Per-capita Income Research Articles

13-OR: Medication Use among Youth-Onset Diabetes in India—An Analysis of Socioeconomic Factors and Cost of Care

Background: Reported prevalence of youth-onset diabetes (15-30y) in India range from 1 to 1.5% with half the cases being diagnosed. National estimates indicate only 2 in 5 diagnosed cases are taking medication. Yet, data are scarce on the socio-economic predictors and financial burden associated with medication use in this population. Methods: Using data from the National Family Health Survey 2019-21 among youth (n = 4682) with diagnosed diabetes, we estimated the association of socio-economic factors (i.e., household wealth quintile, urbanicity, and household members with diagnosed diabetes) and medication use. We used robust survey-weighted Poisson regression adjusting for sex, age, high school completion and state fixed effects. Using the National Sample Survey 2017-18, we benchmarked the average cost of inpatient and outpatient diabetes medication among youth with diabetes (n = 120) as a proportion of national net per-capita income (Rs. 115,224). Results: Nationally, 1.2% (1.1 - 1.3) of youth 15-30 years old had diabetes, 75% of these cases were diagnosed and 30.9% (95%CI: 28.8, 33.0) of those diagnosed were talking medications. Urban residence (Prevalence ratio, PR: 1.30 [1.13, 1.51]) and increasing household wealth (highest (ref: lowest) 1.28 [1.02, 1.59]) were associated with higher medication use. A household member with diabetes was associated with lower medication use (0.45 [0.32, 0.63]). Out-of-pocket expenses corresponded to 47.0% (31.7, 62.3) of national per capita income. Medications accounted for 35.9% (22.9, 49.0) and 44.9% (33.1, 56.8) of the annual expenses for in-patient (Rs. 35511 [14935, 56088]) and out-patient (Rs. 18651 [9025, 28275]) care respectively. Conclusions: Out of pocket expense for persons with youth-onset diabetes in India is, on average, over 40% of per capita income, with medication cost being the biggest driver. These data call for social safety nets to protect family income of those with youth-onset diabetes in India. Disclosure J.Varghese: None. N.M.Varghese: None. K.Narayan: None. Funding National Institutes of Health (P30DK111024)

Disparities in lung cancer screening in a diverse urban population and the impact of a community-based navigational program.

6555 Background: Lung cancer (LC) is the leading cause of cancer death in the US in both men and women; causing 25% of all cancer deaths. Annual lung cancer screening (LCS) with a low-dose CT (LDCT) in high-risk individuals (aged 50-80 with a >20 pack-year smoking history) decreases LC deaths by 20% and is recommended by USPSTF. Despite the efficacy, uptake of LDCT remains low at 6% nationally, and 13% in Rhode Island. Patient (pt) and provider perceived barriers, along with racial, ethnic and socioeconomic disparities widen the gap. We evaluated the implementation of a LCS navigation program at an urban community health center (CHC) with a multiethnic, socioeconomically underserved population. Methods: A bilingual (English and Spanish speaking) pt navigator was integrated into routine clinic practice at a large primary care CHC group, across 4 sites, starting in January 2022. The navigator’s role was to assess pt and provider awareness of the LCS process, assess for systemic barriers, and provide navigational support for the LDCT process. Pts eligible for LCS at the CHC from 1/2022 to 12/2022 were retrospective examined; 50 to 80 years and a >20 pack-year smoking history. The navigator administered a questionnaire to assess barriers to LDCT and demographic variables. Results: A total of 360 eligible pts were seen across the CHC practice in 2022, of which 149 (41.4%) agreed to undergo LDCT after counseling and shared decision making and 28% of these (n 101) completed LDCTs. 153 of the eligible pts completed the survey questionnaire. Of these, 50% were females; 40% were Hispanic/Latinx, 40% were non-Hispanic/Latinx and 22% declined to answer. Majority, 61% were white, 10% African American/Black and 28% declined to answer. A sizeable proportion were non-English speaking (34%) and resided in cities with Rhode Island’s lowest per-capita incomes (Pawtucket 48%), Central Falls (32%) and North Providence/Providence (10%). In assessing barriers to LCS, 46% of pts were not aware of the LCS process and 44% were unaware that LCS was covered by health insurance; 58% of eligible pts did not recall their PCP discussing LCS. Of the LDCTs resulted available at the time of analysis, 84% were Lung RADS-1 and 16% Lung RADS-4 category. Conclusions: Our study highlights the unique barriers to LCS in an urban multiethnic community. While access to LCS remains an issue, pt awareness of the lung cancer screening process was the major barrier. A patient navigation program is critical to the success of LCS in a community, by providing education to patients and providers and the necessary logistical support needed in the LDCT process. With a community based navigational program, we demonstrate a significant increase in lung cancer screening rates in our population to 28% as compared to the state LCS rate of 13%. (Supported by the Robert A. Winn Diversity in Clinical Trials Career Development Award).

Health status and demand for health care of the rural women: preliminary observations from the backward districts of Karnataka state, South India

Background: In the last few decades, rural people’s health care has garnered increased attention. Especially rural women are facing a variety of life-threatening diseases as a result of traditional health culture, gender-based health exclusion, and low socioeconomic status. This study attempted to disclose the health status and demand for health care of rural women in two backward districts of Karnataka state- south India. Methods: The study has used a survey and interview methods of data collection from 426 rural women from two districts of Karnataka. Results: This study found that women reaching menopause state face a slew of health issues; including anemia (44%), stress (63%) menstrual irregularities (39%), heart disease (47%), arthritis (50%), and diabetes (48%) from a low socio-economic profile. Women in the menopausal stage are the most impacted, followed by pre-menopause and reproductive groups. Per-capita income, level of education, and medical expenditure are decisive factors in the demand for quality health care. Conclusions: Changing health culture has a close nexus with the socioeconomic status affecting rural health behaviour of women. Household income and occupation have a key role in determining women’s health. It is time to establish low-cost healthcare insurance for rural women and encourage the medical pluralism that exists in rural areas.

Modeling Human Development Index in Papua and West Sumatera with Multivariate Adaptive Regression Spline

The Human Development Index (HDI), which is an indicator as a comprehensive description of the measure of achievment development in the quality of human life in a region. In Indonesia, there are still many areas with low HDI, especially in Papua Province. This study aims to model and find out what factors affect HDI in Papua Province and West Sumatera Province, using Multivariate Adaptive Regression Spline (MARS). MARS is a modeling methods that can handle high-dimensional data, namely data that has independent variables and a sampel size of data with unknown data patterns in advance, and can be applied to see interaction between the variables used. The result of this study obtained that the best MARS model for Papua Province is a combination of BF=24, MI=2, and MO=0 with GCV=0.55953. while the best MARS model for West Sumatera Province ia a combination of BF=24, Mi=2, and MO=0 with GCV=0.02697. the factors that significantly affect HDI in Papua Province and West Sumatera Province are average lenght of schooling (X2), adjusted per-capita income (X6), life expectancy (X1), percentage of poor population (X4), anf gross regional domestic product (X3). The level of importance of each variable for Papua Province is 100%, 45.26%, 29.24%, 6.55%, and 6.27%. while for West Sumatera Province it is 100%, 96.73%, 57.54%, 34.13%, and 29.6%,respectively. So that in this case based on research results the average lenght schooling (X2) is the variable that most influences HDI in the two regions.

Pre-transplant Medical Evaluation: A Multidisciplinary Approach

Conventional autologous and allogenic hematopoietic stem cell transplants (HSCT) are lifesaving or life extending medical procedures but associated with significant risk for non-infectious and infectious complications. The center for international blood and marrow transplant research estimates that worldwide about 100000 transplants are performed yearly. The frequency of transplantation is varied widely from country to country, with a close association of transplant rates with gross national income (GNI) per-capita. Appropriate indication for transplant is mandatory for these rigorous procedures. Hematological malignancies, bone marrow failure syndromes, inherited immune deficiencies, hemoglobinopathies and inherited metabolic disorders are usual indications for BMT. Sources of hematopoietic stem cells are crucial. Patient evaluation includes psychosocial and systems evaluation. Foundation for the Accreditation of cellular therapy (FACT) is required. General guidelines for patient eligibility are chemo sensitive, adequate performance status, adequate nonhematopoietic organ function, ability to provide informed consent and adequately matched available donor or adequate collection of autologous stem cells. Exclusion criteria include chemo refractory, life expectancy severely limited by other illness, inability to tolerate preparative regimen and pregnancy. Relative contraindications are major medical comorbidities, major psychiatric illness and lack of insurance/financial resources. Comorbidities are cardiac arrhythmia, EF d” 50%, body mass index e” 35 kg/m2, serum creatinine > 2 mg/dl and EFV1 d” 65%. Allogeneic donor evaluation is also vital and includes HLA typing for HLA-A, -B, -DRBI; screening of transmissible diseases, laboratories, consents and notifications. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 212

Exploring the energy intensity – per capita income nexus: evidence from middle-income and high-Income countries

ABSTRACT Assessing changes in energy intensity has become increasingly important in recent years as economies strive toward greater environmental awareness and conservation while, at the same time, improving residents’ standard of living, through economic growth. This study explores the relationship between energy intensity and real per-capita income across the period 1981–2015 for 60 countries. We divide the sample into two segments: middle-income and high-income countries to better explore this relationship. The analysis uses a spline functional form which allows for greater flexibility to detect non-linear relationships. The results for middle-income countries show three distinct threshold levels of per capita income at which the direction of the relationship between energy intensity with per capita income changes. This suggests changes in energy intensity in middle-income countries occur due to changes in demand, fuel substitution and technological progress. The results with respect to the high-income countries do not indicate a threshold level with respect to their current level of income. This may be indicative that these countries have already passed their turning point prior to 1990 and are progressively reducing their energy intensity.

An evaluation of biobanking and therapeutic clinical trial representation among adult glioma patients from rural and urban Utah.

Social determinants of health (SDOHs)-specifically those related to rurality, health care accessibility, and income-may play as-yet-unidentified roles in prognosis for glioma patients, and their impact on access to clinical trials is important to understand. We examined SDOHs of patients enrolled in glioma clinical trials and evaluate disparities in trial participation and outcomes between rural and urban patients. We retrospectively identified patients enrolled in glioma clinical trials at Huntsman Cancer Institute (HCI) from May 2012 to May 2022 to evaluate clinical trial participation. We used multivariable models to evaluate SDOHs and geographic information system mapping to assess representation across Utah's counties. We utilized the most recent 10-year datasets of patients treated for glioma at HCI and from the Utah Cancer Registry to analyze survival and incidence, respectively. A total of 570 participants (68 trials) resided in Utah, 84.4% from urban counties, 13.5% from rural counties, and 2.1% from frontier (least-populous) counties. Nineteen counties (65.5%) were underrepresented in trials (enrolled participants vs. eligible), 1 (3.5%) was represented in a near-1:1 ratio, and 9 (31.0%) were overrepresented. Counties with greater enrollment had greater population densities, highest per-capita income, and proximity to HCI. Among patients treated at HCI, patients from rural/frontier counties had equivalent survival with urban patients across nearly all glioma types, including glioblastomas, despite underrepresentation in clinical trials. By highlighting disparities in clinical trial enrollment, our results can support efforts to improve recruitment in underrepresented regions, which can assist providers in delivering equitable care for all patients.

ENERGY CONSUMPTION AND LIFE EXPECTANCY IN NIGERIA

This study examined the effect of energy consumption (decomposed into renewable and non-renewable energy) on life expectancy in Nigeria from 1981 to 2022. The data for the study is sourced from Central Bank Statistical Bulletin. Energy consumption is proxied by Alternative and Nuclear Energy (ANE), Per Capita Electricity Consumption (CPN) and Fossil Fuel Energy Consumption (FEN), while Life expectancy is proxied by life expectancy at birth. The variables were subjected to stationarity tests and the result shows that the variables were integrated of mixed order of integration (level i(0) & first difference i(1)). This justified the adoption of the Autoregressive Distributed Lag (ARDL) as technique of analysis. The ARDL Bounds test result indicates that long-run relationship exist among the variables in the model. The long result showed that Per Capita Electricity Consumption (EPN) and Per Capita Income (PCI) have positive effect on life expectancy, while Fossil Fuel Energy, Trade Openness, and Alternative and Nuclear Energy (ANE) have negative effect on Life Expectancy in Nigeria. The short run result also shows that per capita electricity consumption has positive effect on life expectancy, while fossil fuel energy consumption and trade openness have negative effect on life expectancy in Nigeria. The study concludes per capital electricity consumption affects life expectancy positively, while fossil fuel energy consumption and alternative and nuclear energy affect life expectancy negatively in Nigeria. This study therefore recommends the adoption of green energy consumption as to improve life expectancy in Nigeria

Factors Influencing the Online Attention to the 2022 Beijing Olympics and Paralympic Winter Games

<p>This study aims to identify the factors influencing the online attention to the 2022 Beijing Olympics and Paralympic Winter Games. In order to accomplish the same, data of online attention to its Baidu index were collected. Factors influencing the online attention to the 2022 Beijing Olympics and Paralympic Winter Games included in this study are populations of the gross and regional permanent residents and young and middle-aged residents and the per-capita disposable income in the China Statistical Yearbook, and the Internet penetration rate in Internet Report. The results demonstrated that the online attention to the 2022 Beijing Olympics and Paralympic Winter Games would be significantly enhanced by increasing the Internet penetration rate and per-capita income. Simultaneously, young and middle-aged groups will also play a role in the remarkable enhancement of online attention. In addition, the large population base of the permanent residents will also help in improving it. There is a clear difference in the geographical distribution between North and South of China in terms of online attention.</p> <p> </p>

Entrepreneurship, Public Policy and Economic Development in Nigeria

This study investigates the impact of public policy measures in entrepreneurship and economic development in Nigeria. Time series data covering the period from 1981 – 2021 was used. Data sourced from the World Development Indicators (WDI) provided by the World Bank 2021 and Central Bank of Nigeria Statistical Bulletin 2021 was use. The variables employed are Income per capita (IPC), Institutional (IQ) Quality, Research and Development (RD) and Capacity of SMEs (COS). Results showed that there is a positive relationship IPC and COS. IQ and RD are statistically insignificant, and IQ indicated a negative relationship. It was also observed that there is a positive relationship between the intercept and COS. This implies that the problem in Nigeria is not policy formulation but that of implementation. Thus, creating a gap or missing-link in the structure of public policy formulation and implementation in Nigeria. We recommend among others that all hands must be on deck at every level of government and amongst all social groups to achieve the goals of policy as it affects all. In addition, the government should create enabling environment for the local entrepreneurs to compete globally and create a level playing ground for entrepreneurship at the domestic level to thrive healthily. Additionally, entrepreneurs need to take advantage of the role of technology to improve their overall productivity

What You See Is … . Not All There Is: Global Income Inequality From a Quasi-Marxist Perspective

ABSTRACT The standard interpretation of inequality uses a number, such as the Gini coefficient, to compare income inequality across countries. These numbers apply universal upper limits to the maximum feasible inequality (Gini = 100) in vastly diverse economies even though floors for socially acceptable living standards vary quite a bit in different societies. I develop a new measure of income inequality — the Nationally Representative Inequality Extraction Ratio (NR IER) — and apply it to 112 countries. The NR IER uses country-by-country social and economic parameters to measure the distance between the actual income distribution and the country-specific feasible limit (a counterfactual distribution). I ground the counterfactual distribution in a functional income concept, corresponding to Marx’s concept of exploitation. NR IERs are inversely related to per-capita income and exceed the feasible limits in the world’s poorest countries. However, I find little variation in extractive inequality between closed autocracies (e.g., China) — where corruption is expectedly extractive — and liberal democracies (e.g., USA). Controlling for different political regimes, the NR IER explains over 60 per cent of a person’s income anywhere in the world.

DIMENSIONS OF GENDER (IN) EQUALITY IN INDIA- A COMPARATIVE STUDY AMONG STATES OF INDIA

Abstract
 This study takesup” Dimensions of Gender Equality in India.”While examining the dimensions the researchers compares the gender development index reports of states in India Gender equality-a driver for economic growth, matters in its own right,and as as pre requisite for the health and development of families and economies. The term gender equality has been on the corpet for the past two decades. The millennium development goals set gender equality and women empowerment at 3 rd place. Earlier women empowerment had been assessed interns of access to resources and later on moved to control over resources. The resources include physical resources. Fiscal resopurces, financial resources and intellectual resources. The term empowerment has been pronounced with the term empowerment after the millennium year. The post 2015 framework present a unique opportunity to build on the achievement of the millennium development goal, while also addressing that lag behind. The sustainable development goal also set Gender equality at fifth place. The reason is that Gender inequality persists everywhere and stagnates the progress of a country. The un equal treatment or perceptions of the individuals on the basis of gender have been witnessed not only in developing countries like India, but also in developed countries aswell. Gender related inequality in human well being is one of the most crucial issues in many states in India.The female dis advantage in survival is the important dimension that has drawn the attention of policy makers. InIndia the situation is not even among the states; Kearela has lesser discrimination while Odissa has higher discrimination. The sex ratio is also high in kerela which shows positive symptoms of women empowerment. Maharastra introduced property rights for women. Its percapita income is high compared to kerela but GDI is low. Female Education growth in kerela promotes gender equality.Has education alone dis appear inequalities is the million dollar question? Per capita income is not so high in kerela as compared to other southern states.
 
 The study examines gender equality on the basis of Gender Development Index, which measures gender gap in human development by accounting disparities between men and women in three dimensions of human develoipme3nt, a long and healthy life, knowledge and a decent standard of living. The global gender gap report places India at 135 out of 146 countries. India has moved from 140 to 135 from last year. Though India is moving towards one of the developed nations in the world, Gender inequality pulling its growth. Which factor is hindering the SGDs 5 the goal gender equality in India? The issue of gender inequality had been in the lime light in all academic conferences, seminars and symposiums. Why gender inequality prevails in higher degree in some states of India? What are the policy measures have to be pinned up? What are the measures to be added in those states? Any other indicators to be included along with HDI indicators? These are the research questions to be addressed. This paper is an attempt made by the researchers to address these issues

The Impact of Air Pollution on the Happiness Index of ASEAN Communities

Happiness is the primary human goal, so a more inclusive, fair, and balanced approach is required to promote a sustainable economy, poverty alleviation, and the happiness and well-being of all people (SDGs Pyramid to Happiness, United Nations 2012). The Human Development Index (HDI) is one indicator that can be used as a benchmark for sustainable development that supports the implementation of the SDGs. In addition to HDI, Per capita income is also pivotal because it involves the community’s ability to meet basic human needs (clothing, board food). Air pollution is a complex problem in today’s society, which secretly seeks public health. Therefore, this study aims to analyze the effect of the HDI, Per Capita Income, and Air Pollution on community happiness. The study population consisted of nine countries in the ASEAN region for the 2015-2019 period. This quantitative research uses secondary data from the World Bank, the United Nations Development Program, and the State of Global Air. The dependent variable used was the Happiness Index (HI), while the independent variables used were the Human Development Index (HDI), Per Capita Income (PCI), and Air Pollution (AP). In this study, to conduct panel data regression analysis, Random Effect Model is assisted with the statistical software Eviews 10. The results of this study indicate that PI (sig. 0,02; coefficient value 0,40) has a positive and significant effect, while HDI (sig. 0,30; coefficient value 1,37) has a positive and not significant effect on HI, and AP (sig. 0,47; coefficient value -0.02) has a negative and insignificant impact on HI. Therefore, the government and society must strive to improve the quality of human resources and the environment to increase people’s happiness.

Assessment of Urban Resilience as an Approach towards Urban Sustainability: A Case of Gurugram India.

Abstract: Indian cities are complex and interdependent system, extremely vulnerable to threats from both natural risks and manmade disasters caused by the growing urban population, migration, depleting resources and terrorism. There are abundant evidences on resource consumption and emissions, biodiversity and land use change to show that Indian cities are responsible for a large part of unsustainable trends which push the planet beyond its ecological boundaries. With expedited urbanization, it becomes imperative to prioritise vulnerability assessment in order to increase resilience and thus attain sustainability. Recent studies indicate that the resilience framework is not consistent; they have either been applied in a natural resource context or focused on a single factor such as socio- economic vulnerability or structural weakness of physical components. Secondly, there is lack of resilience framework for developing nations or local contexts as the applicability of results from developed countries are problematic to instrument technically or theoretically at native scale. Given the diversity of interpretations and application of the resilience assessment in complex urban systems, this paper looks at factors and parameters that influence the Indian cities with major focus on Gurugram.(the third wealthiest city in India, by per-capital income with a massive population but such phenomena growth has overwhelmed city planning even with the availability of funds).The paper further explores the resilience assessment framework based on the five defined and measurable domains including social (education equity, transportation access, health coverage, communication capacity), economic (employment, income, housing capital), institution (migration plan, flood coverage, political fragmentation by Indian institutions such as National Institute of Urban Affairs (NIUA), physical (e.g. water, sanitation, housing and land use), spatial (elevation, spatial and temporal indicators), human (e.g. literacy rate, health insurance) and Environment (e.g. ecosystem services, environmental policies).Various case examples are used to suggest that urban resilience can be conceived as a multidisciplinary framework to analyse the reactive, adaptive and transformative capacities of (and within) the complex urban system of Indian cities.

Growth and Potential of Intra-Industry Trade of India in Agriculture among the BIMSTEC Nations

The unification and development of crawling Asian countries is the burning issue after the declaration of failure of the SAARC (South Asian Association for Regional Cooperation) region. Besides, a small bubble in the ocean of agreements is ‘BIMSTEC’ (Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation), which has not been flourishing to date due to the lack of interest of a dominating country like India, whose focus is on other successful regional blocs. However, recent studies have shown that though it starts late but contributing significantly towards the trade among BIMSTEC countries. And, second, almost all the countries have shared similar cultures, languages and levels of per-capita income except Myanmar and Thailand, which will favour the trade among the region. Thus, the main focus of the study is to analyse the revealed comparative advantage of countries in BIMSTEC, their trade competitiveness and contribution made to the country’s growth before and after formation by the region. Under the study, it was observed that the intra-industry trades of India in Agriculture among the BIMSTEC nations have shown very less potential for trade in all 24 agriculture chapters. Thus, economies need to reframe the policies as required and identify the potential products in agricultural-related goods that can significantly improve the trade balance of the countries. JEL Codes: F14, F15, F19, F53

Decision Tree-Based Ensemble Model for Predicting National Greenhouse Gas Emissions in Saudi Arabia

Greenhouse gas (GHG) emissions must be precisely estimated in order to predict climate change and achieve environmental sustainability in a country. GHG emissions are estimated using empirical models, but this is difficult since it requires a wide variety of data and specific national or regional parameters. In contrast, artificial intelligence (AI)-based methods for estimating GHG emissions are gaining popularity. While progress is evident in this field abroad, the application of an AI model to predict greenhouse gas emissions in Saudi Arabia is in its early stages. This study applied decision trees (DT) and their ensembles to model national GHG emissions. Three AI models, namely bagged decision tree, boosted decision tree, and gradient boosted decision tree, were investigated. Results of the DT models were compared with the feed forward neural network model. In this study, population, energy consumption, gross domestic product (GDP), urbanization, per capita income (PCI), foreign direct investment (FDI), and GHG emission information from 1970 to 2021 were used to construct a suitable dataset to train and validate the model. The developed model was used to predict Saudi Arabia’s national GHG emissions up to the year 2040. The results indicated that the bagged decision tree has the highest coefficient of determination (R2) performance on the testing dataset, with a value of 0.90. The same method also has the lowest root mean square error (0.84 GtCO2e) and mean absolute percentage error (0.29 GtCO2e), suggesting that it exhibited the best performance. The model predicted that GHG emissions in 2040 will range between 852 and 867 million tons of CO2 equivalent. In addition, Shapley analysis showed that the importance of input parameters can be ranked as urbanization rate, GDP, PCI, energy consumption, population, and FDI. The findings of this study will aid decision makers in understanding the complex relationships between the numerous drivers and the significance of diverse socioeconomic factors in defining national GHG inventories. The findings will enhance the tracking of national GHG emissions and facilitate the concentration of appropriate activities to mitigate climate change.

Health seeking behaviours, dengue prevention behaviours and community capacity for sustainable dengue prevention in a highly dengue endemic area, Sri Lanka

Introduction Dengue has become a major health problem in globally as well as locally. The delay in health-seeking is significantly associated with complications leading to severe dengue and active engagement of communities needs to minimize the delays in management to control epidemics. The aim of the study was to evaluate the relationship between sociodemographic characteristics and householders' Health-Seeking Behaviours (HSB), Dengue-Prevention Behaviours (DPB), and Community Capacities (CC) for sustained dengue prevention in Sri Lanka, a country with a high dengue endemicity.MethodsA cross-sectional analytical study was carried out in a district with the highest dengue endemicity from January to April 2019. Of the householders, 532 were chosen randomly. A pre-tested, validated, and interviewer-administered questionnaire was used to assess HSB and DPB. The HSB was assessed using three aspects, initial response for fever management, the duration of blood testing and initial response if suspected dengue. The DPB assessment was evaluated using ‘waste, outdoor water container, indoor water container, roof gutter and water storage management’. ‘Dengue Community Capacity Assessment Tool’, with 14 key items was used to assess the level of community capacity for dengue prevention. Out of the total, ≥ 50% was considered as an “adequate” HSB, DPB and CC. Multiple logistic regression was performed to control confounding effects. The results were expressed as adjusted Odds-Ratios (aOR) and 95% Confidence Intervals (CI).ResultsThe response rate was 93.2% (n = 496). Among them, 44.6% (n = 221) had adequate overall HSB, and 19.2% (n = 95) had adequate DPB. Householders who have ≤ 4 family members are 1.74 times (aOR = 1.74; 95% CI: 1.17 – 2.61) more likely to have adequate HSB and 1.85 times (aOR = 1.85; 95% CI: 1.11 – 3.09) more likely to have adequate DPB. The age group of 46 to 70 years’ individuals (aOR = 1.74; 95% CI:1.12 – 2.92), and who engaged in employment (aOR = 1.68; 95% CI: 1.05 – 2.67) were more likely to have adequate DPB than the group of 18 to 45 years and the non-employed individuals respectively. Of them, 24.6% (n = 122) perceived that they have adequate CC. The householders who have per-capita income < USD 50 are 1.95 times (aOR = 1.95; 95%CI:1.11 – 3.40) more likely to have adequate CC.ConclusionThe HSB, DPB and CC need to be improved to change the behaviour for sustainable dengue prevention and community capacity-building programmes need to be conducted in the Kurunegala district, Sri Lanka.

Excessive daytime sleepiness, but not sleep apnea, sleep duration or insomnia, was associated with poor adherence to anti-hypertensive treatment: The ELSA-Brasil study

Hypertension is the leading risk factor for cardiovascular mortality. Poor adherence may partially explain this scenario. Beyond traditional factors, it is conceivable that sleep conditions such as Obstructive Sleep Apnea (OSA), Sleep Duration (SDUR), sleepiness and insomnia may contribute to impair adherence but the evidence is scanty. Consecutive participants with hypertension from the ELSA-Brasil study performed a home sleep monitoring and 7-days actigraphy to determine OSA (apnea-hypopnea index ≥15 events/hour) and SDUR, respectively. Excessive daytime sleepiness (EDS) and insomnia were evaluated by Epworth Sleepiness Scale (ESS) and Clinical Interview Scheduled Revised (CIS-R), respectively. The 4-itens Morisky questionnaire was used to evaluate adherence to anti-hypertensive therapy. A total of 411 patients were including in the analysis (mean age: 54 ± 8 years, 47% men). Medium/low adherence to anti-hypertensive therapy was observed in 62%. Compared to the high adherence group, the participants with medium/low adherence had lower frequencies of Whites (64.1 vs. 47.8%), high-degree education (50.6 vs. 40%), and monthly per-capita income ($1021.90 vs. $805.20). In contrast, we observed higher frequency of EDS (35.9 vs. 46.1%). No differences were observed for OSA, short SDUR (<6 h) and insomnia. Logistic regression analysis showed that race other than White (OR: 1.80; 95% IC:1.15–2.82), lower monthly income (OR: 1.74; 95% IC:1.01–3.0) and EDS (OR: 1.63; 95% IC:1.05–2.53) were independently associated with medium/low adherence to the anti-hypertensive treatment. Interestingly, EDS mediated the abdominal obesity-adherence outcome. In conclusion, among sleep-related parameters, EDS, but not OSA, short SDUR or insomnia, were associated to impaired adherence to anti-hypertensive therapy.

Subjective Toxicity Profiles of Children With Cancer During Treatment: A Latent Class Analysis.

Children and adolescents may experience a variety of subjective adverse events (AEs) caused by cancer treatment. The identification of distinct groups of patients is crucial for guiding symptomatic AE management interventions to prevent AEs from worsening. The aim of this study was to identify subgroups of children with cancer experiencing similar patterns of subjective toxicities and evaluate differences among these subgroups in demographic and clinical characteristics. A cross-sectional survey was conducted of 356 children in China with malignancies who received chemotherapy within the past 7 days using the pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. A latent class analysis (LCA) was conducted to identify subgroups of patients with distinct profiles of symptomatic AE occurrence. Nausea (54.5%), anorexia (53.4%), and headache (39.3%) were the top 3 AEs children experienced. Nearly all participants (97.8%) experienced ≥1 core AEs, and 30.3% experienced ≥5 AEs. The LCA results identified 3 subgroups ("high gastrotoxicity and low neurotoxicity" [53.2%], "moderate gastrotoxicity and high neurotoxicity" [23.6%], and "high gastrotoxicity and high neurotoxicity" [22.8%]). The subgroups were differentiated by monthly family per-capita income, time since diagnosis, and Karnofsky Performance Status score. Children experienced multiple subjective toxicities during chemotherapy, especially gastrotoxicity and neurotoxicity. Heterogeneity was found in the LCA in the patients' toxicities. The prevalence of toxicities could be distinguished by the children's characteristics. The results showing different subgroups in our study may assist clinical staff in focusing on patients with higher toxicities to provide effective interventions.

Are Autocracies Bad for the Environment? Global Evidence from Two Centuries of Data

Reducing carbon dioxide emissions is crucial for reducing the danger posed by climate change. There are factors for and against democracies in achieving these desired reductions. Using data from 150 countries, we estimate the marginal emission intensity (i.e., the change in per-capita carbon dioxide emissions for a unit change in per-capita income) across autocracies and democracies. We use regional waves of democratization and mean per-capita income of other countries in the region as instruments for democracy and per-capita income, respectively. Using these instruments, we obtain the causal estimate of the difference in marginal emission intensity and confirm that democracies have lower per-capita carbon dioxide emissions per unit increase in per-capita income compared to autocracies. Our results suggest that these benefits of democracies have occurred in recent decades, following the surge in public concerns about climate change and intergovernmental initiatives to reduce emissions. There is also evidence to suggest that strengthening rule enforcement and improving access to justice can be critical in decreasing carbon dioxide emissions.