Association of Hospitalised Infection With Socioeconomic Status in Patients With Rheumatoid Arthritis Receiving Biologics or Tofacitinib: A Population-Based Cohort Study

Objectives: Use of biologics or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) is associated with infection in patients with rheumatoid arthritis (RA). Socioeconomic status is substantial in infectious diseases; however, the impact of socioeconomic status on risk for infection in patients with RA receiving b/tsDMARD remains unclear.Methods: We used the 2003–2017 Taiwanese National Health Insurance Research Database to identify patients with RA receiving b/tsDMARDs. A Cox regression analysis was used to estimate the associations of covariates with the risk of hospitalised infection shown as hazard ratios (HRs) with 95% confidence interval (CIs).Results: We identified 7,647 RA patients who started their first bDMARD/tsDMARD treatment. Log-rank analyses demonstrated the association between age (p < 0.001), urbanisation (p = 0.001), the insured amount (p = 0.021), and the hospitalisation. Cox proportional regression analyses showed that age was independently associated with hospitalised infection in a dose–response manner, whereas a high-income category had an inverse association (HR 0.48, 95% CI 0.23–0.96). Hospitalisation for infection within 5 years was a strong risk factor (HR 5.63, 95% CI 1.91–16.62), and living in a rural area tended to be a risk factor (HR 1.76, 95% CI 0.98–3.14) for incident hospitalised infection.Conclusions: This study showed the crucial impacts of age, socioeconomic status, and history of infection on hospitalised infection in patients with RA receiving b/tsDMARDs. These findings highlight the largely ignored role of socioeconomic status in risk stratification among patients receiving b/tsDMARDs for RA.

The non-sovereign territories: Economic and environmental challenges of sectoral and geographic over-specialisation in tourism and financial services

This paper analyses the economic and geographic characteristics of the world’s principal non-sovereign territories in the context of the growth challenges facing small economies. These territories enjoy high degrees of policy autonomy within a complex array of relationships with their metropolitan countries. Seven of the ten metropolitan powers are European and account for 38 of the 49 inhabited non-sovereign territories. The territories’ distinct economic and geographic characteristics, notably small size and remoteness, have led to their adopting similar niche sectoral growth strategies to those of small sovereign states and a reliance upon tourism and financial services. In spite of the growth challenges faced, most of these territories have attained high levels of per capita gross national income, placing them in the World Bank High Income category. Global heating, economic crises and regional environmental shocks, along with growing international protectionist sentiments, however, raise critical questions regarding the continued viability of their traditional growth strategies, particularly their heavy reliance upon environmentally harmful long-haul air travel and cruise tourism. This paper bridges the gap between large-scale growth studies, which generally overlook non-sovereign entities, and single case studies to examine the determinants of the growth success of non-sovereign territories and their future growth challenges given the pressing need for both economic and environmental sustainability.

COVID-19 Vaccine Acceptance in the Democratic Republic of Congo: A Cross-Sectional Survey

We investigated the level of willingness for COVID-19 vaccination in the Democratic Republic of Congo (DRC). Data were collected between 24 August 2020 and 8 September 2020 through an online survey. A total of 4131 responses were included; mean age of respondents was 35 years (standard deviation: 11.5); 68.4% were females; 71% had elementary or secondary school education. One fourth (24.1%) were convinced that COVID-19 did not exist. Overall, 2310 (55.9%) indicated they were willing to be vaccinated. In a multivariable regression model, belonging to the middle and high-income category (OR = 1.85, CI: 1.46–2.35 and OR = 2.91, CI: 2.15–3.93, respectively), being tested for COVID-19 (OR = 4.71, CI: 3.62–6.12; p < 0.001), COVID-19 community vaccine acceptance (OR = 14.45, CI: 2.91–71.65; p = 0.001) and acknowledging the existence of COVID-19 (OR = 6.04, CI: 4.42–8.23; p < 0.001) were associated with an increased willingness to be vaccinated. Being a healthcare worker was associated with a decreased willingness for vaccination (OR = 0.46, CI: 0.36–0.58; p < 0.001). In conclusion, the current willingness for COVID-19 vaccination among citizens of the DRC is too low to dramatically decrease community transmission. Of great concern is the low intention of immunization among healthcare workers. A large sensitization campaign will be needed to increase COVID-19 vaccine acceptance.

Who indicates Caesarean section in Romania? A cross-sectional survey in tertiary level maternity on childbirth patients and doctors' profiles

Background. Cesarean section (C-section) rate in Romania is the second-highest in the European Union (44.1% in 2017), and the number of C-sections performed in the country has increased in the past decades. Given how common C-section is now, it is important to gain insight into the practice and perceptions of patients and doctors in countries with high C-section rates. The objectives are 1) to compare the preferred modes of birth among women; 2) to draw a profile of patients and doctors in whose case the actual birth method is different from the preferred method; and 3) to analyze the way Romanian women want to give birth. Methods. We conduct a statistical analysis based on an observational, analytical, and cross-sectional survey on 117 singleton pregnant women more than 36 weeks in spontaneous labor in tertiary level maternity in Romania. Various statistical tests have been used to indicate statistical significance. Results. We calculate an increase of almost 58% in actual childbirth mode against preferred childbirth by C-sections, rather difficult to justify based only on medical emergencies. There are 22 patients with non-concordant C-section indications between preferred and actual mode of birth, 7 of them (31.8%) preferred natural birth and 15 (68.2%) preferred C-section. The profiles of patients with concordant and non-concordant delivery modes are different and indicate a statistically significant difference between the preference for delivery and actual birth method. Patients who preferred vaginal birth, but gave birth by C-section, are mature and more educated women, in the middle to high-income category, mostly attended by consultant doctors and specialists. Doctors’ profiles show that specialists and consultants attend the largest share of non-concordant births, while residents and young senior doctors attend mostly vaginal births. Conclusions. We emphasize health system particularities in Romania as triggers of high C-section rates that favor women’s preferences against C-section medical indication. Improving patients’ confidence in the health care system, built on competence and fitted hierarchical team position may lead to choosing the optimal way of birth for childbirth safety and pain control.

The role of innovation in the relationship between university–industry collaboration in R&D and ISO 9001

Purpose This study aims to investigate the relationship between university–industry collaboration (U-I-C) in research and development (R&D) and quality management and explore how the relationship is mediated by innovation. Design/methodology/approach Based on panel data consisting of 109 countries spanning over a five year period (2013-2017) this study investigates, through structural equation modelling, how this relationship is mediated by innovation. Findings The main finding is that there are positive significant direct effects between U-I-C and innovation and between innovation and international organization for standardization (ISO) 9001. Furthermore, the strength and significance of these relations are highly affected by the classification of income in these countries, which ranges from high and upper-middle to lower-middle categories. This paper concludes that countries in the high-income category have higher achievement in U-I-C in R&D, innovation and ISO 9001 when compared to the upper and lower-middle-income categories. Originality/value This paper demonstrates in the empirical study the value of collaboration in R&D between government, industry and academia, as it can encourage scientific research and contribute to quality management and innovation. This research is one of the very few studies to assess the country’s income classification effect on U-I-C in R&D, innovation and ISO 9001. It is recommended that more research is conducted on how countries not ranked in the high-income category could benefit from U-I-C in R&D to enhance innovation and quality management.

Relationship between Contextual Factors, Psychosocial Factors and Hygienic Practices of Tribes in Liberia

This study determined the relationship between contextual factors, psychosocial factors and hygienic practices of the tribes of Liberia. Data were collected from six randomly selected tribes from three regions in Liberia. Convenient, stratified and random sampling techniques were employed to survey 390 household heads who were aged 15 years and above. A correlational design was used and data gathered were analyzed utilizing inferential statistics. Majority of the respondents were males aged 40 years and above and of the middle and high income category. Regression analysis revealed self-efficacy, social environment and cognitive factors as predictors of hygienic practices in terms of disposal of wastes, while self-efficacy, cognitive, policy implementation and cultural identity predicted handwashing. Additionally, social environment, self-efficacy, physical environment, cognitive and policy implementation predicted bathing practices. Respondents who had high income, high educational attainment and of the tribes C and E had a better practice on waste disposal. Those with high income and of the tribes D and C had a better handwashing practice, while those who had high income and of the A and E ethnic groups exhibited better bathing practices.

Who indicates Caesarean section in Romania? A cross-sectional survey in tertiary level maternity on childbirth patients and doctors' profiles

Background. Cesarean section (C-section) rate in Romania is the second-highest in the European Union (44.1% in 2017), and the number of C-sections performed in the country has increased in the past decades. Given how common C-section is now, it is important to gain insight into the practice and perceptions of patients and doctors in countries with high C-section rates. The objectives are 1) to compare the preferred modes of birth among women; 2) to draw a profile of patients and doctors in whose case the actual birth method is different from the preferred method; and 3) to analyze the way Romanian women want to give birth. Methods. We conduct a statistical analysis based on an observational, analytical, and cross-sectional survey on 117 singleton pregnant women more than 36 weeks in spontaneous labor in tertiary level maternity in Romania. Various statistical tests have been used to indicate statistical significance. Results. We calculate an increase of almost 58% in actual childbirth mode against preferred childbirth by C-sections, rather difficult to justify based only on medical emergencies. There are 22 patients with non-concordant C-section indications between preferred and actual mode of birth, 7 of them (31.8%) preferred natural birth and 15 (68.2%) preferred C-section. The profiles of patients with concordant and non-concordant delivery modes are different and indicate a statistically significant difference between the preference for delivery and actual birth method. Patients who preferred vaginal birth, but gave birth by C-section, are mature and more educated women, in the middle to high-income category, mostly attended by consultant doctors and specialists. Doctors’ profiles show that specialists and consultants attend the largest share of non-concordant births, while residents and young senior doctors attend mostly vaginal births. Conclusions. We emphasize health system particularities in Romania as triggers of high C-section rates that favor women’s preferences against C-section medical indication. Improving patients’ confidence in the health care system, built on competence and fitted hierarchical team position may lead to choosing the optimal way of birth for childbirth safety and pain control.

Adolescent Obesity and Overweight Prevalence amongst Urban Population of Pakistan

Background: Adolescent obesity is a worldwide threatening health challenge. Current study was designed to assess the obesity and overweight occurrence in adolescent age groups of 12-18 years pertaining to high and low income groups of the city of Quetta Pakistan. Methods and Results: A total of 2000 school children were investigated and classified into 1088 High Income Category (HIC) and 912 Low Income Category (LIC). Obesity and overweight were reviewed by using Body Mass Index (BMI) and Triceps Skin Fold Thickness (TSFT) specifying age and sex values for adolescents. By using BMI as the core value, occurrence of obesity and overweight remained as 1.3% to 0.5% in LIC respectively. And in HIC the obesity and overweight percentile remained 3.3% and 1.5% respectively (p<0001). While using TSFT criteria, the obesity and overweight occurrence in LIC was 0.4% and 0.4% and in HIC the obesity and overweight assessments were 1.4% and 0.7% respectively (p˂0001). Current study presented that obesity and overweight occurrence found higher in HIC compared to LIC adolescent age groups. This emphasizing the possibilities based on modified pattern of dietary habits and physical activities with mount in income height. Conclusions: Socioeconomic condition matters in pattern of obesity and overweight amongst adolescent.

A COMPARATIVE REVIEW OF INDIAN AND SAUDI ARABIAN SOCIAL WELFARE SCHEMES

Purpose of the study: The aim of the study is to find the similarities between the welfare schemes of Indian and Saudi governments, and the burden of these schemes and their impact on society. This study aims to compare and contrast the welfare schemes of two altogether different types of economy. Methodology: This study applies the methodology of comparative analysis by employing descriptive analysis to study both the similarities and dissimilarities of the welfare schemes of Saudi Arabia and India. Main Findings: Indian and Saudi governments have been spending a lot of welfare schemes of their respective GDPs. The intention of these governments is to help the poor to lead a minimum quality of life. Though the intention is genuine and appreciable, in terms of implementation, the two governments have not yet achieved any desired results even after 60 years of introduction. Applications of this study: India and Saudi Arabia can learn from each other in designing and distributing welfare schemes like Saudi Arabia should focus to have targeted compensation and India to use its unique identification numbers to reduce leakages in its schemes. Instead of focusing on giving subsidies, it is better to devise a strategy with a timeframe to reduce poverty by creating many opportunities for the poor to improve their standard of living. Novelty/Originality of this study: The novelty in this study is a comparison of welfare schemes between two countries with two different types of political systems. While both countries are developing in nature, Saudi Arabia falls under a very high-income category country and India falls under the lower-middle-income category country.

Changes in insurance coverage associated with health care reform for cancer survivors aged 19-64 years.

6527 Background: Beginning in 2014, Medicaid eligibility was expanded in over half of states, enrollment was simplified, and insurance marketplaces were created in all states with premium subsidies for selected individuals, as a result of implementation of the Affordable Care Act (ACA). We examine changes in insurance coverage for cancer survivors overall, and for targeted subgroups affected by specific ACA elements. Methods: We pooled data for cancer survivors aged 19-64 years from the 2012-2015 National Health Interview Survey. Using information on family structure, income, and employment, and linked state-specific Medicaid eligibility policies, we assigned survivors to 3 targeted groups: 1) Medicaid eligible pre-ACA; 2) Medicaid expansion eligible; 3) eligible for premium tax credits for Marketplace plans; and 3 groups not targeted for benefit: a) eligibility gap (income < 100% federal poverty level (FPL) in states not expanding Medicaid); b) with alternative “affordable” coverage; and c) high income ( > 400% FPL). Linear probability regressions examined pre(2012-13)/post(2014-15) coverage changes by eligibility category, adjusting for demographic characteristics. Results: Among 4,115 (wtd N = 6.90M) cancer survivors, insurance pre-ACA was 69% private, 15.2% public, and 12.2% uninsured. Post-ACA, overall public coverage increased by 3.2 percentage points (pct pt) (p = .036), whereas the percent uninsured decreased by 4.5 pct pt (p < .001). Relative to the high income category, the adjusted percent uninsured decreased by 8.4 pct pt (95% CI:1.2-15.5) among pre-ACA Medicaid eligible, by 16.7 pct pt (95% CI:8.9-24.4) among the newly Medicaid eligible, and by 11.3 pct pt (95% CI:1.0-23.4; p = .069) among premium subsidy eligible. No coverage gains were observed for the other 2 categories. Approximately 531,000 cancer survivors remained uninsured after ACA implementation, with over half eligible for either Medicaid (12%) or subsidized Marketplace plans (44%). Conclusions: In the first 2 years post-ACA, cancer survivors experienced substantial increases in insurance coverage, with changes limited to targeted subgroups. Over half of remaining uninsured were eligible for coverage.