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A limited number of studies have used objective measures to examine the associations between the built environment and physical activity (PA) among older adults. This study aimed to examine geographic information systems-derived neighborhood walkability attributes and accelerometer measured PA in older adults. Data were collected from 124 older Taiwanese adults aged over 60 years (mean age: 69.9). Adjusted multiple linear regression was performed to explore the associations between five neighborhood walkability factors (population density, street connectivity, sidewalk availability, access to destinations, and public transportation) and five metrics of accelerometer-measured physical activity (total PA, moderate-to-vigorous PA, light PA, long moderate-to-vigorous PA bouts, and daily step counts). After adjusting for potential confounders, we found that greater sidewalk availability was positively associated with daily step counts in older adults (β = 0.165; 95% confidence interval: 0.006, 0.412; P = 0.043). No associations between other neighborhood environment attributes and PA metrics were observed. In conclusion, high sidewalk availability in the neighborhood may be supportive for older adults’ daily step counts. Further longitudinal research is needed to establish the causality between the built environment and objectively measured PA in older adults. [ABSTRACT FROM AUTHOR]

Structural and individual level factors in prisons create challenges towards detection and management of HIV/tuberculosis. WHO and India’s HIV/tuberculosis control programs recommend intensified case finding in prisons. Low HIV and tuberculosis detection rates suggest poor implementation of existing surveillance strategies within the prison healthcare system in Mizoram’s capital city of Aizawl. We explored the operational feasibility of implementing the intensified case finding strategy in Aizawl central prison. We implemented the intensified screening through entry screening of new inmates, mass screening of resident inmates and exit screening at release. We set up digital chest radiography, sputum smear microscopy and HIV testing facilities within the prison and referral to external facility for Cartridge Based Nucleic Acid Amplification Test (CBNAAT). We screened 738 inmates (Male: 626; Female: 112). Of 53% inmates having presumptive tuberculosis symptoms, 37% underwent sputum microscopy. We detected 14 new tuberculosis cases; overall tuberculosis positivity 1.9%. We tested 65% of 657 inmates for HIV, of which 41 new cases were detected; overall HIV positivity 16.5%. Three male inmates had HIV-tuberculosis co-infection. It is feasible to implement intensified case detection for tuberculosis/HIV in the prison with inter-departmental coordination, albeit with certain challenges. [ABSTRACT FROM AUTHOR]

Background: There is limited information related to health behaviors and their related factors among young men in rural setting of India. This study was conducted to investigate multiple health risk behaviors and outcomes among young men aged 18–24 years in rural India. Methods: This was a community-based cross-sectional survey conducted in the Ballabgarh block of Faridabad district, Haryana, India. Information regarding socio-demographic details, substance use, injury & violence, mental health and sexual behaviors were collected using a semi-structured interview schedule. Age adjusted prevalence estimates of behaviors and outcomes are computed along with 95% Confidence Intervals. Mediation analysis was carried out to examine relationships between socio-demographic variables, select behaviors and outcomes reported in the study. Results: A total of 836 young men participated in the study, with mean (SD) age of 20.6 (1.9) years. The age-adjusted prevalence (with 95% Confidence Interval) for ever use of tobacco, alcohol, and other substances was 34.2% (33.9, 34.5), 23.4% (23.2, 23.6), and 4.5% (4.4, 4.5), respectively. Loneliness and suicidal thoughts were reported by 237 and 35 youth men with age adjusted prevalence as 28.6%, 95% CI: 28.4–28.8 and 4.3%, 95% CI: 4.23–4.31, respectively. A total of 330 young men met serious injury in past one year (prevalence 39.3%, 95%CI: 39.01–39.67). Almost one-third of men (prevalence 30.6%, 95%CI: 30.34–30.85) had engaged in pre-marital sexual intercourse. Current substance use was found to be significant mediator for associations with socio-demographic variables studied for dependent variables viz. pre-marital sexual intercourse and serious injury. Conclusion: High prevalence of various risk behaviors and outcomes was found in young men aged 18–24 years in our rural setting. It is imperative that multi-component health intervention package be rolled out to address these. [ABSTRACT FROM AUTHOR]

Background: The prevalence of overweightness in Bangladesh is increasing, while underweightness also continues to persist. A better understanding of the patterns and socioeconomic risk factors of both conditions, particularly among women, is critical in order to promote the development of interventions to improve maternal health in Bangladesh. This study therefore sought to assess the patterns of under- and overweightness between 2004 and 2014 and to examine the predictors of individual and community-level inequalities of under- and overnutrition in Bangladesh. Methods: Cross-sectional data of 10, 431, and 16,478 ever-married nonpregnant women aged between 15 and 49 years who did not give birth in the two months preceding the survey were extracted from the 2004 and 2014 Bangladesh Demographic and Health Surveys, respectively. Body mass index was used to measure weight status, and underweightness, at-risk for overweightness, overweightness, and obesity were the main outcome variables. Patterns of nutritional change over time was examined by considering the annual average rate of change. Multilevel multinomial logistic regression and quantile regression were used to identify the inequalities. Results: In 2014, the age-adjusted prevalence values of underweightness, at-risk for overweightness, overweightness, and obesity were 19.7%, 14.9%, 18.1% and 4.0%, respectively. A higher average annual rate of reduction of underweightness was found among wealthier, highly educated, and wealthier community–living women, while a rate of increase of overweightness was found among poorer, uneducated, and poor community–living women. Individual and community-level inequalities of malnutrition were observed among these populations. In comparison with women living in low wealth communities, women from wealthier communities were at an increased risk of being at-risk for overweightness [adjusted odds ratio (AOR): 1.53, 95% confidence interval (CI): 1.23–1.91], overweight (AOR: 1.60, 95% CI: 1.27–2.00), and obese (AOR: 2.12, 95% CI: 1.42–3.18). Conclusions: This study suggests the coexistence of a double burden of under- and overnutrition in Bangladesh and that the prevalence of overweightness surpasses that of underweightness. The burdens of under- and overnutrition are strongly associated with women’s individual socioeconomic positions and the nature of the community in which they live. [ABSTRACT FROM AUTHOR]

Objective: To investigate the cost differences between magnetic resonance-guided focussed ultrasound (MRgFUS) and unilateral deep brain stimulation (DBS) for the treatment of medication-refractory essential tremor (ET) in Japan using a cost-minimisation model. Methods: A cost-minimisation model estimated total costs for MRgFUS and unilateral DBS by summing the pre-procedure, procedure, and post-procedure costs over a 12-month time horizon, using data from published sources and expert clinical opinion. The model base case considered medical costs from fee-for-service tariffs. Scenario analyses investigated the use of Diagnosis Procedure Combination tariffs, a diagnosis-related group-based fixed-payment system, and the addition of healthcare professional labour costs healthcare professionals using tariffs from the Japanese Health Insurance Federation for Surgery. One-way sensitivity analyses altered costs associated with tremor recurrence after MRgFUS, the extraction rate following unilateral DBS, the length of hospitalisation for unilateral DBS and the procedure duration for MRgFUS. The impact of uncertainty in model parameters on the model results was further explored using probabilistic sensitivity analysis. Results: Compared to unilateral DBS, MRgFUS was cost saving in the base case and Diagnosis Procedure Combination cost scenario, with total savings of JPY400,380 and JPY414,691, respectively. The majority of savings were accrued at the procedural stage. Including labour costs further increased the cost differences between MRgFUS and unilateral DBS. Cost savings were maintained in each sensitivity analysis and the probabilistic sensitivity analysis, demonstrating that the model results are highly robust. Conclusions: In the Japanese healthcare setting, MRgFUS could be a cost saving option versus unilateral DBS for treating medication-refractory ET. The model results may even be conservative, as the cost of multiple follow-ups for unilateral DBS and treatment costs for adverse events associated with each procedure were not included. This model is also consistent with the results of other economic analyses of MRgFUS versus DBS in various settings worldwide. [ABSTRACT FROM AUTHOR]

Long working hours and a lack of sleep have been suggested to negatively affect the safety of workers. Here, we examined the association between long working hours/sleep-related problems and near-misses/injuries in industrial settings using a nationally representative sample of workers in Japan. Based on the composition ratio of workers by industry, sex, and age in Japan, data from a web-based cross-sectional survey for 18,682 participant full-time workers (7,098 female and 11,584 male; mean age, 43.7 [standard deviation 11.1] years) were analyzed. Nearly 30% and 5% of participants reported any types of near-misses during the past six months and injuries during the past year, respectively. For all types of near-misses and some types of injuries, a significant difference in frequency distribution was observed by industry. After adjustment for demographic, job-, and life-related variables, participants who worked long hours (i.e., more than 51 hours per week) were more likely to report job-related near-misses/injuries than those who worked 35–40 hours per week. The presence of sleep-related problems was also significantly related to near-misses and injuries. However, while sleep-related problems were significantly associated with near-misses/injuries in all industries, the association between long working hours and near-misses/injuries differed by industry. Odds ratios for near-misses/injuries were strongly significant in the “transport/postal services” industry for those who worked more than 51 hours per week compared to those who worked 35–40 hours per week. Comprehensive protective measures for workers, including (1) reducing total hours of service/job-related fatigue, (2) maintaining sufficient sleep hours/good sleep, and (3) increasing awareness about the impact of overwork/long working hours and sleep-related problems on workers’ safety among employers, workers, clients/customers, and the general public might be effective for preventing near-misses and injuries in industrial settings among workers, especially those who work long hours in the “transport/postal services” industry. [ABSTRACT FROM AUTHOR]

Background: Cultural, environmental and logistical factors promote a sedentary lifestyle within Qatar, particularly for females. Sedentary behaviour is acutely associated with poor cognitive function and fatigue, and chronically may be implicated with cognitive decline (i.e. Alzheimer’s disease). Purpose: To examine the effects of breaking up sitting with short-duration frequent walking bouts on cognitive function and fatigue in Qatari females. Method: Eleven sedentary (sitting ≥7 h/day) females completed three visits; the first being familiarisation. In a cross-over randomised manner, experimental visits two and three were identical, except participants either remained seated for 5-h (SIT) or interrupted their sitting every 30-min with a 3-min moderate-intensity walk (WALK) on a motorised treadmill. The Computerised Mental Performance Assessment System (COMPASS) assessed cognition at baseline (-15-min), and then at 2.5-h and 5-h into the experimental conditions. Specific COMPASS tasks employed were; serial-3 subtractions (2-min), serial-7 subtractions (2-min), simple reaction time (RT; 50 stimuli), rapid visual information processing [RVIP (5-min)], choice reaction time (CRT; 50 stimuli), and Stroop (60 stimuli); and a visual analogue scale for fatigue (VAS-F) was completed at the same time intervals. Results: There was a significant condition effect for CRT (f = 26.7, p = 0.007). On average CRT was 101 s (95% CI = -47 to -156 s) quicker in WALK compared to SIT. There was a significant time effect for CRT (f = 15.5, p = 0.01). On average CRT was 134 s slower at 5-h compared to baseline (p = 0.006; 95% CI = -64 to -203 s), and 114 s slower at 5-h compared to 2.5-h (p = 0.01; 95% CI = -44 to -183 s). There was a significant interaction effect for RT in the Stroop incongruent task (f = 10.0, p = 0.03). On average RT was 210 s quicker at 2.5-h in WALK compared to SIT (p = 0.01; 95% CI = -76 to -346 s). Conclusion: Breaking up prolonged sitting with moderate-intensity walking offers an ecologically valid intervention to enhance some aspects of cognitive function, whilst not affecting fatigue in sedentary Qatari females. Whilst these findings are promising, the long-term effects of breaking up sitting on cognitive function requires testing before population level recommendations can be made. [ABSTRACT FROM AUTHOR]

Background: Residential density was found to be associated with excess body weight among adults in Western societies but it remains unclear in China. We aimed to explore the relationship between residential density and excess body weight among adults in China. Methods: This cross-sectional study was conducted in 2017 in urban areas of Nanjing, China. A multi-stage sampling method was used to randomly select participants aged 35–74 years from 8 urban neighborhoods in Nanjing. Status of excess body weight was the outcome variable which was categorized as "yes (BMI≥24)" or "no (BMI<24)" according to specific recommendations for Chinese adults. Residential density was the main explanatory variable which was grouped into tertiles. Odds ratios (OR) and 95% confidence interval (CIs) were calculated to assess the relationship between residential density and excess body weight using mixed-effects regression models after adjusting for age, sex, education, occupation, marital status, redmeat, smoking, physical activity, diabetic status and potential neighborhood-level clustering effect. Results: A total of 1551 participants were recruited with a response rate of 98.9% (1551/1568). The mean age (standard deviation) of participants was 54.7 (11.1) years, and 46% of them were men. With adjustment for potential influential factors, participants in neighborhoods with lower (OR = 1.38, 95% CI = 1.06–1.81) and middle (OR = 1. 29, 95% CI = 1. 01, 1. 64) tertile of residential density were at significantly higher risk of gaining excess body weight relative to their counterparts in communities with upper tertile of residential density. Such a negative association between residential density and excess body weight was observed for men only after stratified analysis by gender. Conclusions: A negative association between residential density and excess body weight was identified in overall and male urban Chinese adults, and the association was independent of physical activity. Results of our study have important implications in guiding public health policy making regarding prevention of excess body weight at community level via establishment of health-friendly neighborhood environment in China. [ABSTRACT FROM AUTHOR]

Background: Although most Indians live in rural settings, data on cardiovascular disease risk factors in these groups are limited. We describe the association between socioeconomic position and cardiovascular disease risk factors in a large rural population in north India. Methods: We performed representative, community-based sampling from 2013 to 2014 of Solan district in Himachal Pradesh. We used education, occupation, household income, and household assets as indicators of socioeconomic position. We used tobacco use, alcohol use, low physical activity, obesity, hypertension, and diabetes as risk factors for cardiovascular disease. We performed hierarchical multivariable logistic regression, adjusting for age, sex and clustering of the health sub-centers, to evaluate the cross-sectional association of socioeconomic position indicators and cardiovascular disease risk factors. Results: Among 38,457 participants, mean (SD) age was 42.7 (15.9) years, and 57% were women. The odds of tobacco use was lowest in participants with graduate school and above education (adjusted OR 0.11, 95% CI 0.09, 0.13), household income >15,000 INR (adjusted OR 0.35, 95% CI 0.29, 0.43), and highest quartile of assets (adjusted OR 0.28, 95% CI 0.24, 0.34) compared with other groups but not occupation (skilled worker adjusted OR 0.93, 95% CI 0.74, 1.16). Alcohol use was lower among individuals in the higher quartile of income (adjusted OR 0.75, 95% CI 0.64, 0.88) and assets (adjusted OR 0.70, 95% CI 0.59, 0.82). The odds of obesity was highest in participants with graduate school and above education (adjusted OR 2.33, 95% CI 1.85, 2.94), household income > 15,000 Indian rupees (adjusted OR 1.89, 95% CI 1.63, 2.19), and highest quartile of household assets (adjusted OR 2.87, 95% CI 2.39, 3.45). The odds of prevalent hypertension and diabetes were also generally higher among individuals with higher socioeconomic position. Conclusions: Individuals with lower socioeconomic position in Himachal Pradesh were more likely to have abnormal behavioral risk factors, and individuals with higher socioeconomic position were more likely to have abnormal clinical risk factors. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have demonstrated that different weight change patterns from adolescence to adulthood may exert different effects on opportunities from which individuals subsequently benefit. Objectives: This study aimed to investigate the association of weight change patterns from late adolescence to young adulthood with monthly wage in young adulthood for both genders in Taiwan. Methods: A nationally representative retrospective panel of 3730 young people (1707 men and 2023 women) from the Taiwan Educational Panel Survey (2001–2014) was included. Individuals were divided into four weight-change-pattern categories based on changes in their body mass index at two time points that were 7 years apart, between late adolescence (aged 18–19 years) and young adulthood (aged 25–26 years). These categories were (1) no obesity, (2) obesity reversal, (3) developing obesity, and (4) persistent obesity. Cross-classified, hierarchical linear regression modeling analysis was performed to explore the association of weight change patterns with monthly wage in young adulthood, after adjustment for both individual- and contextual-level variables. Results: Of the weight-change-pattern categories for both genders, individuals with persistent obesity had the lowest monthly wage. For women, the mean monthly wage decreased progressively for the categories of no obesity, obesity reversal, developing obesity, and persistent obesity (test for difference, P = 0.016; test for trend, P = 0.026). Women with persistent obesity earned 20% less per month than did those who were never obese (P = 0.024), after controlling for individual and contextual factors. For men, no association was found between weight change patterns and monthly wage. Conclusion: Persistent obesity from late adolescence to young adulthood is associated with low monthly wage in young adulthood in women but not in men. These findings highlight the urgency of addressing persistent obesity early in life, especially for women. [ABSTRACT FROM AUTHOR]

Introduction: Open defecation is ongoing in Nepal despite the rise in efforts for increasing latrine coverage and its use. Understanding the reasons for open defecation would complement the ongoing efforts to achieve the ‘open defecation free’ status in Nepal. This study aimed at exploring different motivations of people who practice open defecation in a village in Nepal. Methods: This study was conducted among the people from the Hattimudha village in Morang district of eastern Nepal, who practiced open defecation. Maximum variation sampling method was used to recruit participants for 20 in-depth interviews and 2 focus group discussions. We adopted a content analysis approach to analyze the data. Results: We categorized different reasons for open defecation as motivation by choice and motivation by compulsion. Open defecation by choice as is expressed as a medium for socializing, a habit and an enjoyable outdoor activity that complies with spiritual and religious norms. Open defecation by compulsion include reasons such as not having a latrine at home or having an alternative use for the latrine structures. Despite having a private latrine at home or access to a public latrine, people were compelled to practice open defecation due to constraints of norms restricting latrine use and hygiene issues in general. For women the issues with privacy and issues refraining women to use the same latrine as men compelled women to look for open defecation places. Conclusion: Open defecation is either a voluntary choice or a compulsion. This choice is closely linked with personal preferences, cultural and traditional norms with special concerns for privacy for women and girls in different communities. The ongoing campaigns to promote latrine construction and its use needs to carefully consider these factors in order to reduce the open defecation practices and increase the use of sanitary latrines. [ABSTRACT FROM AUTHOR]

Background: Effective evidence-based breastfeeding support interventions can bolster breastfeeding practices. This study investigated the effect of a multi-component breastfeeding support intervention delivered in hospital and home settings on six-month exclusive breastfeeding (EBF) relative to standard care. Methods: This is a parallel group, randomized clinical trial, in which 362 healthy pregnant women with singleton pregnancy were randomly allocated to a multi-component intervention that included antenatal breastfeeding education, professional, and peer support, delivered in hospital and home settings for six months (experimental, n = 174), or to standard care (control, n = 188). The primary outcome was six-month EBF rate. Secondary outcomes were exclusive and any breastfeeding rates at one and three months, maternal breastfeeding knowledge, attitude, and behavior at six months, and satisfaction with the intervention. Results: The crude six-month EBF rate was similar in both groups (35.2% vs. 28.1% in the experimental and control groups, respectively, p = 0·16). In adjusted analysis, six-month exclusivity was twice as likely in the experimental group relative to standard care (OR = 2.02; 95%CI: 1.20 to 3.39); whereas the odds for any breastfeeding were similar. Participants compliant with all three components were six times more likely to practice EBF for six months relative to standard care (OR = 6.63; 95% CI: 3.03 to 14.51). Breastfeeding knowledge of the experimental group, at six months, was significantly improved compared to the control. No changes were observed in breastfeeding attitude or behavior. Conclusions: Combining education with peer and professional breastfeeding support improved six-month breastfeeding exclusivity and knowledge. [ABSTRACT FROM AUTHOR]

Background: Lead, mercury, cadmium and arsenic are the priority heavy metals of major public health concern in industrialized countries. Exposure to them can cause cognitive impairment and depressive disorders through an effect on Brain-derived neurotrophic factor (BDNF) which is an important biomarker of pregnancy. Despite a number of prior studies on heavy metals pollution, there is few of studies on the effect of heavy metals on BDNF during early pregnancy. This study aims to examine the association between maternal blood heavy metals concentrations and BDNF during the first trimester pregnancy among Myanmar migrants in Thailand. Methodology: This cross sectional study, a part of ongoing birth cohort was conducted at the antenatal care clinic from June to October 2018. A total of 108 with Myanmar migrant pregnancy with a single viable fetus of 0 to 14 gestation weeks who stayed within the industrial plant at least 3 months before were recruited. Socio-demographic characteristics and health behaviors were accessed using a self-report questionnaire. Maternal blood heavy metals (lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As)) were measured using an inductively coupled plasma mass spectrometer and plasma BDNF was measured using an enzyme-linked immunosorbent assay. Multivariate binary logistic regression were modeled to access the association. Results: Median (interquartile rank: IQR) concentrations were: BDNF (6.49 (1.79) μg/ml), Pb (2.77 (1.46) μg/dL), Hg (0.62 (0.54) μg/dL), Cd (0.93(0.86) μg/L) and As (0.40 (0.11) μg/dL) respectively. We categorized BDNF concentrations into high (> median) (n = 54) and low (≤ median) (n = 54) groups. After adjusting for potential confounders, high blood total arsenic concentration had 2.6-fold increased odds (aOR = 2.603, 95% CI: 1.178, 5.751) of low plasma BDNF level as compared with low blood total arsenic group. However, there was no significant association between BDNF and Pb, Hg and Cd. Conclusions: The present findings demonstrate higher blood total arsenic level were more likely to have lower BDNF in early pregnancy. Our study suggested that heavy metal could be worsen BDNF level which plays its important role on biological effect of maternal depressive disorder and newborn neurodevelopment. [ABSTRACT FROM AUTHOR]

Background: Assessing the illness perception of patients with tuberculosis (TB) could improve our understanding of their beliefs about disease and help address problems in their health-seeking behavior. Study aim: We assessed illness perception in patients with pulmonary TB in association with patients’ demographic, socioeconomic, and clinical features. Methods: Adult patients who were newly diagnosed with pulmonary TB at three tertiary hospitals in South Korea were included from November 2016 and September 2018. Participants’ illness perception was assessed using the Brief Illness Perception Questionnaire (BIPQ) at the start of anti-TB treatment. Results: In total, 390 patients with pulmonary TB completed this survey. The mean BIPQ score was 31.6 ± 13.2, and that was positively correlated with clinical TB scores. Patients were highly concerned about their illness, but believed in the treatment. Unhealthy eating habits were mentioned as the most prevalent perceived cause. Coughing for more than one month and alarming symptoms were significantly associated with BIPQ scores ≥ 33. Non-adherent patients had significantly higher BIPQ scores. Conclusions: Assessing the illness perceptions of those with severe TB-related symptoms and signs may help to identify TB patients with vulnerable to poor treatment outcomes. [ABSTRACT FROM AUTHOR]

Most papers on the physical condition of birds during spring migration focused on food availability preceding migratory take-off. Only a few studies examined the effect of climate conditions at the wintering grounds upon autumn arrival on bird physical condition later on. Here, we hypothesized that environmental conditions upon arrival at the wintering grounds, and not necessarily upon departure, have a crucial carry-over effect on bird spring migration. Using 29,000 observations of the lesser whitethroat, Sylvia curruca, and the eastern Bonelli’s warbler, Phylloscopus orientalis, we found temperatures upon arrival at the African wintering grounds to be the only climatic variable correlated with birds’ body state upon spring stopover in Israel, six months later. Two different mechanisms could explain these results. One possibility is that high temperatures create favorable conditions for insect activity, which allows rapid recovery from autumn migration and hence successful winter survival and maintenance. Another possible scenario is that harsh conditions, due to the heat and dry environment, cause high mortality, permitting survival of larger individuals which, then, enjoy reduced inter- and intra-specific competition. Whatever the mechanism is, our findings suggest that conditions upon autumn arrival, and not necessarily at the end of winter as traditionally thought, may have a major impact on migrating birds. [ABSTRACT FROM AUTHOR]

To investigate how changes in eGFR can affect medical costs, a regional cohort of national health insurance beneficiaries in Japan was developed from a nationwide database system (Kokuho database, KDB), and non-individualized data were obtained. From 105,661 people, subjects on chronic dialysis and subjects without consecutive medical checkups were excluded. Finally, medical costs in the follow-up year categorized by annual changes in eGFR between baseline and the next year were longitudinally examined in 70,627 people ranging in age from 40 to 74 years. Global mean costs for subjects with a rapid decrease in eGFR (≤-30%/year) were the highest among all ΔeGFR categories. In men, the cost was 1.42 times that for a stable eGFR. A total of 6,268 (19.4%) men and 5,381 (14.0%) women with eGFR <60 ml/min/1.73 m2 were identified in the baseline year. The mean cost was higher with a low eGFR than without a low eGFR, and there were also higher proportions newly initiating dialysis in 2014 (low eGFR with rapid decrease in eGFR vs. with stable eGFR: 9.61% vs. 0.02% in women, P<0.001). Moreover, the costs for low eGFR subjects with a rapid decrease in eGFR were more than twice those of non-low eGFR subjects with a rapid decrease in eGFR and also compared to low eGFR subjects with a stable eGFR. Moreover, initiating chronic dialysis was considered one of the major causes of high medical costs in women with rapid eGFR decline. To the best of our knowledge, this is the first study of renal disease using a cohort developed from the KDB system recently established in Japan. [ABSTRACT FROM AUTHOR]

Background: Multiple Sclerosis (MS) is a chronic neurological disease with heavy economic and social burdens resulting in significant disability. Objective: This study aims to (1) measure the cost of health resources utilization by MS patients and (2) to examine the difference in utilization and its attributed costs amongst patients who may have a different course of MS and expanded disability status scale (EDSS) scores. Methods: A cross-sectional study using Kuwait National MS registry was conducted to estimate the costs of utilization of resources from 2011 to 2015. Results: Between the period 2011–2015, 1344 MS patients were included in the registry. The average annual cost per MS patient has increased from $10,271 in 2011 to $17,296 in 2015. Utilization of disease-modifying therapies (DMTs) was the main driver of costs reaching 89.9% in 2015. Throughout the five-year period, the occurrence of relapses decreased from 21.8% to 12.2% (p <0.0001). During this same period, ambulatory relapse treatment increased by 5.8% while hospitalizations decreased by 2.6%. Patients with a moderate EDSS score (3.5–6) had the highest average cost (p<0.0001) compared to mild and severe EDSS scores. Conclusions: Multiple sclerosis has been a significant economic burden on the Kuwait healthcare system. DMTs are the main driver of cost. [ABSTRACT FROM AUTHOR]

This study compares the psychometric properties of two versions of the Lubben Social Network Scale (LSNS-18 and LSNS-6) with community dwelling older adults in Mongolia. We recruited 650 older adult in the capital city of Ulaanbaatar and the country’s four rural regions. We used the Geriatric Depression Scale (GDS-15), the Short Form 12 (SF-12) physical and mental health functioning measures, and a multi-dimensional scale of social isolation for confirmatory factor analyses of the LSNS-18 and the LSNS-6. Both versions demonstrated excellent internal consistency and intraclass correlation and both correlated in expected directions with other study measures. Only the LSNS-6 provided a good fit to the data. The LSNS-6 is a viable instrument for assessing the social networks of older adults in Mongolia. The study adds to the sparse literature on measuring social and behavioral determinants of health in resource-constrained settings characterized by aging populations and high internal migration rates. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the running pace and step characteristics among various competitive-level 400-m hurdlers through inter-group and intra-athlete comparisons. We analysed spatiotemporal data involving the split time, mean step length (SL) and mean step frequency (SF) for 13 male world-class and 14 male national-level 400-m hurdlers. We analysed 16.5 ± 3.9 races for each world-class hurdler and 19.8 ± 6.0 races for each national-level hurdler (the total number of analysed runs was 491) using publicly available television and internet broadcasts. Inter-group comparisons showed that both first- and latter-halves split times of the world-class hurdlers were significantly shorter than those of the national-level hurdlers. In the latter-half phase, no significant differences of SL and SF were observed between the world-class and national level hurdlers. Intra-athlete comparisons showed that no athletes favoured only first-half phase in terms of running speed in short finish times. In contrast, finish times of all hurdlers were sensitive to running speed in the latter-half phase. In the latter half of the race, 18 of the 27 hurdlers were identified as being SF reliant during speed enhancements; running speed of the other 9 hurdlers were also sensitive to high SF. In conclusions, important findings regarding high performance in inter-group comparisons do not always corresponded with those in intra-athlete comparisons. All athletes and coaches should first prioritize maintaining high running speeds in the latter half of 400-m hurdles rather than in the first half of the race. [ABSTRACT FROM AUTHOR]

Background: Early pregnancy among unmarried youth is a serious public health challenge. Male youth’s knowledge, attitude and practice (KAP) of sexual and reproductive health (SRH) and its association with the risk of their sexual partners’ pregnancy in China remains unexplored. This study investigates the KAP among Chinese unmarried male youth aged 15–24 years and identifies its association with partner pregnancy using nationally representative data from Survey of Youth Access to Reproductive Health in China (YARHC) in 2009. Methods: Chi-square tests were applied to explore the prevalence of partner pregnancy by male youth’s KAP of SRH and logistic regression were applied to identify the associations of partner pregnancy with knowledge, attitudes and practice among male youth. Results: Among 2853 sexually experienced male youth, totally 597 unmarried male youth caused 852 partner pregnancies and the prevalence rate was 20.93%. Lacking the knowledge of contraception access (OR: 0.66, 95% CI: 0.44–0.99) was significantly associated with lower risk of causing partner pregnancy. Contraception discussion before (1.49, 1.04–2.11) or after first sexual intercourse (1.46, 1.11–1.93), not using valid contraception (1.29, 1.03–1.64) and male contraception decision-maker (1.79, 1.41–2.28) were significantly associated with higher risk of causing partner pregnancy. Conclusion: Our results indicated that male youth’s knowledge and behaviors of sexual and reproductive health were significantly associated with the risk of causing partner pregnancy, and highlighted the importance and need of sexual and reproductive programs targeting male for the prevention of unintended partner pregnancy in China. [ABSTRACT FROM AUTHOR]