対流拡散方程式の一様空間における解の存在と適切性

要約のみTohoku University小川卓克課

対流拡散方程式の一様空間における解の存在と適切性

要約のみTohoku University小川卓克課

Type 2 diabetes and its correlates among adults in Bangladesh: a population based stud

Type 2 diabetes is one of the most prevalent non-communicable diseases in Bangladesh. However, the correlates of type 2 diabetes among adults in Bangladesh remain unknown. We aimed to investigate the correlates of type 2 diabetes among the adults in Bangladesh. Methods : We conducted a cross-sectional study using data from the nationally representative 2011 Bangladesh Demographic and Health Survey. A random sample of 7,543 (3,823 women and 3,720 men) adults of age 35 years and older from both urban and rural areas, who participated in the survey was included. Diabetes was defined as having a fasting plasma blood glucose level of ≥ 7 mm/L or taking diabetes medication during the survey. Hypothesized factors, e.g., age, sex, education, place of residence, social status, body mass index, and hypertension were considered in the analyses. Multivariable logistic regression models were used to identify the important correlates of type 2 diabetes. Results : Among the respondents, the overall prevalence of diabetes was 11 %, and the prevalence was slightly higher in women (11.2 %) than men (10.6 %). Respondents with the age group of 55–59 years had higher odds of having diabetes (odds ratios (OR) = 2.37, 95 % confidence interval (CI): 1.76–3.21) than the age group of 35–39 years. Moreover, respondents who had higher educational attainment (OR = 1.67, 95 % CI: 1.18–2.36) and higher social status (OR = 2.01, 95 % CI: 1.50–2.70) had higher odds of having diabetes than the respondents with no education and lower social status, respectively. We also found socioeconomic status, place of residence (rural or urban), regions of residence (different divisions), overweight and obesity, and hypertension as significant correlates of type 2 diabetes in Bangladesh. Conclusions: Our study shows that older age, higher socioeconomic status, higher educational attainment, hypertension, and obesity were found to be significant correlates of type 2 diabetes. Need-based policy program strategies including early diagnosis, awareness via mass media, and health education programs for changing lifestyles should be initiated for older age, wealthy, and/or higher educated individuals in Bangladesh. Moreover, area-specific longitudinal research is necessary to find out the underlying causes of regional variations

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Healthcare-seeking behaviours of climate-induced internally displaced people and non-displaced people in Bangladesh

Thesis by publication.Bibliography: pages 143-164.Chapter 1. Introduction -- Chapter 2. Climate-induced displacement, impoverishment and healthcare accessibility in mainland Bangladesh -- Chapter 3. Parents' healthcare-seeking behaviour for their children among climate-related displaced people in rural Bangladesh -- Chapter 4. Climate-induced displacement and antenatal care utilization in rural Bangladesh -- Chapter 5. Household's displacement effects on delivery and postnatal care service utilization in rural Bangladesh -- Chapter 6. Conclusion -- Full reference list -- List of appendices.Climate-related extreme events, including floods and riverbank erosion, affect the livelihoods for millions of rural Bangladeshis and force them to change their usual place of residence permanently. However, little is known about healthcare-seeking behaviors of the large and growing number of climate-induced internally displaced people. This thesis explores the displacement disadvantages and healthcare-seeking behaviors of people whose households have experienced displacement due to floods and riverbank erosion, and those whose households have not experienced such displacement.Data for this thesis were collected using a cross-sectional survey from 1,200 randomly selected households, 600 from two displacement-prone districts and 600 from two non-displacement-prone districts, located in the north-western mainland regions of Bangladesh. It draws comparisons between the displaced and the non-displaced, between those displaced suddenly (displacement occurred at short notice due to a natural disaster) and those displaced gradually (resettlement process occurred gradually in anticipation of a natural disaster), and by the frequency of past displacement. Multiple logistic regression was used to identify the effect of displacement and other predictors on each outcome measure relating to the utilization of healthcare services.The results show that the displaced experience multiple disadvantages compared to the non-displaced. The disadvantages of the displaced are intensified by sudden displacement and increased number of displacements. The displaced have reduced healthcare options, which, in turn, affects their healthcare-seeking behaviors. The children of climate-displaced parents are less likely to be treated by a trained provider during illness than those of non-displaced parents. Moreover, the utilization of health facilities for antenatal, delivery and postnatal care services is significantly lower among displaced mothers than among non-displaced mothers.The findings have important implications for enhancing healthcare-seeking behavior of the climate-affected Bangladeshi people, and for the effectiveness of maternal and child healthcare related programs.Mode of access: World wide web1 online resource (xix, 184 pages) map

Population Growth and Economic Development: South East Asia Perspectives

Given current growth rate in different parts of the world, significantly higher in the LDCs, the regional distribution of the world’s population will inevitably change by 2050. Increased dependency ratios, massive income inequality, and natural resource limitations are likely to negatively affect the economic growth in Asia, Africa and Latin America. Although population growth has a whole negative impact on economy, the growth of working age people has a strong positive impact. Demographic variables played a large role in East Asia’s economic success. Increases in life expectancy have a large effect on incomes in East Asia. A rapid decline in fertility led to a substantial reduction in youth dependency ratio, thereby helping to boost growth rates of income per capita. Asia’s experience suggest that population change and productive growth are not independent. Policy-induced changes in demographic and economic variables can promote a virtuous cycle of cumulative causation in which economics and demographics interact in a mutually reinforcing way. Population’s positive impact is most likely to occur where natural resources are abundant, where the possibilities for scale economics are substantial, and where the markets and other conditions (especially government) allocate resources in a reasonably efficient way over time and space. Substantially, demographic change combined with sound and efficient economic policies facilities the way toward development

Geographical variation in the association between physical violence and sleep disturbance among adolescents: A population-based, sex-stratified analysis of data from 89 countries

Objective: To examine geographical variations in involvement in physical violence and sleep disturbance among adolescents. Design: Cross-sectional study. Setting: Eighty-nine low- to middle-income and high-income countries Participants: Adolescents 13-17 years of age. Measurements: Multiple binary logistic regression analyses and meta-analyses were performed to assess the link between physical violence (number of physical fights) and sleep disturbance ("mostly" or "always" experienced worry-induced sleep loss). Results: Among 296,212 adolescents, 8.9% reported sleep disturbance (male: 7.5%, female: 9.6%), with the highest prevalence among adolescents from the Eastern Mediterranean region (14.1%) and high-income countries (14.1%). Overall, sleep disturbance prevalence increased gradually with the increased episodes of physical violence. Adolescents who were involved in physical violence once, 2-3 times, and 4+ times were respectively 18%, 26%, and 77% more likely than their counterparts to experience sleep disturbance (1 time: OR 1.18, 95% CI 1.13-1.24; 2-3 times: 1.26, 1.20-1.34; 4+ times: 1.77, 1.66-1.88). The association between physical violence and sleep disturbance was observed in all regions and country-income groups, with the highest odds of sleep disturbance among adolescents experiencing 4+ times of physical violence in the European region (2.34, 1.17-4.67) and upper-middle-income countries (1.91, 1.73-2.11). The association of physical violence with sleep disturbance by sex was significant in all regions and country-income groups, except the European region. Conclusions: Exposure to physical violence is associated with increased odds of sleep disturbances in adolescents. School and community-level interventions, vigilance, and programs to promote violence-free environments may improve the sleep health of adolescents exposed to physical violence

Regional variations of contraceptive use in Bangladesh: A disaggregate analysis by place of residence.

This study advances current knowledge on contraceptive use in Bangladesh by providing new insights into the extent of regional variations in contraceptive use across rural and urban areas of Bangladesh. We examined the regional variations in contraceptive use among 15,699 currently married women ages 15-49 years using data from the 2014 Bangladesh Demographic and Health Survey (BDHS). Multivariate logistic regression models of contraceptive use were calibrated with sociodemographic attributes and cultural factors. Based on the aggregate sample (i.e., rural and urban combined), we found significant regional variations in contraceptive use across the administrative divisions in Bangladesh. Based on a disaggregate sample (i.e., rural and urban separately), we found that there were significant differences in divisional variations in contraceptive use in rural areas. In contrast, no significant variation in contraceptive use across divisions in urban areas of Bangladesh was found. More specifically, among women living in rural areas, the Rajshahi and Rangpur divisions had higher odds of contraceptive use than the Barisal division, whereas the Chittagong and Sylhet divisions had much lower odds of contraceptive use even after adjusting for selected sociodemographic attributes and cultural factors. A separate analysis of the divisional variations in usage of modern methods of contraception also revealed similar findings with only one exception. Findings of this study provide an evidence-based direction for adapting a pragmatic approach to reducing the divisional disparity of contraceptive use in rural areas of Bangladesh