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IntroductionIn patients with mitral annular disjunction (MAD), it can be difficult to assess the severity of mitral regurgitation (MR), as they present with a prolapsing volume (i.e. volume resulting from mitral valve prolapse, blood volume shift) rather than a regurgitant jet. The influence of the mitral prolapsing volume (MPV) on cardiac dimensions is unknown. We hypothesised that the severity of MR is underestimated in these patients. Our aim was to measure MPV and to investigate its influence on cardiac dimensions in patients with MAD.MethodsWe retrospectively included 131 consecutive patients with MAD from our institution’s echocardiographic database. Transthoracic echocardiography was used to assess MPV. Additionally, we established a control group of 617 consecutive patients with degenerative mitral valve disease and performed propensity score matching.ResultsMedian MPV in the MAD group was 12 ml. MPV was an independent predictor for left ventricular end-diastolic (LVEDD) and end-systolic diameter (LVESD) and left atrial volume (allp 15 ml), LVEDD (56 ± 6 mm vs 51 ± 6 mm,p p p = 0.04] were significantly increased compared to matched patients with degenerative mitral valve disease and similarly assessed severity of MR.ConclusionDue to a volume shift based on the MPV rather than an actual regurgitant jet, MR severity cannot be assessed adequately in MAD patients. Increased MPV induces ventricular and atrial enlargement. These findings warrant future studies to focus on MPV as an additional parameter for assessment of the severity of MR in MAD patients.

Background The role of platelets in the pathogenesis of venous thromboembolism (VTE) is receiving increasing attention; however, limited information is available on platelet function in the acute phase of the disease. Objective To characterize platelet function according to VTE phenotypes. Patients/Methods In total, 154 subjects (isolated pulmonary embolism [iPE], n = 28; isolated deep vein thrombosis [iDVT], n = 35; DVT+PE, n = 91) were included. In this study platelet function analyzer (PFA)-200, light transmission aggregometry (LTA), thrombin generation (TG) in presence (PRP) and absence (PFP) of platelets and platelet flow cytometry were investigated. LASSO regression was used to select clinical and platelet biomarkers that distinguish between VTE phenotypes. Results PFA-200 results did not differ between VTE phenotypes. LTA from DVT+PE subjects showed lowest maximum aggregation after epinephrine and adenosine diphosphate compared to iPE and iDVT. Lower % of PAC-1-positive platelets after in-vitro trigger were present in DVT+PE and iPE compared to iDVT. TG in PRP had lower peak height and velocity in DVT+PE and iPE against iDVT. The results of LASSO regression for the distinction between DVT+PE vs iDVT identified 18 variables (AUC =0.93) of which 72% were platelet biomarkers. For distinction between iPE and iDVT, 10 variables were selected (AUC = 0.96) of which 50% were platelet-related. Obesity was the only variable weakly discriminating between DVT+PE vs iPE (AUC = 0.66). Conclusion This explorative study suggests an important distinction between PE-related phenotypes and iDVT when considering clinical and platelet function data. Lower platelet-dependent TG along with reduced platelet reactivity suggest higher platelet degranulation in PE-dependent phenotypes compared to iDVT.

Adherence to antiretroviral therapy (ART) remains an important factor in HIV prevention and treatment efforts. We explored the individual and environmental factors influencing antiretroviral adherence among PLWH in Ghana. This study used 20 semi-structured in-depth interviews and three focus group discussions (FGD) involving 29 PLWH attending one of three antiretroviral clinics. Thematic analysis covered experiences of PLWH clinic visits, knowledge, attitudes, self-efficacy related to ART adherence, psychological wellbeing and stigma. The findings suggest that both individual and environmental factors including treatment outcome, coping skills, disclosure, self-regulation, healthcare-provider interaction, family and partner support, organization of ART clinics, stigma, and transportation cost influenced treatment adherence. Interventions that empower PLWH and reduce HIV-related stigma in the community will most likely support antiretroviral adherence. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Background: Dicarbonyls are highly reactive compounds and major precursors of advanced glycation end products (AGEs). Both dicarbonyls and AGEs are associated with development of age-related diseases. Dicarbonyls are formed endogenously but also during food processing. To what extent dicarbonyls from the diet contribute to circulating dicarbonyls and AGEs in tissues is unknown.Objectives: To examine cross-sectional associations of dietary dicarbonyl intake with plasma dicarbonyl concentrations and skin AGEs.Methods: In 2566 individuals of the population-based Maastricht Study (age: 60 +/- 8 y, 50% males, 26% with type 2 diabetes), we estimated habitual intake of the dicarbonyls methylglyoxal (MGO), glyoxal (GO), and 3-deoxyglucosone (3-DG) by combining FFQs with our dietary dicarbonyl database of MGO, GO, and 3-DG concentrations in> 200 commonly consumed food products. Fasting plasma concentrations of MGO, GO, and 3-DG were measured by ultra-performance liquid chromatography-tandem mass spectrometry. Skin AGEs were measured as skin autofluorescence (SAF), using theAGE Reader. Associations of dietary dicarbonyl intake with their respective plasma concentrations and SAF (all standardized) were examined using linear regression models, adjusted for age, sex, potential confounders related to cardiometabolic risk factors, and lifestyle.Results: Median intake of MGO, GO, and 3-DG was 3.6, 3.5, and 17 mg/d, respectively. Coffee was the main dietary source of MGO, whereas this was bread for GO and 3-DG. In the fully adjusted models, dietary MGO was associated with plasma MGO (beta: 0.08; 95% CI: 0.02, 0.13) and SAF (beta: 0.12; 95% CI: 0.07, 0.17). Dietary GO was associated with plasma GO (beta: 0.10; 95% CI: 0.04, 0.16) but not with SAF. 3-DG was not significantly associated with either plasma 3-DG or SAF.Conclusions: Higher habitual intake of dietary MGO and GO, but not 3-DG, was associated with higher corresponding plasma concentrations. Higher intake of MGO was also associated with higher SAF. These results suggest dietary absorption of MGO and GO. Biological implications of dietary absorption of MGO and GO need to be determined. The study has been approved by the institutional medical ethical committee (NL31329.068.10) and the Minister of Health, Welfare and Sports of the Netherlands (Permit 131088-105234-PG).

© 2020 Published by Elsevier España, S.L.U. on behalf of Sociedade Portuguesa de Pneumologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)., Introduction and objectives: Asthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma. Materials and methods: Using a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test.äó (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate. Results: 35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01.Çô1.03), female sex (OR 1.87; 95% CI: 1.15.Çô3.04), educational level (OR 0.5; 95% CI: 0.28.Çô0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12.Çô11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35.Çô4.65 if being retired), income (OR 0.23; 95% CI: 0.07.Çô0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03.Çô1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56.Çô7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24.Çô0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments. Conclusions: Uncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives., This study was supported by a grant from the General Directorate of Health (DGS) of the Portuguese Health Ministry and by a scientific grant from AstraZeneca Foundation.

Background Pharmacists have been taking part in vaccination services during the COVID-19 pandemic. However, research identifying pharmacists’ intention to get COVID-19 vaccine is limited. Aim The objective of this study was to determine the intention to receive COVID-19 vaccine and to identify the factors related to it based on the Health Belief Model framework among Turkish pharmacists. Method This is an observational study conducted between December 2020 and January 2021. The online survey was sent to all hospital and community pharmacists working in Turkey. Transtheoretical Model of Behaviour Change and Health Belief Model were used for the development of the questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with the intention to receive COVID-19 vaccine. Results Among all participants (n = 961), 74.7% had an intention to receive the COVID-19 vaccine. In model 1, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were associated with their intention to receive the COVID-19 vaccine (p

Background Cervical cancer (CC) is the cancer with the most incidents and the leading cause of cancer mortality among women in South Africa. CC screening is one of the most cost-effective control approaches for the disease burden. This study assessed the determinants and individual-level indicators of cervical cancer screening uptake among women of reproductive age in South Africa. Methods We analyzed data from the 2016 South Africa Demographic Health Survey. Our analysis focused on 5903 women (15–49 years). We conducted Chi-square test for bivariate analysis, and multivariate binary logistics regression was used to analyze independent association between individual-level factors and women who have had Pap smear testing. Statistical significance was set at p Results The mean age at cervical cancer screening uptake among women in South Africa was 40.8 years (SD 18.6, range 15–95 years). A majority of the women (39.3%) were aged 45 years and above and 54.6% of them resides in urban settlements. About 35.4% of women (n = 2098) have had a Pap smear test, with 66.5% of them who had a Pap smear test resides in Western Cape province. The proportion of women who had a Pap smear test was significantly higher among those with higher educational attainment (68.7%, p = 0.000), in the rich wealth index (50.1%, p = 0.000), and those with health insurance cover (60.3%, p = 0.000). Pap smear testing was found to be more prevalent among women aged 45+ years, were in the white population group, had higher education, were divorced, and had health insurance cover. The predominance of Pap smear test was 14% higher among women who are working in the professional/formal sector (AOR; 1.38, 95% CI; 1.14–1.69). The uptake of Pap smear test was also higher among women aged 35–44 years. Conclusions The prevalence of cervical cancer uptake is substantially low among women aged 15–24 years in South Africa and shows a degree of between-provinces differences. Therefore, heath educational interventions aimed at increasing the uptake of cervical cancer screening services in South Africa are critically needed.

INTRODUCTION: The impact of amyloid positron emission tomography (PET) imaging on patient health outcomes for individuals with dementia is unknown. In the present study, we explored the association between diagnostic outcome and clinician's level of certainty with quality of life (QoL) after [18F]flutemetamol PET results were disclosed in young onset dementia patients in a memory clinic cohort.METHODS: In 154 patients suspected of dementia, QoL was measured before and after [18F]flutemetamol PET results were disclosed. Multiple regression analyses were conducted with (changed) general and disease-specific QoL measures as dependent factors [QoL-Alzheimer disease (AD) and EQ-5D Dutch tariff] and etiological diagnosis and clinician's certainty as independent factors.RESULTS: (Change in) diagnosis of AD was associated to QOL in 2 of the 4 analyses (utility-based QoL β=0.15, P=0.010; disease-specific QoL β=2.0, P=0.037). Diagnostic certainty was associated to QOL in 1 of the 4 analyses (generic QoL β=0.002, P=0.028).DISCUSSION: The diverse results in this explorative analysis do not reflect a univocal association between diagnosis, certainty, and QoL. Nevertheless, this result could be interpreted as a possible potential for advanced diagnostic technologies for AD, which requires confirmation in future research.

Objectives: Population‐specific studies of vaccine uptake in pregnancy are necessary to monitor progress and ensure enablers to vaccination are locally relevant. We aimed to determine the uptake of influenza and pertussis vaccine during pregnancy in women in south‐east Queensland and the reasons why women were choosing not to vaccinate. Methods: A secondary analysis of data collected in a prospective cohort study. Data were collected at enrolment during pregnancy and within six weeks of giving birth. The primary outcome was the proportion of women vaccinated during pregnancy. Results: Among 310 pregnant women, 45.8% and 69.7% were vaccinated against influenza and pertussis, respectively; 123 (39.7%) had received both vaccines. The common predictor of vaccine uptake for influenza, pertussis or both was having had any vaccine in the 12 months prior to pregnancy. Not considering the vaccines necessary and perceptions of the risk of infection were common reasons for not intending to vaccinate. Conclusions: Antenatal vaccine uptake remains suboptimal in women in south‐east Queensland. Barriers to vaccination during pregnancy are complex and vary depending on context and population. Implications for public health: More efforts are needed to promote antenatal uptake, particularly for influenza vaccine and having both the influenza and pertussis vaccines during pregnancy.

Objectives Chronic widespread musculoskeletal pain (CWP) is a characteristic symptom of fibromyalgia, which has been shown to be associated with an altered gut microbiome. Microbiome studies to date have not examined the milder CWP phenotype specifically nor have they explored the role of raised BMI. The aim of this study was to investigate whether the microbiome is abnormal in CWP. Methods CWP was assessed using a standardized screening questionnaire in female volunteers from the TwinsUK cohort including 113 CWP cases and 1623 controls. The stool microbiome was characterized using 16S rRNA amplicon sequencing and amplicon sequence variants, and associations with CWP examined using linear mixed-effects models adjusting for BMI, age, diet, family relatedness and technical factors. Results Alpha diversity was significantly lower in CWP cases than controls (Mann–Whitney test, P-values 2.3e-04 and 1.2e-02, for Shannon and Simpson indices respectively). The species Coprococcus comes was significantly depleted in CWP cases (Padj = 3.04e-03). A genome-wide association study (GWAS) performed for C. comes in TwinsUK followed by meta-analysis with three Dutch cohorts (total n = 3521) resulted in nine suggestive regions, with the most convincing on chromosome 4 near the TRAM1L1 gene (rs76957229, P = 7.4e-8). A Mendelian randomization study based on the results of the GWAS did not support a causal role for C. comes on the development of CWP. Conclusions We have demonstrated reduced diversity in the microbiome in CWP, indicating an involvement of the gut microbiota in CWP; prospectively the microbiome may offer therapeutic opportunities for this condition.

Background Exclusive breastfeeding is critical for infant survival and development. However, the rate of exclusive breastfeeding in the first 6 months of life is low in sub-Saharan Africa. With the current trend in breastfeeding rates in many countries including in Guinea, the World Health Assembly target of at least 50% of children aged less than 6 months being exclusively breastfeed by 2025 is likely to be compromised and lives a numerous infant that are be at risk. The objective of this study was to identify the individual and contextual determinants of the practice of Exclusive Breastfeeding (EBF) in Guinea. Method We conducted a secondary analysis of data from the 2018 Guinea Demographic and Health Survey (DHS). The study population consisted of women who gave birth between the ages of 15 and 49. Our sample consisted of women who had their last birth six (06) months prior to collection. The enumeration areas were our second level. A multilevel logistic regression was performed using Stata version 15.1 software. Three statistical models were implemented: The final model was obtained using the bottom-up step-by-step method. The intra-class correlation coefficient was calculated. Results On the 851 women included in our study, 33% reported having exclusively breastfed during the first 6 months of life of their children. After a multivariate analysis, the variables associated with exclusive breastfeeding are: children aged 2–3 months (OR = 0.53 CI95% = [0.36–0.79]) and children aged 4–5 months (OR = 0.23 IC95% = [0.14–0.36]), women in the Faranah area (OR = 2.69 IC95% = [1.21–5.94]) and those in Mamou (OR = 2.27 IC95% = [1.00–5.94]), women who gave birth in a health facility (OR = 1.94 IC95% = [1.34–2.80]) and women living in polygamous households (OR = 0.68 IC95% = [0.48–0.98]). Conclusion The practice of exclusive breastfeeding remains low in Guinea. For the achievement of Sustainable Development Goals, particularly the improvement of exclusive breastfeeding practices, the individual and contextual determinants identified in this study should be taken into consideration in policies and programmes.

Background Chronic kidney disease (CKD) is a growing global health problem with faster progression in developing countries such as Iran. Here we aimed to evaluate the prevalence and determinants of CKD stage III+. Methods This research is part of the Khuzestan Comprehensive Health Study (KCHS), a large observational population-based cross-sectional study in which 30,041 participants aged 20 to 65 were enrolled. CKD was determined with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73m2, based on two equations of Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). The multivariate logistic regression was used to evaluate the CKD stage III+ determinants. Results Prevalence of CKD stage III+ is estimated to be 7.1, 5.5, and 5.4% based on MDRD, CKD-EPI, and combination of both equations, respectively. More than 89% of CKD subjects aged higher than 40 years. In regression analysis, age more than 40 years had the strongest association with CKD stage III+ probability (OR: 8.23, 95% CI: 6.91–9.18). Higher wealth score, hypertension, High-Density Lipoprotein levels less than 40 mg/dl, and higher waist to hip ratio were all associated with CKD stage III+ while Arab ethnicity showed a protective effect (OR: 0.69, 95% CI: 0.57–0.78). Conclusion Our findings provide detailed information on the CKD stage III+ and its determinants in the southwest region of Iran. Due to strong association between age and CKD stage III+, within a few decades we might expect a huge rise in the CKD prevalence.

Avnit Kumar,1 Masoud Mohammadnezhad,2 William May3 1Department of Primary Care and Nutrition, Fiji National University, Suva, Fiji Islands; 2Department of Public Health and Health Services Management, Fiji National University, Suva, Fiji Islands; 3Department of Internal Medicine, Fiji National University, Suva, Fiji IslandsCorrespondence: Masoud MohammadnezhadDepartment of Public Health and Health Services Management, Fiji National University, Suva, Fiji IslandsEmail masoud.m@hotmail.comBackground: Noncompliance with prescribed medication leads to disease progression, which often leads to premature deaths. It often leads to worsening symptoms of cardiac conditions and hospitalization. Due to the lack of previous research, this study aimed to explore the factors contributing to noncompliance with medication in cardiac patients in Fiji.Methods: This qualitative study was conducted among 25 cardiac patients with congestive heart failure and coronary heart disease who attended special outpatient department (SOPD) clinics at Sigatoka Subdivisional Hospital in Fiji. Purposive sampling was used to select the study sample, and in-depth face-to-face interviews were conducted using a semistructured, open-ended questionnaire. Data were analyzed using thematic analysis, whereby the data collected were grouped in subthemes and then common themes related to the topic.Results: A total of 25 patients were interviewed, with a majority (n=14) being men and 15 Fijian of Indian descent. A greater number (n=17) of participants were above the age of 60 years, 19 had had primary education, while 12 were unemployed. Eight themes were identified as factors affecting noncompliance with medication: scarcity of knowledge, patients’ negative attitudes, poor family support, financial constraints, forgetfulness, irregular clinic attendance, heavy alcohol use, and alternative treatment vs pharmaceutical medication.Conclusion: Noncompliance with medication in cardiac patients contributes to worsening cardiac disease and premature deaths. For factors related to noncompliance, awareness can be raised in SOPD clinics for patients to realize the effects of noncompliance and provide ways to improve compliance. Providing professional counseling services for all SOPD patients would greatly help in increasing compliance with medication in Fiji.Keywords: determinants, noncompliance with medication, cardiac patients, qualitative study, Fiji

Background Dual contraceptive is the use of a barrier like condom along with any modern contraceptive methods which has double significance for the prevention STI including HIV and unintended pregnancy. The prevalence and determinants of dual contraceptive utilization described by different studies were highly inconsistent in Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and determinants of dual contraceptive utilization among HIV positive women in Ethiopia. Methods International database mainly Pub Med, Google scholar, HINARI, EMBASE, Cochrane Library, AJOL was applied to identify original studies. STATA software version 14 was applied to analyze the pooled prevalence of dual contraceptive. I2 test statistics was computed to check the presence of heterogeneity across the studies and eggers test was used to identify publication bias. The pooled prevalence of dual contraceptive utilization was estimated by using a random effects model. The associations between determinants and dual contraceptive utilization were evaluated by using both random and fixed effect models. Result A total 9 studies with 9168 HIV positive women were enrolled in this study. The pooled prevalence of dual contraceptive utilization among HIV positive women in Ethiopia was 26.14% (95% CI 21.20–31.08). Disclosure of HIV status (OR = 4.18,95%CI:2.26–7.72), partner involvement in post-test counselling (OR = 2.31,95%CI:1.63–3.25), open discussion about dual contraceptive with partner (OR = 4.27 95% CI:1.69–10.77), provision of counselling on dual contraceptives by health care provider (OR = 4.47,95% CI:3.81–5.24) and CD4 count > 350 cells/ mm3 (OR = 3.87,95%CI:3.53–4.23) were among the significant factors associated with dual contraceptive utilization. Conclusion The overall prevalence of dual contraceptive utilization among HIV positive women was significantly low. Disclosure of HIV status, partner involvement in post-test counselling, open discussion about dual contraceptive with partner, counselling on dual contraceptive by health care provider and CD4 count > 350 cells/ mm3 were positively affect dual contraceptive utilization. This study implies the need to develop plans and policies to improve partner involvement posttest counseling, integrate the counseling and provision of dual contraceptive at ART clinic at each level of health system.

Background Malawi is one of the countries in SSA with the highest TFR. This study aimed to explore factors associated with modern contraceptive use and intention to use contraceptives among women of reproductive ages (15–49 years) in Malawi. Methods The study used secondary data from 2015 to 16 Malawi Demographic and Health Survey (MDHS) dataset. Logistic regression models were used to derive adjusted odd ratios as the measures of association between need, predisposing and enabling factors, and contraceptive use and the intention to use contraceptives among women. The sample constituted 24,562 women who were successfully interviewed during the MDHS. All comparisons are considered statistically significant at 5% level. Results Overall 54.8% of women were currently using contraceptives, while 69.1% had the intention to use contraceptives. The odds of contraceptive use were significantly low among, women aged 15–19 years, 20–24 years, 25–29 years, 30–34 years, 35–39 years and 40–44 years compared to women aged 45–49 years; women of Tonga ethnic group (OR = O.60, CI = 0.43 0.84) compared to women of Nyanga ethnic group; women from poor households (OR = 0.78, CI = 0.68–0.90) and middle income households (OR = 0.84, CI = 0.74–0.95) compared to women from rich household. Nonetheless, women with no past experience of terminated pregnancy (OR = 1.50, CI = 1.34–1.68) were more likely to use contraceptives compared to women with past experience of terminated pregnancy. Similarly, Women with primary education (OR = 1.56, CI = 1.16–2.09) and secondary education (OR = 1.39, CI = 1.04–1.85) were more likely to use contraceptives compared to women with higher education. While the odds of intending to use contraceptives were significantly high with age only thus among women aged 15–19 years, (OR = 15.18, CI = 5.94–38.77); 20–24 years (OR = 16.77, CI = 7.46–37.71); 25–29 years (OR = 6.75, CI = 3.16–14.45); 30–34 years (OR = 7.75, CI = 3.61–16.65) and 35–39 years (OR = 5.05, CI = 2.29–11.12) compared to women aged 45–49 years. Conclusion As direct policy measure; information, education and communication programmes on family planning among poor and middle income women, and all women in reproductive ages should be strengthened.

Background Childhood morbidities such as diarrhea and pneumonia are the leading causes of death in Ethiopia. Appropriate healthcare-seeking behavior of mothers for common childhood illnesses could prevent a significant number of these early deaths; however, little nation-wide research has been conducted in Ethiopia to assess mothers’ healthcare-seeking behavior for their under five children. Methods The study used the Ethiopian Demographic and Health Surveys (EDHS) data. The EDHS is a cross sectional survey conducted in 2016 on a nationally representative sample of 10,641 respondents. The main determinants of care-seeking during diarrhea and acute respiratory infection (ARI) episodes were assessed using multiple logistic regression analyses while adjusting for complex survey design. Results Only 43% and 35% of households sought medical attention for their children in episodes of diarrhea and ARI, respectively, during a reference period of 2 weeks before the survey. The odds of seeking care for diarrhea are lower for non-working mothers versus working mothers. The likelihood of seeking care for diarrhea or ARI is higher for literate fathers compared to those with no education. The place of delivery for the child, receiving postnatal checkup and getting at least one immunization in the past determined the likelihood of seeking care for ARI, but not for diarrhea. The odds of seeking care are higher for both diarrhea and ARI among households that are headed by females and where mothers experienced Intimate Partner Violence (IPV) violence. Religion and types of family structure are also significant factors of seeking care for diarrhea episodes, but not for ARI. Conclusions The findings call for more coordinated efforts to ensure equitable access to health care services focusing on mothers living in deprived household environment. Strengthening partnerships with public facilities, private health care practitioners, and community-based organizations in rural areas would help further improve access to the services.

Objectives: Human Immunodeficiency Virus (HIV) remains a public health issue with more than 25 million deaths since 1990.ÂÂAs of 2019, Nigeria has a national prevalence of 1.4% among 15- 49 years and about 1.9 million people living with HIV, according to the Joint United Nations Programme on HIV/AIDS. This study assessed the factors responsible for unsuppressed viral load among patients accessing care at Federal Medical Centre HIV Clinic in Abeokuta, southwest Nigeria. Methods: The study design was descriptive cross-sectional. Data was collected using the qualitative method; an In-depth interview was conducted among 20 virally unsuppressed HIV patients currently on Antiretroviral Therapy (ART) at Federal Medical Centre Abeokuta. The participants were purposively selected. The data were analyzed using thematic analysis. Results: Although almost all the participants were aware of HIV, their knowledge of HIV was inadequate. Non- adherence to drugs, side effects of medications, the psychological effects of the disease, forgetfulness, and combination of anti-retroviral drugs with local herbs and alcohol were the associated factors of viral non-suppression among the patients. Conclusion:Scaling up psychological care services using Short Message Services (SMS) to improve viral suppression is, therefore, strongly recommended.

Background In Madagascar, maternal mortality remains stable and high (426 deaths per 100,000 live births). This situation is mainly due to a delay or lack of use of maternal healthcare services. Problems related to maternal healthcare services are well documented in Madagascar, but little information related to maternal healthcare seeking is known. Thus, this paper aims to identify and analyze the factors that influence the utilization of maternal services, specifically, the use of antenatal care (ANC) during pregnancy and the use of skilled birth attendants (SBAs) at delivery. Method We used quantitative and qualitative approaches in the study. Two communes of the Vakinankaratra region, which are located in the highlands, were the settings. Data collection occurred from October 2016 to July 2017. A total of 245 pregnant women were included and followed up in the quantitative survey, and among them, 35 participated in in-depth interviews(IDIs). Logistic regressions were applied to explore the influencing factors of antenatal and delivery healthcare seeking practices through thematic qualitative analysis. Results Among the 245 women surveyed, 13.9% did not attend any ANC visits. School level, occupation and gravidity positively influenced the likelihood of attending one or more ANC visits. The additional use of traditional caregivers remained predominant and was perceived as potentially complementary to medical care. Nine in ten (91%) women expressed a preference for delivery at healthcare facilities (HFs), but 61% of births were assisted by a skilled birth attendant (SBA).The school level; the frequency of ANCs; the origin region; and the preference between modern or traditional care influenced the use of SBAs at delivery. A lack of preparation (financial and logistics problems) and women’s low involvement in decision making at delivery were the main barriers to giving birth at HFs. Conclusion The use of maternal healthcare services is starting to gain ground, although many women and their relatives still use traditional caregivers at the same time. Relatives play a crucial role in maternal healthcare seeking. It would be necessary to target women’s relatives for awareness-raising messages about ANC and childbirth in healthcare facilities and to support and formalize collaborations between traditional healers and biomedical caregivers.

Aklilu Habte,1 Samuel Dessu,2 Kaleegziabher Lukas3 1Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Southern Ethiopia; 2Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Southern Ethiopia; 3Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, EthiopiaCorrespondence: Aklilu Habte Tel +251912744786Email akliluhabte57@gmail.comBackground: A gush of amniotic fluid any time before the onset of labor is known as premature rupture of the membranes (PROM). Its consequences vary from maternal and neonatal mortality and morbidity to country-wide economic loss. At the national level in general, and in the study area in particular, little is known about PROM and its determinants. Hence, this study aimed at identifying determinants of PROM among pregnant women admitted to public hospitals in Southern Ethiopia, 2020.Methods and Materials: A hospital-based unmatched case–control study was conducted on 279 pregnant women (93 cases and 186 controls) admitted to public hospitals from October 1 to 30, 2020. Pregnant women admitted to maternity wards of selected hospitals with a painless gush of fluid spilling out from the vaginal canal were considered as cases. Interviewer-administered questionnaires and data abstraction tools were used to collect data. The data were coded and entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. The determinants of PROM were identified by applying a multivariable logistic regression analysis at a p-value < 0.05.Results: Term PROM accounted for the majority, 55 (59.2%) of cases. Previous history of abortion (AOR: 4.14, 95% CI: 2.21– 9.07), lack of ANC (AOR: 3.51; 95% CI: 1.33– 8.27), previous history of PROM (AOR: 4.91; 95% CI: 2.23– 9.82), caesarean delivery (AOR: 3.02, 95% CI: 1.24– 6,40), using of a maternal waiting room (MWR) (AOR: 0.33, 95% CI: 0.15– 0.74), and mid-upper arm Circumference (MAUC) < 23cm (AOR: 3.69, 95% CI: 1.58– 8.64) were identified as significant determinants of PROM.Conclusion: Health-care providers should work on providing adequate ANC by tracing mothers who have not received it and advising pregnant women to use MWR in the final weeks of their pregnancy. Furthermore, maternal and child health care units must place a strong focus on screening and managing the nutritional status of pregnant women. Furthermore, women with a history of abortion, caesarean section, and PROM need due attention from health care providers to mitigate the occurrence of PROM.Keywords: PROM, determinants, case-control, public hospitals, Ethiopia

Aims To study clinical phenotype, prognosis for all-cause and cardiovascular (CV) mortality and predictive factors in patients with incident heart failure (HF) after aortic valvular intervention (AVI) for aortic stenosis (AS). Methods and results In this retrospective, observational study we included patients from the Swedish Heart Failure Registry (SwedeHF) recorded 2003-2016, with AS diagnosis and AVI before HF diagnosis. The AS diagnosis was established according to International Classification of Diseases 10th revision (ICD-10) codes, thus without information concerning clinical or echocardiographical data on the aortic valve disease. The patients were divided into two subgroups: left ventricular ejection fraction (LVEF) >= 50% (AS-HFpEF) and Funding Agencies|Swedish government [ALFGBG-72900, 73400]; Swedish County Councils, the ALF agreement [ALFGBG-72900, 73400]; Regional Development Fund, Vastra Gotaland County, Sweden [VGFOUREG-931060, VGFOUREG-849081]; Gothenburg Society of Medicine [20/935037]

Background Postpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within 1 year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania. Methods This was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16–44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model. Results Overall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11, 19 and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76, 50.5 and 36%, respectively). Women aged 40–44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively. Conclusion Lactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women’s age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.

Background The current standard of care for acute atrial fibrillation (AF) focuses primarily on immediate restoration of sinus rhythm by cardioversion, although AF often terminates spontaneously. Objective To identify determinants of early spontaneous conversion (SCV) in patients presenting at the emergency department (ED) because of AF. Methods An observational study was performed of patients who visited the ED with documented AF between July 2014 and December 2016. The clinical characteristics and demographics of patients with and without SCV were compared. Results We enrolled 943 patients (age 69 ± 12 years, 47% female). SCV occurred within 3 h of presentation in 158 patients (16.8%). Logistic regression analysis showed that duration of AF p 2 (OR 1.8, 95% CI 1.2–2.8, p = 0.010), symptoms of near-collapse at presentation (OR 2.4, 95% CI 1.2–5.1, p = 0.018), a lower body mass index (BMI) (OR 0.9, 95% CI 0.91–0.99, p = 0.028), a longer QTc time during AF (OR 1.01, 95% CI 1.0–1.02, p = 0.002) and first-detected AF (OR 2.5, 95% CI 1.6–3.9, p Conclusion Early spontaneous conversion of acute AF occurs in almost one-sixth of admitted patients during a short initial observation in the ED. Spontaneous conversion is most likely to occur in patients with first-onset, short-duration AF episodes, lower BMI, and normal left atrial size.

Background Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Methods A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of Results Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother’s knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women’s autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC. Conclusion The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother’s knowledge on PCC, being a model household, and women’s autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.

Background The Chlamydia trachomatis bacterial load could have impact on transmission and sequelae. This is the first study providing comparison of C. trachomatis load at 3 anatomic sites estimated by cycle quantification (Cq) values. Methods Data from 7900 C. trachomatis-positive samples were included (2012–2018). Cq value was used as an inversely proportional measure for C. trachomatis load. Multivariable linear regression analyses assessed differences in mean Cq values. Results Vaginal swabs had the lowest Cq values (31.0) followed by urine (32.5), anorectal swabs (34.0), and oropharyngeal swabs (36.8) (P < .001). Men and women had similar oropharyngeal (36.4 vs 37.3; P = .13) and anorectal (34.2 vs 33.9; P = .19) Cq values. Men (32.2) and women (30.7) aged Conclusions Men and women have a similar C. trachomatis load at extragenital locations arguing for similar transmission potential and clinical relevance. Older patients and HIV-coinfected patients had lower C. trachomatis load, suggesting exposure to previous C. trachomatis infections potentially leading to partial immunity reducing load.

Background Globally, Coronavirus disease-19 has created unprecedented challenges to public health. Healthcare workers (HCWs) are at risk of COVID-19 because of their profession. There are limited studies conducted in Ethiopia among HCWs regarding their compliance with COVID-19 preventive measures. Therefore, this study intended to assess HCWs’ compliance with measures to prevent COVID-19, and its potential determinants in public hospitals in Western Ethiopia. Methods A self-administered, multicenter hospital-based cross-sectional survey was proposed to 422 randomly selected HCWs working in seven public hospitals in Western Ethiopia identified as COVID-19 referral centers. Data were entered into Epi Data version 3.1 and analyzed using SPSS version 24. Binary logistic regression was used to identify potential determinants of outcome variables at p-value Results Out of 422 completed questionnaires, the overall HCWs’ compliance with COVID-19 prevention is 22% (n = 404). In multivariate regression analysis, factors such as spending most of caring time at bedside (AOR = 1.94, 95%CI, 1.06–3.55), receiving training on infection prevention/COVID-19 (AOR = 1.86, 95%CI, 1.04–3.33), reading materials on COVID-19 (AOR = 2.04, 95%CI, 1.14–3.63) and having support from hospital management (AOR = 2.09, 95%CI, 1.20–3.64) were found to be significantly associated with COVID-19 preventive measures. Furthermore, inadequate supplies of appropriate personal protective equipment (83.2%), insufficient supportive medications (78.5%), and lack of provision of adequate ventilation (77.7%) were the barriers to COVID-19 prevention most frequently mentioned by participants. Conclusion Our findings highlight HCWs’ poor compliance with COVID-19 preventive measures. Providing information and refreshing training to improve the level of healthcare workers’ adherence with COVID-19 prevention is as imperative as increasing staff commitment to supply resources necessary to protect HCWs and to reduce healthcare-associated infections transmission of SARS-COV-2.

Background Defining socio-demographic factors, clinical presentations and underlying diseases associated with COVID-19 severity could be helpful in its management. This study aimed to further clarify the determinants and clinical risk factors of the disease severity in patients infected with COVID-19. Methods A multi-centre descriptive study on all patients who have been diagnosed with COVID-19 in the province of Tehran from March 2020 up to Dec 2020 was conducted. Data on socio-demographic characteristics, clinical presentations, comorbidities, and the health outcomes of 205,654 patients were examined. Characteristics of the study population were described. To assess the association of study variables with the disease severity, the Chi-Squared test and Multiple Logistic Regression model were applied. Results The mean age of the study population was 52.8 years and 93,612 (45.5%) were women. About half of the patients have presented with low levels of blood oxygen saturation. The ICU admission rate was 17.8% and the overall mortality rate was 10.0%. Older age, male sex, comorbidities including hypertension, cancer, chronic respiratory diseases other than asthma, chronic liver diseases, chronic kidney diseases, chronic neurological disorders, and HIV/AIDS infection were risk markers of poor health outcome. Clinical presentations related with worse prognosis included fever, difficulty breathing, impaired consciousness, and cutaneous manifestations. Conclusion These results might alert physicians to pay attention to determinants and risk factors associated with poor prognosis in patients with COVID-19. In addition, our findings aid decision makers to emphasise on vulnerable groups in the public health strategies that aim at preventing the spread of the disease and its mortalities.

Objective Mental health care needs of urban, rural, and tribal regions of India are varied and challenging, which require region-specific approaches. A significant treatment gap calls out for a state-wise introspection of existing service delivery models to cater to the specific mental health needs. In Madhya Pradesh, key findings were noted from a camp conducted in one of the tribal districts. To establish patient-centered services, it is important to understand their mental health care needs. Materials and Methods A cross-sectional study within a mental health camp was conducted in the east-central tribal district of Madhya Pradesh by using a semi-structured interview. Statistical Analysis Treatment deficit, pathways to care, and treatment barriers were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20. Results Among 113 patients who sought help, treatment deficit was 85% with patient factors contributing 76% predominantly affecting the unmarried group of patients. Common mental illnesses (CMIs) outnumbered severe mental illnesses (SMIs) of which anxiety spectrum disorder contributed the most. SMIs still appear to remain undiagnosed till late in the course of illness. Nicotine dependence was higher in males (p < 0.001), and an increase in the dependence pattern was observed with increasing age (p = 0.001). Conclusion Rising awareness and recognition of CMIs as a common mental health concern while under-recognition of SMIs among tribal communities needs further research. Considering attribution of symptoms to unknown factors, treatment barriers revolving around patient factors, and higher nicotine dependence in males, a timely evaluation of a multitargeted intervention to establish the balance in access to mental health care among the tribal population of Madhya Pradesh is warranted.

BackgroundThe burden of chronic kidney disease in Africa is three to four times higher compared to high-income countries and the cost of treatment is beyond the reach of most affected persons. The best treatment for end stage renal disease is kidney transplantation which is not available in most African countries. As kidney transplantation surgery is emerging in Ghana, this study assessed factors which could influence the willingness of patients with chronic kidney disease to accept it as a mode of treatment.MethodsThis cross-sectional survey was carried out among patients with chronic kidney disease in Korle-Bu Teaching Hospital. A consecutive sampling method was used to recruit consenting patients. A structured questionnaire and standardized research instruments were used to obtain information on demographic, socio-economic characteristics, knowledge about transplantation, perception of transplantation, religiosity and spirituality. Logistic regression model was used to assess the determinants of willingness to accept a kidney transplant.Results342 CKD patients participated in the study of which 56.7% (n = 194) were male. The mean age of the participants was 50.24 ± 17.08 years. The proportion of participants who were willing to accept a kidney transplant was 67.3% (95%CI: 62.0–72.2%). The factors which influenced participants’ willingness to accept this treatment included; willingness to attend a class on kidney transplantation (p p p p < 0.005). The barriers for accepting kidney transplantation were anticipated complications of transplant surgery and financial constraints.ConclusionMore than two-thirds of CKD patients were willing to accept a kidney transplant and this is influenced by multiple factors. Government health agencies must consider full or partial coverage of kidney transplantation through the existing national health insurance scheme. Further, efficient educational programmes are required to improve both patients’ and physicians’ knowledge on the importance of kidney transplantation in the management of end stage renal disease in Ghana.

Background The status of health of an individual and - more broadly - of a community or population is defined by the status of their determinants of health. A “systemic” approach to define the health determinants is necessary in order to explore the complex relations existing among them. This study is aimed at identifying a ‘composite systemic’ index of health to measure the impact of socioeconomic factors on public health at local level and to analyze possible spatial autocorrelations between neighboring regions. Results A Composite Index of Health (CIH) was constructed on the basis of known indicators of socio-economic well-being by using the COMIC (COMposite Indices Creator) Software and was validated on the Italian population and a nationwide comparison has been performed. Analysis of the determinants showed a significant direct correlation between health, environment, work and wealth and inverse correlation between health and social distress. The analysis of data from Italian provinces confirmed the South-North gradient of well-being. Conclusion The CIH is a reliable and robust index to evaluate the health of a local population. Although it was validated on Italian data, the index can be easily adapted to any Country.

As Africa prepares to overcome the difficult challenges of COVID-19 vaccination roll-outs, a number of factors, including equitable access, effective and efficient sufficient supply chains, a scope of established determinants will need to be considered in order to enhance vaccine acceptability and uptake. In this commentary, we present six major determinants of vaccine acceptability and uptake in Africa. We summarize these determinants with the acronym VAMRIS: V= Vaccine hesitancy; A= Attitude and uptake by health care workers; M= Misinformation; R= Religion; I= Immunization roll out plans; S= Social influences and enabling environment. Understanding determinants of COVID-19 vaccine acceptability will guide public health officials make informed decisions. As the Vaccine becomes progressively available, strategies for efficient roll-out to achieve massive uptake by the targeted population will depend on a number of factors. These include: community engagement efforts; types of health promotion activities and/or messages; community sensitization to dispel myths and misconceptions; endorsements and buy-ins from local champions, celebrities, authorities; logistic considerations; and incentives to health counsellors/workers to create demand. Copyright © 2020 Wirsiy et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Worldwide, adherence to national guidelines for physical activity (PA), and fruit and vegetable consumption is recommended to promote health and reduce the risk for (chronic) disease. This study reports on the effectiveness of various social-cognitive interventions to improve adherence to guidelines and the revealed adherence predictors. Participants (n = 1,629), aged 45–70 years, randomly selected and recruited in 2005–2006 from 23 Dutch general practices, were randomized (centralized stratified allocation) to four groups to receive a 12-month lifestyle intervention targeting guideline adherence for PA and fruit and vegetable consumption. Study groups received either four computer-tailored print communication (TPC) letters (n = 405), four telephone motivational interviewing (TMI) sessions (n = 407), a combined intervention (two TPC letters and two TMI sessions, n = 408), or no intervention (control group, n = 409). After the baseline assessment, all parties were aware of the treatment groups. Outcomes were measured with self-report postal questionnaires at baseline, 25, 47 and 73 weeks. For PA, all three interventions were associated with better guideline adherence than no intervention. Odds ratios for TPC, TMI and the combined intervention were 1.82 (95% CI 1.31; 2.54), 1.57 (95% CI 1.13; 2.18), and 2.08 (95% CI 1.50; 2.88), respectively. No pedometer effects were found. For fruit and vegetable consumption, TPC seemed superior to those in the other groups. Odd ratio for fruit and vegetable consumption were 1.78 (95% CI 1.32; 2.41) and 1.73 (95% CI 1.28; 2.33), respectively. For each behaviour, adherence was predicted by self-efficacy expectations, habit strength and stages of change, whereas sex, awareness and the number of action plans predicted guideline adherence for fruit and vegetable intake. The season predicted the guideline adherence for PA and fruit consumption. The odds ratios revealed were equivalent to modest effects sizes, although they were larger than those reported in systematic reviews. This study indicated that less resource intensive interventions might have the potential for a large public health impact when widely implemented. The strengths of this study were the participation of lower educated adults and evaluation of maintenance effects. (Trial NL1035, 2007-09-06).

Girish Degavi,1 Hazaratali Panari2 1Department of Nursing, College of Health and Medical Science, Bule Hora University, Hagere Mariam, Ethiopia; 2Department of Nursing, Institute of Medicine and Health Sciences, Debre Berhan Univerity, Debre Berhan, EthiopiaCorrespondence: Girish DegaviDepartment of Nursing, College of Health and Medical Science, Bule Hora University, P.O Box 144, Hagere Mariam, EthiopiaEmail girishdegavi1984@gmail.comBackground: Impotence incidence in patients with elevated glycemic index valuesis 30%– 69.01%. While impotence is very prevalent among diabetic men, the condition is mostly left unaddressed and needs assessment and care. Impotence can influence the quality of social, mental, leisure, and sexual life, and can contribute to broken relationships, depression, and reduced self-esteem. The goal of the present work was to research the commonness and determinants of impotence among diabetic patients in hospitals in the northwestern region of Nefasit .Methods: A cross-sectional hospital analysis was done of 239 patients with diabetes mellitusin five of six hospitals in Nefasit by means of systemic random sampling. methods. Data were collected for 2 months from Februaryto April 2019.Results: The mean age of participants was 43.32 years and mean duration of diabetes 8.7 years. Impotence prevalence was found to be 74.2%: 36.1% mild, 34.2% moderate, and 5.8% serious sexual dysfunction. Statistical analysis showed that impotence was considerably associated with being elderly (AOR 14.21, 95% CI 3.22– 70.00), prolonged diabetes (AOR 4.1, 95% CI 1.22– 11.16), and lower monthly income (AOR0.279, 95% CI 0.133– 0.614). There was no association found with BMI, comorbidity, sugar control, or intake of alcohol.Conclusion: The prevalence of impotence in the present study was quite high. Very few patients (5.1%) had been screened for impotence. Care of impotent patients in hospitals for diabetes should be a regular health protocol during follow-up care.Keywords: Asmara, determinants, DM, Nefasit, prevalence

BackgroundEvery day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and lower-middle-income countries. Sub-Saharan Africa (SSA) alone accounts for roughly 66%. If pregnant women gained recommended ANC (Antenatal Care), these maternal deaths could be prevented. Still, many women lack recommended ANC in sub-Saharan Africa. This study aimed at determining the pooled prevalence and determinants of recommended ANC utilization in SSA.MethodsWe used the most recent standard demographic and health survey data from the period of 2006 to 2018 for 36 SSA countries. A total of 260,572 women who had at least one live birth 5 years preceding the survey were included in this study. A meta-analysis of DHS data of the Sub-Saharan countries was conducted to generate pooled prevalence, and a forest plot was used to present it. A multilevel multivariable logistic regression model was fitted to identify determinants of recommended ANC utilization. The AOR (Adjusted Odds Ratio) with their 95% CI andp-value ≤0.05 was used to declare the recommended ANC utilization determinates.ResultsThe pooled prevalence of recommended antenatal care utilization in sub-Saharan Africa countries were 58.53% [95% CI: 58.35, 58.71], with the highest recommended ANC utilization in the Southern Region of Africa (78.86%) and the low recommended ANC utilization in Eastern Regions of Africa (53.39%). In the multilevel multivariable logistic regression model region, residence, literacy level, maternal education, husband education, maternal occupation, women health care decision autonomy, wealth index, media exposure, accessing health care, wanted pregnancy, contraceptive use, and birth order were determinants of recommended ANC utilization in Sub-Saharan Africa.ConclusionThe coverage of recommended ANC service utilization was with high disparities among the region. Being a rural residence, illiterate, low education level, had no occupation, low women autonomy, low socioeconomic status, not exposed to media, a big problem to access health care, unplanned pregnancy, not use of contraceptive were determinants of women that had no recommended ANC utilization in SSA. This study evidenced the existence of a wide gap between SSA regions and countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services.

Erectile dysfunction is currently a growing health concern and one of the most prevalent sexual dysfunctions in men worldwide. Diabetes mellitus is considered a risk factor for developing ED. Therefore, this SHIM study was designed to assess the prevalence, severity and determinant of erectile dysfunction in type II diabetes mellitus patients and healthy men. This hospital-based cross-sectional study was conducted on 132 diabetic male patients and 66 healthy men at the Nkenkaasu hospital, Offinso North, Ghana between January-June, 2019. A pre-structured questionnaire and patients’ medical records were used to document relevant information. Erectile function was assessed using Sexual health inventory for men questionnaire. Data were analyzed using SPSS version 22.0. Chi-square test, binary and multivariable logistic regression analysis were used appropriately. The mean age of study participants was 57.94 ± 9.79 years. The overall mean score on the SHIM test was 12.42 ± 8.15 (range: 1–25), mean of 9.59±7.83 for the type II diabetics and 18.08±5.39 for non-diabetic men. The total erectile dysfunction (ED) prevalence was 81.8% (95% CI: 0.757, 0.869). ED was common in diabetics (70.4%) compared with healthy men (29.6%). Severe ED was 93.7% and 6.3% in the diabetic and non-diabetic men respectively. Multivariate logistic regression revealed that diabetic men with poor health-related quality of life had 3.48 times likelihood of having ED compared to their non-diabetic counterparts (AOR= 3.48, 95% CI; 1.284, 9.453). Very high erectile dysfunction was observed in our study participants. This is worrisome owing to the profound negative impact of ED on the quality of life and fertility of men. It is recommended that periodic assessment of erectile function should form part of routine diabetes care, focusing attention on the modifiable risk factors in preventing, delaying progression, or reversing established ED in persons. Doi: 10.28991/SciMedJ-2021-0301-4 Full Text: PDF

BackgroundHousehold surveys remain important sources of maternal and child health data, but until now, standard surveys such as Demographic and Health Surveys (DHS) have not collected information on maternity care for women who have experienced a stillbirth. Thus, nationally representative data are lacking to inform programmes to address the millions of stillbirths which occur annually.MethodsThe EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). All women answered a full birth history with additional questions on pregnancy losses (FBH+) or full pregnancy history (FPH). A sub-sample, including all women reporting a recent stillbirth or neonatal death, was asked additional maternity care questions. These were evaluated using descriptive measures. Associations between stillbirth and maternal socio-demographic characteristics, babies’ characteristics and maternity care use were assessed using a weighted logistic regression model for women in the FBH+ group.ResultsA total of 15,591 women reporting a birth since 1 January 2012 answered maternity care questions. Completeness was very high (> 99%), with similar proportions of responses for both live and stillbirths. Amongst the 14,991 births in the FBH+ group, poorer wealth status, higher parity, large perceived baby size-at-birth, preterm or post-term birth, birth in a government hospital compared to other locations and vaginal birth were associated with increased risk of stillbirth after adjusting for potential confounding factors. Regarding association with reported postnatal care, women with a stillbirth were more likely to report hospital stays of > 1 day. However, women with a stillbirth were less likely to report having received a postnatal check compared to those with a live birth.ConclusionsWomen who had experienced stillbirth were able to respond to questions about pregnancy and birth, and we found no reason to omit questions to these women in household surveys. Our analysis identified several potentially modifiable factors associated with stillbirth, adding to the evidence-base for policy and action in low- and middle-income contexts. Including these questions in DHS-8 would lead to increased availability of population-level data to inform action to end preventable stillbirths.

Background Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. Methods Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. Results The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011–2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. Conclusions Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.

Background Ectopic pregnancy is an abnormal condition in which implantation of the blastocyst occurs outside the endometrium of the uterus. It is gynecological important, particularly in the developing world, because of associated with enormous rate of high morbidity, during the first trimester of pregnancy. A better understanding of its risk factors can help to prevent its prevalence. However, the determinants of ectopic pregnancy are not well understood and few researches conducted in our country were based on secondary data covering small scale area. This study aimed to identify determinants of ectopic pregnancy among pregnant women attending referral hospitals in Southwestern part of Oromia regional state, Southwest Ethiopia. Methods Hospital-based case control study was employed from June 1 to September 30, 2019. The study was conducted in five referral hospitals in Southwestern part of Oromia regional state. Final sample size includes 59 cases and 118 controls. Data were entered by using Epidata version 3.1 and analyzed using SPSS version 23. Descriptive statistics were used to explore the data. All explanatory variables with p-value of p Results Out of 177 (59 cases and 118 controls) participants, 174 (58 cases and 116 controls) were participating in the study. Prior two or more induced abortions [AOR = 3.95:95% CI: 1.22–13.05], previous history of caesarean section [AOR = 3.4:95% CI: 1.11–10.94], marital status (being single) [AOR = 4.04:95%CI: 1.23–13.21], reporting prior recurrent sexual transmitted infection [AOR = 2.25:95%CI: 1.00–5.51], prior history of tubal surgery [AOR = 3.32:95%CI: 1.09–10.13], were more likely to have an ectopic pregnancy with their respective AOR with 95%CI. Conclusion It was found that having a history of more than two induced abortions during previous pregnancies, marital status (single), recurrent sexual transmitted infection, prior history of tubal surgery and experiencing prior caesarean section were found to be determinants of ectopic pregnancy. Hospitals should give emphasis on prevention and early detection of risks of ectopic pregnancy and create awareness in order to reduce the burden of ectopic pregnancy.

Introduction: During COVID-19 pandemic lockdown, mental health of students was highly pregnable to the loss of social connectedness, disarray of normal pattern of activities as well as academic issues. Adopted coping mechanisms may have played a significant role in surmounting the challenges related to the pandemic. The main aim of the survey is to evaluate the prevalence of depression, its determinants, and association with coping mechanisms among college students during COVID-19 lockdown. Materials and Methods: College students were invited during lockdown to participate in a nationwide cross-sectional e-survey using Snowball sampling technique (dated October 6th–30th, 2020). A total sample size of 920 was calculated. A self-administered questionnaire regarding sociodemographic characteristics, COVID-19 related experiences along with two scales (Patient Health Questionnaire-9 [PHQ-9], and Carver Brief-Coping Orientation to the Problem Experienced -28) for assessment of depression and adopted coping mechanisms was applied to participants. Chi-square test, independent t-test, Pearson's correlation, and hierarchical multiple regression analysis were used to investigate the determinants of depression and its association with coping mechanisms in college students. Results: On analysis of 884 qualified participants, it was revealed that 402 (45.5%) participants have depressive symptoms ranging from moderate to severe level. The mean score of PHQ-9 was 9.82 ± 6.61. Nearly 85% students were lagging behind in studies. Around 5%–10% of students initiated/increased the consumption of substances. The main determinants of depression in this study were age group of 21–24 years, thought of lagging behind in studies and family members/friends/relatives diagnosed with COVID-19. Adaptive coping mechanisms (emotional support, religion, and humor) were significantly associated with lower depressive symptoms and maladaptive coping mechanisms (self-distraction, denial, behavioral disengagement, and venting) were significantly associated with higher depressive symptoms among students. Conclusions: This survey revealed multiple determinants of depression, mainly including academic worries among college students. The college staff should provide a well-structured pedagogical framework to encourage them and alleviate the unpleasant psychological effects of pandemic on students.

Background It has been widely believed that practicing yoga helps to improve individuals’ mental and physical health. However, the proportion of people practicing yoga is not encouraging. Objective This study investigates the determinants, motivations, benefits and barriers to practicing yoga. Material and methods This study is based on a cross sectional survey of 875 individuals in a face-to-face interviews conducted from February to April 2019 in Kathmandu, Nepal. The interviews were conducted using a semi-structured questionnaire, and the statistical analysis of the collected data was done using SPSSV20. Results We find that females, older people, people with access to health education and internet, associated with social organization, and receiving yoga-related training are more likely to practice yoga. Major reported benefits of yoga include improvement in body flexibility and balance, a decrease in the level of stress, improvement in the quality of life, body weight maintenance, and improvement in immunity power. Conclusion Given that most respondents have been benefited from practicing yoga, we recommend people to incorporate yoga into their daily routine.

Objectives To investigate the association between EBF and educational status, household income, marital status, media exposure, and parity in Ethiopia.Methods PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library databases were searched using key terms for all studies published in English between September 2009 and March 2019. The methodological quality of studies was examined using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. To obtain the pooled odds ratio (OR), extracted data were fitted in a random-effects meta-analysis model. Statistical heterogeneity was quantified using Cochran's Q test, tau(2), and I-2 statistics. In addition, Jackknife sensitivity analysis, cumulative meta-analysis, and meta-regression analysis were conducted.Results Out of 553 studies retrieved, 31 studies fulfilled our inclusion criteria. Almost all included studies were conducted among mothers with newborn less than 23 months old. Maternal primary school education (OR 1.39; 95% CI 1.03-1.89; I-2 = 86.11%), medium household income (OR 1.27; 95% CI 1.05-1.55; I-2 = 60.9%) and being married (OR 1.39; 95% CI 1.05-1.83; I-2 = 76.96%) were found to be significantly associated with EBF. We also observed an inverse dose-response relationship of EBF with educational status and income. However, EBF was not significantly associated with parity, media exposure, and paternal educational status.Conclusions In this meta-analysis, we showed the relevant effect of maternal education, income, and marital status on EBF. Therefore, multifaceted, effective, and evidence-based efforts are needed to increase the national level of exclusive breastfeeding in Ethiopia.

There is a paucity of antihypertensive drug adherence studies among stroke patients in West Bengal. With an aim to identify antihypertensive drug adherence and its determinants, this descriptive cross-sectional study was conducted for 2 months among a calculated sample of 133 study participants using predesigned and pretested schedule, the metric "Proportion of days covered (PDC)," and the Morisky, Green, and Levine (MGL) Scale. Data were compiled and analyzed using SPSS software (version 20.0). Adherence rates were 31.6% and 44.4% based on the MGL scale and PDC method, respectively. Higher adherence was significantly associated with increased age (P = 0.006), higher literacy (P = 0.013), increased interval between diagnosis of hypertension and present symptom (P = 0.001), a greater gap between antihypertensive treatment initiation and present symptom (P = 0.003), receiving advice on regular drug intake (P = 0.000), and registered medical practitioner prescribing the medication (P = 0.007).

Background: More than one third of the neonatal deaths at Neonatal Intensive Care Unit of Debre Tabor General Hos- pital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from maternity ward of the hospital. However, there is no recent evidence on the prevalence and specific determinants of birth asphyxia at DTGH. Besides, public health importance of factors like birth spacing weren’t addressed in the prior studies. Methods: A cross sectional study was conducted on a sample of 240 newborns at delivery ward. The collected data were cleaned, coded and entered into Epi -data version 4.2 and exported to Stata version 14. Binary logistic regression model was considered and statistical significance was declared at P< 0.05 using adjusted odds ratio. Results: The prevalence of asphyxia neonatorum was 6.7 % based on the fifth minute APGAR score. From multi-variable logistic regression analysis, antenatal obstetric complications (AOR = 2.63, 95% CI: 3.75, 14.29), fetal malpresentation (AOR = 3.17, 95% CI: 1.21, 15.20), premature rupture of fetal membranes (AOR = 6.56, 95% CI: 3.48, 18.12) and meconium stained amniotic fluid (AOR = 2.73, 95% CI: 1.76, 14.59) were significant predictors. Conclusion: The prevalence of fifth minute asphyxia neonatorum was relatively low. Fortunately, its predictors are modifi- able. Thus, we can mitigate the problem even with our limited resources such as enhancing the existing efforts of antenatal and intra-partum care, which could help early detection and management of any obstetric and neonatal health abnormality.” Keywords: Birth asphyxia; asphyxia neonatorum; prevalence; determinants; Ethiopia.

Introduction Preservation of peritoneal function is essential in long-term peritoneal dialysis. Biocompatible dialysis solutions might prevent or postpone the membrane alteration resulting in ultrafiltration failure and consecutive morbidity and mortality. Methods We conducted an observational cohort study in which we made a longitudinal comparison between the course of peritoneal solute and fluid transport during treatment with conventional and biocompatible solutions. Therefore, prospectively collected peritoneal transport data from the yearly standard peritoneal permeability analysis were analyzed in 251 incident patients treated between 1994 and censoring in 2016. Fluid transport included small pore and free water transport. Solute transport was assessed by creatinine mass transfer area coefficient and glucose absorption. Linear mixed models including change point analyses were performed. Interaction with peritonitis was examined. Results One hundred thirty-five patients received conventional and 116 biocompatible solutions. Sixty-seven percent (conventional) and 64% (biocompatible) of these underwent minimally three transport measurements. Initially, biocompatible fluids showed higher small solute transport and lower ultrafiltration than conventional fluids up to 3 years. Thereafter, conventional fluids showed an increase in small solute transport (+2.7 ml/min per year; 95% confidence interval [CI]: 0.9 to 4.5) and a decrease of free water transport (−28.0 ml/min per year; 95% CI: −60.4 to 4.4). These were minor or absent in biocompatible treatment. Peritonitis induced a decrease of transcapillary ultrafiltration after 2 years on dialysis with conventional solutions (−291 ml/min per year; 95% CI: −550 to −32) while this was absent in biocompatible treatment. Conclusion Despite a higher initial solute transport with biocompatible solutions, these have less influence on functional long-term peritoneal alterations than conventional solutions., Graphical abstract

Background: The primary hurdle for the eradication of HIV-1 is the establishment of a latent viral reservoir early after primary infection. Here, we investigated the potential influence of human genetic variation on the HIV-1 reservoir size and its decay rate during suppressive antiretroviral treatment. Setting: Genome-wide association study and exome sequencing study to look for host genetic determinants of HIV-1 reservoir measurements in patients enrolled in the Swiss HIV Cohort Study, a nation-wide prospective observational study. Methods: We measured total HIV-1 DNA in peripheral blood mononuclear cells from study participants, as a proxy for the reservoir size at 3 time points over a median of 5.4 years, and searched for associations between human genetic variation and 2 phenotypic readouts: the reservoir size at the first time point and its decay rate over the study period. We assessed the contribution of common genetic variants using genome-wide genotyping data from 797 patients with European ancestry enrolled in the Swiss HIV Cohort Study and searched for a potential impact of rare variants and exonic copy number variants using exome sequencing data generated in a subset of 194 study participants. Results: Genome-wide and exome-wide analyses did not reveal any significant association with the size of the HIV-1 reservoir or its decay rate on suppressive antiretroviral treatment. Conclusions: Our results point to a limited influence of human genetics on the size of the HIV-1 reservoir and its long-term dynamics in successfully treated individuals.

Knowledge, attitudes and beliefs (KABs) toward influenza vaccination (IV) play a key role in HCWs' decisions to receive vaccination and can strongly influence patients' IV uptake. We examined the knowledge, attitudes and beliefs of GPs toward IV, exploring their opinion on IV in the elderly, mandatory HCW vaccination and the desirability of an IV trial in the elderly with hospitalization/mortality as effect measure. From November 2018 to March 2019, surveys were emailed to GPs and GP-practices (n = 1676) in three regions of the Netherlands. We assessed the self-reported IV in GPs, reasons for (not) advising IV to personnel, (not) supporting mandatory IV for personnel and (not) desiring a trial on IV in the elderly on hospitalization/mortality. Multivariable logistic regression models were used to determine predictors for GP IV. A total of 552 surveys were completed and 71.9% of the GPs reported receiving IV. Determinants for IV in GPs were male sex (aOR 1.62, 95%CI 1.06-2.49, p = .03) and age >= 60 y (aOR 5.25, 95%CI 1.51-18.32, p = .01). Seventy-nine percent of the GPs recommend IV for their practice personnel. Mandatory IV for personnel was supported by 41.2% of the GPs with GP self-reporting IV being the only determinant (aOR 10.03 (95%CI 5.69-17.70 p = .00)). An IV trial on hospitalization and/or mortality was desired by 60.5% of the GPs. We concluded that the majority of Dutch GPs receives IV and recommends IV to their personnel. These high rates along with the hesitancy of GPs toward mandatory HCW IV should be considered when policymakers decide on a mandate for IV in HCW in general.

Objective: To provide insight into the motivational working mechanisms (i.e. mediators) of an effective physical activity (PA) intervention for adults aged over fifty. Design: The mediation model (N = 822) was investigated in an RCT for the total intervention population, participants who were not norm-active at baseline (targeting PA initiation) and norm-active participants (targeting PA maintenance) separately. Main Outcome Measures: Potential mediators (attitude, self-efficacy, intention, action planning and coping planning) of the effect on PA (6-months) were assessed at baseline, 3 and/or 6 months. Results: The intervention resulted in a decrease in intention (B= −.209; p=.017), and an increase in action planning (B=.214; p=.018) and PA (B=.220; p=.002). Intention and action planning did not mediate the effect on PA. Self-efficacy, although not significantly influenced by the intervention, was found to be the only motivational variable that predicted change in PA (B=.164; p=.007). These results were confirmed among participants initiating PA. Among norm-active participants no significant intervention effects were identified. Conclusion: The motivational factors cannot explain the intervention effect on PA. Most likely, the effect can be explained by an interaction between the motivational factors together. Differences between participants initiating versus maintaining PA, highlight the importance of performing mediation analyses per subgroup.

Background Based on Basic Health Research (RISKESDAS) conducted by Ministry of Health, Indonesia, prediabetes prevalence tends to increase from 2007 until 2018. The numbers are relatively higher in rural than those in urban area despite of small discrepancies between the two (~ 2–4%). The purpose of this study was to identify urban-rural differences in potential determinants for prediabetes in Indonesia. Methods This analysis used secondary data collected from nationwide Health Survey in 2018. Respondents were aged ≥15 years who met inclusion criteria of analysis with no history of diabetes mellitus. Prediabetes criteria followed American Diabetes Association 2019. Multiple logistic regression was also employed to assess the transition probability of potential determinants for prediabetes in urban and rural Indonesia. Results Up to 44.8% of rural respondents were prediabetics versus their urban counterparts at 34.9%, yet non-response bias was observed in the two. Young adults aged 30 years were already at risk of prediabetes. Urban-rural distinction for marital status and triglyceride level was observed while other determinants tended to overlap across residence. Several modifiable factors might contribute differently in both population with careful interpretation. Conclusions The minimum age limit for early prediabetes screening may start from 30 years old in Indonesia. Urban-rural distinction for marital status and triglyceride level was observed, yet non-response bias between the two groups could not be excluded. A proper model for early prediabetes screening need to be developed from a cohort study with adequate sample size.

Introduction Meningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae. To help identify patients at risk for these late effects, we first assessed variables associated with impaired long-term health-related quality of life (HRQoL) and impaired neurocognitive function on group level (i.e. determinants). Next, prediction models were developed to predict the risk for long-term neurocognitive or HRQoL impairment on individual patient-level. Methods Secondary data analysis of a cross-sectional multicenter study with intracranial WHO grade I/II meningioma patients, in which HRQoL (Short-Form 36) and neurocognitive functioning (standardized test battery) were assessed. Multivariable regression models were used to assess determinants for these outcomes corrected for confounders, and to build prediction models, evaluated with C-statistics. Results Data from 190 patients were analyzed (median 9 years after intervention). Main determinants for poor HRQoL or impaired neurocognitive function were patients’ sociodemographic characteristics, surgical complications, reoperation, radiotherapy, presence of edema, and a larger tumor diameter on last MRI. Prediction models with a moderate/good ability to discriminate between individual patients with and without impaired HRQoL (C-statistic 0.73, 95% CI 0.65 to 0.81) and neurocognitive function (C-statistic 0.78, 95%CI 0.70 to 0.85) were built. Not all predictors (e.g. tumor location) within these models were also determinants. Conclusions The identified determinants help clinicians to better understand long-term meningioma disease burden. Prediction models can help early identification of individual patients at risk for long-term neurocognitive or HRQoL impairment, facilitating tailored provision of information and allocation of scarce supportive care services to those most likely to benefit.

Background Diabetic foot ulcer is among the commonest complications of diabetic mellitus attributed to a number of morbidity and mortality cases in diabetic patients. Nowadays, the incidence of diabetic foot ulcer is increasing due to the increased prevalence of diabetes. However, the risk factors of the problem are less studied in Ethiopia. Hence, this study was conducted to assess the determinants of diabetic foot ulcer among adult patients with diabetes attending a diabetic clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019. Patients and Methods An institution-based unmatched case–control study was conducted on 161 patients with diabetes (53 patients with diabetes with foot ulcer and 108 patients with diabetes without foot ulcer). Cases were selected from patients with diabetes with foot ulcer by consecutive sampling technique and controls from patients with diabetes without diabetic foot ulcer by systematic random sampling technique. A binary logistic regression model was used to assess the association between the dependent and independent variables. All variables with a P-value

Background A vigilant prescription of drugs during pregnancy can potentially safeguard the growing fetus from the deleterious effect of the drug while attempting to manage the mother’s health problems. There is a paucity of information about the drug utilization pattern in the area of investigation. Hence, this study was implemented to investigate the pattern of drug utilization and its associated factors among pregnant women in Adigrat general hospital, Northern Ethiopia. Methods An institution-based cross-sectional study was conducted among randomly selected 314 pregnant women who attended obstetrics-gynecology and antenatal care units of the hospital. Relevant data were retrieved from the pregnant women’s medical records and registration logbook. The drugs prescribed were categorized based on the United States Food and Drug Administration (US-FDA) fetal harm classification system. Data analysis was done using SPSS version 20 statistical software. Multivariate logistic regression was employed to analyze the association of the explanatory variables with the medication use, and p Results The overall prescribed drug use in this study was found to be 87.7%. A considerable percentage of the study participants (41.4%) were prescribed with supplemental drugs (iron folate being the most prescribed drug) followed by antibiotics (23.4%) and analgesics (9.2%). According to the US-FDA drug’s risk classification, 42.5, 37, 13, and 7% of the drugs prescribed were from categories A, B, C, and D or X respectively. Prescribed drug use was more likely among pregnant women who completed primary [AOR = 5.34, 95% CI (1.53–18.6)] and secondary education [AOR = 4.1, 95% CI (1.16–14)], who had a history of chronic illness [AOR = 7.9, 95% CI (3.14–19.94)] and among multigravida women [AOR = 2.9, 95% CI (1.57 5.45)]. Conclusions The finding of this study revealed that a substantial proportion of pregnant women received drugs with potential harm to the mother and fetus. Reasonably, notifying health practitioners to rely on up-to-date treatment guidelines strictly is highly demanded. Moreover, counseling and educating pregnant women on the safe and appropriate use of medications during pregnancy are crucial to mitigate the burden that the mother and the growing fetus could face.