Does Underwriter Reputation Affect The Performance Of Ipo Finance Essay - Free Essay Example

Sample details Pages: 18 Words: 5271 Downloads: 7 Date added: 2017/06/26 Category Finance Essay Type Narrative essay Did you like this example? In this paper we examine the relationship between performance of the Chinese IPO firms and the reputation of investment bankers underwriting their stocks. Similar to previous studies on well-developed stock markets, we find that the initial return on the first day of trading is strongly positive for Chinese IPO stocks due to underpricing. This initial return is negatively related to the underwriters reputation, suggesting that the better the reputation of the underwriter, the less underpricing and hence, the lower the initial return of the IPO stock. Don’t waste time! Our writers will create an original "Does Underwriter Reputation Affect The Performance Of Ipo Finance Essay" essay for you Create order Extending the analysis to a ten-day window after the first trading day, we find that the cumulative return becomes negative but that the stocks with more prestigious underwriters experience less decline. We also examine the three-year return of the IPOs. Contrary to previous findings, we find a positive long-run return for the Chinese IPO stocks. This long-run return is positively correlated with underwriter reputation. Finally, we find some evidence of positive long-run operating performance for the IPO firms that employ more prestigious underwriters. 1. Introduction The underpricing of initial public offerings (IPOs) is a well-known phenomenon. Many studies have attempted to offer an explanation for the underpricing of IPOs and their long-term performance (see, for example, Loughran and Ritter, 2002; Ritter and Welch, 2002).[1]A substantial body of research on the initial public offering of common stocks examines the effects of underwriter reputation on the initial and long-run performance of IPOs (see, among others, Logue, 1973; Beatty and Ritter, 1986; Titman and Trueman, 1986; Carter and Manaster, 1990; Maksimovic and Unal, 1993; and Carter et al., 1998). The financial press also provides some evidence of the correlation between IPO performance and underwriter reputation (See Forbes June 20, 1994). However, most previous studies have investigated the markets of developed countries, especially the U.S. stock market. None of them has examined the effects of underwriter reputation on the performance of Chinese IPO stocks. Furthermore, no prior r esearch has documented the relationship between the accounting performance of IPOs and underwriter reputation. Logue (1973) and Beatty and Ritter (1986) are among the first to examine the effect of underwriter reputation. Later studies use different reputation measures to examine the relationship between underwriter reputation and IPO performance. Carter and Manaster (1990, hereafter CM) use underwriters relative placements in stock offering tombstone announcements, Johnson and Miller (1988, hereafter JM) classify underwriters into one of four prestige categories, and Megginson and Weiss (1991, hereafter MW) use the relative market share of underwriters as a proxy for their reputation. Michaely and Shaw (1994) find that IPOs managed by high-prestige investment bankers tend to have smaller initial returns and less negative long-run returns than do IPOs handled by low-prestige underwriters. Brav and Gompers (1996) find that venture-capital-backed IPOs outperform nonventure-backed offerings five years after the offering date. Carter et al. (1998) find that each of the three reputation proxies (C M, JM and MW) is significantly related to the initial returns of IPO stocks. The better the underwriters reputation, the smaller the short-run underpricing and the less severe the long-run underperformance of IPO stocks. Liu and Wu (2002) show that other things being equal, underwriters with better reputations incur a smaller amount of underpricing. They find that underwriter prestige is negatively related to the mean and standard deviation of the initial return of IPO stocks. Although no widely accepted theory has been developed, it is generally believed that IPOs marketed by high-prestige underwriters will experience less severe short-run and long-run underperformance in stock returns and better long-run earnings performance. Chemmanur and Fulghieri (1994) argue that investors count on the investment banks past performance, measured by the quality of IPO firms assisted by them, to assess their credibility. By marketing IPOs with better short-run and long-run performance, investment banks enhance their reputation. Hence, we expect underwriter prestige to be positively related to the short- or long-run market-adjusted returns of IPO stocks. Several papers have investigated the issue of IPO underpricing in China. Mok and Hui (1998) examine the pricing of IPOs in the early years (before 1993) of Chinas stock market development. Su and Fleisher (1999) employ signaling theory to explain the underpricing of IPOs in China. Chan, Wang and Wei (2002) explain the underpricing of IPOs with several institutional variables and investigate short- and long-run stock return and accounting earnings performance relative to different benchmarks. Surprisingly, there are virtually no studies on the effects of underwriter reputation on the IPO performance in the Chinese stock market. In this paper, we examine underwriter reputation and the performance of IPO stocks in the Chinese market. First, we investigate the extent of underpricing, the short-and long-run stock returns following the IPO, and the relationship of these returns to underwriter reputation. Second, we examine the relationship between underwriter reputation and the future accounting performance of IPO firms. A closer examination of Chinas IPO market is warranted for several reasons. First, the institutional and economic environment in China is quite different from most other countries where the effects of underwriters have been investigated extensively. An interesting characteristic of the Chinese IPO market is that the aggregate amount of new shares issued each year is determined by the central government. New issues typically represent a small proportion of the outstanding shares, as the majority of firm shares is owned by the state or other legal entities, and cannot be sold to public investors. Therefore, the management and ownership structure is very different from the IPO firms in other countries. Second, Chinas stock markets have been in smooth operation for only about ten years. Investors are not as knowledgeable and sophisticated as those in well-developed countries. In addition, there is only a nascent institutional investment community in China. Consequently, stock prices are driven by the actions of private investors who typically own very few shares and have done very little investment analysis. These institutional and regulatory differences between China and other countries suggest that the findings from the IPO studies in the U.S. and elsewhere may not directly apply to the Chinese market. For example, underwriter reputation may be more important for the Chinese market because investors are less knowledgeable and have less information on the new stock issues. Thus, Chinese investors may be more willing to accept less underpricing (premium) when stocks are underw ritten by investment bankers with better reputation. Moreover, Chinese IPO market is not well developed. To ensure a successful underwriting, firms have a greater incentive to seek underwriters with good reputation. On the other hand, most of Chinese investment banks are established by central government offices or state-owned firms. Also, the majority of firm shares is owned by the state or other legal entities. Consequently, political relationship may play a very important role in the underwriter selection.[2]For these reasons, underwriter reputation may have different impacts on IPOs in China than in other markets. The remainder of the paper is organized as follows. Section 2 discusses the characteristics of the Chinese IPO market and review prior research on this market. Section 3 discusses data and empirical methodology while Section 4 presents empirical results. Finally, Section 5 concludes the paper. 2. Chinese IPO markets In 1978, China initiated various reforms to restructure its economy towards a socialist-market economy. An important step for this movement was privatizing state-owned enterprises (SOEs) by issuing shares to the public via IPOs. Although the first privatization took place in 1984, subsequent IPO activity was quite modest. In all, there were only 44 IPO issues between 1984 and 1990. The low popularity of IPOs was due in large part to the fact that there were no organized stock exchanges to trade shares. Recognizing the lack of market liquidity, the state established two new stock exchanges in Shanghai and Shenzhen in December 1990 and July 1991, respectively. Before the establishment of these two stock exchanges, the underwriting industry effectively did not exist. With the rapid growth in the stock market, this new industry began to develop quickly. According to a report of The Peoples Bank of China (the central bank of China), by year 2001 there are 177 investment banks authorized to underwrite the IPOs. The total asset of the 177 investment banks is 550 billion RMB, and their total liability is 478 billion. All investment banks are established by some government departments or large state owned firms. Thus, the state has a large control power on these investment banks. The initial public offering process is quite similar with that of the U.S. except that there are more regulations and more tedious application process. A substantial proportion of the initial public offerings is linked to the privatization of state-owned firms. The Chinese government introduced five major categories of shares: (1) state shares, which are held by the State Assets Management Bureau (SAMB); (2) institutional shares held by other state-owned enterprises; (3) employee shares held by managers and employees; (4) ordinary domestic shares (or A-shares), which can be purchased only by Chinese citizens on the Shanghai or Shenzhen Exchange; and (5) foreign shares, which can be purchased only by foreign investors in Mainland China (B-shares), through the Hong Kong Stock Exchange (H-shares) or the NYSE (N-shares). Only A-shares and B-shares are traded on the Shanghai and Shenzhen exchanges. The first three types of shares are not tradable in official exchanges, whereas trading of employee shares is allowed some time (typically one year) after the IPO. The stock offering process in China has vestiges of the Chinese transitional economy with socialist planning. The initial public offering process is more complicated from other countries due to heavier regulation. First, the aggregate value of new shares to be issued each year is part of the national investment and credit plan. The new issue quota is determined jointly by the State Council Securities Committee (SCSC), the State Planning Commission (SPC), and the Peoples Bank of China (PBOC), which is the central bank of China. The quota is allocated to provinces as well as to municipalities. The criteria used for allocation among provinces include the assessment of regional industrial structures, and the need for balanced regional development. Given each regional quota, local securities authorities invite enterprises to request a listing and then make a selection based on the issuing firm performance and regional development objectives. This process of selecting enterprises for listi ng in China differs considerably from other countries, where the decision to list a stock is usually determined by the stock exchange. The selected firms then submit their application for initial public offering to China Securities Regulatory Commission (CSRC). In their application, firms must provide the details about the offering such as when and where the shares will be offered, offering price, the number of shares to be offered, underwriter and the type of underwriting, etc. Once a firm is admitted to issue new shares through an IPO, it will select an underwriting syndicate to issue its shares. In China, most investment bankers issue IPO stocks under a firm commitment. In order to protect the domestic investment banking industry, foreign investment banks are not allowed to underwrite A-shares. Thus, all A-share IPOs issues are underwritten by domestic investment banks mostly owned by the state. Foreign investment banks can only underwrite B, H, N and other foreign shares. Based on the report of China Securities Regulatory Commission (CSRC), there are only 48 foreign underwriters by 2001 authorized to underwrite B, H, N and other foreign shares. These 48 foreign underwriters come from several different places, including the U.S, Japan, Hong Kong, Germany, France and other countries. Foreign underwriters generally have higher reputation in their own country, and but less known in China. In this study, we focus on the underwriting of A shares and the domestic investment banks which underwrite them. There is a body of research that investigates the development of Chinas privatization program and the stock price behavior of listed companies. Corporate earnings typically decline subsequent to listing, a phenomenon in contrast to the findings from studies of other markets. Very high initial returns have been recorded on the first day of IPO listings (e.g., Bailey, 1994; Mok and Hui, 1998; Chen et al., 1999; Chan, Wang, and Wei, 2002), but long-term stock returns and earnings performance are mixed. Mok and Hui (1998) find that positive returns have been achieved a year after listing, while Chan, Wang, and Wei (2002) find that the IPOs underperform the matched non-IPO stocks three years after listing, whether from the view point of stock returns or the earnings performance. These studies focus on the return and earnings performance of IPO stocks. None of them has examined the effect of underwriter reputation on the performance of Chinese IPOs. 3. Data and empirical methodology Our stock return and accounting data are retrieved from the Taiwan Economic Journal (TEJ) database. Information concerning the particulars of each offering, including the number of shares offered by the firm, the underwriters involved, and the offering price have been obtained from CSRC, SHSE and SZSE. All IPOs made from 1990 to 2001 with required data are included in the sample. As mentioned earlier, although the first privatization case took place in 1984, subsequent IPO activity was quite modest, with only 44 issues between 1984 and 1990. Since there werent any official stock exchanges during this period, we have excluded these IPO issues from this study. The sample selection process is summarized in Table I. The final sample includes 944 IPOs issued from 1990 to 2001. Several proxies for underwriter reputation have been employed in previous studies. In this paper, we use the underwriter reputation measures as defined by Carter and Manaster (1990, CM) and Megginson and Weiss (1991, MW). Specifically, we use the number of IPOs underwritten and the relative market share of an investment banker in stock offerings as a proxy for underwriter reputation. We use underwriters relative placements in stock offering tombstone announcements to obtain the CM measure. First, we count how many IPOs that each investment bank has underwritten, and rank the underwriters by this number. We use 50% and 80% to divide the whole underwriters into three groups: low, median and high reputations. The MW measure is constructed using the same process used to obtain CM measure, except that we use the total market value as a criterion to separate the whole underwriters into three groups. We define three levels of underwriter prestige based on the ranking of each reputation prox y, with a score of three representing the most prestigious level and one representing the least prestigious level. To evaluate the aftermarket performance of IPOs, we calculate returns for three periods: (1) the initial return period from the offering date to the first public trading date; (2) the short-term aftermarket period which covers a ten-day period after the IPO, exclusive of the first day of trading; (3) the long-term aftermarket period, which covers a three-year horizon after the IPO, exclusive of the first day of trading. The initial period vary somewhat by IPO issues. Panel B of Table 1 reports the summary statistics of the initial period. We compute the initial return as the percentage difference between the closing price of the first trading date and the offer price: (1) where is the initial return of stock j on the first trading day (day 0), is the closing price of stock j on day 0, and is the offering price of stock j. We also adjust the return for the market effect: (2) where is the market-adjusted return of an IPO stock on day 0, is the closing value of the corresponding A-share market index on the first trading day of the new issue j, is the closing value of the corresponding A-share market index on the day the new issue j is offered. The mean-adjusted initial return is: (3) where N denotes the number of companies in an IPO portfolio. The short- or long-run aftermarket performance is computed based on the buy-and-hold strategy. In order to test the effect of underwriter reputation on short-run returns, we calculate the return over a ten-day horizon after the first trading day, since underwriters usually stabilize the stock price in this period due to their firm commitment to price support. The buy-and-hold return for firm j (Rj) over a ten-day horizon is (4) where represents the return of firm js stock on day t. The initial return on the first trading day is not included in the above calculation. The market-adjusted ten-day return can be computed as: (5) where represents the return of the corresponding A-share market index on day t. The mean market-adjusted return over the ten-day horizon is (6) We next calculate the return for the each of the 36 months following the first day of stock trading. Following Ritter (1991), we assume there are 21 trading days in one month, instead of using a calendar month. Therefore, the first month consists of the first 21 trading days after the first trading day (denoted as day 0), the second month consists of day 22 through day 42, and so on. The long-run aftermarket cumulative return till month T (= 36) for firm j (CRjT) is computed as: (7) where represents the return of firm js stock on day t. Again, the return on the first trading day is not included. The market-adjusted return can be computed as: (8) where represents the return of the corresponding A-share market index on day t. Similarly, the mean market-adjusted cumulative return till month T is computed as follows: (9) Ritter (1991) and Loughran and Ritter (1995) compare the aftermarket return of an IPO portfolio with the returns of non-IPO matching firms (matched by Size, B/M and Size-B/M). Since a relatively high percentage of listed firms in our sample period are IPOs, it is not feasible to construct a meaningful non-IPO matching sample. Instead, we use the buy-and-hold return on the market portfolio as our benchmark return. We examine the explanatory power of the underwriter reputation measures by least squares regressions. Previous studies suggest that underwriter reputation signals the underlying risk of the offering, impounded in the initial return. We segment our sample by underwriter reputation and report the corresponding initial returns, short- and long-run performance for each segment. We use the market-adjusted initial return, short-run return and long-run return as the dependent variables in the regression, and the underwriter reputation measures (CM or MW) as the independent variable. The coefficient for each reputation measure should be negative in the initial return regression. In contrast, for short- and long-run aftermarket return, the coefficient for each reputation measure should be positive if the reputation of investment bankers indeed signals the quality of IPO firms. To assess the marginal impact of underwriter reputation, we control the effects of other IPO characteristics. The first variable is the gross proceeds of the IPO (Size), which is used to control any systematic influence due to the size of the offering. Since larger IPOs are often issued by well-established firms, the risk is expected to be lower and therefore, the initial return is expected to be smaller because these IPO stocks are less underpriced. In contrast, the short- and long-run returns are expected to be larger for these firms because they are more profitable. Based on this argument, the coefficient of size (Size) for the initial return is expected to be negative, while it should be positive for short- and long-run returns. The second variable is the issuing price (Issp). The higher the issuing (offering) price, the lower the initial IPO return. Thus, we expect a negative relationship between the initial IPO return and Issp. The third variable is the lottery ratio (Proba), w hich reflects outside investors demand for new shares. The greater the underpricing of the IPO, the stronger outside investors demand (see Hanley, 1993). This implies a negative relationship between the initial return and Proba. The return regression model can be written as (10) We also estimate this regression model using the market-adjusted ten-day return (AR) and long-run return (ACR) as dependent variables. In the investment banking industry, underwriters with better reputations tend to be more likely to survive market competition. Good underwriters will do their best to price IPOs at the intrinsic values of the firms to prevent losing their reputation and their clients. Also, they tend to market the stocks of high-quality firms. Thus, we expect that the IPOs handled by underwriters with better reputations will have better operating and earnings performance before and after their issuance date. 4. Empirical Results A. Initial IPO returns and Underwriter Reputation Proxies We calculate market-adjusted initial returns of the first trading day for three IPO portfolios, which are formed based on the level of underwriter reputation (either CM or MW measure). Table II provides summary statistics of the initial returns, Size, Issp and Proba. The results in Table II are consistent with the findings of the studies of U.S. and other developed markets. For example, more prestigious investment bankers tend to market the stocks of larger firms with a higher issuance price. As a result, the market-adjusted initial return is negatively related to underwriter reputation. The mean adjusted initial return declines monotonically from 468.44% (466.11%) to 161.18% (159.87%) as the level of underwriter reputation, based on either the CM or MW measure, increases (from a scale of one to three). The standard deviation of the market-adjusted initial return also declines monotonically with the level of underwriter prestige. We also calculate the mean issuance price for each por tfolio. Consistent with these findings, the mean issuance price of the IPOs increases from 6.09 (6.64) to 9.84 (9.84) as underwriter prestige increases from low to high. Panels A and B show that the differences among the returns of the three reputation groups are very large and significant at the 1% level. For example, the difference in the initial returns (market adjusted) between the low and high prestige groups is 307.26% (307.26%) and significant at the 1% level based on the CM measure. Similar results are found for the groups ranked by the MW measure. The results of regressions on the market-adjusted initial return are presented in Table III. The variables of primary interest are the CM and MW underwriter prestige measures. We first estimate the univariate regressions against each reputation measure and control variable, and then estimate the multivariate regressions by including all variables. As expected, the coefficients for CM and MW are all negative and significant at the 1% level for both univariate (rows 1 and 2) and multivariate regressions (rows 6 and 7). Carter et al. (1998) find that the CM measure outperforms the MW measure in explaining the IPO return. In contrast, we find that the performance of these two measures (CM and MW) is quite similar. In addition, the coefficient for each control variable is as expected. The coefficients of control variables are all negative and significant at least at the 5% level. B. Short-Run Performance and Underwriter Reputation When the demand is weak after listing, the lead underwriter will stabilize the stock price through various activities aimed at reducing the selling pressure. Chan, Wang and Wei (2002) show that in the short run the IPOs underperform several market benchmarks. However, they have not examined the relationship between the stock performance of IPOs and underwriter reputation. Table IV presents the cumulative returns and cumulative market-adjusted returns for the IPO portfolios underwritten by investment banks of varying prestige. Panels A and B report these results based on CM and MW reputation proxies, respectively. As shown, all six IPO portfolios underperform the market over the ten-day horizon immediately after the first trading day. This result is consistent with the finding of Chan, Wang and Wei (2002). Our primary interest here is the relative performance of these portfolios. For either reputation proxy (CM or MW), the cumulative return of portfolio 1 is lower than that of portfolio 3 over the ten-day horizon. Based on the CM reputation proxy, the cumulative market-adjusted return is -5.20% for the portfolio with the worst underwriters while it is -2.56% for the portfolio with the best underwriters. Similar results are found for the portfolios based on the MW reputation proxy in Panel B. For example, the difference between the low and high prestige groups is 2.90%, which is significant at the 5% percent level. Table V presents the regression results of the ten-day IPO returns. The coefficients of the reputation proxies are all positive with the MW coefficients significant at the 5% level. Results show that the MW measures have a slightly higher explanatory power than the CM measure. On the other hand, none of the control variables (Size, Issp and Proba) is significant. This result shows that underwriter reputation significantly affects the short-run performance of the IPOs. It is consistent with the contention that underwriters support the stock price during the first several trading days and that underwriters with better reputations make a stronger effort to support the aftermarket price. Note that while the coefficient of underwriter reputation is statistically significant, the R2 is low, suggesting that it may not be economically significant. C. Long-Run Performance and Underwriter Reputation Prior studies have documented that IPO stocks underperform comparable non-IPO stocks over a longer horizon (see, for example, Ritter 1991; Loughran and Ritter 1995; Chen, Firth and Kim 2000; and Chan, Wang and Wei 2002). Using the U.S. IPO data from 1979-1991, Carter, Dark and Singh (1998) find that the long-run market-adjusted returns of IPOs tend to increase, or the IPO underperformance is reduced, with underwriter reputation. However, none of these studies has documented the relationship between the long-run performance of IPOs and the reputation of the underwriters in the Chinese market. Table VI presents the long-run cumulative market-adjusted returns of IPO stocks over a three-year horizon after the offering. Again, IPOs are divided into three groups based on the ranks of the CM and MW measures in Panels A and B, respectively. For the CM portfolios, the three-year cumulative return is -20.80% for the group with lowest underwriter reputation. But for the medium and high prestige groups, the cumulative returns are 12.92% and 17.46%, respectively. Similar results are found for the MW portfolios. Thus, long-run market-adjusted returns increase with underwriter reputation. Contrary to the findings of Loughran and Ritter (1995) and Chan, Wang and Wei (2002), the overall long-run market-adjusted return of Chinas IPOs is positive. Investors can earn higher returns by investing in the IPOs underwritten by better underwriters. The differences in the market-adjusted returns between the low and high prestige groups are large and significant at the 1% level. The difference is 38.26% (42.36%) when groups are ranked based on the CM (MW) measure. The results suggest that the quality of underwriters signals the long-run performance of IPOs. Table VII reports the regression results for the long-run market-adjusted returns of IPO stocks. As expected, the coefficients for CM and MW are positive and significant at the 1% level. These results are consistent with those reported in Table VI, and suggest that underwriters with better reputations have a greater ability to distinguish the quality of issuing firms and that they tend to underwrite stocks of high-quality firms to enhance their reputation. However, it should be noted that regressions contain substantial noise in the data as revealed by low R2. D. Operating Performance and Underwriter Reputation The preceding results show that IPO stocks underwritten by investment bankers with better reputations tend to generate better long-term returns. An important question is whether this stock return performance is reflected in firms operating performance. In this section, we examine the long-run operating performance of IPO firms. Table VIII reports changes in the operating performance of IPO firms surrounding the year of issuance. The performance measures include the operating returns on assets (ROA), operating cash flows on total assets (CFOA), sales growth rate (Sale_G), and asset turnover (ATO). It is shown that ROA, CFOA and ATO decline steadily after the issuance, regardless of which event window is viewed. These results are consistent with the findings of Jain and Kini (1994), Mikkelson, Partch, and Shah (1997) and Chan, Wang and Wei (2002) that the issuing firms operating performance deteriorates after the initial public offering. These results may reflect managers attempts to window-dress their accounting statements prior to going public, which leads to pre-IPO performance being over-stated and post-IPO performance being understated. An important issue is whether the operating performance of issuing firms is correlated with underwriter reputation. Table VIII shows that the operating performance of the IPO group with high underwriter prestige is better than that of the group with low prestige no matter which event window is used. The differences in the operating performance between IPO groups with high and low underwriter prestige are often sizable. For example, the mean ROA of the group with high prestige is 13.85% before the firms issue their IPOs, while that of the group with low prestige is only 11.95%. This means that the ROA of the IPO firm group with low prestige is about 15% lower than that the group with high prestige. In general, the difference between the high and low prestige groups is statistically more significant when the MW reputation measure is used. The return on total asset, the operating cash flow to total asset ratio and asset turnover are all significantly higher for the high-prestige IPO gro up. These results reinforce the findings from stock return performance that high-prestige underwriters have a greater ability to discern the quality of IPO firms. Table IX reports the regression results for IPO firms operating performance before and after the issuing year. The dependent variables of the regressions are the operating performance measures reported in Table VIII whereas the independent variables are CM and MW reputation proxies. The overall results show that operating performance of IPO firms is positively related to underwriter reputation. However, this relationship is not as strong as that exhibited in stock returns. The t statistics are significant at the five percent level for the asset turnover, suggesting that the firm group with better underwriter reputation typically has higher sales before the initial public offering. Other regressions also show positive relations between operating performance measures and underwriter reputation but they are not statistically significant. Thus, although there are indications that firms future performance is positively correlated with underwriter reputation, this positive relationship is weaker than that exhibited by aftermarket stock returns. 5. Conclusion In this paper we examine the relationship between performance of Chinese IPO firms and the reputation of investment bankers underwriting their stocks. Similar to the findings for other markets, we find that the initial return on the first day of trading is strongly positive for Chinese IPO stocks. This strong positive return reflects the IPO underpricing phenomenon well documented in the literature. More importantly, we find that the first-day return is negatively related with the underwriters reputation. Thus, the better the reputation of the underwriter, the smaller the amount of underpricing and hence the lower the initial return of the IPO stock. When we extend our analysis to a ten-day window, we find that the cumulative returns are negative shortly after the first trading day. However, this decline is less severe for the stocks with high-prestige underwriters. The results show that the stocks underwritten by investment bankers with better reputations tend to be more stable in the aftermarket. This implies that better underwriters make a greater effort to stabilize the market after the stock is publicly traded. As we further increase the event horizon to three years, we find several interesting results. The long-run return of Chinese IPO stocks show an overall positive return in the three-year period. This finding contrasts sharply with empirical evidence of overwhelming long-run negative IPO returns for the well-developed markets documented in the literature. The regression results show a striking positive relationship between the long-run returns of IPO stocks and underwriter reputation. Results suggest that either investment bankers with better reputations have a greater ability to discern the quality of issuing firms or quality firms will seek out high-prestige underwriters. At any rate, underwriter reputation signals firm quality. Moreover, there is evidence that the operating performance in terms of various accounting measures is better before and after the stock is publicly traded for those firms hiring underwriters with better reputations. Overall, the results support the contention that IPO returns are positively correlated with underwriter reputation and better investment bankers have a greater ability to predict future profitability of issuing firms.

The Impact Of Parenting Styles On A Child s Development

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She completed her B.A. in Psychology and Philosophy at Hunter College in 1948, and her M.A. and Ph.D. inRead MoreParenting Styles and Their Effects on Children1545 Words   |  7 Pageshave found patterns in parenting styles and their effects on children. Parenting isn’t only a collection of skills, rules, and tricks of the trade (Lloyd, Carol. 2012)†, it defines who you become, reflects your culture and represents values important in a family. Parenting style has a long term impact on a child’s development, success and outlook on life. The three styles of parenting are permissive parenting/hands-off parenting , authorit arian parenting, authoritative parenting .Studies revealed thatRead MoreParenting Styles : Parental Child Rearing1262 Words   |  6 PagesParenting styles play an integral role in the development of a child. During the first few years of life, the parents assume a special role of importance as their child progresses through a unique period of human development. As parents guide their young children from complete dependence into the beginning stages of self autonomy, parenting styles can have both immediate and lasting effects of the child s social functioning in addition to their mental and physical development. In order to ensureRead MoreInfancy and Early Childhood Development1399 Words   |  6 PagesEarly Childhood Development Cynthia Miranda PSY 375 July 2, 2012 Dr. Aneta Bhojwani Infancy and Early Childhood Development Every human being begins developing in one way or another, from the moment they come into this world. Development and all its aspects begin in infancy and continue throughout one’s entire lifetime. It is a common belief that infants and young children are influenced by the environment that surrounds them. Cognitive and social aspects of development are shaped andRead MoreCross-Cultural Differences Between Asian American Parenting1397 Words   |  6 PagesBetween Asian American Parenting Styles To compare, another study, by Cindy Lin and Fu (1990) compared and contrasted the parenting styles amongst Chinese, Immigrant Chinese, and Caucasian-American parents. The study was conducted on mothers and fathers of 138 kindergarteners, and first and second graders in the USA and Taiwan. This study researched the parental authoritativeness, academic achievement, and independence encouragement amongst the two cultures, and parenting styles through the use ofRead MoreChild Rearing Is The Right Type Of Parents983 Words   |  4 Pagesabout having a child. We have discussed about the possibilities that could happen if we do decide to go through with it. More importantly, how good of a parent can we become? Will we be able to provide for all the needs of the child? Will we be able to instill the needed values for the child to grow as an upstanding person? How can we be the right type of parents and should we do it the American or the Filipino way? These are the discussions that we have every time the topic of child rearing comesRead MoreParenting Style, Socio Economic Status Of Family And Maternal Education1534 Words   |  7 Pages Child development included the physical, cognitive, social, and emotional maturation of human beings from fetal period to adulthood. That is also a process which is influenced by interacting biological and environmental processes. About the environmental influences, the family has the most important impact on child development. The influences that I would like to discuss are the parenting style, socio-economic status of family and maternal education. Parenting Style Parenting style is a standard

Septic Shock And Kidney Injury Health And Social Care Essay Free Essays

string(104) " analysis and repeated freezing melt of samples was avoided in order to forestall debasement of plasma\." Systemic inflammatory response syndrome ( SIRS ) is expressed as febrility or hypothermia, tachycardia, tachypnea which may be associated with leucocytosis or leukopenia. SIRS generates broad spread inflammatory reaction in organic structure in response to external abuse which is protective for an person when its effects are restricted to pathogens, in other state of affairss inflammatory reactions are hurtful when they are directed against normal tissues in add-on to pathogens. [ 1,2 ] SIRS can ensue from legion conditions but termed as Sepsis, merely when infection sets in and morbific agent is detected. We will write a custom essay sample on Septic Shock And Kidney Injury Health And Social Care Essay or any similar topic only for you Order Now Sepsis consequences from an single response to external infection, which begins with systemic redness ab initio, followed by curdling abnormalcies and eventually deranged fibrinolysis. When sepsis causes one or more organ disfunction, the syndrome is termed Multiple Organ Dysfunction Syndrome ( MODS ) or terrible sepsis. [ 3 ] Sepsis-induced hypotension which is furnace lining to fluid boluses is termed Septic daze. Hypothermia associated with infected daze indicates hapless tegument and visceral perfusion, is normally associated with hapless forecast and high mortality rates of up to 30 to 40 % . Several serum biomarkers suggested holding diagnostic or predictive value in infected daze, but a unequivocal biomarker for everyday clinical usage is yet to be identified. One such marker is serum lactate which indicates pronounced hypoperfusion and tissue hypoxia in infected daze. Similarly serum Creatinine should besides be considered as marker of lessening organ perfusion in sepsis and Acute Kidney Injury should be regarded as index of ongoing organ harm and likely possibility of oncoming of infected daze. [ 4 ] AKI is due to sudden and drastic decrease in kidney map ( within 48 hours ) characterized by absolute addition in serum Creatinine ( gt ; 50 % from baseline ) or a decrease in urine end product ( oliguria of lt ; 0.5 ml/kg/hour for gt ; 6 hours ) . Nephritic hypoperfusion and ischaemia during infected daze amendss nephritic tubules taking to acute cannular mortification ( ATN ) and have been demonstrated to be a common etiologic factor for AKI development during sepsis [ 5,6 ] . ATN was found to be a consistent histopathological determination in these patients, this would strongly propose that ischaemia and nephritic tubular cell mortification are likely an of import pathogenetic mechanism. [ 7,8 ] Acute kidney hurt have marked impact on the result of critically sick patients. Disease badness tonss such as the Acute Physiology and Chronic Health Evaluation ( APACHE II ) and Sequential Organ Failure Assessment mark ( SOFA ) both have included nephritic disfunction as forecaster of morbidity and mortality ; on the other manus liver disfunction tonss, coagulopathy, thrombocytes and other critical organ maps are non much stressed in APACHE II hiting system. To set up a unvarying definition of nephritic harm, RIFLE categorization was formulated which characterizes Risk, Injury, Failure, Loss and End-stage Kidney ( RIFLE ) . [ 9 ] An of import facet of the RIFLE categorization is that it grades the badness of acute kidney hurt on the footing of alterations in serum creatinine and urine end product from the baseline status. [ 10 ] Urine end product is an of import physiologic mark of organic structure fluid position, and unstable instability is common in critically sick patients due to extravasation of fluid into extravascular infinite or due to 3rd infinite losingss and eventually the nephritic disfunction. This farther suggest that reduced organ perfusion in infected daze plays a cardinal function in development of AKI taking to cut down creatinine clearance and increased serum creatinine degrees. [ 11,12 ] In this survey we compared increasing serum creatinine degrees with plasma lactates and SOFA tonss to observe oncoming of sepsis and infected daze and to prove the hypothesis that ongoing acute kidney hurt can bespeak reduced organ perfusion and oncoming of infected daze in critically sick patients. Patients and Methods: This survey was carried out to happen a correlativity between lifting serum creatinine degrees and oncoming of infected daze in 115 critically sick patients admitted in ICU and were managed following Surviving Sepsis guidelines. [ 13 ] Human ethical blessing was taken by the institutional moralss commission. Written informed consents were obtained from control topics and patients or their relations. The control groups were the healthy relations attach toing the patient. Entire 90 controls were taken, among them 65 were males and 25 females with a mean ( SD ) age of 36.5 ( 8 ) old ages. Among patient group 67 were males and 48 females with mean ( SD ) age 37.5 ( 6 ) old ages. Patients included in our survey had either of the undermentioned characteristics: ( 1 ) Clinical characteristics proposing infection ; ( 2 ) Core temperature gt ; 38AÂ °C or lt ; 35AÂ °C ; ( 3 ) Heart beats gt ; 100/min ; ( 4 ) Respiratory rates gt ; 30 breaths/min or demand for supportive mechanical airing and ( 5 ) Inadequate organ map or daze within 12 hours of registration. Patients excluded were: ( 1 ) aged patients older than 75 old ages ; ( 2 ) NYHA category III or IV patients ; ( 3 ) liver inadequacy ( Child C ) ; ( 4 ) HIV, HBsAg positive serology, Cancer patients. Demographic characteristics like age, sex, primary site of infection, morbific beings and disease badness scores including Acute Physiology and Chronic Health Evaluation Scores ( APACHE II ) and Sequential Organ system Failure Assessment mark ( SOFA ) were recorded for each patient ‘s at the clip of admittance in ICU and later. The plasma of these patients was tested for serum creatinine and lactates degrees at the clip of entry in ICU, so after every 24 hours till their stay in ICU. All the samples collected and patient inside informations gathered during the survey were coded to look into for prejudice and patient confidentiality was maintained as per the guidelines for surveies of human patients. Blood sample aggregation: First blood sample was collected prior to get down of antimicrobic, steroid therapy or vasopressors. Blood samples were collected from cardinal venous line ( 9 milliliter ) into sterilized tubings incorporating 1ml trisodium citrate ( TSC ) at the clip of patient admittance I ICU and later. Plasma was separated by extractor at 10,000 revolutions per minute for 15 min. The plasma was stored at -70AÂ °C for farther analysis and repeated freezing melt of samples was avoided in order to forestall debasement of plasma. You read "Septic Shock And Kidney Injury Health And Social Care Essay" in category "Essay examples" Statistical analysis: The informations were analyzed by nonparametric analysis of discrepancy ( ANOVA ) with Newman-Keuls multiple comparing post-test. The relation between serum creatinine degrees, plasma lactates and APACHE A ; SOFA mark was tested by finding the Pearson correlativity coefficient ( R ) . A P-value of less than 0.05 was considered important. Entire information recordings were obtained in triplicate and consequences of computations are reported as agencies and criterion divergence up to two denary points. All statistical analyses were performed with the Graph Pad InStat 5.0 demo plan ( Graph Pad Software, USA ) . Consequences: Among 115 patients admitted in ICU during the period April 2009 to May 2010, 45 patients were of SIRS, 39 patients were in sepsis and 31 patients in province of infected daze ( Table 1 ) . Sepsis was diagnosed on the footing of specific civilization studies from assorted possible sites of infection, including blood civilization study. Out of 115 patients studied there were 67 male patients and 48 females with a mean ( SD ) age of 37.5 ( 6 ) old ages. Mean serum creatinine degrees in healthy control group was 0.83 AÂ ± 0.26 mg/dl, runing from 0.4 to 1.6 mg/dl. In SIRS group, the average serum creatinine degrees were 3.45 AÂ ± 1.26 mg/dl, runing from 1.2 to 6.2 mg/dl ( Figure 1 ) . The APACHE II and SOFA score correlated linearly with serum creatinine degrees ( r2=0.74, P lt ; 0.001 for APACHE A ; r2=0.69, P lt ; 0.001 for SOFA ; Figure2 ) bespeaking nephritic hurt with badness of redness. In sepsis patients average degrees were 7.15 AÂ ± 1.3, runing from 4.0 to 9.3 mg/dl. Pearson ‘s coefficient showed additive correlativity of serum creatinine and sepsis badness tonss ( r2 = 0.65, P lt ; 0.001 for APACHE and r2 = 0.62, P lt ; 0.001 for SOFA ; Figure2 ) . In patients of infected daze with nephritic disfunction really high serum creatinine degrees were observed with mean of 10.31 AÂ ± 2.29 mg/dl with values runing from 6.0 to 15.2 mg/dl, these values were significantly ( P lt ; 0.01 ) higher than those with sepsis ( 7.01 AÂ ± 1.3 mg/dl ) , SIRS ( 3.49 AÂ ± 1.10 mg/dl ) and the control group ( 0.83 AÂ ± 0.26 mg/dl ) . Detection of metabolic acidosis in arterial blood gas analysis was evaluated farther by blood lactate appraisal ( Figure 3 ) . Blood lactate degrees in SIRS group were ( 5.14 AÂ ± 1.24mmol/L ) with scope from 2.2 to 7.8 mmol/L. Similarly blood lactate degrees in sepsis ( 7.73 AÂ ± 1.4mmol/L ) and infected daze group ( 9.53 AÂ ± 1.2mmol/L ) were significantly high ( 95 % CI in sepsis 7.25 to 8.21 ; daze 8.9 to 10.16 mmol/L ) . In control group mean values were 0.93 AÂ ± 0.39mmol/L ( 95 % CI 0.84 to 1.0 mmol/L ) . In order to detect a relation between extent of nephritic hurt and oncoming of infected daze, creatinine clearance ( taken as step of nephritic map ) was so compared with blood lactate degrees ( taken as index of anaerobiotic metamorphosis and daze ) , Pearson ‘s coefficient showed reverse relation between lifting lactate degrees and Creatinine clearance in patients with terrible sepsis and infected daze ( Figure 4 ; r2=0.48, P lt ; 0.001in sepsis ; r2=0.56, P lt ; 0.001in infected daze ) . The patients included in this survey were non given any nephrotoxic drugs and drug dose were modified as per criterion chronic nephritic disease guideline to forestall farther nephritic hurt [ 14 ] . Discussion: Patients come oning to infected daze during their stay in ICU may hold altered sensorium, deranged liver map, malabsorption syndrome or may hold respiratory trouble. It was observed in our survey that all such patients with infected daze have one common characteristic of crazed kidney map with AKI. The pathophysiology of AKI in infected daze is ill understood due to miss of histopathologic information, which in bend requires nephritic biopsy to observe any parenchymal or vascular alterations in nephritic tissue ; such biopsies are non routinely performed in most ICU set up. [ 15,16 ] In absence of such information, we performed an indirect appraisal of nephritic map during oncoming of infected daze. These observations were based on serum creatinine degrees and creatinine clearance which was so correlated with disease badness tonss ( APACHE II and SOFA ) and serum lactate degrees ( index of anaerobiotic metamorphosis and daze ) . Assorted carnal surveies of AKI have been done which helps in more complex and invasive measurings of nephritic maps. [ 17 ] Most of these carnal surveies were based on either ischemia-reperfusion hurt or drug induced hurt and informations generated from such surveies may assist us in understanding the pathophysiology in a infected patient with AKI. A major paradigm developed from these observations in animate beings and worlds with daze is that AKI is due to nephritic hypoperfusion and ischaemia. This fact supported our position of utilizing AKI as index for decreased organ perfusion and oncoming of infected daze. [ 18 ] Under basal conditions blood flow to kidney is 360 ml/min/100gm of tissue where as blood flow to encephalon ( 50ml/min/100gm ) , bosom ( 70ml/min/100gm ) , lungs ( 25ml/min/100gm ) and liver ( 95ml/min/100gm ) . [ 19 ] Among all the variety meats, kidneys have really high flow rates, approximately three times higher than other critical variety meats, therefore metab olic maps of kidneys were more likely to be affected earliest by decrease in blood flow during infected daze, this may ensue non merely in a decrease in glomerular filtration but besides, in metabolic impairment perchance doing cell decease, acute cannular mortification and terrible AKI. [ 20 ] Glomerular filtration rate ( GFR ) is governed by glomerular filtration force per unit area, which in bend is determined by the relationship between the sensory nerve and motorial arteriolas. When the sensory nerve arteriola constricts due to hypoxia in infected daze, glomerular filtration force per unit area will fall and urine end product and GFR will besides diminish, ensuing reduced creatinine clearance and increased serum creatinine. [ 21 ] Arterial lactate concentration correlates with badness of infected daze and reflects metabolic changes associated with hemodynamic via media. Therefore, the association between high lactate degree and diminishing creatinine clearance are built-in to the badness of the daze and of multi-organ failure. [ 22 ] In add-on, epinephrine extract during infected daze besides enhances lactate production by itself ; the higher adrenaline dosage required in more terrible patients may besides hold contributed to this association. Following the natural history of infected daze in most ICU, it is impossible to happen patients deceasing of infected daze but without nephritic failure, the huge bulk of patients deceasing of multiorgan failure has a outstanding nephritic constituent and requires nephritic replacing therapy during their class in ICU. Renal biopsy during infected daze is non performed routinely because of important hazards owing to azotemic or infected coagulopathy and patient instability. However, this restriction does non impair the relevancy of our observations sing the pathophysiology of infected daze, as kidneys have highest blood flow per gm of tissue and AKI is changeless characteristic of terminal phase multiorgan failure so any via media in nephritic map in critically sick patients should be considered as indicant of decreased organ map and likely oncoming of infected daze. Decision: Kidneies are invariably involved in multiorgan failure of infected daze. Nephritic lesions associated with AKI in infected daze are more complex than the simple ague cannular hurt, so reduced creatinine clearance should be regarded as index of underlying mechanism of decreased organ perfusion and likely possibility of oncoming of infected daze in critically sick patients. Recognition: We thank ICMR, New Delhi for patronizing the MD PhD undertaking. Furthermore we thank Professor Shally Awasthi, Faculty Incharge, Research Cell CSMMU, Lucknow for her changeless moral support and counsel to research chaps. Table 1: Control ( n=90 ) Sir ( n=45 ) Sepsis ( n=39 ) Septic daze ( n=31 ) Age ( old ages ) 38.5AÂ ±8 37.3AÂ ±4 36.2AÂ ±7 39.1AÂ ±4 Heart rate ( beats/min ) 94AÂ ±2.3 116 AÂ ± 16 118 AÂ ± 32 124 AÂ ± 32 Respiratory rate ( breaths/min ) 16AÂ ±3.2 30 AÂ ± 8 24 AÂ ± 6 28 AÂ ± 4 Mean Blood Pressure ( mm Hg ) 90 AÂ ±10.2 89.2 AÂ ± 14.3 98.3 AÂ ± 12.5 68.8 AÂ ± 23.3 Serum Creatinine ( mg/dl ) 0.8AÂ ±2.3 3.49 AÂ ± 1.1 7.0 AÂ ± 1.3 10.12 AÂ ± 2.2 Lactates ( mM/L ) 0.93 AÂ ± 0.39 5.14 AÂ ± 1.24 7.73 AÂ ± 1.4 9.53 AÂ ± 1.2 APACHE II mark – 25.23AÂ ±6.6 28.03AÂ ±6.2 30.0AÂ ±6.3 SOFA mark – 10.89AÂ ±3.4 13.52AÂ ±3.2 13.11AÂ ±2.8 Legends: Table 1: Patients demographic features ( Mean AÂ ± SD ) Figure 1: Average serum creatinine ( mg/dl ) . Differences in average plasma degrees among each group was statistically important ( ** P lt ; 0.001 ) Figure 2: Serum creatinine degrees increased as the badness of disease increased, it correlated linearly with disease badness tonss ( APACHE II A ; SOFA ) . Figure 3: Average blood lactate ( mM/L ) . Differences in average blood degrees among each group was statistically important ( ** P lt ; 0.001 ) . Figure 4: Creatinine clearance compared with lifting blood lactate degrees. It correlated reciprocally with blood lactate degrees. How to cite Septic Shock And Kidney Injury Health And Social Care Essay, Essay examples

India For Achieving Sustainable Development-Myassignmenthelp.Com

Question: Discuss About The India For Achieving Sustainable Development? Answer: Introduction Endeavors of India for achieving the Sustainable Development Goals in a time bound and well-defined manner is very crucial for the development of the country as well as for that of the entire world (Amin, 2015). The contribution of Indias development in the health sector would contribute to the development of the worlds overall health due to the mammoth sized population of the country and the widely ranged inequalities in the socioeconomic and demographic indicators across India (Agnor, Krieger, Austin, Haneuse Gottlieb, 2014). The human development index of India is very much lower as compared to other countries like Russia, China, Brazil despite being listed among one of the largest evolving economies in the past years. India has been the largest contributor to the under-five deaths on a global scale since the decades of 19070s (Amin, 2015). The annual count of death of under-five children in India was recorded to be as high 1.2 million in the years few past years (Country Income Groups (World Bank Classification), 2017). This was accounted to be more than 6 times greater than the records of the largest populated country in the world, China (Denno, Hoopes Chandra-Mouli, 2015). India has been one of the top countries where almost seventy-five percent of the one billion people who are extremely poor live in the world (Dhana, Luchters, Moore, Lafort, Roy, Scorgie Chersich, 2014). The head count for poverty rate at the country level was extremely high which also accounted as to be 21.9 percent in the year 2012 (Agnor et al., 2014). This country also happens to have extensive hunger rate which ranks the country to be at the 97th position among 118 developing nations included in the Global Hunger Index (Darroch, 2016). India is very likely to achieve the universal access to reproductive and sexual health care services by the year 2030 as the country has been taking health goals for its population very seriously which is imminent from the measures that the country is taking (Country Income Groups (World Bank Classification), 2017). Measures for the development and maintenance of health in India Measures for the development and maintenance of health in India relates to the ancient history of the country (Germain, Sen, Garcia-Moreno Shankar, 2015). The country, which is the birth place of Ayurveda that is considered to be the ancient health souvenir, is taking steps regarding development and maintenance of health through various approaches of primary health care in the modern time (Grainger, Gorter, Okal Bellows, 2014). India happens to be a signatory to the declarations that were laid down at the ICPD which stated the objective of achieving the optimum Reproductive Health for All (Squires Anderson, 2015). This has made India to devise and implement a lot of approaches and inputs for the development and delivery of health care along with the manual assistance in regards to the health care (Kim, Goldenberg, Duff, Nguyen Gibson Shannon, 2015). Significant developments have been observed in the sexual and reproductive health care services which integrate the health growth in the aspects of family planning, education and information associated with health, and the integration of reproductive health into national programs and strategies (Katz, McDowell, Green, Jahan, Johnson Chen, 2015). It can be relevant from the fact that India has successfully obtained halting and averting HIV. India is also close to achieving the goal of eradicating the under-five mortality rate (Denno, Hoopes Chandra-Mouli, 2015). India has been very seriously implementing the SDG with very well devised ads systematic efforts, mostly at the local level of the country (UNFPA India, 2017). India has inculcated the vision of No one is to be left behind which denotes to the fact that the country has an overarching goal for reduction of inequalities across class, gender, caste, and region (Dhana et al., 2014). It is a fact that the improvements in the health care system are not up to the desired results, however, the fact that the developments in the provision of good and enhanced overall health services cannot be denied. Moreover, a great extent of inequalities and disparities has been existing in various groups of population in the country (Squires Anderson, 2015). Historical factors The concern and experience in the development in health and the primary care in health in India ages back to the Vedic period (Nath, 2017). The evidence of well-developed and maintained programs of environmental sanitation laid the underground drains and public baths. Health or Arogya was accounted as high priority aspects in the regular life and such concept included mental, socials, spiritual and physical well-being (Darroch, 2016). The lifestyle was very much favorable for the promotion of health and in the daily activities of regular life called the Dina Charya the following necessities of health care were focused: personal habits and hygiene, health education, dietary practices, exercise, sanitation, environmental sanitation, food, self-discipline and code of conduct (Germain et al., 2015). The political changes such as the onslaught of sequential foreign regimes and aggression lead to the extinction of the great era of health (Nair, Baltag, Bose, Boschi-Pinto, Lambrechts, Mathai, 2015). India is a country where the geography is frequently affected by cyclones, floods, and earthquakes. In such natural calamities, the health of the people, mostly the section of people belonging to the poorer sections gets affected (Pachauri, 2017). Through all such past events, the present governments of the country have been taking the health goals of the country with utmost priority and have been devising many approaches to provide enhanced health care to the people belonging poor and underprivileged sections of the country (IDR, 2017). Cultural factors: The cultural factors in India have played a very dominating role in the health aspects of the country, especially in the aspects of sexual and reproductive health. The family planning has been greatly affected by the cultural aspects (Squires Anderson, 2015). In many regions and culture, using contraceptives and condoms in regards to having proper family planning was considered as taboo in the past (Grainger et al., 2014). In the cases of diagnosis, there has been an element of controversy even now in the under-developed regions which have poor literacy rate (UNFPA India, 2017). Uneducated people in the country are mostly unaware of the knowledge regarding biomedicine. The government is still working to spread awareness regarding the benefits of using biomedicine (Agnor et al., 2014). Structural factors: The structural factors that have the greatest influence on health issues in India are the rules, regulations, and control from the local, national, regional and institutional and international organizations (Kim et al., 2015). Further factors that have significant implications on the issues of health include control over capital, corporations that are associated with the health industry, measures of control over the orientation of society including economic, political, cultural, ideology and social aspects (Country Income Groups (World Bank Classification), 2017). The structural factors that relate to the law, policy, and governance contribute to the implications of the people regarding sexual and reproductive health care in the country (Denno, Hoopes Chandra-Mouli, 2015). The political control over the structure of decision making in a country like India has effects on the education and information along with the integration of reproductive health into the program and strategies devised by the country (Katz et al., 2015). Critical factors: The critical factor that possesses implications on the goal of India in achieving the universal access to reproductive and sexual health services by 2030 include the implementation of the state and national agenda which requires collective efforts and political commitment on a long-term basis by the ministries for investing in providing better sexual health to the people (Germain, Sen, Garcia-Moreno Shankar, 2015). The negligence of the higher authorities towards the sexual and reproductive health of the people belonging to the lower and unprivileged sections of the society similar to what the British did during their rule in the country (Nath, 2017). The resistance presented by the people of India having obsolete and traditional beliefs can prove to be detrimental to the progress of the country in achieving these health objectives (Grainger et al., 2014). The coordination of different agencies and authorities in the government has large scale dominance over the success of the health goals of India (Nair et al., 2015). Barriers: The barriers to the implementation and obtaining better sexual and reproductive health condition for the people in India would include discrimination and stigma (Kim et al., 2015). The prejudicial attitudes of people regarding the practices and open communication with the medical professionals restrict the full-fledged execution of the approaches regarding enhancing the sexual and reproductive health of the people in the country (Katz et al., 2015). Improper management of care in the health institutions along as well as by the poor and uneducated people due to improper awareness proves to be a barrier regarding the development of health in such case (Nath, 2017). Ultimately, the individuals belonging to the poor sections of the society are getting affected. Most of such issues are resulting due to the society (Nair et al., 2015). Much of these concerns and issues in the sexual and reproductive health care are constrained due to the cultural and social beliefs (Pachauri, 2017). The funding, policies, and provision of services regarding sexual and reproductive health care are not managed in a proper way (Pachauri, 2017). India has succeeded in its programs regarding sexual and reproductive health care which can be relevant through the implementation of the National Population Policy was formulated in the year 2000 (UNFPA India, 2017). Further, the conditional cash transfer schemes such as Janani Suraksha Yojana which was formulated for the promotion of institutional deliveries have been successful in addressing the financial barriers for the people to have access to healthcare services (IDR, 2017). The government should make enhanced efforts and approaches to provide education and awareness to the uneducated and people belonging to the poorer sections of the country (Squires Anderson, 2015). Survey and inspection on the ground level need to be conducted as to be updated regarding the progress of the approaches (IDR, 2017). Conclusion: The government of India is taking multidimensional approaches to provide enhanced sexual and reproductive health care to the people along with emphasizing mental health, healthy lifestyle and favorable social environment. Empowering and involving the people in making the approaches successful is very much required for success in health care would begin from the regional level of the country. References Amin, A. (2015). Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV. Journal of the International AIDS Society, 18(6Suppl 5). Agnor, M., Krieger, N., Austin, S. B., Haneuse, S., Gottlieb, B. R. (2014). Sexual orientation disparities in Papanicolaou test use among US women: the role of sexual and reproductive health services. American journal of public health, 104(2), e68-e73. Country Income Groups (World Bank Classification). (2017). ChartsBin. Retrieved 2 September 2017, from https://chartsbin.com/view/2438 Denno, D. M., Hoopes, A. J., Chandra-Mouli, V. (2015). Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support. Journal of Adolescent Health, 56(1), S22-S41. Dhana, A., Luchters, S., Moore, L., Lafort, Y., Roy, A., Scorgie, F., Chersich, M. (2014). Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa. Globalization and health, 10(1), 46. Darroch, J. E. (2016). Research gaps in adolescent sexual and reproductive health. The Guttmacher Institute. Germain, A., Sen, G., Garcia-Moreno, C., Shankar, M. (2015). Advancing sexual and reproductive health and rights in low-and middle-income countries: Implications for the post-2015 global development agenda. Global public health, 10(2), 137-148. Grainger, C., Gorter, A., Okal, J., Bellows, B. (2014). Lessons from sexual and reproductive health voucher program design and function: a comprehensive review. International journal for equity in health, 13(1), 33. Kim, S. R., Goldenberg, S. M., Duff, P., Nguyen, P., Gibson, K., Shannon, K. (2015). Uptake of a women?only, sex?work?specific drop?in center and links with sexual and reproductive health care for sex workers. International Journal of Gynecology Obstetrics, 128(3), 201-205. Katz, K. R., McDowell, M., Green, M., Jahan, S., Johnson, L., Chen, M. (2015). Understanding the broader sexual and reproductive health needs of female sex workers in Dhaka, Bangladesh. International perspectives on sexual and reproductive health, 41(4), 182-190. Nath, A. (2017). Indias progress toward achieving the millennium development goals. Retrieved 2 September 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180952/ Nair, M., Baltag, V., Bose, K., Boschi-Pinto, C., Lambrechts, T., Mathai, M. (2015). Improving the quality of health care services for adolescents, globally: a standards-driven approach. Journal of Adolescent Health, 57(3), 288-298. Pachauri, S. (2017). Sexual and reproductive health services: Priorities for South and East Asia. (IDR), I. (2017). Indias Urban Youth Lack Credible Information on Sexual Health, but Social Media Can Help. The Better India. Retrieved 2 September 2017, from https://www.thebetterindia.com/103546/internet-youth-better-reproductive-health/ Squires, D. and Anderson, C.,(2015). US health care from a global perspective: spending, use of services, prices, and health in 13 countries. The Commonwealth Fund, 15, pp.1-16. UNFPA India | Sexual reproductive health. (2017). India.unfpa.org. Retrieved 2 September 2017, from https://india.unfpa.org/topics/sexual-reproductive-health-10