The prevalence of overweight/obesity (OW/OB-defined by body mass index) in low- and middle-income countries is rising, and the sociodemographic characteristics of the most affected populations are changing. The relationship between education, widely recognized as a gender-related variable, and OW/OB in high-income countries is well understood; however, the impact in South Asian (SA) countries is less clear. This systematic review interrogated the relationship between educational attainment and OW/OB, by searching Ovid MEDLINE, CINAHL, EMBASE, and Web of Science for studies published after 2013, reporting the prevalence of OW/OB by educational attainment in eight SA countries. Data were extracted and the association between education and OW/OB was coded as direct, indirect, null, or U-shaped. A total of 32 studies were included in the review. The mean age was 38.5 years. The prevalence of OW/OB ranged between 4.6% and 64.4%. Females were reported to be at higher risk of OW/OB compared with males. Most of the studies reported women with higher education at greater risk of being OW/OB. SA countries are undergoing substantial transformations in their economic and social frameworks that influence how sex and gender mediate cardiovascular risk factors like OW/OB. Preventive strategies must be tailored to the unique characteristics of the SA population.

Initial management of coronavirus disease 2019 (COVID-19) focused on preventing spread and providing supportive care. Authorities disseminated disease information and enforced preventive measures. This intricate task was affected by factors such as initial emotional distress or perceived risk, which influenced adherence to public health recommendations. This study examined the association between trust in local health authorities and national/regional leaders who have provided information about COVID-19 and adherence to COVID-19 preventive behaviors. Data from the International COVID-19 Awareness and Responses Evaluation (iCARE) study was used for the analyses (surveys 5–15, n = 14,453) from 116 countries (September 2020-January 2022). The main predictor was participants' trust, which was categorized into four levels. The primary outcome was adherence to preventive behaviors: (1) handwashing, (2) mask wearing, (3) physical distancing, (4) avoiding gatherings, and (5) self-quarantining. Additional variables included demographics, socioeconomic status, health history and COVID-19 perceptions. We conducted multivariable logistic regressions to determine the association between the level of trust in local health authorities and national/regional leaders and adherence to COVID-19-related preventive health behaviors. 14,453 respondents worldwide, 2852 (25.43

The postpartum period is a time of increased vulnerability to mental health challenges due to physiological, emotional, and social changes, with nearly one-quarter of Canadian mothers reporting symptoms of postpartum depression or anxiety. These challenges may be amplified for racialized mothers, who may encounter systemic barriers such as stigma, discrimination, and limited access to culturally appropriate care. This scoping review aims to map and synthesize the current body of literature on postpartum mental health of racialized mothers living in Canada. This review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR). Two search phases: databases (CINAHL, MEDLINE, PsycINFO and Cochrane Library) and a grey literature search will be used to identify literature. This review will be guided by Arksey and O’Malley’s framework. All studies conducted in Canada and published in English, relevant to postpartum mental health of racialized mothers will be included. The grey literature will focus on programs and interventions for racialized postpartum mothers. We will screen the literature against the inclusion criteria by two independent reviewers and included studies will be presented in a flow diagram in accordance with the PRISMA-ScR guidelines. Data will be extracted and synthesized according to relevant themes or concepts that emerge from the literature and will be presented in diagrammatic or tabular formats. This will be the first scoping review to identify and synthesize evidence on the postpartum mental health of racialized mothers living in Canada. Our results will inform the development of culturally responsive interventions that address the specific needs of this population.

OBJECTIVES:Practice related to the traditional postpartum confinement custom "Zuo Yuezi" vary among individuals, and its relationship with postpartum depression (PPD) remains unclear. This study aims to explore the current practice and heterogeneity of "Zuo Yuezi" among Chinese women and to analyze its association with PPD. METHODS:A cross-sectional study was conducted among 542 women from 3 hospitals between January and February 2016. Data were collected on whether participants practiced "Zuo Yuezi", their willingness and attitudes toward "Zuo Yuezi", demographic characteristics, adherence to specific "Zuo Yuezi" practices, emotional experiences during the "Zuo Yuezi" period, and PPD symptoms. Latent profile analysis (LPA) was used to identify heterogeneity in "Zuo Yuezi" practices, and multivariate logistic regression was used to analyze the association between practice patterns and PPD. RESULTS:A total of 542 postpartum women completed the survey. About 98% (531/542) of participants reported practicing "Zuo Yuezi", among whom 41.2% followed traditional customs and 29.5% followed parental advice. Approximately 95% of women practiced "Zuo Yuezi" for ≥30 days, and nearly half strictly followed a 30-day "Zuo Yuezi" period. Significant heterogeneity was observed in practice components and adherence levels, with the greatest heterogeneity in dietary practices and the lowest in hygiene practices. Latent profile analysis identified 4 levels of adherence to "Zuo Yuezi" practices: low, medium-low, medium, and high. Higher adherence was associated with belief in disease prevention, home-based "Zuo Yuezi" practices, and longer "Zuo Yuezi" duration. Lower adherence was associated with an increased risk of PPD (χ2=16.103, P<0.05). CONCLUSIONS:The practice of "Zuo Yuezi" is widespread but heterogeneous. Lower adherence to "Zuo Yuezi" practices may increase the risk of postpartum depression, highlighting the need for culturally sensitive and individualized perinatal care.

BACKGROUND:Adherence to self-care behaviors can prevent or delay adverse outcomes associated with cardiovascular disease (CVD). Sex and socioculturally constructed gender might impact individuals' ability to adhere to healthy lifestyles. OBJECTIVE:The aim of this study was to systematically identify, evaluate, and synthesize the literature on the influence of sex and gender on adherence to self-care behaviors for CVD risk management in the global context. METHODS:We searched the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Global Health Databases for peer-reviewed original articles published between 2013 and 2023. We selected studies that investigated self-care behaviors, self-care maintenance, or self-care management as outcomes and reported sex- and gender-related factors (such as education level, employment status, and marital status). The data were synthesized in a narrative form. RESULTS:The search identified 3540 studies, 52 of which met the inclusion criteria for full-text review. Global North countries accounted for 55% of all the studies. Self-reported questionnaire scores were used in most of the studies (n = 47). Better self-care was associated with being a woman (n = 17), attaining a higher education level (n = 15), and having higher perceived social support (n = 10). The associations between adherence to self-care behaviors and employment status, socioeconomic status, marital status, and household size were inconsistent. CONCLUSIONS:Adherence to self-care behaviors for CVD risk management varied widely, based on gender-related factors. Further research is needed to use a consistent measure of self-care adherence behavior and integrate a wider range of gender-related factors.

Background:Guidelines emphasize individualized care in the management of stable coronary artery disease (CAD). We aimed to develop and validate clinical prediction models for major adverse cardiovascular events (MACEs) and health status among patients with stable CAD to support individualized, shared decision-making. Methods:For model development and internal validation, we used registries of outpatients with obstructive CAD on coronary angiography in British Columbia (2004-2015) and Alberta (2004-2020). Models were externally validated in ISCHEMIA trial participants with obstructive CAD on coronary computed tomography angiography. Outcomes included MACE (death, myocardial infarction, or stroke) within 3 years, angina-free status, and good-to-excellent physical functioning at 1 year, based on the Seattle Angina Questionnaire. Results:Median age was of study patients was 66-67 years, and 77% were male in both the MACE (n = 34,990) and health status (n = 13,312) model development cohorts. MACEs occurred in 9% (2026 patients) at 3 years. A 14-variable model had a C statistic of 0.68, calibration slope of 0.98, and positive net benefit in decision-curve analysis. At baseline, 41% were angina-free and 21% had good-to-excellent physical functioning, which increased to 64.5% and 72% at 1 year, respectively. C statistics for the angina-free and physical functioning models were 0.67 and 0.78, respectively, and calibration slopes were 0.98-0.99. In external validation, discrimination was modestly reduced and all models slightly underpredicted their respective outcomes, yet the MACE model retained positive net benefit. Conclusions:The CR-DECIDE models had moderate ability to predict MACEs and health status in patients with stable CAD and warrant further assessment of their impact at the point of care.

Abstract Background An English version of the Patient Perception of Patient-Centeredness (PPPC) scale was recently revised, and it is necessary to test this instrument in different primary care populations. Aim This study aimed to assess the validity and reliability of a Chinese version of the PPPC scale. Design A mixed method was used in this study. The Delphi method was used to collect qualitative and quantitative data to address the content validity of the PPPC scale by calculating the Content Validity Index, Content Validity Ratio, the adjusted Kappa, and the Item Impact Score. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to assess the construct validity of the PPPC scale through a cross-sectional survey. The internal consistency was also assessed. Setting/participants In the Delphi consultation, seven experts were consulted through a questionnaire sent by email. The cross-sectional survey interviewed 188 outpatients in Guangzhou city and 108 outpatients in Hohhot City from community health service centers or stations face-to-face. Results The 21 items in the scale were relevant to their component. The Item-level Content Validity Index for each item was higher than 0.79, and the average Scale-level content validity index was 0.97 in each evaluation round. The initial proposed 4-factor CFA model did not fit adequately. Still, we found a 3-factor solution based on our EFA model and the validation via the CFA model (model fit: $${\chi }^{2}=294.573$$ χ 2 = 294.573 , P < 0.001, RMSEA = 0.044, CFI = 0.981; factor loadings: 0.553 to 0.888). Cronbach's α also indicated good internal consistency reliability: The overall Cronbach's α was 0.922, and the Cronbach's α for each factor was 0.851, 0.872, and 0.717, respectively. Conclusions The Chinese version of the PPPC scale provides a valuable tool for evaluating patient-centered medical service quality.

Objective: Metabolic syndrome (MetS), a cluster of 5 interconnected factors, is the main contributor to cardiovascular disease. Although sex- and gender -related elements have been linked to MetS and its components, this association has not been explored among Canadians with or without MetS. In this study, we aimed to identify sex and gender differences in characteristics of MetS in the Canadian population. Methods: This retrospective cohort study used data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database. The CPCSSN contains de -identified electronic health records of >1.5 million Canadians (2010-2019). Individuals 35 to 75 years of age who had a primary care encounter formed the study sample (N=37,813). Multiple logistic regression models were used to estimate adjusted odds ratios for sex and gender differences among Canadians with and without MetS, which was the primary outcome variable. Results: The estimated prevalence of MetS was 41.9%. The risk of developing MetS was significantly lower among females compared with males (odds ratio 0.73, 95% confidence interval 0.70 to 0.76). However, the risk was higher in females who used antidepressants (odds ratio 1.53, 95% confidence interval 1.42 to 1.65). An equal distribution of deprivation indexes was observed between males and females with MetS, with risk slightly higher for those with material deprivation. Females were found to be the most socially deprived. Conclusions: This study provides important sex- and gender -specific differences in MetS among Canadians. Targeting sex- and gender -specific risk factors could assist in reversing the trend of adverse cardiovascular outcomes associated with MetS. (c) 2023 Canadian Diabetes Association.

Objective: The COVID-19 pandemic influences mental health drastically. Therefore, our aim was to investigate whether biological sex and gender-related factors are associated with mental health during the COVID-19 pandemic. Materials and Methods: The International COVID-19 Awareness and Responses Evaluation Study is an international multiwave cross-sectional observational cohort study of public awareness, attitudes, and responses to public health policies (www.mbmc- cmcm.ca/covid19). The study is led by the Montreal Behavioural Medicine Centre in collaboration with 200 international collaborators from 42 countries. It has received research ethics board approval from the Comité d'éthique de recherche du CIUSSS-NIM (Centre intégré universitaire de santé et de services sociaux du Nord- de-l'île-de-Montréal), approval no.: 2020-2099/25-03-2020. Recruitment began on March 27, 2020, and the survey is available in 34 languages. The associations between biological sex, sociocultural gender, and mental health were assessed in multivariate logistic regression models only for the European population (n = 12,300). Results: Positive correlations were found between female sex and "feeling nervous, anxious or worried" (OR = 3.2, p < 0.001, 95% CI 1.87-5.63) and "feeling sad, depressed or hopeless" (OR 1.8, p = 0.031, CI 1.05-3.05). Male sex was related to more frequently "feeling irritable, frustrated, and angry" (OR = 1.8, p = 0.04, 95% CI 1.03-2.99). Concerning gender, a negative correlation between being employed and "feeling lonely or isolated" (OR = 0.26, p < 0.001, 95% CI 0.11-0.59) was observed in the female cohort. Conclusion: Sex and gender differences exist in the emotional responses during the COVID-19 pandemic. Especially, within the female cohort, unemployment is negatively associated with mental health. Therefore, this study suggests more targeted psychological and social support for females during the pandemic.

Background:Sex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries. However, these relationships have not been examined in low- and middle-income countries. The main aim of this study was to examine how sex and gender-related factors are associated with cardiovascular risk factors of people in South Asian countries. Methods:We conducted a retrospective analysis of the World Health Organization's "STEPwise approach to surveillance of risk factors for non-communicable disease" or "STEPS" from six South Asian countries, surveys conducted between 2014-2019. The main outcomes were CVH as measured by a composite measure of STEPS-HEART health index (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension), values ranging from 0 (worst) to 6 (best or ideal) and self-reported occurrence of cardiovascular disease (ie, heart attack and stroke). Multivariate linear and logistic regression models were performed. Multiple imputation with chained equations was performed. Results:The final analytic sample consisted of 33 106 participants (57.5% females). The mean STEPS-HEART index score in the South Asian population was 3.43 [SD: 0.92]. Female sex (β: 0.05, 95% confidence interval (CI) = 0.01-0.08, P < 0.05) was significantly associated with better CVH compared to males. Being married (βmale = -0.30, 95% CI = -0.37, -0.23 vs βfemale = -0.23, 95% CI = -0.29, -0.17; P < 0.001) and having a household size ≥5 (βmale = -0.15, 95% CI = -0.24, -0.06 vs βfemale = -0.11, 95% CI = -0.16, -0.04; P < 0.01) were associated with poorer CVH, more so in males. Being married was also associated with high risk of CVD (ORmale = 2.54, 95% CI = 1.68-3.86, P < 0.001 vs ORfemale = 1.19, 95% CI = 0.84-1.68, P = 0.31), significant in males. Conclusions:Among the South Asian population, being female may be advantageous in having an ideal CVH. However, gender-related factors such as marital status and large household size were associated with poorer CVH and greater risk of CVD, regardless of sex.

ObjectiveGiven the role of sociocultural gender in shaping human behaviours, the main objective of this study was to examine whether sex and gender-related factors were associated with the public’s adherence to COVID-19-recommended protective health behaviours.DesignThis was a retrospective analysis of the survey that captured data on people’s awareness, attitudes and behaviours as they relate to the COVID-19 policies.SettingData from the International COVID-19 Awareness and Responses Evaluation survey collected between March 2020 and February 2021 from 175 countries.ParticipantsConvenience sample around the world.Main outcome measuresWe examined the role of sex and gender-related factors in relation to non-adherence of protective health behaviours including: (1) hand washing; (2) mask wearing; and (3) physical distancing. Multivariable logistic regression was conducted to determine the factors associated with non-adherence to behaviours.ResultsAmong 48 668 respondents (mean age: 43 years; 71% female), 98.3% adopted hand washing, 68.5% mask wearing and 76.9% physical distancing. Compared with males, females were more likely to adopt hand washing (OR=1.97, 95% CI: 1.71 to 2.28) and maintain physical distancing (OR=1.28, 95% CI: 1.22 to 1.34). However, in multivariable sex-stratified models, females in countries with higher Gender Inequality Indexes (GII) were less likely to report hand washing (adjusted OR (aOR)=0.47, 95% CI: 0.21 to 1.05). Females who reported being employed (aOR=0.22, 95% CI: 0.10 to 0.48) and in countries with low/medium GIIs (aOR=0.18, 95% CI 0.06 to 0.51) were less likely to report mask wearing. Females who reported being employed were less likely to report physical distancing (aOR=0.39, 95% CI: 0.32 to 0.49).ConclusionWhile females showed greater adherence to COVID-19 protective health behaviours, gender-related factors, including employment status and high country-wide gender inequality, were independently associated with non-adherence. These findings may inform public health and vaccination policies in current as well as future pandemics.

Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex- and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes with comparisons of data from the global North (ie, developed high-income countries in the Northern hemisphere and Australia) and the global South (ie, regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation’s gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move toward the era of precision medicine, future research is needed that identifies, validates, and measures gender-related determinants and risk factors in the global South.

Objectives: The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, consists of 3-word recall and an executive Clock-Drawing Test (CDT). However, CDT requires at least basic literacy and cultural exposure to analog clocks, conditions not met in many population groups around the world. We developed a modification of the Mini-Cog (MMC) for use with non-literate and literate individuals. Methods: Participants were adults (≥ 60 years) with no neurological diagnosis, with known cognitive impairment due to stroke, Parkinsonism, traumatic brain injury or Alzheimer’s disease, and whose family members were able to read and write. We replaced the CDT with two tasks of everyday life: a serial subtraction task or a multistep performance task. Family members rated the acceptability and feasibility of the Mini-Cog versions using a 6-point scale, and completed a proxy-rated cognitive staging tool, the Dementia Severity Rating Scale (DSRS). Spearman’s rho, Mann- Whitney U and Chi-square tests were used to evaluate group differences and associations between measures. Results: Data were collected from 63 participants (75% ≥ 60 years, 67% non-literate). Literacy was associated with CDT (Chi-square strength 0.9, p < 0.001). Both MMC versions correlated with DSRS in healthy adults and patients (rho 0.6-0.7, p < 0.05). In literate individuals, the acceptability and feasibility of CDT and both alternate distractors were similarly high (5/6). Conclusions: Two alternate distractor tasks may successfully replace CDT in the Mini-Cog. The MMC versions are promising and deserve further study as screening tools for cognitive impairment in larger and more fully characterized samples.

Objective: The FITT (Frequency, Intensity, Time, and Type) principle is an effective foundation in EP. However, the CORRECT components; C–Combination of interventions, O–Order of the Interventions, R–Repetitions, R–Rest period between sets and between sessions, E–Exercise at home, C–Cognitive domain, T–Total dose and re-evaluation plans, should be considered. The purpose of this paper was to describe the updated dynamic and evidence based FITT-CORRECT principle of EP and demonstrates its application using a case study. Results: Literatures, related to EP, clinical reasoning and clinical decision-making, were critically reviewed. Established evidence is summarized to describe an updated dynamic and evidence-based principle of EP. The gaps within the FITT and other related principles of EP are addressed. The FITT-CORRECT principle was introduced and an effective outcome of the updated principle was demonstrated using a case study. The FITT-CORRECT principle integrates many components that are missing in the FITT and other related EP principles. Based on the reported case study, the FITT-CORRECT principle of EP should optimize patients’ intervention outcomes. Physiotherapists can potentially improve their EP by utilizing the FITT-CORRECT in clinical practice.

Intimate partner violence (IPV) in the heterosexual population has gained increasing public concern in China, but little is known about it among men who have sex with men (MSM).1 This study aimed to investigate the prevalence of IPV and associated factors among MSM in Chengdu, China. Participants were recruited from a local MSM-friendly health consulting center. This study used the adjusted Intimate Partner Violence Scale among Gay and Bisexual Men (IPV-GBM scale) to capture lifetime IPV experiences including physical, sexual and emotional violence, monitoring, and controlling behaviors. Among 431 participants, 153 (35.5%) reported any IPV experiences, and 119 (27.6%) reported themselves as being the perpetrator. Adjusted logistic regression models revealed that having been engaged in transactional sex was positively associated with victimization through monitoring behaviors (adjusted odds ratio [ORa] = 2.7, 95% confidence interval CI = [1.7, 7.4]) and perpetration of monitoring behaviors (ORa = 3.9, 95% CI = [1.5, 13.3]); drug use was positively associated with victimization through controlling behaviors (unadjusted odds ratio [ORu] = 2.5, 95% CI = [1.2, 5.0]) and emotional violence (ORa = 1.9, 95% CI = [1.0, 3.5]); older age (≥18 years) of first homosexual intercourse was negatively associated with perpetration of physical violence (ORu = 0.3, 95% CI = [0.2, 0.7]) and sexual violence (ORu = 0.4, 95% CI = [0.2, 1.0]); higher self-esteem was negatively associated with both victimization and perpetration of sexual and emotional violence. We found that victimization and perpetration experiences were correlated in all dimensions of IPV. Violence was prevalent among MSM and merits public attention. This study provides more evidence about IPV among Chinese MSM and identifies two significant factors contributing to IPV (self-esteem and age of first homosexual intercourse), which have been overlooked in previous studies. Researchers should take these factors into consideration for interventions developments.

Introduction Sexually transmitted infections (STIs) are common during pregnancy and can result in adverse delivery and birth outcomes. The purpose of this study was to estimate the prevalence of STIs; Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Trichomonas vaginalis (trichomoniasis), and Human Immunodeficiency Virus (HIV) among pregnant women visiting an antenatal care center in Nepal. Materials and methods We adapted and piloted the WHO standard protocol for conducting a prevalence survey of STIs among pregnant women visiting antenatal care center of Dhulikhel Hospital, Nepal. Patient recruitment, data collection, and specimen testing took place between November 2019-March 2020. First catch urine sample was collected from each eligible woman. GeneXpert platform was used for CT and NG testing. Wet-mount microscopy of urine sample was used for detection of trichomoniasis. Serological test for HIV was done by rapid and enzyme-linked immunosorbent assay tests. Serological test for syphilis was done using “nonspecific non-treponemal” and “specific treponemal” antibody tests. Tests for CT, NG and trichomoniasis were done as part of the prevalence study while tests for syphilis and HIV were done as part of the routine antenatal testing. Results 672 women were approached to participate in the study, out of which 591 (87.9%) met the eligibility criteria and consented to participate. The overall prevalence of any STIs was 8.6% (51/591, 95% CI: 6.3–10.8); 1.5% (95% CI: 0.5–2.5) for CT and 7.1% (95% CI: 5.0–9.2) for trichomoniasis infection. None of the samples tested positive for NG, HIV or syphilis. Prevalence of any STI was not significantly different among women, age ≤ 24 years (10%, 25/229) compared to women age ≥25 years (7.1%, 26/362) (p = 0.08). Conclusions The prevalence of trichomoniasis among pregnant women in this sub-urban population of Nepal was high compared to few cases of CT and no cases of NG, syphilis, and HIV. The WHO standard protocol provided a valuable framework for conducting STI surveillance that can be adapted for other countries and populations.

OBJECTIVE:This study aimed to examine the impact of maternal decision-making autonomy and self-reliance in accessing health care on childhood diarrhea and acute respiratory tract infection (ARI) in Nepal. STUDY DESIGN:This was a cross-sectional study. METHODS:This study used data from the Nepal Demographic and Health Survey 2016. Mothers aged 15-49 years provided information about the health of 5308 children included in this analysis. Composite measures of maternal decision-making autonomy and self-reliance in accessing health care were used as exposure variables. Childhood diarrhea and ARI in the 2 weeks preceding the survey were primary outcome variables. Descriptive statistics and multivariable survey-weighted logistic regression methods were used in the analyses. RESULTS:Maternal decision-making autonomy was high for approximately one-fourth (24.7%) of the children's mothers, and 81.7% of children's mothers reported self-reliance in accessing health care as a big problem. Diarrhea among children in the prior 2 weeks was reported among 8% (95% confidence interval [CI]: 6.9-8.4), whereas ARI was reported among 22% (95% CI: 21.1-23.5). The children of women who viewed a lack of self-reliance as a big problem had a 88% (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.26-2.82, P < 0.01) higher odds of diarrhea and 59% (aOR = 1.59, 95% CI: 1.29-1.95, P < 0.001) higher odds of ARI compared with children of women who did not view self-reliance as a big problem. CONCLUSIONS:The study found a significant effect of maternal self-reliance in accessing health care on childhood diarrhea and ARI, independent of other sociodemographic factors. Improvement in maternal self-reliance in accessing health care of women is essential, particularly their autonomy with regard to healthcare seeking behavior and financial empowerment.

Background Reproductive tract infections (RTIs) have become major but silent public health problems devastating women’s lives in Bangladesh. Accurately and precisely identifying high-risk areas of RTIs through high-resolution risk maps is meaningful for resource-limited settings. Methods We obtained data reported with RTI symptoms by women of childbearing age in the years 2007, 2011 and 2014 from Bangladesh Demographic and Health Survey. High-spatial Environmental, socio-economic and demographic layers were downloaded from different open-access data sources. We applied Bayesian spatial-temporal models to identify important influencing factors and to estimate the infection risk at 5 km spatial resolution across survey years in Bangladesh. Results We estimated that in Bangladesh, there were approximate 11.1% (95% Bayesian credible interval, BCI: 10.5–11.7%), 13.9% (95% BCI: 13.3–14.5%) and 13.4% (95% BCI: 12.8–14.0%) of women of childbearing age reported with RTI symptoms in 2007, 2011 and 2014, respectively. The risk of most areas shows an obvious increase from 2007 to 2011, then became stable between 2011 and 2014. High risk areas were identified in the southern coastal areas, the western Rajshahi Division, the middle of Khulna Division, and the southwestern Chittagong Division in 2014. The prevalence of Rajshahi and Nawabganj District were increasing during all the survey years. Conclusion The high-resolution risk maps of RTIs we produced can guide the control strategies targeted to priority areas cost-effectively. More than one eighth of women of childbearing age reported symptoms suggesting RTIs and the risk of RTIs varies in different geographical area, urging the government to pay more attention to the worrying situation of female RTIs in the country.

Objectives: To characterize contraceptive counseling experiences among women living with HIV (WLWH) receiving HIV care in Kenya. Study Design: Sexually active, WLWH aged 15 to 49 years were purposively sampled from 109 high volume HIV Care and Treatment Centers in Kenya between June and September 2016. Cross-sectional surveys were administered to enroll women on a tablet using Open Data Kit. Poisson generalized linear regression models adjusted for facility-level clustering were used to examine cofactors for receiving family planning (FP) counseling with a provider. Results: Overall, 4805 WLWH were enrolled, 60% reported they received FP counseling during the last year, 72% of whom reported they were counseled about benefits of birth spacing and limiting. Most women who received FP counseling were married (64%) and discussed FP with their partner (78%). Use of FP in the last month (adjusted Prevalence Ratio [aPR] = 1.74, 95% confidence interval [CI]: 1.41-2.15, p < 0.001), desire for children in > 2 years (aPR = 1.18, 95% CI: 1.09-1.28, p < 0.001), and concern about contraceptive side-effects (aPR = 1.13, 95% CI 1.02-1.25, p < 0.05) were significantly higher among WLWH who received FP counseling compared to those that did not. Conclusions: Over one-third of WLWH did not receiving FP counseling with an HIV care provider during the last year, and counseling was more commonly reported among women who were using FP or desired children in > 2 years. Implications: There are missed opportunities for FP counseling in HIV care. FP integration in HIV care could improve FP access and birth spacing or limiting among WLWH. (c) 2021 Elsevier Inc. All rights reserved.

BACKGROUND:The outcome of exercises depends on participants' level of exercise participation. We aimed to investigate the level of exercise participation in individuals with traumatic spinal cord injury during inpatient rehabilitation.METHODS:All participants with traumatic spinal cord injury undergoing inpatient physiotherapy at a rehabilitation center were recruited. Participants with hearing/visual problems were excluded. Hopkins Rehabilitation Engagement Rating Scale and Pittsburgh Rehabilitation Participation Scale were used to evaluate exercise participation levels. One-way ANOVA and unpaired t-test were used to compare level of participation between groups. Pearson's correlation and Chi-square tests were used to evaluate correlation and association.RESULTS:Thirty-five participants with mean age 37.1 ± 11.7 years completed the study. Hopkins Rehabilitation Engagement Rating Scale and Pittsburgh Rehabilitation Participation Scale demonstrated a low level of exercise participation in 31.4 % and 42.9 % participants respectively. Participants with an incomplete injury had high exercise participation levels compared to complete injuries. There were significant group differences (p < 0.001, effect size = 0.8) between complete and incomplete injuries and among various levels of injuries. The level of exercise participation was significantly associated with injury levels and type (p < 0.001, Phi = 0.7 to 0.9).CONCLUSIONS:The exercise participation level was high for incomplete compared to complete injuries in Nepalese individuals with traumatic spinal cord injury. The demographic and socio-economical factors were not associated with level of exercise participation.