Exploring relationships between HIV programme outcomes and the societal enabling environment: A structural equation modeling statistical analysis in 138 low- and middle-income countries.

Countries worldwide have attempted to reduce the incidence of HIV and AIDS associated deaths with varying success, despite significant progress in antiretroviral treatment (ART) and condom use. A chief obstacles is that key populations affected face high levels of stigma, discrimination and exclusion, limiting the successful response to HIV. However, a gap exists in studies demonstrating the moderation effects of societal enablers on overall programme effectiveness and HIV outcomes using quantitative methods.Structural Equation Modeling was used for 138 countries covering a 12-year period to examine how the unfavorable societal enabling environment, including stigma and discrimination, unfavorable legal environment and lack of access to societal justice, gender inequality and other unfavorable development situations affect the effectiveness of HIV programmes and HIV outcomes, while controlling for potentially confounding variables. The results only showed statistical significance when all four societal enablers were modeled as a composite. The findings show the direct and indirect standardized effects of unfavorable societal enabling environments to AIDS-related mortality among PLHIV are statistically significant and positive (0.26 and 0.08, respectively). We hypothesize that this may be because an unfavorable societal enabling environment can negatively affect adherence to ART, quality of healthcare and health seeking behavior. Higher ranked societal environments increase the effect of ART coverage on AIDS related mortality by about 50% in absolute value, that is -0.61 as against -0.39 for lower ranked societal environments. However, mixed results were obtained on the impact of societal enablers on changes in HIV incidence through condom use. Results indicate that countries with better societal enabling environments had fewer estimated new HIV infections and fewer AIDS-related deaths. The failure to include societal enabling environments in HIV response undermines efforts to achieve the 2025 HIV targets, and the related 2030 Sustainable Development indicator to end AIDS, even if sufficient resources are mobilized.

Adolescent's time use and skills development: Do cognitive and non-cognitive skills differ?

This study looks at the association of adolescent's time use on the acquisition of cognitive and non-cognitive (psychological and social) skills, thus contributing to the literature on parental investment and skills development. Specifically, using data relating to adolescent's time spent on school, study, sleep, and play, we investigate how these relate to cognitive and non-cognitive skills of older Indian children. For cognitive skills we use Peabody Picture Vocabulary Test (PPVT), which is a well-accepted measure of verbal intelligence. For non-cognitive skills, we construct a self-esteem variable using pride and shame questions; and a resilience variable using questions pertaining to whether an adolescent can get external help for coping with problems. Our results suggest that time use in all four types of activity has a positive association in the development of cognitive skills but competing associations when it comes to non-cognitive skills. We conclude that parental inputs into skills development, such as guidance about adolescent's time-use, are likely to have a differential association depending on the kind of skills being developed.

Building a multisystemic understanding of societal resilience to the COVID-19 pandemic.

The current global systemic crisis reveals how globalised societies are unprepared to face a pandemic. Beyond the dramatic loss of human life, the COVID-19 pandemic has triggered widespread disturbances in health, social, economic, environmental and governance systems in many countries across the world. Resilience describes the capacities of natural and human systems to prevent, react to and recover from shocks. Societal resilience to the current COVID-19 pandemic relates to the ability of societies in maintaining their core functions while minimising the impact of the pandemic and other societal effects. Drawing on the emerging evidence about resilience in health, social, economic, environmental and governance systems, this paper delineates a multisystemic understanding of societal resilience to COVID-19. Such an understanding provides the foundation for an integrated approach to build societal resilience to current and future pandemics.

Addressing Different Needs: The Challenges Faced by India as the Largest Vaccine Manufacturer While Conducting the World's Biggest COVID-19 Vaccination Campaign.

The COVID-19 pandemic has highlighted some of the challenges that countries face when balancing domestic and global necessities, for example with regard to vaccine needs, production and distribution. As India hosts one of the world's largest vaccine manufacturing industries and has one of the most extensive vaccination strategies, the country is particularly exposed to these challenges. This has become all the more obvious as the country experienced a second pandemic wave in the first half of 2021, which has led to a total ban on exports of COVID-19 vaccines. An analysis of the national vaccination strategy and the domestic vaccine industry through review of peer-reviewed literature, grey literature, and news reports showed the fragile balance between domestic and international needs. A numerical comparison of India's domestic COVID-19 vaccine needs, export agreements, and production capacities was conducted. It was found that at current production rates as of April 2021, meeting all of the needs and complying with all of the agreements would be impossible. Scale-ups in production, as promised by the industry, however, will enable the achievement of all targets in the long term.

Comparative evaluation of shear bond strength of two different chairside soft liners to heat processed acrylic denture base resin: An in vitro study.

BACKGROUND: Chairside softliners are used more frequently than is reported and studies regarding the bond strength of chairside softliners to heat-polymerized denture base resin are few and limited. Hence, this study was conducted to comparatively evaluate the shear bond strength of two chairside soft relining materials viz., autopolymerizing plasticized acrylic resin liner and a silicone-based liner bonded to heat polymerized polymethyl methacrylate denture base resin and to analyze the mode of interfacial bond failure. MATERIALS AND METHODS: Forty test specimens (n = 40) were prepared by bonding plasticized acrylic- and silicone-based soft liner to heat polymerized acrylic resin blocks. Twenty specimens, ten from each group, were subjected to thermal cycling and later to shear bond strength testing. The debonded specimens were then qualitatively analyzed for the mode of failure using scanning electron microscopy. The results obtained were tabulated and statistically analyzed. RESULTS: The mean shear bond strength values obtained for acrylic-based soft liner before and after thermal cycling were 0.3365 ± 0.025 MPa and 0.3164 ± 0.04 MPa, respectively. The mean shear bond strength values obtained for silicone-based soft liner before and after thermal cycling were 0.4159 ± 0.025 MPa and 0.4335 ± 0.02 MPa, respectively. Silicone-based soft liner showed higher shear bond strength than the acrylic-based both before and after thermal cycling (P = 0.0001). Scanning electron microscopy analysis showed a predominantly mixed mode of failure with silicone-based liner and predominantly adhesive mode of failure with acrylic-based soft liner. CONCLUSION: The silicone-based soft liner showed higher shear bond strength to heat polymerized acrylic resin than acrylic-based soft liner both before and after thermal cycling.

Capability deprivation of people with Alzheimer's disease: An empirical analysis using a national survey.

How can one assess the quality of life of older people--particularly those with Alzheimer's disease--from the point of view of their opportunities to do valued things in life? This paper is an attempt to answer this question using as a theoretical framework the capability approach. We use data collected on 8841 individuals above 60 living in France (the 2008 Disability and Health Household Survey) and propose a latent variable modelling framework to analyse their capabilities in two fundamental dimensions: freedom to perform self-care activities and freedom to participate in the life of the household. Our results show that living as a couple, having children, being mobile and having access to local shops, health facilities and public services enhance both capabilities. Age, household size and male gender (for one of the two capabilities) act as impediments while the number of impairments reduces both capabilities. We find that people with Alzheimer's disease have a lower level and a smaller range of capabilities (freedom) when compared to those without, even when the latter have several impairments. Hence they need a special attention in policy-making.

Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty.

In the absence of formal health insurance, we argue that the strategies households adopt to finance health care have important implications for the measurement and interpretation of how health payments impact on consumption and poverty. Given data on source of finance, we propose to (a) approximate the relative impact of health payments on current consumption with a 'coping'-adjusted health expenditure ratio, (b) uncover poverty that is 'hidden' because total household expenditure is inflated by financial coping strategies and (c) identify poverty that is 'transient' because necessary consumption is temporarily sacrificed to pay for health care. Measures that ignore coping strategies not only overstate the risk to current consumption and exaggerate the scale of catastrophic payments but also overlook the long-run burden of health payments. Nationally representative data from India reveal that coping strategies finance as much as three-quarters of the cost of inpatient care. Payments for inpatient care exceed 10% of total household expenditure for around 30% of hospitalized households but less than 4% sacrifice more than 10% of current consumption to accommodate this spending.Ignoring health payments leads to underestimate poverty by 7-8% points among hospitalized households; 80% of this adjustment is hidden poverty due to coping.