Multistage Sampling Method Research Articles

How do households living in arsenic-contaminated regions value safe drinking water in western Bihar, India?

Access to safe drinking water is a critical concern, particularly in areas affected by arsenic contamination. In Bihar, an Indian state, 13 districts are facing groundwater contamination. The report of Ministry of Jal Shakti, Government of India (2021), reveals that about 24 habitations from five districts of Bihar are affected by arsenic groundwater contamination, impacting about 71,946 population and their health and economic conditions. The objectives of the present study are to determine factors that impact households' WTP for arsenic-free drinking water and estimate the mean willingness to pay (WTP) for arsenic-free drinking water. The primary data from 300 households was collected following simple random sampling, and villages were selected through a multi-stage sampling method. The study uses a single-bound dichotomous choice method for WTP elicitation and applies a probit model to determine factors affecting households' WTP for arsenic-free safe drinking water. The mean WTP is estimated to be ₹ 216.68 per household/month, and results find that education, income, health expenditure, awareness level and high-risk exposure to arsenic are the most influential determinants of households’ WTP for arsenic-free drinking water. The influence of education and awareness level is positive, calling for conducting more awareness programs in the arsenic-contaminated areas in Bihar.

Navigating the Middle School Transition in a Non-Western Culture: Exploring the Interplay of Perceived Academic Performance, Time Management, and the Mediating Role of Academic Engagement

This study examines the relationship between time management, academic engagement, and academic success among 11- and 12-year-old students in an online learning environment. A sample of 250 Iranian students was selected using a multi-stage random cluster sampling method The data were collected from students that self-reported via surveys. Results from structural equation modeling revealed that time management significantly predicted academic performance (p < 0.01), with academic engagement mediating this relationship. Students with high academic engagement demonstrated an increased willingness to invest time and effort in their studies. The findings suggest that while interventions aimed at developing time management skills are beneficial for students transitioning to middle school, prioritizing the increase of academic engagement and enthusiasm in middle school students, without explicitly focusing on time management, will lead to enhanced time management skills as well. Consequently, teachers can optimize their efforts and resources by focusing on academic engagement interventions, as academic engagement inherently fosters improved time management skills.

Health literacy and self-management among middle-aged and young hypertensive patients: a parallel mediation effect of illness perception and self-efficacy.

Hypertension is increasingly prevalent among young and middle-aged populations in rural China, accompanied by suboptimal self-management. Given that this population forms the backbone of the labor force, enhancing their self-management capabilities is crucial for improving overall population health. Studies indicate that individuals with good health literacy are more likely to effectively manage their health. Grounded in the health literacy skills framework, a model was constructed in this study to examine the impact of health literacy on self-management among young and middle-aged hypertensive patients in rural China. Meanwhile, the mediating roles of illness perception and self-efficacy were also verified. Using a multi-stage stratified random sampling method, 338 patients were recruited to participate in the study. Structural equation modeling was utilized to establish the relationship model, and bootstrap tests were carried out to examine the mediating effects. The average self-management score was 70.45 ± 11.36. Health literacy exhibited a positive correlation with self-management (standardized β = 0.372, p < 0.001). The mediating effects through illness perception and self-efficacy were 0.040 and 0.236, constituting 6.68 and 39.31% of the total effect, respectively. Illness perception and self-efficacy serve as parallel mediators amid the association between health literacy and self-management. Implementing psychological counseling and health education is imperative for augmenting self-management competence and cultivating an adaptive coping mentality.

Impact of information and communication technology on mobility of urban and rural households: a comparative study from Nigeria

ABSTRACT There has been a growing concern regarding the potential impact of technology on travel patterns, with limited attention given to its effects on both urban and rural households. To address this gap, our study focuses on the influence of Information and Communication Technologies (ICT) on rural-urban mobility. We conducted this research using primary data collected through a multi-stage sampling method, where 50% of the wards were selected randomly. Subsequently, a total of 510 questionnaires in urban areas and 492 questionnaires in rural areas was administered using a systematic sampling approach. The results of this investigation revealed significant variations in the socio-demographic and travel characteristics of respondents within the study areas. Notably, our findings indicate that ICT usage has not entirely replaced traditional trips in urban and rural settings. Instead, it has played a pivotal role in complementing travel activities. The implications of these findings are substantial. As tele-density improves and expands in rural areas, it is foreseeable that more cost-effective travel planning will be achievable.

Epidemiological investigation of iron deficiency among preschool children in 10 provinces, autonomous regions, or municipalities in China

Objective: To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China. Methods: A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test. Results: A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region (χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference (χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) (χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant (χ2=0.51, P=0.476). Conclusions: There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

Awareness of HPV vaccine and its socio-demographic determinants among the parents of eligible daughters in Bangladesh: A nationwide study

BackgroundVaccination against Human papillomavirus (HPV) is recommended to avoid HPV infections and its associated diseases, including cervical cancer. However, there is no awareness study among Bangladeshi population. Hence, this nationwide study was conducted to explore HPV vaccine awareness and its determinants among parents of eligible adolescent girls. MethodsThis study was conducted among the parents of daughters aged 9–15 years from 42 out of 64 randomly selected districts of Bangladesh between June 28 to August 2, 2023. A multistage sampling method was used to enroll 2151 study participants from all eight divisions of Bangladesh. A semi-structured questionnaire was used for face-to-face interviews in this study. The statistical software Stata (Version 17) was used for statistical analyses. ResultsThe average age of the participants was 38.18 (±5.86) years. Only 22.32 % of the participants were aware of the HPV vaccine. Every additional year of age increased the likelihood of being aware of the HPV vaccine by 3 % (AOR: 1.03; 95%CI: 1.00–1.06). Participants residing in the urban area had 3.56 times higher odds of awareness than rural and semi-urban people. Businessmen and housewives had 60 % (AOR: 0.40; 95 % CI: 0.22–0.69) and 77 % (AOR: 0.23; 95 % CI: 0.16–0.33) lower odds in comparison to job holders. The lower-income group exhibited significantly higher odds of awareness (AOR: 0.25, 95%CI: 0.16–0.39) compared to the middle and the higher-income group. Participants who never went through routine health check-ups had 77 % lower odds of being aware than those who availed of regular routine check-ups (AOR: 0.23; 95%CI: 0.16–0.34). ConclusionAwareness of the HPV vaccine among the general population of Bangladesh is very low. Age, residence, occupation, monthly income, and routine medical check-ups were associated with HPV vaccine awareness. A nationwide awareness campaign would increase this awareness level among the Bangladeshi population, especially among the parents of daughters.

Exposure to needlestick injury among healthcare support staff in Greater Accra, Ghana: a cross-sectional study

ObjectivesThis study aims to determine the prevalence and predisposing factors of a needlestick injury (NSI) among healthcare support staff in the Greater Accra region, Ghana.MethodsAn analytical cross-sectional survey was carried...

Designing and Testing the Structural Model of Online Games Addiction Based on Brain-Behavioral Systems: The Mediating Role of Cognitive Fusion and Experiential Avoidance

Introduction: Online games addiction is a growing concern which the prevalence is estimated at 1.2 to 8.5 percent among teenagers and young adults. Aim: The present study was conducted with the aim of investigating the mediating role of cognitive fusion and experiential avoidance in the relationship between brain-behavioral systems and addiction to online games. Method: In terms of method, the research was among descriptive-correlation researches of structural equations type. The statistical population included all the students of the first year of high school in the education and training region of Hormozgan Bastak in the academic year of 2021-2022 which 350 people were selected as a sample using the multi-stage cluster random sampling method. They responded to the questionnaires of behavioral inhibition/activation systems (1994), cognitive fusion (2014), acceptance and action - second edition (2011) and online games addiction(2002). Structural modeling was used to analyze the data. Results: The results showed that the behavioral activation system and the behavioral inhibition system have a significant direct relationship with the online games addiction with coefficient values of 0.46 and 0.42, respectively (P &lt; 0.001). Also, the behavioral activation system and the behavioral inhibition system are significantly related to online game addiction indirectly with the mediation of experiential avoidance with a coefficient value of 0.17 and 0.15, respectively and the behavioral inhibition system with the mediation of cognitive fusion with a coefficient value of 0.21,. (P &lt; 0.001). Conclusion: In order to reduce online games addiction, experts should evaluate personality traits on the one hand in order to identify the sensitivity of behavioral inhibition/activator systems, and on the other hand, seek to reduce cognitive biases along with cognitive and retrospective challenges.

The Effect of Parenting Styles on Early Maladaptive Schemas with the Mediating Role of Overcompensation and Avoidance Coping Styles

Introduction: According to studies, the severity of maladaptive schemas is directly related to parenting experiences and coping methods. Aim: The present study was conducted with the aim of investigating the effect of parenting styles on early maladaptive schemas with the mediating role of overcompensation and avoidance coping styles. Method: This descriptive research was of the correlation type (structural equation modeling). The statistical population was all the students who were studying at the undergraduate level in the country, which was selected by the multistage cluster sampling method (after dividing the entire country into 5 areas and selecting 5 universities by the researcher and five trained colleagues), 1509 participants were selected as a sample and responded to Young Schema (YSQ-S3), Young Parenting (YPI), Young-Ray Avoidance (YRAI) and Young overcompensation (YCI) questionnaires. Data analysis was done by structural equation analysis using SPSS-23 and AMOS-24. Results: The findings showed the appropriate fit of the model (RMSEA=.087, X2/df=31.77, CFI=.93). Parenting styles had a significant direct and positive effect (β=0.27) on early maladaptive schemas (P&lt;0.01). Also, parenting styles had a significant indirect and positive effect (β=0.21) on early maladaptive schemas through the mediating variables of avoidance and overcompensation coping styles (P&lt;0.01). Bootstrap approximation was used to analyze the significance of the effects. Conclusion: The results of this research can be used to explain the factors affecting early maladaptive schemas and as a suitable model for designing comprehensive programs in this field

An inquest into the resource mobilization and utilization capacity of local leaders for community resilience to agriculture-threatening droughts and floods

The main objective of the study was to analyze the relationship between resource mobilization and utilization capacity of local leaders and community resilience to droughts and floods in Lower Muzarabani District of the Zambezi Valley in Zimbabwe. Continual exposure to the hydro-climatic disasters of droughts and floods in Lower Muzarabani has accelerated the vulnerability of poor rural communities, plunging them deeper into poverty and preventing them from taking advantage of economic opportunities. With Lower Muzarabani faced with increasing magnitude, frequency and intensity of droughts and floods, the need for concerted efforts towards building disaster-resilient communities can never be overemphasized. The Conjoint Community Resilience Assessment Model (CCRAM) Household Questionnaire was used to collect data in face-to-face interviews among the sampled households. in Lower Muzarabani. The original CCRAM Model structure, consisting of 5 disaster-resilience factors (Leadership, Collective Efficacy, Preparedness, Place Attachment, and Social Trust) and 28 items, was used as the basis for the survey. The multi-stage sampling method was used in selecting the 200 households for the survey. The major finding obtained with the use of the Pearson Bivariate Correlation Analysis and Linear Regression Analysis was that the efficiency and effectiveness of resource mobilization and utilization activities (represented in the CCRAM model by the preparedness factor) significantly and positively influence community resilience to the hydro-climatic disasters of droughts and floods in Lower Muzarabani.

Associations between insufficient sleep, skipping breakfast and depressive symptoms in children and adolescents: A school-based cross-sectional study in China

ObjectiveInsufficient sleep and skipping breakfast are increasingly prevalent among children and adolescents. Both behaviors are associated with the onset of depression. This study aims to examine the independent and joint associations of these two behaviors with depressive symptoms, and investigate whether these associations varied by age or sex. MethodsThe Center for Epidemiological Studies Depression Scale (CES-D) was used to evaluate the depressive symptoms. This cross-sectional study including 11,887 students aged 11–19 years using a stratified cluster, multistage sampling method in Ningbo, China. Multiple logistic regressions were conducted to evaluate the independent and joint association between insufficient sleep, skipping breakfast and depressive symptoms. Sensitivity analyses and stratified analyses by age and sex were performed using the same modelling strategies. ResultsThe overall prevalence of depressive symptoms was 15.27%. Skipping breakfast (Odds Ratio (OR) = 2.557, 95% Confidence Interval (CI) = 2.236–2.925) and insufficient sleep (OR = 1.547, 95%CI = 1.390–1.723) was independently associated with depressive symptoms. Compared to students with “sufficient sleep and breakfast every day”, the OR was 4.385 (95%CI = 3.649–5.271) for those with “insufficient sleep and skipping breakfast”. Meanwhile, the joint association was moderated by age group, with a more apparent association observed in the 11–15-year-old group compared to the 16–19-year-old group. ConclusionsThese findings indicated that insufficient sleep and skipping breakfast were independently and jointly associated with depressive symptoms. Insufficient sleep and skipping breakfast could be considered as two of the predictors of depression.

Christian Final Year College Student: Preparedness and Consciousness in Adopting Biblical Principles to Survive and Thrive in Exile During the One-Year NYSC Program

This research aims to investigate the level of awareness and readiness of final year Christian students in adopting a biblical-based exile lifestyle model. Two research questions and two hypotheses were proposed to guide this study. A descriptive survey research design was employed. The sampling technique used proportional multistage stratified random sampling method to obtain a sample size of 340 final year Christian students in State-owned colleges in Imo Province. The researcher-developed assessment scale titled "Christian Students' Awareness and Readiness Scale for Facing Life Challenges in Exile (CAPLCERS)" was utilized for data collection. This assessment scale comprises two clusters, A and B, with internal consistency reliabilities measured using Cronbach's Alpha of 0.78 and 0.82 respectively. Mean and standard deviation were used to answer research questions, while z-test was employed to test hypotheses at a significance level of 0.05. The research findings indicate that the level of awareness among final year Christian students regarding life challenges in exile during the one-year mandatory National Youth Service Corps (NYSC) program is significantly below the expected average. Meanwhile, their readiness level to adopt biblical models for survival and growth in exile is significantly above the expected average. Based on these findings, the research recommends several actions: college authorities need to equip final year students with awareness of potential life challenges they may face during the one-year NYSC program; campus Christian fellowships also need to help prepare their members with biblical models and principles that can assist Christians in surviving and thriving in exile situations; and Christian fellowships or organizations in NYSC training camps need to assist Christian Corps members in integrating and striving for welfare in their placement areas while learning to love and contribute to the growth of communities that may differ in beliefs and cultures.

A Community-Based Cross-Sectional Study on Awareness and Acceptance of Homosexuality in Coimbatore.

Acceptance of the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community among the public varies greatly depending on cultural and social factors. The present study estimated homosexuality acceptance and the factors influencing its recognition among the general population in Coimbatore, Tamil Nadu, India. This cross-sectional study was performed among people residing in urban and rural field practice areas of a tertiary care hospital in Coimbatore. Using a multistage random sampling method, people over 18 years of age were selected. A total of 670 individuals participated, and data was obtained. Data on sociodemographic characteristics and homosexuality acceptance were collected using the Homosexuality Attitude Scale. Overall, homosexuality acceptance was 61% among the community. Homosexuality acceptance was significantly associated with age (p<0.001), residence (p=0.014), marital status (p<0.001), religion (p<0.001), education (p=0.001), and occupation (p<0.001). Overall acceptance was better among young participants as compared to the elders. Thus, our study highlights the need for a shift in perspective among the older generation, which may significantly improve their overall acceptance of homosexuality.

Postharvest practices and loss determinants for interventions among smallholder potato farmers in Tiyo district, Arsi zone, Ethiopia

Postharvest loss reduction, which will contribute to several sustainable development goals (SDGs) including SDG 1, 2, 3, 9, 12 and 13, is an important strategy for food and nutrition security. It requires interventions designed based on timely and reliable statistical data. However, lack of produce-specific loss data and associated factors along the postharvest value chain stages remains a challenge to implement appropriate interventions. Therefore, a survey was conducted on socio-demographic characteristics, postharvest practices, extent and causes of losses, and factors influencing postharvest loss of potato crops in Tiyo district of Arsi Zone, Ethiopia in 2022. A multistage sampling method was used to select a total of 209 smallholder potato farming household heads through a combination of purposive and simple random sampling techniques. Quantitative data collection was carried out online using computer-assisted personal interviewing (CAPI) by programming a semi-structured questionnaire in KoboCollect software for tablets. Descriptive statistics and ordinal probit regression model were used to analyze the collected data and determinant factors influencing postharvest loss of potatoes at various farm-level stages, respectively. An aggregate of 15-46% loss exists between harvesting and marketing. Losses during harvesting, sorting, cleaning, packaging, field-to-storage transport, storage, and storage-to-market transport were 58.9%, 6.2%, 2.9%, 2.4%, 3.8%, 20.1%, and 5.7%, respectively. Elevated loss during harvesting and storage in the area is likely to reflect poor handling and storage practices. The primary causes of losses were poor harvesting and handling techniques, poor storage facility, and insects and worms. Moreover, regression model estimations of categorical losses, as perceived by farmers, reveal that socio-demographic variables and postharvest factors influenced potato loss. During the harvest stage, working family members significantly (p&lt;0.01) increased loss while years of schooling (p&lt;0.05) significantly reduced loss. In addition, harvesting using leaf color change observation as a criterion had significantly (p&lt;0.01) mitigated potato loss. In storage, female respondents (p&lt;0.05), land size (p&lt;0.05), and lack of training (p&lt;0.1) had accentuated loss. During transport, the age of household reduced (p&lt;0.1) loss whereas farming experience promoted (p&lt;0.1) it. To reduce the existing losses, farmers’ awareness should be increased concerning each stage. The study recommends the need for stakeholders’ intervention focusing on postharvest knowledge and skill capacity building, demonstration of simple innovative ventilated storage construction using locally available materials, appropriate packaging (such as reusable plastic crates) and transport methods, and simple value addition methods (such as potato drying using indirect solar dryers and potato flour processing for fortifying local cereals). Key words: CAPI, Ethiopia, ordinal probit regression, postharvest practices, potato loss determinants

Clinical usefulness of urinary symptoms and urinalysis in diagnosis of Schistosoma haematobium infection in an endemic area in Southern Nigeria: descriptive study

Background: Schistosoma haematobium infection occurs worldwide with the largest number of cases seen in sub-Saharan Africa. Most of the infections are acquired during childhood and are linked to urogenital diseases which contributes significantly to morbidity and mortality. A study on the use of urinary symptoms, signs and urinalysis in the diagnosis of S. haematobium infection might aid in providing early, prompt and rapid intervention that will limit associated complications. Methods: The study was a descriptive cross-sectional of 421 children aged 6-12 years in Ohaukwu LGA, Ebonyi State, recruited from four public primary schools using multistage sampling method. Urinary symptoms and signs were obtained using a questionnaire; urine samples were collected for urinalysis and urine microscopy. Simple proportions and odds ratio (CI) were used to analyze the data. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for various symptoms and signs. The data was analyzed with IBM-SPSS 20. Significance was set at p&lt;0.05. Results: The prevalence of S. haematobium infection among school children in Ohaukwu LGA was 30.17%. Visible blood in urine 71.77% and dysuria 70.16% were the predominant symptoms while liver tenderness 8.87% was the most common sign. The sensitivity vs specificity of visible blood in urine and microscopic haematuria were 71.77% vs 94.43% and 100.00% vs 97.21% respectively. Conclusions: Microscopic haematuria alone was highly sensitive and specific and can be a reliable alternative to the gold standard in making diagnosis of S. haematobium infection in children living in this endemic region.

Anemia and Associated Factors among Public Elementary School Children in Asella Town, Southeast Ethiopia: A Facility-Based Cross-Sectional Study.

Anemia has a negative impact on school children, including poor physical growth and reduced mental performance. Children show poor attentiveness, behavior, and memory and reduced school performance. There is limited evidence of the magnitude of anemia and associated factors in school-age children in Ethiopia, including the study area. To assess the magnitude of anemia and associated factors among public elementary school children in Asella Town, Southeast Ethiopia, in 2022. A school-based cross-sectional study was conducted in Asella Town from April 5 to May 5, 2022. A total of 442 school children aged 7-14 years were included in the study using the multistage sampling method. Data were collected using a pretested and semistructured questionnaire through a face-to-face interview technique. The hemoglobin concentration was determined by using the HemoCue 301+ analyzer. Anthropometric data and stool examinations were collected from participants. Data were entered into EpiData version 4.6, transported, and analyzed by Statistical Package for Social Sciences version 26. Bivariable and multivariable logistic regression analyses were carried out. Adjusted odds ratios along with their 95% confidence interval were used, and a p value of ≤0.05 was used for declaring statistical significance. A total of 435 students with a mean age and standard deviation of 10.77 ± 2.21 years participated in the study. The magnitude of anemia was 78 (17.9%), with a 95% CI (14.3, 21.47). Of the participants, 63 (14.5%) were mild anemic and 15 (3.4%) were moderately anemic. Children whose mothers have no formal education (AOR = 3.94, 95% CI: 1.89, 8.21), underweight children (AOR = 3.83, 95% CI: 1.98, 7.40), and parasites in their stool (AOR = 3.72, 95% CI: 1.50, 9.20) were significantly associated with anemia in school-age children. Anemia among school-age children was found to be a mild public health problem. Uneducated mothers, intestinal parasite infections, and underweight children were found to be determinants of anemia among school-age children. Health professionals should provide health education for mothers about child-feeding practices and the consumption of dietary sources of iron.

Differences in influencing mechanism of clinicians’ adoption behavior for liver cancer screening technology between the leading and subordinate hospitals within medical consortiums

BackgroundMedical consortiums have been extensively established to facilitate the integration of health resources and bridge the technical gap among member institutions. However, some commonly appropriate technologies remain stagnant in subordinate hospitals, although they have been routinely applied in leading hospitals. Besides, the mechanism underlying differences in clinicians’ adoption behavior at different levels of institutions was unknown. Therefore, this study aimed to investigate the differences in influencing mechanisms of clinicians’ hepatic contrast-enhanced ultrasound technology (CEUS) utilization behavior between leading and subordinate hospitals within medical consortiums, thus providing clues for expanding effective and appropriate technologies within integrated care systems.MethodsA self-designed scale was developed based on the theory of planned behavior (TPB). A multistage sampling method was applied to investigate clinicians who were aware of CEUS and worked in liver disease-related departments within the sampled medical institutions. The final sample size was 289. AMOS 24.0 software was used to construct multi-group structural equation modeling (SEM) to validate the hypotheses and determine the mechanism of hepatic CEUS utilization.ResultsIt revealed that behavioral intention significantly influenced adoption behavior, regardless of whether it was in leading hospitals or subordinate hospitals (β = 0.283, p < 0.001). Furthermore, behavioral attitude (β = 0.361, p < 0.001) and perceived behavioral control (β = 0.582, p < 0.001) exerted significant effects on adoption behavior through behavioral intention. However, in leading hospitals, subjective norm had a significant positive effect on behavioral intention (β = 0.183, p < 0.01), while it had a significant negative impact on behavioral intention in the subordinate hospitals (β = -0.348, p < 0.01).ConclusionTo effectively translate the adoption intention into actual behavior, it is recommended to elucidate the demand and facilitators involved in the process of health technology adoption across leading and subordinate hospitals. Additionally, bolstering technical support and knowledge dissemination within subordinate hospitals while harnessing the influential role of key individuals can further enhance this transformative process.

The effect of obesity phenotype changes on cardiovascular outcomes in adults older than 40 years in the prospective cohort of the Tehran lipids and glucose study (TLGS): joint model of longitudinal and time-to-event data

BackgroundObesity is a worldwide health concern with serious clinical effects, including myocardial infarction (MI), stroke, cardiovascular diseases (CVDs), and all-cause mortality. The present study aimed to assess the association of obesity phenotypes and different CVDs and mortality in males and females by simultaneously considering the longitudinal and survival time data.MethodsIn the Tehran Lipid and Glucose Study (TLGS), participants older than three years were selected by a multi-stage random cluster sampling method and followed for about 19 years. In the current study, individuals aged over 40 years without a medical history of CVD, stroke, MI, and coronary heart disease were included. Exclusions comprised those undergoing treatment for CVD and those with more than 30% missing information or incomplete data. Joint modeling of longitudinal binary outcome and survival time data was applied to assess the dependency and the association between the changes in obesity phenotypes and time to occurrence of CVD, MI, stroke, and CVD mortality. To account for any potential sex-related confounding effect on the association between the obesity phenotypes and CVD outcomes, sex-specific analysis was carried out. The analysis was performed using packages (JMbayes2) of R software (version 4.2.1).ResultsOverall, 6350 adults above 40 years were included. In the joint modeling of CVD outcome among males, literates and participants with a family history of diabetes were at lower risk of CVD compared to illiterates and those with no family history of diabetes in the Bayesian Cox model. Current smokers were at higher risk of CVD compared to non-smokers. In a logistic mixed effects model, odds of obesity phenotype was higher among participants with low physical activity, family history of diabetes and older age compared to males with high physical activity, no family history of diabetes and younger age. In females, based on the results of the Bayesian Cox model, participants with family history of diabetes, family history of CVD, abnormal obesity phenotype and past smokers had a higher risk of CVD compared to those with no history of diabetes, CVD and nonsmokers. In the obesity varying model, odds of obesity phenotype was higher among females with history of diabetes and older age compared to those with no history of diabetes and who were younger. There was no significant variable associated with MI among males in the Bayesian Cox model. Odds of obesity phenotype was higher in males with low physical activity compared to those with high physical activity in the obesity varying model, whereas current smokers were at lower odds of obesity phenotype than nonsmokers. In females, risk of MI was higher among those with family history of diabetes compared to those with no history of diabetes in the Bayesian Cox model. In the logistic mixed effects model, a direct and significant association was found between age and obesity phenotype. In males, participants with history of diabetes, abnormal obesity phenotype and older age were at higher risk of stroke in the Bayesian Cox model compared to males with no history of diabetes, normal obesity phenotype and younger persons. In the obesity varying model, odds of obesity phenotype was higher in males with low physical activity, family history of diabetes and older age compared to those with high physical activity, no family history of diabetes and who were younger. Smokers had a lower odds of obesity phenotype than nonsmokers. In females, past smokers and those with family history of diabetes were at higher risk of stroke compared to nonsmokers and females with no history of diabetes in the Bayesian Cox model. In the obesity varying model, females with family history of diabetes and older ages had a higher odds of obesity phenotype compared to those with no family history of diabetes and who were younger. Among males, risk of CVD mortality was lower in past smokers compared to nonsmokers in the survival model. A direct and significant association was found between age and CVD mortality. Odds of obesity phenotype was higher in males with a history of diabetes than in those with no family history of diabetes in the logistic mixed effects model.ConclusionsIt seems that modifications to metabolic disorders may have an impact on the heightened incidence of CVDs. Based on this, males with obesity and any type of metabolic disorder had a higher risk of CVD, stroke and CVD mortality (excluding MI) compared to those with a normal body mass index (BMI) and no metabolic disorders. Females with obesity and any type of metabolic disorder were at higher risk of CVD(, MI and stroke compared to those with a normal BMI and no metabolic disorders suggesting that obesity and metabolic disorders are related. Due to its synergistic effect on high blood pressure, metabolic disorders raise the risk of CVD.

Assessment of Parkland Tree Species and Their Management Practice in Ana Sora District of Guji Zone, Southern Ethiopia

The study was conducted to identify parkland tree species and their management practice by smallholder farmers in Ana Sora District of Guji Zone, Southern Ethiopia. The study was conducted by using multistage sampling methods. In the first stage one district was purposively selected based on the potential of park land tree species. Then, from the district by using simple random sampling methods two kebeles were selected and purposively from 40 farm lands an assessment of parkland tree species were conducted. In this study, 31(thirty one) tree species were identified in parklands of the study area and majority of them were indigenous tree species. In terms of parkland tree species preferences, Schefflera abyssinica, Hagenia abyssinica, Millettia ferruginea, Cordia africana and Croton macrostachyus were the most preferred top five tree species of the study area respectively. This study also showed that, farmers practiced thinning, pruning and pollarding management activities for better growth of underneath crops, to transfer the biomass of the trees to the crop fields and for various products of the trees. Moreover, smallholder farmers of the study area were obtained different services and products such as bee forages, shade, construction material, soil fertility improvement and fuel wood from parkland tree species either retained or planted on their farm lands. However, parkland tree species of the study area were faced various constraints. Therefore, attention should be given on conservation of parkland tree species and farmers should be encouraged by the government through research and extension services and supplying by planting materials to improve the significant of ecological and productive role of parkland tree species of the study area.

Impact of Improved Rice Variety Adoption on Smallholder Farmers Rice Productivity and Gross Farm Income Enhancement in North Western Ethiopia

The research was assessed status of adopting improved rice technology as well as evaluate its impact on rice productivity and gross farm income in Ethiopia. The research showed the importance of adopting improved rice technologies using impact evaluating techniques such as propensity scoring matching (PSM). The research was used descriptive and econometric methods of data analysis to elaborate the respondents’ characteristics, farming practices, adoption status and to estimate its impact. The research used multistage sampling methods to select 180 smallholder rice producers. Amhara and Benshangul Gumuz region are the potential rice producers which targeted for this study. Zones, districts and kebles of these regions were selected random that can be represent the region as well as the rice producers in Ethiopia. The research revealed that 44.44% of the respondents were adopted improved rice technology and pawe_1 is the most frequently used by respondents. The econometric result revealed that treated groups were gained high rice output 3,019.70 quintal per hectare over the controlled groups 1,971.40 quintal per hectare as well as in terms of gross income treated groups were earned higher income which is 46,159.78 ETHB than the controlled groups which were earned 29,797.14 ETHB on average. This indicated that adopting improved rice technology was brought 34.72% and 35.45% of increment in rice productivity and gross income on smallholders’ rice producers respectively. Adopting of agricultural technologies are a means of improving the smallholder farmers crop production, productivities and income generated from that farm activities. Therefore, any governmental and non-governmental institution should be focused on the outreach of these agricultural technologies to end user over all part of the country.