BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding readmission for new congestive heart failure (CHF) following index admission for AF in the developing world are poorly described.
OBJECTIVE: The study aimed to assess the rate, predictors, and outcomes of 120-day CHF readmission after index admission for AF in Syria.
METHODS: This retrospective cohort study collected all adult patients without known CHF who had an index admission with AF to Latakia\'s tertiary center between June 2021-December 2023. Data were taken from patients\' medical notes. The primary outcome included readmission with incident CHF within 120 of index discharge, and secondary outcomes included predictors and outcomes of these CHF readmissions.
RESULTS: A total of 660 patients were included in the final analysis, of which 69 (11.7%) were readmitted with new CHF within 120 days of index discharge. Readmitted patients had higher median age (58 vs 70 years, p < .001). Factors that independently increased 120-day CHF incidence were age ≥60 years (HR: 9.8, 95% CI: 4.8-23.6, p < .001), diabetes mellitus (DM) (HR:2.9, 95% CI:1.7-4.9, p < .001), valvular heart disease (VHD) (HR:1.7, 95% CI:1.04-2.78, p = .047), and hypertension (HR:2.5, 95% CI:1.5-4, p < .001). Inpatient mortality occurred in six readmitted patients (9%). LVEF <40% (HR:6.7, 95% CI: 24.31, p = .01) and DM (HR:7.2, 95% CI: 1.9-33, p = .004) were independently associated with inpatient mortality.
CONCLUSIONS: Hospitalization for new CHF was common in Syrian patients discharged with AF. The clinical predictors of incident CHF emphasize the importance of integrated management of lifestyle risk factors and common comorbidities in AF patients to optimize outcomes in resource-depleted communities.

BACKGROUND: In Myanmar, ongoing conflict since the 2021 military coup d\'etat has been characterized by targeted violence against health workers (HWs), particularly those participating in the pro-democracy movement. Existing knowledge about the challenges faced by health workers in Myanmar is scant, including their perspectives on mitigating their suffering and the broader impact on community health. This knowledge gap prompted our study to assess the extent of the violence, its impact on the workers and the community, and identify resource priorities.
METHODS: This qualitative study employed purposive and snowball sampling to recruit health workers affiliated with the Civil Disobedience Movement (CDM). We interviewed 24 HWs in Myanmar between July and December 2022, predominantly physicians and nurses. We used a semi-structured interview guide and conducted interviews remotely due to the security situation. We adopted content analysis to understand participation in the CDM movement, experiences of violence, personal and professional impacts, the sequelae to community health, how HWs responded as well as their ongoing needs.
RESULTS: Thematic content analysis revealed that violence was both individually targeted and widespread. Health workers faced professional, financial, and personal impacts as a result. The health system as a whole has been severely diminished. Health workers have had to adapt to continue to provide care, for example some fled to rural areas and worked clandestinely, exchanging their services for food and shelter. In those settings, they continued to face insecurity from airstrikes and arrests. Health workers have also experienced moral distress and burden due to their resistance and protest against the regime.
CONCLUSIONS: The coup and ensuing violence severely disrupted the healthcare system, resulting in shortages of supplies, reduced quality of care, and exacerbated challenges during the COVID-19 pandemic. Despite facing significant hardships, HWs remained resilient, engaging in resistance efforts within the CDM and seeking support from local communities and international organizations. They expressed a need for increased awareness, financial assistance, and concrete support for the health system to address the crisis.

BACKGROUND: Tiredness, poor concentration, disturbed sleep and poor appetite can all be caused by depression, which is a common mental disorder and a leading cause of disability worldwide. This study aimed to assess the prevalence of major depressive disorder, suicidal ideation, and risk factors in Sudanese children and adolescents during the Sudanese army conflict.
METHODS: A descriptive cross-sectional community-based study was carried out among Sudanese children between 11 and 17 years old who living in Sudan at the start of the conflict by using a self-administered questionnaire under the guidance of parents, if necessary. The questionnaire was adapted from the Patients Health Questionnaire-9 (PHQ-9) checklist for the assessment of major depression disorder symptoms according to the Diagnostic and Statistical Manual Edition 5th Edition (DSM-5). The questionnaire was translated into Arabic by two expert translators, and its validity and reliability were confirmed. Data analysis was performed using Statistical Package for the Social Sciences version 25 software, and descriptive analysis and any appropriate statistical tests were performed.
RESULTS: Among the 963 participants, the mean age was 15.18 ± 2.1 years, 65.5% were female, and 67.7% had major depressive disorder. There was a significant relationship between MDD score, age, sex, current residency status, and traumatic event exposure, with P values less than 0.001 for all variables.
CONCLUSIONS: Major depressive disorder was highly prevalent among Sudanese children and adolescents included in the present study. Additionally, suicidal ideation, which requires immediate intervention, was reported to be very high. The findings will help the government to provide proper mental health interventions for affected people.

BACKGROUND: Colombia has high numbers of internally displaced people, forced to migrate due to the conflict. 1 in 3 displaced women undergo pregnancy during adolescence, compared to around 1 in 5 in the non-displaced population, alongside health and resource inequalities between these groups. There is limited qualitative information available from the perspectives of displaced women experiencing adolescent pregnancy. This research explores how structural violence may feature in their experiences.
METHODS: Qualitative methods were used. Participants were recruited with purposive sampling, using key informants and snowball sampling technique. 14 semi-structured interviews were conducted in Ciudad Bolívar, Bogotá, involving 11 displaced women who began childbearing age 15-19 in the past 10 years, and 4 participants\' mothers. Data was analysed using the theoretical framework of structural violence, and emergent themes categorised using thematic analysis.
RESULTS: Pregnancy was considered advantageous in many ways, but this was contradicted by resulting disadvantages that ensued. Structural violence was embedded in life stories, manifesting in poverty and difficulties accessing reliable income, poor access to healthcare and education following pregnancy. Institutional and interpersonal discrimination confounded these challenges.
CONCLUSIONS: Pregnancy during adolescence was a contradictory experience, representing both a safety net and a trap due to a complex interplay of structural and cultural violence in everyday survival. Policymakers must consider the importance of the context surrounding adolescent pregnancy and address systematic disadvantages affecting women in these positions.
The violent conflict in Colombia has left many people forced to leave their homes and become ‘internally displaced’. Internally displaced women are more likely to become pregnant during their adolescence than non-displaced women. This work tries to understand more about the everyday lives of displaced women who experience adolescent pregnancy, through interviews. The interviews were analysed and results interpreted using the theory of ‘structural violence’. Structural violence describes how social structures such as racism, sexism, war and poverty determine life choices, leading to suffering and inequality. The work found that pregnancy and motherhood in adolescence for displaced women was positive in many ways by bringing purpose, status and companionship. However, these women also experienced many challenges after pregnancy, such as exclusion from education and secure employment and difficulty accessing healthcare. This demonstrated that structural violence features in multiple interconnected forms in the daily lives of displaced adolescent mothers. The work urges policymakers to appreciate the complexity of context surrounding adolescent pregnancy and motherhood, and to address the structural disadvantages facing women in these situations.

The process of athlete selection and deselection in sport involves not only athletes but also coaches, managers, performance directors, talent pathway coordinators and the wider organisation. Athlete selection and deselection can be viewed as the opposite sides of the same coin in that the process may be the same for all athletes but the outcome is very different. The outcome of this process can evoke extremely powerful emotions ranging from elevation to devastation. While selection and deselection are part of competitive sport regardless of type, level, gender or age, research is scarce. Employing the Delphi method, a total of 20 participants comprised the expert panel (coaches, athletes and other key personnel in high performance) from various sports, and ages ranged from 21 to 59 years old. Following three rounds, 60 items reached the pre-determined consensus level of 75%. The 60 items were then further content analysed and grouped with respect to the three key stakeholders: athlete (14), coach (21) and organisation (25). Within each of these categories, subcategories emerged: personal, interpersonal, procedural, educational, supportive, communicative and reviewing behaviours and actions that athletes, coaches and organisations can take to ease the navigation, apply consistency and establish a common ground during this challenging situation.

BACKGROUND: Since the onset of the Russian invasion on 24 February 2022, the health system in Ukraine has been placed under tremendous pressure, with damage to critical infrastructure, large losses of human resources, restricted mobility and significant supply chain interruptions. Based on a longstanding partnership between the Ukrainian Institute for Social Research after Oleksandr Yaremenko (UISR after O. Yaremenko) and the Institute for Global Public Health at the University of Manitoba, we explore the impact of the full-scale war on non-governmental organizations (NGOs, including charitable organizations) providing services for key population groups in Ukraine.
METHODS: We conducted in-depth qualitative interviews with key representatives from NGOs working with key population groups (i.e., people living with HIV, sex workers, men who have sex with men, people who inject drugs and transgender people) throughout Ukraine. Members of the UISR after O. Yaremenko research team recruited participants from organizations working at national, regional and local levels. The research team members conducted 26 interviews (22 with women and four with men) between 15 May and 7 June 2023. Interviews were conducted virtually in Ukrainian and interpretively analysed to draw out key themes.
RESULTS: Applying Roels et al.\'s notion of \"first responders\", our findings explore how the full-scale war personally and organizationally impacted workers at Ukrainian NGOs. Despite the impacts to participants\' physical and mental health, frontline workers continued to support HIV prevention and treatment while also responding to the need for humanitarian aid among their clients and the wider community. Furthermore, despite inadequate pay and compensation for their work, frontline workers assumed additional responsibilities, thereby exceeding their normal workload during the extraordinary conditions of war.
CONCLUSIONS: NGOs play a vital role as responders, adapting their services to meet the emergent needs of communities during structural shocks, such as war. There is an urgent need to support NGOs with adequate resources for key population service delivery and to increase support for their important role in humanitarian aid.

UNASSIGNED: Ongoing military conflict in Sudan has had significant repercussions on the health and well-being of the population, particularly among women of reproductive age. This study aimed to investigate the impact of conflict on maternal health by employing a mixed qualitative and quantitative research approach.
UNASSIGNED: Through in-depth interviews and survey questionnaires (388 women), this study examined the experiences and challenges faced by pregnant women and new mothers and the availability and accessibility of maternal healthcare services in conflict-affected areas. Using a qualitative approach, in-depth interviews were conducted with 35 women who had recently given birth or were pregnant in regions affected by the Khartoum State-Sudan conflict. Thematic analysis was used to analyze the data collected from the interviews.
UNASSIGNED: Most women did not have access to healthcare services (86.6%), and out of the total sample, 93 (24%) experienced adverse outcomes. The factors associated with adverse effects were parity (OR 1.78, CI [1.15-2.75], p-value 0.010), gestational age (OR 2.10, CI [1.36-3.25], p-value 0.002), access to healthcare (OR 2.35, CI [1.48-3.72], p-value 0.001), and delivery mode (OR 1.68, CI [1.05-2.69], p = 0.030). Factors significantly associated with accessibility to maternal healthcare services included age (OR, 1.28; = 0.042) and higher conflict levels (1.52 times higher odds, p = 0.021). The narratives and experiences shared by women exposed the multifaceted ways in which the conflict-affected maternal health outcomes.
UNASSIGNED: The significance of this study lies in its potential to contribute to the existing literature on maternal health in conflict-affected areas, especially in Sudan, and to help us understand how women can receive maternal health services.

BACKGROUND: Conflict leads to the displacement of people, making it more difficult for them to cope with increasing stress. In war-affected regions, people use different strategies to cope with their stress. This study examines the coping strategies of internally displaced persons (IDPs) and those in host communities in war zones.
METHODS: People living in the IDP camp and host communities in Maiduguri, Nigeria were recruited using a convenient sampling strategy. A 28-item Hausa version of the Brief COPE Scale wasused for data collection. Data were analyzed using linear regression and presented as unstandardized beta (B) and standard error (SE).
RESULTS: A total of 562 participants were recruited (IDPs, n = 281; and the host communities, n = 281). Problem- and emotion-focused coping strategies were identified as the most common approaches used in host communities; however, dysfunctional strategies were morecommon among the IDPs. Age (younger or older adulthood) was identified as a predictor forthe use of emotion-, problem-, and dysfunctional-focused coping strategies.
CONCLUSIONS: Host communities were more likely to use a problem-and emotion-focused approach to coping, while IDPs were more likely to use dysfunctional strategies. Location and demographic factors (being single, aged 18-29years, >50 years and older) also influenced coping.

OBJECTIVE: Marital satisfaction is a complex phenomenon influenced by a variety of factors, including personality traits, communication, conflict resolution, and economic stability. This study aims to examine the relationship between personality and marital satisfaction among reproductive-age women, exploring how these factors interplay and contribute to the overall dynamics of marital relationships.
METHODS: A cross-sectional study was conducted among reproductive-age women to assess marital satisfaction and personality traits using established assessment tools. The demographic data were collected through a structured questionnaire, and the relationship between personality traits and marital satisfaction was analyzed using confirmatory factor analysis (CFA). Regression models were used to identify significant predictors of marital satisfaction, and the fit of the CFA model was evaluated using various indicators.
RESULTS: The mean age of the participants was 33.7 (±8.09) years, while the mean age of their husbands was 38.3 (±9.27) years. The results showed that conscientiousness and agreeableness had significant positive associations with marital satisfaction. Communication and conflict resolution emerged as key components of marital satisfaction, with standardized coefficients of 0.894 and 0.818, respectively. Financial management was also found to be strongly related to marital satisfaction, indicating the importance of economic stability in maintaining marital harmony.
CONCLUSIONS: The study underscores the significance of personality traits, communication, conflict resolution, and financial management in shaping marital satisfaction among reproductive-age women. The results suggest that interventions targeting improved communication and effective conflict-resolution strategies can enhance marital satisfaction. Additionally, addressing financial stressors and promoting economic stability could lead to better marital outcomes. These findings align with previous research, highlighting the need for a holistic approach to understanding and improving marital satisfaction. Further research is recommended to explore these relationships in different cultural contexts and with broader demographic groups.

UNASSIGNED: Mental disorders are highly prevalent and affect people across all regions of the world. The State of Jammu and Kashmir has been witness to a conflict for about three decades. Little is known about the extent of mental disorders in Kashmir. There was a dire need to estimate the prevalence of mental disorders among the rural population of Kashmir. The study was undertaken to estimate the point prevalence of specific mental disorders in rural population of Kashmir, sociodemographic correlates of mental disorders and to assess the service utilization in individuals with mental disorders.
UNASSIGNED: Community-based survey carried out in rural districts of Kashmir using a mixed sampling technique. The survey was conducted in six blocks of two districts (Pulwama and Baramulla) of Kashmir. Mini-International Neuropsychiatric Interview (MINI) for psychiatric morbidity was used. Appropriate statistical methods were applied.
UNASSIGNED: In total, 11.3% of adult population suffers from mental illness in the valley. As compared to males (8.4%), females had a higher prevalence (12.9%). Depressive disorders (8.4%) were the most common psychiatric disorders, followed by anxiety disorders (5.1%). Only 12.6% of patients suffering from mental disorders had sought treatment for their illnesses.
UNASSIGNED: The findings of this study have cleared many doubts and indicated the prevalence of 10 common mental health disorders in the general population as well as among different socioeconomic groups in Kashmir. This study has indicated low levels of treatment sought by people with mental illness.