Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal multiple Indicator cluster survey (MICS) 2019

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).

Of Rats and Men, a Translational Model to Understand Vancomycin Pharmacokinetic/Toxicodynamic relationships.

Vancomycin area under the concentration curve (AUC) is known to predict vancomycin induced acute kidney injury (AKI). Data were analyzed from a rat model (n=48) and two prospective clinical studies [PROVIDE (n=263) and CAMERA2 (n=291)]. A logit-link model was used to calculate the multiplicative factors between the probability of AKI from clinical studies and the rat. The rat was 2.7 to 4.2 times more sensitive to AKI between AUCs of 199.5 and 794.3 mg*h/L, respectively.

Analysis of Interwell Connectivity of Tracer Monitoring in Carbonate Fracture-Vuggy Reservoir: Taking T-Well Group of Tahe Oilfield as an Example

Carbonate fracture-vuggy reservoirs are one of the hot spots in oil and gas exploration and development. However, it is extremely difficult to describe the internal spatial structure of the fracture-vuggy unit and understand the interwell connection relationship. As a method to measure reservoir characteristics and feedback reservoir production information directly according to the detected concentration curve, interwell tracer technology provides a direct measure for people to understand the law of oil-water movement and reservoir heterogeneity and is widely used in various domestic oil fields. Based on the flow law of tracer and the CFD flow simulation basic model, this paper establishes the physical conceptual model and studies the influence of three physical parameters (the flow velocity of the fluid passing through the connected channel, diameter of the connected channel, and length of the connected channel) on the concentration curve at the outlet. In addition, the influence of different interwell connection modes on tracer concentration was studied and classified scientifically. According to the simulation, the tracer concentration curve can be classified into three types: unimodal curve, bimodal curve, and multimodal curve. Finally, the injection-production well group in the T-well area of the Tahe Oilfield is taken as an example, the connection mode between injection and production wells in this well area is further discussed and has been verified, which can be used as a reference for the connectivity analysis of similar carbonate reservoirs.

INCOME INEQUALITY IN UKRAINE: FEATURES OF ECONOMIC BEHAVIOR OF HOUSEHOLDS

The goal of article is to identify the characteristics of economic behavior of households based on the study of inequality and statistical analysis of their income and expenditure for the period of 2014–2019. The population differentiation according to the level of per capita equivalent income for 2019 was analyzed and Gini coefficient was calculated based on the methods of economic and mathematical statistics. The Lorentz concentration curve was constructed using the graphical-variational method. Based on the method of analysis and synthesis, the resources and expenditures of households in 2014–2019 were studied and conclusions were made about their economic behavior. The calculated Gini coefficient for Ukraine's economy in 2019 is 23.50% which means that there is a moderate level of inequality in the country. The analysis of household income and expenditure statis-tics provides information on low standards of living, as the main sources of household income are wages, pensions, scholarships, and social benefits; the most important item of expenditure is food expenditures. Economic behavior of households, resulting from the current standard of living, the structure of its resources and expenditures, is defined as passive and is characterized by adaptation, conformism and patience of the population to their living conditions, which hinders the active development of so-cio-economic system and the change of economic thinking. The Lorentz curve proves the low level of population differentiation in Ukraine, however, given the high proportion of the poor in the country, there is a need to improve the methodology for collecting and compiling statistical information. The scientific novelty is in the practical application of the method of calculating the Gini coef-ficient and construction of the Lorentz concentration curve on the basis of data from the State Statistics Service was developed. Based on the analysis of household income and expenditure, the type of their economic behavior was defined as passive. The practical significance is in the basis for the study of different types of economic human behavior in the system of social relations based on the analysis of socio-economic inequality was developed. Keywords: income inequality, economic behavior, welfare level, Gini coefficient, Lorentz curve. У статті виявлено особливості економічної поведінки домогосподарств на основі дослідження нерівності та статистич-ного аналізування їх доходів і витрат за період 2014–2019 років. На основі методів економіко-математичної статистики проаналізовано диференціацію населення за рівнем середньодушових еквівалентних доходів за 2019 рік, розраховано коефіцієнт Джині. За допомогою графічно-варіаційного методу побудована крива концентрації Лоренца. Розрахований коефіцієнт Джині для економіки України у 2019 році складає 23,50% та означає, що наявний помірний рівень нерівності в країні. Аналізування статистики доходів та витрат домогосподарств надає інформацію про низький рівень життя насе-лення, оскільки основними джерелами формування грошових доходів домогосподарств є оплата праці, пенсії, стипендії, соціальні допомоги, а найбільш вагомою статтею витрат залишаються витрати на продукти харчування. Економічна по-ведінка домогосподарств, що випливає з поточного рівня життя населення, структури його ресурсів і витрат, визначається як пасивна та характеризується пристосуванством, конформізмом та терплячістю населення до умов їх існування, що заважає активному розвитку соціально-економічної системи та зміни економічного мислення населення. Крива Лоренца підтверджує низький рівень диференціації населення в Україні, але зважаючи на високу долю бідного населення в країні є потреба удосконалення методики збору та формування статистичної інформації. Ключові слова: нерівність доходів, економічна поведінка, рівень добробуту, коефіцієнт Джині, крива Лоренца.

Of Rats and Men, a Translational Model to Understand Vancomycin Pharmacokinetic/Toxicodynamic relationships

BackgroundVancomycin is a first line antibiotic for many common infectious diseases and is the most commonly prescribed antibiotic in the United States hospital setting. Vancomycin is also well known to cause kidney injury; two recent prospective studies have identified that increasing vancomycin area under the concentration curve predicts vancomycin induced kidney injury (VIKI). However, outside of clinical trials, it is unclear if pre-clinical data can quantitatively describe VIKI in patients.MethodsData were simultaneously analyzed from a pre-clinical rat model and two prospective clinical studies. Logged vancomycin area under the concentration curve (AUC) data for rats (n=48) and patients from PROVIDE (n=263) and CAMERA2 (n=291) were included. VIKI was defined as urinary KIM-1 concentrations ≥9.42 ng/mL in the rat and according to KDIGO stage 1 kidney injury for all human patients. Multiple generalized linear models were explored, and the order of magnitude was calculated between the probability of acute kidney injury (AKI) from the average obtained in the clinical studies (i.e. CAMERA2 and PROVIDE) and the rat for 0.1 increments in Log10AUC bounded common concentrations obtained in the therapeutic range (i.e. ~200 −800 mg*24h/L).ResultsA logit link model best fit the data. When calculating the multiplicative factors between the studies therapeutic range AUCs, the rat was an average 2.7 to 4.2 times more sensitive to AKI between AUCs of 199.5 (i.e. log 10 AUC=2.3) and 794.3 mg*h/L (i.e. log 10 AUC=2.9), respectively.ConclusionsA pre-clinical rat model was quantitatively linked to toxicity data from two large human studies. The rat is an attractive pre-clinical model to explore exposure toxicity relationships with vancomycin. External validation is required.

Drug-Drug Interaction Study of Benznidazole and E1224 in Healthy Male Volunteers

ABSTRACT E1224 is a prodrug of ravuconazole (RVZ), an antifungal drug with promising anti-Trypanosoma cruzi activity, the causative organism of Chagas disease (CD). This study was designed to assess the pharmacokinetics (PK) and safety interactions of benznidazole (BNZ), the drug of choice for treatment of CD, and E1224 in healthy volunteers. This open-label, single-center, sequential, single- and multiple-oral-dose study enrolled 28 healthy male subjects. These subjects received BNZ (2.5 mg/kg) once daily on days 1 and 9 and twice daily from day 12 to day 15 and E1224 once daily from day 4 to day 15 (loading dose of 400 mg for 3 days and maintenance dose of 100 mg for 9 days). The maximum concentration (Cmax) and area under the concentration curve from zero to infinity for BNZ were comparable, whether BNZ was given alone or with E1224 at steady state, with ratios of geometric means for BNZ-RVZ to BNZ of 0.96 and 0.83 and corresponding 90% confidence intervals (CIs) of 0.91 to 1.10 and 0.80 to 0.87, respectively. However, RVZ Cmax and area under the concentration curve from zero to 24 h increased by about 35% when concomitantly administered with BNZ at steady state (ratio of geometric means for RVZ-BNZ/RVZ of 1.31 and 1.36 and corresponding 90% CIs of 1.23 to 1.39 and 1.31 to 1.41, respectively). Both compounds were well tolerated. There were no clinically relevant safety interactions between E1224 and BZN. Given these results, coadministration of RVZ and BNZ should not require any adaptation of E1224 dosing.

Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization

This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen’s theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government’s free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed.

Factors Influencing the Reference Interval of Thyroid Stimulating Hormone in Healthy Adults: A Systematic Review and Meta-analysis

Background: Thyroid stimulating hormone (TSH) is an important indicator for evaluating thyroid function. Many studies have reported that the TSH reference interval is susceptible to external factors. This paper summarizes the related studies published in recent years and comprehensively analyzes the effects of these factors on the TSH reference interval in healthy people.Methods: Articles published from January 1980 to January 2020 were searched in PubMed, EMBASE, Cochrane, Scopus, Medline English databases and CNKI, WanFang and CQVIP Chinese databases. In total, 21 studies were ultimately included. All data were analyzed using Review Manager 5.3 software and STATA 16.0 software. Microsoft Excel 2010 was used to draw the TSH concentration curve changing with age, and GraphPad 6.0 was used to draw the TSH concentration curve with sex.Results: The TSH reference interval was significantly influenced by sex and age. The overall trend of TSH concentration reveals that males are lower than females. The TSH reference interval is divided into 20~59-year-old, 60~69-year-old and over 70-year-old age groups for males and 20~39-year-old, 40~49-year-old, 50~69-year-old and over 70-year-old age groups for females. Regardless of sex, TSH concentrations all increase with age. In iodine-deficient areas, TSH reference intervals are generally lower than those in iodine-sufficient or iodine-excessive areas. The TSH reference interval in Asia and North American countries is generally higher than that in most European countries. Even the detection methods are consistent, different detection instruments can affect the TSH reference interval. Sample size and race are also important factors.Conclusion: The TSH reference interval was significantly influenced by sex and age, race, region, iodine intake, sample size, detection instruments and methods, but other factors should not be ignored. Therefore, it is necessary for each laboratory to validate an appropriate TSH reference interval based on local conditions.