Assessment of knowledge and awareness of stroke among the Syrian population: unveiling the current landscape in Syria through the first nationally representative study.

Stroke is a global public health concern, contributing to high rates of morbidity and mortality. In Syria, the current conflict and associated challenges have had a profound impact on healthcare infrastructure, including education and awareness programs related to stroke. An essential aspect of preventing stroke is the awareness of individuals. The study aimed to investigate factors associated with knowledge and awareness of stroke among Syrian people. A cross-sectional national representative study was conducted in Syria. The questionnaire was created on Google form and disseminated as a link through online platform social media like Facebook, WhatsApp, and Twitter. The population of the study was divided using proportionate random sampling into the 14 governorates. A random sample was selected from each area. The STROBE reporting guideline for cross-sectional studies was followed. Logistic regression analysis was performed to identify the factors associated with poor knowledge of stroke. A total of 1013 Syrian adults participated in the study. With more than half of them were females (53.5%) and employed (55.6%). Significant associations were found between ability to identify at least one correct risk factor and employability status (p = 0.029), single group (p = 0.036) and smokers (p < 0.001). In addition, significant associations were found between identifying at least one correct stroke symptom and smokers (p < 0.001) and no-obese people (p = 0.048). Furthermore, younger age group (below 30 years) were significantly able to list at least one correct stroke consequence compared to the older age groups (p = 0.025). Moreover, a significantly higher number of smokers compared to non-smokers correctly identified at least one stroke consequence (p = 0.019). The study revealed that there is a relatively weak understanding of the preventable nature of stroke among Syrian population. The overall awareness is still inadequate and varies depending on lifestyle factors and employment status.

Combined forest and soil management after a catastrophic event.

At the end of October 2018, a storm of unprecedented strength severely damaged the forests of the eastern sector of the Italian Alps. The affected forest area covers 42,500 ha. The president of one of the damaged regions asked for help from the University of Padua. After eight months of discussion, the authors of this article wrote a consensus text. The sometimes asper debate brought to light some crucial aspects: 1) even experienced specialists may have various opinions based on scientific knowledge that lead to conflicting proposals for action. For some of them there is evidence that to restore a destroyed natural environment it is more judicious to do nothing; 2) the soil corresponds to a living structure and every ecosystem's management should be based on it; 3) faced with a catastrophe, people and politicians find themselves unarmed, also because they rarely have the scientific background to understand natural processes. Yet politicians are the only persons who make the key decisions that drive the economy in play and therefore determine the near future of our planet. This article is an attempt to respond directly to a governor with a degree in animal production science, who formally and prudently asked a university department called "Land, Environment, Agriculture and Forestry" for help before taking decisions; 4) the authors also propose an artistic interpretation of facts (uncontrolled storm) and conclusions (listen to the soil). Briefly, the authors identify the soil as an indispensable source for the renewal of the destroyed forest, give indications on how to prepare a map of the soils of the damaged region, and suggest to anchor on this soil map a series of silvicultural and soil management actions that will promote the soil conservation and the faster recovery of the natural dynamic stability and resilience. ELECTRONIC SUPPLEMENTARY MATERIAL: Supplementary material is available for this article at 10.1007/s11629-019-5890-0 and is accessible for authorized users.

Gender and patient complaints: are they related?

BACKGROUND: Several studies suggest that the gender of patients and their healthcare providers affects overall patient satisfaction. AIMS: We sought to determine whether the gender of patients or providers was associated with the number of complaints filed by patients against providers. METHODS: In this case-controlled study, complaints from a health maintenance organisation were analysed for gender disparity during a 12-month period. RESULTS: The odds ratio for patients' female gender to be associated with complaints was 3.10 (95% confidence interval 1.73-5.55, P<0.001). Women were also more likely than men to cite providers' behaviour as the cause of complaints. No significant associations were noted between the number of complaints and a complainant's age, diagnosis of chronic pain or psychiatric illness, or with the provider's gender, age or length of employment in the organisation. The heterogeneity of gender effect demonstrated in the literature suggests that this effect is likely to be unique to the different practice settings. CONCLUSION: Evaluating the presence of this phenomenon in the different practice settings is recommended, to improve patient satisfaction and subsequently the quality of care.

Efficacy of continuous glucose monitoring in improving glycemic control and reducing hypoglycemia: a systematic review and meta-analysis of randomized trials.

OBJECTIVE: We conducted a systematic review and meta-analysis to assess the efficacy of continuous glucose monitoring (CGM) in improving glycemic control and reducing hypoglycemia compared to self-monitored blood glucose (SMBG). METHODS: We searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and Scopus for randomized trials of adults and children with type 1 or type 2 diabetes mellitus (T1DM or T2DM). Pairs of reviewers independently selected studies, assessed methodological quality, and extracted data. Meta-analytic estimates of treatment effects were generated using a random-effects model. RESULTS: Nineteen trials were eligible and provided data for meta-analysis. Overall, CGM was associated with a significant reduction in mean hemoglobin A1c [HbA1c; weighted mean difference (WMD) of -0.27% (95% confidence interval [CI] -0.44 to -0.10)]. This was true for adults with T1DM as well as T2DM [WMD -0.50% (95% CI -0.69 to -0.30) and -0.70 (95% CI, -1.14 to -0.27), respectively]. No significant effect was noted in children and adolescents. There was no significant difference in HbA1c reduction between studies of real-time versus non-realtime devices (WMD -0.22%, 95% CI, -0.59 to 0.15 versus -0.30%, 95% CI, -0.49 to -0.10; p for interaction 0.71). The quality of evidence was moderate due to imprecision, suggesting increased risk for bias. Data for the incidence of severe or nocturnal hypoglycemia were sparse and imprecise. In studies that reported patient satisfaction, users felt confident about the device and gave positive reviews. CONCLUSION: Continuous glucose monitoring seems to help improve glycemic control in adults with T1DM and T2DM. The effect on hypoglycemia incidence is imprecise and unclear. Larger trials with longer follow-up are needed to assess the efficacy of CGM in reducing patient-important complications without significantly increasing the burden of care for patients with diabetes.