BACKGROUND: Ongoing conflict between multiple armed groups, including pastoralist herders in the Central African Republic (CAR) causes frequent population displacements, food insecurity and scarcity of healthcare services. The inaccessibility and insecurity of many areas of CAR limit data collection and assessments from national nutritional surveys. Community health workers (CHWs) trained by an international non-governmental organisation, The MENTOR Initiative, deliver basic healthcare to children under 5 years old living in hard-to-reach and conflict-affected areas in eight subprefectures of north-west CAR. Their nutritional status and its associations with geography, malaria, season and conflict are unknown.
METHODS: CHW monthly records (October 2015-August 2021), Armed Conflict Location and Event Data project conflict data and The World Bank Group meteorological data for eight subprefectures of north-west CAR were analysed. Associations between counts of global acute malnutrition (GAM) assessed by mid-upper arm circumference and malaria, season and conflict were investigated using negative binomial regression.
RESULTS: Of the 457,325 consultations with children aged 6-59 months, 6.2% and 0.4% were classified as moderately or severely malnourished, respectively. The negative binomial model demonstrated differences in counts of GAM by subprefecture. Counts of GAM were positively associated with the case rate of severe malaria (IRR = 1.045; 95% CI: 1.04-1.06) and the rainy season (July-September) (IRR = 1.10; 95% CI: 1.03-1.17). Conflict events coded as Battles in ACLED were associated with lower counts of GAM (IRR = 0.78; 95% CI: 0.62-0.97).
CONCLUSIONS: This analysis shows geographical differences in levels of malnutrition in north-west CAR and demonstrates clear associations between malnutrition, season and malaria. It provides evidence that levels of GAM may be underestimated in north-west CAR in areas experiencing conflict. These findings highlight the need for targeted nutritional support to reach children most at risk of malnutrition. CHWs are a proven effective means of delivering essential primary healthcare services in hard-to-reach, conflict-affected areas.

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.

As a response to the COVID-19 pandemic, the United Nations Security Council passed resolution S/RES2532 (2020), requesting the cessation of hostilities. Despite ceasefire initiatives, evidence suggests that both conflict and violent events remained unabated-and, in some cases, escalated during the first months of the pandemic. This study uses interrupted time series analyses to examine the impact of the pandemic on violent and non-violent political events-including health system-related violence-in Libya, which has been experiencing a protracted conflict since 2014. We find a reduction of approximately 21 battles (p < 0.001) only during the first month of the pandemic. However, overall, throughout the pandemic, there was an increase of roughly one battle per month (p < 0.001). The violence that affected healthcare workers decreased during the first year of the pandemic (p < 0.001); but by the second year the reduction in healthcare worker-related violence had dissipated. While the pandemic seems to have mitigated the level of violence experience by healthcare workers, the overall pattern of violence is a troubling one, particularly since they were observed while there is an international agreement for a ceasefire in place and a specific peace agreement occurring in Libya. The pattern suggests that policy to protect healthcare workers may need to be enhanced even more during crisis settings.

Healthcare disagreements are common, but recognising the causes is essential to reaching a moral consensus. The article describes the challenges associated with resolving the disagreements. Therefore, a systematic and timely team-based discussion, ethics consultation with ethicists and the hospital ethics committee, active participation of all members\' discussions, and scheduled debriefings are pragmatic ways to find balance when healthcare professionals disagree. Teams need these attempts to build consensus and make moral decisions. It also fosters harmony, prioritises patient and team interests and, most importantly, keeps the team intact.

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This article details the Russian government\'s efforts to influence Canadians\' perceptions of the war in Ukraine. Specifically, we examined Russian information campaigns tailored to Canadian audiences on X (formerly known as Twitter) and the supportive ecosystems of accounts that amplify those campaigns. By 2023, this ecosystem included at least 200,000 X accounts that have shared content with millions of Canadians. We identified ninety accounts with an outsized influence. The vast majority of the influential Canadian accounts were far right or far left in orientation. These networks were among Canada\'s most prolific and influential political communities online. We determined this by comparing these networks\' potential influence to the online community engaging with Canada\'s 338 members of Parliament on X and a sample of twenty influential X accounts in Canada. The sophistication and proliferation of Canada-tailored narratives suggest a highly organized and well-funded effort to target Canadian support for Ukraine.

Rates of global conflict have increased by over 40% from 2020 to 2023, increasing the demands on healthcare systems and impacting healthcare training, education and workforce. There is a need for innovative educational support from the international community. Distance education is a sustainable avenue that is not as contingent on travel, political, or financial restrictions. We sought to undertake a preliminary scoping exercise of the issues involved in delivering distance medical teaching to conflict zones, by reviewing examples in the literature and interviewing key stakeholders in this field. We found that there was need and scope to deliver specific, case-based, non-practical teaching, and to re-connect medical personnel with the international community and research. We propose recommendations to achieve this: directing purpose according to learner needs, evaluations and care outcomes; maintaining patient confidentiality and anonymity; supplementing, rather than undermining, existing educational infrastructures; co-ordinating with relevant stakeholders and expatriates, whilst maintaining neutrality; and consider the use of pre-existing, low-cost online scripts and social media platforms, as well as non-live, low-bandwidth modes of technology.

Mental fatigue is a variation in the psychophysiological state that subjects encounter during or after prolonged cognitive activity periods, affecting top-down attention and cognitive control. The present study aimed to investigate the effects of mental fatigue on attention in the context of the three attention networks according to the Posnerian model (alerting, orienting, and executive networks) by combining the Attentional Network Test (ANT) and event-related potentials technique. Thirty healthy subjects were enrolled in the study. A continuous arithmetic task lasting one hour induced mental fatigue, and EEG recordings were conducted before and after the task while subjects were performing the ANT. The efficiencies of three networks were comparable between groups, while RTs shortened only in the control group and the accuracy related to the alerting and conflict networks declined only after mental effort. Mental fatigue reduced N1 amplitude during alerting network engagement and p3 amplitude during orienting. It also reduced N2 and P3 amplitude during the conflict, particularly the incongruent target-locked response. These findings underscore the covert effects of mental fatigue on attention, suggesting that even in healthy young subjects, compensatory mechanisms may maintain adequate overt performances, but fatigue still has a detrimental effect on top-down attentional mechanisms.

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The impact of inter-group conflict on population dynamics has long been debated, especially for prehistoric and non-state societies. In this work, we consider that beyond direct battle casualties, conflicts can also create a \'landscape of fear\' in which many non-combatants near theatres of conflict abandon their homes and migrate away. This process causes population decline in the abandoned regions and increased stress on local resources in better-protected areas that are targeted by refugees. By applying analytical and computational modelling, we demonstrate that these indirect effects of conflict are sufficient to produce substantial, long-term population boom-and-bust patterns in non-state societies, such as the case of Mid-Holocene Europe. We also demonstrate that greater availability of defensible locations act to protect and maintain the supply of combatants, increasing the permanence of the landscape of fear and the likelihood of endemic warfare.