Major Crisis Research Articles

Study of the Psychological Condition of Students Living in Border Conflict Regions

Since the 1990s, the conflicts and destructive processes that began in Abkhazia and South Ossetia have remained a major crisis for the population of Georgia. For nearly 30 years, the populations of both regions, governed by powerful Russian influence and de facto authorities, have been isolated from the rest of Georgia. The lack of social and intensive interactions, limited communication, and ideological confrontations have further distanced Georgians, Abkhazians, and Ossetians from one another. Under conditions of constant fear, socio-economic hardship, and restricted mobility, protecting the rights of students living in border and conflict regions, ensuring access to essential services, and addressing their mental health remain significant challenges for Georgian society. Students are a crucial part of society who can not only participate in processes of change and development but also become initiators of transformative processes. Given that mental health is linked to an individual’s psychosocial and physical well-being, studying students' mental health is important not only in terms of their knowledge and skills but also in terms of assessing their psychological condition and providing appropriate responses. Therefore, the aim of this study is to examine the psychological condition of students living in border conflict regions. To achieve this goal, the research utilized instruments adapted for the Georgian population, including the Death Anxiety Scale (DAS), Life Orientation Test–Revised (LOT-R), Patient Health Questionnaire-9 (PHQ-9), and PROMIS Emotional Distress—Anxiety—Short Form. By employing these tools, it became possible to analyze the mental health challenges faced by students in border conflict regions and identify differences in their psychological conditions based on specific characteristics.

Tissue nano-transfection of antimicrobial genes drives bacterial biofilm killing in wounds and is potentially mediated by extracellular vesicles

The emergence of bacteria that are resistant to antibiotics is on track to become a major global health crisis. Therefore, there is an urgent need for new treatment options. Here, we studied the implementation of tissue-nanotransfection (TNT) to treat Staphylococcus aureus-infected wounds by delivering gene cargos that boost the levels of naturally produced antimicrobial peptides. The Cathelicidin Antimicrobial Peptide gene (CAMP), which produces the antimicrobial peptide LL-37, was used as model gene cargo. In vitro evaluation showed successful transfection and an increase in the transcription and translation of CAMP-coding plasmid in mouse primary epithelial cells. Moreover, we found that the extracellular vesicles (EVs) derived from the transfected cells (in vitro and in vivo) carried significantly higher concentrations of CAMP transcripts and LL-37 peptide compared to control EVs, possibly mediating the trafficking of the antimicrobial contents to other neighboring cells. The TNT platform was then used in vivo on an excisional wound model in mice to nanotransfect the CAMP-coding plasmid on the edge of infected wounds. After 4 days of daily treatment, we observed a significant decrease in the bacterial load in the CAMP-treated group compared to the sham group. Moreover, histological analysis and bacterial load quantification also revealed that TNT of CAMP on S. aureus-infected wounds was effective in treating biofilm progression by reducing the bacterial load. Lastly, we observed a significant increase in macrophage recruitment to the infected tissue, a robust increase in vascularization, as well as and an increased expression of IL10 and Fli1. Our results demonstrate that TNT-based delivery of gene cargos coding for antimicrobial compounds to the wound is a promising approach for combating biofilm infections in wounds.

A Cohort Study of Lt. Col. Luke J. Weathers VA Medical Center Patients with Positive FIT and Incomplete GI Evaluation during the COVID-19 Pandemic.

The reasons for and incidence of delay in screening colonoscopies during the coronavirus disease 2019 (COVID-19) pandemic are of major public health interest. The risks and reasons for delay likely vary between public and private institutions. This research sought to analyze data regarding the completion of screening colonoscopies after a positive fecal immunochemical test (FIT) before and during the COVID-19 pandemic and the reasons for a delay in obtaining these results at the Lt. Col. Luke Weathers, Jr. Veterans Affairs Medical Center. The goals were to evaluate the institutional resilience and analyze the problems associated with this major healthcare crisis. This closed cohort study included all positive FITs from our local Veterans Affairs (VA) medical center from October 2019 to January 2020 and July 2020 to May 2021. A total of 115 VA patients with a positive FIT prepandemic and 157 VA patients with a positive FIT during the pandemic were included. Completion rates within 180 days were measured, and charts were reviewed to identify the reasons for lack of completion. Both community and local VA procedures for veterans were included. Univariate and multivariable analyses were applied to calculate odds ratios (ORs). The Pearson χ2 test was applied to calculate P values. VA patients' percentage of timely completion was lower pre-COVID-19 than it was during the pandemic, and the percentage of delayed completion was higher pre-COVID-19 than it was during the pandemic. Comparing patients who completed a colonoscopy with those who did not, increasing age had an OR of 0.947 (95% CI 0.920-0.975), and White race had an OR of 0.504 (95% CI 0.291-0.873). Evaluating delays in colonoscopy completion, VA colonoscopies versus referral to the community had an OR of 4.472 (95% CI 1.602-12.483), and pre-COVID-19 completion versus during COVID-19 had an OR of 4.663 (95% CI 1.727-12.594) with multivariable logistic regression. There was a statistically significant increase in timely colonoscopy completion during the study period when compared with the pre-COVID-19 period. The completion rate was higher at the Lt. Col. Luke Weathers, Jr. VA Medical Center than a large population average in 2020, possibly related to community colonoscopies and an aggressive case management system. In addition, increasing age and White race were associated with decreased colonoscopy completion. Predictors of an increased delay in colonoscopy completion included a pre-COVID-19 positive FIT and colonoscopies performed within the VA rather than being referred to providers in the community. A common reason for delay in all of the groups was patients declining intervention and delay/lack of referral.

Investigating the hepatoprotective and antidiabetic properties of cryogenically pulverized Turkish propolis water extracts in streptozotocin-induced diabetic rats

Diabetes is a major global health crisis, affecting millions of people worldwide and necessitating the search for effective and safe treatments, leading to various complications, including liver damage. This study investigated the hepatoprotective and antidiabetic properties of cryogenically pulverized Turkish propolis water extracts (WBTP) in streptozotocin-induced diabetic rats.Propolis samples were collected from the West Black Sea Region of Turkey and prepared as -80 °C (PP-80) and -196 °C (PP-196) water extracts. Thirty male Wistar albino rats were divided into five groups: normal control, diabetic control, diabetic + PP-80 (250 mg/kg), diabetic + PP-196 (250 mg/kg), and diabetic + metformin (250 mg/kg). After 35 days of treatment, various parameters were evaluated, including body weight, blood glucose, glycated hemoglobin (HbA1c), serum biochemistry, antioxidant enzyme activities, and histopathology of the pancreas.The results showed that WBTP extracts, especially PP-80, significantly improved body weight and reduced blood glucose and HbA1c levels. Analysis of lipid profiles revealed improvements in HDL, LDL, triglycerides, and total cholesterol levels with WBTP treatment. The antioxidant defense systems were also enhanced in the WBTP-treated groups. Histopathological examination revealed that WBTP extracts mitigated pancreatic tissue damage in the diabetic rats.In conclusion, the WBTP extracts possess hepatoprotective and antidiabetic properties, suggesting a promising avenue for further research. It emphasizes the importance of addressing both diabetes and hepatopathologies concurrently and highlights WBTP extracts as natural and potentially safer alternatives to synthetic antidiabetic drugs. Specifically, PP-80 extracts demonstrate robust effects in managing diabetes and associated liver complications in streptozotocin-induced diabetic rats, indicating their therapeutic potential.

A New Test for Evaluating the Psychological Impact of COVID-19 in Nurses

Introduction During the COVID-19 pandemic, many health care workers were involved and suffered significant physical and psychological strain, and nursing was one of the main players. Clearly and objectively establishing the psychological impact on nurses during the pandemic is necessary for long-term recovery and to be prepared for new outbreaks in the future. Aim The aims of this study were to evaluate the perceived impact on nurses at risk of psychological stress at work during a major health care crisis and determine the psychological impact and its influencing factors. Methods An online questionnaire was designed and distributed between April 9 and April 19, 2020, in Spain. The comprehensive self-conducted questionnaire included demographic information and the Psychological Stress and Adaptation at work Score. For the analysis, descriptive statistics, logistic regressions, and receiver operating characteristic curves were determined. Results A total of 825 nurses (33% working in intensive care units and emergency departments) answered the questionnaire. A logistic regression analysis revealed that nurses with higher psychological stress scores experienced more physical overload (P = .02), higher psychological overload (P < .01), poor teamwork (P = .02), more distress due to new circumstances (P < .01), more personal impact of how society responded to COVID-19 (P < .01), anticipation of negative future consequences (P < .01), and worse balance between family and work (P < .01). The area under the curve for the cutoff point of Psychological Stress and Adaptation at work Score 40 was 0.82 (95% confidence interval, 0.79-0.91), with 70% sensitivity and 81% specificity. The positive predictive value was 72%, and the negative predictive value was 80%. Conclusion Psychological Stress and Adaptation at work Score is a rapid and accurate test for evaluating the psychological well-being of health care staff that can be used when crisis prevents the use of conventional stress diagnosis methods. Higher psychological impact was observed in nurses who worked in the intensive care unit and in the hospital ward.

Continuity in public transport provision during the Covid-19 pandemic – responding to organisational and health challenges facing workers

PurposeThis paper explores and analyses the major challenges faced by both customer-facing and office-based public transport employees during the early stages of the Covid-19 pandemic and the responses of their employers to their concerns.Design/methodology/approachQualitative semi-structured interviews and focus groups were carried out, involving 39 employees and directors representing a wide range of professionals working in the transport sector in three European countries, Poland, Ireland and the UK. Data were analysed through thematic analysis and the emerging issues explored.FindingsMajor employee challenges included: access to resources for safe working; worker mental health and well-being; and the effects of changing working practices, particularly flexible working, on their wider household circumstances and work–life balance (especially combining childcare responsibilities with work). First, physical health safety measures (such as PPE) were put in place for all workers, although sometimes with delays. Second, concerning practical support for mental health and well-being at work, the findings highlight that their employers’ practical support was considered limited by some customer-facing participants. In contrast, participants working from home were offered considerably greater employer support for their well-being, including increased and regular communication regarding work and non-work-related topics to tackle isolation and lack of social interactions. Third, work–life balance, and especially childcare were significant issues for those working from home. To improve organisational resilience, employer support for workers needs to better reflect employees’ job role, work setting and location, as well as their household demands such as childcare.Practical implicationsThe lessons learned from this study contribute to future employer responses and practices and their organisational resilience, both in times of major crises and also for improving mental-health and childcare support in normal times.Originality/valueThe study considers the role of employee perspectives on organisational resilience and service continuity in public transport during a crisis and in three countries. Importantly, the data were gathered contemporaneously during the early stages of the pandemic, and so are not influenced by retrospective rationalisation or uncertain recollections.

THE EFFECT OF SPUTTERING TEMPERATURE OF TiO2/ITO-PEN PHOTOANODES IN DYE SENSITIZED SOLAR CELL

Currently, the world is facing a major crisis related to the lack of sustainable, safe, and environmentally friendly energy resources. Dye sensitized solar cells (DSSC), another name for third-generation solar cells, have gained a lot of interest due to ease of production, cheapness, and environmental friendliness. The photoanode is among DSSC's most crucial components. In this research, the active layer on the TiO2 photoanode was optimized to improve the efficiency of the DSSC. The active layer was deposited using Radio Frequency (RF) magnetron sputtering on an Indium tin oxide-polyethylene naphthalate (ITO-PEN) substrate. The sputtering temperature was varied to 25, 80, 120, and 160℃ for one hour. The thin film TiO2/ITO-PEN photoanode will be characterized by means of X-ray Diffraction (XRD), Ultraviolet-Visible (UV-Vis) spectroscopy, and solar simulator. The XRD analysis shows that the best crystal size is 14.55 nm for a sputtering temperature of 80℃. According to the UV-Vis data, optical absorption increases with increasing sputtering temperature. The wavelength range where the absorption peak occurs is 252–465 nm, and the smallest value of the energy gap is found at a sputtering temperature of 25℃ with a value of 3.02 eV. For the TiO2/ITO-PEN thin layer, the maximum efficiency was achieved at 0.12% at a sputtering temperature of 25°C.

Is SNOT-22 a Reliable Tool During Periods of High Stress? A Retrospective Cohort Study.

To assess the impact of a major crisis, such as the October 7, 2023, terror attack, on SNOT-22 scores, especially the extra-rhinologic subdomains. This retrospective cohort study was conducted at the Rhinology Clinic in a Tertiary University Hospital. Patients who visit our Rhinology Clinic routinely complete the SNOT-22, a widely employed questionnaire designed for evaluating health-related quality of life in individuals with rhinologic conditions. Patients were divided into two groups: 5 weeks before the October 7 terror attack and 5 weeks after. Primary outcomes for analyses included the Sedaghat Subdomain model of the SNOT-22. Descriptive analysis and Welch's t-test were used to compare SNOT-22 subdomain scores between groups. A total of 159 patients completed the SNOT-22 questionnaire, with 60 before and 99 after October 7, 2023. A general decrease in average scores was observed across all subdomains, with a significant decrease in the Nasal subdomain (p = 0.0388). Subgroup analysis showed an increase in the Ear/Facial subdomain in Arabic and the Sleep and Function subdomains in English, though not statistically significant. In sex-based sub-analysis, female patients showed a significant decrease in the Emotions subdomain. Our study was unable to establish a direct link between the terror attack and specific SNOT-22 subdomains. However, the observed trends suggest that SNOT-22 may display variability or unreliability when used during periods of high stress. III Laryngoscope, 2024.

Reflections of Economic Shocks and Price of Crude Oil on Gold Price Volatility within Asian Nations

The focus of this study is to examine the effects of economic shocks along with the crude oil price on gold prices in Asian countries. This study utilizes a regression analysis to measure the relationship between the macroeconomic indicators, crude oil price, and gold price in six selected nations from 1990 until 2022. The validity of the data was diagnostically checked by performing a VIF procedure, autocorrelation test, and normality test on residual, and data were analyzed via EViews software. The analysis showed mixed findings, however, a major variable that positively affects the fluctuation of the gold price is “the crude oil price” and it reflects global economic stability in the six countries. A sudden rise in crude oil prices might trigger conflicts in oil-exporting countries and limit access to material sources. This situation may force investors to move their funds into a safe-haven commodity like gold. The fluctuations in crude oil prices are not only a response to current market conditions but also alarming a lot more fundamental problems in an economy, which include approaching economic recessions, currency devaluation and a major financial crisis. For practical implications, this study suggests that policymakers pay extra attention to this commodity besides other economic indicators like inflation, interest and currency rates, and a GDP rate to ensure a sustainable economic condition. To the best of the authors’ knowledge, this study is the first that examines the economic shocks along with crude oil prices pre-and-post COVID-19 pandemic focusing on a few Asian countries.

Sustainability of Treatment Programs Utilizing Medications for Opioid Use Disorders in Incarcerated Young Adults.

The epidemic of opioid overdose brought a major health crisis to the front line of public health in the United States. Early efforts have focused on the prevention of production, distribution, and consumption of the drugs. However, there is little information about youth populations at risk for opioid overdose and their response to targeted treatment plans. The San Bernardino County Youth Opioid Response (SBCYOR) coalition in collaboration with the San Bernadino County (SBC) Probation Department organized a safety net system for at-risk youth by improving communication among county resources. This program mainly focused on individuals aged 12 to 24 years in the county's detention centers along with educational and prevention projects such as naloxone programs for first responders in the region. To describe the impact of the SBCYOR program on at-risk youth, we compare the frequencies of patients referred and treated with medications for opioid use disorder (MOUD) at the SBC Probation Department, which was responsible for individuals from age 12 to less than 18 years, with those from the West Valley Detention Center (WVDC), which was responsible for adults (18 to 24 years of age), from September 2020 through June 2022. Similar proportions of youths were referred for treatment of opioid use disorder (OUD) at the respective sites (3.7% SBC Probation Department, 3.6% WVDC). Of these, however, 78.0% were treated with MOUD at SBC Probation Department compared with only 7.1% at WVDC. SBCYOR coalition partners were able to transform their services into a comprehensive medical and behavioral health program for the incarcerated youth population at risk for OUD.

A koronavírus-járvány társadalmi és gazdasági hatásai a határ menti térségek fejlődésére a magyar–szlovák határrégiók esetében

The Social and Economic Impact of the Coronavirus Pandemic on the Development of Border Regions in the Case of the Hungarian–Slovak Border Regions Borders in a given social context seem to be eternal and unchangeable, but their exact location, their permeability, their functions and the regulations assigned to them are in fact constantly changing according to the ideals of the respective societal eras. The SARS-CoV-2 neo-coronavirus infection, identified in December 2019 as the cause of Covid-19 disease, has become a global pandemic, causing a major health, economic and social crisis. The pandemic had an impact on the single market mechanisms established by the European Union, affecting freedoms—the free movement of services, goods, capital and people—and on almost every aspect of everyday life as it had been until then. In border regions, these effects were magnified. The active socio-economic interactions of the Hungarian–Slovak border regions were interrupted overnight as a result of the border traffic measures, causing significant negative changes and restructuring the functioning of cross-border processes.

(Re)constructing global health security and universal health coverage: norm contestation and interaction

Abstract To effectively tackle public health challenges, policy-makers increasingly advocate for aligning global health security (GHS) and universal health coverage (UHC), two influential norms driving international health cooperation. However, despite operating within overlapping spheres of governance, the normative histories linking GHS and UHC remain relatively unexplored in the literature. This article examines how GHS and UHC have been (re)constructed—from distinct policy sectors to synergistic norm regimes—through repeated contestation and interaction. Utilizing the ‘norm life-cycle’ framework to trace development across three stages (emergence, tipping-point/cascade and internalization), this study discursively analyses key texts from major crises and international agreements spanning several decades to unpack how norms and their underlying discourses and core functions have influenced each other as they evolved. The findings illustrate that GHS and UHC norms would be better understood as dynamic ‘processes’ rather than static concepts. The article concludes that GHS and UHC norms have shaped each other more significantly than previous scholarship suggests, characterizing them as continuously evolving, closely interlinked and increasingly integrated. This work contributes not only to the broader scholarship on international norms theory, but also offers pragmatic implications for navigating normative development where multiple norms compete for influence amid ever-shifting priorities.

Emergency Preparedness for Waterborne Diseases in the Wake of Floods in Northern Cameroon: A Call for Immediate Action

Severe flooding in Northern Regions of Cameroon (Far North, North and Adamawa Regions), triggered by torrential rains, has led to widespread displacement, destruction of infrastructure, and significant disruptions in essential services, particularly water, sanitation, and healthcare. This article, issued by public health researchers from Science For Life Foundation and Pinnacle University Institute, highlights the heightened risk of waterborne diseases following the recent floods and underscores the urgent need for enhanced emergency preparedness and response measures. Floods create conditions conducive to the spread of diseases such as cholera, typhoid fever, dysentery, and viral hepatitis by contaminating drinking water supplies with sewage and waste. Vulnerable populations, including children, pregnant women, the elderly, and those with pre-existing health conditions, are at increased risk. Overcrowding in temporary shelters further exacerbates the potential for disease outbreaks. The impact of climate change is intensifying the frequency and severity of such flooding events, making timely and effective intervention critical. This article reviews best practices for preventing and mitigating waterborne disease outbreaks, offering guidance to government authorities, health agencies, humanitarian organizations, and local communities. It aims to catalyze immediate action to safeguard public health and prevent a major crisis in the aftermath of the flooding Keywords: Waterborne Diseases, Flooding, Emergency Preparedness.

Impacts of the COVID-19 pandemic on the experiences of incarcerated pregnant people

BackgroundThe COVID-19 pandemic disproportionately impacted incarcerated populations, yet few studies have investigated the specific effects on incarcerated pregnant people. This study compares pregnant people’s experiences of pregnancy and parenting in prison before and during the pandemic in order to explore the impacts of COVID-19 on this population.MethodsWe conducted semi-structured interviews with pregnant people at a state prison as part of a larger study on pregnant people’s experiences during incarceration. Interviews explored participants’ experiences and decision-making related to pregnancy and parenting while incarcerated. This secondary analysis compared interviews conducted between June 2019 and March 2020 (pre-COVID-19) to interviews conducted between June and November 2020 (during COVID-19). Interviews conducted during the pandemic included questions about the impact of COVID-19 on participants’ experiences. Brief three and six-month follow-up interviews were conducted when possible.ResultsCOVID-19 introduced new stressors and exacerbated preexisting stressors around participants’ reproductive and parenting experiences. Three major themes emerged: 1) incarceration causes mental, emotional, and physical distress during pregnancy and parenting; 2) COVID-19 worsened conditions of incarceration, contributing to participants’ distress; and 3) the introduction of quarantine protocols during the pandemic felt uniquely punitive for pregnant and postpartum people.ConclusionsThe COVID-19 pandemic was characterized as a major crisis and primary threat to public health, particularly for incarcerated individuals. Yet just as COVID-19 exacerbated preexisting disparities for marginalized, non-incarcerated communities, incarcerated pregnant people similarly described a “worsening” of already-intolerable conditions. The indiscriminate application of quarantine protocols for pregnant people reflects broader carceral logics of control that do not account for the wellbeing of pregnant and postpartum people and their infants, as evidenced by current practices of infant separation, a lack of support, and physically taxing living conditions.

A randomized clinical trial of emotional freedom techniques for chronic pain: Live versus self-paced delivery with 6-month follow-up.

Chronic pain represents a major global healthcare crisis, and current treatments are limited in effectiveness and safety. Emotional freedom techniques (EFTs) show promise as a potential psychological treatment. The current study investigated the effect of a randomized clinical trial of EFT for chronic pain in a sample of 147 adult chronic pain sufferers (89.9% female; mean 54.63 years). Participants engaged in a 6-week EFT programme (either online self-paced or in-person). The per-protocol analysis indicated pain severity and interference scores were significantly lower at the end of treatment for the EFT group compared to waitlist, and these were sustained at follow-up. There were no differences between the in-person or self-paced programmes at follow-up for pain severity and interference. Somatic symptoms were significantly lower after EFT, although no further differences at follow-up. Quality of life scores were significantly higher after EFT, which were sustained at follow-up, and no differences between two styles of programme. No significant effects were found for anxiety, depression, happiness or satisfaction with life across the 6-week programmes for either style of delivery or at follow-up. These are discussed in terms of clinical score meanings. Intent-to-treat analysis was consistent with the per-protocol analyses. Limitations of the study are identified and future directions are discussed. Findings offer early promise for EFT as a potentially effective pain management strategy, as well as support for online intervention without compromising treatment outcomes. An emerging body-based intervention for chronic pain may be a possible solution for remote clients who cannot attend in-person sessions. In this clinical trial Emotional Freedom Techniques (EFT) significantly reduced chronic pain severity and interference, and there were no differences between and online self-paced program toan online in-person EFT intervention. Both were equally effective, also enhancing quality of life without compromising outcomes. The results were significant at 6-month follow-up/. These findings highlight a body-based approach as a promising, accessible pain management strategy, and highlights that online programs may be part of the solution for chronic pain patients.

The effects of neighborhood disadvantage and adverse childhood experiences on conditioned pain modulation in adults with chronic low back pain

Chronic low back pain (cLBP) remains a major health crisis worldwide. Current conceptualizations of cLBP utilize the biopsychosocial model, yet research on social factors remains limited. Adverse childhood experiences (ACEs) are a risk factor for a variety of chronic health problems, including cLBP. However, the extent to which socioeconomic context might influence associations between ACEs and cLBP remains unclear. Socioeconomic factors such as healthcare access and living conditions, which cluster at the neighborhood level, may affect how ACEs relate to cLBP in adulthood. This study examined (1) the relationship between ACEs and conditioned pain modulation (CPM), and (2) the moderating effect of area-level deprivation index (ADI) in a sample of community-dwelling adults with cLBP. 183 adults with cLBP (53% female, 62.8% non-Hispanic Black) reported on ACEs, ADI, sociodemographics, and completed experimental testing of conditioned pain modulation (CPM). Greater ACEs were associated with a less efficient CPM response for individuals residing in low neighborhood deprivation (p < 0.01). ACEs were not significantly associated with CPM for those residing in average (p = 0.31) or high deprivation (p = 0.15). Our findings suggest that a history of ACEs is associated with diminished ability to inhibit pain, especially among individuals living in less deprived neighborhoods. The association between ACEs and CPM was weakest for the portion of our sample residing in neighborhoods with the most deprivation. People from disadvantaged backgrounds may experience numerous psychosocial stressors that hinder CPM, making it difficult to assess the specific impact of ACEs on CPM. Trial registrationThis study utilized baseline data collected as part of a parent trial titled “Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain” (ERASED - ClinicalTrials.gov ID: NCT03338192). PerspectiveThis study demonstrates that early life adversity is associated with abnormal endogenous pain modulation, particularly for participants who live in neighborhoods characterized by less deprivation.

Estimating the lives that could be saved by expanded access to weight-loss drugs

Obesity is a major public health crisis in the United States (US) affecting 42% of the population, exacerbating a spectrum of other diseases and contributing significantly to morbidity and mortality overall. Recent advances in pharmaceutical interventions, particularly glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide, liraglutide) and dual gastric inhibitory polypeptide and GLP-1 receptor agonists (e.g., tirzepatide), have shown remarkable efficacy in weight-loss. However, limited access to these medications due to high costs and insurance coverage issues restricts their utility in mitigating the obesity epidemic. We quantify the annual mortality burden directly attributable to limited access to these medications in the US. By integrating hazard ratios of mortality across body mass index categories with current obesity prevalence data, combined with healthcare access, willingness to take the medication, and observed adherence to and efficacy of the medications, we estimate the impact of making these medications accessible to all those eligible. Specifically, we project that with expanded access, over 42,000 deaths could be averted annually, including more than 11,000 deaths among people with type 2 diabetes. These findings underscore the urgent need to address barriers to access and highlight the transformative public health impact that could be achieved by expanding access to these novel treatments.

Education and socioeconomic status as predictors of refugee mental health: insights from a study of Jordan-based Syrian refugee sample.

The Syrian civil war is considered as the greatest humanitarian crisis in modern history, which has resulted in a major refugee crisis. A significant concern is the high prevalence of mental disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) among Syrian refugees. While the focus of most refugee mental health research has been pre-migration trauma, post-migration challenges and stressors, which can also be significant determinants of mental health, are often ignored. The purpose of this study was to assess mental health of Syrian refugees as compared to local Jordanians, and to examine sociodemographic factors and perceived stressors that are associated with mental distress among participants. This was a cross sectional study conducted in northern region of Jordan among Syrian refugee and Jordanian adults. We used the validated Arabic version of Afghan Symptoms Checklist (ASC) to assess mental distress among participants. A total of 929 subjects (43% Syrian refugees, 56% females) participated in this study. Disparities in education, monthly income, and health insurance were significant between Syrian refugees and Jordanians, p < 0.001. The mean score in ASC was significantly higher among Syrian refugees, particularly among refugee females (mean ASC score ± standard deviation: Syrian refugee females: 58.22 ± 1.13; Syrian refugee males: 45.31 ± 1.28; Jordanian females: 51.06 ± 0.91; Jordanian males: 46.45 ± 1.08, p = 0.002). Multivariable linear regression showed that the estimated difference in the mean of ASC score between males and females is 7.42 (p < 0.001), and the estimated mean difference between Syrian refugees and Jordanians is 2.76 (p = 0.019). Interestingly, the estimated mean of ASC scores for individuals with high education level is decreased by 4.18 as compared to individuals with lower education level (high school or less), p < 0.001. Education level was highly predictable of mental distress of Syrian refugees, particularly female refugees. Enhancing higher educational opportunities is proposed for improving socioeconomic status of refugees which might serve as a buffering strategy for mental distress among this vulnerable population.

Navigating economic crisis: Factors shaping resilience in Sri Lankan construction SME supply chains

In today’s construction industry, supply chains are subject to much greater disruption than they were in the past, resulting in a greater need for resilience. However, there is a gap in the literature that examines the resilience of construction small and medium scale Enterprises (SMEs) specifically focusing on developing countries. This article is a step towards identifying the factors influencing the resilience of construction SME supply chains taking the case of Sri Lanka: a developing country which is currently amidst a major economic crisis. This research study adopted a mixed-method approach, employing 08 structured interviews with employees ranging from executive level to top level management of 08 construction SMEs followed by a questionnaire survey considering a sample of 195 construction SMEs also with executive level to top level management of each construction SME. The findings indicated that Collaboration, Entrepreneurial Orientation (EO), Internal Integration, and Outsourcing have a positive significant impact on the resilience of Sri Lankan construction SMEs’ supply chains during an economic crisis, while ‘collaboration’ and ‘EO’ are the most influential factors respectively. Therefore, construction SMEs must prioritize and enhance collaboration and EO when devising supply chain strategies to strengthen resilience during economic crises. This paper contributes to filling the research gap by investigating factors influencing construction SME supply chains in a developing country during an economic crisis. Moreover, it contributes to the knowledge by being one of the latest empirical studies focusing on the construction SME supply chains in Sri Lanka. The findings provide a valuable reference for both policymakers and practitioners seeking to improve the resilience of construction SME supply chains.

Patterns of psychiatric admissions across two major health crises: L' Aquila earthquake and COVID-19 pandemic lockdown.

This study examined psychiatric hospitalisation patterns in San Salvatore Hospital in L' Aquila (Italy), during two major crises: the 2009 earthquake and the COVID-19 pandemic lockdown. The investigation spans two four-year periods, from 2008 to 2011 and from 2019 to 2022, with a focus on the trimester around the earthquake and the first wave/lockdown of the pandemic. We analysed weekly psychiatric unit admissions of adults diagnosed with schizophrenia spectrum disorder, major depression, bipolar disorder, and alcohol/substance use disorder. Four-year periods around the Earthquake and COVID-19 Lockdown were divided into sixteen trimesters, and Generalised linear models were used to analyse the relationship between weekly hospitalisation frequency and trimesters by diagnosis using a Poisson distribution. A total of 1195 and 1085 patients were admitted to the psychiatric ward in the 2008-2011 and 2019-2022 periods, respectively. Weekly hospitalisations in the earthquake trimester were lower than during the previous one for all diagnoses (schizophrenia spectrum: -41.9%, p = 0.040; major depression: -56.7%, p = 0.046; bipolar disorder: -69.1%, p = 0.011; alcohol/substance use disorder: -92.3%, p = 0.013). This reduction persisted for 21, 18, and 33 months after the earthquake for schizophrenia spectrum, bipolar, and alcohol/substance use disorders, respectively. Contrarily, patterns of weekly admissions around the COVID-19 lockdown remained substantially stable in the short term. However, a consistent long-term hospitalisation increase for all diagnoses characterised the first half of 2022 (the cessation of anti-COVID-19 measures; schizophrenia spectrum: +68.6%, p = 0.014; major depression: +133.3%, p = 0.033; bipolar disorder: +180.0%, p = 0.034; alcohol/substance use disorder: +475.0%, p = 0.001). The present study indicated that exposure to major health crises can have both short- and long-term effects on psychiatric ward admission, holding significant implications for current and future major health emergency management strategies.