Prevalence and determinants of using complementary and alternative medicine for the treatment of chronic illnesses: A multicenter study in Bangladesh

Background While conventional medicine (CM) is commonly used to treat non-communicable diseases (NCDs), complementary and alternative medicine (CAM) is gaining popularity as a healthcare option in Bangladesh. We aimed to investigate the prevalence and factors associated with using CAM solely and using CAM in conjunction with CM for chronic illness treatment among NCD patients in Bangladesh. Methods A multicenter cross-sectional study was conducted, including 549 adults with a confirmed chronic illness diagnosis from three tertiary care hospitals in Dhaka city. Interviews were used to gather socio-demographic data, while medical records were used to get information on chronic illnesses. A multinomial logistic regression model was used to determine the associated factors of utilizing CAM primarily and CAM use in conjunction with CM to manage the chronic disease. Results Out of 549 NCD patients (282 women [51.4%], mean [standard deviation] age 45.4 [12.8] years), 180 (32.8%) ever used CAM for the treatment of chronic illness. Also, 15.3% of patients exclusively used CAM among the NCD patients, while 17.5% used CAM in conjunction with CM. Homeopathy medicine was the most prevalent type of treatment among CAM users (52.2%). Furthermore, 55.5% of CAM users said they used it due to its less adverse effects, and 41.6% trusted its effectiveness for chronic illness. Elderly patients (≥60 years) preferred CAM in complementary with CM, but they did not rely only on CAM. According to the multinomial regression analysis, unmarried patients, predominantly in the younger age group, adopted CAM significantly for chronic illness treatment (Relative risk ratio, RRR = 0.29, 95% CI = 0.12–0.71, reference = Unmarried). Patients in the high-income group used CAM in conjunction with CM (RRR = 6.26, 95% CI = 1.35–18.90, reference: low-income), whereas patients in the high-income group did not rely on CAM alone (RRR = 0.99, 95% CI = 0.34–2.85). Conclusion Although CM remains the mainstream of health care in Bangladesh, CAM services play an essential role in people’s health care, particularly in treating chronic illnesses. Physicians of Bangladesh should be aware that their patients may be using other services and be prepared to ask and answer questions regarding the risks and benefits of using CAM in addition to regular medical care. Thus, clinicians required to follow best-practice guidelines, which are currently not practiced in Bangladesh, when disseminating information regarding integrative techniques that combine CM and CAM approaches.

Comparison of Machine Learning Analysis on Predictive Factors of Children’s Planning-Organizing Executive Function by Income Level: Through Home Environment Quality and Wealth Factors

Background and objective: This study identifies whether children's planning-organizing executive function can be significantly classified and predicted by home environment quality and wealth factors.Methods: For empirical analysis, we used the data collected from the 10th Panel Study on Korean Children in 2017. Using machine learning tools such as support vector machine (SVM) and random forest (RF), we evaluated the accuracy of the model in which home environment factors classify and predict children's planning-organizing executive functions, and extract the relative importance of variables that determine these executive functions by income group.Results: First, SVM analysis shows that home environment quality and wealth factors show high accuracy in classification and prediction in all three groups. Second, RF analysis shows that estate had the highest predictive power in the high-income group, followed by income, asset, learning, reinforcement, and emotional environment. In the middle-income group, emotional environment showed the highest score, followed by estate, asset, reinforcement, and income. In the low-income group, estate showed the highest score, followed by income, asset, learning, reinforcement, and emotional environment.Conclusion: This study confirmed that home environment quality and wealth factors are significant factors in predicting children’s planning-organizing executive functions.

Prevalence of Iron Deficiency Anemia among Adolescent School Children of Manipur, India

Background: Iron deficiency anemia (IDA), one of the most common types of nutritional anemia worldwide is considered a major public health problem in developing countries. Prevalence in India remains alarmingly high. Population of Manipur, a small state in the north-eastern part of India, is different with distinct race, culture, socio-demographic pattern and dietary habits. Therefore, this cross-sectional study was conducted to determine the prevalence and risk factors of IDA among apparently healthy school children of Manipur, India. Methods: Three hundred and seventy-nine blood samples (163 males and 216 females) were collected randomly from urban and rural school children in the age group of 13 to 19 years from Imphal west and Thoubal districts of Manipur respectively. Eligible participants were subjected to haemoglobin (Hb) estimation and serum ferritin (SF) assay. Moreover, a questionnaire was designed to collect demographics, food and drink habits, hygienic practices and socioeconomic status. BMI of the students were also recorded. Results: The overall prevalence of IDA was 23.2% (n = 88), of whom 81.81% were females (n = 72) and 18.18% were males (n = 16). Prevalence of IDA among the males and females was higher in the rural compared to urban schools but not statistically significant. Correlation between BMI and Hb was significant (p < 0.05) but not with serum ferritin status. Students belonging to the middle income group had the highest prevalence of ferritin deficiency followed by the high income group and low income group respectively. Both the Hb and serum ferritin levels of students who do hand wash before meals were significantly higher than those who do not. Both hemoglobin and serum ferritin levels do not differ significantly among students who prefer home-made traditional food and junk food. Conclusion: This study revealed that the majority of the students, especially females, have IDA that might become worse by malnutrition, lifestyle habits, and lack of awareness. Our results suggest that IDA can be prevented by providing proper knowledge on the healthful diet, improved lifestyle, and harmful effect of IDA to the students.

Revisiting the Existence of EKC Hypothesis under Different Degrees of Population Aging: Empirical Analysis of Panel Data from 140 Countries

Population aging and environmental sustainability have become two hot topics in the world today. To clarify whether the Environmental Kuninets Curve (EKC) hypothesis between the economy and the environment is still valid in the context of population aging is the key to reveal the complexity of social-ecological systems in aging societies. So far, the impact of population aging on the environment has not been clear. To this end, an empirical analysis on the threshold panel model was conducted using panel data of 140 countries from 2000 to 2015. The global findings suggest that economic growth was the main reason for the increase in the ecological footprint at the beginning of aging. However, deepening aging weakened this association between economic and ecological footprints. For high-income countries, with the deepening of aging, the economic and ecological footprints were firstly negatively correlated, then positively correlated, and finally negatively correlated. In other words, the EKC hypothesis remained valid in high-income countries as aging deepened. In contrast, for the low- and middle-income group, the economic-environmental association was not affected by the degree of aging. This result sheds light on the variability of different income country groups in coping with the environmental impacts of aging. For the high-income group, policy makers should pay attention to the aging threshold in socio-ecological management. Only in this way can the development of aging and the ecological environment be reconciled to the greatest extent.

Employment and Livelihoods among Tribal in India

The present article attempts to explore one of the most pertinent issues of livelihood among tribals in India. In this context, the following two key issues have been examined: (a) whether tribal people are still engaged primarily in agriculture or forestry related activities for their livelihood or they have moved to non-farm and industrial activities over the years and (b) whether the government affirmative action like reservation policy has helped the tribal people in joining more government/public/formal sector jobs. This article is based on analysis of last two decades secondary data from National Sample Surveys (NSS) and Census of India. On the basis of the analysis of the data it has been observed that the participation of tribals in public sector or formal sector jobs has increased over the years, which may be due to various affirmative actions by the governments’ reservation policy. However, the human capital base of tribals is still much below the other social groups. Another important fact has been revealed through probit regression analysis that the government reservation policy is exclusionary in effect. Maximum benefits have been derived by those who are highly educated and those who belong to high income group. These issues need urgent policy interventions for creating better livelihood conditions for the tribal population particularly for those who are relatively less benefitted.

Did More Generous Health Insurance Improve Health Outcomes of The Elderly? Evidence From China

Background: Catastrophic Medical Insurance (CMI) has been piloted in China Since 2012 and gradually implemented in various regions. Most studies focus on its impact on medical economic risks, and few studies discussed the impact of CMI on health of the elderly.Methods: This study used Chinese Longitudinal Healthy Longevity Survey (CLHLS) data to explore the impact of CMI on health of the elderly. Difference-in-differences (DID) and Propensity score matching-DID were employed to study the health impact of CMI. Heckman selection model was used to study the potential mechanisms.Results: We found that the implementation of CMI improved the mental health of the elderly, and the effect was limited. Moreover, the positive effect of CMI on the health of the elderly was mainly in the high-income group, and CMI had no significant effect on any health indicators of the low-income group population. The potential channel of CMI health improvement was its ability to increase hospitalization rate in the elderly. Conclusions: Therefore, the health promotion and equity of CMI deserve more attention, and the compensation level of CMI needs to be improved under the premise of sustainable and effective supervision of the fund.

Comparison of household income in in-hospital outcomes after implantation of left ventricular assist device

Introduction: Due to the inability to keep up with the demand for heart transplantation, there is an increased utilization of left ventricular assist devices (LVAD). However, paucity of data exists regarding the association of household income with in-hospital outcomes after LVAD implantation. Methods: Retrospective cohort study using the NIS to identify all patients ⩾18 years who underwent LVAD implantation from 2011 to 2017. Statistical analysis was performed comparing low household income (⩽50th percentile) and high income (>50th percentile). Results: A total of 25,503 patients underwent LVAD implantation. The low-income group represented 53% and the high-income group corresponded to 47% of the entire cohort. The low-income group was found to be younger (mean age 55 ± 14 vs 58 ± 14 years), higher proportion of females (24% vs 22%), and higher proportion of blacks (32% vs 16%, p < 0.001 for all). The low-income group was found to have higher prevalence of hypertension, chronic pulmonary disease, smoking, dyslipidemia, obesity, and pulmonary hypertension ( p < 0.001 for all). However, the high-income cohort had higher rate of atrial tachyarrhythmias and end-stage renal disease ( p < 0.001). During hospitalization, patients in the high-income group had increased rates of ischemic stroke, acute kidney injury, acute coronary syndrome, bleeding, and need of extracorporeal membrane oxygenation ( p < 0.001 for all). We found that the unadjusted mortality had an OR 1.30 (CI 1.21–1.41, p < 0.001) and adjusted mortality of OR 1.14 (CI 1.05–1.23, p = 0.002). Conclusion: In patients undergoing LVAD implantation nationwide, low-income was associated with increased comorbidity burden, younger age, and fewer in-hospital complications and all-cause mortality.

A PROPOSAL FOR AFFORDABLE WAQF HOUSING PROJECTS IN MALAYSIA: PUBLIC PERCEPTION OF HOUSE CHARACTERISTICS

Housing affordability is important to ensure houses are affordable to everyone across all income categories, whether they are in the low-income, middle-income (M40), or high-income group. Building housing projects on waqf land will help increase the supply of affordable houses, especially targeted at the M40 group, while also addressing the shortage of affordable housing for the M40 cohort. This study analyses public perceptions of house characteristics and relate these factors to affordable housing prices. The independent variables are location, infrastructure, facilities, size, design and quality. By applying a quantitative research design, the study aims to understand the relationship between various demanded housing characteristics vis-a-vis the price of the house. A sample of 261 usable responses was analysed using the Structural Equation Modelling (SEM). The results show that house size is not statistically significant in influencing the housing price, while location, infrastructure and design of the house are positively significant factors. These findings are expected to provide important inputs to the relevant authorities on factors that are critical in influencing the prices of housing projects built on waqf land in Malaysia.

Diversity in food consumption: Evidences from urban Kerala

Food is fundamental to human survival and it appears to be the first item of the family budget allocation of all irrespective of class to which they belong. Kerala ranks top among the major States of India in the MPCE on food in the post liberalized era. A perusal of NSS data exhibits that, MPCE of urban Kerala is ahead of the rural for the last few decades, however, a sharp decline is noted in the last decade (2001-2011). Along with an increase in MPCE on food, an increase in food diversity is being expected. The study probe into the extent of food diversity among different income strata of urban Kerala with the unit-level data from NSS 68 consumer expenditure survey. The findings indicate that the share of expenditure on cereal in total food expenditure is high in the low-income class and low in the high-income group. The state of Kerala has high food diversity across all income classes signals a better diet quality of people. It is revealed that food diversity is low in the high and low-income groups compared to middle-income group.

Individual Characteristics Associated with Active Travel in Low and High Income Groups in the UK

Active travel (AT) has gained increasing attention as a way of addressing low levels of physical activity. However, little is known regarding the relationship between income and AT. The aim of this study was to investigate characteristics associated with undertaking AT in an adult population and by low- and high-income groups. Data collected from the Physical Activity and the Rejuvenation of Connswater (PARC) study in 2017 were used. Participants were categorised into socio-economic groups according to their weekly household income, and were categorised as participating in ‘no’ AT or ‘some’ AT and ‘sufficient’ AT. Multivariable logistic regression explored characteristics associated with AT in the full cohort, and the low- and high-income groups separately. Variables associated with AT in the low-income group were body mass index (BMI), physical activity self-efficacy, marital status, long term illness, difficulty walking and housing tenure. For the high-income group, BMI, marital status, housing tenure and education were associated with AT. For both income groups, there were consistent positive associations with the action/maintenance phase of the stage of change model across all AT categories. The findings suggest that population sub-groups may benefit from targeted initiatives to support engagement in AT and prevent further widening of inequalities.