International Populations Research Articles

Psychometric Properties of the Chinese Version of Aberdeen Varicose Veins Questionnaire (AVVQ) in Patients With Varicose Veins of Lower Extremity: A Cross-Sectional Study.

Varicose veins in the lower extremities significantly impairs patients' quality of life, highlighting the importance of targeted quality of life assessments for specific diseases. The Aberdeen Varicose Vein Questionnaire (AVVQ) was specifically designed to assess the impact of lower extremity varicose veins on quality of life. This study comprised two phases: in the first phase, the AVVQ was translated and culturally adapted, and the second phase was an evaluation of the psychometric characteristics of the Chinese version of AVVQ in 328 patients with varicose veins of lower extremities. Confirmatory factor analysis revealed that the Chinese AVVQ comprises 13 items distributed across four dimensions, accounting for a total variance of 61.74%, with a Cronbach's α of 0.745 and a content validity index of 0.908. Furthermore, there was a negative correlation between the AVVQ scores and the SF-36. In addition, the difference in AVVQ scores by CEAP classification was statistically significant. These findings affirmed the Chinese version of the AVVQ as both reliable and valid, making it a valid tool for evaluating the quality of life in Chinese patients with varicose veins and applicable across various international contexts and diverse patient populations.

Long-Acting Growth Hormone Therapy in Pediatric Growth Hormone Deficiency: A Consensus Statement.

Several long-acting growth hormone (LAGH) therapies have recently become available, but guidance on their usage in children with growth hormone (GH) deficiency is limited. International experts in pediatric endocrinology were invited to join a consensus group based on their expertise in treating children with daily GH and LAGH. The group comprised 11 experts from 10 countries across the world. Online group meetings were held in February to March 2024 followed by a 1-day in-person meeting in May 2024 to finalize the consensus recommendations. A targeted literature search approach was used to identify and share evidence ahead of the meetings. Formulations considered were limited to those with international populations in phase III pivotal trials and regulatory approvals in multiple countries. Topics covered include patient selection and preference, dose adjustment, initiating and switching therapies, administration, adherence and missed doses, practical considerations, and knowledge gaps. LAGH formulations offer a potential advantage over daily GH injections for children with GH deficiency in terms of reduced injection frequency and treatment burden; this may also be associated with improved adherence and treatment outcomes over time. However, data on LAGH in pediatric GH deficiency are mostly limited to clinical trials, and long-term, real-world data are currently lacking. This article provides an international consensus on the use of LAGH therapy in children with GH deficiency to guide practitioners when considering these new treatment options for their patients. Long-term data are needed to fill current data gaps and allow the creation of comprehensive evidence-based recommendations.

English-medium instruction as an internationalisation strategy at a second-tier Chinese University: instructors’ challenges and their shaping factors

Joining the tide of global internationalisation of higher education, Chinese universities have embraced English-medium instruction (EMI) as a strategic response. The adoption of EMI is to comply with government mandates and for institutional survival, as it will increase the international ranking and bring in more income from international students. The switch of medium of instruction and pedagogical issues arising therefrom have drawn considerable scholarly attention. However, little attention has been paid to the implementation of EMI in second- or mid-tier universities, and, particularly, to the attendant pedagogical issues. In comparison to top-tier universities, second-tier universities’ instructors must deal with amplified tensions created between the pedagogical needs and institutional requirements brought by the EMI policy. This study seeks to shed light on the challenges, and their contributing factors, confronted by educators in these universities. Employing a language policy analysis framework informed by policy enactment theory, the research draws upon an examination of both national and institutional policy documents, as well as interviews conducted with nine educators and administrative leaders across three distinct faculties. The investigation reveals that the emergent challenges in implementing EMI stem from several sources, including lax admission standards for international students and the divergent backgrounds and requirements of local versus international student populations. These findings underscore the imperative for a thorough appraisal of contextual nuances before the formulation and implementation of language-in-education policies. This is particularly salient in second-tier academic institutions, which often grapple with limited resources and may not possess the same level of preparedness to adapt their systems as swiftly as their more resourced counterparts.

Spatial variations in health service utilization among migrant population: a perspective on health equity.

As health equity becomes a prioritized goal in global health policy, extensive research has revealed that socio-economic and geographical factors jointly exacerbate barriers to medical service access for both internal and international migrant populations, further accelerating existing health disparities. This study explores healthcare service utilization disparities among internal migrants in China, a population profoundly affected by the country's economic reforms and urbanization since the late 1970s. These transformations have led to significant migratory movements and subsequent healthcare challenges for these populations. Leveraging data from the 2017 China Migrant Dynamic Survey, comprising 169,989 samples across 28 provinces, we introduce a novel metric-the "No Treatment ratio" (NT-ratio). This ratio quantifies the proportion of migrants who, after falling ill, choose not to seek treatment relative to the total migrant population in a given province or region, serving as a critical measure of health risk. Building upon Anderson's Behavioral Model of Health Services Use, we adapted the model to better reflect the unique circumstances of migrant populations. The study employs spatial autocorrelation, hotspot analysis, and geodetector techniques to dissect the multifaceted factors influencing healthcare disparities. Our Findings reveal that the NT-ratio is significantly higher in eastern and northeastern China. Key factors influencing the NT-ratio include age, left-behind experiences, health education, and per capita medical resources. In response to these disparities, we recommend optimizing the distribution of medical resource, strengthening tiered diagnosis and treatment systems, and integrating health, education, and social security resources. These measures aim to improve healthcare utilization among migrant populations and reduce health inequities, aligning with global health objectives.

Adjustment and campus friendliness for international students studying in the United States

International students are an increasingly important population in the United States, growing in both size and contributions. While research has outlined challenges encountered by international students and the importance of campus climate, little research has defined and empirically assessed the friendliness of college and university campuses toward international students from the students’ perspectives, which was the aim of the current study. Universities with large international student populations were invited to distribute a survey that included the International Friendly Campus Scale (IFCS; Wang, et al., 2014) and two open-ended questions about students’ positive and negative experiences. The sample included 938 international students from eight universities in the United States, of which 622 and 566 students answered the first and second open-ended questions, respectively. Through thematic analyses of the open-ended questions, this study identified factors that international students find most helpful for their cross-cultural adjustment in addition to aspects of their campuses that could be improved. Results suggest that helpful factors for international student adjustment include social support, events, campus resources, access to shared and diverse cultures, an inclusive environment, language fluency and opportunities for learning, and individual characteristics. Areas of improvement include increased events and socialization, better communication, a more welcoming attitude toward diversity, improved administrative support, more financial support, and decreased discrimination. Additionally, correlation and group comparisons were used to assess international students’ perception of campus climate and compare patterns between different demographic groups. Practical suggestions based on these results are also discussed.

Healing the Whole: An International Review of the Collaborative Care Model between Primary Care and Psychiatry.

The collaborative care model (CCM) was created to improve the delivery of mental health care and is reported to improve access, enhance treatment outcomes, and reduce healthcare costs. To understand the impacts of the CCM on symptom management, diverse populations, and sustainability in healthcare systems, a systematic review was conducted. Several databases were searched for articles assessing the CCM. The inclusion criteria limited the studies to those (1) published between January 2008 and January 2024; (2) written in the English language; (3) analyzing adult patients; (4) analyzing symptom improvement in major depressive disorder, generalized anxiety disorder, or post-traumatic stress disorder; and (5) fitting the given definition of a CCM. We identified 9743 articles. Due to missing information or duplication, 4702 were excluded. The remaining articles were screened, yielding 468 articles for full-text analysis, of which 16 articles met the inclusion criteria. Of these articles, five primarily focused on individual patient outcomes, five focused on specific populations, and six reviewed system impacts; eleven articles studied US populations and five studied international populations. An analysis revealed that in 12 of the final articles, the CCM led to a statistically significant improvement in anxiety and depression symptoms with viable implementation and sustainability strategies. The CCM is an effective method for improving patient symptoms and can be potentially affordable in healthcare systems.

Adequate housing as a social determinant of the health of international migrants and locals in Chile between 2013 and 2022

BackgroundAdequate housing is a fundamental right and a social determinant of health. It also represents a historically contentious topic in Latin America. Migratory flows to Chile have become increasingly precarious in the past few years, limiting opportunities for adequate housing, with potential repercussions on the health of international migrants and the general population. This study aims to analyse adequate housing as a social determinant of health among international migrants and locals between 2013 and 2022 in Chile.MethodsObservational cross-sectional study based on repeated versions of the nationally representative Socioeconomic Characterization Survey in Chile. Adequate housing indicators adapted from the United Nations Housing Rights Programme guidelines were analyzed with relation to individual health, distinguishing between the local and international migrant populations. Logistic regression models were fitted for housing indicators with migration as the main independent variable and for short-term and long-term healthcare needs in locals and immigrants with housing as the main dependent variables. Models were adjusted for sociodemographic variables and considered the complex sample design.ResultsDescriptive findings indicated higher availability of services and infrastructure among international migrants, and a disadvantage for habitability, location, and affordability by quintiles compared to locals. Logistic regression models, adjusting for demographic variables, revealed significant associations between migration status and overcrowding (OR 6.14, 2022), poor housing materiality (OR 5.65, 2022) and proximity to healthcare centres (OR 1.4, 2022) compared to locals. Experiencing hazardous situations consistently predicted short-term healthcare needs in both migrants (OR = 1.4, 2022) and locals (OR = 2.8, 2022). Overcrowding predicted both long and short-term healthcare needs among locals across the years and long term needs among migrants in 2013 and 2015.ConclusionsWe found significant inequities in adequate housing between migrant populations and locals in Chile, and some inequities among both populations based on structural socioeconomic deprivation. Experiencing hazardous situations emerged as a social determinant of health among international migrants in 2022, potentially suggesting growing challenges related to social exclusion in urban areas. However, limitations such as exclusion criteria of the survey and sample sizes for data on the migrant population potentially suggest that housing challenges and their impact on health are underestimated.

The socio-cultural experience of Chinese international students in Australian schools: challenges and opportunities

ABSTRACT Objective The needs and experiences of Chinese international students in the context of secondary education have been largely under-researched. Tertiary education research has shown international student populations are particularly susceptible to acculturative stressors, loneliness, and isolation in host cultures therefore it is important to consider these factors amongst secondary students studying abroad who are potentially even more vulnerable. Method This qualitative research explored the experiences and challenges faced by Chinese secondary students in Australia and their help-seeking behaviour. Interview data was collected from 17 participants across two different school settings. Results Thematic analysis identified three key themes; Adjustment Difficulties, Academic Difference and Help-seeking and support. It was found that the challenges experienced by international students consisted of living, academic and sociocultural factors. Participants reported experiencing cultural discrimination but were reluctant to seek formal help for this. Conclusion The results have implications for Australian secondary schools given the high number of international students that study in the country. Recommendations are made for how international students can be better supported.

Co-production of an online research and resource platform for improving the health of young people—The hype project

Mental health conditions tend to go unrecognised and untreated in adolescence, and therefore it is crucial to improve the health and social outcomes for these individuals through age and culturally appropriate interventions. This paper aims firstly to describe the development and implementation of the HYPE project platform (a research and resource platform co-designed and co-produced with young people). The second aim is to describe the characteristics of participants who engaged with the platform and an embedded pilot online survey. Participatory action research approach was used to address objectives of the HYPE project. Data were analysed to: (1) help improve access to health and social services, (2) guide provision of information of online resources and (3) deliver complementary community-based events/activities to promote mental health and to ultimately prevent mental health issues. Pilot and main phases of the HYPE project demonstrated the capacity and feasibility for such a platform to reach local, national, and international populations. Analyses demonstrated that the platform was particularly relevant for young females with pre-existing health difficulties. Some of the barriers to involving young people in research and help-seeking are discussed.

Multi-centre benchmarking of deep learning models for COVID-19 detection in chest x-rays.

This study is a retrospective evaluation of the performance of deep learning models that were developed for the detection of COVID-19 from chest x-rays, undertaken with the goal of assessing the suitability of such systems as clinical decision support tools. Models were trained on the National COVID-19 Chest Imaging Database (NCCID), a UK-wide multi-centre dataset from 26 different NHS hospitals and evaluated on independent multi-national clinical datasets. The evaluation considers clinical and technical contributors to model error and potential model bias. Model predictions are examined for spurious feature correlations using techniques for explainable prediction. Models performed adequately on NHS populations, with performance comparable to radiologists, but generalised poorly to international populations. Models performed better in males than females, and performance varied across age groups. Alarmingly, models routinely failed when applied to complex clinical cases with confounding pathologies and when applied to radiologist defined "mild" cases. This comprehensive benchmarking study examines the pitfalls in current practices that have led to impractical model development. Key findings highlight the need for clinician involvement at all stages of model development, from data curation and label definition, to model evaluation, to ensure that all clinical factors and disease features are appropriately considered during model design. This is imperative to ensure automated approaches developed for disease detection are fit-for-purpose in a clinical setting.

Black African Students in Predominantly White U.S. Higher Education Institutions

Black African students are increasingly choosing the United States as their preferred destination for higher education, and many choose to study at predominantly White institutions. The purpose of this qualitative study was to investigate factors that may influence their identification and commitment to those institutions. Researchers interviewed 20 sub-Saharan Africans at a predominantly White Southeastern university. Findings revealed that construed external image, overall satisfaction with the school, promotion of the institution, and willingness to maintain membership shape the extent to which Black African students are identified and committed to their university of choice. Furthermore, the study also found that prestige does not appear to influence Sub-Saharan African students' identification and commitment to a school in the U.S., but race has mixed effects depending on how it gets interpreted by students. These findings suggest implications for research and practice for student affairs professionals to better serve and retain their international populations.

Is there evidence for factorial invariance of the COVID Stress Scales? an analysis of North American and cross-cultural populations.

The COVID-19 pandemic impacted the mental health of more citizens globally than any previous modern viral outbreak. In response to the psychological challenges associated with COVID-19, the COVID Stress Scales (CSS) were developed to assess the presence and severity of COVID-related distress. The initial North American validation study of the CSS identified that the scale comprised five factors: danger and contamination fears, fear of socioeconomic consequences, xenophobia, checking and reassurance seeking, and traumatic stress symptoms. The CSS have since been validated across a multitude of international populations. However, findings support a five- and six-factor model. Methodological issues make interpreting most studies supporting a five-factor model challenging. The purpose of this study was to re-evaluate the factor structure of the CSS using data from North American samples, to assess for potential factorial invariance, and compare these results to cross-cultural findings. Multiple confirmatory factor analyses (mCFA) were conducted across 28 different groups (e.g., age, ethnicity/race, sex) from two large independent North American samples from 2020 (n = 6827) and 2021 (n = 5787), assessing the fit indices of the five-, six-, and alternative-factor model of the CSS. The current results provide evidence for factorial invariance of the six-factor model of the CSS across different North American demographics and highlight potential challenges in interpreting the results of studies that have supported a five-factor model of the CSS.

Potential Hepatitis a Analysis: Research on Healthy and Safe Lifestyles in Indonesian Education in Taiwan

Purpose: This research aims to develop a predictive model using the Health Belief Model behavioral theory approach to understand changes in eating habits and physical activity among Indonesian students in Taiwan. Given the historical context of hepatitis A outbreaks in Taiwan and the importance of preventive health behaviors, the study seeks to lay the foundation for further intervention research focused on promoting healthy lifestyles among Indonesian students. Methods: The research employs a basic research approach to develop a predictive model, drawing on the Health Belief Model framework. Data collection involves administering questionnaires to Indonesian students in Taiwan to assess their eating habits, physical activity, knowledge about hepatitis A prevention, and adherence to Clean and Healthy Living Behavior (PHBS) practices. Statistical analysis is conducted to identify factors influencing knowledge and behavior related to hepatitis A prevention. Results and Discussion: Analysis of questionnaire data from 112 Indonesian students reveals that many behaviors do not reflect PHBS practices aimed at preventing hepatitis A transmission. The results indicate that factors such as age, gender, and level of education significantly influence knowledge about hepatitis prevention and healthy hygiene behavior. Specifically, higher levels of knowledge correlate with better preventive behaviors, suggesting the importance of educational interventions in promoting health awareness among students. Implications of the Research: The findings have implications for public health interventions targeting Indonesian students in Taiwan to prevent hepatitis A transmission and promote healthy lifestyles. By identifying factors influencing knowledge and behavior related to hepatitis prevention, the research provides insights for developing targeted interventions and educational campaigns aimed at improving health outcomes among this population. Originality/Value: This research contributes to the literature by applying the Health Belief Model framework to understand and predict changes in eating habits and physical activity among Indonesian students in Taiwan. The study addresses the need for preventive health measures in response to hepatitis outbreaks and underscores the importance of cultural and contextual factors in shaping health behaviors among international student populations. The findings provide a basis for future intervention research and highlight the significance of promoting health awareness and preventive practices in diverse cultural settings.

Designing and Implementing Health and Wellness Programs: Positioning Health and Wellness at the Forefront of a Polytechnic Institution

The past 20 years has seen a renaissance of activity with respect to workplace wellness. The concept of providing a health and wellness program for employees has grown to include employee assistance aid. Within the Polytechnic community the health and wellness programs have expanded to the student body as well. If you consider the fact that a Polytechnic has a population of some small cities, then the case for support of providing services is well founded. Due to the mix of international and domestic student populations the wellness programming has taken on a new mosaic of services. The attention to cultural sensitivities and competencies need to be addressed and incorporated when contemplating any services and programming to be delivered to the Polytechnic community. Most recently, with the increase of mental health issues amongst staff and students it is time to implement a strong interdisciplinary approach to wellness and mental health.

Comparative Analysis of Lexical Bundles in Dissertation Abstracts: Insights for Teaching Academic English to Chinese Students

Lexical bundle research in academic abstracts has predominantly focused on research articles, with less attention given to dissertation abstracts. This is particularly relevant for Chinese graduate students who are required to provide English abstracts in their dissertations. Addressing this gap, the study compared the structural and functional distribution of lexical bundles in dissertation abstracts by linguistics students from China and the United States to inform academic instruction. Two corpora, the Chinese University Student Collection and the American University Student Collection, each with 700 abstracts, were compiled and analyzed. The findings showed that Chinese students proportionally used more noun phrase (NP) and prepositional phrase (PP)-based lexical bundles, but fewer verb phrase (VP)-based ones, compared to their American counterparts. Additionally, they used a higher proportion of research- and participant-oriented bundles, but fewer text-oriented bundles. These differences highlight distinct structural and functional preferences in lexical bundle usage between the two student groups. This study underscores the importance of adapting instructional strategies to address these differences, enhancing English academic writing skills of Chinese graduate students by acknowledging the diverse linguistic approaches of international student populations.

Modeling Climate Change Effects on Genetic Diversity of an Endangered Horse Breed Using Canonical Correlations.

The historical increase in the occurrence of extreme weather events in Spain during the last thirty years makes it a perfect location for the evaluation of climate change. Modeling the effects of climate change on domestic animals' genetic diversity may help to anticipate challenging situations. However, animal populations' short life cycle and patent lack of historical information during extended periods of time drastically compromise the evaluation of climate change effects. Locally adapted breeds' gene pool is the base for their improved resilience and plasticity in response to climate change's extreme climatic conditions. The preservation of these domestic resources offers selection alternatives to breeders who seek such improved adaptability. The Spanish endangered autochthonous Hispano-Arabian horse breed is perfectly adapted to the conditions of the territory where it was created, developed, and widespread worldwide. The possibility to trace genetic diversity in the Hispano-Arabian breed back around seven decades and its global ubiquity make this breed an idoneous reference subject to act as a model for other international populations. Climate change's shaping effects on the genetic diversity of the Hispano-Arabian horse breed's historical population were monitored from 1950 to 2019 and evaluated. Wind speed, gust speed, or barometric pressure have greater repercussions than extreme temperatures on genetic diversity. Extreme climate conditions, rather than average modifications of climate, may push breeders/owners to implement effective strategies in the short to medium term, but the effect will be plausible in the long term due to breed sustainability and enhanced capacity of response to extreme climate events. When extreme climatic conditions occur, breeders opt for mating highly diverse unrelated individuals, avoiding the production of a large number of offspring. People in charge of domestic population conservation act as catalyzers of the regulatory changes occurring during breeds' climate change adaptive process and may identify genes conferring their animals with greater adaptability but still maintaining enhanced performance. This model assists in determining how owners of endangered domestic populations should plan their breeding strategies, seeking the obtention of animals more resilient and adapted to climate-extreme conditions. This efficient alternative is focused on the obtention of increased profitability from this population and in turn ensuring their sustainability.

Using the Natural Language Acquisition Protocol to Support Gestalt Language Development

Purpose: The purpose of this article is to describe gestalt language development, a natural style of language acquisition, and describe how the Natural Language Acquisition (NLA) protocol can be used to support autistic and non-autistic individuals with language development. NLA builds on previous research findings and is used to detail and quantify the stages of gestalt language development. Method: This article is based on a review of the literature that describes echolalia and the language acquisition process of individuals who develop language in a gestalt style. Results: For years, autistic people have been sharing about their lived experiences with acquiring language through “scripts” and “ echolalia.” Collaborating with families and establishing a connection based on trust between the clinician and the child are essential components of supporting gestalt language development and are at the core of NLA. Conclusions: Clinicians can use the strategies outlined in NLA to support language development in gestalt language processors. In the interest of not excluding autistic people or underrepresented groups, it is necessary to change the traditional sequence of research to include marginalized communities such as multilingual and international populations in future studies regarding gestalt language development.

Curriculum Quality, Process Innovation, School Reputation, and Perceived Value Affecting the Loyalty of Chinese Higher Education Students in Thailand

This qualitative case study investigates the factors influencing the loyalty of Chinese higher education students in Thailand, focusing on curriculum quality, process innovation, institution reputation, and perceived value. Through in-depth interviews of 30 selected students and content analysis of the transcripts, the study uncovered the nuanced perspectives of Chinese students and revealed the significance of these factors in shaping their loyalty. Findings highlighted the importance of curriculum quality, faculty reputation, and support services in influencing perceived value, while also introducing the concept of process innovation as a key factor impacting loyalty. The study offered valuable insights to the understanding of loyalty to an institution and provided actionable recommendations for higher education institutions aiming to enhance the loyalty of their international student populations in the context of global competition and the unique challenges faced by Chinese students in Thailand.

Household physical activity and subjective well-being: An international comparison among East Asian older adult populations

PurposeEngaging in lifelong physical activity has multiple health benefits for older populations. Household physical activity occupies older adults’ awake time, and they can be an important energy expenditure during the day. The purpose of this study was to investigate the association between older adults’ household physical activity and subjective well-being in four East Asian societies. MethodsThe study design was a secondary data analysis. Data were retrieved from the module of Families 2016 in the database of the East Asian Social Survey. Participants were community-dwelling older adults with a mean age of 70.30±7.50 years and who lived in China, Japan, Korea, and Taiwan. Data were collected by interviews via structured questionnaires between 2016 and 2018. Descriptive analyses, independent t-tests, and an analysis of covariance were performed for the statistical analyses. ResultsIn total, there were 3,432 valid responses. Participants who lived in Taiwan had significantly lower levels of total household physical activity than those living in other societies. Older adults’ household physical activity was found to significantly differ by age, educational degree, gender, religion, marital status, occupation, and whether living alone. Older adults with high levels of household physical activity had significantly higher self-rated health and marital satisfaction than those with low levels. ConclusionsHousehold physical activity has potential benefits for subjective well-being across international older adult populations. Increasing household physical activity is recommended for older married couples to maintain marital satisfaction.

Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts

Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin. In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model. A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17-49 ml/min) and 3 pediatric cohorts (median eGFR range of 26-45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7-6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R2 7%-44% across cohorts). There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations.