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Introduction: Living with chronic diseases such as Diabetes mellitus type 2 will make patients experience change or imbalance include biological, psychological, social and spiritual. One of psychology aspects in patients with Diabetes mellitus type 2 is psychological well being (PWB). Emotional response of type 2 DM patients since the early diagnosis to begin undergoing the treatment will be different for each person. Type 2 DM patients need a good transition process to achieve well being state. The transition from a healthy to a diseased condition is needed for the successful self care management of type 2 DM patients. The purpose of this research was to explore the description of PWB in patients of type 2 Diabetes mellitus in six aspects of PWB and PWB facilitate and inhibitor factors in type 2 DM patients. Methods: This research used qualitative design research with case studies approach. The subject of research was seven participants who met the inclusion criteria. Data collection was done by structured interview and observation. Data analysis was done by thematic analysis. Result and Analysis: This study generated 14 themes. The result showed that the process of type 2 DM patients subjected to the process of transition from a healthy condition into ill condition. The transition process started with cyclic lose response which influence type 2 DM patient to self control and make a right decision-making to self care. Self-control would make type 2 DM patients able to adapt and engage with new experiences that become a new habit for type 2 DM patients and will facilitate type 2 DM patients in adapting to the internal and external environment and make type 2 DM patients have a positive hope in their life. Discuss and conclusion: finding in this study would hopefully be beneficial for professional health staff to make assessment about PWB in type 2 DM patients, nurse hopefully can assist patients in transition with the condition of type 2 DM. Need further research about the relation between self acceptance and self control, activation process till engagement to new habit in type 2 DM patients, perceived support to PWB in type 2 DM patient DM. Keywords: psychological well being, type 2 Diabetes mellitus, qualitative

Competences of the nurse can be a good ability when supported with a positive perception of nurses about the competence itself. This study describe the nurse competencies in taking care patients with mental disorders and barriers in the implementation of these competencies. This study design used qualitative descriptive phenomenology. Population was nurse who worked at the Mental Hospital. Participants were 17 nurses from two Mental Hospital in East Java which obtained by purposive sampling. Data was collected by indepth interview and focus group discussion (FGD). Equipment tools used media player, FGD guidelines and field notes. The data were analyzed by thematically analysis based Colaizzi . The results produce eight themes. The nurse's perception of competence in caring for patients with mental disorders are implementing nursing care, Standard Procedures Operational (SPO) and nursing modality therapy. While nurses encounter obstacles when applying competence in the implementation of nursing documentation, limited facilities, the lack of effectiveness management system, limited human resource and the condition of the patient. The findings of this study can be used by nurses as a material to develop documentation formats more effectively and hospital management are expected to pay more attention to aspects of the guidance and supervision of the implementation of competence. Research suggested based on the findings is to analyze the relationship between supervision and nurse’s performance and satisfaction Keyword: Nurse, Competencies, Mental Disorder

Hospital surfaces can harbour bacterial pathogens, which may disseminate and cause nosocomial infections, contributing towards mortality in low- and middle-income countries (LMICs). During the BARNARDS study, hospital surfaces from neonatal wards were sampled to assess the degree of environmental surface and patient care equipment colonisation by Gram-negative bacteria (GNB) carrying antibiotic resistance genes (ARGs). Here, we perform PCR screening for extended-spectrum β-lactamases (bla CTX-M-15 ) and carbapenemases (bla NDM , bla OXA-48 -like and bla KPC ), MALDI-TOF MS identification of GNB carrying ARGs, and further analysis by whole genome sequencing of bacterial isolates. We determine presence of consistently dominant clones and their relatedness to strains causing neonatal sepsis. Higher prevalence of carbapenemases is observed in Pakistan, Bangladesh, and Ethiopia, compared to other countries, and are mostly found in surfaces near the sink drain. Klebsiella pneumoniae, Enterobacter hormaechei, Acinetobacter baumannii, Serratia marcescens and Leclercia adecarboxylata are dominant; ST15 K. pneumoniae is identified from the same ward on multiple occasions suggesting clonal persistence within the same environment, and is found to be identical to isolates causing neonatal sepsis in Pakistan over similar time periods. Our data suggests persistence of dominant clones across multiple time points, highlighting the need for assessment of Infection Prevention and Control guidelines., (© 2024. The Author(s).)

A mobile colistin resistance gene mcr was first reported in 2016 in China and has since been found with increasing prevalence across South-East Asia. Here we survey the presence of mcr genes in 4907 rectal swabs from mothers and neonates from three hospital sites across Nigeria; a country with limited availability or history of colistin use clinically. Forty mother and seven neonatal swabs carried mcr genes in a range of bacterial species: 46 Enterobacter spp. and single isolates of; Shigella, E. coli and Klebsiella quasipneumoniae. Ninety percent of the genes were mcr-10 (n = 45) we also found mcr-1 (n = 3) and mcr-9 (n = 1). While the prevalence during this collection (2015-2016) was low, the widespread diversity of mcr-gene type and range of bacterial species in this sentinel population sampling is concerning. It suggests that agricultural colistin use was likely encouraging sustainment of mcr-positive isolates in the community and implementation of medical colistin use will rapidly select and expand resistant isolates., (© 2024. The Author(s).)

This longitudinal cohort study examined changes in illness perceptions, coping strategies, and quality of life in hospitalized participants who had sustained extremity injuries, and examined the associations among these changes. A sample of 138 patients with extremity injuries was recruited between August 2019 and April 2020 from the trauma units of two similar referral medical centers, each with a capacity of over 200 beds in Surabaya City, Indonesia. Outcome measures were assessed prior to hospital discharge and 3 months post-discharge, including the Brief Illness Perception Questionnaire, the Brief Coping Orientation to Problems Experienced, and the World Health Organization Quality of Life. Hierarchical multiple regression analyses were conducted. We found that lower scores for illness perceptions (i.e., how a participant appraised and understood their medical condition and its possible consequences) and maladaptive coping strategies were significantly associated with lower quality of life scores. In addition, scores for adaptive coping strategies moderated the association between illness perceptions and quality of life. Our findings suggest that clinicians should endeavor to improve patients' illness perceptions and adaptive coping strategies during the first 3 months post-injury to promote improvement in quality of life following extremity injury., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2023 by National Association of Orthopaedic Nurses.)

Recognizing the growing importance of the green energy market-renewable energy stocks and bonds-and its classification as a viable financial asset, this paper examines hedging strategies with brown market instruments-gold, oil, bond and the composite S&P500-on the green energy markets. That is, we examine whether, and to what extent brown assets can provide a hedge for green assets, using variants of the multivariate GARCH framework (DCC, ADCC and GO-GARCH). Our dataset spans the period 01/12/2008 to 30/09/2021. To account for the influence of the COVID-19 pandemic, we split the dataset into two-pre-covid (1/12/2008-10/03/2020) and covid-era (11/03/202-30/09/2021). Two key findings emanate from our results: first, conventional bonds and stocks provide the most consistent hedge for investment in the green markets. Second, the results are sensitive to the state of the market-hedging effectiveness declined during the covid period in the green stock market. Among other things, it is recommended that investors include instruments of the green market in portfolio allocation., Competing Interests: Conflict of interestThere is no conflict of interest among the authors. The manuscript has not been submitted for publication purposes in another journal., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Early development of the microbiome has been shown to affect general health and physical development of the infant and, although some studies have been undertaken in high-income countries, there are few studies from low- and middle-income countries. As part of the BARNARDS study, we examined the rectal microbiota of 2,931 neonates (term used up to 60 d) with clinical signs of sepsis and of 15,217 mothers screening for bla CTX-M-15 , bla NDM , bla KPC and bla OXA-48 -like genes, which were detected in 56.1%, 18.5%, 0% and 4.1% of neonates' rectal swabs and 47.1%, 4.6%, 0% and 1.6% of mothers' rectal swabs, respectively. Carbapenemase-positive bacteria were identified by MALDI-TOF MS and showed a high diversity of bacterial species (57 distinct species/genera) which exhibited resistance to most of the antibiotics tested. Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae/E. cloacae complex, the most commonly found isolates, were subjected to whole-genome sequencing analysis and revealed close relationships between isolates from different samples, suggesting transmission of bacteria between neonates, and between neonates and mothers. Associations between the carriage of antimicrobial resistance genes (ARGs) and healthcare/environmental factors were identified, and the presence of ARGs was a predictor of neonatal sepsis and adverse birth outcomes., (© 2022. The Author(s).)

Objectives: Elevated waist circumference results from an excessive accumulation of visceral fat, causing an impairment of health. Waist circumference is highly correlated with diabetes, cardiovascular disease, and all-cause mortality. This study aimed to estimate the overall, sex-specific, and region-specific prevalence rates of central obesity in Nigeria., Study Design: Systematic review and meta-analysis., Methods: Online searches of Google Scholar, PubMed, and Scopus were conducted, and studies were selected based on predefined criteria. Random effects model was fitted using inverse variance method with correction using Sidik-Jonkman's estimator., Results: Eighteen studies consisting of 21,859 individuals conducted between 1996 and 2021 were included in the meta-analysis. Thirty-nine percent (95% confidence interval [CI]: 25%-54%, I 2  = 99.3%) of adult Nigerians are centrally obese (by International Diabetes Federation criteria). This translates to estimated 46.8 million centrally obese adult Nigerians. More than half (54% [95% CI: 39%-68%]) of adult females are centrally obese. This is four times the prevalence in males (13% [95% CI: 5%-24%]). Southern regions have higher prevalence of central obesity than northern regions (48% vs 18%). The overall mean waist circumference in Nigeria is 83.8 cm (95% CI: 80.8-86.8 cm, I 2  = 99.8%, P value is <0.001)., Conclusions: Females, urban residents, and individuals living in the northern part of Nigeria have a high burden of central obesity. Public health measures for halting the epidemic of obesity should be targeted at these high-risk groups., (Copyright © 2022 The Royal Society for Public Health. All rights reserved.)

Introduction: Teaching and learning process is increasingly metamorphosing from the traditional chalk and talk to the modern dynamism in the information and communication technology. Medical education is no exception to this dynamism more especially in the teaching of gross anatomy, which serves as one of the bases of understanding the human structure., Objective: This study was conducted to determine the gender preference of preclinical medical students on the use of traditional (chalk and talk) and PowerPoint presentation in the teaching of gross anatomy., Subjects and Methods: This was cross-sectional and prospective study, which was conducted among preclinical medical students in the University of Maiduguri, Nigeria. Using simple random techniques, a questionnaire was circulated among 280 medical students, where 247 students filled the questionnaire appropriately. The data obtained was analyzed using SPSS version 20 (IBM Corporation, Armonk, NY, USA) to find the method preferred by the students among other things., Results: Majority of the preclinical medical students in the University of Maiduguri preferred PowerPoint method in the teaching of gross anatomy over the conventional methods. The Cronbach alpha value of 0.76 was obtained which is an acceptable level of internal consistency. A statistically significant association was found between gender and preferred method of lecture delivery on the clarity of lecture content where females prefer the conventional method of lecture delivery whereas males prefer the PowerPoint method, On the reproducibility of text and diagram, females prefer PowerPoint method of teaching gross anatomy while males prefer the conventional method of teaching gross anatomy., Conclusion: There are gender preferences with regard to clarity of lecture contents and reproducibility of text and diagram. It was also revealed from this study that majority of the preclinical medical students in the University of Maiduguri prefer PowerPoint presentation over the traditional chalk and talk method in most of the questions ask., Competing Interests: There are no conflicts of interest.

Objective: To compare suxamethonium with atracurium using the priming principle, for rapid sequence orotracheal intubation assessing onset time, time to successful laryngoscopy and intubation and quality of intubating conditions., Patients and Methods: A prospective double-blind, randomised study was performed in 90 ASA physical status I and II patients aged between 18 and 64 years undergoing elective surgery requiring endotracheal intubation between October 2002 and June 2003 in a university teaching hospital . All patients were premedicated with 5-10mg oral diazepam and randomly assigned to one of two groups to receive either suxamethonium as a bolus dose (group A) or atracurium (priming with 0.05 mg/kg followed by 0.55 mg/kg after induction of anaesthesia) (group B). In both groups, the trachea was intubated when there was maximal muscle relaxation, determined clinically by jaw muscle relaxation. Muscle paralysis using a PNS, quality of intubating conditions, and occurrence of muscle weakness due to the priming dose of atracurium, time to laryngoscopy and onset time were all noted., Results: Onset time was 87.1 +/- 25.60s and 135.8 +/- 46.23s in groups A and B respectively (P < 0.05). Group A had a laryngoscopy time of 73.6 +/- 25.22s compared to 107.7 +/- 41.32s in group B (P < 0.05). Intubating conditions were significantly better in group A compared to group B (P < 0.05). The frequency of muscle weakness from the priming dose of atracurium was 6.6%., Conclusion: Atracurium, using the priming principle, is an option in our environment for modified rapid sequence induction when suxamethonium is contraindicated.