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Despite an overall downward trend in child sex ratios in India, some of the most imbalanced districts in 2001 (fewer girls than boys) showed signs of becoming more balanced in 2011. This analysis looked in depth at these districts to better understand the nature of the improvement in the child sex ratio using two rounds of data from the Census of India from 2001 and 2011. Data were used from the 153 districts that showed improvement in their child sex ratio between 2001 and 2011. The improvement was decomposed into: (1) less sex-selective abortion and (2) improved girl compared with boy mortality. Most of the improvement in child sex ratios were shown to be due to reductions in sex-selective abortion, although this still made up the majority of the cause of imbalanced sex ratios in 2011. Child sex ratio improvement has been happening in both rural and urban areas of India, and there is evidence of stagnation in mortality decline for urban girls.

Objective To evaluate equity in the allocation and distribution of vaccines for coronavlrus disease 2019 (COVID-19) to countries and territories participating in the COVID-19 Vaccines Global Access (COVAX) Facility. Methods We used publicly available data on the numbers of COVAX vaccine doses allocated and distributed to 88 countries and territories qualifying for COVAX-sponsored vaccine doses and 60 countries self-financing their vaccine doses facilitated by COVAX. We conducted a benefit-incident analysis to examine the allocation and distribution of vaccines based on countries' gross domestic product (GDP) per capita. We plotted cumulative country-level per capita allocation and distribution of COVID-19 vaccines from COVAX against the ranked per capita GDP of the countries and territories to generate a measure of the equity of COVAX benefits. Findings By 23 January 2022 the COVAX Facility had allocated a total of 1 678 517 990 COVID-19 vaccine doses, of which 1 028 291 430 (61%) doses were distributed to 148 countries and territories. Taking account of COVAX subsidies, we found that countries and territories with low per capita GDP benefited more than higher-income countries in the numbers of vaccines. The benefits increased further when the analysis was adjusted by population age group (aged 65 years and older). Conclusion The COVAX Facility is helping to balance global inequities in the allocation and distribution of COVID-19 vaccines. However, COVAX alone has not been enough to reverse the inequality of total COVID-19 vaccine distribution. Future studies could examine the equity of all COVID-19 vaccine allocation and distribution beyond the COVAX-facilitated vaccines. Objectif Mesurer le niveau d'equite en matiere de repartition et de distribution des vaccins contre la maladie a coronavirus 2019 (COVID-19) dans les pays participant au mecanisme COVAX (COVID-19 Vaccines Global Access). Methodes Nous avons utilise les donnees accessibles au public sur le nombre de doses de vaccin COVAX allouees et distribuees a 88 pays et territoires ayant droit aux lots offerts par COVAX, ainsi qu'a 60 pays financant eux-memes leurs doses avec l'aide de COVAX. Nous avons effectue une analyse d'incidence des benefices afin d'etudier la repartition et la distribution des vaccins en fonction du produit interieur brut (PIB) par habitant. Enfin, nous avons represente, sous forme de graphique, la repartition et la distribution cumulees des vaccins contre la COVID-19 provenant de COVAX pour chaque habitant a l'echelle nationale, puis les avons comparees au classement du PIB par habitant des pays et territoires concernes, en vue de mesurer le niveau d'equite des avantages COVAX. Resultats Au 23 janvier 2022, le mecanisme COVAX avait attribue 1 678 517 990 doses de vaccin contre la COVID-19, dont 1 028 291 430 (61%) ont ete distribuees a 148 pays et territoires. En tenant compte des subsides COVAX, nous avons decouvert que, 'en termes de nombre de vaccins, les pays et territoires possedant un faible PIB par habitant en ont davantage beneficie que les pays a revenu plus eleve. Ce benefice s'est accru lorsque nous avons parametre l'analyse selon la categorie d'age de la population (65 ans et plus). Conclusion Le mecanisme COVAX aide a attenuer les inegalites de repartition et de distribution des vaccins contre la COVID-19. Neanmoins, lui seul ne suffit pas a inverser la tendance a la disparite en matiere de distribution de tels vaccins. Les futures etudes pourraient s'interesser a l'equilibre de repartition et de distribution de tous les vaccins contre la COVID-19, et pas uniquement ceux fournis dans le cadre du mecanisme COVAX. Objetivo Evaluar la equidad en la asignacion y distribucion de las vacunas para la enfermedad por coronavirus de 2019 (COVID-19) a los paises y territorios que participan en el Mecanismo de acceso mundial a las vacunas contra la COVID-19 (Mecanismo COVAX). Metodos Se utilizaron los datos disponibles publicamente sobre el numero de dosis de vacunas del Mecanismo COVAX asignadas y distribuidas a 88 paises y territorios que cumplian los requisitos para recibir las dosis de vacunas patrocinadas a traves del Mecanismo COVAX y a 60 paises que autofinanciaban sus dosis de vacunas con el apoyo del Mecanismo COVAX. Se realizo un analisis de beneficios e incidencias para revisar la asignacion y distribucion de las vacunas segun el producto interno bruto (PIB) per capita de los paises. Se trazo la asignacion y distribucion acumulativa per capita a nivel de pais de las vacunas contra la COVID-19 del Mecanismo COVAX frente al PIB per capita clasificado de los paises y territorios para generar una medida sobre la equidad de los beneficios del Mecanismo COVAX. Resultados A 23 de enero de 2022, el Mecanismo COVAX habia asignado un total de 1 678 517 990 dosis de vacuna contra la COVID-19, de las que 1 028 291 430 (61 %) se distribuyeron a 148 paises y territorios. Teniendo en cuenta las subvenciones del Mecanismo COVAX, se comprobo que los paises y territorios con un PIB per capita bajo se beneficiaron mas que los paises con mayores ingresos en lo que respecta al numero de vacunas. Los beneficios aumentaron aun mas cuando el analisis se ajusto por grupos de edad de la poblacion (mayores de 65 anos). Conclusion El Mecanismo COVAX esta ayudando a equilibrar las desigualdades a nivel mundial en la asignacion y distribucion de las vacunas contra la COVID-19. Sin embargo, el Mecanismo COVAX por si solo no ha sido suficiente para revertir la desigualdad en la distribucion total de las vacunas contra la COVID-19. Los estudios futuros podrian analizar la equidad de toda la asignacion y distribucion de las vacunas contra la COVID-19 ademas de las vacunas que se obtienen a traves del Mecanismo COVAX., Introduction Equitable vaccine distribution can be a major factor towards global control of the coronavirus disease 2019 (COVID-19) pandemic. (1) The COVID-19 Vaccines Global Access (COVAX) Facility was created to [...]

BackgroundLife expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected - they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available.New research networkIn order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following influences within a country: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens.ConclusionFurther research using this framework has considerable potential to advance effective policies to advance health and equity.

Background: Accumulating evidence has suggested the pathogenic roles of chronic inflammation and neutrophils in diabetic kidney disease (DKD). This study investigated the relationship between neutrophils, all-cause, and cardiovascular disease (CVD) mortality in type 2 diabetes mellitus (T2DM) patients with DKD. Methods: We used data from the National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2020 to investigate the relationship between circulating neutrophils counts, kidney function indices, all-cause, and CVD mortality in adult T2DM patients with DKD. Clinical predictive models and risk scores for long-term mortality were constructed. Results: 44,332 patients [8034 with T2DM and 36,323 without T2DM] were included. Two thousand two hundred twenty patients had DKD, and 775 died (31.5% related to CVD) during a follow-up of 6.18 (range: 5.94–6.42) years. Higher neutrophil counts (Quartile 4, Q4) were associated with increased all-cause and CVD mortality [HR 1.73 (95% CI 1.34–2.25) and 1.81 (95% CI 1.14–2.89), respectively, p < 0.0001 and 0.01]. Neutrophil counts in Q4 showed a positive correlation with urine albumin-creatinine ratio (UACR) but a negative association with eGFR (p < 0.01 for all). Clinical predictive models incorporating neutrophil counts showed satisfactory performance in forecasting 5-year and 10-year CVD mortality-free survival (ROC AUC 0.824 and 0.842, respectively), and the nomogram-predicted survival demonstrated good concordance with observed survival. Conclusions: Higher levels of circulating neutrophil counts show a significant correlation with renal abnormalities and higher all-cause and CVD mortality in T2DM patients with DKD. The novel clinical predictive models and risk scores incorporating neutrophil counts may facilitate stratification and, hence, risk factor management in DKD patients. [ABSTRACT FROM AUTHOR]

Background: Most studies on the impact of the COVID-19 pandemic on depression burden focused on the earlier pandemic phase specific to lockdowns, but the longer-term impact of the pandemic is less well-studied. In this population-based cohort study, we examined the short-term and long-term impacts of COVID-19 on depression incidence and healthcare service use among patients with depression. Methods: Using the territory-wide electronic medical records in Hong Kong, we identified all patients aged ≥ 10 years with new diagnoses of depression from 2014 to 2022. We performed an interrupted time-series (ITS) analysis to examine changes in incidence of medically attended depression before and during the pandemic. We then divided all patients into nine cohorts based on year of depression incidence and studied their initial and ongoing service use patterns until the end of 2022. We applied generalized linear modeling to compare the rates of healthcare service use in the year of diagnosis between patients newly diagnosed before and during the pandemic. A separate ITS analysis explored the pandemic impact on the ongoing service use among prevalent patients with depression. Results: We found an immediate increase in depression incidence (RR = 1.21, 95% CI: 1.10–1.33, p < 0.001) in the population after the pandemic began with non-significant slope change, suggesting a sustained effect until the end of 2022. Subgroup analysis showed that the increases in incidence were significant among adults and the older population, but not adolescents. Depression patients newly diagnosed during the pandemic used 11% fewer resources than the pre-pandemic patients in the first diagnosis year. Pre-existing depression patients also had an immediate decrease of 16% in overall all-cause service use since the pandemic, with a positive slope change indicating a gradual rebound over a 3-year period. Conclusions: During the pandemic, service provision for depression was suboptimal in the face of increased demand generated by the increasing depression incidence during the COVID-19 pandemic. Our findings indicate the need to improve mental health resource planning preparedness for future public health crises. [ABSTRACT FROM AUTHOR]