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There is a growing body of evidence that suggests that mental health problems are over-represented in medical schools. Studies have shown that there are multiple factors that contribute to this, such as the duration and nature of the course and maladaptive coping strategies in medical students such as self-medication. However, stigma and a ‘culture of shame’ are formidable barriers to mental healthcare services and consequently many medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment. Medical schools must therefore raise awareness of the importance of mental health, promote wellbeing, and pioneer innovative programmes that reduce mental health related stigma. Data from recent research has revealed that programmes comprised of an Expert by Personal and Professional Experience (EEPE) (i.e. psychiatrists who have recovered from mental health problems) are associated with statistically significant reductions in mental health related stigma in medical students.
This paper introduces the TRANSFORM project, which aims to improve access to mental health services for people with serious and enduring mental disorders (SMDs – psychotic disorders and severe mood disorders, often with co-occurring substance misuse) living in urban slums in Dhaka (Bangladesh) and Ibadan (Nigeria). People living in slum communities have high rates of SMDs, limited access to mental health services and conditions of chronic hardship. Help is commonly sought from faith-based and traditional healers, but people with SMDs require medical treatment, support and follow-up. This multicentre, international mental health mixed-methods research project will (a) conduct community-based ethnographic assessment using participatory methods to explore community understandings of SMDs and help-seeking; (b) explore the role of traditional and faith-based healing for SMDs, from the perspectives of people with SMDs, caregivers, community members, healers, community health workers (CHWs) and health professionals; (c) co-design, with CHWs and healers, training packages for screening, early detection and referral to mental health services; and (d) implement and evaluate the training packages for clinical and cost-effectiveness in improving access to treatment for those with SMDs. TRANSFORM will develop and test a sustainable intervention that can be integrated into existing clinical care and inform priorities for healthcare providers and policy makers.
This study summarises the scenario of maritime traffic anomalies, like the increased congestion and U-turn of ships caused by the ship grounding in the Suez Canal in March 2021. Here, satellite automatic identification system based ship trajectories, and Sentinel-1 and Sentinel-2 images based ship positions are analysed after subdividing the study area into seas, lakes and canals. The results show that the blockage affected the maritime traffic for more than three weeks, waiting ship numbers increased from 5 to 122, and daily one to three ships made a U-turn between 23 and 31 March in the Gulf of Suez. Ship density also increased to more than double in Bitter Lakes with a minimum waiting time of 7 days. Hence, to avoid such prolonged waiting of ships, we propose a warning method based on the sharp speed decrease rate, U-turn and congestion.
University equality and diversity policy and strategies are at high risk of becoming quickly obsolete and unactionable in their relevance, solutions and implementation (a theme noted in Bhopal & Pitkin, 2020). Commitments have been made since the implementation of the Equality Act 2010. This area of interrogation highlights actions that can be made to ensure that all equality and diversity strategies are embedded with intersectionality at the heart of their development.
Wilkinson and Picket’s book The Spirit Level (2009) showed evidence of the levels of inequality experienced in the US and triggered a debate in the UK where the Equality Act was passed in 2010. To comply with legal requirements regarding discriminatory practices, HEIs were obliged to produce policies on good practice in a range of areas including processes of recruitment and appointment (ECU, 2012). Universities commit themselves to EDI issues as a result of legislation. However, this leads to promoting ideas about achieving one’s potential, and presenting themselves as meritocratic (Crozier, 2018). Research has shown a different kind of story. The symbolic commitment to diversity is revealed in Sara Ahmed’s findings in her book, On Being Included (2012). It demonstrates how diversity has been institutionalised in universities, where Whiteness and privilege conceal how racism operates and resistance to change regarding equality is expressed as a ‘brick wall’. The injustice experienced in neoliberal societies is replicated in universities and is central in Danny Dorling’s Injustice (2021), June Sarpong’s Diversify (2017), Kalwant Bhopal’s White Privilege (2018), and Nicola Rollock’s, Staying Power (2019). Scientifically speaking, people of colour are told that there are minimal differences between races (Saini, 2021; Rutherford, 2020). However, Black, Asian and minority ethnic academic staff continue to experience discrimination and exclusion exemplified by the small number of Black, Asian and minority ethnic staff at professorial level (Bhopal & Jackson, 2013; Bhopal, 2014; 2015; Arday, 2015). In 2017– 18, Black, Asian and minority ethnic staff progression stood at 13 per cent and universities began to investigate the barriers through collaboration between leaders, staff and student unions (LFHE, 2017; SOAS, 2018).
Subjective wellbeing in terms of objective outcome can be useful to determine the level of progress in clinical practice as well as research studies in Bangladesh. Besides, cultural understanding of well-being for Bangladeshi population is also equally important to report. A valid Bangla version of the five-item WHO Well-being Index can be a suitable measure to achieve the purposes. Therefore, the present study aimed at validating the WHO-5 Well-being Index for general population in Bangladesh.
After following the standard procedures for translation, back-translation, and committee translation, the initial Bangla version of the scale was developed and pretested. Based on the feedback during pretesting, a slight modification was made and the final version was developed. This final version was administered to 269 participants of different socioeconomic backgrounds to find out the reliability and validity of the scale from March 2019 to May 2019. The data analysis was conducted using SPSS 24.
The scale demonstrated acceptable internal consistency (α = 0.754) and test-retest reliability (r = 0.713), divergent validity (r = −0.443, p < 0.01 with the Bangla version of Perceived Stress Scale-10) and convergent validity (r = 0.542, p < 0.01 with the Bangla version of Warwick-Edinburgh Mental Well-Being Scale). The data also yielded one-factor structure for the scale in exploratory factor analysis explaining 38.68% of total variance. The factor-structure was further supported in the confirmatory factor analysis (χ2 = 295.852, χ2/df = 2.017, RMSEA = 0.062, CFI = 0.986, TLI = 0.964, and SRMR = 0.0255).
The findings suggested the Bangla version of the WHO-5 Well-being Index is a psychometrically valid and reliable tool for general adult population in Bangladeshi when it comes to measuring subjective well-being both in clinical practice and research studies.
The paper presents a 1 × 2 B-shaped antenna array for dual-band operation at 4 and 8 GHz. The antenna design consists of a rectangular patch with two annular-strip lines fabricated on the top layer and finite ground plane on the bottom layer. The array is formed by designing an optimum T-shaped microstrip line for impedance matching. The dimensions of the antenna array are 78 × 36 × 1.6 mm3. Full-wave simulations have been conducted and the measured results are in good consent with the simulated results. The measured impedance bandwidth (reference −10 dB) has been observed at 3.84–4.16 and 7.78–8.38 GHz. Measured peak gain and radiation efficiency at 4 and 8 GHz are 8.3, 9.4 dB and 82.5 and 81.2%, respectively.
Physical and emotional punishment of children is highly prevalent in the Asia-Pacific region. These actions predict a range of physical and emotional harms, prompting a worldwide effort to eliminate them. A key strategy in this effort is to change parental beliefs regarding the acceptability of physical and emotional punishment. The Positive Discipline in Everyday Parenting (PDEP) program was designed to change those beliefs by teaching parents about child development and strengthening their problem-solving skills. A sample of 377 parents in the Asia-Pacific region completed the program: 329 mothers and 47 fathers of children ranging in age from infancy to adolescence. The parents lived in Australia (n = 135), Japan (n = 172) or the Philippines (n = 70). In all three countries, parents’ approval of punishment in general, and physical punishment specifically, declined and they became less likely to attribute typical child behavior to intentional misbehavior. By the end of the program, at least 75% of parents in each country felt better prepared to respond nonviolently to conflict with their children.
Little is known around how general practitioners (GP) approach tobacco products beyond traditional cigarettes.
To examine GP perceptions of tobacco and electronic cigarette (EC) products, and their attitudes and behaviours towards product cessation.
A 13-item self-completed anonymous questionnaire measured awareness of waterpipe tobacco smoking (WTS) and smokeless tobacco (ST). Cessation advice provision, referral to cessation services, and the harm perception of these products were asked using five-point Likert scales that were dichotomised on analysis. Correlates of cessation advice were analysed using regression models.
We analysed 312 responses, of whom 63% were aware of WTS and between 5–32% were aware of ST products. WTS and ST were considered less harmful than cigarettes by 82 and 68% of GPs, respectively. WTS, ST, and EC users were less advised (P<0.001) and referred (P<0.001) to cessation services compared to cigarette users. Ethnic minority and senior GPs were more likely to provide cessation advice for WTS and ST users compared to younger white GPs. GPs who were recent tobacco users were less likely to give cessation advice to cigarette users (adjusted odds ratios 0.17, 95% confidence interval 0.03–0.99, P<0.049).
Conclusions (implications for practice and research)
GPs had lower harm perception, gave less cessation advice, and made less referrals for WTS and ST users compared to cigarettes. Our findings highlight the need for targeted tobacco education in general practice. More research is needed to explore GP perceptions in depth as well as patient perspectives.
Land masking of Synthetic Aperture Radar (SAR) images is generally accomplished by applying either archived shoreline databases or image segmentation. However, those methods cannot be solely applied to geographical areas complicated with many small islands and exposed rocks. Therefore, we have proposed a new procedure where Sobel edge extraction is applied to detect the edges of all objects from KOMPSAT-5 X-band SAR images, followed by a merging process with the edges from the land objects based on Electronic Navigational Chart (ENC) coastlines. Using the land mask data, geometrically corrected SAR images were masked before applying a ship detection algorithm. This land masking procedure was applied to several images covering different areas of the Korean Peninsula. The results show that land targets such as newly constructed and natural objects were also masked, and thus did not create false alarms during ship detection. Therefore, this method can be used to assist precise ship detection using SAR images in coastal waters.
Asian populations have a higher percentage body fat (%BF) and are at higher risk for CVD and related complications at a given BMI compared with those of European descent. We explored whether %BF was disproportionately elevated in rural Bangladeshi women with low BMI. Height, weight, mid-upper arm circumference, triceps and subscapular skinfolds and bioelectrical impedance analysis (BIA) were measured in 1555 women at 3 months postpartum. %BF was assessed by skinfolds and by BIA. BMI was calculated in adults and BMI Z-scores were calculated for females <20 years old. Receiver operating characteristic (ROC) curves found the BMI and BMI Z-score cut-offs that optimally classified women as having moderately excessive adipose tissue (defined as >30 % body fat). Linear regressions estimated the association between BMI and BMI Z-score (among adolescents) and %BF. Mean BMI was 19·2 (sd 2·2) kg/m2, and mean %BF was calculated as 23·7 (sd 4·8) % by skinfolds and 23·3 (sd 4·9) % by BIA. ROC analyses indicated that a BMI value of approximately 21 kg/m2 optimised sensitivity (83·6 %) and specificity (84·2 %) for classifying subjects with >30 % body fat according to BIA among adults. This BMI level is substantially lower than the WHO recommended standard cut-off point of BMI ≥ 25 kg/m2. The equivalent cut-off among adolescents was a BMI Z-score of –0·36, with a sensitivity of 81·3 % and specificity of 80·9 %. These findings suggest that Bangladeshi women exhibit excess adipose tissue at substantially lower BMI compared with non-South Asian populations. This is important for the identification and prevention of obesity-related metabolic diseases.
Momordica charantia L. (Cucurbitaceae) is a commonly cultivated functional food plant. In the present study, karyological variation among 34 accessions of M. charantia originating from the Indian subcontinent (Bangladesh, India and Pakistan) and Thailand was evaluated. Ploidy levels ranging from diploid (2n= 22) to hexaploid (2n= 66) were observed. Hexaploidy in M. charantia is reported herein for the first time. Chromosome length ranged from 0.8 to 2.9 μm. The hexaploid accessions had submetacentric and subtelocentric chromosomes. All accessions harboured median and submedian chromosomes. Only one hexaploid accession (TOT1140) had chromosomes with subterminal centromeres. There was considerable variation in chromosome length and chromosome arm ratio.
Education plays an important role in development. Basic education is at the core of national strategies aimed at enhancing human development, social and political empowerment and economic progress. The recognition of the value of education is clearly reflected in the second goal of the UN Millennium Development Goals, which aims to achieve universal primary education for children everywhere, boys and girls alike, by 2015. Achieving these goals is particularly important in this age of the global knowledge economy, where many socioeconomic groups in developing countries risk exclusion from the economic and social benefits that this new knowledge economy can potentially provide (Castells 1996).
A long-standing relationship exists between education and technology; some would suggest it began with the invention of the printing press. As new technologies emerged, educational providers have tried to integrate them into the learning process. The emergence of newer information and communications technologies (ICTs), like computers and mobile phones, has significantly widened the scope of how technologies can facilitate educational processes and there is a growing interest in using ICTs in developing countries' educational settings. Many believe that introducing ICTs into these contexts will have great impact given the systematic problems of access to quality education in the developing world. Yet evidence is lacking with regard to the actual impact of ICTs on the educational sector. Trucano, in a 2005 World Bank/infoDev study, found that the impact of ICT use on learning outcomes is unclear and open to much debate as reportedly very little useful data exist on several dimensions of ICT interventions in education.
The objective of the current analysis was to explore the association of multiple micronutrients with Hb concentration among pregnant women in a South Asian setting, a topic that has not been adequately explored.
Sociodemographic, anthropometric and micronutrient status (plasma ferritin, transferrin receptor, retinol, α- and γ-tocopherol, folate, vitamin B12, Zn) and Hb concentration were assessed at early pregnancy.
The biochemical sub-study was nested within a double-blind, placebo-controlled, community-based vitamin A and β-carotene supplementation trial in rural north-western Bangladesh (JiVitA). All assessments were conducted before trial supplementation was initiated.
A systematic sample of 285 women was selected from those enrolled in the biochemical sub-study.
Seventeen per cent of women were mildly anaemic; moderate and severe anaemia was uncommon (2·1 %). α-Tocopherol, vitamin B12 and Zn deficiencies were common (43·5 %, 19·7 % and 14·7 %, respectively); however, vitamin A, folate and Fe deficiencies were comparatively rare (7·4 %, 2·8 % and <1 %, respectively). Plasma Zn, vitamin B12 and α-tocopherol were positively associated and plasma γ-tocopherol was negatively associated with Hb (P < 0·05) after adjustment for gestational age, inflammation status, season and nutritional status measured by mid-upper arm circumference.
Among pregnant women in rural Bangladesh with minimal Fe deficiency, plasma Zn, vitamin B12, and α- and γ-tocopherol concentrations were associated with Hb concentration. Appreciating the influence on Hb of micronutrients in addition to those with known associations with anaemia, such as Fe, folate, and vitamin A, is important when addressing anaemia in similar settings.
Equations for predicting body composition from bioelectrical impedance analysis (BIA) parameters are age-, sex- and population-specific. Currently there are no equations applicable to women of reproductive age in rural South Asia. Hence, we developed equations for estimating total body water (TBW), fat-free mass (FFM) and fat mass in rural Bangladeshi women using BIA, with 2H2O dilution as the criterion method. Women of reproductive age, participating in a community-based placebo-controlled trial of vitamin A or β-carotene supplementation, were enrolled at 19·7 (sd 9·3) weeks postpartum in a study to measure body composition by 2H2O dilution and impedance at 50 kHz using multi-frequency BIA (n 147), and resistance at 50 kHz using single-frequency BIA (n 82). TBW (kg) by 2H2O dilution was used to derive prediction equations for body composition from BIA measures. The prediction equation was applied to resistance measures obtained at 13 weeks postpartum in a larger population of postpartum women (n 1020). TBW, FFM and fat were 22·6 (sd 2·7), 30·9 (sd 3·7) and 10·2 (sd 3·8) kg by 2H2O dilution. Height2/impedance or height2/resistance and weight provided the best estimate of TBW, with adjusted R2 0·78 and 0·76, and with paired absolute differences in TBW of 0·02 (sd 1·33) and 0·00 (sd 1·28) kg, respectively, between BIA and 2H2O. In the larger sample, values for TBW, FFM and fat were 23·8, 32·5 and 10·3 kg, respectively. BIA can be an important tool for assessing body composition in women of reproductive age in rural South Asia where poor maternal nutrition is common.
Immigrant care workers play an increasingly important role in home and long-term care in Canada, yet the full extent of their relations with older persons in those settings is relatively unknown. This article examines the role of immigrant care workers in both home and long-term care sectors, with a focus on relations with older clients and implications for quality of care. The data are derived from interviews with workers, employers, and older clients conducted in various home and long-term care services for older adults across three Canadian provinces: Ontario, British Columbia, and Quebec. Factors stemming from immigrant care workers’ ethnic/racial background, language barriers, and contextual factors such as staff shortage in different care settings for older adults complicate the relationship between immigrant care workers and their clients. In some cases, these factors diminish the quality of care. We point to some policy alternatives that our findings suggest should be considered.
Global production and trade in small pelagic fish (SPF) are affected by complex interactions between physical, ecological and economic systems, which give rise to relatively long-term, asynchronous cycles in SPF abundance and distribution. These cycles can have serious impacts on local SPF fisheries' production, but because they tend to be counterbalancing, global production of SPF tends to remain relatively stable. Nevertheless, recent patterns of landings indicate that most SPF are being harvested at or near their maximum yield levels, which in the face of increasing demand is expected to result in rising prices in supply-limited markets. Adding to these concerns are the uncertainties of climate change, which leads us to consider important economic issues related to SPF fisheries production, starting with how the redistribution of SPF resources affects respective rates of resource utilization, particularly when SPF move between independently managed fishing zones. This entails an associated issue, the time preferences for experiencing the range of benefits from SPF resources among nations sharing access to these resources. Because the ecological and economic impacts of climate change will extend well beyond directed SPF fisheries, we consider the economic impact of a climate–SPF regime shift from an ecosystem perspective. Of interest here is the full range of economic benefits SPF resources provide; not only their commercial value, but as prey for commercially valuable predators, and for recreational and non-commercial predators. In this context we examine the socially optimum use of these resources, balancing the benefits from commercially harvesting SPF with those from leaving them in the ocean ecosystem.
To assess the nutritional status and risk factors of undernutrition in post-menarcheal girls in rural northern Bangladesh.
Cross-sectional data on anthropometric measurements, dietary intake, work activity, morbidity and socio-economic status were collected from 12- to 19-year-old primigravidae (n 209) and never-pregnant adolescents (n 456) matched on age and time since menarche. Multiple regression analyses were conducted to determine predictors of stunting, thinness, upper-arm muscle (UAMZ) and fat area Z-scores (UAFZ) among the adolescent girls.
A large proportion of adolescents (49 %) were stunted (height-for-age Z-score <−2) and underweight (40 %; weight-for-age Z-score <−2), but not thin (BMI-for-age <5th percentile; ∼10 %). The mean (sd) UAMZ and UAFZ of the adolescent girls was −0·3 (0·64) and −0·9 (0·40), respectively. Lean mass increased whereas fat mass declined with age. Both stunting and thinness were positively associated with age and time since menarche (P < 0·05). Young age (12–14 years) and literacy were protective against stunting among pregnant adolescents (OR = 0·29, 95 % CI 0·09, 0·88 and OR = 0·50, 95 % CI 0·26, 0·96, respectively). Having symptoms of diarrhoea or dysentery (OR = 7·40, 95 % CI 1·43, 38·29) predicted thinness and was associated with lower UAMZ and UAFZ among never-pregnant girls (both P < 0·05). Performing light-to-moderate activities was protective against thinness among never-pregnant girls (OR = 0·43, 95 % CI 0·22, 0·82), whereas pregnant adolescents who performed high levels of strenuous activities had greater UAMZ (P < 0·05).
Undernutrition was widespread among this post-menarcheal adolescent population. Younger and literate adolescents were less likely to be stunted, whereas thinness and body composition were associated with morbidity and work activity.
Floating gardening is a form of hydroponics or soil-less culture. It is an age-old practice of crop cultivation in the floodplains of southern Bangladesh, where aquatic plants such as water hyacinth (Eichhornia crassipes) are used to construct floating platforms on which seedlings are raised and vegetables and other crops cultivated in the rainy season. The platform residue is used in the preparation of beds for winter vegetable gardening. Floating gardening was introduced in 2006 on a pilot-scale in the north-east wetlands of the country, as a contribution to food security and as a supplementary income for the marginalized community. The overall experience of floating cultivation in three selected villages was encouraging. Local people became aware of this new farming system and their level of knowledge improved. Communities were mobilized into groups to make floating platforms, and platform residues were later used to establish winter gardens. Cultivation was successful on both types of plot, and vegetables were both consumed by the producers and sold in the market. The input–output analysis revealed floating gardening to be a feasible alternative livelihood option for the wetland dwellers. The method provided targeted landless people with parcels of land in the monsoon, enabling them to grow vegetables. Floating gardening and associated winter gardening appear to have the potential for introduction to other parts of the world where aquatic weed management is a major problem.