CC License Research Articles

CYCLOPS: A cyclists’ orientation data acquisition system using RGB camera and inertial measurement units (IMU)

This paper introduces CYCLOPS, an acquisition system developed to capture images and inertial measurement data of moving cyclists from a vehicle. The development of CYCLOPS addresses the need to acquire useful data for training machine learning models capable of predicting the motion intentions of cyclists on urban roads. Considering its application, it is a completely original development. The system consists of two devices. The first device is installed on the bicycle and is based on an electronic acquisition board comprising an inertial measurement unit (IMU), a microcontroller, and a transceiver for sending the cyclist’s acceleration and orientation data to a vehicle. The second device is installed on the vehicle and uses the same board architecture to acquire the vehicle’s accelerations and orientations, along with an RGB monocular camera. The data is stored in real-time in a laptop’s drive for subsequent analysis and manipulation. The hardware architecture is presented in detail, including the designs to install the devices, for IMUs configuration, and software installation on the laptop. All design and software files required to develop the proposed system are available for download at: doi.org/10.17632/3yx5y8b7tm.1, licensed under the Open-source license CC BY 4.0.

Disparities in Prevalence of COVID-19, Long COVID, Disease Severity, and Mental Health Outcomes among US Adults by Industrial Sector of Employment, September-November 2022

Background: The coronavirus disease (COVID-19) pandemic has had a major adverse impact on people’s health and well-being in the United States (US) and globally. Although inequalities in COVID-19 prevalence and to a lesser extent in Long COVID and related mental health impact among US adults have been documented, disparities in COVID-related outcomes by industrial sector of employment, an important social determinant, have not been studied. Using the latest nationally representative data, we examine disparities in COVID-19, Long COVID, and associated mental health impact among US adults aged ≥18 years by industrial sector. Methods: Using three consecutive rounds of the US Census Bureau’s Household Pulse Survey from September 14 to November 14, 2022 (N=148,813), disparities in COVID-related outcomes by industrial sector were modeled by multivariable logistic regression after controlling for race/ethnicity, socioeconomic status, health insurance, and other demographic characteristics. Results: During September–November 2022, an estimated 117 million or 48.7% of US adults reported having been diagnosed with COVID-19; 34.3 million or 29.4% of COVID patients reported developing Long COVID; 14.7 million or 12.6% of COVID patients reported experiencing severe COVID symptoms; 10.7% of COVID patients reported serious depression, and 17.8% reported serious anxiety. Adjusted for covariates, workers in wholesale trade, finance and insurance, educational services, healthcare, social assistance, and accommodation and food services had 30-39% higher odds of being diagnosed with COVID-19 than workers in the agricultural sector. Workers in social assistance, real estate, utilities, construction, and healthcare sectors had 48-102% higher adjusted odds of developing Long COVID than workers in wholesale trade. Conclusion and Implications for Translation: Marked disparities in COVID-related outcomes existed, with workers in employment industries such as healthcare, social assistance, real estate, arts and entertainment, and accommodation and food services being at increased risk of COVID-19 diagnosis, Long COVID, severe COVID symptoms, serious depression, and anxiety. Equitable access to social services and healthcare, including mental and behavioral health services, among workers afflicted with these conditions is critical to reducing inequities in COVID-related health outcomes. Copyright © 2023 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

State and Metropolitan Area Disparities in Long COVID-19 and Related Symptoms among US Adults, June-October 2022

Background: Little research exists on sociodemographic and geographic inequalities in Long COVID, defined as COVID-19 symptoms lasting 3 months or longer. Using the latest nationally representative data, we examine geographic disparities in prevalence of Long COVID and severe COVID symptoms among United States (US) adults aged ≥18 years. Methods: We analyzed five consecutive rounds of the US Census Bureau’s Household Pulse Survey from June 1 to October 17, 2022 (N=108,064). Using multivariable logistic regression and health disparity indices, we modeled disparities in Long COVID and severe COVID symptoms by state and metropolitan area, controlling for race/ethnicity, socioeconomic status, health insurance, and other demographic characteristics. Results: During June–October 2022, an estimated 35.4 million or 32.2% of COVID patients in the US reported developing Long COVID; and 15.2 million or 13.8% of COVID patients reported experiencing severe COVID symptoms. The prevalence of Long COVID ranged from 24.0% in the District of Columbia (DC), 25.4% in Hawaii to 39.2% in Alabama, 39.9% in Wyoming, and 43.6% in West Virginia. Adjusted for covariates, adults with COVID-19 diagnosis in Alabama, Wyoming, and West Virginia had 48-178% higher adjusted odds of developing Long COVID than their counterparts in DC. Adults with COVID-19 diagnosis in Alabama, Arkansas, Colorado, Iowa, Kentucky, Mississippi, Montana, North Dakota, South Dakota,Texas, Utah, Virginia, Wyoming, and West Virginia had 2.0-2.5 times higher adjusted odds of experiencing severe COVID symptoms than their counterparts in Vermont. Large disparities in prevalence of Long COVID and severe COVID symptoms existed among the 15 largest metropolitan areas of the US, with the prevalence of Long COVID ranging from 21.9% in San Francisco to 38.0% in Riverside, California. Socioeconomic, demographic and health insurance characteristics explained 34% of the state-level disparity and 45% of the metropolitan-area disparity in Long COVID prevalence. Conclusion and Implications for Translation: Marked geographic disparities existed, with COVID patients/survivors in the Southeast, Southwest, and Northern Plains states being at substantially higher risks of developing Long COVID and severe COVID symptoms. Equitable access to care and support services among patients with Long COVID is critical to reducing inequities in COVID-related healthoutcomes. Copyright © 2023 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Understanding Russia’s Actions in Ukraine as the Crime of Genocide (Translation into Ukrainian by Denys Azarov)

This is the Ukrainian-language version of the article previously published in the Journal of International Criminal Justice (Denys Azarov, Dmytro Koval, Gaiane Nuridzhanian, Volodymyr Venher, Understanding Russia’s Actions in Ukraine as the Crime of Genocide, Journal of International Criminal Justice, Volume 21, Issue 2, May 2023, Pages 233–264, https://doi.org/10.1093/jicj/mqad018) by Oxford University Press. The translation is published under the terms of the Creative Commons Attribution License CC BY 4.0. Abstract from an English edition. The new wave of Russia’s aggression against Ukraine that began on 24 February 2022, and the intensification of the armed conflict accompanied by grave breaches of international humanitarian law, has received significant scholarly attention. Many academic interventions have examined the developments in Ukraine through the frameworks of jus ad bellum and jus in bello. Some, however, have applied a genocide lens to make sense of reported numerous and widespread violations of international humanitarian and human rights law. This article contributes to the latter stream of scholarship by contextualizing the arguments for the existence of genocidal intent behind the seemingly unrelated crimes committed by the armed forces of the Russian Federation all over Ukraine. The authors pay particular attention to the language and pseudo-historical references used by Russia’s leaders as a justification for the invasion of Ukraine and argue that these statements and expressions indicate the existence of genocidal intent. This article also reflects on the issue of the systematic destruction of cultural heritage of Ukraine as further evidence of the intent to destroy the Ukrainian nation understood as a protected national group under the Genocide Convention, at least in part. Finally, the authors analyse the genocidal acts that have apparently been committed, including killings; the causing of serious bodily or mental harm; the forcible transfer of Ukrainian children to Russia, and the deliberate infliction of conditions of life aimed at the physical destruction of the Ukrainian nation. It is stressed that there are reasonable grounds to believe that the destruction of the Ukrainian nation by Russia has been pursued through commission of these prohibited acts. Their nature and large-scale character serve as further evidence of genocidal intent to destroy the Ukrainian nation.

From Option B+ to Universal "Test and Treat" in Cameroon: Identification and Evaluation of District-level Factors Associated with Retention in Care.

Retaining women in Option B+ services is crucial for eliminating new pediatric HIV infections. However, there are few studies on factors influencing retention at the district level. This study evaluates the factors associated with retention in two health districts of Cameroon. From September 1, 2015, to February 29, 2016, we reviewed the records of pregnant and breastfeeding women initiating Option B+, a lifelong approach to preventing mother-to-child transmission (PMTCT) of HIV, between October 2013 and July 2014. We abstracted sociodemographic and clinical data from registers in 22 health facilities in the Bamenda urban and Kumba rural districts into spreadsheets. Cox regression age-adjusted survival curves were used to compare retention probabilities at 6 and 12 months post-antiretroviral therapy (ART) initiation. Multivariable modified Poisson regressions were run to estimate adjusted relative risk (aRR) of factors associated with retention in PMTCT care at 12 months post-ART initiation. STATA software was used for the analyses. Of the 560 files reviewed, majority, 62.7% (n=351), were above 24 years of age and married, 68.9% (n=386). From the multivariable analysis, enrolling early in antenatal care (ANC) (aRR: 1.50, 95% CIL: 1.17-1.93) and knowing the male partner's HIV-negative status (aRR: 1.16, 95% CI: 1.00-1.34) were significantly associated with higher retention in care, adjusting for maternal age, marital status, and distance from the health facility. By health district, knowing the male partner's HIV-negative status (aRR: 1.30, 95% CI: 1.13-1.50) in the Bamenda urban and enrolling early in ANC (aRR: 2.03, 95% CI" 1.21-3.41) in the Kumba rural district, had significantly higher retention rates after adjusting for the same covariates. Overall, factors influencing retention varied by urban or rural district. Therefore, tailored district-level interventions are needed to enhance early ANC enrollment in the rural and partner HIV status disclosure in the urban districts to improve retention in PMTCT care.

Evaluation of Virtual Prenatal Care for Obstetric Care Delivery During the COVID-19 Pandemic: A Mixed Method Research Study Using the Consolidated Framework in Implementation Research.

Coronavirus 2 (SARS-CoV-2), a novel respiratory virus, rapidly spread, and placed patients at increased risk for short and potentially long-standing medical illnesses. The pandemic necessitated the rapid implementation of virtual prenatal care via telemedicine in obstetrics to maintain social distancing measures. The aim of this study was to assess and understand the patient perspectives of the rapidly implemented virtual prenatal care via a telemedicine model during the Coronavirus disease 2019 (COVID-19) pandemic utilizing the Consolidated Framework in Implementation Research (CFIR). Following the implementation of virtual prenatal care in March 2020, pregnant patients at a large urban clinic in the southeastern United States completed a 19-question anonymous survey that included open and closed-ended questions on their experience receiving virtual prenatal care via telemedicine or in-person prenatal care from May to December 2020. The survey and mixed-methods data analysis was guided by the CFIR framework. A total of 59 patients completed the survey. One-third (31%, n=18) of the patients found virtual prenatal care to be an acceptable alternative model, and half (53%, n=31) found it acceptable only during a pandemic, preferring to return to in-person visits. Qualitative analysis found that some patients were deterred by limited in-person examinations and uncertainty with the virtual platform, while others appreciated the reduced need for transportation, childcare, and time spent. Most patients found virtual prenatal care to be easy to access and an acceptable alternative during the pandemic; however, most would prefer to return to in-person prenatal care visits. Future comparative research studies should examine how, among others, virtual prenatal care versus in-person prenatal care impacts specific maternal and fetal outcomes.

Improving Reproductive and Maternal Healthcare Uptake in India: An Evaluation of Project Ujjwal Public-Private Partnership Program

Background and Objective: Project Ujjwall was a public private partnership established to improve maternal and child health (MCH) outcomes in Bihar and Odisha in India. This paper examines whether Project Ujjwal meaningfully increased the usage of family planning methods and maternal health services to determine whether the Ujjwall program model should be expanded in India. This is the first attempt to establish the causal impact of Project Ujjwal on access to reproductive healthcare in India. Methods: Data were obtained from the National Family Health Survey of India. A difference-in-differences strategy and linear probability models were used to estimate the likelihood of ever having encountered family planning information or ever having used contraceptives, antenatal care, etc. Results: The sample size for Odisha was 4,540; the sample size for Bihar was 3,818; the total sample size for all states in the control group was 24,922. Within Odisha and Bihar, Project Ujjwal increased the likelihood of ever having used any contraceptive by 8.9%, increased the likelihood of having ever accessed antenatal care from a licensed doctor or nurse by 2.5% and increased the likelihood of having ever encountered family planning media by 5.1%. However, most results seem differentially driven by the success of the program in either Odisha or Bihar: among all results, only the odds that a woman received delivery assistance (2.8%) and the odds that a woman will have used oral contraceptives by (9.3%) increased statistically significant in both states. Conclusion and Implications for Translation: These results are promising and show Project Ujjwal may have been more effective than existing government programs. Limitations of this analysis include a lack of information about the demand generation tactics and an inability to include state-level fixed effects due to over-specification concerns. Disparities in the impact of Project Ujjwal on Bihar and Odisha and the lack of specific information about latent demand both suggest the need for further investigation. Copyright © 2023 Lokhande. Published by Global Health and Education Projects, Inc.This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Sexually Transmitted Infections in Pre-Exposure Prophylaxis Patients

Background and Objective: Pre-exposure prophylaxis (PrEP) effectively prevents the spread of the human immunodeficiency virus (HIV). HIV is a disease primarily contracted by men who have sex with men or the sharing of needles, syringes, and other drug injection equipment. However, there is some disparity over the thought that PrEP patients have a disproportionate incidence of sexually transmitted infections (STIs) compared with non-PrEP patients. This study aims to clarify the disparity and identify if PrEP patients have a higher incidence of STIs. Methods: A survey of 143 respondents was conducted on STI incidence, risk factors, and abstinence from May 13, 2022, to June 20, 2022. The results were analyzed in Statistical Package for the Social Sciences (SPSS V28.0.0.0). SPSS was used to analyze the descriptive statistics associated with STI data obtained from the Naval Medical Readiness and Training Command, Camp Lejeune, Community Health Clinic Patient and Laboratory Tracker. Results: This study found a higher incidence of STIs among PrEP patients than non-PrEP patients and a statistical significance (p = 0.010) between the number of partners a person had sex with over the past year and the lifetime incidence of STIs. Portions of the data in the linear regression were used to calculate the significance and can be used as a predictor of STIs based on the number of partners a person has. This can help patients within this community understand their actual risk of contracting an STI based on a potential risk factor. Conclusion and Implications for Translation: This study found a higher incidence of STIs among PrEP patients than non-PrEP patients. Additionally, the study can help public health professionals understand the risks associated with military patients who take PrEP and target specific risk factors that influence the disparity in the incidence of STIs. Future studies may use survey data from this study to understand the implications of other risk factors and their association with STIs. Public health professionals can also use these data to develop a predictive index for many risk factors. A predictive index on STI risk is an extremely valuable tool as it allows users to view their risk of obtaining an STI. Copyright © 2023 Sleeman and Hoban. Published by Global Health and Education Projects, Inc.This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Editorial: Special issue of the International Journal of Action Research on industrial democracy

Bibliography: Ravn, Johan E./Imaz Alias, Oier/Haga, Trond Sanne/Greenwood, Davydd J.: Editorial: Special issue of the International Journal of Action Research on industrial democracy, IJAR – International Journal of Action Research, Vol. 19, Issue 1-2023, pp. 3-6. https://doi.org/10.3224/ijar.v19i1.01-----Open Access License: This contribution is available in Open Access under the Creative Commons license CC BY 4.0 (Attribution 4.0 International) as of May 31, 2023. More information about the license and the terms of use can be found here.

Safety of Hyperbaric Oxygenation Treatment and Evaluation of Associated Clinical Parameters: A Single-Institutional Prospective Cohort Study

Background and Objective: Adverse events (AEs) associated with hyperbaric oxygen therapy (HBOT) are uncommon and typically not serious, being the most frequent otic/sinus barotrauma. The objective of this study is to analyze the safety of the HBOT at 1.45 atmosphere absolute (ATA) and compare it with reportsat the same and higher pressures of treatment. AE per session was 7.1% for total AE and 4.1% for overall barotrauma. AE was reported in 28.3% of patients (n=49), with barotrauma and non-barotrauma AE in 20.3% (n=35) and 8.1% (n=14). All barotrauma was recorded as subjective (100% of ear ache without eardrum damage, Teed scale=0). The frequency of total AE obtained in our study was statistically higher for 1.5, 2, and >2 ATA. Non-barotrauma AE was also higher; the frequency of total AE obtained in our study was statistically significant for 1.5, 2, and >2 ATA but objective barotrauma was not present, and it was significantly lower than previously reported (p < 0.001). A very slow rate of pressurizations (below 1 psi/min) was associated with ear pain (OR=3.32; 95 CI%, 1.32-8.35; p < 0.001). The AEs reported in this safety surveillance prospective study are minor, and no objective barotrauma was reported. HBOT at 1.45 ATA is a safe treatment, that can be performed with a portable light and a less expensive hyperbaric chamber. Methods: A total of 175 patients (68 male, 107 female) were included in this prospective study. All patients were treated with HBOT at our facility from December 2019 to August 2021. For the comparative analysis, reports from studies published from 2012 to 2021 in MEDLINE EMBASE, BIREME, Lilacs, Scielo, and the Cochrane library were used. Binary variables are described in percentages with a 95% confidence interval (95% CI). Inferential analysis was performed using a bivariate analysis by calculating odds ratio (OR) with 95% confidence intervals. Statistical analyses and sample size calculations were performed with Stata version 13.0 (College Station, TX, USA). Results: In this study, the AE per session was 7.1% for total AE and 4.1% for overall barotrauma. AE was reported in 28.3% of patients (n=49), with barotrauma and non-barotrauma AE in 20.3% (n=35) and 8.1% (n=14), respectively. All barotrauma was recorded as subjective (100% of ear ache without eardrum damage, Teed scale=0). The frequency of total AE obtained in our study was statistically higher for 1.5, 2, and >2 ATA. Non-barotrauma AE was also higher, but objective barotrauma was not present and was significantly lower than previously reported (p <0.001). A very slow rate of pressurizations (below 1psi/minute) was associated with ear pain (OR = 3.32; 95% CI, 1.32-8.35; p <0.001). Conclusion and Implications for Translation: In this study, the AE reported in this prospective safety surveillance study are minor, and no objective barotrauma was reported. The HBOT at 1.45 ATA is a safe treatment that can be performed with a portable lighter and a less expensive hyperbaric chamber. This study supports the hypothesis that hyperbaric oxygenation therapy at 1.45 ATA is a safe treatment, allowing for the spread and application of adjuvant treatment in different pathologies. Copyright © 2023 Monge-Martínez, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

The Role of Perceived Susceptibility, Perceived Severity, Perceived Barriers and Benefits in COVID-19 Vaccine Hesitancy and Uptake Among Outpatient Surgery Nurses in the United States: A Qualitative Study

Background and Objective: This qualitative study explores outpatient nurses’ perceptions of coronavirus disease 2019 (COVID-19) and the COVID-19 vaccine, aiming to inform future research and health education strategies for reducing vaccination hesitancy among healthcare workers, particularly nurses. The nurses recruited for this study were all registered nurses (RNs). Studies have shown that registered professional nurses consistently display higher vaccination hesitancy versus other healthcare groups, specifically doctors. Little is known about the vaccine acceptance disparities that exist among healthcare workers, or why nurses appear to consistently display higher rates of vaccine hesitancy, versus other healthcare groups, especially doctors. Methods: Semi-structured interviews guided by the health belief model were conducted with 8 outpatient nurses, and a focus group guided by the health belief model was conducted with 5 outpatient nurses, for a total of 13 nurses (N=13). The data were triangulated through interviews, a focus group, and a literature review. In addition, an independent external secondary analyst confirmed the findings. Results: Three key themes appeared: (1) sources of information (trusted sources of information), (2) experience (belief about personal risk and personal responsibility), and (3) logistics (COVID-19 testing requirements, booster frequency, and mandate versus choice). Conclusion and Implications for Translation: We advise public health professionals to adopt a grassroots approach to vaccine hesitancy interventions, engaging and training doctors and nurses. We also recommend consistency in prevention approaches, as that produces trust. We also recommend further research into the booster requirement, as requiring an unknown number of boosters appears to lower trust among nurses. Copyright © 2023 Matta et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Impact of COVID-19 on Essential Health Care of Rural People in Northern Bangladesh: A Cross-Sectional Study

Background and Objectives: The coronavirus disease 2019 (COVID-19) has an unpredicted effect on global society. The main objective of this study is to determine the impact of COVID-19 on rural people’s access to health care in Northern Bangladesh. Methods: A cross-sectional community-based design was used. Data were collected from four different districts in the Rajshahi and Rangpur divisions using the multistage sampling technique. A pre-tested semi-structured questionnaire was used for data collection. SPSS version 25 was used for the statistical analysis. Results: Among 639 respondents, 59.5% were female, and 40.5% were male. The mean age was 34.3 years (SD ±10). The family income ceiling was reduced to -15.6% for incomes between $10,000 and $20,000, and -12.7% for incomes between $20,000 and $30,000. Because 38.2% of respondents’ income was reduced during COVID-19, they now fall into the income category of ≤10,000 Bangladeshi Taka. Due to a lack of transportation, 41.7% of respondents never sought medical attention. During the COVID-19 period, respondents reported physical illness (24.4%), severe stress problems/mental illness (39.2%), and either injuries or urgent health problems (3.8%).The percentage of respondents who did not seek medical attention because they were afraid of becoming infected with COVID-19 was 30.3%. The majority of respondents, 67.3% (n=188), stated that they were unable to locate any maternal and child health care institutions. Conclusion and Implications for Translation: The COVID-19 pandemic caused a significant disruption in the delivery of essential health services.To address future COVID-19 outbreaks and similar pandemics, the government and private sector must work together, as well as global collaboration. Copyright © 2023 Rahman, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

The interplay of ADHD symptoms and exercise in youth

The interplay of ADHD symptoms and exercise in youth

Interbirth Intervals of Immigrant and Refugee Women in the United States: A Cross-Sectional Study.

Despite guidelines recommending an interval of at least 18-24 months between a live birth and the conception of the next pregnancy, nearly one-third of pregnancies in the United States are conceived within 18 months of a previous live birth. The purpose of this study was to examine the associations between multiple immigration-related variables and interbirth intervals among reproductive-aged immigrant and refugee women living in the United States. This was a cross-sectional, quantitative study on the sexual and reproductive health (SRH) of reproductive-aged immigrant and refugee women in the United States. The data were collected via an online survey administered by Lucid LLC. We included data on women who had complete information on nativity and birth history in the descriptive analysis (n = 653). The exposure variables were immigration pathway, length of time since immigration, and country/region of birth. The outcome variable was interbirth interval (≤18, 19-35, or ≥36 months). We used multivariable ordinal logistic regression, adjusted for confounders, to determine the factors associated with having a longer interbirth interval among women with second- or higher-order births (n = 245). Approximately 37.4% of study participants had a short interbirth interval. Women who immigrated to the United States for educational (aOR = 4.57; 95% CI, 1.57-9.58) or employment opportunities (aOR = 2.27; 95% CI, 1.07-5.31) had higher odds of reporting a longer interbirth interval (19-35 or ≥36 months) than women born in the United States. Women born in an African country had 0.79 times the odds (aOR = 0.79; 95% CI, 0.02-0.98) of being in a higher category of interbirth interval. Although all birthing women should be counseled on optimal birth spacing through the use of postpartum contraception, immigrant and refugee women would benefit from further research and policy and program interventions to help them in achieving optimal birth spacing. SRH research in African immigrant and refugee communities is especially important for identifying ameliorable factors for improving birth spacing.

A dataset of Sentinel-2 Digital RGB imagery acquired in Andalusia region of Spain between June 2015 and October 2020 annotated for blind Spectral Unmixing using Deep Learning (License CC BY 4.0)

A dataset of Sentinel-2 Digital RGB imagery acquired in Andalusia region of Spain between June 2015 and October 2020 annotated for blind Spectral Unmixing using Deep Learning (License CC BY 4.0)

Association Between Social Determinants of Health Issues and Maternal Obesity Among American Racial/Ethnic Groups.

Social determinants of health impact various clinical health outcomes in the population. We conducted this study to examine the impact of adverse social determinants of health (SDOH) characteristics on maternal obesity among hospitalized pregnant women in the US and its potential differential impact on women of different races/ethnicities. The nationwide pregnancy hospitalization data analyzed in this study were collected through the Nationwide Inpatient Sample (NIS) database during 2016-2018. We conducted descriptive analyses to evaluate the relationship between patient characteristics and maternal obesity. Using the adjusted survey logistic regression model, we calculated the independent association between social determinants of health (SDOH) risk factors and hospitalization characteristics (exposure) and maternal obesity (outcome). Lastly, stratified survey logistic regression models were created for each racial/ethnic group to examine the differential impact in the association between SDOH issues and maternal obesity. The prevalence of SDOH issues was highest in non-Hispanic (NH) Black women (6.59 per 1000 hospitalizations), whereas the prevalence of obesity among those with SDOH issues was highest in Hispanic women (15.3 per 100 hospitalizations). We observed that pregnant women with SDOH issues were 1.15 times as likely (95% CI: 1.05-1.25) to experience maternal obesity compared to those without SDOH issues. Relative to their counterparts without SDOH issues, Hispanics and NH-Others with SDOH issues had increased odds of obesity, whereas NH-White and NH-Black mothers with SDOH had similar odds of obesity (p>0.05). In conclusion, pregnant women with SDOH issues had an increased likelihood of obesity diagnosis and the association demonstrated differential impact across racial/ethnic sub-populations. This information has potential utility for counseling and formulation of targeted interventions for pregnant women.

Prevalence and Correlates of Medication Non-adherence among Hypertensive Patients on Follow-up in Central Kenya

Background and Objective: Poor adherence to antihypertensive medications is a major barrier to blood pressure control among patients living with hypertension. In Kenya, a significant number of hypertensive patients have uncontrolled blood pressure, but data on medication adherence among this patient population is scarce. This study sought to determine the prevalence and correlates of medication non-adherence among hypertensive patients on follow-up in two referral hospitals in central Kenya. Methods: We undertook a cross-sectional study comprising of 339 hypertensive patients undergoing follow-up care in two referral hospitals located in Nyeri County between October and December 2019. Medication adherence was assessed using a validated medication adherence questionnaire. Medication adherence was a dichotomous variable (adherent vs non-adherent), with the prevalence of non-adherence being measured as a proportion. Independent predictors of medication non-adherence were identified by fitting a multiple logistic regression model, where adjusted odds ratios (AORs) were computed for various covariates and interpreted at a 5% level of significance and 95% confidence interval (CI). Results: The study sample largely comprised of the female gender (65.2%) and elderly people (mean age, 65 years +/- 12). Nearly half (46.6%) of the hypertensive patients interviewed were non-adherent to their medications. The factors associated with non-adherence were: having poor hypertension knowledge (AOR, 5.6, 95% CI, 3.3, 9.4); being on more than one antihypertensive medication (AOR, 2.8, 95% CI, 1.7, 4.7) and being on two or more daily doses of medications (AOR, 2.3, 95% CI, 1.3, 4.1). Conclusion and Implications for Translation: Non-adherence to prescribed medications is highly prevalent among hypertensive patients in central Kenya, and it should therefore be identified as a public health concern. Strategies aimed at optimizing medication adherence among hypertensive patients in this region may consider focusing on educational interventions to increase hypertension knowledge and also on simplification of treatment regimens. Copyright © 2023 Mutua, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Factors Affecting Paramedic Personnel in the Assessment and Management of Emergency Pediatric Patients within the Prehospital Settings in the United Kingdom.

A paramedic's role in the United Kingdom is to primarily respond and provide emergency medical care to patients in the community. Pediatric patients form a small percentage of ambulance call-outs per year, which impacts a paramedic's confidence and competence when implementing effective healthcare protocols due to few attempts and existing opportunities to address pediatric patients' needs. There are also pre-existing gaps and barriers in pediatric emergency paramedic education and the lack of exposure to that specific patient group for emergency medical service healthcare providers in the prehospital settings when responding to pediatric medical emergencies. Further guidance and support in paramedic practice and education could be advantageous in providing effective tools and knowledge to improve pediatric emergency care in prehospital settings.

The Mental Health of Syrian Refugees in the United States: Examining Critical Risk Factors and Major Barriers to Mental Health Care Access

Owing to the 2011 civil war, many Syrians have become displaced internally within the country, have fled to neighboring countries in the region, or have resettled as refugees in the United States (US) through the United States Resettlement Program (USRP). Few studies have been conducted on the mental health of adult Syrian refugees in the US. We conducted an ecological study on the relationship between the mental health status of Syrian refugees in the US, risk factors that negatively affect their mental health post-settlement, and the barriers that prevent them from seeking mental health care. We found that racialization, targeting, under-employment, and concerns about relatives still in Syria negatively affect the mental health of Syrian refugees post-settlement. Challenges with the English language, stigma, lack of access to adequate insurance and transportation, and poor health system acculturation were barriers to Syrian refugee mental health care-seeking behavior in the US. While the US is accepting and resettling Syrian refugees in various parts of the country, it is also important that it focuses on and invests in the mental health needs of the refugees, so as to improve their physical and mental well-being. Copyright © 2023 Arsmtrong-Mensah et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Measurement Does Not Take Place in a Legal Vacuum

Measurement Does Not Take Place in a Legal Vacuum