Health Morbidity Research Articles

SAT374 Indirect and Intangible Burden of PCOS: A Patient Advocacy Organization Study

Abstract Disclosure: L. Thai: Employee; Self; PCOS Challenge: The National Polycystic Ovary Syndrome. O. Delau: None. S. Yadav: None. R.P. Buyalos: Employee; Self; Fertility & Surgical Associates of California. S. Ottey: Employee; Self; Executive Director at PCOS Challenge: The National Polycystic Ovary Syndrome. Other; Self; Received honoraria from Institute for Family Centeredness, Travel support for attendance at Women's Health Innovation Summit. W. Patterson: Employee; Self; PCOS Challenge: The National Polycystic Ovary Syndrome. R. Azziz: Advisory Board Member; Self; Arora Forge. Consulting Fee; Self; Rani Therapeutics, Fortress Biotech, Spruce Biosciences, Core Access Surgical Technologies. Grant Recipient; Self; Foundation for Research and Education Excellence, Ferring Pharmaceuticals. Stock Owner; Self; Martin Imaging. Background: Polycystic Ovary Syndrome (PCOS) is a complex genetic trait, and the most common endocrine disorder of women, clinically evident in between 10% to 20% of all reproductive-aged women. PCOS is associated with reproductive, cardio-metabolic, dermatologic, maternal health and mental health morbidities, with an estimated healthcare-associated economic burden exceeding $15 billion yearly for the U.S. alone. However, the extent of indirect (lost wages due to disability or death related to the disease) and intangible (related to pain, suffering, and reduced QOL) costs of PCOS are unknown. Objective: To determine the extent of the indirect and intangible burden of PCOS. Materials and methods: We performed a prospective survey among members of an international patient advocacy organization using the Work Productivity and Activity Impairment Questionnaire: General Health v2.0 (WPAI:GH), the European QOL (EQ-5D), and the Willing-to-Pay (WTP) assessment instruments. Results: A total of 426 women responded to the study. The WPAI:GH indicated that 77.9% (332/426) were employed and had worked in the past 7 days, with 71.1% working ≥31 hrs. Of all respondents, 20.4% (70/344) reported missing ≥6 hrs for health problems. Health problems significantly (Likert score 8-10) affected the ability to do regular daily activities in 18.3% and productivity while working in 9.0%. Of the total hours worked, 9.97% (1162/11654) were reported as missed due to health problems. The EQ-5D survey indicated that 51.6% and 35.8% of respondents suffered moderate to extreme anxiety/depression and pain/discomfort, resp; and 11.5%, 6.0%, and 18.9% reported moderate to significant difficulty in walking, self-care (washing and dressing), and usual activities (e.g., housework, etc.), resp. When assessing how good or bad their health was on the day of the survey, 40.6%, 50.1%, and 9.2% described it as the ‘best/near best’, ‘moderate’, or ‘worse/near worse’ that they could imagine, resp. When queried regarding the maximum amount they were WTP as a one-time payment within their economic means for a hypothetical cure of PCOS, 61.0%, 24.9%, and 12.7% of respondents stated they were willing to spend $0-$5000, $5001-$25,000, and >$25,000, resp, although many noted they were willing to pay well beyond what they could afford. Conclusions: Regarding indirect burden, due to health problems, 10% of total hours worked were reported missed, and 20% of respondents reported missing ≥6 hrs.; in 9% of respondents, health problems significantly affected work productivity. Regarding intangible burden, >50% of respondents reported significant anxiety/depression and 20% moderate to significant difficulty in their usual activities; 10% reported their health as the worse/near worse they could imagine. Overall, the economic burden of PCOS far exceeds its direct medical costs, and indirect and intangible costs need to be considered. Presentation Date: Saturday, June 17, 2023

Sleep and circadian disruptors: Unhealthy noise and light levels for hospitalized pediatric patients.

Noise and light levels during hospitalizations can disrupt sleep and circadian health, resulting in worsened health outcomes. This study describes patterns of noise and light for inpatient children undergoing stem cell transplants. Objective meters tracked noise and light levels every minute for 6 months. Median overnight sound was 55 dB (equivalent to conversational speech). There were 3.4 loud noises (>80 dB) per night on average. Children spent 62% of the 24-h cycle in nonoptimal lighting, with daytime light dimmer than recommended 98% of the time. Over the 6-month period, the lowest overnight noise level recorded exceeded World Health Organization recommendations for sleep, with frequent spikes into ranges known to cause wakings. During the day, children were rarely exposed to light sufficient to preserve healthy circadian rhythms. Hospitals should address systematic environmental and workflow disruptors to improve the sleep and circadian health of patients, particularly those already at elevated risk for health morbidities.

The Certified QPR Pathfinder Training Program: A Description of a Novel Public Health Gatekeeper Training Program to Mitigate Suicidal Ideation and Suicide Deaths

Suicide represents a significant public health concern. One approach to reducing suicide rates is to train gatekeepers—community members who, through their day-to-day practices, interact with a substantial proportion of the population—to detect individuals at elevated suicide risk and refer them to appropriate mental health care services. One of the most well-known community gatekeeper training programs is Question, Persuade, and Refer (QPR), which has been delivered to millions worldwide. Gatekeeper training, including QPR, shows considerable promise in reducing suicide risk. However, one limitation of existing gatekeeper training programs is that they rely on referrals to mental health services, which are often non-existent, understaffed, and/or undertrained regarding suicide risk. As such, novel approaches are needed to equip community gatekeepers with primary mental health first aid and suicide-focused counseling. This article describes, for the first time, the fundamental concepts of a newly developed and more expansive version of QPR, the QPR Pathfinder Training. The QPR Pathfinder Training is web-based training program designed to create a cadre of “super gatekeepers” to address suicide at scale. The QPR Pathfinder Training will equip communities to address the critical shortage of mental health care services around the globe and, in turn, reduce mental health morbidities and decrease the suicide rates.

Neurocognitive impairment associated with chronic morbidity in long-term survivors of Hodgkin Lymphoma

AbstractThoracic radiation is associated with significant cardiopulmonary morbidities in survivors of long-term Hodgkin lymphoma and may affect neurocognitive outcomes. Survivors (N = 204; 52.5% female; mean [standard deviation] age, 36.6 [8.01] years) treated with thoracic radiation and age-, sex-, and race/ethnicity-matched community controls (N = 205; 51.7% female; age, 36.7 [9.17] years) completed standardized neurocognitive testing, echocardiography, pulmonary function tests, and vascular studies during the same visit. Treatments were abstracted from medical records. Cardiac (ie, left ventricular ejection fraction [LVEF], global longitudinal strain [GLS]), vascular (ie, large and small artery elasticity [SAE]), pulmonary (ie, diffusing capacity of the lungs for carbon monoxide [DLCO] and forced expiratory volume [FEV1]), and chronic health conditions were evaluated for associations with age-adjusted neurocognitive performance using multivariable linear regression. Compared with controls, survivors had lower performance (P < 0.05) in visuomotor (0.11 vs 0.41), visual processing speed (0.25 vs 0.64), short-term recall (−0.24 vs 0.12), and flexibility (−0.04 vs 0.28). Survivors had lower pulmonary (FEV1, DLCOcorr), cardiac (LVEF, GLS), and vascular function (SAE) than controls (all P < 0.001). FEV1 was associated with visuomotor (P = .008) and visual processing speed (P = .05), and flexibility (P = .05). GLS was associated with short-term recall (P = .03). SAE was associated with flexibility (P = .007). Neurocognitive outcomes were also associated with moderate-to-severe neurologic chronic conditions (P < .05). Findings suggest a link between subclinical cardiopulmonary and vascular findings, neurologic morbidity, and neurocognitive impairments. Prevention of health morbidity may benefit neurocognitive outcomes.

PTSD and alcohol use disorders predict the pace of cellular aging

Advanced epigenetic age is associated with psychopathology and may help to explain the link between psychopathology and physical health morbidity and mortality. Using a longitudinal sample of 171 trauma-exposed Veterans, we modeled the rate of change in epigenetic age across two time points (averaging 5.58 years apart) using two epigenetic age algorithms (GrimAge and Horvath) and tested associations with posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), and depression. Results showed that PTSD (β = .199) and AUD (β = .186) were associated with a quickened pace of epigenetic aging over time (ps <.021). Results replicate and extend prior work and offer foundational support for identifying interventions that slow the pace of biological aging among those with psychopathology.

Factors associated with colonization by carbapenem-resistant enterobacteria in oncological patients: a case-control study

Introduction: Colonization and infections caused by Carbapenemase Producing Enterobacteria (CPE) are a global problem, being associated with an increase in hospitalization time, costs for health services, and morbidity and mortality rates. Oncologic patients represent a group of special interest and there are few studies involving CPE colonization among these patients. Aim: to investigate factors associated with colonization in cancer patients. Outlining: Case-control study developed in a tertiary reference hospital in cancer treatment in Porto Alegre, Brazil, from January to December 2017. The population consisted of patients diagnosed with cancer in clinical or surgical hospitalization. Results: The univariate analysis showed that variables associated with colonization by CPE were age, male sex, tumors with bone type of surgical hospitalization, number of intra-hospital transfers since hospitalization, hospitalization time &gt;30 days, ICU hospitalization in the last 30 days, ICU time more than 15 days, surgical procedure in the last 30 days, use of antibiotics in the last 30 days, presence of tumor wound, and KPC infection. After multivariate analysis, male sex, external hospital as origin, hospital stay longer than 30 days, antibiotic use in the last 30 days, and presence of tumor wound, remained associated with EPC colonization. Use of aminoglycosides, and linezolide were associated with CPE colonization. Implications: We identified variables associated with CPE colonization in oncologic patients. Our results may indicate actions to prevent CPE colonization and consequent development of infections.

Who persistently consumes dietary supplements? A multifaceted analysis using South Korea's nationally representative health and nutrition examination survey data.

This study aimed to identify multifaceted factors affecting intake of dietary supplements among Koreans. Korean National Health and Nutrition Examination Survey (KNHANES) data from 2018 to 2020 were obtained, pertaining to functional food intake, health related behaviors and morbidities. A total of 12,031 participants representing the Korean adult population were identified into two groups: 1 year more consumer group (N = 4,345) vs. non-consumer group (N = 7,686). A logistic regression analysis was performed to analyze the predictors of dietary supplement consumptions. Sociodemographic variables were associated with dietary supplement use. Participants who were female (odds ratio [OR] = 1.85; 95% CI, 1.59-2.15), older (OR = 1.06; 95% CI, 1.04-1.08), married (OR = 6.39; 95% CI, 3.44-11.85), highly educated, and high income earners consumed significantly more dietary supplements. Non-smoking (OR = 1.27; 95% CI, 1.06-1.53) and performing aerobic exercise (OR = 1.28; 95% CI, 1.13-1.46) predict dietary supplement consumption. Self-rated health status and health-related quality of life increased the likelihood of dietary supplement intake by 1.86 (OR = 1.86; 95% CI, 1.04-3.32) and 7.77 times (OR = 7.77; 95% CI, 1.66-33.40), respectively. The number of chronic diseases, cancer, or stroke was not significantly associated with intake. Those with obesity tended to less consume dietary supplements (OR = 0.85; 95% CI, 0.74-0.97). Hypertension (OR = 3.14; 95% CI, 1.36-7.21), osteoporosis (OR = 1.47; 95% CI, 1.11-1.95), and asthma (OR = 0.44; 95% CI, 0.27-0.73) were significantly associated with the intake. Considering that healthy behaviors and subjective health led to the consumption of dietary supplements, whereas current disease or catastrophic experience did not, the intake of dietary supplements should be included in health promotion in Korea.

719 Barriers and Facilitators Towards People Experiencing Homelessness When Accessing Surgical Care: A Critical Review of the Literature

Abstract Aim People experiencing homelessness (PEH) are a vulnerable group in which physical health morbidities are much more common than the general population. Despite this, the inability to access healthcare remains a main concern. This literature review aims to identify the barriers and facilitators PEH face towards accessing safe surgical care, and to provide actionable strategies. Method A literature search was carried out on multiple databases. Thematic analysis of the included papers identified themes relating to barriers, facilitators, and actionable strategies. Result Twelve papers were identified. Eleven themes related to barriers and facilitators were identified and five for actionable strategies. The themes related to barriers included access to community care, fragmented follow-up care, transportation, lack of recovery shelters, infections, and post-operative complications. Themes related to facilitators included street medicine programmes and the utilisation of patient navigators. Actionable strategies identified for health workers included the improvement of education, enhancing existing social safety nets, improved screening, tailoring discharge and surgical plans with the view of unfeasible follow up. Conclusions Current papers are not based on UK data and there are limited data sources available. However, analysis of the available data has shown many barriers and limited facilitators towards surgical care, highlighting the need for further studies. With a rising population of PEH in the UK these findings highlight the need for further research to create strategies that allow for safe surgical care in this population.

Disparities in primary and emergency health care among "off-reserve" Indigenous females compared with non-Indigenous females aged 15-55 years in Canada.

Access to primary care protects the reproductive and non-reproductive health of females. We aimed to quantify health care disparities among "off-reserve" First Nations, Métis and Inuit females, compared with non-Indigenous females of reproductive age. We used population-based data from cross-sectional cycles of the Canadian Community Health Survey (2015-2020), including 4 months during the COVID-19 pandemic. We included all females aged 15-55 years. We measured health care access, use and unmet needs, and quantified disparities through weighted and age-standardized absolute prevalence differences compared with non-Indigenous females. We included 2902 First Nations, 2345 Métis, 742 Inuit and 74 760 non-Indigenous females of reproductive age, weighted to represent 9.7 million people. Compared with non-Indigenous females, Indigenous females reported poorer health and higher morbidity, yet 4.2% (95% confidence interval [CI] 1.8% to 6.6%) fewer First Nations females and 40.7% (95% CI 34.3% to 47.1%) fewer Inuit females had access to a regular health care provider. Indigenous females waited longer for primary care, more used hospital services for nonurgent care, and fewer had consultations with dental professionals. Accordingly, 3.2% (95% CI 0.3% to 6.1%) more First Nations females and 4.0% (95% CI 0.7% to 7.3%) more Métis females reported unmet needs, especially for mental health (data for Inuit females not reported owing to high variability). During reproductive age, Indigenous females in Canada face many disparities in health care access, use and unmet needs. Solutions aimed at increasing access to primary care are urgently needed to advance health care reconciliation.

The causal impact of mental health on tobacco and alcohol consumption: an instrumental variables approach

The reciprocal relationship between psychiatric and substance use disorders is well-known, yet it remains largely unknown whether mental health morbidity causally leads to addictive behaviours. This paper utilises a fixed effects instrumental variables model, which is identified by time-varying sources of plausibly exogenous variations in mental health, and a nationally representative panel dataset from Australia to present robust evidence on the causal impact of mental distress on cigarette smoking and alcohol drinking behaviours. We find that mental distress significantly increases the prevalence and intensity of either cigarette or alcohol consumption. Further analysis reveals that mental distress also substantially increases household monetary expenditures on either tobacco or alcohol. The impact is greater for lower educated individuals or children of smokers, and is slightly higher for males. Our findings highlight the importance of mental health screening and treatment programs, especially among lower educated individuals or children of smokers, to assist in the prevention of addictive activities.

Health Effects of Cyclones: A Systematic Review and Meta-Analysis of Epidemiological Studies.

More intense cyclones are expected in the future as a result of climate change. A comprehensive review is urgently needed to summarize and update the evidence on the health effects of cyclones. We aimed to provide a systematic review with meta-analysis of current evidence on the risks of all reported health outcomes related to cyclones and to identify research gaps and make recommendations for further research. We systematically searched five electronic databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) for relevant studies in English published before 21 December 2022. Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we developed inclusion criteria, screened the literature, and included epidemiological studies with a quantitative risk assessment of any mortality or morbidity-related outcomes associated with cyclone exposures. We extracted key data and assessed study quality for these studies and applied meta-analyses to quantify the overall effect estimate and the heterogeneity of comparable studies. In total, 71 studies from eight countries (the United States, China, India, Japan, the Philippines, South Korea, Australia, Brazil), mostly the United States, were included in the review. These studies investigated the all-cause and cause-specific mortality, as well as morbidity related to injury, cardiovascular diseases (CVDs), respiratory diseases, infectious diseases, mental disorders, adverse birth outcomes, cancer, diabetes, and other outcomes (e.g., suicide rates, gender-based violence). Studies mostly included only one high-amplitude cyclone (cyclones with a Saffir-Simpson category of 4 or 5, i.e., Hurricanes Katrina or Sandy) and focused on mental disorders morbidity and all-cause mortality and hospitalizations. Consistently elevated risks of overall mental health morbidity, post-traumatic stress disorder (PTSD), as well as all-cause mortality or hospitalizations, were found to be associated with cyclones. However, the results for other outcomes were generally mixed or limited. A statistically significant overall relative risk of 1.09 [95% confidence interval (CI): 1.04, 1.13], 1.18 (95% CI: 1.12, 1.25), 1.15 (95% CI: 1.13, 1.18), 1.26 (95% CI: 1.05, 1.50) was observed for all-cause mortality, all-cause hospitalizations, respiratory disease, and chronic obstructive pulmonary disease hospitalizations, respectively, after cyclone exposures, whereas no statistically significant risks were identified for diabetes mortality, heart disease mortality, and preterm birth. High between-study heterogeneity was observed. There is generally consistent evidence supporting the notion that high-amplitude cyclones could significantly increase risks of mental disorders, especially for PTSD, as well as mortality and hospitalizations, but the evidence for other health outcomes, such as chronic diseases (e.g., CVDs, cancer, diabetes), and adverse birth outcomes remains limited or inconsistent. More studies with rigorous exposure assessment, of larger spatial and temporal scales, and using advanced modeling strategy are warranted in the future, especially for those small cyclone-prone countries or regions with low and middle incomes. https://doi.org/10.1289/EHP12158.

Mother-Baby Friendly Community Health Services Training Course For Maternity Staff to Prevent Stunting in Children

. Stunting is one of the significant nutritional issues around the world. Stunting is a common phenomenon among Indonesian and Malaysian children. In 2019, statistics from the National Health Morbidity Survey (NHMS) Malaysia reported that 21.8% of Malaysian children under four years were stunted. Some studies revealed that exclusive breastfeeding was one of the highest risk factors for stunting. All health workers caring for women and children during the post-natal period and beyond have a crucial role in establishing and sustaining breastfeeding. Many health workers cannot fulfill this role effectively because they have yet to be trained. The materials in the training course are designed to make it possible for trainers, even those with limited experience in teaching the subject, to conduct up-to-date. Community service activities are carried out at Tengku Ampuan Afzan Hospital in Kuantan, Malaysia. The procedure for community service activities is divided into several stages; the first was coordination with the Head of the Tengku Ampuan Afzan Hospital in Kuantan, Malaysia. The next stage is implementing a mother-baby-friendly services training course for maternity staff to prevent stunting. The last stage is the evaluation of the competencies of nurses. The results of the community service show that 25 nurses have the competencies to become exclusive breastfeeding counselors and are certified

Physical Limitations, Health Rumination/Worry, and Depressive Symptoms: Gender Differences among African Americans.

Although studies have documented the relationships between physical health, health rumination/worry, and mental health, few investigations have assessed these linkages within African American communities. Using a community-based sample of residents in historically lower-income, African American communities (N = 306), this study assesses the mediating role of health rumination/worry in the physical limitation-depressive symptom relationship, and the moderating effect of gender on the relationship between health rumination/worry-depressive symptoms. Findings demonstrate that health rumination/worry explains half of the physical limitation-depressive symptom relationship, and the relationship between health rumination/worry and depressive symptoms is stronger for African American men than women. The findings underscore the importance of intersectional research for policy efforts aimed at reducing mental health morbidities within African American communities.

Planetary Health and Mental Health Nexus: Benefit of Environmental Management.

Human activities have induced unprecedented global shifts in natural systems including the climate, the oceans, cryosphere and biosphere. The impacts of these changes on physical health are clear and are accelerating at an alarming rate. Climate change and its consequences, especially disruptive events like floods, droughts and heat waves also impact the mental health of affected populations, increasing risk for post-traumatic stress, depression and anxiety disorders. However, the impact of climate change on mental health is not well examined and has received less attention than climate's impacts on physical health. The paper examines the planetary health-mental health nexus. It assesses the existing state of knowledge on the association between climate events, natural disasters, pollution, access to green space and mental health. It also presents a global analysis of the economic costs of climate-related mental health disorders by developing scenarios estimating the costs of mental illness at the country level predicted to be attributable to changes in environmental factors during the period 2020-2050. Globally, the additional societal costs of mental disorders due to changes in climate-related hazards, air pollution and inadequate access to green space are estimated to be almost US$47 billion annually in 2030. These estimated costs will continue to grow exponentially to US$537 billion in 2050, relative to a baseline scenario in which these environmental factors remain at 2020 levels. Our scenario analysis shows that the costs associated with climate-related mental health morbidity and mortality are high already and continue to will increase sharply in coming decades. There is need therefore to strengthen the evidence linking climate change to mental health and to prioritize the development of evidence-based and impactful interventions to address the global burden of environment-related mental disorders.

Working 40 years as medical doctors.

The health status of health professionals, including medical doctors is an important topic, although it is an under-researched area in Hungary and in the East-Central European countries as well. Our quasi-cohort research was focused on the health status, morbidities, anthropometric parameters, lifestyle and professional career of Hungarian medical doctors who graduated in 1979, following them 25y, 30y and 40y after graduation, seeking differences between professional groups and genders. In 2019, the mean age of participants was 64.9y, the average number of children was 2.08, higher among surgical professionals (2.43). Men reported higher number of own children. The number of night shifts decreased during the past decades. Most of them is already retired, 70% is working besides receiving a pension. 27% changed their medical specialty, 36% intended to work in another field of medicine, when graduated. About 10% of them achieved scientific (PhD) degree, most of them were satisfied with own professional carrier. The body weight and BMI significantly increased during decades, without statistical difference between genders and professional groups. Diabetes was self reported in 7%, hypertension in 44%. Men neglected more frequently their regular health check-up. Compared to their patients at the same age, 71% rated their own health status better. Among those, who reported regular physical activities, the ratio of men was higher; the average time spent on sport was the same as in the past decades, although the ratio of persons who had regular physical activity decreased, fewer participated in team sport activities. Their sleeping habit is quiet, the time is 6.3 h between workdays and 7.7 h on weekends. Burn-out was not reported. The ratio of smokers decreased; the self-reported daily intake of alcoholic beverages was 1.3, the weekly 3.7 units. Differences described earlier between professional groups disappeared. The problems of the recent Hungarian health care system were similarly rated, although the income of Hungarian physicians has increased to a great extent in the past years. Orv Hetil. 2023; 164(29): 1127-1133.

Taste receptors influencing effective modalities in human health - A cutting edge update on TAS1R and TAS2R receptor polymorphisms in taste perception and disease risk.

Background: Taste is the characteristic sensory modality of the gustatory system associated with dietary intake. The ability of humans to perceive different tastes is predisposed by the activity of taste receptors. The expression of TAS1R family of genes enables the detection of sweetness and umaminess, whereas TAS2R enables the detection of bitterness. The varying levels of expression of these genes within different organs of the gastro-intestinal tract, regulates the metabolism of biomolecules including carbohydrates and proteins. Variations in the gene encoding for taste receptors might affect its binding affinity to tastant molecules and thereby pertain to varying degrees of sensation to taste among individuals. Aim: The goal of this review is to highlight the significant role of TAS1R and TAS2R as a potential biomarker to identify the incidence of morbidities and its probable onset. Method: We thoroughly investigated the SCOPUS, PubMed, Web of Science and Google Scholar databases for literature relating to the association between TAS1R and TAS2R receptors in highlighting the genetic variation during various health morbidities. Results: It has been shown that the abnormalities in taste perception restrain an individual from consuming the adequate amount of food. Taste receptors not only influence the dietary habits but also determine different aspects of human health and well-being. Conclusion: According to the available evidence the dietary molecules conferring varying taste modalities are observed to have therapeutic significance apart from its nutritive value. The taste associated incongruous dietary pattern is a risk factor for various morbidities including obesity, depression, hyperglyceridaemia, and cancers.

Mental Health and Psychosocial Problems among Children and Adolescents in Jordan: A Scoping Review.

Introduction: In Jordan, mental health morbidity among children and adolescents is on the rise. Several studies in Jordan have assessed mental health issues and their associated factors among adolescents; however, there remains a lack of a collation of data regarding such issues. Objectives: To review the prevalence rates of mental health problems among children and adolescents in Jordan to understand the evidence base concerning psychiatric morbidity. Methods: The PubMed database, Cochrane Library, Virtual Health Library (VHL) Lilac, and APA PsycArticles were searched for literature published between January 2010 and May 2023. Studies were included if they were conducted on children and adolescents (≤19 years), were observational studies that reported prevalence data regarding psychosocial problems, and were studies conducted in Jordan. Results: The search yielded 211 records, of which 33 studies were assessed for eligibility and 28 met the inclusion criteria. The sample age ranged from 6-19 years. The prevalence rates ranged from 7.1% to 73.8% for depression, 16.3% to 46.8% for anxiety, 13.0-40.6% for ADHD, 11.7-55.2% for overall emotional and behavioral difficulties, 16.2-65.1% for PTSD, and 12-40.4% for eating disorders. Conclusions: The findings highlight the magnitude of mental health problems among children and adolescents and the heterogeneity of the results. Further studies are needed to investigate the prevalence of eating disorders among refugees, as well as sleeping disorders and substance use disorders among all adolescents.

Risk Factors for Hepatitis B Virus Infection in North Ethiopia: A Case-Control Study.

Hepatitis B virus infection (HBV) is an important clinical and public health problem that contributes to liver-related public health morbidity and mortality. Although childhood vaccination was introduced in 1980, hospital admissions, morbidity and mortality rates from HBV infection increased in Ethiopia. Risk factors for HBV infection and associated complications generally vary from case to case. No epidemiological studies have identified the risk factors for HBV infection in northern Ethiopia. Therefore, this study aimed to identify risk factors for HBV infection in specialist and teaching hospitals in Ayder. From March 2019 to May 2019, an unmatched hospital-based case-control study has been carried out on a total of 213 patients [71 cases and 142 controls] in northern Ethiopia. Cases were selected sequentially and two consecutive controls were selected for each case by a simple random method. The data were collected using pretested questionnaires structured by the interviewer as part of a face-to-face interview. Data were entered in Epi Data version 3.1, exported and analyzed with SPSS version 22. Binary and multivariable logistic regression analyses were used. Statistical significance was given as P <0.05. Multivariate logistic regression analysis revealed that patients with familial exposure to hepatitis (AOR 3.7, 95% CI: 1.5-9.01), prior traditional medical procedure (AOR 1.2, 95% CI: 1.08-3.4), any history of dental procedures (AOR 3.8, 95% CI: 1.8-9.01) were associated risk factors to hepatitis B virus infection, and awareness of sexually transmitted hepatitis B virus infection (AOR 0.084, 95% CI: 0.01-0.6) is less likely to be infected with hepatitis B virus infection. This study (findings) demonstrated that contact with a case of hepatitis in the family, history of dentist visits, prior traditional medical procedure, and lack of awareness of its transmission through sexual contact have been identified as independent risk factors for the development of hepatitis B virus infection.

Metered Dose Inhalers (MDI’S) for High-Performance Pulmonary Drug Delivery in Assistance to Nanotechnology

Respiratory infections pose a severe danger to public health's morbidity and death on a global scale. Delivery via the lungs can be accomplished using several drug delivery tools, including nebulizers, MDI’s and dry powder inhalers. Metered dosage inhalers are the most intriguing and the clinician's first preference out of all of them. This review emphasized based on metered dose inhalers for the delivery of pulmonary drugs. This study focuses on the provision of various therapies employing lipid nanocarriers, polymeric nanoparticles dendrimers &amp; micelles, among others, using metered dose inhalers, liposomes, solid lipid nanostructures, nanostructured lipid carriers, and other topics were thoroughly explored. The market scenario for different MDI’s as well as information on digital metered dose inhalers is also covered in this review.

Pathogenesis, Updates on Current Treatment Options and Alvimopan for Postoperative Ileus

ABSTRACT: Postoperative Ileus (POI) is a recurrent incident following intestinal as well as other types of surgery that causes aggregation of gases and inner secretions in patients, resulting in significant costs to health care providers and morbidity. The pathophysiology of the POI is multifactorial, and treatment duration of the POI associated with the degree of surgical trauma. Exogenous opioids, neurohormonal dysfunction, fluid overload, inflammation, and gastrointestinal strain are the main pathophysiological factors underlying POI. Different treatment options currently available to reduce duration of POI. Recent studies have shown that the effective approaches in reducing patient morbidity with early return of gut functions are Enhanced Recovery After Surgery (ERAS) pathway and laparoscopic surgery. Alvimopan (ALV) is a peripherally acting antagonist of the µ opioid receptor in postoperative ileus. Alvimopan (Entereg®), the FDA-approved product for the fastest recovery of bowel (large and small) resection with primary anastomosis, shows potential advances for the treatment of POI. It has limited bioavailability through the oral route due to solubility limitations. ALV prevents binding of opioid agonists to the μ-opioid receptor and assists in stopping constipation in the GI tract; it is also not able to cross the blood-brain barrier, so it does not obstruct with centrally mediated opioid analgesia. The safety &amp; efficacy studies of Alvimopan showed that the patients who go through segmental bowel surgeries along with primary anastomosis and given ALV reduces the duration of stay and overall direct costs compared with control group. The objectives of this systematic review were to give an update of categorization systems, pathogenesis mechanisms, current treatment for established POI, and updates on Alvimopan for POI.