soil bacterial community structure and yield in a saline‐sodic soil cropped with rice

AbstractOrganic improvement measures play a crucial role in the reclamation of saline‐sodic soil. However, there is still a limited understanding regarding the relationships between soil microbes and soil properties and crop yield in response to the application of these organic materials to saline‐sodic soils. In a field trial, the following treatments were carried out: no modifier input (CK) and compound lignite organic modifier 30 t/ha (LOM) with 2 years of rice cultivation, no modifier input (RF) with 5 years of rice cultivation, and the full amount of straw was returned to the field with rice‐duck farming (SW). Compared with RF and CK, the SOM content in the 0–20 cm soil layer of SW and LOM was significantly increased by 4.600 and 5.020 g kg−1, respectively, while the total alkalinity and pH were significantly decreased. In the 20–40 cm soil layer, the LOM treatment resulted in decreased pH and total alkalinity compared with other treatments. Overall, changes in soil microbial structure changes were significantly associated with SOM and pH levels. In the 0–20 cm soil layer, the LOM treatment significantly increased the relative abundance of Proteobacteria, while SW treatment significantly increased the relative abundance of Bacteroidetes and Firmicutes compared with CK. Moreover，the relative abundances of Longobacteriaceae of Bacteroidetes, Hydrogenaceae, and Xanthomonas of Proteobacteria were positively correlated with crop yield. The yields of SW and LOM were 6985.587 and 7879.910 kg ha−1, respectively. These results demonstrate that implementing comprehensive organic improvement measures can enhance the properties of saline‐sodic soil and increase crop yield, with lignite composite organic amendments may be more suitable for sustainable agricultural development.

Comparison of ambient radiofrequency electromagnetic field (RF-EMF) levels in outdoor areas and public transport in Switzerland in 2014 and 2021

Mobile communication technology has evolved rapidly over the last ten years with a drastic increase in wireless data traffic and the deployment of new telecommunication technologies. The aim of this study was to evaluate the ambient radiofrequency electromagnetic field (RF-EMF) levels and temporal changes in various microenvironments in Switzerland in 2014 and 2021. We measured the ambient RF-EMF levels in V/m in the same 49 outdoor areas and in public transport in 2014 and 2021 using portable RF-EMF exposure meters carried in a backpack. The areas were selected to represent some typical types of microenvironments (e.g. urban city centres, suburban and rural areas). We calculated the summary statistics (mean, percentiles) in mW/m2 and converted back to V/m for each microenvironment. We evaluated the distribution and the variability of the ambient RF-EMF levels per microenvironment types in 2021. Finally, we compared the ambient RF-EMF mean levels in 2014 and 2021 using multilevel regression modelling. In outdoor areas, the average ambient RF-EMF mean levels per microenvironment in 2021 ranged from 0.19 V/m in rural areas to 0.43 V/m in industrial areas (overall mean: 0.27 V/m). In public transports, the mean levels were 0.27 V/m in buses, 0.33 V/m in trains and 0.36 V/m in trams. In 2021, mean levels across all outdoor areas were −0.022 V/m lower (95% confidence interval: -0.072, 0.030) than in 2014. Results from our comprehensive measurement study across Switzerland suggest that RF-EMF levels in public places have not significantly changed between 2014 and 2021 despite an 18-fold increase in mobile data transmission during that period. The absence of temporal changes may be owed to the shift to newer mobile communication technologies, which are more efficient.

Powerful CEOs and investment efficiency

This study investigates whether chief executive officers (CEOs) with excessive power make efficient investment decisions. We employ a comprehensive measure of CEO power and find that highly powerful CEOs tend to reduce investment efficiency by increasing overinvestment. This inefficiency is more pronounced with strong information asymmetry, agency problems, and product market competition. We also find that a firm's operation complexity and the presence of effective internal and external governance can help mitigate investment inefficiency; however, when most independent directors are co-opted or powerful CEOs are recruited from outside the firm, the investment inefficiency deteriorates. Moreover, inefficiency and overinvestment tend to increase with CEO tenure, the level of CEO power, and financial constraints faced by the firm. These findings shed light on the complex dynamics between CEO power, investment decisions, and various factors influencing their effectiveness.

Adherence to and persistence with adjuvant hormone therapy, healthcare utilization, and healthcare costs among older women with breast cancer: A population-based longitudinal cohort study

IntroductionTo assess associations between adherence to and persistence with adjuvant hormone therapy, healthcare utilization, and healthcare costs among older women with breast cancer. Materials and MethodsThis study was a population-based longitudinal cohort study using the Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare claims. This study included older women diagnosed with stage I-III hormone receptor-positive breast cancer from 2009 through 2017. Participants were considered adherent with a proportion of days covered (PDC) of 0.80 or more and persistent if they had no hormone therapy discontinuation, i.e., a break of at least 180 continuous days. Length of persistence was calculated as time from therapy initiation to discontinuation. All participants were followed for up to five years after hormone therapy initiation. Generalized linear mixed models with repeated measures or hurdle generalized linear mixed models in the event of excess zeroes were used to assess associations between adherence to and persistence with annual healthcare utilization and costs. ResultsThis study included 25,796 women. Being adherent was associated with lower annual healthcare utilization, i.e., hospitalizations, hospital days, emergency room visits, and hospital outpatient visits. Persistence was associated with fewer annual hospitalizations, hospital days, emergency room visits, and hospital outpatient visits. Adherent participants had lower annual inpatient costs, outpatient costs, medical costs, and total healthcare costs despite higher prescription drug costs. Both being persistent and longer persistence were associated with lower inpatient costs, outpatient costs, medical costs, and total healthcare costs despite higher prescription drug costs. DiscussionThis study underscores the economic benefits associated with adherence to and persistence with adjuvant hormone therapy based on comprehensive measures for healthcare utilization and costs. To our best knowledge, this was the first study that reported total healthcare cost savings associated with adherence to and persistence with adjuvant hormone therapy.

Readiness for interprofessional learning among health science students: a cross-sectional Q-methodology and likert-based study

BackgroundInterprofessional education (IPE) prepares healthcare students for collaboration in clinical practice, but the effectiveness of this teaching method depends on students’ readiness for and perceptions of IPE. Evaluating students’ readiness for and perceptions of IPE is challenging, due to the lack of comprehensive measures. This study characterized the level of IPE readiness and perspectives across first-year undergraduate and graduate health science students using the readiness for interprofessional learning Likert Scale (RIPLS) and Q-methodologies.MethodsThis is a cross-sectional, online study. Students were randomized to answer the Likert-scale version of RIPLS (80%) or a matched Q-methodology survey (20%). An ANCOVA compared RIPLS scores between students from different program levels (graduate/undergraduate) and specialization (health professional and general programs). The Q-data was analysed using a by-person factor analysis.ResultsThree hundred and four (33% response rate) and 71 (30% response rate) students completed the Likert scale and the Q-methodology surveys, respectively. Students from graduate programs demonstrated high readiness for IPE (higher total RIPLS scores p < 0.001) in comparison to undergraduates. Three factors, associated with program specialization (p = 0.04), emerged from the Q-methodology analysis characterizing students learning priorities. Students in undergraduate general programs were focused on IPE relevance and benefits to “the clinical team”, students in graduate programs focused on “the patient”, and those in undergraduate health professional programs focused on themselves (“me”).ConclusionsThis novel mixed-methods approach combining traditional Likert-scales with Q-methodology elucidated not only associations between program and specialization with readiness (Likert) but also which components of IPE were valued the most (Q-methodology) and by whom.

Defining and Measuring Economic Development: A Literature Review and Outlook

Economic development is an increasingly popular topic in different research areas. However, there is not a definite, categorical, and settled definition for economic development, nor a comprehensive measure that is agreed upon. This study aims to fill this gap through a literature review of the scholarly publications 1950–2020 in all the English-language peer-reviewed journals in the subject areas of public administration and development. On this basis, the article identifies 19 themes as well as 14 types of improvements around which it is possible to group this multi-faceted topic. Specifically, the article highlights for each of the identified themes and types of improvements how economic development is defined and measured. In addition to that, our review reveals issues and research questions that go unaddressed. We conclude the article by providing our recommendations in this regard.

Associations between placental pathology and poor intrauterine growth among a cohort of mother-infant singleton pairs in Leyte, the Philippines.

Poor intrauterine growth has negative impacts for child growth and development and disproportionately affects children living in low-resource settings. In the present study, we investigated relationships between placental pathologies and indicators of poor intrauterine growth. We enrolled a longitudinal cohort of 279 mother-infant pairs from Leyte, the Philippines. Placental measures included characteristics, pathological findings, and immunohistochemistry. At birth, intrauterine growth was assessed using anthropometric measures, weight-for-gestational age, and the clinical assessment of nutritional status score (CANSCORE) for determining fetal malnutrition. Multivariate linear regression and log-binomial regression models were applied, controlling for potential confounding factors. Maternal vascular malperfusion (MVM) was related to reduced birthweight (P < 0.0001), birth length (P = 0.002), head circumference (P = 0.001), and weight-to-length ratio (P = 0.016). MVM increased the risk for preterm delivery (P = 0.0005) and small for gestational age (SGA) (P = 0.016). Acute chorioamnionitis (P = 0.013) and MVM (P = 0.021) both led to an increased risk for fetal malnutrition defined by CANSORE<25. Villous tissue activated caspase-3 was associated with lower birth length (P = 0.0006), higher weight-to-length ratio (P = 0.004), reduced risks for SGA (P = 0.011) and low weight-to-length ratio for gestational age (P = 0.004). The present study applied comprehensive measures for intrauterine growth and demonstrates that low placental weight and placental pathology, chiefly MVM, contribute to poor intrauterine growth. A better understanding of the mechanistic role of specific placental pathologies on adverse newborn outcomes will provide opportunities for reducing incidence of poor intrauterine growth and associated long-term morbidities.