Relevant Determinants Research Articles

From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania

ObjectiveTo improve understanding of the drivers of the increased caesarean section (CS) rate in Romania and to identify interventions to reverse this trend, as well as barriers and facilitators.DesignA formative...

Operational Status Evaluation of Smart Electricity Meters Using Gaussian Process Regression With Optimized-ARD Kernel

Operational Status Evaluation (OSE) is essential for the health management of Smart Electricity Meters (SEM). This paper develops a machine learning-enabled OSE method for SEM. Specifically, the Gaussian Process Regression (GPR) is developed for modeling analysis, where an Optimized Automatic Relevance Determination (OARD) kernel is first used. Though the conventional ARD kernel structure can capture the potential mapping relationship between running time, temperature, humidity, and Measurement Error (ME), it cannot extract the influence degree of different stresses on the ME. To address this problem, an OARD kernel structure is proposed to identify the contribution of each part in ARD structure to the target data. Furthermore, the quartiles line instead of 95% confidence interval is exploited to enhance the performance of GPR for long-term prediction. Combining the two above improvements, a novel OSE model is established for the future-oriented long-term operation of the SEM. It is the first-known data-driven application that utilizes the GPR with OARD kernel to perform OSE for SEM. Actual SEM datasets collected from both dry and hot region are used for model validation and prediction. The results demonstrate that the proposed GPR model with OARD Matern52 kernel outperforms other conventional kernel approaches in the aspect of interpretability. More importantly, the operational status of the SEM in future can be assessed via the proposed OSE framework.

Linguistic Features of Copywriting and Rewriting in the Field of Text Content for Corporate Websites: Semantic Aspect.

The study's relevance lies in the distinction between the cognitive processes of human readers and search robots, particularly the contextual understanding and relevance determination capabilities of modern search engines. This study aims to address contemporary challenges related to online textual content, specifically focusing on texts found on corporate websites and corporate blogs. The study employs a comprehensive approach to analyze the creation of texts, considering both copywriting and rewriting techniques. The analysis includes an examination of textual activity on corporate websites and blogs. The research methodology involves investigating linguistic and psycholinguistic aspects, as well as the principles underlying search engines and their role in organic website promotion. The study also delves into the nature of multimedia articles as a distinct format of online content. The major finding of this research lies in the proposed method for assessing the cognitive effectiveness of copywriting and rewriting. The study sheds light on the intricate interplay between multimedia articles and their textual components, showcasing their potential for impactful audience engagement. The analysis of internet copywriting and rewriting in the realm of marketing discourse reveals their significance for search engine tasks and user engagement. In conclusion, this research underscores the practical importance of understanding the cognitive effectiveness of texts generated through copywriting and rewriting. The findings emphasize the role of multimedia articles and their textual elements in influencing audience engagement online. The study highlights the crucial connection between internet copywriting, rewriting, and successful marketing discourse, optimizing content for search engines and enhancing user experience.

Determinants of residents’ support for urban tourism in times of uncertainty: Exploring the case of the city of Madrid

Residents are key actors in the management of tourist destinations, especially in times of uncertainty such as those that characterize the current context of multidimensional crisis (ecological, political, social or economic). The role of tourism in these crises, its contribution to their acceleration or its work in recovery, makes it necessary to deepen the support of residents for tourism in complex times such as the present. The context generated by the COVID-19 health crisis is a good framework for this reflection, although it has not been sufficiently explored. This article draws on Social Exchange Theory to explain residents' support for tourism in urban destinations during periods of uncertainty such as those generated by the health crisis, focusing on factors that have so far been little explored: risk perception, community involvement and the management of tourism constraints. A structural multiple indicator multiple cause (MIMIC) model is proposed to test the theoretical model. Using data derived from a survey of 342 residents in the city of Madrid (Spain), the results show that, in addition to benefits as a predictor of residents' support for tourism in contexts of uncertainty, risk perception and the management of tourism constraints are also relevant determinants of this support. The findings have important implications for decision-makers and public managers of urban destinations in the current period of multiple crises.

Characteristics of the subject of official forgery: based on the analysis of law enforcement practice

The article examines the views of various scholars on the definition of the subject of a criminal offense in general and the elements of forgery in particular. The author analyzes the report of the Prosecutor General’s Office of Ukraine for 2019-2022 on the commission of a criminal offense under Article 366 of the Criminal Code of Ukraine. The author examines, among other things, socio-demographic, socio­role, moral, psychological and criminal law features of the personality structure of a criminal committing forgery. An attempt is made to identify the main features inherent in the subject of this criminal offense. The main attention is paid to the construction of his criminological portrait and determination of the functional relevance of such information.
 In the study of the characteristic features inherent in the subject of criminal forgery, an important place is given to the personality structure of the offender who commits this crime. This structure is a set of his/her socially significant qualities that have developed in the process of various interactions with other people. The analysis of the characteristic features of such a person also involves the maximum consideration of psychological characteristics and biologically determined qualities, which in turn determine human behavior, including criminal behavior. Therefore, it should be taken into account that these qualities have a significant impact on criminal behavior. Thus, the subject of forgery is characterized by a system of signs, properties, qualities that define him/her as a person who has committed a criminal offense.
 The author provides a criminological and socio-psychological characterization of the subject of forgery, analyzes the demographic, moral and social characteristics of such a person, as well as his/ her anti-social criminal behavior, and provides a substantiation of the socio-psychological portrait of a criminal who commits a criminal offense under Article 366 of the Criminal Code of Ukraine. Such a person is also characterized by a certain system of moral and psychological beliefs, properties, attitudes, intellectual, emotional and volitional qualities. Given the above, the characterization of an official as part of this criminal offense has specific features that are determined by the peculiar official status of such a person and significantly distinguish it from the general characterization of the subject of the criminal offense.

Naturally Occurring and Widespread Resistance to Bioactive Natural Products.

Naturally occurring resistances diminish the effectiveness of antibiotics, and present significant challenges to human health. Human activities are usually considered as the main drivers of the dissemination of antibiotic resistance, however, the origin of the clinical antibiotic resistance can be traced to the environmental microbes, and the clinically relevant resistance determinants have already pre-existed in nature before the antibiotics come into clinic. In this concept, we present the naturally occurring and widespread resistance determinants recently discovered during the biosynthesis study of bioactive compounds. These widely prevalent resistances in environmental microbes, including antibiotic producers and non-producers, advance the understanding of the origin of resistance, and provide prediction for the clinically relevant resistance to aid in the rational design of more effective drug analogues to combat resistance.

State of the literature discussing smoke-free policies globally: A narrative review.

Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.

A pre-implementation examination of barriers and facilitators of an electronic prospective surveillance model for cancer rehabilitation: a qualitative study

BackgroundAn electronic Prospective Surveillance Model (ePSM) uses patient-reported outcomes to monitor symptoms along the cancer pathway for timely identification and treatment. Randomized controlled trials show that ePSMs can effectively manage treatment-related adverse effects. However, an understanding of optimal approaches for implementing these systems into routine cancer care is limited. This study aimed to identify barriers and facilitators prior to the implementation of an ePSM to inform the selection of implementation strategies.MethodsA qualitative study using virtual focus groups and individual interviews was conducted with cancer survivors, oncology healthcare providers, and clinic leadership across four cancer centres in Canada. The Consolidated Framework for Implementation Research (CFIR) guided the interviews and analysis of barriers and facilitators based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process).ResultsWe conducted 13 focus groups and nine individual interviews with 13 patient participants and 56 clinic staff. Of the 39 CFIR constructs, 18 were identified as relevant determinants to the implementation. The adaptability, relative advantage, and complexity of an ePSM emerged as key intervention-level factors that could influence implementation. Knowledge of the system was important at the individual level. Within the inner setting, major determinants were the potential fit of an ePSM with clinical workflows (compatibility) and the resources that could be dedicated to the implementation effort (readiness for implementation). In the outer setting, meeting the needs of patients and the availability of rehabilitation supports were key determinants. Engaging various stakeholders was critical at the process level.ConclusionsImproving the implementation of ePSMs in routine cancer care has the potential to facilitate early identification and management of treatment-related adverse effects, thereby improving quality of life. This study provides insight into important factors that may influence the implementation of an ePSM, which can be used to select appropriate implementation strategies to address these factors.

Assessment of radiation safety culture among radiological technologists in medical imaging departments in Saudi Arabia

This study aimed to evaluate the perception of radiation safety culture among medical radiological technologists (MRTs) in the Kingdom of Saudi Arabia. The study was performed from June 2022 to February 2023 and involved MRTs from various hospitals and medical centres in Saudi Arabia. A cross-sectional study was conducted using a self-administered and previously validated radiation safety culture survey instrument in medical imaging departments. The survey comprises 11 determinants of radiation safety culture, including personal accountability, teamwork in imaging, teamwork across imaging stakeholders, questioning attitude, feedback loops, organisational learning, leadership actions, non-punitive response, error reporting, radiation policy and overall perception of radiation safety. A total of 496 MRTs participated in this study. Results showed that most of the MRTs were male (75.0%), between 25 and 44 yr old (71.0%), with a bachelor’s degree (53.2%) and had less than 5 yr of experience (41.1%). The highest mean scores were for personal accountability (4.43 ± 0.62) and teamwork in imaging (4.22 ± 0.91), while the lowest mean score was for non-punitive response (2.94 ± 1.01). The majority of the MRTs reported good perception for the personal accountability (71.8%), teamwork in imaging (56.5%) and organisational learning (46%) scales; moderate perception for the teamwork across imaging stakeholders (53.2%), questioning attitude (71%), feedback loops (47.6%), leadership actions (74.2%), error reporting (53.2%), radiation policy (54.8%) and overall perception of radiation safety (62.1%) scales; and poor perception for the non-punitive response scale (45.2%). Individual and organisational interference are warranted to adhere to a strong radiation safety culture with continuing education. Moreover, repeated measures are necessary to assess for categorical improvement associated with the relevant determinants that are also important to support a positive radiation safety culture.

Fatores associados aos desfechos desfavoráveis de tratamento da tuberculose em idosos no Brasil: uma análise multinomial

Abstract Objective To identify, within the three axes of vulnerabilities (individual, social, and programmatic), the factors associated with unfavorable treatment outcomes of tuberculosis (TB) among older adults in Brazil between 2015 and 2019. Method This is a cross-sectional study utilizing secondary data from the Notifiable Diseases Information System (SINAN) regarding reported TB cases in Brazil, among individuals aged 60 years or older. The covariates associated with the outcome of interest (p≤0.20) were included in a multinomial logistic regression model using the cure category as the reference. Results Older adults self-identified as black or mixed-race, experiencing homelessness, with mental health disorders, living with the human immunodeficiency virus (HIV), and engaging in the use of licit and illicit drugs had higher odds of loss to follow-up. Furthermore, older adults experiencing homelessness, with mental health disorders, engaging in the use of licit and illicit drugs, and who did not undergo bacilloscopy, presented higher odds of death due to TB. For the outcome of death due to other causes, individuals living with diabetes mellitus and HIV, engaging in the use of licit and illicit drugs, also had higher odds of experiencing this outcome Conclusion The results highlighted the influence of factors on TB treatment outcomes in older adults, encompassing the individual, social, and programmatic axes. Aspects such as advanced age, race, female sex, comorbidities, and homelessness were identified as relevant determinants, emphasizing the need for integrated approaches to improve outcomes and promote a favorable treatment outcome for TB in older adults.

Determination of the clinical relevance of donor epitope-specific HLA-antibodies in kidney transplantation.

In kidney transplantation, survival rates are still partly impaired due to the deleterious effects of donor specific HLA antibodies (DSA). However, not all luminex-defined DSA appear to be clinically relevant. Further analysis of DSA recognizing polymorphic amino acid configurations, called eplets or functional epitopes, might improve the discrimination between clinically relevant vs. irrelevant HLA antibodies. To evaluate which donor epitope-specific HLA antibodies (DESAs) are clinically important in kidney graft survival, relevant and irrelevant DESAs were discerned in a Dutch cohort of 4690 patients using Kaplan-Meier analysis and tested in a cox proportional hazard (CPH) model including nonimmunological variables. Pre-transplant DESAs were detected in 439 patients (9.4%). The presence of certain clinically relevant DESAs was significantly associated with increased risk on graft loss in deceased donor transplantations (p < 0.0001). The antibodies recognized six epitopes of HLA Class I, 3 of HLA-DR, and 1 of HLA-DQ, and most antibodies were directed to HLA-B (47%). Fifty-three patients (69.7%) had DESA against one donor epitope (range 1-5). Long-term graft survival rate in patients with clinically relevant DESA was 32%, rendering DESA a superior parameter to classical DSA (60%). In the CPH model, the hazard ratio (95% CI) of clinically relevant DESAs was 2.45 (1.84-3.25) in deceased donation, and 2.22 (1.25-3.95) in living donation. In conclusion, the developed model shows the deleterious effect of clinically relevant DESAs on graft outcome which outperformed traditional DSA-based risk analysis on antigen level.

The perspective of school leaders on the implementation of evidence-based practices: A mixed methods study.

School leaders play an integral role in the use of implementation strategies, which in turn support special education teachers in the implementation of evidence-based practices (EBPs). In this convergent mixed methods study, we explored school leaders' perceptions of the facilitators and barriers to EBP implementation, particularly for students receiving special education, as well as the importance and feasibility of 15 implementation strategies. School leaders (N = 22, principals, assistant principals, school psychologists, etc.) participated in a semistructured interview that included three parts-qualitative questions, quantitative ratings of strategies' importance and feasibility, and discussion of the top three implementation strategies. Data strands were analyzed independently and then integrated to generate meta-inferences. The qualitative data identified facilitators such as access to resources about the intervention (e.g., professional development) and collaboration and teamwork, while barriers centered on lack of school supports, culture/climate, and organizational factors (e.g., lack of communication). The quantitative data indicated that the implementation strategy provide ongoing consultation/coaching was rated as important and feasible. Monitor the progress of the implementation effort was rated as important but less feasible, while conduct educational meetings and change the environment were rated as feasible, but less important. Build partnerships to support implementation was rated as less important and feasible. There was convergence and divergence in mixed methods findings. This study underscores the critical need to increase school leaders' knowledge and skills related to implementation science to better leverage implementation strategies that address the confluence of relevant implementation determinants.

Physiological and molecular predictors of cycling sprint performance.

The study aimed to identify novel muscle phenotypic factors that could determine sprint performance using linear regression models including the lean mass of the lower extremities (LLM), myosin heavy chain composition (MHC), and proteins and enzymes implicated in glycolytic and aerobic energy generation (citrate synthase, OXPHOS proteins), oxygen transport and diffusion (myoglobin), ROS sensing (Nrf2/Keap1), antioxidant enzymes, and proteins implicated in calcium handling. For this purpose, body composition (dual-energy X-ray absorptiometry) and sprint performance (isokinetic 30-s Wingate test: peak and mean power output, Wpeak and Wmean ) were measured in young physically active adults (51 males and 10 females), from which a resting muscle biopsy was obtained from the musculus vastus lateralis. Although females had a higher percentage of MHC I, SERCA2, pSer16 /Thr17 -phospholamban, and Calsequestrin 2 protein expressions (all p < 0.05), and 18.4% lower phosphofructokinase 1 protein expression than males (p < 0.05), both sexes had similar sprint performance when it was normalized to body weight or LLM. Multiple regression analysis showed that Wpeak could be predicted from LLM, SDHB, Keap1, and MHC II % (R 2 = 0.62, p < 0.001), each variable contributing to explain 46.4%, 6.3%, 4.4%, and 4.3% of the variance in Wpeak , respectively. LLM and MHC II % explained 67.5% and 2.1% of the variance in Wmean , respectively (R 2 = 0.70, p < 0.001). The present investigation shows that SDHB and Keap1, in addition to MHC II %, are relevant determinants of peak power output during sprinting.

The more they need care, the more they struggle to receive it. Older patients and the inverse care law

Universal health coverage (UHC) is the condition in which every member of a certain community have access to essential, effective care without financial hardship. Increasing older adults suffering from chronic morbidities and/or social isolation struggle to receive the care they need precisely when they need it most. These patients need care personalization, multidisciplinary integration and professional cooperation more than high-tech biomedical treatment, as plenty of social determinants frequently hamper the effectiveness of each single treatment received. If the health inequalities resulting from suboptimal organization of care can be reduced, taking action becomes a question of social justice. This paper aims to 1) describe some relevant determinants of health that prevent many older adults from receiving the care they need, 2) outline some policies to avoid ageism and minimize rationing.

Probabilistic seismic performance estimation through surrogate model and unbiased multi‐fidelity Monte Carlo predictor

AbstractThis study introduces an approach for probabilistic seismic performance estimation, which focuses on the probability of intensity measures exceeding a specified value based on engineering demand parameters. Conventional methods face challenges owing to the increase in computational costs associated with the uncertainties in earthquake scenarios. To address this, we use high‐fidelity (HF) and low‐fidelity (LF) model data to develop a multilevel hierarchy of surrogate models, which improves the simulation‐based probabilistic estimation. However, designing a reliable LF model and ensuring the accuracy of the surrogate model hierarchy remains challenging. Herein, we present a multi‐fidelity Monte Carlo (MFMC) predictor combined with a conventional surrogate model to improve probabilistic seismic performance estimation, thereby leveraging LF model efficiency and HF data accuracy for unbiased results. We addressed the challenge of constructing a suitable LF model by using a surrogate model trained from limited HF data. The MFMC predictor improves the accuracy of probabilistic analysis than the surrogate models trained from limited HF data. Further, the automatic relevance determination method is introduced to select the most appropriate inputs for the surrogate model. A case study featuring a special moment‐resistant frame, subject to uncertainties from both ground motion and structural properties, illustrates the efficiency of the method. A LF model is developed using the Kriging method, followed by the construction of the MFMC predictor for probabilistic analysis, thereby leveraging both limited HF and numerous LF data. Comparing the exceedance probability curves obtained from the MFMC predictor with those from direct Monte Carlo simulations and conventional Kriging showed that our proposed method offers a promising tool for probabilistic seismic performance estimation under uncertainty.

Integrasi Agama dan Sains dalam Perspektif Ismail Raji Al-Faruqi

The purpose of this research is to find out the thoughts of Ismail Raji Al-Faruqi related to the Integration of religion and Science. This research method uses descriptive qualitative using a literature study approach (Library Research). The results of this study show that Ismail Raji al-Faruqi (1921-1986) was born in Jaffa, a city on the southern coast of Palestine, (now in the territory of Israel). Al-Faruqi's monotheistic worldview is actually based on the desire to renew and refresh the initial ideational insights of the Salafiyah movement reformers, such as: Muhammad ibnu Abdul Wahab, Muhammad Idris As-Sanusi, Hasan Albana and so on. The Islamization of science is done by synthesizing Islam and modern science. This process must go through twelve stages, namely: (1) Mastery of modern scientific disciplines (2) Survey of disciplines. (3) Mastering the treasures of Islam, (4) If anthologies have been prepared, the treasures of Islamic thought must be analyzed from the perspective of relevant contemporary problems. (5) Determination of specific relevance for each discipline. (6) Critical appraisal of the modern discipline. (7) Critical appraisal of the Islamic treasury (8) Survey of the problems facing Muslims. (9) Survey of the problems facing humanity. (10) Creative analysis and synthesis. (11) Recasting modern disciplines into an Islamic framework. (12) Dissemination of the Islamicized knowledge.

Influencing variables of health: dimensions and their determinants – A systematic review

BACKGROUND: The aim of this systematic review is to identify all determinants and influencing factors to quantify health as holistically as possible using a multilevel model. The model is derived from determinants, influencing factors and variables of found health measurement constructs. Thus, the quantifiability of health in the model can be ensured. METHODS: The present systematic review is based on the items of the PRISMA guidelines and thus corresponds to the valid guidelines of a systematic review. Literature searches were conducted in English (PubMed, Scopus, Web of Sciences) and German databases (BISp-Surf). All instruments that measured health within one of the five identified dimensions of health (mental, physical, social, existential, environmental) were included. The scores were rated with a quality appraisal tool. All scores were incorporated into a newly created multilevel health model to show health as holistically as possible with all important determinants, influencing factors and variables. RESULTS: In total, 47 instruments distributed over five dimensions of health were found through the systematic literature search. Of these, 19 instruments were rated as "weak", 19 as "medium" and six as "strong". The review offers good comparability because most instruments were questionnaires. CONCLUSION: A multilevel health model based on health measurement instruments was created. This model offers a simple and clear holistic representation of relevant determinants and influencing factors of health. In the future, the model can be used as a basis for the creation of a multidimensional health score that can evaluate people’s individual health.

Experts' perceptions on motivators and barriers of healthy and sustainable dietary behaviors among adolescents: The SWITCH project

The interplay of influences shaping dietary behaviors of adolescents needs to be well-understood to develop effective strategies stimulating healthy and sustainable behaviors. This study aimed to identify the most relevant, urgent, changeable and effective motivators and barriers of healthy and sustainable dietary behaviors among adolescents (10–19 years), as perceived by an inter- and transdisciplinary expert panel. Experts working in practice (N = 19) and academia (N = 13) – in the field of sustainability, health, nutrition and/or education – participated in this exploratory mixed-methods study. Five online semi-structured focus groups were conducted (6–7 participants). Data was thematically analyzed by two coders independently, using the socioecological framework. Subsequently, the same experts individually selected the five most relevant determinants and rated those on their urgency, changeability and effectiveness through an online questionnaire (N = 21). Participants revealed a wide system of 31 main determinants including 173 sub-determinants that motivate or hinder healthy and sustainable eating among adolescents. This system of determinants was mapped on the different layers of the socioecological model: individual factors (25 motivators; 30 barriers), social environments (15 motivators; 13 barriers), physical environments (18 motivators; 15 barriers), macro-level environments (19 motivators; 38 barriers). ‘Role of peers' (social environment) was selected most as a determinant to be targeted in interventions (N = 13; urgency (M = 6.38) changeability (M = 3.85), effectiveness (M = 5.62)), followed by ‘food environment around school' (N = 9; urgency (M = 5.78) changeability (M = 3.44), effectiveness (M = 5.44)), ‘social influences' (N = 7; urgency (M = 5.43) changeability (M = 4.00), effectiveness (M = 5.71)), ‘autonomy in development' (N = 7; urgency (M = 6.00) changeability (M = 4.29), effectiveness (M = 5.86)) and ‘food availability' (N = 7; urgency (M = 6.29) changeability (M = 3.29), effectiveness (M = 6.29)). The prioritized determinants indicate that adolescents should be provided more supportive social and physical environments that promote healthy and sustainable dietary behaviors, taking into account their growing autonomy.

Tailoring Rheumatoid Arthritis Treatment through a Sex and Gender Lens.

Rheumatoid arthritis (RA) occurs more frequently in women than in men, and the studies that have addressed clinical and prognostic differences between the sexes are scarce and have contradictory results and methodological problems. The present work aims to evaluate sex- and gender-related differences in the clinical expression and prognosis of RA as well as on the impact on psychosocial variables, coping behavior, and healthcare use and access. By identifying between sex differences and gender-related outcomes in RA, it may be possible to design tailored therapeutic strategies that consider the differences and unmet needs. Being that sex, together with age, is the most relevant biomarker and health determinant, a so-called personalized medicine approach to RA must include clear guidance on what to do in case of differences.

Validation of CHERG'S Verbal Autopsy-Social Autopsy (VASA) tool for ascertaining determinants and causes of under-five child mortality in Pakistan.

The majority (40%) of the world's under-five mortality burden is concentrated in nations like Nigeria (16.5%), India (16%), Pakistan (8%), and the Democratic Republic of the Congo (6%), where an undetermined number of under-five deaths go unrecorded. In low-resource settings throughout the world, the Verbal Autopsy-Social Autopsy (VASA) technique may assist assess under-five mortality estimates, assigning medical and social causes of death, and identifying relevant determinants. Uncertainty regarding missing data in high-burden nations like Pakistan necessitates a valid and reliable VASA instrument. This is the first study to validate Child Health Epidemiology Reference Group-CHERG's VASA tool globally. In Pakistan, data from such a valid and reliable tool is vital for policy. This paper reports on the VASA tool in Karachi, Pakistan. Validity and reliability of the CHERG VASA tool were tested using face, content, discriminant validation, and reliability tests on one hundred randomly selected mothers who had recently experienced an under-five child death event. Data were computed on SPSS (version-21) and R software. Testing revealed high Item-content Validity Index (I-CVI) (>81.43%); high Cronbach's Alpha (0.843); the accuracy of between 75-100% of the discriminants classifying births to live and stillbirths; and I-CVI (>82.07% and 88.98% respectively) with high accuracy (92% and 97% respectively) for assigning biological and social causes of child deaths, respectively. The CHERG VASA questionnaire was found relevant to the conceptual framework and valid in Pakistan. This valid tool can assign accurate medical and non-medical causes of child mortality cases occurring in Pakistan.