Population, poverty and economic development

Challenges confronting sustainability in nuclear medicine practice

BACKGROUND

Sustainability can be defined as the state in which consumption or depletion do not exceed regeneration. It can further be considered in five dimensions: environmental, economic, social, human resources, and ecological.

KEY FINDINGS

There are a number of key issues that threaten sustainability across nuclear medicine clinical and research practices, and across the five dimensions of sustainability there is a requirement for compromise between conflicting priorities. Nonetheless, the field of nuclear medicine benefits from an inherent culture of innovation and forethought which fosters adaptation in order to achieve sustainability.

CONCLUSION

The principles of sustainability are particularly challenging to navigate due to resource scarcity in nuclear medicine associated with both workforce shortages and supply disruptions. Specific challenges and adaptations are outlined for each of the five dimensions of sustainability.

IMPLICATIONS FOR PRACTICE

There are opportunities for improving sustainability of nuclear medicine practice although success is reliant on a deeper understanding of the interplay across the five dimensions of sustainability.

Net benefit of smaller human populations to environmental integrity and individual health and wellbeing

Introduction

The global human population is still growing such that our collective enterprise is driving environmental catastrophe. Despite a decline in average population growth rate, we are still experiencing the highest annual increase of global human population size in the history of our species-averaging an additional 84 million people per year since 1990. No review to date has accumulated the available evidence describing the associations between increasing population and environmental decline, nor solutions for mitigating the problems arising.

Methods

We summarize the available evidence of the relationships between human population size and growth and environmental integrity, human prosperity and wellbeing, and climate change. We used PubMed, Google Scholar, and Web of Science to identify all relevant peer-reviewed and gray-literature sources examining the consequences of human population size and growth on the biosphere. We reviewed papers describing and quantifying the risks associated with population growth, especially relating to climate change.

Results

These risks are global in scale, such as greenhouse-gas emissions, climate disruption, pollution, loss of biodiversity, and spread of disease-all potentially catastrophic for human standards of living, health, and general wellbeing. The trends increasing the risks of global population growth are country development, demographics, maternal education, access to family planning, and child and maternal health.

Conclusion

Support for nations still going through a demographic transition is required to ensure progress occurs within planetary boundaries and promotes equity and human rights. Ensuring the wellbeing for all under this aim itself will lower population growth and further promote environmental sustainability.

Conditional cash transfers and women's reproductive choices

We study potential non-targeted effects of a large-scale national conditional cash transfer program-Peru's Juntos-on the fertility and reproductive decisions of adult beneficiaries. We use an event study design, exploiting time and geographic variation in the rollout of the program, to identify the causal effects of the program. We find that Juntos decreases the number of children that adult beneficiaries have and that these effects persist over time. We explore various mechanisms and find that Juntos does not affect fertility preferences but rather empowers women to avoid unwanted births. We provide evidence that this decrease is most likely due to better access to and more extensive use of modern birth control methods.

Exploring configurations of social determinants for enhancing older adult health in China: an fuzzy-set qualitative comparative analysis based on 31 provinces in China

With China's aging population on the rise, addressing population aging has become a national priority, particularly focusing on improving older adult health. This study employs the social determinants of health framework, considering China's unique macro-social, economic, policy, healthcare, and family cultural factors, to develop a framework for understanding the social determinants of health for older adult in China. Using the fsQCA method and a configurational perspective, the complex relationship between social determinants of health and older adult health status is examined. The findings indicate that individual social determinants alone are insufficient for achieving high levels of older adult health. Instead, three configurations of social determinants have been identified as conducive to high older adult health: Economic Development-Environment - Cultural Dominant Type, Socio-Economic Development - Older Adult Security - Environment - Cultural Dominant Type, and Economic Development Dominant Type. These configurations offer diverse pathways for enhancing older adult health. Conversely, the study identifies two configurations associated with low older adult health levels, exhibiting an asymmetric relationship with the configurations resulting in high older adult health levels. Moreover, economic development consistently emerges as a core condition across all three configurations associated with high older adult health levels, while two configurations associated with low older adult health lack this core condition. These findings underscore the universal contribution of enhancing economic development to improving older adult health.

Standardized rate of hospitalization for violent injuries among different generations in counties and cities in Taiwan from 2000 to 2015

This study aimed to understand the distribution of the standardized rate of hospitalization for violent injuries in counties and cities in Taiwan. The ICD-9 diagnosis code N-codes 995.5 (abused child) and 995.8 (abused adult) or E-code E960-E969 (homicide and intentional injury by others) were defined as research cases. The study analyzed the standardized medical treatment rate of children and adolescents aged 0 to 17, adults aged 18 to 64, and older adults over 65 years old suffering from violence for the first time. During the 15-year period, the counties and cities with the highest rate of medical treatment for violent injuries among children (unit: per 105 people) were Pingtung County (33.1 males, 22.9 females), Lienchiang County (8.8 males, 9.8 females), and New Taipei City (8.2 males, 8.8 females). For adults, Pingtung County (73.2 males, 36.8 females), New Taipei City (26.0 males, 14.3 females), and Yunlin County (19.7 males, 7.7 females) registered the highest rates. For older adults, Pingtung County (33.6 persons), New Taipei City (12.5 persons), Yun Lin County (11.2 persons), and Taichung City (9.2 persons) registered the highest rates. The highest rates of older female adults receiving treatment were recorded in Pingtung County (15.1 persons), Yunlin County (9.0 persons), Taichung City (5.5 persons), and New Taipei City (5.1 persons). With the Poisson regression model, the relative risk ratio of seeking medical care owing to violence in Pingtung County (reference: Taipei City) was 25.1 times for children, 20.1 times for adults, and 11.7 times for older adults. The counties and cities with higher rates of violent medical treatment for adults and older adults during the 15-year period were Pingtung County, New Taipei City, and Yunlin County. For children and adolescents, Pingtung County, Lienchiang County, and New Taipei City recorded the highest rates. Pingtung County had the highest risk of sexual violence. These results may be related to the local industrial structure, demographic composition, and other characteristics explained in the text.

Structure Simulation and Equilibrium Evaluation Analysis of Regional Water Resources, Society, Economy and Ecological Environment Complex System

Currently, the implementation of water resource spatial equilibrium strategy is a fundamental policy of water resource integrated management in China; it is also a considerable challenge to explore the relationship structure features of water resources, society, economy and ecological environment (WSEE) complex system. For this purpose, firstly, we applied information entropy, ordered degree and connection number coupling method to reveal the membership characteristics between different evaluation indicators and grade criterion. Secondly, the system dynamics approach was introduced to describe the relationship features among different equilibrium subsystems. Finally, the ordered degree, connection number, information entropy and system dynamics integrated model was established to conduct relationship structure simulation and evolution trend evaluation of the WSEE system. The application results in Hefei city, Anhui Province, China, demonstrated that: (1) the variation of overall equilibrium conditions of WSEE system in Hefei city, 2020-2029 was higher compared to that of 2010-2019, though the increasing rate of ordered degree and connection number entropy (ODCNE) became slower after 2019; and (2) the annual ODCNE value from 2020 to 2029 of WSEE system under dry year scenarios increased about 0.0812, which indicated that the construction of Yangtze-Huaihe Diversion (YHD) project could play significant positive role in mitigating the equilibrium situation of WSEE system in Hefei city in the future. On the whole, this study is capable of providing the guidance basis for constructing a theoretical framework of structure simulation and equilibrium evaluation analysis of WSEE complex system.

Bayesian models for spatial count data with informative finite populations with application to the American community survey

The American Community Survey (ACS) is an ongoing program conducted by the US Census Bureau that publishes estimates of important demographic statistics over pre-specified administrative areas. ACS provides spatially referenced count-valued outcomes that are paired with finite populations. For example, the number of people below the poverty line and the total population for each county are estimated by ACS. One common assumption is that the spatially referenced count-valued outcome given the finite population is binomial distributed. This conditionally specified (CS) model does not define the joint relationship between the count-valued outcome and the finite population. Thus, we consider a joint model for the count-valued outcome and the finite population. When cross-dependence in our joint model can be leveraged to 'improve spatial prediction' we say that the finite population is 'informative.' We model the count given the finite population as binomial and the finite population as negative binomial and use multivariate logit-beta prior distributions. This leads to closed-form expressions of the full-conditional distributions for an efficient Gibbs sampler. We illustrate our model through simulations and our motivating application of ACS poverty estimates. These empirical analyses show the benefits of using our proposed model over the more traditional CS binomial model.

A brief review of vitamin D as a potential target for the regulation of blood glucose and inflammation in diabetes-associated periodontitis

Diabetes is a metabolic disorder associated with various complications, including periodontitis. The risk of periodontitis is increased in patients with diabetes, while vitamin D deficiency is associated with both diabetes and periodontitis. Thus, there is a need to identify the molecular effects of vitamin D on the regulation of inflammation and glucose in diabetes-associated periodontitis. The Web of Science, Scopus, and PubMed databases were searched for studies of the molecular effects of vitamin D. Molecular effects were reportedly mediated by salivary secretions, interactions of advanced glycation end products (AGEs) with receptors of AGEs (RAGEs), cytokines, and oxidative stress pathways linking diabetes with periodontitis. Vitamin D supplementation attenuates inflammation in diabetes-associated periodontitis by reducing the levels of inflammatory cytokines and numbers of immune cells; it also has antibacterial effects. Vitamin D reduces cytokine levels through regulation of the extracellular signal-related kinase 1/2 and Toll-like receptor 1/2 pathways, along with the suppression of interleukin expression. Glucose homeostasis is altered in diabetes either because of reduced insulin production or decreased insulin sensitivity. These vitamin D-related alterations of glucoregulatory factors may contribute to hyperglycaemia; hyperglycaemia may also lead to alterations of glucoregulatory factors. This review discusses the pathways involved in glucose regulation and effects of vitamin D supplementation on glucose regulation. Further studies are needed to characterise the effects of vitamin D on diabetes-associated periodontitis.

Geographical distribution of fertility rates in 70 low-income, lower-middle-income, and upper-middle-income countries, 2010-16: a subnational analysis of cross-sectional surveys

BACKGROUND

Understanding subnational variation in age-specific fertility rates (ASFRs) and total fertility rates (TFRs), and geographical clustering of high fertility and its determinants in low-income and middle-income countries, is increasingly needed for geographical targeting and prioritising of policy. We aimed to identify variation in fertility rates, to describe patterns of key selected fertility determinants in areas of high fertility.

METHODS

We did a subnational analysis of ASFRs and TFRs from the most recent publicly available and nationally representative cross-sectional Demographic and Health Surveys and Multiple Indicator Cluster Surveys collected between 2010 and 2016 for 70 low-income, lower-middle-income, and upper-middle-income countries, across 932 administrative units. We assessed the degree of global spatial autocorrelation by using Moran's I statistic and did a spatial cluster analysis using the Getis-Ord Gi* local statistic to examine the geographical clustering of fertility and key selected fertility determinants. Descriptive analysis was used to investigate the distribution of ASFRs and of selected determinants in each cluster.

FINDINGS

TFR varied from below replacement (2·1 children per women) in 36 of the 932 subnational regions (mainly located in India, Myanmar, Colombia, and Armenia), to rates of 8 and higher in 14 subnational regions, located in sub-Saharan Africa and Afghanistan. Areas with high-fertility clusters were mostly associated with areas of low prevalence of women with secondary or higher education, low use of contraception, and high unmet needs for family planning, although exceptions existed.

INTERPRETATION

Substantial within-country variation in the distribution of fertility rates highlights the need for tailored programmes and strategies in high-fertility cluster areas to increase the use of contraception and access to secondary education, and to reduce unmet need for family planning.

FUNDING

Wellcome Trust, the UK Foreign, Commonwealth and Development Office, and the Bill & Melinda Gates Foundation.

System Dynamics Model for Evaluating Socio-Economic Impacts of Different Water Diversion Quantity from Transboundary River Basins-A Case Study of Xinjiang

With the rapid development of social economy and global climate warming, scarce transboundary water resources, as one of the basic resources for socio-economic development, have increasingly become the focus of basin countries. To investigate the socio-economic impacts of different water diversion quantity from transboundary river basins, we used a system dynamics (SD) model to reflect interactions between population, water resources, and socio-economic development, and applied it to a case study in Xinjiang to simulate its change tendency from 2011 to 2030 from the temporal dimension. Then, four water diversion quantity of transboundary river basins and four alternative socio-economic development patterns were designed to comprehensively evaluate these impacts of water diversion quantity change on the socio-economy of the region along the river under different socio-economic development patterns. The results indicate that (1) there was a positive correlation between water diversion quantity and the economic output value of the region along transboundary river basins, and the marginal benefit of transboundary water resources would decrease gradually; (2) considering the difficulty of water diversion from transboundary river basins and the protection of downstream water use and ecological health of transboundary river basins, we believe that increasing the transboundary water resources by 20% was more conducive to the sustainable development of Xinjiang’s socio-economy; (3) through the comparison of dynamic evolutions of socio-economic development and water impacts under four socio-economic development patterns, it is best for Xinjiang to plan its future development in the coordinated development of economic-resource scenario. Following this scenario, not only would the total output value of the socio-economy be better than other scenarios, but this also helps to alleviate the contradiction between the water supply and demand, which expected there would be a water shortage of 1.04 billion m³ in 2029 under 20% increase in water diversion quantity. Therefore, appropriate water diversion quantity, reasonable adjustment of industrial production growth rate, reduction of water consumption quotas of different industries and domestic water quota, and improvement of collection and treatment rate for sewage should be given priority in water resources management decision-making in Xinjiang or other arid regions along transboundary river basins.

Generating and capitalizing on the demographic dividend potential in sub-Saharan Africa: a conceptual framework from a systematic literature review

Background: Africa will double its population by 2050 and more than half will be below age 25. The continent has a unique opportunity to boost its socioeconomic welfare. This systematic literature review aims to develop a conceptual framework that identifies policies and programs that have provided a favorable environment for generating and harnessing a demographic dividend. This framework can facilitate sub-Saharan African countries' understanding of needed actions to accelerate their demographic transition and capitalize on their demographic dividend potential. Methods: The search strategy was structured around three concepts: economic development, fertility, and sub-Saharan Africa. Databases used included PubMed and EconLit. An inductive approach was employed to expand the reference base further. Data were extracted using literature records following a checklist of items to include when reporting a systematic review suggested in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: The final review consisted of 78 peer-reviewed articles, ten reports from the gray literature, and one book. Data were categorized according to relevant demographic dividend typology: pre-dividend and early-dividend. The results from the literature review were synthesized into a framework consisting of five sectors for pre-dividend countries, namely 1) Governance and Economic Institutions, 2) Family Planning, 3) Maternal and Child Health, 4) Education, and 5) Women's Empowerment. An additional sector, 6) Labor Market, is added for early-dividend countries. These sectors must work together to attain a demographic dividend. Conclusions: A country's demographic transition stage must guide policy and programs. Most sub-Saharan African countries have prioritized job creation and employment for youth, yet their efforts to secure a productive labor market require preliminary and complementary investments in governance, family planning, maternal and child health, education, and women's empowerment. Creating a favorable policy environment for generating and capitalizing on a demographic dividend can support their stated goals for development.

Fertility preferences among couples in Nigeria: a cross sectional study

Background

The persistently high and stalled total fertility in Sub-Saharan Africa, including in Nigeria, calls for new efforts towards fertility reduction. Most efforts on fertility desire in sub-Saharan Africa have focused either on individual men or women with little focus on couples as a unit of analysis. Moreover, the influences of different types of marriages in which couples reproduce have not been adequately explored. Therefore, this study examined fertility desires among couples in Nigeria.

Methods

This paper used data from the Nigeria Demographic and Health Survey (NDHS) of 2018 to assess fertility desire by marriage type among couples in Nigeria. In addition, the association between fertility desire and disparity in couples’ educational attainment, place of residence, region, religion, occupation, wealth status, children ever born and contraceptive use were considered. The participants consisted of 6813 couples aged between 15–49 years. Couples’ characteristics were reported using frequency and percentage distribution tables. Descriptive and logistic regression analyses were conducted.

Results

Overall, the study revealed that 73.8% of couples were in monogamous relationships while 26.2% were in polygynous relationships. The mean ideal number of children for men and women were 7.2 and 6.1, respectively. Also, 49.3% of the couples reported husbands desired more children, 43.9% claimed wives desired more children, while 6.8% indicated equal number of desired children among wives and husbands. The results of binary logistic regression showed that couples in polygynous relationships were 4.3 times as likely to desire more children, compared to couples in monogamous relationships (OR = 4.3; 95% CI: 3.5, 5.3). Couples in polygynous relationships wanted as many as four times the number of children desired by couples in monogamous relationships. Fertility desire was significantly higher among couples who indicated the following: either was using contraceptives (OR = 2.3; 95% CI: 1.6–3.4), both were not using contraceptives (OR = 2.8; 95% CI: 1.9, 4.1), lived in North East (OR = 2.0; 95% CI: 1.5, 2.6) and North West (OR = 1.7; 95% CI: 1.3, 2.3), both were not working (OR = 1.33, 95% CI; 1.1, 1.6) and were adherents of Islam (OR = 1.8; 95% CI; 1.5, 2.4).

Conclusion

These findings reflect the role of region, use of contraceptives, work status and religion in the fertility desire of couples. Implementing programmes and policies on sexual education and reproductive rights of couples and individuals may reduce high fertility desire and its adverse consequences, such as child and maternal morbidity and mortality in Nigeria.

Pattern and correlates of out-of-pocket payment (OOP) on female sterilization in India, 1990-2014

Background

Large scale public investment in family welfare programme has made female sterilization a free service in public health centers in India. Besides, it also provides financial compensation to acceptors. Despite these interventions, the use of contraception from private health centers has increased over time, across states and socio-economic groups in India. Though many studies have examined trends, patterns, and determinants of female sterilization services, studies on out-of-pocket payment (OOP) and compensations on sterilisation are limited in India. This paper examines the trends and variations in out-of-pocket payment (OOP) and compensations associated with female sterilization in India.

Methods

Data from the National Family Health Survey - 4, 2015–16 was used for the analyses. A composite variable based on compensation received and amount paid by users was computed and categorized into four distinct groups. Multivariate analyses were used to understand the significant predictors of OOP of female sterilization.

Results

Public health centers continued to be the major providers of female sterilization services; nearly 77.8% had availed themselves of free sterilization and 61.6% had received compensation for female sterilization. About two-fifths of the women in the economically well-off state like Kerala and one-third of the women in a poor state like Bihar had paid but did not receive any compensation for female sterilization. The OOP on female sterilization varies from 70 to 79% across India. The OOP on female sterilization was significantly higher among the educated and women belonging to the higher wealth quintile linking OOP to ability to pay for better quality of care.

Conclusion

Public sector investment in family planning is required to provide free or subsidized provision of family welfare services, especially to women from a poor household. Improving the quality of female sterilization services in public health centers and rationalizing the compensation may extend the reach of family planning services in India.

Nagaland health assessment: High mortality rates and difficulty accessing essential health services in Lahe Township, Republic of the Union of Myanmar

INTRODUCTION

Lahe Township belongs to Myanmar`s Naga Self-administered Zone, which is one of the most remote and mountainous areas in Myanmar. However, the limited health data available for the region suggests that there could be neglected health needs that require attention. The purpose of this study was to assess the health status of the population of Lahe Township.

METHODS

A cross-sectional study design incorporating a two-stage cluster sampling methodology recommended by the WHO was used to conduct a household level survey. In the first stage, 30 village clusters were selected from all villages situated in the Lahe Township through systematic sampling with probability of selection proportional to the population size of each village based on the 2014 Myanmar census. In the second stage, a GPS-based sampling method was used to select 30 households within a village cluster. The head of the household completed the survey for all members of the household. Questionnaires inquired about maternal health, mortality, morbidities, childhood nutritional status, access to health care, and water & sanitation. The resulting data was stratified by urban/rural status.

RESULTS

Data was collected on 5,929 individuals living in 879 households, of which 993 individuals (16.7%) were children 5 years old or younger. The median age was 18.0 (IQR 8.0-35.0). Children 15 years old or younger represented 44.7% of the population. 19.8% of households reported at least 1 household member sick during the previous 30 days. The crude mortality rate per 10,000 people per day was 0.58 (95% CI: 0.48-0.69). The under 5 mortality per 10,000 people per day was 0.74 (95% CI: 0.50-1.06). Only 46.7% of households could access a hospital if there was a need.

CONCLUSION

Our results demonstrate a high rate of mortality and the inability to access healthcare in Lahe Township, which should be addressed to prevent further deterioration of health.

Factors influencing unmet need for family planning among Ghanaian married/union women: a multinomial mixed effects logistic regression modelling approach

BACKGROUND

Unmet need for family planning is high (30%) in Ghana. Reducing unmet need for family planning will reduce the high levels of unintended pregnancies, unsafe abortions, maternal and neonatal morbidity and mortality. The purpose of this study was to examine factors that are associated with unmet need for family planning to help scale up the uptake of family planning services in Ghana.

METHODS

This cross sectional descriptive and inferential study involved secondary data analysis of women in the reproductive age (15-49 years) from the Ghana Demographic and Health Survey 2014 data. The outcome variable was unmet need for family planning which was categorized into three as no unmet need, unmet need for limiting and unmet need for spacing. Chi-squared test statistic and bivariate multilevel multinomial mixed effects logistic regression model were used to determine significant variables which were included for the multivariable multilevel multinomial mixed effects logistic regression model. All significant variables (p < 0.05) based on the bivariate analysis were included in the multinomial mixed effects logistic regression model via model building approach.

RESULTS

Women who fear contraceptive side effects were about 2.94 (95% CI, 2.28, 3.80) and 2.58 (95% CI, 2.05, 3.24) times more likely to have an unmet need for limiting and spacing respectively compared to those who do not fear side effects. Respondents' age was a very significant predictor of unmet need for family planning. There was very high predictive probability among 45-49 year group (0.86) compared to the 15-19 year group (0.02) for limiting. The marginal predictive probability for spacing changed significantly from 0.74 to 0.04 as age changed from 15 to 19 to 45-49 years. Infrequent sexual intercourse, opposition from partners, socio-economic (wealth index, respondents educational level, respondents and partner's occupation) and cultural (religion and ethnicity) were all significant determinants of both unmet need for limiting and spacing.

CONCLUSIONS

This study reveals that fear of side effect, infrequent sex, age, ethnicity, partner's education and region were the most highly significant predictors of both limiting and spacing. These factors must be considered in trying to meet the unmet need for family planning.

Comprehensive evaluation and scenario simulation for the water resources carrying capacity in Xi'an city, China

The quantity and quality of water resources are of great importance in maintaining urban socio-economic development. Accordingly, substantial research has been conducted on the concept of the water resources carrying capacity (WRCC). In this study, analytic hierarchy process (AHP) and system dynamics (SD) models were combined to construct a multi-criteria evaluation system of the WRCC and a socio-economic/water resources SD model for Xi'an. The developmental trends of the society, economy, water supply/demand, and wastewater discharge were obtained from 2015 to 2020 using five scenarios designed for distinct purposes; these scenarios and trends were comprehensively evaluated using a combination of qualitative and quantitative analyses. The results indicated that the WRCC (0.32 in 2020) in Xi'an will shift from a normal to a poor state if the current social development pattern is maintained; therefore, we conclude that the socio-economic development of Xi'an is unsustainable. However, under a comprehensive scheme, the WRCC index (0.64 in 2020) will increase by 48% compared with the WRCC index under a business-as-usual scenario. Further, some practical suggestions, including the promotion of industrial reforms and the improvement of water-use efficiency and recycling policies, were provided for improving the regional WRCC.

Low fertility may be a significant determinant of ovarian cancer worldwide: an ecological analysis of cross- sectional data from 182 countries

BACKGROUND

Ageing, socioeconomic level, obesity, fertility, relaxed natural selection and urbanization have been postulated as the risk factors of ovarian cancer (OC56). We sought to identify which factor plays the most significant role in predicting OC56 incidence rate worldwide.

METHODS

Bivariate correlation analysis was performed to assess the relationships between country-specific estimates of ageing (measured by life expectancy), GDP PPP (Purchasing power parity), obesity prevalence, fertility (indexed by the crude birth rate), opportunity for natural selection (Ibs) and urbanization. Partial correlation was used to compare contribution of different variables. Fisher A-to-Z was used to compare the correlation coefficients. Multiple linear regression (Enter and Stepwise) was conducted to identify significant determinants of OC56 incidence. ANOVA with post hoc Bonferroni analysis was performed to compare differences between the means of OC56 incidence rate and residuals of OC56 standardised on fertility and GDP respectively between the six WHO regions.

RESULTS

Bivariate analyses revealed that OC56 was significantly and strongly correlated to ageing, GDP, obesity, low fertility, Ibs and urbanization. However, partial correlation analysis identified that fertility and ageing were the only variables that had a significant correlation to OC56 incidence when the other five variables were kept statistically constant. Fisher A-to-Z revealed that OC56 had a significantly stronger correlation to low fertility than to ageing. Stepwise linear regression analysis only identified fertility as the significant predictor of OC56. ANOVA showed that, between the six WHO regions, multiple mean differences of OC56 incidence were significant, but all disappeared when the contributing effect of fertility on OC56 incidence rate was removed.

CONCLUSIONS

Low fertility may be the most significant determining predictor of OC56 incidence worldwide.

Usability evaluation of obstetrics and gynecology information system using cognitive walkthrough method

Background and aim

Obstetrics and gynecology information system is a critical component of the HIS in social security organization health centers. The objective of this study was to evaluate the usability of this system using the cognitive walkthrough method. Also, the present study provided a detailed formal description of how the cognitive usability evaluation can be applied and reported for a health care information system.

Methods

This study was conducted at the Mashhad University of Medical Sciences' usability lab from March 2016 to June 2017. A two-phase approach was used to conduct the cognitive walkthrough evaluation: preparatory and evaluation. The preparation was done in three stages: first, we investigated users' capabilities and background knowledge through a semi-structured interview. Second, the evaluation scenario was developed based on the most common tasks in routine workflow of users. Finally, each task was broken down into sequences of actions. In the evaluation phase, three usability experts independently assessed each action using a four-item checklist. Problems were categorized thematically and were reported from three different perspectives: Question-based, Task-based, and Evaluator-based. The data were then analyzed to understand the contribution of each task, along with its mean severity score.

Results

Evaluators' responses were compared and any conflict was resolved in an expert panel. A total of 116 usability problems were identified based on the consensus of the evaluators. Inadequate system feedback was found to be the main source of 43% of the problems, and resulted in users confusion.

Conclusion

Since the system was evaluated in its pilot implementation phase, there was an opportunity to prevent future potential usability problems. The use of a mixed quantitative and qualitative approach in this usability study provided a more comprehensive perspective of the system problems. This study provided a detailed description of conducting CW usability evaluation which can be used as a practical guide for future studies.

Telephone based weight loss intervention: Relevance for developing countries

Obesity is a major public health challenge not only for developed but developing countries as well. The World Health Organization recommends the immediate use of effective, efficient and widely accessible weight loss interventions. Telephone based weight loss intervention could provide a cheaper and wider reach of obese participants. Previous systematic reviews on telephone based weight loss interventions either excluded studies that had obese participants with co-morbidities or were silent on their inclusion. Obese/overweight individuals with co-morbidities constitute an important population in any weight loss intervention study due to the strong association of obesity with major chronic health conditions. This paper, reviews the efficacy of telephone based weight loss intervention solely in overweight/obese individuals with obesity related diseases and discusses its relevance for developing countries.

The cultural evolution of fertility decline

Cultural evolutionists have long been interested in the problem of why fertility declines as populations develop. By outlining plausible mechanistic links between individual decision-making, information flow in populations and competition between groups, models of cultural evolution offer a novel and powerful approach for integrating multiple levels of explanation of fertility transitions. However, only a modest number of models have been published. Their assumptions often differ from those in other evolutionary approaches to social behaviour, but their empirical predictions are often similar. Here I offer the first overview of cultural evolutionary research on demographic transition, critically compare it with approaches taken by other evolutionary researchers, identify gaps and overlaps, and highlight parallel debates in demography. I suggest that researchers divide their labour between three distinct phases of fertility decline--the origin, spread and maintenance of low fertility--each of which may be driven by different causal processes, at different scales, requiring different theoretical and empirical tools. A comparative, multi-level and mechanistic framework is essential for elucidating both the evolved aspects of our psychology that govern reproductive decision-making, and the social, ecological and cultural contingencies that precipitate and sustain fertility decline.

Getting family planning and population back on track

After a generation of partial neglect, renewed attention is being paid to population and voluntary family planning. Realistic access to family planning is a prerequisite for women's autonomy. For the individual, family, society, and our fragile planet, family planning has great power.

The Effect of Fertility Reduction on Economic Growth

We assess quantitatively the effect of exogenous reductions in fertility on output per capita. Our simulation model allows for effects that run through schooling, the size and age structure of the population, capital accumulation, parental time input into child-rearing, and crowding of fixed natural resources. The model is parameterized using a combination of microeconomic estimates, data on demographics and natural resource income in developing countries, and standard components of quantitative macroeconomic theory. We apply the model to examine the effect of a change in fertility from the UN medium-variant to the UN low-variant projection, using Nigerian vital rates as a baseline. For a base case set of parameters, we find that such a change would raise output per capita by 5.6 percent at a horizon of 20 years, and by 11.9 percent at a horizon of 50 years.

Population priorities: the challenge of continued rapid population growth

Rapid population growth continues in the least developed countries. The revisionist case that rapid population could be overcome by technology, that population density was advantageous, that capital shallowing is not a vital concern and that empirical investigations had not proved a correlation between high population growth and low per capita income was both empirically and theoretically flawed. In the modern world, population density does not play the role it did in nineteenth-century Europe and rates of growth in some of today's least developed nations are four times than those in nineteenth-century Europe, and without major accumulation of capital per capita, no major economy has or is likely to make the low- to middle-income transition. Though not sufficient, capital accumulation for growth is absolutely essential to economic growth. While there are good reasons for objecting to the enforced nature of the Chinese one-child policy, we should not underestimate the positive impact which that policy has almost certainly had and will have over the next several decades on Chinese economic performance. And a valid reticence about telling developing countries that they must contain fertility should not lead us to underestimate the severely adverse impact of high fertility rates on the economic performance and prospects of many countries in Africa and the Middle East.

Where next?

This paper provides a personal perspective on the rich discussions at the Bixby Forum. The size, rate of growth and age structure of the human population interact with many other key factors, from environmental change to governance. While the details of future interactions are sometimes difficult to predict, taken together they pose sombre threats to a socially and economically sustainable future for the rich and to any realistic possibility of lifting the world's bottom two billion people out of poverty. Adaptive changes will be needed to cope with an ageing population in countries with low fertility or below, but these are achievable. More worrying, continued rapid population growth in many of the least developed countries could lead to hunger, a failure of education to keep pace with growing numbers, and conflict. The assumption that the demographic transition from high to low birth rates occurs as a result of exogenous social and economic forces is being replaced by a clearer understanding of the many barriers that separate women from the knowledge and technologies they need to manage their childbearing within a human rights framework. The forum ended with a clear consensus that much more emphasis needs to be given to meeting the need for family planning and to investing in education.