South Africa has the highest global burden of HIV/AIDS with over 7.9 million people living with HIV/AIDS. Women and girls bear a disproportionate burden of the disease, which is potentially driven by low levels of correct HIV knowledge and high levels of gender-based violence. Our study aimed to determine the factors that influence uptake of HIV testing among reproductive aged women between 15-49 years in South Africa. Data from the 2016 (N=8514) iteration of the Demographic and Health Survey was utilized. Our outcome variable was HIV testing (yes/no) and our predictor variables were age at first sex, highest educational level, marital status, and recent condom use. We conducted descriptive statistics, chi-square analysis and T-test for our categorical and continuous variables (age at first sex), respectively. We further conducted multiple logistic regression to determine predictors of HIV testing. Frequencies, mean age at first sex, p-values, odds ratios, and 95% confidence intervals with alpha set to 0.05 were reported. Of 6489 women included in the final analysis, 5915 (91.15%) of women had ever been tested for HIV, 4964 (76.50%) and 746 (11.50%) had secondary and higher education as their highest educational level The mean age at first sex for women who had ever tested for HIV was 17.55 + 2732.7 years compared to 17.17 + 3119.7 years for women who had never tested for HIV (P<0.0001). The majority of respondents were never married (N=3415,52.63%) and 1746 women (26.91%) were married. Women who used condom during the last sex were 2883 (44.43%) compared to 3606 (55.57%) women who did not. The relationship between marital status and HIV testing (P=0.0009) and condom use and HIV testing (P=0.0471) were all statistically significant. After adjusting for confounders, we found that women with primary education had a 44.4% decrease in the odds of HIV testing and women with no education had a 61% decrease, compared to women to women who had secondary education (OR = 0.556, CI= 0.429-0.719, P<0.0001), (OR = 0.394, CI= 0.251-0.620, p<0.0001)., Women who had higher education had a 46% increase in the odds of HIV testing compared to women who had secondary education (OR = 1.460, CI= 1.049-2.033, P=0.0249). Being married and living with partner were associated with a 59.6% and 90% increase in the odds of having been tested HIV (OR = 1.596, CI= 1.276-1.996, P<0.0001) and (OR = 1.907, CI= 1.441-2.524, P<0.0001) compared to women who had never been married. No longer living together/separated was associated with a 4.5 times higher odds of HIV testing (OR = 4.491, CI= 1.826-11.045, P=0.0011) among women compared to never been married. Age at first sex was not significantly associated with HIV testing in the final model (OR = 1.028, CI= 0.995-1.062, P= 0.1020). Our study suggests the need to increase basic education up to secondary level and beyond among women in South Africa to increase uptake of HIV testing and reduce the burden of HIV/AIDS.

Background: Diarrhea is the passage of 3 or more loose or liquid stools per day. Globally, it is the second-leading cause of death among under-five children, accounting for 9% of all under-five deaths, and kills more young children than Acquired Immunodeficiency Syndrome (AIDS), malaria and measles combined. In developing countries, an estimated 1.8 million people die annually due to diarrheal diseases, and more than 80% of them are children under 5 years, while 88% of these deaths are in South Asia and Sub-Saharan Africa (SSA). There are limited studies that investigate the prevalence and factors associated with diarrhea in SSA despite the health burden. Method: The Demographic and Health Survey (DHS) children’s recode dataset of 2015 for Chad was used for this study. The predictor variables were; age of child, source of drinking water, maternal highest level of education, drank from bottle with nipple, and the outcome variable was diarrhea recently. Descriptive statistics for all variables were completed, and Chi-square analyses were conducted to determine associations between predictor variables and the outcome, diarrhea recently. Simple and multiple logistic regressions were completed to determine factors that predict diarrhea in the last two weeks. Odds ratios, 95% confidence intervals, and p-values were reported. Results: The total sample size was (N=16,710). About 3292 (19.70%) children had diarrhea, 13418 (80.30%) children had no diarrhea. A high prevalence of diarrhea in under-five children was observe particularly in those who drink water from unprotected well (1070 cases), had mothers with only primary level of education (796 cases), and did not drink from bottles with nipple (2961 cases). Based on the age of child, the odds of having diarrhea were over 60% lower in children 3 years old and below [aOR = 0.39, C.I (0.279-0.538), p <.0001] compared to 4 years old and above. Based on the source of drinking water, children that drank from a protected spring were 74% less likely to have diarrhea [0.26, 0.084-0.827, p=0.0223] compared to those that drank from other sources. The study also showed that children that drank from bottles with nipple were 16% less likely of having diarrhea [0.84, 0.726-0.968, p=0.0166] compared to those that did not drink from bottles with nipple. However, maternal highest level of education had no significant association with the odds of having diarrhea in these children. Conclusion: Caregivers should ensure absolute hygiene and provide safe drinking water to under-five children, especially those above 3 years who may easily access contaminated water sources themselves. We also encourage the use of bottles with nipple heads for drinking in children. Further studies are needed in SSA on other factors influencing diarrhea risk in those under five.

Interventions that promote alternative income generation (AIG) to address social determinants of health are associated with increased household income and improved health outcomes. Organizations have used beekeeping to address poverty and other development goals with mixed outcomes. Beekeeping presents a viable option to promote AIG. Organizations increase their risk of failing to achieve positive outcomes when beekeeping interventions are inadequate. This project aims to develop an organizational assessment tool that measures organizational position in relation to evidence-based factors for income generation and improved quality of life among global beekeepers. The assessment is organized into seven domains that correspond with PRECEDE-PROCEED and may be a useful iterative diagnosis, evaluation, and monitoring tool. The instrument was developed through a literature review and adapted to PRECEDE-PROCEED to include organizational, ecological, and evaluation factors. The instrument was pretested among content experts and revised before being administered to BEECause Gambia (BCG). BEECause’s mission is to reduce poverty and promote pollinator and honeybee populations. The assessment results were analyzed to propose recommendations to BCG to consider in future strategic planning processes. The pretest included a survey and cognitive interviews to identify and revise problematic statements. Pretest survey statements were evaluated using a five-point Likert scale. Scores £ 3 directly informed the cognitive interview protocol, which allowed respondents to explicate their feedback and concerns. Interview results were analyzed for trends between respondents and corroborated against evidence-based factors. Statements were revised to consider optimal domain alignment, content validity, and meaningfulness. The revised survey included seven domains, 49 statements and one open-ended response. BEECause’s overall assessment score was 4.1. By domain their scores were 4.1 in design, 4.1 in implementation, 4.2 in predisposing factors, 3.1 in enabling factors, 3.8 in reinforcing factors, 4.2 in impact, and 5.0 in outcomes. Domain and statement scores underwent SWOT analysis. Scores ³ 4 were considered strengths. Scores < 4 were considered weaknesses, opportunities, and threats. The assessment resulted in three recommendations to BCG including 1) build financial security, 2) build stakeholder confidence, and 3) address enabling and reinforcing factors. This project may serve as a model for public health efforts in AIG.

The main purpose of this paper is to provide evidence of financial leverage, liquidity, profitability, and firm size ability to predict bankruptcy of Swedish small and medium-sized enterprises (SMEs), and to create a bankruptcy prediction model for Swedish SMEs. The sample consists of 1086 Swedish SMEs, among which 543 did go bankrupt between 2015 and 2019. The paper employs logistic regression and Mann-Whitney U-test to test the hypotheses. The independent variables are derived from previous research and further filtered in a selection process, resulting in a final set of six variables. Financial leverage, liquidity, profitability, and firm size is found to have significantly predictive abilities to determine SME bankruptcy. The model has an overall classification accuracy of 77.6% out-of-sample and is able to classify 82.2% of the bankruptcies correctly out-of-sample.

Foreign direct investments, FDI, have been increasing a lot the latest years and a significant part of the total investments made are allocated to the real es-tate industry. This paper is investigating the impact of several di˙erent macro variables on foreign direct investment allocated to real estate at the Swedish market. The objective of the thesis is to investigate what factors that a˙ects the inflow of FDI, i.e. are there any factors that can be used as indicators for an attractive market seen from a foreign investor perspective? This is done by regression analysis on a data set containing monthly data with 146 observa-tions, where the levels of foreign direct investments is the dependent variable and the di˙erent factors are the independent variables. The variables used in the regression are chosen based on earlier findings regarding their impact on FDI, but applied on a developed country. The variables are di˙erent ma-jor macroeconomic variables such as lagged transaction volume, stock market performance, inflation, currency level, interest rate and unemployment. The findings of the regression are that both lagged transaction volume and level of unemployment are significant variables on a 1% and 5% level respectively. The results suggest that investors tend to invest in hot markets and follow each other, plausibly that smaller investors shadows pioneers on the specific market. Level of unemployment was found significant with a negative sign, meaning that when unemployment levels are decreasing, the transaction volume will increase. Seeing decreasing unemployment as a factor for a prospering country, it is plausible that the parameter has an impact on the real estate transaction volume. Variables not found support for are stock performance, inflation, currency levels and interest rate. / Utländska direktinvesteringar har ökat markant de senaste åren och en sig-nifikant del av dessa investeringar I fastigheter. Den här rapporten undersöker inverkan av olika makrofaktorer på nivån av utländska direktinvesteringar på den svenska marknaden. Målet med rapporten är att undersöka om några av dessa faktorer kan användas som indikatorer för hur attraktiv den svenska fastighetsmarknaden är för utländska investerare. Det här har undersökts med hjälp av regressionsanalys på data som samlats på månadsbasis med 146 ob-servationer. Den beroende variabeln är nivån av utländska direktinvesteringar och de oberoende variablerna är de olika makrofaktorerna. De oberoende vari-ablerna är valda baserat på tidigare forskning, variabler som börsutveckling, BNP, nivå på arbetslöshet, laggad investeringsvolym med flera. Resultatet av regressionen visar att laggad investeringsvolym och nivån på arbetslöshet är signifikanta på 1% respektive 5% nivå. Resultatet implicerar att investerare föl-jer varandra, alternativt att de baserar beslut på samma faktorer när de väljer att investera. Arbetslösheten verkar ha någon slags implikation på framtida nivåer av utländska investeringar. Variablerna som inte var signifikanta var börsutveckling, inflation, växelkurs samt reporänta.

The purpose of this paper is to build a model that incorporates current data of Africa, both regarding risks and opportunities into a strategic framework that should enable a more informed foreign direct investment decision for multinational enterprises (MNEs). The parameters used in the model were carefully chosen as determinants to foreign direct investment (FDI) based on extensive literature reviews. The model currently covers 101 major cities in 40 African countries. The model calculates and ranks indexes of African cities in terms of prospective investment opportunities. It is a general model with the flexibility of adapting to the user’s specific needs, since they can be highly heterogeneous depending on the industry and the type of to FDI considers. To test the validity of the model, standardized weights were used and the results were compared to current reports of FDI inflows to Africa. The results given by the model were to some extent compliable with the result of current FDI inflows, which thereby can be seen as sign of validity.

In the finance literature determinants of Capital structure have been widely debated. Previous studies have mainly focused on microeconomic determinants in countries outside Sweden and research on the Swedish market has been sparse. This study aims to analyze how microeconomic determinants such as profitability, firm size and tangible assets affect the capital structure and further how the determinants from the Swedish macroenvironment like inflation, tax rate and interest rate affect capital structure. The study considers previous theories on capital structures relevance and evaluates the Swedish firms support for the Irrelevance Theory, Pecking order and the Trade-off theory. In other words, by evaluating how the determinants affect the capital structure we were able to see connections between theory and how Swedish firms determine their financing decision.  Based on a review of the literature and theories, the determinants, the quantitative approach,  and collection method was decided. The data was collected over a 10-year period between  2010 - 2019 and amounted to 1116 firms and 44 632 observations. A multiple regression  method was performed where the dependent variable the debt ratio was split into short-term,  long-term, and total debt to get a better understanding of the results.  Analysis of the results demonstrated that Swedish firms' total debt ratio had a significant negative relation towards profitability. This indicates that Swedish firms choose to finance their operation with internal funds rather than with debt which supports the Pecking order Theory. However, the determinant growth show significant negative relationship to the  debt ratio which is in support for the Trade-off theory. The results imply Swedish firms conflicting support for theories on capital structure. Our results from a change in the  Swedish macroenvironment show that inflation causes firms long-term debt ratio to  decrease, which potentially demonstrates the fear of higher interest rates as inflation hits  and an unwillingness to finance with debt when the cost of financial distress increases.   Considering previous studies has shown contrasting results on the determinants effect on capital structure. We consider our findings to be in line with overall expectations and believe we add further knowledge which can be applied to the Swedish business environment.

BACKGROUND: This work serves as a cases study for the findings of the Rockefeller Foundation-Boston University Commission on Health Determinants, Data, and Decision-Making (3-D Commission). The dissertation assessed public views of what matters for health, the degree of incorporation of SDoH in Covid-19 decision-making, and the mental health consequences of SDoH disruptions in diverse contexts using multiple data sources. METHODS: An online survey collected relevant individual-level data from Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States using RIWI—a professional global survey platform that uses a patented Random Domain Intercept Technology™ (RDIT™). National-level data retrieved included Covid-19 policy data from the Oxford Covid-19 Government Response Tracker (OxCGRT) and data from the International Labour Organization (ILO) on the informal labor sector. All data were used in descriptive and multivariable regression analyses. RESULTS: Of 8,754 respondents, 56.2% (95% CI: 55.1%, 57.2%) ranked healthcare as the most important determinant of health. Politics was the determinant with the greatest absolute difference between what respondents considered matters for health versus what they perceived decision-makers think matters for health. Overall, more restrictive Covid-19 stay-at-home orders were associated with a higher burden of SDoH disruptions while more expansive income support policies were associated with a lower burden of disruptions. The lowest two income quintile in all countries reported the highest burden of employment insecurity, financial insecurity, and food/supplies insecurity. The income gradient of SDoH disruptions persisted after controlling for government income support policies. Experiencing Covid-19 SDoH disruptions was then associated with a higher burden of both depression symptoms and probable post-traumatic stress disorder (PTSD). The prevalence of probable PTSD was about three times higher among people who experienced at least one Covid-19 SDoH disruption compared to those who did not experience a disruption. CONCLUSION: This research showcases the need for more investment in communication efforts around the importance of SDoH both to the general public and decision-makers. Moreover, SDoH disruptions and their association with adverse mental health outcomes during the Covid-19 pandemic highlight the lack of consideration for SDoH in the design and implementation of policies. Countries in different contexts would benefit from implementing the 3-D Commission principles and recommendations to ensure that decision-making on health is guided by equity and informed by data on SDoH. / 2024-08-30T00:00:00Z

Individuals, who work in high risk confrontational (HRC) settings in which a conflict exists, experience high-stress levels in their jobs and are known to have a high level of decreased performance and decreased survival. Individuals being trained to handle such conflicts should be trained effectively to accomplish the ultimate objective, staying alive. The problem is the lack of research and program evaluations examining effectiveness of training simulations in the transfer of skills under HRC settings. The purpose of my study was to test if the skill of target acquisition could be effectively transferred to a real environment (RE) after exposure within a virtual environment (VE). Ackerman's (1988) Theory of Ability Determinants of Skill Acquisition supports the progression participants advance through in the transfer of learning. A randomized posttest only comparison group design was used. The population involved 24 novice paintball players. Participants were randomly assigned to a simulation treatment or a non-simulation comparison application. Two days after receiving the intervention, participants engaged in live practice sessions (game 1 and game 2) in a RE where target acquisition skills were measured. Evidence suggests significant differences were found between novice players in the type of intervention received and the number of targets acquired in a RE, whereas, no significant change in scores was found between practice sessions, and no interaction was found between intervention received and practice. Recommendations for replicating studies include: (a) focusing on the manipulation of specific variables within the training context, (b) using different live environments, (c) examining factors that influence teaming and strategy formation, and (d) combining experts and novice players for a closer representation of a population in an HRC setting.

Community engagement in health assessment enables researchers to better understand and prioritize community needs. The value of community engagement is increasingly documented; however, few studies engage youth. Research and assessments are often done for youth, but not with youth. Youth bring a unique contextual lens to community issues; without engagement, the likelihood that resultant efforts would be accepted by or appropriate for youth decreases. This dissertation explores opportunities and methodological approaches for, and contributions and feasibility of engaging youth in non-profit hospital community health needs assessments (CHNAs) mandated through the Affordable Care Act. This study has three specific aims, utilizing multiple methodological approaches: • Aim 1: Assess the current level of youth engagement, and prevalence of youth-focused priority areas in Massachusetts CHNAs. CHNAs were reviewed and analyzed using the Community Health Improvement Data Sharing System’s community engagement template. • Aim 2: Compare assessment results of focus groups and participatory photo mapping (PPM) in documenting youth observations of Boston community conditions. Three focus groups and PPM processes engaged 46 high-school age youth. Data were qualitatively compared, with attention to youth-identified community assets, concerns, and recommendations. • Aim 3: Compare youth results with existing CHNAs and identify potential contributions of youth engagement. Using the social determinants of health framework, youth recommendations were compared to Boston hospital community health improvement (CHI) publications to observe the convergence and divergence of priorities. While all MA hospitals minimally complied with required CHNA community engagement criteria, there was no standard practice or approach. 20% of CHNAs engaged youth, primarily through focus groups; yet, 80% of CHNAs that identified priorities included youth-focused priorities. Youth-driven results focused upon social determinants of health factors; furthermore, PPM results provided more detailed and granular CHI recommendations. Youth-identified CHI recommendations complemented those identified by hospitals, indicating that youth engagement can potentially strengthen CHI priorities and identify salient strategies for addressing youth health, specifically. Findings can be extrapolated to the many institutions conducting assessments, including health departments and Community Action Agencies. Findings will be disseminated through a series of practice briefs that make recommendations to hospitals, assessment practitioners, and youth organizations to consider for future efforts.