Search Results (158)

Background: Eating disorders (EDs) and self-harm (SH) are both associated with distress, poor psychosocial functioning, and increased risk of mortality. Much of the literature discusses the complex interplay between SH and ED behaviours where co-occurrence is common. The onset of both is typically seen during teenage years into early adulthood. A better understanding of the functions of these behaviours is needed to guide effective prevention and treatment, particularly during the crucial developmental years. An earlier review has explored the functions of self-harm, but an equivalent review for eating disorder behaviours does not appear to have been completed. Objectives: This evidence synthesis had two objectives. First, to identify and synthesise published first-hand accounts of the reasons why people engage in eating disorder behaviours with the view to develop a broad theoretical framework of functions. Second, to draw comparisons between the functions of eating disorder behaviours and self-harm. Methods: A qualitative evidence synthesis reporting first-hand accounts of the reasons for engaging in eating disorder behaviours. A ‘best fit’ framework synthesis, using the a priori framework from the review of self-harm functions, was undertaken with thematic analysis to categorise responses. Results: Following a systematic search and rigorous screening process, 144 studies were included in the final review. The most commonly reported functions of eating disorder behaviours were distress management (affect regulation) and interpersonal influence. This review identified significant overlap in functions between self-harm and eating disorder behaviours. Gender identity, responding to food insecurity, to delay growing up and responding to weight, shape, and body ideals were identified as functions more salient to eating disorder behaviours. Similarly, some self-harm functions were not identified in the eating disorder literature. These were experimenting, averting suicide, personal language, and exploring/maintaining boundaries. Conclusions: This evidence synthesis identified a prominent overlap between psychological functions of eating disorder behaviours and self-harm, specifically in relation to distress management (affect regulation). Despite clear overlap in certain areas, some functions were found to be distinct to each behaviour. The implications for delivering and adapting targeted interventions are discussed. Full article

This study explores how adjustments in risk management can influence the future financial performance of 20 countries in the MENA (Middle East and North Africa) region. While the existing literature has explored risk factors in emerging economies, this research provides novel empirical evidence on how risk management practices influence long-term financial stability and growth, a dimension underexplored in the MENA context. Using a Panel Vector Autoregression (PVAR) model, we analyze data from 2005 to 2021 to quantify the dynamic relationship between risk mitigation strategies and key financial outcomes, accounting for regional volatility and cross-country heterogeneity. This methodology allows for the examination of the impact of risk management on future financial outcomes, considering both current uncertainties and strategic approaches to mitigating risks. The results reveal that robust forward-looking risk management practices significantly impact the future financial performance and resilience of the countries in the MENA region. Our findings highlight that a well-designed risk management strategy is crucial for averting financial crises and supporting long-term economic growth and sustainability of nations. This study contributes to the understanding of how strategic risk management can drive future economic and financial stability in the MENA region, providing unique insights into the role of forward-thinking risk practices in shaping national success. Full article

Background: Pancreatic cancer (PC) is among the deadliest types of cancer globally. While early detection helps avert adverse outcomes, screening is only recommended for individuals at high risk, specifically those with familial and/or genetic predispositions. The objectives of this study are to systematically review primary studies on the cost-effectiveness of PC screening and to identify the critical factors that influence cost-effectiveness. Methods: This systematic review was performed using PRISMA guidelines. Economic evaluation studies on PC screening were identified from searches on the SCOPUS and PubMed databases. The quality of reporting of the selected articles was assessed according to CHEERS 2022. Using predefined inclusion and exclusion criteria, two reviewers conducted the title–abstract review, full-text review, and data extraction to select relevant articles. The authors’ consensus was used to settle disagreements. The primary outcome was the incremental cost-effectiveness ratio, measured by cost per quality-adjusted life year and cost per life year saved. Results: Nine studies were selected for the final review. Most studies demonstrated that one-time screening for PC among high-risk individuals was cost-effective compared with no screening, while others found annual screening to also be cost-effective. High-risk was generally defined as having a >5% lifetime risk of PC and included individuals with either familial pancreatic cancer (FPC) or genetic susceptibility syndromes such as Peutz–Jeghers Syndrome, hereditary pancreatitis, hereditary non-polypoid colorectal cancer syndrome, familial adenomatous polyposis, and BRCA2 mutations. Individuals with new-onset diabetes (NOD) were also considered high-risk. Screening using mainly endoscopic ultrasound was cost-effective among FPC individuals and those with genetic syndromes. Risk-based screening was also cost-effective among patients with NOD. Conclusion: Screening for PC is cost-effective among selected high-risk individuals. However, cost-effectiveness depends on epidemiological factors, cost, the diagnostic performance of screening tools, and the overall design of studies. Full article

Background: Breastfeeding is widely regarded as the optimal method of infant nutrition. A notable benefit of breastfeeding is its potential to avert the development of childhood overweight and obesity. This assertion holds particular significance in the context of infants whose mothers have exhibited gestational diabetes, a condition that has been demonstrated to be associated with an increased risk of carbohydrate and/or fat disorders in offspring, potentially leading to the onset of overweight and obesity in later life. Objective: The objective of the present study was to examine the variations in the anthropometric dimensions of infants across three distinct time points during the initial year of life, with a particular focus on the correlation between infant feeding practices and the prevalence of gestational diabetes in maternal subjects. Additionally, this study encompassed an analysis of the disparities in anthropometric dimensions between infant males and females. Methods: The study population included 42 infants whose mothers had been diagnosed with gestational diabetes between the 24th and 28th week of pregnancy, as well as 28 infants of women without gestational diabetes. The infants’ dietary habits, including breastfeeding, mixed feeding, and formula feeding, were assessed, and their anthropometric measurements were obtained at three time points: 7 ± 1 weeks postpartum, 6 months ± 1 week postpartum, and 12 months ± 1 week postpartum. The infants were measured for weight, length, head circumference, and thickness of the subscapular skin fold. We also calculated their BMI and Ponderal Index, and the measurements were referenced to WHO centile grids. Results: At 7 ± 1 weeks postpartum, exclusively breastfed infants exhibited higher weight compared to those who were mixed-fed or formula-fed (p = 0.03). However, at 1 year of age, breastfed infants demonstrated significantly lower weight compared to formula-fed infants (p = 0.019). Furthermore, at 12 months, breastfed boys exhibited lower weight, length, BMI, and lower subscapular skinfold thickness compared to formula-fed infants. Conclusions: Breastfeeding has been shown to play a pivotal role in preventing obesity in children. In the initial postnatal period, infants who are fed breast milk exhibit a higher weight compared to those who are fed formula. However, by the age of 12 months, the weight of breastfed infants typically falls below that of formula-fed infants. Diabetes during pregnancy has been observed to have no impact on the anthropometric dimensions of infants up to the age of one. Nevertheless, further research is necessary to comprehensively assess the long-term implications of maternal GDM in their offspring. Full article

Osteoporosis, the most common bone disorder, profoundly impacts women’s health, especially during postmenopausal phases. Characterised by diminished bone mineral density (BMD), it increases the risk of fractures, affecting mobility, quality of life, and potentially mortality. The present review analyses the intricate interactions among physiological alterations, diseases, and medications that lead to bone mineral density reduction in women. It underscores the importance of gynaecologists in the prevention, diagnosis, and management of osteoporosis via early risk assessment, suitable hormone treatment, and lifestyle modifications. Essential considerations encompass the categorisation of osteoporosis into primary (age-related) and secondary (attributable to diseases or pharmacological treatments) types, with particular emphasis on predisposing conditions such as premature menopause, hormone deficits, and cancer therapies. The significance of diagnostic instruments such as DXA and novel methodologies like trabecular bone score and quantitative ultrasonography is emphasised for precise evaluation and surveillance. The review also addresses nutritional methods, physical exercise, and pharmaceutical interventions, including hormone replacement therapy (HRT), selective oestrogen receptor modulators (SERMs), and other anti-resorptive drugs, to preserve bone health. This review highlights the important role of gynaecologists in maintaining women’s bone health, promoting a proactive strategy to avert osteoporosis-related complications and enhance long-term results. Full article

Effective wildfire smoke risk and evacuation communication is urgently needed to avert unnecessary deaths as wildfires increase in frequency and intensity. Human exposure to wildfires has doubled in the last two decades. Low-income, marginalized communities are the most disadvantaged in their ability to respond. A systematic literature review of wildfire and wildfire smoke risk communication research between 2014 and 2024 was conducted. Web of Science and Scopus databases were searched using the keywords “wildfire”, “communication”, “wildfire smoke”, “risk”, and “public health”, resulting in 23 studies. The findings revealed marginalized communities were ill-prepared to respond to wildfires and take protective action against wildfire smoke. The findings were summarized across eight areas: the needs of marginalized communities to respond to wildfires, the role of trusted messengers to disseminate wildfire and smoke risk messaging, using diverse channels, timing and frequency considerations for disseminating messages, time-sensitive evacuation versus wildfire smoke risk messaging, targeted messaging for subgroups, the importance of coordinating messages across agencies and local government, and government perspective. Theory did not guide these research efforts with the exception of one study, and most studies were qualitative. The literature did not report on distinguishing indoor from outdoor protective action against smoke risk, reaching vulnerable communities such as nursing and older adult facilities, and postfire messaging. Evidence is needed on these fronts, along with experimental messaging studies to determine the most persuasive messages for motivating protective actions against wildfire and smoke risk. Full article

Metabolic syndrome (MetS) constitutes a spectrum of interconnected conditions comprising obesity, dyslipidemia, hypertension, and insulin resistance (IR). While a singular, all-encompassing treatment for MetS remains elusive, an integrative approach involving tailored lifestyle modifications and emerging functional food therapies holds promise in preventing its multifaceted manifestations. Our main objective was to scrutinize the efficacy of cranberry proanthocyanidins (PAC, 200 mg/kg/day for 12 weeks) in mitigating MetS pathophysiology in male mice subjected to standard Chow or high-fat/high-fructose (HFHF) diets while unravelling intricate mechanisms. The administration of PAC, in conjunction with an HFHF diet, significantly averted obesity, evidenced by reductions in body weight, adiposity across various fat depots, and adipocyte hypertrophy. Similarly, PAC prevented HFHF-induced hyperglycemia and hyperinsulinemia while also lessening IR. Furthermore, PAC proved effective in alleviating key risk factors associated with cardiovascular diseases by diminishing plasma saturated fatty acids, as well as levels of triglycerides, cholesterol, and non-HDL-C levels. The rise in adiponectin and drop in circulating levels of inflammatory markers showcased PAC’s protective role against inflammation. To better clarify the mechanisms behind PAC actions, gut–liver axis parameters were examined, showing significant enhancements in gut microbiota composition, microbiota-derived metabolites, and marked reductions in intestinal and hepatic inflammation, liver steatosis, and key biomarkers associated with endoplasmic reticulum (ER) stress and lipid metabolism. This study enhances our understanding of the complex mechanisms underlying the development of MetS and provides valuable insights into how PAC may alleviate cardiometabolic dysfunction in HFHF mice. Full article

Water pollution is a significant problem stemming from several causes, with the contamination of heavy metal(oid)s being a primary concern. This is especially concerning because of the poisonous characteristics of these metal(oid)s and their effects on the aquatic ecosystem. This research is distinguished by its unique methodology for assessing metal(oid)s in the surface water of Bangladeshi rivers over a period of sixteen years, from 2007 to 2022. This work seeks to elucidate recent results on metal(oid) concentrations, contamination levels, multivariate statistical analyses, source identification using positive matrix factorization models, and probabilistic health risks. The findings reveal that the concentrations of chromium, nickel, arsenic, cadmium, and lead exceeded the acceptable limits for drinking water established by the World Health Organization (WHO) by factors of 4.64, 2.25, 22.51, 45.60, and 10.13, respectively. Our meta-analysis, subsequent to a Principal Component Analysis, indicated that increased concentrations of hazardous metals account for 85.47% of the variation from both anthropogenic and natural causes. Ecological risk indicators, including the metal index (84.06) and the Nemerow pollution index (10.55), indicated significant metal contamination. Ecological risk indicators, like the metal index (84.06) and the Nemerow pollution index (10.55), indicate substantial metal contamination. The positive matrix factorization (PMF) model detected the following sources of metals in water: industrial (22%), mixed (32%), agricultural activities (27%), and natural sources (19%). Furthermore, Monte Carlo-simulation-based assessments of health hazards indicated that the mean hazard index (HI) and cancer risk values for adults (301.89 and 422.76) and children (51.56 and 39.45) significantly exceeded the recommended limits, suggesting that both adults and children are vulnerable to potential non-carcinogenic and carcinogenic health risks. The immediate execution of control measures and regulations is essential to avert escalating pollution in surface water, protect ecosystems, and mitigate health hazards. Full article

To enhance the security and supervision of emergency materials from their source to transport, thus preventing safety incidents, a tripartite evolution model integrating the government, material production enterprises, and logistics entities is proposed. This model, situated within the framework of a government-established blockchain platform, combines evolutionary game theory and prospect theory. It examines the strategy evolution of emergency material’s security subjects amid diverse government reward punishment measures and enterprise risk perceptions. Our findings indicate that employing dynamic reward–punishment measures not only conserves government regulatory resources but also incentivizes enterprises to enhance the quality of emergency materials security. This dynamic approach effectively encourages responsible behavior, averting rebellious tendencies or speculative mindsets in enterprises with deviating risk perceptions regarding emergency materials security. Full article

For well over a century, unresolved ambiguities in defining land as a finite, non-renewable resource have often facilitated rent-seeking and shaped inequitable distributions of wealth derived from nature and collective contributions. In the absence of clear conceptual and legal distinctions between land’s intrinsic worth and the incremental value conferred by human-made improvements, communities and ecosystems were frequently denied their rightful share, thereby influencing inequitable economic, social, and environmental trajectories. Though not universal, these historical patterns now reemerge in “digital land” platforms, where data, user engagement, and communal knowledge are likewise subject to private appropriation. By bridging these classical land debates with emerging forms of digital exploitation, this article offers a novel theoretical framework that reveals how unresolved land-valuation ambiguities reappear in user-generated data ecosystems. Without robust conceptual frameworks and effective regulatory oversight, such digital spheres risk replicating the exploitative logic once attached to physical land. By clarifying these parallels, this article underscores the urgent need for well-informed governance inspired by past land policy debates—particularly those focused on equity, transparency, and sustainability. Ensuring that resource management, whether rooted in soil or servers, consistently adheres to principles of fairness and shared prosperity is essential to avert new forms of unregulated extraction and to advance more inclusive, sustainable development. Full article

Background/Objectives: Whole grain consumption is recognized as a key component of healthy diets, offering protection against non-communicable diseases, including type 2 diabetes (T2D). However, in Japan, whole grain intake remains low, with brown rice—a traditional whole grain—underutilized despite its demonstrated health benefits. This study aimed to explore the health and economic impacts of increasing brown rice consumption among Japanese adults aged 40–79 years. Methods: Using a discrete-time Markov cohort macro-simulation model, we projected the effects of replacing 30% and 80% of mean white rice consumption with brown rice over 10 years. Input parameters were based on published epidemiological data and national healthcare expenditures. Key outcomes included cumulative T2D incidence, all-cause mortality, and associated healthcare costs. Results: Increasing brown rice consumption could prevent 1.3–3.4% of new T2D cases, avert 0.01–0.02% of all-cause deaths, and save from USD 31.3 million to USD 80.5 million in healthcare costs. Sensitivity analyses revealed that the relative risk of T2D associated with brown rice intake had the greatest influence on variabilities in projected cost savings. Conclusions: Although the projected reductions in T2D and healthcare costs were modest, the findings highlight the potential of increased brown rice consumption to alleviate the economic and public health burden of T2D in Japan. Incorporating brown rice into dietary patterns may support multidisciplinary lifestyle approaches for T2D prevention. Further research is warranted to explore long-term care costs for the management of complications and the benefits of other whole grains in the Japanese diet. Full article

Nowadays, in the complex business network system, the interaction of firms across borders is facing several challenges. Many studies in the literature also suggest numerous approaches to overcome these challenges. However, a few of the obstacles for internationalizing firms were studied and the challenges are increasing against firms’ growth opportunities cross-border. Taking this into account, the present research emphasized the roles of enterprises’ e-business adoptions of countries on cross-border firms’ internationalization by drawing from network theory and technology–organization–environment frames. By employing a fixed effect model to 365 enterprises, leaders’ attitudes of preferring technology-intensive firms, network infrastructure, risk-averting attitudes, country’s market size, multilingual services, e-government status, threats from competitors, reliable utility sources, human capital quality, costs of adoptions and telecom services enrichments, and costs of adopting different online services need to be taken into account before internationalization of born global companies. Full article

Background/Objectives: Patients on chronic anticoagulation undergoing metabolic surgery represent an increased risk of complications, including both bleeding and thrombotic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The optimal perioperative management of patients who are receiving chronic anticoagulation therapy (CAT) is complex. In the colorectal surgery literature, patients on CAT have a 10% rate of peri-procedural bleeding and a 3% rate of thromboembolism. The aim of this study was to evaluate and compare the safety and postoperative outcomes between patients with and without CAT undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at a tertiary referral center in the United Arab Emirates (UAE). Methods: All patients who underwent primary bariatric surgery between September 2015 and July 2019 were retrospectively reviewed. The first group included patients with CAT, and the second group included patients without CAT. Demographics, perioperative outcomes, and postoperative results were examined. Results: Our study included 542 patients, 22 (4%) with CAT and 520 (96%) without CAT. Mean age was 46.3 ± 10.5 years in the CAT group and 36.0 ± 11.7 years in the non-CAT group (p < 0.001); median BMI was 41.8 (range 33.1–61.3) and 42.7 (range 30.1–78.4) kg/m², respectively (p = 0.52). The CAT group had significantly higher rates of hypertension (77.2% vs. 32.5%, p < 0.001), obstructive sleep apnea (81.8% vs. 31.5%, p < 0.001), and coronary artery disease (31.8% vs. 2.8%, p < 0.001). In the CAT group, 8/22 (36.4%) patients underwent Roux-en-Y gastric bypass and 14/22 (63.6%) sleeve gastrectomy, compared to 228/520 (43.8%) and 292/520 (56.2%), respectively, in the non-CAT group (p = 0.51). There were no statistically significant differences in postoperative emergency department (ED) visits (18.1% vs. 24.2%, p = 0.51), early major complications (4.5% vs. 3.4%, p = 0.54), readmission rates within 30 days (4.5% vs. 3.6%, p = 0.56), or late complications (4.5% vs. 4.2%, p = 0.60). Mean length of stay was significantly longer in the CAT group (4.6 vs. 2.6 days, p < 0.001). The mean follow-up was 10 ± 7.3 months for the CAT cohort and 11 ± 9.7 months for the non-CAT cohort (p = 0.22). Weight loss outcomes at 12 months were comparable, with a percent total body weight loss (TBWL) of 27.0 ± 7.3% in the CAT group and 28.9 ± 8.3% in the non-CAT group (p = 0.29). There were no deaths in either group. Conclusions: In this series, at a tertiary referral center in the UAE, metabolic surgery is safe for CAT patients. Multidisciplinary preoperative preparation might be warranted to avert potential complications. Full article

Background: Umbilical artery thrombosis (UAT) masquerading as a single umbilical artery (SUA) is a rare but critical diagnostic challenge in prenatal care. Case Presentation: We described a case of a 22-year-old primigravida with an uneventful obstetric history who presented with reduced fetal movements at 22 weeks of gestation. Ultrasound showed no gross fetal structural anomalies while umbilical artery Doppler flow imaging revealed an isolated SUA. The patient again presented with diminished fetal movement at 24 weeks gestation, and a diagnosis of intrauterine demise was confirmed ultrasonographically. She was then induced and delivered a macerated stillborn female fetus. Placental examination revealed three umbilical vessels with an occlusive thrombus seen within the umbilical artery consistent with UAT, a finding previously mistaken for SUA. Conclusions: This case underscores the diagnostic difficulties of UAT radiologically, especially when there was no prior documented evidence of two umbilical arteries. Identification of at-risk fetuses would allow for close monitoring or effective interventions to be implemented as early as possible to avert preventable fetal loss. Full article

Background: A Peripherally Inserted Central Catheter (PICC) is a safe and effective Central Vascular Access Device when properly used. Therefore, it has become an increasingly frequent procedure. Nurses are often the professionals responsible for its insertion, maintenance, and removal. Despite the advantages of this device, it presents risks and possible associated complications. This scoping review aims to identify and analyze nursing interventions to prevent complications in adults with PICC. Methods: The review was conducted according to Joanna Briggs Institute’s scoping review proposal. The electronic databases Pubmed, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, Nursing & Allied Health Collection: Comprehensive, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Library, Information Science & Technology Abstracts, and MedicLatina were consulted in October 2023. Additionally, we searched the websites of the Registered Nurses Association of Ontario and the Canadian Vascular Access Association. We included articles published in English and Portuguese between 2018 and 2023. Results: A total of 170 articles were initially identified. After selecting and analyzing the articles, 13 studies were included. This review identified nursing interventions in adults to prevent PICC-related complications, categorized into five main groups: pre-procedure, during the procedure, post-procedure, maintenance, and team management interventions. Nurses are pivotal in averting PICC complications by employing evidence-based nursing interventions at each process stage. Conclusions: The importance of nursing interventions in enhancing patient safety, improving health outcomes, and informing clinical practice highlights the need for standardized protocols, specialized training, and consistent patient education for PICC care. Full article