Intermediate Educational Level Research Articles

Factors Contributing Towards Women Employability: An Impact Assessment of a Women Skill Development Training Program

It is an impact assessment study of a women skill development training program namely District Industrial Homes in Punjab. A quasi experimental (ex post facto) research design has been applied to develop a counterfactual relationship between the outcomes of this program and the demographic and personal characteristics of the women trainees that have get training from the program within time period of 2016 to 2019. The analysis has observed that computer application and stitching/ cutting are most popular trades among women. Further, it has been observed as the time period since the women has gotten training increased the visibility of trained women in market is decreased. The majority of the women were unmarried, of age 15 to 25 years and majority of them have education level intermediate or above. The female work participation was much higher among the women respondents, however, majority of them were unemployed and had no utilization of their skills in daily life business. The data shows that all the unemployed women were unmarried and all the entrepreneur women were either divorced or widow. Another interesting fact have been revealed from the bivariate analysis that all the women that were unemployed have education metric or below metric and all the women that have any employment status have intermediate or above education level. The women employment status has been found more in families with large family size comparatively and all the women that did not practice the veil were unemployed. The female work participation and women employment status have been observed relatively high in low income families. The multinomial regression analysis have established that education level, mother’s education level, family size and own family house contribute positively and age dependency ratio, female work participation, veil and family employment (total) has negative impact on women employment status.

Inclusion of Artificial Intelligence Concepts and Applications in Computer and Information Technology Curricula in the Saudi General Education

The study aimed to identify the inclusion of Artificial Intelligence (IA) concepts and applications in the content of Information and Communication Technology (ICT) textbooks in Saudi general education. The study adopted the descriptive approach using the method of content analysis. To achieve the purpose of the study, a content analysis tool was developed, and the ICT textbooks were analyzed. The study results indicated that the concepts and applications of AI were available in the content of the intermediate school books in varying overall proportions: (3.46%) in 7th grade, (6.7%) in 8th grade, and (10%) in 9th grade. Additionally, the AI concepts and applications were available in secondary ICT textbooks content: (15%) in 11th grade and (18%) in both 10th-12th grades. The study recommended reconsidering the inclusion of IA concepts and its applications in the ICT textbooks content for the intermediate and secondary educational levels and increasing the inclusion of the AI concepts and applications with transforming from teaching ICT alone in the curricula to focusing more on computing beside the ICT.

Incidence and risk factors of severe non-proliferative/proliferative diabetic retinopathy: More than a decade follow up in the Tehran Lipids and Glucose Study.

Aims/IntroductionTo examine the incidence rate of severe non‐proliferative and proliferative diabetic retinopathy (severe‐NPDR/PDR) and determine its potential risk factors.Materials and MethodsThe study consisted of 1,169 participants (675 women) with type 2 diabetes mellitus, aged ≥20 years. A trained interviewer collected information about the history of pan‐retinal photocoagulation as a result of diabetic retinopathy. Multivariable Cox proportional hazards regression models were applied.ResultsWe found 187 cases (126 women) of severe‐NPDR/PDR during a median follow‐up period of 12.7 years; the corresponding incidence rate was 13.6 per 1,000 person‐years. Being overweight (hazard ratio [HR], 95% confidence interval [CI] 0.60, 0.39–0.92) and obese (HR 0.48, 95% CI 0.27–0.83) were associated with lower risk, whereas being smoker (HR 1.75, 95% CI 1.12–2.74), having fasting plasma glucose levels 7.22–10.0 mmol/L (HR 2.81, 95% CI 1.70–4.62), fasting plasma glucose ≥10 mmol/L (HR 5.87, 95% CI 3.67–9.41), taking glucose‐lowering medications (HR 2.58, 95% CI 1.87–3.56), prehypertension status (HR 1.65, 95% CI 1.05–2.58) and newly diagnosed hypertension (HR 1.96, 95% CI 1.06–3.65) increased the risk of severe‐NPDR/PDR. Among newly diagnosed diabetes patients, being male was associated with a 59% lower risk of severe‐NPDR/PDR (HR 0.41, 95% CI 0.21–0.79). Furthermore, patients who had an intermediate level of education (6–12 years) had a higher risk of developing PDR (HR 1.86, 95% CI 1.05–3.30) compared with those who had <6 years of education.ConclusionsAmong Iranians with type 2 diabetes mellitus, 1.36% developed severe‐NPDR/PDR annually. Normal bodyweight, being a smoker, out of target fasting plasma glucose level, prehypertension and newly diagnosed hypertension status were independent risk factors of severe‐NPDR/PDR. Regarding the sight‐threatening entity of advanced diabetic retinopathy, the multicomponent strategy to control diabetes, abstinence of smoking and tight control of blood pressure should be considered.

Impact of socio-demographic factors on knowledge, attitude and practices toward scabies among syrian refugees in Jordan: A prospective cross sectional study

BackgroundScabies is one of the prevalent dermatological conditions, accounting for a substantial proportion of skin diseases in developing countries. It represents a significant health challenge when an outbreak appears in homecare and refugee camps as it may lead to enormous morbidity and high treatment costs. Because Scabies can be easily prevented through education, the purpose of this study was to assess the impact of socio-demographic factors on the level of knowledge, attitude, and practices among Syrian refugees in Jordan's northern region. MethodsA prospective cross-sectional study was conducted among Syrian refugees attending primary health centers in northern Jordan, Ramtha, Mafraq, and Irbid, from February 2021 to May 2021. The targeted population was adult Syrian refugees above the age of 18. Two thousand participants were included in this study using simple random selection. The study questionnaire included socio-demographic characteristics and knowledge questions such as hearing about Scabies, causes of Scabies, signs and symptoms of Scabies, and its way of transmission. The data was analyzed using (SPSS) version 25. ResultsFemales with a mean age of 37.9 years old comprised the majority of the participants. The majority of the participants were married and had intermediate levels of education. The knowledge about Scabies lacked among the majority of the respondents (N = 1259); 321 respondents had moderate knowledge, while only 650 had good knowledge. A statistically significant association was found between knowledge scores and all demographic characteristics, including gender, marital status, income, and educational level. ConclusionThe general knowledge about Scabies among Syrian refugees is relatively low, with 1259 out of 2000 participants having a bad knowledge score. Moreover, the level of knowledge, attitude, and practices toward Scabies is highly affected by the demographic factors of the Syrian refugees' Health education for refugees is needed to improve their knowledge and help implement prevention programs.

Consumption of ultra-processed foods and its association with sociodemographic factors in the adult population of the 27 Brazilian state capitals (2019).

ABSTRACTOBJECTIVE To describe the magnitude of consumption of ultra-processed foods in the adult population (≥ 18 years old) in the capitals of the 27 federative units of Brazil, as well as its association with sociodemographic variables.METHODS Data used in this study stem from participants (n = 52,443) of the 2019 wave of the annual survey of the “National surveillance system for risk and protective factors for chronic diseases by telephone survey” (Vigitel). The consumption of ultra-processed foods was described based on a score, corresponding to the sum of positive responses to questions about consumption on the previous day of thirteen subgroups of ultra-processed foods frequently consumed in Brazil. Poisson regression models were used to describe the crude and adjusted associations between high consumption of ultra-processed foods (scores ≥ 5) and sex, age group, and level of education.RESULTS The frequency of high consumption of ultra-processed foods was 18.2% (95% CI 17.4–19.0). With or without adjustment for other sociodemographic variables, this frequency was significantly lower in females and decreased linearly with age. In the crude analysis, there was an increase in the frequency of high consumption from the lower level to the intermediate level of education and a decrease in this consumption from the intermediate level to the upper level. In the analysis adjusted for sex and age, the frequency of high consumption of ultra-processed foods was significantly lower at the higher level of education (12 or more years of study), with no differences between the other levels.CONCLUSION Ultra-processed foods are consumed with high frequency in the adult Brazilian population in the 27 capitals of the federation. Being male, younger and having less education than university are conditions that increase, independently, the consumption of these foods.

Business cycle and mortality in Spain

In the last couple of decades, there has been a lot of interest on the impact of macroeconomic fluctuations on health and mortality rates. Many studies, for different countries, find that mortality is procyclical. However, studies examining the effects of more recent recessions are less conclusive, finding mortality to be less procyclical, or even countercyclical. In this paper, using data of Spanish provinces from 1999 to 2016, we investigate how this relationship works in the context of a country that is subject to extreme business cycle fluctuations. Furthermore, we analyze the impact of unemployment for different mortality causes and we explore differences by sex, age group and level of education. In general terms, we find mortality to be procyclical so that when the economy is in a recession, mortality falls. When exploring mortality causes, we show that deaths from cardiovascular disease, cancer, senility, transport accidents and homicides are procyclical. By sex, we find procyclicality for both men and women. By age, mortality is procyclical for all age groups; however, the causes of death that result in this procyclical behavior are specific to each age group. By educational level, suicide appears as a countercyclical cause for individuals with intermediate levels of education.

Assess and evaluate knowledge, attitude and practice of first aid management of epistaxis among general population in Aseer region.

Introduction:Epistaxis or nose bleeds is one the most common reported emergencies in the ear, nose and department. Causes of epistaxis varies from being trivial such as nose picking or dry air or trauma to concerning such as infections or elevated blood pressure to life threatening condition such as malignancies.Methods:The purposely constructed questionnaire was used for this research. The questionnaire was constructed by the panel of experts, language, psychological, doctors and subject specialist was there in the team. Internal consistencies of the questionnaire was measure through cronbach alpha.Results:Cronbach alpha = 0.84. Mean ± S.D of age of the respondents were 27.8 ± 9.8. 71.6% were females, 91.5% were belongs to Aseer region, 86.6% were living in village, 77.0% have intermediate level of education, 59.2% were single, 41.6% having health care profession. 51.1% having income less than 5000SAR.Conclusion:Most of them rely on internet and social media to gain knowledge regarding home management of epistaxis. This has limitations as they do not get a hands-on experience. Therefore, we recommend that first aid camps and workshops in management of epistaxis should be organized in order to properly educate the general population regarding its home management.

Incidence of excess body weight and annual weight gain in women and men: Results from the ELSA-Brasil cohort.

To estimate annual weight gain and the incidence of overweight and obesity, stratified according to gender and socioeconomic factors. From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we included 13 625 women and men aged 35-74 (2008-2010) who attended a follow-up visit after a mean 3.8-years. Standardized questionnaires were used to record sociodemographic data, and height and weight were measured on all participants during in-person visits at research centers. The incidence rate to overweight was calculated among those not having excess weight at baseline, and incident obesity among those not having this condition at baseline. We evaluated the incidence of overweight and obesity in men and women, adjusted by age, through Poisson regression with robust variance. Large annual weight gain by gender was being defined as ≥90th percentile in the cohort. A global incidence of 7.7% for overweight and 10.6% for obesity was observed, with higher levels seen among black woman (28.5%), young men (21.1%) and woman with low educational level (35.0%). The proportions of overweight and obesity increased with age at both time points, more commonly among those with the lowest levels of per capita income and fewer years of schooling. Large annual weight gain was greater among participants with an intermediate level of education and those who self-identified as black. A high overall risk of becoming overweight/obese was found, especially among women. The roles of race and education level are fundamental to understanding the effects produced by social inequalities in rates of excess weight.

Prevalence, types, and combinations of multiple problems among recipients of work disability benefits

Purpose For persons on disability benefits who are facing multiple problems, active labour market policies seem less successful. Besides health problems, these people perceive personal, social, and environmental problems. Since very little is known about these “non-medical” problems our aim was to explore the prevalence of clients experiencing multiple problems, the types and number of perceived problems, combinations of perceived problems, and associated characteristics in a group of work disability benefit recipients. Methods We performed a cross-sectional study, using self-reported data on perceived problems and socio-demographics, and register data from the Dutch Social Security Institute on diagnosed diseases and employment status. A convenient group of labour experts recruited eligible clients on work disability benefit. Results Of the 207 persons on work disability benefit, 87% perceived having multiple problems. Most reported problems were related to physical (76%) or mental (76%) health. Health problems most frequently occurred together with a mismatch in education, financial problems, or care for family members. Clients with lower education experienced significantly more problems than clients with an intermediate or high educational level. Conclusions Clients with multiple problems face severe and intertwined problems in different domains of life, and need tailored multi-actor work disability management. Implications for rehabilitation Clients with multiple problems face severe and intertwined problems in different domains of life; therefore, interventions tailored to deal with needs related to specific problems might be more effective than traditional programs. Interventions should match experienced barriers, and involve multi-actor work disability management with all the challenges of mutual cooperation. For persons with multiple problems a focus on pure medical barriers is too narrow, because personal, social, and environmental factors might also obstruct participation in work.

Telemedicine during the Coronavirus Disease (COVID-19) Pandemic: A Multiple Sclerosis (MS) Outpatients Service Perspective.

Background: During the COVID-19 pandemic, the need for a broader implementation of telemedicine for many diseases has become apparent. Televisits are one type of telemedicine in which clinical visits are conducted remotely using an audio-visual connection with the patient at home. The use of televisits is more established in Stroke care but was also recently formally evaluated for Multiple Sclerosis (MS). This retrospective case series describes patient characteristics and reasons for televisits in persons with MS during the COVID-19 pandemic outbreak in Italy, which was declared in February 2020. Methods: Recruitment occurred in a general hospital based MS clinic during Italy’s lockdown months period (9 March–18 May). Each subject completed at least one televisit. The baseline data included were demographics and MS history; reasons for the remote house calls were analyzed focusing on COVID-19 related needs. Results: Forty-six participants completed at least one study visit. The patients enrolled were more often females suffering from Relapsing Remitting Multiple Sclerosis (RRMS). Half of the patients had an intermediate level of education and lived within a 60 min drive from the clinic. These patients predominately had a short disease duration and were mostly involved in oral treatment. The main reasons for the call were drug use and counseling on social distancing. In 5 cases, COVID-19 infection was reported. Conclusions: Televisits during the COVID-19 outbreak demonstrated their utility as a care delivery method for MS. Hence, it is vital to facilitate the implementation of this technology in common practice to both face infectious threats and increase accessibility of the health care system.

Drop-out from chronic pain treatment programmes: Is randomization justified in biopsychosocial approaches?

ObjectiveTo identify profiles of patients who are at risk of dropping out from biopsychosocial approaches to chronic pain management.PatientsA total of 575 patients were included in the study. Of these, 203 were randomized into 4 treatment groups: self-hypnosis/self-care; music/self-care; self-care; and psychoeducation/cognitive behavioural therapy. The remaining 372 patients were not randomized, as they presented with the demand to learn self-hypnosis/self-care, and therefore were termed a “self-hypnosis/self-care demanders” group.MethodsSocio-demographics and behavioural data were included in the analyses. Univariates analyses, comparing early drop-outs (never attended treatment), late drop-outs (6/9 sessions’ treatment) and continuers were conducted in order to select variables to include in a multivariate logistic regression.ResultsUnivariate analyses yielded 8 variables, out of 18 potential predictors for drop-out, which were eligible for inclusion in the multivariate logistic regression. The model showed that having an intermediate or high educational level protects against dropping out early or late in the pain management process. Having to wait for more than 4 months before starting the treatment increases the risk of never starting it. Being randomized increases the risk of never starting the treatment.ConclusionIn a context in which randomization is considered a “gold standard” in evidence-based practice, these results indicate that this very principle could be deleterious to pain management in patients with chronic pain.LAY ABSTRACTThe aim of this study was to identify profiles of patients who are at risk of dropping out from biopsychosocial approaches to chronic pain management. A total of 575 patients were included in the study. Of these, 203 patients were randomized into 4 treatment groups: self-hypnosis/self-care; music/self-care; self-care; psychoeducation/cognitive behavioural therapy. The remaining 372 patients were not randomized, as they presented with the demand to learn self-hypnosis/self-care, and hence formed a “self-hypnosis/self-care demanders” group. Analyses of socio-demographics and behavioural data were conducted, comparing early drop-outs (never attended treatment), late drop-outs (6/9 sessions’ treatment) and continuers. Results showed that having an intermediate or high educational level protects against dropping out early or late in the management process. Having to wait for more than 4 months before starting the treatment, and being randomized, increases the risk of never starting it. Thus, in a context in which randomization is considered as a “gold standard” in evidence-based practice, these results indicate that this very principle could be deleterious to pain management in patients with chronic pain.

Health literacy and adherence to treatment in different districts in Chile.

The relationship between health literacy and adherence has been described in medical literature, especially for patients with non-communicable diseases (NCDs). However, the relevance that an individual's local context can have has not been considered. This study aimed to examine the association of both concepts at a population level and estimate the correlation between health literacy and adherence to pharmacological treatment in adults from 14 districts in different regions in Chile. A cross-sectional study was carried out in 14 districts from 3 different regions of Chile. Sampling was carried out by volunteers. Three questionnaires were applied: sociodemographic; Morisky-Green-Levine (MMAS-4) and the Short Assessment of Health Literacy for Spanish Adults test (SAHLSA-50). Data were analyzed descriptively, and a Multilevel Poisson Regression model was fitted to evaluate the relationship between health literacy and adherence to pharmacological treatment, considering the districts as fixed intercepts. A total of 1,336 persons were surveyed; 811 self-reported as having at least 1 NCD. A 83.4% had adequate literacy and 37.1% were adherent to pharmacological treatment, regardless of their health literacy. A 3.6% (variance partition coefficient = 0.036) correlation of adherence to treatment was observed in respondents living in the same district. Those with inadequate health literacy had a 12% greater prevalence of being non-adherent (prevalence ratio 1.12; IC 95% 0.87 - 1.47) when adjusting for individual variables. These results could suggest that the individual's local context does not influence the relation of functional health literacy and adherence to pharmacological treatment in populations with basic and intermediate levels of education. We suggest further studies in this matter.

Education and stroke: evidence from epidemiology and Mendelian randomization study

We aim to characterize the association between education and incident stroke (including total stroke, ischemic stroke, and hemorrhagic stroke) and assess whether there is a causal relationship between them. The final sample size was 11,509 in this study from the Atherosclerosis Risk in Communities (ARIC) study. Cox hazard regression models were used to explore the association between education level and incident stroke. Two-sample Mendelian randomization (MR) was used to estimate the causality. During a median follow-up of 25.3 years, 915 cases (8.0%) of stroke occurred. Participants with advanced education level were associated with 25% (HR 0.75; 95% CI 0.62, 0.91) decreased the rate of incident total stroke. Hazard ratio of intermediate and advanced education level for ischemic stroke were 0.82 (0.69, 0.98) and 0.73 (0.60, 0.90) separately. In the MR analysis, we observed evidence that education was likely a negetive causal risk factor for ischemic stroke (OR 0.764, 95% CI 0.585–0.998, P = 0.048). Higher education level was associated with a decreased rate of total stroke and ischemic stroke incident, but not hemorrhagic stroke incident. There might be a protective causal association between education and ischemic stroke (but not total stroke nor hemorrhagic stroke).

Socio-Demographic Correlates of Cycling to School among 12- to 15-Year Olds in Southern Germany.

Depending on the region and urbanization level, the rate of cycling to school in Germany varies largely. The influence of distance from home to school, educational level, the school’s region, and parents’ socio-demographic characteristics on cycling to secondary school in Germany is unclear. Therefore, this study analyzed students’ and parents’ socio-demographic correlates of cycling to school, including separate analyses by gender, among 12- to 15-year-olds attending different (sub)urban schools in Southern Germany. In 2019, 121 students (girls: 40.5%, boys: 59.5%) aged 13.1 ± 0.9 and 42 parents (mothers: 81%, fathers: 19%) aged 47.8 ± 5.5 participated. Students completed a self-report questionnaire; parents completed a self- and proxy-report questionnaire. In total, between 61.7% and 67.5% of students sometimes cycled to school. Binary logistic regressions revealed that being a girl, increasing age, attending an intermediate educational level combined with a suburban school region (small or medium-sized town), increasing distance from home to school, and having parents who did not cycle to work led to declining odds of cycling to school. Many 12- to 15-year-olds sometimes cycled to school in (sub)urban school regions in Southern Germany. As several socio-demographic characteristics correlated with cycling to school, this should be considered when developing a future school-based bicycle intervention.

Changes and determinants of unmet oral health treatment need.

Our aim was to describe the nature and determinants of the changes in unmet treatment need between the years 2000 and 2011 after a major oral healthcare reform and a wider supply of subsidized care. The study used a longitudinal sample (n=3838) of adults who had participated in both the Health 2000 and 2011 surveys (BRIF 8901). Those reporting self-assessed treatment need without having visited a dentist in the previous 12months were categorized as having unmet treatment need. Two logistic regression models were applied to determine the effects of predisposing and enabling factors on change in unmet treatment need. Model 1 was conducted among those who reported unmet treatment need in 2000 and evaluated the determinants for improvement. Model 2 was conducted among those who did not have unmet treatment need in 2000 to evaluate the risk factors for having unmet treatment need by 2011. Unmet treatment need was reported by 25% of the participants in 2000 and by 20% in 2011. Those with unmet treatment need in 2000 were less likely to report improvement by 2011 if they had poor subjective oral health, basic or intermediate education level, or poor perceived economic situation in 2000. Those who did not have unmet treatment need in 2000 were more likely to have it in 2011 if they were males or from northern Finland and less likely to if they came from central Finland or were older. The wider supply of subsidized oral health care during the study years did not lead to complete elimination of treatment need. The determinants of unmet treatment need, such as low or intermediate education level and perceived economic difficulties, should be used in targeting the services at those with treatment need to achieve better oral health outcomes.

Are Parent Education Level Have Influence to Choose First Facility / Helper for Fracture in Children with Osteogenesis Imperfecta

Introduction: Osteogenesis Imperfecta (OI) disease can develop fractures with or without trauma. Initial management of fracture cases depends on the patients' parents and it may affect the results. Various kinds of factors can influence parents' decision making in health issues, one of which is the level of education.&#x0D; Methods: This research was conducted by analyzing the results of the questionnaire for the parental education level. Patients that fulfilled the inclusion criteria were part of the study from January to March 2020.&#x0D; Results: The data showed that 38 (31%), 31 (26%), 29 (24%), and 23 (19%) patients were treated by bonesetters, hospitals, primary health care centers, and private clinics. There were 38 (31%) parents who took their children to bonesetters, mostly have intermediate education level. Mostly parents with high level of education bring their children treated in hospitals (49%). There was a significant correlation between their education level (P = 0.000) regarding decision making in the first fracture case.&#x0D; Conclusion: The parents' educational level of patients diagnosed with OI affects decision making in determining the first treatment facility for managing cases of fracture.&#x0D; Practice Implication : Parental education level plays an important role in making appropriate decisions for medical treatment

Education and heart failure: New insights from the atherosclerosis risk in communities study and mendelian randomization study

IntroductionWe aim to characterize the nature and magnitude of the prospective association between education and incident heart failure (HF) in the Atherosclerosis Risk in Communities (ARIC) Study and investigate any causal relevance to the association between them. MethodsThe final sample size was 12,315 in this study. Baseline characteristics between education levels were compared using 1-way ANOVA test, the Kruskal-Wallis test, or the χ2 test. We used the Kaplan-Meier estimate to compute the cumulative incident of HF by education levels and the difference in estimate was compared using the log-rank test. Cox hazard regression models were used to explore the association between education levels and incident HF. Two-sample Mendelian randomization (MR) based on publicly available summary-level data from genome-wide association studies (GWASs) was used to estimate the causal influence of the education and incident HF. ResultsDuring a median follow-up of 25.1years, 2453 cases (19.9%) of incident HF occurred. After multiple adjustments in the final model, participants in the intermediate and advanced education levels were still associated with 18% and 21% decreased rate of incident HF separately. In MR analysis, we detected a protective causal association between education and HF (P=0.005). ConclusionsParticipants with higher education levels were associated with a decreased rate of incident HF. There was a causal association between education and HF.

Education, health behavior, and working conditions during the pandemic: evidence from a German sample

ABSTRACT Education is a main cause of health inequality because it influences health behavior as well as structural conditions that impact health, such as living and working conditions. We examine how different educational groups reacted to the beginning of the COVID-19 pandemic in Germany by looking at health-related behavior – social distancing, increased hygiene, and mask wearing – as well as changes in working conditions – work from home, reduced working hours, and not working – as a structural indicator that can mitigate the risk of infection. More than three quarters of respondents in all educational groups complied with recommended social distancing and hand hygiene behaviors, and differences by education did not exceed ten percentage points. Regarding working conditions, highly educated respondents had a likelihood of over 45 percent to work from home during the pandemic. This number decreased to 17 and 11 percent for those with intermediate and low levels of education, respectively. It seems that education-based inequalities in the risk of infection with COVID-19 do not primarily stem from differences in health behavior but rather from structural causes, that is, inability to practice social distancing at work.

The Perception of Ecosystem Services of Mountain Farming and of a Local Cheese: An Analysis for the Touristic Valorization of an Inner Alpine Area

Mountain husbandry systems and their related products may directly or indirectly provide either ecosystem services (ESs) or disservices to humanity. The present study aims to evaluate the perception that a local mountain community has towards animal husbandry in the Lanzo Valleys (Piedmont, Italy) and towards the typical local dairy product, Toma di Lanzo, as well as to investigate the consumers’ habits and preferences, to detect possible positive impacts on mountain tourism. A questionnaire was delivered to 233 respondents. The perception of the impact was scored using a five-point Likert scale. The results show a very positive perception of the product Toma di Lanzo because of its origin and type of processing, with different perceptions of the local society depending on age (p &lt; 0.01), residence (p &lt; 0.01), and education level (p &lt; 0.05). The respondents had a very positive awareness of the impact of mountain livestock farming in the Lanzo Valleys. The most important perceived ESs are cultural identity and maintenance of local breeds. Women, non-residents, and respondents with an intermediate education level generally had a more positive perception of ESs. There was a very low perception of disservices derived from mountain animal farming. The main perceived obstacles to the spread of benefits derived from these farming systems were the scarce presence of specific supporting politics and the low income generated by mountain farming activities. The coexistence of touristic activities and extensive livestock farming systems has to be associated with a better promotion of mountain products like Toma di Lanzo to improve the sustainability of mountain regions.

Abandoning resectional intent in patients initially deemed suitable for esophagectomy: a nationwide study of risk factors and outcomes.

The main curative treatment modality for esophageal cancer is resection. Patients initially deemed suitable for resection may become unsuitable, most commonly due to signs of generalized disease or having become unfit for surgery. The aim was to assess risk factors for abandoning esophagectomy and its impact on survival. All patients diagnosed with an esophageal or gastroesophageal junction cancer in the Swedish National Register for Esophageal and Gastric Cancer from 2006-2016 were included and risk factors associated with becoming ineligible for resection were analyzed in multivariable logistic regression analysis. Overall survival was explored by multivariable Cox regression models. Among 1,792 patients planned for resection, 189 (11%) became unsuitable for resection before surgery and 114 (6%) had exploratory surgery without resection. Intermediate and high educational levels were associated with an increased probability of resection (odds ratio (OR) 1.46, 95% CI 1.05-2.05, OR 1.92, 95% CI 1.28-2.87, respectively) as was marital status (married: OR 1.37, 95% CI 1.01-1.85). Clinically advanced disease (cT4: OR 0.38, 95% CI 0.16-0.87; cN3: OR 0.27, 95% CI 0.09-0.81) and neoadjuvant treatment were associated with a decreased probability of resection (OR 0.62, 95% CI 0.46-0.88). Five-year survival for non-resected patients was only 4.5% although neoadjuvant treatment was associated with improved survival (HR 0.75, 95% CI 0.56-0.99). Non-resected patients with squamous cell carcinoma had comparatively reduced survival (HR 1.64, 95% CI 1.10-2.43). High socioeconomic status was associated with an increased probability of completing the plan to resect whereas clinically advanced disease and neoadjuvant treatment were independent factors associated with increased risk of abandoning resectional intent.