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The objective of this cross-sectional study was to determine the gender differences in hypertension awareness, antihypertensive use and blood pressure (BP) control among the adult Nepalese population (≥18 years) using data from the nationally representative Nepal Demographic and Health Survey 2016. A weighted sample of 13,393 adults (5620 males and 7773 females) was included in the final analysis. After conducting descriptive analyses with the selective explanatory variable, multivariable logistic regression analysis was performed to assess the association between the outcome variable and the explanatory variables. The strength of the association was expressed in adjusted odds with 95% confidence intervals. A higher proportion of women had their BP checked (87.7% females vs 73.0% males, p<0.001) and were aware of their raised BP (43.9% females vs 37.1% males, p<0.001) compared with men. Although female hypertensive individuals had a higher prevalence of antihypertensive medication use than their male counterparts (50.1% females vs 47.5% males), a higher proportion of male hypertensive participants had their BP controlled (49.2% females vs 53.5% males). Women with the poorest wealth index had a lower prevalence of antihypertensive use than their male counterparts. The odds of having their own BP measured increased with age among men but decreased with age among women. The household wealth index was positively associated with the odds of BP measurement, awareness of own BP and antihypertensive use. This study revealed that although women had a higher prevalence of hypertension awareness and antihypertensive medication use, the practice did not translate into better BP control. Inequality in antihypertensive medication use was observed among the poorest wealth quintiles. Public health programmes in Nepal should focus on reducing these inequalities. Further research is needed to learn why females have poorer control of BP, despite having higher antihypertensive medication use.
This study evaluated cardiac function using tissue Doppler echocardiography and assessed electrocardiographic findings in children diagnosed with Wilson’s disease.
Asymptomatic patients with a diagnosis of Wilson’s disease (n = 43) were compared to healthy controls (n = 37) that were age and gender matched.
The standard electrocardiographic and conventional echocardiographic examinations were similar in both groups. The left ventricular ejection fraction, shortening fraction, and diastolic function were not significantly different between the two groups. The Tei index for mitral lateral, mitral septal, tricuspid lateral, tricuspid septal, and inter-ventricular septum on tissue Doppler echocardiography was higher in the patient group, yet it did not reach statistical significance. Mitral lateral and septal systolic annular velocity values were significantly lower in the patient group when compared to the control group (p = 0.02 and 0.04, respectively). Also, mitral lateral and septal isovolumetric contraction time values were higher in the patient group (p = 0.04). Although the left ventricular values were not significantly different, relative left ventricular wall thickness was higher in the patient group when compared to the control group, and concentric remodelling in the left ventricle was found in 7 (16%) of 42 patients. QT interval (p = 0.02) and P-wave dispersion values (p = 0.04) were significantly higher in the patient group compared to the control group, and these tend to predict arrhythmias.
Our study based on the tissue Doppler echocardiography assessment indicated a subclinical systolic, rather than diastolic, dysfunction in the myocardium with increased QT interval and P-wave dispersion, despite the young age of the patients and short disease duration.
Most reports on the outcome of children who present with heart failure, due to heart muscle disease, are from an era when ventricular assist devices were not available. This study provides outcome data for the current era where prolonged circulatory support can be considered for most children.
Methods & Results:
Data was retrieved on 100 consecutive children, who presented between 2010 – 2016, with a first diagnosis of unexplained heart failure. Hospital outcome was classified as either death, transplantation, recovery of function or persistent heart failure. Median age at presentation was 24 months and 58% were < 5 years old. Hospital mortality was 12% and 59% received a heart transplant. Most, 79%, of the transplants were carried out on patients with a device. Recovery of function was observed in 18% and 10% stabilised on oral therapy. Eighty-four percent of the deaths occurred in the <5 year old group. Shorter duration of support was associated with survival (34 days in survivors versus 106 in non-survivors, p = 0.01) and 72% were on an assist device at time of death.
Heart failure in children who require referral to a transplant unit is a serious illness with a high chance of either transplantation or death. Modifications in assist devices will be required to improve safety, especially for children < 5 years old where the donor wait may be prolonged. The identification of children who may recover function requires further study.
Oxygen is the main treatment of carbon monoxide (CO) poisoning. In two simultaneous cases, the efficacy of conventional and continuous positive airway pressure (CPAP)-administered oxygen therapy was compared. A 63-year-old man and his 58-year-old wife were brought to the emergency department with complaints of dizziness, headache, and nausea. The man had a history of congestive heart failure and additionally had shortness of breath. Initial carboxyhemoglobin (COHb) values were 26% in the male patient and 24% in his wife. For the female patient, oxygen therapy was performed with a reservoir balloon mask; a CPAP device was used for the male patient. The COHb levels decreased below five percent after approximately two hours in the male patient and at the end of five hours in his wife. In follow-up, symptomatic relief was achieved in both patients and no additional complications were observed. According to our experience, CPAP ventilation can be a new and effective method for oxygen therapy in CO poisoning.
Medicine is one of the most important areas of higher education. It is important that undergraduate students are well educated and have theoretical knowledge, but also have good clinical skills after graduating from medical training.
To understand whether the training objectives of the emergency medical internship was completed or not and to find the relationship between young doctors’ self-confidence and what they can do via using Rosenberg self-esteem scale (RSES). In addition, an objective was to consider which learning methods are more useful based on the feedback.
This survey study was performed in 2018 at Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey with the students who completed an emergency department rotation in the 2017-2018 education term. The questionnaire was composed by the researchers. It consisted of three parts which were included demographic information and education methods in emergency medicine of internships, questions about knowledge goals and learning goals for basic medicine applications, and RSES to assess young doctors’ self-confidence.
96 young doctors with the mean age of 25.22 ± 1.216 years(minimum 23 and maximum 30 years) were in the study5. 3 (55.2%) of which were female. All young doctors were evaluated with RSES4. (4.2%) of which were low self-confidence and 32 (33.3%) of which were high self-confidence. The best useful learning methods were clinical application of interaction with patients (n=828. 5%) and invasive procedures performed on patients (n=727. 5%).
The more you practice, the more you learn. Practice-based education is an important factor in a young doctor’s life. Besides, the higher self-confidence you have, the more you can. Young doctors with high self-esteem see themselves as qualified to perform applications even in complicated situations. However, more studies are needed to find out whether they could really perform or not.
The “problem of memory” in epistemology is concerned with whether and how we could have knowledge, or at least justification, for trusting our apparent memories. I defend an inductive solution – more precisely, an abductive solution – to the problem. A natural worry is that any such solution would be circular, for it would have to depend on memory. I argue that belief in the reliability of memory can be justified from the armchair, without relying on memory. The justification is, roughly, that my having the sort of experience that my apparent memory should lead me to expect is best explained by the hypothesis that my memories are reliable. My solution is inspired by Harrod's (1942) inductive solution. Coburn (1960) argued that Harrod's solution contains a fatal flaw. I show that my solution is not vulnerable to Coburn's objection, and respond to a number of other, recent and likely objections.
The objective of this study was to assess differences in myocardial systolic and diastolic function and vascular function in children 2−5 years of age born to diabetic as compared to non-diabetic mothers.
This study was a retrospective cohort conducted in 2016 at The Aga Khan University Hospital, Karachi, Pakistan. It included children between 2 and 5 years of age born to mothers with and without exposure to diabetes in utero (n = 68 in each group) and who were appropriate for gestational age. Myocardial morphology and function using echocardiogram and carotid intima media thickness (cIMT) and pulse wave velocity was performed to evaluate cardiac function as well as macrovascular remodelling in these children. Multiple linear regression was used to compare the groups.
There was no significant difference in cardiac morphology, myocardial systolic and diastolic function, and macrovascular assessment between the exposed and unexposed groups of AGA children. Subgroup analysis demonstrated a significantly decreased mitral E/A ratio in children whose mothers were on medications as compared to those on dietary control (median [IQR] = 1.7 [1.6–1.9] and 1.56 [1.4–1.7], respectively, p = 0.02), and a higher cIMT in children whose mothers were on medication as compared to controls (0.48 [0.44–0.52] and 0.46 [0.44–0.50], respectively, p = 0.03).
In utero exposure to uncontrolled maternal diabetes has an effect on the cardiovascular structure and function in children aged 2−5 years. However, future work requires long-term follow-up from fetal to adult life to assess these changes over the life course.
Resin acid-enriched composition (RAC) mainly containing tall oil fatty acid with an active component of resin acid (RA) can improve the microbial population in the digestive system, change the microbial fermentation, and improve the feed conversion ratio. We investigated the effects of dietary supplementation of RAC on sow colostrum yield (CY), colostrum composition and gut microbiota. Tall oil fatty acid and RA are commonly termed RAC and CLA, pinolenic, abietic, dehydrobiotic acids are characteristic components of RAC. The experiment was conducted in three trials in three respective herds. Sows were fed with a control diet and the same diet supplemented with 5 g RAC/day per sow during the last week of gestation. The 16S ribosomal RNA gene sequencing technique was used to assess sows’ faecal microbiota populations at farrowing. Colostrum nutritional composition, acute phase proteins (APPs) and immunoglobulin (Ig) content were also assessed. Individual piglets were weighed at birth and 24 h after the birth of first piglets in order to calculate CY and later at 3 to 4 weeks to calculate average daily gain. The RAC-fed sows had significantly higher IgG levels (P<0.05) in all three herds but treatment did not influence colostrum IgA and IgM concentration. There were no significant differences in colostrum protein, lactose and fat content in sows of the two diet groups (P>0.05), but those fed RAC had higher levels of colostrum serum amyloid A. Colostrum yield was significantly higher in RAC-fed sows in herds 2 and 3 with heavier piglets between 3 and 4 weeks of age (P<0.05), but not in herd 1 (P>0.05). Resin acid-enriched composition supplementation significantly increased some beneficial and fermentative bacteria (Romboutsia and Clostridium sensu stricto) than the control diet (P<0.01) while some opportunistic pathogens (Barnesiella, Sporobacter, Intestinimonas and Campylobacter), including Proteobacteria, were suppressed. Therefore, RAC added to the sow diet at late pregnancy increases colostrum IgG, colostrum availability for neonate piglets, and seems to promote better maternal intestinal microbial sources.
Evidence exists of an increasing prevalence of chronic conditions within developed and developing nations, notably for priority population groups. The need for the collection of geospatial data to monitor the health impact of rapid social-environmental and economic changes occurring in these countries is being increasingly recognized. Rigorous accuracy assessment of such geospatial data is required to enable error estimation, and ultimately, data utility for exploring population health. This research outlines findings from a field-based evaluation exercise of the SOMAARTH DDESS geospatial-health platform. Participatory-based mixed methods have been employed within Palwal-India to capture villager perspectives on built infrastructure across 51 villages. This study, conducted in 2013, included an assessment of data element position and attribute accuracy undertaken in six villages, documenting mapping errors and land parcel changes. Descriptive analyses of 5.1% (n = 455) of land parcels highlighted some discrepancies in position (6.4%) and attribute (4.2%) accuracy, and land parcel changes (17.4%). Furthermore, the evaluation led to a refinement of the existing geospatial health platform incorporating ground-truthed reflections from the participatory field exercise. The evaluation of geospatial data accuracies contributes to understandings on global public health surveillance systems, outlining the need to systematically consider assessment of environmental features in relation to lifestyle-related diseases.
Information and communication technologies (ICTs) have become an element of strategic importance to all countries. Researchers argue that ICTs may open up new avenues for economic growth, competitiveness and human development. It is widely recognised that ICTs have the potential of overcoming many of the barriers faced by people with visual impairment (VI). Based on an interpretive study using the narrative interview method, this article contributes to this literature by presenting perceptions and understandings of how the use of ICTs can be used to promote the ‘development’ of people with VI in Bangladesh. We approached this study through the economist and Nobel Laureate Amartya Sen’s work on ‘development as freedom’ that focuses on, among other themes, five dimensions of freedom — social, economic, protective, political and transparency. We collected stories from 18 people with VI who had received ICTs training and support from resource centres, and from some disability rights activists and leaders who use ICTs. Our findings suggest that ICTs can be used as tools for improving the wellbeing of people with VI by enhancing different aspects of freedom suggested by Sen. ICTs tools assist people with VI by providing them with educational and work opportunities, and thus increase the potential for social inclusion and economic development. We conclude that governments, nongovernment organisations and development partners in countries such as Bangladesh may use ICTs to expand different types of ‘freedom’ for marginalised groups such as people with VI and persons with disabilities in general.
The present study aimed to identify the factors that affect immediate (within 24 h after farrowing onset) postnatal piglet mortality in litters with hyperprolific sows, and investigate their associations with behaviour of postpartum sows in two different farrowing housing systems. A total of 30 sows were housed in: (1) CRATE (n=15): the farrowing crate closed (0.80×2.20 m) within a pen (2.50×1.70 m), and (2) OPEN (n=15): the farrowing crate open (0.80×2.20×1.80 m) within a pen (2.50×2.40 m) with a provision of 20 ls of hay in a rack. A total of 518 live born piglets, produced from the 30 sows, were used for data analyses during the first 24 h after the onset of parturition (T24). Behavioural observations of the sows were assessed via video analyses during T24. Total and crushed piglet mortality rates were higher in OPEN compared with CRATE (P<0.01, for both). During T24, the OPEN sows tended to show higher frequency of postural changes (P=0.07) and duration of standing (P=0.10), and showed higher frequencies of bar-biting (P<0.05) and piglet trapping (P<0.01), when compared with the CRATE sows. During T24, the mortality rates caused by crushing were correlated with the piglet trapping event (r=0.93, P<0.0001), postural changes (r=0.37, P<0.01), duration of standing (r=0.32, P<0.01) and frequency of bar-biting behaviour (r=0.51, P<0.01) of the sows (n=30). In conclusion, immediate postnatal piglet mortality, mainly due to crushing, may be associated with potential increases in frequency of postural changes, duration of standing and incidence of piglet trapping in postpartum sows in the open crate system with large litters.
The aim of this study is to determine early changes in cardiac function of children with chronic kidney disease by using 2D-speckle tracking echocardiography.
The study included 38 children – 16 girls and 22 boys – diagnosed as having chronic kidney disease in the nephrology department with a glomerular filtration rate of <90 ml/minute/1.73 m2 for at least 3 months. A total of 37 – 15 girls and 22 boys – age- and sex-matched healthy children were included as the control group. 2D-Speckle tracking echocardiography was performed in all subjects.
The mean age was 13.45±2.8 years in patients and 12.89±3.07 years in controls. Systolic and diastolic blood pressures and left ventricular mass index were significantly higher in patients (p<0.05). The values of mitral e, mitral a, mitral e/a ratio, and mitral deceleration time were not different between the groups. Tricuspid annular plane systolic excursion values were lower in patients (p<0.01). Global strain values in apical long-axis 3-chamber and 2-chamber views were significantly lower in patients (p<0.05). Longitudinal, radial, and circumferential peak systolic strain values were lower in patients, but the difference was statistically significant in all segments of longitudinal view and basal segment of circumferential view (p<0.05). Radial and circumferential systolic strain rates were significantly lower in patients in all three segments (p<0.05). Moreover, early diastolic strain rate was significantly lower in longitudinal and radial apical segments and in all segments of circumferential measurements in patients. Besides, strain rate e/a ratio was significantly lower in all longitudinal segments of patients (p=0.01).
The study concluded that 2D-speckle tracking echocardiography method can determine cardiac involvement earlier than conventional echocardiography in children with chronic kidney disease having preserved ejection fraction.
Compensatory gain describes an accelerated growth seen in animals following a period of nutrient restriction. Methionine (Met) is the second limiting amino acid in typical swine diets and is essential for muscle growth. This study was conducted to determine (1) if a Met-deficient diet can cause growth retardation in growing pigs, (2) if returning to a normal feeding can yield compensatory gain in the pigs previously fed the Met-deficient diet, and (3) if this Met-deficiency followed by the normal feeding program affects carcass characteristics. Twenty individually-penned crossbred young barrows were randomly allotted to two dietary treatments (n = 10). One Met-deficient (D1) and one Met-adequate (D2) diets were formulated based on corn and soybean meal and fed to respective pigs for 31 days. After that, all pigs were fed the same commercial grower-finisher diet until market weight (around 125 kg), then slaughtered, and carcass characteristics measured. The D1 and D2 pigs began with similar body weights (23.5 vs. 23.6 kg; P = 0.935), but after 31-days on the dietary treatments, D1 pigs were lighter than D2 pigs (51.6 vs. 55.0 kg; P = 0.102). After feeding the normal diet for 55 days, D1 and D2 pigs had similar body weights (122.7 vs. 122.6 kg; P = 0.989). In terms of carcass characteristics, however, D1 pigs had thicker back-fat (at 10th rib; 2.95 vs. 2.51 cm; P = 0.015), heavier belly weight (11.0 vs. 9.6 kg; P = 0.005), lighter ham weights (untrimmed: 20.8 vs. 21.6 kg; P = 0.043; trimmed: 19.6 vs. 20.6 kg; P = 0.016), lighter picnic shoulder weight (8.72 vs. 9.80 kg; P = 0.041), lighter total lean cut weight (51.8 vs. 53.8 kg; P = 0.055), and lower lean cut percentage (56.4 vs. 59.0%; P = 0.012). These results indicate that the Met-deficient diet produced growth-retarded pigs, which showed compensatory gain after the normal feeding. At slaughter, the pigs previously fed the Met-deficient diet had more fat and less lean tissue than their non-deficient counterparts.
Zygogramma bicolorata Pallister is a potential biocontrol agent of Parthenium hysterophorus L. (Asteraceae). This study was carried out to understand the effect of abiotic (temperature and moisture) and biotic factors (age and reproductive status) on the induction and termination of diapause in Z. bicolorata. We also evaluated the effect of diapause on longevity and fecundity of Z. bicolorata. In Z. bicolorata the induction of diapause occurred between the months of July and December. No diapause was observed in May and June, which coincided with the commencement of the monsoon rains. The percentage of diapause induction in Z. bicolorata was found to increase from one generation to another as well as with the age of adults. Diapause significantly increased the fecundity of females as compared to the fecundity in pre-diapause conditions. Soil moisture (80% RH) played an important role in providing the conditions for initiation and termination of diapause. Similarly, 18.4 and 12.5% of diapause adults resumed their activity in 6 and 5 days when exposed to temperatures of 40° and 45° C for 2 h every day, respectively. Exposure of adults to low temperatures, i.e. 5° and 10° C induced 94.3 and 92.5% diapause, respectively, with no adult mortality. Thus, our findings reveal suitable conditions for preventing and inducing diapause in Z. bicolorata, which is of great importance in the suppression of P. hysterophorus. We discuss the implications of these findings in the control of P. hysterophorus.
Introduction: Over the last few decades, health care facility design has been studied to look at its effect on many patient-centred outcomes. However, limited data exists on the impact that specific physical features of a clinical space may have on learning and the educational experience. The aim of this study is to develop a set of characteristics which clinicians, clinical teachers and residents believe should be present in a clinical space to maximize trainees learning, using an emergency department (ED) as a context. Methods: A qualitative methodology used semi- structured interviews with a purposive sample of twelve attending physicians and residents who work in EDs of varying age and design at several sites of a quaternary university hospital. We explored their perceptions of the physical features in the clinical and learning environment that supported or impeded teaching and learning. The interviews were transcribed and thematically analyzed. Results: Preliminary results show that many physical characteristics of the clinical space are perceived to have an impact on trainees learning experience. A design with separation between clinician-learner dyads and the patients, with a visual access; shared clinical space among different health care professionals within a reasonable distance; availability of enough clinical space for specific emergency presentations; features such as adequate size, appropriate light, and control of sound were all perceived to enhance and augment clinical learning. Not surprisingly, non-design factors such as the presence of a functioning team and the availability of adequate equipment and technology was considered as important as the characteristics of physical space to optimize learning. Conclusion: This study demonstrates the importance and the impact of physical space design on trainees learning in a dynamic clinical environment. It provides teachers and policy-makers with a basis for developing criteria of the physical characteristics of a healthcare facility to maximize learning.