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Yamada S, Tsuruya K, Kitazono T, Nakano T. Emerging cross-talks between chronic kidney disease-mineral and bone disorder (CKD-MBD) and malnutrition-inflammation complex syndrome ( MICS) in patients receiving dialysis. Clin Exp Nephrol 2022; 26:613-629. [PMID: 35353283 PMCID: PMC9203392 DOI: 10.1007/s10157-022-02216-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/22/2022] [Indexed: 12/14/2022]
Abstract
Chronic kidney disease–mineral and bone disorder (CKD–MBD) is a systemic disorder that affects multiple organs and systems and increases the risk of morbidity and mortality in patients with CKD, especially those receiving dialysis therapy. CKD–MBD is highly prevalent in CKD patients, and its treatment is gaining attention from healthcare providers who manage these patients. Additional important pathologies often observed in CKD patients are chronic inflammation and malnutrition/protein-energy wasting (PEW). These two pathologies coexist to form a vicious cycle that accelerates the progression of various other pathologies in CKD patients. This concept is integrated into the term “malnutrition–inflammation–atherosclerosis syndrome” or “malnutrition–inflammation complex syndrome (MICS)”. Recent basic and clinical studies have shown that CKD–MBD directly induces inflammation as well as malnutrition/PEW. Indeed, higher circulating levels of inorganic phosphate, fibroblast growth factor 23, parathyroid hormone, and calciprotein particles, as markers for critical components and effectors of CKD–MBD, were shown to directly induce inflammatory responses, thereby leading to malnutrition/PEW, cardiovascular diseases, and clinically relevant complications. In this short review, we discuss the close interplay between CKD–MBD and MICS and emphasize the significance of simultaneous control of these two seemingly distinct pathologies in patients with CKD, especially those receiving dialysis therapy, for better management of the CKD/hemodialysis population.
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Zegeye B, Adjei NK, Olorunsaiye CZ, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA, Yaya S. Time trends in socio-economic and geographic-based inequalities in childhood wasting in Guinea over 2 decades: a cross-sectional study. Int Health 2022; 15:10-18. [PMID: 35106565 PMCID: PMC9808518 DOI: 10.1093/inthealth/ihac002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Today, an estimated 7.3% (50 million) of all children <5 y of age suffer from wasting, with more burden in African countries including Guinea. Investigating inequalities in childhood wasting is essential for designing efficient programs and interventions, but no related evidence exists in Guinea. This study aimed to examine the trends in the prevalence of childhood wasting and the extent of sex, socio-economic and geographic-based disparities in Guinea. METHODS Data from the 1999, 2005 and 2012 Guinea Demographic and Health Surveys and the 2016 Guinea Multiple Indicator Cluster Survey, with a total of 16 137 children <5 y of age were included for analysis. For inequality analysis, we used the 2019 updated World Health Organization Health Equity Assessment Toolkit (HEAT) software. Inequality was measured using four summary measures (difference [D], population attributable risk [PAR], ratio [R] and population attributable fraction [PAF]) for five equity stratifiers (economic status, education, place of residence, sex and subnational region). We computed 95% confidence intervals (CIs) around the points estimates to measure statistical significance. RESULTS The findings revealed a pro-rich (R=1.68 [95% CI 1.11 to 2.24]), pro-urban (PAR=-1.04 [95% CI -1.90 to -0.18]) and subnational region (D=8.11 [95% CI 4.85 to 11.36]) inequalities in childhood wasting across all surveys. Except in 2005, education-based disparities (PAF=-18.2 [95% CI -36.10 to -0.26]) were observed across all survey years, but not sex-based disparities. An approximately constant inequality pattern was seen across all dimensions. CONCLUSIONS This study showed inequalities in childhood wasting in Guinea with a disproportionately higher risk of wasting among children from disadvantaged subpopulations/mothers, including uneducated, poorest/poor, rural residents and regions. Policies that target disadvantaged populations need to be considered in order to ensure social protection, access to a wholesome diet and universal and quality health services.
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Zegeye B, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA, Olorunsaiye CZ, Yaya S. Disparities in use of skilled birth attendants and neonatal mortality rate in Guinea over two decades. BMC Pregnancy Childbirth 2022; 22:56. [PMID: 35062893 PMCID: PMC8783403 DOI: 10.1186/s12884-021-04370-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Maternal mortality remains high in sub-Saharan African countries, including Guinea. Skilled birth attendance (SBA) is one of the crucial interventions to avert preventable obstetric complications and related maternal deaths. However, within-country inequalities prevent a large proportion of women from receiving skilled birth attendance. Scarcity of evidence related to this exists in Guinea. Hence, this study investigated the magnitude and trends in socioeconomic and geographic-related inequalities in SBA in Guinea from 1999 to 2016 and neonatal mortality rate (NMR) between 1999 and 2012. METHODS We derived data from three Guinea Demographic and Health Surveys (1999, 2005 and 2012) and one Guinea Multiple Indicator Cluster Survey (2016). For analysis, we used the 2019 updated WHO Health Equity Assessment Toolkit (HEAT). We analyzed inequalities in SBA and NMR using Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D) and Ratio (R). These summary measures were computed for four equity stratifiers: wealth, education, place of residence and subnational region. We computed 95% Uncertainty Intervals (UI) for each point estimate to show whether or not observed SBA inequalities and NMR are statistically significant and whether or not disparities changed significantly over time. RESULTS A total of 14,402 for SBA and 39,348 participants for NMR were involved. Profound socioeconomic- and geographic-related inequalities in SBA were found favoring the rich (PAR = 33.27; 95% UI: 29.85-36.68), educated (PAR = 48.38; 95% UI: 46.49-50.28), urban residents (D = 47.03; 95% UI: 42.33-51.72) and regions such as Conakry (R = 3.16; 95% UI: 2.31-4.00). Moreover, wealth-driven (PAF = -21.4; 95% UI: -26.1, -16.7), education-related (PAR = -16.7; 95% UI: -19.2, -14.3), urban-rural (PAF = -11.3; 95% UI: -14.8, -7.9), subnational region (R = 2.0, 95% UI: 1.2, 2.9) and sex-based (D = 12.1, 95% UI; 3.2, 20.9) inequalities in NMR were observed between 1999 and 2012. Though the pattern of inequality in SBA varied based on summary measures, both socioeconomic and geographic-related inequalities decreased over time. CONCLUSIONS Disproportionate inequalities in SBA and NMR exist among disadvantaged women such as the poor, uneducated, rural residents, and women from regions like Mamou region. Hence, empowering women through education and economic resources, as well as prioritizing SBA for these disadvantaged groups could be key steps toward ensuring equitable SBA, reduction of NMR and advancing the health equity agenda of "no one left behind."
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Mohamed SOO, Ahmed EM. Prevalence and determinants of antenatal tetanus vaccination in Sudan: a cross-sectional analysis of the Multiple Indicator Cluster Survey. Trop Med Health 2022; 50:7. [PMID: 35000614 PMCID: PMC8744220 DOI: 10.1186/s41182-022-00398-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background Tetanus vaccination is an indispensable component of the antenatal care (ANC) and is considered one of the most effective and protective measures against tetanus deaths. However, data on antenatal tetanus vaccination in Sudan are scarce. We aimed to explore the level of antenatal tetanus vaccination and to identify the influencing factors in a nationally representative population sample.
Methods We used the latest available data (2014) of the Sudan Multiple Indicator Cluster Survey (MICS), developed by the United Nations Children’s Fund (UNICEF). We assessed the level of antenatal tetanus vaccination among women of childbearing age who gave at least one birth preceding the survey and defined adequate antenatal tetanus vaccination according to the World Health Organization (WHO) recommendations. Data analysis was performed using descriptive statistics, bivariate analysis, and multivariate logistic regression analysis. Results The total number of women of childbearing age involved in this analysis was 5433. Most of the participants (28.6%) were 25–29 years old, and vast majority of them (73.7%) live in rural areas. The prevalence of mothers who had adequate tetanus vaccination was 60.0%. Antenatal tetanus vaccination was significantly associated with higher level of mothers’ education (AOR = 1.70, 95% CI 1.25–2.32), higher household wealth index (AOR = 1.89, 95% CI 1.41–2.54), having four or more ANC visits (AOR = 1.49, 95% CI 1.30–1.71), and living in areas with low intensity of armed conflicts (AOR = 1.34, 95% CI 1.14–1.57). Conclusions Socioeconomic status had a significant impact on adequate antenatal tetanus vaccination. The results indicate the existence of variable rates and unequal access to tetanus vaccination among women of childbearing age in Sudan.
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Bhusal UP. Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal multiple Indicator cluster survey ( MICS) 2019. BMC Public Health 2021; 21:2246. [PMID: 34893047 PMCID: PMC8665495 DOI: 10.1186/s12889-021-12287-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Inequality in maternal healthcare use is a major concern for low-and middle-income countries (LMICs). Maternal health indicators at the national level have markedly improved in the last couple of decades in Nepal. However, the progress is not uniform across different population sub-groups. This study aims to identify the determinants of institutional delivery, measure wealth-related inequality, and examine the key components that explain the inequality. METHODS Most recent nationally representative Multiple Indicator Cluster Survey (MICS) 2019 was used to extract data about married women (15-49 years) with a live birth within two years preceding the survey. Logistic regression models were employed to assess the association of independent variables with the institutional delivery. The concentration curve (CC) and concentration index (CIX) were used to analyze the inequality in institutional delivery. Wealth index scores were used as a socio-economic variable to rank households. Decomposition was performed to identify the determinants that explain socio-economic inequality. RESULTS The socio-economic status of households to which women belong was a significant predictor of institutional delivery, along with age, parity, four or more ANC visits, education status of women, area of residence, sex of household head, religious belief, and province. The concentration curve was below the line of equality and the relative concentration index (CIX) was 0.097 (p < 0.001), meaning the institutional delivery was disproportionately higher among women from wealthy groups. The decomposition analysis showed the following variables as the most significant contributor to the inequality: wealth status of women (53.20%), education of women (17.02%), residence (8.64%) and ANC visit (6.84%). CONCLUSIONS To reduce the existing socio-economic inequality in institutional delivery, health policies and strategies should focus more on poorest and poor quintiles of the population. The strategies should also focus on raising the education level of women especially from the rural and relatively backward province (Province 2). Increasing antenatal care (ANC) coverage through outreach campaigns is likely to increase facility-based delivery and decrease inequality. Monitoring of healthcare indicators at different sub-population levels (for example wealth, residence, province) is key to ensure equitable improvement in health status and achieve universal health coverage (UHC).
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Shaker‐Berbari L, Qahoush Tyler V, Akik C, Jamaluddine Z, Ghattas H. Predictors of complementary feeding practices among children aged 6-23 months in five countries in the Middle East and North Africa region. MATERNAL & CHILD NUTRITION 2021; 17:e13223. [PMID: 34137179 PMCID: PMC8476411 DOI: 10.1111/mcn.13223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
Ensuring diets of children aged 6-23 months meet recommended guidance is crucial for growth and development and for the prevention of malnutrition including stunting, wasting and micronutrient deficiencies. Despite some improvement, indicators related to undernutrition and overnutrition fall short of global targets in the Middle East and North Africa (MENA) region that consist of low- and middle-income countries witnessing political and social changes and a nutrition transition. This research aims at reviewing the situation related to the diets of children aged 6-23 months in five selected countries in the MENA region, examining factors affecting complementary feeding and providing recommendations for guiding effective strategies to improve it. The study triangulated data on complementary feeding status and predictors from semistructured interviews with 30 key informants, and multivariable analysis of household surveys in Egypt, Jordan, Lebanon, State of Palestine and Sudan including data on refugees in Lebanon and Jordan. There remain considerable gaps in complementary feeding differing noticeably among geographic areas. Findings from qualitative and quantitative analyses showed that maternal factors, including maternal education and age, household level factors such as paternal education and wealth, community-level factors (culture and geographic location), and utilization of health services, were associated with minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) at varied levels in the five countries. Interventions to improve complementary feeding practices should include actions tailored to the needs of the population at multiple levels including at the caregiver's level, household, service use, community and policy level.
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Lyons M, Akowuah E, Hunter S, Caputo M, Angelini GD, Vohra HA. A survey of minimally invasive cardiac surgery during the COVID-19 pandemic. Perfusion 2021; 37:789-796. [PMID: 34247534 DOI: 10.1177/02676591211029452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lack of scientific data on the feasibility and safety of minimally invasive cardiac surgery (MICS) during the COVID-19 pandemic has made clinical decision making challenging. This survey aimed to appraise MICS activity in UK cardiac units and establish a consensus amongst front-line MICS surgeons regarding standard best MICS practise during the pandemic. METHODS An online questionnaire was designed through the 'googleforms' platform. Responses were received from 24 out of 28 surgeons approached (85.7%), across 17 cardiac units. RESULTS There was a strong consensus against a higher risk of conversion from minimally invasive to full sternotomy (92%; n = 22) nor there is increased infection (79%; n = 19) or bleeding (96%; n = 23) with MICS compared to full sternotomy during the pandemic. The majority of respondents (67%; n = 16) felt that it was safe to perform MICS during COVID-19, and that it should not be halted (71%; n = 17). London cardiac units experienced a decrease in MICS (60%; n = 6), whereas non-London units saw no reduction. All London MICS surgeons wore an FP3 mask compared to 62% (n = 8) of non-London MICS surgeons, 23% (n = 3) of which only wore a surgical mask. London MICS surgeons felt that routine double gloving should be done (60%; n = 6) whereas non-London MICS surgeons held a strong consensus that it should not (92%; n = 12). CONCLUSION Whilst more robust evidence on the effect of COVID-19 on MICS is awaited, this survey provides interesting insights for clinical decision-making regarding MICS and aids to facilitate the development of standardised MICS guidelines for an effective response during future pandemics.
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Fabbri C, Bhatia A, Petzold M, Jugder M, Guedes A, Cappa C, Devries K. Modelling the effect of the COVID-19 pandemic on violent discipline against children. CHILD ABUSE & NEGLECT 2021; 116:104897. [PMID: 33451678 PMCID: PMC9754318 DOI: 10.1016/j.chiabu.2020.104897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic could increase violence against children at home. However, collecting empirical data on violence is challenging due to ethical, safety, and data quality concerns. OBJECTIVE This study estimated the anticipated effect of COVID-19 on violent discipline at home using multivariable predictive regression models. PARTICIPANTS Children aged 1-14 years and household members from the Multiple Indicator Cluster Surveys (MICS) conducted in Nigeria, Mongolia, and Suriname before the COVID-19 pandemic were included. METHODS A conceptual model of how the COVID-19 pandemic could affect risk factors for violent discipline was developed. Country specific multivariable linear models were used to estimate the association between selected variables from MICS and a violent discipline score which captured the average combination of violent disciplinary methods used in the home. A review of the literature informed the development of quantitative assumptions about how COVID-19 would impact the selected variables under a "high restrictions" pandemic scenario, approximating conditions expected during a period of intense response measures, and a "lower restrictions" scenario with easing of COVID-19 restrictions but with sustained economic impacts. These assumptions were used to estimate changes in violent discipline scores. RESULTS Under a "high restrictions" scenario there would be a 35%-46% increase in violent discipline scores in Nigeria, Mongolia and Suriname, and under a "lower restrictions" scenario there would be between a 4%-6% increase in violent discipline scores in these countries. CONCLUSION Policy makers need to plan for increases in violent discipline during successive waves of lockdowns.
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Huang Y, Danovaro-Holliday MC. Characterization of immunization secondary analyses using demographic and health surveys (DHS) and multiple indicator cluster surveys ( MICS), 2006-2018. BMC Public Health 2021; 21:351. [PMID: 33581740 PMCID: PMC7880859 DOI: 10.1186/s12889-021-10364-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 01/31/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Infant immunization coverage worldwide has plateaued at about 85%. Using existing survey data to conduct analyses beyond estimating coverage may help immunization programmes better tailor strategies to reach un- and under-immunized children. The Demographic and Health Survey (DHS) and the Multiple Indicators Cluster Survey (MICS), routinely conducted in low and middle-income countries (LMICs), collect immunization data, yet vaccination coverage is often the only indicator reported and used. We conducted a review of published immunization-related analyses to characterize and quantify immunization secondary analyses done using DHS and MICS databases. METHODS We conducted a systematic search of the literature, of immunization-related secondary analyses from DHS or MICS published between 2006 and August 2018. We searched 15 electronic databases without language restrictions. For the articles included, relevant information was extracted and analyzed to summarize the characteristics of immunization-related secondary analyses. Results are presented following the PRISMA guidelines. RESULTS Among 1411 papers identified, 115 met our eligibility criteria; additionally, one article was supplemented by the Pan American Health Organization. The majority were published since 2012 (77.6%), and most (68.9%) had a first or corresponding author affiliated with institutions in high-income countries (as opposed to LMICs where these surveys are conducted). The median delay between survey implementation and publication of the secondary analysis was 5.4 years, with papers with authors affiliated to institutions in LMIC having a longer median publication delay (p < 0.001). Over 80% of the published analyses looked at factors associated with a specific vaccine or with full immunization. Quality proxies, such as reporting percent of immunization data from cards vs recall; occurrence and handling of missing data; whether survey analyses were weighted; and listing of potential biases or limitations of the original survey or analyses, were infrequently mentioned. CONCLUSION Our review suggests that more needs to be done to increase the increase the utilization of existing DHS and MICS datasets and improve the quality of the analyses to inform immunization programmes. This would include increasing the proportion of analyses done in LMICs, reducing the time lag between survey implementation and publication of additional analyses, and including more qualitative information about the survey in the publications to better interpret the results.
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Berti PR, Nardocci M, Tran MH, Batal M, Brodmann R, Greliche N, Saville NM. Using DHS and MICS data to complement or replace NGO baseline health data: an exploratory study. F1000Res 2021; 10:69. [PMID: 34123367 PMCID: PMC8145218 DOI: 10.12688/f1000research.47618.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Non-government organizations (NGOs) spend substantial time and resources collecting baseline data in order to plan and implement health interventions with marginalized populations. Typically interviews with households, often mothers, take over an hour, placing a burden on the respondents. Meanwhile, estimates of numerous health and social indicators in many countries already exist in publicly available datasets, such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), and it is worth considering whether these could serve as estimates of baseline conditions. The objective of this study was to compare indicator estimates from non-governmental organizations (NGO) health projects’ baseline reports with estimates calculated using the Demographic and Health Surveys (DHS) or the Multiple Indicator Cluster Surveys (MICS), matching for location, year, and season of data collection. Methods: We extracted estimates of 129 indicators from 46 NGO baseline reports, 25 DHS datasets and three MICS datasets, generating 1,996 pairs of matched DHS/MICS and NGO indicators. We subtracted NGO from DHS/MICS estimates to yield difference and absolute difference, exploring differences by indicator. We partitioned variance of the differences by geographical level, year, and season using ANOVA. Results: Differences between NGO and DHS/MICS estimates were large for many indicators but 33% fell within 5% of one another. Differences were smaller for indicators with prevalence <15% or >85%. Difference between estimates increased with increasing year and geographical level differences. However, <1% of the variance of the differences was explained by year, geographical level, and season. Conclusions: There are situations where publicly available data could complement NGO baseline survey data, most importantly when the NGO has tolerance for estimates of low or unknown accuracy.
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Identifying children at risk of intellectual disability in UNICEF's multiple indicator cluster surveys: Cross-sectional survey. Disabil Health J 2020; 14:100986. [PMID: 32859553 DOI: 10.1016/j.dhjo.2020.100986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Research on intellectual disability has been criticized for primarily addressing the situation of people in high-income countries. OBJECTIVE /Hypothesis. To determine whether MICS6 data on 'functional difficulty associated with learning' (FDAL) in low- and middle-income countries could be used as a proxy indicator for intellectual disability. METHODS Secondary analysis of nationally representative data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys (MICS) on 244,915 children in 18 middle- and low-income countries. RESULTS The prevalence of FDAL in middle- and low-income countries was broadly similar to the estimated prevalence of intellectual disability in high-income countries. The association between risk of FDAL and household wealth was weak, with alternative measures of developmental delay showing significantly stronger associations with household wealth. The risk of making potential false negative errors in identifying FDAL increases as household wealth and level of maternal education decrease. The risk of making potential false positive errors in identifying FDAL is greater among more highly educated respondents, although this association is only statistically significant among older children. CONCLUSIONS The use of FDAL as a proxy indicator for intellectual disability cannot be recommended given: (1) it would probably underestimate the overall prevalence of intellectual disability in middle and low income countries; and (2) it is likely to be overestimate prevalence among families with higher socio-economic position (SEP) and underestimate prevalence among families with lower SEP.
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Shibre G, Zegeye B, Haidar J. Extent of and trends in inequalities in child stunting in Sierra-Leone from 2005 to 2013: evidence from demographic and health surveys and multiple indicator cluster surveys. Int J Equity Health 2020; 19:88. [PMID: 32503547 PMCID: PMC7275402 DOI: 10.1186/s12939-020-01212-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Comprehensive assessment of stunting disparity in Sierra-Leone has not been done so far. We aimed to document extent and over time dynamics of inequality in stunting in Sierra-Leone using approaches that facilitate implementation of interventions aim to eliminate non-justified stunting disparity in the country. METHODS The data for the study were derived from two rounds of the Sierra Leone Demographic and Health Survey conducted in 2008 and 2013, and two rounds of the Sierra Leone Multiple Indicator Cluster Survey done in 2005 and 2010. We used the 2019 update WHO Health Equity Assessment Toolkit (HEAT) to do the analysis. The toolkit makes use of data stored in the WHO Health Equity Monitor database. We analyzed stunting inequality using summary measures: Population Attributable Risk, Population Attributable Fraction, Difference and Ratio. The summary measures were computed for five equity stratifers: wealth, education, child's sex, place of residence and subnational region. We computed 95% Confidence Interval (CI) for each point estimate to show whether or not observed stunting inequalities are statistically significant, and whether or not the disparity changed over time statistically significantly. RESULTS The findings demonstrated stark inequalities in stunting in all the studied dimensions of inequality. While residence and subnational regional related inequalities remain unchanged over time, wealth and educational inequality had seen slight improvement during the same time period. Large sex related stunting inequality remained during the first three surveys time points, but it disappeared in 2013. CONCLUSIONS Huge stunting disparities occurred in Sierra Leone, and the disparity disproportionately affects disadvantaged subpopulations and male children. Nutrition interventions that specifically target the subgroups which suffer more from the burden of stunting are required.
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Miller AC, Garchitorena A, Rabemananjara F, Cordier L, Randriamanambintsoa M, Rabeza V, Razanadrakoto HTR, Rakoto Ramakasoa R, RamahefarisonTiana O, Ratsimbazafy BN, Ouenzar MA, Bonds MH, Ratsifandrihamanana L. Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar. BMC Pediatr 2020; 20:108. [PMID: 32138722 PMCID: PMC7059323 DOI: 10.1186/s12887-020-1985-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background 50% of Malagasy children have moderate to severe stunting. In 2016, a new 10 year National Nutrition Action Plan (PNAN III) was initiated to help address stunting and developmental delay. We report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of Ifanadiana in southeastern Madagascar in 2016. Methods The data are from a cross-sectional analysis of the 2016 wave of IHOPE panel data (a population-representative cohort study begun in 2014). We interviewed women ages 15–49 using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. We analyzed ECDI data using standardized z scores for relative relationships for 2 outcomes: at-risk-for-delay vs. an international standard, and lower-development-than-peers if ECDI z scores were > 1 standard deviation below study mean. Covariates included demographics, adult involvement, household environment, and selected child health factors. Variables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level. Results Of 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. This was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had > = 4 stimulation activities in past 3 days. Greater paternal engagement (OR 1.5 (1.09, 2.07)) was associated with increased delay vs. international norms. Adolescent motherhood (OR. 4.09 (1.40, 11.87)) decreased children’s development vs. peers. Engagement from a non-parental adult reduced odds of delay for both outcomes (OR (95%CI = 0.76 (0.63, 0.91) & 0.27 (0.15, 0 48) respectively). Stunting was not associated with delay risk (1.36 (0.85, 2.15) or low development (0.92 (0.48, 1.78)) when controlling for other factors. Conclusions In this setting of high child malnutrition, stunting is not independently associated with developmental risk. A low proportion of children receive developmentally supportive stimulation from adults, but non-parent adults provide more stimulation in general than either mother or father. Stimulation from non-parent adults is associated with lower odds of delay.
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Lee SE, Choi SP, Oh KS, Kim J, Lee SM, Cho KR. Flexible Magnetic Polymer Composite Substrate with Ba 1.5Sr 1.5Z Hexaferrite Particles of VHF/Low UHF Patch Antennas for UAVs and Medical Implant Devices. MATERIALS 2020; 13:ma13041021. [PMID: 32102415 PMCID: PMC7078708 DOI: 10.3390/ma13041021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/16/2022]
Abstract
Our goal is to fabricate flexible magnetic polymer composites as antenna substrates for very high frequency (VHF)/low ultra high frequency (UHF) antennas for unmanned aerial vehicles (UAVs) and medical devices. Magnetodielectric materials, which have permeability (μ) similar to permittivity (ε), have attracted great attention, because they facilitate miniaturization of microwave devices while keeping or enhancing electromagnetic characteristics. Mechanically millled Ba1.5Sr1.5Co2Fe24O41 (Ba1.5Sr1.5Z) hexaferrite particles were used to increase permeability in the interesting frequency band. The microwave properties of Ba1.5Sr1.5Z composites were predicted and measured. Hansen's zero-order analysis of antenna bandwidth and electromagnetic field simulation showed that the hexaferrite-based flexible composite could enhance a bandwidth and achieve the miniaturization of antennas as well. The magnetic antenna substrates can be a good solution to integrate antennas into the UAVs whose dimensions are comparable to or larger than communication wavelength.
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Mutunga M, Frison S, Rava M, Bahwere P. The Forgotten Agenda of Wasting in Southeast Asia: Burden, Determinants and Overlap with Stunting: A Review of Nationally Representative Cross-Sectional Demographic and Health Surveys in Six Countries. Nutrients 2020; 12:nu12020559. [PMID: 32093376 PMCID: PMC7071426 DOI: 10.3390/nu12020559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 12/11/2022] Open
Abstract
Childhood wasting is among the most prevalent forms of undernutrition globally. The Southeast Asia region is home to many wasted children, but wasting is not recognized as a public health problem and its epidemiology is yet to be fully examined. This analysis aimed to determine the burden of wasting, its predictors, and the level of wasting and stunting concurrence. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in six countries in the region were analyzed. The pooled weighted prevalence for wasting and concurrent wasting and stunting among children 0–59 months in the six countries was 8.9%, 95% CI (8.0–9.9) and 1.6%, 95% CI (1.5–1.8), respectively. This prevalence is approximately 12-fold higher than the 0.7% prevalence of high-income countries; and translated into an absolute number of 1,088,747 children affected by wasting and 272,563 concurrent wasting and stunting. Wasting prevalence was 50 percent higher in the 0–23-month age group. Predictors for wasting included source of drinking water, wealth index, urban residence, child’s age and history of illness and mother’s body mass index. In conclusion, our analysis showed that wasting is a serious public health problem in the region that should be addressed urgently using both preventive and curative approaches.
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Nambiar P, Kumar S, Mittal CM, Sarkar IC. Outcomes of Bilateral Internal Thoracic Arteries in Minimally Invasive Coronary Artery Bypass Grafting With Analogy to the SYNTAX Trial. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 14:227-235. [PMID: 31203737 DOI: 10.1177/1556984519837391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Minimally invasive CABG is making positive strides in the evolution of coronary artery bypass surgery. We carried out a retrospective study of the efficacy and outcomes of the usage of bilateral internal thoracic arteries in MICS CABG patients over a 6 year period using primary (MACCE) and secondary outcome measures and also carried out a subgroup analysis of patients with diabetes and methodology of revascularization, and with analogy to the SYNTAX trial of the relative risk. METHODS Nine hundred and forty patients underwent multivessel MICS CABG via a left mini-thoracotomy from August 2011 to September 2017 and complete revascularization was done using the left internal thoracic artery-right internal thoracic artery Y (LITA-RITA Y) composite conduit. Efficacy and outcomes were evaluated by primary (MACCE) and secondary outcome measures including total length of stay, return to full physical activity, and quality of life. Propensity score matched analyses were carried out in diabetics, in the methodology of revascularization (MICS OPCABG vs. MICS ONCABG), and by comparison to the SYNTAX trial for relative risk. Mean follow-up was 2.9 years (maximum was 5.6 years). RESULTS Out of the 940 patients, 843 (89.6%) were diabetic and 97 (10.4%) were nondiabetic. Average grafts were 3.2. There were 9 mortalities (0.9%). The average ICU and hospital stay was 40 ± 12 hours and 3.1 days. Ten patients (1.06%) required reintervention by angioplasty. A total of 99.3% patients were free from major adverse cardiac and cerebrovascular events (MACCE) at follow-up. Mean follow-up was 33 months and 846 (90%) of the patients were followed up. Based on propensity score-matched groups, patients who had their surgery done by MICS ONCABG (beating heart technique) had greater mean number of grafts and hospital length of stay and had significantly longer ICU stay, extubation in OR and blood loss in comparison to patients who had their CABG done by the MICS OPCABG technique. The new technique has shown favorable risk reduction in comparison to both the arms of the SYNTAX trial. CONCLUSIONS The safety, efficacy and outcomes of minimally invasive CABG evaluated by primary (MACCE) and secondary outcomes and quality-of-life measures have been good in this study, especially in diabetics, and have shown results better than conventional CABG. The learning curve can be safely negotiated by using peripheral cardiopulmonary bypass assistance and comparison with the SYNTAX trial has shown a relative reduction in all-cause risk.
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El Gamel A. Minimal Access Aortic Root Surgery: An "Elite Sport" or Is it for Everyone? Heart Lung Circ 2019; 28:1767-1769. [PMID: 31813479 DOI: 10.1016/j.hlc.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Corsi DJ, Perkins JM, Subramanian SV. Child anthropometry data quality from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and National Nutrition Surveys in the West Central Africa region: are we comparing apples and oranges? Glob Health Action 2018. [PMID: 28641057 PMCID: PMC5496063 DOI: 10.1080/16549716.2017.1328185] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND There has been limited work comparing survey characteristics and assessing the quality of child anthropometric data from population-based surveys. OBJECTIVE To investigate survey characteristics and indicators of quality of anthropometric data in children aged 0-59 months from 23 countries in the West Central Africa region. METHODS Using established methodologies and criteria to examine child age, sex, height, and weight, we conducted a comprehensive assessment and scoring of the quality of anthropometric data collected in 100 national surveys. RESULTS The Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) collected data from a greater number of younger children than older children while the opposite was found for the National Nutrition Surveys (NNS). Missing or implausible height/weight data proportions were 12% and 8% in MICS and DHS compared to 3% in NNS. Average data quality scores were 14 in NNS, 33 in DHS, and 41 in MICS. CONCLUSIONS Although our metric of data quality suggests that data from the NNS appear more consistent and robust, it is equally important to consider its disadvantages related to access and lack of broader socioeconomic information. In comparison, the DHS and MICS are publicly-accessable for research and provide socioeconomic context essential for assessing and addressing the burden of undernutrition within and between countries. The strengths and weaknesses of data from these three sources should be carefully considered when seeking to determine the burden of child undernutrition and its variation within countries.
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Na M, Aguayo VM, Arimond M, Dahal P, Lamichhane B, Pokharel R, Chitekwe S, Stewart CP. Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014. MATERNAL AND CHILD NUTRITION 2017; 14 Suppl 4:e12564. [PMID: 29148183 PMCID: PMC6586161 DOI: 10.1111/mcn.12564] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/07/2017] [Accepted: 10/09/2017] [Indexed: 12/30/2022]
Abstract
There is evidence that suboptimal complementary feeding contributes to poor child growth. However, little is known about time trends and determinants of complementary feeding in Nepal, where the prevalence of child undernutrition remains unacceptably high. The objective of the study was to examine the trends and predictors of suboptimal complementary feeding in Nepali children aged 6–23 months using nationally representative data collected from 2001 to 2014. Data from the 2001, 2006, and 2011 Nepal Demographic and Health Surveys and the 2014 Multiple Indicator Cluster Survey were used to estimate the prevalence, trends and predictors of four WHO‐UNICEF complementary feeding indicators: timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). We used multilevel logistic regression models to identify independent factors associated with these indicators at the individual, household and community levels. In 2014, the weighted proportion of children meeting INTRO, MMF, MDD, and MAD criteria were 72%, 82%, 36% and 35%, respectively, with modest average annual rate of increase ranging from 1% to 2%. Increasing child age, maternal education, antenatal visits, and community‐level access to health care services independently predicted increasing odds of achieving MMF, MDD, and MAD. Practices also varied by ecological zone and sociocultural group. Complementary feeding practices in Nepal have improved slowly in the past 15 years. Inequities in the risk of inappropriate complementary feeding are evident, calling for programme design and implementation to address poor feeding and malnutrition among the most vulnerable Nepali children.
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Kanda H, Kunisawa T, Kitahara H, Iida T, Toyama Y, Kanao-Kanda M, Mori C, Kamiya H. Cerebral Hypoxia Caused by Flow Confliction During Minimally Invasive Cardiac Surgery With Retrograde Perfusion: A Word of Caution. J Cardiothorac Vasc Anesth 2017; 32:1838-1840. [PMID: 29126685 DOI: 10.1053/j.jvca.2017.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Indexed: 11/11/2022]
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Rodriguez M, Ruel M. Minimally Invasive Multivessel Coronary Surgery and Hybrid Coronary Revascularization: Can We Routinely Achieve Less Invasive Coronary Surgery? Methodist Debakey Cardiovasc J 2017; 12:14-9. [PMID: 27127557 DOI: 10.14797/mdcj-12-1-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Coronary artery bypass grafting (CABG) is the gold standard in managing severe coronary artery disease. However, it is associated with prolonged recovery and potential complications, in part due to the invasiveness of the procedure. Less invasive CABG techniques attempt to improve the quality and quantity of life in the same way as surgical revascularization but with fewer complications. Minimally invasive coronary surgery (MICS) through a small thoracotomy allows for complete revascularization with good results in graft patency. Perioperative mortality is low, and there is decreased need for blood transfusion, lower surgical site infection rates, and an earlier return to full physical function. Hybrid coronary revascularization (HCR) attempts to combine the advantages of coronary artery bypass grafting with those of percutaneous coronary intervention. Several studies have shown that HCR provides better short-term outcomes with regard to decreased ventilation and ICU time, reduced need for blood transfusion, and shortened hospital stay. However, the rates for major adverse cardiovascular events and mortality are comparable to conventional CABG, except for patients with a high SYNTAX score who displayed increased mortality rates. There is also strong evidence of a higher need for repeat revascularization with HCR compared to CABG. Overall, MICS and HCR appear to be viable alternatives to conventional CABG, offering a less invasive approach to coronary revascularization, which may be especially beneficial to high-risk patients. This article discusses approaches that deliver the advantages of minimally invasive surgical revascularization that can be adapted by surgeons with minimal investment with regards to training and infrastructure.
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Jarstad JS, Jarstad AR, Chung GW, Tester RA, Day LE. Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:39-43. [PMID: 28243022 PMCID: PMC5327173 DOI: 10.3341/kjo.2017.31.1.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME). Setting Ambulatory surgical center. Methods Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (<16 mmHg), normal (16 to 21 mmHg), and elevated (>21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student's t-tests. Results Mean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/−5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%). Conclusions Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater. Synopsis Immediate postoperative IOP adjustment following cataract surgery before the patient leaves the operating theater may reduce the incidence of CME and provide patient safety and economic benefits.
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Li D, Liu D, Kang C, Zou X. A Low Power Low Phase Noise Oscillator for MICS Transceivers. SENSORS 2017; 17:s17010140. [PMID: 28085107 PMCID: PMC5298713 DOI: 10.3390/s17010140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/23/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
Abstract
A low-power, low-phase-noise quadrature oscillator for Medical Implantable Communications Service (MICS) transceivers is presented. The proposed quadrature oscillator generates 349~689 MHz I/Q (In-phase and Quadrature) signals covering the MICS band. The oscillator is based on a differential pair with positive feedback. Each delay cell consists of a few transistors enabling lower voltage operation. Since the oscillator is very sensitive to disturbances in the supply voltage and ground, a self-bias circuit for isolating the voltage disturbance is proposed to achieve bias voltages which can track the disturbances from the supply and ground. The oscillation frequency, which is controlled by the bias voltages, is less sensitive to the supply and ground noise, and a low phase noise is achieved. The chip is fabricated in the UMC (United Microelectronics Corporation) 0.18 μm CMOS (Complementary Metal Oxide Semiconductor) process; the core just occupies a 28.5 × 22 μm2 area. The measured phase noise is −108.45 dBc/Hz at a 1 MHz offset with a center frequency of 540 MHz. The gain of the oscillator is 0.309 MHz/mV with a control voltage from 0 V to 1.1 V. The circuit can work with a supply voltage as low as 1.2 V and the power consumption is only 0.46 mW at a 1.8 V supply voltage.
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Lee HY, Van Huy N, Choi S. Determinants of early childhood morbidity and proper treatment responses in Vietnam: results from the Multiple Indicator Cluster Surveys, 2000-2011. Glob Health Action 2016; 9:29304. [PMID: 26950559 PMCID: PMC4780114 DOI: 10.3402/gha.v9.29304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 12/13/2022] Open
Abstract
Background Despite significant achievements in health indicators during previous decades, Vietnam lags behind other developing countries in reducing common early childhood illnesses, such as diarrhea and respiratory infections. To date, there has been little research into factors that contribute to the prevalence and treatment of childhood morbidity in Vietnam. Objective This study examines the determinants of diarrhea and ‘illness with a cough’ and treatments for each of the conditions among young children in Vietnam, and describes trends over time. Design Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. Multivariable logistic regressions were undertaken to investigate factors associated with these childhood illnesses and proper treatment patterns. Results Between 2000 and 2011, the prevalence of diarrhea among children under the age of five declined from 11 to 7%, while having illness with a cough increased to 40% in 2011 after falling from 69 to 28% between 2000 and 2006. During the same period, the prevalence of oral rehydration therapy (ORT) for treating diarrhea increased from 13 to 46%, whereas the rate of seeking formal treatment for illnesses with a cough fell from 24 to 7%. Multivariable models indicated that children who were older than 2 years (odds ration [OR]: 0.44, 95% confidence interval [CI]: 0.37–0.53, p<0.001), male (OR: 1.21, 95% CI: 0.64–2.37, p<0.05), living in rural areas (OR: 1.28, 95% CI: 1.00–1.64, p<0.05), or of Kinh ethnicity (OR: 0.70, 95% CI: 0.56–0.87, p<0.01) were more likely to suffer from diarrhea. Ethnic differences and higher household wealth were factors significantly associated with having illness with a cough. In particular, the effect of level of wealth on illness with a cough varied in each wave. Mothers with higher levels of education had higher odds of seeking ORT compared with mothers with the lowest level of education. Seeking formal treatment for children who have illness with a cough was associated with being in a household in the richest wealth quintile (OR: 0.56, 95% CI: 0.34–0.91, p<0.05). Conclusions This study demonstrates the importance of identifying different risk factors for these two illnesses and also factors associated with healthcare-seeking behaviors in order to reduce the burden of childhood morbidity in Vietnam. Policies aimed at tackling childhood morbidities should include comprehensive strategies that impact on socioeconomic and environmental factors.
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Van Huy N, Lee HY, Nam YS, Van Tien N, Huong TTG, Hoat LN. Secular trends in HIV knowledge and attitudes among Vietnamese women based on the Multiple Indicator Cluster Surveys, 2000, 2006, and 2011: what do we know and what should we do to protect them? Glob Health Action 2016; 9:29247. [PMID: 26950557 PMCID: PMC4780092 DOI: 10.3402/gha.v9.29247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/14/2015] [Accepted: 11/15/2015] [Indexed: 11/21/2022] Open
Abstract
Background In Vietnam, women are at risk of HIV infection due to many factors. However, there is limited evidence about what women know and how they behave to protect themselves from HIV. Objective The objective of this study was to investigate the trends in comprehensive HIV/AIDS knowledge, attitude, and associated factors among Vietnamese women from 2000 to 2011. Design Data from three waves of the Vietnam Multiple Indicator Cluster Surveys (years 2000, 2006, and 2011) were used. Logistic regression methods examined factors associated with each of two dependent variables, HIV/AIDS knowledge and attitude toward HIV/AIDS. Results Although there was an increasing trend in basic HIV/AIDS knowledge and positive attitude toward the disease, in Vietnamese women in the general population over the survey years, the prevalence of women with basic HIV/AIDS knowledge and positive attitude toward HIV/AIDS was low. Multivariable models indicated that women who had higher levels of education, lived in urban areas, had higher economic status, and knew about places of HIV-related services were more likely to have good HIV/AIDS knowledge (e.g. in 2011, AOR's=3.01; 1.27; 1.88; 2.03, respectively). Women with higher educational attainment, knew about HIV services, and had better HIV knowledge were more likely to report positive attitude toward HIV/AIDS (e.g. in 2011, AOR's=2.50; 1.72; 2.23, respectively). Conclusions This study recommends that public health programs for the control of HIV, such as behavioral change communication campaigns or social policies for women, should focus not only in improving the quality of existing HIV/AIDS counseling and testing services but also on expanding coverage to increase accessibility to these services for women in rural areas. In addition, efforts to raise the level of knowledge about HIV/AIDS and improve attitude toward the disease should be undertaken simultaneously. The results of this study can help inform HIV control policies and practices in other developing countries.
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