Search results for: infant mortality rate

Authors: Gunjan Srivastava, Shamila Kalia

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Dalbergia sissoo Roxb., (Family- Leguminosae; Subfamily- Papilionoideae), is an economically and ecologically important tree species having medicinal value. Of the rich complex of insect fauna, ten have been recognized as potential pests of nurseries and plantations. Present study was conducted to explore an effective ecofriendly control of Dichomeris eridantis Meyrick, an important defoliator pest of D. sissoo. Health and environmental concerns demanded devising a bio-intensive pest management strategy and employing ecofriendly measures. In the present laboratory bioassay two entomopathogenic fungi Acremonium perscinum and Beauveria bassiana were tested and compared for evaluating the efficacy of their seven different concentrations (besides control) against the 3rd, 4th and 5th instar larvae of D. eridantis, on the basis of mean percent mortality data recorded and tabulated for seven days after treatment application. Analysis showed that both treatments vary significantly among themselves. Also, variations amongst instars and duration with respect to their mortality were highly significant (p < .001). All their interactions were found to vary significantly. B. bassiana at 0.25x107 spores / ml spore concentration caused maximum mean percent mortality (62.38%) followed by mean percent mortality at its 0.25x106 spores / ml concentration (56.67%). Mean percent mortality at maximum spore concentration (0.054x107 spores / ml) and next highest spore concentration (0.054 x106 spores / ml) due to A. perscinum treatment were far less effective (mean percent mortality of 45.40% and 31.29%, respectively). At 168 hours mean percent mortality of larval instars due to both fungal treatment applications reached its maximum (52.99%) whereas, at 24 hours mean percent mortality remained least (5.70%). In both cases, treatments were most effective against 3rd instar larvae and least effective against 5th instar larvae. A comparative acccount of efficacy of B. bassiana and A. perscinum on the 3rd, 4th and 5th instar larvae of D. eridantis on 5th, 6th and 7th post treatment observation days after their application, on the basis of their median lethal concentrations (LC50) proved B. bassiana to be more potential microbial pathogen of the two fungal microbes, for all the three instars (3rd, 4th and 5th) of D. eridantis, on all the three days (5th, 6th and 7th post observation days after application of both treatments). Percent mortality of D. eridantis increased in a dose dependent manner. Koch’s Postulates tested positive, thus confirming the pathogenicity of B. bassiana against the larval instars of D. eridantis. LC90 values of 0.280x1011 spores/ml, 0.301x108 spores/ml and 0.262x108 spores/ml concentrations of B. bassiana were standardized which can effectively cause mortality of all the larval instars of D. eridantis in the field after 5th, 6th and 7th day of their application, respectively. Therefore, these concentrations can be safely used in nurseries as well as plantations of D. sissoo for effective control of D. eridantis larvae.

Keywords: Acremonium perscinum, Beauveria bassiana, Dalbergia sissoo, Dichomeris eridantis

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Authors: L. Al-Mulla, B. M. Thomas, N. R. Bhat, M. K. Suleiman, P. George

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Mangroves are halophytic shrubs habituated in the intertidal zones in the tropics and subtropics, forming a complex and highly dynamic coastal ecosystem. Historical evidence indicating the existence followed by the extinction of mangrove in Kuwait; hence, continuous projects have been established to reintroduce this plant to the marine ecosystem. One of the major challenges in establishing large-scale mangrove plantations in Kuwait is the very high rate of seedling mortality, which should ideally be less than 20%. This study was conducted at three selected locations in the Kuwait bay during 2016-2017, to evaluate the effect of four planting techniques on mangrove seedling establishment. Coir-pillow planting technique, comp-mat planting technique, and anchored container planting technique were compared with the conventional planting method. The study revealed that the planting techniques significantly affected the establishment of mangrove seedlings in the initial stages of growth. Location-specific difference in seedling establishment was also observed during the course of the study. However, irrespective of the planting techniques employed, high seedling mortality was observed in all the planting locations towards the end of the study; which may be attributed to the physicochemical characteristics of the mudflats selected.

Keywords: Avicennia marina (Forsk.) Vierh, coastal pollution, heavy metal accumulation, marine ecosystem, sedimentation, tidal inundation

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Authors: S. Madhusudhan, G. V. Vaniprabha

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Worldwide statistics have shown that smoking contributes significantly to mortality, with nicotine, being more addictive. Smoking causes more than 7,00,000 deaths/year in India. Compared to the general population, the prevalence of smoking is found to be much higher among people with psychotic disorders and, more so in schizophrenia. Schizophrenic patients who smoke tend to have higher frequency of heavy smoking, with rates ranging from 60% to as high as 80%. Hence, smokers with psychiatric disorders suffer higher rates of morbidity and mortality secondary to smoking related illnesses.

Keywords: brief intervention, nicotine dependence, schizophrenia

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Authors: Sadia Munir

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Preeclampsia is the contributor to the worldwide maternal mortality of approximately 100,000 deaths a year. It complicates about 10% of all pregnancies and is the first cause of maternal admission to intensive care units. Predicting preeclampsia is a major challenge in obstetrics. More importantly, no major progress has been achieved in the treatment of preeclampsia. As placenta is the main cause of the disease, the only way to treat the disease is to extract placental and deliver the baby. In developed countries, the cost of an average case of preeclampsia is estimated at £9000. Interestingly, preeclampsia may have an impact on the health of mother or infant, beyond the pregnancy. We performed a systematic search of PubMed including the combination of terms such as preeclampsia, biomarkers, treatment, hypoxia, inflammation, oxidative stress, vascular endothelial growth factor A, activin A, inhibin A, placental growth factor, transforming growth factor β-1, Nodal, placenta, trophoblast cells, microRNAs. In this review, we have summarized current knowledge on the identification of potential biomarkers for the diagnosis of preeclampsia. Although these studies show promising data in early diagnosis of preeclampsia, the current value of these factors as biomarkers, for the precise prediction of preeclampsia, has its limitation. Therefore, future studies need to be done to support some of the very promising and interesting data to develop affordable and widely available tests for early detection and treatment of preeclampsia.

Keywords: activin, biomarkers, growth factors, miroRNA

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Authors: Nelson Rotimi Osungbemiro, Sanni Rafiu Olugbenga, Abayomi Olufemi Olajuyigbe

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Ninety Fingerlings of Clarias gariepinus were exposed to the pathogenic Flavobacterium columnare a Gram Negative bacteria responsible for high mortality in fish pond raised young fish (fries and fingerlings) of Clarias sp. in Southwestern Nigeria. After feeding with 40% crude protein pelletized fish feed for 5 days, the fishes were divided into two groups, one group was treated with extracts from Calendula officinalis flowers, while the second group was not treated (control). The results indicated that, at day 5, colony formation had been manifesting and at day 7, skin lesion occurred and at the 8th day, first mortality of fish occurred, and this continued steadily on the 9th-12th day when all the fishes were dead. Whereas, in the group that was treated with Calendula sp., no single mortality was recorded. This research shows that plant extract from Calendula flowers is an effective antimicrobial agent against the virulent pathogenic Flavobacterium columnare disease.

Keywords: antimicrobial, Flavobacterium columnare, Clarias gariepinus, fish

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Authors: Marek Kuźniewski, Magdalena B. Kaziuk , Danuta Fedak, Paulina Dumnicka, Ewa Stępień, Beata Kuśnierz-Cabala, Władysław Sułowicz

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Background: The high prevalence of cardiovascular morbidity and mortality among patients with chronic kidney disease (CKD) is observed especially in those undergoing dialysis. Osteoprotegerin (OPG) and its ligands, receptor activator of nuclear factor kappa-B ligand (RANKL) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) have been associated with cardiovascular complications. Our aim was to study their role as cardiovascular risk factors in stage 5 CKD patients. Methods: OPG, RANKL and TRAIL concentrations were measured in 69 hemodialyzed CKD patients and 35 healthy volunteers. In CKD patients, cardiovascular dysfunction was assessed with aortic pulse wave velocity (AoPWV), carotid artery intima-media thickness (CCA-IMT), coronary artery calcium score (CaSc) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) serum concentration. Cardiovascular and overall mortality data were collected during a 7-years follow-up. Results: OPG plasma concentrations were higher in CKD patients comparing to controls. Total soluble RANKL was lower and OPG/RANKL ratio higher in patients. Soluble TRAIL concentrations did not differ between the groups and OPG/TRAIL ratio was higher in CKD patients. OPG and OPG/TRAIL positively predicted long-term mortality (all-cause and cardiovascular) in CKD patients. OPG positively correlated with AoPWV, CCA-IMT and NT-proBNP whereas OPG/TRAIL with AoPWV and NT-proBNP. Described relationships were independent of classical and non-classical cardiovascular risk factors, with exception of age. Conclusions: Our study confirmed the role of OPG as a biomarker of cardiovascular dysfunction and a predictor of mortality in stage 5 CKD. OPG/TRAIL ratio can be proposed as a predictor of cardiovascular dysfunction and mortality.

Keywords: osteoprotegerin, tumor necrosis factor-related apoptosis-inducing ligand, receptor activator of nuclear factor kappa-B ligand, hemodialysis, chronic kidney disease, cardiovascular disease

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Authors: Wisit Wichitkosoom

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Objectives: To find out the more effect of early cardiologist consultation using a simple technology on the diagnosis and early proper management of patients with Non-STEMI at emergency department of district hospitals without cardiologist on site before transferred. Methods: A cohort study was performed in Udonthani general hospital at Udonthani province. From 1 October 2012–30 September 2013 with 892 patients diagnosed with Non-STEMI. All patients mean aged 46.8 years of age who had been transferred because of Non-STEMI diagnosed, over a 12 week period of studied. Patients whose transferred, in addition to receiving proper care, were offered a cardiologist consultation with average time to Udonthani hospital 1.5 hour. The main outcome measure was length of hospital stay, mortality at 3 months, inpatient investigation, and transfer rate to the higher facilitated hospital were also studied. Results: Hospital stay was significantly shorter for those didn’t consult cardiologist (hazard ratio 1.19; approximate 95% CI 1.001 to 1.251; p = 0.039). The 136 cases were transferred to higher facilitated hospital. No statistically significant in overall mortality between the groups (p=0.068). Conclusions: Early cardiologist consultant can reduce length of hospital stay for patients with cardiovascular conditions outside of cardiac center. The new basic technology can apply for the safety patient.

Keywords: critical, telemedicine, safety, non STEMI

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Authors: Anthony J. Kondracki, Bonzo I. Reddick, Jennifer L. Barkin

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We sought to examine the association of maternal Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and treponema pallidum (TP) (syphilis) infections with preterm birth (PTB) (<37 weeks gestation), low birth weight (LBW) (<2500 grams) and prenatal care (PNC) attendance. This cross-sectional study was based on data drawn from the 2020 United States National Center for Health Statistics (NCHS) Natality File. We estimated the prevalence of all births, early/late PTBs, moderately/very LBW, and the distribution of sexually transmitted infections (STIs) according to maternal characteristics in the sample. In multivariable logistic regression models, we examined adjusted odds ratios (aORs) and their corresponding 95% confidence intervals (CIs) of PTB and LBW subcategories in the association with maternal/infant characteristics, PNC status, and maternal CT, NG, and TP infections. In separate logistic regression models, we assessed the risk of these newborn outcomes stratified by PNC status. Adjustments were made for race/ethnicity, age, education, marital status, health insurance, liveborn parity, previous preterm birth, gestational hypertension, gestational diabetes, PNC status, smoking, and infant sex. Additionally, in a sensitivity analysis, we assessed the association with early, full, and late term births and the potential impact of unmeasured confounding using the E-value. CT (1.8%) was most prevalent STI in pregnancy, followed by NG (0.3%), and TP (0.1%). Non-Hispanic Black women, 20-24 years old, with a high school education, and on Medicaid had the highest rate of STIs. Around 96.6% of women reported receiving PNC and about 60.0% initiated PNC early in pregnancy. PTB and LBW were strongly associated with NG infection (12.2% and 12.1%, respectively) and late initiation/no PNC (8.5% and 7.6%, respectively), and ≤10 prenatal visits received (13.1% and 10.3%, respectively). The odds of PTB and LBW were 2.5- to 3-foldhigher for each STI among women who received ≤10 prenatal visits than >10 visits. Adequate prenatal care utilization and timely screening and treatment of maternal STIs can substantially reduce the burden of adverse newborn outcomes.

Keywords: low birthweight, prenatal care, preterm birth, sexually transmitted infections

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Authors: Maria Ines Azambuja

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Graphic displays of Age-Period-Cohort (APC) mortality trends generally uses data aggregated within 5 or 10-year intervals. Technology allows one to increase the amount of processed data. Displaying occurrences by 1-year intervals is a logic first step in the direction of attaining higher quality landscapes of variations in temporal occurrences. Method: 1) Comparison of UK mortality trends plotted by 10-, 5- and 1-year intervals; 2) Comparison of UK and US mortality trends (period X age and cohort X age) displayed by 1-year intervals. Source: Mortality data (period, 1x1, males, 1933-1912) uploaded from the Human Mortality Database to Excel files, where Period X Age and Cohort X Age graphics were produced. The choice of transforming age-specific trends from calendar to birth-cohort years (cohort = period – age) (instead of using cohort 1x1 data available at the HMD resource) was taken to facilitate the comparison of age-specific trends when looking across calendar-years and birth-cohorts. Yearly live births, males, 1933 to 1912 (UK) were uploaded from the HFD. Influenza references are from the literature. Results: 1) The use of 1-year intervals unveiled previously unsuspected period, cohort and interacting period x cohort effects upon all-causes mortality. 2) The UK and US figures showed variations associated with particular calendar years (1936, 1940, 1951, 1957-68, 72) and, most surprisingly, with particular birth-cohorts (1889-90 in the US, and 1900, 1918-19, 1940-41 and 1946-47, in both countries. Also, the figures showed ups and downs in age-specific trends initiated at particular birth-cohorts (1900, 1918-19 and 1947-48) or a particular calendar-year (1968, 1972, 1977-78 in the US), variations at times restricted to just a range of ages (cohort x period interacting effects). Importantly, most of the identified “scars” (period and cohort) correlates with the record of occurrences of Influenza A epidemics since the late 19th Century. Conclusions: The use of 1-year intervals to describe APC mortality trends both increases the amount of information available, thus enhancing the opportunities for patterns’ recognition, and increases our capability of interpreting those patterns by describing trends across smaller intervals of time (period or birth-cohort). The US and the UK mortality landscapes share many but not all 'scars' and distortions suggested here to be associated with influenza epidemics. Different size-effects of wars are evident, both in mortality and in fertility. But it would also be realistic to suppose that the preponderant influenza A viruses circulating in UK and US at the beginning of the 20th Century might be different and the difference to have intergenerational long-term consequences. Compared with the live births trend (UK data), birth-cohort scars clearly depend on birth-cohort sizes relatives to neighbor ones, which, if causally associated with influenza, would result from influenza-related fetal outcomes/selection. Fetal selection could introduce continuing modifications on population patterns of immune-inflammatory phenotypes that might give rise to 'epidemic constitutions' favoring the occurrence of particular diseases. Comparative analysis of mortality landscapes may help us to straight our record of past circulation of Influenza viruses and document associations between influenza recycling and fertility changes.

Keywords: age-period-cohort trends, epidemic constitution, fertility, influenza, mortality

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Authors: Bahar Tunctan, Sefika Pinar Kucukkavruk, Meryem Temiz-Resitoglu, Demet Sinem Guden, Ayse Nihal Sari, Seyhan Sahan-Firat

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We hypothesized that rexinoids such as bexarotene, a selective retinoid X receptor α (RXRα) agonist, may be beneficial for preventing mortality due to inflammation associated with increased expression/activity of inducible nitric oxide synthase (iNOS) induced by lipopolysaccharide (LPS). Therefore, we investigated effects of bexarotene on the changes in circulating protein levels of iNOS (an index for systemic iNOS expression), myeloperoxidase (MPO) (an index for systemic inflammation), and lactate dehydrogenase (LDH) (an index for systemic tissue injury) in LPS-induced systemic inflammation model resulting in septic shock in rats. Rats were injected with saline (4 ml/kg; i.p.), LPS (10 mg/kg; i.p.), dimethylsulphoxide (4 ml/kg, 0.1%; s.c.) at time 0. Mean arterial blood pressure and heart rate were measured using a tail-cuff device. Bexarotene (0.03, 0.1, 0.3, and 1 mg/kg; s.c.) was administered to separate groups of rats 1 h after injection of saline or LPS. The rats were sacrificed 4 h after saline or LPS injection and blood was collected for measurement of serum iNOS, MPO, and LDH protein levels. Blood pressure decreased by 31 mmHg and heart rate increased by 63 bpm in the LPS-treated rats. Bexarotene at 0.3 and 1 mg/kg doses caused 20% mortality 4 h after LPS injection. In the LPS-treated rats, serum iNOS, MPO, and LDH protein levels were increased. Bexarotene only at 0.1 mg/kg dose prevented the LPS-induced hypotension and increased in iNOS, MPO, and LDH protein levels. These data are consistent with the view that a decrease in systemic iNOS levels contributes to the beneficial effect of bexarotene to prevent the hypotension associated with inflammation and tissue injury during rat endotoxemia. [This work was financially supported by The Scientific and Technological Research Council of Turkey (SBAG-109S121)].

Keywords: bexarotene, inflammation, iNOS, lipopolisaccharide, RXRa

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Authors: Ana Paula S. A. Correa, Allan K. R. Galardo, Luana A. Lima, Talita F. Sobral, Josiane N. Muller, Jessica F. S. Barroso, Nercy V. R. Furtado, Ednaldo C. Rêgo., Jose B. P. Lima

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Malaria is a public health problem in the Brazilian Legal Amazon. Among the integrated approaches for anopheline control, the Indoor Residual Spraying (IRS) remains one of the main tools in the basic strategy applied in the Amazonian States, where the National Malaria Control Program currently uses one of the insecticides from the pyrethroid class, the Etofenprox WP. Understanding the residual efficacy of insecticides on different surfaces is essential to determine the spray cycles, in order to maintain a rational use and to avoid product waste. The aim of this study was to evaluate the residual efficacy of Etofenprox - VECTRON ® 20 WP on surfaces of Unplastered Cement (UC) and Unpainted Wood (UW) on panels, in field, and in semi-field evaluation of Brazil’s Amapa State. The evaluation criteria used was the cone bioassay test, following the World Health Organization (WHO) recommended method, using plastic cones and female mosquitos of Anopheles sp. The tests were carried out in laboratory panels, semi-field evaluation in a “test house” built in the Macapa municipality, and in the field in 20 houses, being ten houses per surface type (UC and UW), in an endemic malaria area in Mazagão’s municipality. The residual efficacy was measured from March to September 2017, starting one day after the spraying, repeated monthly for a period of six months. The UW surface presented higher residual efficacy than the UC. In fact, the UW presented a residual efficacy of the insecticide throughout the period of this study with a mortality rate above 80% in the panels (= 95%), in the "test house" (= 86%) and in field houses ( = 87%). On the UC surface it was observed a mortality decreased in all the tests performed, with a mortality rate of 45, 47 and 29% on panels, semi-field and in field, respectively; however, the residual efficacy ≥ 80% only occurred in the first evaluation after the 24-hour spraying bioassay in the "test house". Thus, only the UW surface meets the specifications of the World Health Organization Pesticide Evaluation Scheme (WHOPES) regarding the duration of effective action (three to six months). To sum up, the insecticide residual efficacy presented variability on the different surfaces where it was sprayed. Although the IRS with Etofenprox WP was efficient on UW surfaces, and it can be used in spraying cycles at 4-month intervals, it is important to consider the diversity of houses in the Brazilian Legal Amazon, in order to implement alternatives for vector control, including the evaluation of new products or different formulations types for insecticides.

Keywords: Anopheles, vector control, insecticide, bioassay

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Authors: Matthew Heidman, Susan Dallabrida, Analice Costa

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Background:Accuracy of caregiver reported outcomes is essential for infant growth and tolerability study success. Crying/fussiness, stool consistencies, and other gastrointestinal characteristics are important parameters regarding tolerability, and inter-caregiver reporting can see a significant amount of subjectivity and vary greatly within a study, compromising data. This study sought to elucidate how caregiver reported questions related to stool frequency are answered before and after a short amount of training and how training impacts caregivers’ understanding, and how they would answer the question. Methods:A digital survey was issued for 90 daysin the US (n=121) and 30 days in Mexico (n=88), targeting respondents with children ≤4 years of age. Respondents were asked a question in two formats, first without a line of training text and second with a line of training text. The question set was as follows, “If your baby had stool in his/her diaper and you changed the diaper and 10 min later there was more stool in the diaper, how many stools would you report this as?” followed by the same question beginning with “If you were given the instruction that IF there are at least 5 minutes in between stools, then it counts as two (2) stools…”.Four response items were provided for both questions, 1) 2 stools, 2) 1stool, 3) it depends on how much stool was in the first versus the second diaper, 4) There is not enough information to be able to answer the question. Response frequencies between questions were compared. Results: Responses to the question without training saw some variability in the US, with 69% selecting “2 stools”,11% selecting “1 stool”, 14% selecting “it depends on how much stool was in the first versus the second diaper”, and 7% selecting “There is not enough information to be able to answer the question” and in Mexico respondents selected 9%, 78%, 13%, and 0% respectively. However, responses to the question after training saw more consolidation in the US, with 85% of respondents selecting“2 stools,” representing an increase in those selecting the correct answer. Additionally in Mexico, with 84% of respondents selecting “1 episode” representing an increase in the those selecting the correct response. Conclusions: Caregiver reported outcomes are critical for infant growth and tolerability studies, however, they can be highly subjective and see a high variability of responses without guidance. Training is critical to standardize all caregivers’ perspective regarding how to answer questions accurately in order to provide an accurate dataset.

Keywords: infant nutrition, clinical trial optimization, stool reporting, decentralized clinical trials

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Authors: Walid A. Alkeridy, Arwa Aljasser, Khalid Mohammed Alayed, Saad Alsaad, Amani S. Alqahtani, Claire Ann Lim, Sultan H. Alamri, Doaa Zainhom Mekkawy, Mohammed Al-Sofiani

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Introduction: The history of publicly funded Home Health Care (HHC) service in Saudi Arabia dates back to 1991. The first HC program was launched to provide palliative home care services for patients with terminal cancer. Thereafter, more programs launched across Saudi Arabia most remarkably was launching the national program for HHC by the Ministry Of Health (MOH) in 2008. The national HHC MOH program is mainly providing long-term care home care services for over 40,000 Saudi citizens. The scope of the HHC service program provided by the Saudi MOH is quite diverse, ranging from basic nursing care to specialized care programs, e.g., home peritoneal dialysis, home ventilation, home infusion therapy, etc. Objectives: The primary aim of our study is to report the prevalence of chronic conditions among Saudi people receiving long-term HHC services. Secondary aims include identifying the predictors of mortality among individuals receiving long-term HHC services and studying the association between frailty and poor health outcomes among HHC users. Methods: We conducted a retrospective and cross-sectional data collection from participants receiving HHC services at King Saud University Medical City, Riyadh, Saudi Arabia. Data were collected from electronic health records (EHR), patient charts, and interviewing caregivers from the year 2019 to 2022. We assessed functional performance by Katz's activity of daily living and the Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). Mortality was assessed by reviewing the death certificates if patients were hospitalized through discharge status ascertainment from EHR. Results: The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. The following variables were statistically significant between deceased and alive individuals receiving HHC services; clinical frailty scale, the total number of comorbid conditions, and functional performance based on the KATZ activity of daily living scale and the BADLS. We found that the strongest predictors for mortality were pressure ulcers which had an odds ratio of 3.75 and p-value of < 0.0001, and the clinical frailty scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services. Moreover, we found a high rate of annual readmission for individuals enrolled in HHC, which requires further analysis to understand the possible contributing factors for the increased rate of hospital readmission and develop strategies to address them. Future studies should focus on designing quality improvement projects aimed at improving the quality of life for individuals receiving HHC services, especially those who have pressure ulcers at the end of life.

Keywords: homecare, Saudi, prevalence, chronic

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Authors: Nyussupova Gulnara, Kenespayeva Laura, Kelinbayeva Roza, Aubakirova Gaukhar, Zhumagulov Chingiz, Aidarkhanova Gaukhar

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The article analyzes the development of demographic processes in four regions of the Western region of the Republic of Kazakhstan (Aktobe, Atyrau, West Kazakhstan, and Mangystau) for the period from 2000 to 2022. This study uses theoretical and methodological analysis of scientific literature, methods of comparative, statistical analysis, GIS methods, grouping and systematization, index method and structural analysis. The research identified regional characteristics, development trends, and disproportions in the population of the studied areas within the framework of sustainable demographic development. The population dynamics, the age-sex structure of the population, life expectancy, natural movement of the population, including maternal and infant mortality, are considered as important indicators of the region’s sustainability. The features of migration processes in the Western region of Kazakhstan and the factors that determine them are identified. Conclusions are drawn about the level of sustainable development of the population of the studied region based on demographic processes. The results obtained will provide scientific, methodological and information support in the sectors of economics and science, including the preparation of socio-economic development programs and the development of scientific research using GIS.

Keywords: sustainable development, demographic processes, Western Region, Republic of Kazakhstan, population structure, natural population movement, migration

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Authors: Adelson G. Guillarte, M. D., Noel J. Belonguel, Jarungchai Anton S. Vatanagul

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Patients with malignant middle cerebral infarction (MCA) (with massive brain swelling and herniation) were reported to have a mortality rate of 80% even with the appropriate conservative medical therapy. European Trials (DECIMAL, DESTINY I, and II, HAMLET) showed significant improvement in mortality and functional outcome with hemicraniectomy. No known published local studies in the region, thus a local study is vital. This is a single center, retrospective, descriptive, cross-sectional, chart review study which includes ≥18 year-old patients with malignant MCA infarction, who underwent hemicraniectomy, and those who were given conservative medical therapy alone, from January 2008 to December 2012 at Perpetual Succour Hospital. Excluded were patients whose charts are with insufficient data, prior MCA stroke, with concomitant intracerebral hemorrhage and with other serious medical conditions or terminal illnesses. Minimum of 32 populations were needed. Data were presented in mean, standard deviation, frequency and percentage distribution. Man n Whitney U test and Chi Square test were used. P-values lesser than 0.05 alpha were considered statistically significant. A total of 672 stroke patients were admitted. 34 patients pass the inclusion criteria. 9 underwent hemicraniectomy and 25 were treated by conservative medical therapy alone. Although not statistically significant (64% vs 33%, p=0.112) there were more patients noted improved in the conservative treatment group. Meanwhile, the Hemicraniectomy group have increased percentage of mortality (67%) (p=0.112). There was a decreasing trend in the average NIHSS score in both groups from admission to post-op 7 days (p=0.198, p=0.78). A bigger multicenter prospective study is recommended to control inherent biases and limitations of a retrospective and smaller study.

Keywords: cerebral infarct, hemicraniectomy, ischemic stroke, malignant middle cerebral artery (MCA) infarct

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Authors: Jung-Hong Hong, Jing-Cen Yang, Cai-Yu Ou

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The analysis of geographic inequality heavily relies on the use of location-enabled statistical data and quantitative measures to present the spatial patterns of the selected phenomena and analyze their differences. To protect the privacy of individual instance and link to administrative units, point-based datasets are spatially aggregated to area-based statistical datasets, where only the overall status for the selected levels of spatial units is used for decision making. The partition of the spatial units thus has dominant influence on the outcomes of the analyzed results, well known as the Modifiable Areal Unit Problem (MAUP). A new spatial reference framework, the Taiwan Geographical Statistical Classification (TGSC), was recently introduced in Taiwan based on the spatial partition principles of homogeneous consideration of the number of population and households. Comparing to the outcomes of the traditional township units, TGSC provides additional levels of spatial units with finer granularity for presenting spatial phenomena and enables domain experts to select appropriate dissemination level for publishing statistical data. This paper compares the results of respectively using TGSC and township unit on the mortality data and examines the spatial characteristics of their outcomes. For the mortality data between the period of January 1^st, 2008 and December 31^st, 2010 of the Taitung County, the all-cause age-standardized death rate (ASDR) ranges from 571 to 1757 per 100,000 persons, whereas the 2^nd dissemination area (TGSC) shows greater variation, ranged from 0 to 2222 per 100,000. The finer granularity of spatial units of TGSC clearly provides better outcomes for identifying and evaluating the geographic inequality and can be further analyzed with the statistical measures from other perspectives (e.g., population, area, environment.). The management and analysis of the statistical data referring to the TGSC in this research is strongly supported by the use of Geographic Information System (GIS) technology. An integrated workflow that consists of the tasks of the processing of death certificates, the geocoding of street address, the quality assurance of geocoded results, the automatic calculation of statistic measures, the standardized encoding of measures and the geo-visualization of statistical outcomes is developed. This paper also introduces a set of auxiliary measures from a geographic distribution perspective to further examine the hidden spatial characteristics of mortality data and justify the analyzed results. With the common statistical area framework like TGSC, the preliminary results demonstrate promising potential for developing a web-based statistical service that can effectively access domain statistical data and present the analyzed outcomes in meaningful ways to avoid wrong decision making.

Keywords: mortality map, spatial patterns, statistical area, variation

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Authors: Hatice Torcu Koc, Zeliha Erdogan

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This study presented the investigation of the population structure of Upeneus moluccensis in order to provide further knowledge and to compare the data with the studies before and thus help in the management of the population in the İskenderun Bay. For this purpose, a total of 370 golden-banded goatfish were caught by a commercial vessel monthly at a depth of 50-60 m. from İskenderun Bay in the years 2016-2018. Von Bertalanffy growth equation,length-weight relationships, sex ratio, age, condition, and gonado and hepato-somatic index values of U.peneus moluccensis specimens were determined. For this, the lengths and weights were measured using a dial caliper of 0.05 mm and a sensitive balance. Total lengths were 7.2–17.5 cm in females and 7.0–17.9 cm in males, while total weight ranges for females and males were 3.91-64.26 g and 3.69-60.95 g., respectively. Length-weight relationship for all individuals was calculated as W=0.004*L³ ³⁸, R²=0.85. Growth parameter was determined as L∞= 20.75 cm, k=0.33, t₀= - 0.56. The age readings were done by using the Bhattacharya method. The population was composed of 3 ages (1-3). The sex ratio was found as 1:1.42, corresponding to 41.4% males and 58.6% females, in favor of females (p<0.05). Values of the average condition and hepatosomatic index were found to be shown a similar pattern for males (1.088, 1.104) and females (1.124, 1.177), respectively. According to GSI values, the spawning period started in March and increased to April, May, and September. It was estimated that total (Z) mortality, natural (M) mortality, and fishing (F) mortality rates were estimated as Z=0.94 year-¹, M=0.033 year-¹, and F=0.63 year-¹, respectively. As the exploitation rate was estimated to be E=0.67, it can be shown that the golden-banded goatfish stock was influenced by overfishing. The findings of this study are very important to point out the population of U. moluccensis, which penetrated into the eastern Mediterranean Sea of Türkiye due to global heating and the construction of the Suez Canal and to be basic data for the next fisheries investigations.

Keywords: biology, U. moluccensis, invasive, lessepsian, İskenderun Bay

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Authors: Carlos Minguez, Christian F. Sagbay, Erika E. Ordoñez

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Guinea pigs (Cavia porcellus) play prominent roles as experimental models for medical research and as pets. However, in developing countries like South America, the Philippines, and sub-Saharan Africa, the meat of guinea pigs is an economic source of animal protein for the poor and malnourished humans because guinea pigs are mainly fed with forage and do not compete directly with human beings for food resources, such as corn or wheat. To achieve efficient production of guinea pigs, it is essential to provide insurance against vitamin C deficiency. The objective of this research was to investigate the effect of the partial replacement of alfalfa with fresh citrus pulp (Citrus sinensis) in a diet of guinea pigs on the growth performance, slaughter traits and mortality during the fattening period (between 20 and 74 days of age). A total of 300 guinea pigs were housed in collective cages of about ten animals (2 x 1 x 0.4 m) and were distributed into two completely randomized groups. Guinea pigs in both groups were fed ad libitum, with a standard commercial pellet diet (10 MJ of digestible energy/kg, 17% crude protein, 11% crude fiber, and 4.5% crude fat). Control group was supplied with fresh alfalfa as forage. In the treatment group, 30% of alfalfa was replaced by fresh citrus pulp. Growth traits, including body weight (BW), average daily gain (ADG), feed intake (FI), and feed conversion ratio (FCR), were measured weekly. On day 74, the animals were slaughtered, and slaughter traits, including live weight at slaughter (LWS), full gastrointestinal tract weight (FGTW), hot carcass weight (with head; HCW), cold carcass weight (with head; CCW), drip loss percentage (DLP) and dressing out carcass yield percentage (DCY), were evaluated. Contrasts between groups were obtained by calculated generalized least squares values. Mortality was evaluated by Fisher's exact test due to low numbers in some cells. In the first week, there were significant differences in the growth traits BW, ADG, FI, and FCR, which were superior in control group. These differences may have been due to the origin of the young guinea pigs, which, before weaning, were all raised without fresh citrus pulp, and they were not familiarized with the new supplement. In the second week, treatment group had significantly increased ADG compared with control group, which may have been the result of a process of compensatory growth. During subsequent weeks, no significant differences were observed between animals raised in the two groups. Neither were any significant differences observed across the total fattening period. No significant differences in slaughter traits or mortality rate were observed between animals from the two groups. In conclusion, although there were no significant differences in growth performance, slaughter traits, or mortality, the use of fresh citrus pulp is recommended. Fresh citrus pulp is a by-product of orange juice industry and it is cheap or free. Forage made with fresh citrus pulp could reduce about of 30 % the quantity of alfalfa in guinea pig for meat and as consequence, reduce the production costs.

Keywords: fresh citrus, growth, Guinea pig, mortality

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Authors: Abdelmanie Suleimat, Nagham Abu Shaqra, Sawsan Majali, Issam Adawi, Heba Abo Shindi, Anas Al Mohtaseb

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The Government of Jordan recognizes that maternal mortality constitutes a grave public health problem. Over the past two decades, there has been significant progress in improving the quality of maternal health services, resulting in improved maternal and child health outcomes. Despite these efforts, measurement and analysis of maternal mortality remained a challenge, with significant discrepancies from previous national surveys that inhibited accuracy. In response with support from USAID, the Jordan Maternal Mortality Surveillance Response (JMMSR) System was established to collect, analyze, and equip policymakers with data for decision-making guided by interdisciplinary multi-levelled advisory groups aiming to eliminate preventable maternal deaths, A 2016 Public Health Bylaw required the notification of deaths among women of reproductive age. The JMMSR system was launched in 2018 and continues annually, analyzing data received from health facilities, to guide policy to prevent avoidable deaths. To date, there have been four annual national maternal mortality reports (2018-2021). Data is collected, reviewed by advisory groups, and then consolidated in an annual report to inform and guide the Ministry of Health (MOH); JMMSR collects the necessary information to calculate an accurate maternal mortality ratio and assists in identifying leading causes and contributing factors for each maternal death. Based on this data, national response plans are created. A monitoring and evaluation plan was designed to define, track, and improve implementation through indicators. Over the past four years, one of these indicators, ‘percent of facilities notifying respective health directorates of all deaths of women of reproductive age,’ increased annually from 82.16%, 92.95%, and 92.50% to 97.02%, respectively. The Government of Jordan demonstrated commitment to the JMMSR system by designating the MOH to primarily host the system and lead the development and dissemination of policies and procedures to standardize implementation. The data was translated into practical and evidence-based recommendations. The successful impact of results deepened the understanding of maternal mortality in Jordan, which convinced the MOH to amend the Bylaw now mandating electronic reporting of all births and neonatal deaths from health facilities to empower the JMMSR system, by developing a stillbirths and neonatal mortality surveillance and response system.

Keywords: maternal health, maternal mortality, preventable maternal deaths, maternal morbidity

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Authors: Christos E. Lampropoulos, Maria Konsta, Tamta Sirbilatze, Ifigenia Apostolou, Vicky Dradaki, Konstantina Panouria, Irini Dri, Christina Kordali, Vaggelis Lambas, Georgios Mavras

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Objectives: Full Mini Nutritional Assessment (MNA) questionnaire is one of the most useful tools in diagnosis of malnutrition in hospitalized patients, which is related to increased morbidity and mortality. The purpose of our study was to assess the nutritional status of elderly, hospitalized patients and examine the hypothesis that MNA may predict mortality and extension of hospitalization. Methods: One hundred fifty patients (78 men, 72 women, mean age 80±8.2) were included in this cross-sectional study. The following data were taken into account in analysis: anthropometric and laboratory data, physical activity (International Physical Activity Questionnaires, IPAQ), smoking status, dietary habits, cause and duration of current admission, medical history (co-morbidities, previous admissions). Primary endpoints were mortality (from admission until 6 months afterwards) and duration of admission. The latter was compared to national guidelines for closed consolidated medical expenses. Logistic regression and linear regression analysis were performed in order to identify independent predictors for mortality and extended hospitalization respectively. Results: According to MNA, nutrition was normal in 54/150 (36%) of patients, 46/150 (30.7%) of them were at risk of malnutrition and the rest 50/150 (33.3%) were malnourished. After performing multivariate logistic regression analysis we found that the odds of death decreased 20% per each unit increase of full MNA score (OR=0.8, 95% CI 0.74-0.89, p < 0.0001). Patients who admitted due to cancer were 23 times more likely to die, compared to those with infection (OR=23, 95% CI 3.8-141.6, p=0.001). Similarly, patients who admitted due to stroke were 7 times more likely to die (OR=7, 95% CI 1.4-34.5, p=0.02), while these with all other causes of admission were less likely (OR=0.2, 95% CI 0.06-0.8, p=0.03), compared to patients with infection. According to multivariate linear regression analysis, each increase of unit of full MNA, decreased the admission duration on average 0.3 days (b:-0.3, 95% CI -0.45 - -0.15, p < 0.0001). Patients admitted due to cancer had on average 6.8 days higher extension of hospitalization, compared to those admitted for infection (b:6.8, 95% CI 3.2-10.3, p < 0.0001). Conclusion: Mortality and extension of hospitalization is significantly increased in elderly, malnourished patients. Full MNA score is a useful diagnostic tool of malnutrition.

Keywords: duration of admission, malnutrition, mini nutritional assessment score, prognostic factors for mortality

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: Chidiebere Joy Nwankwo, Benjamin S. C. Uzochukwu, Florence T. Sibeudu

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Background: Family planning is one of the most cost-effective ways to prevent maternal, infant, and child mortality. It can decrease maternal mortality by reducing the number of unintended pregnancies, the number of abortions, and the proportion of births at high risk. It has been seen to improve the health and economic well-being of families and communities and ensures women’s planned childbearing in order to achieve education and career goals which could raise family income thereby reducing poverty. The choice and use of a particular family planning method and their sources vary globally. Rural Communities often face significant challenges in accessing and utilizing family planning services. Aim: This study set out to assess Access and Utilization of Family Planning Services among Women of Reproductive Age in a Rural Community of Enugu state, Nigeria. Rural communities were chosen for this study because past demographic surveys have shown that women in urban areas are more likely to accept and practice family planning compared to those in rural areas. Method: A Descriptive Cross-sectional Research design was employed to achieve the aim and objectives of the study. Data collected from 177 consenting participants using interviewer-administered questionnaires was analysed using Descriptive statistics to summarize the Socio-demographic characteristics of the participants and Access and Utilization of Family Planning Services among the participants including Reasons for using different Family Planning Methods and Barriers encountered in Access and Utilization of these services. A Cross-tabulation between Socio-demographic Characteristics of respondents and the use of Family Planning services was carried out. Result: The findings of this study revealed that majority of the participants (72.9%) have not utilized any family planning service. Out of those (27.1%) that have used any family planning service, majority of them are still currently using a form of family planning service and have access to them in health facilities, patent medicine vendors and others based on multiple responses. Male condoms were the most utilized modern family planning service. Based on multiple responses, inaccessibility, personal beliefs and partner’s objection were the most identified barriers encountered in accessing family planning services. Conclusion: Access and uptake of family planning services in rural communities is lower than the national average. Increasing access to family planning is an urgent priority for rural areas Interventions that will scale up Access and Utilization of family planning services in rural communities should be intensified.

Keywords: access, family planning, rural community, utilization

Procedia PDF Downloads 47

Authors: Aisha Maroof

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Introduction: Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers and health systems. Severe 2019 novel coronavirus infectious disease (COVID-19) with pneumonia is associated with high rates of admission to the intensive care unit (ICU) and they are at high risk to obtain the hospital acquire bloodstream infection (HAIs) such as central line associated bloodstream infection (CLABSI), catheter associated urinary tract infections (CAUTI) and laboratory confirm bloodstream infection (LCBSI). The chances of infection transmission increase when healthcare worker’s (HCWs) practice is inappropriate. Risk related to hand hygiene (HH) and personal protective equipment (PPE) as regards multidrug-resistant organism transmission: use of multiple gloving instead of HH and incorrect use of PPE can lead to a significant increase of device-related infections. As it reaches low- and middle-income countries, its effects could be even more, because it will be difficult for them to react aggressively to the pandemic. HAIs are one of the biggest medical concerns, resulting in increased mortality rates. Objective: To assess the effect of intervention on compliance of hand hygiene and PPE among HCWs reduce the rate of HAI in COVID-19 patients. Method: An interventional study was done between July to December, 2020. CLABSI, CAUTI and LCBSI data were collected from the medical record and direct observation. There were total of 50 Nurses, 18 doctors and all patients with laboratory-confirmed severe COVID-19 admitted to the hospital were included in this research study. Respiratory tract specimens were obtained after the first 48 h of ICU admission. Practices were observed after and before intervention. Education was provided based on WHO guidelines. Results: During the six months of study July to December, the rate of CLABSI, CAUTI and LCBSI pre and post intervention was reported. CLABSI rate decreasedd from 22.7 to 0, CAUTI rate was decreased from 1.6 to 0, LCBSI declined from 3.3 to 0 after implementation of intervention. Conclusion: HAIs are an important cause of morbidity and mortality. Most of the device related infections occurs due to lack of correct use of PPE and hand hygiene compliance. Hand hygiene and PPE is the most important measure to protect patients, through education it can be improved the correct use of PPE and hand hygiene compliance and can reduce the bacterial infection in COVID-19 patients.

Keywords: hospital acquire infection, healthcare workers, hand hygiene, personal protective equipment

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Authors: Kajori Banerjee, Laxmi Kant Dwivedi

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“Health transition” is defined to be “a process through which high levels of mortality, morbidity and disability are reduced to low levels by influencing cultural, social and behavioural factors”. Life expectancy in India has been on the rise and parallel the burden of disease and disability has also risen noticeably. Borrowing data from Indian Census (2001, 2011), this study identifies the gender-wise burden of disability by calculating disability free life expectancy (DFLE) and life lived with disability (LWD). Sullivan’s method of calculating DFLE using proportion of disabled is used for this purpose. The change in person years lived with disability in the decade 2001-11 is further decomposed using Arriaga’s method into mortality and disability effects (ME and DE) to check the magnitude and direction of contribution of mortality and disability. Nationally, along with DFLE, LWD has amplified too. Despite having the highest life expectancy and DFLE, LWD in Kerala, was highest for both sexes in 2001. But in 2011, the LWD was highest among the males of Orissa and females of Rajasthan. For the overall population, DE is positive for the prime working age groups of 20-40years indicating that there has been an increase in the disability proportion holding mortality constant for 2001-2011. Females exhibit higher positive DE implying greater loss of healthy years due to disability than males. The findings call for an immediate attention to the causes of rising disability burden among the working population, especially females, as this might heavily effect the availability of quality labour force and its relative economic output in the Indian labour market. This also hints at the degrading quality of the elongated life and needs to be given the required attention to enhance the quality of life lead in the Nation.

Keywords: disability-free life expectancy, disability effect, life expectancy, mortality effect

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Authors: Mostafa Najim, Alaa Rahhal, Fadi Khir, Safae Abu Yousef, Amer Aljundi, Feryal Ibrahim, Aliaa Amer, Ahmed Soliman Mohamed, Samira Saleh, Dekra Alfaridi, Ahmed Mahfouz, Sumaya Al-Yafei, Faraj Howady, Mohamad Yahya Khatib, Samar Alemadi

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Background: Coronavirus disease 2019 (COVID-19) increases the risk of coagulopathy among critically ill patients. Although the presence of antiphospholipid antibodies (aPLs) has been proposed as a possible mechanism of COVID-19 induced coagulopathy, their clinical significance among critically ill patients with COVID-19 remains uncertain. Methods: This prospective observational study included patients with COVID-19 admitted to intensive care units (ICU) to evaluate the prevalence and clinical significance of aPLs, including anticardiolipin IgG/IgM, anti-β2-glycoprotein IgG/IgM, and lupus anticoagulant. The study outcomes included the prevalence of aPLs, a primary composite outcome of all-cause mortality, and arterial or venous thrombosis among aPLs positive patients versus aPLs negative patients during their ICU stay. Multiple logistic regression was used to assess the influence of aPLs on the primary composite outcome of mortality and thrombosis. Results: A total of 60 critically ill patients were enrolled. Of whom, 57 (95%) were male, with a mean age of 52.8 ± 12.2 years, and the majority were from Asia (68%). Twenty-two patients (37%) were found to have positive aPLs; of whom 21 patients were positive for lupus anticoagulant, whereas one patient was positive for anti-β2-glycoprotein IgG/IgM. The composite outcome of mortality and thrombosis during ICU did not differ among patients with positive aPLs compared to those with negative aPLs (4 (18%) vs. 6 (16%), aOR= 0.98, 95% CI 0.1-6.7; p-value= 0.986). Likewise, the secondary outcomes, including all-cause mortality, venous thrombosis, arterial thrombosis, discharge from ICU, time to mortality, and time to discharge from ICU, did not differ between those with positive aPLs upon ICU admission in comparison to patients with negative aPLs. Conclusion: The presence of aPLs does not seem to affect the outcomes of critically ill patients with COVID-19 in terms of all-cause mortality and thrombosis. Therefore, clinicians may not screen critically ill patients with COVID-19 for aPLs unless deemed clinically appropriate.

Keywords: antiphospholipid antibodies, critically ill patients, coagulopathy, coronavirus

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Authors: Sri Widati, Ira Nurmala

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The Se’i Tradition was considered to contribute highly to the high maternal mortality rate in South Amanuban, East Nusa Tenggara. This tradition is still preserved due to the social support that has influenced the decision to carry out the Se’i to pregnant women and post-partum women. The purpose of this study is to analyze this social support towards the Se’i Tradition on pregnant women in East Nusa Tenggara. This research was an explorative study with in-depth interviews, observations, and focus group discussions (FGD) in collecting the data. This study showed that emotional support towards Se’i was commonly given by families, specifically by the mother-in laws. Instrumental support was shown by the husbands and the traditional midwives who helped delivered the babies. Informational support was found on the pregnant women and their mother-in laws. Appraisal support was given by all the neighbors and relatives of the pregnant women by telling how comfortable it was to go through this tradition which eventually affected those women to carry it out themselves. The Se’i Tradition is still carried out and mostly supported by the relatives of the pregnant women. The first recommendation of this study is to suggest people to only follow the suggestions from the local health staff to give birth in the local health centers and not to do the tradition anymore. The second recommendation is to urge the government to give support in the form of transportation facilities for pregnant women to reach the local health staff.

Keywords: the Se’i tradition, social support, pregnant women, maternal mortality, post-partum women

Procedia PDF Downloads 530

Authors: Hang T. T. Tran, Ha T. Le, Hanh T. P. Tran, Hung V. Cao, Giang T. H. Nguyen, Dien M. Tran, Tobias Alfvén, Linus Olson

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Background: Hypoxic Ischemic Encephalopathy is one of the major causes of neonatal death and those who survive with severe encephalopathy are more likely to develop adverse long-term outcomes such as neurocognitive impairment and cerebral palsy, which is a huge burden, especially in low-middle income countries. It is important to have a long-term follow-up for early detection and promote early intervention for these groups of high-risk infants. Aim: To determine the neurological outcome of cooling infants at 18 months and identify an optimized neurological examination scale for Hypoxic Ischemic Encephalopathy infants in Vietnam. Method: Descriptive study of neurodevelopmental outcomes at 18 months of HIE infants who underwent therapeutic hypothermia treatment in Vietnam. All survived cooling infants were assessed at discharge and at 6, 12, and 18 months by a pediatric physical therapist and a neurologist using two assessment tools: Ages and Stages Questionnaires and the Hammersmith Infant Neurological Examination scale to detect impairments and promote early intervention for those who require it. Results: During a 3-year period, a total of 130 neonates with moderate to severe HIE underwent therapeutic hypothermia treatment using Phase change material mattress (65% moderate, 35% severe – Sarnat). 43 (33%) died during hospitalization and infancy; among survivors, 69 (79%) completed 3 follow-ups at 18 months. At 18 months, 25 had cerebral palsy, 11 had mild delayed neurodevelopment. At each time-point, infants with a normal/mildly delayed neurodevelopment had significantly higher Ages and Stages Questionnaires and Hammersmith Infant Neurological Examination scores (p<0.05) than those with cerebral palsy. Conclusion: The study showed that the Ages and Stages Questionnaires and Hammersmith Infant Neurological Examination is a helpful tool in the process of early diagnosis of infants at low and high neurological risk and identifying those infants needing specific rehabilitation programme.

Keywords: encephalopathy, phase-change-material, neurodevelopment, cerebral palsy

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Authors: M. J. Alcedo, K. Ito, K. Maeda

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A stockperson has a significant influence on the productivity and welfare of their animals. This influence may be good or bad depending on their stockmanship competence. In this study, stockmanship competence (SC) is defined as the capacity of the stockperson to ensure the welfare of their animals by providing their animal’s needs. The study was conducted to evaluate the stockmanship competence of backyard goat raisers and to examine its relationship to productivity and economic profitability. This was made possible by interviewing 101 backyard goat raisers who have undergone farmer livestock school on integrated goat management (FLS IGM) in Region I, Philippines on September 3-30, 2012 and March 4-17, 2013. Secondary data needed were gathered from the local government agencies involved. Data on stockmanship, goat productivity and farmer’s income before and after attending FLS-IGM were gathered through a semi-structured interview. Questions for stockamnship were based on the Philippine recommends on goat production, tips on goat raising and other scientific literature. Stockmanship competence index score (SCIS) was computed by summing the raw scores derived from each components of SC divided by the total number of components. Pearson correlation through SPSS was used to see the relationship between SC, productivity and income. Result showed that majority raised native and upgraded goats. The computed mean SCIS before and after undergoing FLS-IGM was 38.53% and 75.81%, respectively, an improvement of 49.17%. Both index scores resulted in significant differences in productivity and income. The median mature weight and mortality rate of goats before FLS-IGM, where SC was low, was 14 kg and 50% respectively. On the other hand, after stockmanship had improved, the median mature weight increased to 19 kgs and mortality rate decreased to 11.11%. Likewise, fewer goat diseases were observed by farmers as compared before. With regards to income, there was 127.34% difference on the median net income derived by farmers. Result implies that improved stockmanship competence can lead not only to increased productivity and income of backyard goat raisers but also welfare of the animal.

Keywords: stockmanship, backyard goat production, animal welfare, Philippines

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Authors: Thao Nguyen, Maximiliano Hyon, Sany Rajagukguk, Anna Melkonyan

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Introduction: Type 2 Diabetes is a well-established risk factor for severe SARS-CoV-2 infection. Uncontrolled hyperglycemia in patients with established or newly diagnosed diabetes is associated with poor outcomes, including increased mortality and hospital length of stay. Objectives: Our study aims to compare three different glycemic management strategies and their association with clinical outcomes in patients hospitalized for moderate to severe SARS-CoV-2 infection. Identifying optimal glycemic management strategies will improve the quality of patient care and improve their outcomes. Method: This is a retrospective observational study on patients hospitalized at Adventist Health White Memorial with severe SARS-CoV-2 infection from 11/1/2020 to 02/28/2021. The following inclusion criteria were used: positive SARS-CoV-2 PCR test, age >18 yrs old, diabetes or random glucose >200 mg/dL on admission, oxygen requirement >4L/min, and treatment with glucocorticoids. Our exclusion criteria included: ICU admission within 24 hours, discharge within five days, death within five days, and pregnancy. The patients were divided into three glycemic management groups: Group 1, managed solely by the Primary Team, Group 2, by Pharmacy; and Group 3, by Endocrinologist. Primary outcomes were average glucose on Day 5, change in glucose between Days 3 and 5, and average insulin dose on Day 5 among groups. Secondary outcomes would be upgraded to ICU, inpatient mortality, and hospital length of stay. For statistics, we used IBM® SPSS, version 28, 2022. Results: Most studied patients were Hispanic, older than 60, and obese (BMI >30). It was the first CV-19 surge with the Delta variant in an unvaccinated population. Mortality was markedly high (> 40%) with longer LOS (> 13 days) and a high ICU transfer rate (18%). Most patients had markedly elevated inflammatory markers (CRP, Ferritin, and D-Dimer). These, in combination with glucocorticoids, resulted in severe hyperglycemia that was difficult to control. Average glucose on Day 5 was not significantly different between groups primary vs. pharmacy vs. endocrine (220.5 ± 63.4 vs. 240.9 ± 71.1 vs. 208.6 ± 61.7 ; P = 0.105). Change in glucose from days 3 to 5 was not significantly different between groups but trended towards favoring the endocrinologist group (-26.6±73.6 vs. 3.8±69.5 vs. -32.2±84.1; P= 0.052). TDD insulin was not significantly different between groups but trended towards higher TDD for the endocrinologist group (34.6 ± 26.1 vs. 35.2 ± 26.4 vs. 50.5 ± 50.9; P=0.054). The endocrinologist group used significantly more preprandial insulin compared to other groups (91.7% vs. 39.1% vs. 65.9% ; P < 0.001). The pharmacy used more basal insulin than other groups (95.1% vs. 79.5% vs. 79.2; P = 0.047). There were no differences among groups in the clinical outcomes: LOS, ICU upgrade, or mortality. Multivariate regression analysis controlled for age, sex, BMI, HbA1c level, renal function, liver function, CRP, d-dimer, and ferritin showed no difference in outcomes among groups. Conclusion: Given high-risk factors in our population, despite efforts from the glycemic management teams, it’s unsurprising no differences in clinical outcomes in mortality and length of stay.

Keywords: glycemic management, strategies, hospitalized, SARS-CoV-2, outcomes

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Authors: J. Aliyu, A. O. Raji, A. A. Ibrahim

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The study was carried out to assess the fertility, early and late embryonic mortalities as well as hatchability by strain, season and hen’s weight in Nigerian indigenous chickens reared on deep litter. Four strains (normal feathered, naked neck, frizzle and dwarf) of hens maintained at a mating ratio of 1 cock to 4 hens, fed breeders mash and water ad libitum were used in a three year experiment. The data generated were subjected to analysis of variance using the SAS package and the means, where significant, were separated using the least significant difference (LSD). There were significant effects (P < 0.05) of strain on all the traits studied. Fertility was generally high (84.29 %) in all the strains. Early embryonic mortality was significantly lowest (P < 0.01) in naked neck which had the highest late embryonic mortality (P < 0.001). Hatchability was significantly highest (P < 0.01) in normal feathered (80.23 %) and slightly depressed in frizzle (74.95 %) and dwarf (72.27 %) while naked neck had the lowest (60.80 %). Season of the year had significant effects on early embryonic mortality. Dry hot season significantly (P < 0.05) depressed fertility while early embryonic mortality was depressed in the wet season (15.33 %). Early and late embryonic mortalities significantly increased (P < 0.05) with increasing weight of hen. Dwarf, frizzle and normal feathered hens could be used to improve hatchability as well as reduce early and late embryonic mortalities in Nigerian indigenous chickens.

Keywords: chicken, fertility, hatchability, indigenous, strain

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