scholarly journals Barriers to Optimal Acute Management of Stroke: Perspective of a Stroke Center in Mexico City

2021 ◽  
Vol 12 ◽  
Author(s):  
Vanessa Cano-Nigenda ◽  
Enrique Castellanos-Pedroza ◽  
Diana Manrique-Otero ◽  
Beatriz Méndez ◽  
María Fernanda Menéndez-Manjarrez ◽  
...  
Keyword(s):  
Demographic Data ◽  
Total Sample ◽  
Acute Management ◽  
Middle Income ◽  
Middle Income Countries ◽  
Telephone Interviews ◽  
Single Center Study ◽  
Private Car ◽  
The Mean ◽  
Stroke Center

Background: Stroke is a leading cause of death and disability worldwide, particularly in low- and middle-income countries. We aimed to identify the main barriers to optimal acute management of stroke in a referral center.Methods: Demographic data was collected from patients assessed with acute stroke in the emergency department of the Instituto Nacional de Neurología y Neurocirugía (INNN) from January to June 2019. Additionally, a telephone interview was conducted with patients/primary caregiver to know which they considered the main reason for the delay in arrival at INNN since the onset of stroke.Results: 116 patients were assessed [age 65 ± 15 years, 67 (57.8%) men]. Patients consulted other facilities prior to arrival at INNN in 59 (50.9%) cases (range of hospitals visited 1–4), 83 (71.6%) arrived in a private car, with prenotification in only 4 (3.4%) of the total sample. The mean onset-to-door time was 17 h (45 min−10 days). Telephone interviews were done in 61 patients/primary caregivers, stating that they consider the multiple evaluations in other facilities [n = 26/61 (42.6%)] as the main reason for delay in arrival at the ED, followed by ignorance of stroke symptoms and treatment urgency [n = 21/61 (34.4%)].Conclusion: In this small, retrospective, single center study, the main prehospital barrier to optimal acute management of stroke in a developing country is multiple medical evaluations prior to the patient's transport to a specialized stroke hospital, who mostly arrived in a private car and without prenotification. These barriers can be overcome by strengthening public education and improving patient transfer networks and telemedicine.

scholarly journals In-hospital mortality among incident hemodialysis older patients in Peru

2019 ◽  
Vol 12 (2) ◽  
pp. 142-147
Author(s):  
Percy Herrera-Añazco ◽  
Pedro J Ortiz ◽  
Jesus E Peinado ◽  
Tania Tello ◽  
Fabiola Valero ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Older Patients ◽  
Linear Models ◽  
Venous Catheter ◽  
Ageing Population ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Understanding the pattern of mortality linked to end stage renal disease (ESRD) is important given the increasing ageing population in low- and middle-income countries. Methods We analyzed older patients with ESRD with incident hemodialysis, from January 2012 to August 2017 in one large general hospital in Peru. Individual and health system-related variables were analyzed using Generalized Linear Models (GLM) to estimate their association with in-hospital all-cause mortality. Relative risk (RR) with their 95% confidence intervals (95% CI) were calculated. Results We evaluated 312 patients; mean age 69 years, 93.6% started hemodialysis with a transient central venous catheter, 1.7% had previous hemodialysis indication and 24.7% died during hospital stay. The mean length of stay was 16.1 days (SD 13.5). In the adjusted multivariate models, we found higher in-hospital mortality among those with encephalopathy (aRR 1.85, 95% CI 1.21-2.82 vs. without encephalopathy) and a lower in-hospital mortality among those with eGFR ≤7 mL/min (aRR 0.45, 95% CI 0.31-0.67 vs. eGFR>7 mL/min). Conclusions There is a high in-hospital mortality among older hemodialysis patients in Peru. The presence of uremic encephalopathy was associated with higher mortality and a lower estimated glomerular filtration rate with lower mortality.

scholarly journals Research and Development as a Moderating Variable for Sustainable Economic Performance: The Asian, European, and Kuwaiti Models

2020 ◽  
Vol 12 (18) ◽  
pp. 7525
Author(s):  
Ahmad Salman ◽  
Ali Al-Hemoud ◽  
Saja A. Fakhraldeen ◽  
Maha Al-Nashmi ◽  
Suad M. AlFadhli ◽  
...  
Keyword(s):  
Research And Development ◽  
Economic Performance ◽  
The State ◽  
Gdp Per Capita ◽  
Series Data ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Mean ◽  
Per Capita ◽  
The State Of Kuwait

The research and development (R&D) expenditure in Kuwait is insufficient to lead to innovation and a knowledge economy. Investment in R&D has been shown to sustain elevated economic performance. The objective of this study is to explore the association between three competing dimensions of R&D indicators that lead to sustainable economic performance within any given country, namely, R&D expenditure, the number of researchers, and the number of patent rights, using time-series data collected over a 20-year period (1996–2016) by the World Bank Group. R&D indicators were compared between high- and middle-income countries including models from Asian (South Korea, Singapore, and Malaysia) and European (Finland and Ireland) countries as well as the State of Kuwait. Moreover, a case study describing R&D investments in Kuwait is presented. Overall, the results reveal higher R&D spending, number of researchers, and gross domestic product (GDP) per capita for the Asian and European models. Current R&D expenditure in Kuwait is estimated at 0.08% of GDP (2016), which is significantly lower than the mean of the middle-income countries (1.58%). Furthermore, the number of researchers (per million) in Kuwait (386) is less than half of the mean number of researchers in middle-income countries (775) (2015). Low R&D investments in the State of Kuwait has gradually led to a decreased GDP per capita. Regression analysis shows that GDP per capita can be predicted solely based on the number of researchers (beta = 0.780, R2 = 0.608). The number of researchers is the most crucial variable to predict GDP per capita, and the R&D expenditure is a good indicator of the number of researchers. These findings offer invaluable insight into the sustainable development goals (SDG 9). To our knowledge, this paper presents the first application of the effect of R&D on sustainable economic performance with reference to the SDG target 9.5 “Research & Development”. Thus, in order to enhance scientific research (both academic, professional, and industrial), countries need to increase the number of researchers, and these actions are necessary to introduce sustainable growth to GDP.

scholarly journals ‘When she rises, we all rise’: a crowdsourcing challenge to increase women’s participation in an infectious diseases research fellowship

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ewen Liu ◽  
Juliet Iwelunmor ◽  
Grace Gabagaya ◽  
Helen Anyasi ◽  
Alejandra Leyton ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Middle Income ◽  
Media Communication ◽  
Research Fellowship ◽  
Middle Income Countries ◽  
Women's Participation ◽  
The Mean ◽  
Social Media Communication ◽  
The Impact ◽  
Low And Middle Income

Abstract Background Women are under-represented in many mid-career infectious diseases research fellowships, including a TDR fellowship for low- and middle-income country (LMIC) researchers. TDR solicited creative ideas as part of a challenge contest to increase the number of women fellowship applicants. The purpose of this study is to examine themes from submitted ideas and the impact of implementing the top three ideas on the number of women applicants. Methods We solicited ideas for modifying the TDR fellowship using a crowdsourcing challenge. Then we used a mixed methods approach to evaluate texts submitted in response to the challenge. The qualitative analysis identified themes from eligible submissions. The quantitative analysis examined the mean score (1–10 scale) assigned to submitted ideas and also the number of eligible women applicants before (2014–7) and after (2018) implementing the top three ideas. Results We received 311 ideas on improving women’s participation in this fellowship from 63 countries. Among all ideas, 282 (91%) were from women and 286 (92%) were from low- and middle-income countries (LMICs). Thirty-three (17%) ideas received an overall mean score of 7.0 or greater. The top three ideas included enhanced social media communication targeting women, improving career mentorship, and creating a nomination system to nudge women applicants. These ideas were implemented as part of the 2018 fellowship application cycle. The number of eligible women applicants increased from 11 in 2016 to 48 in 2018. The number of eligible men applicants increased from 55 in 2016 to 114 in 2018. Women represent 44% (8/18) of the 2018 cohort. Conclusion This suggests that the challenge contest resulted in strong participation from women in LMICs. The three top ideas likely contributed to a greater number of women applicants to this mid-career fellowship. Further ways of enhancing women’s participation in global health training are needed.

scholarly journals Health Risk Associated with Near-Road Ambient Air Concentration of Particulate Matter in Mukono Municipal Council, Uganda

2021 ◽  
Vol 9 (1) ◽  
pp. 127-137
Author(s):  
Edward Kibikyo Mukooza
Keyword(s):  
Air Pollution ◽  
Health Risk ◽  
Ambient Air ◽  
Air Concentration ◽  
Middle Income ◽  
Middle Income Countries ◽  
Premature Deaths ◽  
Increased Risk ◽  
The Mean ◽  
Pm2.5 Concentration

More than 98% of urban centres exceeding 100,000 people in Low and Middle-Income Countries (LMICs), do not meet the WHO air quality limits. Data on air pollution from LMICs is scarce. We measured the mean concentrations of near-road PM2.5 in the period of Aug.-Dec. 2020, described the Mukono Municipality’s near-road populations’ exposure to PM2.5, and assessed the associated health risk. PurpleAir PA-II laser particle counters, measured near-road ambient air PM2.5 concentration in Mukono Municipality during the period of 09/1/20 to 12/04/20. Excel Toolpak was used for data analysis and the health risk assessed with the WHO AirQ+ tool. The mean ambient near–road PM2.5 in Mukono Municipality were 30.97, 33.84 and 47.74 ug/m3for background, near-unpaved and near-paved roads, respectively. Mukono Municipality’s population was exposed to ambient PM2.5 concentrations higher than the WHO annual limit of 10 ug/m3. This level of air pollution is associated with preventable annual premature deaths of up to 133.11 per 100,000 population. Vehicles were assumed to be the predominant source of near-road ambient air PM2.5 pollution. The Municipality’s population was exposed to near-road ambient air PM2.5 exceeding the WHO annual limit by as much as *4.7 for the paved roads, *3.3 for the unpaved roads and *3 for the background. This leads to increased risk of preventable premature deaths in the Municipality.Mukono Municipality could monitor PM2.5; guide developers to placebuildings more than 100 meters away from roadsides and should promotepolicies for newer vehicles on Ugandan roads.

scholarly journals Perception of Breastfeeding among Female Medical Students, Taibah University, Medina, Saudi Arabia 2012

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Ghaida Aziz, Ghaida jabri, Ghaida Al-Ahmadi, Mona Ehab, Marw
Keyword(s):  
Medical Students ◽  
Statistical Tests ◽  
Demographic Data ◽  
Knowledge Score ◽  
Total Sample ◽  
Cross Sectional Study ◽  
Hormonal Contraceptives ◽  
Cross Sectional ◽  
The Mean ◽  
Knowledge And Attitude

Breast feeding (BF) is known to have many advantages but our Arab region has a pattern similar to western countries; where exclusive breastfeeding less than 35%. Knowledge given to women during her antenatal visits plays an important influential role in her attitude and practice of BF later on.  Objective: To explore knowledge and attitude of female medical students at Taibah University about breastfeeding.  Methods: A Cross sectional study was carried out from October to November 2012. It included female medical students. Stratified sampling allocation technique was used; with a total sample of 149 students. A specialty designed self-administrated questionnaire in Arabic form was used. It included socio-demographic data, obstetric history, data about the knowledge and attitude of female medical students towards breastfeeding value and guidelines. Mean percent knowledge score for value of BF, mean percent score for BF guidelines and mean percent score for attitude were calculated. Appropriate statistical tests for qualitative and quantitative data were used accordingly. Results: Majority (91.9%) (of the studied sample) was never married and 37.6% got their knowledge about BF via books. Regarding ever married women, 58.3% only were gravid (mean =2.2±1.94). Only 25.0% were family planning users; 66.7% of them used hormonal contraceptives. Only 20% breast fed their infants with a mean duration for exclusive BF of 3.8 ± 2.87 months and mean age of weaning of 2.3 ±0.63 months. The mean knowledge percent score for guidelines of BF was 64.7±8.45. The mean attitude percent score for concepts related to BF was 76.9±7.91. Conclusion: Media and internet have minor roles in getting knowledge about BF. The mean knowledge score about advantages of BF, guidelines of BF and attitude towards BF of all female medical students; especially academic years were unsatisfactory.

scholarly journals Impact of a Postcrash First Aid Educational Program on Knowledge, Perceived Skills Confidence, and Skills Utilization Among Traffic Police Officers: A Single-Arm Before-After Intervention Study

2020 ◽  
Author(s):  
Menti Lastone Ndile ◽  
Gift G. Lukumay ◽  
Karin Bolenius ◽  
Anne H. Outwater ◽  
Britt-Inger Saveman ◽  
...  
Keyword(s):  
Police Officers ◽  
Educational Program ◽  
Road Traffic ◽  
Knowledge Score ◽  
Confidence Score ◽  
First Aid ◽  
Nonparametric Tests ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Mean

Abstract Background An overwhelming proportion of road traffic deaths and injuries in low- and middle-income countries (LMICs) occur in prehospital environments. Lay first responders such as police officers play an important role in providing initial assistance to victims of road traffic injuries either alone or in collaboration with others. The present study evaluated a postcrash first aid (PFA) educational program developed for police officers in Tanzania. Method A 16-hour PFA educational program was conducted in Dar es Salaam, Tanzania, for 135 police officers. Participants completed training surveys before, immediately and six months after the training (before, N = 135; immediately after, N = 135; after six months, N = 102). The primary outcome measures were PFA knowledge, perceived skills confidence, and skills utilization. Parametric and nonparametric tests were used to analyse changes in outcome. Results The mean PFA knowledge score increased from 44.73% before training ( SD = 20.70) to 72.92% six months after training ( SD = 18.12), p ˂ .001, N = 102. The mean PFA perceived skills confidence score (measured on a 1–5 Likert scale) increased from 1.96 before training ( SD = 0.74) to 3.78 six months after training ( SD = 0.70), p ˂ .001, N = 102. Following training, application of the recovery position skill ( n = 42, 46%) and application of the bleeding control skill ( n = 45, 49%) were reported by nearly half of the responding officers. Less than a quarter of officers reported applying head and neck immobilization skills ( n = 20, 22%) following training. Conclusion A PFA educational program has shown to improve police officers’ knowledge and perceived skills confidence on provision of first aid. However qualitative research need to be conducted to shed more light regarding reasons for low utilization of trained first aid skills during follow-up.

scholarly journals Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries

2021 ◽  
Author(s):  
Roshan Chudal ◽  
◽  
Elina Tiiri ◽  
Anat Brunstein Klomek ◽  
Say How Ong ◽  
...  
Keyword(s):  
Low Income ◽  
Internalizing Symptoms ◽  
Psychiatric Symptoms ◽  
Total Sample ◽  
Estimating Equation ◽  
Asian Countries ◽  
Cross Sectional ◽  
Middle Income ◽  
The Mean ◽  
Traditional Victimization

AbstractThere has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13–15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22–1.29; boys, OR 1.29, 95% CI 1.25–1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.

scholarly journals Intersecting Vulnerabilities: The Impacts of COVID-19 on the Psycho-emotional Lives of Young People in Low- and Middle-Income Countries

2020 ◽  
Vol 32 (5) ◽  
pp. 1613-1638 ◽  
Author(s):  
Prerna Banati ◽  
Nicola Jones ◽  
Sally Youssef
Keyword(s):  
Young People ◽  
Social Protection ◽  
Well Being ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Telephone Interviews ◽  
Chronic Poverty ◽  
Education Community ◽  
Low And Middle Income

AbstractAcross diverse contexts, emerging evidence suggests that the COVID-19 pandemic is increasing levels of anxiety and stress. In calling for greater attention to people’s psychosocial and emotional well-being, global actors have paid insufficient attention to the realities of the pandemic in low- and middle-income countries, where millions of people are already exposed to intersecting vulnerabilities. Chronic poverty, protracted violence, conflict and displacement, coupled with weak health, education and protection systems, provide the backdrop of many adolescents’ lives. Drawing on qualitative in-country telephone interviews with over 500 adolescents in Ethiopia, Côte d’Ivoire and Lebanon, this article unpacks the age and gendered dimensions of COVID-19 and its response. We conclude by discussing the implications for COVID-19 recovery efforts, arguing that embedding adolescent-centred, inclusive approaches in education, community-based health and social protection responses, has the potential to mitigate the psycho-emotional toll of the pandemic on young people and promote resilience.

scholarly journals Consequences of COVID-19 pandemic lockdown on emergency and stroke care in a German tertiary stroke center

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Robin Jansen ◽  
John-Ih Lee ◽  
Bernd Turowski ◽  
Marius Kaschner ◽  
Julian Caspers ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Hot Spot ◽  
Stroke Care ◽  
Single Center ◽  
Stroke Patients ◽  
Number Of Patients ◽  
Single Center Study ◽  
The Mean ◽  
Stroke Center ◽  
Center Study

Abstract Background COVID-19 pandemic caused a decline in stroke care in several countries. The objective was to describe lockdown stroke care in a tertiary stroke center in Düsseldorf, Germany near Heinsberg, a German hot spot for COVID-19 in spring 2020. Methods In a retrospective, observational, single-center study, we compared all patients treated in our emergency department (ED), patients seen by a neurologist in the ED, ED patients suffering from ischemic and hemorrhagic strokes and transient ischemic attacks (TIAs) as well as stroke patients admitted to our stroke unit during lockdown in spring 2020 (16 March 2020–12 April 2020) to those cared for during the same period in 2019 and lockdown light in fall 2020 (2 November – 29 November 2020). Results In spring 2020 lockdown the mean number of patients admitted to our ED dropped by 37.4%, seen by a neurologist by 35.6%, ED stroke patients by 19.2% and number of patients admitted to our stroke unit by 10% compared to the same period in 2019. In fall lockdown light 2020 effects were comparable but less pronounced. Thrombolysis rate was stable during spring and fall lockdown, however, endovascular treatment (EVT) rate declined by 58% in spring lockdown and by 51% in fall lockdown compared to the period in 2019. Conclusions Our study indicates a profound reduction of overall ED patients, neurological ED patients and EVT during COVID-19 pandemic caused lockdowns. Planning for pandemic scenarios should include access to effective emergency therapies.

scholarly journals Rising mean incomes for whom?

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242803
Author(s):  
Liang Frank Shao ◽  
Melanie Krause
Keyword(s):  
Welfare Effects ◽  
Parametric Estimation ◽  
Middle Income ◽  
Mean Values ◽  
Income Share ◽  
Middle Income Countries ◽  
Income Data ◽  
The Mean ◽  
Micro Level ◽  
Over Time

Not everybody is benefiting equally from rising mean incomes. We discuss the mean-income population share (MPS), the population percentage of earners below mean income, whose evolution can capture how representative rising mean values are for middle income households. Tracking MPS and its associated income share MIS over time indicates to what extent economic growth is inclusive of both the middle and the bottom of the income distribution. We characterize MPS and MIS analytically under different growth scenarios and compare their parametric estimation using micro-level and grouped income data. Our empirical application with panel data of 16 high- and middle-income countries shows that in the last decades rising mean incomes have mostly not favored middle income households in relative perspective, while the overall welfare effects of the changes in MPS and the correlation structure with the Gini coefficient are mixed.

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