Belgium and the Netherlands are prominent destinations for immigrants. Whereas policymakers before assumed migrants would eventually return to their countries of origin, both countries began around the turn of the century to acknowledge the permanence of migrant communities, prompting the development of civic integration policies. These policies, particularly in Flanders and the Netherlands, now require newcomers—especially non-EU+ migrants—to complete structured integration trajectories, including language instruction and social orientation. This article critically examines the civic integration frameworks in the Low Countries, identifying three key trends: the expansion of the target population, the increasing coerciveness of integration requirements, and the culturalization of citizenship through historical education. It argues that history has become a central tool in these programs, with governments explicitly curating historical narratives to be taught to newcomers. Civic integration courses thus function as sites of state-sponsored history, where the host society presents a selective self-image to the immigrant ‘Other.’ By analyzing the treatment of colonial history within these courses, the article reveals how integration policies reinforce a moral hierarchy between host society and newcomers. Rather than fostering inclusive citizenship, these practices often perpetuate a ‘we–they’ dichotomy.
The Low Countries became a centre of printmaking in the early modern period. Printmaking was a disruptive image-technology because it produced images as multiples on an unprecedented scale. With its success also came problems. One was that copying became a problem as it had not been before in the visual arts. This article discusses three approaches used by early modern printmakers to dealing with the problems presented by copying and the fact that prints came in multiples. The first was to acquire privileges as legal protection against copying. Privileges are usually seen as the predecessors of copyright, but here it is argued that this is only part of the story and that they also served as a claim of reliability. A second approach was to take full advantage of the opportunities presented by the fact that prints came in multiples, and to produce images as efficiently as possible, in effect endlessly copying the same images. A third approach was to purposefully ignore the technological possibilities of printmaking and instead produce small print runs or slightly different states of one image. These approaches, it is argued, were related both to technological possibilities and to changing ideas about the (visual) arts, showing how the meanings of concepts such as ‘invention’ and ‘skill’ were shifting at this time.
S. Soni, Kamal Kajal, Lakshmi Narayana Yaddanapudi
et al.
Background & objectives: The COVID-19 pandemic emerged as a major public health emergency affecting the healthcare services all over the world. It is essential to analyze the epidemiological and clinical characteristics of patients with COVID-19 in different parts of our country. This study highlights clinical experience in managing patients with COVID-19 at a tertiary care centre in northern India. Methods: Clinical characteristics and outcomes of consecutive adults patients admitted to a tertiary care hospital at Chandigarh, India, from April 1 to May 25, 2020 were studied. The diagnosis of SARS-CoV-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat and/or nasopharyngeal swabs. All patients were managed according to the institute's consensus protocol and in accordance with Indian Council of Medical Research guidelines. Results: During the study period, 114 patients with SARS-CoV-2 infection were admitted. The history of contact with COVID-19-affected individuals was available in 75 (65.8%) patients. The median age of the patients was 33.5 yr (13-79 yr), and there were 66 (58%) males. Of the total enrolled patients, 48 (42%) were symptomatic. The common presenting complaints were fever (37, 77%), cough (26, 54%) and shortness of breath (10, 20.8%). Nineteen (17%) patients had hypoxia (SpO224). Thirty four (29.8%) patients had an accompanying comorbid illness. Age more than 60 yr and presence of diabetes and hypertension were significantly associated with severe COVID-19 disease. Admission to the intensive care unit (ICU) was needed in 18 patients (52%), with three (2.6%) patients requiring assisted ventilation. Mortality of 2.6 per cent (3 patients) was observed. Interpretation & conclusions: Majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Fever was noted only in three-fourth of the patients and respiratory symptoms in half of them. Patients with comorbidities were more vulnerable to complications. Triaged classification of patients and protocol-based treatment resulted in good outcomes and low case fatality.
Background Hepatitis B virus(HBV) infection is a global public health problem, even though its prevalence is disproportionately high in low- and middle-income countries. Mother-to-child transmission is a major route of HBV transmission in endemic areas. This study aimed to assess the prevalence of HBV and its determinants among pregnant women attending antenatal care at Mizan-Tepi University Teaching Hospital and Mizan Health Center, Southwest Ethiopia. Methods A cross-sectional study was conducted between January 13th 2020 and February 5th 2020 among 370 pregnant women. The sample size was proportionally allocated to each health institution according to the total pregnant women on antenatal care at the respective health institution and a consecutive sampling technique was used to select study participants. Serum hepatitis B surface antigen (HBsAg) was tested using a rapid diagnostic test. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 22. Multiple logistic regression analysis was done to identify the independent predictors of HBsAg serostatus at p-value <0.05. Results Three hundred seventy of the total 375 pregnant women participated in the study resulting in a response rate of 98.7%. Twenty-two (5.9%) of the pregnant women screened were found positive for HBsAg (prevalence=5.9%; 95% CI: 3.9–8.80%). History of contact with jaundice patients (AOR=9.87; 95% CI: 2.98–32.65), sharing sharp materials (AOR=3.96; 95% CI: 1.23–11.08) and history of multiple sexual partners (AOR=6.77; 95% CI: 2.44–18.78) were significantly associated with Hepatitis B Virus infection. Conclusion The endemicity of hepatitis B virus seroprevalence is intermediate in the study settings. Factors associated with hepatitis B virus serostatus were behavioral; hence, modification of these factors may help to prevent the infection.
Background Hypertension is one of the noncommunicable cardiovascular diseases (CVDs), and its prevalence is rising in middle- and low-income countries. It is not given enough attention in the developing countries like Ethiopia. Not enough data and studies about hypertension are available in Ethiopia. This study aimed to determine the prevalence of hypertension and its associated risk factors among secondary school teachers in Bahir Dar city administration. Methods An institutional-based cross-sectional survey was conducted among secondary school teachers in Bahir Dar. Two hundred twenty-two randomly selected teachers were interviewed, and data related to the demographic, behavioral, health, and dietary characteristics of the individuals were recorded. Blood pressure data were taken. Logistic regression analysis had been used to assess independent risk factors for hypertension. p-values of less than 0.05 were considered statistically significant. Results The overall prevalence of hypertension in the study was 29.28%. Age 41 to 50 (AOR: 2.506; 95% CI: 1.103–5.694; and p=0.028), having self-reported diabetes mellitus (AOR: 8.595; 95% CI: 2.795–26.424; and p < 0.0001), having a family history of hypertension (AOR: 3.387; 95% CI: 1.579–7.285; and p=0.002), khat chewing (AOR: 5.426; 95% CI: 1.811–16.256; and p=0.003), physical inactivity (AOR: 5.212; 95% CI: 1.974–13.763; and p=0.001), and presence of self-reported repeated stress (AOR: 3.027; 95% CI: 1.404–6.527; and p=0.005) were the risk factors associated with hypertension. Conclusions Different intervention measures with a particular emphasis on prevention by introducing lifestyle modifications are highly recommended to mitigate and control hypertension.
Background One-fourth of neonatal death is due to neonatal sepsis and nearly 98% of these deaths are occurring at low- and middle-income countries. In Ethiopia, forty percent of under-five mortality occurs during the neonatal period, of which neonatal sepsis accounts for 30-35% of neonatal deaths next to prematurity and its complications. On the other side, among the survived neonates with neonatal sepsis, there exist as vulnerable to short and long-term neurological and developmental morbidity impacting the overall productivity of the child as adult. Methods A longitudinal prospective cohort study was conducted among selected 289 neonates with neonatal sepsis who were admitted in the neonatal intensive care unit at public hospitals in Ethiopia from 1st March 2018 to 31st December 2019. Data were entered into Epi data version 3.02 and exported to SPSS V 25 for analysis. The Kaplan-Meier survival curve together with log-rank test was used to estimate the survival time of the neonates. Variables which had p value < 0.05 in multivariable analysis using the cox proportional hazard model were declared as statistically significant predictors of mortality. Results The study was conducted with a total of 289 neonates admitted with neonatal sepsis. The cumulative proportion of surviving at the end of the fourth day was 99.5%, and it was 98.2% at the end of the fifth day. In addition, it was 96.6%, 93.5%, and 91.1% at the end of the sixth, seventh, and eighth day, respectively. The incidence of mortality was 8.65 per 100 neonates admitted with neonatal sepsis. Having a history of intrapartum fever (AHR: 14.5; 95% CI: 4.25, 49.5), history of chorioamnionitis (AHR: 5.7; 95% CI: 2.29, 13.98), induced labor (AHR: 7; 95% CI: 2.32, 21.08), and not initiating exclusive breastfeeding within one hour (AHR: 3.4; 95% CI: 1.34, 12.63) were the independent predictors of mortality. Conclusion The survival status of neonates among neonates admitted with neonatal sepsis was high at the early admission days and high cumulative proportion of death as the admission period increased. The risk of mortality was high among the neonates with early onset of neonatal sepsis as compared with late onset of neonatal sepsis and history of intrapartum fever, history of diagnosed chorioamnionitis, onset of labor, and EBF initiation within one hour were the independent predictors of mortality among neonates admitted with neonatal sepsis.
OBJECTIVES Evidence demonstrates the detrimental impact of depression in patients with congestive heart failure (CHF), however, large-scale prospective data from Low and Middle Income Countries (LMICs) is limited. We assessed the prevalence of depression in a large sample with CHF from Karachi, Pakistan, and the impact of depression on all-cause mortality, disability and health-related quality of life (QoL). METHODS 1009 patients diagnosed with CHF were recruited from public hospitals in Karachi, Pakistan. Patients were screened for depression at baseline using the Beck Depression Inventory (BDI) and the diagnosis was confirmed using the Clinical Interview Schedule-Revised (CIS-R). Health-related QoL and disability were measured using the EuroQol (EQ-5D) and Brief Disability Questionnaire respectively at baseline and after a 6-month follow-up. RESULTS A total of 670 (66%) patients were depressed at baseline and 821 participants completed 6-month follow up assessments (retention rate: 81%). At baseline, lower income (p < 0.001) and lower education level (p = 0.03) were associated with higher BDI scores. Higher BDI scores were associated with a history of depression (p < 0.001), higher NYHA class (p < 0.001), diabetes (p < 0.001), COPD (p = 0.007), renal disease (p < 0.001) and stroke (p = 0.02). 145 participants were deceased at 6-months. Regression analysis showed that at follow up, higher BDI scores in depressed participants were associated with higher all-cause mortality (OR 1.23 (95% CI: 1.11-1.36); p < 0.001). CONCLUSION The rate of depression was high among Pakistani patients with CHF. Severity of depression correlated with increased mortality. Further research on controlled intervention trials in this population is warranted.
N. Thakkar, Syed Saqlain Ahmad Gilani, Q. Hasan
et al.
Significance Measles vaccine is a highly effective healthcare intervention, but getting vaccine to those in need remains a major problem. Complicating the issue, high-burden countries typically have low-quality infrastructure, severely limiting the number of infections detected and therefore limiting our understanding of local epidemiology. Here we show that statistical disease models can be fitted to sparse case data from Pakistan using a fast linear regression approach. This method yields estimates of the effects of past interventions, the seasonal likelihood of measles transmission, and the magnitude of future outbreaks under different intervention policies. We use these models to understand in general when and where vaccine should be distributed, and these results were used to inform Pakistan’s 2018 vaccination campaign planning. Measles remains a major contributor to preventable child mortality, and bridging gaps in measles immunity is a fundamental challenge to global health. In high-burden settings, mass vaccination campaigns are conducted to increase access to vaccine and address this issue. Ensuring that campaigns are optimally effective is a crucial step toward measles elimination; however, the relationship between campaign impact and disease dynamics is poorly understood. Here, we study measles in Pakistan, and we demonstrate that campaign timing can be tuned to optimally interact with local transmission seasonality and recent incidence history. We develop a mechanistic modeling approach to optimize timing in general high-burden settings, and we find that in Pakistan, hundreds of thousands of infections can be averted with no change in campaign cost.
Background: Diabetes mellitus is increasing its share of burden to the health-related problems in developing countries such as India. Urban slum residents constitute the “vulnerable population” who lack the basic health amenities. Lack of effective screening for primary prevention has been one of the reasons for the rising burden. Materials and Methods: The cross-sectional study was conducted among 400 adults aged between 30 and 60 years residing in a settled slum of Rukmini Nagar area of Belagavi city, Karnataka. Data were collected after taking written informed consent from each participant using a pretested questionnaire that included demographic information and details of the risk factors. Risk of developing diabetes was assessed by using Indian Diabetes Risk Score. Results are expressed as proportions, and analysis was done using Chi-square test and multiple logistic regression analysis. Results: The mean age of participants was 44.3 ± 8.7 years. The proportion of low, moderate, and high risk of developing diabetes mellitus was 7%, 63%, and 30%, respectively. The prevalence of newly diagnosed cases was 10.25%. Moreover, 57.1% of them with positive family history were in the high risk category; 76.9% of the sedentary workers were at higher risk; overweight and obese individuals had higher proportion of the high and moderate risk (P < 0.0001). Correlation coefficient (R) was 0.782, and coefficient of determination (R2) was 0.61. Conclusions: Our study demonstrated that advancing age, low physical activity, family history, overweight, and obesity were the prominent factors that predicted the risk of diabetes in the near future. Hence, focused interventions for urban slum dwellers are imperative and draw special attention.
This article analyses the complex interrelation between the VOC and scholarship by investigating the relationship between the Company and Georg Everhard Rumphius (1627-1702). First, it will consider the line Rumphius drew between himself as scholar and as a VOC employee. Secondly, the Company’s policy of secrecy is scrutinised in order to show how and to what extent it was in conflict with the habit of sharing knowledge and objects in the Republic of Letters. The third facet examines how the VOC context influenced Rumphius’s scholarly work and how his scholarly ambitions shaped some of his occupational writings. Building on these three aspects, this article argues that it was of paramount importance for Rumphius to maintain the image of his being a ‘good employee’ in order to obtain assistance from influential people within the VOC that might allow him to achieve his scholarly goals. However, the case of Rumphius also proves that doing research under the auspices of the Company came at a price, because in the process he lost all control over his works.
Objective: Globally oral cancer is one of the ten most common cancers with prevalence being high in Central and South East Asian countries. This survey was conducted to estimate the prevalence of oral pre-malignant lesions (OPML) and to identify their risk factors. Methods: A community based cross-sectional study was carried out among 2033 individuals aged ≥18 years. A questionnaire was administered to collect socio-demographic characteristics, various risk factors for oral cancer and presence of its symptoms. Oral cavity of all the participants was examined in detail by the study investigator as per WHO guidelines for the early diagnosis of oral neoplasia. Result: The prevalence of OPML was found to be 3.73%. Among those with OPML, all were ever tobacco consumers and had poor oral hygiene. A significant association was observed between OPML and younger age group (OR=2.56, 95% CI 1.08-6.02), males (OR=26.76, 95% CI 8.40-85.19) and low socio-economic status (OR = 1.91, 95% CI 1.20-3.02). Tobacco (p<0.001), alcohol (OR= 7.92, 95% CI 4.77-13.14) and areca nut consumption (OR = 5.48, 95% CI 3.42-8.77) were strongly associated with OPML. On multivariate analysis among ever tobacco users, OPML was associated with younger individuals, males and those using smokeless forms of tobacco (p <0.05). The study showed that the participants with OPML were more likely to be never married (OR=1.6, 95% CI 0.92-2.96), to be unskilled workers (OR= 1.45, 95% CI 0.61-3.43), to have suffered from oral trauma (OR =1.30, 95% CI 0.75-2.26), to have consumed hot and spicy food frequently (OR=1.53, 95% CI 0.96-2.24), to have consumed fruits infrequently (OR=1.53, 95% CI 0.90-2.59) and to report family history of any cancer (OR = 1.29, 95% CI 0.58-2.87). However, these associations were statistically insignificant. Conclusion: The study reinforces that use of substances such as tobacco, alcohol and areca nut are the modifiable risk factors for OPML.
Abstract Background. Annually, Saudi Arabia is the host of the Hajj mass gathering. We aimed to determine the Middle East respiratory syndrome coronavirus (MERS-CoV) nasal carriage rate among pilgrims performing the 2013 Hajj and to describe the compliance with the Saudi Ministry of Health vaccine recommendations. Method. Nasopharyngeal samples were collected from 5235 adult pilgrims from 22 countries and screened for MERS-CoV using reverse transcriptase–polymerase chain reaction. Information regarding the participants' age, gender, country of origin, medical conditions, and vaccination history were obtained. Results. The mean age of the screened population was 51.8 years (range, 18–93 years) with a male/female ratio of 1.17:1. MERS-CoV was not detected in any of the samples tested (3210 pre-Hajj and 2025 post-Hajj screening). According to the vaccination documents, all participants had received meningococcal vaccination and the majority of those from at-risk countries were vaccinated against yellow fever and polio. Only 22% of the pilgrims (17.5% of those ≥65 years and 36.3% of diabetics) had flu vaccination, and 4.4% had pneumococcal vaccination. Conclusion. There was no evidence of MERS-CoV nasal carriage among Hajj pilgrims. While rates of compulsory vaccinations uptake were high, uptake of pneumococcal and flu seasonal vaccinations were low, including among the high-risk population.