Multistage Stratified Random Sampling Research Articles

Motivational Factors to Purchase Eco-Friendly Millets in Tirunelveli District

Millets are among the crops that are the simplest to grow in a field. Because it is a crop that is fed through rain, it requires less care and fertilizer than wheat and rice. Millets were among the first crops farmed for food. Millets grow more quickly, fit into a range of cropping plants, and are particularly good at adapting to changing climatic and environmental circumstances. As a result, they are easy to plant and care for. This article examines the factors that influence individuals in the Tirunelveli district to purchase environmentally friendly millets. The present paper highlights the satisfactory level and motivational factors to purchase eco-friendly millets in Tirunelveli district. The data was collected from 460 consumers by applying a multistage stratified proportionate random sampling method and analysed the collected data by using statistical tools including Percentage analysis, One-sample t-test and Factor analysis. The results of the factor analysis shows that promotion, personal and reference groups, and product positioning are some of the key factors that influence Tirunelveli consumers' decision to purchase eco-friendly millets.

Social cohesion and reconciliation between the Rohingya and host communities in Cox's Bazar, Bangladesh

PurposeThe Rohingyas are forcefully displaced from Myanmar and sheltered in the Cox's Bazar district of Bangladesh. They have outnumbered the local people indicating a critical condition of their living situation after the year 2017 influx. The aim of this paper is to present how coexistence has impacted social cohesion and reconciliation among different groups of Rohingyas and host communities.Design/methodology/approachA cross-sectional survey was conducted with 903 households through a multistage stratified random sampling. Social cohesion and reconciliation (SCORE) index was measured as a multifaceted theoretical construct based on the exploratory and confirmatory factor analyses.FindingsThe findings of this study are inclined toward the miracle of social cohesion and reconciliation between the Rohingya and host communities. Also, it is revealed that youth, males and Rohingyas who came before the year 2017 influx are more cohesive. In the host or local community, people having lower income, less education and involvement with the informal sector are revealed as less cohesive.Practical implicationsThis study suggests vocational training as a short-term, cash-for-work as a mid-term and repatriation, proper identity, and protection services as long-term strategic plans to make the two communities more cohesive.Originality/valueThis study focuses on the SCORE indexes with a quantitative format, applying a second-order factor model.

Online information acquisition affects food risk prevention behaviours: the roles of topic concern, information credibility and risk perception

BackgroundThe COVID-19 pandemic has not only brought great challenges to the global health system but also bred numerous rumours about food safety. Food safety issues have once again attracted public attention.MethodsThe data were drawn from the fifth wave of the first Taiwan Communication Survey database. The respondents were selected via multistage stratified random sampling. The sampling units were townships/districts, villages/neighbourhoods and households. The sample consisted of 2098 respondents. This study first used propensity value matching to analyse the direct impact of online food safety information acquisition on preventive behaviours and examined the heterogeneous impact caused by the difference in the degree of topic attention through value matching. Hayes’ PROCESS macro model 6 was applied to confirm the mediating effect and the serial mediating effect.ResultsThe research results show that an increase in the frequency of the acquisition of online food safety information significantly increases individuals’ food risk prevention behaviour. However, only users with high concern about the issue are affected. The food risk prevention behaviour of users with low concern about this issue is not affected by the acquisition of online food safety information. Further analysis shows that risk perception and information credibility both play mediating roles in the impact of online food safety information acquisition on food risk prevention behaviour. Moreover, the transmission and united effects of information credibility and risk perception play a distal mediating role.ConclusionsFood risk prevention behaviours are an important topic for personal health as well as government management. Our study’s findings can provide empirical evidence for risk managers and decision-makers to reevaluate the role of the internet in food risk management.

Mediating effect of body fat percentage in the association between ambient particulate matter exposure and hypertension: a subset analysis of China hypertension survey

BackgroundHypertension caused by air pollution exposure is a growing concern in China. The association between air pollutant exposure and hypertension has been found to be potentiated by obesity, however, little is known about the processes mediating this association. This study investigated the association between fine particulate matter (aerodynamic equivalent diameter ≤ 2.5 microns, PM2.5) exposure and the prevalence of hypertension in a representative population in southern China and tested whether obesity mediated this association.MethodsA total of 14,308 adults from 48 communities/villages in southern China were selected from January 2015 to December 2015 using a stratified multistage random sampling method. Hourly PM2.5 measurements were collected from the China National Environmental Monitoring Centre. Restricted cubic splines were used to analyze the nonlinear dose-response relationship between PM2.5 exposure and hypertension risk. The mediating effect mechanism of obesity on PM2.5-associated hypertension was tested in a causal inference framework following the approach proposed by Imai and Keele.ResultsA total of 20.7% (2966/14,308) of participants in the present study were diagnosed with hypertension. Nonlinear exposure-response analysis revealed that exposure to an annual mean PM2.5 concentration above 41.8 µg/m3 was associated with increased hypertension risk at an incremental gradient. 9.1% of the hypertension burden could be attributed to exposure to elevated annual average concentrations of PM2.5. It is noteworthy that an increased body fat percentage positively mediated 59.3% of the association between PM2.5 exposure and hypertension risk, whereas body mass index mediated 34.3% of this association.ConclusionsThis study suggests that a significant portion of the estimated effect of exposure to PM2.5 on the risk of hypertension appears to be attributed to its effect on alterations in body composition and the development of obesity. These findings could inform intersectoral actions in future studies to protect populations with excessive fine particle exposure from developing hypertension.

Cognitive status and its risk factors in patients with hypertension and diabetes in a low-income rural area of China: A cross-sectional study.

The proportion of older people with dementia in China is gradually increasing with the increase in the aging population over recent years. Hypertension and diabetes are common non-communicable diseases among rural populations in China. However, it remains unclear whether these conditions affect the occurrence and development of cognitive impairment as there is limited research on cognitive status and its risk factors among residents of rural areas. A multi-stage stratified cluster random sampling method was used to select 5400 participants from rural permanent residents. A self-designed structured questionnaire was used to investigate demographic data of the participants. Cognitive function was assessed using the Montreal Cognitive Function Assessment Scale (MoCA). The results were analyzed using chi-square test, ANOVA and multiple linear regression analysis. A total of 5028 participants returned the survey, giving a response rate of 93.1%. Higher education (odds ratio (OR)=3.2, 95% confidence interval (CI) 2.87-3.54, p<0.001), higher income (OR=1.61, 95% CI 1.16-2.07, p<0.001), and dietary control (OR=0.66, 95%CI 0.34-0.98, p<0.001) were protective factors. A visual representation of the relationship between annual income and MoCA score showed an inverted U-curve, the group with an annual income of 6000-7999 RMB had a maximum OR of 1.93 (95%CI 0.12-2.74, p<0.001). While difficulty in maintaining sleep were risk factors for cognitive impairment (OR=-2.28, 95% CI-4.18-0.39, p=0.018). Participants with middle incomes had better cognitive status than those with the highest incomes. Higher education, proper diet control and good sleep are beneficial to the cognitive status of residents in rural areas.

Resource Use Efficiency of Cucumber (Cucumis sativus L.) in Sultanpur District of Uttar Pradesh, India

his study was designed to measure the profitability and resource use efficiency of cucumber production during agricultural year 2021-22 in Sultanpur district of Uttar Pradesh. The study utilized a multistage stratified purposive cum random sampling technique to select districts, blocks, villages, and respondents. Using a pre-tested questionnaire, primary data and information were collected from 100 cucumber producing farmers, categorized in 66 marginal, 23 small and 11 medium farmers were chosen from the five villages in the Dubeypur block of the Sultanpur district. For functional analysis, Cobb - Douglas production function was employed for estimating resource use efficiency. The t-test for testing the significance of factor elasticities and the F-test for testing the significance of R2 were used. The study revealed that return to scale was found to be increasing in cucumber production and Marginal Value Product was more than one in all the cases except few, which indicate the further chance of investment on variable inputs to get the optimum income. Through comprehensive analysis of financial efficiency measures, it has been revealed that marginal farms exhibit greater profitability in terms of farm business income compared to small and medium-sized farms.

Factors Contributing to the Change in Overweight/Obesity Prevalence Among Indian Adults: A multivariate decomposition analysis of data from the National Family Health Surveys.

Concerns over the escalating burden of non-communicable diseases call for the redressal of behavioral risk factors like increased body mass index. Most studies have failed to quantify the contribution of socio-demographic characteristics in a linear trend. The present study aims to estimate the current prevalence of overweight and obesity in Indian adults and the contribution of different socio-demographic factors to the increasing prevalence. We carried out a secondary data analysis of two National Family Health Survey (NFHS) rounds. The final sample includes 558,122 women and 84,477 men from round 4, and 574,099 women and 74,761 men were included from round 5, using a multi-stage stratified random sampling approach. Overweight/obesity was our primary dependent variable. Weighted bivariate analysis was used to ascertain the prevalence, and the adjusted odds ratios were computed to ascertain the potential predictors. The contribution of different factors towards rising burden over two time points was estimated using multivariate decomposition analysis for non-linear response models. Overall weighted prevalence of overweight and obesity in males and females per NFHS-5 was 44.02% and 41.16%, respectively, compared to 37.71% and 36.14% in NFHS-4. Decomposition analyses depict that the proportion of obesity increased by 6.37% and 5.10% points among men and women, respectively, over the two rounds. Compositional differences of participants (endowment) attributed to 16.54 and 49.90% differences, and the difference in coefficient or effect accounted for 83.46 and 50.10%, respectively, of the increase in the prevalence. The most significant factors contributing to increased prevalence were age, improving socio-economic status, smoking, unclean cooking fuel, and diabetes. The incremental rise in such a short period, mainly attributed to the effect of socio-demographic variables, is concerning. Policy interventions should prioritize health advocacy programs and aggressively target behavioral modifications while preparing the health systems to manage the people living with obesity.

Prevalence and severity of dental caries in school children in Saudi Arabia: A nationwide cross-sectional study

AimThis nationwide study assessed the prevalence and severity of dental caries in 6-, 12-, and 15-year-old school children across Saudi Arabia. This study examined differences between genders and among regions regarding the mean values of decayed, missing, and filled teeth (dmft/DMFT), the care index (CI), and the significant caries index (SiC index). Materials and methodsData from 19,870 participants, 10,435 males and 9435 females, were collected using stratified multistage cluster random sampling. The survey team divided Saudi Arabia into five regions (northern, eastern, western, southern, and middle). To represent each respective region, a large city, two random towns (peri-urban), and four random rural areas were selected for surveying. Lastly, the sampling technique was applied by choosing random schools and random classes within the selected schools. Dental caries were assessed using the dmft/DMFT score, CI, and the top 30% and 10% of the sample dmft/DMFT scores (SiC30 and SiC10, respectively). ResultsThe overall prevalence of caries was 65.6%, with 72.1 occurring in primary teeth and 61.7% in permanent teeth. The percentages of individuals with missing teeth and filled teeth were 9.0% and 20.5%, respectively. The mean dmft was 3.93 ± 3.60, while the mean DMFT was 2.42 ± 2.52; most of the DMFT components were significantly higher in females than males, while the dmft components were higher in males. The northern region had the highest and worst DMFT/dmft ratios of the five regions. The mean SiC30 and SiC10 values were significantly higher than the overall average DMFT/dmft values (P < 0.001). ConclusionDental caries remain a public health challenge among school children in Saudi Arabia. The SiC and CI analysis indicated that caries management had a high overall efficacy, but that certain groups of the population may need targeted management in the future.

DECOMPOSING MULTIDIMENSIONAL POVERTY: A CASE STUDY OF MAMIT DISTRICT, MIZORAM

Purpose: The study intends to examine the incidence and intensity of multidimensional poverty in Mamit District of Mizoram. Methodology: This study was based on primary data which was collected through a multi-stage stratified random sampling technique. At the first stage, Mamit District was selected solely based on socio-economic indicators for conducting the survey. The second stage involved random selection of 15 villages, five villages from each block. Requisite data were then collected randomly through structured questionnaires which was designed based on the requirement for computation of Multidimensional Poverty Index. From the collected data, the incidence of poverty (headcount ratio), the intensity of poverty and MPI were computed using Alkire-Foster Methodology. The study follows the Global MPI Brief Methodological Note, 2017 in the choice of dimensions, indicators, thresholds and weights assigned to each indicator. Results: From the result of the analysis, the multidimensional poverty in the study area is moderate. The incidence of poverty across the study area is ranging between 0.32 - 0.38 while the intensity of poverty shows slight differences with negligible margin ranging between 0.39-0.411. Decompositions by indicators show that the nutrition has surpassed all other indicators with 22 percent contribution to overall MPI of Mamit district followed by year of schooling with 15 percent. Applications of this study: The findings of the study can be based for formulation of government poverty reduction policies and can be used effectively in improving the existing poverty reduction strategies in the state. KEY WORDS: Multidimensional Poverty, Decomposition, Mamit District, Mizoram.

National prevalence and risk factors for tungiasis in Kenya

BackgroundTungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans, the female of which burrows into the skin, causing pain and itching. The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens. The tungiasis research community is keen to develop survey methods to fill this gap. Here we used a school-based, thorough examination method to determine the prevalence and risk factors for tungiasis in Kenya.MethodsWe conducted the first nationally representative survey of tungiasis, including nine counties covering the major ecological zones of Kenya. A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school. Pupils were examined thoroughly for tungiasis. Two surveys were conducted, the first between May and July 2021 and the second between October 2021 and April 2023 when pupils were also interviewed for risk factors. Mixed effect logistic regression models were used to test associations of independent variables with tungiasis using the school as a random effect.ResultsThe overall prevalence of tungiasis in the first survey was 1.35% [95% confidence interval (CI): 1.15–1.59%], and 0.89% in the second survey. The prevalence ranged from 0.08% (95% CI: 0.01–0.59%) in Taita Taveta county to 3.24% (95% CI: 2.35–4.44%) in Kajiado county. Tungiasis infection was associated with county of residence, male sex [adjusted odds ratio (aOR) = 2.01, 95% CI: 1.52–2.67], and lower age (aOR = 0.81, 95% CI: 0.75–0.88). For the first time we demonstrate an association with attending public schools rather than private schools (aOR = 5.62, 95% CI: 1.20–26.22) and lower socioeconomic status (aOR = 0.10, 95% CI: 0.03–0.33). Using a rapid screening method of the top of feet only, would have missed 62.9% of all cases, 78.9% of mild cases and 20.0% of severe cases.ConclusionsTungiasis is widely but heterogeneously distributed across Kenya. School-based surveys offer an efficient strategy for mapping tungiasis distribution.Graphical

The prevalence of red-green color vision deficiency and its related factors in an elderly population above 60 years of age.

To determine the prevalence of red-green (RG) color vision deficiency (CVD) in an elderly population and its related factors. This report is a part of the Tehran Geriatric Eye Study: a cross-sectional population-based study that was conducted on the elderly population (≥60y) of Tehran, Iran using multi-stage stratified random cluster sampling. All study participants underwent complete ocular examination, including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, and slit-lamp biomicroscopy. The color vision was tested using Ishihara plates with the near optical correction in place. Of the 3791 invitees, 3310 participated in the study. The data of 2164 individuals were analyzed after applying the exclusion criteria. The prevalence of R-G CVD was 3.73% (95%CI: 2.37%-5.09%) in the whole sample; the prevalence of protanomaly, protanopia, and deuteranopia was 1.51%, 1.76%, and 0.45%, respectively. The prevalence of R-G CVD was significantly higher in males than in females. The prevalence of RG CVD increased with advancing age from 2.91% in the age group 60-64y to 5.8% in the age group ≥80y (P=0.070). According to the multiple logistic regression model, male sex, and glaucoma were significantly related to RG CVD. Older age and hypertension also had a marginally significant relationship with RG CVD. Changes in color vision occur in the elderly due to the aging process and some physiological and pathological factors. Since the change in visual perception may affect the person's performance, this aspect of the visual system's function should also be taken into consideration in the examinations of the elderly.

Prevalence and factors associated with pentavalent vaccination: a cross-sectional study in Southern China

BackgroundImmunization is one of the most far-reaching and cost-effective strategies for promoting good health and saving lives. A complex immunization schedule, however, may be burdensome to parents and lead to reduced vaccine compliance and completion. Thus, it is critical to develop combination vaccines to reduce the number of injections and simplify the immunization schedule. This study aimed to investigate the current status of the pentavalent diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B conjugate (DTaP-IPV/Hib) vaccination in Southern China as well as explore the factors in the general population associated with uptake and the differences between urban and rural populations.MethodsA cross-sectional study was conducted with recently enrolled kindergarten students in Hainan Province between December 2022 and January 2023. The study employed a stratified multistage cluster random sampling method. Information regarding the demographic characteristics and factors that influence decisions were collected from the caregivers of children via an online questionnaire. Multivariate logistic regression was used to determine the factors associated with the status of DTap-IPV/Hib vaccinations.ResultsOf the 4818 valid responses, 95.3% of children were aged 3–4 years, and 2856 (59.3%) held rural hukou. Coverage rates of the DTaP-IPV/Hib vaccine, from 1 to 4 doses, were 24.4%, 20.7%, 18.5%, and 16.0%, respectively. Caregivers who are concerned about vaccine efficacy [adjusted odds ratio (aOR) = 1.53, 95% confidence interval (CI): 1.30–1.79], the manufacturer (aOR = 2.05, 95% CI: 1.69–2.49), and a simple immunization schedule (aOR = 1.26, 95% CI: 1.04–1.54) are factors associated with a higher likelihood of vaccinating children against DTaP-IPV/Hib. In addition, caregivers in urban areas showed more concern about the vaccine price (P = 0.010) and immunization schedule (P = 0.022) in regard to vaccinating children.ConclusionsThe DTaP-IPV/Hib vaccine coverage rate in Hainan Province remains low. Factors such as lower socioeconomic status, cultural beliefs, concerns about vaccine safety, and cost may hinder caregivers from vaccinating their children. Further measures, such as health education campaigns to raise knowledge and awareness, and encouragement of domestic vaccine innovation, which would reduce out-of-pocket costs, could be implemented to improve the coverage of DTap-IPV/Hib vaccination.Graphical

Prevalence of falls, injury from falls and associations with chronic diseases among community-dwelling older adults in Guangzhou, China: a cross-sectional study.

As a developing country with the largest older adult population in the world, strengthening the research on falls among the older adults is undoubtedly an urgent item in China. This study aimed to explore the prevalence and risk factors associated with falls and injury from falls among community-dwelling older adults in Guangzhou, China, particularly focusing on their associations with chronic diseases. A total of 1,629 participants aged 65 years and above were selected from 11 counties in Guangzhou by the multi-stage stratified random sampling method in 2021. Socio-demographic characteristics, health and lifestyle factors, the status of falls, and injury from falls were measured by structured questionnaires through face-to-face interviews. Chi-square tests and logistic regression analysis were used to identify factors associated with falls and injury from falls. Chord diagrams were used to explore their associations with chronic diseases. A total of 251 participants (15.41%, 95% CI: 13.98%-17.25%) reported falls, and 162 participants (9.46%, 95% CI:7.72%-11.55%) indicated an injury from falls. Logistic regression analysis showed the results as follows: female patients (adjusted OR = 1.721, 95% CI: 1.681-1.761) aged ≥80 years (1.910, 1.847-1.975), unemployed (1.226, 1.171-1.284), uninsured (1.555, 1.448-1.671), average monthly household income of 2,001-4,000 CNY (1.878, 1.827-1.930), number of services provided by the community health center ≥13 times per year (1.428, 1.383-1.475), illness within 2 weeks (1.633, 1.595-1.672), high-intensity physical activity (2.254, 2.191-2.32), sedentary (1.094, 1.070-1.117), and number of chronic disease illnesses ≥3 (1.930, 1.870-1.993). Meanwhile, those risk factors were also associated with injury from falls. The older adults with medium-intensity physical activity were at lower risk (0.721, 0.705-0.737) of falls and higher risk (1.086, 1.057-1.117) of being injured from falls. Chord diagrams showed the correlations between chronic diseases and falls and injury from falls among community-dwelling older adults in Guangzhou, China. The high prevalence of falls is found among community-dwelling older adults in Guangzhou, China, which is related to multiple factors such as demographic variables, lifestyle, and health status, especially for chronic diseases. Therefore, targeted interventions should be developed and implemented urgently.

Analysis of Demand for Fish in Urban Malawi

The purpose of this study was to find the drivers of demand for various fish species in urban Malawi. Previous demand studies on the fisheries sector in Malawi have, mainly, treated fish as a homogenous commodity thereby making information regarding households’ general consumption patterns for different fish species scanty. This study, therefore, concentrates on the disaggregated analysis of the demand for the major fish species caught and consumed in Malawi. It focuses on fish from both capture fishery and aquaculture sub-sectors namely; Engraulicypris sardella (usipa), Copadichromis spp (utaka), Lethrinops spp (kambuzi); Clarias gariepinus (mlamba); Rhamphochromis spp (mcheni); Barbus Paludinosus (matemba); and Lake Malawi tilapia (chambo). It employs primary data collected from the households in Blantyre city using a multistage stratified random sampling method. Results show that the demand for usipa is influenced by a household’s location in a high-density area, and has low-income levels. Utaka, on the other hand, is positively influenced by the age of the household head and the number of people employed in the household while chambo is positively influenced by the high education level of the household head, high-income levels, and the household’s location in the high-density areas. The study has also found that mcheni and mlamba are positively influenced by income levels while the demand for matemba is positively the household head’s state of being married but it is negatively influenced by the number of children in the household. Policy implications arising from this study are that in the course of carrying out market segmentation, the fish marketers in Malawi must concentrate on selling usipa to households in high-density areas and focus on households with low-income levels. The selling of utaka while chambo should mainly be sold to households whose heads have high education, have high-income levels, and are located in high-density areas.

Corneal densitometry and associated factors in an elderly population

ABSTRACT Clinical Relevance Knowing normative corneal optical density (COD) values is important for identifying pathologic corneal changes. Background The aim of this work is to determine the distribution and associated factors of COD in the elderly population. Methods This report is a part of a cross-sectional population-based study conducted on the elderly population (≥60 years) of Tehran, Iran from Jan 2019 to Jan 2020. Using a multi-stage stratified random cluster sampling method, a total of 160 clusters were randomly selected from 22 districts of Tehran city. Study participants underwent a complete ocular examination including measurement of visual acuity, refraction, and slit-lamp biomicroscopy. Corneal densitometry was evaluated using the Pentacam HR. Generalized estimating equation (GEE) models were used to investigate associations of COD with study variables. Results A total of 3633 eyes from 2068 individuals were analysed. Of these, 1256 (60.7%) were female, and the mean age of the individuals was 66.42 ± 5.28 (60 to 95) years. The mean entire COD was 21.96 ± 4.45 greyscale unit (GSU) (95% CI: 21.57–22.34). There was a statistically significant difference in the mean COD between the anterior, central, and posterior layers (p < 0.001); the highest and lowest average COD was related to the anterior and posterior corneal layers, respectively. The lowest and highest mean COD were observed in the 0–2 mm [17.21GSU (95% CI:16.87–17.55)], and 10–12 mm annular zones [31.4 GSU (95% CI: 30.89–31.91)], respectively (p < 0.001). According to the multiple GEE model, the COD had a statistically significant direct relationship with age, central corneal thickness, and mean keratometry, while it was significantly inversely associated with female sex, anterior chamber depth, white-to-white distance, and corneal volume. Conclusion These normal values of COD in the present study could be used as reference data in older adults. The associated factors of COD should be taken into account to avoid misinterpretation of physiologic changes as pathologic processes.

Are people interested in receiving advice from their general practitioner on how to protect their health during heatwaves? A survey of the German population

ObjectiveClimate change increases the frequency, intensity and length of heatwaves, which puts a particular strain on the health of vulnerable population groups. General practitioners (GPs) could reach these people and...

Energy and macronutrients intake of the elderly aged 75 years and above in China in 2015

To analyze the intake of energy and macronutrients in the elderly aged 75 years and above in China. The data was sourced from the China National Chronic Non-communicable Disease and Nutrition Surveillance, which adopted a multi-stage stratified clustered random sampling method and selected 298 monitoring points from 31 provinces across the country to carry out chronic non-communicable disease and nutrition surveillance of Chinese adults. The condiments weighting method and 3-day 24-hour dietary review method were used to collect dietary data for residents. Based on the dietary survey result of 3368 elderly people aged 75 years and above in the surveillance, the intake of energy and macro nutrients of elderly people was analyzed. Among the elderly aged 75 years and above included in the analysis, there were 1727 males and 1641 females, 1511 people in urban areas and 1857 people in rural areas, 1956 people aged 75-79, 1412 people aged ≥ 80. The average energy intake of the elderly aged 75 years and above in China was(1601.0±473.4)kcal, and the average intakes of carbohydrate, protein and fat were(219.6±76.6)g, (48.2±18.6)g and(60.2±31.5)g, respectively. The energy supply ratios of carbohydrate, protein and fat were 54.9%, 12.0% and 33.1% respectively. The carbohydrate intake and its energy supply ratio of the urban elderly((200.0±74.0)g and 51.8%) were significantly lower than those of the rural elderly((235.5±75.0) and 57.4%), while the protein intake and its energy supply ratio((50.2±18.9)g and 13.0%), fat intake and its energy supply ratio((61.2±30.2)g and 35.2%)of the urban elderly were significantly higher than those of the rural elderly((46.5±18.2)g and 11.2% for protein, and(59.4±32.5)g and 31.4% for fat). According to Chinese dietary reference intake standard, only 28.1% of the elderly aged 75 and above reached the recommended value of energy, 71.9% of the elderly did not take enough energy, the proportion of insufficient protein intake was 72.2%, 68.5% in urban areas and 75.2% in rural areas, the proportion of people with fat to energy ratio more than 30% was 58.5%, 65.3% in urban areas and 52.9% in rural areas. The energy intake of the elderly aged 75 years and above in China was insufficient, the protein intake was low, the fat to energy ratio was too high, and the dietary structure was unreasonable.

Causal Paradigm Between Common Comorbidities of Cardiovascular and Metabolism-Related Diseases in Elderly: Evidence from Cross-Sectional and Mendelian Randomization Studies.

Comorbidity is a common problem among elderly people, significantly damaging individuals' health and healthcare systems. However, observational studies may be susceptible to residual confounding factors and bias. The present study aimed to assess the causal effect of common chronic disease comorbidity using the Mendelian randomization (MR) approach. Data for the present study were obtained from a community survey conducted between 2018 and 2020 in four counties in Ganzhou City, southern China. A cross-sectional survey was conducted using a multi-stage stratified random sampling method. A total of 1756 valid questionnaires were collected to analyze common chronic disease comorbidities. Genetic variants associated with hypertension, diabetes, stroke, and hyperlipidemia-related factors were selected as instrumental variables for univariate and multivariate MR analyses. The self-reported prevalence of chronic disease in the older adult population in Southern China was 68.1%, with hypertension (46.1%), diabetes (10.5%), and hyperlipidemia (8.5%) being the three most common conditions. The prevalence of chronic disease comorbidity was 20.7% among the 12 chronic diseases studied. Hypertension was identified as a predictor of diabetes (OR [95% CI]: 1.114 [1.049, 1.184], p < 0.001), and diabetes mellitus was equally identified as a risk factor for hypertension (OR [95% CI]: 1.118 [1.069, 1.187], p < 0.001). Furthermore, high triglyceride levels were identified as a risk factor for hypertension (OR [95% CI]: 1.262 [1.129, 1.411], p < 0.001). In contrast to intracranial hemorrhages, hypertension had a significant impact on ischemic stroke (OR [95% CI]: 1.299 [1.161, 1.454], p < 0.001). The causal association between multiple cardiovascular and metabolism-related diseases is mediated by hypertension, with a bidirectional cause-and-effect relationship between hypertension and diabetes. Hypertension is a risk factor for ischemic stroke, and the hyperlipidemia-related factor triglycerides (TG) influence hypertension. Therefore, prioritizing hypertension prevention and control in the elderly is critical for effective chronic disease management.

Knowledge and predictors of attitudes of hepatitis B virus infection prevention among adults in Tolon, Northern Ghana.

Viral hepatitis is one of the major public health concerns, targeted for eradication by 2030. Though previous research has concentrated largely on pregnant women and urban areas, rural populations are reported to be greatly affected in northern Ghana. This study determined knowledge and predictors of attitudes toward hepatitis B virus (HBV) infection prevention among adults in Tolon District, Northern Ghana. This was a population-based cross-sectional descriptive study with a quantitative approach. A multistage stratified random sampling technique was used to select 195 adults. Data were analysed using SPSS version 26. Composite scores were generated for knowledge and attitude levels. At 0.05 precision level, multiple linear regression was performed to determine predictors of respondents' attitudes. The overall knowledge level (48.7%) of participants on HBV infection was average, with the majority (67.0%) demonstrating unsatisfactory attitudes towards the prevention. The regression equation was statistically significant (F (3,191) = 61.051), p < 0.001. About half (49%) of the variance in attitude was explained by the independent variables. Participants predicted attitude score was determined as 3.784 - 0.040 (age) + 0.435 (knowledge), where age was measured in years and knowledge was measured as scores on a continuous variable scale. Knowledge levels are sub-optimal with unsatisfactory attitudes toward HBV infection prevention in the study setting. Participants' age and knowledge of HBV are significant predictors of attitudes toward its prevention. There is a need to increase access to formal education and health promotion programs in the district, to complement government efforts to attain Sustainable Development Goal 3 (SDG-3).

Trends in health service needs, utilization, and non-communicable chronic diseases burden of older adults in China: evidence from the 1993 to 2018 National Health Service Survey

BackgroundAging is associated with an increased prevalence of non-communicable chronic diseases (NCDs), functional impairments, and diverse demands for health services. This study analyzed the trends in older adults’ needs and utilization of health services from 1993 to 2018 in China, as well as chronic disease-related economic burdens.MethodsThe research data were collected from the six cross-sectional National Health Service Survey (NHSS), implemented every 5 years from 1993 to 2018. A multi-stage stratified random cluster sampling method has been adopted in the NHSS. The data on the older population's socio-economic characteristics, health service needs, and utilization were collected from the 6 waves National Health Service Survey (NHSS) 1993–2018. In the 2013 and 2018 NHSSs, EQ-5D-3L and visual analogue scale were used to evaluate the health condition. And the prevalence of NCDs and related Out-of-pocket (OOP) expenditures were collected. Functional dependency and impairment were collected in 2018. The Katz Activities of Daily Living scale was used to evaluate six functions, including self-feeding, dressing, bathing, transferring, toilet hygiene, and controlling bowel movements.ResultsThe two-week morbidity rate and prevalence of NCDs showed a rapid upward trend in older adults. With the development of health system reform and universal health insurance coverage, older adults' two-week medical consultation rate increased from 25.6% in 1993 to 40.1% in 2018, and the hospitalization rate rose from 6.1% to 24.9%. The difference in health service needs and utilization between urban and rural areas decreased, and the hospitalization rate in rural areas (26.3%) exceeded that in urban areas (23.6%) for the first time in 2018. Functional independence become more severe as aged. The proportion of severe functional impairment was 6.9% and 2% in the group aged 80 or over and group 70–79 years, respectively. Regarding disability status, 32.5% had hearing problems and 31.4% had visual impairment. The highest prevalence rates of NCDs in older adults were found in hypertension (36.9%), followed by diabetes (10.6%), cerebrovascular disease (5.4%), ischemic heart disease (4.5%), and intervertebral disc disease (4.2%). The average annual OOP expenditures attributed to NCDs increased from ¥2481.8 RMB in 2013 to ¥8255.9 RMB in 2018 for older adults. About 90.7% of older adults prefer to live in the residential community, leading to the demands for preventive healthcare (30.4%), medical treatment (14.1%), and elderly education (8.6%).ConclusionThe elevated risks of age-related impairments and chronic morbidities, and increased demands for preventive healthcare are critical public health issues. Policymakers should strengthen primary healthcare and move towards integrated delivery to improve access and quality of care for older adults. The integration of healthcare and social security constitutes an adaptive trend in meeting the multi-level demands of an aging society.