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Open Access June 25, 2025

Performance and Validity of Knee Function Assessment Tools After Total Knee Arthroplasty: A Systematic Review

Abstract Objective: To identify and evaluate the main functional assessment tools applied in the postoperative monitoring of patients undergoing total knee arthroplasty (TKA), and to synthesize the functional outcomes reported through these instruments in the current scientific literature. Methodology: A structured review was conducted following PRISMA 2020 guidelines. [...] Read more.
Objective: To identify and evaluate the main functional assessment tools applied in the postoperative monitoring of patients undergoing total knee arthroplasty (TKA), and to synthesize the functional outcomes reported through these instruments in the current scientific literature. Methodology: A structured review was conducted following PRISMA 2020 guidelines. Thirty-one peer-reviewed studies were selected through a targeted manual search based on predefined eligibility criteria. Included studies evaluated functional recovery following TKA using validated outcome measures such as the WOMAC, KSS, KOOS, IKDC, SF-36, and SANE. Data extraction focused on the instruments used, patient population characteristics, and reported outcomes. A descriptive synthesis was compiled in Table 1. Additionally, 15 studies with quantitative data were analyzed using a forest plot to illustrate risk ratios (RR) and 95% confidence intervals (CI) for functional improvement. Risk of bias was assessed qualitatively based on methodological rigor, clarity of reporting, and validation of the outcome tools. Results: All included studies reported improvements in functional status following TKA. Most risk ratios ranged from 0.66 to 0.85, indicating a consistent reduction in the risk of postoperative functional limitation. High-quality studies demonstrated more precise effect estimates and greater internal validity. The SANE scale emerged as a valid and practical tool with high responsiveness, including in its culturally adapted Brazilian version. Despite heterogeneity in study design, the direction of effect remained consistent across all included studies. Conclusion: Validated functional assessment tools are essential for monitoring recovery after total knee arthroplasty. Instruments such as WOMAC and SANE demonstrate strong clinical utility and psychometric validity. Their systematic use enhances outcome comparability, supports individualized rehabilitation planning, and improves decision-making in orthopedic care.
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Systematic Review
Open Access June 06, 2025

Food security, dietary diversity, and age as determinants of nutritional status among adolescent girls in coastal Bangladesh

Abstract Background: Adolescent girls living in disaster-prone coastal regions of Bangladesh face heightened nutritional vulnerability due to limited food access, poor dietary diversity, and environmental stressors. Despite growing concerns about adolescent malnutrition, few studies have examined the combined influence of food security, dietary diversity, and age on nutritional outcomes in these [...] Read more.
Background: Adolescent girls living in disaster-prone coastal regions of Bangladesh face heightened nutritional vulnerability due to limited food access, poor dietary diversity, and environmental stressors. Despite growing concerns about adolescent malnutrition, few studies have examined the combined influence of food security, dietary diversity, and age on nutritional outcomes in these settings. Objectives: This study aimed to assess the association between dietary diversity, food security, and age with the nutritional status of adolescent girls in coastal Bangladesh. Methods: A cross-sectional survey was conducted among 345 adolescent girls aged 10–19 in Chattogram and Cox’s Bazar. Data on dietary intake were collected using a 24-hour dietary recall and a food frequency questionnaire. Household food security was assessed using a validated scale. Nutritional status was determined using BMI-for-age classifications. Bivariate and multivariate analyses explored associations between dietary diversity, food security, age, and nutritional status. Results: Among participants, 10.14% were underweight, and 29.85% were either overweight or obese. While 17.39% demonstrated high dietary diversity (≥7 food groups), the majority had moderate diversity (5 or 6 food groups) (59.42%). Food-insecure households were significantly more likely to have overweight or obese adolescents (p < 0.05). Although dietary diversity was associated with BMI in bivariate analysis, it was not a significant predictor in the multivariate model. Age showed a significant relationship with both dietary diversity and nutritional status. Conclusion: The findings emphasize the importance of addressing household food security and age-related nutritional vulnerabilities in coastal areas. Interventions should prioritize age-sensitive, culturally appropriate strategies to improve dietary quality and prevent the double burden of malnutrition among adolescent girls.
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Article
Open Access April 10, 2025

Impact of Vaccination on Severe Outcomes in COVID-19 Reinfections and Breakthrough Infections

Abstract COVID-19 vaccines have demonstrated efficacy in reducing the prevalence of serious illnesses. The relative risk of hospitalization and mortality for patients who get breakthrough infections after immunization versus those who develop reinfections after a prior spontaneous infection is examined in this correspondence. Based on a study on U.S. Veterans who were not vaccinated and experienced [...] Read more.
COVID-19 vaccines have demonstrated efficacy in reducing the prevalence of serious illnesses. The relative risk of hospitalization and mortality for patients who get breakthrough infections after immunization versus those who develop reinfections after a prior spontaneous infection is examined in this correspondence. Based on a study on U.S. Veterans who were not vaccinated and experienced reinfections had a much higher risk of experiencing severe illness outcomes compared to those who had received immunizations and experienced breakthrough infections, even if the rates of reinfection and breakthrough infection were similar. Our findings highlight the value of immunization in reducing severe COVID-19 outcomes, even in the presence of reinfections.
Correspondence
Open Access March 06, 2025

Impact of Food Security on Dietary Diversity and Nutritional Intake Among Pregnant Women in Low-Resource Settings

Abstract Background: Food security and dietary diversity are essential determinants of maternal health, particularly among pregnant women in refugee populations who face heightened vulnerabilities due to displacement and inadequate living conditions. This study examines the impact of food security on dietary diversity and nutritional intake among pregnant Rohingya women residing in the makeshift [...] Read more.
Background: Food security and dietary diversity are essential determinants of maternal health, particularly among pregnant women in refugee populations who face heightened vulnerabilities due to displacement and inadequate living conditions. This study examines the impact of food security on dietary diversity and nutritional intake among pregnant Rohingya women residing in the makeshift camps of Ukhiya, Cox’s Bazar. Methods: A descriptive cross-sectional study was conducted among 96 pregnant Rohingya women from June to September 2022. Data were collected using structured questionnaires assessing socio-demographic characteristics, food security, and dietary diversity. Food security was evaluated using the Household Food Insecurity Access Scale (HFIAS), while dietary diversity was assessed through a 24-hour dietary recall and a 7-day food frequency questionnaire. Data were analyzed using SPSS (Version 26) and Stata (Version 13), employing descriptive statistics and chi-square tests to examine associations. Results: Most participants (57.3%) were food secure, and 85.4% demonstrated high dietary diversity, consuming seven or more food groups. However, 21.9% of households experienced severe food insecurity, highlighting ongoing challenges in food access. The highest consumption was observed for starch, flesh foods, dark green leafy vegetables, and vitamin A-rich fruits and vegetables (99.0%), while dairy products (69.8%) and organ meat (34.4%) were consumed less frequently. Despite high dietary diversity, severe food insecurity persists, indicating gaps in food assistance programs. Conclusions: While food support programs appear to contribute to high dietary diversity among pregnant Rohingya women, severe food insecurity remains a significant concern. Strengthening food security interventions, improving access to diverse nutrient-rich foods, and integrating sustainable food assistance models are essential to addressing these challenges. Future research should explore long-term strategies to enhance food security and assess the impact of targeted nutritional interventions on maternal health outcomes in refugee settings.
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Open Access February 21, 2025

Diminished Returns of Educational Attainment on Unpaid and Paid Maternity Leave of Mothers Giving Birth in Poverty

Abstract Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ [...] Read more.
Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ Diminished Returns (MDRs) posits that structural racism, segregation, and labor market discrimination limit the benefits of socioeconomic resources, such as education, for Black and Latino individuals. This suggests that the effects of education on maternity leave may not be uniform across racial and ethnic groups. Objective: This study aimed to examine the MDRs of education on access to unpaid and paid maternity leave among Black and Latino mothers compared to White mothers giving birth while living in poverty. Methods: We utilized baseline data from the Baby’s First Years Study (BFY), a longitudinal investigation of the effects of poverty on child development. The sample consisted of 1,050 mothers living in poverty who had recently given birth. Maternity leave (paid and unpaid) was assessed via self-report, and educational attainment was measured in years of schooling. Structural equation modeling (SEM) and interaction terms were employed to analyze racial and ethnic differences in the relationship between education and access to maternity leave. Results: Educational attainment was positively associated with access to unpaid maternity leave for the overall sample of mothers giving birth in poverty, but this association was weaker for Black and Latino mothers compared to non-Latino White mothers. Education did not significantly increase the likelihood of paid maternity leave, and there were no group differences for this association. Conclusion: This study highlights the urgent needs to address structural racism, labor market discrimination, and residential segregation that diminish the impact of education on living conditions for Black and Latino mothers, compared to non-Latino White mothers, even for those living under poverty. Policymakers and practitioners should develop targeted interventions to reduce racial and ethnic disparities in access to paid and unpaid maternity leave and other critical resources, particularly for new mothers living in poverty. Addressing these inequities is essential for improving maternal and newborn health outcomes and promoting social justice.
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Article
Open Access February 15, 2025

Knowledge related to umbilical cord care among mothers of neonates attending outpatient departments in Sherpur district, Bangladesh

Abstract Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among [...] Read more.
Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among mothers of neonates in Sherpur District, Bangladesh, and identify factors associated with knowledge levels. Methods: A descriptive cross-sectional study was conducted from July to October 2020 at Sherpur Sadar Hospital. A total of 193 mothers of neonates were recruited using a non-randomized purposive sampling method. Data was collected through a pre-tested, semi-structured, interviewer-administered questionnaire. Knowledge levels were categorized as "Good" (>6) or "Poor" (≤6) based on responses to 10 structured questions. Statistical analyses, including chi-square tests and crude odds ratios (COR), were performed to identify socio-demographic factors associated with knowledge levels. Results: Of the 193 participants, 48.7% demonstrated "Good" knowledge, while 51.3% had "Poor" knowledge. Education level (p = 0.01), occupation (p = 0.02), family type (p < 0.001), and family size (p = 0.04) were significantly associated with knowledge levels. Mothers with higher education and those from joint families exhibited better knowledge. However, 28.5% of respondents were unaware of the typical umbilical cord-shedding timeframe, and 44% could not identify signs of infection. Unsafe practices, such as using medications (14.5%) or hot compression (7.2%) for drying the cord, were reported. Conclusion: The study reveals significant gaps in maternal knowledge regarding umbilical cord care in Sherpur District, driven by socio-demographic disparities and cultural practices. Targeted health education programs, emphasizing evidence-based cord care practices and leveraging local social structures, are urgently needed to improve neonatal health outcomes in similar resource-limited settings. Future research should evaluate the effectiveness of these interventions to inform policy and practice.
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Article
Open Access February 04, 2025

The Use of Differentiated Instruction to Achieve Culturally Responsive Teaching

Abstract With an increasing diversity of learners in today’s educational set-ups, there is an insurmountable need to cater for individual differences including the cultural variations among learners. It is therefore necessary for educators to develop culturally responsive teaching that enhances intercultural competencies of learners. As educators strive to provide inclusive learning environments in which [...] Read more.
With an increasing diversity of learners in today’s educational set-ups, there is an insurmountable need to cater for individual differences including the cultural variations among learners. It is therefore necessary for educators to develop culturally responsive teaching that enhances intercultural competencies of learners. As educators strive to provide inclusive learning environments in which learners from diverse cultural backgrounds learn equitably, differentiated instruction becomes a practical tool. This paper explores how differentiated instruction can support and enhance culturally responsive teaching by examining how tailored instructional approaches can bridge cultural gaps and enhance educational outcomes. The aim is to provide a comprehensive understanding of how educators can effectively integrate differentiated instructional methodologies to achieve the goals of Culturally Responsive Teaching. The study used a descriptive survey design to determine the use of differentiated instruction by junior school teachers in Kenya and a systematic review of literature, practical examples, and studies on teachers’ practices in culturally responsive teaching. The study outcomes indicated that teachers used various differentiated instructional strategies with flexible grouping being the most commonly used strategy. However, there arises a concern, that teachers were not very familiar with cultural variations of learners in their classrooms even as they developed their differentiated instructional strategies. Literature provided the principles and practices of culturally responsive teaching. The combination of these results were used to formulate a conceptual framework for Culturally Responsive Differentiated Instruction (CRDI) that provides insights for practitioners to develop and implement culturally responsive differentiated instructional strategies. The study recommends that a framework to support teachers in the implementation of inclusive and equitable curriculum through CRDI be developed, CRDI be integrated into the teaching processes and the teachers be trained on providing for learner differences through CRDI.
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Open Access December 10, 2024

Psychological Corollaries, Self-Care and Coping Behaviors of Healthcare Workers During COVID-19 Pandemic: An Integrative Review

Abstract Background: The COVID-19 pandemic posed significant psychological challenges to frontline healthcare workers (HCWs), including anxiety, stress, and emotional strain. Aim: This study investigates the psychological impact on HCWs during the pandemic and explores coping strategies employed to manage distress. Methods: An integrative review was conducted using 24 studies published [...] Read more.
Background: The COVID-19 pandemic posed significant psychological challenges to frontline healthcare workers (HCWs), including anxiety, stress, and emotional strain. Aim: This study investigates the psychological impact on HCWs during the pandemic and explores coping strategies employed to manage distress. Methods: An integrative review was conducted using 24 studies published between January and December 2020. These studies were analyzed to identify common psychological outcomes and coping mechanisms among HCWs. Results: Healthcare workers experienced significant psychological distress during the COVID-19 pandemic, including anxiety, stress, insomnia, and depression. Anxiety was the most commonly reported issue, particularly among women, younger healthcare workers, and frontline staff. Stress levels were heightened by high workloads, exposure to COVID-19 patients, and inadequate protective measures. Coping strategies and self-care behaviors, such as seeking social support and utilizing institutional resources, varied in effectiveness across populations. Conclusion: The findings highlight the urgent need for targeted mental health support and resilience programs for HCWs, ensuring they are better equipped to face future health crises.
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Integrative Review
Open Access December 03, 2024

Diabetes Nursing Education Its Implication Towards an Improved Quality of Life of Persons with Diabetes: A Systematic Review

Abstract Background: Diabetes is a chronic global health issue that requires effective management to improve patient outcomes and quality of life. Nursing education plays a critical role in empowering diabetic patients with self-management skills. Aim This systematic review evaluates the impact of diabetes-focused nursing education on patient outcomes and quality of life. Methods: This study [...] Read more.
Background: Diabetes is a chronic global health issue that requires effective management to improve patient outcomes and quality of life. Nursing education plays a critical role in empowering diabetic patients with self-management skills. Aim This systematic review evaluates the impact of diabetes-focused nursing education on patient outcomes and quality of life. Methods: This study uses PRISMA guidelines and a systematic approach to identify and evaluate relevant literature. Results and Discussion: Among the 14 studies reviewed, eight emphasized self-management education, while four incorporated multidisciplinary approaches. Findings consistently demonstrated that structured nursing education programs significantly improved self-management behaviors, glycemic control, and patient knowledge. For instance, nurse-led self-management programs resulted in substantial enhancements in self-care skills and diabetes-related knowledge. Moreover, interventions that combined health education with psychological support were particularly effective, leading to better blood glucose control and increased adherence to treatment. Studies that examined quality of life reported reductions in anxiety, improved lifestyle habits, and better overall self-management. These findings highlight the multifaceted benefits of nursing education, suggesting that structured, supportive programs positively impact both clinical and psychological aspects of diabetes care. Conclusion: The review emphasizes the value of comprehensive nursing education that integrates both clinical guidance and psychological support for holistic diabetes management. Implications: Ongoing professional development and culturally sensitive education programs are recommended to address the diverse needs of diabetic patients. Future research should investigate the long-term effects of nursing education and explore innovative strategies to enhance diabetes management outcomes.
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Systematic Review
Open Access November 26, 2024

Impact of Classroom from the Primary Level of the Acquisition of English as a Second Language in Bangladesh

Abstract This paper examines the impact of primary level classroom environments on the acquisition of English as a second language (L2) in Bangladesh, comparing English-medium and Bangla-medium schools. The study investigates how different instructional approaches and early exposure to English influence language proficiency among students. Through a mixed-methods approach, including surveys, interviews, [...] Read more.
This paper examines the impact of primary level classroom environments on the acquisition of English as a second language (L2) in Bangladesh, comparing English-medium and Bangla-medium schools. The study investigates how different instructional approaches and early exposure to English influence language proficiency among students. Through a mixed-methods approach, including surveys, interviews, and proficiency tests, the research reveals significant differences in language acquisition outcomes between the two educational settings. Findings indicate that students in English-medium schools, who are exposed to Natural approach methods of language learning and immersive English-speaking environments, demonstrate higher proficiency in speaking and listening skills compared to their Bangla-medium counterparts, who primarily receive grammar-focused instruction. The study highlights the critical role of early exposure to English, with students who begin learning the language at a younger age showing better phonological and syntactic development. Additionally, the integration of technology in language teaching emerges as a valuable tool for enhancing language learning, particularly in contexts with limited classroom exposure. The research suggests that Bangla-medium schools could benefit from adopting more interactive, student-centered teaching methods and integrating digital tools to support practical language use. The study's findings have significant implications for educational policy, advocating for a shift towards more immersive and communicative teaching practices to improve English language acquisition in Bangladesh. This research contributes to the broader understanding of SLA and offers practical recommendations for enhancing language education in similar contexts.
Article
Open Access November 15, 2024

Education Does Not Equally Increase Financial Well-being for All

Abstract Background: Financial well-being is a key domain of overall well-being, encompassing an individual's ability to meet financial obligations, secure their financial future, and maintain a sense of financial freedom. Education is often viewed as a critical pathway to enhancing financial well-being. However, the returns of education on financial well-being are not uniform across racial, ethnic, [...] Read more.
Background: Financial well-being is a key domain of overall well-being, encompassing an individual's ability to meet financial obligations, secure their financial future, and maintain a sense of financial freedom. Education is often viewed as a critical pathway to enhancing financial well-being. However, the returns of education on financial well-being are not uniform across racial, ethnic, and nativity groups. The theory of Minorities’ Diminished Returns (MDRs) suggests that the positive effects of education on outcomes such as income and financial security are weaker for marginalized groups, including Black individuals, Latinos, and immigrants. Objective: This study examines the diminished returns of education on financial well-being among Black, Latino, and immigrant populations in the United States. We aim to investigate how structural inequalities contribute to weaker financial returns on education for these groups compared to their White and native-born counterparts. Methods: We utilized data from the Understanding America Study (UAS 2014) to conduct a cross-sectional analysis of adult respondents. The study assessed financial well-being outcomes (e.g., income, savings, and financial security) and their association with educational attainment across racial, ethnic, and nativity groups. Regression models were employed to test for interaction effects between education and race/ethnicity/nativity, adjusting for sociodemographic factors such as age, gender, employment, and family structure. Results: Our analysis included 8,121 individuals. The mean age of the respondents was 48 years (SD = 16). High education was associated with higher financial well-being (B = 1.284, 95% CI: 1.157, 1.410). The interaction terms between education and immigrant status (B = -0.507, 95% CI: -0.930, -0.084), race (Black) (B = -0.770, 95% CI: -1.208, -0.331), and ethnicity (Hispanic) (B = -0.589, 95% CI: -0.969, -0.210) were all significant, suggesting that immigrant, Black, and Hispanic individuals experience diminished returns on education in terms of financial well-being, relative to US-born non-Hispanic White individuals. The significant negative interactions between education and minority statuses (Black, Hispanic, and immigrant) indicate that while education generally improves financial well-being, the magnitude of this improvement is substantially smaller for these marginalized groups. Conclusion: Understanding how education translates to financial well-being across different racial, ethnic, and nativity groups is critical for addressing persistent financial disparities.
Article
Open Access April 29, 2024

Predictors of Patient Outcomes Associated with Transfer Status to Definitive Care Hospitals: A Study of Admitted Road Traffic Injured Patients in Two Major Trauma Hospitals in The Gambia

Abstract The Gambia uses the Primary Health Care model with no trauma response system. Trauma patients are transferred through multiple levels of health care facilities before definitive care hospitals. This study was conducted to identify predictors of injury factors associated with transfer. In this study, we examined characteristics of transferred patients compared to those directly admitted in [...] Read more.
The Gambia uses the Primary Health Care model with no trauma response system. Trauma patients are transferred through multiple levels of health care facilities before definitive care hospitals. This study was conducted to identify predictors of injury factors associated with transfer. In this study, we examined characteristics of transferred patients compared to those directly admitted in definitive care hospitals. The study was conducted in two major trauma hospitals in The Gambia. 251 road traffic injury (RTI) patients were either transferred (84%) from lower-level health centers or directly admitted (16%) to one of the study hospitals. Transferred patients were more likely to have been pedestrian/bicyclists (aOR = 1.81; 95% CI = 0.86 – 3.80). Administration of antibiotics was significantly associated with direct admit than transferred patients (aOR = 6.84; 95% CI = 2.38 – 19.68). Transferred patients were more likely to receive intravenous fluid compared to direct admits (aOR = 0.03; 95% CI = 0.01 – 0.08). The study results have implications for policies and planning in the healthcare setting in The Gambia and other LMICs with similar settings. Based on the findings of this study, it is essential that hospital management teams adapt to increasing reliance of RTI patients on lower-level healthcare facilities. The study results suggest increased burden on lower-level health care facilities. Efforts and resources should focus more on supporting lower-level facilities.
Article
Open Access March 06, 2024

Liver Cancer: A Psychological CBT Group Intervention Possibility Based on Scientific Review

Abstract This article focuses on primary liver cancer and tries to present a possible CBT-Cognitive Behavioral Therapy group intervention of 6 sessions and a follow up based on a scientific review. We present an international national data analyze of the problem and characterize it in terms of symptoms, diagnosis and treatment. From the psychological point of view our goal is to show and reflect on the [...] Read more.
This article focuses on primary liver cancer and tries to present a possible CBT-Cognitive Behavioral Therapy group intervention of 6 sessions and a follow up based on a scientific review. We present an international national data analyze of the problem and characterize it in terms of symptoms, diagnosis and treatment. From the psychological point of view our goal is to show and reflect on the connection between theory and practice in research mental health and the quality of life of people suffering from liver cancer. CBT interventions programme have shown efficacy and effectiveness on improving quality of life of patients. The expected outcomes of CBT intervention are mainly a better adaptation to cancer and a better perception on quality of live.
Review Article
Open Access March 05, 2024

Culture Shock in Nursing: A Concept Analysis

Abstract 1) Background: Culture shock is a common experience by internationally educated nurses (IENs) working in foreign countries, characterized by disorientation and discomfort due to distinct norms, values, and rituals. 2) Aim: this study explores culture shock in IENs and explores mitigation techniques to enhance understanding of challenges faced in foreign cultural contexts. [...] Read more.
1) Background: Culture shock is a common experience by internationally educated nurses (IENs) working in foreign countries, characterized by disorientation and discomfort due to distinct norms, values, and rituals. 2) Aim: this study explores culture shock in IENs and explores mitigation techniques to enhance understanding of challenges faced in foreign cultural contexts. 3) Method: Using Concept Analysis by Walker and Avant (2019). 4) Results: A total of 20 articles were reviewed. Four major attributes were identified: psychological and emotional impact, communication barriers, acculturation and quality of life, and organizational challenges. 5) Conclusion: This paper explores the challenges faced by nurses from foreign countries due to cultural adjustment and proposes solutions to minimize its effects. It is beneficial for nurses, healthcare organizations, and policymakers, aiming to improve patient care and health outcomes. 6) Implication for Practice: Addressing culture shock can promote a smooth transition, enhance nurses' experience, and improve their cultural competence. Providing tailored orientation and mentorship programs can help IENs feel supported and empowered, leading to increased job satisfaction, retention rates, and better patient outcomes.
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Open Access February 17, 2024

An Overview of Short- and Long-Term Adverse Outcomes and Complications of Perinatal Depression on Mother and Offspring

Abstract Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present) that start throughout pregnancy or during the first 4 weeks [...] Read more.
Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present) that start throughout pregnancy or during the first 4 weeks postpartum respectively: 1) Unintentional notable slimming up or down; 2) Sleepiness or sleeplessness; 3) Tiredness sensation; 4) Guilty or futility sensation; 5) Declined concentration capacity; 6) Frequent suicidal thoughts; 7) Psychomotor excitation or delay. Perinatal depression carries vital and adverse consequences on mother’s psychosocial aspects of life, pregnancy and delivery outcomes, her interrelations specifically with the new born with poorer overall health and influences negatively on offspring from the intrauterine life passing by complicated delivery experiencing hard unstable childhood reaching unhealthy adolescence and adulthood. These negative consequences necessitate a great attention for prevention, screening and prompt treatment for antenatal and postnatal depression to prevent such disastrous effects.
Brief Review
Open Access November 03, 2023

Quality of Communication between Healthcare Providers and Pregnant Women: Impact on Maternal Satisfaction, Health Outcomes, and Shared Decision-Making

Abstract The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication [...] Read more.
The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication between healthcare providers and pregnant women is essential for optimal maternal care during pregnancy and childbirth. Maternal satisfaction is a fundamental metric of patient-centered care, and improved communication, characterized by empathy, information sharing, and active listening, cultivates trust and enhances women's contentment with their care experiences. Positive provider-patient interactions are associated with improved emotional well-being, reduced stress levels, and increased adherence to prenatal recommendations, contributing to positive health outcomes for both mother and fetus. Shared decision-making is impacted by open and transparent dialogue between healthcare providers and pregnant women. Inclusive discussions about available interventions, risks, and benefits empower women to make informed choices aligned with their preferences and values. This shared decision-making promotes autonomy, self-efficacy, and a collaborative care partnership, potentially influencing the birthing experience and postpartum adaptation. However, challenges persist in communication quality, such as variability in healthcare provider communication styles, cultural considerations, and system-level factors. Addressing these challenges through targeted interventions, training, and policy implementation can further enhance the overall maternal care experience. Further research is needed to explore innovative strategies that optimize communication and promote positive outcomes throughout the continuum of maternal care.
Review Article
Open Access October 07, 2023

A Systematic Review of Observational Studies Focusing on Impact of Telehealth Consultation in Osteoporosis Management during the Pandemic

Abstract Background: The COVID-19 pandemic disrupted routine osteoporosis care due to clinic closures and limited in-person consultations. Telehealth emerged as an alternative model enabling remote care delivery and monitoring. However, previous reviews on telehealth either did not include the pandemic period or had a limited focus in scope. Evidence synthesized specifically for osteoporosis care [...] Read more.
Background: The COVID-19 pandemic disrupted routine osteoporosis care due to clinic closures and limited in-person consultations. Telehealth emerged as an alternative model enabling remote care delivery and monitoring. However, previous reviews on telehealth either did not include the pandemic period or had a limited focus in scope. Evidence synthesized specifically for osteoporosis care during the pandemic is needed but lacking. Methods: We systematically searched PubMed, MEDLINE, EMBASE, PsycINFO, Web of Science, and CINAHL for studies on telehealth for osteoporosis published between January 2021 and March 2023. Five studies met the inclusion criteria of: osteoporosis population, telehealth intervention, and COVID-19 pandemic timeframe. Data was extracted on study characteristics, COVID-19 outcomes, osteoporosis status, telehealth purpose, patient satisfaction, and clinical outcomes. Result: The five studies showed telehealth was used for monitoring data, delivering test results, adjusting medications, and assessments. Osteoporosis prevalence among telehealth users ranged 30-100%. High patient satisfaction was reported with telehealth versus in-person care. No major differences occurred in medication delays or fractures between telehealth and in-person groups. Conclusion: This review found telehealth enables effective osteoporosis care and monitoring during the pandemic, with high patient and provider satisfaction. However, more robust randomized controlled trials are needed to establish stronger evidence around telehealth's impacts on clinical osteoporosis outcomes. Implications: Though promising, further high-quality studies will help clarify telehealth's role in improving osteoporosis care and outcomes. Findings inform guidelines on integrating telehealth into routine management. Evidence on user perspectives optimizes telehealth implementation policies.
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Systematic Review
Open Access August 23, 2023

Determinants and Satisfaction Outcomes of Pregnancy Care in China: The Case of Ghanaian Women in Zhenjiang

Abstract The concept of maternity care satisfaction focuses on women's expectations and results in women having a positive attitude about the care received during pregnancy, childbirth and after birth. The proportion of births to Ghanaian migrant mothers in China is increasing, and there is an increasing demand for information regarding their reproductive health. To reduce maternal and neonatal morbidity [...] Read more.
The concept of maternity care satisfaction focuses on women's expectations and results in women having a positive attitude about the care received during pregnancy, childbirth and after birth. The proportion of births to Ghanaian migrant mothers in China is increasing, and there is an increasing demand for information regarding their reproductive health. To reduce maternal and neonatal morbidity and death rates, it is crucial for foreign women who use maternity services to be satisfied with their care. Ghanaian women's birth experiences in China might be harmed by language and cultural disparities. Little is known about their experiences in China's homogeneous society. A survey of 317 postnatal Ghanaian foreigners in Zhenjiang, China provided the study's data and was analyzed using IBM SPSS Statistics 25. The results showed that (76%) of postnatal foreigners were satisfied with delivery care. Though the satisfaction level was high, respondents raised the issues of poor communication (62.8%) and high cost of delivery care (52.4%) as some of the general experiences they faced. Healthcare providers’ strengthening routine monitoring of maternal and newborn health programs will help deliver more woman-centered care.
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Case Study
Open Access August 20, 2022

Nursing Student Engagement with Their Learning: A Mixed Methods Study

Abstract Student engagement in educational activities is essential for achieving desired learning outcomes. Despite this, little is known about the engagement patterns of nursing students from diverse or disadvantaged backgrounds. A mixed method study was conducted to explore engagement patterns within and outside the classroom but not during clinical placements. Students were asked what engagement means [...] Read more.
Student engagement in educational activities is essential for achieving desired learning outcomes. Despite this, little is known about the engagement patterns of nursing students from diverse or disadvantaged backgrounds. A mixed method study was conducted to explore engagement patterns within and outside the classroom but not during clinical placements. Students were asked what engagement means to them and what influences their engagement. Students were also asked how many hours they engaged in each of their undergraduate subjects and the reasons for this. The study was conducted at an Australian education provider. All students (n = 240) enrolled in the Bachelor of Nursing course were invited to participate. Lecture attendance was high at the start of the semester, fluctuated weekly and declined as the semester progressed. Students averaged between 3.5 and 4.4 hours of engagement per subject per week. They defined engagement as actually coming to class and a commitment to learning. Students were engaged by new, interesting content and disengaged by repetitive or complex content and poor tutoring. Most students want to engage but are distracted by intrinsic and extrinsic factors. Research should explore how to best assess students without the concurrent academic workload interfering with their studies.
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Article
Open Access June 30, 2022

Weekly Quizzes Reinforce Student Learning Outcomes and Performance in Biomedical Sciences in-course Assessments

Abstract Studies have highlighted the benefits of frequent quizzing in class. Frequent quizzing can promote more student attendance, engagement, practice and review, and achievement. Conversely, the opponents of frequent quizzing suggest that too frequent testing might hinder learning by frustrating anxious students and inhibiting larger units of instructional material. Notably, most studies have used [...] Read more.
Studies have highlighted the benefits of frequent quizzing in class. Frequent quizzing can promote more student attendance, engagement, practice and review, and achievement. Conversely, the opponents of frequent quizzing suggest that too frequent testing might hinder learning by frustrating anxious students and inhibiting larger units of instructional material. Notably, most studies have used degree examinations to evaluate the impact of quizzes on student learning and performance, yet little is known about whether quizzes can reinforce student performance in the in-course assessments (ICAs) despite ICA importance in student learning. The present study aimed to test the hypothesis that administration of weekly MCQ quizzes can enhance the leaning outcomes and performance of biomedical science students in assessment methods such as essay and oral presentation that can directly measure and provide information about student learning. It was therefore limited to in-course assessments. We found that the performance of the weekly quiz student group is remarkably better than that of the control student group in both the essay and oral presentation ICAs, which are two measures and indicators of student learning, suggesting improved student learning outcomes and performance after administrating weekly MCQ quizzes that also promoted student attendance in classrooms. The findings of this research study have implications for students, teachers, and curriculum designers in higher education.
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Article
Open Access August 21, 2021

Global Analysis of Potential COVID 19 Transmission and Enabling Factors

Abstract Background: Coronavirus disease has caused global turmoil especially causing huge impact on human life all over the world. Current reports states more than 3 million people have lost life and more than 160 million people are known to be suspected with the SARS-CoV-2. Transmission and disease incidence rates are indicators to assess the seriousness of COVID-19 pandemic and studies to understand the factors that aid in this direction are very vital to curb the disease. Methods: The study intends to discover the relationship by performing statistical analysis using correlation and multiple linear regression analysis between the variable’s population density, temperature, relative humidity, and active time of virus and find out the parameters that predict the cases reported per million population in 83 countries. Results: Analysis indicates active time of virus in days is very positively associated with the COVID -19 cases in all the countries r = .604, p < .01. Active time of virus shows strong negative correlation with temperature r = -.930, p [...] Read more.
Background: Coronavirus disease has caused global turmoil especially causing huge impact on human life all over the world. Current reports states more than 3 million people have lost life and more than 160 million people are known to be suspected with the SARS-CoV-2. Transmission and disease incidence rates are indicators to assess the seriousness of COVID-19 pandemic and studies to understand the factors that aid in this direction are very vital to curb the disease. Methods: The study intends to discover the relationship by performing statistical analysis using correlation and multiple linear regression analysis between the variable’s population density, temperature, relative humidity, and active time of virus and find out the parameters that predict the cases reported per million population in 83 countries. Results: Analysis indicates active time of virus in days is very positively associated with the COVID -19 cases in all the countries r = .604, p < .01. Active time of virus shows strong negative correlation with temperature r = -.930, p < .01 revealing that rise in temperature will reduce the virus activity in the population. Together, these variables will account for 36.2% variance in the cases per million population with no significant prediction estimated from any factor. Conclusion: The study outcomes clearly state that population density alone is insufficient to estimate the extent of influence on COVID -19 cases as the number of persons living per sq. km of land is a dynamic quantity tend to fluctuate over time and space due to migration of population. In conjunction to the previous studies reported on the environmental and climatic factors influencing the cases reported, population dynamics does not show much significance on the disease spread and incidence. Contribution: The rise in confirmed cases and the high incidence rate reported in countries can be attributed to the active time of virus life expectancy as there is a positive correlation observed between the COVID-19 cases reported and the virus active time in the examined countries. Also, environment and climatic factors play a role in modulating the infection and transmission rate with less significant influence of population density on the COVID-19.
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Open Access June 07, 2021

Long term data on obstructive sleep apnea treatment in insomnia and anxiety related disorders - importance in the post-covid19 era?

Abstract Patients with comorbid neurotic and anxiety disorders are more receptive of the discomfort accompanying continuous positive airway pressure therapy than average obstructive sleep apnea patients. The purpose of the study was to analyze short-term and long-term continuous positive airway pressure therapy adherence data of patients with obstructive sleep apnea and comorbid anxiety and stress-related [...] Read more.
Patients with comorbid neurotic and anxiety disorders are more receptive of the discomfort accompanying continuous positive airway pressure therapy than average obstructive sleep apnea patients. The purpose of the study was to analyze short-term and long-term continuous positive airway pressure therapy adherence data of patients with obstructive sleep apnea and comorbid anxiety and stress-related dyssomnias, as this group of disorders is expected to rise in the post-covid era. Study retrospectively analyzed clinical outcomes of obstructive sleep apnea patients. All subjects with obstructive sleep apnea were diagnosed based on in-lab video polysomnography, further referred to CPAP titration and were invited for regular follow-up visits. The results showed that subjects with comorbid obstructive sleep apnea and anxiety-related disorders used ventilation therapy more hours per day (6,690 hours/day vs. 5,000 hours/day, ****p<0,0001, anxiety (n=19) vs. controls (n=60)). Patients from the anxiety group remained longer in our therapy program (7,086 years vs. 2,905 years, ****p<0,0001) and had markedly better control over their weight, as the body-mass index of the control group increased by +1,065 kg/m2 per year and the body-mass index in the examination group increased only by +0,296 kg/m2 every year. Our data document that obstructive sleep apnea patients on ventilation therapy, who do not have enough control over their increasing body weight might highly benefit from therapy approaches similar to patients with anxiety-related dyssomnias and that management of obstructive sleep apnea is not an obstacle in concomitant treatment of neurotic and anxiety-related dyssomnias.
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Open Access February 16, 2026

Tuberculosis among elderly patients: diagnostic and therapeutic challenges (2020-2024)

Abstract Background: Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. Methods: A retrospective descriptive study was conducted including all TB cases reported between 2020 and [...] Read more.
Background: Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. Methods: A retrospective descriptive study was conducted including all TB cases reported between 2020 and 2024. Data from the National Tuberculosis Program were analyzed for demographic characteristics, clinical form, bacteriological confirmation, comorbidities, and treatment outcomes. Results: Of 1,335 TB cases, 352 (26.4%) occurred in individuals aged ≥65 years. Pulmonary TB accounted for 80.7% of cases. Men represented 63.4% of patients, and 56.8% lived in urban areas. Bacteriological confirmation was achieved in 82% of pulmonary cases, and treatment success exceeded 85%. Diabetes mellitus (26.5%) and arterial hypertension (31%) were the most common comorbidities. An increase in TB cases was observed in the post-COVID-19 period. A significant association was found between age and clinical form of TB (p < 0.001). Conclusions: Elderly individuals constitute a substantial proportion of TB cases and frequently present with chronic comorbidities. Despite diagnostic challenges, favorable treatment outcomes were achieved, highlighting the need for integrated and early management strategies in this population.
Brief Report
Open Access January 16, 2026

Evaluating the Effectiveness of Occupational Health and Safety Management Practices in Improving Workplace Safety in Nigerian Construction Sites

Abstract The construction industry remains one of the most hazardous sectors globally, with Nigeria experiencing a high incidence of workplace accidents despite the adoption of Occupational Health and Safety Management (OHSM) frameworks. This study evaluated the effectiveness of OHSM practices in improving workplace safety across construction companies in Nigeria’s coastal cities. A cross-sectional design [...] Read more.
The construction industry remains one of the most hazardous sectors globally, with Nigeria experiencing a high incidence of workplace accidents despite the adoption of Occupational Health and Safety Management (OHSM) frameworks. This study evaluated the effectiveness of OHSM practices in improving workplace safety across construction companies in Nigeria’s coastal cities. A cross-sectional design was employed, combining quantitative surveys of construction workers (n = 1,400) with qualitative interviews of 35 managers and supervisors. Quantitative data were analyzed using SPSS version 28, while thematic analysis was applied to qualitative responses. Findings revealed a generally positive perception of OHSM, with 54.4% of workers rating OHS policy effectiveness as “Good” and 52.0% rating health outcomes as “Good.” However, accident frequency remained a concern, with 46.4% reporting accidents occurred “Occasionally” and 31.9% acknowledging them as “Frequent” or “Very Frequent.” Comparative analysis showed indigenous firms were rated higher in policy effectiveness and health outcomes but also reported slightly higher accident frequencies than international firms. Thematic analysis identified five key monitoring and evaluation strategies including routine inspections, regular training, audits, behavioural reinforcement, and access control, Also, five measures of OHSM effectiveness, including compliance observation, incident tracking, KPIs, employee feedback, and benchmarking. OHSM was found to positively influence project outcomes by reducing compensation costs, enhancing reputation, and improving supervision and quality of work. OHSM practices in Nigeria’s construction sector are perceived as effective in policy and health outcomes, yet accident rates remain a critical challenge. The study underscores the importance of continuous training, stricter enforcement, behavioural reinforcement, and systematic performance evaluation.
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Open Access January 31, 2026

Management of Placenta Accreta Spectrum Disorders: A Prospective Single-Centre Experience of 236 Cases in Riyadh, Saudi Arabia (2018–2024)

Abstract Objective: To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. Methods: We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical [...] Read more.
Objective: To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. Methods: We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical City between April 2018 and December 2024. Women with high suspicion of PAS were electively admitted at 31+6 weeks’ gestation for optimisation when feasible and delivered by midline laparotomy and fundal or classical caesarean incision with the placenta left in situ. Definitive management consisted of hand-assisted retrograde caesarean hysterectomy or segmental uterine resection with reconstruction. Outcomes included operative time, quantified blood loss, transfusion requirements, intra- and postoperative complications, intensive care unit (ICU) admission, hospital stay, and neonatal morbidity. Results: A total of 236 women with confirmed PAS were managed. Median maternal age was 36 years and placenta previa coexisted in 86.9%. Elective caesarean delivery at 34+0–35+6 weeks occurred in 72.0%, whereas 28.0% required emergency delivery for haemorrhage or labour. Caesarean hysterectomy was performed in 85.2% and conservative segmental uterine resection in 14.8%. Median operative time was 135 minutes and median blood loss 4.3 L; the median transfusion requirement was six units of packed red blood cells. Intraoperative complications occurred in 27.1%, most commonly bladder injury (14.8%). One woman (0.4%) died intraoperatively from disseminated intravascular coagulation with intracardiac thrombosis. ICU admission was required in 66.0%. Neonatal intensive care unit admission occurred in 53.0%, mainly because of prematurity; there were no neonatal deaths. Conclusion: Centralised multidisciplinary management of PAS with planned delivery at 34–35 weeks, avoidance of placental removal, and use of retrograde hysterectomy or segmental resection can minimise haemorrhage and maternal mortality while maintaining acceptable neonatal outcomes in a high-volume referral centre.
Article
Open Access December 09, 2025

Hidden Malignancy in Pregnancy: Metastatic Adenocarcinoma of Colon Disguised as Liver Hemangioma Leading to Maternal Mortality

Abstract Introduction: Colorectal cancer during pregnancy is a complex and rare condition often presenting with benign gastrointestinal symptoms that overlap with normal pregnancy related changes, leading to delayed or misdiagnosis. Further, hepatic metastases may complicate recognition, especially when initially interpreted as benign lesions such as hemangiomas. So, early identification and [...] Read more.
Introduction: Colorectal cancer during pregnancy is a complex and rare condition often presenting with benign gastrointestinal symptoms that overlap with normal pregnancy related changes, leading to delayed or misdiagnosis. Further, hepatic metastases may complicate recognition, especially when initially interpreted as benign lesions such as hemangiomas. So, early identification and management are crucial and remain challenging for optimizing maternal and fetal outcomes. Clinical Description: A case of 39-year-old gravida 5 para 4 at 24 weeks+1 day with chronic hypothyroidism, longstanding anemia and a one year history of epigastric + right upper quadrant pain with suspected hemorrhage from a known liver hemangioma. Further imaging suggested a malignant hepatic lesion where colonoscopy and biopsy confirmed stage IV metastatic colon adenocarcinoma with liver and adrenal metastases. Her condition deteriorated and delivered a stillborn infant at 26 weeks of 780 grams following placental abruption. She continued to decline despite supportive care and died. Conclusion: This case illustrates the diagnostic challenges of colorectal cancer in pregnancy where nonspecific symptoms and inaccurate imaging results contributed to delayed diagnosis. The aggressive nature of the disease emphasizes the importance of prompt diagnosis and integrated care approach to improve both maternal and fetal outcome.
Case Report
Open Access November 12, 2025

Effect of Sleep Deprivation on Executive Functioning Among Young Adults: Meta-Analysis

Abstract Background: Sleep deprivation is increasingly prevalent among young adults due to academic, occupational, and social demands, making them susceptible to circadian disruption. Executive functioning—encompassing working memory, inhibitory control, and cognitive flexibility is essential for academic and professional success. This meta-analysis quantifies the effect of sleep deprivation on [...] Read more.
Background: Sleep deprivation is increasingly prevalent among young adults due to academic, occupational, and social demands, making them susceptible to circadian disruption. Executive functioning—encompassing working memory, inhibitory control, and cognitive flexibility is essential for academic and professional success. This meta-analysis quantifies the effect of sleep deprivation on executive functioning in healthy young adults. Practical Implications: These findings highlight the need for evidence-based interventions such as university-level sleep education programs, flexible academic scheduling, and workplace policies promoting adequate sleep to optimize cognitive performance and productivity among young adults. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, PsycINFO, and Web of Science were searched (January 2000–March 2024) for studies assessing acute (<6 hours sleep or ≥24 hours total deprivation) or chronic (<6 hours/night over multiple days) sleep deprivation in young adults. Outcomes included validated executive function tests (e.g., Stroop, N-Back). Random-effects meta-analysis (Hedges’ g) was conducted using R (version 4.3.2) with metafor/meta packages. Heterogeneity (I², Q-test), sensitivity (leave-one-out), and publication bias (funnel plot, Egger’s test) were evaluated. Results: Out of 2,478 screened studies, 39 met inclusion criteria (n=4,578). Sleep deprivation had a moderate-to-large detrimental effect on executive functioning (Hedges’ g = -0.62, 95% CI [-0.78, -0.45], p<0.001). Subdomain analysis revealed greatest impairment in working memory (g = -0.71), followed by inhibitory control (g = -0.59) and cognitive flexibility (g = -0.49) (all p<0.001). Moderate heterogeneity was present (I² = 58%), with results robust to sensitivity analysis. Egger’s test indicated no significant publication bias (p=0.22). Interpretation: Sleep deprivation significantly impairs executive functioning in young adults, especially working memory. Interventions improve sleep may enhance cognitive performance and should be integrated into public health strategies and educational policies. Future research should assess chronic restriction and individual vulnerability factors.
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Meta-Analysis
Open Access November 09, 2025

Application of Building Information Modelling (BIM) for Enhancing Safety and Environmental Performance on Construction Sites in Nigeria

Abstract Background: Building Information Modelling (BIM) improves safety planning in construction by enabling visualization and simulation to identify and reduce risks. However, its adoption in Nigeria is limited. This study examines the application of BIM in enhancing safety and environmental performance on construction sites in Nigeria. Methodology: A quantitative cross-sectional survey [...] Read more.
Background: Building Information Modelling (BIM) improves safety planning in construction by enabling visualization and simulation to identify and reduce risks. However, its adoption in Nigeria is limited. This study examines the application of BIM in enhancing safety and environmental performance on construction sites in Nigeria. Methodology: A quantitative cross-sectional survey was conducted using a structured online questionnaire distributed to professionals in Nigeria’s construction industry. A purposive sampling method was employed to target respondents with relevant BIM experience. Data were analysed using SPSS version 28, applying descriptive statistics, chi-square tests, and logistic regression at a 5% significance level. Result: Findings show that BIM was fully adopted by 7.0% of organizations, with only 19.8% of respondents using it to identify safety hazards during planning. While 76.8% reported no notable safety benefit, 19.5% identified improved risk management as the key benefit. Most respondents (80.2%) reported no noticeable environmental benefits. Among those who did, improved energy efficiency was the most cited benefit (16.4%). Respondents with 10 or more years of experience were significantly more likely to report enhanced safety and environmental outcomes (AOR = 4.555; p = 0.003) and adequate BIM utilization (AOR = 3.255; p = 0.023). Those with intermediate BIM experience were also more likely to report high enhancement (AOR = 2.857; p = 0.039) and effective tool use (AOR = 2.881; p = 0.050). Conclusion: This study revealed that BIM has the potential to improve construction outcomes in Nigeria if supported by training, experience, and structured implementation.
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Open Access October 01, 2025

Place-Based Diminished Returns of Economic Resources in Rural America: A Framework for Understanding Geography-Conditioned Inequality

Abstract Background: Socioeconomic status (SES) is widely associated with improved health, behavioral, and educational outcomes. However, emerging research suggests that these benefits are not uniformly experienced across populations or contexts. The theory of Marginalization-related Diminished Returns (MDRs) has primarily focused on racial and ethnic disparities, showing that individuals from [...] Read more.
Background: Socioeconomic status (SES) is widely associated with improved health, behavioral, and educational outcomes. However, emerging research suggests that these benefits are not uniformly experienced across populations or contexts. The theory of Marginalization-related Diminished Returns (MDRs) has primarily focused on racial and ethnic disparities, showing that individuals from racially marginalized groups often experience weaker protective effects of SES. There is a lack of evidence on geography—particularly rural residence—as a moderator of SES effects. Objective: This review explores how place, especially rural contexts in the U.S., shapes the extent to which SES translates into improved outcomes. We extend the MDRs framework to include place-based and geography-based marginalization, arguing that even among non-Hispanic White populations, rural residence can lead to diminished returns on education, income, and other forms of capital. Content: Drawing on theoretical models such as Fundamental Cause Theory and Bronfenbrenner’s Ecological Systems Theory, and synthesizing empirical findings from studies of academic achievement, substance use, and educational aspirations, this review highlights how structural disadvantages in rural areas weaken the effectiveness of individual and family-level resources. Conclusion: Rural health and educational disparities are not solely due to a lack of resources but may also reflect systemic conditions that erode the value of existing resources. Policy interventions must be place-aware and address the contextual constraints that limit opportunity. Future research should more explicitly test how geography moderates the effects of SES across a range of outcomes and populations.
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Perspective Article
Open Access September 28, 2025

Gut-Brain Axis in Autism Spectrum Disorder: A Bibliometric and Microbial-Metabolite-Neural Pathway Analysis

Abstract The gut-brain axis (GBA) has emerged as a central focus in the study of neurodevelopmental disorders, particularly autism spectrum disorder (ASD). Research suggests that microbial composition and its metabolic byproducts influence neural development, synaptic plasticity, and behavior [1,2,3]. A structured bibliometric analysis of Scopus and Web of Science records was performed using Bibliometrix [...] Read more.
The gut-brain axis (GBA) has emerged as a central focus in the study of neurodevelopmental disorders, particularly autism spectrum disorder (ASD). Research suggests that microbial composition and its metabolic byproducts influence neural development, synaptic plasticity, and behavior [1,2,3]. A structured bibliometric analysis of Scopus and Web of Science records was performed using Bibliometrix and VOSviewer to trace trends and thematic evolution of GBA–ASD literature [7,8]. In parallel, a data-driven pathway modeling approach maps microbial metabolites (e.g., short-chain fatty acids, tryptophan catabolites) to host signaling pathways including vagal stimulation, immune cytokine modulation, and blood–brain barrier (BBB) permeability [4,5]. Simulations implemented in Python’s NetworkX illustrate how perturbations in metabolite flux may influence CNS outcomes. The findings reveal growing emphasis on butyrate, serotonin, microglial priming, and maternal immune activation in ASD-related GBA studies, and highlight the need for rigorous empirical validation of computational predictions [9,10,11].
Brief Report
Open Access September 18, 2025

Does Stress Explain the Effects of Sexual/Gender Minority Status on Children’s Behavioral and Emotional Risk?

Abstract Background: Sexual and gender minority (SGM) youth are at elevated risk for adverse mental health and substance use outcomes. Stressors such as family conflict, discrimination, and trauma have been suggested as possible mediators of these disparities. Aims: This study examined whether family conflict, discrimination, and trauma mediate the associations between SGM identity and [...] Read more.
Background: Sexual and gender minority (SGM) youth are at elevated risk for adverse mental health and substance use outcomes. Stressors such as family conflict, discrimination, and trauma have been suggested as possible mediators of these disparities. Aims: This study examined whether family conflict, discrimination, and trauma mediate the associations between SGM identity and adverse outcomes, including suicide attempt, major depressive disorder (MDD), nicotine use, and marijuana use. Methods: Participants were children from the Adolescent Brain Cognitive Development (ABCD) study. SGM identity was reported at baseline, while outcomes included past MDD and suicide attempts as well as future nicotine and marijuana use. Structural equation modeling (SEM) was used to test both direct and indirect pathways linking SGM identity to mental health and behavioral outcomes. Results: No significant mediation was found through family conflict, discrimination, or trauma. Instead, effects of SGM identity were primarily direct: SGM youth had higher odds of past suicide attempts and MDD, as well as future marijuana use, but not future nicotine use. Stressor variables, however, were independently associated with outcomes. Discrimination predicted all outcomes; trauma was positively associated with suicide, nicotine, and marijuana use but not MDD; and family conflict predicted all outcomes except MDD. Conclusion: Family conflict, discrimination, and trauma did not mediate SGM disparities in mental health and substance use, but each emerged as an independent predictor of risk. These findings highlight the complexity of mechanisms underlying SGM-related disparities and suggest the need for future research to explore additional pathways and contextual influences.
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Open Access September 04, 2025

Evidence-Based Protocols for the Prevention and Treatment of Prosthetic Joint Infection in Total Hip Arthroplasty: A Systematic Review

Abstract Objective: This systematic review aimed to identify, synthesize, and critically analyze the available evidence on clinical protocols used for the prevention and treatment of prosthetic joint infection (PJI) in total hip arthroplasty (THA), based on studies published between 2000 and 2025. Methods: The review was conducted according to PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, Web of Science, and Embase between January and April 2025. Eligible studies included clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses published in English that addressed either preventive or therapeutic strategies for PJI in THA. Study selection, data extraction, and quality assessment were carried out independently by two reviewers. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Results: A total of 32 studies were included. Preventive measures identified in the literature comprised combined antibiotic prophylaxis (cefazolin and gentamicin), multimodal perioperative protocols such as ACERTO, nasal decolonization for Staphylococcus aureus [...] Read more.
Objective: This systematic review aimed to identify, synthesize, and critically analyze the available evidence on clinical protocols used for the prevention and treatment of prosthetic joint infection (PJI) in total hip arthroplasty (THA), based on studies published between 2000 and 2025. Methods: The review was conducted according to PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, Web of Science, and Embase between January and April 2025. Eligible studies included clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses published in English that addressed either preventive or therapeutic strategies for PJI in THA. Study selection, data extraction, and quality assessment were carried out independently by two reviewers. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Results: A total of 32 studies were included. Preventive measures identified in the literature comprised combined antibiotic prophylaxis (cefazolin and gentamicin), multimodal perioperative protocols such as ACERTO, nasal decolonization for Staphylococcus aureus, silver-impregnated dressings, and structured post-discharge surveillance. Treatment strategies included DAIR (Debridement, Antibiotics, and Implant Retention), the DAPRI technique, one-stage and two-stage revision surgeries, muscle flap reconstructions, and protocols without spacers. These interventions were associated with significantly reduced infection rates and improved clinical outcomes when applied appropriately and in accordance with patient-specific factors. Conclusion: Effective prevention and treatment of PJI in total hip arthroplasty require a systematic and evidence-based approach. Integrated protocols—spanning preoperative optimization, meticulous intraoperative techniques, and rigorous postoperative monitoring—have proven effective in reducing infection incidence. In cases of established infection, surgical management must be tailored to the timing of infection, microbial profile, and host conditions. Two-stage revision remains the gold standard for complex infections, while one-stage revision and emerging techniques like DAPRI offer promising results in selected cases. This review contributes to the standardization of clinical practice and supports improved patient outcomes.
Systematic Review
Open Access July 25, 2025

Significance of Job Satisfaction and Quality Patient Care

Abstract This commentary letter was conducted to evaluate Wang et al.'s (2025) research study on the relationship between perceived staffing and quality of care among hospitals. The current study's findings show that the relationship between professional self-efficacy and job performance is mediated by work engagement. Life contentment influences work engagement, which is associated with enhanced job [...] Read more.
This commentary letter was conducted to evaluate Wang et al.'s (2025) research study on the relationship between perceived staffing and quality of care among hospitals. The current study's findings show that the relationship between professional self-efficacy and job performance is mediated by work engagement. Life contentment influences work engagement, which is associated with enhanced job performance. However, involvement acts as a mediator between job performance and burnout, which could affect the quality of patient care. Staffing satisfaction and quality patient care are closely related, and it is essential for healthcare institutions to prioritize appropriate workforce levels and address the nursing shortage. However, there are still unanswered questions in this sector, such as researching nursing-specific care procedures, addressing data challenges, and understanding the connections between nursing practice and patient care outcomes. Future research should address the "black box" of nursing practice and address variations in the quality of patient care provided by nurses.
Commentary Letter
Open Access June 11, 2025

Biomechanical and Functional Performance of Hip Prosthesis Materials in Total Hip Arthroplasty: A Systematic Review

Abstract This systematic review aimed to evaluate the biomechanical properties, functional performance, and clinical outcomes of different hip prosthesis materials and designs used in total hip arthroplasty (THA). A comprehensive search strategy identified 34 peer-reviewed studies published between 2015 and 2024. The materials investigated included cobalt-chromium-molybdenum (CoCrMo), titanium alloys, [...] Read more.
This systematic review aimed to evaluate the biomechanical properties, functional performance, and clinical outcomes of different hip prosthesis materials and designs used in total hip arthroplasty (THA). A comprehensive search strategy identified 34 peer-reviewed studies published between 2015 and 2024. The materials investigated included cobalt-chromium-molybdenum (CoCrMo), titanium alloys, PEEK, ceramics, and advanced surface coatings such as polycrystalline diamond (PCD). In addition, dual mobility systems, lattice structures, and additively manufactured and patient-specific implants were assessed. The studies utilized clinical trials, finite element analysis, and biomechanical testing to compare outcomes such as wear resistance, stress distribution, osseointegration, and range of motion. The findings demonstrated that titanium alloys and porous lattice structures reduce stress shielding, while ceramics and CoCrMo provide superior wear resistance. Dual mobility implants improved joint stability and range of motion, particularly in high-risk patients. PEEK and PCD showed promising properties but lacked robust long-term data. The integration of advanced manufacturing technologies and material innovations has led to more personalized and biomechanically efficient solutions for THA. Further longitudinal studies are needed to validate these developments. This review provides a critical synthesis of the biomechanical, functional, and clinical implications of contemporary hip prosthetic systems.
Systematic Review
Open Access May 24, 2025

Exploring Smartphone Use and Learning Behaviors among Senior High School Students: Insights from a Developing Region in Indonesia

Abstract Smartphone use among adolescents has surged globally, reshaping communication and learning patterns, especially in developing countries. However, the implications of such digital habits on students in rural or under-resourced areas remain underexplored. This study aims to examine the patterns of smartphone usage and its effects on learning among high school students in Tarutung, a developing [...] Read more.
Smartphone use among adolescents has surged globally, reshaping communication and learning patterns, especially in developing countries. However, the implications of such digital habits on students in rural or under-resourced areas remain underexplored. This study aims to examine the patterns of smartphone usage and its effects on learning among high school students in Tarutung, a developing region of North Sumatra, Indonesia. Utilizing a quantitative descriptive approach, data were collected from 358 students using structured questionnaires. The results show that 96.05% of students own personal smartphones regardless of socioeconomic background, with an average daily usage of 4 hours and 45 minutes. While 91.81% believe smartphones support their learning, 25.99% report declining academic performance. Alarmingly, 20.62% of students admitted involvement in cyberbullying activities, highlighting a critical digital risk impacting the school environment and student well-being. The study concludes that although smartphones offer educational benefits, their misuse can lead to negative academic, social, and psychological outcomes. This study recommends digital literacy curricula and structured cooperation between parents and educators to prevent risks while optimizing educational opportunities in smartphone use.
Article
Open Access May 20, 2025

Periprosthetic Joint Infections in Total Hip Arthroplasty: Diagnostic Advances, Treatment Algorithms, and Technological Innovations — A Comprehensive Review

Abstract Objective: This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. Methods: [...] Read more.
Objective: This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. Methods: A systematic review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, targeting studies published between 2015 and 2025. Articles were selected based on their contribution to understanding the clinical, microbiological, and surgical aspects of PJI in THA. Fifty-five studies met the inclusion criteria and were analyzed descriptively. Results: PJI in THA is influenced by multifactorial risk profiles, including obesity, diabetes, and immunosuppression. Staphylococcus aureus, particularly MRSA, remains the most frequently isolated pathogen, followed by Gram-negative organisms and fungal species. Diagnostic innovations such as next-generation sequencing have enhanced pathogen detection, while two-stage revision remains the gold standard for chronic infections. Emerging strategies—such as antimicrobial coatings, tailored antibiotic protocols, and multidisciplinary care models—demonstrate promise in improving clinical outcomes. Conclusion: Managing PJI in THA necessitates a comprehensive and individualized approach, integrating early and accurate diagnosis, pathogen-specific treatment, and advanced preventive measures. The integration of emerging technologies and personalized care pathways is critical to optimizing outcomes and reducing the clinical and economic burden of PJI.
Review Article
Open Access May 11, 2025

Why Smoking Right after Waking Up Is Harmful to Health

Abstract Smoking is a well-documented risk factor of cardiovascular diseases (CVD) and premature death. Previous studies have focused on smoking duration and total cigarette consumption, but a 2024 paper by Li et al. highlights the time between waking up and smoking the first cigarette as a risk factor of mortality, noting that smoking ≤5 minutes after waking is strongly linked to a higher risk of [...] Read more.
Smoking is a well-documented risk factor of cardiovascular diseases (CVD) and premature death. Previous studies have focused on smoking duration and total cigarette consumption, but a 2024 paper by Li et al. highlights the time between waking up and smoking the first cigarette as a risk factor of mortality, noting that smoking ≤5 minutes after waking is strongly linked to a higher risk of mortality and a higher chance of incident myocardial infarction or stroke, and may be a sign of nicotine dependence. Another study by Hu et al. (2024) states that early-morning smoking more strongly correlates with incident type 2 diabetes than total cigarette consumption, adding to preceding evidence that early-morning smoking is linked to type 2 diabetes and chronic obstructive pulmonary disease (COPD). The demonstrated association with adverse health outcomes and early-morning smoking suggests delayed time to first cigarette can be a useful target as part of smoking interventions. These findings indicate the necessity of public health policies targeting smoking behaviour in addition to cessation as a way to decrease the associated disease burden.
Letter to Editor
Open Access May 09, 2025

Association Between Maternal Vitamin B12 Intake and Early Childhood Cognitive Development: Implications for Public Health

Abstract Background: Maternal nutrition plays a crucial role in fetal brain development, with vitamin B12 being essential for neuronal myelination and cognitive function. The paper by Hrezova et al. entitled “Vitamin B12 Intake During Pregnancy Linked to Child Speech Development and Intelligence Quotient”, examines the association between maternal B12 intake and early childhood neurodevelopment. [...] Read more.
Background: Maternal nutrition plays a crucial role in fetal brain development, with vitamin B12 being essential for neuronal myelination and cognitive function. The paper by Hrezova et al. entitled “Vitamin B12 Intake During Pregnancy Linked to Child Speech Development and Intelligence Quotient”, examines the association between maternal B12 intake and early childhood neurodevelopment. Methods: Using data from 5,151 mother-child pairs in the ELSPAC-CZ cohort, maternal B12 intake was assessed through dietary questionnaires, and child cognitive outcomes were evaluated at 18 months, 3 years, and 8 years. Multivariate adjustments were applied to control for potential confounders. Results: The research reports that higher maternal B12 intake was positively associated with improved language comprehension at 18 months (B=0.20,95% CI 0.06,0.34) and increased verbal IQ at 8 years (B=1.08,95% CI 0.09,2.08). However, no significant relationship was observed between maternal B12 intake and speech intelligibility at age 3 (OR=1.03,95% CI 0.99,1.07). Findings suggest B12’s role in early cognitive development but highlight gaps in its long-term effects. Conclusions: Ensuring adequate maternal B12 intake is vital for optimizing early neurodevelopment. Public health initiatives should promote B12 supplementation, especially for pregnant women at risk of deficiency. Further research with objective biomarkers is needed to clarify long-term effects.
Letter to Editor
Open Access May 05, 2025

Persistent Social Welfare Needs Among Educated Caribbean Black Individuals: Evidence of Minorities' Diminished Returns

Abstract Background: Educational attainment is strongly linked to increased employment opportunities, higher income, and greater financial security, making its inverse relationship with reliance on social welfare programs well-documented. However, consistent with the Minorities' Diminished Returns (MDRs) theory, the protective effects of education may be weaker for racial and ethnic minority [...] Read more.
Background: Educational attainment is strongly linked to increased employment opportunities, higher income, and greater financial security, making its inverse relationship with reliance on social welfare programs well-documented. However, consistent with the Minorities' Diminished Returns (MDRs) theory, the protective effects of education may be weaker for racial and ethnic minority groups compared to non-Latino Whites. This study examines whether the impact of educational attainment (measured as years of schooling) on social welfare use differs between Caribbean Black and White adults in the United States, focusing on outcomes since age 18 and in the past year. Objective: To investigate the relationship between years of schooling and the likelihood of using social welfare programs, while exploring whether this association varies between Caribbean Black and White adults, in alignment with the MDRs framework. Methods: Data were derived from the National Survey of American Life (NSAL), a nationally representative dataset with a robust sample of Black and White adults in the United States. The study focused on Caribbean Black and White participants aged 18 and older. Structural equation modeling (SEM) was employed to examine the relationship between years of schooling and social welfare use, adjusting for covariates including age, gender, employment status, and marital status. Interaction terms were used to assess potential differences in the returns of education across racial groups. Results: Higher educational attainment was associated with reduced likelihood of using social welfare programs overall. However, consistent with the MDRs framework, the protective effect of education was weaker for Caribbean Black individuals compared to their White counterparts. Caribbean Blacks with similar levels of education as Whites were more likely to report using social welfare programs since age 18 and in the past year, highlighting diminished returns on education for this population. Conclusion: This study extends the MDRs framework to Caribbean Black populations, a group rarely studied in the U.S., revealing significant disparities in the economic benefits of education. The findings underscore the need for policies that address systemic barriers limiting the economic returns of education for racial and ethnic minorities, including Caribbean Blacks, to promote greater equity in social and economic outcomes.
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Open Access May 05, 2025

Educated Yet Unhealthy? Diminished Returns of Education for Immigrants in the USA

Abstract Background: Minorities’ Diminished Returns (MDRs) theory posits that the health benefits of socioeconomic resources, such as education, are smaller for marginalized and minoritized populations, including immigrants. While MDRs have been extensively documented for racial and ethnic minorities, less is known about whether these diminished returns extend to immigrant populations. This study [...] Read more.
Background: Minorities’ Diminished Returns (MDRs) theory posits that the health benefits of socioeconomic resources, such as education, are smaller for marginalized and minoritized populations, including immigrants. While MDRs have been extensively documented for racial and ethnic minorities, less is known about whether these diminished returns extend to immigrant populations. This study tested MDRs of education on various health and cognitive outcomes, including self-rated health (SRH), cognitive function, numeracy, number of chronic medical conditions, and limitations in activities of daily living (ADLs) among immigrants compared to non-immigrants in the United States. Objective. To examine whether educational attainment confers weaker protective effects on SRH, cognitive function, numeracy, chronic medical conditions, and ADLs in immigrants compared to non-immigrants, confirming the presence of MDRs across these domains. Methods: We used data from the Understanding America Study (UAS), a nationally representative survey of U.S. adults. We tested the association between educational attainment and five outcomes—SRH, cognitive function, numeracy, number of chronic medical conditions, and limitations in ADLs—across immigrant and non-immigrant groups. Multivariate regression models were employed, adjusting for key sociodemographic covariates. Results: The protective effects of education on a range of health outcomes were significantly weaker for immigrants compared to non-immigrants. Education level showed weaker associations with SRH, cognitive function, numeracy, number of chronic conditions, and ADLs among immigrants. These findings suggest that even at higher levels of educational attainment, immigrants experience poorer health and cognitive functioning than their U.S.-born counterparts. Conclusion: This study offers strong evidence for the MDRs of education on multiple health outcomes among U.S. immigrants. One possible explanation is that, despite achieving higher levels of education, immigrants often face structural barriers—such as discrimination, limited access to resources, and economic inequities—that constrain the health-related benefits typically associated with educational attainment. Additionally, a portion of immigrant education may be acquired outside the United States, where credentials may not be fully recognized or rewarded within the U.S. labor market. These findings highlight the importance of policies aimed at addressing systemic inequities and improving access to healthcare, employment opportunities, and social support for immigrant communities. Future research should further explore the mechanisms underlying these diminished returns and identify policy solutions to reduce their impact. Keywords: Educational Attainment, Immigrants, Nativity, Self-Rated Health, Chronic Disease, Activities of Daily Living (ADL), Cognitive Function
Original Article
Open Access May 05, 2025

To Be Twice as Good to Get Half

Abstract “To Be Twice as Good to Get Half” is a common mindset among high aspiration and ambition Black individuals in the U.S., capturing the lived reality of Minorities’ Diminished Returns (MDRs). This paper explains that MDRs reflect how, even with high levels of ambition, self-efficacy, education, and income, Black individuals and other marginalized groups do not experience the same protective benefits [...] Read more.
“To Be Twice as Good to Get Half” is a common mindset among high aspiration and ambition Black individuals in the U.S., capturing the lived reality of Minorities’ Diminished Returns (MDRs). This paper explains that MDRs reflect how, even with high levels of ambition, self-efficacy, education, and income, Black individuals and other marginalized groups do not experience the same protective benefits for health and well-being as White populations. Systemic obstacles embedded within U.S. society weaken the expected returns on socioeconomic achievements for racialized individuals, creating a reality where “being twice as good” still results in lesser outcomes. High-SES Black individuals, for instance, continue to face significant risks for adverse outcomes, such as depression and chronic disease, due to structural inequities across domains like labor market discrimination, segregation, and accumulated disadvantage from childhood. Our analysis identifies key mechanisms—including interpersonal discrimination, lower-quality education, and structural racism in sectors like banking, policing, and real estate—that erode the protective effects of SES across racial lines. Mediating factors, such as chronic stress, allostatic load, and epigenetic changes over the life course, further compound these diminished returns, weakening the expected physical and mental health benefits. Drawing on extensive evidence from U.S. national and local datasets and corroborated by international studies, this paper underscores the necessity of policies that dismantle structural barriers rather than relying solely on SES improvements. Recommendations include implementing multi-sectoral policies, recognizing the unique challenges of middle-class non-White populations, and approaching policy with humility, acknowledging that achieving equity is a long-term endeavor. By challenging the “bootstraps” narrative, this paper advocates for structural interventions aimed at genuine health and economic equity for all racial and socioeconomic groups. While we provide an in-depth analysis of MDRs’ phenomena, mechanisms, mediators, and policy implications, the experience is often distilled as, “I have to be twice as good to get half.”
Article
Open Access May 01, 2025

The Importance of Job Satisfaction, Work Engagement, and Sufficient Staffing in the Nursing Practice

Abstract The commentary paper reviewed the above research study conducted by Wang et al. (2025), and the investigators examined the association between nurse staffing, job satisfaction, and work engagement, and how these variables impact the quality of care provision provided among the Chinese hospitals. Despite knowing that low staffing within the healthcare facilities is a global issue, Wang and [...] Read more.
The commentary paper reviewed the above research study conducted by Wang et al. (2025), and the investigators examined the association between nurse staffing, job satisfaction, and work engagement, and how these variables impact the quality of care provision provided among the Chinese hospitals. Despite knowing that low staffing within the healthcare facilities is a global issue, Wang and colleagues believed that low staffing is negatively and significantly associated with nurse’s welfare and patient care outcome. This issue causes an increase in burnout and decreased retention of healthcare providers within the clinical setting. It is important to consider and focus on improving and fostering job satisfaction and work engagement among nurses to provide better quality care even within a low staffing environment. According to Wang and colleagues, low staffing outcomes could be mitigated by encouraging workplaces to create healthy and supportive environments for the engaged and satisfied nurses. These would result in better out among patients and increase job fulfilment and welfare among nurses.
Commentary
Open Access April 09, 2025

Color of Poverty Matters: Socioeconomic Resources and Health of Mothers Giving Birth to Children into Poverty

Abstract Background: Childhood poverty is a critical determinant of developmental, health, and behavioral outcomes. However, racial and ethnic differences in how families experience and navigate poverty suggest that a one-size-fits-all approach may not be an effective approach for alleviating disparities. Understanding baseline demographic, socioeconomic, health, and behavioral characteristics among [...] Read more.
Background: Childhood poverty is a critical determinant of developmental, health, and behavioral outcomes. However, racial and ethnic differences in how families experience and navigate poverty suggest that a one-size-fits-all approach may not be an effective approach for alleviating disparities. Understanding baseline demographic, socioeconomic, health, and behavioral characteristics among families in poverty is crucial to designing equitable interventions. Objective: To examine racial and ethnic differences in baseline demographic, socioeconomic, health, and behavioral characteristics among families living in poverty, using data from the Baby's First Years (BFY:2018-2019) Study. Methods: This analysis used baseline data from the BFY study, a randomized controlled trial (RCT) designed to evaluate the effects of monthly cash assistance on children’s developmental outcomes. The sample included 1,050 children and their families, consisting of mothers and, when available, fathers. Descriptive analyses were conducted to compare demographic, socioeconomic, health, and behavioral outcomes across racial and ethnic groups, focusing on Black, Hispanic, and other mothers. Results: Significant racial and ethnic differences were observed. Regarding demographic factors, Hispanic mothers were older than White mothers. In terms of socioeconomic factors, Hispanic mothers had fewer years of education compared to White mothers, while Black mothers were more likely to receive food stamps than mothers from other groups. Regarding health and behaviors, Black mothers reported worse self-rated health but were less likely to plan for breastfeeding compared to White mothers. In contrast, Hispanic mothers reported lower levels of depression and were more likely to plan for breastfeeding. Conclusion: These findings highlight the heterogeneity of experiences among families living in poverty, with significant differences across racial and ethnic groups. Such disparities underscore the importance of tailoring anti-poverty policies to the unique needs of diverse populations. Future research should explore how the effects of interventions, such as cash assistance or guaranteed income, may differ across racial and ethnic groups to inform equitable and effective policy development.
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Open Access April 03, 2025

Depression, Subjective Health, Obesity, and Multimorbidity are Associated with Epigenetic Age Acceleration

Abstract Background: Epigenetic aging, measured through various DNA methylation-based clocks, may have implications for predicting disease risk. However, the sensitivity of different epigenetic clocks that have emerged as biomarkers for biological aging and in predicting physical and mental health outcomes remains uncertain. This study examines the age and sex-adjusted associations between [...] Read more.
Background: Epigenetic aging, measured through various DNA methylation-based clocks, may have implications for predicting disease risk. However, the sensitivity of different epigenetic clocks that have emerged as biomarkers for biological aging and in predicting physical and mental health outcomes remains uncertain. This study examines the age and sex-adjusted associations between multiple epigenetic age acceleration measures and three key health indicators, including self-rated health, depressive symptoms, and body mass index (BMI), in a nationally representative sample of U.S. middle-aged and older adults. Methods: We analyzed data from 4,018 adults in the 2016 wave of the Health and Retirement Study (HRS), which included several epigenetic age acceleration measures: HORVATH, HANNUM, LEVINE, HORVATHSKIN, LIN, WEIDNER, VIDALBRALO, YANG, ZHANG, BOCKLANDT, GARAGNANI, and GRIMAGE. Linear regression models were used to assess the associations between epigenetic age acceleration and self-rated health (poor health), depressive symptoms, and BMI, adjusting for age and sex. Results: We found significant positive associations between epigenetic age acceleration and worse self-rated health, higher depressive symptoms, and increased BMI. However, these associations varied across different epigenetic clocks, with some measures potentially having more consistent utility for specific health outcomes than others. Conclusion: Epigenetic age acceleration is linked to poorer self-rated health, greater depressive symptoms, and higher BMI, but choosing which epigenetic clock(s) to use is also important. These findings underscore the need to consider multiple epigenetic aging markers when assessing health risks and highlight the potential for particular clocks to serve as more sensitive indicators of physical and mental health outcomes.
Article
Open Access March 29, 2025

Comprehensive Review of Conservative and Surgical Treatment Strategies for Knee Osteoarthritis: Efficacy, Safety, and Emerging Therapies

Abstract Knee osteoarthritis (KOA) is a chronic degenerative joint disorder that significantly impairs mobility and quality of life. While surgical interventions such as total knee arthroplasty (TKA) are effective in severe cases, conservative treatments are critical for early and intermediate disease management. This review evaluates the efficacy, safety, and clinical applications of both conservative and [...] Read more.
Knee osteoarthritis (KOA) is a chronic degenerative joint disorder that significantly impairs mobility and quality of life. While surgical interventions such as total knee arthroplasty (TKA) are effective in severe cases, conservative treatments are critical for early and intermediate disease management. This review evaluates the efficacy, safety, and clinical applications of both conservative and surgical treatment approaches, including lifestyle modifications, physical therapy, pharmacological interventions, regenerative medicine, and surgical procedures. The integration of a multidisciplinary approach is emphasized as a key strategy for optimizing clinical outcomes and tailoring interventions to disease severity.
Review Article
Open Access March 29, 2025

How Stigma Affects Patients Seeking Help for Drug Addiction

Abstract Stigma surrounding drug addiction remains a critical barrier to effective treatment, significantly influencing healthcare access, patient engagement, and recovery outcomes. This study explores the multifaceted impact of stigma on individuals seeking help for substance use disorders (SUDs), with a focus on healthcare-related discrimination, internalized stigma, and structural barriers. Research [...] Read more.
Stigma surrounding drug addiction remains a critical barrier to effective treatment, significantly influencing healthcare access, patient engagement, and recovery outcomes. This study explores the multifaceted impact of stigma on individuals seeking help for substance use disorders (SUDs), with a focus on healthcare-related discrimination, internalized stigma, and structural barriers. Research indicates that negative perceptions among healthcare providers contribute to delayed treatment-seeking behaviors, reduced adherence to medication-assisted treatment (MAT), and increased relapse rates. Additionally, patients internalizing these societal judgments experience heightened psychological distress, social isolation, and decreased self-efficacy, further hindering their recovery process. To address these challenges, evidence-based strategies such as addiction medicine education, trauma-informed care, harm reduction approaches, and peer support models have been shown to effectively reduce stigma and improve treatment outcomes. Hospital administrators and nursing leaders play a critical role in fostering a culture of empathy, advocating for the reframing of addiction as a neuro-psycho-biological disease rather than a moral failing. Future research should explore digital mental health interventions, motivational interviewing techniques, and interdisciplinary collaboration to further dismantle stigma and enhance the effectiveness of addiction treatment programs. This study highlights the urgent need for systemic policy changes, targeted educational programs, and a shift in clinical attitudes to create a more inclusive and stigma-free healthcare environment. Through implementing these approaches, healthcare providers can ensure equitable access to treatment and improve long-term health outcomes for individuals with opioid use disorder (OUD) and other substance-related conditions.
Essay
Open Access March 25, 2025

Resting-State Sensory-Motor Connectivity between Hand and Mouth as a Neural Marker of Socioeconomic Disadvantage, Psychosocial Stress, Cognitive Difficulties, Impulsivity, Depression, and Substance Use in Children

Abstract Background: The sensory-motor network is essential for integrating sensory input with motor function and higher-order cognition. Resting-state functional connectivity (rsFC) within this network undergoes significant developmental changes, and disruptions in these connections have been linked to behavioral and psychiatric outcomes. However, the relationship between sensory-motor [...] Read more.
Background: The sensory-motor network is essential for integrating sensory input with motor function and higher-order cognition. Resting-state functional connectivity (rsFC) within this network undergoes significant developmental changes, and disruptions in these connections have been linked to behavioral and psychiatric outcomes. However, the relationship between sensory-motor connectivity, early-life adversity, and later health behaviors remains understudied. Objective: This study examines the associations between rsFC within the sensory-motor network (mouth and hand regions) and key social, psychological, and behavioral factors, including baseline and past socioeconomic status (SES), trauma exposure, family conflict, impulsivity, major depressive disorder (MDD), and future substance use. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) Study, a national sample of U.S. children. Resting-state fMRI data were used to assess functional connectivity within the sensory-motor network. Bivariate analyses examined associations between rsFC in the sensory-motor mouth and hand regions and baseline SES, past SES, childhood trauma exposure, family conflict, impulsivity, and MDD. Longitudinal analyses assessed whether baseline rsFC predicted future substance use. Results: Greater rsFC between the sensory-motor mouth and hand regions was significantly associated with lower SES, higher trauma exposure, and greater family conflict. Increased connectivity was also correlated with older age and more advanced puberty status. Higher rsFC between the sensory-motor mouth and hand regions was linked to greater impulsivity, lower cognitive function, an increased likelihood of MDD, and future marijuana use. Conclusion: These findings suggest that sensory-motor connectivity is sensitive to socioeconomic and psychosocial stressors, with potential long-term implications for mental health and substance use risk. The results highlight the importance of early-life environmental factors in shaping neurodevelopmental trajectories and emphasize the need for targeted interventions to mitigate the effects of adversity on brain function and behavior. Future research should further explore the role of sensory-motor network alterations in behavioral health outcomes as a function of environmental stressors.
Original Article
Open Access March 12, 2025

Academic Aspirations of 12th Grade Students in the United States: Place-Based Diminished Returns of Parental Education in Rural Areas

Abstract Background: The Motivational Theory of Life-Span Development suggests that individual aspirations are shaped by both internal and external resources. Parental education is a key determinant of educational aspirations, yet its effects may vary by geographic location, demonstrating spatial patterns of Minorities’ Diminished Returns (MDRs). Objectives: This [...] Read more.
Background: The Motivational Theory of Life-Span Development suggests that individual aspirations are shaped by both internal and external resources. Parental education is a key determinant of educational aspirations, yet its effects may vary by geographic location, demonstrating spatial patterns of Minorities’ Diminished Returns (MDRs). Objectives: This study examines the association between parental education and aspirations for graduate or professional education among non-Latino White adolescents, with a specific focus on urban-suburban versus rural differences. Methods: Using data from the 12th-grade cohort of the Monitoring the Future (MTF) 2024 survey, we conducted multivariate analyses to assess the relationship between parental education and aspirations for graduate or professional education. We further examined whether this association was moderated by geographic location (urban-suburban vs. rural) to identify place-based MDRs. Results: Higher parental education was associated with greater aspirations for advanced education; however, this effect was weaker in rural areas compared to urban and suburban settings. These findings highlight that even among non-Latino White adolescents, rural residence diminishes the benefits of socioeconomic resources, providing evidence of place-based MDRs. Conclusion: Rural residents face a dual disadvantage—both lower socioeconomic status and weaker returns on those resources—necessitating targeted interventions beyond resource allocation. To address disparities in educational aspirations in rural areas, policymakers should focus on improving equitable access to educational opportunities and ensuring that these resources translate into comparable outcomes across different social and geographic contexts.
Article
Open Access March 09, 2025

Hippocampus Functional Connectivity, Impulsivity, and Subsequent Substance Use

Abstract Background: The hippocampus plays a critical role in memory and decision-making processes, with its resting-state functional connectivity (rsFC) linked to various behavioral outcomes. This study investigates whether baseline brain-wide rsFC of the hippocampus mediates the relationship between impulsivity and subsequent substance use, specifically tobacco and marijuana use, in adolescents. [...] Read more.
Background: The hippocampus plays a critical role in memory and decision-making processes, with its resting-state functional connectivity (rsFC) linked to various behavioral outcomes. This study investigates whether baseline brain-wide rsFC of the hippocampus mediates the relationship between impulsivity and subsequent substance use, specifically tobacco and marijuana use, in adolescents. Methods: Data were drawn from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study. Resting-state fMRI data were used to evaluate the functional connectivity of the hippocampus with key brain networks, including the cingulo-parietal network, visual network, sensory-motor network, and default mode network (DMN). Impulsivity was assessed using validated self-report measures, and substance use (tobacco and marijuana) was evaluated at follow-up. Mediation models were conducted to examine the extent to which hippocampal rsFC explains the association between impulsivity and substance use. Results: Baseline hippocampal rsFC with the cingulo-parietal network, visual network, sensory-motor network, and DMN showed marginal associations with future tobacco and marijuana use. Additionally, hippocampal rsFC was significantly associated with impulsivity, which, in turn, predicted higher substance use at follow-up. These findings suggest that hippocampal rsFC partially mediates the relationship between impulsivity and substance use behaviors. Conclusions: Hippocampal functional connectivity with brain networks may influence the pathway from impulsivity to future substance use in adolescence. These findings emphasize the importance of hippocampal connectivity in understanding the neural mechanisms underlying risk behaviors and may inform the development of targeted interventions to reduce substance use in this vulnerable population.
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Open Access March 04, 2025

SMOKES: Study of Measurement of Knowledge and Examination of Support for tobacco control policies

Abstract Background: Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. Objectives: This study introduces the rationale, design, methodology, and participants of the SMOKES Study [...] Read more.
Background: Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. Objectives: This study introduces the rationale, design, methodology, and participants of the SMOKES Study (Study of Measurement of Knowledge and Examination of Support for tobacco control policies), which is conducted to evaluate tobacco use, tobacco-related knowledge and attitude, as well as support for tobacco control policies among college and university students. Methods: The SMOKES Study was designed to address significant gaps in literature by focusing on college and university students in a non-Western context. A multi-center, cross-sectional design was employed to collect data from a diverse sample of college and university students across different geographical provinces in Iran. The survey instrument incorporated a range of measures covering socio-demographic characteristics, university-related variables, family tobacco use status, personal tobacco consumption behaviors (including detailed assessments of cigarette, hookah, and electronic cigarette use), and attitudinal as well as knowledge-based assessments related to vaping. Support for tobacco control policies is also measured. Data were collected using an online survey that included self-administered questionnaires, enabling access to a large diverse sample. This study may be used to determine the prevalence of ever and current use of cigarettes, electronic cigarettes, and hookah, as well as examining the correlates of single, dual, and poly-tobacco use. The study also aims to assess the role of social determinants, attitudes, and ethnic/geographic differences in shaping these outcomes. Results: The study sample consisted of 2403 college and university students, including undergraduates enrolled in different academic programs from all faculties and disciplines. Participants were drawn from universities across 15 provinces, and 11 ethnic groups, ensuring a heterogeneous sample with respect to socio-demographic background, ethnicity, and institutional affiliation. This diversity enhances the generalizability of the findings and allows for the exploration of subgroup differences in tobacco use patterns and policy support. Conclusions: The SMOKES Study offers a framework for examining tobacco-related knowledge and the acceptability of tobacco control policies among a key part of the population, being college and university students. By providing detailed insights into the prevalence and correlates of tobacco knowledge, attitude, use, as well as the tobacco control policy support, the study lays the groundwork for tailored public health interventions and more effective tobacco regulation strategies particularly for college campuses in a non-Western setting.
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Open Access February 26, 2025

Lower Successful Quit Rate of Menthol Tobacco Users in a Tobacco Cessation Program: An Explanatory Analysis in Search of Potential Mechanisms

Abstract Background: Menthol-flavored tobacco products are disproportionately used in low-income African American communities, a result of decades of targeted marketing and systemic inequities. Menthol use has been associated with lower quit rates, often compounded by factors such as lower trust in healthcare systems, reduced access to cessation programs, and other structural barriers. [...] Read more.
Background: Menthol-flavored tobacco products are disproportionately used in low-income African American communities, a result of decades of targeted marketing and systemic inequities. Menthol use has been associated with lower quit rates, often compounded by factors such as lower trust in healthcare systems, reduced access to cessation programs, and other structural barriers. Despite this, few studies have systematically examined the explanatory mechanisms that might clarify why menthol-flavored tobacco is linked to poorer cessation outcomes among participants in tobacco cessation programs. Aims: This study aimed to investigate the potential mechanisms by which menthol tobacco use is associated with lower quit rates across three types of smoking cessation interventions. Methods: Participants were randomized into one of three smoking cessation interventions: in-person (CEASE), self-help, or online/hybrid programs. Smoking abstinence was assessed three months post-intervention as the primary outcome. Secondary analyses explored whether demographic, socioeconomic, or behavioral factors mediated the association between menthol use and quit rates across the intervention arms. Results: Menthol tobacco use was significantly associated with lower quit rates (p < 0.01). This association was not explained by demographic, socioeconomic, health, or addiction-related factors. While menthol use was associated with lower education and employment levels, demographic characteristics, physical or mental health, or addiction did not explain the effect of menthol on tobacco cessation. These findings suggest that the lower quit rates observed among menthol users cannot be attributed to any third factors assessed in this study. Conclusions: Menthol tobacco use independently predicts lower quit rates, and the mechanisms behind this disparity remain unclear. The consistent findings across different intervention types highlight the need for further research to uncover the underlying pathways and to design targeted strategies to improve cessation outcomes for menthol users.
Article
Open Access February 25, 2025

Nucleus Accumbens Resting State Functional Connectivity is Linked to Family Income, Reward Salience, and Substance Use

Abstract Background: As a central component of the brain's reward system, nucleus accumbens (NAcc) plays a crucial role in reward salience and substance use behaviors. Changes in the NAcc are also relevant to higher rates of substance use of youth and adults from low-income backgrounds. Although resting-state functional connectivity (rsFC) of the NAcc provides valuable insights into the neural [...] Read more.
Background: As a central component of the brain's reward system, nucleus accumbens (NAcc) plays a crucial role in reward salience and substance use behaviors. Changes in the NAcc are also relevant to higher rates of substance use of youth and adults from low-income backgrounds. Although resting-state functional connectivity (rsFC) of the NAcc provides valuable insights into the neural mechanisms underlying reward processing and the propensity for self-reported reward salience and substance use, research exploring the association between NAcc rsFC and brain networks beyond the default mode network (DMN) and prefrontal cortex (PFC) is limited. Objective: To investigate the role of the resting-state functional connectivity of the NAcc with the cingulo-opercular network, sensorimotor mouth network, and sensorimotor hand network in the association between socioeconomic status, self-reported reward salience, and future substance use. Methods: Data were obtained from the Adolescent Brain Cognitive Development (ABCD) study. NAcc rsFC with the cingulo-opercular network, sensorimotor mouth network, and sensorimotor hand network was assessed at baseline. Socioeconomic status was measured using family income. Self-reported reward salience was assessed using validated psychometric scales. Substance use outcomes were tracked longitudinally over the study period. Structural Equation Modeling was employed to examine the covariances between family income, NAcc rsFC, reward salience, and subsequent substance use. Results: Higher baseline family income was positively associated with baseline NAcc rsFC (B = 0.092, p < 0.001) and negatively associated with baseline reward salience (B = -0.040, p = 0.036) and future substance use (B = -0.081, p < 0.001). Baseline NAcc rsFC was strongly and positively associated with reward salience (B = 0.734, p < 0.001) and future substance use up to age 13 (B = 0.124, p < 0.001). Additionally, baseline reward salience was positively associated with future substance use (Covariance = 0.176, p < 0.001). Conclusion: The findings suggest that NAcc rsFC with brain networks beyond the DMN or PFC may contribute to the links between low parental socioeconomic status, reward salience, and substance use risk. Expanding the understanding of NAcc rsFC provides new insights into the neural mechanisms underlying these associations. These results have important implications for developing targeted interventions aimed at preventing substance use, particularly among low-income youth with heightened reward salience. Further research is needed to explore causal pathways and moderating factors influencing these relationships.
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Open Access February 25, 2025

Resting-State Functional Connectivity Between the Cingulo-Opercular and Default Mode Networks May Explain Socioeconomic Inequalities in Cognitive Development

Abstract Background: The Cingulo-Opercular Network (CON) is a crucial executive control network involved in regulating actions and facilitating higher-order cognitive processes. Resting-state functional connectivity between the CON and the Default Mode Network (DMN) plays a vital role in cognitive regulation, enabling the transition between internally focused and externally directed tasks. This [...] Read more.
Background: The Cingulo-Opercular Network (CON) is a crucial executive control network involved in regulating actions and facilitating higher-order cognitive processes. Resting-state functional connectivity between the CON and the Default Mode Network (DMN) plays a vital role in cognitive regulation, enabling the transition between internally focused and externally directed tasks. This study investigates whether resting-state functional connectivity between the CON and DMN mediates the effects of social determinants, such as educational opportunities and family structure, on cognitive outcomes in youth. Aims: This study aims to explore how CON-DMN connectivity influences the relationship between social gradients and cognition in youth. Specifically, it examines whether resting-state functional connectivity between these networks mediates the effects of educational opportunities and family structure on cognitive outcomes and seeks to uncover the neural mechanisms underlying these social gradients. Methods: Data were derived from the Adolescent Brain Cognitive Development (ABCD) study, a large longitudinal dataset of over 11,000 children aged 9–10 years. Cognitive outcomes were assessed using standardized NIH toolbox measures: Total Composite, Fluid Reasoning, Picture Vocabulary, Pattern Recognition, and Card Sorting. Social determinants were operationalized using indicators such as parental education, family composition, and neighborhood educational opportunities (COI). Resting-state functional connectivity (rsFC) between the CON and DMN was measured using functional magnetic resonance imaging (fMRI). Structural equation modeling (SEM) was employed to test whether CON-DMN rsFC mediated the relationship between social determinants and cognitive outcomes, adjusting for potential confounders such as age, sex, and race/ethnicity. Results: Stable family structure and greater educational opportunities were significantly associated with improved cognitive performance. These relationships were mediated by reduced functional connectivity between the CON and DMN. Conclusion: Reduced functional connectivity between the CON and DMN serves as a neural mechanism linking social gradients, such as educational opportunities and family structure, to better cognitive outcomes in youth.
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Open Access February 24, 2025

Socioeconomic Status, Trauma, Cognitive Function, Impulsivity, Reward Salience, and Future Substance Use: Role of Left Caudate Connectivity with the Cingulo-Opercular Network

Abstract Background: While understanding how corticostriatal connectivity is associated with socioeconomic status (SES), trauma exposure, cognitive function, reward salience, impulsivity, and future substance use is essential to identifying neurobiological pathways that contribute to health disparities and behavioral outcomes, very few studies have tested the role of left caudate resting-state [...] Read more.
Background: While understanding how corticostriatal connectivity is associated with socioeconomic status (SES), trauma exposure, cognitive function, reward salience, impulsivity, and future substance use is essential to identifying neurobiological pathways that contribute to health disparities and behavioral outcomes, very few studies have tested the role of left caudate resting-state functional connectivity (rsFC) with the cingulo-opercular network as a proxy of corticostriatal connectivity in social, cognitive, and behavioral processes. Objective: This study investigates the associations between left caudate-cingulo-opercular connectivity and multiple biopsychosocial domains, including low SES, high trauma exposure (financial and life events), cognitive function, reward salience, impulsivity, depression, and future substance use (tobacco and marijuana use). Methods: Resting-state functional magnetic resonance imaging (rs-fMRI) data were analyzed to assess connectivity between the left caudate and the cingulo-opercular network. Data on socioeconomic status, trauma exposure, cognitive performance, and mental health were collected from participants. Future substance use behaviors were evaluated through longitudinal follow-ups. Correlation and regression analyses were conducted to examine relationships between corticostriatal connectivity and the targeted domains. Results: Corticostriatal hypoconnectivity was associated with lower SES, higher trauma exposure, poorer cognitive function, heightened reward salience, higher impulsivity, and history of depression. Additionally, corticostriatal hypoconnectivity at baseline predicted future tobacco and marijuana use during follow-up years. Conclusion: Corticostriatal hypoconnectivity, particularly the rsFC between the left caudate and the cingulo-opercular network, may represent a potential mechanism linking a wide range of social, emotional, and behavioral problems in youth. These findings suggest that corticostriatal hypoconnectivity could serve as a neurobiological marker for identifying individuals at risk for depression, low cognitive function, high reward salience, impulsivity, and substance use, emphasizing the interplay between socioeconomic and neurocognitive factors in shaping behavioral health trajectories.
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Open Access February 19, 2025

The CEASE Tobacco Cessation Controlled Trial for Low-Income Racial and Ethnic Minority Participants: Key Predictors of Success

Abstract Background: Tobacco use remains disproportionately high among low-income and racial-ethnic minority populations. The CEASE program, with its self-help, hybrid/online, and in-person modalities, has demonstrated efficacy in promoting tobacco cessation. However, predictors of successful cessation among participants in these groups remain unclear. Objective: To identify baseline predictors of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program, with a focus on demographic, socioeconomic, behavioral, and psychosocial factors. Methods: Participants were allocated into three intervention arms: self-help, CEASE hybrid/online, and CEASE in-person. Baseline characteristics, including demographics (e.g., age, gender), socioeconomic status (e.g., education, employment), substance use profiles (e.g., cigarette packs per week, use of other tobacco products, menthol tobacco use), physical health (e.g., general health, number of cardiometabolic risk conditions), mental health (e.g., depressive symptoms, perceived stress), perceived social support, and nicotine dependence, were analyzed as potential predictors of cessation success. Multivariable logistic regression models were used to identify factors associated with successful quitting, controlling for the study arm. Results: In addition to the study arm, gender, baseline depression, cardiometabolic conditions, tobacco flavor, and the use of other tobacco products were significant predictors of quit success. Individuals receiving in-person interventions had significantly higher odds of quitting (AOR = 3.79, p < 0.05). Women were significantly less likely to quit compared to men (AOR = 0.24, p < 0.01). Participants with a greater number of cardiometabolic risk conditions were more likely to quit (AOR = 1.93, p < 0.05), while those with higher levels of depression had lower odds of quitting (AOR = 0.61, p < 0.05). Menthol tobacco users were also less likely to quit (AOR = 0.10, p < 0.05). Interestingly, individuals who used other forms of tobacco in addition to cigarettes had increased odds of quitting (AOR = 2.86, p [...] Read more.
Background: Tobacco use remains disproportionately high among low-income and racial-ethnic minority populations. The CEASE program, with its self-help, hybrid/online, and in-person modalities, has demonstrated efficacy in promoting tobacco cessation. However, predictors of successful cessation among participants in these groups remain unclear. Objective: To identify baseline predictors of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program, with a focus on demographic, socioeconomic, behavioral, and psychosocial factors. Methods: Participants were allocated into three intervention arms: self-help, CEASE hybrid/online, and CEASE in-person. Baseline characteristics, including demographics (e.g., age, gender), socioeconomic status (e.g., education, employment), substance use profiles (e.g., cigarette packs per week, use of other tobacco products, menthol tobacco use), physical health (e.g., general health, number of cardiometabolic risk conditions), mental health (e.g., depressive symptoms, perceived stress), perceived social support, and nicotine dependence, were analyzed as potential predictors of cessation success. Multivariable logistic regression models were used to identify factors associated with successful quitting, controlling for the study arm. Results: In addition to the study arm, gender, baseline depression, cardiometabolic conditions, tobacco flavor, and the use of other tobacco products were significant predictors of quit success. Individuals receiving in-person interventions had significantly higher odds of quitting (AOR = 3.79, p < 0.05). Women were significantly less likely to quit compared to men (AOR = 0.24, p < 0.01). Participants with a greater number of cardiometabolic risk conditions were more likely to quit (AOR = 1.93, p < 0.05), while those with higher levels of depression had lower odds of quitting (AOR = 0.61, p < 0.05). Menthol tobacco users were also less likely to quit (AOR = 0.10, p < 0.05). Interestingly, individuals who used other forms of tobacco in addition to cigarettes had increased odds of quitting (AOR = 2.86, p < 0.05). No other factors, including demographic variables (e.g., age), socioeconomic status (e.g., education, marital status), substance use profiles (e.g., cigarette packs per week, NRT use), or nicotine dependence, were significant predictors of cessation success. Conclusion: Baseline self-reported anxiety/depression and depressive symptoms play a critical role in reducing the likelihood of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program. These findings underscore the importance of addressing mental health challenges as part of tobacco cessation interventions to enhance their efficacy. Future research should explore targeted strategies for integrating mental health support into cessation programs to improve outcomes for underserved populations.
Article
Open Access February 17, 2025

Gender Differences in the Association Between Socioeconomic Status and Cardiometabolic Health: National Health and Nutrition Examination Survey

Abstract Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the [...] Read more.
Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the poverty-to-income ratio (PIR), and CMD indicators—including obesity, diabetes, and cardiovascular disease (CVD)—among men and women using data from the National Health and Nutrition Examination Survey (NHANES). Methods: This cross-sectional study utilized NHANES data (1999-2018), adjusting for race/ethnicity and age. SES was operationalized using PIR, with CMD outcomes (obesity, diabetes, and CVD) as dependent variables. Generalized linear models (GLM) were employed to evaluate the main effects of SES on CMD, with gender included as a moderator. Results: Higher SES was associated with lower overall CMD risk. However, the protective effects of SES were more pronounced in women than in men for all outcomes. These findings suggest that gender-specific pathways may mediate the relationship between SES and CMD. Women may derive greater health benefits from higher SES due to factors such as reduced stress exposure, healthier behaviors, and increased healthcare utilization. Conversely, the weaker association observed in men may reflect differences in social hierarchy sensitivity, responses to unemployment, or other contextual factors. Conclusion: The findings highlight the importance of gender-specific considerations when addressing SES-related disparities in CMD outcomes. Policies and interventions aimed at reducing CMD burden should account for these gender differences to promote equitable improvements in cardiometabolic health. Further research is needed to unravel the mechanisms driving these differences and to inform targeted strategies.
Article
Open Access February 16, 2025

Uneven Impact of Maternal Education at Birth on High School Grades of Black and White Students

Abstract Background: The Minorities' Diminished Returns (MDRs) theory posits that social determinants of health, such as parental education, exert weaker protective effects on health and educational outcomes in racialized and minoritized populations compared to White populations. Aim: This study examines whether higher maternal education is associated with better high school GPA in Black [...] Read more.
Background: The Minorities' Diminished Returns (MDRs) theory posits that social determinants of health, such as parental education, exert weaker protective effects on health and educational outcomes in racialized and minoritized populations compared to White populations. Aim: This study examines whether higher maternal education is associated with better high school GPA in Black youth and whether this association aligns with the MDRs framework. Methods: Data were drawn from the Future of Families and Child Wellbeing Study also known as Fragile Families and Child Wellbeing Study (FFCWS) baseline and 22nd year follow-up (1990-2022). This study included 1873 Black or White participants who were followed from birth to age 22. Linear regression models were used to assess the association between maternal education and high school GPA, adjusting for sociodemographic covariates. Analyses focused on the differential effects of maternal education across racial groups, particularly among Black youth. Results: While maternal education was positively associated with high school GPA, this effect was weaker for Black students compared to their White counterparts. Specifically, each additional year of maternal education corresponded to a lower GPA increase in Black students, consistent with the MDRs hypothesis. Conclusion: Findings support the MDRs theory, indicating that maternal education has a reduced protective effect on high school GPA among Black youth. These results underscore the need for policies that address structural factors beyond education to promote equitable academic achievement.
Article
Open Access February 14, 2025

Trauma Erodes Financial Returns of Educational Attainment

Abstract Background: Educational attainment is often regarded as a pathway to economic stability and social mobility. However, the Minorities’ Diminished Returns (MDRs) framework has demonstrated that the effects of educational attainment on various economic, behavioral, and health outcomes are weaker for marginalized populations, including racial/ethnic minorities, immigrants, LGBTQ+ individuals, [...] Read more.
Background: Educational attainment is often regarded as a pathway to economic stability and social mobility. However, the Minorities’ Diminished Returns (MDRs) framework has demonstrated that the effects of educational attainment on various economic, behavioral, and health outcomes are weaker for marginalized populations, including racial/ethnic minorities, immigrants, LGBTQ+ individuals, and those living in disadvantaged areas. While MDRs have been documented for various marginalized demographic groups, the role of trauma in moderating socioeconomic outcomes remains underexplored. Objective: This study examines whether lifetime trauma exposure diminishes the positive association between educational attainment and poverty-to-income ratio (PIR), a key indicator of economic well-being. Methods: Using data from the National Survey of American Life (NSAL), we analyzed a nationally representative sample of 6,008 adults, including Black, White, Latino, and Other racial/ethnic groups. We employed linear regression models to evaluate the association between the independent variable educational attainment and the outcome PIR. We then tested lifetime trauma as a moderator of this association. Models controlled for age, gender, employment, and race/ethnicity. Results: Educational attainment was positively associated with PIR across all groups, but the strength of this association was significantly attenuated for individuals with a history of lifetime trauma. These effects were independent of covariates. Conclusions: These findings extend the MDRs framework by highlighting trauma as a potential contributor to diminished returns of education on socioeconomic wellbeing. Structural inequities that increase trauma exposure in minoritized populations may also limit the economic benefits of education, particularly for groups with multiple trauma exposures. Policies aimed at addressing economic inequality must integrate social policies that reduce trauma and stress.
Article
Open Access February 12, 2025

Unequal Benefits: How Parental Education Falls Short for Black and Latino Youth

Abstract Background: Parental education is a key determinant of academic performance, yet its protective effects may differ by race and ethnicity. The concept of Minorities’ Diminished Returns (MDRs) highlights the weaker association between socioeconomic resources and outcomes for marginalized populations, including Black and Latino youth. Objective: To investigate whether the [...] Read more.
Background: Parental education is a key determinant of academic performance, yet its protective effects may differ by race and ethnicity. The concept of Minorities’ Diminished Returns (MDRs) highlights the weaker association between socioeconomic resources and outcomes for marginalized populations, including Black and Latino youth. Objective: To investigate whether the positive association between parental education and school performance (letter grades) is weaker for Black and Latino youth compared to non-Latino White youth. Methods: Data were drawn from the Monitoring the Future (MTF) 2023 study. The sample included Black, Latino, and non-Latino White youth. The outcome was a nine-level continuous measure of academic performance based on self-reported letter grades, with higher scores indicating better performance. Multivariate regression models tested interactions between parental education and race/ethnicity in predicting grades, adjusting for confounders such as family income, gender, and school characteristics. Results: A total number of 7584 12th graders entered the study. Parental education was positively associated with school performance across all groups, but the magnitude of this association was significantly smaller for Black and Latino youth compared to non-Latino White youth. Even after controlling for socioeconomic and contextual factors, the racial and ethnic differences in the strength of this association persisted. Conclusions: Our findings provide evidence of Minorities’ Diminished Returns (MDRs) in the academic domain, with Black and Latino youth experiencing weaker benefits of parental education on school performance. These disparities suggest that structural barriers and systemic inequities undermine the translation of parental educational attainment into academic success for marginalized groups. Policy interventions must address these structural barriers to promote equity in educational outcomes.
Article
Open Access February 11, 2025

Childhood Depression, Hopelessness, and Suicidal Attempt Predict Earlier Tobacco and Marijuana Use Initiation During Adolescence

Abstract Background: Emotional problems have been associated with substance use, yet longitudinal research examining this relationship during childhood and adolescence in large, diverse, community-based samples remains limited. Aims: This study investigates the prospective associations between three emotional problems—hopelessness, depression, and suicide attempts—before ages 9–10 and [...] Read more.
Background: Emotional problems have been associated with substance use, yet longitudinal research examining this relationship during childhood and adolescence in large, diverse, community-based samples remains limited. Aims: This study investigates the prospective associations between three emotional problems—hopelessness, depression, and suicide attempts—before ages 9–10 and the subsequent initiation of tobacco and marijuana use before ages 14–15, using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods: Data from the ABCD study were analyzed. Baseline emotional problems, including hopelessness, depression, and suicide attempts, were assessed at ages 9–10 through structured parent interviews. Substance use outcomes (tobacco and marijuana initiation) were tracked from baseline to follow-up at ages 14–15 using structured self-report measures. Structural Equation Modeling (SEM) was employed to assess the predictive roles of these early-life emotional problems, controlling for potential confounders such as demographic factors and family and neighborhood socioeconomic status. Results: Baseline hopelessness, depression, and suicide attempts at ages 9–10 were significant predictors of tobacco and marijuana use initiation at ages 14–15. These associations remained robust after adjusting for confounders, indicating the independent effects of early emotional problems on adolescent substance use initiation. Conclusions: Emotional problems in early childhood, including hopelessness, depression, and suicidal behavior, are critical predictors of substance use initiation during adolescence. These findings underscore the importance of early identification and targeted mental health interventions to reduce the risk of substance use among vulnerable youth.
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Open Access February 10, 2025

Higher-than Expected Social Security Reliance Among Educated Black Americans: Minorities' Diminished Returns in National Health Interview Survey (NHIS) 2023

Abstract Background: While educational attainment is generally associated with reduced reliance on Social Security and disability benefits, Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of educational attainment are not equally distributed across racial groups and are weaker for minoritized populations. This study explores the association between educational [...] Read more.
Background: While educational attainment is generally associated with reduced reliance on Social Security and disability benefits, Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of educational attainment are not equally distributed across racial groups and are weaker for minoritized populations. This study explores the association between educational attainment and reliance on Social Security and disability benefits among Black and White adults in the United States. Objective: Building on the MDRs framework, we analyzed data from the National Health Interview Survey (NHIS) 2023 to examine how educational attainment impacts reliance on Social Security disability income, disability benefits, and public assistance for Black and White adults. Methods: We used a nationally representative sample of Black and White adults from the NHIS 2023 dataset. The outcomes assessed were reliance on three income sources: (1) Social Security disability income, (2) disability benefit income, and (3) public assistance disability income. Educational attainment was classified into three levels: less than high school (reference), high school diploma to some college, and college graduate or more. Logistic regression models assessed the relationship between educational attainment and reliance on each income source, with separate analyses for Black and White adults to evaluate differential effects. Results: Higher levels of educational attainment (high school diploma to some college and college graduate or more) were associated with lower odds of relying on Social Security disability, disability benefits, and public assistance. However, the protective effects of educational attainment were notably stronger for White adults than for Black adults. Among Black adults, even high educational attainment showed limited effectiveness in reducing reliance on these income sources, underscoring the Minorities' Diminished Returns (MDRs) phenomenon. Conclusions: Although educational attainment reduces reliance on Social Security and disability-related income sources, these protective effects are less pronounced for Black adults compared to White adults. The findings reveal persistent racial disparities in the economic returns of education, suggesting that structural factors may undermine the socioeconomic and health benefits of educational achievement for Black Americans. Targeted policy interventions may be needed to improve economic stability for Black adults, including those with higher educational credentials.
Article
Open Access February 09, 2025

The Future of Longevity Medicine from the Lens of Digital Therapeutics

Abstract Digital therapeutics (DTx) are emerging as a pivotal tool in promoting longevity by addressing non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and mental health disorders. These software-driven interventions offer personalized, evidence-based treatments that can be accessed via digital devices, making healthcare more accessible and scalable. One of the key advancements [...] Read more.
Digital therapeutics (DTx) are emerging as a pivotal tool in promoting longevity by addressing non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and mental health disorders. These software-driven interventions offer personalized, evidence-based treatments that can be accessed via digital devices, making healthcare more accessible and scalable. One of the key advancements in DTx is the integration of artificial intelligence (AI) and machine learning (ML) to tailor interventions based on individual health data. This personalization enhances the effectiveness of treatments and supports preventive care by identifying risk factors early. The need for digital therapeutics is underscored by the rising prevalence of NCDs, which are responsible for a significant portion of global mortality and healthcare costs. Traditional healthcare systems often struggle to provide timely and personalized care, especially in low-resource settings. DTx can bridge this gap by offering cost-effective solutions that are easily scalable. Moreover, digital therapeutics can address health inequities by providing low-cost interventions to underserved populations, thereby reducing the burden of NCDs and improving overall health outcomes. As technology continues to evolve, the potential for DTx to enhance longevity and quality of life becomes increasingly promising. Recent advancements in longevity medicine and technology have focused on extending both lifespan and healthspan, ensuring that people not only live longer but also maintain good health throughout their extended years. This review article highlights these advancements that are contributing to this compelling subject of Longevity.
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Open Access February 07, 2025

CEASE Tobacco Cessation Program: Validation of Self-Rated Quit with Fagerstrom Test for Nicotine Dependence

Abstract Background: Despite advancements in smoking cessation interventions, few programs have demonstrated sustained effectiveness among low-income, underserved populations. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program was developed to address this gap and support tobacco cessation in these communities. However, it remains unclear whether self-reported [...] Read more.
Background: Despite advancements in smoking cessation interventions, few programs have demonstrated sustained effectiveness among low-income, underserved populations. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program was developed to address this gap and support tobacco cessation in these communities. However, it remains unclear whether self-reported outcome measures in this context are in line with more objective outcome measures. Aims: This study aimed to validate self-reported quit rates using the Fagerström Test for Nicotine Dependence (FTND) as a gold standard outcome measure for evaluation of the effectiveness of the CEASE smoking cessation intervention compared to a self-help approach among low-income, underserved adult smokers. Methods: A quasi-experimental design was employed to evaluate this community-based intervention. Although participants were initially assigned to three groups, this report focuses on two arms that show the major difference in the efficacy of the program: (1) the self-help group (reference; Arm 1) and (2) the in-person CEASE group (Arm 2). Outcomes included successful quitting, assessed through self-reports, and changes in FTND scores. To examine the concordance between these measures, we tested whether changes in FTND scores fully explained the relationship between the intervention and self-reported quitting. Potential confounders included demographic, socioeconomic, and health-related variables. Data were analyzed using regression and structural equation modeling (SEM). Results: The majority of participants were Black Americans, followed by White individuals and those of other racial backgrounds. The CEASE intervention (Arm 2) demonstrated effectiveness in reducing nicotine dependence (measured by FTND) and increasing self-reported quit rates compared to the self-help group. Importantly, changes in FTND scores fully explained the effect of the CEASE intervention on self-reported quitting, highlighting the program’s impact on addiction severity. Conclusion: Successful quitting measured using self-report is in line with the decline in nicotine addiction severity among low-income racial minority populations. CEASE holds promise as a scalable solution to address smoking disparities in underserved communities.
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Open Access January 24, 2025

High Socioeconomic Status Black Adolescents Attend Worse Schools than Whites

Abstract Background: School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, [...] Read more.
Background: School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, Minorities’ Diminished Returns (MDRs) theory suggests that Black families may not experience the same benefits of high family SES due to structural barriers. This study examines the association between family SES and school characteristics, focusing on racial disparities in access to high-quality educational environments. Objective: To investigate the relationship between family SES (parental education and household income) and multiple school characteristics (poverty, teacher experience, graduation rates, and college enrollment), and to assess racial differences in these associations. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study, a national sample of US adolescents, was analyzed. We used multivariate regression models to examine associations between family SES and school characteristics and to test for interactions by race, specifically comparing Black and White adolescents. Results: Higher family SES was associated with positive school characteristics overall, including lower school poverty, greater teacher experience, and increased graduation and college enrollment rates. However, these positive effects of high family SES on school characteristics were significantly weaker for Black adolescents than for White adolescents. Black adolescents from high-income families were more likely than White adolescents from similar backgrounds to attend schools with higher poverty rates, less experienced teachers, and reduced graduation and college enrollment rates. Conclusion: Our findings highlight persistent racial inequities in access to educational opportunities, even among families with comparable socioeconomic resources. The diminished returns of family SES for Black adolescents underscore the role of structural barriers in limiting access to high-quality schools. These findings emphasize the need for policy interventions to address systemic inequalities that hinder Black families from fully leveraging their SES to access favorable educational environments.
Article
Open Access January 24, 2025

Neurocognitive, Emotional, and Behavioral Costs for Adolescents Due to Diminished Returns of Parental Employment on Trauma

Abstract Background: Parental employment is a significant social determinant of children's developmental outcomes, shaping their cognitive and behavioral trajectories. However, the effects of parental employment may not be equally protective across racial groups. The Minority Diminished Returns (MDRs) framework suggests that socioeconomic status (SES) factors, such as employment, yield fewer [...] Read more.
Background: Parental employment is a significant social determinant of children's developmental outcomes, shaping their cognitive and behavioral trajectories. However, the effects of parental employment may not be equally protective across racial groups. The Minority Diminished Returns (MDRs) framework suggests that socioeconomic status (SES) factors, such as employment, yield fewer protective benefits for Black families compared to White families. Objective: This study investigates the diminished returns of parental employment on trauma and associated neurocognitive and behavioral outcomes in children, with a focus on racial variation in these effects. Methods: Using data from the Adolescent Brain Cognitive Development (ABCD) study, a large and diverse sample of children was analyzed. We applied MDRs theory and social determinants of health frameworks to examine the association between parental employment, trauma, and children's cognitive and behavioral outcomes. The analysis controlled for family SES, neighborhood factors, and racial group differences. Results: Preliminary findings suggest that while parental employment is generally protective against trauma, the strength of this association is diminished for Black children. Black families with employed parents experience higher levels of trauma and stress compared to their White counterparts, which may contribute to racial disparities in cognitive and behavioral outcomes. Conclusion: Parental employment may not equally buffer against trauma-related risks for Black children, reflecting the broader pattern of diminished returns for racially disadvantaged groups. These findings highlight the need for policies addressing the unequal benefits of SES across racial groups.
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Open Access January 24, 2025

Cingulate Gyrus Volume as a Mediator of the Social Gradient in Cognitive Function

Abstract Background: Socioeconomic status (SES) is a well-established predictor of cognitive function in children, but the neurobiological pathways through which SES influences cognitive outcomes remain underexplored. This study examines the role of the cingulate gyrus (region of the brain that is involved in emotion regulation, decision-making, error detection, and cognitive control) in mediating [...] Read more.
Background: Socioeconomic status (SES) is a well-established predictor of cognitive function in children, but the neurobiological pathways through which SES influences cognitive outcomes remain underexplored. This study examines the role of the cingulate gyrus (region of the brain that is involved in emotion regulation, decision-making, error detection, and cognitive control) in mediating the relationship between SES and cognitive performance, with a focus on whether these effects vary by sex. Objective: To investigate the role of the cingulate gyrus in mediating the association between social gradients (family SES) and cognitive function in children and assess potential sex differences in these pathways. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study. Cognitive function was assessed using a composite measure of executive function and general cognitive ability. Structural MRI data were used to measure the volume of the cingulate gyrus. Path analysis was conducted to examine the mediating role of the cingulate gyrus in the association between SES and cognitive function. Interaction terms were included to test for sex differences. Results: Higher SES was significantly associated with a larger cingulate gyrus volume and better cognitive function. The volume of the left cingulate gyrus partially mediated the relationship between family and neighborhood SES and cognitive function, explaining a portion of the social gradient in cognitive outcomes. No significant sex differences were found in these mediating effects. Conclusions: The cingulate gyrus partially mediates the link between SES and cognitive function in children. These findings suggest that social disparities in cognitive function may operate, in part, through neurobiological changes such as those in the cingulate gyrus, without significant variation by sex.
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Open Access January 23, 2025

Population Diversity Matters: Heterogeneity of Biopsychosocial Pathways from Socioeconomic Status to Tobacco Use via Cerebral Cortical Volume in the ABCD Study

Abstract Background: Most neuroscience research has predominantly focused on White, middle-class populations, leading to gaps in understanding how socioeconomic status (SES) influences brain development and health behaviors in racially diverse groups. Tobacco use, a major public health concern, is influenced by both family and neighborhood SES, with early initiation during adolescence predicting [...] Read more.
Background: Most neuroscience research has predominantly focused on White, middle-class populations, leading to gaps in understanding how socioeconomic status (SES) influences brain development and health behaviors in racially diverse groups. Tobacco use, a major public health concern, is influenced by both family and neighborhood SES, with early initiation during adolescence predicting long-term health outcomes. The Adolescent Brain Cognitive Development (ABCD) study provides a unique opportunity to examine racial disparities in the pathways from SES to brain development and behavior, especially through the lens of Marginalization-Related Diminished Returns (MDRs), where the effects of SES are attenuated for minority groups. Objective: This study investigates racial variation in the associations between SES, cerebral cortical volume, and tobacco use initiation, comparing Black and White youth over 4-6 years of follow-up. Methods: Data from the ABCD study were analyzed to assess pathways from family income to adolescents’ cortical volume via the needs-to-income ratio, and from cortical volume to tobacco use initiation. Structural equation modeling was used to evaluate these pathways, stratified by race, with a focus on comparing Black and White participants. Covariates included family and neighborhood SES, demographic factors, and baseline behavioral measures. Results: We found that the positive association between income (via the needs-to-income ratio) and total cortical volume was significantly weaker for Black youth compared to White youth. Additionally, the link between larger total cortical volume and reduced risk of tobacco initiation was also weaker in Black adolescents. These findings were consistent over 4-6 years of follow-up, suggesting that Black youth experience diminished returns from higher SES in terms of brain development and behavioral outcomes. Conclusions: Our findings highlight significant racial disparities in the pathways from SES to brain development and tobacco use initiation, supporting the Marginalization-Related Diminished Returns (MDRs) framework. While higher SES is associated with larger cortical volumes and lower tobacco use risk in White youth, these associations are attenuated in Black adolescents.
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Open Access January 23, 2025

Weaker Effects of Educational Attainment on Chronic Medical Conditions in American Indian Alaska Native, Black, and Latino Adults: National Health Interview Survey 2023

Abstract Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors [...] Read more.
Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors contributing to these disparities. While higher socioeconomic status is generally associated with better health outcomes, this benefit may be diminished for racialized and minoritized populations. Objective: This study investigates the protective effects of educational attainment and income-to-poverty ratio on the prevalence of chronic medical conditions and examines whether these effects vary across racial and ethnic groups, specifically among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino White adults. Methods: Using data from the 2023 National Health Interview Survey (NHIS), this cross-sectional study analyzed the association between educational attainment and chronic medical conditions across racial and ethnic groups. Logistic regression models were employed to assess whether the strength of the relationship between education and chronic medical conditions differed by racial/ethnic group, controlling for key demographic and socioeconomic covariates. Sample size was 29,373 which was reflective of 256,566,689 US population. Results: Consistent with the theory of Minorities' Diminished Returns, findings showed that the protective effects of higher educational attainment on chronic medical conditions were significantly weaker for Black, Latino, and American Indian and Alaska Native adults than for their non-Latino White counterparts. Even among individuals with higher education, Black, Latino, and American Indian and Alaska Native adults faced elevated risks of chronic medical conditions. Conclusion: While educational attainment generally reduces the prevalence of chronic medical conditions, this protective effect is moderated by racial and ethnic background. Structural barriers limit the health benefits of educational attainment. This underscores the need for policies that address structural inequities—such as low-quality education and occupational segregation—that constrain the protective health effects of educational attainment for minoritized groups.
Article
Open Access January 23, 2025

Trauma and Early Puberty May Be Stronger Predictors of Early Tobacco Initiation in Girls Compared to Boys

Abstract Objective: This study investigates the pathways linking socioeconomic status (SES), trauma, early puberty, and tobacco use, with a focus on how these relationships differ by sex. Using data from the Adolescent Brain Cognitive Development (ABCD) study, we explore how SES and race contribute to trauma exposure, which in turn may influence early puberty and tobacco use. The study also examines [...] Read more.
Objective: This study investigates the pathways linking socioeconomic status (SES), trauma, early puberty, and tobacco use, with a focus on how these relationships differ by sex. Using data from the Adolescent Brain Cognitive Development (ABCD) study, we explore how SES and race contribute to trauma exposure, which in turn may influence early puberty and tobacco use. The study also examines potential mediating effects of trauma and early puberty on the association between SES and tobacco use, while comparing these pathways for males and females. Methods: Data were drawn from the ABCD study, and structural equation modeling (SEM) was employed to test direct and indirect pathways between SES, trauma, early puberty, and tobacco use. The sample was stratified by sex to assess differences in these relationships for males and females. Key predictors included SES, race, and age, while outcomes were trauma, early puberty, and tobacco use. The model assessed mediating effects of trauma and early puberty on tobacco use. Results: Trauma was a significant predictor of early puberty for females (B = 0.032, SE = 0.015, p = 0.039) but not males. Early puberty was significantly linked to tobacco use for females (B = 0.048, SE = 0.015, p = 0.001) but not for males. Additionally, trauma had an effect on tobacco use among females (B = 0.048, SE = 0.014, p < 0.001) but not males. Lower SES was significantly associated with higher trauma exposure for both males (B = -0.109, SE = 0.014, p < 0.001) and females (B = -0.110, SE = 0.015, p < 0.001). Conclusions: The findings suggest that trauma and early puberty play more significant roles in the pathways from SES to tobacco use for females than for males. While trauma and early puberty are crucial mediators for females, these factors are less predictive for males. These results highlight the importance of sex-specific interventions targeting trauma and early puberty as pathways to early tobacco use.
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Open Access January 22, 2025

Tech Transformations: Modern Solutions for Obstructive Sleep Apnea

Abstract Recent advancements in the screening, diagnosis, and management of obstructive sleep apnea (OSA) have significantly improved patient outcomes. For screening, the use of home sleep apnea testing (HSAT) has become more prevalent, offering a convenient and cost-effective alternative to traditional in-lab polysomnography. HSAT devices have shown good specificity and sensitivity, particularly in [...] Read more.
Recent advancements in the screening, diagnosis, and management of obstructive sleep apnea (OSA) have significantly improved patient outcomes. For screening, the use of home sleep apnea testing (HSAT) has become more prevalent, offering a convenient and cost-effective alternative to traditional in-lab polysomnography. HSAT devices have shown good specificity and sensitivity, particularly in patients with a high pre-test probability of OSA. In terms of diagnosis, advancements in wearable technology and mobile health applications have enabled continuous monitoring of sleep patterns and respiratory parameters. These tools provide valuable data that can be used to identify OSA more accurately and promptly. Additionally, machine learning algorithms are being integrated into diagnostic processes to enhance the accuracy of OSA detection by analyzing large datasets and identifying patterns indicative of the condition. Management of OSA has also seen significant progress. Continuous positive airway pressure (CPAP) therapy remains the gold standard, but new developments include auto-adjusting CPAP devices that optimize pressure settings based on real-time feedback. Mandibular advancement devices and hypoglossal nerve stimulation are emerging as effective alternatives for patients who are CPAP-intolerant. Furthermore, lifestyle interventions such as weight management, positional therapy, and exercise have been shown to complement medical treatments, leading to better overall outcomes. This review article highlights these advancements that collectively contribute to improved patient adherence, reduced symptoms, and enhanced quality of life for individuals with OSA.
Review Article
Open Access January 16, 2025

Extreme Heat Exposure and Adolescent Cognitive Function

Abstract Background: Extreme heat exposure is an increasing public health concern, particularly in the context of climate change. Limited research has explored its impact on children's cognitive outcomes. This study investigates the association between extreme heat exposure and cognitive function in 9–10-year-old children, using data from the Adolescent Brain Cognitive Development (ABCD) study. [...] Read more.
Background: Extreme heat exposure is an increasing public health concern, particularly in the context of climate change. Limited research has explored its impact on children's cognitive outcomes. This study investigates the association between extreme heat exposure and cognitive function in 9–10-year-old children, using data from the Adolescent Brain Cognitive Development (ABCD) study. Additionally, we assess whether this effect is independent of socio-demographic factors such as race, family socioeconomic status (SES), and neighborhood SES. Methods: Data were drawn from the ABCD study, comprising over 10,000 children aged 9–10 years. Cognitive function was assessed through standardized cognitive tests, while extreme heat exposure was estimated using geographic and climate data. Structural equation modeling (SEM) was employed to examine the direct effects of heat exposure on cognitive outcomes and to account for potential confounding variables, including race, family SES, and neighborhood SES. Results: Black families, low SES households, and children from low SES neighborhoods were disproportionately exposed to extreme heat. Extreme heat exposure was significantly associated with lower cognitive function in children, and this association remained robust even after adjusting for socio-demographic factors. Conclusions: Extreme heat exposure is linked to diminished cognitive function in children, particularly among socio-economically disadvantaged and marginalized populations. Given the increasing frequency of extreme heat events due to climate change, future research should further explore these implications for children’s cognitive outcomes. Policy interventions that improve access to cooling infrastructure, expand green spaces, and prioritize at-risk populations are critical to mitigating the adverse cognitive effects of extreme heat in low SES communities.
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Open Access January 16, 2025

Heat Exposure Predicts Earlier Childhood Pubertal Initiation, Behavioral Problems, and Tobacco Use

Abstract Background: Climate change has raised significant concerns about its impact on health, particularly for vulnerable populations such as children and adolescents. While extensive research has examined physical health effects, limited attention has been given to the influence of extreme heat on developmental and behavioral outcomes. Objectives: This study investigates the association [...] Read more.
Background: Climate change has raised significant concerns about its impact on health, particularly for vulnerable populations such as children and adolescents. While extensive research has examined physical health effects, limited attention has been given to the influence of extreme heat on developmental and behavioral outcomes. Objectives: This study investigates the association between extreme heat exposure and early puberty initiation (ages 9-10), using data from the Adolescent Brain Cognitive Development (ABCD) study. It further explores how early puberty correlates with behavioral problems and tobacco use initiation. Methods: Data from 11,878 participants in the ABCD study were analyzed to examine the relationship between extreme heat exposure (independent variable) and puberty initiation (outcome). Behavioral problems and tobacco use initiation were evaluated as downstream outcomes of early puberty. Covariates included age, sex, and race/ethnicity, and behavioral problems were assessed using the Child Behavior Checklist (CBCL). Structural equation modeling (SEM) was employed for analysis. Results: Extreme heat exposure was significantly associated with earlier puberty initiation at ages 9-10. Early puberty, in turn, correlated with higher levels of behavioral problems and an increased likelihood of tobacco use initiation. Conclusions: These findings underscore the importance of addressing environmental factors such as extreme heat to reduce risks associated with early maturation, including behavioral and substance use challenges. Targeted interventions and policies are needed to mitigate the impact of extreme heat on child development, and longitudinal studies are essential to confirm these results and inform effective prevention strategies.
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Open Access November 21, 2024

Diminished Returns of Educational Attainment on Body Mass Index Among Latino Populations: Insights from UAS Data

Abstract Background: Educational attainment is a well-established predictor of physical health outcomes, including body mass index (BMI). However, according to the theory of Minorities' Diminished Returns (MDRs), the health benefits of education tend to be weaker for ethnic minorities compared to non-Latino Whites, due to structural inequalities and social disadvantages. Objective: [...] Read more.
Background: Educational attainment is a well-established predictor of physical health outcomes, including body mass index (BMI). However, according to the theory of Minorities' Diminished Returns (MDRs), the health benefits of education tend to be weaker for ethnic minorities compared to non-Latino Whites, due to structural inequalities and social disadvantages. Objective: This study examines whether the association between educational attainment and BMI is weaker among Latino individuals compared to non-Latino individuals, in line with the MDRs framework. Methods: Data were drawn from the 2014 wave of the Understanding America Study (UAS), a nationally representative internet-based panel. Body mass index (BMI) was the outcome of interest. Linear regression models were used to analyze the association between educational attainment and BMI, with an interaction term for ethnicity to explore differences in the relationship between Latino and non-Latino people. Models were adjusted for age, sex, marital status, and labor market participation and results were presented as beta coefficients, p-values, and 95% confidence intervals (CIs). Results: Higher educational attainment was associated with lower BMI for both Latino and non-Latino participants (p < 0.001). However, the interaction between educational attainment and ethnicity was significant (p < 0.05), indicating that Latino individuals experienced smaller reductions in BMI because of higher education compared to non-Latino people. Conclusion: This study provides evidence of diminished returns from educational attainment on BMI among Latino individuals. These findings support the MDRs framework, suggesting that structural barriers may limit the health benefits of education for Latino populations. While education is a key determinant of physical and mental health, its benefits are not equitably distributed across ethnic groups. Structural inequalities, chronic stress, poor neighborhood environments, and adverse educational and occupational conditions likely contribute to this disparity. Addressing these underlying factors through targeted policy interventions is necessary to promote health equity for Latino populations.
Article
Open Access November 21, 2024

Unequal Returns: Education Fails to Fully Prepare Black and Latino Americans for Retirement

Abstract Background: Retirement is a universal life stage, marking the culmination of an individual's working years. However, many people face financial challenges during retirement due to insufficient financial planning. Retirement preparedness is essential for ensuring economic security and maintaining a high quality of life in later years. Education is often viewed as a key driver of retirement [...] Read more.
Background: Retirement is a universal life stage, marking the culmination of an individual's working years. However, many people face financial challenges during retirement due to insufficient financial planning. Retirement preparedness is essential for ensuring economic security and maintaining a high quality of life in later years. Education is often viewed as a key driver of retirement preparedness, as it is linked to higher earnings, better financial literacy, and improved decision-making. However, the Minorities' Diminished Returns (MDRs) theory suggests that the economic, cognitive, and behavioral benefits of education are weaker for racial and ethnic minorities compared to non-Latino Whites. Objective: This study aims to examine the relationship between educational attainment and retirement preparedness, focusing on whether this association differs among Black, Latino, and non-Latino White individuals, using data from the Understanding America Study (UAS). Methods: Data were drawn from the UAS, a nationally representative internet-based panel survey. The sample included participants from diverse racial and ethnic backgrounds. Linear regression models were used to evaluate the association between educational attainment, measured in years of schooling, and retirement preparedness. Interaction terms were included to test whether the association varied by race and ethnicity. Models were adjusted for potential confounders, including age, sex, marital status, employment status, and immigration. Results: In the overall sample, higher educational attainment was significantly and positively associated with better retirement preparedness (p < 0.001). However, consistent with the MDRs framework, the strength of this association was significantly weaker for Black and Latino participants compared to non-Latino White participants (p < 0.05). Non-Latino Whites with higher education levels reported substantially better retirement preparedness, while the same level of education yielded smaller gains in retirement preparedness for Black and Latino individuals. Conclusion: The findings support the Minorities' Diminished Returns theory, showing that although educational attainment enhances retirement preparedness for all groups, Black and Latino individuals derive fewer benefits compared to their non-Latino White counterparts. These disparities point to persistent structural inequalities and systemic barriers within the education system and labor market, as well as the effects of segregation and discrimination, which undermine the economic benefits of education for marginalized populations. Addressing these disparities requires targeted policy interventions aimed at eliminating racial and ethnic inequalities in retirement outcomes and ensuring equitable benefits from educational attainment for all groups.
Article
Open Access November 19, 2024

The Cost of Opportunity: Anti-Black Discrimination in High Resource Settings

Abstract Objective: Inequalities exist in children’s educational outcomes—including reading proficiency, school discrimination, and school disciplinary actions—across zip codes with different levels of educational childhood opportunity index (COI). This study examines the interaction between race and educational environment on children’s educational outcomes. We hypothesize that race, parental [...] Read more.
Objective: Inequalities exist in children’s educational outcomes—including reading proficiency, school discrimination, and school disciplinary actions—across zip codes with different levels of educational childhood opportunity index (COI). This study examines the interaction between race and educational environment on children’s educational outcomes. We hypothesize that race, parental education, and their interaction are associated with perceived school discrimination, which in turn reduces their cognitive, academic, and emotional wellbeing. We also hypothesize that Black children with high socioeconomic status (SES) report high perceived school discrimination in high-COI settings. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study, which measures a wide range of educational, cognitive, and emotional outcomes. At the same time, the ABCD children are sampled across areas with vast differences in COI rankings, that can be classified into these five categories: very high, high, average, low, and very low educational COIs. Our structural equation models (SEM) tested the additive and interactive effects of race and educational attainment on perceived school discrimination, and the effects of school discrimination on various cognitive abilities (reading proficiency, picture vocabulary, and list sorting working memory), school suspension, as well as depressed mood. Our multi-group SEM assessed how these relationships vary across educational COI levels. Results: Our findings showed that high SES Black children report highest school discrimination in residential areas with highest COIs. This is based on the observation that the interaction between race and parental education on experiences of school discrimination were only significant in areas with highest COI. Across residential areas with different COI levels, students who experienced higher school discrimination had higher suspension, worse depression, and worse cognitive performance. Conclusion: While higher COIs are associated with better academic outcomes, Black-White gaps exist in the role of increased COI through increased racial bias that children perceive. These findings underscore the complexity of educational equity, suggesting that improving COI alone is insufficient for eliminating racial disparities in school experiences. Policies should be in place to reduce school-based discrimination against Black students in high COI settings.
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Open Access November 16, 2024

Digital Therapeutics: A New Dimension to Diabetes Mellitus Management

Abstract Digital therapeutics (DTx) play a transformative role in diabetes management by leveraging technology to provide personalized, data-driven medical interventions. These tools enhance self-management by offering continuous monitoring and real-time feedback on glucose levels, diet, and physical activity. This personalized approach helps patients adhere to treatment plans and make informed lifestyle [...] Read more.
Digital therapeutics (DTx) play a transformative role in diabetes management by leveraging technology to provide personalized, data-driven medical interventions. These tools enhance self-management by offering continuous monitoring and real-time feedback on glucose levels, diet, and physical activity. This personalized approach helps patients adhere to treatment plans and make informed lifestyle changes, leading to improved clinical outcomes such as reduced HbA1c levels and better overall diabetes control. The importance of DTx lies in their ability to make diabetes care more accessible and convenient. Mobile apps and telemedicine platforms enable patients to receive support and guidance from anywhere, reducing the need for frequent in-person visits. Additionally, DTx often include behavioral support features like reminders, educational content, and motivational tools, which are crucial for maintaining healthy habits and managing stress. Currently, the dynamics of DTx in diabetes are rapidly evolving, with increasing integration of artificial intelligence and machine learning to further personalize and optimize care. As the adoption of these technologies grows, they hold the potential to significantly improve patient outcomes and revolutionize diabetes management on a global scale. This article will focus on the benefits of novel digital therapeutics for prevention and management of type II diabetes that are currently available in the market.
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Open Access November 09, 2024

Educated but on Social Security Disability Insurance: Minorities’ Diminished Returns

Abstract Background: Educational attainment is widely regarded as a key predictor of economic and social outcomes in later life, including the likelihood of receiving Social Security Disability Insurance (SSDI). According to the Minorities' Diminished Returns (MDRs) theory, however, the benefits of education may be less pronounced for racial and ethnic minorities compared to non-Latino [...] Read more.
Background: Educational attainment is widely regarded as a key predictor of economic and social outcomes in later life, including the likelihood of receiving Social Security Disability Insurance (SSDI). According to the Minorities' Diminished Returns (MDRs) theory, however, the benefits of education may be less pronounced for racial and ethnic minorities compared to non-Latino Whites. This study investigates whether the effects of education on the likelihood of receiving SSDI differ by race and ethnicity, focusing on Black and Latino Americans. Objective: The primary aim of this study was to examine the relationship between educational attainment (measured in years of schooling) and the likelihood of receiving SSDI, with a specific focus on exploring how this relationship varies by race and ethnicity, in line with the MDRs framework. Methods: Data were drawn from the Understanding America Study (UAS), a nationally representative, internet-based panel survey. The sample included Black, Latino, and non-Latino White U.S. adults. Our sample size was 12,975 adults over the age of 18. Logistic regression models were used to assess the association between educational attainment and receiving SSDI, adjusting for demographic variables such as age, sex, employment status, and marital status. Interaction terms between race/ethnicity and educational attainment were included to explore whether the returns on education varied across racial and ethnic groups. Results: Higher educational attainment was significantly associated with a lower likelihood of receiving SSDI in the overall sample. However, consistent with the MDRs framework, the protective effect of education was significantly weaker for both Black and Latino individuals compared to non-Latino Whites. Black and Latino participants with similar levels of education as their non-Latino White counterparts were more likely to receive SSDI, reflecting diminished returns on educational attainment for these groups. Conclusion: This study provides strong evidence supporting the MDRs theory, demonstrating that the protective effects of education on the likelihood of receiving SSDI are not equally distributed across racial and ethnic groups. Black and Latino Americans experience weaker returns on their education when it comes to avoiding SSDI, likely due to structural inequalities and systemic barriers. These findings highlight the need for policies that address not only educational disparities but also the broader societal factors that limit the benefits of education for racial and ethnic minorities.
Article
Open Access August 07, 2024

Revolutionizing Active Pharmaceutical Ingredients: From Concept to Compliance

Abstract Active Pharmaceutical Ingredients (APIs) serve as the cornerstone of pharmaceutical development, driving therapeutic efficacy and safety in drug formulations. This article provides a comprehensive overview of the lifecycle of APIs, starting from their discovery and development, through to manufacturing processes and regulatory oversight. The development of APIs begins with intensive research and [...] Read more.
Active Pharmaceutical Ingredients (APIs) serve as the cornerstone of pharmaceutical development, driving therapeutic efficacy and safety in drug formulations. This article provides a comprehensive overview of the lifecycle of APIs, starting from their discovery and development, through to manufacturing processes and regulatory oversight. The development of APIs begins with intensive research and discovery efforts, where medicinal chemists and pharmacologists identify and optimize potential compounds through computational modelling, high-throughput screening, and structure-activity relationship studies. Promising candidates undergo rigorous preclinical testing to assess pharmacological properties, safety profiles, and potential adverse effects in animal models. Upon successful preclinical outcomes, APIs progress to clinical trials, involving phases of testing in human subjects to evaluate efficacy, dosage regimens, and safety profiles under controlled conditions. Clinical trial data are meticulously analyzed to support regulatory submissions, demonstrating the API's therapeutic benefits and safety for eventual patient use. Manufacturing APIs involves complex chemical synthesis or biotechnological methods, ensuring precise control over reaction conditions, purity, and yield. The scale-up from laboratory synthesis to industrial production demands adherence to Good Manufacturing Practices (GMP), where stringent quality control measures verify consistency, potency, and stability throughout production batches. Regulatory oversight by authorities such as the Food and Drug Administration (FDA) in the United States and the European Medicines Agency (EMA) in Europe ensures that APIs meet stringent standards of safety, efficacy, and quality before market approval. Manufacturers must submit comprehensive Chemistry, Manufacturing, and Controls (CMC) data, detailing manufacturing processes, analytical methods, and stability studies to support regulatory filings.
Review Article
Open Access November 05, 2024

Black-White Gap Across Levels of Educational Childhood Opportunities: Findings from the ABCD Study

Abstract Objective: This study examines racial disparities in educational outcomes—including reading proficiency, grade point average (GPA), school discrimination, and school disciplinary actions—across regions with different levels of educational childhood opportunity index (COI). Our aim is to explore how these racial gaps between Black and White students vary in areas with differing educational [...] Read more.
Objective: This study examines racial disparities in educational outcomes—including reading proficiency, grade point average (GPA), school discrimination, and school disciplinary actions—across regions with different levels of educational childhood opportunity index (COI). Our aim is to explore how these racial gaps between Black and White students vary in areas with differing educational opportunities. We hypothesize that higher COI is associated with smaller academic achievement gaps but may also correspond with greater racial bias in unfair school treatment. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study, which provides comprehensive measures of educational outcomes, cognitive performance, and COI. National COI rankings were used to classify regions into five categories: very high, high, average, low, and very low educational opportunity. We analyzed racial gaps in reading proficiency, and experiences of discrimination and suspension across these COI categories. Multi-group Structural Equation Models (SEM) were used to assess how the relationship between race and educational outcomes varies across COI levels. Results: Our findings confirmed that Black-White gaps in reading proficiency and cognitive test performance (Flanker task) were less pronounced in regions with higher COI. However, racial disparities in school disciplinary actions and experiences of discrimination were more pronounced in higher-opportunity areas. Specifically, the effect of Black race was stronger in regions with the highest COI, where Black students experienced a disproportionately higher rate of unfair school treatment, including both school discrimination and suspensions, compared to their White peers. Conclusion: This exploratory study supports that while higher educational opportunities are associated with smaller academic achievement gaps between Black and White students, they might be linked to increased racial bias in school disciplinary actions and discriminatory treatment. These findings underscore the complexity of educational equity, suggesting that improving access to quality education alone is insufficient to eliminate racial disparities in school experiences. Addressing school-based bias and discrimination must accompany efforts to enhance educational opportunities.
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Open Access November 03, 2024

Students' Perceptions of the Usefulness of Formative Feedback in Mathematics Lessons

Abstract This study aimed to examine students' perceptions of the usefulness of formative feedback in mathematics lessons at Sagnerigu Municipality in the Northern Region of Ghana. Quantitatively, this study employed a descriptive non-experimental survey design. The population comprises all pupils of public Junior High Schools in the Sagnerigu Municipality. A purposive sampling technique was used to [...] Read more.
This study aimed to examine students' perceptions of the usefulness of formative feedback in mathematics lessons at Sagnerigu Municipality in the Northern Region of Ghana. Quantitatively, this study employed a descriptive non-experimental survey design. The population comprises all pupils of public Junior High Schools in the Sagnerigu Municipality. A purposive sampling technique was used to select the Junior High School students for the study. The criterion purposive sampling technique was used to select 518 final-year students for the 2022 Basic education certificate examination from 14 schools in Sagnerigu Municipality. The chosen schools comprised 291 students from high-performing schools and 227 students from low-performing schools. The primary tool for the study was the Student Feedback Perception Questionnaire (SFPQ), administered to the student participants. The Descriptive statistical tool was used to analyse the mean and standard deviation of the data. The study's examination of students' perceptions of feedback revealed a moderate level of perceived usefulness. This emphasises the importance of feedback as a tool for student growth and development. However, the findings also suggest the need for further support and guidance to optimise the impact of feedback on student learning outcomes. The findings also suggest that students value feedback that helps them improve their skills and strategies in Mathematics and keeps them on track to succeed. It also highlights the importance of providing different types of feedback to cater to the diverse learning needs of students. Educators can create a conducive environment that promotes student engagement and achievement by equipping teachers with effective feedback techniques, emphasising constructive comments and avoiding grades.
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Open Access November 01, 2024

Impacts of Drug Shortages in the Pharmaceutical Supply Chain

Abstract Drug shortages represent a significant and growing challenge within the pharmaceutical supply chain, with profound implications for patient care, public health, and healthcare costs. This manuscript provides a comprehensive examination of the causes and impacts of drug shortages, highlighting the multifaceted nature of this issue. Key factors contributing to shortages include manufacturing [...] Read more.
Drug shortages represent a significant and growing challenge within the pharmaceutical supply chain, with profound implications for patient care, public health, and healthcare costs. This manuscript provides a comprehensive examination of the causes and impacts of drug shortages, highlighting the multifaceted nature of this issue. Key factors contributing to shortages include manufacturing complications, limited availability of active pharmaceutical ingredients (APIs), market dynamics that discourage the production of less profitable medications, and regulatory challenges that slow down the approval process for new manufacturing capacities. The consequences of these shortages are far-reaching. Patients often face treatment delays, which can lead to adverse health outcomes, increased hospitalization rates, and even mortality. Healthcare providers experience heightened operational costs as they seek alternative therapies and manage complications resulting from inadequate treatment. Furthermore, the frequent occurrence of drug shortages erodes public trust in both the healthcare system and the pharmaceutical industry, leading to decreased patient adherence to prescribed therapies. To mitigate the impacts of drug shortages, this manuscript proposes several strategic solutions, including enhanced communication among stakeholders, diversification of supply sources, increased regulatory flexibility, and collaborative approaches between public and private sectors. Additionally, raising awareness among healthcare providers and patients regarding the causes and potential alternatives can empower stakeholders to navigate shortages effectively. Ultimately, addressing drug shortages necessitates a proactive and coordinated effort from all participants in the pharmaceutical supply chain. By implementing these strategies, stakeholders can enhance the resilience of the supply chain, ensuring that essential medications remain accessible and that patient care is not compromised. The findings of this manuscript underscore the urgent need for ongoing vigilance and collaborative action to tackle the challenges posed by drug shortages, safeguarding public health and improving healthcare outcomes globally.
Review Article
Open Access October 31, 2024

The Long Shadow of Early Poverty: Poverty at Birth, Epigenetic Changes at Age 15, And Youth Outcomes at Age 22

Abstract Background: Early life socioeconomic conditions and race/ethnicity are critical determinants of long-term health and behavioral outcomes. Epigenetic changes, particularly those measured by the GrimAge biomarker, may mediate the impact of these early adversities on later life outcomes. This study investigates the relationships between race/ethnicity, poverty at birth, epigenetic aging at age [...] Read more.
Background: Early life socioeconomic conditions and race/ethnicity are critical determinants of long-term health and behavioral outcomes. Epigenetic changes, particularly those measured by the GrimAge biomarker, may mediate the impact of these early adversities on later life outcomes. This study investigates the relationships between race/ethnicity, poverty at birth, epigenetic aging at age 15, and subsequent self-rated health, school discipline, depression, and school dropout at age 22. We explored sex differences in these paths. Methods: Data were drawn from the Fragile Families and Child Wellbeing Study (FFCWS), which included 733 youth with comprehensive follow-up data up to age 22. Structural Equation Modeling (SEM) was employed to assess the pathways from race/ethnicity and poverty at birth to epigenetic aging (GrimAge) at age 15, and subsequently to self-rated health and school discipline at age 22. The model controlled for potential confounders including sex, family structure, and parental education. Results: Race/ethnicity and poverty at birth were significantly associated with higher GrimAge scores at age 15 (p < 0.05). Higher GrimAge scores were predictive of poorer self-rated health (β = -0.08, p < 0.05) and increased instances of school discipline (β = 0.13, p < 0.01) at age 22. The indirect effects of race/ethnicity and poverty at birth on self-rated health and school discipline through GrimAge were also significant (p < 0.05), suggesting that epigenetic aging partially mediates these relationships. Sex differences were also observed. Poverty at birth predicted faster epigenetic aging at age 15 for males not females. We also observed that faster epigenetic aging at age 15 was predictive of school discipline of male not female participants at age 22. In contrast, faster epigenetic aging at age 15 was predictive of self-rated health (SRH) of female not male participants at age 22. Conclusions: This study provides evidence that with some sex differences, race/ethnicity and poverty at birth contribute to accelerated epigenetic aging (GrimAge) by age 15, which in turn predicts poorer self-rated health and increased school discipline issues by age 22. These findings emphasize the importance of early interventions targeting social determinants to mitigate long-term health and behavioral disparities. Addressing these early life conditions is crucial for improving health equity and outcomes in young adulthood.
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Open Access October 30, 2024

Social Determinants of Successful Smoking Cessation: An Eight-Year Analysis of Population Assessment of Tobacco and Health (PATH) Data

Abstract Background: Smoking cessation is a crucial public health goal due to its substantial impact on reducing the morbidity and mortality associated with tobacco use. However, significant disparities in smoking cessation success persist across socioeconomic groups in the United States. Objectives: This study aimed to examine differences in smoking cessation rates among daily smokers [...] Read more.
Background: Smoking cessation is a crucial public health goal due to its substantial impact on reducing the morbidity and mortality associated with tobacco use. However, significant disparities in smoking cessation success persist across socioeconomic groups in the United States. Objectives: This study aimed to examine differences in smoking cessation rates among daily smokers based on race, ethnicity, and socioeconomic status (SES) using data from the Population Assessment of Tobacco and Health (PATH) study, spanning waves 1 to 6 (eight years). Methods: Longitudinal data from PATH were analyzed, focusing on baseline daily cigarette smokers followed over an eight-year period to assess cessation outcomes. SES was measured by education and poverty status. Successful smoking cessation was defined as sustained abstinence from cigarettes for 12 months or more at the final wave. Logistic regression models identified predictors of successful cessation, adjusting for potential confounders, including age, nicotine dependence, and access to cessation resources. Results: The analysis revealed significant disparities in cessation success across racial, ethnic, and SES groups. Smokers living in poverty and those with lower educational attainment were less likely to achieve cessation success than their counterparts. Race (Black) and ethnicity (Latino) were also significantly associated with lower cessation success. Conclusions: This study highlights the social determinants of smoking cessation success among U.S. adult smokers, with lower success rates observed among those in poverty and with less educational attainment. These findings emphasize the need for targeted interventions that address the unique barriers to cessation faced by low-SES groups. Public health strategies should prioritize equitable access to cessation resources and culturally tailored interventions to reduce these disparities and improve cessation outcomes among all smokers.
Article
Open Access September 05, 2024

Caste-based Diminished Returns of Educational Attainment on Wealth Accumulation in India

Abstract Background: Education is widely recognized as a key driver of wealth generation, providing individuals with the opportunity to enhance their socioeconomic status. However, the effectiveness of education in generating wealth varies significantly across different social groups. In the United States, research has shown that Black individuals experience weaker economic returns on education [...] Read more.
Background: Education is widely recognized as a key driver of wealth generation, providing individuals with the opportunity to enhance their socioeconomic status. However, the effectiveness of education in generating wealth varies significantly across different social groups. In the United States, research has shown that Black individuals experience weaker economic returns on education compared to their White counterparts, a phenomenon explained by the theory of Minorities' Diminished Returns (MDRs). Although MDRs have been documented in various countries, their relevance to caste-based disparities in India remains unexplored. Objective: This study aims to investigate the caste-based diminished returns of education on wealth in India. We hypothesize that the returns on educational attainment, in terms of wealth generation, will be weaker for individuals from Scheduled Castes (SCs) compared to those from higher castes, using data from the India Demographic and Health Surveys (DHS). Methods: This study was a cross-sectional analysis of DHS -2019/2021 data from India, examining the relationship between educational attainment and wealth across different caste groups (scheduled castes and non-scheduled castes). Multivariate regression models will be employed to assess the interaction between caste and education in predicting wealth outcomes, controlling for relevant covariates such as age, gender, and region. Results: The study is expected to find that the returns on education, in terms of wealth, are significantly weaker for individuals from Scheduled Castes compared to those from higher castes. This would indicate that caste-based discrimination continues to hinder the economic progress of Scheduled Castes, even when they achieve similar levels of education as their upper-caste counterparts. Conclusion: The findings of this study will extend the MDR framework to the Indian context, demonstrating that caste-based disparities result in diminished returns on education for wealth generation. This study underscores the need for targeted policies that address the specific barriers faced by Scheduled Castes in translating educational attainment into economic success and highlights the ongoing impact of caste-based discrimination in India.
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Open Access August 24, 2024

Higher Neighborhood Crime Rates Don't Always Predict Early Initiation of Tobacco, Marijuana, and Alcohol

Abstract Background: The initiation of substance use during adolescence is a significant public health concern with long-term implications. Structural and environmental factors, such as community-level crime statistics related to drug offenses, are often assumed to influence the likelihood of substance use among youth. However, the relationship between these environmental crime indicators and [...] Read more.
Background: The initiation of substance use during adolescence is a significant public health concern with long-term implications. Structural and environmental factors, such as community-level crime statistics related to drug offenses, are often assumed to influence the likelihood of substance use among youth. However, the relationship between these environmental crime indicators and early substance use initiation in adolescents is not well understood. Objective: This study aims to examine the association between environmental drug-related crime statistics—derived from Uniform Crime Reports, including drug abuse violations, drug sales, marijuana sales, drug possession, and driving under the influence (DUI)—and the use of tobacco, marijuana, and alcohol among adolescents aged 9-16 in the United States. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study, which follows a cohort of adolescents from ages 9-10 to 16, were analyzed. 11,878 participants entered our analysis. The primary environmental measures included total drug abuse violations, drug sale offenses, marijuana sale offenses, drug possession offenses, and DUI reports. Substance use outcomes of interest were the frequency and prevalence of tobacco, marijuana, and alcohol use across the observed age range. Results: Contrary to expectations, higher levels of drug-related crime in a community were not associated with increased use of tobacco, marijuana, or alcohol among adolescents. In fact, the study found a significant inverse relationship between the total number of drug-related crimes and tobacco use, suggesting lower tobacco use in areas with higher reported drug abuse violations, drug sales, marijuana sales, drug possession, and DUI incidents. No significant associations were observed between these crime indicators and the use of marijuana or alcohol. Conclusions: These findings challenge the prevailing assumption that higher environmental drug-related crime statistics necessarily predict greater substance use among adolescents. The observed inverse relationship between drug-related crime and tobacco use warrants further investigation to understand the underlying mechanisms and to inform targeted intervention strategies. Future research should explore the complex interplay between structural environmental factors and youth substance use to better inform public health policies.
Article
Open Access March 30, 2024

Essence Control of Active Pharmaceutical Ingredients

Abstract Active Pharmaceutical Ingredients (APIs) form the backbone of pharmaceutical formulations, influencing their efficacy, safety, and stability. Essence control of APIs involves stringent regulation and optimization of their chemical, physical, and biological properties to ensure consistent quality and therapeutic outcomes. This manuscript explores the critical aspects of essence control in APIs, [...] Read more.
Active Pharmaceutical Ingredients (APIs) form the backbone of pharmaceutical formulations, influencing their efficacy, safety, and stability. Essence control of APIs involves stringent regulation and optimization of their chemical, physical, and biological properties to ensure consistent quality and therapeutic outcomes. This manuscript explores the critical aspects of essence control in APIs, including synthesis, characterization, quality assessment, and regulatory considerations. The synthesis of Active Pharmaceutical Ingredients is a pivotal stage in pharmaceutical manufacturing, where precise control over chemical reactions and process conditions is paramount to achieving high-quality, safe, and effective medicines. Advances in synthetic methodologies, optimization strategies, sustainability practices, and the implementation of PAT technologies continue to drive innovation in API synthesis, supporting the development of novel therapeutic agents and enhancing pharmaceutical manufacturing efficiency.
Review Article
Open Access August 18, 2024

Extreme Heat Exposure Is Associated with Higher Socioeconomic Disadvantage and Elevated Youth Delinquency

Abstract Background: Climate change has led to an increase in the frequency and intensity of extreme heat events, a trend expected to continue. This poses significant health risks, particularly for vulnerable populations like children. While previous research has largely concentrated on the physical health impacts of extreme heat, less attention has been given to behavioral outcomes, such as [...] Read more.
Background: Climate change has led to an increase in the frequency and intensity of extreme heat events, a trend expected to continue. This poses significant health risks, particularly for vulnerable populations like children. While previous research has largely concentrated on the physical health impacts of extreme heat, less attention has been given to behavioral outcomes, such as delinquency. Objectives: This study investigates the association between extreme heat exposure and delinquency among children, utilizing data from the Adolescent Brain Cognitive Development (ABCD) study. It also explores the potential mediating roles of neighborhood socioeconomic status (SES; measured by median home value), puberty, peer deviance, and financial difficulties. Methods: Data from the national ABCD study were analyzed to assess the relationship between extreme heat exposure (exposure) and delinquency (outcome). Covariates included race/ethnicity, sex, and age. Mediators examined were neighborhood SES, puberty, peer deviance, and financial difficulties. Structural equation modeling (SEM) was employed for data analysis. Results: Overall, 11,878 children entered our analysis. The analysis revealed a significant association between extreme heat exposure and higher levels of delinquency among children. Children more exposed to extreme heat were more likely to be Black, reside in lower SES neighborhoods, experience greater financial difficulties, and have more advanced puberty status. The group facing the highest heat exposure was also economically disadvantaged. Conclusions: The findings suggest that children already disadvantaged by socio-economic factors are disproportionately affected by extreme heat, leading to increased delinquency. This highlights the need for targeted interventions to protect these vulnerable populations and address the mediators of extreme heat exposure. Future research should focus on longitudinal studies and evaluate the effectiveness of various mitigation strategies to address these disparities.
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Open Access August 14, 2024

Handing Money to the Poor Is Never Enough: The Impact of Marginalization-Related Diminished Returns

Abstract Recent US studies such as Baby’s First Years have again demonstrated that unconditional cash transfers and guaranteed income do not lead to significant improvements in the health, economic status, and well-being of individuals living in poverty. In this perspective article we review the emerging literature on this topic and offer explanations for the observed outcomes. We then apply the theory and [...] Read more.
Recent US studies such as Baby’s First Years have again demonstrated that unconditional cash transfers and guaranteed income do not lead to significant improvements in the health, economic status, and well-being of individuals living in poverty. In this perspective article we review the emerging literature on this topic and offer explanations for the observed outcomes. We then apply the theory and empirical evidence on marginalization-related diminished returns (MDRs) also called minorities diminished returns (MDRs) to elucidate the weak or null effects of cash transfers in the lives of marginalized populations. According to the MDR theory, marginalization not only reduces access to resources but also reduces their utility. Individuals who experience long-term poverty and marginalization exhibit smaller than expected benefits from new resources, such as cash, in adulthood. This is due to the deeply entrenched structural barriers and systemic discrimination that persist throughout their lives. The existing literature suggests that socioeconomic changes in adulthood have limited impact on the health and well-being of populations that have been raised in poverty. This is because the advantages of increased socioeconomic status (SES) are often undermined by ongoing marginalization and limited access to supportive resources and opportunities. As a result, simply providing cash transfers is insufficient to create substantial and lasting improvements in the lives of those living in poverty. To address these challenges, we recommend a multifaceted approach that includes childhood poverty prevention, interventions aimed at reducing marginalization, and comprehensive multi-sector strategies. By focusing on early intervention and addressing the root causes of poverty and marginalization, we can create more effective and sustainable solutions to improve health and well-being among disadvantaged populations. This holistic approach recognizes the complexity of poverty and the necessity of addressing both immediate needs and long-term structural barriers to achieve meaningful change.
Perspective
Open Access August 11, 2024

Walking the Divide: A Public Health Journey from Manhattan to Harlem

Abstract This perspective article discusses the striking contrasts and inequalities observed during a walk from Manhattan to Harlem in New York City, highlighting the significant social and economic differences that have profound implications for public health and social policy. Through this journey, we explore various aspects including racial segregation, the composition of shops, smoking habits, street [...] Read more.
This perspective article discusses the striking contrasts and inequalities observed during a walk from Manhattan to Harlem in New York City, highlighting the significant social and economic differences that have profound implications for public health and social policy. Through this journey, we explore various aspects including racial segregation, the composition of shops, smoking habits, street cleanliness, police presence, unemployment, real estate disparities, and the pervasive sense of insecurity. The transition from a predominantly White Manhattan to a predominantly Black and Hispanic Harlem underscores the historical and systemic inequalities that continue to shape the city's demographic and economic landscape. These disparities, rooted in discriminatory housing policies, economic disparities, and social exclusion, manifest in poorer health outcomes, higher rates of substance use, and limited economic opportunities for minority populations. By addressing these structural issues through targeted policies and sustained interventions, we can work towards reducing health disparities and promoting racial equity. This paper also highlights the concept of Minorities' Diminished Returns (MDRs), where the benefits of education and income are less pronounced for minority individuals compared to their White counterparts, further perpetuating cycles of disadvantage. Comprehensive efforts to dismantle systemic inequities are essential for fostering a more equitable and healthy society.
Perspective
Open Access July 27, 2024

Paradoxical Effects of Income and Income Inequality on Racial Health Disparities

Abstract The intersection of race and place in shaping health disparities presents complex dynamics, as evidenced by studies in cities like Detroit, Baltimore, and Philadelphia, where predominantly Black and economically disadvantaged populations experience high overall rates of health problems. Surprisingly, these cities do not exhibit the most pronounced racial disparities. In contrast, areas with a [...] Read more.
The intersection of race and place in shaping health disparities presents complex dynamics, as evidenced by studies in cities like Detroit, Baltimore, and Philadelphia, where predominantly Black and economically disadvantaged populations experience high overall rates of health problems. Surprisingly, these cities do not exhibit the most pronounced racial disparities. In contrast, areas with a higher percentage of White residents, indicative of greater income inequality, show stark differences in health outcomes between Black and White populations. This disparity underscores how conditions diverge more sharply between Black and White individuals in wealthier urban areas. This phenomenon suggests a complex and sometimes counterintuitive relationship among race, place, income, and income inequality in shaping racial health disparities. These dynamics have significant policy implications. Addressing health disparities requires nuanced strategies that recognize the multiplicative effects of race and income inequality on health outcomes. Policies focusing on areas with a high disease burden, such as Detroit, Philadelphia, and Baltimore can effectively mitigate disparities both locally and more broadly. Conversely, interventions targeting regions with lower disease prevalence, but higher racial disparities must be approached carefully to avoid exacerbating inequalities. In conclusion, understanding and addressing the complex drivers of health disparities demand comprehensive approaches that acknowledge the intertwined influences of race, income, and place. By prioritizing interventions that address economic disparities alongside health initiatives, policymakers can foster more equitable health outcomes across diverse communities.
Perspective
Open Access July 18, 2024

Household Income and Offspring Education Explain Blacks’ Diminished Returns of Parental Education

Abstract Background: High parental education promotes various aspects of offspring well-being including reducing their risk of depression/anxiety, criminal justice involvement, and welfare reliance. However, according to minorities’ diminished returns, these benefits are not equal across racial groups, with Black families experiencing diminished returns of parental education compared to White [...] Read more.
Background: High parental education promotes various aspects of offspring well-being including reducing their risk of depression/anxiety, criminal justice involvement, and welfare reliance. However, according to minorities’ diminished returns, these benefits are not equal across racial groups, with Black families experiencing diminished returns of parental education compared to White families. This study explores the role of household income and offspring educational attainment as potential serial pathways that operate as mechanisms underlying diminished returns of parental education on offspring outcomes in Black families. Gender differences in these effects were also explored. Methods: Utilizing data from the Future of Families and Child Wellbeing Study (FFCWS) over a 22-year follow-up period (seven waves), we examined the serial mediation by household income and offspring educational attainment in explaining the relationship between parental education and offspring outcomes namely depression, anxiety, criminal justice involvement, and welfare reliance [Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP)]. We used structural equation modeling (SEM) with household income as the first mediator and young adult education as the second mediator. Multi-group models were used to explore gender differences in these paths. Results: The study confirmed the role of our proposed serial mediators for Blacks’ weaker effects of parental education on offspring outcomes. We observed weaker effects of first affects household income, with this effect being for Black families compared to White families, which then impacted educational attainment of the offspring. The findings indicate that household income plays a crucial mediating role, but its effect is weaker in Black families. Additionally, the educational attainment of offspring from highly educated Black parents is less effective in improving outcomes compared to their White peers, further contributing to diminished returns. Some gender differences were observed for the effects of educational attainment on economic and health outcomes of young adults. Conclusions: The study underscores the need to reconsider traditional assumptions about the comparability of family conditions and outcomes across racial groups with similar levels of parental education. The findings highlight the importance of targeted policies and interventions aimed at enhancing the economic stability and educational outcomes of Black families to address these disparities. Policies should focus on promoting the economic well-being of highly educated Black parents and improving the educational outcomes of their children.
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Article
Open Access July 15, 2024

The Role of Dignity and Respect in Maternity Care: An Integrative Literature Review

Abstract This integrative literature review aims to explore the pivotal role of dignity and respect in maternity care, focusing on their profound impact on the experiences of pregnant individuals. Emphasis is placed on cultural competence as a crucial factor in fostering understanding and respect for diverse backgrounds, promoting inclusive approaches to maternal care. The overarching goal is to underscore [...] Read more.
This integrative literature review aims to explore the pivotal role of dignity and respect in maternity care, focusing on their profound impact on the experiences of pregnant individuals. Emphasis is placed on cultural competence as a crucial factor in fostering understanding and respect for diverse backgrounds, promoting inclusive approaches to maternal care. The overarching goal is to underscore the significance of dignified and respectful care in enhancing maternal satisfaction, postpartum outcomes, and overall well-being. Methods: The review synthesizes existing literature (n=22) on maternity care, dignity, and respect, drawing insights from diverse sources to comprehensively analyze the multifaceted nature of this critical healthcare aspect. Cultural competence is explored as a key theme in understanding and appreciating the varied backgrounds of pregnant individuals. The analysis encompasses factors such as effective communication, healthcare provider attitudes, cultural competence, informed consent, and systemic considerations, shedding light on their collective influence on dignity and respect in maternity care. Principal Findings: The literature review reveals that providing dignified and respectful care significantly contributes to improving maternal satisfaction and postpartum outcomes. Cultural competence emerges as a crucial element, ensuring that care approaches are inclusive and tailored to diverse cultural backgrounds. Effective communication, positive healthcare provider attitudes, and considerations for systemic factors are identified as key determinants of the dignity and respect experienced by pregnant individuals. The findings underscore the interconnectedness of these factors in shaping the overall quality of maternity care. Practical Applications: Recommendations stemming from the literature review include interventions aimed at enhancing healthcare providers' communication skills, cultural competence training, and the promotion of patient-centered care models. Acknowledging the systemic factors influencing maternity care, the review calls for collaborative efforts among healthcare providers, policymakers, and researchers to create an environment that upholds pregnant individuals' autonomy and values. The practical applications emphasize the need for comprehensive and culturally sensitive approaches to ensure that all pregnant individuals receive dignified and respectful care. In summary, this integrative literature review provides a comprehensive understanding of the critical role of dignity and respect in maternity care, offering insights into effective strategies for improvement and emphasizing the importance of cultural competence and collaborative efforts in shaping the future of maternal healthcare.
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Review Article
Open Access July 12, 2024

Racial Gap in Household Income Explains Black-White Disparities in the Intergenerational Transmission of Educational Attainment

Abstract Background: Racial disparities in educational outcomes persist in the United States, with Black individuals experiencing lower levels of educational attainment and a higher rate of school disciplinary actions compared to their White counterparts. Parental education is a known predictor of offspring educational attainment, but its effects may vary by race. Understanding the role of household [...] Read more.
Background: Racial disparities in educational outcomes persist in the United States, with Black individuals experiencing lower levels of educational attainment and a higher rate of school disciplinary actions compared to their White counterparts. Parental education is a known predictor of offspring educational attainment, but its effects may vary by race. Understanding the role of household income in mediating these effects is crucial for developing targeted policy interventions to reduce educational inequalities. Objectives: This study aimed to examine the role of household income in mediating the differential effects of maternal education on two youth educational outcomes (educational attainment by age 22 and school disciplinary action) in Black and White families. Methods: Data were drawn from the 22 years of follow-up of the Future of Families and Child Wellbeing Study (FFCWS), a longitudinal study following a cohort of children born in large U.S. cities between 1998 and 2000. Participants included 1,647 Black and 689 White young adults who were followed from birth to age 22. Maternal education, household income, family structure, and paternal incarceration were assessed at baseline (birth), and two youth educational outcomes, namely educational attainment and any school disciplinary action, were assessed at age 22 (emerging adulthood). Using structural equation modeling (SEM), mediation analysis was conducted to examine whether household income partially mediates the effects of maternal education on youth educational outcomes, with race (Black vs. White) as the moderator. Results: The results indicated that maternal education was positively associated with youth educational attainment and negatively associated with school disciplinary actions in the pooled sample that included both Black and White families. However, the effect of parental education on educational attainment at age 22 was weaker for Black than White families. Household income partially mediated racial differences in the effect of maternal education on youth educational attainment. The results suggest that lower household income in Black families is why we observe a weaker effect of parental education on youth educational attainment for Black youth compared to White youth. Conclusions: Findings suggest that the lower household income of families is one of the reasons high maternal education levels are associated with lower youth educational attainment in Black than White families. Addressing income disparities through tax policies may help reduce racial disparities in education and promote educational equity for Black youth.
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Article
Open Access June 07, 2024

Quality Assurance in Curriculum Development in Ghana’s Higher Education System: A Case Study of UMaT

Abstract Over the past decades, quality assurance has received significant prominence in higher education management across the world. While the concept is pertinent to all areas of higher education management, nowhere is it considered more crucial than in curriculum development, given the importance of curriculum in supporting students to achieve the needed learning outcomes. In this study, we explored [...] Read more.
Over the past decades, quality assurance has received significant prominence in higher education management across the world. While the concept is pertinent to all areas of higher education management, nowhere is it considered more crucial than in curriculum development, given the importance of curriculum in supporting students to achieve the needed learning outcomes. In this study, we explored how quality is ensured in curriculum development in Ghana, using a STEM university, University of Mines and Technology (UMaT), as a case study. We specifically examined the procedure for curriculum development in the university, how quality assurance is ensured during the process, and the challenges associated with the process. We explore the case using qualitative techniques, particularly in-depth interviews. Fourteen (14) participants were purposively sampled from four (4) functional levels responsible for curriculum development in the university. The study found that the quality of curriculum in UMaT is largely determined by both national and institutional quality assurance frameworks. The major challenges that hamper quality assurance are the need to design curriculum at a shorter notice to fulfil accreditation requirement, lack of experts to support curriculum development, and less consultation with other relevant stakeholders as required by the regulator, Ghana Tertiary Education Commission (GTEC).
Article
Open Access May 03, 2024

Congruence Between Intended and Observed Transactions in the Implementation of the Senior High School (SHS) Social Studies Curriculum in Ghana

Abstract This study aimed to evaluate the Social Studies Curriculum for Senior High Schools in Ghana to determine whether the subject has attained its goal(s) or not, using Stake’s Countenance Evaluation Model. The study took place in the Asante Akim North District. The population for study were all Social Studies teachers and students in the district. The multi-stage sampling technique was adopted for the [...] Read more.
This study aimed to evaluate the Social Studies Curriculum for Senior High Schools in Ghana to determine whether the subject has attained its goal(s) or not, using Stake’s Countenance Evaluation Model. The study took place in the Asante Akim North District. The population for study were all Social Studies teachers and students in the district. The multi-stage sampling technique was adopted for the study and the sample size was 120, made up of 100 students and 20 teachers. The concurrent mixed method approach was adopted. The main instruments used for collecting data were questionnaires, interviews (focus group and unstructured interview), observation and documentary analysis. Quantitative data were tabulated, organised, analysed and interpreted to draw sound conclusions and generalisations. The data were presented in the form of tables and percentages. Words were used to interpret the tables and percentages for easy understanding. The qualitative data responses were described and explained in the form of themes. Sometimes responses were quoted verbatim to authenticate claims made. The study looked at the congruence between what was intended to occur and what was observed before and during the implementation of the curriculum in the Asante Akim North District. On the transactions, it was revealed that teachers in the district communicate the problem the topic seeks to address and the specific objectives to the learners during instruction. Also, teachers varied their teaching methods, techniques and strategies. However, teachers failed to take students out on field trips. Also, they failed to use video documentaries to deliver their lessons inhibiting students’ creativity as they are denied the opportunity to explore and get first-hand information to build up knowledge and develop the needed attitudes and values. From the findings, it is therefore recommended that the National Council for Curriculum and Assessment should increase the time allotted to the teaching of Social Studies at the SHS level from 3-periods of 40 minutes a week to 5-periods of 40 minutes a week to give teachers and learners ample time to discuss, debate, digest and solve problems during instructional hours to enable the goal of the subject attained.
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Open Access April 24, 2024

Optimization of Delirium Care in Adult Patients with Cancer: A Comprehensive and Integrative Review of Efficacy and Patient Outcomes

Abstract Delirium is a major complication most commonly observed in patients with advanced cancer. However, despite its prevalence, the early diagnosis, management, and prevention of this condition have not seen significant progress. Aim of this research is to provide insights into the prevalence of delirium, the optimization of interventions for managing delirium symptoms, their effectiveness and the [...] Read more.
Delirium is a major complication most commonly observed in patients with advanced cancer. However, despite its prevalence, the early diagnosis, management, and prevention of this condition have not seen significant progress. Aim of this research is to provide insights into the prevalence of delirium, the optimization of interventions for managing delirium symptoms, their effectiveness and the impact of underlying factors on the reversibility of delirium in advanced cancer patients receiving palliative care. The review involved systematic searches of relevant databases including MEDLINE, CINAHL, ProQuest Nursing and Allied Health, and PsychInfo using refined search terms. Eight publications out of 614 studies originally searched were selected and critically reviewed. Their quality was assessed using Joanna Briggs Institute's Critical Appraisal Tool for Case Series. Data abstraction and content analysis were performed to synthesize the findings. Delirium is prevalent among advanced cancer patients in palliative care, with rates ranging from 10.3% to 24.1%. Pharmacotherapy and non-pharmacological interventions showed effectiveness in reducing delirium symptoms. Delirium was found to be reversible through palliative care interventions, antipsychotic medications, and exercise therapy. Effective delirium management is crucial in improving the quality of life of cancer patients. This review emphasizes the importance of subtype-specific treatments, standardized guidelines, and long-term follow-up studies. Implementing evidence-based individualized approaches to delirium management can optimize treatment efficacy and clinical outcomes in patients as well as improve the quality of care. Tailored interventions, standardized protocols, and further research are hereby recommended.
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Review Article
Open Access March 16, 2024

Metaverse in Nursing: A Concept Analysis

Abstract Background: Over the past decade, there has been a rapid advancement in technology and virtual reality applications, leading to the emergence of the metaverse - a virtual universe where users interact with each other and their surroundings through immersive experiences. In the nursing profession, the metaverse presents unique opportunities to enhance patient care, education, and collaboration. [...] Read more.
Background: Over the past decade, there has been a rapid advancement in technology and virtual reality applications, leading to the emergence of the metaverse - a virtual universe where users interact with each other and their surroundings through immersive experiences. In the nursing profession, the metaverse presents unique opportunities to enhance patient care, education, and collaboration. Aim: To analyze and identify the attributes of metaverse in nursing, exploring its dimensions, benefits, challenges, and implications. By examining relevant literature, this study will contribute to a better understanding of the metaverse in nursing. Method/Design: Concept analysis by Walker and Avant (2019). Results: Metaverse in nursing involves three defining attributes: use of advanced technologies, better access to education and healthcare, and collaboration and community building. Antecedents of metaverse in nursing require technological advancements, increased digital literacy, demand for innovative education, globalization of healthcare education Conclusion: Metaverse in Nursing suggests that it is a promising technology that has the potential to enhance nursing practice and improve patient outcomes, but further research is needed to fully explore the impact of its integration.
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Article
Open Access January 30, 2024

Perceptions and Attitudes of Social Studies Teachers in the Usage of Multimedia Resources in Teaching and Learning of Social Studies Concepts

Abstract Qualitatively, the study focused constructivist [...] Read more.
Qualitatively, the study focused constructivist research paradigm. A case study research design was adopted for the study. The study population comprised all six (6) Social Studies teachers, the headmaster and the School Improvement Support Officer (SISO). Purposive and convenient sampling techniques were used to select the participants for the study. The main instrument for data collection was a semi-structured interview guide and observation protocol. The data were analysed using the interpretative technique based on the themes arrived at during the data collection from the semi-structured interview. The study revealed that multimedia usage is a quality enhancer in educational settings for teaching Social Studies concepts. It also indicated that teachers perceived their incompetence when using technology as they feel less in control of their classes and are unlikely to explore new possibilities that utilise technology when planning their lessons. They learn the theoretical aspect and practice and perceive the teacher’s role in the classroom changes from an instructor to a facilitator, which changes the teaching method to student-centred (constructive methodology) which aids content absorption by the learner through learning by doing. The study also indicated that teachers perceived their incompetence when using technology as they felt less in control of their classes and were unlikely to explore new possibilities that utilised technology when planning their lessons. It is recommended that the Ministry of Education and National Teaching Council collaborate with Ghana Education Service to set up Social Studies training centres in all the district capitals equipped with competent staff to periodically organise in-service training for teachers to build their capacity on how to pedagogically incorporate multimedia resources in their instructions to improve students learning outcomes.
Article
Open Access November 22, 2023

Pregnancy outcome in patients with previous infection with COVID-19 and the health of newborns

Abstract The study is a follow-up of the study "Coronavirus in pregnant patients and their clinical outcomes – results of a case-control study" conducted by R.Kadriu et al (2023) in which,in addition to the pregnant patients whose outcome is now being investigated,a control group of patients who were not pregnant,conducted with pregnant patients and a control group that were non-pregnant patients.This [...] Read more.
The study is a follow-up of the study "Coronavirus in pregnant patients and their clinical outcomes – results of a case-control study" conducted by R.Kadriu et al (2023) in which,in addition to the pregnant patients whose outcome is now being investigated,a control group of patients who were not pregnant,conducted with pregnant patients and a control group that were non-pregnant patients.This study was conducted 6 months after the discharge of the patients and their newborns,and highlights the impact of COVID-19 on their health as well as the health of the newborns. The aim of the study is to follow up the patients after 6 months of their hospitalization as COVID-19 patients and after their delivery.In the COVID study, none of the health indicators showed statistically significant differences between the population before and after hospitalization.Patient data were collected at the case level summarized in their respective groups.For secondary objectives, several comparative analyzes were performed regarding comorbidity-related parameters and available risk factors.A significance level (α) of 0.05 was used for statistical significance. While these results may be reassuring regarding the stability of health status, one should be aware of the limitations of the study, including sample size and specific population characteristics.
Article
Open Access July 26, 2023

Compassion Fatigue in Oncology Nurses: An Integrative Review

Abstract Oncology nurses are more likely to get compassion fatigue (CF) than nurses in other fields because of the emotional stress and poor outlook of cancer patients. Because of this, the care might not be very good, the job might not be very satisfying, and there is a good chance that the patient's pain won't be noticed. Aim. To synthesize empirical evidence on compassion fatigue in order to [...] Read more.
Oncology nurses are more likely to get compassion fatigue (CF) than nurses in other fields because of the emotional stress and poor outlook of cancer patients. Because of this, the care might not be very good, the job might not be very satisfying, and there is a good chance that the patient's pain won't be noticed. Aim. To synthesize empirical evidence on compassion fatigue in order to extract the common, central, and fundamental elements that may improve nursing care. Design. An integrative review Results. Fifteen (15) studies met the eligibility criteria wherein five themes emerged. These are the level of compassion fatigue among oncology nurses, the oncology nurses' perspectives on compassion fatigue, precipitating factors leading to CF with 2 subthemes (work environment and a feeling of lack of support), the influence of compassion fatigue on the personal lives and general well-being of cancer nurses, and the consequences on the quality of oncology nurses' professional lives at work. Conclusion. CF is a significant problem for nurses who work in specialized areas such as cancer units, demonstrated as a basic incapacity to nurture others. The integration of studies provides evidence of clinical practice application which can provide better outcomes and improve nursing care. Implications for Practice. The findings provide understanding into healthcare practice on how to avoid compassion fatigue. Clinical management approaches that can mitigate compassion fatigue and its negative repercussions are presented, as well as the formation of peer support groups that have the ability to ameliorate CF.
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Review Article
Open Access June 27, 2023

Teachers’ Knowledge Base in Community Resources Used in Assessing Social Studies Concepts

Abstract The purpose of this study was to examine teachers’ knowledge base in community resources used in assessing Social Studies concepts in the University of Education Practice Junior High School (JHS), Winneba. The case study design was employed as the study's qualitative methodology. The population comprised two Social Studies teachers in the University Practice JHS, Winneba. Purposive and convenient [...] Read more.
The purpose of this study was to examine teachers’ knowledge base in community resources used in assessing Social Studies concepts in the University of Education Practice Junior High School (JHS), Winneba. The case study design was employed as the study's qualitative methodology. The population comprised two Social Studies teachers in the University Practice JHS, Winneba. Purposive and convenient sampling techniques were used to select the teachers and school for the study. The main instrument for data collection was the interview guide. The two teachers were interviewed because they were in a position to give all the relevant information required for the research. They were also readily available at the time of the research. The study revealed that even though the Social Studies teachers were aware of community resources, they did not involve them often in their lesson delivery. However, in the only case where a teacher took the learners round the school compound to look at the various types of rocks, the learners were excited and willing to learn. The assessment results also showed that almost all learners, both low and high achievers had high scores. Evidence from the inquiry also shows that teachers used only traditional forms of assessment in Social Studies. Teachers give multiple choice and essay type of assessment items to learners. Teachers did not involve community resources in the assessment of Social Studies concepts because of challenges like inadequate time allocated for the teaching of the subject, financial constraints, bureaucratic processes involved in obtaining permission and the need to meet the requirements of external examinations. It is recommended that the Ghana Education Service (GES) should design appropriate policies to ensure that provision is made in the school academic calendar for field trips and community resource engagement for Social Studies education. Social Studies teachers should also be trained on the full range of assessment techniques suggested in the 2012 syllabus. Emphasis should be laid on authentic/alternate assessment practices. At the school level, heads of Social Studies department should organise periodic in-service training for the teachers to ensure that the curriculum, instruction and assessment practices are aligned to ensure that the subject attains its intended goals and outcomes.
Article
Open Access May 15, 2023

Social Studies Teachers' Authentic Assessment Practices, Tools and Challenges in Assessing Students' Learning Outcomes

Abstract Assessment is a vital aspect of curriculum practice. The study adopted explanatory mixed-method approach and sequential research design. The population for the study comprised all Social Studies teachers in Junior High Schools in the Ayensuano District. Convenient sampling techniques and census method were used to select the district, and all the one hundred and twenty-seven (127) teachers who [...] Read more.
Assessment is a vital aspect of curriculum practice. The study adopted explanatory mixed-method approach and sequential research design. The population for the study comprised all Social Studies teachers in Junior High Schools in the Ayensuano District. Convenient sampling techniques and census method were used to select the district, and all the one hundred and twenty-seven (127) teachers who teach Social Studies in the junior high schools in the district. The main instruments used for data collection and analysis were questionnaire and interview guide. The quantitative data was analysed both descriptive and inferential statistical tools. The qualitative data was transliterated and coded based on themes. Pre-set themes were used to generate the transcript (text) data based upon the research questions and discussed. The study concluded that authentic assessment practices by Social Studies teachers included the occasional guidance they give to their students about how to interpret topics and situations into relevant tasks with a clearly defined goal, and how to relate their knowledge in practical challenges. The study also revealed that refined essays, oral presentations, interviews, case study discussions, and live performances as authentic assessment strategies or tools Social Studies teachers used in assessing their students' learning outcomes in lessons. The study indicated that large class size, traditional assessment (examination) system, insufficient logistics and infrastructure, a paucity of funds to begin various activities and programs, a lack of motivation from school administrators, time constraints and difficulty in developing some authentic assessment tasks coupled with assessing some lessons using authentic assessment method are some of the criteria that influence the effectiveness of authentic assessment execution in teaching Social Studies courses. It is recommended that educational leaders should provide the resources to motivate Social Studies teachers to use authentic assessments for students’ learning in the classroom situation. It is also recommended that, Colleges of Education, Universities and National Teaching Council should organise professional development workshops and seminars to build the capacity of trained Social Studies teachers on the effective uses of authentic assessment practices.
Article
Open Access December 25, 2022

Cancer Risk Assessment Tools in Primary Care Settings: An Integrative Review

Abstract Background: There are currently numerous risk instruments available to aid in predicting the present or future chance of getting a cancer diagnosis. It aids in determining a person's likelihood of developing certain cancers by looking at various risk factors, including environmental, behavioral, and genetic. Aim: To analyze the effectiveness of cancer risk assessment techniques [...] Read more.
Background: There are currently numerous risk instruments available to aid in predicting the present or future chance of getting a cancer diagnosis. It aids in determining a person's likelihood of developing certain cancers by looking at various risk factors, including environmental, behavioral, and genetic. Aim: To analyze the effectiveness of cancer risk assessment techniques utilized in primary care settings. Methods: An integrative review of literature Results: Five (5) studies were met the criteria based on the inclusion and exclusion criteria. These tools demonstrated effectiveness in improving patient outcomes and serving as useful therapeutic tools in the primary care setting. Conclusion: Advantages that may aid clinicians in the primary care setting in validating the diagnosis and assisting patients in determining the early signs and symptoms in the diagnosis of cancer. The role of assessment tools can enhance the reliability and caliber of clinical judgment, which can enhance patient outcomes. Implications: The role of healthcare professionals, such as oncologists, nurses, and the healthcare team, on cancer risk assessment in the primary care setting across the lifespan is crucial to ensure a care plan tailored to each patient’s needs.
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Review Article
Open Access December 23, 2022

Climate Change's Impact on Agriculture and Food Security: An Opportunity to Showcase African Animal Genetic Resources

Abstract One of the current issues facing humanity is ensuring sustained global food security in the face of devastating effects of climate change; this challenge is particularly pressing on the African continent. Here, I present an opinion piece identifying local animal genetic resources as "African leverage point" that provide the highest chances to cushion rural fork to climate change, enhance [...] Read more.
One of the current issues facing humanity is ensuring sustained global food security in the face of devastating effects of climate change; this challenge is particularly pressing on the African continent. Here, I present an opinion piece identifying local animal genetic resources as "African leverage point" that provide the highest chances to cushion rural fork to climate change, enhance environmental sustainability and food security in Africa. When it comes to boosting food production, coping with climate change, or bolstering the delivery of a wide range of ecosystem services, I believe that African animal genetic resources are essential alternatives for the sustainable growth of the livestock industry and its contribution to food security. Africa needs to address the support and development of indigenous animal genetic resources in order to meet the basic food needs of more than 1 billion people, address numerous environmental issues with continental implications, and focus on more effective and resilient food systems with the greatest impact on food security. The indigenous animal resources diversity and support actions to this unique group could provide a boost in protein that is lacking to constitute healthy diets in Africa. The priorities of nonprofit organizations, foundations, governments, citizens' groups, and companies can be influenced by this leverage point in the African food system. Due to continuous food insecurity, which appears to be becoming worse with climate change and makes it even harder to accomplish the SDGs on the continent, Africa has paid a hefty price for being misled about the worth of its own animal genetic resources. To the contrary, it is highly improbable that a strategy to improve food security and rural livelihoods that undermines the utilization of indigenous animal genetic resources will be viable in long-term. If Africa makes an effort, is committed, and fully commits resources to putting indigenous animal genetic resources at the forefront of combating food insecurity and accelerating the achievement of SDGs, it can achieve more under the adverse prevailing climate change induce environmental conditions. Our personal opinion is that we would not have had the ongoing food problems, even in the face of climate change, if Africa had over the years implemented the necessary mechanisms to develop and promote local animal genetic resources. What lies ahead in terms of climate change effect on food security in Africa is anyone's guess – but whatever it is, promoting continental adapted indigenous animal genetic resources portfolio is ready to handle it. Development and promotion of African animal genetic resources should be part of a continental strategy to transform smallholder animal production by 2050, in line with the goals of achieving the SGDs, to improve rural household food security, and bringing rural economy prosperity, resilience, sustainability, and all other desired animal related food outcomes for rural healthy diets. African animal genetic resources are the most important but underutilized resource to address the issue of ongoing food insecurity. The responsible use of local animal genetic resources through climate smart animal husbandry practices also contributes to food security, rural development and increased employment opportunities. African genetic improvement programs involving indigenous animal genetic resources must be considered as regards to local agriculture and livestock development aspirations, appropriateness to local reality and livelihood security, as well as environmental friendliness. Animal agriculture will fill in the enormous gaps in the continent's food supply if this animal group receives adequate attention and is used integrated properly in crop and livestock systems which characterize smallholder farming sector in Africa. Because they have evolved over time to accommodate the various climatic conditions and environmental pressures on the continent, Africa's native animal genetic resources are particularly resilient. Indirectly, the impact of climate change offers a chance to use native animal genetics from Africa. The use of local animal genetic diversity has the potential to substantially improve Africa's food security landscape hence should be given special consideration for sociocultural, environmental, and economic aspects, and with regard for smallholder farmer-specific factors of interest. African animal genetic resources have contributed significantly to the food and nutrition security aspects of the millions of people in their communities of origin and custody in Africa. The purpose of the perception piece is to educate the reader about the fundamental mechanisms that control the use of continental animal genetic resources and how the outlook for these mechanisms can be manipulated in the future for the benefit of improving food security in Africa. The discussion provides in-depth insight into the pertinent literature in understanding the significance of local animal genetic resources in terms of their contribution to food security in Africa.
Perspective
Open Access November 25, 2022

Effects of Teachers’ Supervision on the Safety of Kindergarten Pupils in the Central Region of Ghana

Abstract The supervisory role of kindergarten teachers is primarily concerned with supervising and managing the efforts of their learning environment to create safe, positive learning environments for all learners, as well as ensuring that no child is left alone or unsupervised by teachers or caregivers while under their supervision. The purpose of this study was to examine the effects of teachers’ [...] Read more.
The supervisory role of kindergarten teachers is primarily concerned with supervising and managing the efforts of their learning environment to create safe, positive learning environments for all learners, as well as ensuring that no child is left alone or unsupervised by teachers or caregivers while under their supervision. The purpose of this study was to examine the effects of teachers’ supervision on the safety of kindergarten pupils in Komenda Edina Eguafo Abirem (K.E.E.A.) Municipality in the central region of Ghana. Qualitatively, the Instrumental Case Study Design was employed in this study to gather information on the participants. The population consisted of 227 Kindergarten teachers in the KEEA Municipality of Ghana. Convenience sampling technique was used to select sixteen (16) public kindergarten teachers for the study. The main instrument used for data collection was semi-structured interview guide. The data were analyzed thematically. The analysis of the data was done with the help of online qualitative software, Taguette version 1.3, Using the Taguette, the researchers highlighted quotes and phrases from the interviews that were significant to the study. The study supported that, establishing a well-conducive school environment enhance teachers’ supervision which goes a long way to ensures learners’ comfortability and safety; maximize learners’ academic performance; lessen fear in learners; promote teaching and learning; and support learners’ participation in play experiences. It is recommended that, key players in education such as Ministry of Education and Ghana Education Service should investigate the effect of teacher supervision on learners’ safety vis-a-vis with its educational implications. It is also recommended that, kindergarten teachers should be encouraged to supervise their learners to guarantee positive outcomes of promoting learners’ comfortability and safety; maximizing learners’ academic performance; promoting teaching and learning; and contributing to support learners’ participation in play experiences.
Article
Open Access November 04, 2022

Long Term Outcomes and Survivorship of Bilateral Lower Limb Arthroplasties in Patients with Multiple Epiphyseal Dysplasia

Abstract Background: Multiple epiphyseal dysplasia (MED) a rare form of skeletal dysplasia with early-onset osteoarthritis affecting the hip and knee joints. There is paucity of evidence regarding the long term outcomes of arthroplasty in this patient cohort. This is the first study to describe the outcomes of bilateral arthroplasty of the hip and knee in patients with MED. Methods: A prospective study of patients with MED who underwent bilateral staged total hip arthroplasty (THA) and bilateral simultaneous total knee arthroplasty (TKA) between July 2013 to April 2014. Preoperative and postoperative clinical and radiographic assessment including functional outcomes namely Merle d’aubigne score, Harris hip score (HHS), Knee society score (KSS) and numeric rating scale (NRS) for pain were recorded in prospective database and evaluated. Results: 3 patients (female - 1 / male - 2) with MED who underwent bilateral lower limb arthroplasty of the hip and knee were reviewed periodically with an average followup of 7.31 years. Mean preoperative Merle d'Aubigné score (6.33 ± 0.58), HHS (31.83 ± 5.31) and KSS (28.67 ± 7.97) increased following bilateral lower limb arthroplasty with mean postoperative Merle d'Aubigné score (16.33 ± 0.58), HHS (84.33 ± 5.99) and KSS (86.33 ± 7.09) (P<0.001). Mean NRS decreased from 7.33 ± 0.58 in the preoperative period to 0.67 ± 0.58 at the most recent followup (P [...] Read more.
Background: Multiple epiphyseal dysplasia (MED) a rare form of skeletal dysplasia with early-onset osteoarthritis affecting the hip and knee joints. There is paucity of evidence regarding the long term outcomes of arthroplasty in this patient cohort. This is the first study to describe the outcomes of bilateral arthroplasty of the hip and knee in patients with MED. Methods: A prospective study of patients with MED who underwent bilateral staged total hip arthroplasty (THA) and bilateral simultaneous total knee arthroplasty (TKA) between July 2013 to April 2014. Preoperative and postoperative clinical and radiographic assessment including functional outcomes namely Merle d’aubigne score, Harris hip score (HHS), Knee society score (KSS) and numeric rating scale (NRS) for pain were recorded in prospective database and evaluated. Results: 3 patients (female - 1 / male - 2) with MED who underwent bilateral lower limb arthroplasty of the hip and knee were reviewed periodically with an average followup of 7.31 years. Mean preoperative Merle d'Aubigné score (6.33 ± 0.58), HHS (31.83 ± 5.31) and KSS (28.67 ± 7.97) increased following bilateral lower limb arthroplasty with mean postoperative Merle d'Aubigné score (16.33 ± 0.58), HHS (84.33 ± 5.99) and KSS (86.33 ± 7.09) (P<0.001). Mean NRS decreased from 7.33 ± 0.58 in the preoperative period to 0.67 ± 0.58 at the most recent followup (P<0.001). One patient had heterotrophic ossification following THA. There were no revisions. Conclusions: Bilateral lower limb arthroplasty of the hip and knee is a good treatment option to restore function and mobility in MED patients with advanced degenerative arthritis. Careful preoperative planning, meticulous surgical techniques, patient focussed postoperative rehabilitation with multidisciplinary team approach are vital to ensure good functional outcomes and implant survivorship.
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Case Series
Open Access June 18, 2022

Social Studies Teachers’ Competence in Assessing Learning Outcomes in Affective Domain

Abstract The main purpose of this study was to examine Social Studies teachers’ competence in teaching and assessing learning outcomes in affective domain in senior high schools in the Aowin Municipality in Western North Region in Ghana. A quantitative approach was used in this study as it allowed the researchers to carry out an objective analysis and generate factual knowledge through measurement. The [...] Read more.
The main purpose of this study was to examine Social Studies teachers’ competence in teaching and assessing learning outcomes in affective domain in senior high schools in the Aowin Municipality in Western North Region in Ghana. A quantitative approach was used in this study as it allowed the researchers to carry out an objective analysis and generate factual knowledge through measurement. The survey design was used for the study. The study population constituted Social Studies teachers in the 40 Junior High Schools in the Aowin Municipality of the Western North Region of Ghana. Simple random and convenient sampling techniques were used to select the schools and respondents for the study. The simple random sampling was used to select 20 schools to participate in the study. This was to provide an equal opportunity for each school to participate in the study. From these selected schools, a convenience sampling technique was used in selecting forty (40) teachers (two from each school in the Aowin Municipality where Social Studies is offered as a core subject. The main instrument used for the study was structured questionnaire. Descriptive statistics in the form of percentages was used to analysis the data in this study. The study concluded that Social Studies teachers hardly teach and assess directly in the affective outcome, hence the affective domain is neglected in the teaching and learning of the subject. It is recommended that the universities and other training institutions should strengthen the teaching on the use of the techniques for assessing the affective domain. In-service training courses should also be organised regularly for social studies teachers on the use of the techniques for the assessment of affective domain.
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Article
Open Access May 22, 2022

Pooled prevalence and contextual determinants of contraceptive utilization among reproductive-age women in The Gambia: Evidence from 2013 – 2020 Demographic Health Surveys

Abstract Background: Family planning (FP) methods have been found as an efficient approach of reducing fertility and are therefore widely supported in order to decrease population growth, particularly in poor nations. Promoting contraception availability among women (15 – 49) age has also been shown to be an efficient public health strategy for improving maternal and newborn health outcomes. This [...] Read more.
Background: Family planning (FP) methods have been found as an efficient approach of reducing fertility and are therefore widely supported in order to decrease population growth, particularly in poor nations. Promoting contraception availability among women (15 – 49) age has also been shown to be an efficient public health strategy for improving maternal and newborn health outcomes. This paper aimed at exploring the pooled prevalence of contraceptive uptake and its contextual determinants among women of childbearing age in The Gambia. Methods: The Gambia Demographic and Health Survey (GDHS) in both 2013 and 2019-20 was used for this study. Data were obtained from a pooled 22,098 women aged 15-49 (10,233 for 2013 and 11,865 for 2019-20) through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value <0.05 were included into the model. A multivariable logistic regression model was used to assess the predictors of contraceptive usage at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 15. Results: The weighted pooled prevalence of modern contraceptive utilization in The Gambia was 10.1%. Younger age, compared with women aged 25-29; 30-34; 35-39; 40-44; primary education (aOR=1.25, 95% CI=1.05-1.49); secondary education (aOR=1.57, 95% CI= 1.32-1.85); Higher education (aOR=1.90, 95% CI=1.34-12.69); living in urban areas (aOR=1.49, 95% CI= 1.25-1.79); parity 2-4 (aOR=1.21, 95% CI= 1.01-1.47); told about FP at health facility (aOR=2.97, 95% CI= 2.61-3.38), and no desire for many children (aOR=1.96, 95% CI= 1.62-2.37) were more like to use modern contraceptives among Gambian women. Conclusion: The programme certainly needs to consider improvements in the quality of care being offered to acceptors. Government agencies should target these programs and campaigns on regional FP demands and provide suitable culturally sensitive and regionally adaptive services to the communities' contexts. The programme should intensify its efforts in rural and urban settings to improve accessibility to and availability of FP services.
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Article
Open Access February 24, 2022

Textile Design and Product Innovations from Adinkra and Bogolanfini Ideographic Mergers

Abstract This study seeks to introduce an interactive design concept by merging Adinkra and Bogolanfini symbols into textile designs and convert them into utilitarian products. The qualitative research design method and the human-centred design approach were employed to identify, understand and assess how effective Adinkra and Bogolanfini ideographs can be adapted for textile designs and other product [...] Read more.
This study seeks to introduce an interactive design concept by merging Adinkra and Bogolanfini symbols into textile designs and convert them into utilitarian products. The qualitative research design method and the human-centred design approach were employed to identify, understand and assess how effective Adinkra and Bogolanfini ideographs can be adapted for textile designs and other product applications. The target samples for this study comprises variety of Adinkra symbols and Bogolanfini patterns. The significance of sampling in this study was to select suitable kinds of Adinkra and Bogolanfini patterns. Lines, shapes and texture were utilised to determine which particular symbols were included and which were not suitable. The CorelDraw vector software was used to convert and develop images of the Adinkra symbols and Bògòlanfini patterns and then manipulated into the final textile design. The design outcomes are indicative of the fact that varieties of Adinkra symbols and Bogolanfini patterns are prospective image resources for textile designs. The study recommends that textile design students and practitioners at various institutions and dispositions should be encouraged to explore the breadth of ideographs available across the West African sub-region for design ideas.
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Article
Open Access January 14, 2022

Are Nociplastic Pain and Neuropathic Pain Different Pains?

Abstract The International Association for the Study of Pain has classified pain into nociceptive pain, neuropathic pain, and nociplastic pain based on the cause of the pain. At present, nociplastic pain is pain that is not nociceptive pain and has the following characteristics: no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease [...] Read more.
The International Association for the Study of Pain has classified pain into nociceptive pain, neuropathic pain, and nociplastic pain based on the cause of the pain. At present, nociplastic pain is pain that is not nociceptive pain and has the following characteristics: no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. If there is tissue damage, disease or lesion, it is neuropathic pain; if there is none, it is nociplastic pain. In other words, the difference in diagnosis is whether or not tissue damage, disease, or lesion can be found at the current medical level (testing equipment). The treatment of nociplastic pain is almost the same as the treatment of neuropathic pain. Fibromyalgia is included in nociplastic pain. To my knowledge, of the nociplastic pain and neuropathic pain, fibromyalgia is the disease with the highest number of pharmacological and non-pharmacological treatments with evidence of efficacy. Effective treatments for fibromyalgia are often given to neuropathic pain. This expands treatment options. I presume that tissue damage, disease or lesion will be found in fibromyalgia through advances in the medical science by the time humans emigrate to Mars. The distinction between nociplastic pain and neuropathic pain complicates the diagnosis of chronic pain. However, the distinction does not improve the treatment outcomes. Medical science is the discipline to find a treatment method that can produce better outcomes. In the event of a medical controversy, the medical theory with better treatment outcomes should be adopted. It is desirable to combine nociplastic pain and neuropathic pain into one pain. This will simplify diagnosis and increase treatment options (improve treatment outcomes) in nociplastic pain and neuropathic pain.
Opinion
Open Access November 29, 2021

Mucormycosis and Candida Infections in Patients of COVID-19 Pneumonia: A Systematic Review

Abstract Introduction: The city of Wuhan in China reported the first case of coronavirus, termed as SARS-CoV-2, in December 2019. To date, 187,827,660 cases have been reported to the WHO (3). With current research focusing on potential therapeutic agents for the coronavirus disease and vaccines, there remain major gaps in our understanding of the pathophysiology and clinical course of this viral [...] Read more.
Introduction: The city of Wuhan in China reported the first case of coronavirus, termed as SARS-CoV-2, in December 2019. To date, 187,827,660 cases have been reported to the WHO (3). With current research focusing on potential therapeutic agents for the coronavirus disease and vaccines, there remain major gaps in our understanding of the pathophysiology and clinical course of this viral pneumonia. Secondary infections are one of them. In this systematic review, we analyze the outcomes of two fungal infections in patients of COVID-19, viz. Mucormycosis and candida. Methodology: A systematic review has been done on secondary infections with mucor and candida fungi in patients of COVID-19. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. Twenty-three studies were included in the final analysis. Our review included studies from various countries across the globe. The risk of bias was analyzed using the NIH Quality Assessment Tool for Case Series Studies. This study did not require ethical approval as data was obtained from already available databases, and patients were not directly involved. Results: A total of 23 articles were included in the final review and the total number of patients included was 79 Male: female ratio was calculated to be 1.6 and the average age of patients was 52 years (ranging from 24-86 years). Various types of comorbidities were seen in the included patients, the most common being diabetes mellitus. Among the 18 patients in the cohort of mucormycosis, 7 patients died and four studies did not report patient outcomes. Among the 61 patients, 13 patients died and one patient was still ventilated at the time of publication. Conclusion: Secondary infections after COVID-19 are a cause of major concerns. Further studies and case reports are needed to better understand the various other types of secondary infections and also to formulate strategies to prevent these.
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Systematic Review
Open Access November 22, 2021

COVID-19 and Legionella Co-Infection

Abstract Introduction: Concurrent infections or co-infections in patients diagnosed with Coronavirus Disease-19 (COVID-19) are not uncommon and predict a pejorative prognosis. A co-infection accounts for 1 out of every 5 cases of COVID-19 and increases the likelihood of adverse health outcomes such as mechanical ventilations, ICU admissions, and death. Specifically, Legionella spp. [...] Read more.
Introduction: Concurrent infections or co-infections in patients diagnosed with Coronavirus Disease-19 (COVID-19) are not uncommon and predict a pejorative prognosis. A co-infection accounts for 1 out of every 5 cases of COVID-19 and increases the likelihood of adverse health outcomes such as mechanical ventilations, ICU admissions, and death. Specifically, Legionella spp. co-infection presents additional challenges in COVID-19 patients because of its rarity, similar clinical presentation to SARS-CoV-2, and poorer outcomes without prompt treatment. Cases Presentation: Case 1. A 62-year-old female presented with a 3-day history of subjective fever and worsening shortness of breath. Room air saturation (saO2) was 70% and improved to 100% on noninvasive positive- pressure ventilation (NIPPV). Lung auscultation revealed rales BL. Chest X –Ray (CXR) showed patchy airspace opacities bilaterally (BL), SARS-CoV-2 PCR and urine legionella antigen tests were positive. The diagnosis of hypoxic respiratory failure secondary to COVID-19 and Legionella pneumonia was made. Patient was admitted to intensive care unit (ICU) and managed with decadron, remdesivir, one unit of convalescent plasma for COVID-19 and Azithromycin for Legionella. Patient subsequently developed acute respiratory distress syndrome (ARDS). ARDS protocol was initiated. 13 days after, the patient was compassionately extubated. Case 2. A 41-year-old male presented with 5-day history of fever, worsening shortness of breath, cough and diarrhea. Patient admitted history of ethanol abuse. SaO2 was 88% and improved on oxygen canula. Lung auscultation revealed rhonchi BL. CXR showed extensive left lung consolidation. Urine test for legionella antigen was positive. COVID-19 PCR was negative, but SARS-CoV-2 IgG was reactive. The diagnosis of Legionnaire disease was made. Despite initial treatment with Azithromycin, patient's hypoxia continued to worsen requiring NIPPV, and subsequently mechanical ventilation in the ICU. The adjunction of empiric treatment for COVID-19 with convalescent plasma, remdesivir and steroids improved both clinicals and laboratory findings. Discussion: The cases illustrated the practical challenges of managing COVID-19 and legionella co- infection. Legionella spp and SARS-CoV-2 overlapping incubation periods and similar clinical presentations and complications. In the absence of diagnosis and treatment, legionella pneumonia has an intrinsic mortality rate of up to 80%. As some COVID-19 mitigation strategies, such as the closure of businesses, have enhanced the conditions for Legionella spp proliferation, the incidence of Co-infection with COVID-19 may increase. We recommend clinicians to have high-indexed suspicion of COVID-19 and Legionella co-infection in order to obtain complete work up at patient’s initial presentation.
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Case Report
Open Access November 05, 2021

Cerebral Palsy and Heterotaxy Syndrome: A Case Report

Abstract Background: Cerebral palsy is not only a serious neurodevelopmental disease causing significant morbidity in children, but also a traumatic experience leading to psychosocial trauma to the parents/caregivers of the affected children. It is usually caused by prenatal or early post-natal insults to the newborn brain which may be associated with some congenital syndromes like congenital heart [...] Read more.
Background: Cerebral palsy is not only a serious neurodevelopmental disease causing significant morbidity in children, but also a traumatic experience leading to psychosocial trauma to the parents/caregivers of the affected children. It is usually caused by prenatal or early post-natal insults to the newborn brain which may be associated with some congenital syndromes like congenital heart disease with transposition of the viscera but rarely a heterotaxy syndrome, a condition characterized with congenitally abnormal arrangement of the thoracic and abdominal viscera. Method: We present a case report of a 12-month-old boy with neurodevelopmental delay, recurrent episodes of non-mucoid and non-bloody diarhoea, occasional constipation, bilious vomiting, abdominal distension and fever with associated cough and difficulty in breathing. Results: We discuss an unusual presentation of cerebral palsy and heterotaxy syndrome diagnosed clinically with supporting evidence from both laboratory and radiological tests. Cerebral palsy was diagnosed from the history of birth asphyxia, delayed developmental milestone, limb spasticity and low values for all sub-scores of Bayley-III scale. Heterotaxy syndrome was diagnosed from the radiologic evidence of dextrocardia, left-sided stomach, centrally located liver and malrotation of gut with volvulus. We also provide a brief literature review of the incidence and prevalence, causes and risk factors, classification, clinical presentation and associated co-morbidities of heterotaxy syndrome. Conclusion: Diagnosis of heterotaxy syndrome in a child with background cerebral palsy is a great challenge to both physicians and radiologists. This is more so in developing countries due to poor availability of good diagnostic apparatus, therefore, a high index of suspicion is needed. A clear understanding of the clinical features, comprehensive history taking and thorough physical examination are important in making prompt diagnosis. Timely and appropriate imaging is necessary to prevent delays in diagnosis and treatment which lead to poor outcomes.
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Case Report
Open Access October 19, 2021

The Medical Community Should Make the Unified Disease Concept, Definition, and Diagnostic Criterion of Medically Unexplained Pain (or Symptoms)

Abstract MUP (medically unexplained pain) is a pain whose cause cannot be determined by diagnostic imaging, blood test, physical examination and past medical history, etc. Many departments have independently created the concept, definition, and diagnostic criterion in MUP. This leads to an abnormal situation in which each department has different disease concepts and diagnostic criteria. It is [...] Read more.
MUP (medically unexplained pain) is a pain whose cause cannot be determined by diagnostic imaging, blood test, physical examination and past medical history, etc. Many departments have independently created the concept, definition, and diagnostic criterion in MUP. This leads to an abnormal situation in which each department has different disease concepts and diagnostic criteria. It is out-of-the-ordinary that physicians from the different departments make different diagnoses in the same patient. MUP has caused confusion in clinical practice. The medical community should make the unified disease concept, definition, and diagnostic criterion of MUP. For this purpose, the various scientific organizations involved in MUP need to discuss. In this case, the first priority should not be the majority vote, but the treatment outcomes. The solution to a medical controversy is to choose a medical theory or treatment method that produces better long-term results.
Opinion
Open Access August 12, 2021

Responding to the Call through Translating Science into Impact: Building an Evidence-Based Approaches to Effectively Curb Public Health Emergencies [Covid-19 Crisis]

Abstract COVID-19 demonstrated a global catastrophe that touched everybody, including the scientific community. As we respond and recover rapidly from this pandemic, there is an opportunity to guarantee that the fabric of our society includes sustainability, fairness, and care. However, approaches to environmental health attempt to decrease the populations burden of COVID-19, toward saving patients from [...] Read more.
COVID-19 demonstrated a global catastrophe that touched everybody, including the scientific community. As we respond and recover rapidly from this pandemic, there is an opportunity to guarantee that the fabric of our society includes sustainability, fairness, and care. However, approaches to environmental health attempt to decrease the populations burden of COVID-19, toward saving patients from becoming ill along with preserving the allocation of clinical resources and public safety standards. This paper explores environmental and public health evidence-based practices toward responding to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward retrieving research publications, “grey literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which include effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy making; conducting sound evaluation; do a thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioural, environmental, social as well as systems interventions (BESSI) toward reducing transmission.
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Review Article
Open Access July 30, 2021

Air of Uncertainty from Pollution Profiteers: Status of Ambient Air Quality of Sawmill Industry in Ilorin Metropolis, Kwara State, Nigeria

Abstract We can’t stop breathing, but we can do something about the quality of air that we breathe. Clean fresh air is indispensable ingredient for a good life quality. Individuals poses the right towards expecting that the breathed air will not harm people. Thus, fighting air pollution will not only improve health outcomes, productivity, and well-being, it’s also essential toward reducing the emissions of [...] Read more.
We can’t stop breathing, but we can do something about the quality of air that we breathe. Clean fresh air is indispensable ingredient for a good life quality. Individuals poses the right towards expecting that the breathed air will not harm people. Thus, fighting air pollution will not only improve health outcomes, productivity, and well-being, it’s also essential toward reducing the emissions of greenhouse gas as well as fighting climate change. For examples, a third of the global population is at risk from unhealthy of ambient air pollutants concentrations, with the loss of approximately 6.4 million healthy-life-years attributed specifically to chronic exposure to ambient particulate matter. Expert panels have consistently rated air pollution as a greater health hazard than water pollution. Pollution of air is the leading source of unexplained and undiagnosed diseases, besides have remained associated with a variety of serious human health risks, and in fact, a threshold has not been established under which these pollutants exert no adverse effects. This study evaluates ambient air quality at major sawmill sites in Ilorin Metropolis, Kwara State, Nigeria. “Measurements of Air pollution were accurately carried out using direct reading, automatic in situ gas monitors; Hand held mobile multi-gas monitor with model AS8900 [Combustible (LEL), and Oxygen (O2)], BLATN with model BR – Smart Series air quality monitor (PM10, Formaldehyde) and air quality multimeter with model B SIDE EET100 (Dust (PM2.5), VOC, Temperature and Relative Humidity)”. The outcomes disclosed among others, the average concentrations of CO, O2 as well as other measured parameters for instance formaldehyde (HcHo) etc., they are also consistently low as well as within acceptable range in terms of National as well as Global monitoring standards for air quality indices. However, there are few exceptions for instance the average volatile organic compounds (VOCs) concentrations, PM2.5, PM10 as well as Combustible (LEL) respectively, which are higher when compared to National and Global standards. This high figure is due to pollutant amount existing in the sawmills air environment resulting from input of influents from activities of the sawmill. However, as a result, air pollution in the city of Ilorin is found to be increasingly polluted and are of major health concern because of their synergistic action. Due to the high evidences and values, it can lead to a remarkable rise in over-all figure of hospital visits/ patients’ admissions with acute respiratory illnesses as soon as air pollutants level remained high. Hence, there is the need for an aggressive control of ambient air pollution.
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Article
Open Access November 05, 2022

Application of Neural Networks in Optimizing Health Outcomes in Medicare Advantage and Supplement Plans

Abstract The growing complexity and variability in healthcare delivery and costs within Medicare Advantage (MA) and Medicare Supplement (Medigap) plans present significant challenges for improving health outcomes and managing expenditures. Neural networks, a subset of artificial intelligence (AI), have shown considerable promise in optimizing healthcare processes, particularly in predictive modeling, [...] Read more.
The growing complexity and variability in healthcare delivery and costs within Medicare Advantage (MA) and Medicare Supplement (Medigap) plans present significant challenges for improving health outcomes and managing expenditures. Neural networks, a subset of artificial intelligence (AI), have shown considerable promise in optimizing healthcare processes, particularly in predictive modeling, personalized treatment recommendations, and risk stratification. This paper explores the application of neural networks in enhancing health outcomes within the context of Medicare Advantage and Supplement plans. We review how deep learning models can be leveraged to predict patient risk, optimize resource allocation, and identify at-risk populations for preventive interventions. Additionally, we discuss the potential for neural networks to improve claims processing, reduce fraud, and streamline administrative burdens. By integrating various data sources, including medical records, claims data, and demographic information, neural networks enable more accurate and efficient decision-making processes. Ultimately, this approach can lead to better patient care, reduced healthcare costs, and improved satisfaction for beneficiaries of these programs. The paper concludes by highlighting the current limitations, ethical considerations, and future directions for AI adoption in the Medicare Advantage and Supplement sectors.
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Open Access November 02, 2023

Revealing Complexity: Confronting Challenges in the Pharmaceutical API Supply Chain

Abstract The pharmaceutical industry relies extensively on Active Pharmaceutical Ingredients (APIs) as essential components in the production of drugs. The supply chain supporting these APIs is complex, encompassing multiple stages from raw material sourcing to distribution to pharmaceutical manufacturers worldwide. This manuscript explores the intricate challenges encountered within the pharmaceutical API [...] Read more.
The pharmaceutical industry relies extensively on Active Pharmaceutical Ingredients (APIs) as essential components in the production of drugs. The supply chain supporting these APIs is complex, encompassing multiple stages from raw material sourcing to distribution to pharmaceutical manufacturers worldwide. This manuscript explores the intricate challenges encountered within the pharmaceutical API supply chain, focusing on regulatory compliance, quality control, supply chain disruptions, and global dependencies. Regulatory compliance poses a significant hurdle, with varying standards across regions necessitating meticulous adherence to ensure market access and product safety. Quality control and assurance are paramount to maintaining consistency and purity in APIs, yet they present ongoing challenges such as batch variability and contamination risks. Supply chain disruptions, ranging from natural disasters to geopolitical tensions, highlight vulnerabilities in global sourcing strategies, underscoring the need for resilient supply chain management practices. Global dependencies on a limited number of suppliers or regions expose the industry to supply shortages and pricing pressures, exacerbated by geopolitical events and trade policies. These dependencies necessitate strategic diversification and risk mitigation efforts to ensure continuity in API availability and affordability. By addressing these challenges collaboratively, stakeholders can enhance the resilience and reliability of the pharmaceutical API supply chain, thereby ensuring uninterrupted access to essential medications and improving global healthcare outcomes.
Review Article
Open Access February 22, 2023

Navigating the Pharmaceutical Supply Chain: Key Strategies for Balancing Demand and Supply

Abstract The pharmaceutical industry is fundamental to global healthcare, providing essential medicines that improve health outcomes and quality of life. However, the demand and supply dynamics within this sector are highly complex, shaped by various factors including demographic changes, evolving disease burdens, technological advancements, regulatory challenges, and economic pressures. This manuscript [...] Read more.
The pharmaceutical industry is fundamental to global healthcare, providing essential medicines that improve health outcomes and quality of life. However, the demand and supply dynamics within this sector are highly complex, shaped by various factors including demographic changes, evolving disease burdens, technological advancements, regulatory challenges, and economic pressures. This manuscript explores the intricate relationship between pharmaceutical medicine demand and supply, focusing on key strategies that can help companies effectively navigate these challenges. The demand for pharmaceutical products is driven by several factors, such as population growth, the aging population, the rise of chronic diseases, and the emergence of new health threats. Additionally, healthcare accessibility, affordability, and policy changes significantly impact the consumption of medicines, while innovations in medical technologies and therapies create new treatment needs. On the supply side, pharmaceutical companies face challenges related to manufacturing capacity, raw material availability, distribution logistics, and compliance with ever-evolving global regulatory frameworks. To address these challenges, the manuscript discusses strategic approaches to managing both demand and supply in the pharmaceutical sector. Key strategies include advanced demand forecasting through data analytics, optimizing supply chains for efficiency and resilience, implementing just-in-time inventory models, and investing in flexible manufacturing systems. Furthermore, global collaboration and partnerships, as well as effective risk management practices, are highlighted as essential to ensuring the availability of medicines, particularly in times of crisis or global health emergencies. This manuscript also delves into the role of policy advocacy and regulatory harmonization in stabilizing the pharmaceutical market, ensuring that medicines are accessible to all populations. In conclusion, the pharmaceutical industry must continually adapt to meet the evolving challenges of demand and supply, embracing innovation and collaboration while maintaining a focus on patient access and global healthcare equity. Through strategic planning and adaptive solutions, the pharmaceutical sector can ensure the continuous availability of critical medicines worldwide, meeting both current and future health needs.
Case Report
Open Access November 16, 2022

AI-Driven Automation in Monitoring Post-Operative Complications Across Health Systems

Abstract Artificial intelligence systems have been previously used to predict post-operative complications in small studies and single institutions. Here we developed a robust artificial intelligence model that predicts the risk of having cardiac, pulmonary, thromboembolic, or septic complications after elective, non-cardiac, non-ambulatory surgery. We combined structured and unstructured electronic health [...] Read more.
Artificial intelligence systems have been previously used to predict post-operative complications in small studies and single institutions. Here we developed a robust artificial intelligence model that predicts the risk of having cardiac, pulmonary, thromboembolic, or septic complications after elective, non-cardiac, non-ambulatory surgery. We combined structured and unstructured electronic health record data from 3.5 million surgical encounters from 25 medical centers between 2009 and 2017. Our neural network model predicted postoperative comorbidities 15 to 80 times faster than classical models. As such, our model can be used to assess the risk of having a specific complication postoperatively in a fraction of a second. With our model, we believe clinicians will be able to identify high-risk surgical patients and use their good judgment to mitigate upcoming risks, ultimately improving patient outcomes [1].
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Open Access December 27, 2019

The Role of Neural Networks in Advancing Wearable Healthcare Technology Analytics

Abstract Neural networks are bringing a transformation in wearable healthcare technology analytics. These networks are able to analyze a vast amount of data to help in making decisions concerning patient care. Advancements in deep learning have brought neural networks to the forefront, making data analytics a straightforward process. This study will help in unveiling the use of ICT and AI in medical [...] Read more.
Neural networks are bringing a transformation in wearable healthcare technology analytics. These networks are able to analyze a vast amount of data to help in making decisions concerning patient care. Advancements in deep learning have brought neural networks to the forefront, making data analytics a straightforward process. This study will help in unveiling the use of ICT and AI in medical healthcare technology, crawling through some industry giants. Wearable Healthcare Technologies are becoming more popular every day. These technologies facilitate collecting, monitoring, and sharing every vital aspect of the human body necessary for diagnosing and treating an ailment. At the advent of global digitization, health data storage and systematic analysis are taking shape to ensure better diagnostics, preventive, and predictive healthcare. Healthcare analytics powered by neural networks can significantly improve health outcomes, maximizing individuals' potential and quality of life. The breadth and possibilities of connected devices are getting wider. From personal activity monitoring to quantifying every bit of health statistics, connected devices are making an impact in measurement, management, and manipulation. In healthcare, early diagnosis could be a lifesaver. Data analytics can help in a big way to make moves and predictions to save lives. We are in another phase of the digitization era, "Neural Network and Wearable Healthcare Technology Analytics." A neural network could be conceived as an adaptive system made up of a large number of neurons connected in multiple layers. A neural network processes data in a similar way as the human brain does. Using a collection of algorithms, for many neural networks, objects are composed of 'input' and 'output' layers along with the layers of the neural network.
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Open Access December 27, 2019

Predictive Analytics in Biologics: Improving Production Outcomes Using Big Data

Abstract Biopharmaceuticals, or biologics, are a burgeoning sector in the pharmaceutical industry, predicted to reach $239.4 billion by 2025. This unparalleled growth is often attributed to the enhanced specificity offered by large molecules over small molecules. The large size of the constituent proteins necessitates the continuous implementation of big data predictive analytics to elucidate the most [...] Read more.
Biopharmaceuticals, or biologics, are a burgeoning sector in the pharmaceutical industry, predicted to reach $239.4 billion by 2025. This unparalleled growth is often attributed to the enhanced specificity offered by large molecules over small molecules. The large size of the constituent proteins necessitates the continuous implementation of big data predictive analytics to elucidate the most effective candidates in the lead optimization process. These same methodologies can be applied, and with the advent of machine learning and automated predictive analytics, this is becoming an increasingly facile task, to the augmentation and optimization of the downstream production processes that comprise the majority of the development cost of any biologic. In this work, big data from cell line generation, product and process design, and large-scale lead validation studies have been used to compare the applicability of simple statistical models against these black-box approaches for the rapid acceleration of enzymes to the pilot plant stage. This research can be expanded upon to exploit the big datasets generated as part of the progression of biologics through the development pipeline to further optimize production outcomes. Over the coming months, data from the project will be used to probe which approaches are amenable to which processes and, as a result, more amenable to various economic simulations. The computed optimization objective for the HIT must include the cost of acquiring, storing, and analyzing data to construct these predictive models, alongside the expected commercial reward of choosing an optimally ranked candidate. In this vein, perspective must be taken in the probable future price, capability outputs, and ownership issues of increasingly sophisticated data analysis software as superstructures become more frequent. It is frequently stated that decisions made to reduce production costs are data-driven, but that is not because more economically or energetically costly experiments or production methods are employed; to truly evaluate production steps, dynamic energy, and economic models need to become more commonplace. Conversion of process quality approaches from large questionnaires, risk analysis, and expert opinion-driven methods to statistical and thus more reliable approaches is an area of future research in analytics used herein.
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Open Access December 27, 2019

Data Engineering Frameworks for Optimizing Community Health Surveillance Systems

Abstract A Changing World Demands Optimized Health Surveillance Systems – and How Data Engineering Can Help There is a growing urgency to manage the public health and emergency response practices effectively today, in light of complex and emerging health threats. Fortunately, a host of new tools, including big and streaming data sources, methods such as machine learning, new types of hardware like [...] Read more.
A Changing World Demands Optimized Health Surveillance Systems – and How Data Engineering Can Help There is a growing urgency to manage the public health and emergency response practices effectively today, in light of complex and emerging health threats. Fortunately, a host of new tools, including big and streaming data sources, methods such as machine learning, new types of hardware like blockchain or secure enclaves, and means of data storage and retrieval, have emerged. But, with these innovations comes a grand challenge: how to blend with, and adapt them to, the traditional public health practices. The long-in-place infrastructures and protocols to protect and ensure the welfare of communities are in need of change, or at least update, to enhance their marked longevity of impact directly on the health outcomes and community wellbeing they were designed to fortify. It is in this vein that the essay is written and composed. The investigation in this essay is to query what, particularly, might be the aspects and influences of the emerging veritable cornucopia of new data engineering frameworks that are either being developed specifically for health surveillance and wellness, or are available to be co opted from devices and services already thriving in the current market and research milieu. Knowing what these ways may be could well aid in molding their uptake and spread, ensuring their beneficial impacts on those communities who stand to gain the most. The essay is divided into several key segments. After this introduction, section two details the research methods. In the section that follows, the maximum health outcome potentials of these novel frameworks are reviewed. Part four of the essay takes a more critical approach, addressing how the success of these methods may be hindered and future research avenues. Lastly, the concluding information suggests some actions to take to aid best suit the implementation of these ways, and suggests some thoughts for further research after the completion of these inquiriestrand [1].
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Open Access December 27, 2021

Advancing Healthcare Innovation in 2021: Integrating AI, Digital Health Technologies, and Precision Medicine for Improved Patient Outcomes

Abstract Advances of wearables, sensors, smart devices, and electronic health records have generated patient-oriented longitudinal data sources that are analyzed with advanced analytical tools to generate enormous opportunities to understand patient health conditions and needs, transforming healthcare significantly from conventional paradigms to more patient-specific and preventive approaches. Artificial [...] Read more.
Advances of wearables, sensors, smart devices, and electronic health records have generated patient-oriented longitudinal data sources that are analyzed with advanced analytical tools to generate enormous opportunities to understand patient health conditions and needs, transforming healthcare significantly from conventional paradigms to more patient-specific and preventive approaches. Artificial intelligence (AI) with a machine learning methodology is prominently considered as it is uniquely suitable to derive predictions and recommendations from complex patient datasets. Recent studies have shown that precise data aggregation methods exhibit an important role in the precision and reliability of clinical outcome distribution models. There is an essential need to develop an effective and powerful multifunctional machine learning platform to enable healthcare professionals to comprehend challenging biomedical multifactorial datasets to understand patient-specific scenarios and to make better clinical decisions, potentially leading to the optimist patient outcomes. There is a substantial drive to develop the networking and interoperability of clinical systems, the laboratory, and public health. These steps are delivered in concert with efforts at enabling usefully analytic tools and technologies for making sense of the eruption of overall patient’s information from various sources. However, the full efficiency of this technology can only be eliminated when ethical, legal, and social challenges related to reducing the privacy of healthcare information are successfully absorbed. Public and media are to be informed about the capabilities and limitations of the technologies and the paramount to be balanced is juvenile public healthcare data privacy debate. While this is ongoing, the measures have been progressed from patient data protection abuses for progress to realize the full potential of AI technology for hosting the health system, with benefits for all stakeholders. Any protection program should be based on fairness, transparency, and a full commitment to data privacy. On-going innovative systems that use AI to manage clinical data and analyzes are proposed. These tools can be used by healthcare providers, especially in defining specific scenarios related to biomedical data management and analysis. These platforms ensure that the significant and potentially predictive parameters associated with the diagnosis, treatment, and progression of the disease have been recognized. With the systematic use of these solutions, this work can contribute to the realization of noticeable improvements in the provision of real-time, personalized, and efficient medicine at a reduced cost [1].
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Open Access December 27, 2021

Advancements in Smart Medical and Industrial Devices: Enhancing Efficiency and Connectivity with High-Speed Telecom Networks

Abstract Emerging smart medical instruments combined with advanced smart industrial equipment facilitate the collection of vast volumes of critical data. This data not only enables significantly more accurate and cost-effective diagnosis and maintenance but also enriches the datasets available for AI algorithms, leading to improved insights and outcomes. The integration of high-speed and ultra-reliable [...] Read more.
Emerging smart medical instruments combined with advanced smart industrial equipment facilitate the collection of vast volumes of critical data. This data not only enables significantly more accurate and cost-effective diagnosis and maintenance but also enriches the datasets available for AI algorithms, leading to improved insights and outcomes. The integration of high-speed and ultra-reliable telecommunications infrastructure is crucial, as it supports the cloud model. This model allows for off-device aggregation in the cloud, which effectively offloads infrastructure demands and provides an extended runway for future technological improvements before the deployment of the next generation of devices. However, in certain scenarios, latency and bandwidth limitations present significant challenges. These limitations require that a substantial amount of AI and machine learning processing is conducted directly on the transmitted data, which places rigorous demands on both the processing subsystems and the communications links themselves. The current project directly addresses the accelerator side of this multifaceted issue. It will carry out comprehensive end-to-end demonstrations leveraging pilot 5G networks and telemedicine facilities, collaborating closely with major industry participants to showcase the capabilities and potential of this innovative technology. This collaborative effort is essential to pushing the boundaries of what is possible in smart medical instruments and industrial applications [1].
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Open Access December 27, 2020

Designing Self-Learning Agentic Systems for Dynamic Retail Supply Networks

Abstract The evolution of supply chains (SC) from a linear to a network structure created an opportunity for new processes, product/service offerings, and provider-business. Rising customer service expectations have led to the need for innovative SC designs to develop and sustain competitive performance globally. Firms are forced to respond and adapt accordingly, thereby leading to design, network, [...] Read more.
The evolution of supply chains (SC) from a linear to a network structure created an opportunity for new processes, product/service offerings, and provider-business. Rising customer service expectations have led to the need for innovative SC designs to develop and sustain competitive performance globally. Firms are forced to respond and adapt accordingly, thereby leading to design, network, operational, and performance dynamics. Traditionally, SCs are treated as static structures, focusing solely on design and/or operational optimization. Such perspectives are not viable options for SC domains, as they address only a portion of the dynamic problem space, use a deterministic assumption of dominant design variables, capitalize on past data to predict future decisions, and offer pre-classified forecasting options complemented with a limited comprehension of systemic SC elasticity. Novel self-learning agentic systems are proposed that blend the sciencematics of SC decisions and dynamics. The designs guide firms seeking to build adaptive SCs using operational decision processes. The designs address the agentic nature of SC, embedding computational interaction models of firm SC networks. The designs contrast the stochastic action-taking and thereby the performance outcomes, discovering opportunities for adaptive operational designs of SC tasks. Fine-tuning and meta-learning are new design capabilities that adapt to evolving dynamic environments. Frameworks for behavioral customization and systematic exploration of the design space are provided as user guides. Exemplar designs are also provided to serve as a translation template for users to express operational models of their own contexts. To account for the dynamics of supply chains (SC), agent-based models are increasingly adopted. Such models exhibit SC structure and/or formulation dynamics. Though existing efforts commence adjacent-only structural changes, dynamism with respect to tasks is crucial for SC design and operational strategy development. Proposed is a process modeling library and workflow for discovering intricate designs of adaptive agentic systems. The library revises Dataflow and Structure, concealing sequencing and context designs of processes. Prompted specifications describe and enact designs. Applications in SC formulation discovery are provided.
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Open Access December 26, 2018

Understanding Consumer Behavior in Integrated Digital Ecosystems: A Data-Driven Approach

Abstract This study aims to achieve a new understanding of how, why, and when consumer behavior is shaped, enacted, and experienced inside and across integrated digital ecosystems related to large-scale trackable goods, all in service of helping marketers optimize their business performance in the new economy. The pioneering understanding begins by exploring what motivates the choices of a homogeneous [...] Read more.
This study aims to achieve a new understanding of how, why, and when consumer behavior is shaped, enacted, and experienced inside and across integrated digital ecosystems related to large-scale trackable goods, all in service of helping marketers optimize their business performance in the new economy. The pioneering understanding begins by exploring what motivates the choices of a homogeneous group of consumers to organize their consumption of national and store brand varieties of consumer package goods in a certain manner. Thereafter, the essay explores how, if at all, the other digital activities of consumers across various product-related digital spaces and on various platforms build expertise and interest in these products such that they exert an effect on the purchase choices for these products. The essay then advances to asking how online information seeking, in various product-related digital spaces, on various platforms, and from various sources, and taking place at various points in the purchase journey affects online-offline dynamics in purchasing these products. Thereafter, the research examines how paid digital communication in various product-related digital spheres and forms, enabled by consumer advertising engagement on various platforms, boosts the offline sales of these products. Finally, by employing a new methodology that combines consumer scanning data, self-reported online activity data, and transaction data collected from an ad-tech partner, the research presents a fresh set of marketing action levers and performance outcomes on chosen products. Along the way, progress is made on four under-investigated topics in the advertising literature – the role of consumer actors and their expertise in the online-offline purchasing dynamics for ads, advertising engagement, consumer digital spaces, and consumer digital activity investment.
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Open Access December 26, 2021

Designing Scalable Healthcare Data Pipelines for Multi-Hospital Networks

Abstract Healthcare is increasingly recognized as a data-intensive industry. Multi-hospital networks, among other organizations, face mounting operational and governance challenges because of rigid data-integration pipelines that support all data sources and destinations in the network. These pipelines have become difficult to modify, causing them to lag behind the changing needs of the clinical operation. [...] Read more.
Healthcare is increasingly recognized as a data-intensive industry. Multi-hospital networks, among other organizations, face mounting operational and governance challenges because of rigid data-integration pipelines that support all data sources and destinations in the network. These pipelines have become difficult to modify, causing them to lag behind the changing needs of the clinical operation. Scalable data-pipeline architectures better support clinical decision making, optimize hospital operations, ease data quality and compliance concerns, and contribute to improved patient outcomes. Meeting scalability goals requires breaking up monolithic data-integration pipelines into smaller decoupled components and aligning service-level agreements of pipeline components and source systems. Parallelization and adoption of distributed data-warehouse technology mitigate the burden of ingesting data into a multi-hospital network. However, latency requirements still warrant the construction of separate pipelines for data ingress from clinical devices, electronic health records, and external laboratory-information systems. Healthcare associations recommend near real-time data availability for a growing list of clinical and operational applications. Mishandling the real-time ingestion of data from clinical devices, in particular, compromises availability and performance. Scalable architectural patterns for real-time streaming Ingestion from heterogeneous data sources, transport processes, and back-end processing structures are detailed.
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