Development of Flood Preparedness Behavior Scale: A Methodological Validity and Reliability Study.

BACKGROUND: Floods are the most frequent natural disasters with a significant share of their mortality. Preparedness is capable of decreasing the mortality of floods by at least 50%. This paper aims to present the psychometric properties of a scale developed to evaluate the behavior of preparedness to floods in Sudan and similar settings. METHODS: In this methodological scale development study, experts assessed the content validity of the items of the developed scale. Data were collected from key persons of 413 households living in neighborhoods affected by the 2018 floods in Kassala City in Sudan. A pre-tested questionnaire of sociodemographic data and the Flood Preparedness Behavior Scale (FPBS) were distributed to the participants' houses and recollected. Construct validity of the scale was checked using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency of the scale was checked using Cronbach's alpha. Test-retest reliability was assessed by Pearson's correlation coefficient. Item analyses and tests of significance of the difference in the mean scores of the highest and lowest score groups were carried out to ensure discriminatory power of the scale items. RESULTS: Experts agreed on the scale items. Construct validity of the scale was achieved using EFA by removing 34 items and retaining 25 items that were structured in three factors, named as: measures to be done before, during, and after a flood. Confirmatory factor analysis confirmed the construct obtained by EFA. The loadings of the items on their factors in both EFA and CFA were all > 0.3 with significant associations and acceptable fit indices obtained from CFA. The three factors were found to be reliable in terms of internal consistency (Cronbach's alpha coefficients for all factors were > 0.7) and test-retest reliability coefficient. In item analysis, the corrected total item correlations for all the items were > 0.3, and significant differences in the means of the highest and lowest score groups indicated good item discrimination power. CONCLUSION: The developed 25 items scale is an instrument which produces valid and reliable measures of preparedness behavior for floods in Sudan and similar settings.

Domains and Psychometric Properties of Scales Measuring Disaster Preparedness among General Population: A Systematic Literature Review.

INTRODUCTION: There is no universal tool for measuring disaster preparedness in the general population. This study aimed to provide a summary of the domains and psychometric properties of the available scales that assess preparedness for disasters, or one of its main types, among individuals or households. METHODS: This study is a systematic review of the literature on disaster preparedness tools. Studies published up to December 2022 were identified through a systematic search of four databases: Google Scholar, PubMed, Scopus, and Web of Science. Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) were used to review and evaluate the psychometric properties. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used to report this article. RESULTS: Twelve articles met the inclusion criteria. Among them, five scales measured general disaster preparedness, five measured earthquake preparedness, one measured flood preparedness, and one measured bushfire preparedness. The scales had a number of dimensions ranging from one to six. The most common item topics in the included scales were as follows: having an evacuation plan (n = 7), information source (n = 7), fire extinguisher (n = 6), and emergency kit (n = 5). The scales were rated sufficient for content validity (n = 10), structural validity (n = 5), internal consistency (n = 5), and test-re-test reliability (n = 6). One scale was checked for criterion validity and was rated as insufficient according to the COSMIN guidelines. CONCLUSION: The findings suggest the need to improve the psychometric properties of the scales, expand their contents, and develop scales relevant to target populations. This study provides useful information for researchers to develop comprehensive assessment tools and valuable sources of items for future scales.

Radiotherapy-Induced Neurocognitive Impairment Is Driven by Heightened Apoptotic Priming in Early Life and Prevented by Blocking BAX.

Although external beam radiotherapy (xRT) is commonly used to treat central nervous system (CNS) tumors in patients of all ages, young children treated with xRT frequently experience life-altering and dose-limiting neurocognitive impairment (NI) while adults do not. The lack of understanding of mechanisms responsible for these differences has impeded the development of neuroprotective treatments. Using a newly developed mouse model of xRT-induced NI, we found that neurocognitive function is impaired by ionizing radiation in a dose- and age-dependent manner, with the youngest animals being most affected. Histologic analysis revealed xRT-driven neuronal degeneration and cell death in neurogenic brain regions in young animals but not adults. BH3 profiling showed that neural stem and progenitor cells, neurons, and astrocytes in young mice are highly primed for apoptosis, rendering them hypersensitive to genotoxic damage. Analysis of single-cell RNA sequencing data revealed that neural cell vulnerability stems from heightened expression of proapoptotic genes including BAX, which is associated with developmental and mitogenic signaling by MYC. xRT induced apoptosis in primed neural cells by triggering a p53- and PUMA-initiated, proapoptotic feedback loop requiring cleavage of BID and culminating in BAX oligomerization and caspase activation. Notably, loss of BAX protected against apoptosis induced by proapoptotic signaling in vitro and prevented xRT-induced apoptosis in neural cells in vivo as well as neurocognitive sequelae. On the basis of these findings, preventing xRT-induced apoptosis specifically in immature neural cells by blocking BAX, BIM, or BID via direct or upstream mechanisms is expected to ameliorate NI in pediatric patients with CNS tumor. SIGNIFICANCE: Age- and differentiation-dependent apoptotic priming plays a pivotal role in driving radiotherapy-induced neurocognitive impairment and can be targeted for neuroprotection in pediatric patients.

Ambient air pollution and clinical dementia: systematic review and meta-analysis.

OBJECTIVE: To investigate the role of air pollutants in risk of dementia, considering differences by study factors that could influence findings. DESIGN: Systematic review and meta-analysis. DATA SOURCES: EMBASE, PubMed, Web of Science, Psycinfo, and OVID Medline from database inception through July 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies that included adults (≥18 years), a longitudinal follow-up, considered US Environmental Protection Agency criteria air pollutants and proxies of traffic pollution, averaged exposure over a year or more, and reported associations between ambient pollutants and clinical dementia. Two authors independently extracted data using a predefined data extraction form and assessed risk of bias using the Risk of Bias In Non-randomised Studies of Exposures (ROBINS-E) tool. A meta-analysis with Knapp-Hartung standard errors was done when at least three studies for a given pollutant used comparable approaches. RESULTS: 2080 records identified 51 studies for inclusion. Most studies were at high risk of bias, although in many cases bias was towards the null. 14 studies could be meta-analysed for particulate matter <2.5 µm in diameter (PM2.5). The overall hazard ratio per 2 µg/m3 PM2.5 was 1.04 (95% confidence interval 0.99 to 1.09). The hazard ratio among seven studies that used active case ascertainment was 1.42 (1.00 to 2.02) and among seven studies that used passive case ascertainment was 1.03 (0.98 to 1.07). The overall hazard ratio per 10 µg/m3 nitrogen dioxide was 1.02 ((0.98 to 1.06); nine studies) and per 10 µg/m3 nitrogen oxide was 1.05 ((0.98 to 1.13); five studies). Ozone had no clear association with dementia (hazard ratio per 5 µg/m3 was 1.00 (0.98 to 1.05); four studies). CONCLUSION: PM2.5 might be a risk factor for dementia, as well as nitrogen dioxide and nitrogen oxide, although with more limited data. The meta-analysed hazard ratios are subject to limitations that require interpretation with caution. Outcome ascertainment approaches differ across studies and each exposure assessment approach likely is only a proxy for causally relevant exposure in relation to clinical dementia outcomes. Studies that evaluate critical periods of exposure and pollutants other than PM2.5, and studies that actively assess all participants for outcomes are needed. Nonetheless, our results can provide current best estimates for use in burden of disease and regulatory setting efforts. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021277083.

Evaluating the Feasibility of Pro-Neurotensin and 25-Hydroxyvitamin D3 as Possible Indicators for Type 2 Diabetes Mellitus and Its Complications.

(1) Background: Type 2 diabetes mellitus (T2DM) and metabolic syndrome are associated with decreased vitamin D. In contrast, high pro-neurotensin (pro-NT) levels are linked with an increased risk of T2DM and cardiovascular disease. We aimed to determine the validity of pro-NT and 25-dihydroxy vitamin D3 levels as predictors for T2DM complications; (2) Methods: One hundred T2DM, and one hundred healthy volunteers participated in this case-control study. Their Pro-NT and 25-hydroxyvitamin D3 levels were evaluated using the ELISA technique; (3) Results: Pro-NT and 25 (OH) vitamin D3 have significant validity and accuracy in T2DM prediction, 84.5%, and 90.5%, respectively (p = 0.001). At a value of <29.5, 25-Hydroxy vitamin D3 showed 88% sensitivity and 93% specificity in predicting T2DM. At a value of >124 Pmol/L, Pro-NT showed 81% sensitivity and 88% specificity in predicting T2DM. At a value of 16.5, 25-Hydroxy vitamin D3 had 78.4% sensitivity and 68.3% specificity in predicting T2DM complications. At a value of >158 pmol/L, Pro-NT predicted T2DM complications with 67.6% sensitivity and 56.0% specificity; (4) Conclusions: 25 (OH) Vit D3 and Pro-NT could identify T2DM patients and predict T2DM complications. More extensive research is required to adequately validate this novel perspective with a large population study.

Neurological manifestations in mild and moderate cases of COVID-19.

BACKGROUND: The coronavirus disease due to SARS COVID-2 emerged from Wuhan city in China in December 2019 and rapidly spread to more than 200 countries all over the world as a global health pandemic. Its primary presentation is respiratory and cardiac. However, some neurological manifestations are also reported. We tried to explore the reported neurological manifestations in a group of non-hospitalized mild and moderate COVID-19 patients. We contacted 107 patients via phone calls and e-mail messages, within 10 days of clinical presentation. The collected data regarded the neurological and non-neurological symptoms of the disease using a questionnaire that collected medical information of each patient. RESULTS: It is found that 100% of patients have been reported with at least one neurological symptom during the first 10 days of COVID-19 presentation. The most common were headache which recorded 72% of the total. Then anosmia-dysgeusia which reached 52%, then myalgia with 44%, fatigue with 33% and dizziness with 32%. While the less common was numbness, migraine, loss of concentration, and seizures. CONCLUSION: There are many neurological manifestations found to be very common in COVID-19 patients even in mild cases, which when added to the increasing reports of serious cases of Guillain-Barre syndrome, acute necrotizing encephalopathy, myelitis, stroke, and encephalitis in COVID-19 patients support CNS invasion of the virus and assures the importance of neurological assessment of COVID-19 patients both in the acute phase of infection and after recovery for potential neurological sequelae.

Peripheral Polyneuropathy and Cognitive Impairment in Type II Diabetes Mellitus.

BACKGROUND: Neuropathy is one of most common complications in diabetic patients. Diagnosis of diabetic neuropathy is essential for decreasing the rate of the disability and death. Neuron-specific enolase (NSE) is released from damaged neuronal cells and enters the blood circulation through an injured blood brain barrier. Therefore, serum NSE can reflect the damage of neurons and brain tissue. OBJECTIVE: To evaluate peripheral polyneuropathy and cognitive function in Type 2 Diabetes Mellitus (T2DM) and correlate them with NSE level as a possible biomarker of diabetic neuropathy. SUBJECTS AND METHODS: Forty five T2DM patients with polyneuropathy were randomly recruited in this study compared to 45 healthy age and sex matched subjects as a control. Patients group were divided into two subgroups, 24 diabetic patients with painful peripheral neuropathy and 21 with painless peripheral neuropathy. All were subjected to clinical assessment by diabetic neuropathy symptom score, Dyck neuropathy grading, Mini-Mental State Examination (MMSE), assessment of HbA1c, NSE biomarker and neurophysiological assessment (nerve conduction study (NCS), event related potential (P300wave) and somatosensory evoked potential (SSEP) of the right median nerve). RESULTS: There were significant decrease in cognitive functions in diabetic patients compared to controls and a significant increase in NSE in diabetic patients. There were no significant difference between patients with painless and painful diabetic neuropathy as regard MMSE, HbA1c and NSE. There were significant correlation of P300 in diabetic patients with HbA1c and NSE. CONCLUSION: Neurophysiological assessment of diabetic patients by NCS, SSEP and P300 have well evaluation of cognitive functions, painless, and painful diabetic polyneuropathy. NSE is a beneficial biomarker in diabetic patients to pick up neurological complications.

Global overview of refugees: comparison of 2005 and 2015 data for the 10 most affected countries.

BACKGROUND: The refugee problem has become a global concern with multidimensional characteristics. Monitoring migration flows over time and comparing the situation with a number of indicators can give clues on how to manage the problem. AIMS: In this study, the global refugee issue was discussed by focusing on such data including the potential factors causing crises in the most affected countries. METHODS: In this ecological study, the analysis was completed for the countries that either "host" or "source" refugees between 2005 and 2015. Excel-dataset was formed for United Nations Development Programme (UNDP), World Bank and United Nations High Commissioner for Refugees (UNHCR) datasets and were converted to SPSS-23.0. Mapping was done via pixelmap. RESULTS: In 2005, Pakistan, Islamic Republic of Iran, and the United States of America were the first three on the hosting country list, while Germany ranked 8th and China 9th. In 2015, Turkey ranked first as hosting country while previously it was not even in the top 10 countries. Geographical proximity plays a crucial role during displacement. Countries differ from each other according to the values of selected indices. CONCLUSIONS: Global solutions integrated with local precautions to reduce the worldwide burden of migration are required.

Pattern and outcome of acute kidney injury among Sudanese adults admitted to a tertiary level hospital: a retrospective cohort study.

INTRODUCTION: Little is known about the pattern and outcome of Acute Kidney injury (AKI) in Sudan. This study aimed to determine the etiology and outcome of AKI among Sudanese adults. METHODS: A retrospective cohort study was conducted in a tertiary level hospital, Soba University Hospital, Sudan. The medical records of all adults admitted to hospital from the 1st of January to 31st of December 2014 were reviewed. The diagnosis and severity of AKI was defined as per the Kidney Disease Improving Global Outcomes (KDIGO) recommendations. RESULTS: The medical records of 6769 patients were reviewed. AKI was diagnosed in 384 patients (5.7%); being community acquired in 82.6% of cases. Sepsis, volume depletion, obstructive uropathy, heart failure, acute glomerulonephritis and severe malaria were the commonest causes of AKI diagnosed in 44%, 38.5%, 8.9%, 5.7%, 4.7% and 3.1% of patients, respectively. Following treatment complete renal recovery was seen in 35.7% of patients; whereas 31.2% of patients died. Predictors of increased risk of death were old age [OR 1.03, 95% CI (1.01-1.057); P=0.003], presence of chronic liver disease [OR 2.877, 95% CI (1.5-5.5); P=0.001], sepsis [OR 2.51, 95% CI (1.912-4.493);P=0.002] and the severity of AKI [OR 3.873, 95% CI(1.498-10.013);P=0.005]. CONCLUSION: AKI was diagnosed in 5.7% of adults admitted to hospital. Most patients were having community acquired AKI. Old age, the presence of chronic liver disease, sepsis, and the severity of AKI as per KDIQO staging were significant predictors of mortality.

Relationship between functional and structural retinal changes in myopic eyes.

BACKGROUND: The aim of this study was to investigate the retinal structure in different grades of myopia and correlate it with the functional changes detected with multifocal electroretinogram (mf-ERG) and try to show the most important determining factors. METHODS: The study included 80 participants divided into four groups according to their spherical equivalent refractive error, namely, emmetropia (within ± 0.50 D), mild myopia group (greater than -0.50 to -3.00 D), moderate myopia group (more than -3.00 to -6.00 D) and high myopia group (greater than -6.00 D). Full ophthalmologic examination was performed for all participants, including visual acuity (VA), slitlamp examination, Goldmann applanation tonometry, indirect ophthalmoscopy, axial length (AL) measurement, retinal nerve fibre layer thickness assessment and mf-ERG stimulation. RESULTS: Axial length was significantly higher in myopes than emmetropes; also it was higher the greater the degree of myopia. There was a reduction in the amplitude and prolongation of implicit times of mf-ERG in myopia. Also P1 implicit time of the mf-ERG response was prolonged the greater the degree of myopia. The retinal nerve fibre layer was significantly thinner in myopic groups than the emmetropic group. The thinning of the retinal nerve fibre layer increased the more the degree of myopia. Multiple regression analysis of myopic patients showed that AL is the most important determinant of most of the mf-ERG five-rings retinal response density (RRD), mf-ERG four-quadrant (Q) RRD, most of the five-rings P1 amplitude and all five-rings latencies. The most important determinant factors of mean Q RRD were VA, AL and retinal nerve fibre layer thickness. CONCLUSION: The retina of the myope is subject to both structural and functional alterations compared to that of the emmetrope. Significant correlations exist between the functional and structural changes and can be explained on bases of longer AL and increasing myopic refraction.

Appropriate use of non-prescription ibuprofen: a survey of patients' perceptions and understanding.

OBJECTIVES: The aim was to investigate patients' perceptions and understanding on the appropriate use of non-prescription ibuprofen. METHODS: In this pilot study, a self-administered anonymous survey was completed by 183 patients presenting at one of the eight selected community pharmacy premises in South Australia and the Northern Territory during the study. The questionnaire comprised items on: demographics (age, gender), current medications, frequency of ibuprofen use, medical consultations, reading manufacturer's printed dosage/warning instructions, sources from which drug information was gathered and understanding of common indications for ibuprofen. KEY FINDINGS: Sixty per cent of patients (n = 110/183), predominantly females, were currently on other medications and 64.5% of patients (n = 118/183) did not seek medical advice before using non-prescription ibuprofen. Seventy-one per cent (n = 130) of these patients had used ibuprofen for more than a year. The majority of patients did not provide precise answers for the common indications of ibuprofen. Sixty-six per cent of patients (n = 110) reported rarely or never reading manufacturer's printed warning instructions on the potential drug interactions or adverse effects associated with the use of the product. CONCLUSIONS: Many patients are unaware that non-presciption analgesics such as ibuprofen can cause potentially serious adverse effects when used in combination with other common medications.