Female Education Level Research Articles

Factors influencing management of dry cell battery waste: a case of Greater Accra Region in Ghana

Indiscriminate disposal of dry cell battery (DCB) waste contributes to environmental and public health issues in developing countries such as Ghana, due to the toxic nature of this specific waste. Accordingly, a study was conducted in Accra, Ghana, to determine the socio-economic and demographic factors influencing handling DCB waste, aiming a sustainable environment. Using a random sampling technique, a descriptive cross-sectional survey was conducted, encompassing 367 respondents from the Accra-Tema Metropolitan areas and Tema West Municipal Assembly in Greater Accra, Ghana. Using descriptive and multivariate statistical methods, the survey data were analysed with the Statistical Package for Social Sciences (SPSS) version 27. The results of this study show that female gender and residential area are likely to positively influence the use of DCB at home. Education significantly affects the use of DCB and its proper disposal. The results also suggest that 78% of the respondents disposed of DCB waste in waste bins. The mean monthly income of the respondents stands at USD 270, which is average and likely partially to positively influence the disposal of the DCB. The data collected revealed that female gender, age group, family size, and education level influence the indiscriminate disposal of DCB waste and DCB waste recycling. The results highlight that educated females above the age of 55, with a monthly income, are likely to properly segregate DCB waste. This study contributes to the knowledge gap in relation to dry cell battery waste management (DCBWM) in developing countries, aiming to advance global sustainability. This study is expected to contribute to educate and create awareness in managing DCB waste to reduce its indiscriminate disposal which leads to environmental pollution and negatively affects human health and environmental sustainability in Ghana.

Regional trends, spatial patterns and determinants of health facility delivery among women of reproductive age in Nigeria: A national population based cross-sectional study.

Globally, about 810 women die daily from pregnancy and childbirth complications, and the burden is highest in Africa. The United Nations sustainable development goal has a maternal mortality ratio (MMR) target of 70 per 100,000 live births by 2030. Nigeria, the largest country in Africa, has an MMR of 512 per 100,000 live births, thus there is need for intensified efforts to reduce maternal deaths in the country. Proper utilisation of maternal health services including health facilities for delivery is crucial to achieving this. This study assesses the regional trends, spatial patterns and determinants of health facility delivery among women of reproductive age in Nigeria. This is a weighted secondary analysis of the Nigerian Demographic and Health Survey (NDHS). The sample included women who had a live birth in the preceding 5 years of the NDHS 2008, 2013 and 2018. Bivariate analysis and multilevel logistic regression were carried out to assess the determinants of health facility delivery. Trends analysis was done using bar graphs and spatial analysis showed the distribution of health facility delivery by State. Forty-one percent of women delivered their last child in a health facility. The proportion of women who delivered at a health facility increased from 2008 to 2018 for all regions, with exception of the South-south region. Determinants of facility-based delivery include; ethnicity, level of education, wealth index, exposure to mass media (AOR 1.34; 95% CI 1.20-1.50), number of childbirths, number of antenatal visits (AOR 4.03; 95% CI 3.51-4.62), getting a companion to go the health facility (AOR 0.84; 95% CI 0.72-0.98), community level poverty, community level of female education, community distance to health facility, and geographical region. There is an urgent need to deploy appropriate strategies and programme to improve health facility delivery in Nigeria.

The rise in female consciousness contributes to advancing household energy transition: Evidence from Chinese households

Gender is an indispensable dimension, gender equality and empowering all women are core elements in transitioning to sustainable energy. However, current research on how female consciousness impact energy fairness remains insufficient. To fill this gap, utilizing data from the China Family Panel Studies (CFPS), encompassing 16,000 households and 43,147 respondents, we explore how female consciousness influences energy transition. The findings reveal that a rise in female consciousness contributes to advancing household energy transition, particularly in eastern and urban areas where this effect is more pronounced. Further moderating effect analyses indicate that improved levels of female education and heightened female income further enhance the effective utilization of female awareness in driving household energy transition. The study not only deepen our understanding of the relationship between female consciousness and energy transition but also provide a scientific basis for developing energy policies promoting gender equality in developing countries, thus fostering global gender equality and sustainable energy development.

Analysis of Female Employment Situation Based on Data from Jilin Province in China

In recent years, Chinas GDP has continued to grow, yet the labor share has not increased in a consistent manner. This paper employs an empirical analysis based on data from Jilin Province, China. It uses questionnaires and econometric modeling methods to investigate the role of gender in economic life and the role of other factors (such as employment pressure, the role of unions, etc.) in this process. The questionnaire survey examines the current state of gender employment discrimination in China, focusing on the existence, causes, and influencing factors of employment discrimination. In constructing the econometric model, this paper assumes a negative relationship between the proportion of female employees and the labor share, while there is a positive relationship between female education level and the labor income share. The two hypotheses, based on common sense and literature, are then tested by an econometric model. The results indicate that the proportion of female employees is indeed negatively correlated with the share of labor income, suggesting that women face more significant employment challenges.

Identifying factors underlying increased emergency care needs of Black patients with pancreas cancer.

e13749 Background: In a retrospective study, we observed that African American/Black patients are 2.8x more likely to have recurrent ED visits than non-Black patients. These findings motivated this prospective study using a standardized questionnaire to better understand the factors leading to ED visits among Black patients. Methods: A study of Black patients with pancreas cancer who had at least 1 ED visit in a 5 month period in 2022-2023 was conducted. Computational identification of health system encounters by patients with pancreas cancer was performed using ICD10 C25* as a cohort identifier. The cohort was filtered by encounter type for ED and self-reported race for Black. Weekly, an African American oncology nurse practitioner called these patients to administer a questionnaire regarding social determinants of health and discuss reasons underlying the ED visit. Three attempts were made to contact each patient. Demographic and clinical features were obtained from the electronic health record. Results: During this 5-month period, 31 patients meeting criteria were identified; among these 31 who had at least 1 ED visit, 45% had ≥2 ED visits and 13% had ≥5 ED visits. The cohort was 68% female with mean age of 70.3 and median household income of $92,608. 74% had non-metastatic disease and 35% were on chemotherapy at the time of visit. 52% of patients had Medicare, 35% had commercial insurance, 10% had Medicaid, and 3% were uninsured. We reached 55% patients, of whom 71% agreed to participate. Notably, 83% endorsed high school as their highest level of education, 25% were immigrants to the United States, and 17% experienced financial barriers to care (Table). 33% had been seen at our institution’s pancreas cancer multidisciplinary clinic. Two recurrent themes noted during discussions with these patients were that that those with multiple ED visits were nearing end-of-life and/or had caretakers or family members in the medical field. Conclusions: We identified female gender, education level, immigrant status, and financial barriers to care as themes associated with ED visit burden in Black patients with pancreas cancer. Having caretakers in the medical field, who may have witnessed the consequences of healthcare disparities, may also contribute to higher rates of ED use. We hope to use these data to inform interventions to address these disparities. [Table: see text]

Disability burden of epilepsy in Türkiye: How does it differ from other newly industrialized countries?

IntroductionEpilepsy accounts for a substantial part of the global burden of disability. This study aimed to investigate the employment history of people with epilepsy in Türkiye, evaluate the role of education level in employment and epilepsy burden, and compare epilepsy employment data in different societies according to sociodemographic index data. MethodsThis prospective study included 420 people 16–76 years of age who were diagnosed with epilepsy according to the criteria of the International League Against Epilepsy. Socioeconomic, clinical, and employment data were collected using a questionnaire in face-to-face interviews. ResultsThe study sample was 52 % women, the mean age was 34.2 ± 12.7 years (range: 16–76 years), and the mean disease duration was 17.2 ± 12.6 years. Only 26.7 % (n = 112) of the participants were actively working, 38.8 % had never worked, and 64.5 % had changed jobs at least twice (mean 2.45 job changes). The unemployment rate among the study sample was 7 times higher than in the general population. Female gender, low self and parental education levels, high seizure frequency, and the use of multiple anti-seizure medications were significantly associated with lower employment. ConclusionWe determined that the employment rates and education levels of people with epilepsy in Türkiye are low, the unemployment rate is high, and the burden of epilepsy is higher when compared with other low-middle income and newly industrialized countries and national population data. Education and employment opportunities for people with epilepsy in Türkiye should be improved to reduce the burden of epilepsy-related disability and thereby increase quality of life, welfare, and psychosocial well-being in this group.

Adverse Childhood events of individuals and its relationship with resilience

ObjectiveThe aim of this study is to examine the relationship between childhood trauma and psychological resilience in the Turkish Cypriot community and to identify the predictors of psychological resilience. MethodThe research was conducted with 354 individuals in a web-based online environment in Northern Cyprus. Data were collected using a “Personal Information Form”, the “Adverse Childhood Events Scale”, and the “Resilience Scale for Adults”. Percentage, mean, standard deviation, and Pearson's correlation analysis were used in the data analysis. ResultsIn the study, 16.67 % of the participants were exposed to war or conflict when they were young and 10.17 % had a mental illness. In addition, it was determined that there were statistically significant and negative correlations between the Adverse Childhood Events Scale scores and the scores they got from the Adult Resilience Scale and the sub-dimensions of the scale. Female gender and education level predicted the scores on the Resilience Scale for Adults positively, and the presence of mental disease and the scores on the Adverse Childhood Events Scale negatively predicted the scores on the Resilience Scale for Adults. Conclusionİn this study, gender, educational status, presence of mental illness, and the total score on the Adverse Childhood Events Scale were determined to be predictive variables affecting resilience. Considering the research findings, it is recommended that nurses plan studies for the protection of the mental health of children and adolescents and the groups exposed to trauma should be psychologically supported to raise individuals with high resilience.

PENERAPAN ALGORITMA K-MEANS DALAM PENGKATEGORIAN INSOMNIA

Complaints of sleep disorders or insomnia are usually typified by trouble falling asleep and staying asleep, unwillingness to go back to sleep after waking, and sleep that is poor in quantity and quality. When sleep is of a high caliber, the body’s metabolism will be balanced, and vice versa. The state of the body will be affected if the sleep is of low quality, as well as affecting human emotions and the body's metabolic system. Several factors are considered to cause insomnia, including female gender, age, marital status, income, and education level. Due to the numerous variables that may considered as causes of insomnia, it is necessary to group categories in determining whether insomnia is categorized or not using a klastering technique, namely the K-Means Method. By using the K-Means method, it was found that based on the 452 data used, the result was that there were 204 data, or 45.13% belonging to the Insomnia klaster and 248 data or 54.87% belonging to the Not Insomnia klaster.

Post-COVID-19 syndrome, who at risk and why: an insight from Qatar 2022.

Despite the recovery from the COVID-19 pandemic, many people experience post-COVID-19 syndrome, which negatively impacts their health and function. This condition has become a significant public health problem that requires immediate attention. To study the prevalence, clinical characteristics, and predictors of post-COVID-19 Syndrome in Qatar during 2022. An analytic cross-sectional study was conducted among COVID-19 confirmed cases from January 2022 to July 2022 in Qatar. A simple random sample was employed to include (n = 588) participants from the list of cases and invited to participate in a telephone survey. The World Health Organization's standard case definition for PCS was adopted. Out of 368, the prevalence of post-COVID-19 syndrome was 43.2% (n = 159). Most PCS cases were females (67.9%; n = 108), married (73.6%; n = 117), and university and higher educational level (83.6%; n = 133). However, 78.7% (n = 125) reported poor to moderate levels of social support. Only 30.2% (n = 48) of PCS patients had a history of chronic diseases, and 5.7% (n = 9) required hospital admission during acute illness. Among PCS cases, the most commonly reported symptoms were fatigue (75.5%), followed by anxiety (49.1%), forgetfulness (46.5%), mood alteration (45.3%), and general weakness (39.6%). The logistic regression revealed that female gender (AOR: 2.58 95%CI: 1.58-4.225, p < 0.0001), university and high educational level (AOR: 2.2, 95%CI: 1.256-3.98, p < 0.006), poor level of social support (AOR: 2.45; 95%CI: 1.55-4.13; p < 0.002), were significant predictors for PCS. Post-COVID-19 syndrome may go under-recognized. More efforts are needed to raise awareness and mobilize the resources to respond to this ongoing public health problem.

An empirical analysis of the demand for family planning satisfied by modern methods among married or in-union women in Nigeria: Application of multilevel binomial logistic modelling technique.

Given the health and economic benefits of family planning (FP), Nigeria's very low demand for FP satisfied by modern methods (mDFPS) of less than 50% is therefore a major public health concern, especially considering the global target aimed at achieving an mDFPS of at least 75% by year 2030 for all countries. In view of this, together with recognising the possible contextual nature of health outcomes, this study aimed to empirically analyse the mDFPS among married or in-union women of reproductive age (WRA) in Nigeria. A multilevel binomial logistic model with two levels of analysis was used: individual and community levels. Secondary cross-sectional data were obtained from the 2018 Nigeria Demographic and Health Survey, and analyses were performed using Stata 15.0. The analytical sample size was 9,122 WRA nested in a total of 1,072 communities. The mDFPS was approximately 31.0%. The median odds ratio (MOR) estimated from the final multilevel model was 2.245, which was greater than the adjusted odds ratio (aOR) for most of the individual-level variables, suggesting that the unexplained/residual between-community variation in terms of the odds of women having their mDFPS was more relevant than the regression effect of most of the individual-level variables. This was with the exception of the regression effects of the following individual-level variables: women's husbands that had higher education level in comparison to their counterparts who had husbands with no formal education (aOR = 2.539; 95% CI = 1.896 to 3.399; p<0.001); and women from the Yoruba ethnic group in comparison to their counterparts from the Hausa/Fulani/Kanuri ethnic group (aOR = 2.484; 95% CI = 1.654 to 3.731; p value<0.001). However, other individual-level variables with positive statistically significant regression effects on mDFPS were: women who mentioned that money for accessing health care was not a problem; women's empowerment in relation to the visitation of family and relatives; and women being exposed to FP messages through various media sources, all in comparison to their respective counterparts. On the other hand, at the community level, women in communities where a high percentage of them had at least a secondary education had statistically significant greater odds of having mDFPS than women in communities with lower education levels (aOR = 1.584; 95% CI = 1.259 to 1.991; p<0.001). We found similar findings regarding women residing in communities with exposure to FP messages through various media sources. However, using the 80% interval ORs (80% IORs) as a supplemental statistical measure for further understanding the regression effects of community-level variables showed that all of the 80% IORs had a value of '1', signifying considerable uncertainty in the regression effects of all community-level variables due to the substantial residual variation existing between communities. Our study showed that to achieve the dire increase in mDFPS in Nigeria, policy interventions aimed at improving the education level of both females and males, especially beyond the secondary school level, should be implemented. Additionally, all of the various media sources should be extensively utilised, both at the individual and the community level, by the Nigerian government to spread information on the importance of women having their mDFPS.

Influence of social determinants of health in the evolution of the quality of life of older adults in Europe: A comparative analysis between men and women

Population aging is a global phenomenon due to declining birth rates and increased life expectancy. This demographic shift poses a challenge to society, requiring adaptation of policies, economies, and healthcare systems to safeguard the well-being of older individuals. Health inequalities, influenced by social determinants such as education, economic status, and place of residence, impact this population group, with notable differences between men and women. Several studies have demonstrated that social determinants of health (SDH) affect the quality of life (QoL) of older individuals, especially women. In general, women report lower quality of life indicators, lower educational levels, and poorer health compared to men. This study aims to examine how social determinants of health can influence the quality of life of the population aged 50 or older in different European countries, from a sex perspective, through a longitudinal approach. The main SDHs associated with poorer QoL were female sex advanced age, economic hardship, educational level, and geographic location within Europe. Depression in women and men in Southern Europe was associated with a decrease in QoL scores.

Influence of Female Educational Level on Consumption of Family Education

As education becomes more and more important, more and more families pay attention to education, and the proportion of education consumption in family consumption is increasing. According to the data of the Seventh National Census Bulletin, with the popularization of basic education, women 's level of education is increasing. This study uses the Chinese Family Tracking Survey completed by the Chinese Social Science Survey Center of Peking University in 2020. The aim of this study was to investigate the effect of female educational level on family education consumption by means of linear regression. It is concluded that there is a significant positive correlation between female education level and family education consumption. It suggests that the higher the level of education for women, the higher the consumption of family education, and the level of education for women has an increasing impact on the level of consumption of family education. The education level of women has become an important factor affecting the consumption of family education.

Pengaruh Kesehatan Reproduksi Wanita dan Pemberdayaan Wanita Terhadap Tingkat Partisipasi Angkatan Kerja Wanita di Indonesia

This study aims to find out and analyze how the influence of women's reproductive health and women's empowerment on the participation rate of the female workforce in Indonesia. This study used secondary data sourced from the Indonesian Central Bureau of Statistics with the research variables grouped into two parts, namely the bond variable which in this study was determined as the female labor force participation rate and the independent variables consisting of women's life expectancy, young women's marriage, female mother, female education level, female per capita income and female involvement in parliament. This study uses panel data regression analysis with the selected method, namely the Common Effect Model (CEM). The results showed that women's life expectancy, young women's marriage, women's fertility rates and women's involvement in parliament each had a negative and insignificant effect on women's labor force participation. Women's education level has a negative and significant effect on female labor force participation and women's per capita income has a positive and significant effect on female labor force participation.

Exploring the role of female egalitarian values in the 2022 protests in Iran, using data from the World Values Survey

ABSTRACT Since the Iranian Revolution of 1979 there have been intermittent protests against the ruling regime over civil rights issues, with the 2022 protests often regarded as the most significant challenge to the status quo so far. These protests were perceived as being led by young women. For the first time, this study uses survey data to analyze why that should be. It investigates the evolving values of women in Iran with respect to gender equality, the impact of increased levels of female education and the adoption of new technologies that changed the way they socialized, to explain why young women led the protests. Using data from the World Values Surveys in Iran (in 2005 and 2020), and existing literature, it places this social conflict into the context of recent cultural changes in Iran. Specifically, it analyses data on the differing values and opinions of various segments of the population, by age and gender, and how they changed over time, to explore the influences that led to the protests and provide historical context as to why they occurred when they did.

Da li socijalno-demografski faktori značajno utiču na lečenje depresije?

Introduction: Depression is a common illness worldwide. Several studies have confirmed a tight relation between certain socio-demographic factors and the risk of undergoing depression. Aim: This study aims to find out which socio-demographic factors indicate a more unfavorable treatment outcome following depression assessment scales. Material and methods: The research is a longitudinal study, retrospective in design which consists of two phases. Upon entrance, socio-demographic data (sex, age, marital status, occupation, and education level) and Hamilton Depression Rating Scale (HDRS or HAMD) scores of 30 participants were recorded. After a four-week treatment, HAMD scores were again recorded and compared with those obtained in the initial phase. Results: Patients with female gender, old age, employment, and low educational level as sociodemographic factors experienced weak changes in the HAMD scores. On the other hand, patients who were male, young aged, unemployed, and had higher education studies scored lower HAMD scores after treatment and, successfully obtained strong changes in the HAMD scores. Results for marital status were inconclusive. The level of statistical significance was set at p &lt; 0.001. Conclusion: Female gender, aging, lower education and employment are factors that may have attributed to poor treatment improvement and hence should be taken into consideration by general practitioners. Likewise, marital status proved to be a statistically significant factor. However, no inclination towards a specific category was noticed.

Determinants of Diet Quality in Adolescents: Results from the Prospective Population-Based EVA-Tyrol and EVA4YOU Cohorts.

(1) Background: Unhealthy dietary behaviors are estimated to be one of the leading causes of death globally and are often shaped at a young age. Here, we investigated adolescent diet quality and its predictors, including nutrition knowledge, in two large Central European cohorts. (2) Methods: In 3056 participants of the EVA-Tyrol and EVA4YOU prospective population-based cohort studies aged 14 to 19 years, diet quality was assessed using the AHEI-2010 and DASH scores, and nutrition knowledge was assessed using the questionnaire from Turconi et al. Associations were examined utilizing multivariable linear regression. (3) Results: The mean overall AHEI-2010 score was 42%, and the DASH score was 45%. Female participants (60.6%) had a significantly higher diet quality according to the AHEI-2010 and DASH score. AHEI-2010 and DASH scores were significantly associated (p < 0.001) with sex, school type, smoking, and total daily energy intake. The DASH score was additionally significantly associated (p < 0.001) with age, socioeconomic status, and physical activity. Participants with better nutrition knowledge were more likely to be older, to attend a general high school, to live in a high-income household, to be non-smokers, and to have a higher diet quality according to the AHEI-2010 and DASH score. (4) Conclusions: Predictors of better diet quality included female sex, physical activity, educational level, and nutrition knowledge. These results may aid focused interventions to improve diet quality in adolescents.

Skills in handling Turbuhaler, Diskus in the west of China

ObjectiveThe purpose of this study was to evaluate the inhaler skills of patients with asthma and chronic obstructive pulmonary disease in a hospital in western China after receiving one medication education by pharmacists and the factors related to these skills.MethodsWe included 96 subjects using Turbuhaler and 74 subjects using Diskus in a hospital in western China. They were educated once by pharmacists before medication, and then their skills of operating these inhalers were visually evaluated the next time they were used. Using the seven-step inhalation administration method designed by AnnaMurphy, a clinical pharmacist at GLENFIELD Hospital in the UK, the inhaler use technique score scale was established and scored in turn. The age, sex, time of first illness, smoking status, education level and type of health insurance purchased by each patient were recorded to assess their relationship with overall inhaler skills.Results19.8% of the subjects who used Turbuhaler could not use it correctly, and 43.2% of the subjects who used Diskus could not use it correctly. The step with the highest error rate with Turbuhaler and Diskus is to "exhale slowly to residual volume". Chi-square test was carried out for each step of the operation of the two kinds of inhalers, and it was found that there was a significant difference in the operation accuracy of the two kinds of inhalers in the first, third and eighth steps. In univariate analysis, advanced age, female and low educational level were related to the lack of inhaler technology, but in multivariate analysis, only low educational level was a significant independent risk factor.ConclusionAmong the patients with asthma and chronic obstructive pulmonary disease in western China, some patients have good inhaler operation skills, but there are still many patients who can not use inhalers correctly, and the lower education level is significantly related to the incorrect use of inhalers.

Astronomy for Girls

Abstract In 1874–75 American Protestant missionaries in Beirut published two astronomy textbooks in Arabic. While male students at the Syrian Protestant College studied Cornelius Van Dyck’s Foundations of Astronomy, girls at secondary schools—the highest level of female education—studied Eliza Everett’s Principles of Astronomy: For Use in Schools. These texts appeared at the height of a cross-cultural encounter between American Protestants and the inhabitants of Beirut and Mount Lebanon that added new meanings to the Arabic concept of science (ʿilm). Historians have analyzed men’s discussions to chart how ʿilm, once a broad category akin to “knowledge” in English, came to include a neo-Baconian understanding of the modern English “science.” This article turns to science pedagogy, a field that included both men and women, to argue that the conceptual transformation of ʿilm also entailed an epistemological division along lines of gender and age. Overall, the story reveals how a study of women in science sheds light on the gendered history of science in Arabic.

The relationship between the status of female rights and economic growth in developing countries and how policymakers can help

Globally speaking, the social status of women is relatively low, especially in developing countries. Women face higher barriers than men to attending education, entering the job market, gaining equal wages, and becoming entrepreneurs. As essential economic participants, the status of female rights directly impacts the economy’s growth and should have more attention paid to them. This essay investigates this issue with a particular focus on developing countries, given that the situation is worse for women there, and any changes made to improve the situation will have a more significant impact on economic development. This paper uses economic theories to examine how female rights status affects economic development from three perspectives: education level, entrepreneurship, and the gender pay gap. The education level of females influences the participation rate, employment rate, and earnings, all contributing to economic growth. The female social status affects the difficulty of becoming an entrepreneur, and entrepreneurship creates more job opportunities, increases investment, and stimulates innovations. The gender pay gap would negatively impact the economy because it discourages females from entering the job market and investing in education. Moreover, this paper also looks into various policies in place to address such inequalities and provides a brief evaluation of their implementation. In conclusion, all three points related to female rights are critical, and the government should put more effort into addressing gender inequalities to protect an economy’s future economic development.

Education and Fertility: A Review of Recent Research in Europe

This paper reviews research on education and childbearing in Europe over the last decade. Early demographic research attributed declining fertility in advanced economies in the second half of the twentieth century to increasing female educational levels. The twenty-first century has witnessed further increases in educational attainment coupled with trend reversals in fertility. The relationship between education and fertility has become more complex, sparking renewed interest in the interplay between the two life domains. We examine how educational enrolment and attainment influence individuals’ fertility behaviour – both fertility timing and level – and how the relationship between education and fertility is shaped by contextual factors such as family policies, macroeconomic shocks, and normative changes in gender attitudes. We also summarise the recent literature on educational gradients in male fertility and review methodological developments to address issues of self-selection and unmeasured heterogeneity in the study of education and fertility. Finally, this paper identifies and discusses challenges and important areas for future research.