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The synergistic effects of microcredit access and agricultural technology adoption on maize farmer’s income in Kenya
Addressing global food security demands urgent improvement in agricultural productivity, particularly in developing economies where market imperfections are perverse and resource constraints prevail. While microcredit is widely acknowledged as a tool for economic empowerment, its role in facilitating agricultural technology adoption and improving agricultural incomes remains underexplored. This study examines the synergistic effects of microcredit access and agricultural technology adoption on the incomes of maize farmers in Kenya. Using household-level data, we employ an endogenous switching regression framework to control possible endogeneity in access to microcredit. Our findings shows that microcredit access positively influences the adoption of advanced agricultural technologies. Key determinants, including marital status, use of fertilizer application, access to extension services, and cooperative membership, are identified as significant determinants of microcredit access. Notably, the Average Treatment Effect on the Treated (ATT) indicates a 40.52% increase in income among farmers who access microcredit, mainly driven by the timely adoption of high-quality seeds, improved agricultural technologies, and enhanced inputs. These results highlight microcredit’s role in promoting allocative efficiency and enhancing Total Factor Productivity (TFP) within agricultural systems. Robustness checks, including propensity score matching and sensitivity analyses, corroborate these findings. The study recommends the implementation of targeted financial policies and educational initiatives meant to promote credit access, encourage savings, and enhancing financial literacy, particularly for credit-constrained households. Integrating these measures could strengthen rural financial markets and drive sustainable agricultural development across the regions.
Construction of management tools for early warning of prevacuum steam sterilization failure
Objective The aim of this study is to develop a set of management tools for early warning of steam sterilization failure, including a failure risk checklist and a calculation model for assessing early sterilization failure risk, and to verify the early warning effectiveness of the management tools through check experiment. Methods This study included two stages. The first stage involved the construction of a failure risk checklist and the development of a computational formula for early sterilization failure risk by expert consultation. In the second stage, the early warning effectiveness of the sterilization failure management tools was verified through a comparative verification method based on the consultation results of two experts. Results The evaluation system comprised a total of 10 early warning indicators divided into 3 categories: "Staff", "Steam sterilizer" and "Medical devices". The Cronbach’s α coefficient for internal consistency reliability was 0.837, the total content validity index (S-CVI) was 0.884, and the item-content validity (I-CVI) ranged from 0.762 to 1. In management practices, the sterilization qualification rate of the experimental group was 100%, compared to 99.78% in the control group. There were significant differences between the two groups in terms of accidental downtime (hours) and the normal operation rate of the equipment caused by equipment failure. Conclusion This study constructed an early warning model for the vacuum steam sterilization process failures. This model facilitates more accurate identification of sterilization failure risks, which helps medical institutions in enhancing sterilization quality control and early interventions.
Effects of two training workshops upon university students’ learning of critical thinking
We evaluated the effect of two workshops on learning about critical thinking amongst first- year university students. 66 Chilean pedagogy students participated, all female, with ages ranging between 18 and 37 years. Two experimental groups were organized, one with direct teaching (n = 22) and another one with semi-directed teaching (n = 19), plus a control group (n = 25). Pre- and post-tests were applied with an abbreviated Pencrisal critical thinking questionnaire. The results showed statistically significant differences in both experimental groups between the pre- and post-test, with a greater difference in experimental group 1, while the control showed no significant differences. The covariables evaluated were age and academic performance upon entering university, observing that even after controlling for the aforementioned variables, there are differences between the experimental groups and the control. We discuss the possible positive effect of direct teaching in critical thinking as a more effective strategy.
Effect of case management on viral load in adult clients enrolled due to non-suppression in Capricorn District, South Africa: A case control study
Background Case management is a structured, client centered approach that incorporates various strategies such as employing lay counsellors to provide psychosocial and adherence support to strengthen antiretroviral (ART) adherence, improve retention in care and viral load (VL) suppression. This study aimed to evaluate the effects of case management on VL in clients enrolled due to non-suppression (> = 50 copies/ml) in Capricorn District, Limpopo Province. Methods We conducted a case control study using two datasets (1) cases were selected from case management data collected from June 2021 to November 2022 at 35 facilities and captured on the REDCap system. (2) controls were identified from TIER.Net data from facilities where case management is not available and with at least two VLs on record since June 2021. Our study was restricted to clients with an unsuppressed (> = 50 copies) VL at enrollment, over the age of 18 years and excluded clients with a missing VL at enrollment. Using similar age, gender, and VL characteristics, an equal number of clients not receiving case management was randomly sampled from the TIER.Net data. Descriptive and multivariate logistic regression analysis were used to determine the factors associated with viral suppression. Results Our final study sample consisted of 3 256 clients, half of which received case management (N = 1 628), 1084 (33%) with a first VL in study of 50–399 copies/ml, 404 (12%) 400–999 copies/ml and 1768 (54%) >1000 copies/ml. Post case management intervention results showed that 49% had a VL below 50 copies/ml amongst those receiving case management and 44% among those who did not receive case management. In the adjusted model we found that case management (Odds ratio [OR] 1.25; 95% Confidence Interval [CI] 1.08–1.44) versus no case management, 35–54 years old (1.43; 1.07–1.91) and 55+ year old (1.88; 1.35–2.61) versus 18–24-year-old increased odds of VL suppression whilst being male (0.72; 0.61–0.84) versus being female has decreased odd of VL suppression. Conclusion Close to half of the clients had a VL below 50 copies/ml after case management. Factors that increased the odds of VL suppression were case management and older age, whilst being male was associated with reduced odds of VL suppression. Differentiated services for virally unsuppressed clients would be helpful for men. Case management was associated with viral suppression in those with a starting VL > 1000 copies/ml and not for those starting with low level viremia (50–999 copies/ml).
Determining the perceptions and practices of oncologists regarding venous thromboembolism risk assessment in ambulatory cancer patients: A qualitative study
Cancer-associated thrombosis (CAT) can increase morbidity and mortality for cancer patients. Therefore, guidelines recommend predicting VTE risk and thromboprophylaxis for high-risk patients. Many studies critique oncologists’ adherence to thromboprophylaxis guidelines for cancer patients. Meanwhile, most of these studies did not discuss in detail the reasons and facilitators for oncologists’ adherence to thromboprophylaxis guidelines. Therefore, the current study aimed to explore in depth the perceptions and practices of oncologists working in oncology centers in Baghdad, Iraq, regarding VTE and its risk assessment among ambulatory cancer patients. A qualitative study with face-to-face individual-based interviews was conducted with oncologists working in four major oncology centers in Baghdad, Iraq using a semi-structured interview guide. The guide was developed based on previous relevant literature and validated by a panel of experts. The interviews were conducted from November 2023 to January 2024. Thematic analysis approach was used for data analysis. Thirty-one oncologists were interviewed in this study. Twenty-two of the interviewed oncologists reported that they detect VTE among their cancer patients. 64% of participating oncologists reported that they did not conduct VTE risk assessments for their cancer patients. Only four oncologists reported assessing VTE risk using the Khorana score. 58% of oncologists reported that they prescribe thromboprophylaxis for high-risk patients; meanwhile, only 11% of them reported prescribing anticoagulants in a dose similar to that reported by thromboprophylaxis guidelines. 77% of participating oncologists reported that pharmacists have a significant role in preventing cancer-related thrombosis by helping physicians prescribe a safe and effective prophylactic anticoagulant and in calculating VTE risk scores. In conclusion, CAT is commonly diagnosed among Iraqi cancer patients. VTE risk assessment for ambulatory cancer patients is rarely conducted by oncologists working at Oncology centers in Baghdad, Iraq. The prophylactic anticoagulants were rarely prescribed in appropriate dose and/or duration for patients at high risk of VTE. Pharmacists can help oncologists follow thromboprophylaxis guidelines by calculating VTE risk score and recommending a safe and effective dose of appropriate prophylactic anticoagulant.Educating and training oncologists about VTE risk assessment is recommended to enhance their practice in thromboprophlaxis.
Telehealth equity and access communication skills pilot simulation for practicing clinicians
Objectives This pilot study evaluated a telehealth training simulation program for practicing clinicians, specifically focused on addressing patient issues of equity and access to healthcare via improving telehealth communication. Methods Participants participated in a one-hour simulation experience with two cases. Performance was assessed pre- and post-intervention using a checklist measuring communication domains related to equity and access in telehealth. Participant satisfaction was secondarily measured via survey. Results Results showed measurable gains in clinicians’ abilities to effectively incorporate equity and access communication skills. Participants found the session useful and recommended the training experience. Conclusions The findings of this pilot study highlight the potential of simulation-based telehealth training for practicing clinicians, emphasizing clinicians’ attention to patients’ equitable access to healthcare. Future studies should aim to explore the durability of learning and investigate the generalizability of this training approach to other telehealth competencies and settings.
Identity, language and communication concerns of subcultures: The case of Antalya Cretans
In today’s world, there is almost no homogeneous culture without interaction, and multiculturalism has become the most important phenomenon for all societies. Therefore, this cultural diversity, consisting of differences in culture, language, identity, religion, etc. has also brought along many problems. In the United Nations Educational, Scientific and Cultural Organization’s in “Convention for the Safeguarding of Intangible Cultural Heritage”, it is stated that identifying, documenting and surveying intangible cultural heritage of communities contributes to social harmony and tolerance. This research has been conducted on the identity, language, and communication of the Cretan in Türkiye. The purpose of the study is to contribute to social peace and tolerance by examining the identity, language, and communication perceptions and concerns of the Crete-origin community living in Türkiye as a subculture group, within the context of multiculturalism and intercultural communication. In this direction, preliminary interviews, observations and semi-structured in-depth interviews were made in the fieldwork carried out between May-July 2024 in the of the Cretan immigrants who have migrated and settled in Antalya at the first settlements one of the world cities with intense multiculturalism. In the study, an answer has been sought to the question “What are the identity and linguistic anxiety, harmony and conflict situations in the communication and interaction of Cretans living in Turkey as a subculture with the dominant culture?”. The findings were subjected to thematic and descriptive analysis and interpreted. It is predicted that the findings and results of this research can be used to contribute to studies aimed at preventing identity, linguistic and cultural incompatibility and possible conflicts caused by increasing migration movements.
Energy consumption forecasting for oil and coal in China based on hybrid deep learning
The consumption forecasting of oil and coal can help governments optimize and adjust energy strategies to ensure energy security in China. However, such forecasting is extremely challenging because it is influenced by many complex and uncertain factors. To fill this gap, we propose a hybrid deep learning approach for consumption forecasting of oil and coal in China. It consists of three parts, i.e., feature engineering, model building, and model integration. First, feature engineering is to distinguish the different correlations between targeted indicators and various features. Second, model building is to build five typical deep learning models with different characteristics to forecast targeted indicators. Third, model integration is to ensemble the built five models with a tailored, self-adaptive weighting strategy. As such, our approach enjoys all the merits of the five deep learning models (they have different learning structures and temporal constraints to diversify them for ensembling), making it able to comprehensively capture all the characteristics of different indicators to achieve accurate forecasting. To evaluate the proposed approach, we collected the real 880 pieces of data with 39 factors regarding the energy consumption of China ranging from 1999 to 2021. By conducting extensive experiments on the collected datasets, we have identified the optimal features for four targeted indicators (i.e., import of oil, production of oil, import of coal, and production of coal), respectively. Besides, we have demonstrated that our approach is significantly more accurate than the state-of-the-art forecasting competitors.
Soil bacterial and fungal diversity and composition respond differently to desertified system restoration
Desertification is a major ecological issue worldwide that results in the destruction of terrestrial ecosystems. Restoration of desertified ecosystems has been carried out in recent decades, but the role of soil microorganisms in this process is poorly understood. Thus, to deconstruct the effects of desertified system restoration on soil microbial communities, we examined the changes in soil characteristics as well as the variations in and drivers of soil microbial diversity and community composition of the Hulun Buir Sandy Land in Northeast China, where restoration activities have been performed for approximately 30 years. The results revealed that with desertified system restoration, plant species richness and aboveground biomass increased significantly. The soil properties, characterized by organic carbon, total nitrogen and available nitrogen content improved. Moreover, soil pH decreased significantly from 7.75 in mobile dunes to 7.17 in fixed dunes (P < 0.05). Compared to mobile dunes, the Chao1 and Shannon diversity indices of bacteria increased significantly in fixed dunes. In contrast, the fungal richness index (Chao1 index) decreased significantly during desertified system restoration. The fungal Shannon diversity index also showed a decreasing trend, although it was not significant (P > 0.05). Proteobacteria was the most prevalent bacterial phylum, with a relative abundance of over 40%. In fixed dunes, the relative abundances of Actinobacteria, Acidobacteria, Gemmatimonadetes, and Chloroflexi significantly increased, whereas the relative abundance of Firmicutes significantly decreased. For fungi, Ascomycota was the dominant phylum, with a relative abundance of 97.6% in fixed dunes compared with 82.4% in mobile dunes. Plant species richness and soil pH were the major determinants of the soil microbial communities. This research provides important insights into the changes in soil microbial communities and their relationships with environmental factors during desertified system restoration, which can help guide sustainable land management practices and the restoration of desertified areas.
NMR spectroscopy derived plasma biomarkers of inflammation in human populations: Influences of age, sex and adiposity
Understanding the distribution and variation in inflammatory markers is crucial for advancing our knowledge of inflammatory processes and evaluating their clinical utility in diagnosing and monitoring acute and chronic disease. 1H NMR spectroscopy of blood plasma and serum was applied to measure a composite panel of inflammatory markers based on acute phase glycoprotein signals (GlycA and GlycB) and sub-regions of the lipoprotein derived Supramolecular Phospholipid Composite signals (SPC1, SPC2 and SPC3) to establish normal ranges in two healthy, predominantly white cohorts from Australia (n = 398) and Spain (n = 80; ages 20–70 years). GlycA, GlycB, SPC1 and SPC3 were not significantly impacted by age or sex, but SPC2 (an HDL-related biomarker) was significantly higher in women across all age ranges by an average of 33.7%. A free-living Australian population cohort (n = 3945) was used to explore the relationship of BMI with the panel of inflammatory markers. The glycoprotein signals were directly associated with BMI with GlycB levels being significantly higher for women in all BMI classes. Conversely, SPC2 was found to be inversely associated with BMI and differed significantly between the sexes at each BMI category (normal weight p = 3.46x10-43, overweight p = 3.33x10-79, obese p = 2.15x10-64). SPC1 and SPC3 were markedly less affected by BMI changes. Given the significant association between SPC2 and sex, these data suggest that men and women should be modelled independently for NMR-determined inflammatory biomarkers, or that data should be corrected for sex.
Persistence of Phi6, a SARS-CoV-2 surrogate, in simulated indoor environments: Effects of humidity and material properties
The SARS-CoV-2 virus caused the COVID-19 pandemic and brought major challenges to public health. It is transmitted via aerosols, droplets, and fomites. Among these, viral transmission through fomites is not well understood although it remains a very important transmission route. This motivated us to study how fomites play a role in viral transmission within controlled indoor environments. To achieve this, we investigated viral aerosol persistence on fomites under different humidity levels to mimic the built environment. We developed a protocol to study the effect of humidity on viral infectivity using a full-scale environmental chamber. The results show that the infectivity of aerosolized Phi6 in air decreased by ≥ 1 log10 as the relative humidity (RH) increased from 25% to 75% but then increased by ≥ 1 log10 as the RH further increased to 85%, resulting in a characteristic V-shape curve which varied with exposure time. Consistently, we show that although material properties may impact viral persistence, changes in the local humidity more significantly influence viral persistence on fomites. These results provide new insights into indoor fomite-mediated viral transmission under different environmental conditions. These findings will help guide the design of more effective strategies for viral control in indoor environments.
Machine learning model to study the rugby head impact in a laboratory setting
The incidence of head impacts in rugby has been a growing concern for player safety. While rugby headgear shows potential to mitigate head impact intensity during laboratory simulations, evaluating its on-field effectiveness is challenging. Current rugby-specific laboratory testing methods may not represent on-field conditions. This study aimed to create a machine-learning model capable of matching head impacts recorded via wearable sensors to the nearest match in a pre-existing library of laboratory-simulated head impacts for further investigation. Separate random forest models were trained, and optimised, on a training dataset of laboratory head impact data to predict the impact location, impact surface angle, neck inclusion, and drop height of a given laboratory head impact. The models achieved hold-out test set accuracies of 0.996, 1.0, 0.998, and 0.96 for the impact location, neck inclusion, impact surface angle, and drop height respectively. When applied to a male and female youth rugby head impact dataset, most impacts were classified as being to the side or rear of the head, with very few at the front of the head. Nearly 80% were more similar to laboratory impacts that included the neck with an impact surface angled at 30 or 45° with just under 20% being aligned with impacts onto a flat impact surface, and most were classified as low drop height impacts (7.5-30cm). Further analysis of the time series kinematics and spatial brain strain resulting from impact is required to align the laboratory head impact testing with the on-field conditions.
University students’ health-related quality of life and its determinants. Results from a cross-sectional survey during the COVID-19 pandemic
Being a university student is a vulnerable period marked by transitions and uncertainties which can impair their physical and mental well-being as well as overall quality of life. The existing literature suggests that certain groups of students might be particularly affected by that. In addition, quality of life might have been further affected by the COVID-19 pandemic. Therefore, this article investigated university students’ quality of life and its determinants during the COVID-19 pandemic using an online survey among students of one German university. Quality of life was measured using SF-12’s physical (PCS) and mental dimension (MCS). We conducted stratified descriptive analyses followed by regression analyses. 875 respondents completed the questionnaire, of whom 63.0% were female and 95.7% had a German nationality and 16.0% reported having a migration background. Mean age was 23 years. Medical (17.7%) and law students (15.8%) were the biggest groups, but all other faculties of the university were also covered. Concerning respondents’ health-related quality of life, mean PCS was 51 (95%CI = (47–55)), while mean MCS was 36 (95%CI = (30–43). Students with non-German nationality (PCS: 49; MCS: 29) and students with migration background (PCS: 50; MCS: 31) showed particularly low quality of life in the mental dimension. In multivariable regression analyses, associations of the included determinants with PCS were rather weak. In contrast, there were strong associations between MCS and having a migration background with regression coefficient β = -26.1 (95%CI = (-38.5 – -13.7)) and studying Law with β = -17.7 (95%CI = (-28.2 – -7.2)). When comparing these findings with pre-pandemic studies, it seems that university students’ quality of life during the pandemic was as low as it had been before while–as in pre-pandemic studies–certain groups of students generally fared worse than others did. This suggests that universities should actively promote students’ health and should implement measures to specifically support particularly vulnerable students such as students with migration background or students of certain subjects.
Unveiling the efficacy of repetitive transcranial magnetic stimulation in Parkinson’s disease: A comprehensive review of systematic analyses
Background Many systematic reviews (SRs) have reported the repetitive transcranial magnetic stimulation (rTMS) for Parkinson’ s disease (PD), but the quality of the evidence is unclear. The aim of this study was to summarize the evidence provided by SRs on the effect of rTMS on PD. Methods A comprehensive search for SRs published from the establishment of the library to March 1, 2024, was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, VIP and Wanfang databases. The A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), the Risk of Bias for Systematic Reviews (ROBIS), and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool were used to evaluate the methodology quality, risk of bias and evidence quality of SRs, respectively. Results We identified 16 SRs. According to the results of the AMSTAR-2, 12.5% (2/16) of the SRs rated as high quality, 43.75% (7/16) rated as low quality, and 43.75% (7/16) rated as very low quality. Based on the ROBIS tool, 6 (37.5%) SRs had low risk of bias. The GRADE results suggested that 16.13% (10/62) of the evidence was of moderate quality, 33.87% (21/62) of the evidence was of low quality and 50% (31/62) of the evidence was of very low quality. Moderate-quality results show that rTMS can improve PD motor symptoms. Conclusions Here we show that rTMS can improve the motor symptoms of PD, but its effectiveness in treating non-motor symptoms of PD is inconsistent. Due to the methodological limitations and diversity in study designs, future studies should focus on addressing these issues by providing thorough methodological details, standardizing rTMS protocols, evaluating side effects, and comparing with other treatments.
Individual and community-level determinants of knowledge of obstetric danger signs among women in Southern Ethiopia: A multi-level mixed effect negative binomial analysis
Introduction One of the key strategies to achieve the sustainable development goal by reducing maternal deaths below 70 per 100,000 is improving knowledge of obstetric danger signs (ODS). However, mothers’ knowledge of ODS is low in general and very low in rural settings, regardless of local and national efforts in Ethiopia. Further, there is significant variation of ODS knowledge among women from region to region and urban/rural settings. Most studies are limited only to northern Ethiopia and focused on individual-level determinants. Thus, this study aimed to assess the individual and community-level determinants of knowledge of obstetrics danger signs among women who delivered in the last 12 months in the northern zone of the Sidama region, Ethiopia. Methods We conducted a community-based cross-sectional study from October 21 to November 11, 2022. A multi-stage sampling procedure was utilized to select study participants. A structured and pretested questionnaire was utilized to collect data. Open Data Kit (ODK) smartphone application was used to collect data at women’s homes. A multi-level mixed-effects negative binomial regression model was used to control effects of clusters and confounders. Results The overall response rate of this study was 99.12%. The proportion of knowledge of obstetrics danger sign was 22.3% (95% CI: 18.7, 25.9). Government-employed women [adjusted incidence ratio (AIR) = 1.37; 95% CI: 1.20, 1.56], women who had exposure to mass media (AIR = 1.16; 95% CI: 1.08, 1.25), women who had received model family training (AIR = 1.15; 95% CI: 1.10, 1.25), autonomous women (AIR = 1.34; 95% CI: 1.25, 1.46), women who had faced health problems during pregnancy (AIR = 1.21; 95% CI: 1.11, 1.32), and urban women (AIR = 1.22; 95% CI: 1.09, 1.62) were determinants positively affect knowledge of ODS. Conclusion Only one in five women has good knowledge of ODS in the study setting. Urban residence, mass media exposure, receiving model family training, facing health problems during pregnancy, and women’s autonomy were the main determinants of knowledge of ODS. Any intervention strategies should focus on multi-sectorial collaboration to address determinants of knowledge of ODS at the individual and community level. Reinforcing the existing model family training, particularly focusing on rural women and women who denied autonomy in decision-making about health care, should be considered. Awareness creation should be increased about ODS through mass media exposure.
Somatization symptomology and its association with stress in patients with irritable bowel syndrome
Irritable Bowel Syndrome (IBS) patients and Somatization Symptom Disorder (SSD) patients experience somatization symptoms relative to their corresponding processes. IBS patients may also have a diagnosis of both IBS and SSD. Somatization symptoms cause significant psychological, emotional and social distress. Conversely, stress in any form is believed to contribute to IBS symptoms. Whether stress mediated somatization symptoms in patients with IBS provide a pathway for these IBS symptoms is not as well understood. This cross-sectional study was performed at Shifa International Hospital, Islamabad between March 1st, 2023, and January 14th, 2024. Purposeful sampling was done to recruit study participants from three different populations as somatization is common in all three populations. As a result, there were three different samples in the study. Participants were eligible to participate if they had a diagnosis of IBS, somatic symptom disorder (SSD), or IBS with somatization (IBS-SSD) and were currently receiving treatment at the gastroenterology outpatient clinic and/or psychiatric outpatient clinic. Patient Health Questionnaire (PHQ-15) and Somatic Stress Response Scale (SSRS) were used to assess somatic symptoms and their association of stress-related somatic symptoms. Data was entered and analyzed using descriptive and inferential statistics. Data was self-reported by the participants. The largest sample size 67(100%) was from the IBS patient population. Two other samples were small i.e., there were 21 (100%) participants in SSD sample, and a very few numbers of participants 12 (100%) in the IBS diagnosis with a comorbidity of SSD sample. Majority of the patients were young i.e., 50≤ (77.7%), (71.4%), (74.99%); and male (59.7%), (66.6%), (50.0%) from the IBS, SSD, and IBS-SSD samples. Majority of the participants in the IBS (56.7%) and SSD (61.9%) samples had a high school diploma or the equivalent. In the IBS-SSD sample, the largest percentage (41.7%) of participants had more than a bachelor’s degrees. M = 85.67 (+/-23.26) for SSRS scores and M = 17.81(+/-5.28) for PHQ-15 scores in SSD patients. M = 75.21 (+/-19.59) for SSRS scores and M = 14.76 (+/-5.07) for PHQ-15 scores in IBS patients. M = 75.17 (+/-20.55) for SSRS scores and M = 14.92 (+/-6.27) for PHQ-15 scores in IBS-SSD patients. Many participants had somatization symptoms in the severe range (≥ 15) i.e., 34(50.7%), 17(81.0%), 6(50.0%) in IBS, SSD, and IBS-SSD samples respectively. Considering the PHQ scores by age in the IBS sample, highest mean scores were observed for the highest age group (60–69 years) i.e., 16.50 (+/- 5.68) despite fewer number of participants in this age group. PHQ scores also significantly differed by education groups i.e., significant differences were observed between education group 1 and 2 as well as group 2 and 3, p<0.05. On simple linear regression, PHQ-15 scores significantly predicted variations in SSRS scores, p <0.05, R2 = 69.6% for IBS sample, R2 = 68.7% for the SSD sample, and R2 = 66.0% for patients with IBS, SSD and IBS with somatization respectively. Stress related somatic symptoms are positively correlated with somatization complaints in IBS patients. Increased somatization scores were observed in the elderly. Targeted psycho-social interventions could help mitigate the negative effects of somatization in IBS patients.
Effect of the COVID-19 pandemic on colorectal cancer screening in two university-affiliated health care systems
Objectives In two large university affiliated healthcare systems, we examined trends in colorectal cancer (CRC) screening both prior to and during the COVID-19 pandemic to compare the trends in non-invasive screening tests and colonoscopy. Materials and methods In this retrospective time-trend analysis, we obtained the numbers of colonoscopies and non-invasive tests performed monthly during the pandemic and the year prior to it. We obtained colonoscopy data from five endoscopy units with the indication determined by dual independent review. Monthly numbers of completed fecal immunochemical (FIT) and FIT-DNA tests were obtained from the electronic medical records of both health systems. Trends in testing, numbers, and stage of incident CRCs diagnosed during the 30-month interval were examined using Poisson regression and logistic regression, respectively. Results From January 2019 to June 2021, we identified 16,939 FIT tests, 2,942 FIT-DNA tests, and 38,332 colonoscopies from the two health systems, and 368 colorectal cancers (105 early stage, 263 advanced stage) from the private hospital system. Overall colonoscopy volume declined by 18.7% (from 16,483 to 13,393) in 2020 compared to 2019 in both health systems, returning to baseline in 2021. Non-invasive tests declined by 21.9% in 2020, but increased in 2021 due to greater use of FIT/DNA. Compared to 2019, incident CRCs declined in 2020 but rebounded in 2021, with no difference in early versus late-stage cancers. Conclusions These trends in CRC screening tests may be useful for modeling the effects of the pandemic on the longer-term outcomes of CRC incidence and mortality.
Preventing zoonotic spillover through regulatory frameworks governing wildlife trade: A scoping review
Wildlife trade can create adverse impacts for biodiversity and human health globally, including increased risks for zoonotic spillover that can lead to pandemics. Institutional responses to zoonotic threats posed by wildlife trade are diverse; understanding regulations governing wildlife trade is an important step for effective zoonotic spillover prevention measures. In this review, we focused on peer-reviewed studies and grey literature conducted on regulatory approaches that govern domestic and international wildlife trade in order to assess the role of local, national and global-level institutions in the prevention of zoonotic spillover and infection transmission between humans. The five-stage scoping review protocol described by Arksey and O’Malley to map key concepts and main sources and types of evidence available was followed to understand and analyze empirical evidence from peer-reviewed studies and grey literature conducted on regulatory approaches that govern domestic and international wildlife. Sources were included if they discuss at least one of three points: regulatory approaches governing the wild animal trade, including wild animal markets, traditional medicine or exotic pets; regulatory approaches governing importation of wild animals and the international wildlife supply chain; or the role of local, national, and global-level institutions in regulating wild animal trade for food, traditional medicine or exotic pets. A total of 1598 sources were retrieved, from which 32 sources were included in the final review (30 studies + 2 grey literature reports). Based on published literature, regulations governing wildlife trade are inconsistent within and between countries. Organizations regulating wildlife trade may have competing interests, which can lead to fragmentation and a lack in coordination and oversight. National compliance with international regulations can be an issue. Reducing the probability of spillover events in wildlife trade is key to prevent future pandemics. Our results indicate a need for enhanced regulatory harmonization within and between national and supranational regulations. Coordination and collaboration for prevention of zoonotic infection and spillover may be enhanced through future research focused on the effectiveness of timely Information sharing and global- and national- level harmonization of wildlife trade regulations.
Insufficient LGBTQ+ education across disciplines suggested by national survey of health professionals in training
Health professionals often feel underprepared to treat patients who identify as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+). Additionally, lack of access to professionals who are knowledgeable about LGBTQ+ inclusive care contributes to the myriad of health disparities experienced by LGBTQ+ communities. This cross-sectional survey study explores the preparedness of healthcare profession trainees for caring for LGBTQ+ patients by quantifying the hours and quality of training health profession trainees receive in LGBTQ+ education across disciplines. We surveyed US-based health professionals in training (HPiT) across disciplines (N = 155) on their training programs’ LGBTQ+-specific curricula and educational opportunities. Ordered logistic regression analysis assessed the relationship between the number of hours of LGBTQ+-specific education and other discipline, organization, and individual factors. Respondents reported an average of 4.75 (SD = 3.04) hours devoted to LGBTQ+-specific education. Physician assistant trainees reported receiving the highest number of hours of LGBTQ+-specific education (M = 6.63, SD = 1.98), followed by psychology (M = 5.30, SD = 3.54), medical (M = 5.12, SD = 3.38), nursing (M = 4.17, SD = 3.28), and trainees in other health fields (M = 3.88, SD = 2.47). Across all disciplines, trainees rated their LGBTQ+-specific education on average as “good”. Despite rising awareness, the quantity and quality of dedicated LGBTQ+-specific education remains concerningly low across all measured disciplines and US regions. Future research must investigate strategies to overcome common barriers to increasing LGBTQ+ education in health professions training by maximizing the impact of limited hours through integrating LGBTQ+ content into existing materials, supporting trainee leadership, and implementing institutional support for educators teaching LGBTQ+ content. Regulatory bodies must reconsider the current guidance for LGBTQ+ education quantity and quality to advise institutions on best-practice guidelines to prepare trainees for LGBTQ+ patient care.
Pain management practice and associated factors among nurses working in Ethiopia: A systematic review and meta-analysis
Background Pain management is a crucial component of patient care that promotes relaxation, lowers complications, improves quality of life, and shortens hospital stays. Several studies assessed the nurses’ pain management practices in Ethiopia. However, the findings of these studies are highly variable and inconsistent. Therefore, the study aims to determine the overall prevalence of pain management practice and associated factors among nurses working in Ethiopia. Method The study included all observational quantitative research articles conducted among nurses in Ethiopia. We used Google Scholar, PubMed, Cochrane Library, and Scopus searching databases. The Newcastle—Ottawa Scale was used to check the study quality. Then I2 statistics and Cochran’s Q test were used to evaluate heterogeneity. The Funnel, Egger’s test, and non-parametric trim and fill effect tests were used to check publication bias by using a random effect model. Finally, we conducted subgroup analysis and sensitivity tests to evaluate statistical heterogeneity and the presence or absence of any influential study. Result In the final analysis, we included eighteen studies, and 4,213 nurses participated. The overall pooled prevalence of nurses with good pain management practice was 43.79% (95% CI: 38.52, 49.06%). In-service training AOR; 95% CI 3.21 (1.87, 4.54), good knowledge AOR; 95% CI 2.44 (1.78, 3.09), positive attitudes AOR; 95% CI 2.84 (1.24, 4.44), and pain management guidelines in health facilities AOR; 95% CI 3.46 (1.48, 5.44) were the significant associated factors with pain management practice among nurses in Ethiopia. Conclusion This study found that over half of Ethiopian nurses had poor pain management practices. Knowledge, attitude, training, and pain management guidelines in health facilities were significant factors. Therefore, health managers and stakeholders should prioritize pain management awareness, attitudes, availability of guidelines, and in-service training to improve patient care and outcomes.