Study Period Research Articles

Tuberculosis in elderly Australians: a 10-year retrospective review.

This report describes the epidemiology of active tuberculosis (TB) in elderly Australians (≥65 years) with analysis of the factors associated with TB disease and successful treatment outcomes. A retrospective study of TB cases reported to the National Notifiable Diseases Surveillance System over a 10-year period from 2011 to 2020 was conducted. Cases were stratified by sex, age, risk factors, drug resistance, treatment type and outcome. Notification rates and incidence rate ratios with 95% confidence intervals were calculated and factors associated with treatment success analysed using multivariable logistic regression. A total of 2231 TB cases among elderly people were reported over the study period, with a 10-year mean incidence rate of 6.2 per 100 000 population. The median age of cases was 75 years (range 65-100 years); most were male (65%) and born overseas (85%). Multivariable analysis found that successful treatment outcome was strongly associated with younger age, while unsuccessful treatment outcome was associated with being diagnosed within the first 2years of arrival in Australia, ever having resided in an aged-care facility and resistance to fluoroquinolones. Compared to other low-incidence settings in the Western Pacific Region, TB incidence in elderly people is low and stable in Australia, with most cases occurring among recent migrants from TB-endemic settings. Continued efforts to reduce TB importation and address migrant health, especially among elderly people, are important.

Economic Growth Determinants in Pakistan: An Empirical Analysis Using ARDL Model

The objective of this study is to examine the determinants that affect Pakistan’s economic growth. The study examines the causal relationship between economic determinants and growth from 1972 to 2021. Key determinants in the model include physical capital stock, employed labour force, bank credit, human capital, exports, and imports. Autoregressive Distributed Lag (ARDL) model was used to fulfil the research objectives. The study found long-term co-integration between the variables. Both physical capital and human capital were found to be statistically significant, positively affecting economic growth. Thus, both are complimentary to economic growth rather than substitutes. The study noted that employed labour force, bank credit, exports, and imports did not affect economic expansion. It suggests that neither import substitution nor export promotion is effective in achieving sustainable growth in the period of study. Furthermore, an increase in the employed labour force is not sufficient for economic growth after controlling for the effect of human capital. Results suggest that improvement in infrastructure and human capital productivity are essential to achieve sustainable growth.

Doxorubicin as Risk Factor for Fascial Dehiscence After CRS-HIPEC for Peritoneal Metastases.

Among postoperative complications, fascial dehiscence (FD) is registered in up to 10% of patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). This study aimed to evaluate the risk factors related to FD after CRS-HIPEC. A retrospective analysis of a prospectively maintained database of consecutive patients who underwent CRS-HIPEC between 2015 and 2023 was performed. For each patient, risk factors for postoperative fascial dehiscence were identified using multivariate analysis. During the study period (2018-2023), 217 patients were treated with CRS-HIPEC. The incidence of FD was observed in seven cases (3.2%), which were reoperated with direct fascial closure. In three cases, FD was associated with other grade III-IV complications. Body mass index, (BMI; p=0.024), doxorubicin-based HIPEC (p=0.005), and open technique (p=0.004) were identified as risk factors for FD in univariate analysis. Systemic chemotherapy, prior surgical score, and peritoneal cancer index (PCI) were not associated with an increased risk of FD. In multivariable regression analysis, doxorubicin-based HIPEC and open technique were confirmed as risk factors for FD. Although FD is a relatively rare event after CRS-HIPEC, open technique and doxorubicin-based HIPEC were significant predictors of this complication. Specific fascial closure techniques and proper wound care should be considered in high-risk patients.

Anthropogenic–induced environmental and ecological changes in the Nile Delta over the past half-century

Anthropogenic activities over the past half-century have had a negative impact on the wetland ecosystem in the Nile Delta, which provides essential provisioning and regulating services. Therefore, it is crucial to systematically investigate pollution levels and their ecological consequences at both spatial and temporal scales in order to promote sustainable development. In this study, data on metal pollution in the Manzala Lake were compiled through a systematic review of all published literature from 1968 to 2020. Additionally, agricultural data (including land use, pesticide and fertilizer usage, and discharge) and economic data for the same time period were collected to identify the main drivers of pollution. The results indicated an overall increasing trend in heavy metal concentrations during the study period. The average concentrations of metals, arranged in descending order, were as follows: Fe (15,115.5 μg/g) > Mn (722 μg/g) > Zn (115.4 μg/g) > Cu (65.9 μg/g) > Ni (62.5 μg/g) > Cr (58.1 μg/g) > Pb (54.1 μg/g) > Cd (4.7 μg/g) > Hg (0.1 μg/g). A linear regression model revealed that wastewater discharge, water reuse, and the use of pesticides and fertilizers are the main sources of heavy metal pollution in the Manzala Lake. Consequently, there has been a dramatic decrease in the biodiversity of fish and molluscan communities. The study also found a correlation between heavy metal pollution and socio-economic development, highlighting the urgent need for attention to the conservation, management, and sustainable development of the lake.

Browning from headwaters to coastal areas in the boreal region: Trends and drivers

Browning of freshwaters, mainly caused by increased terrestrial organic carbon loading, has been widely studied during the last decades. However, there are still uncertainties regarding both the extent of browning in different aquatic ecosystems and the actual importance of different driving forces and mechanisms. To refine understanding of the extent and causes of browning and its temporal variation, we gathered a comprehensive dataset including 746 Finnish water quality monitoring stations representing various waterbody types: streams, rivers, lakes, and coastal waters. Monotonic trend analyses revealed that TOC concentrations increased in all waterbody types during the study period from 1990 to 2020, whereas non-linear trends indicated that upward trends in TOC concentrations have substantially decreased since the mid-2000s. However, despite the upward trends levelling off, non-linear analyses also indicated decreases in TOC concentrations at only a few stations. As a result, the TOC contents of the majority of Finnish waterbody types in 2020 were at a higher level than in 1990. To examine the driving forces of increasing TOC concentrations, we selected 100 riverine catchments and linked the detected trends to 24 different drivers, including both hydrometeorological and catchment characteristics. The increased TOC concentrations in surface waters could be connected to diverse human impacts: hydrometeorological variables impacted by climate change, decreased acidic deposition, and land use in terms of peatland drainage. The importance of increased temperatures was emphasized, and its role as a driver of increased leaching of organic carbon in the forthcoming years is expected to grow with climate change.

Root traits and biomass production of drought‐resistant and drought‐sensitive arabica coffee varieties growing under contrasting watering regimes

AbstractDrought is a major factor affecting coffee production, and different genotypes exhibit varying degrees of resistance to drought stress. We examined root traits and biomasses of drought‐resistant (74110, Angafa, Bultum, Chala, and Gawe) and drought‐sensitive (75227, Koti, Melko CH2, Menasibu, and Mokah) Coffea arabica varieties at seedling stage under contrasting watering regimes (water stressed and well watered) for 30 days followed by 15 days of recovery to identify the association between drought resistance and root traits and dry matter partitioning, and the impact of drought stress on growth performance of arabica coffee varieties. We used a split‐plot design with three blocks, where watering regime was the whole‐plot factor and variety was the subplot factor. During water‐stress and recovery periods, the interaction effect between watering regime and variety significantly affected root traits and dry matter partitioning, while the watering‐regime main effect affected biomass. We observed a higher (1) tap root diameter (0.34 cm), lateral root number (80.7), and root volume (4.7 cm−3) for 74110; (2) lateral root number (79.3), specific root length (24.8 cm g−1), and root‐mass ratio (0.41 g g−1) for Bultum; and (3) root length density (3.3–5.2 cm cm−3), root angle (42.6°–47.8°), root‐mass ratio (0.40–0.42 g g−1), and root‐shoot ratio (0.67–0.72 g g−1) for Angafa, Chala, and Gawe under water‐stressed condition. During both study periods, biomasses were much lower under water‐stressed than under well‐watered condition. The findings show the association between drought resistance and root traits and dry matter partitioning, and the impact of drought stress on growth performance of young arabica coffee.

СОРТОИЗУЧЕНИЕ ОБРАЗЦОВ КУНЖУТА В УСЛОВИЯХ АСТРАХАНСКОЙ ОБЛАСТИ

The research was carried out in 2020–2022 in the south of Chernoyarsk district of Astrakhan region in order to identify promising and adaptive sesame breeding material to the conditions of the region for its further involvement in the creation of new varieties of this crop. The work was carried out on an irrigated plot, the soil of the experimental plot in terms of granulometric composition was heavy loamy, the soil type was light chestnut. The meteorological conditions that developed during the study period were typical for the cultivation zone. The material for the study was 70 collection samples of sesame from All-Russian Institute of Plant Genetic Resources named after N.I.Vavilov (VIR). The Solnechny variety was chosen as the standard. During the work, the following samples were identified: K-188 (Turkey), K-1060 (India), K-239 (Greece), K-1506 (Venezuela), K-594 (Tajikistan). Their yield varied over the years as follows: in 2020 – 2.2…3.1 t/ha, while the value of this indicator for the standard was 1.7 t/ha; in 2021 – 1.3…2.5 t/ha and 2.7 t/ha; in 2022 – 1.3…2.8 t/ha and 2.4 t/ha, respectively. For these samples, environmental plasticity and stability were calculated according to Eberhart and Russell. The high-intensity group (bi>1, σ2d→0) includes samples K-239 (Greece, bi=2.05 and σ2d=0.08); K-1506 (Venezuela, bi=2.18 and σ2d=0.10); K-594 (Tajikistan, bi=1.91 and σ2d=0.09). The standard indicators of environmental adaptability were as follows: bi=-2.39 and σ2d=0.09. Considering that in addition to adaptability, the samples K-1506 (Venezuela) and K-594 (Tajikistan) had an average yield of 2.0 t/ha in the conditions of Astrakhan region for 2020-2022, and the sample K-188 (Turkey) for the study period exceeded the value of this indicator for the standard by an average of 0.53 t/ha, they can be recommended as a promising breeding material for creating sesame varieties.

Prediction of cardiovascular and renal risk among patients with apparent treatment-resistant hypertension in the United States using machine learning methods.

Apparent treatment-resistant hypertension (aTRH), defined as blood pressure (BP) that remains uncontrolled despite unconfirmed concurrent treatment with threeantihypertensives, is associated with an increased risk of developing cardiovascular and renal complications compared with controlled hypertension. We aimed to identify the characteristics of aTRH patients with an elevated risk of major adverse cardiovascular events plus (MACE+; defined as stroke, myocardial infarction, or heart failure hospitalization) and end stage renal disease (ESRD). This retrospective cohort study included aTRH patients (BP ≥140/90mmHg and taking ≥3antihypertensives) from the United States-based Optum® de-identified Electronic Health Record dataset and used machine learning models to identify risk factors of MACE+ or ESRD. Patients had claims for ≥3antihypertensive classes within 30 days between January 1, 2015andJune 30, 2021, and two office BP measures recorded 1-90 days apart within 30 days to 11 months after the index regimen date. Of a total 18797 070 patients identified with any hypertension, 71100 patients had aTRH. During the study period (mean 25.5 months), 4944 (7.0%) patients had a MACE+ and 2403 (3.4%) developed ESRD. In total, 22risk factors were included in the MACE+ model and 16 in the ESRD model, and most were significantly associated with study outcomes. The risk factors with the largest impact on MACE+ risk were congestive heart failure, stages 4 and 5 chronic kidney disease (CKD), age ≥80years, and living in the Southern region of the United States. The risk factors with the largest impact on ESRD risk, other than pre-existing CKD, were anemia, congestive heart failure, and type 2 diabetes. The overall study cohort had a 5-year predicted MACE+ risk of 13.4%; this risk was increased in those in the top 50% and 25% high-risk groups (21.2% and 29.5%, respectively). The overall study cohort had a predicted 5-year risk of ESRD of 6.8%, which was increased in the top 50% and 25% high-risk groups (10.9% and 17.1%, respectively). We conclude that risk models developed in our study can reliably identify patients with aTRH at risk of MACE+ and ESRD based on information available in electronic health records; such models may be used to identify aTRH patients at high risk of adverse outcomes who may benefit from novel treatment interventions.

To Study the Prescription Pattern of Antihypertensive Drugs in Teerthanker Mahaveer Hospital Moradabad (U.P.)

Objective of the study: To assess prescribing pattern of antihypertensive drugs use and adherence to various clinical guidelines in the Hospital. Materials and methods: A prospective observational study was carried out for a period of six months in the IPD and OPD tertiary care hospital. Prescriptions were analyzed during the study period. All the patients of age ≥ 20 (20-70 age) years with or without comorbidities, including males and females, who were diagnosed with hypertension as per JNC 8, ESH/ESC, NICE, STG, IHG, and receiving antihypertensive drugs were included. Discussion: The results of our study suggested that out of the total number of hypertensive patients (202) males were 54.45% witch females were 45.55%. Therefore, there was immensely need of proper awareness about the hypertension and its etiologies among the population especially of younger generation. In this scenario, clinical pharmacist could do a lot more for the patients and overall society because of their expertise in Pharmaceutical Care. Conclusion: Calcium channel blockers, Diuretics, ARB as monotherapy and ARB with CCB as combination therapy were the choices for the treatment of Hypertensive patients as a single drug and combination drug therapy. As per the JNC 8 & ESC/ESH guidelines majority of the prescription patterns were achieved and found optimal at the study site.

Increased Maternal BMI at Time of Delivery Associated with Poor Maternal and Neonatal Outcomes.

Current literature on the risks and outcomes of obesity in pregnancy almost exclusively utilizes prepregnancy body mass index (BMI). Given the rising obesity rate across the United States along with a paucity of available information on the relationship between delivery BMI and maternal and neonatal outcomes, our study aimed to determine the association of maternal BMI at delivery with antepartum, intrapartum, and neonatal complications at an academic referral hospital. This study is a secondary analysis of data collected for a prospective cohort study of Coronavirus Disease-2019 (COVID-19) in pregnancy. This analysis included all patients who delivered term singleton infants between May 1, 2020, and April 30, 2021, at the University of Iowa Hospitals and Clinics. Demographic and clinical data were obtained from the electronic medical record. The relationship between maternal BMI and maternal and neonatal characteristics of interest was assessed using logistic regression models. A statistical significance threshold of 0.05 was used for all comparisons. There were 1,996 women who delivered term singleton infants during the study period. The median BMI at delivery was 31.7 kg/m2 (interquartile range 27.9, 37.2), with 61.1% of women having a BMI ≥ 30.0 kg/m2. Increasing BMI was significantly associated with nonreassuring fetal status, unscheduled cesarean birth, overall cesarean birth rate, postpartum hemorrhage, prolonged postpartum stay, hypertensive diseases of pregnancy, neonatal hypoglycemia, neonatal intensive care unit admission, decreased APGAR score at 1 minute, and increasing neonatal birth weight. Even when controlling for preexisting hypertension in a multivariate model, increasing BMI was associated with gestational hypertension and preeclampsia. Increased maternal BMI at delivery was associated with adverse perinatal outcomes. These findings have implications for clinical counseling regarding risks of pregnancy and delivery for overweight and obese patients and may help inform future studies to improve safety, especially by examining reasons for high cesarean rates. · Sixty-one percent of delivering patients had a BMI330 kg/m2 at delivery.. · There was a higher cesarean rate with increasing delivery BMI.. · For every 5-unit increase in maternal BMI, neonatal weight increased by 0.47 g..

Laparoscopic liver resection as a treatment option for intrahepatic cholangiocarcinoma.

Laparoscopic liver resection (LLR) remains controversial in the treatment of intrahepatic cholangiocarcinoma (ICC). The aim of the present study is to investigate the outcomes of LLR for ICC compared to open liver resection (OLR). We retrospectively reviewed patients who underwent surgery for ICC between January 2013 and February 2020. OLR and LLR were compared after propensity score matching (PSM). Overall survival (OS) and recurrence-free survival (RFS) were compared between the matched groups. During the study period, 219 patients met the inclusion criteria (OLR = 170 patients, 77.6%; LLR = 49 patients, 22.4%). Two groups of 43 patients each were analyzed after PSM. The 5-year RFS and OS were 44.6% and 47.9% in the OLR group and 50.9% and 39.8% in the LLR group, respectively. Hospital stay and intensive care unit care were significantly shorter and lower in the LLR group than in the OLR group, respectively. Total postoperative complications and complication rates for those Clavien-Dindo grade 3 or higher were similar between the OLR group and the LLR group. Multiple tumors and lymph node metastases were predisposing factors for tumor recurrence and death in multivariate analysis. The present study suggests that LLR should be considered in selective ICC because of short hospitalization and similar oncologic outcome and overall survival.

Comparison of non-COVID-19 critically ill patients between pre-pandemic and pandemic period admitted from emergency department to internal medicine intensive care unit

Aim: During the COVID-19 pandemic, a large number of intensive care unit beds have been organized for critically ill COVID-19 patients. However, the need for intensive care for non-COVID-19 critical patients continues. In our study, we aimed to compare non-COVID-19 critically ill patients admitted to the internal medicine intensive care unit from the emergency department before and during the pandemic period.
 Materials and Methods: Patients who were admitted to the internal medicine intensive care unit from the emergency department were grouped as pre-pandemic (March 2018-March 2020) and during the pandemic (March 2020-March 2022) and compared retrospectively in terms of the number of hospitalisations, demographic characteristics, length of intensive care unit stay and mortality.
 Results: The number of emergency department patient admissions other than surgical reasons was 579.657 during the study period. 63.33 % of these patients were admitted before the pandemic and 36.67% during the pandemic period. The number of patients included in our study was 493 before the pandemic and 460 during the pandemic period. Median age was 61 (30) in the pre-pandemic period and 64 (26.8) in the pandemic period, p=0.022. There was no significant difference in terms of comorbidities. The main reason for hospitalisation was similar and sepsis was the leading reason for hospitalisation. The frequency of acute renal failure in intensive care unit was significantly higher during the pandemic period. Mortality was 25.2% before the pandemic and 24.3% during the pandemic period, p=0.760.
 Conclusion: Although emergency department admissions decreased, the number of non-COVID-19 internal medicine intensive care unit hospitalisations did not decrease. This situation reveals the importance of organising intensive care beds for hospitalisation for non-COVID-19 reasons in order not to disrupt health services during the pandemic period.

Ultrasound Gel as a Source of Burkholderia cepacia Sepsis Outbreak in Preterm Neonates

Background: In the middle of 2018, we noticed an outbreak of sepsis due to Burkholderia cepacia complex among inborn babies, and this continued till December 2020. These babies were not responding to conventional antibiotic therapy. Aim: To study the clinical profile of neonates with Burkholderia septicemia, to determine its antimicrobial susceptibility patterns, and to identify the source of infection. Materials and methods: This was a retrospective descriptive study conducted in the inborn nursery of the Government Medical College, Thiruvananthapuram for a period of 30 months, from June 2018 to December 2020. All babies whose blood culture was positive for Burkholderia were identified from the records. Microbiological surveillance was done for source identification. Results: Out of the total 2264 neonates admitted during the study period, 84 (3.7%) had Burkholderia cepacia sepsis. The mean gestational age was 31(2) weeks. The most common clinical presentation was feed intolerance (64%) and 12% had a liver abscess. The highest antimicrobial sensitivity was observed for ceftazidime and cotrimoxazole (100%) followed by cefoperazone-sulbactam (98%) and meropenem (94%). The outbreak was controlled by the withdrawal of contaminated muti-use USG gel and the implementation of the practice of single-use sterile USG gel. Conclusions: Gastrointestinal manifestations are predominantly a manifestation in Burkholderia cepacia sepsis and a strong suspicion of liver abscess should be kept in mind. cotrimoxazole and ceftazidime are the best choice of antibiotics. Unsterile ultrasound gel use in the labor room and NICU can be a source of infection

O123: External peri-stomal skin granulations in paediatric tracheostomy: incidence, outcomes and a proposed treatment algorithm

Abstract Background External peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm. Methods A retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted. Results A total of 50 episodes of peri-stomal granulation were identified in 27 children (52%). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality. Conclusion Non-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes.

Global, regional, and national temporal trends of diet-related ischemic stroke mortality and disability from 1990 to 2019.

Stroke is the second leading cause of death and the third leading cause of disability in the general population worldwide. However, the changing trend of ischemic stroke burden attributable to various dietary risk factors has not been fully revealed and may contribute to a better understanding of stroke epidemiology. Our article aimed to evaluate the temporal trend of diet-related ischemic stroke burden to inform future research and policy-making. This analysis was based on the data from the Global Burden of Disease (GBD) Study 2019 (spanning years 1990 to 2019), and we used the joinpoint regression to model temporal trends in diet-related ischemic stroke burden across countries and regions of the world during the study period. Six specific dietary factors known to influence stroke risk, including sodium, red meat, fiber, vegetables, whole grains, and fruits, were evaluated in the GBD study to determine their individual and joint impact on ischemic stroke. The changing trend was primarily measured by the average annual percent change (AAPC). Age-standardized rates (ASRs) of mortality and years lived with disability (YLD) per 100,000 population were used to evaluate disease burden. Finally, the socioeconomic background, which was quantified as sociodemographic index (SDI), and its association with diet-related ischemic stroke burden were also explored with the Pearson correlation coefficient. During the study period, the ischemic stroke ASR of mortality attributable to overall dietary risk decreased by an average of 1.6% per year, while the ASR of YLD decreased by an average of 0.2% per year. High sodium diet was still a key driver of diet-related ischemic stroke, accounting for 8.4% and 11.0% of deaths and disabilities, respectively, in 2019. In addition, we found a negative association between temporal evolution of stroke burden and socioeconomic background (r = -0.6603 for mortality and r = -0.4224 for disability, P < 0.001), which suggested that the developing countries with weak social and economic foundation faced greater challenges from the ongoing burden of diet-related strokes compared with developed countries. Our study found declining trends and revealed the current status of diet-related ischemic stroke mortality and disability. Interdisciplinary countermeasures involving the development of effective food policies, evidence-based guidelines, and public education are needed in the future to combat this global epidemic. The data used for analysis were open-access and can be obtained from https://vizhub.healthdata.org/gbd-results/.

Factors Influencing the Effectiveness of Midwife Led Debriefing on Prevention of Postpartum Depression in Western, Kenya

Childbirth is a stressful event in women’s lives and could influence emotions which may lead to mental ill health like depression in the postnatal period if not resolved. Depression is a common mental disorder with serious consequences especially during the postpartum period. The prevalence of postpartum depression varies globally, and can be as low as 0.5% or as high as 60.8% in the first year after childbirth. Due to its detrimental impacts, postpartum depression is a serious public health problem. Debriefing is a type of interpersonal therapy, utilized to treat and prevent serious depressive disorders in both pregnant women and the general adult population. Although debriefing has been shown to be useful in both preventing and treating postpartum depression, its effectiveness has not been fully evaluated. The purpose of the study was to assess factors influencing the effectiveness of midwife-led debriefing on prevention of Postpartum Depression in Western region, of Kenya. The study used a quasi-experimental design with pre and post-test assessments. Systematic random sampling was used to identify and allocate participants. The target population was women of childbearing age and study participants were women who gave birth during the study period, of which a sample of 212 participated. Data were collected using standard questionnaire including Edinburg postpartum depression scale (EPDS) score and an interview schedule. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Chi-square was used to test association between variables. Logistic regression model was used to assess the influence of time-based outcome, based on social cultural and demographic characteristics of women on prevention of postpartum depression. Study results indicated that parity, Age, living together with spouse and social support (p=0.004; p=0.003; p=0.002) were significant factors. Additionally, it showed that social support significantly reduced the symptoms of postpartum depression. In conclusion, at the 5% significance level, the key factor was social support (p=0.001) &lt;0.05 which showed that participants postpartum depression symptoms decreased greatly. Midwife led debriefing is recommended as a routine care during perinatal period. Further studies to be done to explore how social support influences midwife led debriefing on prevention of Postpartum depression.

Effect of Increasing Government Debt Profile on Economic Prosperity of Nigeria

The study aimed at assessing the effect of increasing government debt profile on economic prosperity of Nigeria. Specifically, the study examined the extent that Gross Domestic Product (GDP) was affected, during the period of study, by rising domestic debt, external debt, and cost of borrowing in Nigeria. The data for analysis were sourced principally from CBN Bulletins and Debt Management Office. The null hypotheses that domestic debt, external debt, and cost of borrowing do not significantly affect Gross Domestic Product, were tested through a multiple regression analysis. The findings indicate that Domestic Debt has a positive and significant effect on Gross Domestic Product in Nigeria with coefficient of 1.005965 and p-value of 0.0000. Furthermore, the external debt stock reveals a negative and non-significant effect on Gross Domestic Product with coefficient of -0.083963 and p-value of 0.5909, while Cost of Borrowing exposes a positive and non-significant effect on Gross Domestic Product in Nigeria with coefficient of 0.038835 and p-value of 0.7589. The R-squared (Coefficient of Determination) indicates that 98% of the variations in Gross Domestic Product in Nigeria could be explained by changes in Domestic Debt, External Debt and Cost of Borrowing. The implication of the findings is that economic prosperity is facilitated by Domestic Borrowing while External Borrowing must be avoided where possible because of its’ negative effect on GDP. In addition, the effect of Cost of Borrowing on GDP is purely dependent on the appropriateness of use of borrowed fund. The study recommended that government should first explore internal sources of fund whenever borrowing is unavoidable in preference to foreign/external sources, reduce or avoid external borrowing and properly apply the borrowed fund for its economy to prosper.

Surveillance of Waterborne Disease Outbreaks Associated with Drinking Water - United States, 2015-2020.

Public health agencies in U.S. states, territories, and freely associated states investigate and voluntarily report waterborne disease outbreaks to CDC through the National Outbreak Reporting System (NORS). This report summarizes NORS drinking water outbreak epidemiologic, laboratory, and environmental data, including data for both public and private drinking water systems. The report presents outbreak-contributing factors (i.e., practices and factors that lead to outbreaks) and, for the first time, categorizes outbreaks as biofilm pathogen or enteric illness associated. 2015-2020. CDC launched NORS in 2009 as a web-based platform into which public health departments voluntarily enter outbreak information. Through NORS, CDC collects reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents as well as foodborne and waterborne outbreaks of nonenteric disease. Data provided by NORS users, when known, for drinking water outbreaks include 1) the number of cases, hospitalizations, and deaths; 2) the etiologic agent (confirmed or suspected); 3) the implicated type of water system (e.g., community or individual or private); 4) the setting of exposure (e.g., hospital or health care facility; hotel, motel, lodge, or inn; or private residence); and 5) relevant epidemiologic and environmental data needed to describe the outbreak and characterize contributing factors. During 2015-2020, public health officials from 28 states voluntarily reported 214 outbreaks associated with drinking water and 454 contributing factor types. The reported etiologies included 187 (87%) biofilm associated, 24 (11%) enteric illness associated, two (1%) unknown, and one (<1%) chemical or toxin. A total of 172 (80%) outbreaks were linked to water from public water systems, 22 (10%) to unknown water systems, 17 (8%) to individual or private systems, and two (0.9%) to other systems; one (0.5%) system type was not reported. Drinking water-associated outbreaks resulted in at least 2,140 cases of illness, 563 hospitalizations (26% of cases), and 88 deaths (4% of cases). Individual or private water systems were implicated in 944 (43%) cases, 52 (9%) hospitalizations, and 14 (16%) deaths.Enteric illness-associated pathogens were implicated in 1,299 (61%) of all illnesses, and 10 (2%) hospitalizations. No deaths were reported. Among these illnesses, three pathogens (norovirus, Shigella, and Campylobacter) or multiple etiologies including these pathogens resulted in 1,225 (94%) cases. The drinking water source was identified most often (n = 34; 7%) as the contributing factor in enteric disease outbreaks. When water source (e.g., groundwater) was known (n = 14), wells were identified in 13 (93%) of enteric disease outbreaks.Most biofilm-related outbreak reports implicated Legionella (n = 184; 98%); two nontuberculous mycobacteria (NTM) (1%) and one Pseudomonas (0.5%) outbreaks comprised the remaining. Legionella-associated outbreaks generally increased over the study period (14 in 2015, 31 in 2016, 30 in 2017, 34 in 2018, 33 in 2019, and 18 in 2020). The Legionella-associated outbreaks resulted in 786 (37%) of all illnesses, 544 (97%) hospitalizations, and 86 (98%) of all deaths. Legionella also was the outbreak etiology in 160 (92%) public water system outbreaks. Outbreak reports cited the premise or point of use location most frequently as the contributing factor for Legionella and other biofilm-associated pathogen outbreaks (n = 287; 63%). Legionella was reported to NORS in 2015 and 2019 as the cause of three outbreaks in private residences (2). The observed range of biofilm and enteric drinking water pathogen contributing factors illustrate the complexity of drinking water-related disease prevention and the need for water source-to-tap prevention strategies. Legionella-associated outbreaks have increased in number over time and were the leading cause of reported drinking water outbreaks, including hospitalizations and deaths. Enteric illness outbreaks primarily linked to wells represented approximately half the cases during this reporting period. This report enhances CDC efforts to estimate the U.S. illness and health care cost impacts of waterborne disease, which revealed that biofilm-related pathogens, NTM, and Legionella have emerged as the predominant causes of hospitalizations and deaths from waterborne- and drinking water-associated disease. Public health departments, regulators, and drinking water partners can use these findings to identify emerging waterborne disease threats, guide outbreak response and prevention programs, and support drinking water regulatory efforts.

Estimates of the prevalence of male circumcision in sub-Saharan Africa from 2010-2023-A systematic review and meta-analysis.

Male circumcision (MC) is a key part of the package of interventions to prevent HIV, the biggest health challenge in sub-Saharan Africa. To estimate the male circumcision prevalence and to evaluate the progress towards meeting WHO targets in sub-Saharan Africa during the period 2010-2023. We carried out a systematic review and meta-analysis of studies published during the period 2010-2023. We searched PubMed, Scopus, Cochrane CENTRAL, Google Scholar, WHO and the Demographic and Health Survey for reports on MC prevalence in sub-Saharan Africa. MC prevalence was synthesized using inverse-variance heterogeneity models, heterogeneity using I2 statistics and publication bias using funnel plots. A total of 53 studies were included. The overall prevalence during the study period was 45.9% (95% CI 32.3-59.8), with a higher MC prevalence in Eastern (69.9%, 95%CI 49.9-86.8) compared to Southern African (33.3%, 95%CI 21.7-46.2). The overall prevalence was higher in urban (45.3%, 95%CI 27.7-63.4) compared to rural settings (42.6%, 95% 26.5-59.5). Male circumcision prevalence increased from 40.2% (95% CI 25.0-56.3) during 2010-2015 to 56.2% (95% CI 31.5-79.5) during 2016-2023. Three countries exceeded 80% MC coverage, namely, Ethiopia, Kenya and Tanzania. Overall, the current MC prevalence is below 50%, with higher prevalence in Eastern African countries and substantially lower prevalence in Southern Africa. Most of the priority countries need to do more to scale up medical male circumcision programs.

A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study.

Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through "think-aloud" testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.