Life-course effects of air pollution (LEAP) on cardio-respiratory morbidity in the MRC National Survey of Health and Development

Most of the epidemiological studies of long term exposure to air pollution showed increased risk of death from cardio-respiratory diseases. However the effect of long-term exposure to air pollution on morbidity is less clear. Additionally, questions as to which stage of life is more important in the effect of air pollution on health in adulthood are still unanswered. This project investigates the relationship between long-term exposure to air pollution and cardio-respiratory morbidity using the National Survey for Health and Development (NSHD) with consideration to lifestyle and socioeconomic factors. A comparison between early life and more recent exposures to air pollution will also be made. Finally, the effect of cumulative and change in air pollution over the life course will be explored. Lung function was measured and self-reported chronic bronchitis (CB) symptoms and ischaemic heart disease (IHD) were collected in 1989, 1999 and 2006/10 for more than 3000 participants. A residential history of the NSHD participants from 1962 onwards was constructed using addresses and/or postcodes and was geocoded and linked to model black smoke (BS) sulphur dioxide (SO2) in 1962, 1971, 1981 and 1991 and nitrogen dioxide (NO2) air pollution in 1991, 2001 and 2010-11. Earlier childhood exposures to air pollutants were assessed using the Douglas and Waller index. Relationships to air pollution were investigated using various statistical models. Contrary to expectations, some results suggested protective effects of air pollution on lung function and symptoms of CB. BS showed positive associations with lung function particularly from 1999 follow-up; 10 µg/m3 of BS in 1971 and 10 µg/m3 in 1991 were associated with 19.2ml (95%CI: 3.5-34.9) and 82.9ml (95%CI: 21.2-144.5) increase in Forced Vital Capacity (FVC) respectively. SO2 showed some positive (protective) associations; 10 µg/m3 of SO2 in 1962 was associated with 3.9 ml (95%CI: 0.1-7.9) increase in Forced Expiratory Volume in 1 second (FEV1) and 5.4 ml (95%CI: 0.2-10.7) increase in Forced Vital Capacity (FVC) in 1989. BS and SO2 both showed positive (protective) associations with lung function decline where 10 µg/m3 of BS in 1981 was associated with 80 ml (95%CI: 16-150) less decline in FVC ; and 10 µg/m3 of SO2 in 1991 was associated with 70 ml (95%CI: 22-120 ) less decline in FVC over the 20 year period. Change and cumulative BS did not show a clear pattern in generalized analyses, however results from stratified analyses suggested positive effects on men that indicate higher BS exposure was associated with better lung function. These protective effects were more consistently observed in SO2 analyses; 10 µg/m3 change (decrease) in SO2 between 1962 and 1991 was associated with 4.3ml (95%CI: 0.4-8.2) higher FEV1 in 1989, 6.1 ml (95%CI: 0.6-11.5) higher FVC in 1989, and 8.4ml (95% CI: 3.0-13.9) higher FVC in 1999. Higher cumulative exposure of 10 µg/m3 of SO2 was associated with 0.5 ml (95% CI: 0.1-0.9) increase in FVC in 1999. Air pollution was not associated with prevalence of CB, results indicated some protective effects. Air pollution was not associated with IHD prevalence; however detrimental effects were suggested. A healthy survivor effect would explain the findings for CB and lung function whereby the most exposed individuals who potentially experience more ill health are under-represented in the study and were differentially lost to follow up. Some evidence was found to suggest greater drop-out in individuals with higher exposure in more deprived areas. However, positive association between decline in air pollution and lung function may be related to the large falls in air pollution levels over the time period of study.Open Acces

Determining the Impact of the ASP Health Club’s Sports Initiative Awareness Campaign on Elementary Students’ Physical Activity Habits

Ever increasing sedentary lifestyles have brought on many issues in the health and wellness of school aged children, particularly those in the third grade through fifth grade level. According to a literature review by the Dominican University of California, awareness is directly associated with an increase in fitness levels; the relation between them a positive one. The purpose of this study was to determine if the awareness program at the American School of Palestine had any tangible effects on its students. It sought to measure the correlation between the school’s activities in the awareness program conducted by members of the ASP Heart Health Club and two of its students’ daily habits: time spent on electronic devices, and time spent on physical activities. The data was gathered from the subjects by means of a questionnaire and clinical charts recording the students’ height and weight in order to calculate their individual BMIs. Participants in this study included all students of the third grade through the fifth grade level, featuring both genders, and amounting to approximately two hundred individuals. The data was collected thrice, recorded and analyzed for the presence of outliers which were removed. Our data indicated that we were able to decrease the amount of time students spent on electronic devices and increase the time spent on physical activity at the fourth grade level. There seemed to be a minimal or negative effect with the third and fifth grade students on average. We believe that a longer study duration and a more effective campaign program may lead to better awareness of the importance of maintaining a healthy and fit lifestyle

Outcomes of the National Head and Neck Cancer Awareness and Screening Campaign in Oman

Objectives: The prognosis of head and neck cancer (HNC) depends substantially on disease stage at the time of diagnosis. Unfortunately, the majority of HNC patients present at relatively late stages. In Oman, a national screening campaign was conducted to increase public awareness of HNC and encourage early detection. This study aimed to report the outcomes of that campaign. Methods: The campaign took the form of biannual events conducted at a tertiary care centre and in public malls in Muscat, Oman from April 2015 to July 2019. Data were collected from participants using the Head and Neck Cancer Alliance screening form. Otolaryngologists and oral maxillofacial surgeons performed a thorough physical evaluation of the head and neck region. Results: Of the 1,500 individuals visiting the hospital and malls during the campaign events, a total of 509 agreed to undergo screening (response rate: 33.9%). Of these, 12.8% had positive screening results and 5.9% required further evaluation. However, none of the cases with suspicious findings were found to be malignant after a thorough evaluation. Overall, 16.9% of the participants were aware of the early signs of HNC; in addition, 5.5% knew how to perform an oral self-examination. Conclusion: Screening is a simple and safe method for the prevention and early detection of HNC. Mass screening and public awareness programmes may help to reduce the burden of this disease in Oman.Keywords: Head and Neck Cancer; Early Detection of Cancer; Mass Screening; Knowledge; Health Risk Behaviors; Oman

Oncocytoma of the upper conjunctival fornix

Oncocytomas are tumors characterized by large, eosinophilic epithelial cells with abundant mitochondria that form ductular or glandular spaces. While these tumors have been described in other organs, those of the ocular adnexa occur infrequently, with the caruncle being the most common site of involvement. Conjunctival oncocytomas are extremely rare and are believed to arise from the ductal elements of the lacrimal gland proper and the accessory lacrimal glands of the conjunctiva. We describe the clinical and histological features of a case of an oncocytoma presenting as an atypically located superior fornix mass in a 78-yearold female, with a review of the literature

Nursing Students’ Perception and Attitude toward Objective Structured Clinical Examination (OSCE) in Oman

Objective: To explore undergraduate nursing students’ perception and attitude toward the OSCE. Methods: This cross-sectional descriptive study was conducted between April-May 2020, among undergraduate nursing students in the College of Nursing at Sultan Qaboos University. Two self-administered questionnaires were employed to obtain data on students’ perception and attitude toward OSCE. Students’ feedback on OSCE was collected using open-ended questions about OSCE strengths, weakness, and recommendation for improvement. Surveys responses were based on a 5-point ordinal scale ranging from strongly disagree to strongly agree. Students’ Feedback on OSCE was analyzed as descriptive data by identifying the common themes and categorize them in groups. Results: A total of 160 students completed the study questionnaires. Most agreed that OSCE atmosphere is not good (66.3%) and it shouldn’t be the only mode of practical Examination (40.6%). Also, 64.4% of the students felt that timing allocated to complete the skills was not adequate. The data shows that 33.1% of the examinees felt that OSCE examination is more stressful than clinical examination. In addition, few students supported that OSCE has improved their communication skills and it increased their confidence level to perform nursing skills. Conclusion: The findings of this study appear alarming in regard to students’ perception about the overall process and the validity of OSCE examination as an assessment method. Nursing educators need to consider further evaluation and improvement of the OSCE in order to improve students’ acceptance and appreciation of OSCE as an important form of clinical learning and as an assessment method. Keywords: Objective Structured Clinical Examination; Nursing Education; Baccalaureate; Evaluation; Attitude; Nursing Students; Practical Nursing

Hepatitis C Virus Infection in Populations With Liver-Related Diseases in the Middle East and North Africa.

We investigated hepatitis C virus (HCV) epidemiology in populations with liver-related diseases (LRDs) in the Middle East and North Africa. The data source was standardized databases of HCV measures populated through systematic reviews. Random-effects meta-analyses and meta-regressions were performed, and genotype diversity was assessed. Analyses were based on 252 HCV antibody prevalence measures, eight viremic rate measures, and 30 genotype measures on 132,358 subjects. Pooled mean prevalence in LRD populations was 58.8% (95% confidence interval [CI], 51.5%-66.0%) in Egypt and 55.8% (95% CI, 49.1%-62.4%) in Pakistan; these values were higher than in other countries, which had a pooled prevalence of only 15.6% (95% CI, 12.4%-19.0%). Mean prevalence was highest in patients with hepatocellular carcinoma at 56.9% (95% CI, 50.2%-63.5%) and those with cirrhosis at 50.4% (95% CI, 40.8%-60.0%). Type of LRD population and country were the strongest predictors of prevalence, explaining 48.6% of the variation. No evidence for prevalence decline was found, but there was strong evidence for prevalence increase in Pakistan. A strong, positive association was identified between prevalence in the general population and that in LRD populations; the Pearson correlation coefficient ranged between 0.605 and 0.862. The pooled mean viremic rate was 75.5% (95% CI, 61.0%-87.6%). Genotype 4 was most common (44.2%), followed by genotype 3 (34.5%), genotype 1 (17.0%), genotype 2 (3.5%), genotype 6 (0.5%), and genotype 5 (0.3%). Conclusion: HCV appears to play a dominant role in liver diseases in Egypt and Pakistan and has a growing role in Pakistan. Testing and treatment of LRD populations are essential to reduce disease burden and transmission and to reach HCV elimination by 2030

The negotiated order and electronic patient records:a sociomaterial perspective

In this article, we consider how the notion of the negotiated order can be reinterpreted by drawing on ideas from sociomateriality. We argue that the negotiated order is an ongoing accomplishment in which a heterogeneous set of situated sociomaterial practices (or actors) are implicated. To do this, we draw upon an in-depth study of the use of a computerised physician order entry system in a hospital in Saudi Arabia. We explore how a computerised physician order entry system, as a new sociomaterial actor, performatively repositions the actors involved and hence offers the conditions of possibility for medical work practices to be renegotiated. We show that it is often contingent, mundane, situated sociomaterial practices that enact the conditions under which the negotiated order becomes re-established in terms of division of labour, legitimacy, collaboration, and social capital. We argue that as the social and material are co-constitutive, or intra-actional, it makes more sense to talk about the negotiated intra-actional order rather than the negotiated order. Importantly, such a change in conceptual vocabulary reveals the empirical and ontological issues at stake; essential for a more nuanced understanding of change/becoming

Knowledge, Misconceptions and Attitudes towards Labor Regional Analgesia in a University Hospital: A Cross-Sectional Study

Background: Pain relief in labor is considered an important concern in the management of pregnant females in childbirth. The aim of this study is to assess the knowledge and attitudes of Jordanian females towards various regional analgesic techniques. Methods: We conducted a cross-sectional survey on 652 Jordanian women with a mean age of 32.9 (±8.17). Data collection took place at the gynecological and obstetrics clinics between December, 2017 and September, 2018. Results: Subjects with higher educational levels tend to have better knowledge about regional analgesia (p-value = 0.003), are less likely to ask for general anesthesia (GA) (p < 0.001), and have more previous regional analgesia 47.9% (p < 0.001). Moreover, multiparous women had better knowledge about regional analgesia and higher tendency to ask for it as an efficacious analgesic method during delivery (p < 0.05). Conclusions: In conclusion, even though higher educational levels and multiparty were significantly associated with better knowledge and acceptance rate of regional analgesia, sources of information about regional analgesia plays an important role, emphasizing on the significant role of anesthesiologists and obstetricians in increasing the awareness levels in our society

Strategic network: Managerial myopia point of view

The strategic network of any organization plays a significant role in the industry. Therefore, companies must study the factors hindering the construction of this network. Companies need a strategic network of alliances and partnerships to complement each other and constitute a superpower that competitors cannot overcome. This study explores the size of obstacles posed by managerial myopia in weakening the ability of organizations to build their strategic network. Current paper tests the influential relationship between managerial myopia and the ability of organizations to build their strategic network in one of the most important institutions within the oil sector. Results show a negative impact of managerial short-sightedness on an organization's ability to build a successful strategic network that enables it to coexist within an atmosphere of competition. This study recommends that organizations adopt the concept of managerial hyperopia as a valuable tool for organizational success