The proliferation of motor tricycle usage in precarious transportation contexts and the performance of micro and small manufacturers

Micro and small businesses (MSBs) in developing countries increasingly use motor tricycles to navigate transportation-induced supply chain disruptions. However, there is a lack of empirical understanding of whether and when these resources benefit such firms. This study draws on the contingent resource-based theory to examine how motor tricycle deployment relates to the performance of MSBs under varying conditions of supply chain dynamism in a developing country. The study tests its hypotheses on primary data from 267 micro and small manufacturers in Ghana using moderated regression analysis. The results indicate that motor tricycle deployment positively relates to MSB performance in Ghana (β = 0.024, SE = 0.007, p = 0.001). The results further show that supply chain dynamism positively moderates the relationship between motor tricycle deployment and MSB performance (β = 0.008, SE = 0.004, p = 0.035). In contributing to the limited literature on the firm-level performance implications of the increasing use of motor tricycles among micro and small businesses in developing countries, this study's results underscore the importance of adopting a contingency-based approach to understand the complexities inherent in the relationship between motor tricycle deployment and firm performance in these settings

Associations of blood glucose levels with some diabetes risk factors (body mass index, blood pressure and total body fat) in inhabitants of Ho Municipality, Ghana: a cross-sectional survey

One complex metabolic disorder that can unenviably affect the normal human physiology is diabetes mellitus (DM). It is indeed one of the commonest noncommunicable diseases that has heightened to an epidemic level worldwide. For diseases like DM, hypertension, cardiovascular disease, type II DM, and other chronic diseases, body mass index (BMI) is identified as a positive and independent risk factor associated with morbidity and mortality. The objective of the study was to determine the relationships between BMI, blood pressure, and total body fat among inhabitants of periurban Ho, Ghana. A cross-sectional survey was carried out between May and June, 2018, among 132 inhabitants of Ho to determine the prevalence and associations among DM risk factors. The participants were selected by systematic random sampling. Standardized international protocols were used to measure BMI, blood pressure, blood glucose, and total body fat. Out of 132 respondents, majority 96 (72.7%) were female and the most common age group was 54-60 (31.1%). From the BMI classifications, 65 (49.2%) people were of normal weight while 6 (4.5%) were underweight. Total body fat (%) and blood pressure, likewise total body fat and BMI recorded significant associations of values (0.299, p<0.001-systolic; 0.298, p=0.001-diastolic), and 0.585 (p<0.001), respectively. On the contrary, there were insignificant associations found between blood glucose and diastolic blood pressure and also blood glucose and systolic blood pressure (0.100, p=0.253) and (0.057. p=0.514), respectively using the Spearman’s correlation analysis. Lastly, the test of association of socio-demographics and anthropometrics revealed there was a significant (p<0.001) correlation between total body fat and BMI using Pearson’s correlation analysis. BMI is closely related to total body fat and blood pressure; hence, education on lifestyle modification needs to be intensified to create awareness among the inhabitants of Ho municipality of Ghana. It is imperative to educate Ghanaians and beyond about the risk factor associations that predispose an individual to DM

Exploring the knowledge and awareness of diabetes mellitus among inhabitants of Ho municipality in Ghana: A cross-sectional study

One of the fast-growing major non-communicable diseases (NCD) that poses a danger to global public health is Diabetes mellitus (DM). Trends in  the incidence of DM indicate a disproportionate increase in developing countries due to current rapid demographic transitions from traditional to  more westernized and urbanized lifestyles. Knowledge of DM is vital for curbing or control. The objectives of this study were to evaluate the level of  knowledge and awareness of DM among the Ho municipality general population, identify areas of deficiency for targeted health education efforts,  and identify respondent characteristics that may be associated with knowledge of diabetes. A survey involving 132 respondents (age over 18 years)  was conducted in the Ho municipality of the Volta region of Ghana. A 42-item pre-tested questionnaire was administered to participants to evaluate  general and specific knowledge and awareness of DM. The Pairwise Multiple Comparison and Fisher’s Exact tests were used to test the hypotheses  and associations between the respondents’ knowledge level and groups respectively. Of the 132 respondents, 22% were in the age range of 40-46  years; 72.7% were female. Mean over all diabetes knowledge composite score was poor: 32.99% (CI; 27.5, 38.5). Respondents performed best in the  symptoms section: mean score was 36.247% (CI; 29.0, 43.4); and worst in the section on complications: mean score was 30.909% (CI; 23.6, 38.2). In  multiple linear regression analyses, education level, older age, own self having diabetes, and having a family member/relative/friend with diabetes  were significantly associated with knowledge of diabetes. Knowledge of diabetes among the inhabitants of Ho municipality respondents was  interpreted as being inadequate 32.99% (CI; 27.5, 38.5). Some deficient portions and factors associated with knowledge of diabetes were identified.  Relevant information for targeted health education programs in Ghana and beyond may be considered as one of such benefits of these findings.  &nbsp

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

In search of operational resilience: how and when improvisation matters

The need to improvise during supply chain disruptions to enhance operational resilience is ever more critical. Yet, managers appear to lack an understanding of how and when improvisation matters. We apply the conservation of resources theory to conceptualize how firms activate spontaneous and creative improvisation during supply chain disruptions and theorize how that relates to operational resilience in low and high supply chain disruption conditions. We test our arguments on primary data from a sample of 259 firms in Ghana. We find that creative improvisation has a positive relationship with operational resilience, and this relationship is stronger in high supply chain disruption conditions. Spontaneous improvisation, on the contrary, is unrelated to operational resilience in both low and high supply chain disruption conditions. These findings indicate that not all types of improvisation contribute to operational resilience, suggesting the need for a nuanced approach to theorizing and applying the improvisation concept in supply chains

Global Retinoblastoma Presentation and Analysis by National Income Level

This cross-sectional analysis reports the retinoblastoma stage at diagnosis across the world during a single year, investigates associations between clinical variables and national income level, and investigates risk factors for advanced disease at diagnosis. Key PointsQuestionIs the income level of a country of residence associated with the clinical stage of presentation of patients with retinoblastoma? FindingsIn this cross-sectional analysis that included 4351 patients with newly diagnosed retinoblastoma, approximately half of all new retinoblastoma cases worldwide in 2017, 49.1\% of patients from low-income countries had extraocular tumor at time of diagnosis compared with 1.5\% of patients from high-income countries. MeaningThe clinical stage of presentation of retinoblastoma, which has a major influence on survival, significantly differs among patients from low-income and high-income countries, which may warrant intervention on national and international levels. ImportanceEarly diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. ObjectivesTo report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and ParticipantsA total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and MeasuresAge at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. ResultsThe cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4\%) were female. Most patients (n=3685 {[}84.7\%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n=2638 {[}62.8\%]), followed by strabismus (n=429 {[}10.2\%]) and proptosis (n=309 {[}7.4\%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5\%) patients having intraocular retinoblastoma and 2 (0.3\%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1\%) having extraocular retinoblastoma and 94 of 498 (18.9\%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 {[}95\% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 {[}95\% CI, 4.30-7.68]). Conclusions and RelevanceThis study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs