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A Critical Review of the Circular Economy Concept and Sustainable Development in Bamenda, Northwest Region of Cameroon
No full textIt is assumed that deploying the Circular Economy (CE) model will result in high resource efficiency (Boon & Anuga, 2020). This study contrasts the appeal for CE with what Chambers (2014) refers to as outsiders. This paper investigates the circular economy concept and strategies in place for circularity in the agro-food and ecology sector in Bamenda (I & III) Northwest Region of Cameroon, with a focus on SDGs 2 (zero hunger), 5 (gender equality), 10 (reduced inequalities), 12 (responsible consumption and production), and 13 (climate change). Data was collected via semi-structured interviews with ten organizations in the agro-food and ecology sector and focus group discussions with eight farmers. Secondary data was also collected via a review of related literature. A qualitative research design was employed, specifically a survey that allowed for probing and measuring variables related to circular economy and sustainable development. Primary data collected was analyzed using Microsoft Online for transcription and NVivo 14, a software program for qualitative data analysis. The analysis followed an inductive thematic approach, which involves identifying patterns and themes within the data without preconceived categories. This paper provides a comprehensive overview of the circular economy concept and the strategies to achieve circularity in Bamenda (I & III). It highlights techniques used for circularity, emphasizing resource reuse, recycling, and multi-use strategies. This study found that circular farming practices have significant potential to drive sustainable development and achieve SDGs 2, 5, 10, 12, and 13 in Bamenda. Local receptiveness to circular practices is evident, with many already involved. It recommends leveraging existing circular practices and knowledge to effectively communicate the benefits of circular economy principles to drive sustainable development. However, the study reveals a lack of widespread adoption due to knowledge and technological gaps. To overcome barriers, it recommends awareness campaigns, policy support, capacity building, and leveraging indigenous knowledge. Political instability also poses challenges, necessitating a stable environment for circular development. Overall, circular practices can enhance environmental sustainability, reduce waste, and improve livelihoods in Bamenda. Key findings highlight the importance of tangible benefits, supportive policies, local engagement, revised definitions emphasizing societal-wide prosperity, regenerative practices, addressing gender disparities, and addressing waste management challenges
Multimodal imaging in Schubert-Bornschein congenital stationary night blindness
No full textBackground: Schubert-Bornschein (SB) is the most common type of people with congenital stationary night blindness (CSNB). The aim of the study is to describe the optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) findings in patients with SB CSNB. Methods: Prospective, observational case series including three patients with genetically confirmed CSNB along with matched controls, who underwent complete ophthalmic examination and multimodal imaging. Results: On SD-OCT, a significant focal outer plexiform layer (OPL) thickening and a corresponding focal outer nuclear layer (ONL) thinning were identified in the macular area (p < 0.001). OCTA analysis overall showed decreased density of macular deep capillary plexus (mDCP) and macular choriocapillaris (mCC) (p = 0.008 and p = 0.033, respectively). DCP vessel density in the area corresponding to OPL thickening was significantly increased compared to the remaining retina (p < 0.001). Conclusion: SB CSNB is characterized by retinal vascular impairment, as detected on OCTA. © 2022 Taylor & Francis Group, LLC
Exploring the diverse definitions of 'evidence': A scoping review
Get PDFObjectives To systematically collect and analyse diverse definitions of 'evidence' in both health and social sciences, and help users to correctly use the term ' evidence' and rethink what is the definition of ' evidence' in scientific research. Design Scoping review. Methods Definitions of evidence in the health sciences and social sciences were included. We have excluded the definition of evidence applied in the legal field, abstracts without full text, documents not published in either Chinese or English and so on. We established a multidisciplinary working group and systematically searched five electronic databases including Medline, Web of Science, EBSCO, the Chinese Social Sciences Citation Index and the Chinese Science Citation Database from their inception to 26 February 2022. We also searched websites and reviewed the reference lists of the identified studies. Six reviewers working in pairs, independently, selected studies according to the inclusion and exclusion criteria, and extracted information. Any differences were discussed in pairs, and if there was disagreement, it was resolved via discussion or with the help of a third reviewer. Reviewers extracted document characteristics, the original content for the definitions of ' evidence', assessed definitions as either intensional or extensional, and any citations for the given definition. Results Forty-nine documents were finally included after screening, and 68 definitions were obtained. After excluding duplicates, a total of 54 different definitions of ' evidence' were identified. There were 42 intensional definitions and 12 extensional definitions. The top three definiens were ' information', ' fact' and ' research/study'. The definition of ' evidence' differed between health and social sciences. The term ' research' appeared most frequently in the definitions. Conclusions The definition of ' evidence' has gradually attracted the attention of many scholars and decision-makers in health and social sciences. Nevertheless, there is no widely recognised and accepted definition in scientific research. Given the wide use of the term, we need to think about whether, or under what circumstances, a standardised, clear, meaningful and widely applicable definition of ' evidence' might be helpful. © 2024 Author(s). Published by BMJ
Nutrition Knowledge, Attitudes, and Practice towards Breast Cancer Prevention among University Female Students in Lebanon
Get PDFBackground: According to the International Agency for Research on Cancer (IARC), breast cancer (BC) became the most diagnosed cancer type in 2020 worldwide, in general, and in Lebanon in specific. The median age at diagnosis of patients with BC in Lebanon is 10 years earlier than that in the United States (U.S.). Early preventive measures in the Lebanese young female population could mitigate the increased incidence of the disease. Accumulating evidence is showing that adopting adequate dietary practices could reduce the burden of BC.
Objectives: The objective of this study is to assess nutrition-related BC prevention knowledge, attitudes, and practice (KAP) of female university students, and to examine the relationship between sociodemographic, anthropometric, behavioral, and general characteristics of students and their KAP.
Methods: A cross-sectional study was carried out between February and March 2023 on a convenient sample of 356 American University of Beirut (AUB) female students aged between 18 and 25 years old, with no previous or current diagnosis of BC from all 7 faculties at AUB.
A self-administered questionnaire was used to obtain information on nutrition KAP towards BC prevention as well as information on the sociodemographic, anthropometric, behavioral, and general characteristics of the students. The knowledge part of the questionnaire addressed the students’ knowledge of the relationship between diet and BC, and impact of other non-modifiable and modifiable nutrition-related BC risk factors, and the relationship between certain food items with BC. The attitude part of the questionnaire collected information on whether the students believe that nutrition or food selection can decrease the risk of BC, and that adherence to a healthy diet can reduce the risk of developing BC in the next generation. The practice questionnaire collected information on the students’ usual intake of specific foods reported to be associated with BC. Descriptive and analytical statistics were used to assess nutrition- related BC prevention knowledge, attitudes, and practice (KAP) of female university students, and to examine the association between sociodemographic, anthropometric, behavioral, and general characteristics of students and their KAP. The final scores of each of the KAP were summed up for every student. The ranges of answers varied between 0-18 for knowledge, 0-28 for attitude, and 0-30 for practice.
Knowledge and practice scores were considered poor (scores < median score) and good (scores ≥ median score). Good knowledge scores were noted for those who received a score of ≥ 12.00, and good practice scores were given for those with scores ≥ 10.00. Attitudes were categorized as negative (scores < median of 20.00) and positive (scores ≥ median score of 20.00). All analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 25.
Results: The mean and median scores of knowledge, attitude, and practice of the total sample were similar with 11.68 ± 3.30, 19.62 ± 2.84, and 9.40 ± 5.59, for the mean and 12.00, 20.00, and 10.00, for the median respectively. The ranges of scores obtained for KAP were 2-18, 9-27, and 0-30, respectively.
A significantly higher percentage of students had good knowledge and positive attitude scores if they were majoring in a health-related major as compared to those in non- health-related majors (73.2% vs 45.5%, and 62.7% vs 41.1%,, respectively).
The mean GPA of students having good knowledge scores was significantly greater than that of students having poor knowledge scores (3.54 ± 0.40 vs 3.43 ± 0.48, respectively). Students having positive attitude or good practice scores were more likely to have a GPA ≥3.63 compared to those having a negative attitude or poor practice (51.6% vs 37.8%, and 50.9% vs 37.8%, respectively).
Those having a positive attitude score were also significantly less likely to report their “amount of perceived stress” as ≥3 compared to those having negative attitude (93.3% vs 97.7%). The mean knowledge and attitude scores of the health-related majors’ students were significantly higher than that of non-health-related majors’ students (12.67 ± 2.97 vs 10.9 ± 3.35, and 20.46 ± 2.69 vs 19.00 ± 2.80, respectively). There was a statistically significant positive correlation between the overall knowledge and the overall attitude (r=0.41). However, there was no statistically significant correlation between practice and each of the knowledge or attitudes’ scores. Both health-related majors and GPA (capped at 4.0) were significant predictors of both total knowledge and total attitude scores, while only GPA was a significant predictor of total practice score.
Conclusion: This study showed that pursuing a health-related major positively influenced the students’ nutrition knowledge and attitude scores of BC prevention, and that having a higher GPA predicted better nutrition KAP toward BC prevention. The amount of perceived stress negatively influenced nutrition attitude scores. These findings provide evidence for a relationship between health education and KAP and encourage further expansion in the Lebanese female population to develop evidence- based culture-specific awareness campaigns to mitigate the increasing trend of BC in the Lebanese female population. Future studies are needed, on a larger scale, to unravel the predictors of nutrition-related BC prevention practices, in the Lebanese population
Working together for patient health: Assessing interprofessional competencies among healthcare professionals in Lebanon
Get PDFIntroduction: Interprofessional collaboration (IPC) is the gold standard for safe, high-quality, and accessible patient-centered care. This study aims to assess IPC core competencies among Lebanese healthcare providers from different professions and explore the influence of several factors, including leadership, work ethics, and specialty, on healthcare IPC in Lebanon. Methods: This cross-sectional online survey enrolled 245 healthcare workers in Lebanon between July and December 2021. The Interprofessional Education Collaborative (IPEC) Competency Self-Assessment Tool Version 3 was used to assess IPC. Bivariate and multivariate analyses were carried out to compare the total competency scale and subscales between the leadership group, work ethic, specialty, and education level, taking into account potential confounding variables, namely, age and gender. Results: The mean competency total scale was 4.22 ± 0.68. The bivariate analysis showed a significantly higher mean competency among participants who have a full-time job, higher administrative leadership (4.30 vs. 3.08, p = 0.001), interpersonal leadership (4.29 vs. 2.94, p = 0.006), conceptual leadership (4.28 vs. 3.15, p = 0.010) and higher work ethics (4.51 vs. 4.12, p < 0.001). Older age (r = 0.15, p = 0.017) was also significantly associated with higher competency. The multivariate analysis showed that having only high work ethics, as compared to low, remains significantly associated with higher total interprofessional competency, including the Interaction and Interprofessional Values subscales. No differences in IPEC scales between pharmacists and other healthcare providers were noted. Conclusion: The IPEC total competency score was higher among full-time healthcare providers and those who scored higher on leadership skills and work ethics. The study outcome shows the importance of education in interprofessional practice. © 2023 Elsevier Inc
Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries
Get PDFImportance: Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective: To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Design, Setting, and Participants: Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Exposures: Countries' per capita income levels and world region; individuals' socioeconomic demographics. Main Outcomes and Measures: Self-reported use of aspirin for secondary prevention of CVD. Results: The overall pooled sample included 124505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Conclusion and Relevance: Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.. © 2023 American Medical Association. All rights reserved
Investigating the possible mechanisms of autonomic dysfunction post-COVID-19
Get PDFPatients with long COVID suffer from many neurological manifestations that persist for 3 months following infection by SARS-CoV-2. Autonomic dysfunction (AD) or dysautonomia is one complication of long COVID that causes patients to experience fatigue, dizziness, syncope, dyspnea, orthostatic intolerance, nausea, vomiting, and heart palpitations. The pathophysiology behind AD onset post-COVID is largely unknown. As such, this review aims to highlight the potential mechanisms by which AD occurs in patients with long COVID. The first proposed mechanism includes the direct invasion of the hypothalamus or the medulla by SARS-CoV-2. Entry to these autonomic centers may occur through the neuronal or hematogenous routes. However, evidence so far indicates that neurological manifestations such as AD are caused indirectly. Another mechanism is autoimmunity whereby autoantibodies against different receptors and glycoproteins expressed on cellular membranes are produced. Additionally, persistent inflammation and hypoxia can work separately or together to promote sympathetic overactivation in a bidirectional interaction. Renin-angiotensin system imbalance can also drive AD in long COVID through the downregulation of relevant receptors and formation of autoantibodies. Understanding the pathophysiology of AD post-COVID-19 may help provide early diagnosis and better therapy for patients. © 202
SYSTEMATIC INTERVENTION TO REDUCE RADIATION DOSE FROM FLUOROSCOPIC GUIDED PROCEDURES IN THE RADIOLOGY DEPARTMENT
No full textBackground: Radiation effects are one of the pillars that determines how radiologists, radiology technologists and radiology trainees practice radiology and take decisions related to patient care and management. Although the risk of cancer increases with the ionizing radiation dose, the severity of the stochastic effects does not; the patients will either develop cancer or will not. Hence, the principle “as low as reasonably achievable” (ALARA) of radioprotection became fundamental to the principles of radiation protection. Fluoroscopic guided lumbar puncture to retrieve CSF is an example of a radiological procedure that may potentially result in a significant radiation dose. We developed a 3-point systematic approach with checklist for fluoroscopic guided lumbar puncture, with the aim to decrease the radiation dose/fluoroscopy time of the procedure.
Objectives: In this study we aim to check if our developed 3-point systematic approach with checklist for the fluoroscopic guided lumbar puncture will reduce the fluoroscopic time of the procedure with similar or improved complications and failure rates compared to the standard technique.
Methods: We did a retrospective review of patients that underwent fluoroscopic guided lumbar puncture (LP) in the department of Radiology, at the University of Iowa Hospitals and Clinic, Iowa City, IA, USA between 2019 and 2021. 145 cases performed using the developed 3-point systematic approach with checklist and 226 cases performed using the standard technique were included in our study. We collected data on relevant patient demographics, date of procedure, type of procedure, fluoroscopy time, immediate complications, CSF color, physician performing the procedure and procedure technical success rate. The chi-squared test was used to compare categorical variables and the independent t-test was used to compare continuous variables between the two age groups. Univariate and multivariate linear regression models were conducted to investigate the effect of different patient and procedural factors on fluoroscopy time. Statistical analyses were carried out with the use of IBM SPSS software package version 28.0, level of significance of p < 0.05.
Results: There is significant reduction in radiation dose and fluoroscopy time in the group where the 3-point systematic approach with checklist was used (2.03 sec) compared to the group where only the standard technique was used (25.62 sec). This significant dose reduction remained statistically significant when adjusting for several potential confounders: type of the procedure (lumbar puncture with or without myelogram), age, BMI, date of the study (first vs second half of the academic year), gender and staff performing the procedure. Furthermore, there is statistically significantly higher success rate of the fluoroscopic guided lumbar puncture in the group where the 3-point systematic approach with checklist was used (99.3%) compared to the group where only the standard technique was used (95.6%). There was no statistically significant difference in the complication rate and traumatic tap rate between the group where the 3-point systematic approach with checklist was used and the group where only the standard technique was used. In our linear regression model, doing a myelogram, increased patient age and doing the procedure in the first half of the year are factors contributing to a statistically significant increase in fluoroscopy time.
Conclusion: The 3-point systematic approach with checklist was associated with 1162% decrease in fluoroscopy time/radiation dose of fluoroscopic guided lumbar punctures and statistically significantly increase in success rate reaching more than 99% compared to the standard technique. No difference in traumatic tap rates and complication rates was noted between the two groups. We believe that our study will provide a cornerstone for future research on effective interventions and approach for dose reduction in fluoroscopy guided procedures
Interview Transcripts
No full textIn-depth interviews were conducted with 14 local and international humanitarian agencies working in Lebanon. Interviews were recorded, transcribed and subject to thematic analysis.N
Antimicrobial stewardship in the era of the COVID-19 pandemic: A systematic review protocol on the opportunities and challenges for Sub-Saharan Africa
Get PDFBackground: Antimicrobial resistance (AMR) remains one of the leading threats to global public health and this may increase following COVID-19 pandemic. This is particularly the case in Africa where regulations on antimicrobial usage are weak. This protocol outlines the steps to undertake a systematic review to synthesize evidence on drivers of AMR and evaluate existing approaches to strengthening antimicrobial stewardship (AMS) programs in Sub-Saharan Africa (SSA). On the basis of the evidence generated from the evidence synthesis, the overarching goal of this work is to provide recommendations to support best practices in AMS implementation in SSA. Methods: A systematic search will be conducted using the following databases: Global Health Library, PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Google Scholar, Global Health, Embase, African Journals Online Library, Web of Science, antimicrobial databases (WHO COVID-19, TrACSS, NDARO, and JPIAMR), and the Cochrane databases for systematic reviews. Studies will be included if they assess AMR and AMS in SSA from January 2000 to January 31, 2023. Results: The primary outcomes will include the drivers of AMR and approaches to AMS implementation in SSA. The Preferred Reporting Items for Systematic Reviews and Meta-analyses will guide the reporting of this systematic review. Conclusions: The findings are expected to provide evidence on best practices and resource sharing for policy consideration to healthcare providers and other stakeholders both at the local and international levels. Additionally, the study seeks to establish drivers specific to AMR during the COVID-19 era in the SSA, for example, with the observed increasing trend of antimicrobial misuse during the first or second year of the pandemic may provide valuable insights for policy recommendation in preparedness and response measures to future pandemics. PROSPERO registration number: CRD42022368853. © Copyright 2023 the Author(s). Published by Wolters Kluwer Health, Inc