Health and psychological determinants of uncontested divorce in the city of Kermanshah

Background: Because of the increasing trend of uncontested divorce in the courts, as two out of every three divorces are related to uncontested divorce, scrutinizing the health and psychological causes of the rate of uncontested divorce is of great importance. The aim of this study was to examine the psychological and health factors affecting uncontested divorce Methods: The present study was a cross-sectional data secondary analysis in which the existing data were analyzed. After obtaining official permission from the family courts in the city of Kermanshah, the data related to the issue of uncontested divorce during 2017 and 2019 were received and analyzed. The sampling method in this study was a census in which all legal cases of applicants for uncontested divorce in city of Kermanshah in the years of 2017-2018 have been reviewed. Results: 2842 cases referred to welfare organization for consultation, of which, 2331 cases led to uncontested divorce and 511 cases not led to uncontested divorce (compromise). Among the psychological factors, the variables of suspicion, pessimism and depression; and among health variables, the variable of sexual satisfaction had a statistically significant relationship with uncontested divorce and anxiety, aggression and infertility did not have a statistically significant relationship. Conclusion: Considering the role of suspicion and pessimism, depression and sexual dissatisfaction in uncontested divorce, it was recommended that specific preventive strategies should be considered by the authorities. These strategies can provide both education and counseling in pre-marital and post-marital periods, as well as during the uncontested divorce process

HUBUNGAN SELF CONSCIOUSNESS DENGAN KUALITAS HIDUP REMAJA YANG MENGALAMI ACNE VULGARIS

Remaja menganggap acne vulgaris sebagai sesuatu yang menganggu penampilan dan merasa tidak nyaman dengan adanya acne vulgaris, sehingga berdampak pada rendahnya kualitas hidup. Kualitas hidup remaja yang mengalami acne vulgaris dilihat dari kesehatan fisik, psikologis, hubungan sosial dan lingkungan. Salah satu faktor yang mempengaruhi kualitas hidup adalah self consciousness. Penelitian ini bertujuan untuk mengetahui apakah ada hubungan self consciousness dengan kualitas hidup pada remaja yang mengalami acne vulgaris. Subjek penelitian berjumlah 285 siswa. Pengukuran dilakukan dengan menggunakan skala self consciousness dari Scheier (koefisien reliabilitas 0,776) dan skala kualitas hidup dari WHO QoL Bref (koefisien reliabilitas 0,875). Analisis data dengan menggunakan korelasi spearman (rs). Hasil analisis menunjukkan koefisien korelasi spearman 0,188 (p=0,001) artinya ada hubungan positif antara self consciousness dengan kualitas hidup pada remaja yang mengalami acne vulgaris, semakin tinggi self consciousness semakin tinggi kualitas hidup dan semakin rendah self consciousness semakin rendah kualitas hidup

The impact of a 360° virtual tour of the college environment on the anxiety of newly arrived students during the COVID-19 pandemic

Background: University education has been held virtually during the COVID-19 pandemic. However, students were confused and anxious while attending college, both because they were exposed to a new environment and fearful of coronavirus infection.Objectives: The purpose of this study was to investigate the effect of a 360° virtual tour of the college physical environment on the anxiety of newly arrived students during the COVID-19 pandemic.Methods: This single-blind, randomized, controlled trial was conducted between January and February 2021, with 80 nursing, midwifery, and surgical technology students from the Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. Students were randomly allocated into an intervention group and a control group, each with 40 students. Students in the intervention group received a 360° virtual tour of the college physical environment to be familiarized with the college environment. Students in the control group, on the other hand, were personally familiarized with the physical environment of the college. Students' anxiety levels were measured before and after the intervention using the Spielberger State-Trait Anxiety Inventory (STAI). Independent samples t-test, paired t-test, and chi-square test were used to analyze the data.Results: The mean anxiety score in the intervention group decreased from 48.2±2.66 to 37.7±3.03 after the intervention (P<0.001). However, the mean anxiety score did not change significantly in the control group (P=0.59).Conclusion: A 360° virtual tour can reduce the anxiety of newly arrived students before entering the college environment

The effects of two surgical gowning and gloving methods on the extent of contamination of surgical team members' gowns and gloves: A single-blind controlled trial

Background: The method used to wear the surgical gown and gloves has a critical role in the extent of surgical site contamination.Objectives: The purpose of this study was to compare the effect of gown and gloves wearing in the integrated and closed methods on the extent of contamination of surgical team members' gowns and gloves. Methods: A single-blind controlled trial was conducted with 70 eligible surgical staff who were randomly assigned to two groups of 35. The intervention group wore sterile, integrated gown-glove units, whereas the control group wore separate gowns and gloves using the closed technique. Glitterbug fluorescent powder was used to measure contamination. An ultraviolet flashlight was used to make the Glitterbug powder visible. Participants in both groups wore their gowns and gloves after dipping their hands in fluorescent powder. After one hour of the surgery, the gowns and gloves were removed from the body, a mobile phone was used to take photos of the areas containing powder, and ImageJ software was used to measure the area of contamination. The independent samples t-tests and chi-square test were used to analyze the data.Results: The contaminated area of gloves was 0.06±0.24 mm2 for the integrated gown-glove unit method and 2.26± 5.87 mm2 for the closed gown and gloves wearing method (P= 0.03). The contaminated area of the gown was zero for the integrated method and 3.06±7.57 mm2 for the closed method (P= 0.02).Conclusion: The extent of contamination was less when using the integrated gown-glove unit than the closed method. The surgical staff are recommended to use integrated gown-glove units to reduce the risk of contamination of gowns and gloves used for surgery

Policymaking for Applying the Approach of Bring Your Own Device in COVID-19 Pandemic: A Perspective

By beginning of the year 2020, COVID-19 has spread all over the world. The virus has caused numerous social, medical, and political challenges. One of the major challenges faced by countries to control the outbreak of the virus was the stability of economic and social activities and the simultaneous fulfilling of work during quarantine. Under such circumstances, telework is employed as one of the important policies control the virus. Moreover, many employees have tendency for remote working or teleworking. In such a situation, the importance of applying the Bring Your Own Device (BYOD) approach to fulfill job duties seems obvious. To enjoy the benefits of BYOD, organizations need the right policy for applying BYOD. This perspective endeavors to shed light on how to apply BYOD policy. From the researchers’ point of view, the important facets that could be addressed when applying BYOD can be described like this: policy is appropriate decision-making and implementation, technical infrastructure, continuous communication, staff training, security and privacy protocols, and agreement between staff and organization as well as the use of cloud computing

Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis

Background: Exploring changes in health inequality and its determinants over time is of policy interest. Accordingly, this study aimed to decompose inequality in neonatal mortality into its contributing factors and then explore changes from 1995-2000 to 2005-2010 in Iran. Methods: Required data were drawn from two Iran’s demographic and health survey (DHS) conducted in 2000 and 2010. Normalized concentration index (CI) was used to measure the magnitude of inequality in neonatal mortality. The contribution of various determinants to inequality was estimated by decomposing concentration indices in 1995- 2000 and 2005-2010. Finally, changes in inequality were investigated using Oaxaca-type decomposition technique. Results: Pro-rich inequality in neonatal mortality was declined by 16%, ie, the normalized CI dropped from -0.1490 in 1995-2000 to -0.1254 in 2005-2010. The largest contribution to inequality was attributable to mother’s education (32%) and household’s economic status (49%) in 1995-2000 and 2005-2010, respectively. Changes in mother’s educational level (121%), use of skilled birth attendants (79%), mother’s age at the delivery time (25-34 years old) (54%) and using modern contraceptive (29%) were mainly accountable for the decrease in inequality in neonatal mortality. Conclusion: Policy actions on improving households’ economic status and maternal education, especially in rural areas, may have led to the reduction in neonatal mortality inequality in Ira

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed agespecific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitorin

Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

Background: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings: In 2019, health spending globally reached$8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this,$13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and$1·4 billion was repurposed from existing health projects. $3·1 billion (22·4$2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7$1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Funding: Bill & Melinda Gates Foundation

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

© 2020 Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding: Bill & Melinda Gates Foundation

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic