Low Work Capacity Research Articles

Naujųjų anti-CD20 monokloninių antikūnų vaidmuo gydant itin aktyvią recidyvuojančiąją remituojančiąją išsėtinę sklerozę: ofatumumabo klinikinis efektyvumas ir saugumas

Multiple sclerosis is the most common chronic demyelinating neurodegenerative central nervous system disease among young adults. Considering its extent in a relatively young population, multiple sclerosis determines a significant socioeconomic burden to the society due to the cost of disease modifying treatment and a lower working capacity of patients and their caregivers. It is important to control neuroinflammation in the central nervous system caused by the pathologic activity of immune cells by considering a high efficacy treatment early in the disease course in order to prevent accumulation of neurological damage and to improve long term outcomes. According to the newest clinical studies, anti-CD20 therapies have proven their effectiveness and safety in active relapsing multiple sclerosis treatment: since 2018, ocrelizumab, and, since 2023, ofatumumab have both been available as treatment options in Lithuania. Because of its high potency and safety, as well as the specific mechanism of action, ofatumumab is effective in lower doses, and, after initial training at a health care facility, it can be self-administered through subcutaneous injection. This article reviews the efficacy, safety data and treatment indications of the latest available anti-CD20 monoclonal antibodies.

Selective adsorption of acetylene over carbon dioxide on glycine functionalized HKUST-1 with enhanced moisture stability

HKUST-1 is one of the most widely studied Metal-Organic Frameworks and is known for strong acetylene adsorption performance. However, it suffers from poor stability and lower working capacity after moisture exposure. To address this issue, we comparatively apply pristine HKUST-1 and glycine functionalized HKUST-1. They were prepared by a well-known low energy-consuming hydroxy double salt method. The ultrafast synthetic method was applied to obtain HKUST-1-ultrafast (HKUST-1-UF) and one glycine per three Cu sites was added HKUST-1 (HKUST-1-UF-GLY0.3). An adsorption study of C2H2 on the HKUST-1-UF and HKUST-1-UF-GLY0.3 shows that the introduction of glycine as the secondary binding unit increased the C2H2 uptake performance compared to that of bare HKUST-1. An evaluation of stability against moisture exhibits that the structural stability of HKUST-1-UF-GLY0.3 is enhanced compared to HKUST-1-UF. Further, in a breakthrough experiment using an equimolar C2H2/CO2 gas mixture, HKUST-1-UF-GLY0.3 exhibits a longer breakthrough time compared to HKUST-1-UF after thermal pre-treatment, or even pre-humidifying (RH 60% and RH 80%) overnight. The adsorbents can be repeatedly used as a C2H2 adsorbent over CO2.

Shock Raman spectra and structural transformation of powdered TKX-50 by the plate impact experiments combined with real-time Raman detection

As an energetic material of great interest, the work capacity of dihydroxylammonium 5,5′-bistetrazole-1,1′-diolate (TKX-50) has been questioned recently. Although some research groups have explored the reasons for the low working ability of TKX-50, the plane impact experiment on powdered TKX-50 is obviously closer to the practical application, and the conclusions based on this are more guiding. Hence, we performed shock Hugoniot measurements of powdered TKX-50 between 5.65 and 16.29 GPa. The plane impact experiments of powdered TKX-50 were carried out and the shocked Raman spectra were collected. By Raman spectroscopy analysis, a new peak of powdered TKX-50 was found between 19.47 GPa and 24.96 GPa, which may be caused by decomposition/phase transition and was related with the low work capacity.

The role of labor in cash holdings: Evidence from the supply-side impact of COVID-19

This study investigates the dynamics of corporate cash holdings. We argue that firms in industries with low remote work feasibility have more incentives to hold cash during COVID-19 because of a precautionary saving motive or to retain their employees. The analysis results consistently show that firms less able to transition to remote work maintain higher cash holdings during COVID-19, and, more importantly, this effect is stronger for firms with more employees. Furthermore, we find that a higher share of female workers is associated more strongly with high levels of cash holdings for firms with low remote work capacity during COVID-19.

Microstructure evolution and deformation behaviors of pulse electro-assisted deformation in M50 bearing steel

M50 bearing steel, as a typical high-carbon and high-alloy steel, exhibits low cold working capacity with high susceptibility to produce voids during the ring rolling process. In this paper, the deformation behavior and microstructure evolution during the pulse electro-assisted tensile of M50 bearing steel was studied. The results show that the maximum flow stress of the pulse electro-assisted deformation (PEAD) specimen decreases by 24.4% compared with that of the traditional deformation (TD) specimen. However, the section shrinkage rate of the PEAD specimen is increased by 32.2%, which is even higher than that of the hot deformation (HD) specimens. This indicates the positive role of pulse current on the increase of plasticity. Besides, a constitutive model of the PEAD process was established by fitting the experimental data. With the assistance of pulse current, the deformation resistance and work hardening are reduced, so the number of voids is significantly reduced due to the easier metal flow. Moreover, the energy barrier of recrystallized grain nucleation is decreased, while the nucleation rate is increased under pulse current. As a result, the occurrence of recrystallization leads to the reduction of average grain size from 4.51 μm to 1.62 μm. According to the high-resolution transmission electron microscopy (HRTEM) and electron backscatter diffraction (EBSD) characterizations, the dislocation density decreases by 24% under the applied current, which should be ascribed to the increase of atomic flux and lattice diffusion coefficient. This work provides a new idea for solving the plastic deformation problem of M50 bearing steel.

THE CHARACTERISTICS LEVEL OF MATERNAL SATISFACTION IN RECEIVING ANTENATAL CARE (ANC)

The low working capacity of puskesmas midwives in health care facilities is one indicator of low work effectiveness, as well as service satisfaction for pregnant women . The purpose of this study was to identify the level of maternal satisfaction about obstetric examination services antenatal care (ANC) by health workers at Karang Pule Health Center. Research design using descriptive survey research methods . the population, namely all pregnant women who did ANC at the Karang Pule Health Center in January to June 2020, was 96 people. Sampling technique Accidental sampling. Number of samples as many as 30 respondents, how to process data using Likert scale. From the results showed that the level of maternal satisfaction in the acceptance of ANC examination services in general from the aspect of Tangibles, expressed satisfaction as many as 23 respondents (76.67%), Reliability expressed satisfaction as many as 23 respondents (76.67%), Responsivenes expressed satisfaction as many as 24 respondents (80%), assurance expressed satisfaction as many as 22 respondents (73.33%),Emphaty expressed satisfaction as many as 24 respondents (80%), the results of this study concluded 78, 38% expressed satisfaction. It is expected from the results of this study to be one of the inputs on the need to improve the attention and standards of ANC services in health centers

Triple physically cross-linked hydrogel artificial muscles with high-stroke and high-work capacity

Owing to the high-water content and excellent biocompatibility, polymeric hydrogels are good candidates to mimic natural muscles in biomedical and bioengineering fields, but the low stroke and low work capacity limited them to be used as artificial muscles. Herein, inspired by the ordered structure of skeletal muscles, high performance anisotropic hydrogels comprising of triple physically cross-linked networks are developed by the electrostatic interactions between positively charged tunicate cellulose nanocrystals (TCNC) and –COO− of polymers, hydrophobic association of stearyl methacrylate (SMA) moiety in sodium dodecyl sulfate (SDS) micelles, and –COO−/Fe3+ ionic coordination. The elastic potential energy can be stored in polymeric networks by locking the pre-stretched hydrogel via ionic coordination, which can be released by dissociating the ionic coordination under acidic condition. Based on their excellent mechanical property reinforced by TCNCs, the developed hydrogel artificial muscles exhibit high actuation stroke (75 %) and high-work capacity (210 J kg−1), which are higher than those of skeletal muscles. These hydrogel muscles demonstrated potential for wide applications in being designed as biceps to lift skeleton’s arm and as micromotors to drive boat model under acidic condition because of their high-stroke, high-work capacity and comparable output efficiency with natural muscles.

MIL-101-Cr/Fe/Fe-NH2 for Efficient Separation of CH4 and C3H8 from Simulated Natural Gas.

Adsorptive separation based on porous solid adsorbents has emerged as an excellent effective alternative to energy-intensive conventional separation methods in a low energy cost and high working capacity manner. However, there are few stable mesoporous metal-organic frameworks (MOFs) for efficient purification of methane from other light hydrocarbons in natural gas. Herein, we report a series of stable mesoporous MOFs, MIL-101-Cr/Fe/Fe-NH2, for efficient separation of CH4 and C3H8 from a ternary mixture CH4/C2H6/C3H8. Experimental results show that all three MOFs possess excellent thermal, acid/basic, and hydrothermal stability. Single-component adsorption suggested that they have high C3H8 adsorption capacity and commendable selectivity for C3H8 and C2H6 over CH4. Transient breakthrough experiments further certified the ability of direct separation of CH4 from simulated natural gas and indirect recovery of C3H8 from the packing column. Theoretical calculations illustrated that the van der Waals force proportional to the molecular weight is the key factor and that the structural integrity and defect can impact separation performances.

Wireless Miniature Magnetic Phase-Change Soft Actuators.

Wireless miniature soft actuators are promising for various potential high-impact applications in medical, robotic grippers, and artificial muscles. However, these miniature soft actuators are currently constrained by a small output force and low work capacity. To address such challenges, a miniature magnetic phase-change soft composite actuator is reported. This soft actuator exhibits an expanding deformation and enables up to a 70 N output force and 175.2 J g−1 work capacity under remote magnetic radio frequency heating, which are 106–107 times that of traditional magnetic soft actuators. To demonstrate its capabilities, a wireless soft robotic device is first designed that can withstand 0.24 m s−1 fluid flows in an artery phantom. By integrating it with a thermally-responsive shape-memory polymer and bistable metamaterial sleeve, a wireless reversible bistable stent is designed toward future potential angioplasty applications. Moreover, it can additionally locomote inside and jump out of granular media. At last, the phase-change actuator can realize programmable bending deformations when a specifically designed magnetization profile is encoded, enhancing its shape-programming capability. Such a miniature soft actuator provides an approach to enhance the mechanical output and versatility of magnetic soft robots and devices, extending their medical and other potential applications.

Miniature coiled artificial muscle for wireless soft medical devices.

Wireless small-scale soft-bodied devices are capable of precise operation inside confined internal spaces, enabling various minimally invasive medical applications. However, such potential is constrained by the small output force and low work capacity of the current miniature soft actuators. To address this challenge, we report a small-scale soft actuator that harnesses the synergetic interactions between the coiled artificial muscle and radio frequency–magnetic heating. This wirelessly controlled actuator exhibits a large output force (~3.1 N) and high work capacity (3.5 J/g). Combining this actuator with different mechanical designs, its tensile and torsional behaviors can be engineered into different functional devices, such as a suture device, a pair of scissors, a driller, and a clamper. In addition, by assuming a spatially varying magnetization profile, a multilinked coiled muscle can have both magnetic field–induced bending and high contractile force. Such an approach could be used in various future untethered miniature medical devices.

Mechanism of void healing in cold rolled aeroengine M50 bearing steel under electroshocking treatment: A combined experimental and simulation study

M50 bearing steel, as the important material used in aeroengine bearing, exhibits low cold working capacity with high susceptibility to produce voids. This would lead to the deterioration of mechanical property, which critically limits the industrial application of cold ring rolling (CRR) in M50 bearing rings. In this work, the mechanism of void healing in cold rolled aeroengine M50 bearing steel subjected to electroshocking treatment (EST) was investigated by combining experimental and simulation studies. The experimental results obtained using the three-dimensional X-ray microscopy (3D-XRM) technique show that the porosity of the CRR samples decreases from 0.26% to 0.09% after EST. The healing effect of larger voids is not obvious, while small voids are likely to be healed under EST. The simulation results indicate that due to the inhomogeneous distribution of the physical field, the local thermal compressive stress of as high as 2565.9 MPa is generated around the ellipsoidal void and thus drives void healing process. The healing process of ellipsoidal voids under EST can be divided into elastic and plastic deformation stages considering von Mises yield criterion. In the initial stage, only a small elastic deformation of 53.53 nm occurs in the minor axis direction of the void. In the plastic deformation stage, the material flows along the normal direction of the void with a reduction in the aspect ratio, thereby compressing the void surfaces and promoting their healing. Additionally, the degree of void healing depends on the shape characteristics (curvature and aspect ratio) of the void rather than the current direction. This research elucidates a new elastoplastic mechanism of void healing under EST, which also provides a promising prospect for the application of CRR in M50 bearing steel. • In situ characterization of voids before and after EST was realized using 3D-XRM. • A new elastoplastic mechanism of void healing under EST was elucidated. • The driving force of void healing was revealed by analysing the physical field distribution. • The ellipsoidal void is healed with the reduction in the aspect ratio. • The degree of void healing depends on the shape of the void rather than the current direction.

Resting and exercise haemodynamic characteristics of patients with advanced heart failure and preserved ejection fraction.

AimsThis study aimed to describe haemodynamic features of patients with advanced heart failure with preserved ejection fraction (HFpEF) as defined by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).Methods and resultsWe used pooled data from two dedicated HFpEF studies with invasive exercise haemodynamic protocols, the REDUCE LAP‐HF (Reduce Elevated Left Atrial Pressure in Patients with Heart Failure) trial and the REDUCE LAP‐HF I trial, and categorized patients according to advanced heart failure (AdHF) criteria. The well‐characterized HFpEF patients were considered advanced if they had persistent New York Heart Association classification of III–IV and heart failure (HF) hospitalization < 12 months and a 6 min walk test distance < 300 m. Twenty‐four (22%) out of 108 patients met the AdHF criteria. On evaluation, clinical characteristics and resting haemodynamics were not different in the two groups. Patients with AdHF had lower work capacity compared with non‐advanced patients (35 ± 16 vs. 45 ± 18 W, P = 0.021). Workload‐corrected pulmonary capillary wedge pressure normalized to body weight (PCWL) was higher in AdHF patients compared with non‐advanced (112 ± 55 vs. 86 ± 49 mmHg/W/kg, P = 0.04). Further, AdHF patients had a smaller increase in cardiac index during exercise (1.1 ± 0.7 vs. 1.6 ± 0.9 L/min/m2, P = 0.028).ConclusionsA significantly higher PCWL and lower cardiac index reserve during exercise were observed in AdHF patients compared with non‐advanced. These differences were not apparent at rest. Therapies targeting the haemodynamic compromise associated with advanced HFpEF are needed.

Demographic, psychosocial and health disparities between living and deceased renal allograft recipients in Switzerland.

Living donor renal transplantation is widely performed in Switzerland with a superior long-term outcome and lower waiting time compared with deceased renal transplantation. However the chances of receiving a living donor kidney transplant are not the same for all transplant candidates. The current study aimed to identify psychosocial and demographic characteristics that predict lower access to living kidney donation in Switzerland. The study was a nationwide multicentre study nested within the Swiss Transplant Cohort Study. Pre-transplant demographic, psychosocial and health characteristics of 1126 deceased and 859 living renal transplant recipients were compared using logistic regression analysis. Transplant candidates with higher age (odds ratio [OR] per 10 years 0.67, 95% confidence interval [CI] 0.60&ndash;0.74), lower education (OR 0.46, 95% CI 0.36&ndash;0.59), a work capacity of less than 50% (OR 0.48, 95% CI 0.35&ndash;0.66), single or formerly married (OR 0.38, 95% CI 0.26&ndash;0.53 / OR 0.37, 95% CI 0.26&ndash;0.53) or with a higher hospital depression score (OR per 5 points 0.61, 95% CI 0.50&ndash;0.74) were less likely to receive an allograft from a living donor. In some regions of Switzerland candidates were more likely to undergo living transplantation than in other regions. No association was found with gender or income. Interventions to increase access to kidney transplantation from living donors should target transplant candidates of older age, lower education, lower working capacity and not living in a committed relationship. The observed regional differences suggest that additional determinants of living donation may play a role such as population and health professional attitudes toward living donation.

Work Ability Assessment in Nursing Workers

&#x0D; &#x0D; &#x0D; Objective: To identify the nursing staff of a university hospital's work ability index and point out which factors interfere in the quality of the work of these workers. Method: This is a cross-sectional, descriptive and analytical survey, quantitative, composed of 54 nursing professionals from the medical clinic ward sector of a large hospital in Uberlândia (Minas Gerais, Brazil). Data collection is performed using two tools: sociodemographic questionnaire and Work Ability Index (WAI). The G-Test by Williams was applied to assess the significant association between sociodemographic and occupational variables and those related to the work ability index. It was used the BioEstat® version 5.3 program to perform all analyzes with a significance level of 0.05 (5%). Results: The research showed that nursing professionals had a predominance of good workability (40,7%), the prevalence of young adults, the highest percentage between 31-40 years, 81,5% are women, 50% are in a marital relationship, 63% are open to public tender, and they had no back injuries. It was also found that the only professionals who had a low work capacity were nursing technicians, corresponding to 5,6% of the total percentage. Conclusion: It is known that a hospital environment is a place that favors the illness process of nursing workers. The worker who owns and maintains adequate physical and mental health can perform his duties better and have a better capacity for work, therefore taking better care of the patient.&#x0D; &#x0D; &#x0D;

COVID-19 상황에서 여행업 종사자의 고용불안 경험에 관한 근거이론 연구

Based on the grounded theory, this study examined the experience of employment insecurity of travel industry workers during the COVID-19. In-depth interviews were conducted with travel industry workers who experienced employment insecurity after COVID-19. We conducted the theoretical sampling until the data achieved the satuaration. The data were continuously reviewed by experts during the analysis processes and NVivo 12 was used to manage and analyze the data. In the open coding process, we found total of 118 concepts, 30 sub-categories, and 12 categories related to employment insecurity of travel industry during the COVID-19. The findings suggest that casual condition was turned out to be ‘tourism crisis caused by COVID-19', contextual conditions were ’industrial structure vulnerable to external factors’, ‘insufficient employment policy’ and ‘digitalization of the tourism industry’ The phenomenon was 'experience of employment insecurity of travel industry workers' and the intervening condition were 'psychological change', 'low work capacity of human resources' and 'limited turnover opportunities'. The action and interaction were 'search and utilize of employment policy', 'k-quarantine and a system-based HRM' and 'establishment of tourism employment safety net'. The consequence was 'improvement of the tourism employment structure in the New Normal Era'. In the selective coding stage, the core category was found to be 'improvement of the tourism employment structure in the New Normal Era according to tourism employment insecurity'.

Clinical and functional approaches to comprehensive treatment of periodontal diseases in children with type I diabetes

Relevance. The high prevalence of microvascular complications in children with type I diabetes mellitus (DM) has a serious impact on the quality of life and can result in a lower working capacity and early disability. The negative effect of the drug therapy, inability to fully comply with the acceptable age-related safety limits, specific metabolism and pharmacokinetic features in childhood – all these reveals the need to improve the patterns for comprehensive treatment of periodontal diseases in children with type I diabetes.The purpose was to explain the clinical and functional effectiveness of the combined enzyme and magnet &amp; laser therapy in comprehensive treatment of the periodontal microcirculatory disorders in children suffering from type I diabetes. Materials and methods. The study involved 97 children diagnosed with type I diabetes, aged 12-17 y.o., with the present disease history from 6 months to 12 years. The microcirculation was assessed by laser Doppler flowmetry. Microcirculatory disorder correction was performed by a local exposure to a running low-frequency pulsed magnetic field combined with enzyme therapy. Results. The dynamic magnetic therapy has proven to increase the effectiveness of capillary blood flow in children with early signs of vascular congestion and hyperemia, while Phlogenzym, a polyenzyme formulation, needs to be added in cases of vascular congestion and ischemia. Conclusion. The effectiveness of physiotherapeutic and pharmacological effect of Phlogenzym along with the dynamic magnetic therapy shows that it can be recommended as an alternative to the conventional anti-inflammatory, antiseptic and antibiotic therapy during the pre-surgical treatment and post-surgical follow-up care as well as at the maintenance phase, both in an inpatient and outpatient setting.

WOMAC score and arthritis diagnosis predict decreased agricultural productivity

BackgroundArthritis and joint pain are highly prevalent in agricultural (ag) workers. Many ag operations are sustained by a small number of workers, and the disability of even one worker thus contributes to economic hardship. This study investigated associations between joint health in Montana ag workers and economic well-being and work capacity.MethodsThis observational mixed-methods study utilized quantitative survey data and qualitative focus group data. 299 ranchers and farmers in 9 Montana counties completed either an online or paper survey that included participant demographics, joint symptoms, history of arthritis and arthritis type, financial status, work capacity, and the need to rely on others to complete one’s work. The Western Ontario and McMaster Universities arthritis index (WOMAC) survey was completed by those with hip or knee pain. Data were entered into REDCap v8.9.2 for analysis with SAS 9.4, using logistic and linear regression models to detect associations between covariables and to calculate odds ratios and confidence intervals. Focus groups were held with ranchers in two Montana counties, discussing similar topics, and the themes expressed were identified.Results87.6% of survey respondents reported joint pain, 47.8% a diagnosis of arthritis, and 22.4% osteoarthritis (OA). A 10-point increase in WOMAC was significantly associated with lower work capacity (OR 2.00; 95% CI [1.58, 2.55], p < 0.01), worse financial condition (OR 1.23; 95% CI [1.01,1.48], p = 0.04), and increased reliance on others (OR 1.82; 95% CI [1.32, 2.55], p < 0.01). An arthritis diagnosis was associated with worsening work capacity (OR 4.66; 95% CI [2.71, 8.01], p < 0.01) and increased odds of relying on others (OR 3.23; 95% CI [1.56, 6.66], p < 0.01). A diagnosis of OA was significantly associated with decreased work capacity (OR 3.47; 95% CI [1.97, 6.11], p < 0.01). Unadjusted for age and BMI, we found a significant association between years spent working in agriculture and joint health, which became non-significant after adjusting for age and BMI. Focus group themes included decreased productivity with increased joint symptoms and a tendency for ranchers to avoid interaction with the health care system.ConclusionPoor joint health is associated with economic risk on Montana ranches and farms.

Reduced Variability of Endurance Time in New Protocols for Exercise Tests in COPD.

PurposeFor exercise testing of COPD patients, a standard endurance test (ET) with constant workload is recommended. The test suffers from large inter-individual variability and need for large sample sizes in order to evaluate treatment effects.MethodsA new protocol for ET in COPD was designed. In contrast to the standard ET, the new ET involved an increasing workload in order to reduce the standard deviation of endurance time. Two new ETs were compared with the standard ET. In Study A, the new ET started at 75% of the patient’s maximum workload (WMAX) and increased stepwise with 3%/2 min until exhaustion. Study B started at 70% of WMAX and increased linearly with 1%/min.ResultsIn Study A, that included 15 patients, the standard deviation and range for endurance time and work capacity were narrower for the new versus the standard ET. However, the higher mean workload at end and the low mean work capacity relative to the standard ET indicated that the stepwise increase was too aggressive. In Study B, that included 18 patients, with a modified protocol, the averages for endurance time, workload at end and work capacity were similar for new and standard ET, while the standard deviations and ranges for endurance time and work capacity were kept more narrow in the new ET. The variances for endurance time were not equal between the standard ET and the two new ETs (p<0.05 for both according to Levene’s test).ConclusionThe new ET reduced the number of patients with extreme endurance times (short and long) compared to the standard test. The new test showed a significant lower variance for endurance time, which potentially can lead to fewer patients needed in comparative studies. The overall best results were observed with a low linear increase during endurance.

Pre-existing mental health disorders affect pregnancy and neonatal outcomes: a retrospective cohort study

BackgroundThis was a hospital registry-based retrospective age-matched cohort study that aimed to compare pregnancy and neonatal outcomes of women with pre-existing mental disorders with those of mentally healthy women.MethodsA matched cohort retrospective study was carried out in the Department of Obstetrics and Gynecology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, a tertiary health care institution. Medical records of pregnant women who gave birth from 2006 to 2015 were used. The study group was comprised of 131 pregnant women with mental disorders matched to 228 mentally healthy controls. The primary outcomes assessed were antenatal care characteristics; secondary outcomes were neonatal complications.ResultsPregnant women with pre-existing mental health disorders were significantly more likely to have low education, be unmarried and unemployed, have a disability that led to lower working capacity, smoke more frequently, have chronic concomitant diseases, attend fewer antenatal visits, gain less weight, be hospitalized during pregnancy, spend more time in hospital during the postpartum period, and were less likely to breastfeed their newborns. The newborns of women with pre-existing mental disorders were small for gestational age (SGA) more often than those of healthy controls (12.9% vs. 7.6%, p < 0.05). No difference was found comparing the methods of delivery.ConclusionsWomen with pre-existing mental health disorders had a worse course of pregnancy. Mental illness increased the risk to deliver a SGA newborn (RR 2.055, 95% CI 1.081–3.908).

Empirical studies of factors associated with child malnutrition: highlighting the evidence about climate and conflict shocks

Children who experience poor nutrition during the first 1000 days of life are more vulnerable to illness and death in the near term, as well as to lower work capacity and productivity as adults. These problems motivate research to identify basic and underlying factors that influence risks of child malnutrition. Based on a structured search of existing literature, we identified 90 studies that used statistical analyses to assess relationships between potential factors and major indicators of child malnutrition: stunting, wasting, and underweight. Our review determined that wasting, a measure of acute malnutrition, is substantially understudied compared to the other indicators. We summarize the evidence about relationships between child malnutrition and numerous factors at the individual, household, region/community, and country levels. Our results identify only select relationships that are statistically significant, with consistent signs, across multiple studies. Among the consistent predictors of child malnutrition are shocks due to variations in climate conditions (as measured with indicators of temperature, rainfall, and vegetation) and violent conflict. Limited research has been conducted on the relationship between violent conflict and wasting. Improved understanding of the variables associated with child malnutrition will aid advances in predictive modeling of the risks and severity of malnutrition crises and enhance the effectiveness of responses by the development and humanitarian communities.