Self‐collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among underscreened women and will likely form a crucial part of the WHO's strategy to eliminate cervical cancer by 2030. In high‐income countries with long‐standing, organised cervical screening programmes, self‐collection is increasingly becoming available as a routine offer for women regardless of their screening histories, including under‐ and well‐screened women. For these contexts, a validated microsimulation model determined that adding self‐collection to clinician collection is likely to be cost‐effective on the condition that it meets specific thresholds relating to (1) uptake and (2) sensitivity for the detection of high‐grade cervical intraepithelial neoplasia (CIN2+). We used these thresholds to review the ‘early‐adopter’ programme‐level evidence with a mind to determine how well and how consistently they were being met. The available evidence suggested some risk to overall programme performance in the situation where low uptake among underscreened women was accompanied by a high rate of substituting clinician sampling with self‐collection among well‐screened women. Risk was further compounded in a situation where the slightly reduced sensitivity of self‐sampling vs clinician sampling for the detection of CIN2+ was accompanied with lack of adherence to a follow‐up triage test that required a clinician sample. To support real‐world programmes on their pathways toward implementation and to avoid HPV self‐collection being introduced as a screening measure in good faith but with counterproductive consequences, we conclude by identifying a range of mitigations and areas worthy of research prioritisation.
Abstract Background Gestational diabetes mellitus (GDM) is a major pregnancy endocrine problem that has several confirmed risk factors and is associated with adverse pregnancy-related outcomes (PRO). Objective To evaluate the relationship between GDM diagnosis and the associated risk factors of PRO (maternal, intrapartum, perinatal, and neonatal) in accordance with International Association of Diabetes and Pregnancy Study Groups criteria. Materials and Methods This prospective cohort study was performed with 531 singleton parturient (265 GDM and 266 non-GDM). They were selected consecutively from referral hospitals, and the maternal, intrapartum, perinatal, and neonatal outcomes were assessed. Results The major risk factors influencing the GDM diagnosis were maternal age, obesity, family history of diabetes, previous history of GDM, and previous history of macrosomia. In the comparison of PRO between the groups, significant associations were detected for emergency cesarean delivery, preeclampsia, polyhydramnios, premature rupture of membrane, preterm delivery, and neonatal hyperbilirubinemia in the GDM group. In the multivariate logistic regression analysis, a previous history of stillbirth was significantly associated with maternal and perinatal outcomes. The odds ratios (CI 95%) of the PRO in the women with a GDM diagnosis were: maternal = 2.43 (1.51-3.90), intrapartum = 2.05 (1.35-3.11), perinatal = 2.00 (1.29-3.10), and neonatal = 1.68 (1.08-2.62). The PRO was significantly correlated with GDM diagnosis, but not with the risk factors. Conclusion The adverse pregnancy outcomes were significantly correlated with GDM diagnosis, and the outcomes were not directly affected by the risk factors. Given the related adverse outcomes for mothers and offspring, early screening and management of GDM is necessary especially in Asians and in low-/middle-income countries.
Where has sustainability come from and how could it become such a popular idea? This special issue analyses the intersection between twentieth-century attempts to attune environmental, social and economic concerns in the Low Countries and the rise of ‘sustainable development’ from the 1980s onwards. The introduction to this issue first relates the articles to the international historiography on sustainability and elaborates their shared approach. Second, the varieties of sustainability practiced in Belgium, the Netherlands and Congo – as analysed in the contributions on forestry, breweries, pisciculture, water management, agriculture, and the alternative food movement – are presented. Based on their results, the period from the 1940s until the 1990s can be characterised as an ‘age of interdependence’ during which a distinct notion of sustainability emerged. Sustainability was interpreted in the light of global interconnections. Transnational governing coalitions, aided by experts and the ideal of planning, were established to achieve a balance between environmental, social and economic interests. The environment became an important object of post-war public debate and policy because of its connections to society and the economy. Building on these histories of sustainability, the introduction finally explores how historians enhance our understanding of the Anthropocene. Waar komt duurzaamheid vandaan en hoe kon het idee zo populair worden? Dit themanummer analyseert het snijvlak van twintigste-eeuwse pogingen om ecologische, sociale en economische belangen in de Lage Landen met elkaar in evenwicht te brengen en de opkomst van ‘duurzame ontwikkeling’ vanaf de jaren 1980. De inleiding positioneert de bijdragen in de internationale geschiedschrijving van duurzaamheid en licht hun gemeenschappelijke werkwijze toe. Vervolgens peilt de inleiding de invullingen van duurzaamheid in België, Nederland en Congo, zoals die in de bijdragen over bosbouw, bierbrouwerijen, viskweek, waterbeheer, landbouw en de alternatieve voedselbeweging worden geanalyseerd. Op basis van de artikelen kan de periode van de jaren 1940 tot de jaren 1990 als een ‘era van interdependentie’ bestempeld worden, waarin een specifieke invulling van duurzaamheid opkwam. Duurzaamheid werd geïnterpreteerd tegen de achtergrond van een groeiend bewustzijn van mondiale verbondenheid. Transnationale samenwerkingsverbanden probeerden met behulp van experts en ambitieuze planning een balans te vinden tussen ecologische, sociale en economische belangen. Juist door de verbanden die werden gelegd met de sociale en economische perspectieven werd het milieu in deze periode steeds belangrijker geacht. Naar aanleiding van deze duurzaamheidsgeschiedenissen verkent de inleiding ten slotte hoe historici ons begrip van het Antropoceen vergroten.
In the Benelux countries, value-added tax (VAT) revenue is a significant source of fiscal revenue, and for that reason, it plays an extremely important role in creating the fiscal policy of this group of countries. Value-added tax is a type of sales tax that taxes all stages of sales, from the producer to the final consumer. This form of taxation satisfies both fiscal and non-fiscal goals of taxation and has a dominant position in the fiscal systems of modern states. The aim of the paper is, based on data collected from relevant sites, for the period 2000-2020. year, analyzes the value-added tax in the Benelux countries. The paper presents a theoretical overview and findings, which can be helpful to tax policymakers, with special emphasis on indirect taxation. Pointing out the importance of VAT revenues and closing the VAT gap is the basic practical implication of this paper.
Abdulmgeed F Alruways, N. Alotaibi, M. Rashikh
et al.
Objective: Coronary artery disease (CAD) is one of the leading causes of death and disability worldwide. Amongst the Middle East countries, Saudi Arabia is facing rapid progressive urbanization by the adoption of a westernized lifestyle and food habits, which contribute to the rising burden of CAD. We aim to evaluate the awareness and prevalence of CAD risk factors among Saudi adults. Methods: This was a cross-sectional study conducted between January and March 2020. Data were collected through an online survey using a self-administered questionnaire. Data assessed on socio-demographic variables, family history of CAD, knowledge of risk factors, symptoms, and complications of CAD. Results data were entered and analyzed using IBM SPSS statistics, version 25. All comparisons were considered significant at P < 0.05. Results: A total of 311 subjects (48.6% men and 51.4% women) included, and most of the participants were between 18 and 25 years. A majority of the participants did not hear about CAD (82%) and unaware of any risk factors (26.4%), symptoms (25.1%), and complications (72.7%) of CAD. The prevalence of a family history of CAD (9.3%), overweight/obesity (58.6%), physical inactivity (79.1%), and smoking (24.1%) observed considerably high among the participants. Conclusion: The present study reveals that a significantly low level of awareness and a high prevalence of CAD risk factors found among Saudi adults. Therefore, the awareness program is needed at the public level to increase the knowledge of CAD risk factors so that persons with high risk for future CAD can be prevented.
Abstract Cities across the Global South are facing huge challenges associated with rapid urbanisation, lack of infrastructure services and climate change, including frequent storms and recurrent floods that inundate large areas of their urban landscape. Often, the worst affected groups are those living in low-income settlements located in floodplains of the city. Maxaquene A is an example of such a settlement in Maputo, Mozambique, a country with a strong history of storms and floods due to its geographical location. This paper describes a rapid flood risk assessment conducted by the authors, in Maxaquene A. The assessment obtained both community and external stakeholder perceptions of challenges in the neighbourhood, accompanied by a description of how floods have affected infrastructure such as drainage and sanitation, services such as pit emptying and solid waste collection, and localised infrastructure solutions developed by the community as a coping mechanism. The assessment highlighted the need for collaboration with community members to co-develop appropriate flood risk management strategies and infrastructure solutions. This work will pave the way for greater in-depth research with residents of Maxaquene A, neighbouring settlements in Maputo and other informal settlements in the Global South, to drive change in climate change adaptation across the built environment.
Background COPD affects millions of people worldwide. Poor treatment adherence contributes to increased symptom severity, morbidity and mortality. This study was designed to investigate adherence to COPD treatment in Turkey and Saudi Arabia. Methods An observational, cross-sectional study in adult COPD patients in Turkey and Saudi Arabia. Through physician-led interviews, data were collected on sociodemographics and disease history, including the impact of COPD on health status using the COPD Assessment Test (CAT); quality of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Treatment adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis examined the predictors of non-adherence and the impact of adherence on symptom severity. Results Four hundred and five COPD patients participated: 199 in Turkey and 206 in Saudi Arabia. Overall, 49.2% reported low adherence (MMAS-8 15) compared to 58.4% reporting medium/high adherence (p=0.0008). Patients with low adherence reported a lower mean 3-level EQ-5D utility value (0.54±0.35) compared to those with medium/high adherence (0.64±0.30; p10 was associated with lower adherence (OR 2.50 [95% CI: 1.43–4.39] and 2.43 [95% CI: 1.39–4.25], respectively; p=0.0008). Being a high school/college graduate was associated with better adherence compared with no high school (OR 0.57 [95% CI: 0.33–0.98] and 0.38 [95% CI: 0.15–1.00], respectively; p=0.0310). After adjusting for age, gender, and country, a significant association between treatment adherence (MMAS-8 score ≥6) and lower disease impact (CAT ≤15) was observed (OR 0.56 [95% CI: 0.33–0.95]; p=0.0314). Conclusion Adherence to COPD treatment is poor in Turkey and Saudi Arabia. Non-adherence to treatment is associated with higher disease impact and reduced quality of life. Depression, age, and level of education were independent determinants of adherence.
This article is part of the forum 'Rethinking the VOC: Between Archival Management and Research Practice'.
Global history has in the last decades developed as a popular approach in history writing. The history of the Dutch East India Company (voc) is inevitably a global one. But how perceptive are histories of the voc to trends in global history? Does conceptualizing voc history as a global history bring any value to the exercise? This essay argues that global history will encourage historians of the voc to ask new questions and pursue new lines of research. It will prod historians to put voc archives to innovative use and integrate the Company into writing more inclusive comparative and connected histories of the Indian Ocean and early modern world.
In de geschiedwetenschap heeft een globale benadering de laatste decennia aan belangstelling gewonnen. De geschiedenis van de Verenigde Oostindische Compagnie (voc) is onmiskenbaar een globale geschiedenis. Maar hoeveel aandacht is er in de huidige geschiedschrijving van de voc voor deze trend inzake wereldgeschiedenis? Wat is de waarde van de conceptualisering van de geschiedenis van de voc als een wereldgeschiedenis? In dit essay wordt beargumenteerd dat een mondiale benadering historici van de voc aanmoedigt nieuwe vragen en onderzoeksthema’s op te werpen. Een globaal perspectief zal historici stimuleren de archieven van de voc op een vernieuwende manier te gebruiken en de geschiedenis van de Compagnie te integreren in een meer inclusieve, vergelijkende en verweven geschiedenis van de Indische Oceaan en van de vroegmoderne wereld.
BackgroundTrauma is the leading cause of death for adults under 44 years of age. Survival after traumatic out-of-hospital cardiac arrest (OHCA) has been reported to be poor, and its epidemiology is not well defined. A few studies have reported better survival in response to pre-hospital life-saving interventions. Currently, no published data on traumatic cardiac arrests in the field exist from low- and lower middle-income countries. We aimed to explore the epidemiology and outcomes of traumatic OHCA patients from Karachi, Pakistan.We conducted a longitudinal cohort study at emergency departments (ED) of five major public and private hospitals of the city from January to April 2013. Data was collected on all adult patients (age 18 years or more) presenting to the hospitals directly from field with cardiac arrest and history of trauma using a structured questionnaire. Patients with do-not-resuscitate status and those referred from other hospitals were excluded.ResultsDuring 3 months, a total of 187 patients were enrolled with mean age of 35.1 years. About 95% were men, and 68.4% had a penetrating injury. Even though half of the patients had a witnessed arrest, none received a bystander cardiopulmonary resuscitation (CPR). 83.4% were brought to the hospital in an ambulance, with median response and scene times of 3 and 2 min respectively; however, only 3 received any pre-hospital life-support interventions. One hundred eighty-one patients (96.7%) were pronounced dead on arrival to the ED, and of the remaining 6 patients, 4 received CPR in the EDs. Overall survival at the end of ED stay was 0%. Patients who received life-support interventions survived for longer time, though not clinically significant, as compared to those who did not (45 min vs. 35 min, p = 0.02).ConclusionThere was no survival after a traumatic OHCA in Karachi, Pakistan. Even though ambulances reached the scene in a very short time, pre-hospital interventions were largely absent. There is a strong need to strengthen our pre-hospital care system but most importantly train the general public to deal with emergencies and be able to provide timely bystander CPR.