'Speaking Up' for patient safety and staff well-being::a qualitative study

Background Freedom To Speak Up Guardians (FTSUGs) and Confidential Contacts (CCs) were appointed nationally following the Mid Staffordshire inquiry to listen to and support staff who were unable to address concerns through normal channels of communication.Aim Explore perceptions of an FTSUG and CCs through shared experiences and personal stories.Objectives (1) Explore perceptions of an FTSUG and CCs. (2) Consider how individuals can be best supported. (3) Improve staff knowledge on speaking up. (4) Understand factors influencing reflections around patient safety. (5) Share exemplars of good practice through use of personal stories to promote a culture of openness to raise concerns.Method A focus group of eight participants, namely the FTSUG and CCs working within one large National Health Service (NHS) trust, was used to gather data. Data were collated and organised using a created table. Thematic analysis enabled each theme to emerge and be identified.Conclusion (1) An innovative approach to the introduction, development and implementation of an FTSUG and CC roles and responsibilities in healthcare. (2) To gain insight into the personal experiences of a FTSUG and CCs working within one large NHS trust. (3) To be supportive of culture change with committed leadership responsiveness

Study of fetomaternal arterial doppler parameters in early onset pre-eclampsia and its correlation with perinatal outcomes

Background: Development of pre-eclampsia (PE) at less than 34 weeks of gestation is known as early onset PE (EOPE) and is commonly associated with more severe adverse maternal and fetal outcomes. The purpose of this study was to study Doppler parameters of uterine, umbilical and fetal middle cerebral arteries exclusively in women with EOPE and its correlation with perinatal outcomes. This study was a hospital-based observational prospective study.Methods: 60 patient of early onset PE with singleton live pregnancy were included in the study and followed up. The results of sonographic and Doppler examination were analysed and correlated with perinatal outcomes.Results: Adverse perinatal outcomes were seen in 66.66% cases of early onset PE. To predict adverse perinatal outcomes, umbilical artery (Umb A) RI, PI were found to be most sensitive, cerebroplacental ratio (CPR) was most specific indicator with highest positive predictive value (PPV). Absent end diastolic flow /reverse end diastolic flow (AEDF/REDF) were ominous signs.Conclusions: Early onset PE is recently considered a more severe disease with different etiopathogenesis. Doppler study is the primary imaging modality for fetomaternal surveillance for follow up and prediction of perinatal outcome, thus allowing planning of timely management in early onset PE patients, as these patients are at higher risk of adverse perinatal outcomes

Role of corticotropin-releasing hormone in the impact of chronic stress during pregnancy on inducing depression in male offspring mice

This is an accepted manuscript of an article published by Elsevier in Brain Research on 30/07/2020, available online: https://doi.org/10.1016/j.brainres.2020.147029 The accepted version of the publication may differ from the final published version.This work was supported by the National Natural Science Foundation of China (grant no. 81773452).Published versio

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

IMPORTANCE AND CHALLENGES OF CONSERVATION AND SUSTAINABLE DEVELOPMENT OF THE ENVIRONMENT

Abstract: Environment protection is essential for long-term sustainable growth and development in all aspects of life. The ultimate goal of sustainable development is to achieve a balance between the environmental, economic, and socio-political parameters without jeopardizing the quality of life and environment. Sustainable development is constantly pushing us to increase and conserve our resource use through cutting-edge technologies. Every country must meet the fundamental needs for employment, food, energy, water, and sanitary facilities. Everyone has the right to live in a safe and healthy environment. This can be accomplished quickly by reducing pollution, poverty, and unemployment. To legitimize sustainability across all industries, India has passed legislation like the National Green Tribunal Act, 2010. However, the seriousness and efficacy of these laws in terms of the country's environmental standards are being called into question due to a lack of implementation. The importance and challenges of environmental sustainability are discussed in the current chapter. Along with this, India’s environmental regulation is also emphasized

Renal Involvement in Primary Sjogren's Syndrome: A Case Series of Three Cases with Various Clinicopathological Presentations

Sjogren's syndrome is a prevalent and underdiagnosed systemic disease that primarily affects epithelial tissue. It may affect renal function, either as an epithelial disease causing tubulointerstitial nephritis (TIN) or as an immune complex-mediated glomerulopathy. These lesions may cause a variety of clinical features, both overt and occult. The epithelial disease is mediated by B and T cells. The prevalence of renal involvement in primary Sjogren's syndrome has been reported to range approximately from 10% to 30%. Patients with renal involvement in primary Sjogren's syndrome may have renal manifestations, such as renal tubular acidosis (RTA) Type I, TIN, diabetes insipidus, nephrolithiasis, and Fanconi syndrome. Distal RTA was reported more commonly than proximal RTA, which can present as acute hypokalemic paralysis. We present three cases of primary Sjogren's syndrome with significant renal involvement and various clinicopathological presentations

Sikh healthy faith setting toolkit

Sikh Healthy Faith Setting Toolkit produced by the Centre for Sikh and Panjabi Studies and commissioned by Birmingham City Council. For re-use please contact Birmingham City Council.Birmingham City Council

Efficacy of virtual education program to evaluate the knowledge of young mothers in Developmental Milestones: A survey in Delhi/NCR

Efficacy of Virtual Education Program to evaluate the Knowledge of Young Mothers in Developmental Milestones. -A survey in Delhi/NCR. Objective: To evaluate the effectiveness of virtual education program to assess knowledge of young mothers in identifying developmental milestones. Design: A Cross section study was performed on young mothers via online mode of (pre-posttest). Outcome measures: Google form. Population: Young mothers within Delhi NCR, with no more than two children, and a mean age of 20-45 years were included. Backgroud and Purpose: In this study online session have given to assess the knowledge of young mothers in identifying developmental milestones. The purpose of this study was (1) to evaluate the efficacy of online education program on knowledge of young mothers to identifying developmental milestones, (2) To evaluate the outcomes of pre-test and posttest. Subjects. The participants were 100 young mothers from Delhi NCR. Methods. Self-structured questionnaire on knowledge regarding developmental milestones was used in this study, the questionnaire consists of 12 multiple choice answer questions in both the pre-test and post-test, with a video demonstrating the chronological progression of each gross motor milestone ranging from first month of life to twelve months respectfully. Each mother participated in the questionnaire

Efficacy of transcutaneous electronic nerve stimulation in alleviating pain during inferior alveolar nerve block injections in pediatric dentistry

Aim: This study was carried out with the aim of comparing the efficacy of Transcutaneous electrical nerve stimulation (TENS) and 20% benzocaine gel prior to inferior alveolar nerve block (IANB) injections in alleviating pain in children of 8–12 years of age. Materials and Methods: The sample included fifty children in whom TENS application was done and fifty children in whom benzocaine topical application was done prior to administration of IANB injections for the extraction of mandibular posterior teeth. Pain perception was evaluated using Wong–Bakers Facial Pain Rating Scale in both the groups. ANOVA test was used to evaluate the differences in mean pain scores between the groups. Results: The patients demonstrated significant reduction in pain during IANB when TENS was used with a mean pain score of 3.36 as compared to topical application of local anesthetic agent with a mean pain score of 4.76, indicating higher efficacy of TENS. Conclusion: Application of TENS was more comfortable and significantly reduced pain. TENS is a safe, reliable, and practical alternative to be used in pediatric dentistry