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Objective: This study examined diabetes knowledge, health fatalism (the belief that health outcomes are outside one's control), and their interaction, as predictors of Type 2 Diabetes preventive behavior. Participants: Ethnically diverse college students (N = 345) without prior diagnosis of diabetes. Methods: Cross-sectional design using validated self-report measures. Results: Respondents answered approximately half of the diabetes knowledge items correctly. Physical activity and sedentary behavior were not predicted by diabetes knowledge, fatalism, or their interaction. Higher diabetes knowledge was associated with a healthier diet among individuals with low fatalism. Greater fatalism was associated with a poorer diet among individuals with moderate or high diabetes knowledge. Conclusions: Diabetes knowledge was moderate in this college student sample. Greater knowledge was linked with a healthier diet among those with sense of personal control over their health. College health educators may consider emphasizing modifiability of health behaviors in conjunction with Type 2 diabetes education efforts.

BackgroundMaternal and neonatal health outcomes in low- and middle-income countries (LMICs) have improved over the last two decades. However, many pregnant women still deliver at home, which increases the health risks for both the mother and the child. Community health worker programs have been broadly employed in LMICs to connect women to antenatal care and delivery locations. More recently, employment of digital tools in maternal health programs have resulted in better care delivery and served as a routine mode of data collection. Despite the availability of rich, patient-level data within these digital tools, there has been limited utilization of this type of data to inform program delivery in LMICs.MethodsWe use program data from 38,787 women enrolled in Safer Deliveries, a community health worker program in Zanzibar, to build a generalizable prediction model that accurately predicts whether a newly enrolled pregnant woman will deliver in a health facility. We use information collected during the enrollment visit, including demographic data, health characteristics and current pregnancy information. We apply four machine learning methods: logistic regression, LASSO regularized logistic regression, random forest and an artificial neural network; and three sampling techniques to address the imbalanced data: undersampling of facility deliveries, oversampling of home deliveries and addition of synthetic home deliveries using SMOTE.ResultsOur models correctly predicted the delivery location for 68%–77% of the women in the test set, with slightly higher accuracy when predicting facility delivery versus home delivery. A random forest model with a balanced training set created using undersampling of existing facility deliveries accurately identified 74.4% of women delivering at home.ConclusionsThis model can provide a “real-time” prediction of the delivery location for new maternal health program enrollees and may enable early provision of extra support for individuals at risk of not delivering in a health facility, which has potential to improve health outcomes for both mothers and their newborns. The framework presented here is applicable in other contexts and the selection of input features can easily be adapted to match data availability and other outcomes, both within and beyond maternal health.

Plant extracts rich in phenolic compounds have been demonstrated to accelerate wound healing, but their use by oral route has been poorly studied. The leaves of Vitis labrusca are rich in phenolic acids and flavonoids. The goal of this study was to assess the healing properties of the oral administration of hydroalcoholic extract of V. labrusca leaves (HEVL) in a murine model. HEVL was obtained by Soxhlet and dynamic maceration, and their yield and phenolic acids and flavonoid contents were determined. For the wound healing assay, 8 mm wounds were performed on the back of 48 Wistar rats, assigned into four groups (n = 12): CTR (distilled water), HEVL100, HEVL200, and HEVL300 (HEVL at 100, 200, and 300 mg/kg, respectively). On days 7 and 14, wound closure rates were assessed, and the healing wounds were subjected to histological analysis. Soxhlet-obtained extract was selected for the wound healing assay because it provided a higher yield and phenolic acid and flavonoid contents. HEVL significantly reduced leukocytosis in the peripheral blood (p < 0.05), accelerated wound closure (p < 0.05), and improved collagenization (p < 0.05) on day 7, as well as enhanced the epidermal tissue thickness (p < 0.001) and elastic fiber deposition on day 14 (p < 0.01). Furthermore, HEVL promoted an increase in the histological grading of wound healing on both days 7 and 14 (p < 0.01). The doses of 200 and 300 mg/kg provided better results than 100 mg/Kg. Our data provide histological evidence that the oral administration of HEVL improves wound healing in rodents. Therefore, the extract can be a potential oral medicine for healing purposes.

The Earn Group of central Yukon records the transition from a passive to an active margin along western Laurentia in the Late Devonian. Fine-grained clastic rocks and chert of the lower Earn Group contain late Early to Middle Devonian fossils and were deposited in an offshelf environment. The upper Earn Group comprises a mixture of sandstone and conglomerate, fine-grained siliciclastic rocks, and widespread crystal lithic tuff. Zircons from this succession are precisely dated using chemical abrasion isotope dilution thermal ionization mass spectrometry (CA-ID-TIMS) methods on igneous (ca. 363 Ma) and detrital (ca. 378-363 Ma) grains and the ages were confirmed by Frasnian to Famennian fossils. Abrupt, along-strike facies changes within the upper Earn Group of the Glenlyon-Tay River area occur across mapped faults that are inferred to have originated as syndepositional extension faults in the Late Devonian. Occurrences of ca. 363 Ma tuff horizons within all facies of the upper Earn Group provide a temporal correlation across the area. Diorite plutons intrude lower Paleozoic rocks in the area and have U-Pb zircon crystallization dates of ca. 364 Ma. The diorite has calc-alkaline composition consistent with arc magmatism or crustal contamination. The Late Devonian magmatism in the Earn Group is coincident with onset of arc magmatism in the allochthonous Yukon-Tanana terrane, and extension related to rifting and opening of the Slide Mountain ocean in a back-arc setting. Magmatic rocks in the Earn Group of central Yukon thus represent part of a remnant continental arc and back-arc stranded behind the Slide Mountain ocean in the Mississippian. Key words: Late Devonian, magmatism, Earn Group, extension, western Laurentia, biostratigraphy. Le Groupe d'Earn dans le centre du Yukon preserve des preuves d'une transition d'une marge passive a une marge active le long de la Laurentie occidentale au Devonien tardif. Des roches clastiques a grains fins et deschertsdu Groupe d'Earn inferieur renferment des fossiles d'age devonien precoce tardif a devonien moyen et ont ete deposes dans un milieu oceanique. Le Groupe d'Earn superieur comprend un melange de gres et de conglomerats, de roches silicoclastiques a grains fins et de tuf cristallolithique ubiquiste. Des zircons provenant de cette succession sont dates de maniere precise par des methodes de spectrometrie de masse d'ionisation thermique d'ionisation d'isotope d'abrasion chimique (CA-ID-TIMS) appliquees a des grains ignes (~363 Ma) et detritiques (~378-363 Ma), ces ages etant confirmes par des fossiles frasniens et famenniens. Des changements de facies abrupts paralleles a la direction des strates dans le Groupe d'Earn superieur de la region de Glenlyon-riviere Tay sont observes de part et d'autre de failles cartographiees interpretees comme etant, a leur origine au Devonien precoce, des failles d'extension synsedimentaires. La presence d'horizons de tuf de ~363 Ma dans tous lesfaciesduGrouped'Earn superieur fournit une correlation temporelle sur l'ensemble de la region. Des plutons de diorite recoupent des roches du Paleozo'ique inferieur dans la region et donnent des ages U-Pb de cristallisation des zircons de ~364 Ma. La diorite presente une composition calco-alcaline que pourraient expliquer un magmatisme d'arc ou une contamination crustale. Le magmatisme d'age devonien tardif dans le Groupe d'Earn coincide avec le debut du magmatisme d'arc dans le terrane allochtone de Yukon-Tanana et avec l'extension associee au rifting et a l'ouverture de l'ocean de Slide Mountain dans un milieu d'arriere-arc. Les roches magmatiques dans le Groupe d'Earn du centre du Yukon representent donc une partie des vestiges d'un arc continental et d'un arriere-arc echoues derriere l'ocean de Slide Mountain au Mississipien. [Traduit par la Redaction] Mots-cles: Devonien tardif, magmatisme, Groupe d'Earn, extension, Laurentie occidentale, biostratigraphie., Introduction The western edge of North America (or Laurentia in the Paleozoic) was a passive continental margin from early Cambrian to Middle Devonian (Bond et al. 1983; Bond and Kominz [...]

Abstract Background Improving cardiovascular health requires public knowledge and reduction of modifiable cardiovascular disease (CVD) risk factors. This study assessed knowledge of risk factors and warning signs for CVDs among young and middle-aged adults in Morogoro, Tanzania. Methods We conducted a community-based survey as part of cluster randomized controlled study of community health workers (CHWs) intervention for reduction of blood pressure among young and middle-aged adults in rural Morogoro. Information on socio-demographic characteristics, knowledge of risk factors and warning signs for CVDs was collected using an interviewer administered questionaire. Knowledge was assessed using open-ended questions followed by closed-ended questions. Descriptive statistics were used to describe knowledge of risk factors and warning signs. Logistic regression analysis was used to investigate factors associated with adequate knowledge of risk factors and warning signs for CVDs. Results Two-thirds (65.7%) of the participants had heard about CVDs. The main sources of information were mainly relatives/ neighbors (64.8%) and radio (53.0%). Only 28.3% of the participants reported health care providers as source of information about CVDs. More than half of the participants (52.4%) did not mention even one risk factor spontaneously while 55.2% were unable to mention any warning sign. When asked to select from a list, 6.9% were unable to correctly identify any risk factor whereas 11.8% could not correctly identify even a single warning sign. Quarter of participants (25.4%) had good knowledge score of risk factors, 17.5% had good knowledge score of warning signs and 16.3% had overall good knowledge of both risk factors and warning signs. Residing in Ulanga, having higher education level, having ever checked blood pressure and being overweight/obese predicted adequacy of knowledge score for both risk factors and warning signs. Conclusion Knowledge of risk factors and warning signs in this rural population of young and middle-aged adults was generally low. Health care providers were less likely to provide health education regarding risk factors and warning signs for CVDs. Health promotion interventions to increase population knowledge of risk factors and warning signs should be implemented for successful reduction of CVDs in Tanzania.

: Introduction: Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID‐19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented. Methods: From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence ( Results: Questions about pandemic‐related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low‐ (n = 57), lower‐middle (n = 79), upper‐middle (n = 39) and high‐ (n = 50) income countries. Most sites reported being subject to pandemic‐related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID‐19 services, record‐keeping interruptions and suspension of partner support. Almost all sites in low‐prevalence and high‐income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high‐prevalence and lower‐income settings. Few sites in high‐prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi‐month dispensing of ART (95%) and designating community ART pick‐up points (44%). While few sites (5%) reported stockouts of first‐line ART regimens, 10–11% reported stockouts of second‐ and third‐line regimens, respectively, primarily in high‐prevalence and lower‐income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings. Conclusions: While many sites in high HIV prevalence settings and lower‐income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID‐19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings., INTRODUCTION The COVID‐19 pandemic has had major direct and indirect impacts on population health globally, through disruptions in the accessibility and quality of basic health services [1], in supply chains [...]

Purpose To investigate the global burden of sepsis in hospitalized adults by updating and expanding a systematic review and meta-analysis and to compare findings with recent Institute for Health Metrics and Evaluation (IHME) sepsis estimates. Methods Thirteen electronic databases were searched for studies on population-level sepsis incidence defined according to clinical criteria (Sepsis-1, -2: severe sepsis criteria, or sepsis-3: sepsis criteria) or relevant ICD-codes. The search of the original systematic review was updated for studies published 05/2015-02/2019 and complemented by a search targeting low- or middle-income-country (LMIC) studies published 01/1979-02/2019. We performed a random-effects meta-analysis with incidence of hospital- and ICU-treated sepsis and proportion of deaths among these sepsis cases as outcomes. Results Of 4746 results, 28 met the inclusion criteria. 21 studies contributed data for the meta-analysis and were pooled with 30 studies from the original meta-analysis. Pooled incidence was 189 [95% CI 133, 267] hospital-treated sepsis cases per 100,000 person-years. An estimated 26.7% [22.9, 30.7] of sepsis patients died. Estimated incidence of ICU-treated sepsis was 58 [42, 81] per 100,000 person-years, of which 41.9% [95% CI 36.2, 47.7] died prior to hospital discharge. There was a considerably higher incidence of hospital-treated sepsis observed after 2008 (+ 46% compared to the overall time frame). Conclusions Compared to results from the IHME study, we found an approximately 50% lower incidence of hospital-treated sepsis. The majority of studies included were based on administrative data, thus limiting our ability to assess temporal trends and regional differences. The incidence of sepsis remains unknown for the vast majority of LMICs, highlighting the urgent need for improved epidemiological sepsis surveillance., Author(s): C. Fleischmann-Struzek [sup.1], L. Mellhammar [sup.2], N. Rose [sup.1], A. Cassini [sup.3], K. E. Rudd [sup.4], P. Schlattmann [sup.5], B. Allegranzi [sup.3], K. Reinhart [sup.6] [sup.7] [sup.8] Author Affiliations: [...]

As one of the main knowledge producers, researchers can play an important role in contributing to efforts that bridge the gap between knowledge, policy and practice. However, for researchers to play this role, they need knowledge translation (KT) capacities that many typically lack. Furthermore, research has confirmed that little is known on KT training approaches for LMICs researchers and their effectiveness. This paper seeks to contribute to filling this knowledge gap on KT training approaches for LMIC researchers by assessing the effectiveness of a training and mentorship intervention to build African researchers' KT capacity. We conducted KT training and mentorship for 23 early and mid-career researchers from 20 universities in sub-Saharan Africa. This comprised a 5-day intense residential training workshop, followed by a 6-months mentorship. A pre- and post-training test was used to assess the immediate effect of the workshop. The intermediate effect of the training following a 6-month mentorship was assessed by the number of researchers who completed policy briefs during this period and those who participated in the webinar series conducted during this period. Overall, the aggregate average point change in the self-reported learning between the pre-training and the post-training survey was 1.9, which demonstrated the effectiveness of the training workshop. This was confirmed by a 33.7% increase in the aggregate average percentage of participants that responded correctly to questions assessing topics covered in the training between the pre-training and the post-training survey. During the mentorship period, 19 of the 23 researchers prepared and submitted complete drafts of their policy briefs within two months after the training. Fewer (4) researchers revised and submitted final policy briefs. More than half of the trained researchers participated in the webinars conducted in the first three months of the mentorship, whereas less than half of the researchers participated in the webinars conducted in the last three months. KT training and mentorship can be an effective intervention for addressing researchers' KT capacity gaps. For sustainability, KT training and mentorship need to be integrated in graduate training programmes in universities so that future LMIC researchers leave training institutions with the KT capacities they need for influencing policy and programme decisions and actions.

Despite growing interest in evidence among parliamentarians and some emerging literature on evidence use in decision making in parliaments, there is still a notable gap in knowledge on the ecosystem of evidence in parliaments. This paper seeks to contribute to filling this gap by discussing the contribution of a loose regional network, the Network of African Parliamentary Committees on Health (NEAPACOH), to the evidence ecosystem in African parliaments. Although the network was not set up to strengthen evidence use, its mechanisms for realising its goal of strengthening parliamentary committees of health to effectively tackle health challenges in Africa provide an opportunity for understanding how such networks are contributing to strengthening the weak evidence ecosystem in African parliaments. The authors have been involved in the work of the network and therefore use this network for this study purposively. Data were gathered through document review and 34 in-depth interviews with parliamentarians, parliament staff and development partners. Results show that, in a context of weak institutional support and technical capacity to enable evidence use in African parliaments, the network's activities respond to some of the key barriers hindering parliamentarians from using evidence, including: limited access to evidence, complexity of evidence, weak capacity to understand evidence, and weak/lacking linkages with researchers/experts. Apart from generating demand, providing evidence, building capacity for increased evidence use, and linking MPs and researchers/experts, the network creates a sense of competition among countries by requiring countries to make commitments and report progress against the commitments annually, which provide impetus for action.