Impact of Health Insurance and Sociodemographic Characteristics on Survival for Women diagnosed with Breast Cancer in Kentucky

Introduction Objective of the study was to explore the impact of health insurance and socio-demographic factors on survival for breast cancer patients in Kentucky. Breast cancer is the most prevalent cancer among women in the US. Breast cancer survival is affected by various factors including health insurance, residence, age, race, geographical distance, income. Methods The data were obtained from Kentucky Cancer Registry and included 47,128 women diagnosed with primary breast cancer between 2000 to 2014. The relationship of health insurance and other socio-demographic factors was analyzed using Cox regression. ResultsThe overall five-year survival proportion was 0.97, 0.76 and 0.71 respectively for privately insured, Medicaid and Medicare patients. Medicaid and Medicare patients had 1.89 (95% CI, 1.71-2.10), 1.96 (95% CI, 1.75-2.18) times higher hazard of dying respectively compared to privately insured patients. Patients who had no family history of breast cancer had a 15% (HR=1.15, p-value \u3c 0.001) higher hazard of dying compared to those having family history of breast cancer. Tobacco use and marital status also had significant effect on patient’s survival. Other tumor related and biological factors were also included in the regression model. Sub group analysis by SEER summary stage also showed that Medicaid and Medicare patients significantly at disadvantage compared to privately insured patients for both in-situ and regional stage groups. Medicaid patients had 1.41 (HR=1.41, p-value=0.0020) times higher hazard of death compared to privately insured patients whereas Medicare patients and the privately insured patients had no difference in hazard of death for distant stage group. Sub group analysis by age group also showed Medicare and Medicaid patients are disadvantaged compared to privately insured patients for all age groups. Conclusion This study found that Medicaid and Medicare patients had higher hazard of dying compared to privately insured patients. This helps to inform public health professionals and policy makers for advocacy and design policies that bring equal health outcomes regardless of insurance types

Effect of gender preference on fertility: cross-sectional study among women of Tharu community from rural area of eastern region of Nepal

BACKGROUND: Son preference is predominant in developing countries especially South Asian countries and its effect is most visible when the fertility is on transition. Nepal is a country in South Asia where the fertility has declined and son is valued highly. This study examines the parent’s gender preference for children and its effect on fertility and reproductive behaviors. METHODS: Study was conducted in Sonapur village development committee of Sunsari district among women of Tharu community of reproductive age (15–49) currently in union and having at least one child. Data was collected by house to house survey. Data was analyzed with IBM SPSS 20 version. Multinomial and binary logistic regression were used to analyze the relationship among variables. RESULTS: Three hundred women of reproductive age were included in the study. Current average age of the respondents was 31.97 years and mean age at marriage was 18.87 (SD +/-2.615). Child Sex ratio (male: female) of the respondents who didn’t want any more children was 1.41. The birth spacing following male baby was 3.09 years whereas the average birth spacing following female baby was 2.71 years. Age of the respondents and education status of the respondents were also significantly associated with contraceptive practice. Presence of only female children in family significantly increased the desire of other children (AOR = 10.153, 95% CI = 2.357-43.732). CONCLUSION: This study finds that the gender preference affects the fertility and reproductive behavior of the respondents and it is necessary to reduce son preference for the health and well being of children and women

Routine blood parameters of dengue infected children and adults. A meta-analysis

The World Health Organization (WHO) has revised dengue case classification in 2009 to better reflect the severity of the disease. However, there was no comprehensive meta-analysis of pooled routine blood parameters according to the age or the categories of the 2009 WHO classification. This study aimed to meta-analyze the routine blood parameters of dengue infected children and adults. Electronic search was performed with eligible articles included for review. Meta-analysis was conducted for six blood parameters stratified into children, adults and all ages, which were further grouped into the three 2009 WHO case classifications (dengue without warning signs, DwoWS; dengue with warning signs, DwWS; severe dengue, SD), non-severe dengue (non-SD) and ‘All’ cases. A total of 55 articles were included in the meta-analysis. Fifteen studies were conducted in the children’s age category, 31 studies in the adult category and nine studies in all ages. The four selected pooled blood parameters for children were white blood cell (WBC) (×103/L) with 5.11 (SD), 5.64 (DwWS), 5.52 (DwoWS) and 4.68 (Non-SD) hematocrit (HCT) (%) with 36.78 (SD), 40.70 (DwWS), 35.00 (DwoWS) and 29.78 (Non-SD) platelet (PLT) (×103/µL) with 78.66 (SD), 108.01 (DwWS), 153.47 (DwoWS) and 108.29 (non-SD); and aspartate aminotransferase (AST) (/µL) with 248.88 (SD), 170.83 (DwWS), 83.24 (DwoWS) and 102.99 (non-SD). For adult, WBC were 4.96 (SD), 6.44 (DwWS), 7.74 (DwoWS) and 3.61 (non-SD); HCT were 39.50 (SD), 39.00 (DwWS), 37.45 (DwoWS) and 41.68 (non-SD); PLT were 49.62 (SD), 96.60 (DwWS), 114.37 (DwoWS) and 71.13 (non-SD); and AST were 399.50 (SD), 141.01 (DwWS), 96.19 (DwoWS) and 118.13 (non-SD). These blood parameters could not differentiate between each dengue severity according to the WHO 2009 classification, SD, DwoWS, DwWS and non-SD, because the timing of blood drawing was not known and there was an overlapping confidence interval among the clinical classification. Hence, these pooled blood parameter values could not be used to guide clinicians in management and did not correlate with severity as in previous scientific literatures and guidelines

Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal.

BACKGROUND: Menstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girls between menarche and menopause. Despite being an important issue concerning women and girls in the menstruating age group MHM is often overlooked in post-disaster responses. Further, there is limited evidence of menstrual hygiene management in humanitarian settings. This study aims to describe the experiences and perceptions of women and adolescent girls on menstrual hygiene management in post-earthquake Nepal. METHODS: A mixed methods study was carried out among the earthquake affected women and adolescent girls in three villages of Sindhupalchowk district of Nepal. Data was collected using a semi-structured questionnaire that captured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of the Nepal earthquake. Quantitative data were triangulated with in-depth interview regarding respondent's personal experiences of menstrual hygiene management. RESULTS: Menstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8% of the respondents. There were 42.8% women & girls who menstruated within first week of the earthquake. Reusable sanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method (76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake. Disposable pads (77.8%) were preferred by respondents as they were perceived to be clean and convenient to use. Most respondents (73.5%) felt that reusable sanitary pads were a sustainable choice. Women who were in the age group of 15-34 years (OR = 3.14; CI = (1.07-9.20), did not go to school (OR = 9.68; CI = 2.16-43.33), married (OR = 2.99; CI = 1.22-7.31) and previously used reusable sanitary cloth (OR = 5.82; CI = 2.33-14.55) were more likely to use the reusable sanitary cloth. CONCLUSIONS: In the immediate aftermath of the earthquake, women and girls completely depended on the use of locally available resources as adsorbents during menstruation. Immediate relief activities by humanitarian agencies, lacked MHM activities. Understanding the previous practice and using local resources, the reusable sanitary cloth is a way to address the menstrual hygiene needs in the post-disaster situations in Nepal

Age of Individuals Undergoing Cleft Lip and Cleft Palate Surgeries in Nepal

Introduction: Timely repair of cleft lip and palate maximises the benefits of surgery. Developing countries have large number of adults with unrepaired clefts. The impact of a cleft program can be determined by observing the trends of lower age at surgery. Public Health Concern Trust, Nepal has been providing a comprehensive nationwide cleft service since 1999. This study was conducted to see any change in the age at surgery. 
 Methods: A retrospective cross sectional study was conducted to analyse the data of all the individuals’ age at primary cleft surgery from July 1999 to June 2010. Mean and median age of individuals as well as the proportion of individuals operated on at the right age in different years were calculated and compared. 
 Results: The median age for cleft lip surgery decreased from 100 to 24 months. Similarly the median age for cleft palate surgery decreased from 70 to 28 months. Proportion of surgeries carried out in the recommended age also increased. A change in the policy of the program reaching out to more remote areas and removing the age barrier for surgery resulted in older adults receiving surgery and increased median age especially for cleft palate repairs. 
 Conclusions: A nationwide cleft program for a decade had a small impact on age at surgery. There are still many individuals who are missing the ideal age for surgery. The program needs to reach more remote areas. This information will be useful for governmental as well as non-governmental organizations working in the area of clefts. 
 Keywords: age; cleft lip; cleft palate; Nepal. 
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