Search

Referral time for end-stage renal disease (ESRD) patients to nephrologists and initial vascular access method are considered significant factors that impact health outcomes at the time of hemodialysis (HD) initiation. Native arteriovenous fistula (AVF) is strongly recommended as initial access. However, little is known about the referral rate among ESRD receiving HD in Palestine and its correlation with AVF creation. In Ramallah Hemodialysis Center, we investigated the pre-dialysis nephrology care and AVF usage in 156 patients. Type of access at HD initiation was temporary central venous catheter (CVC) in 114 (73%), tunneled hemodialysis catheter (TDC) in 21 (13%) and AVF in 21 (13%). Out of all participants, 120 (77%) were seen by nephrologist prior to dialysis. Of the participants who initiated dialysis with a CVC, 36 (31%) had not received prior nephrology care. All participants who initiated dialysis with functional AVF had received prior nephrology care. Patients who were not seen by a nephrologist prior to HD initiation had no chance at starting HD with AVF, whereas 17% of those who had nephrology care >12 months started with AVF. In conclusion, a relatively large percentage of Palestinian HD patients who were maintained on HD did not have any predialysis nephrology care. In addition, patients who received predialysis nephrology care were significantly more likely to start their HD through AVF whereas all those without predialysis nephrology care started through CVC. More in-depth national studies focusing on improving nephrology referral in ESRD patients are needed to increase AVF utilization.

In the dialysis center in Ramallah, we investigated the attitudes and perceived barriers to having arteriovenous fistula (AVF) in 156 patients. The current method of HD access was AVF in 52% and central venous catheter in 47%. Perceived causes of no or delayed AVF were: patient’s refusal of AVF in 54.5%, late referral to a surgical evaluation in 31.3% and too long to surgical appointments in 14.2%. Among those who refused AVF, reasons were: concern about the surgical procedure in 42.5%, poor understanding of disease/access in 23.3%, fear of needles in 15.1%, denial of disease or need for HD in 17.8%, and cosmetic reasons in 1.4%. Forty six percent of patients believed they received education about AVF prior to the creation of HD access, and 73.7% would recommend AVF as the method of access due to the lower risk of infection (96%), easier to care for (16%), easier showering (14%), and better-associated hygiene (3%). In conclusion, the majority would recommend an AVF as the mode of vascular access for HD. The most common barrier to having an AVF was patient’s refusal to undergo AVF creation because of their concern about the surgical procedure. A systematic evaluation of the process that precedes the creation of AVF may allow for better utilization.

Our aim in this study is to establishing nonstandard foundations, definitions and theorems for completion a noncomplete metric spaces. We have a lot of space or sets X which agree with all usual properties of complete, except at a small size subset of it. In this paper, by using nonstandard analysis tools founded by A. Robinson and axiomatized by E. Nelson, we try to reformulate the definition of completion corresponding to nonstandard modified metric , and to give a nonstandard form to the classical (standard) completion theorem and to use the power of nonstandard tools to overcome the incompetence of those spaces which has deprivation at a small size subset.

Effects of prenatal alcohol exposure (PAE) are rarely measured in preschool children due to relative insensitivity of assessment methods at this age. To examine the potential of a nonverbal battery in early identification of cognitive problems in alcohol-exposed children, 291 prospectively identified Ukrainian children were evaluated using a test battery focusing on early executive functioning (EF) and visuospatial skills, areas of cognitive development particularly sensitive to PAE in older children. Tests included the Differential Ability Scales, 2nd Edition (DAS-2) and several NEPSY/NEPSY-II subtests, standardized in the United States. Others were adapted from commonly used non-standardized neuropsychological measures of EF (Preschool Spatial Span, Imitation Hand Game, A not B, Delayed Attention, Subject Ordered Pointing). Children in two sites in Ukraine, Rivne and Khmelnitsky, were tested at 3 ½-4 ½ years to identify effects of PAE. Although most children performed within the average range, Alcohol-Exposed preschoolers had lower scores on DAS-II Summary Scores as well as on specific subtests. To evaluate the effects of alcohol dose during the pre-pregnancy recognition period and during mid-gestation of pregnancy, generalized linear regression models were used controlling for demographic and individual variables. In addition to DAS-II variables, measures reflecting sustained attention, working memory and ability to shift cognitive set were impacted by alcohol dose. Early executive function appears to subsume these performance differences. In conclusion, findings indicate that the effects of PAE can be identified in the preschool period and reliably measured using tests assessing nonverbal and spatial skills supported by executive functioning.

BackgroundOf the many negative outcomes associated with gestational alcohol use, one that has received relatively little attention is preterm birth and its possible contribution to effects of prenatal alcohol exposure (PAE) on development. To examine the increased risk for premature delivery associated with PAE and the joint influence of preterm birth and alcohol on child outcomes, analysis was carried out in a longitudinal cohort recruited in Western Ukraine.MethodsAlcohol-using women and low or nondrinking controls were identified prenatally for a clinical trial of multivitamins and minerals (MVM) in ameliorating effects of PAE. Women were interviewed to provide information about medical and social status and other drug use. At delivery, information was collected about infant (N = 686) status including gestational age (GA) in weeks. Finally, 441 infants were followed to 6 months of age and cognitive (Mental Developmental Index [MDI]) and motor development (Psychomotor Developmental Index [PDI]) (measured using the Bayley Scales of Infant Development, second Ed (BSID-II).ResultsSeven percent infants were born at

Abstract To identify factors associated with post-recurrence survival (PRS), we examined our institutional recurrence patterns following definitive resection for rectal cancer. We reviewed all patients with rectal cancer diagnosed at three hospitals in the east of Iran from 2011 to 2020. The optimal cut-off value was determined by receiver operating characteristic (ROC) analysis to determine early recurrence. The effect of recurrence time was evaluated on PRS. 326 eligible patients with a mean ± SD age of 56 ± 12.8 years were included in this study. In a median (IQR: Inter-quartile range) follow-up time of 76 (62.2) months, 106 (32.5%) patients experienced at least any recurrence (locoregional or distant metastasis) following primary resection. The median (IQR) time from initial surgery to recurrence was 29.5 (31.2) months. Based on ROC analysis, early recurrence was specified at ≤ 29 months. However, for the patients who experienced only locoregional recurrence, 33 months was the cut-off to define early recurrence. Recurrence time and recurrence management were both significant variables on PRS. Moreover, TNM staging was significantly associated with early recurrence (P = 0.003). In this research, recurrence time, recurrence management and TNM staging were found to be correlated with PRS.

ABSTRACT Aim This study evaluated surgical complication rates, recurrence‐free survival, overall survival (OS), and stoma status of patients with rectal cancer after significant pathologic response following neoadjuvant treatment and curative resection. Pathologic complete response (pCR) and near‐pCR patients constitute patients in our study. Methods Included was a retrospective cohort study of patients with rectal cancer who were diagnosed between July 2011 and September 2022 and who underwent neoadjuvant therapy and surgical resection. Results Of 696 patients with rectal cancer, 149 (21.4%) cases achieved significant pathologic response. During the 64 (70.5) months of follow‐up, recurrence occurred in 16.1% of patients and distant metastases account for the majority of them. Age (p = 0.014) and receiving adjuvant chemotherapy (p = 0.016) were significantly related to the occurrence of recurrence. The five‐year recurrence‐free survival (RFS) and OS rates were obtained at 83% and 87%, respectively. Although age and surgical technique were significant factors in univariate Cox regression analysis, none of the candidate variables were significant prognostic factors for RFS in the multiple models. The risk of surgical complications remained in these patients. The most frequent complication attributed to infection (20.8%). Despite the 24.8% presence of permanent stoma at primary surgery, more than 50% of our patients lived without stoma at the last follow‐up. Conclusion Our recurrence rate was about 16%, and it was related to age and adjuvant chemotherapy. These patients achieved over 80% rates of five‐year RFS and OS. No significant prognostic factors were found on RFS in the multivariable model. As a matter of course, the risk of surgical complications and permanent stoma has still remained in these patients.

Reducing the environmental footprint of concrete is one of the most effective methods to mitigate climate change since cement production contributes to about 8 % of global CO2 emissions. This paper presents an experimental investigation into the strength and flexural performance of reinforced concrete (RC) beams incorporating natural aggregate (NA), recycled concrete aggregate (RCA), and reclaimed asphalt pavement concrete (RAP) at normal and elevated temperatures. The NA was replaced by RAP at three replacement ratios of 40 %, 60 % and 80 %. Additionally, there were four mixes of 80 % RCA-20 % RAP, 60 % RCA-40 % RAP, 40 % RCA-60 % RAP, and 20 % RCA-80 % RAP. A total of 16 beams (L: 1400 mm, W: 150 mm, H: 250 mm) and 128 cylinders (H: 200 m, D: 100 mm) were tested to evaluate the flexural capacity and material strength. Eight RC beams were tested after exposure to a temperature of 600 °C for 3 h. The compressive strength, ultimate flexural load, and mid-span deflection were measured. The results showed that temperature has an adverse effect on the s compressive strength, flexural load capacity, and deflection of RC beams. Specimens made with the RAP and RCA combination showed a significant loss in their load-carrying capacity under elevated temperature by (55 %–65 %), while the temperature effect was relatively less severe in specimens made with high RAP replacement of NA. Increasing the RAP percentage increased the reduction of flexural capacity in RCA-RAP mixes by (3 %–10 %), while in NA-RAP mixes, the effect is similar except for 60 % RAP, which has a smaller reduction compared to 40 % and 80 % RAP.

Introduction. The most important risk factors for lung cancer are the tobacco smoking and residential radon exposure. The study of the interaction of smoking x radon as trigger factor for lung cancer morbidity in the Republic of Moldova was carried out. Material and methods. Data on tobacco smoking prevalence of the national study STEPS 2021, lung cancer morbidity data of 2012-2020 and data of radon measurements using RADTRAK2 during 2018-2021 were used. Data processing tools included summary statistics and cluster analysis. Results. The distribution of high radon values, the number of smokers and the lung cancer morbidity is uneven throughout the country. The formation of higher cluster combining all variables has proceeded by the formation of two clusters: 1. lung cancer incidence, lung cancer prevalence, number of total tobacco smokers, number of male smokers, number of female smokers, and number of urban smokers, 2. radon concentration and number of rural smokers. Conclusions. Study results demonstrate the leading role of tobacco smoking on morbidity among the adult population, regardless of gender in an urban environment with a rather low concentration of radon, and at the same time indicate the cumulative effect of smoking and increased radon concentration in rural areas due to the construction features of houses and lifestyle.

Introduction: The benefits of laparoscopy versus open surgery for patients with rectal cancer have been well established. This study evaluates the role of re-laparoscopy in patients who develop complications following laparoscopic rectal cancer surgery.Methods: This is a retrospective case series of 22 (5.9%) re-laparoscopy cases of the 373 rectal cancer patients with rectal cancer who underwent laparoscopic primary surgery at Omid, Ghaem, and Razavi hospitals in Mashhad, Iran, between July 2011 and December 2020.Results: Twenty-two (5.9%) eligible patients with a mean±SD age of 50.9±10.4 years were included in the study, of which 15 (68.2%) were men and 7 (31.6%) were women. After 22 primary laparoscopic surgeries, anastomosis-fail/peritonitis was the most common complication requiring re-laparoscopy (n=9, 40.9%). Other complications included obstruction (n=8, 36.4%), bleeding (n=3, 13.6%), and intestinal injury (n=2, 9.1%). The complications of all patients (n=22) who underwent re-laparoscopy were successfully managed by re-laparoscopy.Conclusion: In the case of available facilities and the presence of an experienced surgeon in the medical center, re-laparoscopy for managing complications following laparoscopic rectal cancer surgery appears to be safe and effective in selected patients.

Assessing the association between temperature frequency and mortality can provide insights into human adaptation to local ambient temperatures. We collected daily time-series data on mortality and temperature from 757 locations in 47 countries/regions during 1979–2020. We used a two-stage time series design to assess the association between temperature frequency and all-cause mortality. The results were pooled at the national, regional, and global levels. We observed a consistent decrease in the risk of mortality as the normalized frequency of temperature increases across the globe. The average increase in mortality risk comparing the 10th to 100th percentile of normalized frequency was 13.03% (95% CI: 12.17–13.91), with substantial regional differences (from 4.56% in Australia and New Zealand to 33.06% in South Europe). The highest increase in mortality was observed for high-income countries (13.58%, 95% CI: 12.56–14.61), followed by lower-middle-income countries (12.34%, 95% CI: 9.27–15.51). This study observed a declining risk of mortality associated with higher temperature frequency. Our findings suggest that populations can adapt to their local climate with frequent exposure, with the adapting ability varying geographically due to differences in climatic and socioeconomic characteristics.

Background: Temperature variability (TV) is associated with increased mortality risk. However, it is still unknown whether intra-day or inter-day TV has different effects. Objectives: We aimed to assess the association of intra-day TV and inter-day TV with all-cause, cardiovascular, and respiratory mortality. Methods: We collected data on total, cardiovascular, and respiratory mortality and meteorology from 758 locations in 47 countries or regions from 1972 to 2020. We defined inter-day TV as the standard deviation (SD) of daily mean temperatures across the lag interval, and intra-day TV as the average SD of minimum and maximum temperatures on each day. In the first stage, inter-day and intra-day TVs were modelled simultaneously in the quasi-Poisson time-series model for each location. In the second stage, a multi-level analysis was used to pool the location-specific estimates. Results: Overall, the mortality risk due to each interquartile range [IQR] increase was higher for intra-day TV than for inter-day TV. The risk increased by 0.59% (95% confidence interval [CI]: 0.53, 0.65) for all-cause mortality, 0.64% (95% CI: 0.56, 0.73) for cardiovascular mortality, and 0.65% (95% CI: 0.49, 0.80) for respiratory mortality per IQR increase in intra-day TV0–7 (0.9 °C). An IQR increase in inter-day TV0–7 (1.6 °C) was associated with 0.22% (95% CI: 0.18, 0.26) increase in all-cause mortality, 0.44% (95% CI: 0.37, 0.50) increase in cardiovascular mortality, and 0.31% (95% CI: 0.21, 0.41) increase in respiratory mortality. The proportion of all-cause deaths attributable to intra-day TV0–7 and inter-day TV0–7 was 1.45% and 0.35%, respectively. The mortality risks varied by lag interval, climate area, season, and climate type. Conclusions: Our results indicated that intra-day TV may explain the main part of the mortality risk related to TV and suggested that comprehensive evaluations should be proposed in more countries to help protect human health.

Abstract Background Various hematologic parameters have been proposed as prognostic factors in rectal cancer management, but data are conflicting and unclear. This study is designed to investigate the prognostic factor capability of preoperative hematologic parameters with postoperative morbidities and mortality in rectal cancer patients undergoing curative resection. Methods All 200 consecutive rectal cancer patients diagnosed at Ghaem University Hospital from 2017 to 2022 were retrospectively evaluated. The receiver operating characteristic (ROC) curves and machine learning (ML) algorithms of Random Forest, Recursive Feature Elimination, simulated annealing, Support Vector Machine, Decision Tree, and eXtreme Gradient Boosting were administered to investigate the role of preoperative hematologic parameters accompanied by baseline characteristics on three clinical outcomes including surgical infectious complications, recurrence, and death. Results The frequency of infectious complications was correlated with the surgical procedure, while tumor recurrence was significantly influenced by T stage and N stage. In terms of mortality, alongside T and N stage, the status of resection margin involvement was significantly correlated. Based on the ROC analysis, the NLR >2.69, MPV ≤9 fL, and PDW ≤10.5 fL were more classified patients to mortality status. Likewise, the PLT >220 109/L, MPV ≤9 fL, PDW ≤10.4 fL, and PLR >13.6 were correlated with recurrence. However, all factors examined in this study were not significant classifiers for the outcome of surgical infectious complications. The results of ML algorithms were also in line with ROC analysis. Conclusion According to the results of both ROC analysis and ML models, preoperative hematologic parameters are considerable prognostic factors of postoperative outcomes in rectal cancer patients, and are recommended to be monitored by clinicians to prevent unfavorable outcomes.

Abstract Background Comparison of natural orifice specimen extraction (NOSE) and transabdominal specimen extraction (TASE) in colorectal surgery remains controversial. Herein, we aimed to perform a retrospective analysis on surgical outcomes of NOSE and TASE at three hospitals in east of Iran. Method Consecutive locally advanced rectal adenocarcinoma patients who underwent laparoscopic surgery using either NOSE or TASE from 2011 to 2017 were recruited. These patients were followed-up till 2020. Data, including postoperative complications, long-term overall and recurrence-free survival were analyzed retrospectively. Results 239 eligible patients were included in this study. 169 (70.71%) patients underwent NOSE, and 70 (29.29%) patients underwent TASE. Although this study has achieved similar outcomes in terms of overall and recurrence-free survival, metastasis, circumferential margin involvement as well as complications of intra-operative bleeding, obstruction, anastomosis-fail, rectovaginal-fistula in women and pelvic collection/abscess in both groups, we observed higher rates of locoregional recurrence, incontinency, stenosis and the close distal margins involvement in NOSE group and also obstructed defecation syndrome in TASE cases. Conclusion According to our findings, NOSE laparoscopic surgery showed significantly higher incontinency, impotency, stenosis and involvement of the close distal margins rates. Nevertheless, considering the similarity of long-term overall and recurrence-free survival, metastasis, circumferential margin involvement, NOSE procedure is still could be considered as a second choice for lower rectal adenocarcinoma patients.

From automobile manufacturers’ perspective, reduction of warranty cost leads to less expenditures, which then yields higher profits. Hence, it is crucial to leverage the different methods and available tools to achieve such outcome. Connected vehicle data is one critical resource that can be a gamechanger, reducing the associated costs and improving the business profitability. This project uses Mode06 (On-Board diagnostics reported tests results) connected vehicle data along with contextual data to early detect EVAP and purge monitors’ anomalies. Early detection allows fixing the issue through software (SW) and/or hardware (HW) upgrades before it turns into a failure (preventive maintenance), yielding then system quality improvement. Root cause analysis, which can be developed based on the anomaly detection outcomes and which is not within the scope of this paper, allows diagnostics of HW and/or SW related issues in a timely manner and eventually be prepared ahead of time for system failures. In this paper, statistics-based early anomaly detection models, based on vehicle data and fleet data, are developed. The proposed solution is a generic tool that does not make assumptions on data distribution and can be adapted to other systems by tweaking mainly the data cleaning process. It also incorporates specific system definitions of abnormal behavior, which makes it more accurate compared to conventional anomaly detection tools, which are mainly affected by the imbalanced data and the EVAP and purge definition of an anomaly. When deployed with field data, the algorithm showed higher performance, compared to popular anomaly detection techniques, and proved that failures can be prevented through detection of the anomalies several weeks/miles before the actual fail.

Summary: Background: Increased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000–19. Methods: In this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000–19. Temperature variability was calculated as the SD of the average of the same and previous days’ minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades. Findings: An increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901–2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2–4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7–5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3–10·4), followed by Europe (4·4%, 2·2–5·6) and Africa (3·3, 1·9–4·6). Interpretation: Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability. Funding: Australian Research Council, Australian National Health & Medical Research Council.

Obiective. Expunerea rezidențială la radon este al doilea factor de risc al declanșării cancerului pulmonar pentru fumători și primul – pentru nefumătorii. Obținerea rezultatelor veridice în acest sens necesită efectuarea cercetărilor științifice epidemiologice pe scară largă, cu implicarea eșantioanelor adecvate de pacienți, dar aceste studii sunt foarte costisitoare. Problema studierii acțiunii radonului și a tutunului în declanșarea cancerului bronhopulmonar rămâne actuală. Analiza științifică a literaturii de specialitate a servit ca bază pentru inițierea dezvoltării unei metodologii de studiere a interacțiunii radon x fumat ca factor trigger în declanșarea cancerului bronhopulmonar la fumători din Republica Moldova. Material și metode. Experiența mondială privind metodologia studierii interacțiunii radon x fumat a fost examinată, utilizând rezultatele științifice a circa 30 de publicații pe site-urile ResearchGate, Pubmed, BioMedCentral, RSCI, CE Webgate, OMS, AIEA, etc. S-a efectuat sinteza abordărilor actuale ale dezvoltării și implementării metodelor de cercetare pentru elucidarea impactului interacțiunii radon x fumat asupra declanșării cancerului bronhopulmonar. Rezultate. Până în prezent, unele cercetări s-au axat pe studiul efectului expunerii sinergice la fumat/radon asupra apariției cancerului bronhopulmonar. O revizuire a literaturii în domeniu a demonstrat că principalele metode pentru studierea acestui fenomen sunt metodele caz-control și metodele sociologice prin sensibilizarea publicului. Combinând abordările studiate și luând ca bază experiența de succes a cercetărilor internaționale, a fost elaborată metodologia de estimare a interacțiunii radon x fumat asupra declanșării cancerului bronhopulmonar. Se propun două direcții de cercetare: (1) statistică, cu utilizarea datelor asupra fumătorilor în Republica Moldova, concentrația radonului în locuințe și indicatorii de morbiditate/mortalitate și (2) „caz-control”, cu utilizarea chestionarului în studiu pe termen lung în colaborare cu Institutul Oncologic. Concluzii. Dezvoltarea unei metodologii de studiu a influenței interacțiunii radon x fumat asupra declanșării cancerului bronhopulmonar va permite Sistemului de Sănătate Publică să elaboreze instrumentele de control/prevenire/diminuare a maladiei menționate.

Summary: Background: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature–mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature–mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967–5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58–11·07) of all deaths (8·52% [6·19–10·47] were cold-related and 0·91% [0·56–1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60–87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000–03 to 2016–19, the global cold-related excess death ratio changed by −0·51 percentage points (95% eCI −0·61 to −0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13–0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. Funding: Australian Research Council and the Australian National Health and Medical Research Council.

Objectives. Climate change is a topic of major importance, discussed extensively by politicians, businessmen, environmentalists, society and the media. They take place in oceans, soil, open and closed environments. Climate change has many effects on health, and the health sector is one of the main links in the conduct of these clinical conditions. Doctors are specialists who could help raise public awareness of climate change and its impact on health. The aim of the study was focused on determining the link between high air temperatures and deaths from diseases of the circulatory system. Material and methods. A retrospective study was carried out, focusing on the estimation of general mortality and deaths from circulatory system diseases, using daily data on deaths and air temperature in Chișinău, during the summer 2001-2015. Results. The high temperatures during the summer, in the last 15 years (2001-2015), have increased the number of deaths in Chișinău. During high air temperatures, the main nosological groups of noncommunicable diseases, which represent in total over 70% of the causes of death, are neoplasms (C00-D48), diseases of the respiratory system (J00-J99), diseases of the circulatory system (I00-I99) and diseases of the digestive system (K00-K93). The largest contribution to total mortality (~50%) is circulatory system diseases. Conclusions. Weak but reliable statistical relationships have been established between high temperatures and deaths from circulatory system diseases.

Summary: Background: Various retrospective studies have reported on the increase of mortality risk due to higher diurnal temperature range (DTR). This study projects the effect of DTR on future mortality across 445 communities in 20 countries and regions. Methods: DTR-related mortality risk was estimated on the basis of the historical daily time-series of mortality and weather factors from Jan 1, 1985, to Dec 31, 2015, with data for 445 communities across 20 countries and regions, from the Multi-Country Multi-City Collaborative Research Network. We obtained daily projected temperature series associated with four climate change scenarios, using the four representative concentration pathways (RCPs) described by the Intergovernmental Panel on Climate Change, from the lowest to the highest emission scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5). Excess deaths attributable to the DTR during the current (1985–2015) and future (2020–99) periods were projected using daily DTR series under the four scenarios. Future excess deaths were calculated on the basis of assumptions that warmer long-term average temperatures affect or do not affect the DTR-related mortality risk. Findings: The time-series analyses results showed that DTR was associated with excess mortality. Under the unmitigated climate change scenario (RCP 8.5), the future average DTR is projected to increase in most countries and regions (by −0·4 to 1·6°C), particularly in the USA, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2–7·4%. Furthermore, the DTR-related mortality risk increased as the long-term average temperature increased; in the linear mixed model with the assumption of an interactive effect with long-term average temperature, we estimated 0·05% additional DTR mortality risk per 1°C increase in average temperature. Based on the interaction with long-term average temperature, the DTR-related excess deaths are projected to increase in all countries or regions by 1·4–10·3% in 2090–99. Interpretation: This study suggests that globally, DTR-related excess mortality might increase under climate change, and this increasing pattern is likely to vary between countries and regions. Considering climatic changes, our findings could contribute to public health interventions aimed at reducing the impact of DTR on human health. Funding: Korea Ministry of Environment.

Objectives. Review of international experience in creating and promoting programs for communicating the risk of radon exposure for public health in order to elaborate the appropriate approaches for our country in developing a program for communicating the risk of radon exposure. Material and methods. The scientific and practical sources from the countries of the European Region, Canada and the United States of America were used, which cover their national programs and policies for communicating the risk of radon exposure, recommended for implementation by EURATOM Directive 2013/59. Methods used - descriptive, analytical, synthetic. Results. The synthetic analysis of current sources summarizes the scientific evidence to substantiate political decisions and demonstrate the need for multilevel interventions. The key point of these policies is the need for a wider coverage of residents with information about the risk of radon exposure and how to reduce it. Efforts to improve public awareness have had some success in some countries, but it has also been found difficult to convince residents of the importance of radon control and forces them to take measures to mitigate the side effects. Conclusion. Public health policy in the area of radon risk should take into account the responsibility of the government and residents in addressing this issue.

Global animal production systems are often criticized for their lack of sustainability and insufficient resilience to ensure food security. The ‘farm-to-fork’ approach aims at orienting food systems towards the creation of a positive environmental impact, nutritious, healthy, safe and sufficient foods, and fairer economic returns for primary producers. Many countries rely on an imported supply of live animals to fulfill their needs for fresh meat. In Israel, ~60% of the sources of fresh beef come from the import of live animals. In order to encourage sustainable beef production in Israel, the proportion of local beef should be raised at the expense of imported animals. However, for this to be achieved, the superior performance of local beef should be justified. The current study was conducted to compare between the meat quality characteristics of local (Israeli Holstein; N = 205) vs. imported (Australian; N = 169) animals. Generally, while the imported calves presented a higher dressing percentage (p < 0.0001), the local animals were characterized by tenderer meat (p < 0.0001), longer sarcomeres (p < 0.0001), higher a* color attributes and pH (p < 0.001), superior cooking (p = 0.002) and thawing loss (p < 0.0001), higher intra-muscular fat (IMF) content, and a higher PUFA proportion (p < 0.01 and p < 0.0001, respectively) and PUFA:SFA ratio. The findings shown herein may provide sound arguments for stakeholders and policy makers to facilitate sustainable local beef production in Israel.

An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010–2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (−0.92%p/°C) and Australia (−0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population. Keywords: Projection, Mortality, Climate change, Regional variation, Vulnerability

BackgroundHeatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited.Methods and findingsWe collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections.ConclusionsThis study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change.

Objectives. The present study aimed to estimate the number of emergency ambulance call-outs during the very cold winter of 2009/2010 (December–February) with respect to the reference period of 2007-2010. Material and methods. As study material there were considered about 335 000 requests for emergency care in Chisinau, Republic of Moldova, and about 2 500 records of daily temperatures (mean, maximum and minimum) and wind speed from the Chisinau weather station. Quantitative estimation of the number of ambulance call-outs depending on the air temperature values was carried out using the statistical method of linear regression. Results and conclusions. Quantification of the health impact of the low temperatures recorded during the investigated period reveals that minimum diurnal temperatures have the greatest effect on the emergency ambulance call-outs increase: when the air temperature drops by 1°C, the number of total requests increases by 8 cases per day. According to nosology, the respiratory diseases correlate best with low maximum diurnal temperatures: a decrease by 1°C leads to an increase of 9 requests. The highest vulnerability to cold was recorded in the population aged 0-17 years. These findings could serve as a basis for elaboration and implementation of preventive targeting the vulnerable groups.

Objective: The aim of this study was to determine the prevalence of self-medication with antibiotics in children. Materials and Methods: This study was based on a prevalidated questionnaire distributed to 205 families in the United Arab Emirates, during the period of January-October 2014, on self-medication of their children with antibiotics. Data were collected and analyzed using Microsoft Excel® and expressed in terms of both counts and percentages. Results: The response rate was 92.7% most respondents were well educated, and with university degrees and 45 (23.7%) participants were working in the medical field or attained a medical background. The majority of children were between 1 and 12 years of age, and the family's monthly income ranged from moderate to high for most of the participants. Community pharmacy was the main source (152, 80%) of antibiotics, and the main source of information was the pharmacists, followed by doctors and medication leaflets. Reasons for self-medication with antibiotics included previous experience with symptoms (100, 52.6%), and minor illness (67, 35.3%). The majority (141, 74.2%) of participants was aware of consequences of antibiotic misuse and bacterial resistance. The most commonly utilized antibiotic for self-medication was an amoxicillin - clavulanic acid combination. Antibiotics were most commonly used without prescription for respiratory symptoms including sore throat (104, 54.7%), cold/flu (85, 44.7%), and runny nose/nasal congestion (56, 29.5%). Conclusion: Antibiotics are still used for conditions which are viral in origin and parents, misconceptions about antibiotics call for organized extensive efforts to increase public awareness of the rational antibiotic use.

Analiza efectuată în cadrul prezentului articol are ca scop determinarea naturii juridice a dreptului de a cere partaj, cu precădere în cadrul proprietăţii comune pe cote-părţi, drept conferit de art.357 din Codul civil al Republicii Moldova. Tot aici sunt generalizate şi actualizate, în corespundere cu legislaţia în vigoare, modalitatea de reglementare a dreptului de partaj a proprietăţii comune pe cote-părţi, accentuând importanţa cunoaşterii aplicabilităţii corecte şi uniforme pentru practica judiciară. În continuare, sunt determinate trăsăturile specifice dreptului de partaj, totodată făcându-se o compa­raţie cu prevederile legale ale legislaţiei străine. Se aduce claritate în privinţa semnificaţiei termenilor de partaj, drept potestativ şi act juridic de dispoziţie, iar în procesul de cercetare se ajunge la concluzia că natura juridică a dreptului de a cere partaj este cea a unui drept potestativ.REFLECTIONS ON THE LEGAL NATURE OF THE RIGHT TO ASK FOR DIVISION The analysis conducted in this article aims to determine the legal nature of the right to demand division, especially under common ownership quota-party, right conferred by art.357 Civil Code of Republic of Moldova. Here are generalized and updated, in line with current legislation, the method of regulation the right of division regarding property in the share ownership, emphasizing the importance of knowing the correct and uniform application for legal practice. The following are determined the specific features of the right of division, also performed a comparison with the legal provisions of foreign law. The author brings clarity to the meaning of the terms division, potestative right and legal act of disposal, and in the process of research is conclude that the legal nature of the right to demand division is a potestative right.

Background: Globally, renal replacement therapy especially haemodialysis remains pivotal in the effective care of patients with kidney diseases since its acceptance as a treatment modality. Despite being widely embraced as a therapeutic option, several factors still hamper its utilization. A clinical audit of this modality option will allow elucidation of haemodialysis practises and peculiarities., Methods: The charts and records of 280 patients with renal impairments dialyzed between March 1 st 2019 and February 28 th 2023 were evaluated in retrospect. Data on retrieved demographic and clinical information were analyzed using SPSS 25 and patients' short-term survival was determined using the Kaplan Meier survival analysis and log rank test., Results: Out of the 280 patients who had 1716 dialysis sessions, 184 (65.7%) were males. The mean age was 47.9 ± 17.5 years. The majority (80.7%) of the patients had chronic kidney disease (CKD), as 90.2% of the dialysis sessions were for CKD. There was a male preponderance (69.1%) in the population. Hypertension was the commonest cause of CKD (41.2%) while sepsis was the commonest cause of acute kidney injury (50%). The median number of dialysis session was 4.0. The mean pre-dialysis hematocrit was 24.4 ± 7.1% and the mean single pool Kt/V was 0.9 ± 0.02. The femoral vein was the most used vascular access (95.4%). The short-term survival was positively related to the dialysis frequency on Kaplan-Meier analysis., Conclusion: Haemodialytic therapy in patients with renal disease is still of huge impact on survival despite the numerous factors affecting its effective delivery, especially in low-income nations., (© 2023 Bamikefa T.A, et al.)

Chronic kidney disease (CKD) is a burgeoning problem globally, and more than a billion adults were affected as of 2016, with 1.2 million people dying from renal failure in 2017. To arrest the seemingly relentless progression of CKD to renal failure, there is a need to detect CKD early in the community. A community-based study was carried out to look at the prevalence and risk factors of CKD. Anthropometric and other clinical variables were measured. Blood samples were taken for determining creatinine, uric acid, urea, and lipids. CKD was defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. Electrocardiograms and renal ultrasound scans were performed. In total, 201 people were recruited. Those with CKD had a male:female ratio of 1:3.9 and were older. The prevalence of autosomal-dominant polycystic kidney disease and CKD was 531.9 persons/100,000 population and 46.3%, respectively. Systolic blood pressure, pulse pressure, total cholesterol, triglycerides, high-density lipoprotein (HDL), uric acid, QTc interval, and electrocardiographic left ventricular hypertrophy were higher in those with CKD. Age, female sex, and HDL were independently associated with CKD. There was a steep rise in CKD at the community level. Increased awareness of CKD and prompt interventions are therefore imperative., (Copyright © 2022 Copyright: © 2022 Saudi Journal of Kidney Diseases and Transplantation.)

Background: Antenatal depression (AD) is prevalent and associated with adverse pregnancy, maternal and child outcomes, yet no study has addressed its magnitude and predictors in early pregnancy in Nigeria., Aim: To determine the prevalence and factors associated with AD in first half of pregnancy., Setting: Multicentric health facilities in Southern Nigeria., Methods: A multicentric health-facilities-based cross-sectional study was conducted from January to July 2018. Using pretested structure interviewer-administered questionnaires, antenatal depressive symptoms were assessed amongst 511 pregnant mothers with the Edinburg Postnatal Depressive Scale tool. Socio-demographic, socio-economic, clinical, family and social factors were also measured. Descriptive statistics, bivariate and multivariable logistic regression analyses were employed to describe and identify factors associated with AD., Results: The prevalence of antenatal depressive symptoms in early pregnancy in this study was 29.4% (95% confidence interval [CI] 26.6-32.9). Factors independently associated with AD were intimate partner violence (adjusted odds ratios [AOR] = 8.10, 95% CI 5.00-13.14), marital dissatisfaction (AOR 5.48, 95% CI 3.48-8.38), poor social support (AOR 4.70; 95% CI 2.99-7.38), past history of depression (AOR 4.67; 95% CI 2.47-8.80), previous pregnancy complication (AOR 2.50, 95% CI 1.57-3.89), low socio-economic status (AOR 2.41, 95% CI 1.61-3.66) and unplanned pregnancy (AOR 2.35, 95% CI 1.47-3.64)., Conclusions: The prevalence of antenatal depression is high with modifiable risk factors requiring context-specific policies such as provision of family, social and economic support for mothers at the earliest possible contact in the antenatal period., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2022. The Authors.)

Background: Malaria is a parasitic disease of public health concern especially among children because of their vulnerability. Objective: The study sought to evaluate the prevalence and severity of malaria and to assess the factors associated with malaria parasitaemia among children., Methods: This was a hospital-based cross-sectional observation study. We enrolled 303 children aged 6 to 59 months who presented with fever. A structured questionnaire was used to obtain the demographic characteristics, determinant factors and the use of malaria preventive measures. Microscopic examination of blood film for malaria parasite was done. Data were analysed using SPSS version 23.0. The Pearson's Chi-square was used to determine the association between selected socio-demographic variables, clinical characteristics of participants and presence of malaria parasitaemia. A p-value less than 0.05 was considered significant., Results: The mean ± SD age was 24.36 ± 16.63 months, 183 (60.4%) were male. Two hundred and thirteen (70.3%) participants tested positive for Plasmodium falciparum. Severe malaria accounted for 21.1% of all malaria cases. Severe anaemia (37.8%) and cerebral malaria (24.4%) were the common complications observed. Malaria was significantly associated with increasing age (p = 0.007). Children who slept regularly under LLIN and those using insecticidal spray were more likely to be protected from developing malaria (p = 0.002, p = 0.001, respectively). The socioeconomic status, maternal education, family size and knowledge of LLIN were not associated with the development of malaria (p= 0.901, 0.136, 0.413, 0.166, respectively)., Conclusion: The prevalence of malaria is high; there is a need to increase the coverage of IRS, together with LLINs to reduce the transmission and burden of malaria, particularly among the susceptible population., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Background: Hypertension is the commonest cardiovascular risk factor globally and is a cause of untold morbidity and mortality. However, its clinical correlates at the community level have not been well elucidated., Methods: History taking, anthropometric measurements, electrocardiograms and laboratory investigations were done for all the study subjects. Ethical approval was obtained from the institution's ethical body. Analysis was done using SPSS version 20. Two hundred people were recruited for the study. The prevalence of hypertension in the community was 58.5% with 31(15.5%) being newly diagnosed. The Body Mass Index [BMI] (28.2±6vs 25.6±5.3; P=0.003),Waist-Hip ratio (0.9±0.08 vs 0.86±0.06; p= 0.001), total cholesterol (5.675±1.8 vs 4.6±1.7, P=0.000), triglycerides (1.19±0.85 vs 0.91±0.59; p=0.019), LDL cholesterol (3.38±1.6 vs 2.66±1.5; p=0.002), heart rate (82.4±15.8 vs 76.8±11.2; p=0.018) QRS duration (84.8±13.4 vs 80.5±11.2; p=0.040), and QTc (0.423±0.041 vs 0.402±0.035; p=0.001) were higher in those with hypertension. NYHA functional class was worse in hypertensives (p=0.041). Prevalence of left ventricular hypertrophy (LVH) in hypertensives ranged from 2.6 to 48.2%, depending on the criteria used. Systolic blood pressure, pulse pressures, HDL levels and hip circumferences were higher in those with electrocardiographic LVH. Systolic blood pressure (OR:1.045, P=0.006; CI: 1.013-1.079) and a normal BMI (OR: 0.159, p= 0.004; CI: 0.045-0.559) were the independent predictors of LVH in this study., Conclusion: The prevalence of hypertension is rising, even in rural populations, with accompanying LVH, higher QTc and florid cardiovascular risk factors. It is therefore imperative to tighten the reins of control of blood pressure and other cardiovascular risk factors before the cardiovascular morbidity and mortality explode in the rural communities., Competing Interests: The Authors declare that no competing interest exists.

Background: Obstructive sleep apnoea (OSA) is a common medical condition which has long been recognized as a major contributor to morbidity and mortality in developed countries but that remains underdiagnosed, particularly in rural communities. This study aimed to assess the prevalence of adults who have a high risk of obstructive sleep apnoea in a sample of adults living in Ejigbo, a rural community in south western Nigeria., Methods: This was a community-based cross-sectional descriptive study done to assess the prevalence of high risk of obstructive sleep apnoea in adult residents of the community using the STOP-BANG questionnaire. Data collected include socio-demographic characteristics, anthropometric measurements and blood pressure. A blood sample was also taken for lipid profile. Factors associated with a high risk of obstructive sleep apnoea were identified., Results: The study involved 257 participants out of which 88 (34.2%) had a high risk of OSA. Risk of obstructive sleep apnoea was significantly associated with male sex (p<0.001), age (p<0.001), body mass index (BMI) (p=0.001), neck circumference (p<0.001), cigarette smoking (p=0.039) and low density lipoprotein (p=0.043)., Conclusion: Obstructive sleep apnoea is relatively common in the study area. This calls for urgent preventive measures to stem the tide and mitigate the associated morbidity and mortality.