Multistage Stratified Sampling Research Articles

Variations in out-of-pocket spending and factors influencing catastrophic health expenditure of households with patients suffering from chronic conditions in four districts in Sri Lanka

IntroductionHealthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage.ObjectiveWe aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts.Methods A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05.ResultsCommon NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals.ConclusionsPatients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications.

Disordered eating attitude and associated factors among late adolescent girls in Gondar city, northwest Ethiopia: a community-based cross-sectional study.

Disordered eating attitudes are characterized by abnormal beliefs, thoughts, and feelings regarding food and weight control. Dieting, intentional weight loss, and weight control affect 41-62% of girls worldwide. However, there is limited information related to disordered eating attitudes and associated factors among late adolescent girls in Ethiopia, including in the study area. Thus, the study aimed to assess disordered eating attitudes and associated factors among late adolescent girls in Gondar city, northwest Ethiopia. For this community-based cross-sectional study, which was conducted from 26 June to 26 July 2022, in Gondar city, Ethiopia, 1,188 adolescent girls were included. Multistage stratified sampling followed by a systematic random sampling technique was applied to recruit participants for the study. Data were collected using an interviewer-administered questionnaire containing the Eating Attitudes Test-26 (EAT-26). Anthropometric measurements were also taken. Bivariable and multivariable logistic regressions were employed to identify factors associated with disordered eating attitudes. In the final model, variables with a p-value of < 0.05 were considered statistically significant. A total of 1,158 late adolescent girls (a response rate of 97.5%) participated in the study. The prevalence of disordered eating attitudes among late adolescent girls was 9.7% [95% confidence interval (CI): 7.96, 11.4%]. Having a mother who was unable to read and write [adjusted odds ratio (AOR): 3.88 (95% CI: 1.07, 14.11)], having a mother who could read and write [AOR: 4.31: (95% CI: 1.14, 16.24)], having a father who only attended primary school [AOR: 3.78 (95% CI: 1.33, 10.78)], having severe anxiety [AOR: 3.26 (95% CI: 1.42, 7.49)], and severe usage of social media [AOR: 2.80 (95% CI: 1.22, 6.46)] were factors significantly associated with disordered eating attitudes among late adolescent girls. This study revealed that disordered eating attitudes among late adolescent girls were relatively high. The educational status of parents, anxiety, and severe usage of social media were positively associated with disordered eating attitudes. Therefore, nutritional education for parents of adolescents who are vulnerable to unhealthy behavior is imperative. The finding also implied the importance of an inclusive strategy to mitigate the emerging problem of targeting vulnerable groups.

Correlation analysis of myopia and dietary factors among primary and secondary school students in Shenyang, China

Currently, the global prevalence of myopia is high and on the rise, seriously affecting the health of students. Studies have suggested that dietary factors may be associated with the occurrence and development of myopia, but the results are inconsistent. This survey aims to analyze the correlation between dietary factors and myopia while controlling for more confounding factors. A multi-stage stratified cluster sampling method was performed to select 10,619 primary and secondary school students in Shenyang for visual examination, and questionnaires were administered to 6974 of them. Logistic regression was performed with myopia as the dependent variable and the variables with p < 0.1 in the univariate analysis as independent variables. Sensitivity analysis was conducted using propensity score matching. The results showed that the overall prevalence of myopia among primary and secondary school students in Shenyang was 59.1%, with mild myopia predominating. Students who ate fresh fruits two or more times a day had a 0.69 times lower risk of myopia compared to those who did not eat fruits (95% CI 0.50–0.97). However, subgroup analysis demonstrated that this protective effect was only significant for male students, with an OR of 0.59 (95% CI 0.38–0.91). Moreover, female students who consumed sugary beverages once or more a day had a 1.8 times higher risk of myopia compared to those who did not consume sugary beverages (95% CI 1.03–3.15). Vegetable consumption, intake of fried foods, and breakfast habits were not significantly associated with myopia. In summary, excessive consumption of sugary beverages could increase the risk of myopia, especially in female students, whereas fruit intake contributed to reducing the risk of myopia, particularly in male students.

Role of Iodine Status and Lifestyle Behaviors on Goiter among Children and Adolescents: A Cross-Sectional Study in Zhejiang Province, China.

Iodine deficiency is a well-established cause of goiter, while the impact of lifestyle factors on goiter development remains underexplored. The study aims to explore the associations between iodine status, lifestyle factors, and the prevalence of goiter among children and adolescents in Zhejiang Province, China. A cross-sectional survey was conducted in 2022 using a stratified multistage sampling, involving 2261 children aged 6-17. Among these 1562 participants underwent both urinalysis and thyroid ultrasound. Lifestyle factors were assessed through self-reported questionnaires. The prevalence of goiter in the study population was 10.8%. A high urinary iodine concentration (UIC) (>300 μg/L) was significantly associated with a decreased risk of goiter (OR = 0.49, 95%CI: 0.27-0.88). Excessive recreational screen time and a high frequency of dining out were associated with an increased Tvol, while adequate physical activity and sleep were inversely associated with goiter risk, while the combined effect of high UIC and healthy lifestyle showed a protective effect against goiter. Ensuring adequate iodine status and promoting healthy lifestyles are crucial for preventing goiter and enhancing thyroid health in children and adolescents, suggesting that public health strategies should integrate nutritional and lifestyle interventions.

Protocol of health screening related to occupational diseases in 100 000 workers in critical sectors: a cross-sectional study with worksite risk assessment

BackgroundOccupational diseases are one of the most important health problems related to employment However, in Malaysia, there are few epidemiological studies discussing these issues, especially among workers in the industry....

Prevalence of video gaming disorder in Saudi Arabia: a school-based national study

BackgroundVideo gaming is a popular leisure activity among adolescents. Those who play excessively are in danger of educational and social drawbacks and may become addicted to video gaming. Several published studies determined the prevalence of GD among children in specific Saudi regions. However, the current study assessed the national prevalence of video gaming disorder (GD) and its risk factors among school students in Saudi Arabia.MethodsA school-based survey was conducted among adolescents in all regions of Saudi Arabia during the academic year 2021–2022. A multistage stratified cluster sampling technique was used to select the school students. An Arabic-validated version of the 9-item dichotomous (yes/no) GD Scale based on the DSM-5 criteria was used to determine GD prevalence among the students. The score ranged from zero to nine (0–9). Participants who scored five or more were deemed as having GD. Students who scored less than five were classified as normal gamers (score 0–1) or risky gamers (score 2–4).Results We recruited 5332 school students. Their mean age was 15.5 ± 1.7 years, and almost half of them were males (50.7%). According to the GD score, the prevalence of normal gamers was 39.08% (N = 1714), risky gamers 40.47% (N = 1775), and those with GD was, 20.45% (N = 897). Logistic regression was performed to determine the association between video gaming disorder and all the gathered variables, which include age, educational grade, sex, types of video gaming, and categories of video games played. The results showed that nationality, age, educational grade, sex, using only mobile devices to play, and playing puzzle and sports games were not associated with video gaming disorder. On the other hand, it was revealed that using tablets, game consoles, PCs; having multiple devices; and playing online, fighting, car racing, war, and adventure games were significantly linked to GD.ConclusionThe prevalence of GD was 20.45% among Saudi school students who play video games. Utilizing more than one type of gaming device and playing games in the fighting, war, and multiplayer categories via an online connection were significantly linked to having GD. To limit video gaming addiction, we encourage screening, diagnosing, and treating disordered video gamers early. In addition, governmental authorities and video game companies should discuss and revise numerous policy measures to minimize the accessibility of video games, limit the harms and risks related to them, and assist video gamers in becoming effective members of society.

Demographic and socioeconomic disparity in knowledge, attitude, and practice towards tuberculosis in Northwest, China: evidence from multilevel model study

BackgroundTuberculosis (TB) remains a serious global public health problem in China. The right knowledge, attitude, and practice (KAP) towards TB are indispensable to appropriate healthcare-seeking behaviors and treatment services timely. However, there are few studies that addressed the KAP towards TB in high-risk and under-developing regions in China. This study aims to evaluate the KAP towards TB in Ningxia Northwest, China, and identify factors that influence it. The findings can guide future health education and promotion interventions.MethodsA stratified multistage random sampling method was used to conduct a face-to-face questionnaire survey with 33 items for selected residents. The composite score of Knowledge, Attitudes, and Practices (KAP) was divided into two groups, which are poor (scores below the average) and good (scores above the average). A two-level logistic model with a random intercept equation accounted for the similarity of residents within communities to examine the association between individual-level KAP and demographic and socioeconomic factors.ResultsA total of 2,341 residents were recruited, the mean age was 50, and 41.2% were female. The percentages of residents who were total awareness of TB knowledge and had positive attitudes and behavior toward TB were 51.9%, 75.3%, and 76.2%, respectively. The two-level logistic model demonstrated that residents with a high annual family income, urban living, primary school education or higher, occupation of teacher or doctor, a very good self-perceived status, medical insurance, knowing DOTS, and family members or friends with TB history had better knowledge of TB (P < 0.05). Residents living in urban areas, with junior and senior high school education, a very good self-perceived status, health insurance, knowing DOTS, and family members or friends with TB history had positive attitude of TB (P < 0.05). Residents living in urban areas, a primary school education or higher, occupation of teacher, doctor and workers, a very good self-perceived status, medical insurance, knowing DOTS, and family members or friends with TB history had positive practice of TB (P < 0.05).ConclusionsFavorable demographic (higher education levels, teachers or doctors) and socioeconomic (high income, living in urban area) factors are associated to better knowledge, attitudes and practices toward TB in Northwest China. Interventions to improve KAP at the community level are required to speed up the TB reduction rate, which may benefit to ensure the End TB Strategy will be achieved.

HIV knowledge, sexual attitudes, and PrEP-Eligible behaviors among college students in Southwest China: a cross-sectional study

BackgroundThere is an increasing number of human immunodeficiency virus (HIV) reported cases among students in Southwest China. However, the data on HIV/sex-related knowledge, attitude toward sex, sexual behaviors, and correlates of pre-exposure prophylaxis (PrEP)-eligible behaviors among college students in this area is still limited. This study aimed to assess the prevalence of HIV/sex-related knowledge, sexual attitudes, sexual behaviors, and factors associated with PrEP-eligible behaviors among college students.MethodAn online survey from 2020 to 2021 based on a multistage stratified and cluster sampling method was conducted among college students in Southwest China, and a well-designed questionnaire collected data. Propensity score matching (PSM), logistic, and log-binomial regression were used to identify the determinants of PrEP-eligible behaviors.ResultA total of 108,987 students participated in the survey, and 92,946 provided valid responses. 91.6% (85,145/92,946) had good HIV-related knowledge, while only 26.0% (24,137/92,946) reported awareness of sex-related knowledge. Furthermore, more than half of the participants (64.5%) held negative stances towards engaging in “one-night stand”, and 58.9% (617/1,047) reported PrEP-eligible behaviors. Log-binomial regression analysis indicated that unaware of HIV-related knowledge (aPR = 1.66, 95% CI:1.22–2.26, P = 0.001), not discussing about sex with their parent(s) (aPR = 1.16, 95% CI:1.01–1.33, P = 0.021), not receiving sex-related education in school(aPR = 1.24, 95% CI: 1.07–1.45, P = 0.005), not participating in HIV/AIDS prevention activities in the past year (aPR = 1.32, 95%CI:1.09–1.60, P = 0.004), experiencing forced sex (aPR = 2.08, 95% CI: 1.19–3.63, P = 0.010), and having the drug abuse (aPR = 22.21, 95% CI:5.59–88.31, P < 0.001) were significantly associated with increased odds of PrEP-eligible behaviors.ConclusionCollege students in Southwest China exhibited suboptimal HIV/sex-related knowledge, received limited sex education, reported conservative attitudes towards casual sex, and significant PrEP-eligible behaviors. These findings suggest that sexually experienced college students who were unaware of HIV-related knowledge, lacked sex education, experienced forced sex, and reported drug abuse were the key individuals for evaluating eligibility for PrEP initiation, and interventions aimed at increasing awareness of HIV/sex-related knowledge, promoting participation in sex education, addressing issues related to forced sex and tackling drug abuse could contribute to reducing the incidence of PrEP-eligible behaviors among college students.

Estimating the Effect of Disclosure of Patient Safety Incidents in Diagnosis-Related Patient Safety Incidents: A Cross-sectional Study Using Hypothetical Cases.

Disclosure of patient safety incidents (DPSIs) is a strategic measure to reduce the problems of patient safety incidents (PSIs). However, there are currently limited studies on the effects of DPSIs on resolving diagnosis-related PSIs. Therefore, this study aimed to estimate the effects of DPSIs using hypothetical cases, particularly in diagnosis-related PSIs. A survey using 2 hypothetical cases of diagnosis-related PSIs was conducted in 5 districts of Ulsan Metropolitan City, Korea, from March 18 to 21, 2021. The survey used a multistage stratified quota sampling method to recruit participants. Multiple logistic regression and linear regression analyses were performed to determine the effectiveness of DPSIs in hypothetical cases. The outcomes were the judgment of a situation as a medical error, willingness to revisit and recommend the hypothetical physician, intention to file a medical lawsuit and commence criminal proceedings against the physicians, trust score of the involved physicians, and expected amount of compensation. In total, 620 respondents, recruited based on age, sex, and region, completed the survey. The mean age was 47.6 (standard deviation, ±15.1) years. Multiple logistic regression showed that DPSIs significantly decreased the judgment of a situation as a medical error (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.79), intention to file a lawsuit (OR, 0.53; 95% CI, 0.42-0.66), and commence criminal proceedings (OR, 0.43; 95% CI, 0.34-0.55). It also increased the willingness to revisit (OR, 3.28; 95% CI, 2.37-4.55) and recommend the physician (OR, 8.21; 95% CI, 4.05-16.66). Meanwhile, the multiple linear regression demonstrated that DPSIs had a significantly positive association with the trust score of the physician (unstandardized coefficient, 1.22; 95% CI, 1.03-1.41) and a significantly negative association with the expected amount of compensation (unstandardized coefficient, -0.18; 95% CI, -0.29 to -0.06). DPSIs reduces the possibility of judging the hypothetical case as a medical error, increases the willingness to revisit and recommend the physician involved in the case, and decreases the intent to file a lawsuit and commence a criminal proceeding. Although this study implemented hypothetical cases, the results are expected to serve as empirical evidence to apply DPSIs extensively in the clinical field.

Childhood maltreatment associated suicidal risk in Chinese children and adolescents: a mediation of resilience

BackgroundExisting evidence suggests that children and adolescents who had experienced childhood maltreatment (CM) are at higher suicidal risk. However, the mediation role of resilience in this association remains unclear. We aim to investigate the mediation via resilience in the associations between CM and three suicidal risk indicators (suicidal ideation, SI; suicidal plan, SP; suicidal attempt, SA) among a large sample of Chinese children and adolescents.MethodsA population-based cross-sectional survey was conducted in southwestern China Yunnan province. A total of 9723 children and adolescents were included and analyzed by using a multi-stage stratified cluster sampling design. Univariate and multivariate logistic regression models were fitted to explore the associations between CM, resilience, and the three suicidal risk indicators, dose-response trends further elucidated by using the restricted cubic splines. Path models were adopted to estimate the mediation of resilience.ResultsThe estimated prevalence rates for one-year SI, SP and SA were 32.86% (95% CI: 31.93–33.80%), 19.36% (95% CI: 18.57–20.16%) and 9.07% (95% CI: 8.51–9.66%). After adjustment, CM significantly associated with all 3 suicidal risk indicators, and the odds ratios (ORs) were 2.13 (95% CI: 1.91–2.37), 2.45 (95% CI: 2.13–2.81), and 3.61 (95% CI: 2.90–4.52) for one-year SI, SP, and SA, respectively. Path models revealed that resilience significantly mediated the associations between CM and the three suicidal risk indicators, and among all dimensions of resilience, family support presented the strongest mediation consistently.ConclusionsOur study results suggest that intervention measures which focusing on improving psychological resilience might be effective in reducing suicidal risk for children and adolescents who had experienced maltreatment. Prospective studies should be done to corroborate our findings.

Awareness of Colorectal Cancer and associated Factors among Adults in Bahir Dar City, Northwest, Ethiopia.

Colorectal cancer (CRC) is characterized by abnormal cancerous division of cells in the colon or rectum. Colorectal cancer (CRC) is the second most prevalent cause of cancer-related deaths worldwide. Therefore, this study aimed to assess awareness of colorectal cancer and its associated factors among adults in Bahir Dar City, Northwest Ethiopia, in 2023. A community-based, cross-sectional study was conducted in Bahir Dar City from April 17 to May 23, 2023. A total of 845 participants were selected using stratified multi-stage sampling. Interviewer administered questionnaire and validated cancer awareness Questionnaire were used to measure awareness of colorectal cancer in adults. In this study, a total of 845 individuals were approached, and 839 participated, with a response rate of 99.2%. Out of 839 respondents, 314 (37.4%) of them had a high awareness of colorectal cancer. Being female (AOR (4.6) 95% CI (3.19-6.63), living in urban areas [AOR = 4.74; 95% CI (3.14-7.15)], educational level secondary school [AOR = 2.1 times; 95% CI (1.02-4.32)] and college and above [AOR =22.9; 95% CI (1.13-6.47)], and heard about colorectal cancer [AOR = 4.29; 95% CI (2.96-6.22)] had high awareness of colorectal cancer. The current study revealed that awareness of colorectal cancer was low. Sex, residency, level of education, and hearing about CRC, were associated factors of the awareness of CRC. Therefore, community-based education should be promoted about awareness of colorectal cancer.

Current Situation and Influencing Factors of Kindergarten Teachers' Participation in Training for Preschool Sex Education

Objective To understand the current situation and influencing factors of kindergarten teachers' participation in training for preschool sex education in Luzhou city,and provide a basis for improving the sex education literacy of kindergarten teachers in the future. Methods A multi-stage stratified cluster sampling method was adopted,and a questionnaire survey was conducted from December 2021 to January 2022 on the knowledge,attitude,and practice of preschool sex education among all the teachers in 24 kindergartens in Luzhou city. Results Among the 461 teachers,43.0% had participated in lectures/courses/training activities related to preschool sex education;99.1% hoped to participate in lectures/courses/training activities related to preschool sex education;82.6% learned about child sexual knowledge through school education;75.5% expressed the hope to learn about child sexual knowledge through expert training.The results of multivariate Logistic regression showed that except private kindergartens as an inhibiting factor (OR=0.57,95%CI=0.37-0.87,P=0.008),high monthly income (OR=3.52,95%CI=1.13-9.30,P=0.011),more ways to know about sex education knowledge (OR=2.87,95%CI=1.76-4.70,P<0.001),and social support (OR=1.58,95%CI=1.04-2.38, P=0.030) were promoting factors for teachers to participate in the training for preschool sex education. Conclusion The kindergarten teachers presented a participation rate but a high demand for the training for preschool sex education.They mainly obtain the sex education knowledge from school education.The nature of kindergarten,monthly income of teachers,social support situation,and ways of understanding sex education knowledge are the key factors influencing the teachers' participation in the training for preschool sex education.

Translation and cross-cultural adaptation of the Chinese version of the HLS-EU-Q47.

The development of health literacy in China is relatively slow, and there are fewer health literacy scales, which is difficult to measure. Therefore, this study aims to promote the development of health literacy in China through the translation and application of the European Health Literacy Survey Questionnaire (HLS-EU-Q47). The scale was translated into Chinese, back-translated, culturally adapted and finally subjected to psychometric evaluation. A multi-stage stratified sampling method was used to select 2504 residents to test the reliability and validity of a questionnaire on health literacy. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the validity of the results, and the back consistency was calculated by Cronbach's alpha coefficient. The EFA revealed that health care, disease prevention and health promotion explained 78.68% of the total variance in health literacy. The scale and its subscales demonstrated strong internal consistency, with high Cronbach's alpha coefficients ranging from 0.947 to 0.983. CFA confirmed the three-factor model's goodness-of-fit for the Chinese population. The dimensions of healthcare, disease prevention and health promotion showed high convergent validity with an average variance extracted values ranging from 0.52 to 0.60 and composite reliability values ranging from 0.94 to 0.96. The reliable and valid Chinese version of the HLS-EU-Q47 (HLS19-Q47-CN) developed and evaluated in this study is an important tool for assessing health literacy levels in the Chinese population. Furthermore, as this tool has global applicability, it has the potential to assess health literacy levels across different countries, enabling practical international comparisons.

Negative life events, sleep quality, and depression among older adults in Shandong Province, China: A conditional process analysis based on economic income.

Negative life events have been reported as a risk factor for depression. However, the mechanism between negative life events and depression is still unclear. This study aimed to explore the mediating role of sleep quality and the moderating role of economic income in the association between negative life events and depression among older adults aged 60 years and over. A multi-stage stratified sampling method was used to select elderly individuals over 60 years old in Shandong, China, making use of the Household Health Interview Survey (2020). In total, 3868 older adults completed the measures of negative life events, sleep quality, depression, and economic income. Negative life events positively predicted depression among the elderly (proportion of direct effect, 55.12%), and poor sleep quality could mediate this association (proportion of indirect effect, 44.87%). Economic income played a moderating role in the relationship between negative life events, sleep quality, and depression (the first and second half of the mediating effect, the direct effect of negative life events on depression). Both effects were weaker among the elderly with higher economic incomes. Negative life events had positive effects on depression in older adults. Economic income moderated the direct effect of negative life events and the mediating effect (first and second half) of sleep quality on depression. When the elderly experience negative life events, interventions for improving their sleep quality and financial support could effectively prevent depression. Geriatr Gerontol Int 2024; 24: 751-757.

Impact of Male Migration on the Empowerment of Left-behind Muslim Women in Malappuram, Kerala

Migration has been projected as a force capable of developing economies of the labour exporting nations. In the past, religious orthodoxy among the Muslims in Malabar especially in the Malappuram district prevented women from obtaining higher education and finding employment which restricted their freedom and well-being. However, there have been changes in women's perspectives in reaction to changing needs and situations, for which migration and remittances made by migrants abroad have been the important contributing factors. When the male migrates, the left-behind women have to assume increased responsibilities which increases their control over household resources, mobility and decision-making power and the foreign remittances are utilised by the left-behind women to improve their quality of living, education and information. This article explores the effects of male migration and foreign remittances on the left-behind Muslim women in the Malappuram district through the lens of the Capability approach by constructing the Women’s Capability Index based on a sample survey in the Malappuram district using a Stratified Multi-stage random Sampling method. The study identifies a set of capabilities that are appropriate to the context of male migration and the consequent effect on the left behind women’s living arrangement, provides a framework for efficiently evaluating these capabilities, aggregates the capabilities into a single index, and then validates and tests the index. The Ordinal Logistic Regression, used to analyse the role of migration in the capability expansion of left-behind Muslim women shows that the foreign remittances sent by the husbands from abroad have a positive statistically significant effect on the left-behind Muslim women in the study area, implying that with the increase in the foreign remittances received by the left behind women, their capability also increases, whereas the husband's migrant duration does not have a statistically significant effect on the left-behind Muslim women’s capability

Biopsychosocial factors of quality of life among middle-aged adults living alone in South Korea: a secondary data analysis using the 2017 Korea Community Health Survey

BackgroundThis study aimed to investigate quality of life (QoL) in middle-aged adults living alone and identify comprehensive biological, psychological, interpersonal, and contextual factors related to QoL using the dynamic biopsychosocial model. As a secondary analysis, this study used data from the 2017 Korea Community Health Survey conducted by the Korea Disease Control and Prevention Agency.MethodsAmong the total 228,381 respondents, 10,639 middle-aged individuals aged 40–64 years from single-person households (5,036 men and 5,603 women) were included in the analysis. QoL was measured using the EuroQoL-5 Dimension (EQ-5D). The EQ-5D descriptive statistics were provided according to biological, psychological, interpersonal, and contextual factors. Considering the data structure of the multistage stratified cluster sampling method, a complex samples general linear model statistic was used to identify the predictors of QoL.ResultsQoL was lower in those who had undesirable psychological status (e.g., more depressive symptoms, poor subjective health, and higher perceived stress), less engagement in social networking (less frequent contact with friends and less frequent participation in social activities such as religious activities, friendship gathering, and leisure), and lower physical, behavioral, and socioeconomic factors.ConclusionsThis study’s findings indicate that psychological and interpersonal factors should be addressed and prioritized to improve the QoL of middle-aged adults living alone. By providing many opportunities for easily accessible social activities that meet the needs and interests of this demographic, their QoL can be improved through strengthening social support.

Age at natural menopause and associated factors with early and late menopause among Chinese women in Zhejiang province: A cross-sectional study.

Menopause is a significant life transition for women, impacting their physical and psychological health. The age at natural menopause (ANM) and its associated factors have differed by race and region. This study aimed to investigate ANM and associated factors of early and late menopause among Chinese women in Zhejiang province. A cross-sectional study was conducted using a multi-stage stratified cluster sampling method to recruit 8,006 women aged 40-69 years who had resided in Zhejiang province for over 6 months between July 2019 and December 2021. Self-reported ANM and sociodemographics, lifestyle behaviors, reproductive history, and health-related factors were collected using questionnaires in face-to-face surveys. ANM were categorized into three groups: early menopause (<45 years), normal menopause (45-54 years), and late menopause (≥55 years). Kaplan-Meier survival analysis was utilized to calculate the median ANM. Multivariable multinomial logistic regression was employed to explore the associated factors of early menopause and late menopause. A total of 6,047 women aged 40-69 years were included for survival analysis, with 3,176 of them for the regression analysis. The overall median ANM was 51 years (Inter-quartile range [IQR]: 51-52). Women who were smokers (odds ratio [OR]:4.54, 95% confidence interval [CI]:1.6-12.84), had irregular menstrual cycles (OR:1.78, 95% CI:1.12-2.83) and hypertension (OR:1.55, 95% CI:1.09-2.21) had a higher odds ratio of early menopause, while central obesity (OR:1.33, 95% CI:1.03-1.73) and hyperlipidemia (OR:1.51, 95% CI:1.04-2.18) were factors associated with late menopause. This study revealed the associations between ANM and various factors among Chinese women. These factors included socio-demographic factors such as age; life behavior factors like current or prior smoking status; reproductive history factors such as irregular menstrual cycles, miscarriages, and breastfeeding; and health-related factors like central adiposity, hypertension, and hyperlipidemia. These findings provided a basis for understanding factors associated with ANM.

Harmonizing Traditional Knowledge with Environmental Preservation: Sustainable Strategies for the Conservation of Indigenous Medicinal Plants (IMPs) and Their Implications for Economic Well-Being

The coexistence of traditional knowledge and environmental preservation presents a critical nexus in advancing sustainable development efforts, particularly concerning the conservation of indigenous medicinal plants. These plants play a dual role: they are essential components of traditional healing practices and are integral to economic stability, food security, and nutrition in communities worldwide. However, the rapid depletion of biodiversity and ecosystem degradation threaten the availability and sustainability of these vital resources. Despite their cultural and economic importance, there is a noticeable gap in the research addressing the conservation and sustainable use of indigenous medicinal plants, particularly focusing on the preservation of traditional knowledge systems. The existing literature often lacks comprehensive studies that document traditional knowledge practices related to medicinal plant conservation. Additionally, there is limited understanding of how the mismanagement of medicinal plant resources impacts the livelihoods of rural smallholder farmers who heavily rely on these plants for economic gains and food security. Hence, this study sought to explore and investigate the harmonious strategies that integrate traditional knowledge systems with modern conservation practices to safeguard indigenous medicinal plants on economic well-being in the Amatole District Municipality of the Eastern Cape. The study was conducted in 2023, and a structured questionnaire was used to capture the realities and experiences of prominent stakeholders (smallholder medicinal plant farmers). A multi-stratified sampling technique was used to draw up an appropriate sample of 150 smallholder farmers. Descriptive statistics and propensity-score matching were used for analysis. The study results indicated that the women farmers who are 44 years of average age and have 10 years of average schooling duration participate more in the production of indigenous medicinal plants. The average farm size per household is 1 ha, and it is reliant on an average of five members per household. The participation of women with indigenous medicinal plants underscores the significant role of women in traditional knowledge systems and sustainable agricultural practices, contributing to household income and community resilience. Additionally, the findings indicated that smallholder farmers are only aware of keeping indigenous medicinal plants by producing them in protected areas and on-farm conservation; other measures appear challenging to them. The study results reveal that knowledge of seed propagation, lack of knowledge of the implications of endangerment, the removal of forests with the motive of building houses, and, lastly, financial support were the constraints faced by smallholder farmers. Empirical results on the conservation and sustainable use of indigenous medicinal plants revealed that farmers are generating income to sustain the household as well as enhancing food and nutrition security. Based on the study results, it is recommended that government entities and policymakers are urged to prioritize supporting traditional knowledge, implement on-farm conservation, and foster sustainable agricultural practices to ensure biodiversity conservation, cultural preservation, and sustainable livelihoods. Enhancing targeted support for smallholder farmers, including access to land, agricultural services, and financial aid, alongside market development, ensures equitable benefits and sustainable livelihoods. Educational campaigns should raise awareness about indigenous medicinal plants’ ecological and economic importance, integrating traditional knowledge into formal education.

Trends of diabetes in Beijing, China.

The global rise in diabetes prevalence is a pressing concern. Despite initiatives like "The Healthy Beijing Action 2020-2030" advocating for increased awareness, treatment, and control, the specific situation in Beijing remains unexplored. This study aimed to analyze the trends in diabetes prevalence, awareness, treatment, and control among Beijing adults. Through a stratified multistage probability cluster sampling method, a series of representative cross-sectional surveys were conducted in Beijing from 2005 to 2022, targeting adults aged 18-79 years. A face-to-face questionnaire, along with body measurements and laboratory tests, were administered to 111,943 participants. Data from all survey were age- and/or gender-standardized based on the 2020 Beijing census population. Annual percentage rate change (APC) or average annual percentage rate change (AAPC) was calculated to determine prevalence trends over time. Complex sampling logistic regression models were employed to explore the relationship between various characteristics and diabetes. From 2005 to 2022, the total prevalence of diabetes among Beijing adults aged 18-79 years increased from 9.6% (95% CI: 8.8-10.4%) to 13.9% (95% CI: 13.1-14.7%), with an APC/AAPC of 2.1% (95% CI: 1.1-3.2%, P<0.05). Significant increases were observed among adults aged 18-39 years and rural residents. Undiagnosed diabetes rose from 3.5% (95% CI: 3.2-4.0%) to 7.2% (95% CI: 6.6-7.9%) with an APC/AAPC of 4.1% (95% CI: 0.5-7.3%, P<0.05). However, diabetes awareness and treatment rates showed annual declines of 1.4% (95% CI: -3.0% to -0.2%, P<0.05) and 1.3% (95% CI: -2.6% to -0.2%, P<0.05), respectively. The diabetes control rate decreased from 21.5% to 19.1%, although not statistically significant (APC/AAPC=-1.5%, 95% CI: -5.6% to 1.9%). Overweight and obesity were identified as risk factors for diabetes, with ORs of 1.65 (95% CI: 1.38-1.98) and 2.48 (95% CI: 2.07-2.99), respectively. The prevalence of diabetes in Beijing has significantly increased between 2005 and 2022, particularly among young adults and rural residents. Meanwhile, there has been a concerning decrease in diabetes awareness and treatment rates, while control rates have remained stagnant. Regular blood glucose testing, especially among adults aged 18-59 years, should be warranted. Furthermore, being male, elderly, overweight, or obese was associated with higher diabetes risk, suggesting the needs for targeted management strategies.

Prevalence, severity, and risk factors of eczema among young children and adolescents in Saudi Arabia: A national cross-sectional study, 2019

BackgroundEczema is a common inflammatory skin disease with a significant global health burden. Eczema has a significant impact on quality of life. ObjectiveWe aimed to estimate the prevalence, severity, and risk factors associated with eczema among schoolchildren in Saudi Arabia. MethodsUsing the standardized Global Asthma Network questionnaires and methodology, a nationwide cross-sectional study was carried out across 20 regions in Saudi Arabia between March and April 2019. Data were collected from 137 primary schools and 140 intermediate schools using a multistage stratified cluster sampling method. ResultsThe study included 3614 young children aged 6-7 years and 4068 adolescents aged 13-14 years. Current eczema was prevalent among 4.5% of children and 5.1% of adolescents. Severe eczema was reported in 0.8% and 0.9% of young children and adolescents, respectively. Several factors showed significant association with eczema. Among children, eczema was linked positively to having a history of chest infections and wheezing in early life as well as ever attending day care and current exposure to cats. Among adolescents, the main potential risk factors included paracetamol use in the previous year, adherence to a lifestyle of vigorous physical activity, and current exposure to cats. Conversely, high consumption of nuts was found to be negatively associated with eczema. ConclusionThe prevalence of eczema in schoolchildren in Saudi Arabia is lower than the global average but within the average range for the Eastern Mediterranean region. Further studies should be conducted in Saudi Arabia to identify variation among different regions.