Medical crisis during pandemic: Career preferences change in medical student

<span>The COVID-19 pandemic is a major threat to global education. Incidental emotions of fear and anxiety during pandemic have unconsciously influenced preference and outcome about their future career. This study aimed to assess the effect of the COVID-19 pandemic towards career preference change in medical students. A total of 1,027 responses from all over the medical students in Indonesia were collected from an online questionnaire which was broadcasted through social media from 14th July 2020–21st July 2020. This study was using Fear of COVID-19 Scale (FCV-19S) and Depression Anxiety Stress-Scale-21 (DASS-21) to assess fear of COVID-19, stress, anxiety, and depression. Out of 1,027 respondents, 44.6% had stressed, 47.8% had anxiety, and 18.5% had depression with an average FCV-19S score was 17.1. The result showed that the fear and anxiety of COVID-19 during the pandemic had associated significantly with the career decisions in medical students (p=&lt;0.05). Indonesian policymakers had to keep in mind that the fear of the COVID-19 pandemic in medical students is due to the high mortality COVID-19 cases of health workers in Indonesia. Health workers need adequate working conditions and specific protection, this requires prompt attention from stakeholders.</span>

Lived Experiences and Perceptions of Childbirth among Pastoralist Women in North-Eastern Ethiopia: A Multimethod Qualitative Analysis to the WHO Health Systems Responsiveness Framework

Maternity should be a time of hope and joy. However, for women in pastoralist communities in Ethiopia, the reality of motherhood is often grim. This problem is creating striking disparities of skilled birth uptake among the agrarian and pastoral communities in Ethiopia. So far, the depth and effects of the problem are not well understood. This study is intended to fill this research gap by exploring mothers’ lived experiences and perceptions during skilled birthing care in hard-to-reach communities of Ethiopia. An Interpretive Phenomenological approach was employed to analyse the exploratory data. Four key informant interviews, six in-depth interviews, six focus group discussions, and twelve focused observations were held. WHO responsiveness domains formed the basis for coding and analysis: dignity, autonomy, choice of provider, prompt attention, communication, social support, confidentiality, and quality of basic amenities. The skilled birthing experience of nomadic mothers is permeated by a deep-rooted and hidden perceived neglect, which constitutes serious challenges to the health system. Mothers’ experiences reflect not only the poor skilled delivery uptake, but also how health system practitioners are ignorant of Afar women’s way of life, their living contexts, and their values and beliefs regarding giving birth. Three major themes emerged from data analysis: bad staff attitude, lack of culturally acceptable care, and absence of social support. Nomadic mothers require health systems that are responsive and adaptable to their needs, beliefs, and values. The abuse and disrespect they experience from providers deter nomadic women from seeking skilled birthing care. Women’s right to dignified, respectful, skilled delivery care requires the promotion of woman-centred care in a culturally appropriate manner. Skilled birthing care providers should be cognizant of the WHO responsiveness domains to ensure the provision of culturally sensitive birthing care.

Influence of COVID-19 pandemic on local construction firms’ viability

Purpose This paper aims to assess COVID-19 (C-19) pandemic influence in the 37 factors identified from extant literature as factors influencing the viability of local construction firms (LCFs). Design/methodology/approach A sample size of 65 staff of 31 LCFs that were awarded construction projects contracts in institutions in Nigeria was purposefully selected and accessed based on relevant predetermined criteria. Respondents’ views on factors determining the viability of LCFs were obtained. Factors known to be influenced by C-19 are 25 of the 37 factors rated on a five-point Likert scale of importance by the respondents. Mean scores were used to rank the factors and principal component analysis was used to obtain key component factors (CFs) influenced by the C-19 pandemic. Findings Six of the first ten “extremely important” and “very important” factors are known to be influenced by C-19 pandemic. A total of 8 CFs having 20 variables with factor loadings of more than 0.5 each were known to be influenced by C-19. The C-19 pandemic influenced LCFs’ cash flow and management of construction labour, plant and equipment amidst variables that had above 0.8 factor loading. Research limitations/implications A limitation of this study is the inability to conduct close contact interview during this period to obtain personal views on the influence of C-19 on LCFs. However, this does not reduce the quality of findings of this study, as there are valid literature basis hinging this study findings. Practical implications The paper recommends that all stakeholders pay prompt attention to the factors adversely affected by the C-19 pandemic to improve or at the least sustain the viability of LCFs. Originality/value This paper fulfils a present pertinent need of assessing the influence of the C-19 pandemic on various factors influencing the viability of construction firms.

Exploring patient-provider interactions and the health system’s responsiveness to street-connected children and youth in Kenya: a qualitative study

Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.

Prolonged Migraine Aura

Most migraine auras are brief and in some ways provide an early warning for the migraine attack, but when the aura persists it should prompt attention.

COVID-19: What is the new "normal" for medical education?

The emergence of COVID-19 has disrupted medical education. The profound effects of the pandemic will forever change how future physicians learn and care for patients. The delivery of physician training, in the classroom and clinical setting, requires intense and prompt attention from medical educators. In response to the pandemic, faculty members have quickly transitioned much of the medical curriculum to a virtual format. Clerks who are assigned to clinical rotations have faced significant interruption in their clinical activities. It is imperative that the academic community learns from this pandemic and prioritizes a forward-thinking and scholarly approach that embraces practical solutions.

Risk-Based Approach for the Prediction and Prevention of Heart Failure

Targeted prevention of heart failure (HF) remains a critical need given the high prevalence of HF morbidity and mortality. Similar to risk-based prevention of atherosclerotic cardiovascular disease, optimal HF prevention strategies should include quantification of risk in the individual patient. In this review, we discuss incorporation of a quantitative risk-based approach into the existing HF staging landscape and the clinical opportunity that exists to translate available data on risk estimation to help guide personalized decision making. We first summarize the recent development of key HF risk prediction tools that can be applied broadly at a population level to estimate risk of incident HF. Next, we provide an in-depth description of the clinical utility of biomarkers to personalize risk estimation in select patients at the highest risk of developing HF. We also discuss integration of genomics-enhanced approaches (eg, Titin [TTN] ) and other risk-enhancing features to reclassify risk with a precision medicine approach to HF prevention. Although sequential testing is very likely to identify low and high-risk individuals with excellent accuracy, whether or not interventions based on these risk models prevent HF in clinical practice requires prompt attention including randomized placebo-controlled trials of candidate therapies in risk-enriched populations. We conclude with a summary of unanswered questions and gaps in evidence that must be addressed to move the field of HF risk assessment forward.

Clinical characteristics of COVID-19 patients admitted at the Korle-Bu Teaching Hospital, Accra, Ghana

Design: Study design was a retrospective single-center review of hospital data.Setting: The study was conducted at the COVID-19 Treatment Center of the Department of Medicine and Therapeutics of the Korle-Bu Teaching hospital in Accra, Ghana.Participants and study tools: A total of fifty patients with laboratory (rRT-PCR) confirmed COVID-19 infection were involved in the study. A chart review of the medical records of the patients was conducted and the data obtained was documented using a data extraction form.Results: The median age was 53 years and most (36% (18/50)) of the patients were at least 60 years of age. Eighty percent (40/50) of the patients were symptomatic, with cough and difficulty in breathing being the commonest presenting symptoms. The mean duration of hospitalization was 12.3 ± 7.3 days. Hypertension and Diabetes Mellitus were the commonest co-morbidities occurring in 52% (26/50) and 42% (21/50) of patients respectively. Fifty percent of patients developed COVID-19 pneumonia as a complication. The mortality rate was 12% (6/50).Conclusion: In this study, SARS-CoV2 infection affected older adults with hypertension and diabetes mellitus being the common comorbidities. Patients with these comorbid conditions should be counselled by their clinicians to strictly observe the COVID-19 prevention protocols to reduce their risk of acquiring the infection. There is a need to pay critical and prompt attention to the management of patients with COVID-19 pneumonia particularly among people with diabetes to improve outcomes.

How different types of financial service providers support small- and medium- enterprises under the impact of COVID-19 pandemic: from the perspective of expectancy theory

The 2019 novel coronavirus disease (COVID-19) pandemic has significantly impacted several aspects of the society and the economy. A problem that needs prompt attention in this situation is the increasing difficulties faced by small- and medium-sized enterprises (SMEs) in raising capital, which has aroused great concern from multiple stakeholders such as public administrations and regulators. As the major supply of capital, financial service providers (FSPs) play a critical role in financing SMEs. However, how FSPs deal with SME financing during shocks has not yet been fully researched. Accordingly, in this study, a theoretical framework based on expectancy theory is proposed to explore the expected strategic adjustments of FSPs in financing SMEs. Specifically, this study investigates 272 FSPs in China on their expectancy and attitude on financing to SMEs during the COVID-19 pandemic. Furthermore, this study has divided FSPs into three categories: commercial banks, non-bank financial institutions, and credit-enhanced FSPs. Differences among these categories are compared and analyzed.

Epidemiology of annual musculoskeletal injuries among male cricket players in India

Background: Injury surveillance and prevention are as significant as early detection and treatment. This study describes injuries and risk factors involved so that preventive measures can be identified. Aim: To examine the epidemiology of the annual musculoskeletal injuries among injured male cricket players. Method: This study assessed 319 male cricket players, across five State Cricket Associations from January 2017 to January 2018. Results: With an annual injury prevalence of 10.97%, prominent anatomical sites of injury were shoulder (22.85%), lumbar spine (17.14%) and knee (11.42%). Medium pacers sustained 25.71% of the injuries. Age range of 18-24 years had a prominent 37.14% of overuse injuries of which 71.42% were lumbar spine injuries. Lumbar spine injuries resulted in a distinct loss of play days (34.64%). Bowling injuries with 49.5% of loss of play days was most predisposed. Report suggests an upswing in rate of injuries in December (20%). Four surgeries were reported (11.42%). Conclusion: Overuse injuries among young cricket players need prompt attention. Shoulder, lumbar spine and knee are principal anatomical regions that are prone to injuries.