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This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks. This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990–2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation. All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990–2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values. An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions. Asia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa. The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data. The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level. [ABSTRACT FROM AUTHOR]

Background: Chronic non-communicable diseases (NCDs) are the leading cause of morbidity, mortality, and disability worldwide. More than 80% of chronic disease deaths occur in low-income and middle-income countries. Epidemiological data on the burden of chronic NCD and the risk factors which predict them are lacking in most low-income countries. The INDEPTH Network (http://www.indepth-network.org) which includes the Health and Demographic Surveillance System (HDSS) with many surveillance sites in lowmiddle income countries provided an opportunity to establish surveillance of the major chronic NCD risk factors in 2005 using a standardised approach. Objective: This paper presents the conceptual framework and research design of the chronic NCD risk factor surveillance within nine rural INDEPTH HDSS settings in Asia. Methods: This multi-site study was designed as a baseline cross-sectional survey with sufficient sample size to measure trends over time. In each of nine HDSS sites in five Asian countries, a sample of 2,000 men and women aged 25-64 years, using the WHO STEPwise approach to Surveillance (http://who.int/chp/steps), was selected using stratified random sampling (in each 10-year interval) from the HDSS sampling frame. Results: A total of 18,494 men and women from the nine sites were interviewed with an overall response rate of 98%. The major NCDs risk factors included self-reported information on tobacco and alcohol consumption, fruit and vegetable intake, physical activity patterns, and measured body weight, height, waist circumference, and blood pressure. A series of training sessions were conducted for research scientists, supervisors, and surveyors in each site. Data quality was ensured through spot check, re-check, and data validation procedures, including accuracy and completeness of data obtained. Standardised data entry programme, created using the EPIDATA software, was used to ensure uniform database structure across sites. The data merging and analysis were done using STATAVersion 10. Conclusion: This multi-site study confirmed the feasibility of conducting chronic NCD risk factor surveillance in the low and middle-income settings by integrating the chronic NCDs risk factor surveillance into an existing HDSS data collection and management setting. This collaborative work has provided reliable epidemiological data as a basis for developing chronic NCD prevention and control activities. [ABSTRACT FROM AUTHOR]

Physical activity (PA) can help individuals maintain physical function and independence. The association between PA and functional limitations (FL) has not been explored in the Native Hawaiian and Pacific Islander (NHPI) population. The purpose of this study was to examine relationships between PA and FL among NHPI adults (age ≥ 45 years) living in the United States. Cross-sectional data from the 2014 NHPI-National Health Interview Survey (N = 628) was used to create three constructs of FL based on responses from the Functioning and Disability Survey Module: needing equipment/assistance, having difficulty walking, and having difficulty with performing self-care and other fine motor activities. We used 2-stage least squares regression to examine the relationship between PA and FL of NHPI adults while accounting for the potential endogeneity of PA to FL. Compared to NHPI adults who met the guideline for recommended levels of aerobic and strengthening PA, those who met only the strengthening guideline experienced less difficulty in two FL constructs (use of medical equipment/assistance and difficulty walking). Those who met the aerobic guideline reported even less difficulties in all three FL constructs. NHPI adults who met both the aerobic and strengthening guidelines experienced the least difficulties in all three FL constructs compared to those who met neither PA guidelines. PA is associated with function in this adult NHPI population. Aerobic guidelines alone may be more beneficial than meeting the strengthening guideline alone; however, meeting both the aerobic and strengthening guidelines is most protective against FL. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality in developing nations. In this meta-analysis, we aimed to determine the association between indoor air pollution and risk of COPD. Database searches were conducted using indoor air pollution, biomass and COPD related terms to identify relevant articles. The eligible studies were case-control, retrospective cohort, cross-sectional studies and conducted in adults that assessed COPD using any diagnostic criteria. A total of 35 studies with 73,122 participants were included. The pooled analysis showed that exposure to indoor air pollution due to solid biomass fuels increased risk of COPD by 2.65 (95% confidence interval [CI] 2.13–3.31; n = 73,122) and chronic bronchitis by 2.89 (95% CI 2.18–3.82) times more compared to non-biomass fuels. The risk of COPD was higher in Africa region (odds ratio [OR] 3.19), Asia (OR 2.88), South America (OR 2.15), Europe (OR 2.30) and North America (OR 2.14). The results of our meta-analysis indicated that exposure to indoor air pollution due to biomass smoke is strongly associated with COPD. Abbreviations: CS: cross-sectional; CC: case-control; NR: not reported; ATS: American Thoracic Society; BMRC: British Medical Research Council; GOLD: Global Initiative for Obstructive Lung Disease; IAP: indoor air pollution; BMF: biomass fuel; CB: chronic bronchitis; OR: odds ratio; UCI; upper confidence interval; LCI: lower confidence interval; COPD: chronic obstructive pulmonary disease [ABSTRACT FROM AUTHOR]

Many service providers (e.g. mobile network operators) want to turn their business into fully digitalised regimes and offer personalised services. To do so they need access to the consumers' personal data and must explicitly ask consumers for consent. In this cross-national study, including representative samples from seven countries covering Scandinavia, Central-Eastern Europe and South-Eastern Asia, we investigate the effect of trust vs. privacy concerns and the moderating impact of culture when consents are requested. The study shows that trust in service provider has stronger impact on consent giving than privacy concerns, and indicates that 'digital native' more than 'digital immigrant' providers should focus on trust building activities when they enter countries with an individualistic culture. The analyses were made within a PLS-SEM framework. [ABSTRACT FROM AUTHOR]

Background: Suicide ideation is a health issue affecting adolescents worldwide. There are significant variations in suicide ideation between countries and genders, which have not been fully explained. Research is especially lacking in countries outside Europe and North America. Gender equality has been shown to matter in other aspects of adolescent mental health, such as life satisfaction, but has not been researched in relation to suicide ideation at national level. Objective: To investigate how national gender inequality is related to self-reported suicide ideation among adolescents, and whether this association differs between boys and girls. Methods: This is a cross-national, cross-sectional study using individual survey data from the Global School-based Student Health Survey, a survey in Africa, Asia, Latin America and the South Pacific, developed and supported by among others the WHO and the CDC; connecting this to national data: the gender inequality index from the UNDP; controlling for GDP per capita and secondary school enrolment. The data was analysed using a multilevel logistic regression method and included 149,306 students from 37 countries. Results: Higher national gender inequality, as measured by the gender inequality index, was significantly associated with a higher likelihood of suicide ideation in both girls and boys (odds ratio: 1.38 p-value: 0.015), but for girls and both sexes this was only after adjusting for selection bias due to secondary school enrolment (as well as GDP/capita). Interaction models showed that this association was stronger in boys than in girls. Conclusions: National gender inequality seems to be associated with higher levels of suicide ideation among adolescents in mainly low- and middle-income countries, especially among boys. [ABSTRACT FROM AUTHOR]

Objective:To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). Design:Cross-sectional study using a multilingual anonymous questionnaire. Setting:Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday–Friday, 08:00–23:00) during 2 weeks in September 2009. Subjects:We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). Main outcome measures:Patients’ reasons for attending an emergency outpatient clinic versus their RGP. Results:Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46–4.46)] and Asia [OR = 2.32 (95% CI: 1.42–3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. Conclusions and implications:Access to primary care provided by an RGP affects patients’ use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services.KEY POINTSAccess to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients’ use of emergency health care services.The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP.A frequent reason for native Norwegians attending a general emergency outpatient clinic during the daytime is having an RGP outside Oslo.Lack of affiliation with the RGP scheme is a frequent reason for attending a general emergency outpatient clinic among immigrants. [ABSTRACT FROM PUBLISHER]

Background: The association of early maternal birthing age with smaller children has been widely observed. However, it is unclear if this is due to confounding by factors such as socioeconomic status, or the age at which child growth restriction first occurs. Objective: To examine the effect of early maternal birthing age on the first-born child's height-for-age in a sample of developing countries in Africa, Asia, and Latin America. Design: Cross-sectional data from Demographic Health Surveys from 18 countries were used, to select the first-born child of mothers aged 15-24 years and a range of potential confounding factors, including maternal height. Child length/height-for-age z-scores (HAZs) was estimated in age bands of 0-11, 12-23, 24-35, 36-47, and 48-59 months; HAZ was first compared between maternal age groups of 15-17, 18-19, and 20-24 years. Results: 1) There were significant bivariate associations between low child HAZ and young maternal age (71 of 180 possible cases; at p <0.10), but the majority of these did not persist when controlling for confounders (41 cases, 23% of the 180). 2) For children < 12 months, when controlling for confounders, three out of seven Asian countries showed a significant association between lower infant HAZ and low maternal age, as did six out of nine African countries (15-17 or 15-19 years vs. the older group). 3) The association (adjusted) continued after 24 months in 12 of the 18 countries, in Africa, Asia, and Latin America. 4) The stunting differences for children between maternal age groups were around 9 percentage points (ppts) in Asia, 14 ppts in Africa, and 10 ppts in Latin America. These data do not show whether this is due to, for example, socioeconomic factors that were not included, an emerging effect of intrauterine growth restriction, or the child feeding or caring behaviors of young mothers. The latter is considered to be the most likely. Conclusions: The effect of low maternal age on child height restriction from 0 to 11 months occurred in half the countries studied after adjusting for confounders. Poorer growth continuing after 24 months in children of younger mothers was observed in all regions, but needs further research to determine the causes. The effects were about double (in stunting prevalence terms) in Africa, where there was an increase in 10 ppts in stunting for children of young mothers. [ABSTRACT FROM AUTHOR]

Research indicates that adolescents in low-income countries have an early sexual debut and engage in risky sexual behaviours. Few studies in low-income countries however, have explored the factors that influence young people's sexual behaviours. This study examined individual, family and peer-level factors associated with premarital sexual behaviours in the Lao People's Democratic Republic (PDR). A cross-sectional survey was undertaken with unmarried youth aged 18 to 24 years (N= 1200) in Vientiane Capital City. Logistic regression models, controlling for confounding variables, were employed to test for the contribution of factors influencing premarital sexual activity. Most respondents held positive attitudes towards premarital sex, with males having more liberal attitudes than females (mean score of 2.68 vs. 2.32,p< 0.001). Prevalence of premarital sexual activity was higher among males than females (44.7% and 19.2%, respectively). Predictors of premarital sex for males were age, sexual attitudes, perceived parental expectations regarding sex, dating and peer influence. For females, predictors were father's level of education, parent-youth sexual communication, peer influence and liberal sexual attitudes. The results highlight the role of parent-youth interaction and peer influence. The results suggest the need for a range of strategies at the individual, peer and family level, as well as a gender-specific focus. [ABSTRACT FROM PUBLISHER]

It has been observed that Asians and Caucasians possess considerably different craniofacial features, which may affect the anatomical structure of the upper respiratory tract and, consequently, the characteristics of particle deposition. Most deposition studies on the human respiratory tract were primarily based on a limited number of Caucasian subjects. Therefore, data of the particle deposition efficiency in the upper respiratory tract of Asians are needed to supplement the understanding of the deposition characteristics in the human respiratory tract. This study measured the nasal deposition efficiency of particles ranging from 0.5 to 20 μm in five Taiwanese male and four Taiwanese female adults under different inspiratory flow rates. The measured deposition efficiency showed a very large intersubject variability in the inertial parameters, ranging between 103 to 5 × 104 μm2 cm3/s, and the deposition efficiency of the subjects with similar values of the minimum nasal cross-sectional area approaches to each other. This study showed that Taiwanese adults have lower nasal deposition efficiency than Caucasians, and that the differences in the nostril shape, inclination of nostrils, and nasal hair density between the two ethnic groups are likely the causes. In addition, this study suggested that up to 15% of overestimation in the nasal deposition efficiency for larger particles may occur if the inhalation efficiency is not considered. An empirical equation adopting inspiratory flow rate and the minimum nasal cross-sectional area was developed to predict the nasal particle deposition in the upper airway of Taiwanese adults. Copyright 2012 American Association for Aerosol Research [ABSTRACT FROM PUBLISHER]

Background: Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases (NCDs) such as stroke and heart disease. In high income countries, studies have measured the population level of physical activity, but comparable data are lacking from most low and middle-income countries. Objective: To assess the level of physical inactivity and its associated factors in selected rural sites in five Asian countries. Methods: The multi-site cross-sectional study was conducted in nine rural Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network in Bangladesh, India, Indonesia, Thailand, and Vietnam. Using the methodology from the WHO STEPwise approach to Surveillance (STEPS), about 2,000 men and women aged 25-64 years were selected randomly from each HDSS sampling frame. Physical activity at work and during leisure time, and on travel to and from places, was measured using the Global Physical Activity Questionnaire version 2 (GPAQ2). The total activity was calculated as the sum of the time spent in each domain of activities in metabolic equivalent-minutes per week, and was used to determine the level of physical activity. Multivariable logistic regression was used to assess demographic factors associated with a low level of physical activity. Results: The prevalence of physical inactivity ranged from 13% in Chililab HDSS in Vietnam to 58% in Filabavi HDSS in Vietnam. The majority of men were physically active, except in the two sites in Vietnam. Most of the respondents walked or cycled for at least 10 minutes to get from place to place, with some exceptions in the HDSSs in Indonesia and Thailand. The majority of respondents, both men and women, were inactive during their leisure time. Women, older age, and high level of education were significantly associated with physical inactivity. Conclusion: This study showed that over 1/4 men and 1/3 women in Asian HDSSs within the INDEPTH Network are physically inactive. The wide fluctuations between the two HDSS in Vietnam offer an opportunity to explore further urbanisation and environmental impacts on physical activity. Considering the importance of physical activity in improving health and preventing chronic NCDs, efforts need to be made to promote physical activity particularly among women, older people, and high education groups in these settings. [ABSTRACT FROM AUTHOR]

Background: Service-learning is a powerful, but underutilized, educational tool in Asian medical schools. Aim: We compared the ability of two programs providing medical care to low-income populations (clinic-based versus home-based approach) to teach community medicine skills in an Asian medical school. Methods: We conducted a cross-sectional study using a self-administered anonymized questionnaire on medical students who participated in the programs using the Fund for the-Improvement of Postsecondary Education Survey Instrument. Participants also gave an overall score for their learning experience in the programs. Results: Participation rates were 97.4%% (760/780) and 95.8%% (230/240) across the two programs. A majority of participants in either program felt that the experience helped them to improve in all domains surveyed. Regardless of whether one compared those who participated in either program or both programs, the home-based approach was superior at teaching communication skills, teamwork, identifying social issues, gaining knowledge, and applying knowledge. Improved knowledge on long-term management of chronic diseases ( β == 1.25, 95%% CI, 0.55-1.96) was strongly associated with the overall score for those participating in the home-based program. Conclusions: Service-learning programs, in the Asian context, have potential educational value for medical students in a wide range of domains. The home-based approach is superior at teaching certain aspects of community care. [ABSTRACT FROM AUTHOR]