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In addition to risking their physical well-being, frontline physicians are enduring significant emotional burden both at work and home during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to investigate the levels of anxiety and depressive symptoms and to identify associated factors among Bangladeshi physicians during the COVID-19 outbreak.
Methods and design
A cross-sectional study using an online survey following a convenience sampling technique was conducted between April 21 and May 10, 2020. Outcomes assessed included demographic questions, COVID-19 related questions, and the Hospital Anxiety and Depression Scale (HADS).
The survey was completed by 412 Bangladeshi physicians. The findings revealed that, in terms of standardized HADS cut-off points, the prevalence of anxiety and depressive symptoms among physicians was 67.72% and 48.5% respectively. Risk factors for higher rates of anxiety or depressive symptoms were: being female, physicians who had experienced COVID-19 like symptoms during the pandemic, those who had not received incentives, those who used self-funded personal protective equipment (PPE), not received adequate training, lacking perceived self-efficacy to manage COVID-19 positive patients, greater perceived stress of being infected, fear of getting assaulted/humiliated, being more connected with social media, having lower income levels to support the family, feeling more agitated, less than 2 h of leisure activity per day and short sleep duration. All these factors were found to be positively associated with anxiety and depression in unadjusted and adjusted statistical models.
This study identifies a real concern about the prevalence of anxiety and depressive symptoms among Bangladeshi physicians and identifies several associated factors during the COVID-19 pandemic. Given the vulnerability of the physicians in this extraordinary period whilst they are putting their own lives at risk to help people infected by COVID-19, health authorities should address the psychological needs of medical staff and formulate effective strategies to support vital frontline health workers.
Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018–19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.
The World Health Organization set a target of a 15% relative reduction in the prevalence of insufficient physical activity (IPA) by 2025 among adolescents and adults globally. In Bangladesh, there are no national estimates of the prevalence of IPA among adolescents. The aim of this study was to estimate the prevalence of and risk factors associated with IPA among adolescent girls and boys. Data for 4865 adolescent girls and 4907 adolescent boys, collected as a part of a National Nutrition Surveillance in 2018–19, were analysed for this study. A modified version of the Global Physical Activity Questionnaire (GPAQ) was used to collect physical activity data. The World Health Organization recommended cut-off points were used to estimate the prevalence of IPA. Bivariate and multivariable logistic regression was performed to identify factors associated with IPA. Prevalences of IPA among adolescent girls and boys were 50.3% and 29.0%, respectively, and the prevalence was significantly higher among early adolescents (10–14 years) than late adolescents (15–19 years) among both boys and girls. The IPA prevalence was highest among adolescents living in non-slum urban areas (girls: 77.7%; boys: 64.1%). For both boys and girls, younger age, non-slum urban residence, higher paternal education and increased television viewing time were significantly associated with IPA. Additionally, residing in slums was significantly associated with IPA only among the boys. Higher maternal education was associated with IPA only among the girls. This study identified several modifiable risk factors associated with IPA among adolescent boys and girls in Bangladesh. These factors should be addressed through comprehensive public health interventions to promote physical activity among adolescent girls and boys.
Chronic aflatoxin exposure has been associated with childhood stunting (length-for-age/height-for-age < –2 sd), while data lacks for Bangladesh, a country with substantial burden of childhood stunting. This paper examined the association between aflatoxin exposure and childhood stunting in a slum setting of Dhaka city.
In this MAL-ED aflatoxin birth cohort study, plasma samples were assayed for aflatoxin B1-lysine adduct (AFB1-lys) by MS at 7, 15, 24 and 36 months of age for 208, 196, 173 and 167 children to assess chronic aflatoxin exposure. Relationship between aflatoxin exposure and anthropometric measures was examined by mixed-effects logistic regression models.
Setting and participants:
The study was conducted in Mirpur, Dhaka, where children were followed from birth to 36 months.
Prevalence of stunting increased from 21 % at 7 months to 49 % at 36 months of age. Mean AFB1-lys concentrations at 7, 15, 24 and 36 months were 1·30 (range 0·09–5·79), 1·52 (range 0·06–6·35), 3·43 (range 0·15–65·60) and 3·70 (range 0·09–126·54) pg/mg albumin, respectively, and the percentage of children with detectable AFB1-lys was 10, 21, 18 and 62 %, respectively. No association was observed between aflatoxin exposure and stunting in multivariable analyses. Factors associated with childhood stunting were age, low birth weight, maternal height, stool myeloperoxidase and number of people sleeping in one room.
A relatively lower exposure to aflatoxin may not influence the linear growth of children. This finding indicates a threshold level of exposure for linear growth deficit and further investigation in other areas where higher concentrations of aflatoxin exposure exist.
Introduction: Despite the visibility of the homeless population, there is limited data on the information of this patient population. Point-in-time counts and survey data from selected samples (such as those admitted to emergency shelter) have primarily been used. This literature suggests that this hard-to-reach population has high rates of presentation at emergency departments (EDs), and as such, EDs often become their main point of contact for health and social services. Leveraging this fact and administrative data we construct a crude census of homeless persons within Ontario. We further examine demographic characteristics of patients experiencing homelessness, and compare this data to findings from previous literature. Methods: All routinely collected administrative health data from EDs located within Ontario, Canada from 2010-2017 were analyzed to examine patient characteristics. Individuals experiencing homelessness were identified by a marker that was adopted in 2009 replacing their recorded postal code with an XX designation. s. Aggregating by LHIN, date and week of year, we examine the overall number of patients experiencing homelessness and number by LHIN location and seasonality. Demographic outcomes examined include age and sex. Results: 640,897 visits to the ED over 7 years were made by 39,525 unique individuals experiencing homelessness. Number of ED visits has steadily increased over 10 years in all of Ontario, despite decline in shelter use for individuals. Presentations were concentrated in large urban centres like Toronto, Ottawa and Hamilton. Fewer presentations occur in the spring and summer months and rise in the winter. Male patients presented older and in greater numbers than female patients. The modal female age of presentation is in the 20-24 age category. The modal male age of presentation is in the 25-29 age category. Older male patients were more likely to have multiple presentations. Conclusion: The utilization of administrative health data offers a novel, cost-effective method to measure demographic characteristics of people experiencing homelessness. Identifying characteristics of homeless patients through this method allows for a more complete understanding of the characteristics of a hard-to-reach population, which will allow policy makers to develop appropriate services for this sub-group. Furthermore, through analysis of trends of demographics over time, changes in the homeless population can be tracked in real-time to allow for coordination and implementation of services in a time-sensitive manner.
Introduction: Administrative data can aid in study and intervention design, incorporating hard-to-reach individuals who may otherwise be poorly represented. We aim to use administrative health data to examine emergency department visits by people experiencing homelessness and explore the application of this data for planning interventions. Methods: We conducted a serial cross-sectional study examining emergency department use by people experiencing homelessness and non-homeless individuals in the Niagara region of Ontario, Canada. The study period included administrative health data from April 1st, 2010 to March 31st, 2018. Outcomes included number of visits, number of unique patients; group proportions of Canadian Triage and Acuity Scale (CTAS) scores; time spent in emergency; and time to see an MD. Descriptive statistics were generated, and t-tests were performed for point estimates and a Mann-Whitney U test for distributional measures. Results: Our data included 1,486,699 emergency department visits. The number of unique people experiencing homelessness ranged from 91 in 2010 to 344 in 2017, trending higher over the study period compared to non-homeless patients. The rate of visits increased from 1.7 to 2.8 per person. People experiencing homelessness tend to present later in the day and with higher overall acuity as compared to the general population. Time in emergency department and time to see an MD were greater among people experiencing homelessness. Conclusion: Administrative health data allows researchers to enhance interventions and models of care to improve services for vulnerable populations. Given the challenging fiscal realities of research, our study provides insights to more effectively target interventions for vulnerable populations.
Introduction: People experiencing homelessness have complex psychiatric and medical presentations, and have poor access to primary care. Thus, emergency departments (EDs) often become their main point of healthcare contact. Using routinely collected administrative data from EDs, we examine the ED utilization, health and reasons for presentations of people experiencing homelessness.. Methods: All routinely collected administrative health data from EDs located within Ontario, Canada from 2010-2017 were analyzed. Individuals experiencing homelessness were identified by a marker that was adopted in 2009 replacing their recorded postal code with an XX designation. Outcomes include number of unique patients, number of visits and repeat visits, CTAS scores, ambulance utilization, and type of ICD-10 presentation. Results: 640,897 visits to the ED over 10 years were made by 39,525 unique individuals experiencing homelessness. A visit to an ED by a homeless patient resulted in repeat presentation on the same day 5% of the time. The median repeat presentation to an ED was 14 days. In people experiencing homelessness, the most prevalent category of presentations were primary mental health diagnoses, accounting for 34.8% of visits (n = 223,392). Under mental health conditions, psychoactive substance use presentations made up more than 54% of the presentations (n = 121,112). Alcohol was by far the most common cause of substance use/induced disorders (n = 84,805). Conclusion: Applications of administrative data presents a novel method of measuring health and healthcare outcomes for marginalized populations. We found people experiencing homelessness are presenting to ED more frequently in Ontario, with significant mental health and addiction problems. Our study identifies several important health vulnerabilities within the population, which may serve as potential targets for future interventions.
Introduction: Understanding how homeless patients interact with healthcare systems can be challenging. The nature of the population is such that identifying and following these persons can be severely limited by data. Previous studies have used survey data which relies on self-reporting and selected samples such as those persons admitted to homeless shelters (Gray et al. 2011). Other studies have been able to leverage administrative data but only for selected local geographic areas (Somers et al. 2016, Tompkins et al 2003). It is possible that the current literature has not examined a large proportion of homeless persons and their healthcare use. This is concerning because this population can have higher associated medical costs and greater medical resource utilization especially with regards to psychiatric and emergency department (ED) resources (Tulloch et al. 2012, Forchuk et al, 2015). Methods: Administrative health data (2010 to 2017) is used to analyze ambulatory care records for homeless individuals in Ontario, Canada. Uniquely, we are able to use ED contacts as a way of identifying homeless migrations from region to region within Ontario. Using a network analysis we identify high impact ED nodes and discrete hospital networks where homeless patients congregate. We are also able to more fully characterize this population's demographics, health issues, and disposition from the ED. Results: We provide a more complete understanding of migration patterns for homeless individuals, across Ontario and their concomitant ED use and hospitalizations. The three most frequented regions in Ontario (n = 640,897) were Toronto Central (35.96%), Hamilton Niagara Halimand Brant (8.9%) and Champlain (7.84%). In subsequent visits, the majority of patients presented to different EDs, however a subgroup who always presented to the same site was present. Over the 7 year period, migration between visits occurred most often between urban areas, and increased as a whole. Conclusion: The results of the study allow for the enhancement care coordination for vulnerable populations and enhance the availability and delivery of services for sub-groups of homelessness whose care needs may differ based on migration patterns. Services can be coordinated between jurisdictions for homeless individuals, and appropriate referrals can be made across the health care system. Further evidence is provided for a novel method of mapping migration among the homeless and its associations and effects on ED use.
While lithium is well known for its neurotoxicity, there are very few publications about lithium-induced acute dystonic reaction. We are presenting a clinical case of lithium-induced acute intermittent dystonic reaction in a patient with schizoaffective disorder (SAD). The patient is a 69-year-old African-American male with a long history of SAD, who was treated for many years with ziprasidone and divalproex and was admitted with SAD exacerbation. Due to increased QTC interval, we switched patient to lurasidone. After 2 weeks, due to increased ammonia level, divalproex was switched to lithium (600 mg loading dose and then 450 mg twice/day). Three days later, patient developed a series of intermittent episodes of acute dystonia, manifested as mutism, dysarthria, upper and lower extremity muscle rigidity, dysphagia, and tremor (Table 1). Dystonic reactions responded to benztropine. Eventually, lithium was discontinued and patient did well on a combination of carbamazepine and olanzapine. In this case, we would like to emphasize not only the intermittent but also the atypical presentation of acute dystonic reactions with involvement of large muscle groups, the resemblance to NMS, and a “spectrum” of dystonic reactions rather than one clear-cut presentation. We can only speculate the role lurasidone played in this presentation but reoccurrence of dysarthria on day 54 after lithium was restarted points to its major role.
Table not available.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This paper reports on an ultra-wideband low-noise distributed amplifier (LNDA) in a transferred-substrate InP double heterojunction bipolar transistor (DHBT) technology which exhibits a uniform low-noise characteristic over a large frequency range. To obtain very high bandwidth, a distributed architecture has been chosen with cascode unit gain cells. Each unit cell consists of two cascode-connected transistors with 500 nm emitter length and ft/fmax of ~360/492 GHz, respectively. Due to optimum line-impedance matching, low common-base transistor capacitance, and low collector-current operation, the circuit exhibits a low-noise figure (NF) over a broad frequency range. A 3-dB bandwidth from 40 to 185 GHz is measured, with an NF of 8 dB within the frequency range between 75 and 105 GHz. Moreover, this circuit demonstrates the widest 3-dB bandwidth operation among all reported single-stage amplifiers with a cascode configuration. Additionally, this work has proposed that the noise sources of the InP DHBTs are largely uncorrelated. As a result, a reliable prediction can be done for the NF of ultra-wideband circuits beyond the frequency range of the measurement equipment.
Lung surfactant (LS), a thin layer of phospholipids and proteins inside the alveolus of the lung is the first biological barrier to inhaled nanoparticles (NPs). LS stabilizes and protects the alveolus during its continuous compression and expansion by fine-tuning the surface tension at the air-water interface. Previous modelling studies have reported the biophysical function of LS monolayer and its role, but many open questions regarding the consequences and interactions of airborne nano-sized particles with LS monolayer remain. In spite of gold nanoparticles (AuNPs) having a paramount role in biomedical applications, the understanding of the interactions between bare AuNPs (as pollutants) and LS monolayer components still unresolved. Continuous inhalation of NPs increases the possibility of lung ageing, reducing the normal lung functioning and promoting lung malfunction, and may induce serious lung diseases such as asthma, lung cancer, acute respiratory distress syndrome, and more. Different medical studies have shown that AuNPs can disrupt the routine lung functions of gold miners and promote respiratory diseases. In this work, coarse-grained molecular dynamics simulations are performed to gain an understanding of the interactions between bare AuNPs and LS monolayer components at the nanoscale. Different surface tensions of the monolayer are used to mimic the biological process of breathing (inhalation and exhalation). It is found that the NP affects the structure and packing of the lipids by disordering lipid tails. Overall, the analysed results suggest that bare AuNPs impede the normal biophysical function of the lung, a finding that has beneficial consequences to the potential development of treatments of various respiratory diseases.
Cuprous oxide (Cu2O) thin films have been grown on both soda lime glass (SLG) microscope slides and Fluorine-doped Tin Oxide (FTO) substrates by a modified SILAR technique. The pH level of the bath solution was systematically varied in the range of 4.50 – 7.95 to elucidate their effect on the physical properties of the deposited product. The prepared films showed compact surface morphology composed of spherical grains evident from their SEM images. The XRD measurement showed that the as-deposited films were single phase Cu2O with (111) preferred orientation and this texturing was found to be increasing with increasing pH and annealing temperature. The annealed Cu2O films were found to be stable up to 200 °C and completely converted to cupric oxide (CuO) phases when the temperature reached to 350 °C. The estimated optical bandgaps of the as-grown samples were found in the range of 2.28 – 2.48 eV using UV-Vis-NIR transmission data and showing a bandgap narrowing trend with the decreasing level of solution pH. The effect of post-annealing temperatures (75-350 0C) on the as-deposited films was also studied and found to be crucial to control the optical bandgap (1.44 – 2.13) eV and electrical properties of the films. The sheet resistance of the as-deposited samples was found to be decreasing from 4120 MΩ/square to 800 MΩ/square while grown with increasing acetic acid content in the precursor solutions and decreasing up to 2.66 MΩ/square while annealing up to 250 °C in the air.
The objective of the study was to investigate the seasonal variations in proximate and fatty acid composition of wild sobaity (Sparidentex hasta) for a one-year period during (i) pre-spawning (October–December), (ii) spawning (January–March), (iii) post-spawning (April–June) and summer (July–September). Five male and five female fish were collected from market each month and used for the study. Skinless fillets from both sides of sobaity were taken, chopped, minced, frozen and freeze dried. Freeze-dried ground male and female fish samples were pooled separately and homogenized for proximate composition and fatty acid analysis. The results of the investigation showed that the muscle proximate composition and fatty acid profile of sobaity differed significantly (P < 0.05) among different seasons with the highest muscle lipid during the pre-spawning and spawning season. Palmitic acid (C16:0) was the most dominant muscle fatty acid followed by oleic acid (C18:1n-9). The muscle docosahexaenoic acid (DHA, C22:6n-3) levels in pre-spawning and spawning seasons were significantly (P < 0.05) higher than those in other seasons. A good n-3/n-6 ratio (2.26–3.11) and the higher DHA levels (10.16–11.47%) observed in muscles during the pre-spawning and spawning season indicated a better nutritional value of sobaity at this time of the year.
The Eastern Gangetic Plain is among the world's most intensively farmed regions, where rainfed and irrigated agriculture coexist. While the region and especially Bangladesh is a major producer of rice (Oryza sativa L. ssp. indica), there is potential to further develop sustainable rice production systems. Specifically, there is scope to include a replacement crop for the short fallow between rice crops in the dominant cropping pattern of rainfed monsoon rice harvest followed by irrigated spring rice. The aim of the current research was to identify a suitable cool-season legume crop – pea (Pisum sativum L.) or lentil (Lens culinaris Medik. ssp. culinaris) – that could be grown in the brief period between rice crops. The study comprised four crop sequence experiments comparing legume cultivars differing in maturity grown in between both long and short duration rice cultivars. These experiments were done at the Bangladesh Rice Research Institute regional station at Rajshahi over three cropping cycles. This was followed by an evaluation of pea vs. fallow between rice crops on three farmers’ fields in one cropping cycle. Here it is demonstrated that green pod vegetable pea is one of the best options to intensify the rainfed monsoon rice–fallow–spring irrigated rice cropping system, notwithstanding other remunerative rabi cropping options that could displace boro rice. The inclusion of an extra crop, pea as green pod vegetable, increased farm productivity by 1·4-fold over the dominant cropping sequence (rice–fallow–rice) and farm net income by fourfold. The study highlighted the advantages in total system productivity and monetary return of crop intensification with the inclusion of a pea crop between successive rice crops instead of a fallow period.
In glasshouse experiments, Panicum repens rhizomes with more than two nodes emerged from soil depths of 1 to 20 cm. Emergence from one-node rhizomes was greatly reduced at depths more than 5 cm. In contrast, culm emergence from ginger like rhizomes decreased when burial depth (BD) was greater than 20 to 30 cm. P. repens emerged from deeper soil levels with an increasing number of nodes per cutting. Culms emerged from 36% of total underground regenerative organs. About 75 and 95% of the emerged culms were recorded 30 and 60 d after burial, respectively, and 91% emergence was recorded from 20-cm BD. In field studies, only 9% of nodes produced culms following cross-plowing. About 61 and 67% of the emerged culms were recorded 50 and 60 d after land preparation, respectively. Results indicate that mechanical and chemical control methods could be most effective for P. repens when applied approximately 50 d after land preparation. Burying deeper than 30 cm by deep plowing and reducing rhizome length by cross-plowing might effectively reduce emergence of P. repens.
The aim of this study was to investigate the socioeconomic and demographic factors influencing the body mass index (BMI) of non-pregnant married Bangladeshi women of reproductive age. Secondary (Hierarchy) data from the 2011 Bangladesh Demographic and Health Survey, collected using two-stage stratified cluster sampling, were used. Two-level linear regression analysis was performed to remove the cluster effect of the variables. The mean BMI of married non-pregnant Bangladeshi women was 21.60±3.86 kg/m2, and the prevalence of underweight, overweight and obesity was 22.8%, 14.9% and 3.2%, respectively. After removing the cluster effect, age and age at first marriage were found to be positively (p<0.01) related with BMI. Number of children was negatively related with women’s BMI. Lower BMI was especially found among women from rural areas and poor families, with an uneducated husband, with no television at home and who were currently breast-feeding. Age, total children ever born, age at first marriage, type of residence, education level, level of husband’s education, wealth index, having a television at home and practising breast-feeding were found to be important predictors for the BMI of married Bangladeshi non-pregnant women of reproductive age. This information could be used to identify sections of the Bangladeshi population that require special attention, and to develop more effective strategies to resolve the problem of malnutrition.
We conducted a longitudinal assessment in 466 underweight and 446 normal-weight children aged 6–24 months living in the urban slum of Dhaka, Bangladesh to determine the association between vitamin D and other micronutrient status with upper respiratory tract infection (URI) and acute lower respiratory infection (ALRI). Incidence rate ratios of URI and ALRI were estimated using multivariable generalized estimating equations. Our results indicate that underweight children with insufficient and deficient vitamin D status were associated with 20% and 23–25% reduced risk of URI, respectively, compared to children with sufficient status. Underweight children, those with serum retinol deficiency were at 1·8 [95% confidence interval (CI) 1·4–2·4] times higher risk of ALRI than those with retinol sufficiency. In normal-weight children there were no significant differences between different vitamin D status and the incidence of URI and ALRI. However, normal-weight children with zinc insufficiency and those that were serum retinol deficient had 1·2 (95% CI 1·0–1·5) times higher risk of URI and 1·9 (95% CI 1·4–2·6) times higher risk of ALRI, respectively. Thus, our results should encourage efforts to increase the intake of retinol-enriched food or supplementation in this population. However, the mechanisms through which vitamin D exerts beneficial effects on the incidence of childhood respiratory tract infection still needs further research.
Magnetic core shell nanoparticles (NPs) have potential for applications in magnetic random access memory, spintronic devices, and drug delivery systems. Our investigations are focused on the synthesis of inverted core shell nanoparticles and characterization of their structural and magnetic properties. By using our hydrothermal nanophase epitaxy technique, we are able to synthesize well-ordered α-Cr2O3@α-MxCr2-xO3 (M = Co, Ni, Mn, Fe) inverted core-shell nanoparticles. This typically results in the formation of novel phases of MxCr2-xO3 shells having ferromagnetic/ferrimagnetic (FM/FiM) spin ordering and an antiferromagnetic (AFM) Cr2O3 core structure. The combined results from XRD and high-resolution TEM (HRTEM) provide evidence of the presence of corundum phase both in the shell and in the core regions. HRTEM results also show a sharp interface exhibiting epitaxial atomic registry of shell atoms over highly ordered core atoms whereas TEM-EDX analyses show that the M atoms reside predominantly in the shell regions. The XPS analyses of the NPs indicate the M transition metals incorporated in the shell are in the +2 oxidation state. Magnetic measurements show well developed hysteresis loops: The field cooled hysteresis loops reveal horizontal shifts in the applied field axis and vertical shifts in the magnetization axis, relative to the zero-field cooled hysteresis loops. This provides direct evidence for the exchange bias effect between the AFM α-Cr2O3 core and the FM/FiM α-MxCr2-xO3 shell. The XPS data are consistent with oxygen vacancy formation in order to maintain charge neutrality upon substitution of the M2+ ion for the Cr3+ ion in the α-MxCr2-xO3 shell. The FM/FiM ordering in the shell may at least partially result from the F-center exchange coupling between the oxygen-vacancy induced bound magnetic polaron and nearby cations.