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Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85 % of the households were food insecure, with 50 % being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household purchasing power was eroded due to worsened unemployment situation. The use of negative coping strategies to address food insecurity such as reducing the number of meals, reducing food variety and quality, scavenging, and eating street foods was prevalent. In conclusion, this study describes the deeply intertwined nature of chronic poverty and acute crisis, and the subsequent high levels of food insecurity in urban slum settings. Households are extremely vulnerable to food insecurity; the situation worsening during periods of crisis in the perception of slum residents, engendering frequent use of negative coping strategies. Effective response to addressing vulnerability to household food insecurity among the urban poor should focus on both the underlying vulnerabilities of households due to chronic poverty and added impacts of acute crises. [ABSTRACT FROM AUTHOR]

Irradiation of the small intestine can result in depletion of the epithelial stem cell compartment and is often the dose-limiting factor for radiotherapeutic treatment of tumors in the abdominal and pelvic region. Since mitotic cells are most sensitive to radiation, significant radioprotection can be achieved by reducing the number of cells in mitosis at the time of irradiation. We have previously shown that administration of macrophage inflammatory protein (MIP) -1alpha induces a transient 50% reduction in the number of mitotic cells in small intestinal crypts, including the stem cell region, and therefore, MIP-1alpha pretreatment before radiation exposure could result in a substantial reduction of the side effects associated with radiotherapy. Groups of adult mice were exposed to different doses of radiation (6, 8, 10, or 12 Gy), with or without prior administration of 200 microg BB-10010/kg 3 hr before irradiation and radiation damage was assessed by means of the microcolony survival assay. MIP-1alpha pretreatment resulted in significantly increased numbers of surviving crypts (10%) when compared to untreated irradiated animals. The observed radioprotective effects of MIP-1alpha in the small intestine should translate into reduced side effects in a clinically relevant radiotherapy context and could allow larger doses of radiation to be delivered to patients with tumors in the abdominal or pelvic region. [ABSTRACT FROM AUTHOR]

BB10010/MIP-1 alpha reduces the number of proliferating cells in the small intestine, strongly suggesting a radioprotective potential in this organ. This study was designed to optimize BB10010 administration for maximal radioprotection. In single administration protocols 1 or 4 mg/kg of BB10010 was injected into mice 2, 4 or 10 hr before death. In double administration protocols an initial dose of either 0.4 or 200 microg/kg, and a second dose (2.5 hr apart) of 200 microg/kg 4 hr before death were administered. The number of vincristine-arrested metaphases were counted on individually microdissected crypts from the midpoint of the small intestine. When compared to the smaller doses of BB 10010 used in our previous studies, the higher doses used in these experiments did not result in any further reduction in the number of proliferating cells under any of the protocols assessed. Furthermore, some values were found to be above not only those observed with the smaller doses, but also above untreated controls. It is concluded that a single dose of 200 microg/kg of BB10010 offers the most consistent reduction of mitotic cells, and is, therefore, considered optimal for assessment of radioprotection. [ABSTRACT FROM AUTHOR]

Climate finance stakeholders across Africa have long sought to understand the complex nature of the climate cash flow architecture. Distribution models are critical mathematical tools for generating the general characteristics of the cash flow that are used to inform policy decisions. In this paper, we undertake a comprehensive investigation of the climate funds flowing into sub-Saharan Africa (SSA) by suggesting candidate climate finance models that can be used by policy makers to design simulations that can aid in assessing climate risks, identify more efficient climate finance schemes, and obtain optimal control parameter settings under different scenarios. This is achieved by considering climate finance as a form of insurance. Different dimensions of the data are examined following four distinct groupings of the data set. This is to account for different views of risk by the various climate finance participants. The frequency and severity of the approved funds are analyzed with the aid of various mathematical distribution models and regression analyses. The dynamics of a given variable relative to varying scenarios are examined. The findings obtained confirm the presence of emerging risks induced by the nature of the flow. Central Africa for instance records the lowest theme-specific projects and mitigation finance accounts for more than half of all the climate funds while sectoral-wise, adaptation finance is majorly concentrated in the energy sector. The perpetuation of the observed inequalities across the themes, subregions and sector-specific climate-related projects portends grave consequences as these risks begin to accumulate over time. The Burr mixture model best fitted the approved projects' cost distribution and the factors driving the frequency and severity of approved projects ranged from Central Africa to projects in the general environment sector. One of the policy recommendations emphasized was the need to adopt a risk-adjusted distribution model for climate finance allocation in SSA. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Historically, the sacrospinous ligament (SSL) has been used to treat POP in order to restore the apical compartment through a posterior or an anterior vaginal approach. The SSL is located in a complex anatomical region, rich in neurovascular structures that must be avoided to reduce complications such as acute hemorrhage or chronic pelvic pain. The aim of this three-dimensional (3D) video describing the SSL anatomy is to show the anatomical concerns related to the dissection and the suture of this ligament. Methods: We conducted a research of anatomical articles about vascular and nerve structures located in the SSL region, in order to increase the anatomical knowledge and show the best placement of sutures to reduce complications related to SSL suspension procedures. Results: We showed the medial part of the SSL to be most suitable for the placement of the suture during SSL fixation procedures, in order to avoid nerve and vessel injuries. However, nerves to the coccygeus and levator ani muscle can course on the medial part of the SSL, the portion of the SSL where we recommended to pass the suture. Conclusions: Knowledge of the SSL anatomy is crucial and during surgical training it is clearly indicated to stay far away (almost 2 cm) from the ischial spine to avoid nerve and vascular injuries. [ABSTRACT FROM AUTHOR]

Background: The achievement of the global agenda on universal health coverage (UHC) is pivotal in ensuring healthy lives and promoting the well-being of all. However, achieving healthy lives and wellbeing of all has been hampered by the challenge of health care financing. As such, healthcare financing, through health insurance is gaining popularity in developing countries such as Kenya, in their pursuit to achieve universal health coverage. The primary purpose of health insurance and delivery is to improve health. However, there is a paucity of evidence on the effectiveness of health insurance in improving the health outcomes and health status of the Kenyan population. Therefore, this study aimed to analyze the impact of health insurance on health outcomes in Kenya. Methods: The study utilized the most recent nationally representative Kenya Integrated Household Budget Survey (KIHBS) 2015/16 dataset in order to analyze the impact of health insurance on health outcomes. The instrumental variable 2-stage least squares (IV 2SLS) and control function approach (CFA) estimation techniques were used to cater for potential endogeneity and heterogeneity biases present in ordinary least squares (OLS) estimators. Results: Health insurance enrolment leads to a reduction in mortality, thereby improving the health status of the Kenyan population, despite low levels of insurance uptake. However, the insured population experienced higher chronic illnesses and out-of-pocket (OOP) expenditures raising concerns about financial risk protection. The fact that health insurance is linked to chronic illnesses not only reinforces the reverse causality of health insurance and health status, but also that the effects of potential adverse selection strongly drive the strength and direction of this impact. Conclusions: We conclude that health insurance enrolment reduces mortality and hence has a beneficial impact in promoting health. Health insurance coverage therefore, should be promoted through the restructuring of the National Hospital Insurance Fund (NHIF) fragmented schemes and by consolidating the different insurance schemes to serve different population groups more effectively and equitably. The government should revisit the implementation of a universal social health insurance scheme, as a necessary step towards UHC, while continuing to offer subsidies in the form of health insurance to the marginalized, vulnerable and poor populations. [ABSTRACT FROM AUTHOR]

Environmental problems are very concerning, particularly in many cities of developing countries, because they obstruct the creation of a sustainable urban environment. Dhaka, Bangladesh was chosen as the research area of this study, as Bangladesh is a developing country with pollution; moreover, the level of residents' environmental perception was assessed, and their environmental attitudes and awareness were examined in relation to their demographic characteristics. A face-to-face questionnaire survey involving 400 respondents was conducted across various zones of the study area. The mean score, standard deviation, and p value of each respondent's answer were calculated separately using a one-way analysis of variance (ANOVA). Then, a grand mean, average standard deviation, and combined p values for environmental perception and attitude themes were computed theme-wise. Descriptive statistics were produced to illustrate the respondents' level of environmental awareness. The study results revealed that the respondents had a moderate to high level of perceived knowledge about the causes and effects of environmental pollution. They also had an intention to reduce the environmental pollution in their surroundings. The score differences (p <.05) across the age groups, education levels, occupation types, and income groups were nearly all significant, except for those pertaining to the gender of the respondents. Surprisingly, only 18% of the respondents were aware of their home's and neighborhood's garbage management procedures. It is urgent to influence citizens' environmental behaviors to ensure the city's long-term sustainability. This study's findings can be used in decision-making processes regarding sustainable urban environments worldwide. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Sacrospinous ligament (SSL) fixation is an effective and widely used vaginal procedure for correcting apical prolapse. The Saffron Fixation System (Coloplast Corp., Minneapolis, MN, USA) is a new anchoring device aimed at facilitating a durable, easy, and short procedure for SSL fixation with the goal of minimizing operative complications. The objective was to demonstrate the efficacy and safety of anchor deployment and suture fixation for pelvic organ prolapse repair using the Saffron Fixation System. Methods: An observational human cadaver study was conducted to measure the distance between anchor location and anatomical landmarks in the pelvis, and the holding force of the fixated anchors. Anchors were placed in four human cadavers by different implanters. The pull-out force of these anchors was measured to assess efficacy (three cadavers by three implanters) and the distance between anchors and primal vessels and nerves was measured to assess safety (one cadaver by one implanter). Results: Nineteen out of 20 anchors (95%) were correctly placed as judged by independent assessment performed by non-implanting surgeons. Distance between anchors and surrounding nerves and vessels exceeded 10 mm. Mean (SD) pull out-force was 17.9 (5.6) N. Conclusion: The innovative anchoring device that was developed appeared to enable precise and solid anchor placement in the SSL. Future clinical studies are needed to explore if the theoretical advantages of this device translate to improved clinical outcomes in comparison with available suturing and anchoring devices. [ABSTRACT FROM AUTHOR]

Background: Transvaginal suspension procedures often use the sacrospinous ligament (SSL), which attaches onto the ischial spine (IS). However, nerve-related sequelae (e.g., sciatic nerve injury) following such procedures have been reported. Therefore, the current anatomical study was performed to better understand these relationships. Additionally, three case illustrations of patients with injury to the sciatic nerve following sacrospinous ligament suspension procedures are included to exemplify the significance of a thorough knowledge of this anatomy. Methods: In 20 human adult cadavers (40 sides), a gluteal dissection was performed to expose the IS and SSL and regional nerves near the greater sciatic foramen. Measurements between the IS and SSL were made between these structures and surrounding nerves. Results: The average distance between the IS and sciatic nerve was 1.4 cm. From this bony part, the average distance to the S1 and S2 ventral rami was 3.1 cm and 1.9 cm, respectively. From the IS to the lumbosacral trunk, pudendal nerve, nerve to obturator internus, and superior gluteal nerve, the mean distance was 4 cm, 0.5 cm, 0.7 cm, and 4.5 cm, respectively. From the SSL to the lumbosacral trunk, S1 ventral ramus, and S2 ventral ramus, there was an average distance of 4.2 cm, 1.6 cm, and 0.8 cm, respectively. Statistically, in females, the distances from the IS and SSL to the sciatic nerve, lumbosacral trunk, superior gluteal nerve, and S1 and S2 ventral rami were shorter when compared to males. Conclusion: An improved understanding of the relationship between the SSL and IS and nerves near the greater sciatic foramen can lead to fewer intraoperative complications during approaches to various peripheral nerves in this region. Lastly, these relationships might help better understand the nerve injuries following pelvic suspension procedures that use the SSL. [ABSTRACT FROM AUTHOR]

In recent decades, the possibility that climate change will lead to depopulation of vulnerable areas in the global tropics via migration, mortality, or collapsing fertility has generated significant concern. We address this issue by using data on subnational population growth from 1809 subnational units across the global tropics and linked data on climate exposures to examine how decadal temperature and precipitation anomalies influence population-weighted intercensal growth rates. Our fixed-effects regression analysis reveals that the lowest predicted population growth rates occur under hot and dry conditions. The effects of heat and drought are strongest in districts that, at baseline, have high population densities, high precipitation rates, or high educational attainment. These patterns are contrary to common assumptions about these processes, and even the rare combination of hot and dry conditions, occurring in less than 7% of our sample, does not lead to local depopulation. Taken together with previous findings, this suggests that depopulation narratives do not have a strong evidentiary basis. [ABSTRACT FROM AUTHOR]

This paper presents a simultaneous equation, knowledge and perception-based averting behavior model of health risk caused by air pollution, with application to the Jinchuan mining area, China. Three types of averting behavior are distinguished: (a) purchases of purifying equipment, plants, or masks; (b) purchases of preventive or curing medication or food; and (c) adjustment of daily outdoor activities. Two types of perceived health risk are distinguished: (a) risk due to the intensity of exposure and (b) risk caused by the hazardousness of pollutants. The estimations show that an increase in perceived air pollution of two or more days a week leads to a restriction of outdoor activities of approximately 90 min per person per week. Another result is that the average annual household expenditure on air filters, foods, or medicines is 206.25 CNY (US$ 31.73) to prevent the hazardousness of air pollution. The total willingness to pay for air quality improvement is 2.95% of annual net household income. Because air quality improving investments can only be implemented in the medium or long run, daily disclosure of air quality is an adequate short-run policy handle to assist residents to take the right kind and level of risk-reducing actions. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The high prevalence of pelvic organ prolapse (POP) in women requires attention and constant review of treatment options. Sacrospinous ligament fixation (SSLF) for apical prolapse has benefits, high efficacy, and low cost. Our objective is to compare anterior and posterior vaginal approach in SSLF in relation to anatomical structures and to correlate them with body mass index (BMI). Methods: Sacrospinous ligament fixation was performed in fresh female cadavers via anterior and posterior vaginal approaches, using the CAPIO®SLIM device (Boston Scientific, Natick, MA, USA). The distances from the point of fixation to the pudendal artery, pudendal nerve, and inferior gluteal artery were measured. Results: We evaluated 11 cadavers with a mean age of 70.1 ± 9.9 years and mean BMI 22.4 ± 4.6 kg/m2. The mean distance from the posterior SSLF to the ischial spine, pudendal artery, pudendal nerve, and inferior gluteal artery were 21.18 ± 2.22 mm, 17.9 ± 7.3 mm, 19.2 ± 6.8 mm, and 18.9 ± 6.9 mm respectively. The same measurements relative to the anterior SSLF were 19.7 ± 2.7 mm, 18.6 ± 6.7 mm, 19.2 ± 6.9 mm, and 18.3 ± 6.7 mm. Statistical analysis showed no difference between the distances in the two approaches. The distances from the fixation point to the pudendal artery and nerve were directly proportional to the BMI. Conclusions: There was no difference in the measurements obtained in the anterior and posterior vaginal approaches. A direct correlation between BMI and the distances to the pudendal artery and pudendal nerve was found. [ABSTRACT FROM AUTHOR]

The link between air pollution and individual happiness is widely documented. However, the role of social engagement in pollution reduction is seldom considered in the nexus. As such, using large individual-level data from the Gallup World Poll of 151 countries for 2005–2018, this study applies a pooled cross-sectional data approach (controlling for country and year fixed effects) to examine the impact of air pollution on individual happiness and the role of social engagement in shaping the pollution-happiness relationship. The key findings of this study reveal that better air quality raises personal subjective well-being, given that the coefficient of individuals' perceived air quality is positive and statistically significant. More importantly, social engagement in pollution reduction is found to play an important moderating role in shaping the pollution-happiness relationship. Moreover, using a series of robustness checks, such as applying an alternative measure of happiness, an alternative measure of air quality (objective air quality), and using an instrumental variable estimation approach, confirms the positive effect of air quality (perceived or objective) on improving individuals' happiness and the moderating role of social engagement. Furthermore, this study reveals that different demographic characteristics (i.e., age, sex, income, marital status, and urban/rural residence) respond differently to the adverse effects of air pollution and the moderating role of social engagement in pollution reduction. Thus, some policies can be revised and proposed in light of the novel findings of social engagement. In particular, the government should take an active role in combating air pollution and improving air quality by increasing financial input and strengthening environmental protection publicity. The limitations of the study and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Only few studies outside of the US have addressed the issue of out-of-pocket payments (OOP) at the end of life because of a lack of data. We use an exclusive dataset from a major French health insurance company (MGEN), including claim data, both mandatory and voluntary health insurance details, income and individual characteristics, for individuals aged 65 or older who died in 2017. We address three main issues: (1) What is the magnitude of OOP in France at the end of life? (2) How are OOP distributed, and do they present a financial risk to patients? (3) What are the determinants of OOP and what health system reforms could reduce them? Our results indicate that OOP expenses increase in the last year of life and accelerate in the last trimester. Despite some outliers, the French system is successful in protecting individuals from catastrophic OOP. Using generalised linear models, we confirm that improving the pathways of care could generate savings and partially reduce households' financial burden. However, OOP are elastic to income and driven essentially by personal convenience demands. Using concentration curves and Gini coefficients, we show that providing additional insurance against end-of-life OOP would likely be regressive, i.e., socially non-desirable. [ABSTRACT FROM AUTHOR]

Curriculum mapping is a method in which teachers record the operational curriculum to be used for ongoing curriculum review and development. Therefore, schools aim to establish a fluid system for maintaining and updating the curriculum. As teachers are the main practitioners of curriculum mapping, this study aimed to investigate the factors that impact teachers' attitudes towards an online curriculum mapping tool. In this study we employedthe Technology Acceptance Model (TAM) to examine the attitudes of the academic staff in a private school in Dubai towards the use of a curriculum mapping tool and whether the staff role impacted their perceptions. Also, we examined the factors that impact perceived ease of use and perceived usefulness of the curriculum mapping tool. The external factor considered as a determinant of perceived usefulness is relevance, which is studied in terms of long-term planning, short-term planning, curriculum alignment, teachers' collaboration, and students' achievement. The factors considered as determinants of perceived usefulness are training and time. The results indicated that the staff did not have significant positive attitudes towards the tool. Also, while perceived ease of use and actual usage were significantly high, perceived usefulness was significantly low. The results also showed that there were no differences in perceptions according to the staff role except for perceived usefulness, which was significantly higher for leaders compared to teachers. Results also indicated that perceived short-term planning and teacher collaboration were good predictors of perceived usefulness, while perceived training and time were good predictors of perceived ease of use. The results reflect a shallow understanding of the theory that underlies the use of the curriculum mapping tool. School leaders should dedicate time and resources to extend communication about the purpose of curriculum mapping and how the mapping tool can help the process. [ABSTRACT FROM AUTHOR]

This study aims to examine the relationship between daily temperature and mortality in the Klang Valley, Malaysia, over the period 2006–2015. A quasi-Poisson generalized linear model combined with a distributed lag non-linear model (DLNM) was used to estimate the association between the mean temperature and mortality categories (natural n=69,542, cardiovascular n= 15,581, and respiratory disease n=10,119). Particulate matter with an aerodynamic diameter below 10 μm (PM10) and surface ozone (O3) was adjusted as a potential confounding factor. The relative risk (RR) of natural mortality associated with extreme cold temperature (1st percentile of temperature, 25.2 °C) over lags 0–28 days was 1.26 (95% confidence interval (CI): 1.00, 1.60), compared with the minimum mortality temperature (28.2 °C). The relative risk associated with extremely hot temperature (99th percentile of temperature, 30.2 °C) over lags 0–3 days was 1.09 (95% CI: 1.02, 1.17). Heat effects were immediate whereas cold effects were delayed and lasted longer. People with respiratory diseases, the elderly, and women were the most vulnerable groups when it came to the effects of extremely high temperatures. Extreme temperatures did not dramatically change the temperature-mortality risk estimates made before and after adjustments for air pollutant (PM10 and O3) levels. [ABSTRACT FROM AUTHOR]

Introduction: High childhood vaccine adherence is critical for disease prevention, and poverty is a key barrier to vaccine uptake. Interventions like microfinance programs that aim to lift individuals out of poverty could thus improve vaccine adherence of the children in the household. BIGPIC Family Program in rural Western Kenya provides group-based microfinance services while working to improve access to healthcare and health screenings for the local community. The aim of the present paper is to evaluate the association between household participation in BIGPIC's microfinance program and vaccine adherence among children in the household. We hypothesize that microfinance group participation will have a positive impact on vaccine adherence among children in the household. Methods: From 2018 to 2019, we surveyed a sample of 300 participants from two rural communities in Western Kenya, some of whom were participants in the BIGPIC Family's microfinance program. The primary outcome of interest was vaccine adherence of children in the household. Log-binomial models were used to estimate the relationship between microfinance group participation and vaccine adherence, adjusted for key covariates. We also assessed whether the relationship differed by gender of the adult respondent. Results: Microfinance group members were more likely to have all children in their households fully vaccinated [aPR (95% CI): 1.68 (1.20,2.35)] compared to non-microfinance group members. Further, the association was stronger when women were the microfinance members [PR (95% CI): 1.87 (1.27,2.76)] compared to men [PR (95% CI): 1.24 (0.81,1.90)]. Conclusions: Microfinance participation was associated with higher childhood vaccine adherence in rural Western Kenya. Microfinance interventions should be further explored as strategies to improve child health and well-being in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Objective: To measure the economic risk of diseases in Chinese middle-aged and elderly patients with diabetes. Methods: The economic risk of diseases in Chinese middle-aged and elderly patients with diabetes was comprehensively analyzed using the family economic risk of diseases, catastrophic health expenditure, and relative risk of the disease. Results: The proportions of families with low, medium, and high family economic risk of diseases were 64.73%, 8.56%, and 26.71%, respectively. When the defining criteria are 15%, 25%, and 40%, the incidences of catastrophic health expenditure were 66.71%, 60.07%, and 54.59%, respectively. The health expenditure of diabetic patients was 1.80 times that of non-diabetic patients when the difference in patients' income was eliminated. Conclusion: In general, Chinese middle-aged and elderly patients with diabetes face a large economic risk of diseases, which will seriously hinder the improvement of their family life quality. The sociodemographic characteristics related to diabetics will aggravate the patient's economic risk, such as smoking, drinking, and low household income. Moreover, diabetes patients with different basic medical insurance have different economic risk of diseases. [ABSTRACT FROM AUTHOR]

Human health deterioration due to industrial air emissions is gaining global attention. These health impacts are coupled mainly with chronic and acute health issues that are persistent in residents in close proximity to the industrial estates. Similarly, the inhabitants of Islamabad Industrial Estate (IEI) are exposed to intense industrial pollutants that have caused respiratory and irritant health issues. This cross-sectional study has compared two groups on deploying 378 close-ended questionnaires at the household level, after adjusting the potential confounders. The groups were framed as per their distance from IEI as 'Band I' - residence ≤ 650 m and 'Band II' - residence ≥ 650–1300 m. The distances were calculated from the respondent's residence to the outer digitized boundary (perimeter of IEI), whereas the perimeter was digitized using Google Earth and imported into a Geographical Information System. The results of multiple logistic regression for odds ratios confirmed significant increase in chronic respiratory problems (chronic bronchitis OR 1.93 (1.05–3.55), phlegm OR 2.5 (1.4–4.5), dyspnoea OR 2.18 (0.3–1.81)) and acute irritation issues (eye irritation OR 2.59 (1.63–3.90), throat irritation OR 1.782 (0.876–2.725)) in case of Band I. The same diseases were found in Band II but in less severity; however, their existence remained life-threatening for the locality. The study calls for preventive measures by the local residents, health safety measures by the federal government and relocation of populace to safe areas/sectors. [ABSTRACT FROM AUTHOR]

Annoyance caused by air pollution is a matter of public health as it can cause stress and ill-health and affect quality of life, among other burdens. The aim of this study is to apply the multiple correspondence analyses (MCA) technique as a differential tooling to explore relationships between variables that can influence peoples' behaviour concerning annoyance caused by air pollution. Data were collected through a survey on air pollution, environmental issues and quality of life. Face-to-face survey studies were conducted in two industrialized urban areas (Vitoria in Brazil and Dunkirk in France). These two regions were chosen as their inhabitants often report feeling annoyed by air pollution, and both regions have similar industrial characteristics. The results showed a progressive correspondence between levels of annoyance and other active variables in the "air pollution" factor group: as the levels of annoyance increased, the levels of the other qualitative variables (importance of air quality, perceived exposure to industrial risk, assessment of air quality, perceived air pollution) also increased. Respondents who reported feeling annoyed by air pollution also thought that air quality was very important and were very concerned about exposure to industrial risks. Furthermore, they often assessed air quality as horrible, and they could frequently perceive air pollution by dust, odours and decreased visibility. The results also showed a statistically significant association between occurrence of allergies and high levels of annoyance. [ABSTRACT FROM AUTHOR]

Background: Out-of-pocket (OOP) health expenditure is a pressing issue in Egypt and far exceeds half of Egypt's total health spending, threatening the economic viability, and long-term sustainability of Egyptian households. Targeting households at risk of catastrophic health payments based on their characteristics is an obvious pathway to mitigate the impoverishing impacts of OOP health payments on livelihoods. This study was conducted to identify the risk factors of incurring catastrophic health payments hoping to formulate appropriate policies to protect households against financial catastrophes. Methods: Using data derived from the Egyptian Household Income, Expenditure, and Consumption Survey (HIECS), a multiplicative heteroskedastic probit model is applied to account for heteroskedasticity and avoid biased and inconsistent estimates. Results: Accounting for heteroskedasticity induces notable differences in marginal effects and demonstrates that the impact of some core variables is underestimated and insignificant and in the opposite direction in the homoscedastic probit model. Moreover, our results demonstrate the principal factors besides health status and socioeconomic characteristics responsible for incurring catastrophic health expenditure, such as the use of health services provided by the private sector, which has a dramatic effect on encountering catastrophic health payments. Conclusions: The marked differences between estimates of probit and heteroskedastic probit models emphasize the importance of investigating homoscedasticity assumption to avoid policies based on incorrect evidence. Many policies can be built upon our findings, such as enhancing the role of social health insurances in rural areas, expanding health coverage for poor households and chronically ill household heads, and providing adequate financial coverage for households with a high proportion of elderly, sick members, and females. Also, there is an urgent need to limit OOP health payments absorbed by private sector to achieve an acceptable level of fair financing. [ABSTRACT FROM AUTHOR]

Cities are critically facing massive unplanned urbanization over the globe especially in developing and under developed countries. To address the swift expansion of impervious surface and to control its pattern is a foremost challenge for policy makers and urban planners because of the lack of database of urban transformation. This present work dealing with the urban transformation challenge and proposes a modelling approach of the urban trajectory (UT) pattern and its effects (on other land covers) namely, the cycle of urban development, to unfold the transformation of urban expansion in city sphere using spatiotemporal Landsat datasets during 1988-2018 for 1998, 1997, 2008, and 2018 (~10 years interval). The pattern of UT expansion is framed using landscape metrics: patch size quantification based on pre-growth patch and newly-grown patch. We have modelled six categories (i.e., (i) Leapfrog, (ii) Edge, (iii) Inside Edge, (iv) Ribbon, (v) Infilling, (vi) Infilled) to understand how the cycle has been working and possibly effects on the land cover. Furthermore, we have carried out Hot Spot zone analysis for UT growth dominant area identification. The UT results have found, the most expanded was Edge trajectory and least expanded was Infilling trajectory in all time periods. The overall urban expansion has been seen from 25.40% in 1988 to 64.61% in 2018. The result of the growth of an urban nucleus, the ratio of total sprawls expansion to total nucleus area has been found to be 154.34% during 1988-2018. The results of hot spot zone analysis have found that the zones of 1500 m–7000 m urbanized most rapidly during 1988-2018. [ABSTRACT FROM AUTHOR]

The utilization of economic capabilities to raise production in the economy enhances the industrial activities and use of transportation. These activities deteriorate the quality of the environment and raise the level of particulate matter (PM2.5). The objective of this study is to investigate the impact of economic capabilities and population agglomeration on PM2.5 emissions for the sample of 23 sub-Saharan African countries—a highly polluted region of the world. The study used panel regression from 2007 to 2015 and found that production capabilities are highly significant and directly effecting PM2.5 emissions. The Kuznets hypothesis does not hold in this region, and the concentration of population in urban areas is also significant. To avoid the problem of possible endogeneity in the empirical model and for robustness check, the study also utilized system GMM and found consistent results. The findings of the study are highly valuable to reduce PM2.5 and propose that the policymakers in Sub-Saharan African countries should opt for industrial specialization rather than economic complexity and ensure that the proper measures are taken to control PM2.5. Moreover, population concentrations should not be taken place in a few main urban cities. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: We hypothesize that there will be improvement in a novice learners' confidence and skill level with sacrospinous ligament fixation (SSLF) following a pelvic model-based simulation. Methods: We performed a single-blinded randomized controlled trial with obstetrics and gynecology residents who were novices at SSLF. The residents were randomly assigned to two groups. The control group received a lecture on the SSLF procedure and anatomy, whereas the intervention group received the same lecture in addition to a pelvic model-based simulation session taught by urogynecologists. The residents' knowledge of SSLF anatomy and confidence level with the procedure were measured via assessments administered before and after the educational interventions. Their technical skills were objectively assessed by one of two fellowship-trained urogynecologists who were blinded to their group allocation. Results: A total of 28 residents were recruited with 14 residents in each group and equal distribution of junior and senior trainees. None of the residents had previously performed the SSLF procedure. There was no difference in anatomical knowledge between the two groups. The intervention group showed a greater increase in their average confidence score compared with the control group: 4.0 ± 1.4 (95% CI 3.1–4.8) versus 2.6 ± 1.6 (95% CI 1.7–3.4) respectively, with p = 0.02. The intervention group also showed better objective scores in specific technical skills, such as instrument handling (p < 0.001), instrument movement/motion (p < 0.001), and speed (p = 0.01). Conclusion: Our results demonstrate that inclusion of a pelvic model simulation significantly improves confidence and certain technical skills of novice trainees in performing SSLF. [ABSTRACT FROM AUTHOR]

This study aimed to identify the spatial patterns of lower respiratory tract infections (LRIs) and their association with fine particulate matter (PM2.5). The disability-adjusted life year (DALY) database was used to represent the burden each country experiences as a result of LRIs. PM2.5 data obtained from the Atmosphere Composition Analysis Group was assessed as the source for main exposure. Global Moran's I and Getis-Ord Gi* were applied to identify the spatial patterns and for hotspots analysis of LRIs. A generalized linear mixed model was coupled with a sensitivity test after controlling for covariates to estimate the association between LRIs and PM2.5. Subgroup analyses were performed to determine whether LRIs and PM2.5 are correlated for various ages and geographic regions. A significant spatial auto-correlated pattern was identified for global LRIs with Moran's Index 0.79, and the hotspots of LRIs were clustered in 35 African and 4 Eastern Mediterranean countries. A consistent significant positive association between LRIs and PM2.5 with a coefficient of 0.21 (95% CI 0.06–0.36) was identified. Furthermore, subgroup analysis revealed a significant effect of PM2.5 on LRI for children (0–14 years) and the elderly (≥ 70 years), and this effect was confirmed to be significant in all regions except for those comprised of Eastern Mediterranean countries. [ABSTRACT FROM AUTHOR]

Rapid urbanization, the corresponding increase in vehicle ownership, and the continued use of solid fuels as an energy source have resulted in the deterioration of air quality in Kenya. Despite this, there is no publicly available official source of data on air pollution in the country. This article provides an overview of published studies that report the concentrations of widespread ambient pollutants, outline major themes, and identify data gaps. This review reveals that since the 1980's particulate matter (PM) concentrations in some Nairobi locations, such as the industrial area, have been at dangerously high levels. Almost all of the studies included show that PM concentrations in Nairobi violate the World Health Organization (WHO) guidelines. Moreover, black carbon (BC) concentrations in Nairobi are among the highest in the world, indicating the need for cleaner vehicles in the city. There has been much less work done measuring the levels of gaseous pollutant concentrations in Kenya. Based on these findings, policies to reduce air pollution in Kenya and monitoring strategies to fill in the existing gaps are presented. [ABSTRACT FROM AUTHOR]

Health professions education is that part of the education system which applies educational philosophy, theory, principles and practice in a complex relationship with busy clinical services, where education is not the primary role. While the goals are clear—to produce the health workforce that society needs to improve health outcomes—both education and healthcare systems continue to evolve concurrently amidst changes in knowledge, skills, population demographics and social contracts. In observing a significant anniversary of this journal, which sits at the junction of education and healthcare systems, it is appropriate to reflect on how the relationship is evolving. Health professions educators must listen to the voices of regulators, employers, students and patients when adapting to new service delivery models that emerge in response to pressures for change. The recent COVID-19 pandemic is one example of disruptive change, but other factors, such as population pressures and climate change, can also drive innovations that result in lasting change. Emerging technology may act as either a servant of change or a disruptor. There is a pressing need for interdisciplinary research that develops a theory and evidence base to strengthen sustainability of change. [ABSTRACT FROM AUTHOR]

Current-climate precipitation and temperature extremes have been identified by decision makers in West Africa as among the more impactful weather events causing lasting socioeconomic damage. In this article, we use a plausible future-climate scenario (RCP8.5) for the end of the twenty-first century to explore the relative commonness of such extremes under global warming. The analysis presented considers what a typical day in the future climate will feel like relative to current extrema. Across much of West Africa, we see that the typical future-climate day has maximum and minimum temperatures greater than 99.5% of currently experienced values. This finding exists for most months but is particularly pronounced during the Boreal spring and summer. The typical future precipitation event has a daily rainfall rate greater than 95% of current storms. These findings exist in both a future scenario model run with and without parameterised convection, and for many of the Coupled Model Inter-comparison Project version 5 ensemble members. Additionally, agronomic monsoon onset is projected to occur later and have greater inter-annual variability in the future. Our findings suggest far more extreme conditions in future climate over West Africa. The projected changes in temperature and precipitation could have serious socioeconomic implications, stressing the need for effective mitigation given the potential lack of adaptation pathways available to decision makers. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa has lower breastfeeding rates compared to other low- and middle-income countries, and globally holds the highest under-five mortality rates. The aims of this study were to estimate mortality risk for inappropriate breastfeeding, prevalence of breastfeeding, population attributable fraction, and the economic impact of breastfeeding on child mortality, in sub-Saharan Africa. The systematic review included databases from Medline and CINAHL. Meta-analysis of mortality risk estimates was conducted using random effect methods. The prevalence of breastfeeding in Sub-Saharan African countries was determined using UNICEF's database. Population attributable fraction was derived from the prevalence and relative risk data. The cost attributable to child deaths in relation to inappropriate breastfeeding was calculated using the World Health Statistics data. The pooled relative mortality risk to any kind of infant feeding compared to exclusive and early breastfeeding initiation were 5.71 (95%CI: 2.14, 15.23) and 3.3 (95%CI: 2.49, 4.46), respectively. The overall exclusive and early initiation of breastfeeding prevalence were 35%(95%CI: 32%;37%) and 47%(95%CI: 44%;50%), respectively. The population attributable fraction for non-exclusive and late breastfeeding initiation breastfeeding were 75.7% and 55.3%, respectively. The non-health gross domestic product loss resulted in about 19.5 USB$. Conclusion: Public health interventions should prioritize appropriate breastfeeding practices to decrease the under-five mortality burden and its related costs in sub-Saharan Africa. What is Known: • Globally, sub-Saharan Africa holds the highest under five mortality rates and still has lower breastfeeding rates compared to other low- and middle-income countries. • There is a significant association between child mortality and inappropriate breastfeeding practices. What is New: • A five-fold and three-fold increased risks for under-five mortality were estimated with regard to non-exclusive breastfeeding and delayed breastfeeding initiation, respectively. • 55–75% of under-five deaths can be attributable to inappropriate breastfeeding practices and at least part of them could be potentially prevented with breastfeeding promotion interventions, saving a non-health gross domestic product loss of 19.5 USB$. [ABSTRACT FROM AUTHOR]

The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans. [ABSTRACT FROM AUTHOR]

Summary: The aim of this study is to compare body image, body perception, body satisfaction, body-related self-esteem and overall self-esteem of women from three different cultural backgrounds. The survey covers a sample of 187 women, including 133 Germans, 31 Q'eqchi', and 23 Colombians. Two groups (in Germany and Colombia) live in urban centers, while one group (in Guatemala: Q'eqchi') is a jungle-based ethnic group descended from the Maya where the body perception was largely unaffected by media. The instruments used in this study are the Figure Rating Scale, the Body-Esteem Scale and the Rosenberg Self-Esteem Scale. According to the study, German and Colombian women prefer a significantly slimmer body and perceive themselves more critically than Q'eqchi'. There are no significant differences in body perception between German and Colombian women. Q'eqchi' women do not have significantly higher body satisfaction than German and Colombian women. Although German women have significantly higher body satisfaction than Colombian women, Q'eqchi' women have the highest body-related self-esteem on average. Colombian women in turn have a higher body-related self-esteem than German women. There is a positive correlation between body satisfaction with both body-related self-esteem and overall self-esteem in all three groups. In conclusion, the German and Columbian women living in urban settings look much slimmer, prefer much slimmer bodies and have lower body-related self-esteem, compared to jungle-dwelling Q'eqchi' women in Guatemala. [ABSTRACT FROM AUTHOR]

The urban population in Sub-Saharan Africa is projected to expand by nearly 800 million people in the next 30 years. How this rapid urban transition is affecting household-level urban food security, and reverberating into broader food systems, is poorly understood. To fill this gap, we use data from a 2017 survey (n = 668) of low- and middle-income residents of Accra, Ghana, to characterize and compare the predictors of household-level food security using three established metrics: the Household Food Insecurity Access Scale (HFIAS); the Household Food Insecurity Access Prevalence (HFIAP); and the Food Consumption Score (FCS). According to HFIAP, 70% of sampled households are food insecure, but only 2% fall below acceptable thresholds measured by FCS. Only one household reported sourcing food from modern supermarkets and fewer than 3% produce food for consumption through gardening, farming, or fishing. Instead, households rely on purchased food from traditional markets, local stalls and kiosks, and street hawkers. Results from a suite of general linear models show that household assets, education, and demographic characteristics are significantly associated with food security outcomes according to HFIAS and HFIAP. The poor correlation and weak model agreement between dietary recall such as FCS, and experience-based food security metrics, like HFIAS and HFIAP, highlight limitations of employing historically rural-centric food security measurement approaches within the urban context. Given that Sub-Saharan Africa's future is urban, our results add empirical evidence in support of the growing chorus of scholars advocating for comprehensive urban-oriented food security research and policy agendas across Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

This paper examines changes in infant mortality (IM) in Moscow, Russia's largest and most affluent city. Along with some remarkable improvements in Moscow's health system over the period between 2000 and 2014, the overall IM rate for Moscow's residents decreased substantially between 2000 and 2014. There remains, however, substantial intra-city variation across Moscow's 125 neighborhoods. Our regression models suggest that in higher-income neighborhoods measured by percent of population with rental income as a primary source, the IM rate is significantly lower than in lower-income neighborhoods measured by percent of population with transfer income as primary source (housing and utility subsidies and payments to working and low-income mothers, single mothers and foster parents). We also find that the density of physicians in a neighborhood is negatively correlated with the IM rate, but the effect is small. The density of nurses and hospital beds has no effect. We conclude that overall progress on health outcomes and measures of access does not, in itself, solve the challenge of intra-urban inequalities. [ABSTRACT FROM AUTHOR]

There are numerous studies that have estimated the number of deaths attributable to heat and cold using city-level or provincial-level data. However, none of these studies have assessed temperature-mortality relationships using meteorological climate zones and data that covers an entire population/country. This analysis uses a national data set of death records to create time-series data for different regional aggregations. Temperature-mortality relationships are estimated using this data set of 1,717,224 deaths, which covers the whole of Australia between 2006 and 2017. This paper finds that the majority of deaths related to temperature in Australia are caused by heat. It also finds that the reference temperature used to separate impacts into heat-/cold-related mortality has a notable impact on the magnitude of these estimates. Previous studies (using the same methodology) found that most of the temperature-related mortality burden in Australia was attributed to cold temperatures. This led to studies that associated this with a net benefit from climate change. This analysis indicates that studies that found net benefits from climate change need to be re-assessed, especially for Australia and warmer climate zones. [ABSTRACT FROM AUTHOR]

Studies on air pollution suggest that individuals perceive their neighborhoods as less polluted than their cities, termed the "halo effect." This effect is important because how people perceive air quality is highly correlated with whether they will develop coping strategies to reduce health risks from air pollution. We conducted 489 household surveys in two municipalities in south-central Chile, both highly polluted with smoke from wood-burning stoves, to identify differences in perception of air quality at the city, neighborhood, and household levels. We found evidence of a home halo effect even though studies show indoor pollution in these municipalities might be equal to or higher than outdoor pollution. The findings are relevant for local and central governments to improve their communication strategies, which to date have been focused on providing data about outdoor air pollution aggregated at the city level. More detailed and disaggregated information on the health risks linked to indoor air quality can improve residents' awareness and engagement in developing protective and coping behaviors concerning air pollution. [ABSTRACT FROM AUTHOR]

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3–6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. Contrary to the view that urbanization is a major driver of the global rise in obesity, the global increase in body-mass index is shown to be mostly due to increases in the body-mass indexes of rural populations. [ABSTRACT FROM AUTHOR]

Quantitative and qualitative assessments of cell membrane components are essential for the accurate interpreta-tion of processes occurring in biological membranes. Changes in the structure and function of cell membrane components have been linked to oxidative stress. Oxidative stress induced by chronic ethanol consumption or cancer transformation has been implicated in changing the levels of phospholipids and fatty acids in the cell membrane. In this study, we used high-performance liquid chromatography to quantitate the effects of alcohol and malignant transformation on membrane com-ponents, namely phospholipids and free fatty acids. Ethanol increased the phospholipid levels. Moreover, the process of malignant transformation was accompanied by increased levels of phospholipids and arachidonic acid as well as decreased levels of linoleic acid and α-linolenic acid. Thus, these oxidative stress-inducing conditions that cause variations in the cel-lular composition affect the actions of the cell membrane and cell function. [ABSTRACT FROM AUTHOR]

Outdoor air pollution and especially particulate matter pollution is a major environmental health issue that raises concerns of scientists and policy makers. This study focuses on air quality perception in relation to particulate matter in order to find potential patterns. Field questionnaire-based surveys were conducted among pedestrians on two central sites in the city of Athens, Greece, during the winter period while particulate matter of 10 μm or less in diameter (PM10) were concurrently measured on-site at 1-min resolution. The participants were asked to evaluate the dust and the overall pollution-related air quality based on 5-point bipolar scales. Air quality perception patterns were explored considering PM10 concentration, meteorological and thermal conditions, and subjective variables including gender, age, smoking status, and health status. An effect of PM10 on dust perception was identified, suggesting that dusty air quality conditions are reported more frequently when particulate concentration increases. Health status, exposure time, smoking status, and gender were found to affect air quality perception. Participants experiencing health symptoms, exposed to outdoor conditions for more than 30 min, smokers, and females were more likely to report unfavorable air quality conditions. The comparison with the results of a previous study obtained using air pollution station data confirmed the dependence of air quality perception on participants’ characteristics and particularly on their health status. Ordinal logistic regression models showed that for pedestrians who were neither smokers nor experiencing health symptoms and were exposed to outdoor conditions for more than 30 min, a PM10 concentration around 64 μg·m−3 could be a threshold, to perceive dusty air quality conditions. [ABSTRACT FROM AUTHOR]

Global climate models predict increases in the frequency and intensity of extreme heat events across the African continent during the remainder of the twenty-first century. Projected increases in temperature extremes have significant implications for humanity, particularly in the African Great Lakes region (GLR) where some of the world’s poorest and most vulnerable populations reside. Using high-resolution Community Earth System Model (CESM) simulations to investigate the impacts of climate change under Representative Concentration Pathway (RCP) 8.5 and spatially explicit population trajectories consistent with two shared socio-economic pathways (SSPs), we contrast early and projected late century human exposure to temperature extremes and the associated potential health impacts for nine countries of the GLR. While all countries are projected to experience increases in the number of heat stress days, the greatest increases occur in the north and west, in parts of Kenya, Uganda, and the Democratic Republic of Congo. Nighttime relief diminishes due to 3-8° increases in average minimum temperatures. Country-wide population exposure to extreme heat stress increases 7- to 269-fold over current levels. Total population growth as well as rural-urban distribution patterns strongly influence outcomes, but to a lesser degree than the warming climate. [ABSTRACT FROM AUTHOR]

The current study was conducted to investigate the effect of zinc supplementation on the growth performance, intestinal morphology, and the transcription of the barrier function related genes in Pekin ducks. Seven-hundred and sixty-eight 1-day-old Pekin ducks were randomly assigned into six dietary treatments. Each treatment had eight replicates with 16 ducks per replicates. The ducks were fed either a corn-soybean meal basal diet or basal diets supplemented with 15, 30, 60, 120, and 240 mg zinc/kg from zinc sulfate. This experiment lasted for 5 weeks, and the jejunum sample were harvested at 14 and 35 days of age. Results have shown that diets supplemented with zinc significantly increased the duck body weight, average daily gain, and average daily feed intake in different period of experiment (P < 0.05); feed to gain ratio was decreased as the zinc level increased (P < 0.05). Zinc supplementation increased the villus height and decreased the crypt depth in jejunum of ducks (P < 0.05) at 14 and 35 days of age. The transcription of tight junction protein CLDN1, OCND, ZO-1, and ZO-3 in jejunum were increased (P < 0.05), and the messenger RNA (mRNA) levels of leak protein CLDN2 were decreased as the dietary zinc level increased (P < 0.05) at 14 and 35 days of age. The mRNA levels of chemical barrier-related genes MUC2 and TFF-2 in jejunum at 14 and 35 days of age were increased (P < 0.05) by zinc supplementation, and so did the transcription of immunological barrier-related genes lgA, pIgR, LYZ, and AvBD2 (P < 0.05). In conclusion, dietary zinc supplementation exhibited growth-promoting effect on Pekin duck, improved intestinal morphology, and enhanced the intestinal barrier integrity. [ABSTRACT FROM AUTHOR]

Background: Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria.Methods: Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression.Results: Results showed that irrespective of the threshold for the two concepts of total household expenditure and non-food expenditure, having household members aged between 6 and 14 years, having household members aged between 15 and 24 years, having household members aged between 25 and 54 years, having no education, having primary education, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households.Conclusions: Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy. [ABSTRACT FROM AUTHOR]

Citrus peels, which are an environmental menace in many developing countries have been in use in folk medicine for the management of some degenerative conditions, though there was limited information on the mechanism of such medicinal properties. These medicinal properties also promote the peels as functional foods; since they are generally regarded as safe and are consumed in some countries in forms of candies, wines, infusions and additives. Studies on the mechanisms for the antioxidant, anti-diabetic, cardioprotective, neuroprotective and anticancer activities of the peels have established the intereaction with some key enzymes relevant to the management of such diseases. The phenolic compounds and volatile compounds which have been linked with the biological activities of the peels have been characterized. This review looks at the bioactive compounds of citrus peels and the mechanisms for the biological activities of the peels. [ABSTRACT FROM AUTHOR]

The aim of the present study is to evaluate the radioprotective effect of low-dose selenium supplementation (multiple administrations) on radiation toxicities and mortality induced by lethal dose of whole-body irradiation (WBI). For this, BALB/c mice received sodium selenite (4 μg/kg body wt) intraperitoneally for five consecutive days and subjected to WBI at an absorbed dose of 8 Gy (Co, 1 Gy/min). Administration of sodium selenite was continued even during the post irradiation days three times a week till the end of the experiment. The radioprotective effect was evaluated in terms of the improvement in 30 days post irradiation survival, protection from DNA damage, and biochemical and histological changes in radiosensitive organs. The results indicated that low-dose sodium selenite administration did not protect the mice from radiation-induced hematopoietic and gastrointestinal injuries and subsequent mortality. However, it significantly prevented the radiation-induced genotoxicity or DNA damage in peripheral leukocytes. Further sodium selenite administration modulated the messenger RNA (mRNA) expression of GPx1, GPx2, and GPx4 in the spleen and intestine differentially and led to a significant increase in GPx activity (∼1.5 to 2-folds) in these organs. In line with this observation, sodium selenite administration reduced the level of lipid peroxidation in the intestine. In conclusion, our study shows that low-dose sodium selenite supplementation can be an effective strategy to prevent WBI-induced genotoxicity but may not have an advantage against mortality sustained during nuclear emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Curriculum integration is widely discussed in medical education but remains ill defined. Although there is plenty of information on logistical aspects of curriculum integration, little attention has been paid to the contextual issues that emerge from its practice and may complicate students' knowledge integration. Therefore, we aimed to uncover how curriculum integration is manifested through context. Methods: We collected data from the official curriculum and interviewed ten participants (including curriculum designers, facilitators, and students) in the bachelor's medical program at Aalborg University. We observed various learning activities focused on pre-clinical education. Inspired by grounded theory, we analyzed the information we gathered. Results: The following theoretical constructs emerged after the inductive analysis: 1) curriculum integration complexity is embedded in the institutional learning perspectives; 2) curriculum integration is used to harmonize conflicting learning perspectives in curriculum practice; 3) curriculum integration creates tensions that self-organize its structure; and 4) curriculum integration becomes visible in collaborative learning spaces. Discussion: These constructs provide a framework for analyzing curriculum integration in the context in which it is meant to appear, which may assist educationalists to gain a more specific understanding of the term. This may enable effective curriculum integration since contextual issues are addressed in addition to the goals specified in the official curriculum. [ABSTRACT FROM AUTHOR]

The repercussions of climate change will be felt in various ways throughout both natural and human systems in Sub-Saharan Africa. Climate change projections for this region point to a warming trend, particularly in the inland subtropics; frequent occurrence of extreme heat events; increasing aridity; and changes in rainfall-with a particularly pronounced decline in southern Africa and an increase in East Africa. The region could also experience as much as one meter of sea-level rise by the end of this century under a 4 °C warming scenario. Sub-Saharan Africa's already high rates of undernutrition and infectious disease can be expected to increase compared to a scenario without climate change. Particularly vulnerable to these climatic changes are the rainfed agricultural systems on which the livelihoods of a large proportion of the region's population currently depend. As agricultural livelihoods become more precarious, the rate of rural-urban migration may be expected to grow, adding to the already significant urbanization trend in the region. The movement of people into informal settlements may expose them to a variety of risks different but no less serious than those faced in their place of origin, including outbreaks of infectious disease, flash flooding and food price increases. Impacts across sectors are likely to amplify the overall effect but remain little understood. [ABSTRACT FROM AUTHOR]