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In line with the sustainable development goal to end poverty in all forms, the Nigerian Government launched Government Enterprise and Empowerment Programme (GEEP) - as a social investment programme to alleviate poverty by providing credit to petty traders to support entrepreneurship. This study assesses the impact of Government Enterprise and Empowerment Programme (GEEP) on the poverty status of beneficiaries in Cross River State, Nigeria. Specifically, it compared the mean income before, and after accessing the loan, analysed the determinants of poverty status of the respondents in the study area, enumerated the benefits of GEEP to the respondents, and identified the challenges faced by the beneficiaries in accessing the loan. Stratified random sampling technique was used to select 394 respondents who had benefitted from the programme across the eleven Local Government Areas (LGAs) that the programme covered. Data were obtained from primary source with the aid of a well-structured questionnaire, and analyzed using; frequency count, mean, Foster Greer and Thorbecke (FGT) model, paired T- test (Z), and logistic regression analysis. The results showed that, majority of the respondents were male (55.6%) with a mean age of 35 years, and had an average household size of 5 persons. The study also showed that 98.9% of the respondents were educated. The mean monthly income before GEEP support was N 44,535.53, while after GEEP it was N54180.20. Thirty-six percent of the total respondents were poor (36%). The comparative analysis of the mean income before and after accessing the loan showed that, there was a significant difference between their mean incomes at 5% level of significance. Key variables that determined poverty status were; household size and loan amount. The main benefits of GEEP to the respondents were; increase in beneficiaries' income, and improvement in their standard of living. The major challenges faced by the respondents were; lack of appropriate means to repay loan, stressful loan procedure, and difficulty in transferring money from mobile wallet to bank. The study recommended that the loan application process should be less complex to enable quick loan application. The GEEP programme should be sustained, and allowed to have wider coverage in both rural and urban areas of the country as it has assisted a lot of small business owners' access to cheap credit. Key words: Impact, GEEP, empowerment programme, government enterprise, poverty status, INTRODUCTION According to contemporary estimates, quite a number of the world's population (about three billion people) dwell in poverty, with daily incomes of less than three dollars, while nearly 1.2 [...]

Introduction and summary Life insurers have significant exposure to commercial real estate (CRE) primarily through direct mortgage lending and commercial mortgage-backed securities (CMBS). These investments help life insurers match their [...]

Fisheries that target sedentary shellfish present several challenges for deriving management reference points. Stock-recruit relationships often function at a relatively large spatial scale, with planktonic dispersal of eggs and larvae connecting discrete settlement areas, but postsettlement demographics are heterogeneous among local settlement areas. Another challenge is that information on age composition is not available for many invertebrates. Case studies of sedentary shellfish fisheries demonstrate a series of methods for estimating reference points. Biomass dynamics models may be an option for some data-limited fisheries, but inferences of metapopulation productivity can be confounded by serial depletion, so fishery and survey data should be explored for spatial patterns. Yield-per-recruit and eggs-per- recruit models can be size-based and spatially stratified. Demographic models of the full life cycle can integrate regional recruitment processes and postrecruitment processes at smaller spatial scales. Although metapopulation dynamics and spatial heterogeneity in postsettlement demographics can be accounted for in reference points, achieving the optimum yield of sedentary shellfish is largely conditional on managing spatial fishing patterns. KEY WORDS: benthic, shellfish, fisheries, management, reference points, INTRODUCTION Shellfish fisheries are valuable and substantially contribute to global fishery production (e.g., 25% of global consumption, FAO 2022). Worldwide landings of bivalves gradually increased from 0.8 million tons in [...]

Centralized referral systems have been successfully implemented to shorten and equalize surgical wait times; however, ongoing expenses make sustaining these projects challenging. We trialed a low-cost centralized booking project for hernia surgery in a community hospital from July to November 2019. Eligible patients (i.e., those with visible or palpable inguinal or umbilical hernias who were agreeable to an open mesh repair) were booked with the first available surgeon after initial consultation. Centrally booked patients with either inguinal or umbilical hernias waited a mean of 82 (standard deviation [SD] 32) and 80 (SD 66) days, respectively, while those who did not use the centralized system waited 137 (SD 89) and 181 (SD 92) days, respectively. Centralized booking increased operating room utilization as a larger pool of patients was available to call when last-minute cancellation occurred; centralized booking also effectively equalized wait-lists among 6 surgeons. Selective centralized booking is a promising concept that led to more efficient utilization of available operating room time with a significant decrease in wait times; this system could potentially improve access for all patients awaiting general surgery without requiring additional funding., Surgical wait-lists result from a mismatch between supply and demand. This issue is not unique to Canada. The cancellation of scheduled procedures during the COVID-19 pandemic further increased this imbalance. [...]

Mass gatherings include a diverse range of events such as sporting competitions, religious ceremonies, entertainment activities, political rallies and cultural celebrations, which have important implications for population well-being. However, if not managed properly, these events can amplify health risks including those related to communicable diseases, and place undue strain on health systems in host countries and potentially in attendees' home countries, upon their return. The coronavirus disease 2019 (COVID-19) pandemic has provided a unique opportunity to evaluate the risk factors associated with mass gatherings and the effectiveness of applying mitigation measures during infectious disease emergencies. The pandemic has also allowed event organizers and health officials to identify best practices for mass gathering planning in host countries. To guide decisions about whether to hold, postpone, modify or cancel a mass gathering during the COVID-19 pandemic, the World Health Organization and its partners developed normative guidance and derivative tools promoting a risk-based approach to mass gathering planning. This approach involves three steps to guide decision-making around mass gatherings: risk evaluation, risk mitigation and risk communication. The approach was applied in the planning and execution of several mass gathering events, including the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games. Lessons identified from these large-scale international events offer insights into the planning and implementation of mass gathering events during a pandemic, and the broader impacts of such events on society. These lessons may also further inform and refine planning for future mass gatherings. Les rassemblements de masse designent un large eventail d'evenements tels que des competitions sportives, ceremonies religieuses, activites de divertissement, manifestations politiques et fetes culturelles. Tous ont un impact considerable sur le bien-etre de la population. Toutefois, s'ils ne sont pas geres correctement, ils peuvent augmenter les risques sanitaires, notamment concernant les maladies transmissibles, et exercer une pression excessive sur les systemes de sante des pays hotes, voire sur ceux des pays d'origine des participants apres leur retour. La pandemie de maladie a coronavirus 2019 (COVID-19) a offert une occasion unique d'evaluer les facteurs de risque associes aux rassemblements de masse, ainsi que l'efficacite des mesures visant a limiter la propagation dans des situations d'urgence liees a des maladies infectieuses. Cette pandemie a egalement permis aux organisateurs d'evenements et responsables de sante d'identifier les bonnes pratiques a appliquer dans les pays hotes pendant les rassemblements de masse. Afin de guider les decisions relatives au maintien, au report, a la modification ou a l'annulation d'un rassemblement de masse durant la pandemie de COVID-19, l'Organisation mondiale de la Sante et ses partenaires ont mis au point des orientations normatives et des outils derives favorisant une approche tenant compte des risques au moment de la planification. Cette approche comprend trois etapes contribuant a la prise de decision: l'evaluation, la reduction et la communication des risques. Elle a ete deployee lors de la planification et de l'execution de nombreux rassemblements de masse, comme les Jeux olympiques et paralympiques de Tokyo 2020 et Beijing 2022. Les lecons tirees de ces evenements internationaux a grande echelle fournissent des informations sur leur organisation et leur mise en oeuvre en cas de pandemie, ainsi que les impacts de tels evenements sur la societe. Elles sont en outre susceptibles de faciliter et d'ameliorer la planification des futurs rassemblements de masse. Las concentraciones masivas Incluyen una gran variedad de eventos, como competiciones deportivas, ceremonias religiosas, actividades de entretenimiento, mitines politicos y celebraciones culturales, que tienen importantes implicaciones para el bienestar de la poblacion. Sin embargo, si no se gestionan adecuadamente, estos eventos pueden amplificar los riesgos para la salud, incluidos los relacionados con las enfermedades transmisibles, y suponer una carga excesiva para los sistemas sanitarios de los paises anfitriones y, potencialmente, de los paises de origen de los participantes a su regreso. La pandemia de la enfermedad por coronavirus de 2019 (COVID-19) ha brindado una oportunidad unica para evaluar los factores de riesgo asociados a las concentraciones masivas y la eficacia de aplicar medidas de mitigacion durante las emergencias por enfermedades infecciosas. La pandemia tambien ha permitido a los organizadores de eventos y a las autoridades sanitarias identificar las mejores practicas para la planificacion de concentraciones masivas en los paises anfitriones. Para orientar las decisiones sobre la celebracion, el aplazamiento, la modificacion o la cancelacion de una concentracion masiva durante la pandemia de la COVID-19, la Organizacion Mundial de la Salud y sus asociados elaboraron orientaciones normativas y herramientas derivadas que promueven un enfoque de la planificacion de concentraciones masivas basado en los riesgos. Este enfoque consta de tres pasos para orientar la toma de decisiones en torno a las concentraciones masivas: la evaluacion, la mitigacion y la comunicacion de riesgos. El enfoque se aplico en la planificacion y ejecucion de varias concentraciones masivas, incluidos los Juegos Olimpicos y Paralimpicos de Tokio 2020 y Pekin 2022. Las conclusiones extraidas de estos eventos internacionales a gran escala permiten comprender mejor la planificacion y ejecucion de concentraciones masivas durante una pandemia, asi como las repercusiones mas generales de estos eventos en la sociedad. Estas lecciones tambien pueden informar y perfeccionar la planificacion de futuras concentraciones masivas., Introduction Mass gatherings are characterized by the concentration of people at a specific location for a specific purpose over a set period. Such gatherings encompass a diverse range of events, [...]

Louisville native Dr. Jabani Bennett is an interdisciplinary visual artist, yoga instructor, community-engaged educator, leadership consultant, dancer, and mama. She is also the first Black and openly queer director in [...]

To provide insight on how ambulatory care practices can reduce emergency department (ED) visits, we studied changes in Medicare ED visits for primary and specialty care practices in the Transforming Clinical Practice Initiative. We compared practices that transformed more vs less during the 6-year period ending in 2021 (3,773 practices). Using data from a practice transformation assessment tool completed at multiple intervals, we found improvement in the transformation score was associated with reduced ED visits by 6% and 4% for primary and specialty care practices, respectively, 3 to 4 years after first assessment. Transformation in 5 of 8 domains contributed to reduced ED visits. Key words: Medicare; ambulatory care; emergency department; practice transformation https://doi.org/10.1370/afm.3119, INTRODUCTION The Transforming Clinical Practice Initiative (TCPI) was a 4-year national, voluntary, collaborative, peer-based learning initiative to improve quality of care and prepare ambulatory care practices of all specialties to [...]

PURPOSE Person-centered care is foundational to good quality primary care and has positive effects on health outcomes and patient satisfaction. The Person-Centered Primary Care Measure (PCPCM) is a recently developed, patient-reported survey able to assess person-centeredness and has demonstrated strong validity and reliability. Little is known, however, about the feasibility of the PCPCM in non-English-speaking settings. We aimed to translate the questionnaire into Dutch, psychometrically evaluate the translated version, and ensure its feasibility for patients in Dutch primary care. METHODS We translated the PCPCM into Dutch using forward-backward translations. We conducted psychometric evaluations to ensure its feasibility among Dutch- speaking primary care patients, with special attention to low literacy populations. Next, we assessed structural validity, convergent validity using the Quality of Care Through the Patient's Eyes (QUOTE) questionnaire, and internal consistency in a cross-sectional study in primary care. RESULTS Translation and adaptation for low literacy populations required 4 iterations. In 4 general practices, 205 patients completed the survey. Confirmatory factor analyses could not confirm the 1-factor solution. The 3-factor solution was found to be a more optimal fit: comprehensiveness of care, personal relation, and contextual care. Internal reliability was high (Cronbach's [alpha] were 0.82, 0.73, and 0.86, respectively). We found a strong correlation between the total PCPCM and QUOTE scores (Spearman's [rho] = 0.65, P CONCLUSION The Dutch version of the PCPCM has acceptable validity and reliability for measuring person-centeredness in primary care among Dutch-speaking populations including those with low literacy. Key words: primary health care; quality of health care; surveys and questionnaires https://doi.org/10.1370/afm.3135, INTRODUCTION Health is better in regions with more primary care physicians and features of primary care are associated with better health and greater equity. (12) The qualities of primary care [...]

PURPOSE Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. METHODS We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. RESULTS We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. CONCLUSION Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists. Key words: child abuse; health inequities; racism; implicit bias; qualitative research https://doi.org/10.1370/afm.3139, INTRODUCTION The United States Child Abuse and Prevention Treatment Act requires states to enact policies to identify newborns affected by substance use disorders or prenatal substance exposure (PSE) during pregnancy. [...]

PURPOSE COVID-19 is a condition that can lead to other chronic conditions. These conditions are frequently diagnosed in the primary care setting. We used a novel primary care registry to quantify the burden of post-COVID conditions among adult patients with a COVID-19 diagnosis across the United States. METHODS We used the American Family Cohort, a national primary care registry, to identify study patients. After propensity score matching, we assessed the prevalence of 17 condition categories individually and cumulatively, comparing patients having COVID-19 in 2020-2021 with (1) historical control patients having influenza-like illness in 2018 and (2) contemporaneous control patients seen for wellness or preventive visits in 2020- 2021. RESULTS We identified 28,215 patients with a COVID-19 diagnosis and 235,953 historical control patients with influenza-like illness. The COVID-19 group had higher prevalences of breathing difficulties (4.2% vs 1.9%), type 2 diabetes (12.0% vs 10.2%), fatigue (3.9% vs 2.2%), and sleep disturbances (3.5% vs 2.4%). There were no differences, however, in the postdiagnosis monthly trend in cumulative morbidity between the COVID-19 patients (trend = 0.026; 95% CI, 0.025-0.027) and the patients with influenza- like illness (trend = 0.026; 95% CI, 0.023-0.027). Relative to contemporaneous wellness control patients, COVID-19 patients had higher prevalences of breathing difficulties and type 2 diabetes. CONCLUSIONS Our findings show a moderate burden of post-COVID conditions in primary care, including breathing difficulties, fatigue, and sleep disturbances. Based on clinical registry data, the prevalence of post-COVID conditions in primary care practices is lower than that reported in subspecialty and hospital settings. Key words: long COVID; post-COVID conditions; post-infectious disorders; primary health care; family practice; chronic illness; morbidity https://doi.org/10.1370/afm.3131, INTRODUCTION The direct and immediate impact of COVID-19 on the health of the US population has been of generational significance, and the secondary wave of persistent symptoms and new conditions [...]

The triple burden of malnutrition is a problem that is being fought against at global, continental, regional and national levels. When consumed in adequate quantities, healthy diets are important in reversing the menace of malnutrition. In Kenya, grains are an important source of energy and micronutrients. Even though they contribute most energy and micronutrients, a huge Recommended Daily Allowance deficit still exists. Incorporating ancient grains such as quinoa which are nutrient-rich and can survive in harsh climatic zones into the diets, can boost the efforts made towards the fight against malnutrition. Though quinoa adaptation trials have been conducted in Kenya, expanded data on the nutrient content are yet to be compiled. Between May 2022 and August 2022, four varieties of quinoa; Cherry Vanilla, Titicaca, Brilliant Bright Red and Biobio were grown at the University of Nairobi, Upper Kabete campus field station. The harvests of the four varieties were separately analyzed to determine and compare the content levels of macronutrients (carbohydrates, crude protein, fats) and micro-nutrients (manganese, magnesium, potassium, calcium, iron, copper and zinc). The four varieties were significantly different in all the analyzed elements except moisture content. Cherry vanilla had the highest level of crude protein (25.1[+ or -]0.3g/100g) and fat (11.46[+ or -]0.184g/100g) but the lowest level of carbohydrates (42.5[+ or -]0.4%). Titicaca had the highest amounts of; manganese (21.9[+ or -]0.06g/100g), potassium (511.9[+ or -]0.03mg/100g), iron (11.5[+ or -] 0.07mg/100g) and zinc (14.1[+ or -]0.0mg/100g). Biobio variety exhibited the highest amount of magnesium (73.9[+ or -]0.1mg/100g). In conclusion, the different varieties of quinoa significantly differ in their levels of macro and micronutrients. The Kenyan-grown quinoa has the potential to contribute to increased dietary intake of both macronutrients and micronutrients of children aged 2-6 years old. The Kenyan-grown quinoa contains levels of micronutrients in higher amounts compared to maize, rice and wheat - the commonly consumed cereals in Kenya. On this basis, the study recommends that the growing and consumption of quinoa should be promoted in Kenya and introduced into the diets of children aged 2-6 years of age in Kenya. Quinoa-based products for children aged 2-6 years should be developed. Climate zone-oriented agronomic trials on quinoa farming should be conducted. Key words: Quinoa, varieties, Cherry Vanilla, BBR, Titicaca, Biobio, micronutrients, macronutrients, INTRODUCTION Over the past three decades, significant effort has been made to battle the triple burden of malnutrition which encompasses undernutrition, overnutrition and micronutrient deficiency. According to the Joint Child [...]

Agriculture has been the backbone of African economies, and agricultural development has the potential to drive overall economic growth. Considering the importance of agriculture in Africa, foreign aid donors have supported the sector to help push economic growth and reduce poverty. Studies indicate governance quality of a recipient country is an important factor for agricultural aid. Building upon this, the paper explores how bilateral donors provided agricultural aid to two African countries that have different institutional quality, Ghana and Uganda. The analysis of agricultural aid in those two countries was carried out with bilateral aid-profile data from 2011 to 2022. Despite the similar economic importance of agriculture in Ghana and Uganda, donors to Ghana invested the largest amount in agriculture among aid sectors, followed by health. On the other hand, donors to Uganda supported mainly health-relevant sectors with agriculture being ranked only fifth. Donors in both countries implemented agricultural aid mostly as project types. Yet, donors disbursed their aid funds through different aid channels. Donors to Ghana disbursed 48% of agricultural aid funds through the public sector institutions channel (or the state channel). By contrast, donors to Uganda disbursed only 24% of agricultural aid funds through the state channel, essentially bypassing Ugandan public agencies. They instead provided 76% of agricultural aid through the non-state channels such as non-governmental organizations, multilateral organizations, and private entities. Similar donor preferences of the aid disbursement channels were observed with total aid across all aid sectors. Overall, the donor aid profiles suggested donors provided Ghana with more flexible agricultural aid, while in Uganda they controlled agricultural aid more tightly. There could exist multiple underlying reasons for this, but the different level of institutional quality is highly likely one of the possible reasons. For foreign aid, governance quality is an important issue equally to both donors and recipients. Key words: Africa, agriculture, aid channel, bilateral aid, foreign aid, Ghana, governance, Uganda, INTRODUCTION Agricultural development has the potential to drive overall economic growth especially in the early stages of development [1, 2]. The contribution of agricultural development to economic growth may be [...]