Status Variables Research Articles

Understanding the Right to Development among the People of Noida, Uttar Pradesh: A Case Study

Background: The exercise of a people's innate right to complete sovereignty over all of their natural resources and riches is included in the full realization of their right to self-determination, which is encompassed by the human right to development. It allows all people and communities to fully realize their basic freedoms and human rights by allowing them to engage in, contribute to, and benefit from advancements in the fields of economics, society, culture, and politics. Aim: This study aims to assess the understanding of the right to development as a human right among the people. Materials and Methods: A quantitative approach is employed in this research study to assess the understanding of the right to development as human rights. A descriptive survey research design with a sample size of 60, selected through purposive sampling based on specific inclusion and exclusion criteria, is utilized. Data is collected using a structured knowledge questionnaire and analyzed with descriptive and inferential statistics. Results: The study evaluates the knowledge of the understanding of the right to development as human rights among the people of Noida, Uttar Pradesh. The analysis of knowledge levels is based on different demographic factors. Among the general population, 36 (60%) had average knowledge, 22 (36.7%) had good knowledge, and 2 (3.3%) had poor knowledge. The socio-demographic variable of educational status of the general population showed a statistically significant association with the knowledge level of understanding the right to development as human rights, while age, gender, and occupational status were not statistically significant (p < 0.05).

Abstract A004: Clinical test design affects tumor tissue and ctDNA FGFR gene status in metastatic urothelial cancer: a prospective study

Abstract Fibroblast growth factor receptor (FGFR) gene alterations are common in urothelial cancer (UC) and targetable with erdafitinib. The co-approved companion diagnostic is an amplicon-based tumor tissue test that detects a limited number of recurrent FGFR alterations. However, FGFR status may change during disease progression, and rare FGFR alterations not typically covered by existing tests may be of clinical importance. Therefore, in a prospective pan-Canadian study (NCT06129084), we compared standard archival tissue testing to broad targeted sequencing of cell-free circulating tumor DNA (ctDNA) to detect FGFR alterations in UC. Eligible patients had progressing metastatic UC and were undergoing tissue FGFR testing. Blood was drawn at study enrollment and plasma cell-free DNA and matched white blood cell DNA underwent deep-targeted sequencing with a hybridization capture panel including the introns and exons of FGFR1-4 and the common breakpoint region of TACC3. Archival tissue selection and testing was initiated by the treating physician and typically used the Oncomine Focus assay. 210 patients were enrolled across 12 sites, and 140 patients have tissue and ctDNA results available for concordance assessment. 43/140 (31%) of cell-free DNA samples had low tumor fraction (<0.5%) and were considered inconclusive. For the remaining 97 same-patient tissue and ctDNA pairs, FGFR status was identical in 88 (91%). In 7 of 9 discordant cases, the tissue was negative, but ctDNA was positive for FGFR alterations: these were enriched for FGFR3-TACC3 fusions (4/7). Two discordant fusions had canonical breakpoints that can be identified by current amplicon-based companion diagnostics, indicating potential spatiotemporal heterogeneity in somatic FGFR status. The other two discordant (ctDNA-only) fusions had non-canonical breakpoints that are not amenable to detection by current amplicon-based companion diagnostics. In two mutation discordant cases (S249C positive in ctDNA only), lack of signal in tumor tissue could be explained by the presence of additional FGFR3 variants within 25bp of S249 and in cis - disrupting primer binding sites. There were only two cases of tissue-only FGFR alterations among the 97 evaluable pairs (FGFR3-TACC3 fusion, S249C). ctDNA testing of metastatic UC with a broad capture-based approach covering all exons and introns of FGFR genes can identify additional alterations not detected with current amplicon-based companion diagnostics applied to archival tissue. Our results support ctDNA testing as a valuable adjunct to tissue testing, but not as a replacement due to the high frequency of inconclusive ctDNA results, secondary to tumor fraction below the threshold. Assay design, including target enrichment technique, is a significant source of variability in tissue and ctDNA FGFR status and should be carefully considered in future clinical biomarker testing strategies. Citation Format: David C. Müller, Gillian Vandekerkhove, Andrew J. Murtha, Jack V.W. Bacon, Carlos Vasquez-Rios, Maria Stephenson, Kimia Rostin, Elena Schönlau, Connor Wells, Sunil Parimi, Krista Noonan, Naveen S. Basappa, Jenny J. Ko, Daygen Finch, Nimira Alimohamed, Tarek A. Bismar, Gang Wang, Andreas Papadakis, Lucia Nappi, Matti Annala, Cecily Q. Bernales, Alan Spatz, Kim N. Chi, Alexander W. Wyatt, Bernhard J. Eigl. Clinical test design affects tumor tissue and ctDNA FGFR gene status in metastatic urothelial cancer: a prospective study [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2024 May 17-20; Charlotte, NC. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(10_Suppl):Abstract nr A004.

Healthcare disparities, screening, and molecular testing in the changing landscape of non-small cell lung cancer in the United States: a review.

Inequitable access to care continues to hinder improvements in diagnosis and treatment of lung cancer. This review describes healthcare disparities in the changing landscape of non-small cell lung cancer (NSCLC) in the United States, focusing on racial, ethnic, sex-based, and socioeconomic trends. Furthermore, strategies to address disparities, overcome challenges, and improve patient outcomes are proposed. Barriers exist across lung cancer screening, diagnosis, and treatment regimens, varying by sex, age, race and ethnicity, geography, and socioeconomic status. Incidence and mortality rates of lung cancer are higher among Black men than White men, and incidences in young women are substantially greater than in young men. Disparities may be attributed to geographic differences in screening access, with correlating higher incidence and mortality rates in rural versus urban areas. Lower socioeconomic status is also linked to lower survival rates. Several strategies could help reduce disparities and improve outcomes. Current guidelines could improve screening eligibility by incorporating sex, race, and socioeconomic status variables. Patient and clinician education on screening guidelines and patient-level barriers to care are key, and biomarker testing is critical since ~ 70% of patients with NSCLC have an actionable biomarker. Timely diagnosis, staging, and comprehensive biomarker testing, including cell-free DNA liquid biopsy, may provide valuable treatment guidance for patients with NSCLC. Efforts to improve lung cancer screening and biomarker testing access, decrease bias, and improve education about screening and testing are needed to reduce healthcare disparities in NSCLC.

Unravelling the acute respiratory infection landscape: virus type, viral load, health status and coinfection do matter.

Acute respiratory infections (ARI) are the most common infections in the general population and are mainly caused by respiratory viruses. Detecting several viruses in a respiratory sample is common. To better understand these viral codetections and potential interferences, we tested for the presence of viruses and developed quantitative PCR (Polymerase Chain Reaction) for the viruses most prevalent in coinfections: human rhinovirus (HRV) and respiratory syncytial virus (RSV), and quantified their viral loads according to coinfections and health status, age, cellular abundance and other variables. Samples from two different cohorts were analyzed: one included hospitalized infants under 12 months of age with acute bronchiolitis (n=719) and the other primary care patients of all ages with symptoms of ARI (n=685). We performed Multiplex PCR on nasopharyngeal swabs, and quantitative PCR on samples positive for HRV or/and RSV to determine viral loads (VL). Cellular abundance (CA) was also estimated by qPCR targeting the GAPDH gene. Genotyping was performed either directly from first-line molecular panel or by PCR and sequencing for HRV. The risks of viral codetection were 4.1 (IC95[1.8; 10.0]) and 93.9 1 (IC95[48.7; 190.7]) higher in infants hospitalized for bronchiolitis than in infants in primary care for RSV and HRV respectively (p<0.001). CA was higher in samples positive for multiple viruses than in mono-infected or negative samples (p<0.001), and higher in samples positive for RSV (p<0.001) and HRV (p<0.001) than in negative samples. We found a positive correlation between CA and VL for both RSV and HRV. HRV VL was higher in children than in the elderly (p<0.05), but not RSV VL. HRV VL was higher when detected alone than in samples coinfected with RSV-A and with RSV-B. There was a significant increase of RSV-A VL when codetecting with HRV (p=0.001) and when co-detecting with RSV-B+HRV versus RSV-A+ RSV-B (p=0.02). Many parameters influence the natural history of respiratory viral infections, and quantifying respiratory viral loads can help disentangle their contributions to viral outcome.

Exploring the Moderating Effect of Generational Status on the Link Between External Environment and Entrepreneurial Motivation of Indian Women Entrepreneurs

This study examines how external environmental factors affect the motivation of first- and second-generation women entrepreneurs in India, and how their generational status moderates this relationship. We used a survey design method to collect data from 459 women business owners in India, who were classified as first- or second-generation based on whether they were the first or second generation in their family to start a business. We employed the partial least-squares structural equation modelling method to test our hypotheses and evaluate our model. We found that external environmental factors, such as education and training, financial support, government policies and non-financial support, had positive effects on entrepreneurial motivation for both groups of women entrepreneurs. However, we also found that generational status had a significant moderating effect on the link between education and training and entrepreneurial motivation, but not on the other three external environmental factors. Specifically, we found that education and training influenced second-generation women entrepreneurs more strongly than first-generation women entrepreneurs. Our findings have important implications for management practice and policymaking, as well as for the literature on women entrepreneurship. We suggest that concerned authorities should develop differential strategies for first- and second-generation women entrepreneurs, taking into account their different responses to external environmental factors. We also suggest that future research should explore other internal and external environmental factors that might interact with generational status or other variables to shape women entrepreneurs’ motivation.

Zebra finch song parameters are affected by the breeding status of the male, but not temperature variability

Bird song is a crucial feature for mate choice and reproduction. Song can potentially communicate information related to the quality of the mate, through song complexity, structure or finer changes in syllable characteristics. It has been shown in zebra finches that those characteristics can be affected by various factors including motivation, hormone levels or extreme temperature. However, although the literature on zebra finch song is substantial, some factors have been neglected. In this paper, we recorded male zebra finches in two breeding contexts (before and after pairing) and in two ambient temperature conditions (stable and variable) to see how those factors could influence song production. We found strong differences between the two breeding contexts: compared to their song before pairing, males that were paired had lower song rate, syllable consistency, frequency and entropy, while surprisingly the amplitude of their syllables increased. Temperature variability had an impact on the extent of these differences, but did not directly affect the song parameters that we measured. Our results describe for the first time how breeding status and temperature variability can affect zebra finch song, and give some new insights into the subtleties of the acoustic communication of this model species.

Oxidative responses in small juveniles of Colossoma macropomum anesthetized and sedated with Ocimum gratissimum L. essential oil.

This study evaluated the use of essential oil of Ocimum gratissimum (EOOG) for anesthesia and in transport of Colossoma macropomum. Experiment 1, Test 1, anesthesia induction and recovery times were determined using different EOOG concentrations (0, 20, 50, 100, 200, 300mg L-1), with two size classes: Juveniles I (0.86g) and Juveniles II (11.46g) (independent tests in a completely randomized design). Based on the results of Test 1, in Test 2 Juveniles II were exposed to EOOG concentrations: 0, 20, 100mg L-1. Tissue samples were collected immediately after induction and 1h post-recovery, to assess oxidative status variables. Experiment 2, Juveniles I (0.91g) and Juveniles II (14.76g) were submitted to transport in water with different concentrations of EOOG (0, 5, 10mg L-1) (independent tests in a completely randomized design). The effects on oxidative status variables were evaluated. Concentrations between 50 and 200mg L-1 EOOG can be indicated for Juveniles I, while concentrations between 50 and 100mg L-1 EOOG for Juveniles II. The concentration of 100mg L-1 EOOG was able to prevent oxidative damage in the liver. In Experiment 2, the concentrations of 5 and 10mg L-1 EOOG added to the transport water caused sedation for both studied size classes of juveniles and did not cause oscillations in water quality variables nor any mortality. The concentration of 10mg L-1 EOOG improved the oxidative status. It can be concluded that EOOG can be used for anesthesia and transport of C. macropomum.

The Effect of Unemployment on Health in Russia: a Systematic Literature Review (2015‑2023)

The influence of unemployment on health is widely discussed in the economic literature. However, the question about the negative direct effect or the deterioration of health of the unemployed population remains open in the context of the existence of a reverse effect — the influence of health on employment. This study aims to assess the statistical associations between unemployment and health status, as well as to identify direct and reverse effects in this relationship in the Russian studies. The authors use a systematic literature review as the main research method. The search is conducted in Elibrary, Cyberleninka and Google Scholar databases to find published works on the research topic in 2015-2023 for men and women of working age. The full-text search identified fifteen publications that were included in the systematic review. The selected papers used self-rated health, mental health, cardiovascular health, and general well-being as health indicators. All studies confirmed the presence of statistically significant negative associations between the “unemployed” status and health. At the same time, employed respondents of both sexes reported good health one and a half times more often than unemployed individuals. Nine studies presented econometric models linking the labor market status variables to health. Of these, only one paper estimated direct and reverse effects for a mental health variable. There was no direct effect estimate for the self-rated health. This gap in the literature will be addressed by the authors in their next article using the matching method. If the assessment of the direct effect is negative, the authors plan to develop a series of policy recommendations to improve the health of unemployed and economically inactive individuals at the regional and federal levels. Due to the innovative approach, this study is of a great value to the research in health economics.

The (Lack of) Progress in Accountancy Professionalisation: Insights from Non‐accountants in Portugal

Concerns about the success of professional accountancy in terms of its social dimension have been expressed in the literature. This study uses data from a questionnaire survey administered to a Portuguese community sample to provide insights for a better understanding of the social dimension of professional accountancy at the macro level. It examines how lay society in accounting posits accountants along the social judgement variables of status, competition, competence and warmth and tests these variables’ influence on accountants’ social image using structural equation modelling. The results indicate that status, competition, competence and warmth are all critical factors in constructing the social image of modern accountants. Accountants are perceived as modestly warm, highly competent and a cooperative lower middle‐class group. These findings confirm the profession's difficulties in enhancing accountants’ perceived social standing and reinforce the view of limited social mobility in the accountancy profession. The high level of competence identified suggests weak social power in the case of accountancy. Future research may investigate how soft skills and networking abilities in the perceived prototype of competence can promote the higher social standing of the accountancy group.

Propensity score analysis for health care disparities: a deweighting approach

BackgroundPropensity score weighting is a useful tool to make causal or unconfounded comparisons between groups. According to the definition by the Institute of Medicine (IOM), estimates of health care disparities should be adjusted for health-status factors but not for socioeconomic status (SES) variables. There have been attempts to use propensity score weighting to generate estimates that are concordant with IOM’s definition. However, the existing propensity score methods do not preserve SES distributions in minority and majority groups unless SES variables are independent of health status variables.MethodsThe present study introduces a deweighting method that uses two types of propensity scores. One is a function of all covariates of health status and SES variables and is used to weight study subjects to adjust for them. The other is a function of only the SES variables and is used to deweight the subjects to preserve the original SES distributions.ResultsThe procedure of deweighting is illustrated using a dataset from a right heart catheterization (RHC) study, where it was used to examine whether there was a disparity between black and white patients in receiving RHC. The empirical example provided promising evidence that the deweighting method successfully preserved the marginal SES distributions for both racial groups but balanced the conditional distributions of health status given SES.ConclusionsDeweighting is a promising tool for implementing the IOM-definition of health care disparities. The method is expected to be broadly applied to quantitative research on health care disparities.

Deep-Reinforcement-Learning-Based Vehicle-to-Grid Operation Strategies for Managing Solar Power Generation Forecast Errors

This study proposes a deep-reinforcement-learning (DRL)-based vehicle-to-grid (V2G) operation strategy that focuses on the dynamic integration of charging station (CS) status to refine solar power generation (SPG) forecasts. To address the variability in solar energy and CS status, this study proposes a novel approach by formulating the V2G operation as a Markov decision process and leveraging DRL to adaptively manage SPG forecast errors. Utilizing real-world data from the Korea Southern Power Corporation, the effectiveness of this strategy in enhancing SPG forecasts is proven using the PyTorch framework. The results demonstrate a significant reduction in the mean squared error by 40% to 56% compared to scenarios without V2G. Our investigation into the effects of blocking probability thresholds and discount factors revealed insights into the optimal V2G system performance, suggesting a balance between immediate operational needs and long-term strategic objectives. The findings highlight the possibility of using DRL-based strategies to achieve more reliable and efficient renewable energy integration in power grids, marking a significant step forward in smart grid optimization.

Associations between housing and psychological damage by earthquake and modifiable risk factors for dementia in general older adults: Tohoku Medical Megabank community-based cohort study.

To evaluate the association between housing and psychological damage caused by the Great East Japan Earthquake (GEJE) and modifiable risk factors (MRFs) of dementia for general population of older adults. This cross-sectional study enrolled 29 039 community-dwelling older adults (mean age 69.1 ± 2.9 years, 55.5% women). We evaluated disaster-related damage (by complete or not complete housing damage) and psychological damage (by post-traumatic stress reaction [PTSR]) after the GEJE using a self-report questionnaire. MRFs encompassed the presence of depression, social isolation, physical inactivity, smoking, and diabetes. We examined the association between disaster-related damage and MRFs using ordinary least squares and modified Poisson regression models adjusted for sociodemographic and health status variables. Complete housing damage and PTSR were identified in 2704 (10.0%) and 855 (3.2%) individuals, respectively. The number of MRFs was significantly larger for the individuals with complete housing damage (β = 0.23; 95% confidence interval [CI]: 0.19-0.27) and PTSR (β = 0.60; 95% CI: 0.53-0.67). Prevalence ratios (PRs) for depression and physical inactivity were higher in individuals with complete housing damage. The PRs for all domains of the MRFs were significantly higher in individuals with PTSR. Housing and psychological damage caused by the GEJE were associated with an increased risk factor of dementia. To attenuate the risk of dementia, especially among older victims who have experienced housing and psychological damage after a disaster, multidimensional support across various aspects of MRFs is required. Geriatr Gerontol Int 2024; 24: 509-516.

Abstract PS09-04: The benefit of adjuvant pertuzumab and trastuzumab according to estrogen receptor and HER2 expression: sub-analysis of the APHINITY trial

Abstract Background: Some studies suggest that response to HER2-targeting agents may differ according to estrogen receptor (ER) and HER2 expression levels. This study aimed to investigate the magnitude of benefit from the addition of pertuzumab to trastuzumab and chemotherapy according to ER and HER2 expression levels in the APHINITY trial. Methods: APHINITY (NCT01358877; BIG 4-11) was a randomized, double-blind, phase III study comparing the addition of pertuzumab or placebo to adjuvant trastuzumab and chemotherapy in an ITT population of 4804 patients with HER2-positive early breast cancer. The primary objective of this exploratory, unplanned analysis was to compare whether the addition of pertuzumab to trastuzumab had an impact in invasive disease-free survival (IDFS) within different subgroups defined by HER2 FISH amplification ratio and/or ER percentage of positivity on immunohistochemistry (IHC) (centrally assessed). Patients with a FISH ratio less than 2 were excluded from this analysis, leaving 4782 patients. IDFS was defined as the time from randomization until the date of the first occurrence of an IDFS event. HER2 FISH amplification ratio was categorized as low (2≤ FISH ratio &amp;lt; 5) vs. high (FISH ratio ≥5). ER expression on IHC was categorized as negative ( &amp;lt; 1%) vs. positive (≥1%). A subgroup analysis using Cox proportional hazards regression models was used to model IDFS, assessing four categories formed by cross classifying the FISH ratio and ER groups. The model was adjusted for randomized arm, adjuvant chemotherapy regimen received, and a combined variable of nodal status and protocol version. Results: The 4782 patients had a median age of 51 years old (IQR 44-59), with a median follow up time of 73.6 months (IQR 63.0-75.2). Most patients received an anthracycline-based chemotherapy (n=3712, 77.6%). ER expression was positive in 3047 patients (63.7%). HER2 FISH amplification ratio was high in 2479 patients (51.8%). All FISH ratio/ER subgroups seem to derive IDFS benefit from the addition of pertuzumab (HR &amp;lt; 1) (Table 1). The HER2 FISH ratio-low/ER positive subgroup had the largest reduction in risk of an IDFS event, 30% for the pertuzumab arm (HR=0.70, 95% CI 0.51-0.95) versus placebo. Smaller differences in IDFS events were observed between the treatment arms in the other subgroups. The subgroup of tumors with HER2 FISH ratio-high/ER-negative expression showed the numerically smallest benefit in IDFS events with the addition of pertuzumab (HR 0.85, 95% CI 0.59-1.25), see Table 1. Conclusions: In this APHINITY sub-analysis, patients treated with pertuzumab/trastuzumab derive similar benefit regardless of ER and HER2 expression levels. More research is needed to find predictive biomarkers to escalate or de-escalate treatments. Table 1. Abbreviations: FISH: fluorescence in situ hybridization, ER: estrogen receptor; IDFS: invasive disease-free survival; CI: confidence interval; HR: hazard ratio Citation Format: Evandro de Azambuja, Elisa Agostinetto, Faye Samy, Serena Di Cosimo, Philippe Aftimos, Noam Pondé, Daniel Eiger, Matteo Lambertini, David Cameron, Astrid Kiermaier, Andrew Bailey, Giuseppe Viale, Sherene Loi, Martine Piccart. The benefit of adjuvant pertuzumab and trastuzumab according to estrogen receptor and HER2 expression: sub-analysis of the APHINITY trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS09-04.

Association between Waist-Hip Ratio and Female Infertility in the United States: Data from National Health and Nutrition Examination Survey 2017–2020

Introduction: Obesity has previously been correlated with an elevated risk of reproductive system diseases in women. The waist-hip ratio (WHR) has been shown to be correlated with visceral fat, making it one of the most commonly used indicators of abdominal obesity. However, little is known about the relationship between WHR and infertility. Therefore, the aim of this study was to evaluate the effect of the WHR on infertility in women of childbearing age. Methods: The study used cross-sectional data from women aged 20–45 who participated in the National Health and Nutrition Examination Survey (NHANES), which was conducted between 2017 and 2020. We collected details of their waist circumference, hip circumference, fertility status, and several other essential variables. We used multivariate logistic regression analysis and subgroup analyses to assess the association between WHR and infertility. Results: There were 976 participants, with 12.0% (117/976) who experienced infertility. After adjusting for potential confounding factors, our multivariate logistic regression analysis revealed that every 0.1 unit increase in WHR resulted in a more than 35% higher risk of infertility (odds ratio [OR; 95% confidence interval [CI]: 1.35 [1.01∼1.81], p = 0.043). Compared to the group with WHR <0.85, the risk of infertility increased in the group with WHR ≥0.85, with an adjusted OR of 1.74 (95% CI: 1.06∼2.85). When WHR was treated as a continuous variable, it was observed that each 0.1 unit increase in WHR was associated with a relatively high risk in the secondary infertility population after adjusting all covariates, with an OR of 1.66 (95% CI: 1.14∼2.40, p = 0.01). When WHR was analyzed as a categorical variable, the group with WHR ≥0.85 exhibited a significantly higher risk of secondary infertility than the group with WHR <0.85, with the OR of 2.75 (95% CI: 1.35–5.59, p = 0.01) after adjusting for all covariates. Furthermore, the interaction analysis indicated that there was a significant interaction between age status on WHR and the risk of infertility. Conclusion: WHR showed a positive correlation with the risk of infertility. This study highlights the importance of effectively managing abdominal fat and promoting the maintenance of optimal WHR levels to mitigate the progression of infertility, particularly for younger women.

Extended-SpectrumBeta-LactamaseProducingEscherichia coli in Raw Cow Milk At Selling Points and Determinants of Contamination in and Around Chencha, Southern Ethiopia.

Bacterial foodborne infections are a major public health concern globally, and the emergence of antimicrobial-resistant bacteria in food worsens the associated problems which are alarming issues. The current study aimed to isolate E. coli, determine antimicrobial resistance patterns, estimate the prevalence of extended-spectrum beta-lactamase-producing E. coli, and determinants of raw cow milk contamination at selling points in and around Chencha, Southern Ethiopia from January 2021 to April, 2022. A total of 384 milk samples were collected randomly using a cross-sectional study and processed in the laboratory for evaluation of microbial load, bacterial isolation, and antimicrobial susceptibility patterns. The determinants were assessed through a prepared questionnaire, and descriptive statistics and multivariable logistic regression analysis were performed using SPSS version 21. Out of 384 milk samples analyzed for microbial loads, 5.3±1.68 log and 2.17±1.51 log CFU/mL respectively were the mean values of total viable count and total coliform count. A total of 118 (30.7%) samples were contaminated with E. coli of about 11.8% extended-spectrum beta-lactamase producers. Notably, 91 (77.1%) of isolates were multiple drug-resistant isolates. The multivariable logistic regression showed that variables of educational status of milk handlers, hand washing activities, nose picking habit of milk handlers, milk container cleaning activity, milk container type, physical abnormal milk checking status, and attended training on hygienic food handling practices type were significantly associated with the milk contamination in the study area. The results implied that the raw milk samples served in the study area contained bacterial pathogens and a higher microbial load than recommended standards. Our data also confirmed the presence of multiple drug resistant and extended-spectrum beta-lactamase producing E. coli. Therefore, a close follow-up and training of milk handlers is needed. Besides, consumers should be made aware of the risks of consuming raw milk.

Determinants of Mortality in Primigravida in Peoples Medical College Nawabshah.

Objective: To determine the determinants of maternal mortality in primigravida. Methodology: This cross-sectional, descriptive study was conducted from June 2023 to Dec 2023 at the department of Gynecology and Obstetrics of Peoples University of Medical &amp; Health Sciences for women, Nawabshah; a tertiary care center. We studied overall causes of death (direct and indirect) during pregnancy, delivery, and puerperium. Those patients who died after admission were included and analyzed on specially designed proforma. Information collected from hospital records/patient attendants. The reason for admission, status at arrival, cause of death, and potential variables answerable for death were recognized. Data including age, booking status, parity, gestational age, and relevant variables from the current pregnancy, along with the traveling distance from the clinic, was recorded on Performa, and analyses were done on SPSS adaptation 25. Results: During study period 43 maternal deaths occurred in their first pregnancy. The live birth rate was 10020. MMR counted to 429 per lac live birth. Most frequent death occurs at 19 years of age, from the rural population (62%), the majority un-booked (72%), history of domestic violence (48%) was not uncommon. Among these primigravida; 60% having no formal education, 65% were referral cases presented with obstetrical complication and in labor (34.9%). Almost all deaths were due to direct causes (99%). The highest contribution was by hemorrhage 39.5% (PPH=27.9%+ APH 11.6%), followed by sepsis (27.9%), pre-eclampsia/ eclampsia (18.6%), pulmonary embolism (7%), while 4.7% deaths due to unsafe abortion in early pregnancy complications. We found only 2.3% of deaths due to indirect causes. CONCLUSION: It is crucial to highlight that tackling maternal mortality requires a comprehensive strategy, which encompasses enhancing healthcare infrastructure, guaranteeing access to high-quality prenatal and obstetric care, advocating for education and awareness, and tackling social determinants of health. Recognizing and dealing with these factors can help decrease maternal mortality rates for all expectant mothers, including primigravidae. Key words: Primigravida, Maternal Mortality Rate, antenatal care, Obstetric emergency.

THE EFFECT OF PATIENT EXPECTATIONS AND SATISFACTION ON REGIONAL TRUST IN HEALTH TOURISM: A PRIVATE HOSPITAL EXAMPLE

In this study, the effect of health tourists' expectations and satisfaction on their sense of trust in Turkey was examined. In line with the purpose of the research, the sample of the study consists of 178 patients whose structure was determined by the simple random sampling method among the patients in the institution in order to receive health care services. The data were analyzed with the SPSS program. 52.8% of the 178 tourists participating in the research were female and 47.2% were male. In terms of the age variable, 41.6% of the tourists were between the ages of 18-30, 36.5% were between the ages of 31-45, and 21.9% were aged 46 and over. When the educational status variable of the tourists is examined, it was determined that 42.7% of them are primary school graduates, 14.6% were high school graduates, 33.1% were university graduates, and 9.6% were master's and doctorate degrees. As a result of the analysis, it has been determined that meeting the expectations and satisfaction of the participating health tourists has a statistically significant and positive effect on the sense of trust in Turkey. In line with these results, as the expectations of the patients are met and their satisfaction increases, their confidence in Turkey increases

A STRUCTURAL EQUATION MODELING WITH WELFARE INDICATORS: EXAMINING THE RELATIONSHIP BETWEEN SOCIOECONOMIC STATUS, ACCESS TO SERVICES AND MATERIAL DEPRIVATION

This study aims at presenting comprehensive model using welfare indicators such as socioeconomic status, access to services and material deprivation, and examining the relationships between these variables. In the analysis, we use the pooled cross-sectional data set of the Household Budget Survey of the Turkish Statistical Institute (TURKSTAT) covering the period 2015-2019. Since the simultaneous relationship between welfare indicators such as socioeconomic status, material deprivation and access to services is examined using latent variables, Structural Equation Modeling is preferred. The study finds that socioeconomic status, composed of education and income, increases households' access to services and decreases their material deprivation. In addition, as households' access to services increases, their material deprivation decreases. Our study also finds that women's socioeconomic status is lower than men's in Turkiye during the period analysed. Moreover men in households have more limited access to services and face more material deprivation than women. The increase in household size makes access to services more difficult, worsens the socioeconomic situation and increases deprivation. Considering the health status variable, it is concluded that healthy individuals have higher socioeconomic status and suffer from less deprivation.

Immunization Status, Parenting Style, and Posyandu Activeness on Wasting Incidents in Toddlers

In 2020 there were 15 cases of wasting (1,5%), in there were 41 cases of wasting (4,9%) and in 2022 there were 46 cases of wasting (5,4%) at the Kesugihan Health Center. Therefore the purpose of this study was to analyze the influence of immunization status, parenting style and Posyandu activity on wasting in toddlers in the Work Area of ??the Pulung District Kesugihan Health Center, Ponorogo Regency. This study used an observational analytic method with a case control approach. The population in this research was 54, while the subjects were 27 case subjects and 27 controls using a purposive sampling method. Furthermore, the data collected will be analyzed using univariate, bivariate analysis with chi-square test and multivariate analysis using logistic regression. The results of the bivariate analysis showed that the variables of posyandu activity and mother's parenting style had a relationship with wasting in toddlers. Meanwhile, the immunization status variable has no relationship with the incidence of wasting in toddlers. Meanwhile, based on the results of the multivariate analysis research, it shows that the variables of Posyandu activity and parenting patterns have an influence on the incidence of wasting in toddlers.

Comparative Study of Life Satisfaction, Adversity Quotient and Self-concept in Working and Non-working Women

This ex-post facto study examines the relationship between employment status and psychological variables - life satisfaction, adversity quotient, and self-concept - among married women aged 35-45 in semi-urban and urban areas of India. Utilizing purposive sampling with the snowball method, data were collected from 76 working women and 76 non-working women who met specific inclusion criteria. Assessment tools included the Satisfaction with Life Scale (SWLS) for life satisfaction, the Adversity Response Profile (ARP) for adversity quotient, and the Mohsin Self-Concept Inventory (MSCI) for self-concept. Analysis involved one-way analysis of variance (ANOVA). Results revealed significant differences in both life satisfaction and self-concept between working and non-working women, with employed individuals reporting higher levels of satisfaction and self-concept. However, no significant difference was observed in adversity quotient between the two groups. These findings suggest that employment status may influence various aspects of psychological well-being differently among women in India. Implications for policy and intervention strategies aimed at enhancing women's overall well-being are discussed.