Poor Class Research Articles

A Predictive Nomogram for Intensive Care-Acquired Weakness after Cardiopulmonary Bypass.

Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB. Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models. Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram. A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making.

Current state of zooplankton and zoobenthos in the lower stream of the Chulym river (Obi river basin)

A comparison was made of the numerical indicators of zooplankton and zoobenthos of the Chulym River in comparison with those obtained in 1972–1973 in order to assess the transformation of the ecosystem that has occurred over 50 years. It is shown that the zooplankton of the Chulym River has undergone dramatic changes, both qualitatively and quantitatively. The number of zooplankton increased 4–5 times due to small rotifers. At the same time, the zooplankton biomass, and therefore the feed value, decreased by more than half due to a reduction in the number of large crustaceans. The species composition of structure-forming zooplankton species has changed. The number of rotifer species in the riverbed decreased from 55 rotifers to 34. The species of Trichocerca family dropped out of the dominant composition and representatives of the river began to dominate Brachionus family. There is a significant change in the structure of zoobenthos: the number of organisms in the Chulym River bed is 5 times lower than in the 1970s. The species composition in benthic communities has remained almost unchanged over 50 years, while the proportion of some heterotopic insects (caddis flies, mayflies, stoneflies) has increased, and the proportion of oligochaetes, mollusks and chironomids in the biomass has decreased by 4–5 times. In the accessory reservoirs of Chulym, the abundance and biomass of zooplankton and zoobenthos over the past 50 years have remained more or less stable, which may indicate the presence of chronic pollution that affects the ecosystem of the main river channel and does not have time to have a negative impact on the accessory reservoirs during floods. The water quality indicators of the Chulym River and its subsidiary reservoirs, according to biotic indices, are low and correspond to a low or poor water quality class. Such conditions are unfavorable for the further development of zoobenthos and, accordingly, ichthyofauna, for which bottom invertebrates are the food supply.

Risk factors, Clinical presentation and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients

Background: Coronary artery disease (CAD) is the leading cause of mortality, morbidity in the developed and developing country. Ageing is important risk factor for coronary artery disease. The role of conventional cardiovascular risk factors in older persons is incompletely understood because only fragmentary and inadequate data are available in most instance and manifestations of acute myocardial infarction are generally believed to be atypical in the elderly. The aim of the study was to find out the clinical presentation, common risk factors and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients. Methods: An observational study in tertiary level hospital. Study protocol was approved by ethical review committee of Sir Salimullah Medical College & Mitford Hospital, Dhaka. Sample was selected from the population by purposive sampling technique. Detail demographic data were collected from the subject and recorded in structured case report form. Researcher makes contact with patient and patients caregiver, and describe them about study aim-objective, and then informed consent was taken. All collected questionnaire checked very carefully to identify the error in the data. Data processing work were consisting of registration of schedules, editing, coding and computerization, preparation of dummy tables, analysis and matching data. Result: In this series, the maximum number of patients (57.0%) was between 60-69 years age group, with mean value 67.21 ± 9.05 years. Out of 100 cases (62%) cases were male and (38%) were female (Figure 1). Male – female ratio was 1.63:1. Large numbers of respondents came from urban area (58%). Among the patients the poor class (44%) comprising the major percentage of the myocardial infarction patients. In this study majority (58%) of the patients had sedentary lifestyle before the onset of myocardial infarction. Among all the risk factors hypertension was the most common risk factor, present in 62% cases; next common risk factors were Diabetes mellitus 56%, dyslipidemia 32%, obesity 22%, smoking 40%. In this study majority of patients (56%) presented with shortness of breath as predominant symptoms. Besides typical chest pain others important atypical symptoms were atypical chest pain (31%), upper abdominal pain (18%), giddiness (4%) and confusional state (3%). In this study many of the patients had developed acute LVF (34%), arrhythmia (17%), cardiogenic shock (8%). Conclusion: We concluded that the manifestations of AMI are more subtle in the elderly, with different risk factors. The elderly subjects are under thrombolysed and have higher complication rate. Bangladesh J Medicine 2024; 35(1): 9-14

Emerging trends of antimicrobial sensitivity and resistance pattern and drug utilization study in burn patients at tertiary care teaching hospital

Background: One of the cases of accidental injuries is burns. Globally, every year estimated 180,000 mortalities occur due to burns, and most of the deaths are seen in the lower or poor socioeconomic class of developing countries. Due to predominantly poor and low socioeconomic status, overpopulation, poor education, and unreachability to advanced burn care in certain parts of the country - the incidence, complications, and deaths have continued to rise in developing countries. About 75% of the deaths associated with burn injuries are related to wound infection, especially in developing countries. The present study was undertaken to study the microflora of burn wounds as well as drug utilization in the management of burn patients in a tertiary care teaching hospital. Aims and objectives: Assessment of antimicrobial susceptibility and resistant pattern and drug utilization in burns patients. Materials and Methods: This observational cross-sectional descriptive study was performed on 130 hospitalized burn patients over 12 months (from November 2020 to November 2021). All burn patients who were admitted in the hospital and received at least 1 day of treatment were included in the study. All required information, including demographic data, prescribed medication, microbial culture sensitivity report, and treatment outcome were recorded in the case record form. Descriptive statistics using Microsoft Excel version 2019. Results: Of a total of 130 burn patients, 52% were females. The most common type of burn was flame in 69% of patients. The mean length of hospital stay was 9 days and it ranged from 1 to 40 days. Culture from burns wound revealed Pseudomonas aeruginosa (47.6%) as the most common organism isolated followed by Klebsiella pneumoniae (45.2%), Acinetobacter baumannii (14.2%), Proteus mirabilis (14.2%), Staphylococcus aureus (9.5%), and Escherichia coli (4.7%). Among the isolated microorganisms, most of them showed sensitivity to beta-lactam, aminoglycoside, and tetracyclines. Sulphonamide was dominant among the topically applied antibiotics, whereas cephalosporins were dominant among the systemically administered antibiotics. The average number of drugs pre-prescription ranges from 6.5 to 8.5. Conclusion: The present study results are helpful in understanding the pattern of burns wound sepsis, the dominant bacterial organism, the antimicrobial susceptibility/resistance, and the drug utilization pattern in burn patients.

Comparison of Some Land Suitability Evaluating Methods for a Selected Gypsiferous Part in the Northern Karma Region for Irrigated Agriculture

To compare the efficiency of three systems to evaluate the suitability of Gypsiferous land for irrigated agriculture, an area of 8885.4 hectares was selected in the Tharthar region – Iraq within the Euphrates terrace, which formed at Pleistocene period and mainly consisted of gypsum, the study included a semi-detailed survey of the area's soil using the Free-lance method, by selecting three parallel transects, according to the variations in texture class, soil salinity and content of gypsum, five representative pedons locations were identified and morphologically described, also soil samples from each horizon were obtained, as well as we obtained water samples from the Euphrates river-Tharthar canal and every wells located in the study area, it's transferred to the laboratory and the required analyzes were performed. The result showed the predominance of the medium soil texture class and slightly saline soil class (S1) in the study area, with a decrease in the soil carbonate content, on the contrary the soil gypsum content was increased. All wall waters was salinity, which poses a danger to agricultural use, compared to the water of the Euphrates river. A discrepancy was observed between the obtained land suitability classes. While the Sys and Verheye, 1972 system showed two poor suitability classes, Sys et al. 1991 and Al-Baji et al. 2010 has improved the appropriateness of the varieties, but the Kadhim, 2012 system was the best in terms of application in order to include the quality of irrigation water within the classification, so its results were more close to the reality diagnosed during the field visits to the study area and the questionnaire from the land users of the region

English Teachers' Understanding of Cooperative Language Learning and its Opportunities and Challenges in Teaching Writing Skills

Cooperative language learning (CLL) is one of the most successful, effective and extensively used learner-centred strategies in teaching writing skills which can help pupils acquire transferable abilities and motivate them to learn the language in pairs and groups in the classroom. The study aimed to explore the English language teachers' understanding of CLL and its opportunities to enhance students' writing skills along with some challenges they encounter in applying it. It was carried out within the theoretical framework of social interdependence theory. To carry out the study, the phenomenological research method was employed. Two English teachers were purposively selected as the participants for the study of two public schools in Rupandehi. The in-depth interview was used as a major technique for collecting information. The study revealed that the English language teachers had a good understanding and positive views toward CLL to enhance the writing skills of the students. The result also indicated that maximized learning opportunities, teacher as a facilitator, addressing mixed ability learners and increased interaction are the opportunities while multi-level and poor educational background of students, lack of regular professional training and collaborative culture, poor class management and less administrative support have been realized as challenges in effective implementation of CLL. The application of CLL can help revolutionize the traditional way of teaching writing skills engaging learners with the assigned writing tasks.

Dealing with epidemics in late nineteenth century Dublin - A case study of typhoid fever

Epidemics were a regular fact of life in Dublin during the second half of the nineteenth century. There were many infectious diseases to cope with as well as diseases of the respiratory and nervous systems. Death from such diseases was not an unusual occurrence, particularly among the poorer classes, but occasionally annual rates would surge to epidemic levels. Medical knowledge was undergoing a significant advance with an understanding of the role of bacteria displacing the centuries-old theory of miasma but it would be the following century before the role of viruses would be understood. It took some time for miasma to be entirely discounted with bacteria merely replacing the animal poisons previously believed to be the cause of illness. This was just as well as dealing with miasma involved an emphasis on public sanitation and hygiene: effective whether miasma, bacterium or virus. Dublin experienced a typhoid fever epidemic in 1891 and 1893 and the analysis undertaken at the time was unusual for its depth and the quality of geographical information provided. This paper examines that outbreak and explores the importance of geographical factors in explaining its distribution.

Espaços ordinários e transformações extraordinárias: o combate à fome da Ação da Cidadania

Abstract This article examines the creation and the first year of existence of Ação da Cidadania to comprehend how it established a social justice agenda in Brazil by creating awareness and promoting solidarity. The movement redefined the issue of hunger, previously associated with poorer classes, as a problem that affects all sectors of society. Through an analysis of Betinho’s manuscripts and memoirs, promotional material from the organization, and secondary geographical data, this study presents the campaign's role as an intermediary for hunger under a framework of space as a producer of social relations. Ação da Cidadania serves as an example of partnership and solidarity for social change, creating non-state public spaces and inspiring civil organizations and social movements.

Undernourishment Needs Overemphasis: Lived Experiences of Elementary Teachers and Parents Having Undernourished Schoolchildren

This present study aimed to explore the lived experiences of parents and elementary teachers with undernourished children or pupils. These pupils are enrolled in two elementary schools in the 4th District of Santa Catalina under the Division of Negros Oriental, Philippines. Employing the descriptive phenomenological design through the unstructured in-depth interview method on the experiences of teachers and parents with undernourished schoolchildren, twelve participants agreed to participate in this study. Digitally recorded interviews were thematically analyzed to generate the themes and subthemes. We generated four themes: (a) pupils' poor class performance and behavior; (b) teachers' strategic initiative aimed at enhancing performance and behavior; (c) Department of Education’s (DepEd) support for pupils' well-being; and (d) children's poor eating behavior. Teachers were challenged in handling pupils who are undernourished as the latter becomes mentally and physically absent in the classroom. To ensure that these pupils are not left behind, teachers make some interventions, like peer tutoring, to help the pupils cope with every day’s lesson. With the intention of improving the nutritional status of undernourished pupils, schools implemented the school-based feeding program and the giving of nutritious foods that may be brought home for pupils’ breakfast or supper. We conclude that despite the challenges encountered, teachers and parents devise interventions to lessen the negative effects of undernutrition with the help of DepEd.

“In Women’s Hands”

Eugenics had popular appeal and expressions in early 20th-century Denmark. This article tells two stories of what eugenics looked like ‘in the hands’ of bourgeois Danish women as they promoted ‘racial hygiene’ through cultural production. The first story highlights the eugenic feminism of nationally acclaimed women’s rights advocate Thit Jensen through a reading of her play The Stork (1929). The second tells of the Copenhagen Housewife Association’s engagement with new media technology and race science through their eugenics radio Listener Group (1934). Read through a lens that pays especially close attention to race and class, I argue that this work identifies them as significant proponents of eugenic ideology and as contributors to the targeting of the poor and working class in the name of ‘racial hygiene’ – a decidedly racist project.

Evaluation of drinking and irrigation water quality, and potential risks indices in the Dera Ismail Khan district, Pakistan

This study sought to asses drinking and irrigation water quality in the Dera Ismail (DI) Khan District, Pakistan with the aid of using drinking water quality index (WQI) and irrigation water quality indices (IWQI). Seventy two water samples were collected from various water sources such as tube wells, dug wells, hand pumps, streams, and springs throughout the DI Khan district. The investigated physicochemical parameters include pH, TDS, EC, turbidity, total hardness, major cations (Na, K, Ca, Mg), anions (Cl, HCO3, SO4), and heavy metals (Fe, Mo, Cr, Ni, Cu, and Zn). IWQI used in the study includes Kelly's ratio (KR), permeability index (PI), sodium percent (Na%), Magnesium Hazard (MH), potential salinity (PS), residual sodium carbonate (RSC), and sodium adsorption ratio (SAR). With the mean value of 63, WQI revealed that most samples are placed in the good category, with a smaller fraction in the excellent and poor classes. On the other hand, a health risk assessment of the data pointed out that the molybdenum (Mo) and chromium (Cr) concentrations in drinking water could pose health risks to children of the concerned population. Rock weathering appears to be the dominant hydro-geochemical pathway controlling water chemistry, Ca–Mg–HCO3 being the dominant facies, followed by Na–HCO3. Kelly's ratio (KR), sodium percent (Na%), sodium adsorption ratio (SAR), and residual sodium carbonate (RSC) had values higher than the recommended threshold. The use of water for irrigation of agricultural fields may raise relevant ecological concerns in the studied district.

Induced Septic Abortion: Clinical Presentation Management and Outcome

Background & objective: Septic abortion still remains one of the most serious threats to the health of women all over the world. Most women indulge in unsafe abortion, for they no longer want children, but failed to take any contraception. The present study was undertaken to describe their clinical presentation, management and outcome including maternal complications and mortality caused by induced septic abortion. Methods: This descriptive study was conducted in the Department of Obstetrics & Gynaecology in Dhaka Medical College Hospital, Dhaka, Bangladesh over a period of 6 months between July 2008 to December 2008. All patients with septic abortion up to 28 weeks of gestation admitted to the Department of Obstetrics & Gynaecology at Dhaka Medical College Hospital (DMCH) were the study population. Patients with induced septic abortion with signs of infection were included in the study. However, patients with inevitable abortion, missed abortion, spontaneous septic abortion and septic abortion with the medical disorder were excluded from the study. A total of 50 patients based on above-mentioned eligibility criteria were included in the study. Data were analyzed to describe their clinical presentation, management and outcome, which among others included maternal complications and mortality. Result: Almost three-fifth of the patients were in their 3rd decade and 26% in their 4th decade of life with mean age of the patients being 27.2 ± 1.6 years. Over 40% were primary level educated and a sizable portion (36%) was illiterate. Majority of the patients was married (96%), house-wife (82%), rural resident (76%) and belonged to poor socioeconomic class (80%). More than 60% of the patients were in 2nd trimester of pregnancy and over two-thirds (68%) were multipara. For initiating abortion, about one-third (32%) used stick inside the vagina, 24% received menstrual regulation, 14% underwent D & C (dilatation & curettage), 22% took oral medication. More than one-third (36%) of the patients aborted for their pregnancy was unwanted, 20% did it because their pregnancy was unplanned. A few patients however mentioned social problem (6%) and husband’s illness (2%) as the reasons of induced abortion. The lower abdominal pain (96%) and per vaginal bleeding (94%) were the predominant complaints of the patients followed by followed by fever (72%), discharge of foul-smelling lochia (68%) and abdominal distension (12%). On examination majority (96%) was found anemic, toxic (56%), feverish (82%), with lower abdominal tenderness (60%) and dehydration (50%). On local examination, 80% exhibited signs of bleeding with tender fornics. Open external os, dirty vulva and foul-smelling discharge were observed in 74, 60 and 30% of the cases respectively. Vaginal and cervical injuries were found in few cases. More than 90% of the patients improved and cured and 8% died of complications like generalized peritonitis (2%) and septicemia with renal failure (6%). Conclusion: Induced septic abortion patients are generally multipara and present in 2nd trimester of pregnancy. In one-third of cases, the stimulus used to initiate abortion is stick inside the vagina. Other procedures adopted are menstrual regulation, D & C, oral ingestion of abortifacient drugs etc. Reasons of abortion include unwanted or unplanned pregnancy. While the cardinal symptoms at presentation are lower abdominal pain and per vaginal bleeding, cardinal signs are anemia, raised temperature and lower abdominal tenderness. Local examination usually exhibits signs of bleeding with tender fornics, open external os. Vaginal and cervical injuries are sometimes present. Majority of the patients cure on conservative treatment. Some however, require operative treatment. Very few patients died of complications (peritonitis and septicemia with or without renal failure) of the disease. Ibrahim Card Med J 2022; 12 (1): 58-63

Mental well-being of Microfinance Beneficiaries in the Post-Covid Scenario

The world was brought to a sudden standstill with the rise of the Covid-19 Pandemic and the severity of the disease led to loss of lives and livelihood of the masses. The poor were heavily impacted by the disease as the pandemic forced them to be confined within the walls of their homes with no income. The financial, economic and social loss was already irreparable but the impact on mental well-being was also immense. The microfinance beneficiaries generally belong to the rural poor class of the society, who were massively impacted by the pandemic. The study was conducted on 450 microfinance beneficiaries from two districts which recorded highest Covid positive cases in the state of Assam in India. Two scales of WHO-5 and PANAS was used to assess their mental well-being in the post-Covid times. The pandemic also had its toll on the mental health of the microfinance beneficiaries. Mental well-being is below average as per WHO-5. As per PANAS the positive and negative affect scores are slightly above average. Post-pandemic the microfinance beneficiaries are trying to cope up with their losses with a below average mental health along with the burden of repayment of the loans. Anxiety, stress, fear and depression are persistent among the respondents in the post-Covid scenario. Keywords: - Microfinance, Well-being, Mental health, Covid-19

Knowledge and Practices of Patients Regarding Diabetes Self-Management: A Mixed Method Approach

Diabetes Mellitus is a major source of death globally and has shaken middle-income and low-income countries including Pakistan. Objective: To determine diabetes knowledge, and explore the patient’s experiences of type-ii diabetes along with its self-management. Methods: A mixed-method design was used to carry out this study at a tertiary care hospital in KP Pakistan from April to September 2021. Information on patients’ demographic characteristics, diabetes knowledge, and diabetes self-practices, patients’ lived experiences of diabetes self-practices, and barriers to self-care activities were collected. Data were collected through a structured questionnaire and in-depth (IDIs) interviews for measuring diabetes knowledge, and its management. Results: Out of 215 recruited participants, the majority 90% had inadequate knowledge (score=0-4). 3.2% (n=07) had average knowledge (score=5-8) of diabetes, and its self-management. 60% of the participants were from the age group 50-59 years. 70% (n=151) of participants were from poor socioeconomic classes. The results showed an association between illiteracy, poverty, diabetes knowledge, and self-management (p-Value 0.001). The qualitative results expressed that the illiterate and low socioeconomic participants had inadequate diabetes self-management practices. Conclusions: The study inferred that the participants, who had inadequate knowledge about type-II diabetes and its management, were having poor self-care practices of diabetes.

Breast cancer risk factors based on reproductive and nonreproductive profiling of Pakistani women: A hospital based case control study.

Breast cancer (BC) is a global public health problem attributed to varying risk factors. The designing of a targeted screening program focused on at-risk women can be cost-effective in reducing its burden. A hospital based case control study was conducted on 138 cases of breast cancer and 169 healthy controls to investigate the reproductive and non-reproductive risk factors for breast cancer in Pakistani women. The odds ratios (ORs) and 95% confidence intervals (CIs) were computed with unconditional logistic regression. Almost all i.e. 97.83% of cases were married (OR=5.03),70.29% were illiterate (OR=1.88), 73.19% were aged >35 years (OR=0.632) and 81.16% belonged to the poor class(OR=1.81). Early age at menarche (OR, 2.55; 95% CI 1.50-4.31, P=0.0001), hormone replacement therapy (OR=2.057, 95% CI 1.283-3.295, P= 0.002) early pregnancy (OR,2.23, 95% CI 1.29-3.88, P=0.004), history of miscarriage (OR, 2.11, 95% CI 1.32-3.39,P=0.002) & oral contraceptive use (OR, 2.76, 95% CI 1.54-4.92, P= 0.006) were significantly associated with BC. The study highlights the dire need for effective public health programs for high-risk women to address this highly fatal disease.

Assessing the Effect of Urban Growth on Surface Ecological Status Using Multi-Temporal Satellite Imagery: A Multi-City Analysis

Quantification of Surface Ecological Status (SES) changes is of great importance for understanding human exposure and adaptability to the environment. This study aims to assess the effect of urban growth on spatial and temporal changes of SES over a set of neighboring Iranian cities, Amol, Babol, Qaemshahr, and Sari, which are located in moderate and humid climate conditions. Firstly, the built-up footprint was prepared using Landsat images based on the Automatic Built-up Extraction Index (ABEI). Then, the surface biophysical characteristics were calculated. Secondly, the SES was modeled using the Remotely Sensed Ecological Index (RSEI), and the spatio-temporal changes of the SES were evaluated. The results revealed that the average RSEI for these cities increased from 0.48, 0.51, 0.53, and 0.55 in 1986 to 0.69, 0.77, 0.75, and 0.78 in 2022, respectively. The proportion of the poor ecological condition class in these cities rose from 10%, 3%, 5%, and 1% to 74%, 64%, 54%, and 41% during the 1986–2022 period. Our findings indicate that the SES of these cities significantly decreased while they experienced large physical growth. The findings and the methodical approach of the study provide a data-driven approach for monitoring SES in fast growing regions, which is required for studying the impact of climate change on society.

Identification of health-related quality of life profiles among long-term survivors of primary central nervous system tumors

PurposeWe aimed to identify health-related quality of life (HRQOL) latent classes among primary central nervous system tumor (PCNST) long-term survivors (LTS) and to evaluate differences between classes in survivor sociodemographic characteristics, clinical characteristics, and symptoms to guide the development of survivorship care programs tailored to unique class needs.MethodsData from 298 PCNST LTS reporting HRQOL on the EQ-5D-3L were analyzed using latent profile analysis. Correlations and independent group t-tests were performed to identify differences between identified HRQOL classes by sociodemographic, clinical characteristics, and symptoms.ResultsSample mean age was 48 years, 54% were male, 82% Caucasian, 56% employed, 60% had a high-grade glioma, and 52% had a KPS ≥ 90. Two HRQOL classes, good (61%) and poor (39%), were identified. The good HRQOL class reported no problems with self-care and few problems with mobility or usual activities. Thirty-eight percent reported anxiety and depression and 21% pain. Over 94% of the poor HRQOL class had at least moderate problems with mobility and usual activities, and over 50% had pain, self-care issues, anxiety, and depression. Older age (φ = 0.21), unemployment (φ = 0.30), spine tumors (φ = 0.18), active treatment (φ = 0.20), tumor recurrence (φ = 0.28), and poorer KPS scores (φ = 0.61) were associated with membership in the poor HRQOL class.ConclusionsIn the poor PCNST LTS HRQOL class, an overwhelming majority faced significant physical challenges, and the good HRQOL class experienced mood-related disturbance but limited physical challenges. These HRQOL profiles can be used to guide survivorship programs and tailored interventions.

The idea of a welfare state in the aspect of state-legal monism and pluralism

The problem of implementing the idea of a social state is considered from the point of view of state-legal monism and pluralism at the level of humanity, that is the possibility of the emergence of a universally recognized model of such a state or the inevitability of the coexistence of various such models due to national, economic, cultural factors operating in specific countries.Attention is drawn to the fact that such a problem is also relevant in relation to the ideas of a democratic and rule-of-law state. In general, the coincidence of formal characteristics of states reflected in modern constitutions is accompanied by statements about the absence of unified concepts of democracy and human rights. To an even greater extent, this is characteristic of the search for a solution to the so-called social issue. The theses underlying the concept of the welfare state by L. von Stein are presented. In particular, it is indicated that, in his opinion, the simple development of the social security system of the poor class is not enough to solve the “social issue”. The further development of the idea of a social state is shown, discussions are touched upon regarding the understanding of its essence and the problems that were revealed during the social reforms carried out by socio-democratic and liberal forces in capitalist states at the end of the 19th and 20th century.The main approaches to the constitutionalization of the social state are revealed (the “simple” proclamation of “social” statehood in the constitution; the clear formation of the goals and objectives of such a state; the absence of an indication of the social nature of the state). The classifications of the welfare state carried out by G. Esping-Andersen, as well as modern researchers of Russia and neighboring countries are analyzed. It is established that the very existence of a “social issue” and the importance of one or another of its solutions are gradually becoming generally recognized. Despite this, the fixation of the social character of the state has not yet received the same universal distribution as, for example, theses about the democratic and legal nature of the state. Both the implementation of the idea of a welfare state where it is legally recognized, and its declared “projects” are very diverse, while the typology of the welfare state is subject to further study. The social model, the framework of which determines the position of the state in relation to society, is, on the one hand, the result of the evolution of a complex of factors specific to each country, and on the other, the result of a conscious choice. Different models of the welfare state are characterized by different degrees of realization of the interests of different social classes, a different relationship between the beginnings of society and the state. Accordingly, these models are “attractive” to representatives of the haves and have-nots to varying degrees, they compete with each other at the international level. It is concluded that the idea of a social state can be reduced to a certain unity, whereas the ways of its implementation are inevitably multiple.

Investigating household catastrophic health expenditure and coping mechanisms in patients with Chronic Kidney Disease in Enugu, Nigeria: a single center experience

The methods of financing healthcare expenditure for any country are vital in determining the health status of the country. To meet the rising costs of seeking health care, many poor households in managing chronic disease conditions like Chronic Kidney Disease (CKD) often resort to coping strategies that are further detrimental to their well-being. CKD is the 12th highest cause of death and 17th highest cause of disability worldwide. This study assessed the incidence of household catastrophic health expenditure and payment coping mechanism of patients with CKD. It was a descriptive cross-sectional study involving 100 patients with various stages of CKD attending the Nephrology clinics of University of Nigeria Teaching Hospital Enugu, South eastern Nigeria. They were recruited using a systematic sampling technique. A questionnaire was used to collect data. Data were collected using pre-tested semi-structured questionnaires and analyzed using descriptive statistics of frequencies, percentages, mean, standard deviation and interquartile range. Chi-square was used to test for association between payment coping mechanisms used by patients across socioeconomic groups. The study demonstrated uniformly high incidence of catastrophic expenditure for all the respondents both at 10% and 40% threshold (100% and 97%) respectively, with cost of treatment uniformly distributed among the various socioeconomic classes. Most of the patients assessed their treatment by paying out of pocket without reimbursement (88%), with money from personal bank savings being the commonest coping mechanism especially among the poorest Socioeconomic Status (SES) class, and borrowing among the least poor SES class. The study concluded that the prevalence of catastrophic expenditure was very high across all the socioeconomic status. It is recommended that the Nigerian Health Insurance program should be expanded to cover at least dialysis treatment of CKD, if not all aspects of CKD management in order to protect these patients and their household from ill-health mediated catastrophic expenditure.

Circulating choline levels are associated with prognoses in patients with pulmonary hypertension: a cohort study

BackgroundsMounting evidences have highlighted the association between metabolites and cardiovascular diseases. Our previous works have demonstrated that circulating metabolite, trimethylamine oxide, was associated with prognosis of patients with pulmonary hypertension (PH). Choline is a precursor of trimethylamine oxide and its role in PH remains unknown. Here, we aimed to validate the hypothesis that circulating choline levels were associated with prognoses in patients with PH.MethodsInpatients diagnosed with PH—defined as mean pulmonary arterial pressure ≥ 25 mmHg by right heart catheterisation—from Fuwai Hospital were enrolled after excluding relative comorbidities. Fasting blood samples were obtained to assess choline levels and other clinical variables. The primary endpoints were defined as death, escalation of targeted medication, rehospitalization due to heart failure, PH deterioration. The follow-up duration was defined as the time from the choline examination to the occurrence of outcomes or the end of the study. The associations between circulating choline levels and disease severity and prognoses were explored.ResultsTotally, 272 inpatients with PH were enrolled in this study. Patients were divided into high and low choline groups according to the 50th quartile of circulating choline levels, defined as 12.6 µM. After confounders adjustment, the high circulating choline levels were still associated with poor World Health Organization functional class, elevated N-terminal pro-B-type natriuretic peptide, and decreased cardiac output index indicating the severe disease condition. Moreover, elevated choline levels were associated with poor prognoses in PH patients even after adjusting for confounders (hazard ratio = 1.934; 95% CI, 1.034–3.619; P = 0.039). Subgroup analyses showed that choline levels predicted the prognosis of patients with pulmonary arterial hypertension but not chronic thromboembolic pulmonary hypertension.ConclusionsCholine levels were associated with disease severity and poor prognoses of patients with PH, especially in pulmonary arterial hypertension suggesting its potential biomarker role.