Inadequate Access Research Articles

Current status of professional memory clinics, inpatient services, and health professionals in China.

This study aims to explore the current status of dementia-specific diagnosis and treatment in China. This national survey was conducted in mainland China from September 2022 to February 2023, with strong support from the Cognitive Disorders Group of the Chinese Society of Neurology, Chinese Medical Association. Among 2721 hospitals surveyed, 244 (8.97%) have dementia-specific clinics (DSCs) and 166 (6.10%) have dementia-specific inpatient departments (DSIDs). Almost all hospitals have brain structural imaging capabilities and basic hematological examinations, but dementia-specific medical staff (DSMS) equipped for DSCs or DSIDs are rare. The proportion of patients with cognitive impairment receiving care through a DSCs or DSIDs is low, and most patients present with advanced (moderate to severe) disease. The survey shows that the proportion of DSCs and DSIDs is low, and the regional distribution varies significantly. Trained DSMS and specialized facilities for the diagnosis and treatment of dementia are inadequate. This study was a multi-center national research to comprehensively investigate the distribution and features of dementia-specific clinics and inpatient departments in mainland China, given that the limited literature was available regarding the dementia-specific centers. The study points to significant regional differences in the distribution of cognitive-specific clinics and inpatient departments in mainland China. More centers in Eastern Regions compared to Western Regions, a greater presence in provincial capitals as opposed to other cities, and a predominance of tertiary hospitals over non-tertiary ones. The aim is to provide data support for advancements in medical research within this field. Domestic dementia patients have inadequate access to specialized medical resources and expert assistance, which significantly contrasts with the growing number of dementia cases in China.

Perspectives on hand hygiene in Belizean healthcare facilities during the COVID-19 pandemic: a qualitative evaluation with healthcare workers

ABSTRACT The World Health Organization recommends healthcare workers (HCWs) practice hand hygiene (HH) while providing care. Making alcohol-based hand rub (ABHR) available at points of care is recommended during times of high patient volume, such as the COVID-19 pandemic. In low- and middle-income countries, such as Belize, there may be limited access to HH materials within healthcare facilities. This paper examines the motivators and barriers to HH among HCWs in the 11 largest public healthcare facilities in Belize and HCWs' experiences with an intervention. In 2021, focus group discussions (FGDs) gathered HCWs' HH perceptions and preferences. An intervention was then implemented to increase ABHR access and HH training for HCWs. Post-intervention endpoint FGDs in 2022 documented HCWs' experiences with interventions. Baseline FGDs revealed that self-protection and protection of one's household members from illness were key motivators for HCWs' HH practice. Insufficient time, inadequate access to HH supplies, and gaps in education were barriers to practicing HH. At endpoint, participants appreciated increased access to ABHR and its convenience but did not like ABHR's effect on hands. Experiences with the training were mixed. To improve HCWs' HH practices, HH interventions should be tailored to HCWs' context and learning preferences.

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative study.

Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-pocket spending in a nationally representative sample. Using Medicare Current Beneficiary Survey data, we conducted a pooled cross-sectional analysis of Medicare beneficiaries aged 65+ years with a date of death between July 1, 2015 and December 31, 2021. Our primary outcomes were ED visits, total healthcare spending, and out-of-pocket spending in the 7, 30, 90, and 180 days preceding death. We estimated a series of zero-inflated negative binomial models identifying patient characteristics associated with the primary outcomes. Among 3812 older adult decedents, 610 (16%), 1207 (31.7%), 1582 (41.5%), and 1787 (46.9%) Medicare beneficiaries had ED visits in the final 7, 30, 90, and 180 days, respectively, of life. For Medicare beneficiaries with at least one ED visit in the final 30 days of life, the median total and out-of-pocket costs were, respectively, $12,500 and $308, compared, respectively, with $278 and $94 for those without any ED visits (p < 0.001 for both comparisons). Having a diagnosis of dementia (odds ratio [OR] 0.71; 95% confidence interval [CI] 0.51-0.99; p = 0.04) and being on hospice status during the year of death (OR 0.56; 95% CI 0.48-0.66; p = <0.001) were associated with a decreased likelihood of having an ED visit. Having dementia was associated with a decreased likelihood of having any healthcare spending (OR 0.50; 95% CI 0.36-0.71; p = 0.001) and any out-of-pocket spending (OR 0.51; 95% CI 0.36-0.72; p = <0.001). One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half-year of life, with evidence of associated considerable total and out-of-pocket spending.

The Functionality of the Lavatory Facilities in Naraguta Campus of the University of Jos

This study examines the functionality of lavatory facilities at Naraguta Campus, University of Jos, to identify key challenges and propose actionable improvements. Utilizing a mixed-methods approach, we conducted quantitative surveys and qualitative interviews with both staff and students to assess various dimensions of lavatory functionality, including accessibility, cleanliness, maintenance, and user satisfaction. Our findings reveal significant issues related to inadequate accessibility for persons with disabilities, frequent maintenance delays, and suboptimal cleanliness standards. The study underscores the need for comprehensive enhancements in lavatory facilities to better serve the campus community. Recommendations include the implementation of more frequent cleaning schedules, the upgrade of accessibility features, and the establishment of a dedicated maintenance team. This research contributes to the broader discourse on campus facility management and offers a framework for similar assessments in other educational institutions.

Abstract A005: Addressing Moonshot limitations: High-risk racial disparities in leading cancers

Abstract Cancer remains a leading cause of death in the U.S., posing a significant public health challenge with rising incidence rates among young adults. In response, the Biden administration reignited The Cancer Moonshot initiative in 2022, aiming to reduce cancer mortality by 50% over the next 25 years. However, as there remains different mortality rates across subpopulations defined by race and ethnicity, the 50% translates into much more or less depending on the starting point for each group. Achieving this goal would require a 57.0% decrease for Black Americans, 51.9% decrease for White Americans, 21.4% for Asian Americans, 31.0% decrease for Hispanics, and 41.3% decrease for American Indian/Alaska Natives. This study examines the trends in in U.S. cancer incidence, 5-year survival, and mortality during 1992-2022 with a focus on the five leading cancers (lung, colorectal, breast, pancreas, prostate) stratified by race and ethnicity. From 2008-2020, overall cancer death rates have declined by 1.18%/year with attribution to declining lung cancer rates (-2.75%/year, 2005-2020) and anti-smoking campaigns. Estimates have been made on how to meet the Cancer Moonshot through primary, secondary, and tertiary prevention, but these rates have not factored in the different starting points nor racial disparities that exist. Progress has been heterogenous across racial/ethnic groups. Non-Hispanic Black communities continue to face excessive cancer burden compared to counterparts and have had the slowest declines in annual percent changes for mortality. To reach the Moonshot’s mortality goals in 2047, an annual decline of 1.78% across all racial and ethnic groups is needed. However, the required mortality reductions vary by cancer type and are lower for Non-Hispanic Blacks and Non-Hispanic American Indians/Alaska Natives due to inadequate access to screening and treatment. This study delineates the need for multi-level, culturally tailored interventions to improve cancer prevention, screening, and treatment accessibility. To achieve Moonshot objectives, it is imperative to increase the number of on-site patient navigators, enhance accessibility through health education and transportation services, and promote digital campaigns for primary and secondary prevention services. Despite discrepancies in interventions and policy practices, enhancing the cultural competence and holistic nature of these interventions will strengthen efforts towards health equity. These approaches can better serve high-risk groups and alleviate racial disparities in cancerous outcomes. Citation Format: Sukhmani Kaur, Rebecca Kehm, Mary Beth Terry. Addressing Moonshot limitations: High-risk racial disparities in leading cancers [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A005.

Unmet menstrual needs and psychosocial well-being among schoolgirls in Northern Tanzania: baseline results from the PASS MHW study

IntroductionImproving menstrual health among schoolgirls is essential to meeting the Sustainable Development Goals (SDGs) of good health and wellbeing (SDG 03), quality education (SDG 04), and gender equality (SDG 05). School participation and wellbeing among girls in low and middle-income countries are impacted by inadequate access to quality menstrual materials and WASH facilities, taboos around menstruation, and poor knowledge. Comprehensive evidence is needed to address these challenges and guide policy and practice.MethodsAn assisted self-completed questionnaire was used to collect socio-demographic information, menstrual-related data, and school climate data from 486 girls in four mixed-gender government secondary schools in Mwanza, Tanzania. The mean (SD) of three Menstrual Practices and Needs Scale (MPNS-36) sub-scores were calculated. Specifically, the extent to which girls perceived needs for carrying and changing menstrual material in school (transport and school environment); washing and drying menstrual material (reuse needs); and privacy and drying menstrual material in school (reuse insecurity) were met. An ANOVA test compared MPNS scores for groups, and logistic regression examined the association between menstrual health and wellbeing outcomes (self-efficacy, menstrual anxiety, school attendance, and participation) and MPNS subscale scores.ResultsThe mean age of the 486 participants was 15.6 years (SD 1.3); 87% had started menstruating; the mean age at menarche was 14.2 years (SD 1.15). The majority (75%) of girls experienced pain during the last menstrual period, 39% had menstrual-related anxiety, and 16% missed at least one day of school due to menstruation. The mean MPNS subscale score (out of 3) for the reuse needs ranged from 1.0 to 2.1 across schools; 1.6 to 2.1 for reuse insecurity; and 0.9 to 1.8 for transport and school environment needs. The MPNS subscales had sufficient reliability (Cronbach alpha = 0.74 to 0.9). The subscales also had good construct validity with menstrual-related self-efficacy: higher scores for transport and school environment were associated with confidence to seek menstrual support, participate in class, and predict when periods were about to start.ConclusionsSchoolgirls have unmet needs related to transporting and using menstrual material in school, and these needs differed across schools in northern Tanzania. Menstrual-related pain remains a major reason for poor school attendance and participation. Interventions to address menstrual practice needs in schools are required and should include a strong pain management component.

Host WD repeat-containing protein 5 inhibits protein kinase R-mediated integrated stress response during measles virus infection.

MeV is a pathogen that remains a global concern, with an estimated 9 million measles cases and 128,000 measles deaths in 2022 according to the World Health Organization. A large population of the world still has inadequate access to the effective vaccine against the exceptionally transmissible MeV. Measles disease is characterized by a high morbidity in children and in immunocompromised individuals. An important area of research for negative-sense RNA viruses, including MeV, is the characterization of the complex interactome between virus and host occurring at cytoplasmic IBs where viral replication occurs. Despite the progress made in understanding IB structures, little is known regarding the virus-host interactions within IBs and the role of these interactions in promoting viral replication and antagonizing host innate immunity. Herein we provide evidence suggesting a model by which MeV IBs utilize the host protein WDR5 to suppress the protein kinase R-integrated stress response pathway.

A qualitative study on reasons for women’s loss and resumption of Option B plus care in Ethiopia

Loss to follow-up (LTFU) from Option B plus, a lifelong antiretroviral therapy (ART) for pregnant women living with human immunodeficiency virus (HIV), irrespective of their clinical stage and CD4 count, threatens the elimination of vertical transmission of the virus from mothers to their infants. However, evidence on reasons for LTFU and resumption after LTFU to Option B plus care among women has been limited in Ethiopia. Therefore, this study explored why women were LTFU from the service and what made them resume or refuse resumption after LTFU in Ethiopia. An exploratory, descriptive qualitative study using 46 in-depth interviews was employed among purposely selected women who were lost from Option B plus care or resumed care after LTFU, health care providers, and mother support group (MSG) members working in the prevention of mother-to-child transmission unit. A thematic analysis using an inductive approach was used to analyze the data and build subthemes and themes. Open Code Version 4.03 software assists in data management, from open coding to developing themes and sub-themes. We found that low socioeconomic status, poor relationship with husband and/or family, lack of support from partners, family members, or government, HIV-related stigma, and discrimination, lack of awareness on HIV treatment and perceived drug side effects, religious belief, shortage of drug supply, inadequate service access, and fear of confidentiality breach by healthcare workers were major reasons for LTFU. Healthcare workers' dedication to tracing lost women, partner encouragement, and feeling sick prompted women to resume care after LTFU. This study highlighted financial burdens, partner violence, and societal and health service-related factors discouraged compliance to retention among women in Option B plus care in Ethiopia. Women's empowerment and partner engagement were of vital importance to retain them in care and eliminate vertical transmission of the virus among infants born to HIV-positive women.

Vaccines in the fight against antimicrobial resistance - perspectives from South Africa.

Antimicrobial resistance (AMR), in which microbes adapt to and resist current therapies, is a well-recognised global problem that threatens to reverse gains made by modern medicine in the last decades. AMR is a complex issue; however, at its core, it is driven by the overuse and inappropriate use of antimicrobials. Socioeconomic factors have been identified as significant contributors to the emergence and exacerbation of AMR, especially in populations facing inadequate access to healthcare, poor sanitation services and high morbidity and mortality rates. Weak healthcare systems and water, sanitation and hygiene have been highlighted as fundamental risk factors for AMR emergence and transmission. Behavioural factors, such as purchasing antibiotics without a prescription from a registered healthcare professional, not completing the prescribed course or overly prolonged courses of antibiotics, using antibiotics to treat viral infections, lack of access to quality antibiotics, and the proliferation of substandard or falsified (SF) drugs, have also been identified as significant contributors to AMR. Low- and middle-income countries have a higher incidence of antibiotics being dispensed without a prescription than higher-income countries.

Accessibility of TB diagnostic services at primary healthcare clinics in the eThekwini district, South Africa: a geospatial analysis

BackgroundImproving geographic access can aid in managing tuberculosis (TB) by enabling early diagnosis and treatment initiation. Although geospatial techniques have been used to map the transmission patterns of drug-resistant TB...

Effects of Gender and Country of Training on Perceived Access to Opportunities for Neurosurgical Research and Gender-Concordant Mentorship

The current neurosurgical workforce is not large enough to address the significant burden of neurosurgical disease worldwide, and women are under-represented in this surgical specialty. However, trainee opportunities are particularly scarce in lower- and middle-income countries, where the burden of neurosurgical disease is high. Thus, the primary aim of this study was to assess the effects of gender and country on perceived access to neurosurgical research and mentorship opportunities. A cross-sectional survey evaluating perceived access to neurosurgical research and mentorship opportunities was distributed electronically to medical students and unspecialized residents in 10 countries (Colombia, India, Ghana, Nigeria, Saudi Arabia, Spain, Uganda, the United Kingdom, the United States, and Venezuela). 34.0% of men versus 24.9% of women reported interest in neurosurgery (P < 0.001). Only 16.1% of trainees reported adequate access to neurosurgical research opportunities, which did not vary by gender overall (P= 0.070). However, more women reported inadequate access in the United States (P= 0.038), and more men reported inadequate access in Colombia (P= 0.043). In Colombia (P < 0.001), Nigeria (P= 0.003), Saudi Arabia (P= 0.038), the United States (P= 0.004), and Venezuela (P < 0.001), a lower proportion of women than men reported ever having a neurosurgery mentor of their same gender. 59.0% of female respondents noted that having access to female neurosurgeon mentors would increase their interest in neurosurgery, compared to 28.5% of male respondents (P < 0.001). More male than female medical trainees in the surveyed countries reported interest in neurosurgery. However, access to adequate neurosurgical research opportunities, although relatively low overall, did not vary by gender in most countries. Access to gender-concordant mentorship was less common for women than for men, but women expressed that enhanced access to female neurosurgeon mentors would increase their interest in the field. These findings suggest potential avenues for intervention to augment and diversify the global neurosurgical workforce.

Prevalence and factors associated with unmet need for menstrual hygiene management in six countries in Sub-Saharan Africa: A multilevel analysis

BackgroundMenstruation is a normal biological process experienced by more than 300 million women globally every day. Women require clean menstrual absorbents that can be changed as often as needed in a private and safe place with proper hygiene and disposal facilities. These needs must be met consistently throughout the duration of the menstrual cycle. Access to menstrual needs is crucial for women’s health, wellbeing, and dignity. This study assessed the prevalence and factors associated with unmet need for menstrual hygiene management (MHM) in Ethiopia, Kenya, Uganda, Burkina Faso, Ghana, and Niger.MethodsWe used data from the Performance Monitoring for Action (PMA) 2020 surveys. We defined the unmet need for MHM as the “lackof resources, facilities and supplies for MHM.” Sample characteristics were summarised using frequencies and percentages, while prevalence was summarised using proportions and their respective confidence intervals (CI). Factors associated with unmet need for MHM were assessed using multilevel logistic regression models.ResultsThe study included 18,048 women of reproductive age from the six countries. The prevalence of unmet need for MHM was highest in Burkina Faso (74.8%), followed by Ethiopia (69.9%), Uganda (65.2%), Niger (57.8%), Kenya (53.5%), and lowest in Ghana (34.2%). Unmet need for MHM was consistently higher among uneducated and multiparous women, those who reused MHM materials, practiced open defecation, and lived in rural areas across all six countries. The odds of unmet need for MHM were higher among younger women under 35 years, unmarried women, those with lower education levels, and those from poorer households. Similarly, the reuse of MHM materials, use of shared or non-improved toilet facilities, and open defecation increased the odds of unmet need for MHM. In contrast, the presence of handwashing facilities reduced the odds of unmet need for MHM.ConclusionMore than half of the women in five of the six countries have an unmet need for MHM, with significantly higher odds among younger women, those with low wealth status, the unmarried, and those with inadequate access to sanitary facilities. This study highlights the state of period poverty in Sub-Saharan Africa. Efforts to end period poverty should consider MHM needs as an integrated whole, as addressing each need in isolation is insufficient.

The impact of COVID-19 on livelihood assets: a case study of high-value crop farmers in North-West Bangladesh

The COVID-19 pandemic has had a catastrophic impact on public health, extending to the food system and people's livelihoods worldwide, including Bangladesh. This study aimed to ascertain the COVID-19 pandemic impacts on livelihood assets in the North-Western areas (Rajshahi and Rangpur) of Bangladesh. Primary data were collected from 320 farmers engaged in high-value agriculture using a multistage sampling method. The data were analysed using first-order structural equation modelling. The findings reveal a significant impact (p < 0.01) of the pandemic on all livelihood assets in Bangladesh. Notably, human assets exhibited the highest impact, with a coefficient of 0.740, followed sequentially by financial (0.709), social (0.684), natural (0.600), physical (0.542), and psychological (0.537) assets. Government-imposed lockdowns and mobility restrictions were identified as the major causes of the pandemic's negative effects on livelihoods, which included lost income, rising food prices, decreased purchasing power, inadequate access to food and medical supplies, increased social insecurity, and a rise in depression, worry, and anxiety among farmers. The effects of COVID-19 and associated policy measures on the livelihoods of high-value crop farmers have reversed substantial economic and nutritional advances gained over the previous decade. This study suggests attention to the sustainable livelihoods of farmers through direct cash transfer and input incentive programs to minimize their vulnerability to a pandemic like COVID-19 or any other crisis in the future.

Telerehabilitation for Geriatric with Dementia and Long Covid-19

Rehabilitation is crucial for individuals who have survived COVID-19, particularly those who are older and have pre-existing health conditions. These survivors may experience long covid symptoms up to four months after infection. Elderly individuals suffering from long covid face difficulties in undergoing conventional rehabilitation methods due to limitations in mobility, lack of social interaction, and inadequate healthcare accessibility. As a result, telerehabilitation has arisen as an alternate form of care. This case report intends to present empirical evidence on the enhancement of functional status in a geriatric long covid patient following telerehabilitation. We present a case of an elderly woman with underlying dementia who developed long covid. The symptoms included of dyspnea and mobility impairment. We provide a telerehabilitation program for three weeks with an active-assisted range of motion exercises. Following three sessions of telerehabilitation, we could see improvement in her Physical Mobility Scale (PMS). After 20 days, the patient's PMS score increased by 3 points.

Food insecurity and body mass index among older people: A systematic review and meta-analysis

Food insecurity, characterized by inadequate access to sufficient and nutritious food, poses a significant challenge to the health and well-being of older adults. This systematic review and meta-analysis was aimed to examine the association between food insecurity and body mass index (BMI) in older people, i.e., aging 60 and above. PRISMA 2020 guidelines were followed. The protocol was registered in PROSPERO in advance (ID CRD 42024543271). PubMed/MEDLINE, and Scopus were searched up to February 2024. Out of 5834 retrieved article, a total of 13 studies met the inclusion criteria, encompassing diverse geographic regions and socioeconomic contexts. The meta-analysis revealed a significant association between food insecurity and higher BMI (both obesity and overweight) in older adults. Pooled estimates indicated that food-insecure older individuals were more likely to be overweight or obese (combined) compared to their food-secure counterparts [OR= 1.29 (95% CI= 1.28-1.30), p<0.001; I2= 94.92]. Results were also confirmed for overweight or obesity alone. Notably, food insecurity was linked to increased consumption of energy-dense, nutrient-poor foods, contributing to higher BMI. These findings underscore the complex relationship between food insecurity and BMI among older adults, emphasizing the need for targeted interventions to address food access and nutritional quality.

Composite Accessibility Index: A Novel and Holistic Measure for Evaluating Transit Accessibility

The accessibility of public transport is a vital factor for the overall success of transit operations. It determines whether people choose to use and rely on public transport by assessing the ease of accessing opportunities. Accessibility, as a measure of the system’s performance, encompasses various travel segments and can be evaluated from different perspectives. Evaluating transit accessibility in data-constrained environments, particularly in developing countries, requires an optimal framework. The present study proposed a framework by modifying available accessibility measurement indices and trying to encompass all affecting variables in a single composite index. The integrated transit system comprising the bus rapid transit system and city bus in Surat city, India, is selected to demonstrate the proposed framework. The results of the ranked-based correlation coefficient test exhibit the comprehensive assessment capabilities of the proposed composite index in evaluating transit performance. Surat city’s transit network shows better coverage based on the gravity model theory, that is, moderate performance in local coverage offered capacity per population. However, it exhibits poor accessibility with respect to reaching destinations, resulting in below-average transit accessibility. Except for the city center and eastern part, 65% of the city area experiences inadequate accessibility of public transport. These findings align with the city’s low transit mode share of 2.5% and stagnant daily ridership of 0.25–0.28 million passengers in the last half decade. The composite index map serves as a planning tool for optimizing the utilization of available resources and guiding future policy implementations.

Challenges in Implementing Child Sexual Abuse Prevention Materials: A Survey of Primary School Teachers

The study investigates the current state of training materials used to prevent child sexual abuse, focusing on their frequency of use and the challenges faced by teachers in implementing these resources. The research surveyed 534 primary school teachers in Can Tho, Ho Chi Minh City and Binh Duong, revealing that while the materials are generally regarded as useful, they are utilized only at an "average" level, with 54.3% of teachers referencing "Books, newspapers, magazines" during lesson planning. Despite the appreciation for the content and form of these resources, the study identifies significant challenges, notably the time and effort required by teachers to select scientifically sound materials, with an average difficulty score of 3.62. The research highlights that the existing materials, although scientifically based, are often too academic and difficult to apply in practical teaching scenarios. The findings underscore the fragmented and emotionally driven nature of current resources, which lack a solid scientific foundation tailored to children's psychological development. Consequently, this results in inadequate access to well-constructed materials by both parents and children. The study's outcomes provide insights into the frequency of use and the obstacles teachers encounter, offering recommendations for improving the accessibility and applicability of these materials. However, the research is limited to a specific geographic area and teacher demographic, suggesting that the results may not be fully representative of the broader southern region or Vietnam as a whole.

Cybersecurity vulnerabilities and solutions in Ethiopian university websites

This study investigates the causes and countermeasures of cybercrime vulnerabilities, specifically focusing on selected 16 Ethiopian university websites. This study uses a cybersecurity awareness survey, and automated vulnerability assessment and penetration testing (VAPT) technique tools, namely, Nmap, Nessus, and Vega, to identify potential security threats and vulnerabilities. The assessment was performed according to the ISO/IEC 27001 series of standards, ensuring a comprehensive and globally recognized approach to information security. The results of this study provide valuable insights into the current state of cybersecurity in Ethiopian universities and reveals a range of issues, from outdated software and poor password management to a lack of encryption and inadequate access control. Vega vulnerability assessment reports 11,286 total findings, and Nessus identified a total of 1749 vulnerabilities across all the websites of the institutions examined. Based on these findings, the study proposes counteractive measures tailored to the specific needs of each identified defect. These recommendations aim to strengthen the security posture of the university websites, thereby protecting sensitive data and maintaining the trust of students, staff, and other stakeholders. The study emphasizes the need for proactive cybersecurity measures in the realm of higher education and presents a strategic plan for universities to improve their digital security.

Management of BRCA-associated breast cancer patients in low and middle-income countries: a review.

Breast cancer poses a significant global health challenge, with higher incidence rates in developed countries. However, low- and middle-income countries (LMICs) suffer from higher mortality rates due to various factors, including limited screening programs, delayed diagnosis and inadequate access to healthcare and advanced treatments. Approximately 5%-10% of breast cancer cases stem from germline mutations in BRCA-1/2 genes. A positive BRCA1/2 status obtained through genetic testing significantly influences surgical and medical treatment decisions. Therefore, genetic counseling, proper surveillance and customized interventions for BRCA1/2 carriers are essential to maximizing the benefits of monitoring, chemoprevention and risk-reducing surgeries for breast and ovarian cancers. Identification of BRCA mutations also impacts treatment strategies, leading to the integration of chemotherapeutic agents like platinum-based chemotherapy and PARP inhibitors. However, implementing these advanced treatment guidelines in LMICs with complex, fragmented and underfunded healthcare systems presents numerous challenges. In this review, we explore the current status and obstacles associated with managing BRCA1/2-associated breast cancer in LMICs.

Association between liver fibrosis scores and short-term clinical outcomes in hospitalized chronic kidney disease patients: a prospective observational study.

In resource-constrained countries, inadequate access to healthcare and prognostic tools can be the Achilles' heel in effectively managing chronic kidney disease (CKD). There is a significant similarity in the pathogenesis of CKD and liver fibrosis. The role of liver fibrosis (LF) scores in predicting short-term clinical outcomes in hospitalized patients with CKD is unknown. Our study aimed at calculating LF scores and studying the association of liver fibrosis with short-term mortality and morbidity in CKD patients. Patients aged above 15 years diagnosed with CKD as per the KDIGO criteria were enrolled. LF scores, namely, NFS, GPRI, and FIB-4 scores were calculated. Patients were followed up for a period of 28 days for good and poor composite outcomes, namely, the requirement of hemodialysis, non-invasive ventilation, prolonged hospital stay, and neurological and cardiovascular outcomes including death. Among 163 patients, 70.5% were below 60 years of age, 82.2% were male and 35% were diabetic. At 28-day follow up, 52.1% had poor composite outcome. The AUROC for GPRI and FIB-4 in predicting poor outcomes was 0.783 (95% CI: 0.71-0.855) (p < 0.001) and 0.62 (95% CI: 0.534-0.706) (p = 0.008), respectively. The AUROC for GPRI and NFS in predicting all-cause mortality was 0.735 (95% CI: 0.627-0.843) (p = 0.001) and 0.876 (95% CI, 0.8-0.952) (p < 0.001), respectively. We found a positive association between LF scores and CKD outcomes in hospitalized patients. The LF scores significantly predicted poor outcomes in patients with CKD. Among the scores, GPRI was found to be a stronger predictor in predicting outcomes in both diabetic and non-diabetic patients with CKD. A high GPRI score was also associated with poor outcomes and increased mortality in both diabetics and non-diabetics.