Multistage Design Research Articles

Psychological Disorders and Coping among Undergraduate College Students: Advocating for Students' Counselling Services at Kuwait University.

Objectives: The objectives of the current study are twofold. First, it aimed to explore the prevalence of depression, anxiety and stress symptoms (i.e., psychological disorders) among Kuwait University students. Second, it sought to identify and quantify the associated risk factors as well as the students' coping strategies utilized to address these psychological disorders. Methods: We used a cross-sectional study at Kuwait University and selected students using a multistage stratified cluster sampling design among the 15 faculties of Kuwait University. To serve the study purposes, two cross-cultural and validated instruments were used, including the Depression, Anxiety and Stress Scale 21 (DASS-21) and the Brief-COPE scale. Descriptive statistics, as well as logistic regression analysis, were used to analyze the study findings. Results: A sample of 1142 students from various faculties participated in this study. We found that 681 (59.6%), 791 (69.3%) and 588 (51.5%) of the participants had depression, anxiety and stress symptoms, respectively. The highest coping strategies for stressors and challenges faced were moderate and high emotion-based coping strategies (n = 1063, 93.1%). Students from the Faculty of Allied Health Sciences as well as students from the Faculty of Engineering had significantly higher stress levels compared with students from other faculties (p < 0.05). Our results demonstrated that family problems were consistently a significant predictor of depression, anxiety and stress symptoms among Kuwait University students (p < 0.05). We further found that students who presented with stress and anxiety symptoms and those who practiced avoidant-focused coping strategies were substantially more likely to experience depression (ORs ≥ 2.7, p < 0.01). Conclusions: Our findings inferred that the majority of Kuwait University students have a remarkably high prevalence of mental health problems, mainly anxiety, depression, and stress symptoms along with inconsistent coping strategies toward the faced challenges during their studies. Therefore, the most important recommendation of the current study is the establishment of counselling centers in all faculties at Kuwait University. In turn, doing so facilitates the integration of wellness programs and the provision of comprehensive educational seminars, specialized training sessions and self-management techniques for Kuwait University students, leading to desired academic outcomes.

Multi-stage and multi-objective design optimization for improving resilience of base-isolated hospital buildings

The hospital is a critical infrastructure for treating the injured after the earthquake. The hospital is a complex system composed of structure, non-structural components, and medical equipment that are located on different floors, have different importance and seismic performance, and need different control objectives, enhancing any component could improve the hospital's functionality. It is imperative to economically and rationally choose enhancement measures to minimize initial functionality losses and improve hospital resilience. This study provides a hospital functional evaluation method that takes into account the physical dimension of the damage to the structure, non-structural components and medical equipment, as well as the organizational dimension of the treatment process of earthquake casualties. Bayesian networks and discrete event simulation methods are used to calculate the availability probability of medical rooms and the functional indicator of the number of earthquake casualties that can be treated. Then, a two-stage and multi-objective functionality improvement method was proposed to improve hospital functionality. The first stage is the design optimization of the isolation system with the objectives of minimizing the functionality loss and displacement of the isolation layer. The second stage optimizing the enhancement strategies for non-structural components and medical equipment aims at minimizing the functionality loss and enhancement budget. The proposed method uses a fast and elitist non-dominated sorting genetic algorithm (NSGA-II) approach to optimize the design of the isolation system and the enhancement of non-structural components and medical equipment. The method is applied to a hypothetical hospital to highlight the proposed method's capability of improving the hospital's functionality.

Correlation between the systemic immune inflammation index and risk of psoriasis: results from NHANES.

The systemic immune inflammation index (SII) is an effective indicator of systemic inflammatory status. As psoriasis patients present with systemic involvement, we assessed whether SII is associated with psoriasis in adults. We used data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006 and 2009 to 2014. The study used a multistage sampling design that nationally represents the US population. The main outcome was the prevalence of psoriasis. SII was calculated as platelet count × neutrophil count/lymphocyte count and transformed into log2SII. Sampling weights were calculated according to the guidelines of NHANES. The cohort consisted of 13,300 participants, aged 20-59, who provided responses to their psoriasis status. Among the adults included in this study were 358 with psoriasis and 12,942 without psoriasis. Based on multivariate analysis adjusted for multiple covariates, the highest quartile of log2SII positively correlated with psoriasis relative to the lowest quartile. The subgroup analyses showed that participants in quartile 4 correlated with an increased risk of psoriasis among those aged 40 to 59 years, and among those with obesity or metabolic syndrome. Based on sensitivity analyses, the association between log2SII and psoriasis remained after excluding potential systemic medication use. Based on this cross-sectional study, SII was shown to be associated with psoriasis in the US adult population. Longitudinal monitoring of systemic inflammatory status in psoriasis patients may be necessary to prevent the recurrence of psoriasis, especially for those with obesity or metabolic syndrome.

Eye Health Seeking Behavior and Its Associated Factors among Adult Population in Mangu LGA, Plateau State, Nigeria

Purpose: This study was aimed to explore the eye health-seeking behaviors and its associated factors among adult population of Mangu Local Government Area (LGA) of Plateau State, Nigeria in order to promote individual determination for attaining better eye health-seeking behaviors. Methods: This study was a population-based descriptive cross-sectional survey of 802 adult population aged 18 years and above was conducted in Mangu L.G.A, Plateau State, Nigeria using a multi-stage cluster random sampling design. Sociodemographic and eye health-seeking behavior data were collected using self-administered questionnaires. Vision status was defined using World Health Organization categories of visual impairment based on presenting Visual Acuity (VA). Data collected were analyzed using IBM SPSS version 20.0. All p-values reported were two tailed and significance was defined as P&lt;0.05. Results: Although a total of 960 respondents were enumerated for the study, 802 (83.5%) adults participated. There were more female 525 (65.5%) than males 277 (34.5%). The majority 585 (72.9%) of respondents who had eye problems sought care for the eye problem. One hundred and fifty-seven (36.0%) and 153 (35.1%) sought care at the General hospital and at the community health centre respectively. While 38 (8.7%) and 29 (6.7%) sought care from ophthalmologists and Optometrists respectively. Cost of services (34.4%), language barrier (13.0%), decides not to seek care (10.1%) and transportation (9.1%) were the major reasons for not seeking eye care. Conclusion: Although the majority of the respondents sought care for their eye problems, quite a large number of them sought care from non-eye care professionals. Cost of services, language barrier, transportation and services not available in the area were the major factors associated with eye health-seeking behaviour. Reduction in cost of services and health insurance coverage will mitigate these barriers substantially.

Garret Ranking of Constraints Perceived by Silkworm Rearers in Sericulture Enterprise

The current investigation primarily delves into the challenges faced by sericulture growers in mulberry and cocoon production. Sericulture, a highly competitive and capital-intensive enterprise, is prevalent across rural and semi-urban areas in India. This industry not only contributes to household income but also generates employment opportunities for entire families, with women actively participating in various facets of sericulture activities. A multistage sampling design was employed to select districts, tehsils, villages, and sericulture growers for the study. Specifically, Beed, Parbhani, and Jalna districts were purposively chosen in the Marathwada region due to their significant sericulture production. Two tehsils from each district and four villages from each tehsil were then selected, resulting in a total of 24 villages with 240 sample respondents. The study utilized Garret's ranking technique to assess the constraints affecting the adoption of sericulture production. The study identified four key types of constraints in the examined area: economic, technical, marketing, and supply constraints. According to Garret's ranking, the primary economic constraint was the high cost of inputs, including FYM, planting material, and chemical fertilizers. In the realm of technical constraints, a lack of information about Uzi fly control emerged as the major hurdle. Marketing constraints were predominantly characterized by fluctuations in cocoon prices, ranking highest in prominence. Additionally, insufficient FYM availability was highlighted as a significant supply constraint.

Epidemiology of multimorbidity associated with atherosclerotic cardiovascular disease in the United States, 1999–2018

BackgroundThe multimorbidity of Atherosclerotic cardiovascular disease (ASCVD) and many other chronic conditions is becoming common. This study aimed to assess multimorbidity distribution in ASCVD among adults in the United States from 1999 to 2018.MethodsThis cross-sectional survey from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 using stratified multistage probability design. Among the 53,083 survey respondents during the study period, 5,729 US adults aged ≥ 20 years with ASCVD. Joinpoint regression was used to assess the statistical significance of prevalence trends in the prevalence of ASCVD stratified by multimorbidity. The Apriori association rule mining algorithm was used to identify common multimorbidity association patterns in ASCVD patients.ResultsOverall, 5,729 of 53,083 individuals had ASCVD, and the prevalence showed a slow declining trend (biannual percentage change = -0.81%, p = 0.035, average 7.71%). The prevalence of ASCVD significantly decreased in populations without dyslipidemia, diabetes mellitus (DM), hypertension, asthma, chronic obstructive pulmonary disease (COPD), and arthritis (all groups, p < 0.05). Additionally, 65.6% of ASCVD patients had at least four of the 12 selected chronic conditions, with four and five being the most common numbers of conditions (17.9% and 17.7%, respectively). The five most common chronic conditions were (in order) dyslipidemia, hypertension, arthritis, chronic kidney disease, and DM. The coexistence of hypertension and dyslipidemia had the highest support in association rules (support = 0.63), while the coexistence of dyslipidemia, hypertension, metabolic syndrome, and DM had the highest lift (lift = 1.82).ConclusionsDuring the 20-year survey period, there was a significant decrease in the overall prevalence of ASCVD. However, this reduction was primarily observed in individuals without dyslipidemia, DM, hypertension, asthma, COPD, and arthritis. Among populations with any of the evaluated chronic conditions, the prevalence of ASCVD remained unchanged. Most of ASCVD patients had four or more concurrent chronic conditions.

Experimental study and multistage design of multiphase droplets splitting based on T-junction microchannels

The splitting of multiphase droplets in T-junction microchannels is investigated in this work. Based on the single-phase droplet splitting regime and mechanism, the splitting of multiphase droplets is visualized and further analyzed. Focusing on the influence of the interfacial tension between the phases of multiphase droplets on the splitting behavior of multiphase droplets, it is found that the larger the interfacial tension between the two phases, the stronger the hindering effect of droplet fragmentation, and the more difficult the droplet is to break up. Meanwhile, the strengthening effect of baffle structure at the bottom of the T-junction on the multiphase droplet splitting process is evaluated, where the introduction of the baffle greatly reduces the possibility of no breakup. In addition, multistage splitting T-junction microchannel systems are designed and established for the scale-up preparation of multiphase droplets. This study is of great significance for the in-depth understanding of the splitting process of multiphase droplets. The “self-similar” designs of multistage splitting microchannel from droplet splitting phase diagram provide solutions for the large-scale and cross-scale preparation of multiphase droplets in various fields.

Dental caries and associated factors among Turkish children and adults: Findings from the 3rd National Oral Health Survey.

Information on the current status of oral health and related risk factors is lacking in Turkiye. This study aimed to evaluate dental caries and associated factors among the Turkish population using the findings of the third national oral health survey. This cross-sectional epidemiological survey was carried out between March and September in 2018 including five index ages and age groups (5-, 12-, 15-year-olds, 35-44 and 65-74 age groups). A multistage cluster sampling design was used to obtain a national representative sample of these age groups. Participants were interviewed face-to-face using a structured questionnaire, and oral examinations were performed based on the methods and criteria suggested by the World Health Organization. The adjusted prevalence ratio for dental caries was estimated considering sociodemographic and behavioural characteristics by using log-binomial and robust Poisson regression analysis in R and SAS software. After data cleaning, a total of 11 091 participants remained. The prevalence of dental caries was 76.5% (95% confidence interval: 75.4%-77.7%) and determined to be associated with age, dental visit, and pain or discomfort history during the previous year among the Turkish population. Prevalence was also associated with the mother's education level among 5-, 12- and 15-year-olds. For the 35-44 age group, individuals living in urban areas had lower dental caries than those living in rural areas. For 65-74 age group, none of the factors were significantly associated with dental caries. A high prevalence of dental caries was observed in Turkish children and adults. Therefore, it is necessary to strengthen current preventive oral health programs. Regular disease surveillance should be maintained. National oral health targets should be formulated in accordance with Turkiye's needs, resources and structure.

CompARE: study protocol for a phase III randomised controlled platform trial comparing alternative regimens for escalating treatment of intermediate and high-risk oropharyngeal cancer

BackgroundPatients with intermediate and high-risk oropharyngeal cancer (OPC) have poorer response to standard treatment and poorer overall survival compared to low-risk OPC. CompARE is designed to test alternative approaches to intensified treatment for these patients to improve survival.MethodsCompARE is a pragmatic phase III, open-label, multicenter randomised controlled trial with an adaptive multi-arm, multi-stage design and an integrated QuinteT Recruitment Intervention. Eligible OPC patients include those with human papillomavirus (HPV) negative, T1–T4, N1–N3 or T3–4, N0, or HPV positive N3, T4, or current smokers (or ≥ 10 pack years previous smoking history) with T1–T4, N2b–N3. CompARE was originally designed with four arms (one control [arm 1] and three experimental: arm 2—induction chemotherapy followed by arm 1; arm 3—dose-escalated radiotherapy plus concomitant cisplatin; and arm 4—resection of primary followed by arm 1). The three original experimental arms have been closed to recruitment and a further experimental arm opened (arm 5—induction durvalumab followed by arm 1 and then adjuvant durvalumab). Currently recruiting are arm 1 (control): standard treatment of 3-weekly cisplatin 100 mg/m2 or weekly 40 mg/m2 with intensity-modulated radiotherapy using 70 Gy in 35 fractions ± neck dissection determined by clinical and radiological assessment 3 months post-treatment, and arm 5 (intervention): one cycle of induction durvalumab 1500 mg followed by standard treatment then durvalumab 1500 mg every 4 weeks for a total of 6 months. The definitive and interim primary outcome measures are overall survival time and event-free survival (EFS) time, respectively. Secondary outcome measures include quality of life, toxicity, swallowing outcomes, feeding tube incidence, surgical complication rates, and cost-effectiveness. The design anticipates that after approximately 7 years, 84 required events will have occurred to enable analysis of the definitive primary outcome measure for this comparison. Planned interim futility analyses using EFS will also be performed.DiscussionCompARE is designed to be efficient and cost-effective in response to new data, emerging new treatments or difficulties, with the aim of bringing new treatment options for these patients.Trial registrationISRCTN ISRCTN41478539. Registered on 29 April 2015

Prevalence and correlates of metabolic syndrome among adults in Freetown, Sierra Leone: A comparative analysis of NCEP ATP III, IDF and harmonized ATP III criteria

BackgroundMetabolic syndrome (MetS) is a global health concern, especially for low and middle-income countries with limited resources and information. The study's objective was to assess the prevalence of MetS in Freetown, Sierra Leone, using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), International Diabetes Federation (IDF) and Harmonize ATP III. Additionally, we aimed to establish the concordance between these three different criteria used. MethodsThis community-based health screening survey was conducted from October 2019 to October 2022. A multistage stratified random design was used to select adults aged 20 years and above. Mean, interquartile range (IQR), and logistic regression were used for statistical analysis. The kappa coefficient statistics resolved the agreement between these defined criteria. ResultsThe prevalence for NCEP ATP III, Harmonize ATP III and IDF criteria was 11.8 % (95 % CI: 9.0–15.15), 14.3 % (95 % CI: 11.3–18.0), and 8.5 % (95 % CI: 6.2–11.2), respectively for the 2394 selected adults. The kappa coefficient (κ) agreement between the MetS is: Harmonized ATP III and IDF criteria = [(208 (60.8 %); (κ = 0.62)]; Harmonized ATP III and NCEP ATP III = [(201 (58.7 %); (κ = 0.71)]; while IDF and NCEP ATP III was [(132 (38.6 %); (κ = 0.52)]. In the multivariable regression analysis, waist circumference correlated with all three MetS criteria: ATP III [AOR = 0.85; C.I 95 %: (0.40–1.78), p = 0.032], Harmonized ATP III [AOR = 1.14; C.I 95 %: (0.62–2.11), p = 0.024], IDF [AOR = 1.06; C.I 95 % (0.52–2.16), p = 0.018] ConclusionWe reported a high prevalence of MetS in Freetown, Sierra Leone and identified waist circumference as a major risk factor for MetS. This underscores the crucial role of health education and effective management of MetS in Sierra Leone.

A nationwide mobile phone survey for tobacco use in Tanzania: Sample quality and representativeness compared to a household survey

We investigated the feasibility of an interactive voice response (IVR) survey in Tanzania and compared its prevalence estimates for tobacco use to the estimates of the 'Global Adult Tobacco Survey (GATS) 2018′. IVR participants were enrolled by random digit dialing. Quota sampling was employed to achieve the required sample sizes of age-sex strata: sex (male/female) and age (18–29-, 30–44-, 45–59-, and ≥60-year-olds). GATS was a nationally representative survey and used a multistage stratified cluster sampling design. The IVR sample’s weights were generated using the inverse proportional weighting (IPW) method with a logit model and the standard age-sex distribution of Tanzania. The IVR and GATS had 2362 and 4555 participants, respectively. Compared to GATS, the unweighted IVR sample had a higher proportion of males (58.7 % vs. 43.2 %), educated people (secondary/above education: 43.3 % vs. 21.1 %), and urban residents (56.5 % vs. 40 %). The weighted prevalence (95 % confidence interval (CI)) of current smoking was 4.99 % (4.11–6.04), 5.22 % (4.36–6.24), and 7.36 % (6.51–8.31) among IVR (IPW), IVR (age-sex standard), and GATS samples, respectively; the weighted prevalence (95 % CI) of smokeless tobacco use was similar: 3.54 % (2.73–4.57), 3.58 % (2.80–4.56), and 2.43 % (1.98–2.98), respectively. Most differences in point estimates for tobacco indicators were small (<2%). Overall, the odds of tobacco smoking indicators were lower in IVR than in GATS; however, the odds of smokeless tobacco use were reversed. Although we found under-/over-estimation of the prevalence of tobacco use in IVR than GATS, the estimates were close. Further research is required to increase the representativeness of IVR.

Unmet Needs for Support in Activities of Daily Living among Older Persons: The Effects of Family and Household Structures in a Low- and Middle-Income Context.

The unmet need for assistance in activities of daily living (ADLs) accentuates older persons' risk of falls, ill health, hospitalisation, and mortality. In Nigeria, the family arrangements through which older persons derive support are changing due to modernisation, migration, and economic challenges. How the family dynamics explain the unmet needs is poorly understood. This study investigates the influence of family and household structures on older persons' unmet needs in ADLs in southwestern Nigeria. The study analysed the data of 827 older adults aged ≥65 years selected from Oyo State, southwestern Nigeria, using a multi-stage sampling design. Associations were examined using the Poisson-logit hurdle regression model. From the results, 65% of older persons with difficulties had unmet needs in instrumental ADLs and 59% in basic ADLs. Increased unmet needs were associated with older persons living with non-family members (β = 0.19; p < 0.01; 95% C.I. = 0.05-0.32) and widows (β = 0.27; p < 0.01; 95% C.I. = 0.13-0.42). Conversely, unmet needs decreased with higher family size (β = -0.06; p < 0.001; 95% C.I. = -0.08--0.03), living in rich households (β = -0.29; p < 0.001; 95% C.I. = -0.42--0.17), not being the household head (β = -0.27; p < 0.001; 95% C.I. = -0.40--0.15), close family bonds, and proximity to children/caregivers. The study recommends alternative or complementary home-based support mechanisms for seniors with vulnerable family settings in southwestern Nigeria.

Use of Electronic Cigarettes and Associated Factors among Thai Vocational Students: An Institution-based Cross-Sectional Study

Abstract Introduction: The use of young electronic cigarettes (e-cigarettes) is increasing worldwide, including in Thailand, where there are strict regulations governing the availability of e-cigarettes. This study explored e-cigarette use among vocational students and associated factors in Thailand. Methods: We enrolled 1150 students from six vocational institutions in the upper northern region of Thailand using a multistage design and gathered the data through a self-administered questionnaire. Multivariate logistic regression models were used to examine the variables and their association with e-cigarette use. Results: Most of the participants (66.5%) were male, and the average age was 17 ± 1.7 years. The prevalence of e-cigarette use in the past 30 days was 18.4%. We found that the perceived price of e-cigarettes being affordable (adjusted odds ratio [AOR] = 1.7, 95% confidence interval [CI]: 1.0–2.8), traditional cigarette smoking in the past year (AOR = 3.5, 95% CI: 2.4–5.1), a high positive attitude toward e-cigarettes (AOR = 2.6, 95% CI: 1.7–3.9), alcohol consumption in the past year (AOR = 1.8, 95% CI: 1.1–2.8), having close friends who used e-cigarettes (AOR = 4.4, 95% CI: 3.1–6.3), and having low self-esteem (AOR = 1.6, 95% CI: 1.1–2.3) were significantly associated with e-cigarette use in the past 30 days. Conclusion: The use of e-cigarettes is prevalent among Thai vocational students, suggesting that continued maintenance of the enforcement policy on banning the importation of e-cigarettes into the country is thus needed. Furthermore, the government should improve law enforcement, especially against online marketing, and strengthen school-based anti-smoking programs.

EHealth literacy of migrant domestic workers in Hong Kong in the COVID-19 pandemic: A mixed methods study.

Health communication in the COVID-19 pandemic can be effectively implemented if all members of the populations, including marginalized population such as migrant domestic workers (MDWs), have good eHealth literacy. Lessons learned during this critical period may help improve planning and mitigation of the impacts of future health crises. This study aimed to examine and explore the eHealth literacy levels of the MDWs in Hong Kong during the COVID-19 pandemic by using a convergent mixed methods research design. A total of 1156 Hong Kong MDWs participated in a paper-based survey using a multistage cluster random sampling design for the quantitative component. eHealth literacy was measured using an eHealth literacy Scale (eHEALS). For the qualitative component, a purposive sampling of 19 MDWs participated in face-to-face, semi-structured, in-depth interviews. Descriptive statistics and multiple regression analyses were used to carry out the quantitative analysis, while thematic analysis was used for the qualitative analysis. Both quantitative and qualitative data were merged and integrated for mixed-methods analysis. The meta-inferences of the quantitative and qualitative results mainly confirmed that MDWs in Hong Kong had good levels of eHealth literacy. The use of Instagram, YouTube and WhatsApp as the COVID-19 information sources, in addition to having an interest in the topic of the current spread of COVID-19 together with the Hong Kong government's policies related to COVID-19, were found to be associated with eHealth literacy. The eHealth literacy level of MDWs in Hong Kong was shown to be good and it was influenced by the use of popular social media platforms including Instagram, YouTube, and WhatsApp. It is realistic to suggest that such platforms should be harnessed for health communication during the pandemic. Yet, regulations to combat false information on these media are also urgently needed.

Variability in Reproductive Choices: A Comprehensive Analysis of Women's Working Status and Fertility Behavior in Pakistan.

The relationship between women's working status and fertility behavior has been a topic of interest for researchers and policymakers. The societal shifts over time, particularly the increasing participation of women in the workforce, have transformed traditional roles. Women, once primarily perceived as caregivers, are now assuming roles of economic independence. This transformation prompts a re-evaluation of the traditional association between women's working status and fertility behavior. This study aims to investigate the impact of women's working status on fertility behavior using a multistage stratified sampling design. A total of 408 women aged 15 to 49 years were recruited from 2 strata: working and non-working women. The data were collected through face-to-face interviews using a structured questionnaire. Descriptive statistics, cluster analysis, and generalized additive models were used for in-depth analysis of the dataset. An examination of fertility patterns indicates that, on average, working women bear 2.90 live children, while their non-working counterparts have an average of 3.52 children. Stillbirth was reported in 13% of housewives and 15.1% of working women. However, further analysis revealed that the relationship between women's employment status and fertility behavior varied depending on Social and Cultural Norms, Reproductive Rights, Workplace Policies, Economic Independence, Age, and Life Stage. Our findings suggest that promoting access to family-friendly policies and services, as well as challenging gender norms and cultural values, could help address the impact of women's employment on fertility behavior.

Comparison of Labour Absorption Based on Employment Status in the Regencies/Cities of South Sumatra Province

The labour force is one of the factors of economic growth. At the same time, the discrepancy between the labour supply and the demand for it creates unemployment in the country. This study aims to analyze the difference in labour absorption in the labour status group of agricultural free workers and non-agricultural free workers using the variables that are more dominant in influencing labour absorption in the regencies/cities of South Sumatra Province. The sample was selected based on a multi-stage sample design with a probability method based on the cluster sampling method so that 172 people were obtained consisting of 62 free workers in agriculture and 110 free workers in non-agriculture in the regencies/cities of South Sumatra Province. The analysis technique uses the Chi-Square test and Multiple Regression Analysis based on the F-test and t-test. The independent variables in this study are working hours, marital status, gender, education level and employee's age. The results of the analysis show that there is a difference between the absorption of agricultural and non-agricultural free labour. Simultaneously, the variables of working hours, marital status, gender, education level and age affect the absorption of free agricultural and non-agricultural labour. Partially, only the education level variable has no significant effect on the absorption of free agricultural labour. This is because labour in agriculture is less qualified, and workers without a high level of education can be engaged for their performance. In general, in Indonesia the absorption of agricultural free labour is higher than the absorption of non-agricultural free labour. The most dominant variable affecting the absorption of agricultural free labour is gender, while for non-agricultural free labour is marital status.

Oral rehydration therapy and Zinc treatment among diarrhoeal children in India: Exploration from latest cross-sectional National Family Health Survey.

Diarrhoea is one of the deadliest diseases and causing death among children in India, but no systematic attempt is made to understand it especially its control using oral rehydration salts (ORS). It is well known that use of ORS and Zinc have been effective in containing diarrhoea among children. An attempt is made using large scale national data set in India to understand use of ORS and Zinc to control diarrhoea and their associated factors among diarrhoeal children under five in India. Publicly available most recent cross-sectional National Family Health Survey data in India was used for the study. The multi-stage cluster sampling design was used with 2011 Census of India as a sampling frame. Households were selected using a Systematic Random Sampling design from selected primary sampling units in rural and urban clusters. From the selected households, the eligible children were those who suffered from diarrhoea in the two weeks preceding the survey and were less than 5 years old. Using this criterion, out of 232,920 children in the survey of less than five years, 16,213 sample diarrheal children found to be available for the study. Both descriptive and inferential statistical techniques were used to analyse the data. Across India, 61% and 31% of the children were given ORS and Zinc respectively. However, combined ORS + Zinc treatment was only around 24%. The treatment of ORS, Zinc, and combined ORS + Zinc supplementations were significantly higher among younger children, children of 24-35 age group mothers, children from rich wealth index groups, belong to Hindu religion and general caste compared to their counterparts. The logistic regression results showed that consumption of ORS among diarrhoeal children under five years of age depends upon size of a child at birth. For instance, diarrheal children who were very small size at birth compared to very large at birth, had 39% lower odds of consuming ORS (AOR = 0.61; CI 0.48, 0.78; p<0.001). Another important variable is place of first treatment sought for diarrheal children. That is children who first sought treatment in private hospital compared to government hospital had 52% lower odds of ORS consumption. The logistic regression adjusted AORs are similar with Zinc and ORS + Zinc supplementations. To improve the coverage and management of childhood diarrhoea in India, planning activities should focus not only on distribution, and increasing knowledge of ORS preparation especially for urban slum residents and rural disadvantaged groups through demonstration. There should be also proper focus on providing ongoing pathways to ensure proper supply chains.

Maternal and child nutrition services associated with nutritional knowledge and practices, India.

To evaluate whether maternal and child nutrition activities provided through the Indian Integrated Child Development Services scheme in India were associated with improved nutritional knowledge and practices among beneficiary women. We used a multistage sampling design to randomly select 4400 pregnant women or mothers of children younger than 2years for a cross-sectional telephone survey. The respondents were beneficiaries of the scheme from across 11 Indian states. We used multivariate regression models controlling for sociodemographic factors to estimate the association between: scheme activities and nutrition messages heard; and scheme activities and nutrition practices. We also estimated the proportion of the total association with nutrition practices which was mediated by nutrition messages. Among 110 regression models testing unique pairs of seven activities and 18 nutrition messages, 103 showed a statistically significant positive relationship (median risk ratio, RR: 1.14). For activities and nine nutrition practices, 39 out of 54 tested pairs were significantly associated (median RR: 1.16). We observed statistically significant mediation through nutrition messages for 28 out of 42 tested pairs of activities and nutrition practices. Receipt of the scheme's activities was associated with improved nutrition knowledge and practices. Improvements in practices were statistically mediated by improvements in knowledge. These findings suggest that a large-scale nutrition scheme with a strong counselling component could successfully change beneficiary behaviours.

Prevalence and trends of autism spectrum disorder and other developmental disabilities among children and adolescents in the United States from 2019 to 2021.

The National Health Interview Survey (NHIS) is a comprehensive health survey conducted by the National Center for Health Statistics (NCHS) in the U.S., providing valuable insights into the health status of the population. This study focuses on the NHIS child survey between 2019 and 2021, exploring developmental disabilities in U.S. children, including autism spectrum disorder (ASD), attention deficit/hyperactivity disorder or attention-deficit disorder (ADHD/ADD), intellectual disability (ID), other developmental delay (other DD), and learning disability (LD). Leveraging NHIS data, our primary objective is to investigate the latest trends and disparities in the prevalence of developmental disabilities among various racial-ethnic groups. Employing a repeated cross-sectional design, we analyzed NHIS data from 2019 to 2021, focusing on children aged 3-17. The survey employed a meticulous stratified multi-stage sampling design. We utilized SAS version 9.4 for data analysis, calculating race-ethnicity-specific prevalence rates and employing weighted linear regression and the Rao-Scott chi-square test for trend analysis. Among 19,490 children, prevalence rates varied: ASD (3.11%), ADHD/ADD (9.50%), ID (1.85%), other DD (5.66%), and LD (7.49%). Non-Hispanic black children exhibited higher rates of ID and LD, while non-Hispanic white children had the highest ADHD/ADD prevalence. Disparities persisted across sociodemographic subgroups, with variations in prevalence rates. Our study reveals an increase in ASD prevalence and persistent disparities among racial-ethnic groups. Non-Hispanic black children face elevated risks of ID and LD, while non-Hispanic white children exhibit higher rates of ADHD/ADD.

Multi-Stage Multidisciplinary Design Optimization Method for Enhancing Complete Artillery Internal Ballistic Firing Performance

Multi-Stage Multidisciplinary Design Optimization Method for Enhancing Complete Artillery Internal Ballistic Firing Performance