Resilience of refugees displaced in the developing world: a qualitative analysis of strengths and struggles of urban refugees in Nepal

BACKGROUND: Mental health and psychosocial wellbeing are key concerns in displaced populations. Despite urban refugees constituting more than half of the world's refugees, minimal attention has been paid to their psychosocial wellbeing. The purpose of this study was to assess coping behaviour and aspects of resilience amongst refugees in Kathmandu, Nepal. METHODS: This study examined the experiences of 16 Pakistani and 8 Somali urban refugees in Kathmandu, Nepal through in-depth individual interviews, focus groups, and Photovoice methodology. Such qualitative approaches enabled us to broadly discuss themes such as personal experiences of being a refugee in Kathmandu, perceived causes of psychosocial distress, and strategies and resources for coping. Thematic network analysis was used in this study to systematically interpret and code the data. RESULTS: Our findings highlight that urban refugees' active coping efforts, notwithstanding significant adversity and resulting distress, are most frequently through primary relationships. Informed by Axel Honneth's theory on the struggle for recognition, findings suggest that coping is a function beyond the individual and involves the ability to negotiate recognition. This negotiation involves not only primary relationships, but also the legal order and other social networks such as family and friends. Honneth's work was used because of its emphasis on the importance of legal recognition and larger structural factors in facilitating daily coping. CONCLUSIONS: Understanding how urban refugees cope by negotiating access to various forms of recognition in the absence of legal-recognition will enable organisations working with them to leverage such strengths and develop relevant programmes. In particular, building on these existing resources will lead to culturally compelling and sustainable care for these populations

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Energy security of the state: assessment of the level and main directions of strengthening

Thesis for an Academic Degree Master of Economics specialty 1-25 80 01 «Economics». Scientific adviser: Candidate of economic Sciences, Associate Professor Natallia Sychov

Optimization of Tillage Operation Parameters to Enhance Straw Incorporation in Rice-Wheat Rotation Field

In the rice-wheat system, using straw for soil incorporation provides better soil health and improves agricultural production. The experiment was performed in Babaiqiao town, Jiangsu Province, China’s Luhe District, Nanjing City, in June 2024 using a Shichao TG-500 tractor equipped with a Qingxuan 1GKN-180 rotary cultivator. The impacts of the three tillage practices, deep rotary tiller with straw (DRTS), shallow rotary tiller with straw (SRTS), and no-tillage with straw return (NTSR), on the level of soil disturbance were observed in the single-factor and two-factor interaction experiments. Based on the profilometry analysis, it was observed that DRTS had the highest value of soil disturbance while SRTS had a moderate disturbance value and NTSR minimized disturbance. The effects of working depths, forward speed, and rotation speed on the straw return rate have been evaluated by further investigations. The results showed that enhancing straw return rates was significantly impacted by changing the tilling depths and the rotation speeds, especially when using deeper tillage and moderate to high rotary speeds. The investigation found that the forward speed, blade rotation speed, and tillage depth explained the overall rates of straw return, soil breaking, and soil flatness. In the research, the response surface design employed was the Box–Behnken Design (BBD). The optimal operating parameters were 14.23 cm of plowing depth, 297.6 rpm for the rotary blades, and 3.23 km/h for forward speed. Achieved were the following parameters: 94.766% soil breakage rate, 84.97% straw return rates, and 16.36 mm soil flatness. The findings demonstrate the potential to implement strategies through operational parameters to significantly enhance agricultural practices

Impact of a community-based medication delivery program for antihypertensive medications on adherence and blood pressure reduction

Abstract Background Elevated blood pressure (BP) is the leading risk of death globally, and its burden continues to rise, disproportionately so in low- and middle-income countries. Non-adherence to antihypertensive medications is a major cause of uncontrolled hypertension, leading to cardiovascular morbidity and mortality. Ensuring consistent medication access and possession is crucial in addressing non-adherence. Community-based medication delivery is a strategy that can lead to improvement in medication possession, medication adherence, and subsequently BP reduction. Purpose Our program in western Kenya piloted a community medication delivery program for hypertensive patients, aiming to remove structural barriers to medication possession and ensuring consistent access to antihypertensive medications. Here, we reviewed secondary clinical data to evaluate the impact of this program on BP reduction and medication adherence. Methods We conducted a retrospective analysis using clinical records of hypertensive patients who participated in the medication delivery program. Between September 2019 and March 2020, patients who received care from our community-based chronic disease management program also received anti-hypertensive medications delivered to them at their doorstep. We compared differences in self-reported medication adherence and BP reduction between patients who got medication deliveries versus those who did not. Mixed effect models, controlling for baseline measurements, age, gender, and health insurance status were used to analyze outcomes of interest. Results A total of 124 patient records (80.6% female) were reviewed. Baseline systolic blood pressure (SBP) was 155.7 mmHg and baseline self-reported adherence per the Voils DOSE-Nonadherence measure was 2.7, with 1 being perfect adherence and 5 representing poor adherence. 48.4% of patients received at least 1 successful medication delivery. Patients who did not receive any medication deliveries had an SBP increase of 1.5 mmHg relative to baseline, whereas patients who received 1 medication delivery had an SBP reduction of 8 mmHg and patients who received 2 or more medication deliveries had an SBP reduction of 15.2 mmHg (Figure 1). Similarly, change in self-reported medication adherence was poorer in patients who received no medication deliveries (+0.1) versus those who received one medication delivery (−0.5) or 2 or more deliveries (−0.7). Mixed-effect model estimates demonstrated that relative to patients who did not receive any medication deliveries, mean SBP reduction was significantly greater among individuals who did receive medication deliveries (Table 1). Conclusions A community medication delivery program in western Kenya led to improved medication adherence and systolic blood pressure reduction. This is a promising strategy to improve hypertension outcomes for patients with uncontrolled hypertension by removing structural barriers to medication possession. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Purdue University Gloria Franke Pharmacy Practice Advancement Grant Change in blood pressure and adherenceMixed-effect model estimates </jats:sec