Objective:Chronic noncommunicable conditions are a major driver of poor health in low-and middle-income countries,yet the mental health pathways through which these illnesses shape perceived health remain underexamine...Objective:Chronic noncommunicable conditions are a major driver of poor health in low-and middle-income countries,yet the mental health pathways through which these illnesses shape perceived health remain underexamined.This study investigates whether recent mental well-being—measured using the World Health Organization Five-Item Well-Being Index(WHO-5)—mediates the association between chronic illness and self-rated health(SRH)among Egyptian adults aged 32–65.Methods:This study uses nationally representative data from the 2023 Egypt Labor Market Panel Survey(n=23,044)and estimates survey-weighted Ordinary Least Squares models predicting SRH(1=very good/excellent to 5=very bad).The key independent variable is chronic illness status.Mediation analysis is conducted using the Sobel–Goodman method with 1000 bootstrap replicates.All models adjust for sociodemographic covariates including age,sex,education,marital status,and regional residence.Results:Chronic illness is associated with significantly worse SRH(β=0.59,standard error[SE]=0.02,P<0.001).When mental well-being is added to the model,the chronic illness coefficient declines to 0.50(SE=0.02,P<0.001),and WHO-5 is independently associated with better SRH(β=-0.22,SE=0.01,P<0.001).The indirect effect via WHO-5 is 0.08(SE=0.01,P<0.001),indicating that 14.2%of the total association is mediated through recent psychological well-being.Conclusion:Although most of the self-rated health disadvantage linked to chronic illness flows through somatic and functional channels,mental well-being accounts for a meaningful share.Incorporating WHO-5 screening and stepped referral into chronic care could improve subjective health outcomes in Egypt.Mental health integration should be viewed as a critical component of equitable noncommunicable disease strategies.展开更多
Large population passages of the SARS-CoV-2 in the past two and a half years have allowed the circulating virus to accumulate an increasing number of mutations in its genome. The most recently emerging Omicron subvari...Large population passages of the SARS-CoV-2 in the past two and a half years have allowed the circulating virus to accumulate an increasing number of mutations in its genome. The most recently emerging Omicron subvariants have the highest number of mutations in the Spike (S) protein gene and these mutations mainly occur in the receptor-binding domain (RBD) and the N-terminal domain (NTD) of the S gene. The European Centre for Disease Prevention and Control (eCDC) and the World Health Organization (WHO) recommend partial Sanger sequencing of the SARS-CoV-2 S gene RBD and NTD on the polymerase chain reaction (PCR)-positive samples in diagnostic laboratories as a practical means of determining the variants of concern to monitor possible increased transmissibility, increased virulence, or reduced effectiveness of vaccines against them. The author’s diagnostic laboratory has implemented the eCDC/WHO recommendation by sequencing a 398-base segment of the N gene for the definitive detection of SARS-CoV-2 in clinical samples, and sequencing a 445-base segment of the RBD and a 490 - 509-base segment of the NTD for variant determination. This paper presents 5 selective cases to illustrate the challenges of using Sanger sequencing to diagnose Omicron subvariants when the samples harbor a high level of co-existing minor subvariant sequences with multi-allelic single nucleotide polymorphisms (SNPs) or possible recombinant Omicron subvariants containing a BA.2 RBD and an atypical BA.1 NTD, which can only be detected by using specially designed PCR primers. In addition, Sanger sequencing may reveal unclassified subvariants, such as BA.4/BA.5 with L84I mutation in the S gene NTD. The current large-scale surveillance programs using next-generation sequencing (NGS) do not face similar problems because NGS focuses on deriving consensus sequence.展开更多
文摘Objective:Chronic noncommunicable conditions are a major driver of poor health in low-and middle-income countries,yet the mental health pathways through which these illnesses shape perceived health remain underexamined.This study investigates whether recent mental well-being—measured using the World Health Organization Five-Item Well-Being Index(WHO-5)—mediates the association between chronic illness and self-rated health(SRH)among Egyptian adults aged 32–65.Methods:This study uses nationally representative data from the 2023 Egypt Labor Market Panel Survey(n=23,044)and estimates survey-weighted Ordinary Least Squares models predicting SRH(1=very good/excellent to 5=very bad).The key independent variable is chronic illness status.Mediation analysis is conducted using the Sobel–Goodman method with 1000 bootstrap replicates.All models adjust for sociodemographic covariates including age,sex,education,marital status,and regional residence.Results:Chronic illness is associated with significantly worse SRH(β=0.59,standard error[SE]=0.02,P<0.001).When mental well-being is added to the model,the chronic illness coefficient declines to 0.50(SE=0.02,P<0.001),and WHO-5 is independently associated with better SRH(β=-0.22,SE=0.01,P<0.001).The indirect effect via WHO-5 is 0.08(SE=0.01,P<0.001),indicating that 14.2%of the total association is mediated through recent psychological well-being.Conclusion:Although most of the self-rated health disadvantage linked to chronic illness flows through somatic and functional channels,mental well-being accounts for a meaningful share.Incorporating WHO-5 screening and stepped referral into chronic care could improve subjective health outcomes in Egypt.Mental health integration should be viewed as a critical component of equitable noncommunicable disease strategies.
文摘Large population passages of the SARS-CoV-2 in the past two and a half years have allowed the circulating virus to accumulate an increasing number of mutations in its genome. The most recently emerging Omicron subvariants have the highest number of mutations in the Spike (S) protein gene and these mutations mainly occur in the receptor-binding domain (RBD) and the N-terminal domain (NTD) of the S gene. The European Centre for Disease Prevention and Control (eCDC) and the World Health Organization (WHO) recommend partial Sanger sequencing of the SARS-CoV-2 S gene RBD and NTD on the polymerase chain reaction (PCR)-positive samples in diagnostic laboratories as a practical means of determining the variants of concern to monitor possible increased transmissibility, increased virulence, or reduced effectiveness of vaccines against them. The author’s diagnostic laboratory has implemented the eCDC/WHO recommendation by sequencing a 398-base segment of the N gene for the definitive detection of SARS-CoV-2 in clinical samples, and sequencing a 445-base segment of the RBD and a 490 - 509-base segment of the NTD for variant determination. This paper presents 5 selective cases to illustrate the challenges of using Sanger sequencing to diagnose Omicron subvariants when the samples harbor a high level of co-existing minor subvariant sequences with multi-allelic single nucleotide polymorphisms (SNPs) or possible recombinant Omicron subvariants containing a BA.2 RBD and an atypical BA.1 NTD, which can only be detected by using specially designed PCR primers. In addition, Sanger sequencing may reveal unclassified subvariants, such as BA.4/BA.5 with L84I mutation in the S gene NTD. The current large-scale surveillance programs using next-generation sequencing (NGS) do not face similar problems because NGS focuses on deriving consensus sequence.
