Women Anesthesiologists in Sub-Saharan Africa in the Pre-COVID Era: A Multinational Demographic Study.

BACKGROUND: Gender imbalance and poor representation of women complicate the anesthesiology workforce crisis in sub-Saharan Africa (SSA). This study was performed to obtain a better understanding of gender disparity among medical graduates and anesthesiologists in SSA. METHODS: Using a quantitative, participatory, insider research study, led by female anesthesiologists as the national coordinators in SSA, we collected data from academic or national health authorities and agencies. National coordinators were nominees of anesthesiology societies that responded to our email invitations. Data gathered from 13 countries included information on medical graduates, anesthesiologists graduating between 1998 and 2021, and number of anesthesiologists licensed to practice in 2018. We compared data between Francophone and Anglophone countries, and between countries in East Africa and West Africa/Central Africa. We calculated anesthesiology workforce densities and compared representation of women among graduating anesthesiologists and medical graduates.Data analysis was performed using linear regression. We used F-tests on regression slopes to assess the trends in representation of women over the years and the differences between the slopes. A value of P < .050 was considered statistically significant. RESULTS: Over a 20-year period, the representation of female medical graduates in SSA increased from 29% (1998) to 41% (2017), whereas representation of female anesthesiologists was inconsistent, with an average of 25%, and lagged behind. Growth and gender disparity patterns were different between West Africa/Central Africa and East Africa. Representation of female anesthesiologists was higher in East Africa (39.4%) than West Africa/Central Africa (19.7%); and the representation of female medical graduates in East Africa (42.5%) was also higher that West Africa/Central Africa (33.1%). CONCLUSIONS: On average, in SSA, female medical graduates (36.9%), female anesthesiologists (24.9%), and female anesthesiology residents projected to graduate between 2018 and 2022 (25.2%) were underrepresented when compared to their male counterparts. Women were underrepresented in SSA, despite evidence that their representation in medicine and anesthesiology in East African countries was rising.

Excessive screen viewing time by adolescents and body fatness in a developing country: Vietnam.

BACKGROUND AND OBJECTIVES: Screen time among youth has been increasingly recognized as a public health problem because of its link with obesity. This has been demonstrated in many studies conducted in developed countries but few studies have addressed the problem in developing countries, despite an increase literature about the emergence of obesity and a greater access to screen devices in a country like Vietnam. Our study aimed at assessing screen time and its relationship with BMI in adolescents of Ho Chi Minh City (HCMC), Vietnam. METHODS AND STUDY DESIGN: In a cross-sectional study of 2024 junior high school students aged 11-14 of HCMC, students were measured for BMI and questioned on time spent watching television/Video/DVD or using computer for fun. High users were defined as time >=2 h/d. International Obesity Task Force BMI cutoffs were used to define overweight and obesity. RESULTS: Adolescents spent 2.2 h/d in screen time, with higher values for boys than girls (p<0.001). 53.8% of the respondents were high users. Time spent using computers for fun increased with age, and with the household wealthy index. The overall prevalence of overweight and obesity was 21.1%. Using multiple logistic regression, overweight and obesity was higher in boys (adjusted OR=2.66, 95% CI: [2.06; 3.44], p<0.001) and in children aged 11-12 who had a screen time >=2 h/d (adjusted OR=1.48, 95% CI: [1.09; 1.99], p<0.02). CONCLUSIONS: In HCMC, a majority of adolescents spent >=2 h/d on screen time. High screen time is associated with an increased prevalence of overweight and obesity in young adolescents. Public health intervention programs are needed to reduce screen time among youth.

High prevalence of overweight among adolescents in Ho Chi Minh City, Vietnam.

BACKGROUND: Two previous surveys conducted in Ho Chi Minh City revealed an increasing prevalence of overweight and obese adolescents, from 5.9% in 2002 to 11.7% in 2004. From 2004 to 2010, the government set up and implemented health promotion programs to promote physical activity and good nutritional habits in order to prevent overweight and obesity in children and adolescents. Our study aimed to estimate the prevalence of overweight and obesity among adolescents in urban areas of Ho Chi Minh City in 2010. METHODS: A representative sample of 1,989 students aged 11-14 years was selected using a multistage cluster sampling method. 23 schools were randomly selected from the full list of all public junior high schools. In each selected school, 2 classes were chosen at random and all students from the class were examined. Age- and sex-adjusted overweight and obesity were defined using International Obesity Taskforce cut-offs. RESULTS: The prevalences of overweight and obesity were 17.8% and 3.2%, respectively. Prevalences of overweight and obesity were significantly higher in boys (22%, 5.4% ) than in girls (13.3%, 1.3%, p<0.001) and higher in children from districts with a high economic level (20.5% , 3.8% ) than in those from districts with a low economic level (12.1%, 3.8%, p<0.001). Additionally, children living in wealthier families were more overweight and obese than those living in less wealthy families. When using WHO cutoffs, the overall prevalences of overweight and obesity reached 19.6% and 7.9%, respectively. CONCLUSION: Our study's findings suggest that the prevalence of overweight and obesity among secondary school students remains high, especially among boys living in wealthier families. Public health programs should therefore be developed or improved in order to promote good eating habits and physical activity among youth in HCMC.

Superiority of big endothelin-1 and endothelin-1 over natriuretic peptides in predicting survival in severe congestive heart failure: a 7-year follow-up study.

BACKGROUND: Plasma concentrations of atrial and brain natriuretic peptides (ANP, BNP), of their N-terminal pro-peptides, of endothelin-1 (ET-1), and big endothelin-1 (big ET-1) have diagnostic and prognostic significance in congestive heart failure (CHF). However, their respective values as a predictor of survival remain controversial and have never been directly compared in severe CHF. METHODS AND RESULTS: We analyzed, in 47 patients with severe CHF (New York Heart Association [NYHA] class III to IV; age 66 +/- 8 years, ejection fraction 20 +/- 6%), the prognostic performance of a panel of neurohormones and assays (N-terminal pro-ANP 1-25, 68-98 by radioimmunoassay [RIA], and 1-98 by enzyme-linked immunosorbent assay [ELISA], BNP by RIA and immunoradiometric assay [IRMA], N-terminal pro-BNP by Elisa, ET-1 by RIA, and big ET-1 by RIA and Elisa. Data were compared with 40 patients with mild to moderate CHF [NYHA I-II] and 30 healthy subjects. After a follow-up of 81 +/- 15 months, there were 34 deaths and 1 heart transplant. All neurohormones were significantly higher at baseline in patients with severe than in mild to moderate CHF or healthy subjects (all P < .001). Although all neurohormones but BNP IRMA were significant predictors of survival in univariate analysis, only big ET-1 RIA and ET-1 were independent predictors of survival (improvement chi(2): 7.5 and 4.6, P < .01 and P < .05). Using medians as cutpoints of big ET-1 RIA and ET-1, 2 severe CHF populations were defined with a different outcome (5-year survival: 55 versus 18%, P < .01). CONCLUSIONS: Big ET-1 and ET-1 are strong independent predictors of survival in patients with severe CHF and better for this purpose than natriuretic peptides or their pro-peptides. These markers allow easily to identify a population with a very high risk mortality eligible for more aggressive therapies.

Which MR-derived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative study between relative and quantitative measurements.

PURPOSE: To compare predictors of infarct growth in hyperacute stroke from a retrospective review of various relative and quantitative parameters calculated at perfusion-weighted magnetic resonance (MR) imaging performed within 6 hours after ictus. MATERIALS AND METHODS: Fluid-attenuated inversion recovery and diffusion- and perfusion-weighted images were obtained in 66 patients. The initial infarct was delineated on diffusion-weighted images; the hemodynamic disturbance, on apparent mean transit time (MTT) maps; and the final infarct, on follow-up fluid-attenuated inversion recovery images. Relative (without and with deconvolution) and quantitative values of the bolus arrival time, time to peak (TTP), apparent MTT or MTT, cerebral blood volume (CBV), peak height, and cerebral blood flow (CBF) index or CBF were calculated for initial infarct, infarct growth (final minus initial infarct contour), viable hemodynamic disturbance (apparent MTT minus final infarct contour), and contralateral mirror regions. Univariate and multivariate analyses (receiver operating characteristic curves and discriminant analysis) were performed to compare the diagnostic performance of these parameters for predicting infarct growth. RESULTS: At univariate analysis, relative peak height and quantitative CBF were the best predictors of infarct growth; at multivariate analysis, a function of peak height and TTP for relative measurements and CBF alone for quantitative measurements. Quantitative and relative measurements (without or with deconvolution) worked equally well. A combined relative peak height or TTP threshold (<54% or >5.2 seconds, respectively) had a sensitivity of 71% and a specificity of 98%. A quantitative CBF threshold (<35 mL/min/100 g) had a sensitivity of 69% and a specificity of 85%. CONCLUSION: A combination of relative peak height and TTP measurements allowed the best prediction of infarct growth, which obviates more complex quantitative calculation.