Physical multimorbidity, suicidal ideation, and suicide attempts among adults aged ≥50 years from low- and middle-income countries.

OBJECTIVES: The association between physical multimorbidity and suicidal ideation or suicide attempts among older adults from low- and middle-income countries (LMICs) is largely unknown. We aimed to assess this association as well as its mediators using nationally representative data from six LMICs. METHODS: Cross-sectional, community-based data from the Study on Global Aging and Adult Health were analyzed. A total of 11 chronic physical conditions were assessed. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analyses were conducted. RESULTS: The final sample consisted of 34,129 adults aged ≥50 years (mean [SD] age 62.4 (16.0) years; maximum age 114 years; 52.1% females). In the overall sample, physical multimorbidity was associated with increased odds for suicidal ideation (OR = 2.99; 95% CI = 2.06-4.34) and suicide attempts (OR = 2.79; 95% CI = 1.58-4.95), with the association being stronger in males than females. The association between multimorbidity and suicidal ideation or suicide attempts was largely mediated by pain/discomfort (mediated% 33.3%-44.2%), sleep/energy (28.2%-33.8%), and mobility limitations (26.6%-34.8%). CONCLUSIONS: Physical multimorbidity among older adults in LMICs was associated with a substantially increased risk for suicidal ideation and suicide attempts. Addressing the identified mediators in people with physical multimorbidity may aid in the prevention of suicidal ideation and suicide attempts.

Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries.

PURPOSE: Informal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs). METHODS: Cross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted. RESULTS: Data on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18-120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56-1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%). CONCLUSION: Caregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.

From childhood financial hardship to late-life depression: socioeconomic pathways.

OBJECTIVE: Childhood financial hardship is associated with depression throughout the life course, including older adulthood. However, it is still unclear the extent to which occupation, education level and household income are mediators of this association. We aimed to examine the association between childhood financial hardship and late-life depression, and potential socioeconomic mediators using community-based data. METHODS: A nationally representative sample of 3623 non-institutionalized older Spanish adults aged 50+ was used. The associations between childhood financial hardship and depression, socioeconomic mediator variables and confounding variables such as chronic physical conditions, number of close people, and loneliness, were assessed through logistic regression models. Mediation analyses of socioeconomic variables were carried out. RESULTS: Older Spanish adults who experienced a poor childhood financial situation were nine times more likely to obtain a lower level of education than those with a good childhood financial situation, and about three times more likely to suffer from depression. Participants' education level mediated about 35-40% of the association between childhood financial hardship and late-life depression whereas we found no significant mediation effect of household income and occupation skill. CONCLUSION: Improving access to the educational system during the life course might result in a reduction in the prevalence of depression in the general population of older adults and particularly among individuals with low socioeconomic status.

Date palm waste-derived biochar composites with silica and zeolite: synthesis, characterization and implication for carbon stability and recalcitrant potential.

Engineered organo-mineral composites were synthesized from date palm waste biochar and silica or zeolite via mechanochemical treatments. Date palm tree rachis (leaves) waste biomass was pre-treated with silica or zeolite minerals via ball milling and sonication prior to pyrolysis at 600 °C. The resultant organo-mineral composites and pristine materials were characterized using X-ray diffraction, thermogravimetric-differential thermal (TG-DTA), Fourier transform infrared, scanning electron microscope analyses and surface area and porosity analyzer to investigate the variations in physiochemical and structural characteristics. Compared to the resultant composites derived from non-milled date palm biomass, ball milling increased surface area, while decreased crystallinity index and effective particle size of the biochar composites. Silica composited biochars were located near origin in the van Krevelen diagram indicating lowest H/C and O/C molar ratios, thus suggesting higher aromaticity and lower polarity compared to other biochars. TGA thermograms indicated highest thermal stability of silica composited biochars. Ash and moisture corrected TGA thermograms were used to calculate recalcitrance index (R50) of the materials, which speculated high degradability of biomass (R50 < 0.4), minimal degradability of biochars and zeolite composited biochars (0.5 < R50 < 0.7) and high recalcitrant nature of silica composited biochars (R50 > 0.7). Silica composited biochars exhibited highest carbon sequestration potential (64.17-95.59%) compared to other biochars. Highest recalcitrance and carbon sequestration potential of silica composited biochars may be attributed to changes in structural arrangements in the silica-biochar complex. Encapsulations of biochar particles with amorphous silica via Si-C bonding may have prevented thermal degradation, subsequently increasing recalcitrance potential of silica composited biochars.

Correction to: Date palm waste-derived biochar composites with silica and zeolite: synthesis, characterization and implication for carbon stability and recalcitrant potential.

Unfortunately, in the original publication of the article, Prof. Yong Sik Ok's affiliation was incorrectly published.

Date palm waste biochars alter a soil respiration, microbial biomass carbon, and heavy metal mobility in contaminated mined soil.

A 30-day incubation experiment was conducted using a heavy metal-contaminated mined soil amended with date palm feedstock (FS) and its derivative biochars (BCs) at three pyrolysis temperatures of 300 (BC-300), 500 (BC-500), and 700 °C (BC-700) with different application rates (0.0, 5, 15, and 30 g kg-1) to investigate their short-term effects on soil respiration (CO2-C efflux), microbial biomass carbon (MBC), soil organic carbon (SOC), mobile fraction of heavy metals (Cd, Cu, Pb, Zn, Mn, and Fe), pH, and electrical conductivity (EC). The results showed that FS and BC-300 with increasing addition rate significantly reduced soil pH, whereas SOC, CO2-C efflux, and soil MBC were increased compared to the control. On the contrary, BC-500 and BC-700 increased soil pH at early stage of incubation and have small or no effects on SOC, CO2-C efflux, and MBC. Based on the results, the date palm biochars exhibited much lower cumulative CO2-C efflux than feedstock, even with low-temperature biochar, indicating that BCs have C sequestration potential. Applying BC-700 at 15 and 30 g kg-1 significantly reduced cumulative CO2-C efflux by 21.8 and 45.4% compared to the control, respectively. The incorporation of FS into contaminated soil significantly increased the mobile content of Cd and Mn, but decreased the mobile content of Cu. However, BC-300 significantly reduced the mobile content of Cd, Cu, Pb, and Zn. It could be concluded that low-temperature biochar could be used as a soil amendment for reducing heavy metal mobility in mining contaminated soil in addition to minimize soil CO2-C efflux.

Correction to: Date palm waste biochars alter a soil respiration, microbial biomass carbon, and heavy metal mobility in contaminated mined soil.

Unfortunately, in the original publication of the article, Prof. Yang Sik Ok's affiliation was incorrectly published. The author's affiliation is as follows.

SEX DIFFERENCES ON THE WISC-III AMONG CHILDREN IN SUDAN AND THE UNITED STATES.

The sex differences on the WISC-III are reported for the thirteen subtests, the Verbal and Performance IQs, the four Index IQs and the Full Scale IQs in Sudan and the United States. The sex differences are closely similar in the two samples with a correlation of 0.878 (p<0.001) for the thirteen subtests. Males obtained significantly higher Full Scale IQs in the two samples of 0.23d and 0.11d, respectively.

Falls increase the risk for incident anxiety and depressive symptoms among adults aged ≥50 years: An analysis of the Irish longitudinal study on ageing.

BACKGROUND: Little is known about the potential impact of falls on the onset of common mental disorders in older adults. Thus, we aimed to investigate the longitudinal association between falls and incident anxiety and depressive symptoms in adults aged ≥50 years living in Ireland. METHODS: Data from the Irish Longitudinal Study on Ageing were analyzed (Wave 1: 2009-2011; and Wave 2: 2012-2013). The presence of falls and injurious falls in the past 12 months was assessed at Wave 1. Anxiety and depressive symptoms were assessed at Wave 1 and Wave 2 using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and the 20-item Center for Epidemiologic Studies Depression (CES-D), respectively. Covariates included sex, age, education, marital status, disability, and the number of chronic physical conditions. The association of falls at baseline with incident anxiety and depressive symptoms at follow-up was estimated by multivariable logistic regression. RESULTS: This study included 6,862 individuals (51.5% women; mean [SD] age 63.1 [8.9] years). After adjusting for covariates, falls were significantly associated with anxiety (OR = 1.58, 95%CI = 1.06-2.35) and depressive symptoms (OR = 1.43, 95%CI = 1.06-1.92). These associations were no longer significant after including fear of falling in the models. Similar findings were obtained for injurious falls, although the relationship with anxiety symptoms was not statistically significant. CONCLUSIONS: This prospective study of older adults from Ireland found significant associations between falls and incident anxiety and depressive symptoms. Future research may focus on whether interventions to reduce fear of falling could also alleviate anxiety and depressive symptoms.

Assessing the impact of workaholism and work engagement on medical university employee stress and satisfaction levels.

BACKGROUND: Workaholism (WH) is related with high mental trouble and physical objections, low employment and family fulfillment, and low occupation execution; however, work commitment is related with job and life satisfaction. This study aimed to assess the impact of WH and work engagement (WE) on medical university employee job stress and satisfaction. METHODS: This descriptive analytical study was conducted on workers employed in medical universities using validated questionnaires for data collection. The sample size was 330, from which 305 responded with completed questionnaire. The employees were the direct workers of different accessible medical universities in Karachi, Pakistan. The employee enrolment and distribution of the questionnaire was performed using non-probability convenient sampling. The Brief Job Questionnaire (BJQ), Dutch Work Addiction Scale (DUWAS) and Utrecht Work Engagement Scale (UWES) were used to assess the impact of job stress on job satisfaction and WE. The data was analyzed by applying descriptive statistics, Spearman correlation and regression analysis. A p-value of ≤ 0.05 was taken as significant. RESULTS: The study consisted of 117 (38.4%) male and 188 (61.6%) female participants; the mean age of participating employee was 28.50 ± 6.192. The mean score for WE was 3.78 ± 0.467, that of WH was 3.42 ± 0.559, for JS was 4.29 ± 0.400, whereas JSF was 3.10 ± 0.591. A positive correlation was observed between job stress, WH and WE. WH had a strong correlation with job stress and weak correlation with job satisfaction and performance. A significant difference was observed between WE and WH among males and females. CONCLUSIONS: The study presented with a significant effect of job satisfaction with WH and WE with job stress. Hence, indicating the importance of social skills and WE with fellow employees to increase the work productivity and performance. However, in case of over work and WH, an increase of job stress is inevitable.

Safe practices of biomedical and dental waste management amongst practicing dental professionals amid the COVID-19 pandemic.

BACKGROUND: Biomedical waste can potentially compromise the environment and public safety if not safely disposed. OBJECTIVE: The aim was to assess the understanding and safe practices of biomedical and dental waste amongst the dental practitioners and practical year students amid the COVID-19 pandemic. METHODS: A structured and validated questionnaire consisting of 21 closed ended questions was used to collect data from dental practitioners and students working in hospitals and clinics. The questionnaire was distributed in paper and digital form amongst the participants. Descriptive analysis was performed for categorical and numerical variables. Spearman correlation test was used to assess the relationship between awareness and waste disposal practices of dentists. A p-value of≤0.05 was considered as statistically significant. RESULTS: More than three fourth of the participants were aware of proper dental waste disposal steps. One half was aware of the color-coded segregation of biomedical waste management. Two third of the participants were deploying safe biomedical waste practices. Nearly 68% subjects allocated separate labeled containers for disposal of COVID-19 suspected patient's waste. Furthermore, 71.63% participants were practicing PCR test before aerosol procedures. While 88.65% participants believed that the COVID-19 pandemic has increased the financial burden in terms of safe practices and dental waste management. CONCLUSION: The awareness and practices of the participants towards dental waste management was found to be moderate. Satisfactory COVID-19 prevention and transmission measures were observed amongst the participants. BMW management lessons should be included in the academic curriculum and training program needs to be adopted for mass awareness.

Association of objective and subjective far vision impairment with perceived stress among older adults in six low- and middle-income countries.

OBJECTIVES: To assess the association between far vision impairment (objective and subjective) and perceived stress among older adults from six low- and middle-income countries (LMICs, i.e., China, Ghana, India, Mexico, Russia, and South Africa). METHODS: Data from the WHO Study on global AGEing and adult health were analyzed. Objective visual acuity was measured using the tumbling E LogMAR chart and was used as a four-category variable (no, mild, moderate, and severe visual impairment). Subjective visual impairment referred to difficulty in seeing and recognizing an object or a person across the road. Using two questions from the Perceived Stress Scale, a perceived stress variable was computed, and ranged from 0 (lowest stress) to 100 (highest stress). Multivariable linear regression with perceived stress as the outcome was conducted. RESULTS: Data on 14,585 adults aged ≥65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Only severe objective visual impairment (versus no visual impairment) was significantly associated with higher levels of stress (b = 6.91; 95% CI = 0.94-12.89). In terms of subjective visual impairment, compared with no visual impairment, mild (b = 2.67; 95% CI = 0.56-4.78), moderate (b = 8.18; 95% CI = 5.84-10.52), and severe (b = 11.86; 95% CI = 9.11-14.61) visual impairment were associated with significantly higher levels of perceived stress. CONCLUSIONS: This large study showed that far vision impairment was associated with increased perceived stress levels among older adults in LMICs. Increased availability of eye care services may reduce stress among those with visual impairment in LMICs, while more research is needed to better characterize the directionality of the far vision impairment-perceived stress relationship.

Evaluating the Influence of COVID-19 Among Dental Practitioners After Lockdown.

Clinical activities at dental premises after the COVID-19 lockdown period or post-COVID-19 are likely to be a challenge for all practicing dentists. To assess the impact of the COVID-19 pandemic on dentists and change in dental practice following lockdown, a total of 1150 participants were approached through online survey forms registered on www.surveys.google. A link containing details of the questionnaire and a consent form was sent to dentists through emails and social media forums. The questionnaire included 3 domains comprising of seventeen questions. The first section focused on demographics. The second section inquired about the change in dental practice, that is, clinical hours, use of PPE, type of treatment, and patient flow. The third section investigated the impact of COVID-19 on dentistry. Means, standard deviation, and percentages were calculated using descriptive statistics. Chi-square was used to find an association between different variables. The response rate was 87%. Demographic factors revealed participants aged from 20.45 to 40.55 years. The data showed around 89.6% (896) of dentists have altered their clinical working hours post lockdown and, approximately, 59.7% (597) of dentists provided only emergency treatments. 88.1% (881) of the dentists wore PPE during dental procedures. Overall, a huge negative impact of the COVID-19 pandemic was observed among practicing dentists in terms of the dental supply chain, cost, and availability of dental equipment, treatment cost, and bill payments.COVID-19 pandemic compromised dental care. Though dentists were taking precautionary measures and have changed their practice according to the guidelines provided by the ADA and World Health Organization, they were still experiencing monetary loss due to decrease patient influx post lockdown.

Multimorbidity and Subjective Cognitive Complaints: Findings from 48 Low- and Middle-Income Countries of the World Health Survey 2002-2004.

BACKGROUND: Data on the association between multimorbidity and subjective cognitive complaints (SCC) are lacking from low- and middle-income countries (LMICs). OBJECTIVE: To assess the association between multimorbidity and SCC among adults from 48 LMICs. METHODS: Cross-sectional, community-based data were analyzed from the World Health Survey 2002-2004. Ten chronic conditions (angina, arthritis, asthma, chronic back pain, depression, diabetes, edentulism, hearing problems, tuberculosis, visual impairment) were assessed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Multivariable linear regression and mediation analyses were conducted to explore the associations. RESULTS: A total of 224,842 individuals aged≥18 years [mean (SD) age 38.3 (16.0) years; 49.3% males] constituted the final sample. Compared to no chronic conditions, the mean SCC score was higher by 7.13 (95% CI = 6.57-7.69), 14.84 (95% CI = 13.91-15.77), 21.10 (95% CI = 19.49-22.70), 27.48 (95% CI = 25.20-29.76), and 33.99 (95% CI = 31.45-36.53) points for 1, 2, 3, 4, and≥5 chronic conditions. Estimates by sex and age groups (18-44, 45-64,≥65 years) were similar. Nearly 30% of the association between multimorbidity (i.e.,≥2 chronic conditions) and SCC was explained by psychological factors (i.e., perceived stress, sleep problems, anxiety symptoms). CONCLUSION: Multimorbidity is associated with SCC among adults in LMICs. Future studies should investigate whether addressing psychological factors in people with multimorbidity can improve cognitive function, and whether screening for SCC in individuals with multimorbidity can be a useful tool to identify individuals at particularly high risk for future cognitive decline.

Erratum: Alnowibet et al. Healthcare Human Resources: Trends and Demand in Saudi Arabia. Healthcare 2021, 9, 955.

Some details of the authors' names, affiliations, and email addresses were incorrect in the original version of the article [...].

Healthcare Human Resources: Trends and Demand in Saudi Arabia.

This paper estimates the impact of policies on the current status of Healthcare Human Resources (HHR) in Saudi Arabia and explores the initiatives that will be adopted to achieve Saudi Vision 2030. Retrospective time-series data from the Ministry of Health (MOH) and statistical yearbooks between 2003 and 2015 are analyzed to identify the impact of these policies on the health sector and the number of Saudi and non-Saudi physicians, nurses and allied health specialists employed by MOH, Other Government Hospitals (OGH) and Private Sector Hospitals (PSH). Moreover, multiple regressions are performed with respect to project data until 2030 and meaningful inferences are drawn. As a local supply of professional medical falls short of demand, either policy to foster an increase in supply are adopted or the Saudization policies must be relaxed. The discrepancies are identified in terms of a high rate of non-compliance of Saudization in the private sector and this is being countered with alternative measures which are discussed in this paper. The study also analyzed the drivers of HHR demand, supply and discussed the research implications on policy and society. The findings suggest that the 2011 national Saudization policy yielded the desired results mostly regarding allied health specialists and nurses. This study will enable decision-makers in the healthcare sector to measure the effectiveness of the new policies and, hence, whether to continue in implementing them or to revise them.

Sarcopenia and Mild Cognitive Impairment in Older Adults from Six Low- and Middle-Income Countries.

BACKGROUND: Little is known about the relationship between sarcopenia and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs). OBJECTIVE: This study aimed to investigate this association among community-dwelling adults aged≥65 years from six LMICs. METHODS: Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. These data were obtained in China, Ghana, India, Mexico, Russia, and South Africa in 2007-2010. Participants were considered to have sarcopenia if they had low skeletal muscle mass (i.e., lower skeletal mass index) and a weak handgrip strength. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression analysis was conducted to assess associations. RESULTS: The final analytical sample consisted of 12,912 individuals aged≥65 years with preservation in functional abilities without stroke (mean [standard deviation] age 72.2 [10.8] years; 45.2% males). The overall prevalence of sarcopenia and MCI were 11.3% and 18.1%, respectively. After adjusting for potential confounders, there was a positive association between sarcopenia and MCI in all countries (i.e., odds ratio [OR] > 1) with the exception of South Africa, and the overall estimate was OR = 1.60 (95% confidence interval [CI] = 1.32-1.93) with a low level of between-country heterogeneity (I2 = 0.0%). CONCLUSION: There was a positive association between sarcopenia and MCI in this sample of older adults living in LMICs. Causality should be assessed in future longitudinal research, while the utility of sarcopenia as a marker of MCI should also be investigated.

Animal carcass burial management: implications for sustainable biochar use.

This review focuses on existing technologies for carcass and corpse disposal and potential alternative treatment strategies. Furthermore, key issues related to these treatments (e.g., carcass and corpse disposal events, available methods, performances, and limitations) are addressed in conjunction with associated environmental impacts. Simultaneously, various treatment technologies have been evaluated to provide insights into the adsorptive removal of specific pollutants derived from carcass disposal and management. In this regard, it has been proposed that a low-cost pollutant sorbent may be utilized, namely, biochar. Biochar has demonstrated the ability to remove (in)organic pollutants and excess nutrients from soils and waters; thus, we identify possible biochar uses for soil and water remediation at carcass and corpse disposal sites. To date, however, little emphasis has been placed on potential biochar use to manage such disposal sites. We highlight the need for strategic efforts to accurately assess biochar effectiveness when applied towards the remediation of complex pollutants produced and circulated within carcass and corpse burial systems.

Mental Disorders, Musculoskeletal Disorders and Income-Driven Patterns: Evidence from the Global Burden of Disease Study 2017.

BACKGROUND: The aim of the present study was to use the extensive Global Burden ofDiseases, Injuries, and Risk Factors Study (GBD) database from 1990-2017 to evaluate the levels andtemporal correlation trends between disability adjusted life years (DALYs) attributed tomusculoskeletal (MSK) disorders, all mental disorders collectively and by mental disorder subcategory. METHODS: We utilized results of the GBD 2017 to describe the correlation patterns betweenDALYs due to MSK disorders, mental disorders and other diseases among 195 countries. Mixedmodel analysis was also applied. RESULTS: A consistent relation was reported between age-adjustedDALYs attributed to MSK and mental disorders (in total) among the 195 countries, in both sexes,for 1990 to 2017 (1990 Rho = 0.487; 2017 Rho =0.439 p < 0.05). Distinct regional and gender correlationpatterns between age-adjusted DALYs due to MSK and mental disorders were reported. Nocorrelation was reported between DALYs due to MSK and all mental disorders collectively, amongLow- or Middle-income countries. However, in High-income countries (HICs), the correlation wasstrong and consistent between 1990 and 2017 (1990 Rho = 0.735; 2017 Rho = 0.727, p < 0.05). CONCLUSIONS: The reported correlation patterns call for targeted preventive strategies andintervention policies for mental and MSK disorders internationally. Special attention is neededamong HICs.

Fruit and Vegetable Consumption and Potential Moderators Associated with All-Cause Mortality in a Representative Sample of Spanish Older Adults.

This study sought to determine the association between levels of fruit and vegetable consumption and time to death, and to explore potential moderators. We analyzed a nationally-representative sample of 1699 older adults aged 65+ who were followed up for a period of 6 years. Participants were classified into low (≤3 servings day), medium (4), or high (≥5) consumption using tertiles. Unadjusted and adjusted cox proportional hazard regression models (by age, gender, cohabiting, education, multimorbidity, smoking, physical activity, alcohol consumption, and obesity) were calculated. The majority of participants (65.7%) did not meet the recommendation of five servings per day. High fruit and vegetable intake increased by 27% the probability of surviving among older adults with two chronic conditions, compared to those who consumed ≤3 servings per day (HR = 0.38, 95%CI = 0.21-0.69). However, this beneficial effect was not found for people with none, one chronic condition or three or more, indicating that this protective effect might not be sufficient for more severe cases of multimorbidity. Given a common co-occurrence of two non-communicable diseases in the elderly and the low frequency of fruit and vegetable consumption in this population, interventions to promote consuming five or more servings per day could have a significant positive impact on reducing mortality.