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A multimorbidity-focused approach may reflect common etiologic mechanisms and lead to better targeting of etiologic agents for broadly impactful public health interventions. Our aim was to identify clusters of chronic obesity-related, neurodevelopmental, and respiratory outcomes in children, and to examine associations between cluster membership and widely prevalent chemical exposures to demonstrate our epidemiologic approach. Early to middle childhood outcome data collected 2011-2022 for 1092 children were harmonized across the ECHO-PATHWAYS consortium of 3 prospective pregnancy cohorts in six U.S. cities. 15 outcomes included age 4-9 BMI, cognitive and behavioral assessment scores, speech problems, and learning disabilities, asthma, wheeze, and rhinitis. To form generalizable clusters across study sites, we performed k-means clustering on scaled residuals of each variable regressed on study site. Outcomes and demographic variables were summarized between resulting clusters. Logistic weighted quantile sum regressions with permutation test p-values associated odds of cluster membership with a mixture of 15 prenatal urinary phthalate metabolites in full-sample and sex-stratified models. Three clusters emerged, including a healthier Cluster 1 (n = 734) with low morbidity across outcomes; Cluster 2 (n = 192) with low IQ and higher levels of all outcomes, especially 0.4-1.8-standard deviation higher mean neurobehavioral outcomes; and Cluster 3 (n = 179) with the highest asthma (92 %), wheeze (53 %), and rhinitis (57 %) frequencies. We observed a significant positive, male-specific stratified association (odds ratio = 1.6; p = 0.01) between a phthalate mixture with high weights for MEP and MHPP and odds of membership in Cluster 3 versus Cluster 1. These results identified subpopulations of children with co-occurring elevated levels of BMI, neurodevelopmental, and respiratory outcomes that may reflect shared etiologic pathways. The observed association between phthalates and respiratory outcome cluster membership could inform policy efforts towards children with respiratory disease. Similar cluster-based epidemiology may identify environmental factors that impact multi-outcome prevalence and efficiently direct public policy efforts.

An appropriate understanding towards preference of small-scale dairy producers can improve technology adoption. The objective of this study was to understand potential, problem and need of small-scale dairy producers including farmer and his wife. The method used was modification of participatory rural appraisal (PRA) like participatory mapping to detect potential, and Preference ranking to understand problem and need priority. PRA applications were six times during April-September 2009 at central area and non-central area in Enrekang regency. Preference of farmer and his wife toward potential and problem were not different. Only feed technology need was different. Forage sources at central area were more diverse than non-central area but concentrate sources at non-central area were more than central area. Lack of knowledge for feed and concentrate formulation and nutritional requirements, less known of feed use, and low feed quality at dry season were the main problems at central area. At non-central area, lack of knowledge for preserving feed, lack of labour, and feed shortage at dry season were main problem faced by farmers. Knowledge improvement for local feed and complete-feed formulation are priority technology at central area. At non-central area, agricultural waste and forage preserving and complete-feed are needed by farmer.

Grazing adaptability of beef cattle on dwarf variety of late-heading type (DL) napiergrass (Pennisetum purpureum Schumach) pasture was examined in summer season at Miyazaki, Japan in 2005. Five paddocks of DL napiergrass pasture with an area 2500 m2, (500 m2, per paddock) were established since May 2002. Three heads of raising beef cows (Japanese-Black) were rotationally grazed in a week with 4-weeks rest period from June to October. Forage dry yield at pre- and post-grazing averaged 238.6 – 582.6 g/m2 and 152.8 – 309.5 g/m2, respectively with percentage consumption averaged 42.5% – 71.6%. Forage consumption and dry matter intake averaged 14.5 – 50.9 g DM/m2/day and 2.42 – 8.48 kg DM/1 IU/day, respectively with average daily gain was 0,56 kg/day. Grazing adaptability of beef cattle on DL napiergrass needed time for about one week. Thus, the DL napiergrass pasture can be utilized under the rotational grazing at stocking rate of 12 head/ha (calculated 3600 kg LW/ha/day) in the summer season of subtropical area.

Background Lassa fever is an endemic and immediately notifiable disease in Liberia, and one laboratory confirmed case constitutes an outbreak. We described the epidemiological characteristics and hospital outcome of Lassa fever cases hospitalized during the 2022-2023 outbreak in Liberia. Methods A cohort study was conducted using routine Lassa fever surveillance data from the 2022-2023 outbreak in Liberia. Descriptive statistics were used to summarize the data and log binomial regression to assess the association between epidemiological characteristics and mortality. Results A total of 439 suspected Lassa fever cases were reported. The median age was 22 (interquartile range: 10-33) years and 233 (53%) were women. The median number of days between symptom onset and admission was 4 (IQR 2-7). Of the 439 cases, 416 (95%) were tested for Lassa fever and 138 were confirmed with 33% positivity rate. The majority, 290 (69%), of confirmed cases were Conclusions The outbreak highlighted a high disease burden of Lassa fever with young adults disproportionately infected, and substantial mortality, even among those who tested negative for the virus. This underscores the urgent need for preventive measures like vaccines and health education campaigns.

Background Sustaining a ‘fit-for-purpose’ health workforce requires a better understanding of the health care worker cadres that are affected during pandemics and their outcomes. In hospitalized health care workers with confirmed COVID-19 between March 2020 and May 2023 in Liberia, we determined the hospitalization and case fatality rates, type of health care worker cadres affected, their demographic and clinical characteristics and hospital exit outcomes. Methods This was a cohort study using routine data extracted from hospitalization forms for health care workers in 24 designated COVID-19 treatment facilities in Liberia. Results Of the 424 health care workers with COVID-19, hospitalization rates progressively declined between 2020 and 2023, with the highest rates in 2020 (24/1,000 health care workers) and 2021 (14/1,000 health care workers). Case fatality was 2% in both 2020 and 2021 with no deaths thereafter. Among those hospitalized, the highest proportions were nursing cadres with 191(45%), physicians with 63 (15%) and laboratory technicians with 42 (10%). The most frequent reported site for COVID-19 infection was the health facility (326, 89%). COVID-19 vaccination coverage in health care workers was 20%. The majority (91%) of hospitalizations were for mild symptomatic infections. Even in referral centres (n-52), 18 (35%) were for mild infections. Of the 424 who were hospitalized, 412 (97%) recovered, 9 (2%) died and 3 (1%) either left against medical advice or absconded. Of the nine deaths, none were vaccinated, seven had moderate-to-severe disease but were not referred to specialized COVID-19 treatment centers. Conclusions The hospitalized health care workers for COVID-19 were predominantly clinical and laboratory personnel who were mostly unvaccinated, and health facilities were hot-spots for contracting infections. The triage and referral system was weak with unnecessary hospitalization of mild infections. This study provides useful insights for outbreak preparedness including priority vaccination and improving health care worker safety in Liberia.

Studies have suggested that adults with gallbladder disease have increased risk of type 2 diabetes. This prospective cohort study assessed the risk of type 2 diabetes in postmenopausal women with gallbladder disease. Data from women enrolled in the Women's Health Initiative from 1993 to 2005, aged 50-79 years (mean = 63.2; standard deviation, 7.2), were analyzed. Cox proportional hazards regression models were used to estimate the risk of type 2 diabetes associated with gallbladder disease. There were 8,896 new cases of type 2 diabetes after 1,025,486 person-years of follow-up. Gallbladder disease was significantly associated with type 2 diabetes (hazard ratio = 1.52; 95% confidence interval (CI): 1.38,1.67). The observed risk of type 2 diabetes in women with both gallbladder disease and central obesity was 37% higher than expected (relative excess risk due to interaction = 0.37, 95% CI: 0.11,0.63) on the additive scale. The hazard ratios for type 2 diabetes associated with gallbladder disease were 1.25 (95% CI: 1.19,1.32) and 1.48 (95% CI: 1.34,1.63) in women with and without central obesity, respectively, on the multiplicative scale. Results of this study support further studies to determine whether interventions in older women with gallbladder disease would reduce type 2 diabetes risk, especially among those with central obesity. Future research should examine the pathophysiological basis of the association between gallbladder disease and type 2 diabetes.

The extended social cognitive career theory (SCCT) suggests that career intentions are influenced by person inputs, background contextual affordances, learning experiences, self-efficacy expectations and outcome expectations, as well as satisfaction and well-being in academic and work settings. The main purpose of the current study was to examine the career intentions of South African high school learners towards a career in the accounting field. Using proportionate stratified random sampling, 305 learners from eight high schools in a rural community were surveyed. Respondents' intentions to pursue a career in accounting were significantly positively correlated with self-efficacy expectations and outcome expectations. Work satisfaction, earning potential, self-efficacy expectations, personal interest, Accounting being offered as a subject and having a family member in the accounting field are factors influencing participants' career choice. Recommendations are made that could assist in better-informed career decision-making, guidance and support for learners who wish to pursue a career in the accounting field.