Sociodemographic Changes Research Articles

Evaluation of Maternal Ischemia-Modified Albumin Levels during Pregnancy and Their Effect on Fetal Birth Weight.

Background and Objectives: The purpose of this study is to evaluate the impact of maternal ischemia-modified albumin (IMA) levels on pregnancy-related complications, fetal growth, and development over time. Materials and Methods: The prospective longitudinal and single-center study included 43 pregnant women ages 18 to 43. Routine pregnancy follow-up began at the first antenatal examination for all pregnant women before 14 weeks gestation, with IMA levels measured during the first, second, and third trimesters. The albumin cobalt binding test was used to determine the amount of ischemia-modified albumin (IMA). The patients' medical, sociodemographic, and nutritional data were analyzed. The primary outcome was to investigate how changes in maternal ischemia affected albumin levels during pregnancy and the relationship between these changes and newborn weight. Results: This study included 43 cases with a mean age of 28.5 ± 5.2 years and a mean gestation period of 39.2 ± 1.3 weeks. The mean IMA levels for cases in the first trimester, second trimester, and third trimester were 0.53 ± 0.06, 0.64 ± 0.11, and 0.64 ± 0.06, respectively. The second and third trimesters showed significantly higher levels of ischemia-modified albumin (IMA) than the first trimester (p < 0.01). There was no statistically significant difference in IMA levels between the second and third trimesters (p = 1.000; p > 0.05). There was no statistically significant correlation between fetal birth and percentage changes in IMA measurements between the first and second trimesters, the first and third trimesters, or the second and third trimesters (p > 0.05). Conclusions: Our study determined that maternal ischemia-modified albumin levels during pregnancy did not correlate with fetal birth weight. Our findings revealed that age, sociodemographic changes, BMI, weight gain, and pregnancy complications had no effect on the change in IMA levels during pregnancy. We believe that this result will serve as a benchmark for future studies on IMA levels during pregnancy.

Will a government subsidy increase couples' further fertility intentions? A real-world study from a large-scale online survey in Eastern China.

How many couples with at least one child under 3 years would like to have another one or more child(ren) in Eastern China and will an in-cash subsidy be conducive to couple's fertility intentions? In sum, only 15.1% of respondents had further fertility intentions (FFI) before learning about the subsidy, and the planned in-cash subsidy policy increased respondents' overall FFI by 8.5%. Fertility has been declining globally and has reached a new low in China. The reasons why the Chinese three-child policy was under-realized, and how couples will react to a planned monthly ¥1000 (€141.2) subsidy policy, are not fully understood. During January and February 2022, a cross-sectional online survey aiming to understand families' expenses of raising a child under 3 years old, and couples' FFI, was conducted. During the survey period, 272510 respondents scanned the QR code. This study reports the findings pertaining to questions on respondents' sociodemographic characteristics, household factors, FFI, and changes in intention from negative to positive after learning about the planned in-cash subsidy. After exclusion, 144893 eligible responses were included. Respondents' FFI, the effect of a planned ¥1000/month*36 months' in-cash subsidy (€5083.2 in total) on people with a negative FFI before the subsidy, and potential reasons for persistent negative FFI after learning about the subsidy were collected through an anonymous online survey. Stepwise binary logistic regression models were used to select associated factors. The potential fertility rate change and government costs were estimated. A stratified analysis by current child number and sensitivity analysis were also conducted. In sum, 15.7% (22804/144893) of respondents were male, 15.1% of respondents reported a positive FFI, and 10.0% (12288/123051) without an FFI at first changed their intention after learning about the planned in-cash subsidy policy. For those who still said 'no FFI', 46.5%, 20.6%, and 14.7% chose pressure on housing status, expenses on children's education, and lack of time or energy for caring for another child as their first reasons. FFI was strongest in participants receiving the most financial support from their parents, i.e. grandparents (OR = 1.73, 95% CI = 1.63-1.84 for the >¥100000/year group), and weakest in those already having two children (OR = 0.23, 95% CI = 0.22-0.24). For those with no FFI before learning about the subsidy policy, respondents with the highest house loan/rent (>¥120000/year, OR = 1.27, 95% CI = 1.18-1.36) were more likely to change their FFI from 'No' to 'Yes', and those with the highest household income (>¥300000/year, OR = 0.65, 95% CI = 0.60-0.71) were least susceptible to the policy. In our study population, about 1843 more births every year and an additional 0.3 children per woman were projected under a conservative estimation. Annual estimated cost at the provincial scale would be ¥817.7 (€115.5) million, about 1.02‰ of the total General Public Budget Revenue in 2022. The findings were generally robust in the stratified analysis and sensitivity analysis. Selection bias and information errors may exist in the online survey responses. The large sample size and detailed further analysis were used to minimize such biases. Fertility intentions in Eastern China are rather low. Policymakers should focus more on financial and childcare burdens for a better realization of the three-child policy, including housing, education and childcare services. An in-cash subsidy, which has never been used in China previously, shows promising potential for increasing FFI. However, the application of such policy should be in line with local conditions for better cost-effectiveness regarding fertility-boosting and fiscal sustainability for the government in the long run. This work was supported by the National Key Research and Development Plan of China (2019YFC0840702). The authors declare no conflict of interests. N/A.

Societal Shifts in Central Asia: Figures and Trends

Central Asia has been undergoing considerable transformations by becoming mature independent states in international arena and experiencing socio-demographic shifts. It clearly resembles the dynamics described in Moises Naím’s “The End of power” where he argues that “the more, mobility, and mentality” revolutions challenge political leaders with fluid and unpredictable environment. This article aims to do an empirical analysis of the socio-demographic changes in Central Asia to test the assumption in the regional context.

Predictors of clozapine efficacy in treatment-resistant schizophrenia: A cross-sectional analysis of sociodemographic, clinical, biochemical, and electrophysiological EEG changes

Predictors of clozapine efficacy in treatment-resistant schizophrenia: A cross-sectional analysis of sociodemographic, clinical, biochemical, and electrophysiological EEG changes

Sustainable future food demand: Integrating social, health, and environmental considerations in forecasting

Predicting future food demand and understanding its environmental and dietary ramifications are vital for ensuring food system sustainability in an equitable manner. Existing forecasting methods often overlook societal diversity and do not connect projected food demand with its socio-environmental implications. This paper introduces a framework for forecasting a nation's future food demand with considerations for socio-demographics and dietary preferences, along with potential dietary and environmental implications. Israeli household expenditure surveys spanning two decades (1997–2017) representing over 120,000 households were used to explore a series of potential food purchase scenarios for the period up to 2030 and the nutritional and environmental footprints of subgroups. These subgroups included small and large families, young couples, the elderly, and wealthy adult households. Three dietary scenarios based on expected socio-demographic changes were then examined: “Environmental,” “Healthy,” and “Mediterranean” scenarios. All examined scenarios predicted a surge in food demand by 18 to 22 % for the period of 2018–2030. The “business-as-usual” (BAU) scenario emphasizes the expected rise in the consumption of meat, oil products, and food outside the home, leading to a 20 % rise in greenhouse gas emissions. In comparison, in the case of the Healthy scenario, emissions are expected to rise by 22 %, and according to the Environmental scenario by only 10 %. Significant differences were also discovered across various social groups in regard to the analyzed dietary and environmental indicators. Although the study focuses on Israel, the proposed framework's universality makes it adaptable to any country. This could empower policymakers and stakeholders to craft food security informed decisions and targeted interventions that address the needs of diverse social groups while considering socio-environmental implications both presently and in the future.

Professional experiences of spanish advanced practice nurses: qualitative research

BackgroundAdvanced practice nursing has emerged as a result of the evolution of healthcare systems, the changing needs of the population and the academic development of nursing, as well as sociodemographic and epidemiological changes. The aim of this study is to describe the professional experiences of Spanish advanced practice nurses in specific positions within the healthcare system in order to better understand the development and characteristics of this specialised nursing role.MethodsA descriptive qualitative study was conducted. Fourteen advanced practice nurses from healthcare centres participated. Semi-structured interviews were carried out. Braun and Clarke’s method for reflexive thematic analysis was followed. The Atlas. Ti version 22 program was used for technological support. The COREQ checklist was used to optimise the reporting of this qualitative study.ResultsFrom the analysis of the data collected, three themes and six subthemes were extracted: 1) Advanced practice nursing on the rise: (a) The driving forces in the development of advanced practice nursing, (b) Barriers to the development of advanced practice nursing; 2) Advanced practice nurses as a response to the population’s needs: (a) The development of a new professional nursing role, (b) The patient at the centre of care in advanced practice nursing; 3) Training as the foundation for advanced practice nursing: (a) Expert nurses in a specific context, (b) Differences in the level of training depending on the context.ConclusionAdvanced practice nurses have faced countless barriers and difficulties that have impeded them from demonstrating their importance and effectiveness within the healthcare system. A stable regulatory framework for the functions of advanced practice nurses is required to promote care, training and research in the field of advanced practice nursing. Health institutions need to promote the role of advanced practice nurses, facilitate the employment of new professionals, and establish new areas of practice.Trial registrationNot applicable.

Trajectories of Satisfaction with Life Following a Collective, Critical Life Event and Their Relationship with Sociodemographic Factors and Internal Migration: The Example of the German Reunification 1989/90

There are considerable interindividual differences in adjustment processes in satisfaction with life (SWL) following critical life events. We focused on a collective life event, the German reunification in 1989/90, which prompted fundamental changes in the political, social, and economic conditions to investigate the heterogeneity of short- and long-term trajectories of SWL and their association with sociodemographic factors and internal migration. Using data (short-term: 1990–1994, long-term: 1990–2019) from the German Socioeconomic Panel (N = 5548), we applied growth mixture modelling with categorical time for short-term and continuous (quadratic) time for long-term trajectories. Multinomial logistic regression was used to examine associations of the trajectories with internal migration (West German (reference)/East German non-migrants, East-West/West-East migrants), baseline characteristics (sex, age, education, marital status, employment status, household income) and changes (becoming not employed, becoming divorced/separated, change in household income). The best models indicated four classes both long- and short-term, with the majority showing high stable SWL (86.7% (short-term) vs. 62.3% (long-term)); other classes were ‘improvement’ (2.5%, vs. 16.4%), ‘decline-improvement’ (5.2% vs. 9.4%), and ‘decline’ (5.6% vs. 11.9%). For short-term trajectories, East German non-migrants and East-West migrants were more likely to show unstable trajectories. Long-term, both East German non-migrants and East-West migrants had higher odds of increasing SWL, whereas West-East migrants had higher chances for decline-improvement. Differential associations with baseline sociodemographic characteristics and changes thereof were found. The study highlights distinct SWL trajectories following the collective event of German reunification. These trajectories vary based on short- versus long-term perspectives, sociodemographic background, and internal migration patterns.

Association of neighborhood-level superfund sites with atmospheric toxic exposures and increasing cancer risk in the United States: A proof-of-concept geospatial study.

10577 Background: Decades of underinvestment have disproportionately exposed several neighborhoods in the US to hazardous conditions. Superfund is the name given to the environmental program established by the US Congress in 1980, to address abandoned hazardous waste sites. The extent to which Superfund sites have contributed to differences in cancer risk remains unknown. We investigated atmospheric toxic exposures increasing cancer risk by proximity to Superfund sites at the neighborhood level. Methods: In this cross-sectional study of US neighborhoods, census-tract level air toxic cancer risk data from the Environmental Protection Agency for 2019 were linked with census-tract level geolocation data of ~1300 Superfund sites from the Superfund Enterprise Management System database. Linear regression models were utilized to explore association between cancer risk and proximity to Superfunds. Geographically Weighted Regression models explored spatial non-stationarity by modeling spatial relationships that vary across the study area. Bivariate Local Indicators of Spatial Association (LISA) cluster maps were created for superfund site proximity and cancer risk (high-high, low-low, low-high, high-low). Kruskal-Wallis testing compared the distributions of different variables across the four LISA cluster types. Results: Study explored 82,770 census tracts nationwide. For every 10 percentile increase in Superfund proximity, there was an increase of 4% in cancer risk (p &lt; 0.001). This association was strongest in the Intermountain West, South-Southeast, and Northeast regions. High-high clusters (high proximity to Superfund, high cancer risk) had higher percentage of non-White, low-income, unemployed and lower education attainment populations compared to low-low clusters (all p &lt; 0.001). Within high-high clusters, non-White population had the strongest correlation with proximity to Superfunds. Cancer risk was much higher for the top 10% than the bottom 10% of proximity to Superfunds (Table). Conclusions: Our study highlights higher clustering of cancer risk around neighborhoods with existing Superfund sites. Further, we demonstrate the closer a neighborhood is to a Superfund site, the greater the cancer risk is with associated sociodemographic changes. Using a novel approach to geospatial analytics, the results demonstrate the first clear evidence of a dangerous association between Superfunds and healthcare, and encourage the urgent prioritization of Congressional policies that optimize investment in Superfund site clean up for public health. [Table: see text]

Citizens’ Perceptions and Assessment of an Urban Mountainous Forest Restoration: Nature, History, and Changes

Background and objective: Most cities in South Korea have mountainous forests as hinterland green space in their centers, which are used as urban parks. This study was conducted to analyze citizens' perceptions of a mountainous forest restoration project being carried out in Jinju City.Methods: The research site is part of Bibongsan Mountain in Jinju City. Visitors' perceptions of the Bibongsan Restoration Project (BRP), carried out since 2015, were surveyed and analyzed regarding nature, history, and changes. The survey was conducted from August to October 2019, and the collected data were statistically analyzed.Results: The main socio-demographic changes were an increase in the proportion of men among visitors, aging, and an increase of unemployed people in the occupational distribution. The overall assessment of BRP implementation was positive. Visitor perceptions of the value, revival, and restoration of historical resources were more vital than in 2015 and had a strong positive correlation with each other. Visitors identified a high need for safety facilities for elderly visitors, improved wireless communication services, facilities for various recreational activities, outdoor learning facilities and programs for nature study, expanded parking lots, and improved transportation services.Conclusion: The urban mountainous forest restoration project is overall satisfactory and needs to be continued. The results showed that urban mountainous forests are not only recognized as spaces for walking and exercise for health but also recently as historical spaces expressing the unique or featured identity of the city, educational spaces for interest and understanding of nature, and recreational spaces that reflect local lifestyle changes. Thus, urban forests need to be restored in the context of local historical and cultural resources as well as natural resources. In addition, there is a need to be aware of various changes in the population, including aging and an increase in retirees.

How traditional Norwegian outdoor activities are changing; a 10-year follow up in relation to sociodemographic factors.

The study aims to evaluate the relationship between sociodemographic factors and changes in Norwegian outdoor activities between 2008 and 2018. Traditional outdoor activities, such as family trips in nature, the gathering of mushrooms and wild berries, and growing one's own plants to eat, are believed to have a positive impact on physical activity levels and health in general. This study includes repeated cross-sectional surveys conducted in 38 randomly selected schools across two Norwegian counties. In 2008, 1,012 parents of 6th and 7th grade students from 27 schools completed a questionnaire. In 2018, 609 new parents from 25 schools participated. Variables were dichotomized. Descriptive analyses between groups were conducted using chi-square statistics. Binary logistic regression analyses were performed with the three outdoor activities as dependent variables, including year only (model 1), and then also gender, age (continuous), education (own and partners), and household income as independent variables (model 2). Participation in weekly family trips in nature increased from 22% to 28% (p = 0.002), the OR for year 2018 vs. year 2008 was 1.51. Adjusted for sociodemographic factors, the OR remained stable and significant. Education was the only significant sociodemographic factor (OR = 1.60), indicating the odds of those with a higher education to be 60% higher to engage in weekly family trips in nature. Gathering of wild mushrooms and plants remained stable with time. Being female (OR = 1.44), age (OR = 1.049) and education (OR = 1.49) was related to gathering. An increase in growing plants to eat was observed with an increase from 42% to 51% (p < 0.001), OR = 1.33. However, it did not remain significant in model 2. Education was, in general, positively related to growing food (OR = 1.35). We observed a positive increase in family trips in nature over the period from 2008 to 2018. Furthermore, elder parents seem to be more involved in the long-rooted traditional Norwegian grow- and gather culture, and a social gradient is apparent as those with higher education do participate more often in traditional outdoor activities.

Dengue hospitalizations and in-hospital mortality changes in trend in Ecuador: a nationwide study from 2015 to 2022

During recent years, dengue infection has spread rapidly within countries and between regions. Rapid rise in the global burden has been related to sociodemographic changes. Objective This study aimed to analyze dengue hospitalizations and in-hospital mortality trends in Ecuador, along with sociodemographic factors influencing adverse outcomes. Methods This study included 31,616 dengue hospitalizations in Ecuador during 2015–2022, of which 115 (0.36%) died. Data were extracted from national hospital registries. Age adjusted rates were calculated, and for the analysis of changes in trend, a Joinpoint regression was performed. Multivariate binary and multinomial logistic regressions were performed for assessing sociodemographic factors influencing dengue adverse outcomes. Results During 2015–2022, the mean age adjusted dengue hospitalization rate was 22.3 per 100,000 inhabitants with 49.41% annual decrease during 2015–2017 and 31.73% annual increase during 2017–2022 with higher rates in 2020 with 31.61, 2021 with 34.42, and 2022 with 25.81. The mean dengue in-hospital mortality rate was 0.08, mortality rates did not show significant changes during 2015–2022. Higher probability of death was observed in ages ≥50 years and ethnic minorities. People living in rural areas exhibited a 64% higher risk for complicated dengue hospitalization. Conclusions It was observed as an important accomplishment in Ecuador’s ongoing efforts to improve healthcare regarding dengue. 0.36% of dengue hospitalizations ended in death which is below the recommended 1%. The increase in dengue hospitalizations in Ecuador during recent years remains a concern. The COVID-19 pandemic might have influenced dengue prevention and vector control to be neglected leading to an increase in cases.

Household food security status and its associated factors among pensioners in Arba Minch town, South Ethiopia.

Food insecurity has remained a serious public health problem in developing countries, such as Ethiopia, over the past two decades. Vulnerable populations, such as pensioners, have been affected by this problem because of emerging socio-demographic changes, a global financial crisis, and climate change, all of which have contributed to the high food prices. Hence, this study aimed to assess household food security status and associated factors among pensioners in Arba Minch town, South Ethiopia. A community-based cross-sectional study design was conducted from September to October 2023. Two hundred forty-four pensioners were chosen using a simple random sampling technique. Data were collected, cleaned, and entered into EPI-Data version 4.6 and exported to SPSS version 25 for analysis. Variables with a p-value of ≤0.25 in the bivariate analyses were candidates for the multivariable regression analysis. In the multivariable logistic regression, variables with a p-value of 0.05 were considered to have a significant association with the dependent variable. A total of 238 retired people were interviewed, with a response rate of 97.5%. Among the interviewed pensioners, 223 (91.4%) households were food insecure. Having more than one dependent member [AOR = 2.4, 95% C.I: 1.30, 6.64], being jobless after retirement [AOR = 3, 95% C.I:1.17, 5.61], and being in the lowest tertile of wealth status [AOR = 2, 95% C.I:1.36, 4.99] were identified as predictors of food insecurity. The magnitude of household food insecurity was higher compared to the national average, and factors such as the current occupational status of the household head, dependency ratio, and wealth status of the household were significantly associated with household food insecurity. Therefore, policymakers and programmers should provide new strategies focusing on additional income-generating activities and salary increments and consider free services such as school fees and healthcare.

Cities in transition: Krakow‘s social, economic and spatial transformation within the last thirty years (selected aspects)

Krakow is a city that has undergone an immense transformation in recent years. At the end of the 1980s, the period of communism ended and Polish local governments began to operate based on the principles of subsidiarity, decentralisation and independence. In 2004, Poland joined the European Union, which opened up new prospects for development, including in regional and local terms. The world has become a networked and digitized entity susceptible to the influence of innovation. Due to metropolitisation processes, cities, especially those offering above-average earnings, a diversification of economic resources and a relatively high quality of life, began to develop even more dynamically, which had and still has negative consequences. In Poland, there are five cities in which development dynamics have a highly specific dimension. Apart from the capital city of Warsaw, these are Krakow, Wrocław, Poznań and the agglomeration of the so-called Tri-city (Gdańsk, Sopot and Gdynia). The aim of this study is to show how Krakow, the second-largest city in Poland, has evolved over the last three decades at the level of demographics, urban development and economy; how it changed in the historical “milestones” indicated above. Therefore, depending on the availability of statistical data, several time periods were selected and compared with each other in the most important areas of Krakow’s functioning. The research hypothesis is as follows: Krakow’s development policy in key areas optimally uses the opportunities resulting from contextual conditions (social, economic and cultural changes that have taken place in recent decades). The study focuses on the three main problems of the city’s development (the abovementioned key areas of the city’s functioning and development): socio-demographic, spatial and economic changes. The analysis assessed data from the literature, city reports and other available sources, as well as public quantitative data (assessment of data from the National Census for the years 1988, 2002, 2011, 2022; Local Data Bank of Statistics Poland and otherrepositories and reports).

Perceived social support, loneliness, and depression among elderly living in old-age homes.

Older persons occasionally or permanently relocate from their own houses to institutions or old-age homes as a result of the current socio-demographic changes and circumstances. In this scenario, the current study aimed to assess the perceived social support, loneliness, and depression among the elderly living in old-age homes. We have conducted a descriptive cross-sectional study among the elders living in old-age homes in Bengaluru urban, who have been staying in old-age homes for at least 6 months or above, and the age group of 60 years or above. Data were obtained from 40 respondents from four old-age homes using a simple random sampling method. Structured interview schedules have been used which included a socio-demographic profile, geriatric depression scale, multidimensional scale of perceived social support, and emotional and social loneliness scale. The majority of the respondents (82.5%) belonged to the age category of 60-70 years. More than half of the respondents were females (57.5%); 30% of the respondents were widowed. Nearly two-thirds of them belonged to below poverty line families. The analysis showed a negative correlation between perceived social support and loneliness and depression and a positive correlation between loneliness and depression. There is a significant gender difference among study variables such as perceived social support and depression. The results also show significant differences across the categories of socioeconomic status, duration of physical illness, and a number of organizations changed while comparing perceived social support and depression variables. Perceived social support influences older adults' experience of loneliness and depression among inmates of old-age homes. Hence, there is a need to sensitize the staff working in old-age homes on caregiving skills for enabling the elderly to enjoy better-perceived social support and quality of life.

Relationship between Cooling Methods and Energy Consumption for the Development of Low-Carbon Collective Housing in Indonesia

Indonesian urban population increase has led to increased energy demands and housing inventory shortages. The Ministry of Public Works and Housing (PUPR) supplies collective housing for low-income communities (MBR). The development of low-carbon collective housing has been thought to suppress the abrupt increase in household-sector energy demand and lead to mitigated greenhouse gas (GHG) emissions. In tropical climates, it is essential to reduce the dependence on air conditioners (AC) to suppress energy consumption. Therefore, to investigate the relationship between cooling methods and energy consumption, this study surveyed the energy consumption per household and classified the existing cooling patterns of ACs, fans, and window openings in collective housing with different income groups in Indonesia. The results confirmed that the use of AC increases household energy consumption. Meanwhile, the implementation of natural ventilation (NV) showed significantly lower energy consumption with a high thermal satisfaction of more than 80% during the day and 90% at night; thus, both energy consumption reduction and indoor thermal comfort improvement could be achieved through these methods. The findings of this study serve as a starting point for verifying the energy saving effects of air conditioning habits with the consideration of socio-demographic changes for the purpose of decarbonizing collective housing, including future predictions and energy simulations.

Mental strain in German public administrations in the course of the COVID-19 pandemic.

During the COVID-19 pandemic, digital working methods were increasingly implemented within the setting of German public administrations. Beyond the ostensible risk of infection, a high psychological burden arose for the employees. A subsequent progression of mental strain is to be estimated as a residual effect (approximated by controlling other influencing factors) due to the impossibility of a counterfactual control group. An online survey was conducted in 2020 and repeated in 2021 among a cohort of n = 706 employees of 38 departments of three public administrations in North Rhine-Westphalia, Germany. Mental strain was assessed by the Wuppertal Screening Instrument. Its temporal variation was operationalized as the intercept of a first-difference multiple regression model. Unit of analysis was the department level. The prevalence of suboptimal and dysfunctional strain increased from 71% to 73%. The multiple regression model showed a significant increase whilst controlling the influence of socio-demographic changes on the department level. Children, age and educational level were significant predictors. R2 indicated that about 40% of the variance in the temporal variation of mental strain could be explained. The observed factors explained a significant proportion of the increase in mental strain in German public administrations. Still, far more than half of the increase stemmed from external influences which were largely determined by pandemic conditions and latency effects remain still to be seen.

The diabetes care continuum in Venezuela: Cross-sectional and longitudinal analyses to evaluate engagement and retention in care.

The impact of the humanitarian crisis in Venezuela on care for noncommunicable diseases (NCDs) such as diabetes is unknown. This study aims to document health system performance for diabetes management in Venezuela during the humanitarian crisis. This longitudinal study on NCDs is nationally representative at baseline (2014-2017) and has follow-up (2018-2020) data on 35% of participants. Separate analyses of the baseline population with diabetes (n = 585) and the longitudinal population with diabetes (n = 210) were conducted. Baseline analyses constructed a weighted care continuum: all diabetes; diagnosed; treated; achieved glycaemic control; achieved blood pressure, cholesterol, and glycaemic control; and achieved aforementioned control plus non-smoking. Weighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and care continuum stage. Longitudinal analyses constructed an unweighted care continuum: all diabetes; diagnosed; treated; and achieved glycaemic control. Unweighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and changes in care continuum stage. Among 585 participants with diabetes at baseline, 71% were diagnosed, 51% were on treatment, and 32% had achieved glycaemic control. Among 210 participants with diabetes in the longitudinal population, 50 (24%) participants' diabetes management worsened, while 40 (19%) participants improved. Specifically, the proportion of those treated decreased (60% in 2014-2017 to 51% in 2018-2020), while the proportion of participants achieving glycaemic control did not change. Although treatment rates have declined substantially among people with diabetes in Venezuela, management changed less than expected during the crisis.

A Holistic Strategy of Mother and Child Health Care to Improve the Coverage of Routine and Polio Immunization in Pakistan: Results from a Demonstration Project.

The eradication of poliovirus and improving routine immunization (RI) coverage rates present significant challenges in Pakistan. There is a need for interventions that focus on strengthening community engagement to improve routine immunization coverage. Our primary objective is to assess the impact of an integrated strategy designed to enhance community engagement and maternal and child health immunization campaigns on immunization coverage in Pakistan's high-risk union councils of polio-endemic districts. We implemented an integrated approach for routine immunization and maternal and child health in the polio-endemic district of Pakistan. This approach involved setting up health camps and actively engaging and mobilizing the local community. An independent team conducted surveys at three key points: baseline, midline, and endline, to evaluate immunization coverage among children under the age of five. The primary outcome measures for the study were coverage of OPV, IPV, and changes in the proportion of unvaccinated and fully vaccinated children. To select clusters and eligible households in each cluster, we utilized a 30 × 15 cluster sampling technique. Multivariable associations between socio-demographic factors and changes in the proportion of fully vaccinated children at the UC level were assessed using hierarchical linear regression models. A total of 256,946 children under the age of five (122,950 at baseline and 133,996 at endline) were enrolled in the study. By the endline, full immunization coverage had increased to 60% or more in all three study areas compared to the baseline. Additionally, there was a significant increase in the coverage of both OPV and IPV across all three provinces at the endline. The full immunization rates were assessed on three levels of the framework: the distal, intermediate (access and environment), and proximal level (camp attendance and effectiveness). At the distal level, on multivariate analysis, family size was found to be a significant predictor of change in immunity within the families (β = 0.68; p ≤ 0.0001). At the intermediate level, the likelihood of full immunization decreased with the decrease in knowledge about vaccination (β = -0.38; p = 0.002), knowledge about polio vaccine (β = -0.25; p = 0.011), and knowledge about IPV (β = -0.06; p = 0.546). Perceived obstacles to vaccination were fear of adverse events (β = -0.4; p ≤ 0.0001) and lack of education (β = 0.23; p = 0.031), which were found to be significant in bivariate and multivariate analyses. At the proximal level, community mobilization (β = 0.26; p = 0.008) and attendance at health camp (β = 0.21; p ≤ 0.0001) were found to enhance full immunization coverage. On the other hand, the most prominent reason for not attending health camp included no need to attend the health camp as the child was not ill (β = -0.13; p = 0.008). This study found that community mobilization and attendance at health camps significantly enhanced full immunization coverage. The findings highlight the importance of community engagement and targeted interventions in improving immunization coverage and addressing barriers to healthcare seeking.

Market characteristics and entry strategy decision making: The market perspective of Croatian elderly care homes

Background: Socio-demographic changes increase the need for long-term elderly care. Consequently, providing formal institutional service in elderly care homes is an interesting opportunity for entrepreneurs. However, the entry strategy decision is influenced by numerous external variables. Purpose: The main goal is to answer what determines market concentration as one of the most important market entry determinants. Study design/methodology/approach: A linear regression model has been formed and tested on the Croatian elderly care home market, observed on a county level, using data for 2021. Further, a cluster analysis, as a decision-support tool, has been made to assess market characteristics that are more likely to attract new entrants to the elderly care home market. Findings/conclusions: Results indicate that demand for long-term care services plays a significant role, and the market with more elderly will attract more competitors. When the level of GDP per capita and the unemployment rate are observed together, markets with stronger economies tend to attract entrepreneurs. In other words, it is more likely that someone will open an elderly care home in a densely populated county with individuals that can afford formal institutional long-term care for themselves or family members. Limitations/future research: The shortcomings are mainly related to the lack of data on prices and quality measures. Further, information on the number of beds in each elderly care home would enable an alternative calculation of the Herfindahl-Hirschman index, while data on service prices and structure of employees as a proxy for quality (medical and non-medical staff) would enable a more reliable comparative analysis of obtained results. Future studies on this subject include variables related to the portion of unemployed females in the market since female family members more often provide informal care, and at the same time, they are more likely to be employed in formal long-term care institutions.

Sociodemographic profiles and career motivations of Australian dental students.

Prior studies explored factors influencing dental study choice, but shifts from BDSc to DDS degrees in some countries impact demographics and motivations, potentially affecting the dental workforce. The aim of this study was to establish Australian DDS and BOH students' sociodemographics and career motivations. Questionnaires conducted in mid-2019 assessed sociodemographic profiles and career motivations. Statistical analysis utilized descriptive statistics and Fisher's exact test. The overall response rate was 71.3%. DDS students had an average age of 25.2 years, while BOH students averaged 21.5 years. Most BOH (80.7%) and DDS students (52.0%) were female. They were mainly single, local, Australian citizens from metropolitan areas. Self-motivation ranked highest, particularly for DDS students (P < 0.05). Significant motivators included healthcare occupation, helping others, interesting career, and flexible hours (P < 0.05). DDS students were more motivated by flexible hours and independence (P < 0.05), while females emphasized a healthcare profession (P = 0.003). International students were motivated by being their own boss (P = 0.003), and private school graduates valued lifestyle within the profession (P = 0.049). Despite sociodemographic changes, the main motivations for studying dentistry remain consistent. DDS students prioritized lifestyle factors such as time and remuneration over BOH students.