Organization Guidelines Research Articles

Validity and Reliability of the M.D. Anderson Dysphagia Inventory in Turkish Patients with Neurological Disease

Introduction: Dysphagia is a prevalent symptom of various neurological diseases and is associated with decreased quality of life. The M.D. Anderson Dysphagia Inventory (MDADI) is globally utilized tool to assess the impact of dysphagia on quality of life. However, a Turkish version of the scale is not yet available. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Turkish version of the MDADI. Methods: One hundred twenty-four patients who were diagnosed with definite neurological disease completed the study. The cross-cultural adaptation and translation process of the MDADI adhered to the World Health Organization's guidelines using the forward-backward translation method. The feasibility and the floor and ceiling effects were evaluated. Cronbach’s alpha was used to assess internal consistency. The Bland and Altman method and Interclass Correlation Coefficient (ICC) were used to evaluate test-retest reliability. Absolute reliability was determined using the standard error of the measurement (SEM) and minimal detectable change (MDC). Construct validity was assessed using Pearson’s correlation coefficient between the MDADI and the Turkish Swallowing Quality of Life (T-SWAL-QOL) questionnaire. Results: Our study had a feasibility rate of 100%. No floor or ceiling effects were determined for any subscale or composite scores of the T-MDADI. The T-MDADI demonstrated excellent reliability, with Cronbach’s alpha coefficients ranging from 0.89 to 0.96 and ICC values from 0.81 to 0.95, confirming strong internal consistency and test-retest reliability. Measurement precision was supported by a SEM of 3.96 and an MDC of 10.97 for the composite score. In terms of validity, significant correlations were observed between T-MDADI subdomains and T-SWAL-QOL subdomains (r = 0.61–0.80 for food selection, mental health, and social functioning; r = 0.41–0.60 for eating duration and communication; p < 0.01), demonstrating good to very good convergent validity. Conclusion: The T-MDADI demonstrates validity and reliability as a questionnaire for assessing dysphagia-related quality of life in Turkish patients with neurological diseases.

Validity and Reliability of the Thai Version of the Knowledge and Attitudes Survey Regarding Pain (Thai KASRP)

Objective: The knowledge that healthcare providers have about pain management influences the treatment that patients receive. Given the rapid advances in pain knowledge and the uniqueness of pain management in different cultures and contexts, it is necessary to assess pain knowledge in different countries. This study aimed to (1) translate and culturally adapt the original English version of the knowledge and attitudes survey regarding pain (KASRP) instrument into Thai, and (2) conduct a preliminary evaluation of the validity and reliability of the translated questionnaire.Material and Methods: The KASRP instructions and items were translated into Thai using the World Health Organization guideline for the translation of instruments. Content validation of the Thai KASRP was evaluated by an expert panel. Test-retest reliability was evaluated using data from 30 healthcare providers. Face validity was evaluated by 7 healthcare providers for the questionnaire’s clarity, format, and acceptability. All information was used to revise the Thai KASRP into a final version.Results: Some items of the original KASRP were updated to maximize clarity, comprehensibility, and consistency with the current standards of pain management in Thailand. Moreover, some items were removed because their contexts were not compatible with pain practice in Thailand. An expert panel rated 99% of the translated items as relevant and clear, supporting the measure's content validity. Test-retest reliability was good to excellent.Conclusion: The Thai KASRP demonstrated good validity and reliability. It could be used to assess the knowledge and attitudes of health professionals regarding pain management in Thailand.

Practice Guidelines for the Value Evaluation of Clinical Pharmacy Services (version 2)

ObjectiveTo optimize the construction of pharmaceutical services in medical institutions, advance the development of clinical pharmacy as a discipline, enhance the level of clinical pharmacy services, systematically implement and evaluate clinical pharmacy practices, and improve patient therapeutic outcomes, we have developed the Practice Guidelines for the Value Evaluation of Clinical Pharmacy Services (Version 2).MethodsThis guideline was designed following the World Health Organization (WHO) Guideline Development Manual. The Delphi method was employed to identify clinical questions. A comprehensive systematic search was conducted to collect existing evidence on relevant issues, and the systematic reviews, evidence grading, and evidence summaries were subsequently compiled. The guideline employs the Joanna Briggs Institute (JBI) evidence level system from Australia and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system introduced by WHO in 2004 to classify the quality of evidence. Consensus on the recommendations and evidence levels was achieved through the Delphi method, resulting in the formation of the Practice Guidelines for the Value Evaluation of Clinical Pharmacy Services (Version 2).ResultsThrough a questionnaire survey of over 100 experts and the Delphi method voting, 23 preliminary indicators for evaluating the value of clinical pharmacy services were identified. The content of these included indicators was searched according to the PICO principle, followed by systematic reviews, meta-analyses, network meta-analyses, and related original research. Each search strategy was reviewed and approved by the guidelines steering committee. Ultimately, three dimensions for evaluating the value of clinical pharmacy were identified, encompassing 15 indicators, resulting in 20 recommendations.ConclusionThis guideline presents a set of metrics to assess the quality and effectiveness of clinical pharmacy services, which is crucial for enhancing and elevating clinical pharmacy services in healthcare institutions.Systematic review registrationhttp://www.guidelines-registry.org/guide/28502a74-7038-439c-bdee-d355747e2a9d, identifier: PREPARE-2022CN756.

Parental impact on adherence of young children to 24-h movement behaviour guidelines: the Czech FAMIly Physical Activity, Sedentary behaviour and Sleep study.

Human movement behaviour typically unfolds in 24-h cycles, with children being additionally influenced by their parents. Therefore, the aim of this study was to investigate the adherence of 3-10-year-old children to the World Health Organization's (WHO) 24-h movement behaviour guidelines in relation to the behaviours of their mothers/fathers. Data from the Czech cross-sectional FAMIly Physical Activity, Sedentary behaviour and Sleep study included 381 families (with at least one child aged 3-10 years) from urban and rural areas across all three regions of Czechia. Twenty four-hour movement behaviour (sleep, sedentary behaviour, and physical activity) was monitored using ActiGraph accelerometers placed on the non-dominant wrists of children and their parents for seven consecutive days. Children's adherence to the WHO guidelines was analysed using logistic regression analysis. 25.9% of girls and 26.7% of boys simultaneously met all three 24-h movement behaviour guidelines (sleep + sedentary + physical activity), and 44.7% of girls and 46.1% of boys met any combination of two of the three guidelines, regardless of the children's gender, weight, or calendar age. Maternal overweight/obesity significantly (P = .05) decreased the odds of children achieving at least two of the three guidelines, while parental university education and maternal adherence to at least two of the three guidelines significantly (P = .05) increased the odds of children complying with these guidelines. Parents, especially mothers, play an important role in influencing their children in meeting 24-h movement behaviour guidelines and in shaping a healthy lifestyle.

Fuzzy Modeling to Personalized Nutritional Menu

Background: While most healthy diets can help control the progression of disease, they can fail in the long term for many factors. Patients abandon the diet altogether after a while because it is too restrictive or the foods are unappealing; still, others engage in less physical activity because they consume fewer calories. What's more, almost all plans are based on optimization models. These models produce statistical diets offering limited choices to users, and a small substitution can call the whole diet into question. Objective: This article develops an intelligent system for generating flexible nutritional menus that each person can adopt to their environment and dietary preferences (food availability, price, patient eating habits, etc.). The system implements mathematical fuzzy optimization models and constraint satisfaction programming. Methods and Materials: First, the Moroccon foods were decomposed using fuzzy Cmeans. Next, the artificial foods, formed by the centers, were introduced into a fuzzy mathematical optimization diet model, which controlled the total glycemic load and met the World Health Organization (WHO) and Dietary Guidelines for Americans (GDA) recommendations (requirements for personalized menu). Then, we used a genetic algorithm strategy to generate optimal serving sizes and to build a nutritional menu based on the groups formed. To help patients choose customized diets, the menu was transformed into a constraint satisfaction programming model. Results: The proposed strategy was applied to Moroccan foods, experimental results show that all diets offer a wide range of choices to users and that substitutions comply with WHO and GDA recommendations. Conclusion: The suggested scheme has been applied to Moroccan foods; experimental findings demonstrate that all diets provide users with a wide variety of options that keeps consumers on their diet.

Motivators and Barriers Affecting Exercise in Patients With Parkinson's Disease.

Parkinson's disease (PD) significantly impacts the quality of life via both motor and nonmotor symptoms. Exercise is a valuable nonpharmacological intervention that can alleviate PD symptoms and slow disease progression. Understanding the factors that motivate and restrict exercise in PD patients is essential for promoting engagement. This study aimed to identify the motivators and barriers affecting exercise in PD patients. This cross-sectional study assessed exercise habits, motivators, and barriers among PD patients with a modified Hoehn and Yahr stage of ≤2.5. Participants were categorized into non-, low-, and high-exercise groups based on the World Health Organization guidelines. The International Physical Activity Questionnaire, the Korean version of the Sport Motivation Scale, and a barriers-to-exercise questionnaire were utilized. Data from 165 of 196 enrolled patients were analyzed: 28 (17.0%), 88 (53.3%), and 49 (29.7%) in the non-, low-, and high-exercise groups, respectively. The nonexercise group demonstrated higher levels of fatigue and apathy, and more-severe cardiovascular, mood, intellectual, attention, gastrointestinal, and urinary symptoms. While all groups recognized the benefit of exercise, those in the nonexercise group viewed PD symptoms and depressive mood as major barriers, whereas those in the high-exercise group were primarily motivated by personal satisfaction. This study highlights the importance of enjoyment and personal satisfaction to the maintenance of exercise habits among PD patients. By enhancing specific motivators and overcoming barriers, particularly PD symptoms and related nonmotor symptoms, tailored interventions can be implemented to increase exercise adherence and, eventually, improve the quality of life of PD patients.

Accelerometry-Based Physical Activity and Sedentary Behavior Among Chinese Adults - 7 PLADs, China, 2023.

Physical activity (PA) and sedentary behavior (SB) are crucial determinants of both physical and mental health outcomes. However, large-scale studies using objective measurements of these behaviors have not been widely implemented across China. Based on World Health Organization guidelines, 56.8% of participants met the recommendation for moderate-to-vigorous physical activity (MVPA) by accumulating more than 150 minutes per week. Additionally, 37.3% adhered to the SB guideline of less than 8 hours per day. However, only 2.7% of adults achieved compliance with both MVPA and SB recommendations simultaneously. This study provides novel insights into PA levels and SB patterns among Chinese adults using waist-mounted accelerometry. The observed trends of insufficient PA and excessive SB in this multi-provincial sample emphasize the urgent need for targeted interventions to promote physical activity and reduce sedentary time to foster healthier lifestyle behaviors.

PHYSICAL ACTIVITY AMONG OLDER ADULTS WITH AND WITHOUT HIV IN UGANDA: COHORT STUDY IN RURAL UGANDA

Abstract Studies from high-income countries have established the benefits of physical activity (PA) for health among older people. Yet, PA and its links to frailty and quality of life (QOL) in older rural African populations living with HIV remain under-explored. We analyzed data from the first three annual assessments in a cohort of older people living with HIV (PLWH) and age- and sex-similar, community-based people not living with HIV. PA was measured through self-reported minutes of moderate and vigorous PA, converted into metabolic equivalent of task (METs). PA adherence to World Health Organization (WHO) guidelines was defined as a minimum of 150 minutes of moderate PA or 75 minutes of vigorous PA weekly. Linear and logistic generalized estimating equations (GEE) regression models were employed to estimate the association between HIV status and PA, adjusting for frailty, QOL, comorbidities, and age. At enrollment there were 297 PLWH and 302 people not living with HIV, 304 men and 295 women, with a median age of 58 years (IQR:54-63); 96% met PA guidance. After multivariable adjustment, PA in METs was associated with younger age (b=-187.18 per year, p<0.0001), HIV infection (b=-1039.12, p=0.041), higher health-related QOL (b=38.05 per point on a 0-100 scale, p=0.034), frailty (b=-2661.24, p=0.028), and medical comorbidity (b=-2208.07, p<0.0001). Guideline-concordant PA was inversely associated with frailty (OR:0.27, p=0.0076) and medical comorbidity (OR:0.43, p=0.0069). Correlates of lower PA were older age, living with HIV, frailty, and medical comorbidity. Those with frailty and medical comorbidity may not be benefitting from recommended levels of PA.

Maternal RSVpreF Vaccine: A Novel Agent for Respiratory Syncytial Virus Prevention in Infants

Objective: The objective was to summarize available data regarding the safety and efficacy of RSVpreF in the setting of maternal administration for infant protection against respiratory syncytial virus (RSV) while comparing RSVpreF to other RSV prevention strategies. Data sources: A literature search of PubMed was conducted utilizing the phrases “RSVpreF” and “pregnancy.” Additional references were identified through found sources of information. Organizational guidelines, medication labeling, and regulatory organization presentations were utilized. Study selection and data extraction: Clinical trials investigating RSVpreF administration to pregnant women were included as well as other references on pharmacology, pharmacokinetics, and vaccine uptake. Data synthesis: RSVpreF vaccine, administered once to pregnant women, demonstrated a 69.4% (97.58% confidence interval [CI] = 44.3 to 84.1) lower incidence of severe medically attended RSV lower respiratory tract infection (MA RSV-LRTI) and 51.3% (97.58% CI = 29.4 to 66.8) lower incidence of MA-RSV-LRTI at 180 days post birth in 1 placebo-controlled study. The RSVpreF vaccine administered at 24 to 36 weeks did not have a statistically significant higher rate of preterm births (relative risk = 1.20; 95% CI = 0.99 to 1.46) across two studies and in postmarketing data. Relevance to patient care and clinical practice in comparison with existing agents: The RSVpreF vaccine is the first maternal vaccine approved by the US Food and Drug administration for prevention of RSV in all infants. When compared with other agents, the optimal prophylaxis agent is unclear. Conclusions: Maternal immunization with RSVpreF demonstrated a reduction in MA RSV-LRTI, severe MA RSV-LRTI, and RSV-associated hospitalizations for infants. The vaccine is well tolerated, and adverse events continue to be evaluated.

Human health risk assessment of drinking water using heavy metal pollution index: a GIS-based investigation in mega city

Contaminated drinking water poses a significant threat to public health, particularly in urban areas where industrial and environmental pollutants may affect water quality. However, there is a lack of comprehensive studies that evaluate the specific health risks associated with harmful metal contaminants in drinking water. This study seeks to address this gap by assessing water quality and metal contamination using pollution indices and human health risk assessments. The findings will help to identify potential health risks for urban residents and guide the development of targeted interventions and improved water management strategies. The groundwater samples were collected from five different zones in Kasur rural area. A total of 25 samples were collected by random sampling from hand pumps during 4 months (March–June, 2021) for determining various physiochemical attributes (pH, electric conductivity, turbidity, total hardness, chloride, and phosphate) and potentially toxic elements (arsenic, cadmium, and lead) using standard protocols. Results revealed that almost all the physicochemical attributes were close to the World Health Organization (WHO) guidelines. The water quality assessment revealed that pH levels ranged from 7.4 to 9.0, electrical conductivity (EC) between 150 µS/cm and 800 µS/cm, and average turbidity of 12 ± 3.29 NTU, total hardness varied from 200 to 1000 mg/L. Chloride and phosphate concentrations averaged 304 ± 1.28 mg/L and 4.51 ± 1.99 mg/L, respectively. Cadmium levels ranged from 0.15 to 0.53 mg/L, while lead and arsenic concentrations reached up to 7.47 mg/L, exceeding the WHO guidelines. Heavy metal pollution index (HPI) values of all sites were less than critical value of 100. However, by considering the HPI classes, all the locations had high HPI (> 30) class indicating critically polluted water with heavy metals. Through exposure to drinking water, heavy metals had a significant impact on non-carcinogenic risk (HI > 1), according to the hazard index values determined by the human health risk analysis for children, infants, and adults. As compared with metals carcinogenic risk values, lead posed high risks to adults than children and infants as mean CR values for adults, children, and infants were 1.48E + 00, 1.40E + 00, and 7.60E-01, respectively. It is suggested that for drinking water supplies, there is need of installation of treatment plants in the industrial areas to minimize the risk of metal contamination and health issues.

Bringing Order to Chaos Ethically: “Cataloging Code of Ethics” and Critical Cataloging

Goal: The goal of this paper is to address the ethics in cataloging and the concept of critical cataloging, as a sub-movement of critical librarianship, as well as to highlight the intersection of ethics with critical in cataloging. It also provides an overview of the most relevant academic papers, articles, and documents in this field, with a special focus on the Cataloging Code of Ethics, the first comprehensive, collaborative, and internationally accepted Code specific to the profession. This code was published in 2021 by the Cataloging Ethics Steering Committee (CESC), which includes representatives from three library associations from three different countries: the American Library Association (ALA), the Chartered Institute of Library and Information Professionals (CILIP), and the Canadian Federation of Library Associations (CFLA-FCAB). Approach/methodology/design: Using content analysis, this paper presents relevant research on ethical cataloging. Through the methods of comparison, analysis, and synthesis, an inductive approach is used to establish a theoretical framework for the subject of the research. Results: The results show that, particularly in the last two decades, this topic has gained significant attention within the cataloging community. Catalogers, aware of their role in building information architecture, have begun to critically reflect on their profession and articulate the need for a document that provides guidelines for ethical organization of metadata. Social relevance: The research advocates that the power to organize knowledge and the power to name, held by catalogers, must be balanced with professional ethics. A critical approach to the profession and the Cataloging Code of Ethics can aid in this process, which could have positive implications for society as a whole. Originality/value: The originality of this paper lies in its critical examination of a cataloging trend that has not yet been discussed in our region.

Integration of Blockchain-Based Decentralized Finance into Financial Planning and Analysis: A Framework for Corporate Finance Innovation

The integration of Decentralized Finance (DeFi) into Financial Planning and Analysis (FPA) systems marks a pivotal transformation in corporate financial management, presenting organizations with unprecedented opportunities for operational efficiency, risk management, and strategic advancement. This article provides a comprehensive examination of the implementation framework, challenges, and strategic implications of incorporating DeFi technologies into traditional FPA systems. The article analyzes the technical architecture required for successful integration, including smart contract implementation, decentralized liquidity mechanisms, and blockchain-based audit systems, while addressing critical considerations in regulatory compliance and organizational change management. The article reveals significant potential for cost reduction, improved process efficiency, and enhanced risk management capabilities through DeFi integration while highlighting the importance of robust security protocols and governance frameworks. The article also identifies emerging opportunities in artificial intelligence integration, cross-chain interoperability, and industry-specific applications, offering valuable insights for organizations navigating this technological transformation. Furthermore, the article examines implementation challenges and provides strategic solutions for organizations undertaking DeFi integration initiatives. The article demonstrates that while the integration process presents complex technical and organizational challenges, the potential benefits in terms of operational efficiency, cost reduction, and competitive advantage make it a compelling strategic initiative for forward-thinking organizations. This article contributes to the growing body of knowledge on DeFi implementation in corporate settings and provides practical guidelines for organizations seeking to leverage blockchain technology in their financial operations.

Microbiological and physicochemical water quality assessments of the Upper Basin Litany River, Lebanon.

The Litany River has encountered severe environmental pollution. This study focused on assessing the pollution level in the upper basin of the Litany River by monitoring seasonal variation of water quality and testing physicochemical parameters and microbial qualities. A total of 72 freshwater samples were taken from six sites for 1 year during the four seasons. The microbiological parameters included total coliform, fecal coliform, and Escherichia coli counts. The physicochemical parameters comprised pH, total dissolved solids, nitrate, sodium, potassium, biochemical oxygen demand, chemical oxygen demand, total nitrogen, and total phosphorus. The microbiological quality of samples was evaluated by comparing the fecal pollution indicators loads to the SEQ-EAUX2003 standard for irrigation, and the physicochemical analyses were assessed according to Lebanese Standards Institution (LIBNOR) NL161: 2016 and the World Health Organization (WHO) Guidelines for Water Quality. The results revealed that most physicochemical parameters are not within the permitted limit of LIBNOR and WHO, especially in sites S2, S3, and S6 during the dry seasons. The pH ranged between 6 and 8.16. The total dissolved solids reached 1948 mg/L. The nitrate, sodium, and potassium ranged between 0 and 253 mg/L. The total nitrogen and total phosphorous reached 103 and 5.16 mg/L, respectively. The chemical oxygen demand reached 2210 mg/L, and the biochemical oxygen demand reached 732 mg/L. Concerning the microbiological analysis, fecal pollution was detected in all sites during all seasons, with detectable higher values during the dry seasons, and all samples were considered to be non-conforming, with significant spatiotemporal variation of most parameters. Our results highlight the need to take measures to prevent the high level of pollution. This could be achieved by monthly water quality monitoring of the upper basin and introducing appropriate guidelines to detect pathogens and toxic chemicals that affect the entire ecosystem and lead to severe public health issues.

Protektem pikinini blong yu trial: protocol for a single arm field trial to assess the effectiveness of treating-all pregnant women with hepatitis B infection with tenofovir prophylaxis to prevent mother-to-child transmission in Vanuatu, 2024–2025

BackgroundHepatitis B infection is a major public health concern in Vanuatu, with approximately 9% of the general population estimated to be living with chronic hepatitis B. Most new infections are due to mother-to-child transmission (MTCT). Hepatitis B vaccination is available in Vanuatu, but coverage rates for first dose within 24 h of birth and third dose are suboptimal. While treatment of chronic hepatitis B infection with tenofovir disoproxil fumarate (TDF) is available in country, there is no capacity to test hepatitis B e antigen and limited capacity to test hepatitis B virus (HBV) DNA viral load, which is a current eligibility requirement for women in pregnancy to access hepatitis B prophylaxis for MTCT per National guidelines. Recently, the World Health Organization guidelines have been updated to recommend universal peripartum antiviral prophylaxis (PAP) of pregnant women living with hepatitis B to prevent MTCT of HBV, without assessment of viral load in places without access to testing. However, these recommendations are conditional based on low-certainty evidence. The aim of this trial is to evaluate the effectiveness and safety of universal PAP and provide evidence for the global guidelines.MethodsA single arm field trial compared to real world control sites will be conducted in Vanuatu involving pregnant women attending antenatal care services with positive HBsAg rapid tests. Participants at the control sites will undergo routine care. Participants at the intervention sites will all receive oral TDF prophylaxis from second trimester to completion of infant primary hepatitis B vaccination schedule. Primary data analysis will be by intention-to-treat. Initial analyses will be unadjusted comparisons of the intervention sites and control sites. Adjusted analyses will be performed, as needed, and presented in addition to unadjusted comparisons.DiscussionThis study will provide evidence of acceptability, effectiveness and cost-effectiveness of prophylaxis for all women with hepatitis B during pregnancy, as per the updated WHO guidelines, compared with current practice. The outcome of this trial will provide critical information to inform national and global guidelines around universal peripartum antiviral prophylaxis for hepatitis B during pregnancy.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN: ACTRN12623001202651p. Registered 21 November 2023.

Fichte's global material constitution

The article shows that Fichte's conception of human rights implies concrete guidelines for the economic organization of states and international relations. First, I elucidate Fichte's view on human rights at the domestic level. Fichte's complex theory of human rights consists in a meta-right to live in a state that secures at least two “original rights”: a right to bodily inviolability and a right to sufficient property. I focus on the latter. Due to Fichte's unorthodox view of property rights as rights to actions rather than objects, this amounts to a right to work. This right, according to Fichte, must be realized in a planned economy. Second, I focus on the global level. Fichte's right to sufficient (unorthodox) property has implications for three dimensions of global justice: cosmopolitan right, the right of nations and commercial relations. Third, I draw some insights from thinking through Fichte's global material constitution for long observed conceptual tensions regarding his political and legal philosophy, namely between freedom and security as well as cosmopolitanism and nationalism, and for current debates in politics and political theory.

The Impact of Diabetes-related Factors on the Severity and Outcome of COVID-19 Infection in Hospitalized Patients: A Descriptive-analytical Study

Introduction: The COVID-19 pandemic is having a devastating impact on public health, with a higher risk of severe illness and mortality in vulnerable groups. Individuals with a history of diabetes are more prone to severe COVID-19. A collection of hyperglycemia, inflammation, and impaired immunity in diabetes, especially in poor glycemic control, notably increases the risk of COVID-19 severity. Hyperglycemia can trigger the release of inflammatory cytokines, highlighting the intricate relationship between glucose metabolism and inflammation, and contributing to cytokine storms that worsen COVID-19 severity. Understanding this relationship enables healthcare providers to develop personalized care strategies for managing blood glucose in diabetic patients, thereby reducing the risk of severe COVID-19 outcomes. This study aims to identify the factors that contribute to the severe outcomes of COVID-19 in patients with diabetes, to better understand and manage this critical combination. Methods: A total of 411 patients with COVID-19 infection referred to the Teaching Hospital of Mazandaran University of Medical Sciences, Sari, were included in this study. The COVID-19 severity was evaluated according to the World Health Organization (WHO) guidelines. All information including demographic, clinical, and laboratory data as well as severity and outcome of the disease were compared between diabetic and non-diabetic patients. Results: The diabetic patients had higher blood glucose (210.3 ±114.9 mg/dl) compared to nondiabetics (118.74 ±3.8 mg/dl) upon admission (p=0.0001). Diabetics also experienced more severe COVID-19 infection (p=0.048). Patients with severe COVID-19 had significantly higher blood glucose (168.5 ±12.8 mg/dl) than those with non-severe infection (136.6± 6.3 mg/dl) (p=0.013). Diabetics had higher erythrocyte sedimentation rates (ESR) compared to non-diabetics (52.25±2.4 vs. 43.81±1.8 mm/h, p=0.006). Diabetic patients taking ACEIs/ARBs had more severe COVID-19 infection (p=0.031). Conclusion: The study discovered a positive relationship between hyperglycemia and COVID-19 severity, as well as a higher risk of severe COVID-19 among patients taking ACEIs or ARBs.

Barriers and enablers for implementation of clinical practice guidelines in maternity and neonatal settings: A rapid review.

Maternity and neonatal services are rapidly changing in Australia because of evolving needs of the community and patient population. Clinical practice guidelines focused on early interventions and prevention strategies can decrease risk for preventable negative health outcomes in this population. However, despite the existence of several clinical practice guidelines, their translation into practice remains problematic for healthcare services. To identify barriers and enablers for the implementation and adoption of clinical practice guidelines in maternal and neonatal settings. A rapid review was conducted according to Cochrane and World Health Organization guidelines. Systematic reviews, qualitative, quantitative and mixed-methods studies related to clinical guidelines in maternal and neonatal settings published in English Language between 2010 and 2023 meeting study eligibility criteria were identified using PubMed, Cochrane CENTRAL, EMBASE, and CINAHL databases. Forty-eight studies originating from 35 countries were reviewed, representing practice guidelines associated with maternal and neonatal care. Identified barriers and enablers aligned to five main themes related to the contextual level of impact: (i) healthcare system and systemic factors, (ii) patient and population, (iii) guidelines and standards, (iv) organisational capacity, and (v) health professional practice. Findings from this review shed light on the challenges and opportunities associated with introducing clinical practice guidelines in maternal and neonatal care settings. Implementation of guidelines into practice is complex, with different factors affecting their adoption and their use within healthcare settings. Addressing the multifaceted challenges associated with the implementation of clinical practice guidelines in maternal and neonatal care demands a comprehensive and collaborative strategy. Successful adoption of guidelines requires the involvement of stakeholders at all levels, supported by ongoing evaluation, feedback, and dedication to evidence-based practices.

Evaluation of Bacterial Population in Drinking Water Along with Hygiene and Sanitation Facilities of Different Schools in Port City, Bangladesh

In our daily life, drinking water is one of the most essential elements. However, safe and good-quality drinking water is a major concern for human health. Therefore, our study assessed the sanitation, hygiene conditions, and evaluation of bacterial population of drinking water in 40 schools in the port city, of Bangladesh. Total viable count (TVC), total coliform count (TCC), and survey questionnaire were used to complete our study. About 65% of water samples exceeded the acceptable limit (>500 cfu/ml) detected by TVC. The most probable number (MPN) method was used to see the presence of coliform bacteria where about 65% of samples were found contaminated with coliform, among them 12.5% of samples were at very high risk according to World Health Organization (WHO) guidelines. A total of 10 bacterial isolates like Enterobacter sp., E. coli, Klebsiella sp., Salmonella sp., Proteus sp., Serratia sp., Citrobacter sp., Pseudomonas sp., Alcaligenes sp., and Micrococcus sp. were detected in water samples by using four selective media and then identified by using cultural, morphological and biochemical tests. The disc diffusion method was used to detect antibiotic sensitivity with 10 commercially available antibiotics. About 80% of isolates were found completely resistant to erythromycin, amoxicillin, ampicillin, and rifampin and 90% were sensitive to ciprofloxacin, gentamicin, azithromycin, and tetracycline. Antibiotic resistance isolates might pose a serious threat to human health. In most schools, reservoirs of drinking water were found contaminated by various bacteria. Only 48.3% of schools used separate toilets for girls but of poor-quality hygiene and sanitation facilities. Due to poor hygiene, sanitation, and contaminated drinking water, students may suffer from various diseases. Therefore, this study emphasizes the need to raise awareness about hygiene and sanitation facilities by regularly monitoring school drinking water quality to ensure children are out of waterborne diseases. Chittagong Univ. J. B. Sci. Vol. 12 (1 & 2): 130-142, 2024

Predictive Value of Varicocele Grade and Histopathology in Simultaneous Varicocelectomy and Sperm Retrieval in Non-Obstructive Azoospermia: A Retrospective Cohort Study.

Background and Objectives: Varicocele repair in men with non-obstructive azoospermia (NOA) remains a subject of debate due to inconsistent outcomes. This study aimed to evaluate the impact of microsurgical varicocelectomy on sperm recovery rates in men with NOA and to assess the role of varicocele grade and testicular histopathology in predicting postoperative outcomes. Materials and Methods: A retrospective cohort study was conducted of 78 men diagnosed with NOA and clinical varicocele who underwent microsurgical subinguinal varicocelectomy with simultaneous diagnostic and therapeutic testicular biopsy at the Department of Urology of the University of Ioannina between September 2013 and December 2021. Varicoceles were graded I to III based on physical examination and Doppler ultrasound. Histopathological patterns were classified as hypospermatogenesis (HYPO), early maturation arrest (EMA), late maturation arrest (LMA), or Sertoli cell-only syndrome (SCOS). Patients were followed postoperatively at 3, 6, 9, and 12 months, with semen analyses performed according to World Health Organization guidelines to assess sperm presence. Results: At the 12-month follow-up, spermatozoa were detected in the ejaculate of 26 out of 78 patients, resulting in an overall sperm return to ejaculate rate of 33.3%. Varicocele grade significantly influenced outcomes: patients with Grade II varicoceles had the highest sperm return to ejaculate rate (45.2%, 14/31), followed by Grade III (39.1%, 9/23) and Grade I (12.5%, 3/24) (p-value < 0.05). The sperm retrieval rate (SRR) from testicular biopsies also varied with varicocele grade: Grade II had the highest SRR (54.8%, 17/31), followed by Grade III (47.8%, 11/23) and Grade I (33.3%, 8/24). Histopathological findings were significant predictors of sperm retrieval: patients with HYPO had an SRR of 84.8% (28/33) and a sperm return to ejaculate rate of 66.7% (22/33); those with LMA had an SRR of 47.1% (8/17) and a sperm return rate of 23.5% (4/17). No sperm retrieval was observed in patients with EMA (0%, 0/4) or SCOS (0%, 0/24) (p-value < 0.01). Multivariate logistic regression identified varicocele grade and histopathology as independent predictors of sperm retrieval, with higher grades and favorable histopathology associated with increased likelihood of success. Conclusions: Microsurgical varicocelectomy can induce spermatogenesis in a significant proportion of men with NOA, particularly those with higher-grade varicoceles and favorable histopathological patterns such as HYPO or LMA. Varicocele grade and histopathological findings are important predictors of postoperative outcomes and should inform patient selection and counseling. These findings provide valuable insights for optimizing fertility treatments in men with NOA undergoing varicocele repair.

A Nationwide Cross-Sectional Survey of the Prevalence of and Association of Physical Activity With Suicidal, Psychosocial and Health-Risk Indicators Among Adolescents in Bangladesh.

This study investigated the associations between physical activity (PA) and suicidal behaviours, psychosocial outcomes and indicators of health risks. This was a secondary analysis of data from the Global School-Based Student Health Survey (GSHS) database. A total of 2058 adolescents aged 11-17 years in Grades 7-10 completed a self-administered questionnaire. Sex-stratified logistic regression was used to evaluate the associations between PA and suicidal behaviours, psychosocial outcomes and indicators of health risks. We used the least absolute shrinkage and selection operator (LASSO) regression to test whether PA-related factors predicted suicidal, psychological and lifestyle-related behaviours. A generalized linear mixed model (GLMM) examined the contributions of PA to these factors. Half of the adolescents (18.9% boys and 30.3% girls) indicated satisfactory PA per the World Health Organization guidelines. The most active group in terms of frequency of activity and walking or bicycling to school was positively associated with suicidal behaviour. Isolated adolescents reported anxiety despite frequent PA. Reduced frequency of PA was significantly associated with sexual activity, smoking, tobacco product use (girls), alcohol abuse (boys) and other drug use (boys and girls). The LASSO revealed that different PA-related factors predicted suicidal, psychological and lifestyle-related behaviour among girls and boys. The GLMM showed a significant contribution of PA to selected predictors. Increased PA may lower suicidal behaviour among adolescents. The most physically active groups were associated with predictors that varied by sex; boys were bullied, whereas girls experienced physical abuse.