Exploring the hidden mental health consequences of malaria beyond the fever.

Malaria morbidity has various presentations and the focus now shifts to uncommon signs and symptoms of malaria infection such as cognitive impairment to address the morbidity when the mortality declines. About 50% of children admitted to hospitals due to malaria experience neurological complications due to factors like low blood sugar, inflammation, elevated pressure, decreased oxygen levels, and excitotoxicity. Malaria during pregnancy negatively also impacts children's cognitive, behavioral, and executive function leading to neurodevelopmental delay due to increased susceptibility which can significantly affect maternal and child health, leading to higher rates of underestimated factors like anxiety, depression, and PTSD. Despite having the world's second-largest tribal population, India's indigenous and tribal communities and their mental health are less explored and less understood. Western psychological tools and neurocognitive assessment tools are not universally applicable, thus necessitating the development of tailored tools to investigate psychological or neurocognitive impairment. This paper has illuminated the hidden mental health consequences of malaria infection, emphasizing the prevalence, nature, and implications of psychological distress among affected individuals. The findings underscore the importance of recognizing and addressing these psychological consequences in the holistic management and prevention of malaria and its mental health consequences.

The impact of cannabis use disorder on urologic oncologic surgery morbidity, length of stay, and inpatient cost: analysis of the National Inpatient Sample from 2003 to 2014.

PURPOSE: This study examined the impact of cannabis use disorder (CUD) on inpatient morbidity, length of stay (LOS), and inpatient cost (IC) of patients undergoing urologic oncologic surgery. METHODS: The National Inpatient Sample (NIS) from 2003 to 2014 was analyzed for patients undergoing prostatectomy, nephrectomy, or cystectomy (n = 1,612,743). CUD was identified using ICD-9 codes. Complex-survey procedures were used to compare patients with and without CUD. Inpatient major complications, high LOS (4th quartile), and high IC (4th quartile) were examined as endpoints. Univariable and multivariable analysis (MVA) were performed to compare groups. RESULTS: The incidence of CUD increased from 51 per 100,000 admissions in 2003 to 383 per 100,000 in 2014 (p < 0.001). Overall, 3,503 admissions had CUD. Patients with CUD were more frequently younger (50 vs. 61), male (86% vs. 78.4%), Black (21.7% vs. 9.2%), and had 1st quartile income (36.1% vs. 20.6%); all p < 0.001. CUD had no impact on any complication rates (all p > 0.05). However, CUD patients had higher LOS (3 vs. 2 days; p < 0.001) and IC ($15,609 vs. $12,415; p < 0.001). On MVA, CUD was not an independent predictor of major complications (p = 0.6). Conversely, CUD was associated with high LOS (odds ratio (OR) 1.31; 95% CI 1.08-1.59) and high IC (OR 1.33; 95% CI 1.12-1.59), both p < 0.01. CONCLUSION: The incidence of CUD at the time of urologic oncologic surgery is increasing. Future research should look into the cause of our observed phenomena and how to decrease LOS and IC in CUD patients.

Prognostic impact of liver resection side in peri-hilar cholangiocarcinoma: A systematic review and meta-analysis.

BACKGROUND: Perihilar cholangiocarcinoma (pCCA) is a highly lethal hepatobiliary cancer. Radical resection offers the best chance for extended survival, but the efficacy of left-sided hepatectomy (LH) versus right-sided hepatectomy (RH) remains controversial. METHODS: A systematic review and meta-analysis of non-randomized cohort studies comparing LH and RH in patients with resectable pCCA was conducted. Subanalyses were performed based on year of publication, region, number of cases and Bismuth classification (BC) ≥ III. RESULTS: Nineteen studies involving 3838 patients were included, with 1779 (46 %) undergoing LH and 2059 (54 %) undergoing RH. LH was associated with increased overall survival (OS) in subgroup analysis of studies reporting hazard ratios (HR) (logHR 0.59; p = 0.04). LH showed higher rates of arterial resection (14 % vs. 1 %), transfusion (51 % vs. 41 %), operation time (MD 31.44 min), and bile leakage (21 % vs. 18 %), but lower rates of post-hepatectomy liver failure (9 % vs. 21 %) and 90-day mortality (8 % vs 16 %). Three-year disease-free survival rates increased in Western centers but decreased in Eastern centers. CONCLUSION: LH is linked to higher OS in this analysis but is a more demanding technique. Resection side decision should consider several factors, including future liver remnant, tumor location, vascular involvement, and surgical expertise.

American Association for Thoracic Surgery Quality Gateway: A Surgeon Case Study of Its Application in Adult Cardiac Surgery for Quality Assurance.

OBJECTIVE: To demonstrate applying American Association for Thoracic Surgery Quality Gateway (AQG) outcomes models to a Surgeon Case Study of quality assurance in adult cardiac surgery. METHODS: The case study includes 6,989 cardiac and thoracic aorta operations performed in adults at Cleveland Clinic by one surgeon from 2001 to 2023. AQG models were used to predict expected probabilities for operative mortality and major morbidity, and to compare hospital outcomes, surgery type, risk profile, and individual risk-factor levels using virtual (digital) twin causal inference. These models were based on postoperative procedural outcomes after 52,792 cardiac operations performed in 19 hospitals of 3 high-performing hospital systems with overall hospital mortality of 2.0%, analyzed by advanced machine learning for rare events. RESULTS: For individual surgeons, their patients, hospitals, and hospital systems, the Surgeon Case Study demonstrated that AQG provides expected outcomes across the entire spectrum of cardiac surgery, from single-component primary operations to complex multi-component reoperations. Actionable opportunities for quality improvement based on virtual twins is illustrated for patients, surgeons, hospitals, risk profile groups, operations, and risk factors vis-à-vis other hospitals. CONCLUSIONS: Using minimal data collection and models developed using advanced machine learning, this case study shows that probabilities can be generated for operative mortality and major morbidity after virtually all adult cardiac operations. It demonstrates the utility of 21st century causal inference (virtual [digital] twin) tools for assessing quality for surgeons asking "How am I doing?" their patients asking "What are my chances?" and the profession asking "How can we get better?"

Population stratification based on healthcare trajectories: A method for encouraging adaptive learning at meso level.

This paper proposes a method to support population management by evaluating population needs using population stratification based on healthcare trajectories. Reimbursed healthcare consumption data for the first semester of 2017 contained within the inter-mutualist database were analysed to create healthcare trajectories for a subset of the population aged between 60 and 79 (N = 22,832) to identify (1) the nature of health events, (2) key transitions between lines of care, (3) the relative duration of different events, and (4) the hierarchy of events. These factors were classified using a K-mers approach followed by multinomial mixture modelling. Five population groups were identified using this healthcare trajectory approach: "low users", "high intensity of nursing care", "transitional care & nursing care", "transitional care", and "long time in hospital". This method could be used by loco-regional governing bodies to learn reflectively from the place where care is provided, taking a systems perspective rather than a disease perspective, and avoiding the one-size-fits-all definition. It invites decision makers to make better use of routinely collected data to guide continuous learning and adaptive management of population health needs.

Can Obstetrics and Gynecology Hospitalists Reduce Severe Maternal Morbidity?

Maternal mortality in the United States has risen steadily over the past 20 years. Several interventions including maternal mortality committees and safety bundles have been introduced to decrease the trend. Severe maternal morbidity is a more frequent occurrence related to maternal mortality and can be used to track interventions. Within safety bundles, the presence of well-trained on-site staff such as obstetrics and gynecology (OB/GYN) hospitalists is key to correct implementation. In this article, the authors review the role of OB/GYN hospitalists in specific diagnoses and the evidence present to date on OB/GYN hospitalists' role in decreasing severe maternal morbidity.

Diversity, Equity, and Inclusion: Obstetrics and Gynecologist Hospitalists' Impact on Maternal Mortality.

Obstetrics and gynecology hospitalists play a vital role in reducing maternal morbidity and mortality by providing immediate access to obstetric care, especially in emergencies. Their presence in hospitals ensures timely interventions and expert management, contributing to better outcomes for mothers and babies. This proactive approach can extend beyond hospital walls through education, advocacy, and community outreach initiatives aimed at improving maternal health across diverse settings.

Thirty-Day Surgical Morbidity and Mortality in Pelvic and Acetabular Fracture Patients Presenting to a Tertiary Care Hospital in Karachi, Pakistan.

INTRODUCTION: Pelvic fractures, encompassing a spectrum from minor to life-threatening injuries, pose challenges in trauma management. This study focuses on short-term outcomes, exploring morbidity and mortality within 30 days postoperative, among pelvic fracture patients at a tertiary care hospital in Karachi, Pakistan. The majority of pelvic injuries result from intense blunt trauma, with associated risks of concomitant injuries. Pelvic fractures are linked to early complications such as hemorrhage, thromboembolism, and infections, influencing mortality rates. METHODOLOGY: A prospective cohort study involving 53 surgically managed pelvic fracture patients was conducted at Aga Khan University Hospital, Karachi. Variables such as age, gender, comorbidities, mechanism of injury, associated injuries, and presenting vitals were documented. Thirty-day morbidity included surgical site infections, hemorrhagic shock, nerve injuries, and others. Statistical analyses assessed associations between patient characteristics and morbidity. RESULTS: The study revealed a median age of 37 years, with 77% male patients. Most fractures result from motor vehicle accidents. Morbidity occurred in 31.6% of cases, primarily associated with the presence of associated injuries. Postoperative complications included neurological deficits (15.1%) and pulmonary complications (9.4%). No 30-day mortality was reported. DISCUSSION: The study highlights the importance of a multidisciplinary approach in managing pelvic fractures, emphasizing the association between associated injuries and postoperative morbidity. Comorbidities did not significantly impact morbidity, emphasizing the traumatic nature's independent contribution. Timely presentation (median 20 hours) and efficient trauma systems are crucial for optimal outcomes. CONCLUSION: This research contributes insights into short-term outcomes following pelvic fracture fixation in a Pakistani tertiary care setting. By exploring a range of parameters, the study emphasizes the need for comprehensive management strategies to minimize complications and improve patient outcomes. Bridging critical knowledge gaps, this research informs clinical decision-making for pelvic fracture patients in this region.

Using Acidosis as a Surrogate for or Supplement to the Bedside Index of Severity in Acute Pancreatitis Scoring Prediction System Has a Nonsignificant Effect.

Currently, risk stratification calculators for acute pancreatitis (AP) can at best predict acute pancreatitis mortality at 12 hours from the presentation. Given the severe morbidity associated with AP, the identification of additional prognostic indicators, which may afford earlier prediction in length of stay (LOS) and mortality, is desired. Metabolic acidosis can be a prognostic marker for the severity of AP, and venous bicarbonate can reliably and accurately be substituted for arterial base deficit to detect metabolic acidosis. Since serum bicarbonate, anion gap (AG), and corrected AG (CAG) are routinely obtained upon presentation to the emergency department and often daily in the hospital, we conducted a retrospective analysis of 443 patients, evaluating if venous bicarbonate could predict the severity of pancreatitis as well as mortality, admission to the ICU, ICU LOS, and hospital LOS. The inclusion of venous bicarbonate, AG, and CAG in the first 12 hours only slightly improved the predictive capabilities of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score for these secondary outcomes. None of our incorporations of acidemia improved severity predictions more than the BISAP alone. Adding CAG to BISAP scoring had the largest effect on predicting ICU admission and hospital LOS (area under the curve (AUC): 1.12 (confidence interval (CI) 95%: 1.06-1.19), p <.001 and AUC 1.02 (CI 95% 1.01-1.04), p <.001; respectively). ICU LOS was not impacted by the addition of AG, CAG, or venous bicarbonate. In-hospital death (n=12) was too small to be determined.

Racial/ethnic disparity in severe maternal morbidity among women who conceived by in vitro fertilization.

Background: In vitro fertilization (IVF) as a fertility treatment is associated with adverse perinatal outcomes. Racial/ethnic disparity in severe maternal morbidity (SMM) in women who conceived by IVF is understudied. Objective: To examine differences in the association between race/ethnicity and SMM between women who conceived spontaneously and those who conceived using IVF. Methods: We included all singleton live births and stillbirths in the United States, 2016-2021; data were obtained from the National Center for Health Statistics. Maternal race/ethnicity included non-Hispanic White (NHW), non-Hispanic Black (NHB), American Indian and Alaska Native (AIAN), Asian, Pacific Islander (PI), Hispanic, and mixed-race categories. The SMM composite outcome included eclampsia, uterine rupture, peripartum hysterectomy, blood transfusion, and intensive care unit (ICU) admission. We used logistic regression to adjust for potential confounders (such as age, education, parity, prepregnancy body mass index, smoking during pregnancy, chronic hypertension, and preexisting diabetes) and to assess modification of the association between race/ethnicity and SMM by IVF. Results: The study population included 21,585,015 women: 52% were NHW, 15% NHB, 0.8% AIAN, 6% Asian, 0.2% PI, 24% Hispanic, and 2% were of mixed race. IVF was used by 183,662 (0.85%) women; the rate of the SMM composite outcome was 18.5 per 1000 deliveries and 7.9 per 1000 deliveries in the IVF and spontaneous conception groups, respectively (unadjusted rate ratio 2.34, 95% confidence interval [CI] 2.26-2.43). In women with spontaneous conception, NHB, Asian and mixed-race women had elevated odds of SMM compared with NHW women (adjusted odds ratio [aOR]=1.39, 95% CI 1.37-1.41; aOR=1.04, 95% CI 1.02-1.07; and aOR=1.42, 95% CI 1.38-1.46, respectively). Racial/ethnic disparities in SMM and its components were not different between the IVF and spontaneous conception groups for the mixed-race category. NHB and Hispanic women had significantly higher aORs for uterine rupture/intrapartum hysterectomy compared with NHW women in the IVF group, while Asian women had a higher aOR for ICU admission compared with NHW women in the IVF group. Conclusion: Women who conceived by IVF have a greater than two-fold higher risk of SMM and this higher risk is evident across all racial/ethnic groups. However, NHB and Hispanic women who conceived by IVF had a higher risk of uterine rupture/hysterectomy, and Asian women who conceived by IVF had a higher risk of ICU admission. Our results warrant further investigation examining pregnancy and postpartum care issues among racial/ethnic minority women who conceive using IVF.

[Loneliness as health risk: a narrative review]. / Einsamkeit als Gesundheitsrisiko: Eine narrative Übersichtsarbeit.

Loneliness is increasingly recognized as a significant health risk. This review provides an overview of current research on the impact of loneliness on mental and physical health. The findings indicate that loneliness is a significant risk factor of both mental and physical health. Previous reviews focusing on mental health effects reveal that loneliness is associated with the onset of depression, social anxiety, and cognitive decline. Furthermore, loneliness can impede recovery from mental disorders in general, which can be partly attributed to the bidirectional interplay between loneliness and mental health. Regarding physical health, consequences of loneliness have been mostly studied in relation to cardiovascular diseases. Loneliness predicts the onset of cardiovascular diseases and impedes recovery from them. Reviews also highlight that loneliness enhances the likelihood of suicidality and mortality. However, this article also points out the shortage of longitudinal studies, complicating the investigation into how loneliness causally affects future health problems. The health implications of loneliness outlined in this review, some of which are irreversible and can induce suffering and impairment, underscore the importance of interventions aimed at alleviating loneliness as a preventive strategy against both mental and physical illnesses.

The Economic Burden of Childhood Ocular Morbidity in Bangladesh.

INTRODUCTION: Childhood eye morbidity is a great public health problem, especially in low-income countries. This study aimed to determine the economic burden of childhood ocular morbidity on attending tertiary hospitals in Bangladesh. This study also assessed the catastrophic health expenditure (CHE) for childhood ocular morbidity in Bangladesh. METHODS: A cross-sectional mixed method was used for this study from April to October 2023 at two tertiary hospitals in Bangladesh, one government-funded and one private. Face-to-face interviews using a semi-structured quantitative questionnaire with the caregivers/parents and in-depth interviews (IDIs) were conducted among the same respondents of these two hospitals, and a workshop was conducted with the stakeholders during the study period. RESULTS: This was the first study in Bangladesh to determine the cost of pediatric ocular morbidity. Among 335 patients, the total median direct cost at a single time was 3740 ± 18,285 BDT (34 ± 166.2 USD) at the government hospital and 7300 ± 40,630 BDT (66.36 ± 369.36 USD) at the private hospital. The disease-specific median overall cost from diagnosis of the disease was 65,000 BDT (591 USD) for squint, 50,000 BDT (454.54 USD) for cataract, and 30,000 BDT (272.72 USD) for eye injury. Almost 90% of the caregivers/parents faced CHE due to different pediatric ocular morbidity. CONCLUSIONS: These cost estimates can be used as an initial basis for financial decisions that aim to enhance access to care, management, and follow-up of children with ocular morbidity. These cost estimates also offer helpful information for organizational and financial sustainability initiatives. Policymakers can consider serious immediate interventions for securing ocular health services in Bangladesh and prevent families from CHE.

Long-term mortality and morbidity after carotid endarterectomy for symptomatic and asymptomatic carotid stenosis.

OBJECTIVES: To investigate whether the occurrence of ischemic stroke due to carotid stenosis is a marker of the severity of atherosclerotic disease and of an excess risk of cardiovascular morbidity and mortality, and of all-cause mortality, after carotid endarterectomy. METHODS: Patients who had undergone a carotid endarterectomy (CEA) from June 2015 to august 2016 were included. Patients were classified into two groups, namely symptomatic and asymptomatic. Neurological event, myocardial infarction and death during early follow-up were monitored. Major adverse cardiovascular events (MACE), major limb events (MALE), and all-cause mortality were compared for patients with a CEA for an asymptomatic carotid stenosis versus those with a symptomatic stenosis. RESULTS: Among the 190 patients included, 86 (51%) had a CEA for an asymptomatic stenosis and 84 (49%) for a symptomatic stenosis. During the first 30 days, the rate of all-cause death or ischemic stroke was similar in both groups (1%, p=0.986). After 30 days, there were a total of 35 MACE (21.3%) and 15 MALE (9.1%) during mean follow-up of 53 (22.6) months. Overall cardiovascular morbidity and mortality was 30.4%, and did not differ between groups (p=0.565). New ischemic stroke occurred in 11 patients (9.1%) and was significantly more frequent in the asymptomatic group (9 (14.8%) vs 2 (3.6%) in the symptomatic group, (OR: 4.96; CI 95% [1.04-23.77]; p = 0.013)). Overall all-cause mortality was 24% in both groups (p=0.93) CONCLUSION: The occurrence of ischemic stroke of carotid origin prior to revascularization does not appear to be associated with an excess risk of cardiovascular morbidity or mortality or all-cause mortality after surgery.

Revisiting the Role of Balloon Atrial Septostomy Prior to the Arterial Switch Operation.

OBJECTIVES: Patients with dextro-transposition of the great arteries (d-TGA) frequently undergo balloon atrial septostomy (BAS) prior to the arterial switch operation (ASO) to promote atrial-level mixing. Balloon atrial septostomy has inherent risks as an invasive procedure and may not always be necessary. This study revisits the routine utilization of BAS prior to ASO. METHODS: Single-center, retrospective review of d-TGA patients undergoing the ASO from July 2018 to March 2023. Preoperative patient characteristics, pulse oximetry oxygen saturations (SpO2), cerebral/renal near-infrared spectroscopy (NIRS) readings along with prostaglandin status at the time of the ASO were analyzed with descriptive and univariate statistics. RESULTS: Thirty patients underwent the ASO. Of these, 7 (23%) were female, 25 (83%) were white, and median weight at ASO was 3.2 kg (range 0.8-4.2). Twenty-two (73%) patients underwent BAS. There were no demographic differences between BAS and no-BAS patients. Of those who underwent BAS, there was a significant increase in SpO2 (median 83% [range 54-92] to median 87% [range 72-95], P = .007); however, there was no change in NIRS from pre-to-post BAS. Six (27%) patients in the BAS group were prostaglandin-free at ASO. Balloon atrial septostomy patients underwent the ASO later compared with no-BAS patients (median 8 [range 3-32] vs 4 [range 2-10] days old, P = .016) and had a longer hospital length of stay (median 13 [range 7-43] vs 10 [range 8-131] days, P = .108). CONCLUSIONS: While BAS is an accepted preoperative procedure in d-TGA patients to improve oxygen saturations, it is also an additional invasive procedure, does not guarantee prostaglandin-free status at the time of ASO, and may increase the interval to ASO. Birth to direct early ASO, with prostaglandin support, should be revisited as an alternative, potentially more expeditious strategy.

Advances in the multidisciplinary surgical approach to primary spinal sarcomas: insights from a retrospective case series on outcomes and survival.

INTRODUCTION: The management of spinal sarcomas is complex, given their widespread involvement and high recurrence rates. Despite consensus on the need for a multidisciplinary approach with surgery at its core, there is a lack of definitive guidelines for clinical decision-making. This study examines a case series of primary spinal sarcomas, focusing on the surgical strategies, clinical results, and survival data to inform and guide therapeutic practices. METHODS: We conducted a retrospective analysis of patients who underwent surgical resection for primary spinal sarcomas between 2005 and 2022. The study focused on gathering data on patient demographics, surgical details, postoperative complications, overall hospital stay, and mortality within 90 days post-surgery. RESULTS: The study included 14 patients with a primary diagnosis of spinal sarcoma, with an average age of 48.6 ± 12.6 years. Chondrosarcoma emerged as the most common tumor type, representing 57.1% of cases, followed by Ewing sarcoma at 35.7%, and synovial sarcoma at 7.1%. Patients with chondrosarcoma were treated with en-bloc resection, while the patient with synovial sarcoma underwent intra-lesional excision and those with Ewing sarcoma received decompression and tumor debulking. Postoperative assessments revealed significant improvements in neurological conditions. Notably, functional status as measured by the Karnofski Performance Index (KPI), improved substantially post-surgery (from 61.4 to 80.0%) The mean follow-up was 34.9 ± 9.2 months. During this time period one patient experienced fatal bleeding after en-bloc resection complications involving the vena cava. None of the patient needed further surgery. CONCLUSIONS: Our 16-year study offers vital insights into managing primary spinal sarcomas, showcasing the effectiveness of surgical intervention, particularly en-bloc resection. Despite their rarity and complexity, our multidisciplinary treatment approach yields improved outcomes and highlights the potential for refined surgical strategies to become standardized care in this challenging domain.

Modified reconstruction approach after pancreaticoduodenectomy optimizes postoperative outcomes: Results from a multivariate cohort analysis.

Despite technical advances in recent decades and a decrease in hospital mortality (<5%), pancreaticoduodenectomy (PD) is still associated with major postoperative complications, even in high-volume centers. The present study aimed to assess the effect of a modified reconstruction technique on postoperative morbidity and mortality. A cohort study of all patients (n=218) undergoing PD between January 2010 and December 2019 was performed at Attikon University Hospital (Athens, Greece). Several variables were studied, including demographic data, past medical history, perioperative parameters, tumor markers and pathology, duration of hospitalization, postoperative complications, 30-day-survival, postoperative mortality and overall survival using multivariate logistic regression and survival analysis techniques. In this cohort, 123 patients [modified PD (mPD) group] underwent a modified reconstruction after a pylorus-preserving pancreaticoduodenectomy, which consisted of gastrojejunostomy and pancreaticojejunostomy on the same loop and an isolated hepaticojejunostomy on another loop. In the standard PD (StPD) group, 95 patients underwent standard reconstruction. The median age was 67 years, ranging from 25 to 89 years. Compared with in the StPD group, the mPD group had significantly lower rates of grade B and C pancreatic fistula (4.9% vs. 28.4%), delayed gastric emptying (7.3% vs. 42.1%), postoperative hemorrhage (3.3% vs. 20%), intensive care unit admission (8.1% vs. 18.9%), overall morbidity (Clavien-Dindo grade III-V: 14.7% vs. 42.0%), perioperative mortality (4.1% vs. 14.7%), and shorter hospitalization stay (11 days vs. 20 days). However, no difference was noted regarding median survival (35 months vs. 30 months). In this single-center series, a modified reconstruction after PD appears to be associated with improved postoperative outcomes. However, further evaluation in larger multi-center trials is required.

Respiratory Morbidity Among Seed-Processing Industry Workers: A Cross-Sectional Study in Rural West Bengal, 2022-2023.

Background: Seed processing workers are exposed to dust particles generated during the processing of seeds, which can have adverse effects on their respiratory health. Aim: to estimate the prevalence and patterns of respiratory morbidity among seed processing workers in Hooghly district, West Bengal, India, and to explore their use of respiratory personal protective equipment (PPE). Methods: A cross sectional observational study was conducted in 5 seed processing plants from December 2022 to February 2023. A sample size of 129 workers was selected using probability proportionate to population size to select seed processing plants and simple random sampling to select workers at selected plants. Data on sociodemographic characteristics, occupational profile, substance use patterns, respiratory PPE use, and respiratory symptoms were collected through structured interviews. Spirometry was performed with a hand held tabletop spirometer (RMS Helios 401) to assess respiratory function. Results: 52.7% of participants reported at least one chronic respiratory symptom, while 17.1% had evident respiratory morbidity based on spirometry results, with most having restrictive patterns (10.1%). Multivariable regression analysis revealed that factors associated with respiratory morbidity included increasing work years of exposure [1.10 (1.02 1.18)], irregular use of respiratory PPE [4.36 (1.22 15.57)], and primary or below education level [6.09 (1.38 26.98)]. Conclusion: The study highlights the high prevalence of respiratory symptoms and morbidity among seed processing workers. It emphasizes the importance of implementing effective respiratory protection measures and raising awareness about occupational lung diseases in this industry. Further research and interventions are needed to improve the respiratory health and well being of seed processing workers.

The impact of hygienic living conditions on the differentiation of male body height at the beginning of the twentieth century in the USSR.

BACKGROUND: The positive changes in hygienic living conditions are commonly believed to explain secular changes in body height and the age of maturity. However, it is difficult to estimate the separate impacts of these factors due to the lack of social and economic data and variations in the sources of information. We hypothesized that final male body height could be associated with various socioeconomic indicators, such as the development of the medical care system, the quality of nutrition, and the level of sanitary and hygienic conditions. Moreover, we hypothesized that male body height could be associated with the level of morbidity in the region during the time of conscript childhood (from 1 to 7 years old). MATERIALS AND METHODS: We used two main sources of information in the analyses. The first is the data from the Statistical Reference Book published by the Central Statistical Committee in 1929. The second is the annual data from the Statistical Reference Book published in the Russian Empire. Since the conscripts were born between 1906 and 1909, we used datasets from 1910 to 1913. To analyze the data, we used a method of analyzing interacting variables called St. Nicolas House Analysis (SNHA). RESULTS: Our analyses revealed direct associations between the morbidity of some diseases and male body height and other anthropometric parameters. CONCLUSIONS: There are associations between conscript final body height and the morbidity of influenza, dysentery and some venereal diseases, such as chancroid and syphilis. There were no associations between conscript final body height and the level of morbidity during childhood. However, other final parameters, such as BMI, weight, and chest circumference, could be associated with the morbidity of malaria, scabies, scurvy, and scarlet fever during childhood. The prevalence of these diseases could be strongly connected with unfavorable living conditions. The results are similar for both urban and rural areas.

Effect of group antenatal care versus individualized antenatal care on birth preparedness and complication readiness: a cluster randomized controlled study among pregnant women in Eastern Region of Ghana.

BACKGROUND: As utilization of individual antenatal care (I-ANC) has increased throughout sub-Saharan Africa, questions have arisen about whether individual versus group-based care might yield better outcomes. We implemented a trial of group-based antenatal care (G-ANC) to determine its impact on birth preparedness and complication readiness (BPCR) among pregnant women in Ghana. METHODS: We conducted a cluster randomized controlled trial comparing G-ANC to routine antenatal care in 14 health facilities in the Eastern Region of Ghana. We recruited women in their first trimester to participate in eight two-hour interactive group sessions throughout their pregnancies. Meetings were facilitated by midwives trained in G-ANC methods, and clinical assessments were conducted in addition to group discussions and activities. Data were collected at five timepoints, and results are presented comparing baseline (T0) to 34 weeks' gestation to 3 weeks post-delivery (T1) for danger sign recognition, an 11-point additive scale of BPCR, as well as individual items comprising the scale. RESULTS: 1285 participants completed T0 and T1 assessments (N = 668 I-ANC, N = 617, G-ANC). At T1, G-ANC participants were able to identify significantly more pregnancy danger signs than I-ANC participants (mean increase from 1.8 to 3.4 in G-ANC vs. 1.7 to 2.2 in I-ANC, p < 0.0001). Overall BPCR scores were significantly greater in the G-ANC group than the I-ANC group. The elements of BPCR that showed the greatest increases included arranging for emergency transport (I-ANC increased from 1.5 to 11.5% vs. G-ANC increasing from 2 to 41% (p < 0.0001)) and saving money for transportation (19-32% in the I-ANC group vs. 19-73% in the G-ANC group (p < 0.0001)). Identifying someone to accompany the woman to the facility rose from 1 to 3% in the I-ANC group vs. 2-20% in the G-ANC group (p < 0.001). CONCLUSIONS: G-ANC significantly increased BPCR among women in rural Eastern Region of Ghana when compared to routine antenatal care. Given the success of this intervention, future efforts that prioritize the implementation of G-ANC are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04033003 (25/07/2019). PROTOCOL AVAILABLE: Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/ .