Eka Suprapti   Veni Hadju   Rahayu Indriasari   Erniwati Ibrahim   Kadek Ayu Erika   Balqis Nazaruddin   and Muhammad Syafar   

Background: Anemia remains a significant public health problem among adolescent girls, particularly in developing countries. In Indonesia, Islamic boarding schools represent a unique setting where the prevalence of anemia is high and adherence to weekly iron–folic acid (IFA) supplementation as a preventive program is often suboptimal. Understanding the behavioral determinants of anemia prevention is crucial for improving compliance. Methods: A qualitative descriptive study with a phenomenological approach was conducted in an Islamic boarding school in Makassar, Indonesia, identified as having a high prevalence of anemia based on prior school health screening records. Participants were 14 female students (16–18 years) and five teachers selected purposively. Data were collected through in-depth interviews, transcribed verbatim, coded thematically using MAXQDA 24, and analyzed based on TPB constructs: attitudes, subjective norms, and perceived behavioral control. Results: The findings revealed limited knowledge of anemia and the preventive role of IFA supplementation, with many students associating anemia primarily with fatigue and dizziness. Perceptions of susceptibility and seriousness were low, and adherence to the recommended weekly IFA tablet regimen was inconsistent, often limited to when tablets were distributed at school. Significant barriers included unpleasant side effects, forgetfulness, and lack of self-efficacy, while social support from teachers and parents was insufficient. Information sources such as peers, teachers, and social media served as cues to action but were not strong enough to sustain behavioral change. Conclusion: Adolescent girls in Islamic boarding schools demonstrated low awareness and irregular practices of anemia prevention. Educational interventions grounded in the TPB framework, combined with consistent school-based weekly IFA (WIFAS) implementation and family involvement, are needed to strengthen motivation, social support, and self-efficacy in preventing anemia.

Melsa Sagita Imaniar   Dewi Nurdianti   Nita Adhani Pasundhani   Ida Herdiani   Sulidar Fitri   Miftahul Fallah   Aceng Sambas   Henri Setiawan   Budy Nugraha   and Hadi Y Faturochman   

Stunting remains a significant public health issue in Indonesia, where inadequate nutrient intake during complementary feeding contributes to impaired growth in infants and young children. This study compared the nutritional composition, sensory acceptability, and storage stability of broth prepared from free-range and broiler chickens to assess its potential as a supplementary complementary food (MPASI). Proximate analysis showed that free-range chicken broth contained higher protein (1.93% vs. 0.96%), ash (0.19% vs. 0.08%), and carbohydrate (1.05% vs. 0.58%) contents than broiler broth, which exhibited higher moisture (99.12% vs. 97.00%) and fat (1.23% vs. 1.09%). Hedonic testing with 30 panelists demonstrated superior acceptability for free-range broth across all sensory attributes, including color, umami taste, chicken flavor, viscosity, and aftertaste. Shelf-life evaluation under refrigeration (4°C) revealed that free-range broth maintained acceptable sensory and microbiological quality for up to five days, compared to four days for broiler broth. These findings indicate that free-range chicken broth is nutritionally superior, organoleptically preferred, and slightly more stable during storage, with potential implications for integration into complementary feeding strategies aimed at stunting prevention. Further studies should explore clinical outcomes and large-scale feasibility in community settings.

Adhya Miriam Tom   Chris Mathew Prince   Sofia Sajid Ali   Jagat Gopinath   Izzah Tamseel Khanum   Afreen Farhana Udhuman Ali   and Anusha Sreejith   

Thyroid disorders are among the most common endocrine conditions worldwide, yet public awareness varies. In the United Arab Emirates (UAE), rising prevalence and limited health literacy may delay diagnosis and treatment. This study assessed public knowledge, awareness, and health-seeking behavior regarding thyroid disorders through a cross-sectional survey of 625 adult residents using a structured, close-ended questionnaire. Data on sociodemographics and knowledge of thyroid disorders, including general awareness, symptoms, risk factors, causes, diagnosis, and treatment, were analysed using SPSS version 29. Overall, 55.5% of participants demonstrated good knowledge, 26.6% had fair knowledge, and 17.9% showed poor knowledge. Most respondents correctly identified the thyroid's location (89.3%) and function (77.1%), and acknowledged that both genders can be affected (85%). Awareness of symptoms was moderate: weight changes (78.4%) and fatigue (71%) were most recognized, whereas menstrual irregularities (63.7%) and mood disturbances (59.1%) were less well-known. Knowledge of risk factors varied, with heredity (63.2%), stress (63.2%), and female sex (73.8%) commonly identified, though gaps remained regarding modifiable risks. Blood tests were widely recognized as the primary diagnostic tool (88.6%), and 91% were aware that thyroid disorders are treatable. Knowledge levels were significantly associated with gender and education (p < 0.001). Overall, public awareness in the UAE is moderate, with reasonable recognition of common symptoms but limited understanding of risk factors and screening practices, highlighting the need for targeted public health initiatives to enhance early detection and improve outcomes.

Agus Nugraha   Juarfa Pahompu Rajabima   Zirmansyah   Ujang Maman   Asep Usman Ismail   Murodi   Masri Mansoer   and Nindyantoro   

Pesticide residues in vegetables and fruits pose serious health risks, including digestive disorders, respiratory problems, reproductive impairments, and life-threatening diseases such as cancer. This study aims to develop a public policy model that promotes awareness and adoption of healthy food practices, particularly the consumption of pesticide-residue-free food. The research assessed community participation in outreach programs addressing pesticide hazards and examined its relationship with knowledge and food practices. Using a total sampling technique, members of the Association of Women Farming Groups in Bogor, West Java, Indonesia, were surveyed. The findings show that participants demonstrated high levels of engagement in extension activities, strong knowledge of pesticide hazards in commonly consumed food, and active involvement in producing, consuming, and promoting pesticide-residue-free food. Chi-square analysis confirmed significant associations between participation and knowledge, as well as between knowledge and practice. However, participation levels remained influenced by education, while both education level and membership duration significantly affected knowledge and healthy food practices. These results suggest that policy models should prioritize strengthening social participation by expanding community access to local resources, involving multiple stakeholders, and utilizing informal approaches to build social bonds and supportive environments. Incorporating local wisdom and community-based institutions can foster bottom-up transformational participation, bridge gaps between knowledge and practice, and mitigate the influence of socioeconomic status (SES) on healthy food behavior.

Afdal   Indah Sukmawati   Miftahul Fikri   Rezki Hariko   Yessa Maulida   Frischa Meivilona Yendi   Gusni Dian Suri   Nurfarhanah   and Denia Syapitri   

Various studies show that stunting experienced in childhood has a psychological impact when entering adolescence. We used representative longitudinal data to measure the psychological condition of stunted adolescents with special attention to age, height, gender differences and education level. This research is a quantitative descriptive study with a sample of 353 stunted teenagers who were characterized by a height that did not meet WHO standards. The instrument used was a scale of psychological problems of stunted adolescents, which was processed descriptively. The results showed that the tendency for anxiety in the female group had a higher percentage value than in the male group; the aspect of low self-confidence in adolescents in the female gender group has a higher percentage value than in males; and aspects of abnormal hyperactive behavior in stunted adolescents in the female gender group have a higher percentage value than in the male group. The research results also compared the three aspects in terms of age group, school group and height. The research results show the need for special attention regarding psychological problems in stunted adolescents. Counseling interventions with information services and guidance groups are needed to help stunted adolescents overcome the psychological problems they face.

Thanaporn Wongsa   Chanaporn Poldongnok   Budtree Thepthong   and Chan Pattama Polyong   

This study aimed to assess multidimensional occupational hazards—chemical, ergonomic, and accidental—and their associations with health outcomes among sugarcane farmers. A cross-sectional study was conducted among 120 sugarcane farmers in Suphanburi Province. Data were collected through structured interviews, ergonomic assessments using the Rapid Entire Body Assessment (REBA), and biomonitoring of organophosphate metabolites in urine (n=47). Descriptive and multivariable logistic regression analyses were performed. The majority were long-term farmers (mean experience 23.6±14.6 years) with high physical workloads and low economic resources. Nearly half (45.0%) had high ergonomic risk scores, 80.0% reported musculoskeletal pain, and 74.2% experienced acute symptoms within 24 hours after pesticide spraying. No organophosphate metabolites were detected in urine samples. High REBA scores and more than one harvest work cycle were significantly associated with acute symptoms and musculoskeletal disorders (p<0.05). Sugarcane farmers face overlapping ergonomic and chemical hazards that synergistically affect their health. Integrated preventive strategies—combining ergonomic redesign, pesticide safety training, and biomonitoring surveillance—are essential to mitigate multidimensional occupational risks and promote sustainable agricultural health. However, due to the cross-sectional design, causal relationships could not be established. In addition, biomonitoring based on single-spot urine samples from a subsample may not fully capture long-term, intermittent, or low-level pesticide exposure; therefore, future studies employing longitudinal designs and repeated biomonitoring are warranted to address these limitations.

Tri Wiyatini   Sulistiyani   Henry Setyawan   and Daru Lestantyo   

Background: Periodontal diseases remain a public health concern among school-aged children in Indonesia. In Semarang City, Central Java, signs of gingival inflammation persist despite school-based oral health programs. Although health literacy interventions are widely implemented, their clinical impact remains inconsistent. Objective: This study evaluated the effects of an integrated intervention combining periodontal health literacy education with adjunctive chitosan mouthwash on oral health knowledge and gingival status. Methods: A quasi-experimental study with repeated measures was conducted from January to June 2025 among 118 Grade V students from public elementary schools in Semarang City, Indonesia. Participants were assigned to four groups: combined intervention, mouthwash only, health literacy only, and control. Oral health knowledge was assessed using a validated 20-item questionnaire, and gingival status was measured using the Gingival Index at baseline and follow-up (days 3, 5, 7, and 12). Data were analyzed using a generalized linear model with repeated measures. Results: Significant improvements in gingival index were observed across intervention groups, with differential effects over time (p < 0.05). Knowledge improvement was significant only in the combined intervention group and did not differ significantly between groups. Clinical improvements were more consistent than knowledge gains. Conclusion: The integration of periodontal health literacy education with practical self-care strategies, including chitosan mouthwash, demonstrated short-term effectiveness in improving gingival health among school children.

Tri Sunarsih   Winarsih   Dayat Subekti   Herdini Widyaningpertiwi   Endah Puji Astuti   and Elvika Fit Ari Shanti   

Exclusive breastfeeding remains suboptimal in many low-income communities, despite widespread health promotion efforts and increasing access to maternal health services. Understanding the relative influence of psychosocial, environmental, and structural determinants is crucial for designing effective interventions. This study examined factors influencing mothers' intention to practice exclusive breastfeeding among low-income pregnant women in an Indonesian district, applying a PRECEDE-informed framework focused on intention formation during pregnancy. A sequential exploratory mixed-methods design was used. The qualitative phase explored pregnant women's perceptions, barriers, and facilitators, which informed the development of the quantitative phase. In the cross-sectional phase, the structural model was tested using Partial Least Squares–Structural Equation Modeling (PLS-SEM) to assess measurement and structural relationships. The measurement model showed satisfactory reliability and convergent validity. The structural model demonstrated strong predictive power for exclusive breastfeeding intention (R^² = 0.731; Q^² = 0.704; SRMR = 0.057). Predisposing and environmental factors were the most influential determinants, with psychosocial readiness serving as the main driver of intention, and environmental context providing complementary support. Structural access and formal support alone were insufficient to directly influence intention without strong psychosocial readiness. Rather than proposing a new theoretical model, this study offers a context-sensitive application of the PRECEDE framework, clarifying how psychosocial readiness and environmental factors interact to shape exclusive breastfeeding intention during pregnancy in economically constrained settings. The findings provide practical insights for designing targeted, evidence-based maternal health promotion interventions among low-income populations.

Made Indra Wijaya   Azizah Mat Hussin   Masyita Mamot   Minarni Wartiningsih   and Risky Kusuma Hartono   

Stunting remains a persistent public health problem in Indonesia, including in Bali, a province characterized by relatively strong health infrastructure and socioeconomic development. This study aimed to identify determinants of stunting among children under five years of age in a high-tourism, middle-income setting. A matched case–control study was conducted between August and December 2025 across all nine districts of Bali Province, involving 1,377 children aged 6–59 months (459 stunted cases and 918 non-stunted controls) matched by age group and district. Data on maternal characteristics, birth outcomes, infant feeding practices, healthcare utilization, and household environmental conditions were collected through structured caregiver interviews and verified health records. Multivariate logistic regression analysis showed that low birth weight was the strongest determinant of stunting. Maternal education and maternal knowledge of stunting were consistently associated with increased odds of stunting, highlighting the importance of caregiving capacity and health literacy. Feeding practices, limited antenatal care attendance, and incomplete immunization demonstrated moderate but significant associations. Environmental factors, including unsafe drinking water and poor household sanitation, were also independently associated with stunting, although overall prevalence was relatively low. These findings indicate that stunting in Bali arises from the accumulation of moderate risks rather than extreme deprivation, underscoring the need for targeted, proportionate interventions focused on vulnerable households.

Orathai Katkhaw   Tienthong Takaew   Patipat Vongruang   Taweewun Srisookkum   Sunanta Wongrattanakamon   and Thapkhwan Srirattayawong   

Introduction: Smog pollution with tiny particulate matter (PM2.5) can be detrimental to your physical and mental health. This study examined factors associated with people's self-protective behaviors in smog-affected areas. Methods: This study is a cross-sectional survey of 550 adults living in smog-affected areas of Phayao Province, Northern Thailand, between April and May 2024. Data were gathered utilizing a standardized questionnaire. We employed multiple linear regression to examine the relationships between demographic and psychological traits and self-protective behaviors. Results: About 45% of participants (44.7%) reported high levels of self-protective behavior. Older age was associated with higher self-protective behaviors (β = 0.145, p = 0.003), and women reported higher levels than men (β = −0.066, p = 0.048). In contrast, underlying disease (β = −0.172, p < 0.001), higher stress (β = −0.118, p = 0.001), and longer duration of residence in the area (β = −0.188, p < 0.001) were associated with fewer self-protective behaviors. Perceived smog severity showed the strongest positive association with self-protective behaviors (β = 0.525, p < 0.001). The model explained 40.4% of the variance in self-protective behaviors (R = 0.636, R² = 0.404, p < 0.001). Conclusion: Self-protective behaviors during smog pollution were associated with both demographic and psychological factors. Public health programs may be strengthened by pairing risk communication with mental health support, with particular attention to long-term residents and people living with chronic illness. Given the cross-sectional design, the findings should be interpreted as associations rather than causal effects.

Sumathi Sasikala Gnanamuthu   Najeem Hassan Al Balushi   Malek Al-Natour   Limna Mahaboob   Sabitha Sadanandan   Shobana Gangadharan   and Said Abdullah Suliman Al Alawi   

Burnout at work is a major global health concern, particularly in high-stress professions such as nursing. This cross-sectional analytical study examined the prevalence and associated risk factors of burnout among 130 intensive care unit (ICU) nurses working in government hospitals in Oman. Burnout was assessed using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS), which measures emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). Sociodemographic and occupational factors were evaluated using Siegrist's Effort–Reward Imbalance (ERI) model and Karasek's Job Content Questionnaire (JCQ). Results revealed burnout prevalence of 17.8% for EE, 38.2% for DP, and 21.5% for reduced PA. Working more than 40 hours per week was identified as the most significant predictor of burnout. Occupational exhaustion was higher among male nurses and those aged 21–30 years (p = 0.003). Linear regression showed that the Reward scale negatively influenced DP (Sig. = 0.009) and EE (Sig. = 0.004), while the Effort scale (Sig. = 0.011) and Job Crafting Behavior (Sig. = 0.01) significantly affected EE. Over-commitment strongly correlated with DP (Sig. = 0.000), and physical job demands negatively impacted PA (Sig. = 0.017). Long working hours were the major contributing factor to burnout, emphasizing the need for improved working conditions, stress management programs, and supportive interventions for ICU nurses in Oman.

Jumartin Gerung   Sukri Palutturi   Muhammad Syafar   Wahiduddin   Shanti Riskiyani   and Muhammad Tamar   

BACKGROUNDS: Tuberculosis (TB) with comorbidities negatively impacts patients' quality of life, suggesting the need for family support and health promotion. The impact of health promotion intervention on the family's ability to support mental health was aimed to be evaluated by this study. MATERIALS AND METHODS: This quasi-experimental study was conducted in Kendari, Indonesia, from July to December 2024. The population comprised 132 family members of comorbid TB patients, divided into intervention (n=66) and control (n=66) groups. Data were collected using a validated structured questionnaire to assess knowledge and attitudes related to health literacy and social support. These data were analyzed with repeated ANOVA and post-hoc test, with a significance level of p < 0.05. RESULTS: The intervention group showed significant improvements in all measured variables: social support knowledge (pre-test: 9.85 ± 1.33; post-test: 13.18 ± 1.60; p = 0.000) and social support attitudes (pre-test: 17.45 ± 2.04; post-test: 32.55 ± 2.71; p = 0.000). Similarly, Health literacy knowledge increased markedly (pre-test: 9.85 ± 1.42; post-test: 13.18 ± 1.60; p = 0.000), as did health literacy attitudes (pre-test: 18.62 ± 2.15; post-test: 33.72 ± 2.48; p = 0.000). These findings indicate that repeated module-based education effectively improved both social support and health literacy among families of patients with comorbid TB. CONCLUSION: Module-based health promotion effectively improves knowledge and attitudes regarding mental health and social support for comorbid TB patients.

Made Indra Wijaya   Luh Gede Pradnyawati   Dewa Ayu Putu Ratna Juwita   I Putu Dhananjaya Dharsila Gosa   and Ni Nyoman Hita Girindra Wardani   

Foodborne diseases remain a major public health concern in tourist destinations such as Gianyar, Bali, where food hygiene and sanitation are critical for community health and economic sustainability. Community health centers (puskesmas) are mandated to supervise food establishments, yet evidence on the effectiveness of supervision remains limited. This study assessed the relationship between puskesmas supervision and hygiene compliance among food establishments in Gianyar Regency. A cross-sectional study was conducted from January to December 2024 across eight puskesmas. A stratified random sample of 120 food establishments (15 per puskesmas) was assessed using a checklist based on Ministry of Health Regulation No. 1096/2011. Supervision practices were documented through interviews and record reviews. Descriptive analysis and chi-square tests were applied, followed by logistic regression. Only 39.2% of establishments were fully compliant, while 35.0% showed moderate and 25.8% poor compliance. Common deficiencies included inadequate handwashing facilities, improper food storage, and a lack of pest control. Establishments receiving regular supervision (≥ 4 inspections/year) demonstrated significantly higher compliance than those with irregular supervision (51.0% vs. 22.5%, p < 0.01). Food handler knowledge and clean water availability were also significant predictors. Regular puskesmas supervision is strongly associated with improved food hygiene compliance.

Napattaraporn Kaewkhamsorn   Prachuab Lamluk   and Sakesun Thongtip   

Background: Dental caries remains a significant public health challenge among preschool children globally, with parental involvement being critical for effective prevention and management. This study aims to identify the predictors influencing parental intention to seek dental services for their preschool-aged children. Methods: This cross-sectional study was conducted from February to March 2025 in Chiang Rai Province, Northern Thailand. Data were collected from a sample of 184 parents using a structured questionnaire designed to assess constructs of the Theory of Planned Behavior (TPB) regarding dental service utilization. Results: Among the 184 participants, 73.9% were female, with a mean age of 36.8 ± 10.5 years. Regarding family characteristics, 43.5% of participants reported having one or two children, and 91.3% of children were insured under the 30-Baht gold card scheme. Correlation analysis revealed significant positive associations among attitudes, subjective norms, perceived behavioral control (PBC), and parents' intentions to bring their preschool-aged children for dental services (all P-value<0.001). Attitudes were correlated with subjective norms (r = 0.532), subjective norms with PBC (r = 0.534), and PBC with intention (r = 0.450). A multiple linear regression analysis was conducted to identify predictors of parents' intention to bring their preschool-aged children for dental services. After controlling for confounding variables, the model revealed that attitudes (B = 0.426, SE = 0.094, P-value<0.001), subjective norms (B = 0.330, SE = 0.053, P-value<0.001), and PBC (B = 0.382, SE = 0.057, P-value<0.001) were significant positive predictors. Conclusion: Attitudes, subjective norms, and PBC significantly predict parental intention, supporting TPB. Targeting these factors—by promoting positive attitudes, leveraging social influence, and enhancing parental self-efficacy—may improve early childhood dental service use and oral health outcomes.

A. Rizky Amaliah   Andi Zulkifli   Nurpudji Astuti Daud   Nurhaedar Jafar   Muhammad Tahir Abdullah   and Indra Fajarwati Ibnu   

Postpartum blues is a psychological mild disorder that is mostly experienced by postpartum mothers and can later develop into postpartum depression when poorly tackled. Age, education, occupation, number of children in their family, and family support are sociodemographic variables widely reported as significant determinants of postpartum psychological well-being. The aim of the study was to investigate the association between sociodemographic characteristics and the risk of postpartum blues among mothers in the Ammatoa Kajang indigenous community in South Sulawesi, Indonesia. In this research, a cross-sectional, quantitative analytical design was used. The population was limited to only 32 postpartum mothers, recruited through convenience sampling due to cultural constraints. The sociodemographic questionnaire and Edinburgh Postnatal Depression Scale (EPDS) were used to collect the data. Data analysis was performed using univariate and bivariate analyses with the Fisher's Exact Test. The findings indicated that the majority of the respondents fell within the normal EPDS category (93.7%), while 6.3% had a slight risk of postpartum blues. In the bivariate analysis, there were no statistically significant relationships between sociodemographic variables and the risk of postpartum blues (p > 0.05). These results indicate that, among the Ammatoa Kajang indigenous population, traditional sociodemographic risk factors in the general population may be less significant. Organized postpartum practices, paternal involvement, and long-term family support systems are contextual socio-cultural factors that may influence the development of maternal psychological well-being. This study suggests additional comparative studies to examine the interplay between socio-cultural settings and postpartum mental health outcomes.

Tasnim Tasnim   La Ode Saafi   Ridia Utami Kasih   Lodes Hadju   Firmansyah   I Wayan Angga Radiastu   and Juliatin   

Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge in Indonesia, particularly in coastal areas with limited access to health information and services. Conventional leaflet-based education often fails to produce sustainable behavioral change in low-literacy populations. This study compared the effectiveness of multimedia-assisted and leaflet-based focus group discussions (FGDs) in improving knowledge, attitudes, and preventive behaviors toward MDR-TB among coastal residents of Southeast Sulawesi. A community-based quasi-experimental pre–post study was conducted among 106 participants in Abeli Subdistrict, Kendari City, Indonesia. Participants were divided equally into two groups: (1) FGD with multimedia support (PowerPoint and educational videos) and (2) FGD with printed leaflets. Pre- and post-intervention assessments of knowledge, attitudes, and preventive behaviors were conducted using a structured questionnaire. Data were analyzed using Wilcoxon Signed Rank and Mann–Whitney U tests with a significance level of p < 0.05. The study showed that both intervention groups showed significant improvements in knowledge, attitudes, and preventive behaviors after the FGDs (p<0.001). However, participants in the multimedia-assisted group achieved significantly higher gains across all outcome domains than those in the leaflet group (knowledge: p=0.031; attitudes: p=0.033; preventive behaviors: p=0.001). Multimedia integration increased engagement and comprehension, particularly among participants with lower educational backgrounds. In conclusion, multimedia-assisted FGDs are more effective than leaflet-based discussions in enhancing MDR-TB preventive behaviors in low-resource coastal settings. Integrating participatory and multimedia-supported education into community health programs may strengthen TB prevention, improve health equity, and promote sustainable behavioral change.

Delima   Neviyarni   Afdal   Firman   Yarmis Syukur   Sari Arlinda   and Yura Witsqa Firmansyah   

Stunting continues to pose a serious public health concern globally, particularly in low- and middle-income countries such as Indonesia. Maternal knowledge during pregnancy plays a crucial role in early prevention, yet the relative contribution of social support, self-efficacy, and maternal characteristics remains underexplored. An analytical cross-sectional study was conducted among 310 randomly selected pregnant women registered at community health centers in Padang City. Data were collected through validated questionnaires covering knowledge of stunting prevention, social support, self-efficacy, and maternal characteristics. Reliability and validity testing confirmed acceptable values (Cronbach's α ≥ 0.70, CR > 0.70, AVE > 0.50). Structural equation modeling with SmartPLS version 3 was applied to assess relationships among variables, with significance determined at p < 0.05. The model demonstrated strong explanatory power, accounting for 71.3% of the variance in maternal knowledge (R² = 0.713; adjusted R² = 0.705). Maternal characteristics (β = 0.332, p < 0.001), social support (β = 0.216, p < 0.001), and self-efficacy (β = 0.090, p = 0.015) were all significant positive predictors. Effect size analysis revealed social support as the most influential determinant (f² = 0.513, large), followed by self-efficacy (f² = 0.198, moderate), and maternal characteristics (f² = 0.125, small-to-moderate). Predictive relevance was substantial (Q² = 0.560). Pregnant women's knowledge of stunting prevention is shaped primarily by social support, with complementary roles of self-efficacy and maternal characteristics. Interventions that integrate family- and community-based support with strategies to enhance maternal confidence and education may significantly improve stunting prevention efforts in vulnerable populations.

Luh Putu Ratna Sundari   and I Ketut Tunas   

Vitamin D deficiency is often linked to obesity, which features an increased waist-to-hip ratio (WHR) and higher body fat mass. Obesity is also strongly connected to an elevated risk of hypertension. Vitamin D plays a key role in regulating the renin–angiotensin–aldosterone system (RAAS), which controls blood pressure. This study aimed to examine the relationship between serum vitamin D levels, WHR, body fat mass, and blood pressure in obese women to better understand the potential role of vitamin D in blood pressure regulation within this group. A cross-sectional analytic study was conducted among 37 obese women between 20–30 years old. Serum vitamin D levels, WHR, body fat mass, and blood pressure were measured, and the correlations were analyzed using Pearson's correlation test. The mean serum vitamin D level was 21.2 ± 12.2 ng/mL, the mean body fat mass was 41.73 ± 4.46%, and the mean WHR was 0.82 ± 0.05. The mean systolic and diastolic blood pressures were 128.3 ± 13.8 mmHg and 82.9 ± 9.7 mmHg, respectively. Significant negative correlations were observed between vitamin D levels and WHR (r = –0.355, p = 0.031), body fat mass (r = –0.338, p = 0.041), systolic blood pressure (r = –0.387, p = 0.018), and diastolic blood pressure (r = –0.556, p < 0.001). In conclusion, lower serum vitamin D levels were significantly associated with higher WHR, body fat mass, and both systolic and diastolic blood pressure. These findings highlight the role of vitamin D in the regulation of fat metabolism and blood pressure.

Pornpana Somjit   Natnapa Promma   Kritsada Sarndhong   and Sarawut Sangkham   

Childhood overweight and obesity represent major public health challenges in Thailand, particularly in rural areas experiencing rapid nutritional transitions. Schools provide an effective setting for the early establishment of healthy behaviors; however, evidence regarding theory-driven, multi-component interventions in resource-limited settings remains limited. This study evaluated a school-based nutrition promotion program grounded in the PRECEDE–PROCEED Model and Social Cognitive Theory, targeting overweight and obese primary school children in rural northern Thailand. A quasi-experimental pretest–posttest control group design was conducted from January to June 2025 in two public primary schools in Phayao Province. A total of 84 children aged 6–12 years were assigned to either an intervention group (n = 42) or a control group (n = 42). The 12-week intervention comprised healthy school lunch menu modification, interactive nutrition education, family and community reinforcement, and structured physical activity. Outcome measures—including weight-for-height Z-scores (WHZ), daily energy intake, dietary behaviors, and physical activity—were assessed at baseline, post-intervention, and three-month follow-up. ANCOVA and GEE analyses revealed significant reductions in daily energy intake (−128.3 vs. −28.6 kcal/day, p < 0.001) and improvements in dietary behaviors (+18.3 vs. +1.5 points, p < 0.001), which were sustained at follow-up. Physical activity levels increased significantly (p < 0.001). GEE models adjusted for age and sex indicated significantly reduced odds, corresponding to a 56–64% reduction in obesity risk in the intervention group (post-intervention: OR = 0.44; 95% CI: 0.21–0.94; follow-up: OR = 0.36; 95% CI: 0.16–0.82). This study demonstrates that a theory-driven, multi-component school-based intervention effectively improved dietary behaviors, physical activity, and nutritional status, offering a scalable model to guide obesity prevention policies in resource-limited settings.

Ratih Kumala Dewi   Luluk Khusunul Dwihestie   Ratih Paramastuti   and Benedicta Audrey Putri Trisnadewi   

Pre-menopause is marked by estrogen decline, menstrual irregularities, and physical as well as psychological symptoms that reduce women's quality of life. Although hormone replacement therapy (HRT) is commonly used, its long-term risks underscore the need for safer non-hormonal alternatives. This exploratory qualitative study involved 12 perimenopausal women aged 42–48 years in Boyolali, Indonesia. Data were collected through in-depth interviews to explore needs for nutritional, sensory, and psychological interventions, followed by expert validation across multiple disciplines. Thematic analysis was applied to identify key needs, while validation used Aiken's V. Findings revealed four major needs: (1) nutritional: legume-based functional foods low in sugar and purine with ginger for safety and palatability; (2) sensory: a Damask rose aromatherapy pillow to improve sleep and reduce anxiety; (3) psychological: group counseling, psychoeducation, and relaxation exercises; and (4) social: support from family, peers, and community. Expert validation showed high feasibility (Aiken's V ≥ 0.88). This study formulated PRIMA (Pre-Menopause Holistic Intervention Model for Well-being and Quality of Life) as a holistic, non-hormonal framework integrating nutritional, sensory, psychological, and social approaches. PRIMA provides a conceptual foundation for community-based strategies to improve women's well-being, with further controlled trials recommended to assess its effectiveness.

Rоksoliana Zozuliak-Sluchyk   Oksana Protas   Lidiia Tymkiv   Nataliia Sabat   and Vira Syniakova   

This research evaluated the efficacy of digital psychological interventions aimed at bolstering mental health and social well-being among vulnerable population groups. The study involved 200 participants, of whom 187 completed all stages of the investigation. Data were collected using the Scale of Adjustment and Way of Life by Rogers and Dymond, Ryff's Psychological Well-Being Scales, the Depression Anxiety Stress Scales-21, and the Cognitive Emotion Regulation Questionnaire. Analytical methods included descriptive statistics, group comparisons prior to the intervention (t-tests/Mann-Whitney), two-way ANOVA with repeated measures, and thematic analysis of qualitative data. Scale reliability was confirmed through Cronbach's alpha analysis. The experimental group experienced a significant upward trend in social and psychological well-being (from 22.1 to 26.8 points) and a simultaneous decrease in negative emotional states (DASS-21 scores dropped from 13.9 to 9.7 points). Marked improvements were also recorded in social-psychological adaptation. Specifically, constructive emotion regulation (CERQ) increased from 13.9 to 17.4 points within the experimental group, while the control group showed no measurable changes across any parameters. The results underscore the substantial capacity of digital solutions to improve access to psychological support and social resources while reducing structural and individual barriers to their use. The findings further indicate that digital interventions can effectively support well-being, facilitate adaptive processes, and promote constructive emotional regulation among vulnerable populations. Future research should be directed towards evaluating the long-term effects of the intervention and customizing programs to accommodate diverse socio-cultural contexts.

A. Rizky Amaliah   Andi Zulkifli   Nurpudji Astuti Daud   Nurhaedar Jafar   A. Irma Suryani   Indra Fajarwati Ibnu   and Muhammad Tahir Abdullah   

Background: Postpartum blues is a mild emotional problem that often occurs in mothers after childbirth, especially during the first week. If not promptly recognized and managed, it can develop into a more serious psychological issue. Support from a partner, especially the father's role as a breastfeeding father, is crucial. In traditional communities such as the Ammatoa Kajang, the father's role is shaped by cultural values and social systems that separate male and female roles. Objective: This study aims to explore the meaning, obstacles, and potential of the father's role in preventing postpartum blues among breastfeeding mothers within the Ammatoa culture in Tana Toa Village, Bulukumba Regency. Methods: This research uses a qualitative phenomenological approach with Colaizzi's analysis. Informants included traditional leaders, healthcare workers, and fathers of postpartum mothers, selected purposively. Data were collected through in-depth interviews and group discussions, then analyzed thematically. Results: Five main themes emerged: (1) the meaning of the father's role after childbirth, (2) understanding of postpartum blues, (3) husband-wife communication after childbirth, (4) obstacles fathers face in providing support, and (5) expectations regarding the father's role. Findings: The results show that although traditional norms strictly regulate gender roles, there is room for change in the father's role as an emotional and spiritual companion during the postpartum period, in line with the values of kalumannyang, amaradekang, and pasang ri Kajang. Conclusions: The father's role as a breastfeeding father in the Ammatoa indigenous community can be strengthened with a more progressive cultural approach. Community-based education and local values are essential to develop the father's role as protector, caregiver, and emotional balance keeper for the wife, thus helping to prevent postpartum blues.

Syeda Fatima Rizvi   

Knowledge of breast cancer-associated risk factors and screening methods increases the likelihood of early detection, which is directly related to the outcome. This cross-sectional study utilized self-administered online questionnaires about knowledge regarding the risk factors and attitude towards breast cancer screening practice. The responses of 409 adult Saudi females were collected from the Bisha, Asir region, between April and September 2023. The results showed that 311 (76.04%) participants had poor overall knowledge about breast cancer. Age, marital status, and education were significantly associated with the level of knowledge (-value <0.05). Participants could identify increasing age, past medical or family history of breast cancer, and the use of hormone replacement therapy as the most common risk factors. However, only 164 (40.10%) participants ever performed a breast self-examination, and only 32 (7.82%) did it monthly. Only 64 (15.65%) participants were enrolled for mammography. Logistic regression analysis revealed that the participant's level of knowledge was significantly affected by age (OR 0.476489; 95%CI, 0.266-0.854; 0.006424), marital status (OR 0.559148; 95%CI, 0.348-0.899; 0.008155) and family history of BC (OR 1.609428; 95%CI, 0.978-2.647; 0.030455). There is a huge need for awareness programs in this region, with an emphasis on breast self-examination training and screening practice.

Sella Zenitasari   Eugenius Phyowai Ganap   and Mawaddah Ar Rochmah   

Background: Maternal health remains a universal concern in both developed and developing countries. With the advent of e-medicine and other digital health technologies, new opportunities have emerged to improve mothers' health. Delays in seeking, reaching, and receiving care continue to be a significant factor in preventing maternal deaths. E-health interventions may play an important role in addressing these delays by improving access to information, communication, and quality care. This scoping review aims to address gaps in the literature regarding the use of e-health interventions to reduce maternal mortality, including what types of digital interventions were used, what the outcomes were, and what future research needs to be conducted. Methods: A comprehensive literature search was conducted across PubMed, ScienceDirect, and Scopus databases from 1 January 2014 to 31 December 2024, identifying 1922 documents. The selection was limited to original studies involving pregnant women and the application of e-medicine or other digital interventions to improve maternal and neonatal outcomes. Results: This review includes 17 studies following screening and selection. Digital interventions have the potential to reduce maternal and perinatal mortality through telemedicine and mHealth, improve adherence to essential birth practices via e-learning, and enhance data collection and obstetric care quality with EMRs. Telemonitoring offers a cost-effective alternative to hospital admission for low-risk pregnancies. However, effectiveness varies based on context, target population, and integration with existing healthcare systems. Challenges include the need for complementary strategies to address socio-economic determinants, data quality, healthcare provider training, digital literacy, and mental health needs. While some interventions reduce invasive procedures and improve healthcare delivery efficiency, persistently high rates of antenatal and postnatal depression suggest a need for a more holistic approach to maternal healthcare. Conclusion: Integrating e-health solutions into maternal healthcare can significantly reduce delays in emergency situations and improve maternal and perinatal outcomes. While challenges such as infrastructure limitations and caregiver compliance persist, findings highlight the need for tailored strategies to address these barriers. Ultimately, prioritizing e-health initiatives can lead to more effective and equitable maternal care, ensuring timely support for women when it is most needed.

Septiana Juwita   Suwarto   Ika Sumiyarsi Sukamto   and Sugihardjo   

Low Birth Weight (LBW) is globally defined as a newborn weighing less than 2,500 grams, regardless of gestational age. LBW is one of the key indicators reflecting various complex public health issues, and it significantly contributes to both maternal and infant morbidity and mortality. This study aimed to analyze seven Health Belief Model (HBM) indicators in relation to pregnant women's behavior in preventing LBW. A quantitative, cross-sectional research design was used. Purposeful high-risk cluster sampling was applied, resulting in a sample of 220 third-trimester pregnant women. Sampling was conducted at four health centers with the highest LBW case numbers. Inclusion criteria: third-trimester pregnant women, residing for at least 1 year, able to read and write. Data were analyzed using multiple logistic regression, processed with SPSS version 29. Results showed that perceived benefits (B = 0,015; p = 0,022), health motivation (B = 0,015; p < 0,001), and cues to action (B = 0,008; p < 0,001) had positive and significant effects on health behavior. In contrast, perceived susceptibility (p = 0.114), perceived severity (p = 0.531), perceived barriers (p = 0.395), and self-efficacy (p = 0.693) did not show statistically significant effects, as their p-values exceeded 0.05 and their 95% confidence intervals crossed zero. The findings indicate that perceived benefits, health motivation, and especially cues to action are the strongest determinants of health behavior, while perceived susceptibility, severity, barriers, and self-efficacy do not show significant direct effects in the multivariate model. These results highlight the importance of designing health promotion programs that emphasize motivational reinforcement and consistent external cues to effectively improve healthy behaviors in practice.

Herlina   Fridawaty Rivai   Yahya Thamrin   Andi Zulkifli   Muhammad Syafar   Irwandy   and Ilham Alimuddin   

Preparedness for disasters is a critically important aspect and a key determinant of successful disaster management. To minimize the impact of disasters across all stages, nursing interventions are essential in prevention or mitigation, preparedness, response, recovery, and reconstruction or rehabilitation efforts. Despite the importance of these measures, comprehensive information regarding hospital disaster preparedness remains scarce. Therefore, this review aims to provide an in-depth overview of existing research on hospital readiness in responding to disasters. A literature search was performed for articles published between 2018 and 2022 in PubMed, Google Scholar, and ScienceDirect using the keywords "disaster preparedness" and "hospital disaster plan." Studies were included if they analyzed hospital preparedness, employed a cross-sectional design, and were published in English or Indonesian. All selected articles were evaluated independently based on the Joanna Briggs Institute (JBI) criteria. The initial search yielded 1105 articles, but only 13 articles met the inclusion criteria for this review. Among these, the majority indicated that hospitals showed poor preparedness in responding to disasters. They also lacked confidence in their ability to handle major disaster events. The review findings indicate that most hospitals are sub-optimally prepared for disaster management. Policymakers should promote the implementation of disaster preparedness training in hospitals.

Nafeesa Abdul Kareem   and Jayakumary Muttappallymyalil   

Background: The United Arab Emirates (UAE) has a diverse and predominantly expatriate workforce, many of whom are laborers exposed to occupational hazards and vulnerable to health inequities. Although the country has significantly expanded healthcare access through insurance mandates and infrastructure development, there remains a noticeable gap in understanding how laborers actually utilize these services, especially aging workers at greater risk for chronic diseases. Notably, no comprehensive peer-reviewed studies have yet examined healthcare utilization among this key demographic in the UAE. Purpose: This narrative review seeks to fill a critical gap in the literature by synthesizing available evidence on healthcare utilization among laborers in the UAE. It explores the factors that facilitate or hinder access and engagement with healthcare services, with a focus on aging laborers. Methodology: A structured search of PubMed, Scopus, Google Scholar, and grey literature was conducted to identify studies from 2005 to 2023 related to healthcare access and utilization among laborers in the UAE. A total of 85 records were reviewed. Both quantitative and qualitative studies were considered, alongside relevant policy reports and academic articles. Data were extracted on utilization behaviors, enablers, and barriers. Results: Findings indicate that health insurance coverage, proximity to clinics, and employer-supported initiatives are key facilitators. Major barriers include language difficulties, high out-of-pocket costs for medications, lack of regular healthcare providers, and long working hours. Preventive care services remain underutilized, and chronic condition management is inconsistent, particularly for older laborers. Conclusions: While the UAE has made notable strides in improving health system access, targeted efforts are needed to strengthen service continuity and promote healthy aging among laborers. Addressing structural barriers and encouraging preventive care use are the next essential steps. Contributions to the Field: This review contributes to the field by synthesizing existing knowledge on labor healthcare utilization in a unique socio-economic context. It provides a foundation for future research and policymaking aimed at integrating labor health into national health agendas, especially in countries with high migrant labor populations.

Jemwell B. Francisco   Jomar B. Esto   Armand G. Aton   Vinus P. Java   Gauvin Adlaon   Jainah Rose G. Amilbahar   Marianne I. Meriales   Lalyn N. Cabauatan   Jza T. Dana   Gideon S. Sumayo   Ezra Ivan Rey Abalos   Eimer M. Estilloso   Emy A. Morbo   Jayson A. Falle   Cristitito P. Ornopia   and Joven P. Dadap   

This study explored the health practices and behaviors of university students in the Southern Philippines, emphasizing key domains such as health perception and management, nutrition, physical activity, sleep quality, cognitive functioning, and stress tolerance. Employing a quantitative, descriptive-correlational research design, the study surveyed a total of 1,086 students selected through simple random sampling. Data were collected using the Health Practices and Behaviors Questionnaire, a validated tool designed to assess various dimensions of students' health-related behaviors. Descriptive statistics were used to compute composite means, providing an overview of students' engagement in each health domain. In addition, Spearman's rho correlation was applied to examine the relationships among the different health behaviors. Findings revealed that university students generally demonstrated moderate levels of health practices across most areas. Notably, significant positive correlations were identified between specific domains, particularly between physical activity, sleep, and stress tolerance. These findings underscore the interdependent nature of health behaviors, suggesting that improvements in one area may positively influence others. The results highlight the importance of adopting integrated and holistic approaches to health promotion within university settings. Institutions of higher learning are encouraged to implement comprehensive wellness programs that simultaneously address physical, mental, and behavioral health components. Such efforts can enhance not only students' overall well-being but also their academic engagement and performance. Furthermore, the study recommends that future research consider a broader set of variables—such as socioeconomic status, cultural background, and environmental factors—that may influence health practices among university students. By understanding these additional influences, educational institutions and policymakers can design more effective, targeted interventions to support the diverse needs of the student population.

Tri Maryani   Sri Mulyani   and Vitri Widyaningsih   

Background: The success of breastfeeding requires strong willingness, support for breastfeeding mothers and breastfeeding self-efficacy (BSE). This study aims to describe the need for social support for breastfeeding, sources and forms of support provided to primiparous mothers, and analyze the influence of social support on BSE. Methods: The study was conducted in Yogyakarta City among 113 breastfeeding mothers using consecutive sampling. There were 24 informants consisting of breastfeeding mothers (21 persons), nutrition officers of PHCs (1 person), lactation counselors (1 person), and midwives (2 persons). This was a mixed methods study: the qualitative study used a phenomenological approach to specifically identify social support, and the quantitative study used an analytic survey method with a cross-sectional approach. Results: A total of 113 breastfeeding mothers participated in the study, with a mean age of 27.8 years. Most were primiparous (56.6%), had primary–middle level education (50.4%), came from low-income households (56.6%), and were employed (54%). The majority of mothers' knowledge was good. There was a significant relationship between the variables of age, mother's education level, and husband support with self-efficacy scores. The most influential factor was the husband's support (p 0.016), with an effective contribution of 12.5% to BSE. Conclusions: Sources of breastfeeding social support come from husbands, parents, peers, health professionals, and cadres. The variable that strongly influences BSE is husband’s support. It is necessary to have an exclusive breastfeeding promotion program designed from pregnancy to delivery by involving mothers and husbands so as to increase support for breastfeeding mothers.

Ingan Ukur Tarigan   Endang Indriasih   Yuyun Yuniar   Ina Kusrini   Tati Suryati   Dina Bisara Lolong   Selma Siahaan   Tety Rachmawati   Ni Ketut Aryastami   and Jerico pardosi   

Birth Preparedness and Complication Readiness (BPCR) practice is an important WHO program that promotes and educates pregnant women and families to improve access to Skilled Birth Attendance (SBA) and health facilities during pregnancy and delivery. This study examines the influence of BPCR practice, especially delivery planning and other related factors, on the utilization of maternal services in Indonesia. Data were obtained from the 2016 National Health Indicator Survey (SIRKESNAS), a cross-sectional survey with a total sample of 6,790 women aged 10-54 years who had given birth in the past three years before the survey. The outcome variables were the utilization of SBA and delivery in health facilities, whereas the explanatory variable was delivery planning. Multivariate logistic regression analysis was used to assess the association between delivery planning and the utilization of maternal health services. Mothers with a complete delivery plan had a significantly higher chance of using an SBA (OR = 5.05, P-value < 0.001) and a primary health facility (OR = 9.82, P-value < 0.001) during delivery than those with minimal planning. Similarly, mothers who completed antenatal care visits were more likely to use SBA (OR = 8.40, P-value < 0.001), primary health facilities (OR = 7.83, P-value < 0.001), and hospitals (OR = 7.28, P-value < 0.001). Higher education and urban residency increased the likelihood of using a health facility. BPCR, particularly delivery planning, significantly increases access to SBA and health facilities. Strengthening BPCR implementation may reduce delays in receiving timely and adequate care during childbirth.

Phatchupha Huaychan   Chananya Jirapornkul   Chalermsiri Theppitak   and Yuparat Limmongkon   

Workers in the oil and gas industry face limited protection from ergonomic-related injuries that are caused by repetitive tasks, computer work, and awkward body positions. This study aimed to assess the ergonomic risks, determine the prevalence of musculoskeletal disorders (MSDs), and identify the factors associated with high ergonomic risk levels among employees in large firms in Eastern Thailand. This cross-sectional analytical study assessed the ergonomic risks and MSDs among 955 employees in large firms in Eastern Thailand. The data were collected using REBA, ROSA, and the Standard Nordic Questionnaire. REBA indicated that all warehouse employees were at moderate risk (100%), while ROSA revealed high risk levels among all computer workers in the maintenance and warehouse departments (100%). The prevalence of MSDs was highest in the neck, reported by 63.6% in the past 7 days and 95.0% over a 12-month period. Multivariate analysis identified the following significant risk factors for high ergonomic levels: 1) being female (AOR = 7.72, 95% CI: 4.27–13.97), 2) being single (AOR = 2.25, 95% CI: 1.04–4.85), 3) holding a bachelor's degree or higher (AOR = 1.58, 95% CI: 1.03–2.41), 4) being an office or laboratory staff member compared to production workers (AOR = 14.11, 95% CI: 9.13–21.79), 5) not regularly using PPE (AOR = 1.77, 95% CI: 1.16–2.71), 6) experiencing a high level of work stress (AOR = 1.58, 95% CI: 1.07–2.33), and 7) having recent hip/thigh symptoms (AOR = 2.98, 95% CI: 1.58–5.63). These findings underscore the critical need for employers and policymakers to implement integrated ergonomic interventions, including workstation redesign and stress management programs, to mitigate MSD risks in the Thai oil and gas sector.

Buthaina Alkhatib   Lana M. Agraib   and Islam K. Al-Shami   

The development and accumulation of cardiovascular disease (CVD) risk factors are greatly influenced by an individual's health-seeking behavior, which in turn depends on that individual's knowledge and behaviors. The study aimed to evaluate the CVD knowledge among a group of Jordanian adults. A cross-sectional study was conducted in Jordan between June and August 2023 among 2885 adults (18-64 years). Data, including sociodemographic data, were collected via an online self-reported questionnaire and a heart disease knowledge assessment. Heart knowledge scores were calculated. The mean score for the correct answers to the heart disease knowledge questionnaire was 47.9% (46.9% for males and 48.6% for females). Regarding the knowledge score, 37.2% of participants had poor knowledge, 30.9% had moderate knowledge, and 31.9% had good knowledge. Poor knowledge score was significantly affected by being younger (18-24 years) (38.4%), male sex (42%), smoker (35.5%), low economic status (75.6%), lower educational level (58%), single marital status, CVD-free participants (68.3%), and participants with no first-degree CVD family history (63.6%) (<0.001). Jordanian adults lack knowledge of CVD risk factors and symptoms. Additionally, various modifiable socioeconomic variables impacted the CVD knowledge score. This study demonstrates the need to increase Jordanians' understanding of CVD.

Ardonit Xhemajli   Nazim Myrtaj   Seryozha Gontarev   Mitrichka Dzambazovska Stardelova   and Abdulla Elezi   

The main objective of this study was to examine gender differences in health-related quality of life (HRQoL) among 11-year-old students in Kosovo, using the standardized instrument KIDSCREEN-27. Given the sociocultural context of Kosovo, where traditional gender norms may influence children's emotional expression, school engagement, and perceptions of well-being, this study offers an important insight into how boys and girls experience late childhood. An additional objective was to contribute to the regional and international literature on HRQoL in late childhood, with a particular focus on gender-based patterns. A total of 143 students, including 82 boys and 61 girls, from several primary schools in the Republic of Kosovo, participated in this study. The KIDSCREEN-27 questionnaire was self-completed by the students, and the raw data were processed according to the official guidelines, converted into Rasch-scaled values, and subsequently standardized into T-scores, which represent the standardized assessment of the measurement results. To explore gender differences across five distinct dimensions of health-related quality of life among school-aged students, a one-way multivariate analysis of variance (MANOVA) was conducted, followed by univariate analysis of variance (ANOVA). The findings based on Wilks' Lambda (λ = 0.800, F(5,135) = 6.77, p < .001) indicate a statistically significant impact of gender on health-related quality of life, suggesting that gender has a moderate influence on how children assess their quality of life across various dimensions. The univariate analysis showed that boys scored significantly higher in physical well-being, emotional well-being, and school functioning. However, no statistically significant gender differences were found in family relationships and the social support dimension, suggesting a stable social support network for both genders at this age. In conclusion, these findings highlight meaningful gender-specific patterns in HRQoL among Kosovar students, emphasizing the need for educators, school psychologists, and public health professionals to consider gender-sensitive strategies when designing programs that support children's emotional, physical, and academic development.

Ruslang   Ridwan Amiruddin   Yahya   Ariyanti Saleh   Muhammad Syafar   and Nurmala Sari   

Hypertension remains a pressing public health concern in coastal communities, shaped by entrenched cultural beliefs, constrained resources, and inadequate health literacy. This study seeks to elucidate the challenges and unmet needs of the Lake Tempe coastal community in managing hypertension. A qualitative phenomenological design was adopted, with data gathered in March 2025 through in-depth interviews with 14 purposively recruited participants from the Tanasitolo (Nepo Village) and Liu (Worongnge and Pallimae Villages) Community Health Centers. Interviews, lasting 20–40 minutes, were subjected to Colaizzi's analytic method. Six overarching themes were derived: perceptions of hypertension, risk factors, disease management, social support, cultural determinants, and healthcare constraints. Participants' conceptualizations of hypertension were heterogeneous and mediated by traditional beliefs and limited health literacy, frequently attributing the condition to aging or heredity. Principal risk factors encompassed high-salt and high-fat dietary practices, while suboptimal adherence and premature discontinuation of pharmacotherapy undermined disease management. Although families and health cadres provided support, their influence was attenuated by insufficient knowledge. Cultural traditions further shaped health behaviors, while systemic resource deficits and inadequate outreach curtailed healthcare provision. These findings underscore the imperative for culturally attuned, community-driven interventions to foster sustainable hypertension management in coastal populations.

Aida Fitria   Aris Citra Wisuda   Devi Nallappan   Siti Aisyah   Jita Sari   Rizka Angrainy   and Ivansri Marsaulina   

Background: Preeclampsia remains a major contributor to maternal morbidity and mortality worldwide. Early detection and appropriate management strategies are essential to improve maternal outcomes. Syndromic management, which integrates clinical signs and symptoms for timely intervention, has gained attention as a practical approach in maternal health. Objective: This study aimed to evaluate the effectiveness of syndromic management in preventing preeclampsia and supporting risk evaluation among pregnant women. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Relevant articles published between 2019 and 2025 were retrieved from PubMed, Scopus, Web of Science, and Google Scholar. The search initially identified 1,421 records. After screening and applying inclusion and exclusion criteria, 12 studies met the eligibility criteria and were included in the final analysis. Data extraction focused on intervention strategies, maternal health outcomes, and risk evaluation measures. Effect sizes were calculated using random-effects models. Results: The pooled analysis demonstrated that syndromic management significantly reduced the risk of preeclampsia among pregnant women (pooled RR = 0.72, 95% CI: 0.60–0.85, p < 0.001). Syndromic approaches also improved the accuracy of maternal risk evaluation, with moderate heterogeneity across studies (I^²=42%). Subgroup analyses indicated consistent benefits across diverse populations and healthcare settings. Conclusions: Syndromic management is an effective and evidence-based strategy for preeclampsia prevention and risk evaluation in maternal health. Its integration into routine antenatal care may contribute to reducing adverse maternal outcomes and strengthening maternal health systems globally.

Nur Rachmat   M Syafii   Anissa Eka Septiani   and Tarezza Dewi Sekar Mayang   

Walking balance impairment is one of the leading causes of fall risk in the elderly. Aging-induced musculoskeletal degeneration and body composition changes are hypothesized to influence balance and increase fall incidence. This study investigates the relationship between Body Mass Index (BMI), age, and fall risk on walking balance among the elderly. This cross-sectional study involved 55 elderly participants in Sragen, Indonesia, recruited through total sampling based on the complete list of the elderly at Jatisari Village Health Post. Measurements included BMI (using digital scale and stadiometer), fall risk (Morse Fall Scale), and walking balance (8-Foot Up and Go Test). Data were analyzed using multiple linear regression to assess individual and simultaneous effects of independent variables. A significant negative relationship was found between BMI and walking balance (t = -2.124, p = 0.039), age and walking balance (t = -3.641, p = 0.001), and fall risk and walking balance (t = -2.140, p = 0.037). Simultaneously, BMI, age, and fall risk significantly affected walking balance (F = 9.770, p < 0.001). The model explained 35.3% of the variance in balance scores (R^²=0.353). Higher BMI, older age, and increased fall risk are significantly associated with poorer walking balance in the elderly. These findings emphasize the need for targeted interventions by healthcare providers, community health centers, and elderly organizations to enhance mobility and reduce fall risk in aging populations.

Ans Ahmed Mahmood   Mohammed Mustafa Khan   Foaad Hasan   Akhter Ahmed   and Anusha Sreejith   

Introduction: Chronic rhinosinusitis (CRS) is a common chronic inflammatory condition of the paranasal sinuses and nasal mucosa, persisting for at least 12 weeks. It is characterized by nasal obstruction, discharge, facial pain, headache, and loss of smell. Diagnosis is based on symptoms supported by endoscopic or radiologic findings. CRS is influenced by multiple factors including allergies, infections, structural variations, and environmental exposures. Objectives: This study aimed to (1) determine the prevalence of CRS among adults in the United Arab Emirates (UAE), and (2) identify associated risk factors. Methods: A cross-sectional survey was conducted among 350 adult participants in the UAE. Data on demographics, medical history, environmental exposures, and lifestyle factors were collected using a structured questionnaire. CRS was defined based on clinical criteria, and associations with potential determinants were analyzed using statistical tests with significance set at < 0.05. Results: The prevalence of CRS was 14.9%. Significant associated factors included income, nasal allergies, asthma, rhinitis, residence or workplace proximity to construction/industrial sites, use of an air humidifier/purifier, pet ownership, personal nasal problems, and family history of CRS ( < 0.05). Conclusions: CRS prevalence among UAE adults is high but slightly lower than estimates from other Middle Eastern populations. The findings highlight the role of environmental exposures (construction sites, pets), comorbid allergic/respiratory conditions, and genetic predisposition in CRS development. These determinants underscore the need for public health strategies addressing both environmental and medical risk factors.

Cecilia Leslie Pillay   and Jace Pillay   

Most mental health problems start during the child and adolescent stages and persist into adulthood, limiting opportunities for the individual to lead a fulfilling life. High exposure to adverse childhood events is associated with many behavioural and mental disorders. There is a dearth of information about the prevalence of mental health conditions among children and adolescents in South Africa. The study aimed to identify the prevalence of child and adolescent mental health conditions by investigating the mental health of children and adolescents in the Umlazi Education District in KwaZulu-Natal, South Africa. Learners in Grades 4 to 12 (N=1708) between 10 and 19 years old, from primary and secondary schools, both in urban and rural areas in the Umlazi school district, KwaZulu-Natal, South Africa, were selected to participate. The Child and Youth Mental Health Profiling System was administered using the biographical questionnaire, the Adverse Childhood Experiences questionnaire, the Strengths and Difficulties questionnaire, and the DSM-5 Level 1 Cross-Cutting Symptom Measure. The results indicated high levels of mental health difficulties among the learners. Adverse childhood experiences were highly prevalent (61.4%), and several of the mental health difficulties identified indicated gender, age, and race differences. Two significant factors that emerged through the Strengths and Difficulties questionnaire were ‘perceived weakness' and ‘perceived strengths'. The study supports the view that early detection of child and adolescent mental health difficulties will enable support and intervention, helping to promote recovery and build resilience.

Phanit Srisuttha   Uratcha Sadjapong   Pongsaton Silangirn   Keng Chaichana   and Sakesun Thongtip   

Background: Socio-demographic factors, health literacy (HL), and herbal medicine use behaviors are key contributors to improved self-care practices and enhanced quality of life among older adults. We examined the factors associated with herbal medicine use behaviors among elderly individuals in Northern Thailand. Methods: A cross-sectional survey of older persons aged 60 and up was done between April and May 2025, with a total of 382 participants. Socio-demographic factors and herbal medicine use behaviors were assessed using a structured questionnaire. HL was measured using the European Health Literacy Questionnaire (HLS-EU-Q16). Results: The results indicated that the prevalence of herbal medicine use was 67.8%. HL levels were distributed as follows: 60.5% had likely sufficient HL, 21.2% had likely problematic HL, and 18.3% had inadequate HL. In the binary logistic regression analysis, the odds of herbal medicine use were higher among participants aged ≥65 years (OR = 1.71, 95% CI: 1.10–2.65), those without diabetes mellitus (OR = 1.85, 95% CI: 1.09–3.13), individuals with a history of falls in the previous year (OR = 4.47, 95% CI: 1.97–10.13), and those with inadequate HL (OR = 3.12, 95% CI: 1.56–6.27). Conclusions: The findings revealed that participants aged ≥65 years, those without diabetes mellitus, individuals with a history of falls in the previous year, and those with inadequate HL were more likely to use herbal medicine. These results suggest that interventions addressing socio-demographic factors and HL could improve health outcomes related to herbal medicine use in this demographic.

Aulia Asman   Hidayati   Hilma Yessi   Debby Silvia Dewi   Mike Asmaria   Reska Handayani   Vivi Yuderna   Hasmita   Elvi Rahmi   Putri Minas Sari   Kheniva Diah Anggita   Auzia Asman   and Rina Alfina   

This study aims to investigate the relationship between ambient Carbon Monoxide (CO) concentrations and blood pressure risk factors among workers engaged in parking services in the traditional market area of Pariaman City, Indonesia. A cross-sectional design was employed, involving 64 male respondents across four clusters and two work shifts (morning and evening). CO concentrations were measured using a Monoxor III analyzer, while blood pressure readings were categorized based on standard clinical classifications. Although all measured CO levels were below the national safety threshold (average 7.6 ppm), a statistically significant correlation was found between elevated CO concentrations and increased diastolic blood pressure (p < 0.001), especially during evening shifts. Additionally, extended weekly working hours (mean = 58.4 hours), shift timing, and employment duration of approximately ten years or more (long-term workers) were significantly associated with higher blood pressure outcomes. Interestingly, smoking habits, though prevalent among respondents (70.3%), did not show a significant statistical association with either systolic or diastolic pressure. These findings highlight the compounded cardiovascular risks from environmental pollutants and occupational stressors in informal worker settings. The study underscores the need for public health interventions targeting vulnerable urban worker sectors, particularly through improved air quality monitoring, occupational regulations, and preventive health policies in high-exposure environments.

Eunice M. Bao   Rhea Marie T. Clar   Ashley Marie H. Dela Cruz   Angela Mae Violango   Kerslyn P. Selgas   Xhai F. Tajo   Shara Leezza B. Resentes   Mary Fair Ruval O. Estrera   Roberto D. Samson Jr.   and Romel C. Mutya   

With an increasing number of teenage pregnancies, understanding the dynamics of intergenerational caregiving is crucial. This study explores the challenges and resilience of Filipino parents of teenage mothers, addressing a significant research gap in understanding the emotional, social, and financial impacts on parental well-being. A descriptive phenomenological research design was employed, utilizing in-depth interviews with nine purposively sampled mothers of teenage mothers, and narratives were analyzed using thematic analysis. Findings revealed that parents often experienced social shame and embarrassment, which led to isolation and strained relationships. Emotional and physical stress, compounded by financial difficulties, further intensified the parental crisis. Despite these challenges, parents demonstrated resilience by adjusting to new caregiving roles, adapting to new obligations, and seeking external support. The study emphasized the importance of a strong support system, both practical and emotional, in ensuring positive outcomes for teenage mothers and their children. The study underscores the importance of reducing stigma through targeted mental health support, community education programs, and comprehensive parental guidance initiatives. The policy suggestions from this study could serve as guidelines for addressing the multidimensional needs of teenage mothers and their parents.

Pimnipa Kawin   Anukool Manotone   Somkid Juwa   and Taweewun Srisookkum   

Background: As adults advance in age, their health tends to decline, resulting in increased dependency, limited self-care ability, and reduced quality of life (QoL). Among homebound older adults, QoL is influenced by social support, self-efficacy, and health behaviors. Understanding the predictors of QoL in this group is essential for developing sustainable long-term care strategies in Thailand. Purpose: This study aimed to examine the levels of social support, self-efficacy, health behaviors, and QoL among homebound older adults in Chiang Rai Province, and to identify the predictors of their QoL. Methods: A cross-sectional survey was conducted among 362 homebound older adults selected through multistage random sampling. Data were collected using validated questionnaires assessing social support, self-efficacy, health behaviors, and QoL (OPQOL-Brief Thai version). Descriptive statistics and multiple logistic regression were used to determine significant predictors of QoL at the 0.05 significance level. Results: Participants demonstrated moderate levels of social support (62.15%), self-efficacy (65.19%), health behaviors (54.14%), and QoL (75.41%). Monthly income (OR = 1.823, CI = 1.302–2.552), membership in adult associations (OR = 2.515, CI = 1.466–4.313), and self-efficacy (OR = 1.071, CI = 1.034–1.109) were identified as significant predictors of better QoL. Conclusions: The findings highlight that strengthening income stability, promoting participation in adult associations, and enhancing self-efficacy can improve the QoL of homebound older adults. Contributions and Implications: This study provides empirical evidence for public health and social work practices focused on vulnerable adult populations. Community-based interventions integrating financial, psychological, and social support systems are recommended to promote active and healthy living. Limitations: The cross-sectional design limits causal inference. Future longitudinal and intervention studies are recommended to confirm these relationships.

Paden Sherpa   Ranjita Devi   and Barkha Devi   

The menstrual cup (MC) is a highly effective and sustainable menstrual hygiene product that significantly contributes to women's health, empowerment, and overall quality of life. Despite its long-standing availability in Indian markets, its usage remains remarkably low, especially among young women. This study was undertaken to assess the knowledge, attitudes, acceptability, and misconceptions regarding the use of menstrual cups among female undergraduate students across five universities in Sikkim. The current study employed a cross-sectional design. Data were collected from 366 female undergraduate students enrolled in regular courses at five universities in Sikkim between November and December 2023, using a pretested, expert-validated questionnaire. Students were selected through proportionate stratified random sampling, excluding those enrolled in medical courses, those medically contraindicated to use the cup, or those with specific health conditions. Most students (87%) reported having regular menstrual cycles, and sanitary pads were the most commonly used product (88%). Only 5.5% of participants had ever used a menstrual cup, and 67% demonstrated poor knowledge about its use. Over one-third of students (36%) held unfavourable attitudes towards the cup, and 64% expressed willingness to use it if it were freely available. The internet was the primary source of information (60%). Misconceptions were widespread: 37% believed it could not be used during heavy flow; 52% thought it could cause reproductive tract infections; and 42% associated it with urinary tract infections. About 22% incorrectly assumed it could serve as a contraceptive. Statistical analysis was conducted using SPSS software (V 24.0), applying Chi-square tests and Fisher's exact tests to examine associations among knowledge, attitudes, misconceptions, and socio-demographic as well as menstrual factors (p < 0.05). Knowledge and attitudes regarding menstrual cup use were generally inadequate or moderately adequate, with several misconceptions persisting among participants. These findings indicate the value of further education initiatives, information workshops, and awareness programs to support informed choices and encourage safe and sustainable menstrual hygiene practices.

Welton Hebert da Silva   Fábio Luís Falchi de Magalhães   João Antônio Nunes   Thiago Aguiar Cacuro   Antonio Yukio Ueta   and Matheus Cardoso Moraes   

Complementary and Integrative Health Practices (CIHPs) are increasingly incorporated into public health strategies worldwide; however, their institutionalization within local health systems remains uneven. This study analyzes the implementation of CIHPs in Sorocaba, Brazil, through the Saúde Ativa II Project, supported by municipal legislation and targeted funding. A qualitative, document-based thematic analysis was conducted using the STEEPLE framework (Social, Technological, Economic, Environmental, Political, Legal, and Ethical dimensions) to examine institutional records, policy documents, and operational reports. From August 2023 to February 2024, the program engaged more than 4,500 participants in group activities and over 4,300 individual consultations in physiotherapy, nutrition, and reflexology. Key innovations included agile governance inspired by the Scrum framework, digital health tools, and community engagement via social media. The experience underscores the importance of local legislation, data integration, and multidisciplinary coordination in sustaining CIHPs within primary care. Despite structural challenges – such as the absence of standardized indicators, lack of permanent funding, and limited tracking of clinical outcomes – the findings provide actionable insights for public health managers. Future research should explore clinical effectiveness, cost-effectiveness, and comparative analyses across municipalities to strengthen the evidence base for integrating CIHPs into the Unified Health System (SUS).

Sangeeth Kumar A.   Amalan R.   Bharathi Raj K.   Devibala B.   Jayapaul V. L.   Sam Nesamony   Rupesh Kotte   and Nisha M.   

Short-form videos, or "Reels," have become increasingly popular on social media platforms, serving both entertainment and informational purposes. However, excessive viewing of Reels can lead to negative effects. This study conducted a survey of 33 participants to examine how Reels addiction affects users. The results indicate that most participants watch Reels primarily for entertainment, and algorithm-driven suggestions encourage prolonged viewing. Overuse may lead to compulsive scrolling, which negatively affects productivity, emotional well-being, and real-life social engagement. The 33 participants shared their perspectives through responses submitted via Google Forms. Most reported that extended screen time resulted in physical discomfort, digital fatigue, and sleep disturbances. Regular overconsumption of such content has also been associated with reduced attention spans and increased procrastination, particularly in academic contexts. The design of social media platforms stimulates dopamine release, which reinforces habitual usage and increases the addictive nature of Reels. Additional concerns include the spread of misinformation, heightened cybersecurity risks, and threats to data privacy. Nevertheless, moderate engagement can enhance creativity and help relieve stress. To avoid harmful consequences, users are encouraged to set screen time limits and participate in offline activities. This study emphasizes the importance of adopting a balanced approach to Reels consumption, enabling users to enjoy its benefits while minimizing potential drawbacks.

Chidiebere Alozie Nwachukwu   Ijeoma Dorathy Ajaero   and Jemisenia John   

People with underlying health conditions, including people living with HIV/AIDs (PLWHA), are at great risk of contracting COVID-19, and when they do, are likely to suffer severe symptoms. PLWHA face heightened risks as a result of immune compromise, stigma-driven healthcare avoidance, and socioeconomic marginalisation, all of which were determinants extremely relevant in Nigeria's high-HIV-burden settings. This underlines the imperative for population-specific insights, a fact emphasized in all COVID-19 communications. This study, therefore, examined information sources, knowledge and adherence towards COVID-19 among PLWHA in Enugu State, Nigeria. Data were gathered from 300 people living with HIV/AIDS with a 36-item four-point Likert scale questionnaire, while data analysis was done through descriptive and inferential statistics. Results indicated high exposure to COVID-19 information among PLWHA in Enugu State, Nigeria, with healthcare workers (M=3.31, SD=1.07) and social media/internet (M=3.19, SD=0.86) as the dominant sources of information. Knowledge of COVID-19 was high among PLWHA, while educational level (ꞵ=0.043, p=0.010), income level (ꞵ=0.022, p=0.041), information from family/friends/neighbours (ꞵ=0.081, p=0.001) and billboards (ꞵ=0.066, p=0.004) were positively associated with higher COVID-19 knowledge. In addition, there was a moderately positive perception of COVID-19 among PLWHA. However, they had a lower perception of the vulnerability of people with underlying health conditions. Receiving information from healthcare workers (ꞵ=0.073, p=0.001) was associated with positive perceptions of COVID-19, while exposure to television (ꞵ=0.110, p=0.020) predicted negative perceptions. Adherence with COVID-19 preventive practices was significantly higher among males compared to females (ꞵ=0.171, p=0.000), urban residence (ꞵ=0.140, p=0.003) and exposure to billboards (β = 0.077, p = 0.021). The findings of this study reinforce the need for targeted messages through trusted, contextually appropriate channels to address PLWHA's distinct vulnerabilities.

Sara Haj Ali   Taqi-eddin Omar Al-Jarrah   Hamza Issa Yousef   Abdullah Hani Al-Nsour   Tuqa Mohammad Damra   Dalal Raed Al-Dabbas   Noat Rajab Qtaish   and Mohammad Wael Shammout   

Colorectal cancer represents a leading cause of cancer-related morbidity and mortality in Jordan, yet public awareness and screening adherence remain suboptimal. This study assessed colorectal cancer knowledge, screening awareness, and barriers to colonoscopy among Jordanian adults. A questionnaire-based cross-sectional survey was conducted at Al-Hussein Salt New Hospital, evaluating participants' knowledge of colorectal cancer symptoms and risk factors, awareness of screening methods, and perceived barriers to colonoscopy. Among 222 participants (61.7% male, median age 37.0 years [IQR 28.0-50.0]), 48.2% demonstrated a low knowledge level (median score 5.0 [IQR 1.0-9.0]). Only 23.4% were aware of colorectal cancer screening, with 22.1% familiar with specific methods. Despite this, 81.1% expressed willingness to undergo a colonoscopy if recommended. A family history of colorectal cancer paradoxically correlated with reduced screening intention (p=0.046). The predominant barrier was the misconception that asymptomatic individuals do not require screening (reported by 45.2%). These findings reveal significant gaps in colorectal cancer knowledge and screening awareness in Jordan. While willingness to screen is high when advised by physicians, prevalent misconceptions—particularly the belief that symptoms warrant screening—underscore the need for targeted public health campaigns. Improving education on asymptomatic screening and addressing cultural perceptions could enhance early detection and reduce colorectal cancer burden.

Ervina Ervina   

Physical activity offers numerous health benefits, including improved physiological function and a reduced risk of metabolic diseases. This study aimed to evaluate body composition and nutritional intake of individuals engaged in different levels of physical activity. Body composition metrics, including BMI, BMR, body fat mass, visceral fat, subcutaneous fat, and muscle mass were measured. In addition, macronutrient (energy, protein, carbohydrates, fat) and micronutrient (calcium, iron, vitamin B1) intake was assessed using a 24-hour dietary recall. A total of 283 participants (mean age 31.5 ± 11.21 years, 55.5% men, 44.5% women) were classified into two groups based on different physical activity levels of high (N=144) and low (N=139). The high physical activity group exhibited significantly higher BMR (p< 0.001) and muscle mass (p< 0.001), but lower subcutaneous fat (p< 0.001). No significant differences were observed for BMI (p= 0.510) and visceral fat (p= 0.390). In terms of dietary intake, the high physical activity group consumed significantly higher protein (p< 0.001) with lower carbohydrate (p= 0.001), but no significant differences were observed in energy (p= 0.541) and fat (p= 0.913) consumption. However, this group had lower intake of calcium (p< 0.001) and vitamin B1 (p= 0.001). This study highlights the influence of varying physical activity levels on body composition and provides a comparative analysis of nutritional intake across different physical activity groups.

Ekadewi Retnosari   Siti Fatimah   Umi Daimah   and Apri Sulistianingsih   

Background: Husband's support in the birthing process can reduce maternal anxiety and has a positive impact on childbirth. Purpose: This study aims to determine the effect of the psychophysiological education model of childbirth on husbands' activeness in supporting childbirth in the Muara Enim Community Health Centers. Method: The research design is a quasi-experimental pretest-posttest approach. The population of this study was pregnant women with a gestational age of 28-36 weeks. Respondents in this study were 86, divided into two groups. The research was conducted in April-December 2024. The intervention group was provided with systematic education on birth psychophysiology, while the control group received standard care. Data collection was conducted using a pre-test before the intervention and a post-test on husbands' knowledge and behavior. Delivery and postpartum outcomes were measured using observation and questionnaires. Data analysis used chi-square, Mann-Whitney, and Friedman tests. Finding: The results showed that the husband's knowledge and behavior increased significantly (p-value 0.000). Maternal anxiety, labor pain, labor duration and birth experience were better in the intervention group (p-value 0.000), although lacerations and APGAR scores were not significant. Postpartum outcomes showed no difference in involution and breastfeeding practices, but self-efficacy and postpartum depression were better in the intervention group (p value <0.05). Conclusion and Recommendation: Husband education using a psychophysiological model can be an alternative to the importance of the husband's presence in childbirth preparation to improve good birth and postpartum outcomes.

I Ketut Gde Juli Suarbawa   M. Yusuf   Lilik Sudiajeng   and Hendriketa da Silva   

BACKGROUND: Productivity in traditional iron forging is strongly influenced by environmental heat, heavy physical workload, and poor ergonomic practices. In Bali's forging sector, workers are consistently exposed to intense radiant heat, repetitive manual tasks, and inadequate work–rest schedules, all of which contribute to physiological strain and musculoskeletal disorders (MSDs). OBJECTIVE: This study aims to evaluate the combined effects of environmental heat stress, task-related physical load, and organizational work patterns on worker health and productivity. An integrated ergonomic model was developed to examine how thermal exposure, workload intensity, rest duration, and MSDs interact to influence performance in traditional forging activities. METHODS: A cross-sectional study was conducted involving 280 male forging workers aged 21–52 years with 2–9 years of work experience. Physiological indicators—including body mass index (BMI), pulse rate, body surface temperature, and MSD scores—were measured before and after work. Environmental heat exposure was assessed using the Wet Bulb Globe Temperature (WBGT) index. Productivity was evaluated through workers' pulse response during activity and MSD-related discomfort. A Structural Equation Modeling (SEM) approach was employed to analyze pathways linking ergonomic risks to productivity outcomes. RESULTS: Productivity showed a significant decline in relation to task demands, including workload (β = –0.075) and MSD scores (β = –0.110). Organizational factors, particularly prolonged work duration (β = –0.105), further reduced performance, highlighting the importance of structured work–rest cycles. Environmental conditions exerted the strongest negative effect on productivity, with WBGT (β = –0.694) and body surface temperature (β = –0.101) indicating substantial thermal strain (WBGT 29.8℃–30.7℃; post-activity temperature 38.7℃–41.1℃).

Wawan Ridwan Mutaqin   Agus Kristiyanto   Setyo Sri Rahardjo   and Sapja Anantanyu   

Leisure activities are an important occupational domain for post-stroke patients, as many individuals experience significant declines in this area. The aim of this study is to analyze the factors associated with leisure activities and quality of life among post-stroke patients within an associative framework, rather than a causal relationship. This study used a cross-sectional design. The sample of 112 respondents was included, with inclusion criteria that were pre-established. Data collection techniques involved using quality of life instruments, as well as questionnaires on perceptions, participation, self-efficacy, social support, spirituality, and independence. The data were analyzed using path analysis with Amos software. Results showed significant direct effects (p-value <0.05) on: self-efficacy on participation, social support on participation, spirituality on independence, participation on independence, spirituality on QoL, and self-efficacy on QoL. On the other hand, direct effects that were not significant (p-value >0.05) included: perceptions on participation, spirituality on participation, social support on independence, perceptions on independence, self-efficacy on independence, perceptions on QoL, independence on QoL, participation on QoL, and social support on QoL. Indirect effects of variables of perception, self-efficacy, social support, and spirituality through either independence or participation showed no significant impact (p-value >0.05). A multidimensional approach involving management of physical, emotional, and social aspects is crucial for effectively supporting the recovery of stroke patients.

Duro C Dolapo   Jamila Musa   Temitope Kayode   Dan A Gadzama   Ayebatari Lawson   Ibraheem S Abdulraheem   Mallika Singh   and Emily Lamunu   

Background: Maternal satisfaction is a critical component of healthcare delivery, influencing the uptake of services and maternal health outcomes. This study aims to compare pregnant women's satisfaction with maternal health services between urban and rural Primary Healthcare Centers (PHCs) in Abuja, Nigeria. Methods: A cross-sectional comparative study design was employed. Quantitative data were collected from 240 pregnant women attending antenatal care services, evenly distributed between urban and rural PHCs. The questionnaire measured satisfaction across service domains, while the Focus Group Discussion (FGD) provided qualitative insights into service delivery. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 29, with the level of significance set at 0.05. Results: Pregnant women's satisfaction was significantly higher in urban PHCs (76.2%) compared to rural PHCs (23.8%) (p < 0.001). Urban centers benefited from better staffing, infrastructure, and communication, while rural centers experienced challenges such as staff shortages and longer wait times. Multiple binary logistic regression revealed that pregnant women in urban PHCs were 12 times more likely to be satisfied than those in rural PHCs (OR = 11.75, 95% CI = 5.94 to 23.24). Conclusions: The disparity highlights a need for targeted interventions to address resource and service delivery gaps in rural PHCs. Strengthening infrastructure, increasing workforce availability, and improving staff-pregnant women communication are recommended.

Citra Suraya   Aris Citra Wisuda   Tukimin bin Sansuwito   Regidor III Dioso   Suzanna   Arena Lestari   Sri Tirtayanti   and Muhamad Andika Sasmita Saputra   

Background: Hospitalization can trigger significant anxiety in preschool-aged children, affecting recovery and cooperation with care. Storytelling, especially when culturally adapted or digitally delivered, has emerged as a promising basic communication strategy to alleviate such distress. Objective: This review examined the cultural adaptability and digital potential of storytelling in pediatric care, comparing its effectiveness with alternative therapeutic approaches for reducing anxiety in hospitalized preschool children. Methods: A systematic search of PubMed, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane Library, and Google Scholar was conducted from inception to April 2025. Eligible studies included randomized controlled trials and quasi-experimental designs involving traditional, culturally adapted, or technology-assisted storytelling interventions in hospitalized preschool children. Two reviewers independently performed study selection, quality appraisal, and data extraction. Random-effects meta-analysis and meta-regression explored subgroup effects by cultural adaptation, delivery mode, and implementer training. All computations were conducted using RevMan 5.4 and STATA 16. Results: Twelve studies with 1,048 participants from seven countries met the inclusion criteria. Storytelling significantly reduced anxiety compared with standard care or alternative activities (Hedges' g = −0.84, 95% CI: −1.07 to −0.61, p < 0.001). Culturally adapted stories had greater effects than non-adapted formats, while digital delivery provided benefits comparable to in-person methods. Structured implementer training improved outcomes by about 18%. Storytelling was more effective than game-based interventions for procedural anxiety but showed similar results during prolonged hospitalization. Conclusion: Culturally tailored and digitally enhanced storytelling is an effective, adaptable, and feasible approach to reducing anxiety in hospitalized preschool children. Incorporating it into pediatric care training may support wider clinical application.

Amir Ishaq Alshizawi   Ibrahim Mustufa Topiwala   Prasanna Appiya Premvignesh   Abubakker Siddiq Mohamed Hameed   Latifa Nabeel Alsaad   Jayadevan Sreedharan   and Jayakumary Muttappallymyalil   

Dementia is a progressive neurodegenerative disorder and a major public health challenge in aging populations. Its origins are multifactorial, involving genetic, vascular, metabolic, and psychological factors. Increasing age is the leading unchangeable risk factor for dementia, with a marked rise in incidence observed in individuals older than 65, especially with each subsequent five-year interval. The APOE ɛ4 allele further increases susceptibility, though its full impact remains incompletely understood. In contrast, modifiable lifestyle factors—such as physical activity, education, and social engagement—can reduce risk and delay onset. Early detection remains a critical challenge, as mild cognitive impairment often goes unrecognized. While neuroimaging and biomarkers offer diagnostic potential, their high cost and limited accessibility hinder widespread adoption, especially in underserved regions. Emerging technologies, including AI-driven tools and mobile applications, show promise for scalable early detection, though their integration must be carefully managed to complement clinical judgment and human care. Management typically combines pharmacological treatments, such as cholinesterase inhibitors, with non-pharmacological approaches, including cognitive therapy and psychosocial support. However, dementia imposes a substantial burden on caregivers—emotional, physical, and financial—underscoring the urgent need for robust and sustainable support systems. This review highlights the importance of a multidisciplinary approach to dementia care, integrating prevention, early diagnosis, and individualized management strategies to improve outcomes for both patients and caregivers.

Sang-Jin Lee   and Yun-Jeong Kim   

This study analyzed the mediating effect of depression in the relationship between the four major hardships experienced by older adults—namely, physical illness, economic hardship, loneliness, and loss of social role—and their experience of elder abuse. Using data from the 6th National Survey on the Living Conditions of Elderly People (2023), a total of 9,951 individuals aged 65 and over were included in the final analysis after excluding non-responses. Structural equation modeling (SEM), path analysis, and bootstrapping techniques were employed to verify the causal pathways and mediating effects among the variables. The results showed that all four hardship factors had a statistically significant positive effect on depression, and depression, in turn, had a significant positive effect on the experience of elder abuse. However, the direct effects of each hardship factor on elder abuse were not statistically significant, confirming that depression serves as a full mediator. These findings support the Affective Vulnerability Model, which posits that emotional vulnerability plays a more direct role in elder abuse than external stressors themselves. Therefore, proactive interventions and the establishment of psychosocial support systems that consider the emotional well-being of older adults are essential. Alongside improving physical and economic conditions, it is also necessary to implement depression screening and intervention programs.

Mariya Laktionova   Julaev Ilyas   Imasheva Bayan   Laura Serikkyzy   Mairash Baimuratova   and Zauresh Barmanasheva   

Introduction: Recurrent urinary tract infections (UTIs) remain an urgent problem in the practice of obstetricians, gynecologists, and urologists. Despite anatomical predisposing factors, in recent years, increasing attention has been paid to the role of behavioral and hygiene habits in the pathogenesis of recurrent cystitis. Goal: To evaluate the influence of behavioral factors and intimate hygiene features on the risk of recurrent urinary tract infections in women. Materials and methods: A cross-sectional study was conducted with the participation of 348 women who applied to PHC with symptoms of cystitis. The main group included 118 patients with ≥2 episodes of UTI in the last 6 months or ≥3 in the last year; the control group consisted of 230 women without relapses. The survey was conducted using an author's questionnaire (50 questions, 8 thematic blocks). The analysis included the χ² criterion, OR, Cramér's V, and Spearman correlations. Results: Statistically significant risk factors for UTI recurrence were: no urination act after sexual intercourse (OR=11.2; p<0.001), incorrect direction of hygiene (OR=4.9; p<0.001), sexual intercourse during menstruation (OR=4.5; p=0.001), sexual intercourse with symptoms of bacterial vaginosis (OR=4.7; p=0.151), frequent loose stools (OR=2.5; p=0.009), touching genitals without washing hands (OR=1.9; p=0.033), and lack of confidence in partner hygiene (OR=2.0; p=0.014). The majority of women did not receive hygienic recommendations from medical practitioners (89% of the main group and 83% of the control group), but patients in the main group were more likely to show awareness (93% vs. 41%, p<0.001). A high correlation was found between the level of education and compliance with hygiene standards (r=0.75 and r=0.81; p<0.001). Conclusions: The key behavioral risk factors for UTI recurrence include improper intimate hygiene, no postcoital urination act, and low awareness. Increasing the level of education and including hygiene issues in specialist consultations can significantly reduce the frequency of relapses.

Gopi Vankudre   

Refractive errors are the leading cause of visual impairment among young adults globally, and spectacle correction remains the most effective and accessible intervention. However, compliance with spectacle wear is consistently suboptimal, especially among university student populations. The study aims to evaluate the driving factors of spectacle wear and to form a baseline for informed decision-making while supporting the current health intervention within the region that focuses on enhancing visual health and academic progress among the population. This cross-sectional study employed a questionnaire-based tool to collect the responses among the university students that are compliant with spectacle wear. Participants with or without refractive errors having no ocular abnormalities or associated pathologies were included in the study. Participant profile was analyzed using descriptive statistics. The association between the type of attitude among the spectacle compliant group and the participant profile was assessed using chi square test. The association between the mean attitude score and the participants profile was evaluated using Generalized Linear Model. Out of the total 275 participants undergoing ocular examination, 154 (56%) were observed to have refractive errors and only 25 (16.23% of these 154) were spectacle compliant. The higher overall mean benefit score (M= 61.27, SD = 18.02) related to spectacles including utility and psychological aspects of spectacle wear indicates agreement for spectacle wear among the student group. The attitude towards spectacle wear among the spectacle compliant university student group is moderate. The perceived visual comfort with spectacles, as well as the positive and intelligent impression created by spectacle wear, is the key drivers of spectacle wear.

Sunanta Wongrattanakamon   Orathai Katkhaw   Tienthong Takaew   Taweewun Srisookkum   Patipat Vongruang   and Prachuab Lamluk   

Introduction: Smog, especially fine particulate matter (PM_2.5), poses a major public health challenge in Thailand. Village health volunteers (VHVs) play a crucial role in promoting protective behaviors within affected communities. This study examines how health literacy (HL) influences preventive behaviors among VHVs in smog-affected areas of Sukhothai Province, Thailand. Methods: A cross-sectional survey involving 599 VHVs was conducted using a structured questionnaire to assess environmental health literacy (EHL) and preventive behaviors. HL levels were categorized as low (< 60%), moderate (60–79%), and high (≥ 80%) based on total percentage scores. Descriptive statistics and multiple linear regression were applied to identify predictors of preventive behaviors (p < 0.05). Results: The mean HL score was 84.24 (SD = 10.02) out of 110, indicating a moderate HL level (76.6%). Preventive behaviors were rated high (mean = 44.40, SD = 5.73). Regression analysis revealed that HL self-management (β = 0.239, p < .001), access to information (β = 0.217, p < .001), HL knowledge (β = 0.097, p < .05), and perceived smog severity (β = 0.085, p < .05) significantly predicted preventive behaviors, explaining 22.4% of the variance (adjusted R² = 0.224). Conclusions: HL, particularly in self-management and information access, significantly contributes to preventive behaviors among VHVs. Therefore, community-based education aimed at enhancing HL is recommended to mitigate health risks from air pollution.

Tasnim Tasnim   Fitri Rachmillah Fadmi   Titi Saparina L.   Sri Mulyani   Rahmawati   and Lillian Mwanri   

Insufficient drinking water intake is a critical determinant of chronic diseases in Indonesia, including in Southeast Sulawesi Province. This study provides evidence-based insights to inform policy and practice frameworks for chronic disease prevention in high-risk populations living in coastal and mining regions. A cross-sectional study was conducted in Nambo (coastal region) and Morosi (mining region) between May and October 2024. Using cluster random sampling, 100 participants were recruited from each area. Data were collected via structured questionnaires and analyzed using McNemar's test and ANOVA. Findings revealed that knowledge, attitudes, disease seriousness perception, self-efficacy, maintenance, commitment, income, and subjective norms (p<0.05) were key determinants of drinking water adequacy in Nambo. In Morosi, significant determinants included knowledge, attitudes, disease seriousness perception, self-efficacy, maintenance, commitment, and perceived susceptibility (p<0.05). Two determinants were unique to each region: income and subjective norms in Nambo, and perceived susceptibility in Morosi. Belief and recovery were not significant predictors in either region (p>0.05). In conclusion, drinking water adequacy is shaped by both shared and region-specific factors, with environmental and socioeconomic contexts driving differences. These results underscore the importance of tailored public health interventions to improve hydration and reduce chronic disease risks in vulnerable communities.

Daniel Inostroza Briones   and Alexandr Gorielov Salas   

In public health, the impact of noise pollution is a growing threat, given the estimated population exposure of 130 million people with ambient noise levels exceeding 65 dB. The WHO describes a direct relationship between ambient noise and the development of ischemic heart disease, due to noise overstimulating the autonomic nervous system and neuroendocrine system, increasing levels of cortisol and norepinephrine, which lead to the development of cardiovascular pathologies. In Chile, the Ministry of the Environment estimated that in the city of Santiago, 3.7% of ischemic heart diseases were attributable to high levels of ambient noise. The purpose of the study is to estimate the impact of exposure to ambient noise on cardiovascular morbidity during 2018-2020 in Chile. A secondary data analysis of cardiovascular diseases in individuals aged 15-65 years registered by the Department of Statistics and Health Information was conducted, along with data on the population exposed to ambient noise from records of the Ministry of the Environment for the period 2018-2020 in Chile. Ambient noise data and emergency consultations of a cardiovascular type were quantitatively described, calculating the risk for ambient noise and the number of attributable cases. A total of 1,029,796 consultations for circulatory causes were observed, obtaining a global population rate of 2.04 per 100 exposed to ambient noise. Risks for road traffic were calculated for: Acute Myocardial Infarction, Cerebrovascular Accident, and Hypertensive Crisis, obtaining 1,410, 5,879, and 8,551 attributable cases for their respective causes. In Chile, cardiovascular diseases account for over 25% of total causes of death, mainly associated with high rates of hypertension, acute myocardial infarction, and cerebrovascular accident. During the period of 2018-2020, the average dB recorded for ambient noise exceeded the threshold established by the WHO, which could be considered a risk factor for heart disease.

Md. Ashif Hasan Razu   Md. Faruk Shah   and Fahmida Hossain   

Blood donation is crucial to healthcare systems worldwide; nevertheless, voluntary participation is inadequate, especially in developing countries like Bangladesh. This study seeks to explore the attitudes, behaviors, and perceptions of university students regarding blood donation in Bangladesh. A mixed-methods approach was used to gather both quantitative and qualitative data from 40 students at a leading private university in Bangladesh through surveys, in-depth interviews (IDI), and focus group discussions (FGD). The study results reveal several factors affecting students' propensity to donate blood, including moral obligations, spiritual beliefs, and social responsibility. Misperceptions about health concerns and practical obstacles, such as needle fear and the inconvenient locations of donation centers, were identified as deterrents to participation. Although most students view blood donation as a moral obligation and a means of enhancing community welfare, hesitation often arises from apprehension over physical pain and misconceptions. In this regard, students may be classified into three behavioural categories: regular donors, reluctant non-donors, and occasional donors, reflecting the varied motives behind their behaviours. The theories of 'Symbolic Interactionism' and the 'Looking Glass Self' are pertinent here as they highlight the impact of social interactions and self-perception on students' choices to participate in blood donation. This study indicates that raising awareness, addressing misunderstandings, and improving access to donation centers could substantially boost voluntary blood donation among university students. The study findings enhance comprehension of the factors influencing blood donation behaviors and provide valuable insights for fostering a more sustainable blood donation culture in Bangladesh, and hence contribute academically to the fields of medical sociology, medical anthropology, public health and medical science.

Anatolijs Pozarskis   Anda Kivite-Urtane   and Jelena Pozarska   

Aim of the study: To examine sexual orientation among Latvian young adults aged 18 to 30 years and its association with symptoms of depression and anxiety. Material and methods: Data were obtained through a self-administered, anonymous, web-based survey. To evaluate the relationships among variables, descriptive statistics as well as univariate and multivariate logistic regression analyses were conducted. Results: A total of 503 individuals participated in the study, comprising 365 females, 133 males, and 5 participants identifying as other genders. The mean age of respondents was 23.0 years (SD = 3.7). The mean Kinsey score was 1.4 (SD = 1.8), with a median of 1.0 (IQR: 0–2.0), where a score of 1 corresponds to individuals who are predominantly heterosexual with minimal same-sex attraction, and a score of 2 indicates predominantly heterosexual individuals with more than minimal same-sex attraction. Exposure to violence was reported by 20.3% of participants. The prevalence of anxiety and depression symptoms was 56.3% and 37.6%, respectively. Logistic regression analysis demonstrated that a history of violence was significantly associated with increased odds of both anxiety (OR = 2.6; 95% CI: 1.7–4.0) and depression (OR = 2.4; 95% CI: 1.5–3.9). Male gender and a monthly income in the range of €1001–€2000 were associated with reduced odds of experiencing anxiety (OR = 0.4; 95% CI: 0.2–0.5, and aOR = 0.3; 95% CI: 0.1–0.8, respectively). Conclusions: No statistically significant association was found between sexual orientation and the presence of anxiety or depression symptoms (OR = 1.1; 95% CI: 1.0–1.2 and OR = 1.1; 95% CI: 1.02–1.2, respectively).

Sankul Sethia   Manvee Goyal   and Krati Gupta   

The present empirical study investigates the contributions of psychological factors - Hope, Humor, and Learned Helplessness - in managing Diabetes Distress among patients with Type 2 Diabetes Mellitus in the Indian context. The sample of 100 participants aged 25–60 years was recruited using purposive sampling. Standardized scales, including the Adult Hope Scale, Coping Humor Scale, Learned Helplessness Scale, and Diabetes Distress Scale, were administered. Statistical analyses involved descriptive statistics, Pearson correlations, and regression analysis using SPSS. Results indicated significant correlations between Diabetes Distress and Hope (r = –0.281, p < 0.01), Humor (r = –0.413, p < 0.01), and Learned Helplessness (r = 0.501, p < 0.01). Regression analyses showed that Hope (7%), Humor (16.2%), and Learned Helplessness (24.4%) accounted for a significant amount of variance in Diabetes Distress, with Learned Helplessness emerging as the strongest predictor. The findings suggest that psychological variables can significantly influence diabetes distress and offer a pathway for developing psychological interventions in diabetes care. Implications include designing integrated psycho-educational programs targeting positive psychology constructs. The study highlights the necessity of incorporating emotional and psychological frameworks into chronic illness management to alleviate related distress, promote better management, enhance physical health outcomes, and improve overall quality of life.

Bhavika Dugar   Ishvarya S   Vidhya R   Vandana S   Gayathri T   and Divyambika C V   

Objectives: Swimmers are associated with various oral manifestations such as dental erosion, calculus formation and stain, a phenomenon which is referred to as swimmer's mouth. Extrinsic stains are the most frequently encountered presentation, which are attributed to the added antimicrobials (chlorine) in the pool water. Improper pool maintenance, leading to acidic pH, is the main contributory factor for organic deposits on the swimmer's teeth. Hence, the study planned to evaluate the association between the frequency of swimming on the prevalence of extrinsic stains among swimmers. Methods: Professional and recreational swimmers were identified and evaluated using a fourteen-item questionnaire. Oral screening and complete evaluation were done. The level of extrinsic stain was evaluated using the Lobene-stain-index. The results were tabulated using Statistical Package for Social Sciences (Version 17.0) software and subgroup analysis was done using Fisher's exact test for statistical significance. Results: Among the 150 participants, 74% were professional swimmers and 26% were recreational swimmers. 47% of the swimmers have been swimming for a period of more than 8 years. Extrinsic stains were more prevalent in tooth 33 (63% of the participants), followed by teeth 23 and 43 (61% of the participants). Swimmers who brushed more than once daily had fewer stains compared to those who brushed only once a day. Conclusions: The current study showed that maxillary and mandibular canines are more susceptible to stains. Improving pool maintenance and usage of fluoridated toothpaste and powered toothbrushes can aid in reducing the intensity of the stains.

Heru Andika   Gusril Gusril   Anton Komaini   Yanuar Kiram   and Firunika Intan Cahyani   

Outdoor play plays a crucial role in supporting the health and development of elementary school-aged children, yet global trends show a decline in children's physical activity levels. Previous studies have indicated an increase in obesity, decreased physical fitness, and impaired emotional well-being in children, partly due to reduced time spent actively playing outdoors. Low levels of physical activity in children are a serious problem with long-term impacts on the quality of future human resources. This study aims to examine the relationship between outdoor play and child health indicators, such as Body Mass Index (BMI), physical fitness, and the frequency of minor illnesses. This study used a mixed methods approach, with quantitative data obtained through questionnaires and physical measurements of 75 children aged 7–12 years, and qualitative data through in-depth interviews and observations of teachers and students. The results showed that the frequency and duration of outdoor play were positively correlated with physical fitness and ideal BMI, and negatively correlated with the frequency of minor illnesses. Qualitative findings confirm that outdoor activities support children's gross motor development, positive emotions, social interactions, and readiness to learn. However, challenges such as limited play space, parental concerns, and academic pressures limit the consistency of these activities. Therefore, collaborative efforts are needed between schools, parents, and policymakers to create an environment that supports children to be physically active through outdoor play activities.

Wahyuni   Andi Zulkifli Abdullah   Andi Ummu Salmah   Farida Patittingi   Balqis   Tahir Abdullah   Fachry Amal   and Anwar Mallongi   

Child sexual violence is a violation of human rights with long-term impacts, particularly among elementary school-aged children who are vulnerable due to a lack of understanding about self-protection. Prevention efforts through social- norms-based education using animated videos are expected to improve children's knowledge, attitudes, and behaviors in preventing sexual violence. This study aimed to assess the effect of social norms education through animated videos on sexual violence prevention behaviors among elementary school children in Makassar, Indonesia. A Research and Development (R&D) method was employed using the ADDIE model to develop an educational animated video. The video was validated by experts and tested on 30 students at SDIT Ar Rahmah, Makassar. The evaluation assessed the effectiveness of the media in improving students' understanding of social norms and the prevention of sexual violence. The validation process showed a validity score of 92.72%, indicating a highly valid educational tool in terms of content and design. A small-scale trial revealed a 90.83% positive response, demonstrating the media's high level of practicality. Pre-test and post-test analyses using paired t-test and Wilcoxon test indicated significant improvements in knowledge, attitudes, behaviors, and understanding of religious and legal norms related to the prevention of sexual violence (p < 0.05). These findings confirm that the educational animated video is effective in enhancing elementary students' understanding and awareness of social norms and sexual violence prevention.

Gayathri PG   and Ambika R Nair   

This study explores the multifaceted impacts involving legal, physical, psychological, economic and social issues, experienced by women, while undergoing assisted reproductive techniques (ART) due to infertility, with a focus on the medico-legal challenges embedded in India's Assisted Reproductive Technology (Regulation) Act, 2021. A quantitative research design was employed, using structured questionnaires as the primary data collection tool, managed through snowball sampling. A total of 30 valid responses (a convenience sample that was limited by time constraints) were collected from women undergoing ART. Data were analysed using SPSS 22.0 to examine the prevalence and severity of impacts and their correlation with legal challenges. Reliability was assessed using Cronbach's alpha, yielding a value of 0.796, indicating good internal consistency (standard ≥ 0.7). Findings reveal that considering the complex nature of ART legislation, 2021 is quite inadequate and challenging for women, making it difficult for them to navigate and safeguard their rights, concerning clinical, physical and mental health outcomes. While being progressive, the ART (Regulation) Act 2021 fails to adequately address these medico-legal concerns, including inadequate regulation of clinical practices and insufficient psychological care. The study highlights the need for amendments in Indian Council of Medical Research (ICMR) and Assisted Reproductive Technology (Regulation) Act, 2021 to strengthen medico-legal provisions concerning the protection of reproductive health, autonomy and clinical-wellbeing, ensuring ART services to be safe, accessible, and ethically sound for women in India.

Luis Enrique Luna Campos   Dolly Verioska Pinto Vergara   Iván Ulises Quiroz Mendoza   and Juan Miguel Ponce Loza   

This article presents a systematic review of public policies aimed at ensuring equitable access to health services within the framework of the Sustainable Development Goals (SDGs). By analyzing 55 studies published between 2015 and 2024, the research identifies key strategies, patterns, and institutional innovations that have reshaped the architecture of health policies. In addition, comparative experiences from developing and developed countries are incorporated, allowing for a deeper understanding of regional dynamics and their particular challenges. The results demonstrate that effective alignment with the SDGs, particularly Goals 3 and 10, has contributed to the consolidation of more resilient, inclusive, and accountable health systems, especially in contexts of crisis. It highlights that these advances are especially relevant in the face of health emergencies, such as pandemics, where equity in access to services is critical for the sustainability of the system. The study concludes that health equity cannot be achieved through fragmented interventions, but rather through structural transformations based on political commitment, regulatory clarity, and social participation. It also underscores the importance of intersectoral governance and international cooperation as fundamental pillars for achieving equitable universal coverage. Finally, it is recommended that monitoring and evaluation mechanisms be strengthened to ensure that the policies implemented maintain their focus on equity and human rights.

Manisha   Aris Citra Wisuda   Tukimin Bin Sansuwito   and Idris Adewale Ahmed   

Introduction: Hypertension not only affects physical health but also contributes to psychological stress and reduced spiritual well-being. Elevated stress and feelings of spiritual disconnection are common among hypertensive patients, particularly in settings where faith plays a central role. Integrated Islamic Spiritual Care (IISC) provides a culturally relevant, holistic approach to addressing these challenges, especially in Muslim-majority contexts like Indonesia. Objective: To evaluate the effectiveness of IISC in reducing stress and enhancing spiritual well-being among patients with hypertension. Methods: This quasi-experimental study with a pretest–posttest control group design was conducted at Mitra Medika Premiere Hospital from February to May 2025. A total of 120 hypertensive patients were recruited using purposive sampling, with 60 assigned to the intervention group and 60 to the control group. The IISC intervention consisted of structured spiritual counseling, guided prayer, Qur'anic recitation, and reflective discussion sessions. Stress and spiritual well-being were measured before and after the intervention using validated instruments. Results: The intervention group experienced a significant reduction in stress levels and a substantial improvement in spiritual well-being compared with the control group (p < 0.05). The magnitude of change indicated both statistical and clinically meaningful benefits. Conclusions: IISC is an effective intervention for reducing stress and enhancing spiritual well-being in patients with hypertension. Incorporating faith-based spiritual care into hospital services can strengthen holistic, patient-centered healthcare models in culturally aligned settings.

Jeneefer Jeba Rajaselvi   and Navin Kumar   

Menstruation is a natural process that can be challenging for adolescent girls due to physiological, psychological, and social factors. A lack of knowledge and cultural taboos can lead to menstrual distress, hygiene issues, and psychological problems. This pilot study aimed to evaluate the effectiveness of a structured psychosocial education program in reducing menstrual distress among adolescent schoolgirls in Tamil Nadu, India. The study used a pre-experimental design with a one-group pretest-posttest approach. Female students aged 12 to 15 years participated in an eight-week program focusing on menstrual health knowledge, hygiene practices, and social taboos. Validated questionnaires were used to collect data on menstrual practices, knowledge, distress, and perceptions of taboos. The intervention significantly improved participants' knowledge of menstrual health, hygiene practices, and awareness of social taboos. It also led to a notable reduction in self-reported menstrual distress, indicating a positive impact on physical and psychological symptoms. This study demonstrates the effectiveness of psychosocial education in improving menstrual health and well-being among adolescent girls. It underscores the importance of integrating such programs into school curricula to empower young girls and promote body literacy. Overall, this study suggests that educational programs can address public health needs and challenge societal taboos, creating a supportive environment for adolescent girls.

Saurabh Kumar Banerjee   Moon Moon Lahiri   Devika Agarwal   and Baljot Kaur   

Effective management of the supply chain (SCM) is essential for public health, particularly for delivering critical health services related to immunization, tuberculosis (TB) control, and initiatives for non-communicable diseases (NCDs) implemented by the Government of India. This research investigates significant deficiencies in SCM across different health programs by examining the root causes and suggesting a framework for improving the existing conditions. As part of the study, a comprehensive literature review was conducted utilizing the Prisma Flow Diagram. In total, 106 studies were incorporated into qualitative synthesis. Among these, 28 studies were deemed appropriate for inclusion in quantitative synthesis, provided that a meta-analysis was performed. The supply chain for tuberculosis (TB) in India has shortcomings related to drug accessibility, logistics, and procurement processes. Challenges in India's immunization supply chain management consist of limited visibility of vaccine inventories, insufficient cold chain facilities, inadequate manual record-keeping, and a lack of monitoring regarding vaccine safety during transport and storage. Significant issues in the non-communicable disease (NCD) supply chain management in India include constraints in human resources, inconsistent medicine supply, and a fragile referral system. Key strategies to address the shortcomings in India's government tuberculosis (TB) program regarding supply chain management include enhancing drug stock management, improving the distribution network, and bolstering data tracking and reporting systems. To close gaps in Immunization Supply Chain Management, essential strategies involve reinforcing cold chain infrastructure and creating reliable systems for demand forecasting. To improve the supply chain management of non-communicable diseases (NCDs) in India, vital strategies consist of strengthening the healthcare infrastructure at primary healthcare centers, implementing effective inventory management systems, and leveraging digital platforms for monitoring and tracking. All these initiatives must be tailored to better serve underserved communities and consider the specific needs of the local populations.

Forhana Choudhury   and Swati Sharma   

This study explores the complex arena of Eating Disorders among adults, encompassing various conditions such as Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, and the nuanced category of Eating Disorders Not Otherwise Specified (EDNOS). The study focuses on a thematic content analysis of ten TEDx talks from YouTube between 2014 and 2024. It provides detailed narratives of individual experiences of crisis, loss, and non-linear recoveries related to Eating Disorders. Moreover, the study employs the Tripartite Influence Model (TIM) as a theoretical framework, describing the intricate relationship between societal influences, appearance comparisons, and the internalization of body ideals in shaping self-worth and body image. The findings elaborate on the profound impact of societal expectations on adults responsible for disordered eating behaviours, body image disturbances, and complex emotional struggles. Thematic content analysis, guided by the TIM, identifies three key themes: the Illusion of Control, External Validation and Self-Worth, and the Stigma around Eating Disorders. These themes offer a comprehensive understanding of the sociological challenges faced by individuals, highlighting the need for future interventions and support systems against eating disorders. The research contributes to the broader acknowledgment of common sociological causes influencing the onset and development of Eating Disorders among adults, underlining the importance of addressing these issues for individual and societal well-being.

Rery Kurniawati Danu Iswanto   Zahroh Shaluhiyah   Bagoes Widjanarko   and Cahya Tri Purnami   

Adolescent reproductive health is a global issue requiring attention, particularly in parent-child communication. This study aims to identify evidence-based interventions that effectively improve parent-adolescent communication on sexual and reproductive health topics. This study employed a scoping review design following Arksey & O'Malley's framework. Synonyms for key terms were identified using MeSH. Databases searched included Scopus, ScienceDirect, CINAHL, Medline, and PubMed. Relevant literature was identified through five major databases which examined 15 articles with experimental design. Effective interventions were found to involve multicomponent approaches, including digital media, group training, and homework assignments, with an emphasis on cultural contextualization. Interventions featuring repeated sessions and long-term evaluations demonstrated significant improvements in parental and adolescent knowledge, attitudes, and sexual communication skills. Integrated approaches involving schools, communities, and healthcare services also played a critical role. This review highlights that multicomponent intervention designs, culturally sensitive approaches, and ongoing evaluation are key to enhancing family communication about reproductive health. The findings provide guidance for program developers to adapt evidence-based interventions to local social and cultural contexts. The practical implications are effective interventions that should involve repeated sessions, engage community stakeholders, and be tailored to local cultural norms. This review is limited to English-language studies, potentially excluding relevant research from non-English sources or other contexts.

Sbonelo Chamane   Angeline Ngcobo   Prudence Chambale   Kutloano Skhosana   and Musawenkosi Mabaso   

Background: Early-onset hypertension, defined as high blood pressure diagnosed before age 55, is an emerging public health concern associated with adverse cardiovascular outcomes. Methods: This cross-sectional study used data from the 2024 South African General Household Survey. Descriptive statistics were used to summarise sample characteristics. The Pearson Chi-Square Test of Independence was used to assess differences in the prevalence of early-onset hypertension across sample characteristics. A bivariate Generalised Linear Model (GLM) with a binomial distribution and log link function identified significant individual associations, and significant variables were included in a multivariate GLM to determine factors associated with the early onset of hypertension. Results: Of the 32,717 participants aged 20–54 years, 5.3% (95% CI: 5.1–5.6) self-reported having hypertension. The final model showed the factors associated with a higher prevalence of the early onset of hypertension were being aged 35–44 years (aOR= 4.02 [95% CI: 3.32–4.86], p<0.001) and 45–54 years (aOR= 10.13 [95% CI: 8.39–12.24], p<0.001) compared to 20–34 years; females (aOR= 2.23 [95% CI: 2.05–2.64], p<0.001) compared to males; married (aOR= 1.45 [95% CI: 1.27–1.64], p<0.001) compared to never married; Other races (aOR= 1.56 [95% CI: 1.34–1.82], p<0.001) compared to Black African; those who reside in urban areas (aOR= 1.37 [95% CI: 1.19–1.57], p<0.001) compared to rural areas; self-reporting good (aOR= 2.21 [95% CI: 1.73–2.84], p<0.001) and fair or poor health status (aOR= 5.74 [95% CI: 4.64–7.11], p<0.001) compared to excellent/very good; having at least one other chronic illness (aOR= 2.04 [95% CI: 1.73–2.41], p<0.001) compared to no other chronic illness. Conclusions: These findings highlight the need for early prevention and screening efforts targeting young adults, with a specific focus on the high-risk groups identified in this study. Public health interventions should be tailored to address these demographic and health-related risk factors to halt the rising burden of hypertension among younger populations in South Africa.

Ashwini Kumar   Ratna Jay   Rakshitha R Shenoy   Manjula Anil Kunder   Muralidhar M Kulkarni   Sneha Deepak Mallya   and Ananya Kumar Palai   

Background: Vitamin D deficiency is a growing public health issue, even in sun-rich countries like India, due to indoor lifestyles, cultural clothing practices, and reduced sun exposure. Data from coastal Southern Karnataka remain limited. Objective: To assess the prevalence and determinants of vitamin D deficiency among adults attending a tertiary care centre in coastal Southern Karnataka. Methodology: A retrospective cross-sectional study was conducted using electronic medical records of 1,781 adults (≥18 years) who visited a tertiary hospital between April and October 2024. Data on demographics, clinical conditions, substance use, and serum 25-hydroxyvitamin D levels were analysed. Vitamin D deficiency was defined as serum levels <20 ng/mL. Univariate and multivariate logistic regression identified independent predictors, with p<0.05 considered significant. Results: Mean vitamin D level was 22.30 ± 13.15 ng/mL. Overall, 47.7% were deficient and 37.0% insufficient, indicating a high burden. Deficiency was most prevalent among younger adults (18–45 years: 58.9%) and overweight and obese individuals (63.8%). Older adults (>65 years) had better vitamin D status. Females showed a slightly higher deficiency rate than males (50.6% vs. 45.8%). On multivariate analysis, younger age (18–45 years: odds ratio (OR)=2.45; 95% CI=1.59–3.77; 46–65 years: OR=1.67; 95% CI=1.15–2.42) and being overweight and obese (OR=1.38; 95% CI=1.05–1.81) were significantly associated with deficiency. No independent associations were found with gender, chronic diseases, anaemia, or substance use. Conclusions: Vitamin D deficiency is highly prevalent in this region, particularly among younger and overweight and obese adults. Targeted public health strategies are needed to improve awareness, screening, and dietary fortification.

Haoxuan Feng   Siti Ruzita Mahmod   and Rania Hussien Al-Ashwal   

This research explores the association between chronic exposure to low levels of cadmium (Cd) and the risk of developing hypertension and obesity among Chinese adults residing in urban environments. It focuses on both non-linear dose-related effects and demographic susceptibilities that may influence health outcomes. A total of 1,200 adults were recruited from three cities in Shandong Province, a region experiencing rapid industrialization and urban expansion. Participants were selected using a stratified random sampling technique to ensure a representative sample. Urinary cadmium concentrations were measured using inductively coupled plasma mass spectrometry (ICP-MS), a highly sensitive and accurate analytical method. Standardized clinical definitions were applied to diagnose hypertension and obesity. To assess potential linear and non-linear relationships, as well as the modifying effects of sex and body mass index (BMI), the analysis employed logistic regression models, gender-stratified evaluations, and restricted cubic spline (RCS) modelling. The results revealed a significant association between urinary cadmium levels and elevated blood pressure, with the relationship appearing stronger in men, where the odds ratio (OR) was 3.494, compared to women, who exhibited an OR of 2.190. The influence of BMI on hypertension remained stable and independent across all statistical models. Furthermore, RCS analysis demonstrated a non-linear pattern in the relationship between cadmium exposure and the risk of hypertension. Specifically, the risk increased sharply at low to moderate cadmium concentrations and then plateaued at higher exposure levels. This non-linear trend challenges the assumptions of traditional linear threshold models and underscores the importance of using flexible analytical approaches in environmental health research. The findings support the view that cadmium is a vascular toxicant even at relatively low levels of environmental exposure. Moreover, demographic characteristics such as gender and obesity appear to modify individual vulnerability. This study contributes novel insights into how environmental pollutants affect cardiometabolic health in urban populations. It highlights the need for more targeted public health strategies, improved environmental monitoring, stricter regulation of cadmium emissions, and gender-responsive health education programs. Although the cross-sectional design limits causal interpretation, the findings provide a strong basis for future longitudinal investigations.

Pornyanee Intha   Tienthong Takaew   Orathai Katkhaw   Nisuda Yodya   Taweewun Srisookkum   and Sunanta Wongrattanakamon   

This study sought to develop a community-based mental health surveillance and suicide prevention system using a participatory approach in Pong District, Phayao Province, Thailand. The research employed a Participatory Action Research framework informed by Kemmis and McTaggart's four-phase model: planning, action, observation, and reflection. Thirty individuals with a history of suicide attempts and fifty community stakeholders — including local healthcare providers, religious leaders, village health volunteers, and administrative officers — collaborated in co-designing and implementing the intervention. Core activities included suicide risk screening with validated tools (9Q and 8Q), resilience-building workshops, and structured home-based follow-ups. Data were collected through standardized resilience and satisfaction scales and analyzed using descriptive statistics and paired t-tests. The findings indicated significant improvements in mental health outcomes. Depression scores decreased markedly (Mean = 5.03, SD = 8.4, p < .001), and suicidal ideation was reduced (Mean = 6.9, SD = 16.08, p < .05). Participants also reported higher levels of mental toughness and motivation (p < .05), although no significant change was observed in problem-solving abilities. Overall, the study underscores the value of participatory, community-driven models in strengthening mental health outcomes. Embedding such models into national mental health strategies may enhance sustainability, improve access, and ensure culturally appropriate care for vulnerable populations in rural areas.

Nasaruddin Nawir   Ansariadi   Veni Hadju   Deviana Soraya Riu   Citra Kesumasari   Wahiduddin   Masyitha Muis   and Eri Wijaya   

Low birth weight (LBW) and short birth length (SBL) remain significant health challenges in developing countries, including Indonesia. Maternal micronutrient status, particularly iron and vitamin A, plays a crucial role in fetal growth. This study examined the association between maternal soluble transferrin receptor (sTfR) and retinol-binding protein (RBP) levels with infant birth weight and length. A prospective cohort study was conducted in a slum area of Makassar City, involving 170 pregnant women in their second trimester. Data were collected through interviews, anthropometric measurements, and blood sampling, with biomarker analysis conducted using the ELISA method. The mean birth weight and length were 2.98 kg and 47.87 cm, with LBW and SBL prevalence rates of 13.5% and 21.2%, respectively. Linear regression analysis showed no significant association between sTfR and either outcome (p > 0.05). In contrast, higher RBP levels were significantly associated with increased birth weight (p = 0.019) and length (p = 0.021). Logistic regression further indicated that higher RBP levels were linked to reduced odds of LBW (adjusted OR = 0.39; 95% CI: 0.17–0.88) and SBL (adjusted OR = 0.45; 95% CI: 0.21–0.95). sTfR remained non-significant in all models. However, ROC analysis showed low predictive value for both biomarkers (sTfR AUC < 0.4; RBP AUC < 0.6). These findings suggest maternal RBP as a potential biomarker for vitamin A status and fetal growth, while sTfR has limited utility. Comprehensive biomarker assessments may improve early detection of fetal growth disorders in high-risk populations.

Kurnia Yusuf   Aminuddin Syam   Healthy Hidayanty   Kadek Ayu Erika   Anwar Mallongi   Wahiduddin   Intan Sari Areni   Musliha Mustary   and Dewi Purnama Windasari   

Child growth monitoring is a key aspect of public health, contributing to stunting prevention and improving children's quality of life. This review analyzes research trends related to child growth monitoring using a bibliometric approach to identify publication patterns, scientific collaboration, and academic impact. Bibliometric analysis was conducted using Scopus data (1985-2025) analyzed with Biblioshiny in R Studio and VOSviewer. The parameters evaluated included publication volume, international collaboration patterns, author impact index, and research topic trends. The number of publications has increased rapidly since 2010, with the highest spike in 2017-2023. The United States, India, and the United Kingdom were the countries with the highest publication contributions, while the global collaboration rate reached 26.41%. Co-occurrence analysis showed that the dominant topics included stunting, nutritional status, primary healthcare, and anthropometry. Research on child growth monitoring has grown rapidly over the last two decades, with multidisciplinary trends and increased international collaboration. However, gaps remain, especially in the implementation of evidence-based policies in developing countries. Future studies should expand data coverage, including Web of Science databases, and integrate more comprehensive analysis methods to improve the relevance of findings.

Mohammed A. Alkharaiji   and Mohammed A. Alsuliman   

Despite ongoing prevention efforts, workplace injuries continue to be a substantial concern in Saudi Arabia, particularly as the country undergoes rapid economic transformation under Vision 2030. This study aimed to analyze trends in reported occupational injuries across the first three quarters of 2024 in Saudi Arabia. A comprehensive descriptive epidemiological analysis was conducted using 23,109 reported occupational injuries from the Saudi Data & AI Authority (SDAIA) database. Findings indicate a notable increase in injury cases from 6,817 (29.5%) in the first quarter to 9,323 (40.3%) in the third quarter of 2024. Saudi workers accounted for only 9.2% of all reported injuries, with males representing 96.6% of the injured population. The private sector reported 99.2% of all injuries. The leading causes of injury were non-vehicular mechanical forces (54.9%) and falls (28.1%), with traffic accidents contributing to 11.1% of cases. At the time of reporting, 90.3% of injured workers were still receiving treatment. The significant rise in occupational injuries, particularly in the third quarter, underscores the urgency for targeted prevention strategies focused on high-risk groups and prevalent injury mechanisms. Safety regulations and comprehensive training programs aligned with Saudi Vision 2030 objectives are essential to create a safer workplace environment.

Mahfoodha Al Kitani   Amin Gaafar   and Ali Al Yaaribi   

Epidemiological studies have identified a high prevalence of risk factors for non-communicable diseases in Oman. Mobile health (mHealth) applications are used to monitor various physical activity (PA) metrics, such as step counts, as well as other health parameters including PA rate, heart rate variability, and sleep quality. This study evaluated the impact of mHealth applications on PA levels and overall quality of life in the Omani population. This study involved 262 Omani participants (132 men and 130 women) from various geographical regions. Data were collected using an 18-item web-based questionnaire distributed via social media platforms, including Facebook, WhatsApp, and Twitter. Descriptive statistics, such as means and standard deviations (M±SD), were employed to summarize the questionnaire responses, and independent t-tests were performed to examine differences in outcomes based on age and sex. The findings demonstrated that mHealth applications significantly improved PA and quality of life among the participants. Specifically, 84.03% of respondents reported increased consistency in their exercise routines, while 94.25% experienced enhanced mood during PA sessions. The findings substantiate the effectiveness of mHealth applications as interventions for promoting PA and improving quality of life. These results advocate for the broader integration of mHealth technologies within public health frameworks to mitigate the burden of non-communicable diseases in the Omani population.

Lovie Edwin Seru   and Malebogo Moji   

Background: Sedentary behaviours have increasingly become dangerous in this era of non-communicable diseases and high mortality rate. While people living in urban settlements are exposed to an array of sources of information on living a healthier and active lifestyle, remote rural settlements' only guaranteed sources of information are Health Promotion Practitioners comprising local nurses and Health Promotion Assistants. This is notwithstanding the fact that the villagers' socio-cultural peculiarities and unfavourable economic contexts, make them a stark contrast of the Health Promotion Practitioners. Objective: Given the problems that are most likely to occur when people from different socio-cultural backgrounds communicate, it was surmised that the socio-cultural differences between the villagers and the Health Promoters could be impediments to a seamless dissemination of messages about physical activity and sedentary behaviours. This has prompted the question: How do Health Promotion officials execute the diffusion of messages about physical activity and sedentary behaviours? Driven by the scholarship of Social Constructionism, this study aimed to determine the right communication model for disseminating information about physical activity and sedentary behaviours to remote rural communities. Methods: To gather information for this study, a participatory observation and semi-structured interview methods were used. Results: The results show that an attempt to incorporate the cultural expressions and communication practices of the villagers into the communication processes of messages about physical activity and sedentary behaviours was made.

Chetan Singh Cheema   Prasanna Mithra   Saraswathy MV   Rekha T   Nithin Kumar   Isha Saxena   Sidharth Sehgal   Khushi Singh   Satvik Kamboj   Anshu Kumar   Arpan Anurag   and Archith Boloor   

While previous studies have traversed specific aspects of morbidity and lifestyle factors during the pre-COVID period, there is a dearth of research combining both elements holistically during the post-COVID period. Analyzing the convergence of acute and chronic morbidity trends and modifiable risk behaviours in India's post-pandemic setting would help in getting empirically grounded insights to fortify primordial and primary preventive frameworks, delivering actionable evidence to advance preventive healthcare for rapidly urbanizing populations confronting overlapping burdens of Acute and Chronic diseases. This hospital-based cross-sectional study included 203 outpatient attendees (aged ≥ 18 years) in teaching hospitals attached to a Medical School in the Southern Indian State of Karnataka. The collected data were analyzed by using SPSS Version 29.0. Chi-square test was used to determine the association between variables at p-value <0.05 considered statistically significant. The mean BMI of study participants was 22.77 ± 3.60 kg/m². Significant weight changes impacted 103 (50.73%) participants, primarily belonging to normal BMI (n=59, 29.06%). Stress-related factors, weight variation, meal-skipping habits, and psychological dependence activities showed a significant association with BMI (p=0.002, 0.007, 0.030, 0.037, respectively). Chronic disease burden was reported in 95 (46.80%) participants, with cardiovascular diseases being the most prevalent (n=55, 27.09%), while acute illnesses affected 99 (48.77%), with acute respiratory diseases accounting preeminently (n=52, 25.62%). Low routine health check-ups (n=78, 38.42%) were reported, with annual health check-ups being most preferred (n=33, 42.31%). Nearly half of the study participants suffered from chronic diseases. The lifestyle factors were significantly associated with body mass index. More than one-fourth of them had a BMI above the overweight range. They preferred annual health check-up visits over others.

Easter Godwin Nwokah   Chinyere I. Okoro   Ollor Amber Ollor   Adline Erinma Ben-Chioma   Sandra Ujunwa Ekesiobi   and Chidimma Anthonia Azike   

Emergency preparedness and disaster response plans are essential for mitigating health and environmental risks, especially in disaster-prone regions. This review evaluates the effectiveness of such plans using five studies identified through systematic searches on Google Scholar and PubMed, with three studies sourced from Google Scholar and two from PubMed. The selected studies highlight critical aspects of disaster management, including the importance of community engagement, robust infrastructure, and integrated risk assessments. Key findings include the correlation between pre-established waste management protocols and reduced environmental contamination, as well as the role of inclusive planning in minimizing health risks. One study emphasized the environmental sustainability impacts of waste management during disasters, while another focused on the significance of public education in reducing health risks. Additionally, findings revealed barriers such as inadequate infrastructure, limited public trust, and communication gaps that undermine the effectiveness of disaster plans. The review also identifies differences across studies due to geographic focus and methodological approaches, with studies from low- and middle-income regions emphasizing infrastructure challenges, while others highlighted cultural and social factors influencing disaster outcomes. Recommendations for improvement include investing in resilient infrastructure, fostering community-driven planning, enhancing public trust, and promoting cross-sector collaboration. This review underscores the need for holistic, inclusive strategies to strengthen emergency preparedness and disaster response frameworks, ultimately enhancing resilience and minimizing vulnerabilities.

Manjula Rathinam   Eswari Varadharajan   Robert Çitozi   Jagadeeswari Suresh   Purshottam Dhavale   Ibnu Noufal Kambitta Valappil   Karuppasamy Govindasamy   Farjana Akter Boby   and Vlad Adrian Geantă   

Background: Obesity increases the risk of cardiovascular and metabolic diseases, reducing quality of life. While diet and medication help, non-pharmacological approaches like yoga and mindfulness show promise. However, evidence on their combined effects on BMI, lipid profile, and QoL in obese women remains limited. Methods: This RCT included 60 middle-aged obese women (BMI ≥ 30 kg/m²), randomly assigned to an intervention group (Group A, n = 30) or a control group (Group B, n = 30). Group A followed a 12-week supervised program with yogic practices (45 min/day, 5 days/week) and mindfulness meditation (15 min/day, 5 days/week), while Group B maintained their usual lifestyle. Primary outcomes included BMI and lipid profile (total cholesterol, HDL, LDL, triglycerides), with QoL assessed via the WHOQOL-BREF questionnaire. Measurements were taken at baseline and after 12 weeks. Results: After 12 weeks, Group A exhibited a significant reduction in BMI (↓8.4%, p = 0.002) and improvements in lipid parameters, including total cholesterol (↓10.5%, p = 0.009), LDL (↓13.9%, p = 0.004), triglycerides (↓9.6%, p = 0.023), and an increase in HDL (↑10.4%, p = 0.018). Additionally, QoL significantly improved in Group A across physical, psychological, and well-being domains (p < 0.001) compared to the control group. No significant improvements were observed in Group B. Conclusions: Yogic practices with mindfulness meditation improved BMI, lipid profile, and QoL in middle-aged obese women. These findings support yoga and mindfulness as effective non-pharmacological interventions for obesity. Larger studies with longer follow-ups are recommended to assess the sustainability of these benefits.

Apoina Kartini   Suhartono Suhartono   Budiyono Budiyono   Yusniar Hanani Darundiati   Nur Endah Wahyuningsih   and Alfan Afandi   

The prevalence of stunting in agricultural areas is relatively high. Pesticide exposure can cause digestive tract inflammation known as environmental enteric dysfunction (EED), which interferes with nutrient absorption, resulting in impaired growth. Fecal Alpha-1-antitrypsin (AAT) is a parameter to measure the presence of EED. The increase in fecal AAT levels in stunted children in agricultural areas is not yet known. This study aims to prove that the levels of fecal AAT in stunted children are higher than in normal children. This research is an observational study with a cross-sectional approach. The research location was in Dukuhlo Village, Brebes Regency, Indonesia, which is a shallot farming area with high pesticide use intensity, from April to July 2023. The subjects were 70 children aged 8-12 years (32 stunted and 38 normal). Measuring AAT levels in stool preparations was carried out using the Enzyme-Linked Immunosorbent Assay (ELISA) Sandwich method. Data were analyzed using an independent t-test, Mann-Whitney, and chi-square. The stunting and normal groups differed in age (p=0.048), birth weight (p=0.048), and involvement of children in agricultural activities (p=0.041). Fecal AAT levels in stunted children (24.50 ng/ml) were higher than in normal children (13.05 ng/ml) (p=0.045). Children with fecal AAT levels ≥18.05 ng/mL have a 4.2 times higher risk of becoming stunted. There was an increase in fecal AAT levels in stunted children in agricultural areas.

Hassan Saidi   Younes Yassine   Abdessamad El Hamaoui   Zakaria Abidli   and Driss Belghyti   

Meningitis, an inflammation of the meninges often caused by bacterial or viral infections, can lead to significant neurocognitive sequelae in children, even after adequate treatment. This study aims to assess the medium- and long-term neurocognitive influences in children who have recovered from meningitis, focusing on memory, attention, executive functions, and academic performance. The study involved 100 children aged 6 to 12 who had recovered from confirmed bacterial or viral meningitis within the last three years. Neurocognitive assessments were conducted using the fifth edition of the Wechsler Intelligence Scale for Children (WISC-V). To complement these measures, parental questionnaires were used to obtain information on children's behavioral, emotional, and academic functioning. The study highlighted significant neurocognitive challenges in children recovering from meningitis, with working memory being a notable area of concern. Specifically, 40% of participants showed moderate to severe deficits, as identified through WISC-V assessments. Attention: 30% of children exhibited a reduced attention span, which affected their ability to concentrate on tasks. Executive functions: Half of the cohort suffered from disorders affecting planning and cognitive flexibility, which are essential for problem-solving and adaptation. School performance: Children with prolonged hospitalizations (more than 10 days), particularly those following bacterial meningitis, demonstrated significantly lower performance in math and reading, underscoring the long-term educational impact of severe cases. Personalized rehabilitation programs and increased awareness are essential to mitigating long-term consequences. In resource-limited contexts, such as Morocco, strengthening follow-up infrastructure and vaccination campaigns is crucial for improving the quality of life and educational outcomes for affected children.

Dewi P. Windasari   Nurhaedar Jafar   Andi I. Sidin   Kadek A. Erika   Bahruddin Thalib   Kamariana   Kurnia Yusuf   Eri Wijaya   and Esse P. Pawenrusi   

Hypertension, or high blood pressure, remains a significant contributor to cardiovascular morbidity and mortality globally. Lifestyle modification is a key component of hypertension prevention and management. This scoping review examines genogram-based and other healthy lifestyle education models aimed at improving health behaviors in families of hypertension patients. An extensive search was conducted using Science Direct, PubMed, ProQuest, and Google Scholar databases for studies published between 2014 and 2024. The search employed combined keywords related to hypertension, health education, lifestyle interventions, genograms, family support, and educational models. From 94 identified articles, 17 met the eligibility criteria for detailed analysis. Selected studies were evaluated for their objectives, study design, variables, and outcomes. Findings reveal that while many interventions exist, the prevalence of hypertension remains high, underscoring the need for effective family-centered educational strategies. Interventions incorporating lifestyle modifications, adherence to hypertension management guidelines, and the use of genograms to map family health history show promise in fostering behavioral change and improving hypertension control within families. This review highlights the potential of combining genogram-based approaches with other educational models to support sustainable healthy lifestyle changes in families affected by hypertension.

Syamsul Alam   Veni Hadju   Ansariadi   Nurhaedar Jafar   Muh. Tahir Abdullah   Syamsuar Manyullei   Ulin Na'ma Saputra   and Muhammad Isyraqi Ghazian   

Breastfeeding offers crucial health benefits for both mothers and infants, yet many face challenges in maintaining exclusive breastfeeding (EBF) for six months postpartum. Moringa oleifera is a natural galactagogue traditionally used to boost breast milk production, but limited research has examined its effects when consumed during pregnancy on long-term breastfeeding outcomes. This study aimed to evaluate the impact of Moringa supplementation enriched with royal jelly (MRJ) during pregnancy on breastfeeding success at six months postpartum. This research was a follow-up to a double-blind, randomized controlled trial conducted during pregnancy. Participants were randomly assigned to receive either a daily MRJ capsule (intervention group) or a multi-micronutrient supplement (MMS; control group) from the second trimester until delivery. A total of 88 women were enrolled, with 42 in the MRJ group and 46 in the MMS group. Data on maternal and infant characteristics and breastfeeding success scores were collected through structured questionnaires. Most mothers were aged 20–35 years, had diploma-level education, and were predominantly housewives. Baseline characteristics were similar between groups. EBF rates at six months were higher in the MRJ group (52.4%) than in the MMS group (32.6%), although the difference was not statistically significant (p = 0.09). However, the MRJ group had a significantly higher mean breastfeeding success score (95.00 ± 5.02) compared to the MMS group (90.71 ± 11.10) (p = 0.042). Maternal MRJ supplementation during pregnancy significantly improves breastfeeding success at six months postpartum, highlighting its potential as a natural intervention to enhance maternal and infant health.

Iin Octaviana Hutagaol   Masni   Sudirman Nasir   Masyita Muis   Rahayu Indriasari   and Hasnawati Amqam   

Adolescent pregnancy remains a critical public health concern worldwide, associated with increased risks of adverse medical, psychological, and social outcomes for both mothers and their infants. Pregnant adolescents often face unique challenges, including limited access to health information, inadequate support systems, and socioeconomic vulnerabilities, which can exacerbate negative pregnancy outcomes. Self-care practices, including health literacy, mental health support, physical activity, and nutritional management have emerged as vital strategies to empower adolescent mothers and promote better health outcomes. This scoping review aimed to explore the existing literature on self-care interventions targeting pregnant adolescents, with the goal of identifying effective approaches to reduce the risks associated with adolescent pregnancy. A comprehensive search was conducted across three electronic databases, yielding a total of 23 eligible studies. These studies employed a range of research designs, including cross-sectional, cohort, quasi-experimental, and randomized controlled trials, and were conducted in 14 different countries. The findings emphasize the positive impact of self-care interventions on maternal well-being, gestational outcomes, and neonatal health. Key themes included the importance of improving health literacy, fostering mental resilience, encouraging regular physical activity, and promoting adequate nutrition. However, the review also revealed persistent barriers such as cultural stigma, poverty, and limited access to adolescent-friendly health services. These findings underscore the need for context-sensitive, culturally appropriate, and youth-centered programs that address the diverse needs of pregnant adolescents. Moreover, future research should prioritize longitudinal studies to assess the sustained effects of self-care interventions and inform the development of comprehensive, evidence-based policies and practices.

Yenni Zuraidah   Albiner Siagian   R Hamdani Harahap   and Zulhaida Lubis   

Stunting remains a significant public health issue globally, affecting 140 million children under five years. In Indonesia, stunting prevalence has decreased over time but remains high in certain regions, with Mandailing Natal Regency showing rates of 45.76% in 2018 and 49.91% in 2019. Based on the Indonesian Nutritional Status Survey (SSGI), there has been a decrease to 47.7 percent in 2022, 34.2 percent in 2022 and 20.7 percent in 2023. This study aimed to identify the key factors contributing to stunting in Mandailing Natal Regency, North Sumatera, and develop a community-based prevention model. A cross-sectional study was conducted in Mandailing Natal Regency. The study population comprised children under two years, and participants were selected using proportional cluster random sampling. Data were collected from 399 mothers, health workers, and village midwives using structured interviews. Information on socio-economic status, maternal nutrition knowledge, environmental sanitation, and infant feeding practices was gathered. The collected data were analyzed using Structural Equation Modeling (SEM) to determine the factors influencing stunting and to evaluate the relationships between socio-economic status, feeding practices, and sanitation. The SEM analysis revealed that inappropriate complementary feeding practices were the most significant factor influencing stunting (coefficient = 0.778, p = 0.001), followed by poor sanitation (coefficient = 0.077, p = 0.031). Socio-economic status did not directly influence stunting but had an indirect impact through feeding and sanitation practices. Conclusions: Inadequate complementary feeding and poor sanitation are key contributors to stunting in Mandailing Natal Regency. Targeted community interventions addressing these factors are crucial for reducing stunting in this high-prevalence region.

W.G.T.S. Senanayaka   and P. Pathranarakul   

Gender and geographical disparities are distinct concepts, but their influence on health is not fully understood. Therefore, the aim of this study is to determine the impact of gender differences and geographic disparities on the prevalence of non-communicable diseases (NCDs) among middle-aged and elderly people in Sri Lanka. Utilising the data from the latest nationwide Sri Lanka Demographic and Health Survey, the study employed binary and multivariate logistic models to explore the effects of gender differences and geographical disparities on the prevalence of NCDs. After we controlled marital status, wealth, living arrangements, level of education, and unhealthy behaviour, the study finds a significant association between gender, geography, and NCD prevalence. Particularly, factors such as women's financial empowerment and rural residence have emerged as central determinants of health status among the middle-aged and elderly. In this context, the traditional male-female dichotomy does not accurately capture this gender inequality; policymakers need to consider social gender differences in formulating inclusive health interventions. Health disparities between urban and rural older adults are significant. Accordingly, after careful study of the NCD status among urban older adults, targeted health policy measures should be introduced. This study finding aligns with the social determinants of health theory while challenging the rural-urban health gradient theory, suggesting a ‘rural advantage'.

I Wayan Agus Gede Manik Saputra   Ni Komang Semara Yanti   Ni Made Sri Nopiyani   Cokorda Bagus Jaya Lesmana   Muhammad Nasrum Massi   I Wayan Weta   I Wayan Suardana   Anak Agung Sagung Sawitri   Made Agus Hendrayana   I Made Ady Wirawan   and Ni Nyoman Sri Budayanti   

Antimicrobial resistance (AMR) is a global public health problem threatening the availability of antimicrobial drugs and endangering the health of humans, animals, and the environment. While current efforts to address AMR focus on hospitals as the downstream consequences of the problem, a more effective strategy would target upstream drivers through a One Health approach and community. Therefore, this study aimed to develop "Antibiotic-Wise Village" or "Desa Bijak Antibiotika" (SAJAKA) model as a tool to address AMR in community settings by promoting judicious antibiotic use across humans, animals, and the environment through active community participation tailored to local issues. The SAJAKA model was developed using a multi-method approach comprising a preliminary study as a baseline assessment to explore AMR issues in the community, a systematic review to assess AMR community-based interventions, and a Delphi study to define the indicators. Training modules were then developed based on these indicators. The model was subsequently validated through implementation in four rural villages in Bali, Indonesia, involving healthcare workers, housewives, schoolchildren, and farmers. These methods ensured alignment with the study's objective and sustained village-level interventions. SAJAKA model is a valuable and adaptable tool for addressing AMR in community settings. The indicators of SAJAKA model covering human, animal, and environmental health, were established through Delphi Study that reached consensus (Median ≥ 4, IQR ≤ 1.25, agreement rate ≥ 80%). Community engagement-related interventions aimed at fighting AMR were favored over simple interventions. Therefore, SAJAKA model scoring system, which was built on a collaborative and consultative framework, was tested to assess classification status in four villages in rural Bali, Indonesia. The SAJAKA model represented a tool that could be used in community settings to foster public awareness about antibiotic use and the risks of AMR. Implementing the One Health approach, combined with efforts to address the challenges posed by AMR in the community, could lead to significant advancements in the prevention of AMR.

Aoran Li   Chai Ian   and Kok-Why Ng   

Background: Physical activity is declining internationally, and more individuals are becoming apathetic, which is connected with several unfavourable health effects. Gamification appears to be a viable tactic for increasing engagement in physical activity treatments to counter this tendency. The review looks at related behavioural and psychological effects as well as how gamified systems affect the encouragement of physical exercise. Methods: Numerous research on adult participants that has been published in peer-reviewed English-language journals within the past five years is included in the investigation. The analysis provides the most advanced overview of gamification and physical activity by incorporating several important factors, such as the types of physical activity determined, the gamification systems used, the motivational elements involved, and the behavioural and psychological outcomes of young adults in China. Results: The findings have reflected how the incorporation of gamified applications for physical activities has a positive impact on physical activity development among young adults. Young adults are capable of taking the benefits of such gamified physical activity systems as a part of their daily life that has a significant impact on their well-being. It provides benefits to them in terms of physical health as well as having a certain impact on the mental health. Conclusions: Gamification can be considered as a novel strategy that influences the wellbeing of young adults. Personalized gamification strategies influence the adoption of physical activities among individuals while improving their motivation towards such engagement. Hence, the incorporation of such practices can result in enhancing the physical well-being of Chinese youth.

Bhagyashree Nanda   Rakesh Mohanty   Snehanshu Dey   and Suvendu Narayan Mishra   

Background: Schizophrenia symptoms include domains like positive symptoms, negative symptoms, and cognitive symptoms. Few studies say schizophrenia with a family history of schizophrenia has greater impairment in cognitive abilities than schizophrenia without a family history of schizophrenia. The study aims to evaluate neurocognitive performance in schizophrenia patients during symptom-free periods with or without a family history of schizophrenia. Methods: This cross-sectional study was conducted on 99 individuals with schizophrenia with a family history of schizophrenia 40, schizophrenia without a family history of schizophrenia 59. The Positive and Negative Symptom Scale (PANSS), the PGI Battery of Brain Dysfunction (PGIBBD), and the Color Trail Test (CTT) were utilized to assess schizophrenia symptoms, neurocognitive impairment, and cognitive versatility and motor processing speed. Data were collected and then two groups were compared with chi-square test or independent t test. Results: Both PGI BBD and CTT test were compared between the two groups. No significant difference was found in the level of neurocognitive impairment between schizophrenia with or without a family history. Conclusions: Family history did not show any significant difference in the cognitive impairment of schizophrenia patients, highlighting the need for further research in this field.

Shaik Rajah Asif   D Vijaya Geeta   Sai Sudhakar Nudurupati   Jyoshna Pratty   and Mukesh Kondala   

Healthcare quality is significantly influenced by a safety culture, which aims to minimize medical errors, enhance risk management, and facilitate learning. Safety culture research has developed substantially, exploring leadership engagement, patient-centered care, organizational learning, and technology-enabled safety interventions. However, it has been impeded by systematic barriers in healthcare settings (hierarchical structures, inconsistent management support, fear of reprimand), hindering practical translation. This study conducts a bibliometric analysis of safety culture research between 2007 and 2024 using the Scopus database, examining publication growth, citation patterns, keyword evolution, and co-authorship networks. Qualitative thematic analysis was performed using NVivo software to investigate high-impact studies and trends. Results revealed significant growth in safety culture research after 2014, increased cross-disciplinary partnerships, and global contributions. Leadership, safety management, and patient-centered care were prominent themes, while AI-driven safety assessments and digital health technologies are emerging research frontiers. Longstanding challenges must be addressed, such as low error reporting rates, safety concerns from workload pressures, and perception gaps between frontline staff and managers. Recent trends indicate an increasing focus on patient-centered safety assessments, reflexivity in safety improvements, and transformational leadership in fostering a constructive safety culture. The study highlights the need for non-punitive reporting systems, leadership-driven safety culture strategies, and tailored interventions for healthcare settings. This evolving literature has precipitated methodological and thematic progress, but several issues remain unresolved. These findings have implications for policymakers, healthcare leaders, and researchers aiming to evolve safety culture models, increase interdisciplinary collaboration, and incorporate technological innovations to optimise patient outcomes. This study contributes to the literature on improving safety culture in healthcare organisations.

Siti Hardiyanti   Elizabet Catherine Jusuf   Veni Hadju   Mardiana Ahmad   and Saidah Syamsuddin   

Background: Bioactive compound-rich dietary supplements may help alleviate stress-related hormonal imbalances during pregnancy. Method: This quasi-experimental study examined the effects of Visoy, a functional supplement combining soybean and purple sweet potato, on anxiety symptoms and cortisol levels in 60 pregnant women aged 20–35 years with mild to severe anxiety and no chronic diseases. Participants were randomly assigned to intervention and control groups, using a pretest-posttest design. Results: Visoy supplementation significantly improved the intake of antioxidants, energy, fat, and vitamin C, which was associated with notable improvements in cortisol regulation. A significantly higher proportion of participants in the intervention group reached normal cortisol levels post-intervention (93.3%) compared to the control group (66.7%, p=0.010), and mean cortisol levels significantly decreased in the intervention group while increasing in the control (p=0.013). Anxiety scores also declined significantly in both groups; however, the reduction was significantly greater in the intervention group (p=0.000). No significant correlation was found between cortisol levels and anxiety scores at any stage, suggesting independent or complex interactions between physiological and psychological responses. Conclusions and Suggestions: These findings suggest that Visoy may positively influence maternal stress physiology and emotional well-being through distinct pathways. As a non-pharmacological, food-based intervention, Visoy holds promise for enhancing prenatal care. Future research should explore its long-term effects, underlying mechanisms, and applicability in broader populations using more sensitive biomarkers and placebo-controlled designs.

Jhons Fatriyadi Suwandi   Juspeni Kartika   Noviany Noviany   and Agnes Kurniawan   

Intestinal protozoan infection is a major public health concern in Indonesia, particularly among immunocompromised individuals like chemotherapy-treated cancer patients. This study aimed to develop a predictive model for infection risk based on social determinants and clinical characteristics. A cross-sectional study was conducted at Dr. H. Abdul Moeloek General Hospital, Lampung Province, Indonesia, in 2022, involving questionnaires and stool sample analysis. Microscopic examination was performed using sedimentation, iodine staining, and modified Ziehl-Neelsen tests. Statistical analysis showed significant correlations between infection and marital status, as well as erythrocyte levels (p < 0.05). Logistic regression identified key predictors, including age, address, temperature, cancer duration, erythrocytes, hemoglobin, hematocrit, and monocytes. The model explained 47.4% of infection variability (Nagelkerke R2 = 0.474) and demonstrated strong predictive performance (AUC = 85.0%, Hosmer-Lemeshow p = 0.570). Infection probability ranged from 0.35% (low-risk) to 99.77% (high-risk). The dominant risk factors were address, cancer duration, erythrocytes, and hemoglobin, while age, temperature, hematocrit, and monocytes acted as confounders. By targeting these risk factors, healthcare providers can develop effective interventions to reduce the burden of intestinal protozoan infection in this vulnerable population.

Agrina   Sri Wahyuni   Misrawati   Suyanto Suyanto   Yulia Irvani Dewi   and Stephanie Dwi Guna   

Breastfeeding provides numerous benefits for both mothers and infants. However, many mothers face challenges in exclusively breastfeeding their babies due to various sociocultural factors. This cross-sectional study aims to analyze the influence of sociocultural factors, particularly norms and values on the practice of exclusive breastfeeding in a watershed area. A mixed-method approach was used, comprising a quantitative survey of 109 mothers with infants aged 6–24 months and qualitative in-depth interviews with five breastfeeding mothers, dwelling within the working areas of a public health center in Riau, Indonesia. Data collection was conducted in two phases, a quantitative survey and in-depth qualitative interviews. This study utilized a sociocultural questionnaire adopted in full from a previously validated instrument which was designed to assess knowledge, sociocultural norms, and beliefs related to breastfeeding practices. Quantitative data were analyzed using multivariate analysis, specifically multinomial logistic regression, while qualitative data underwent deductive content analysis. The result of study showed that the majority of mothers were aged 20–35 years (86.2%), multiparous (55%), and housewives (94.5%). Exclusive breastfeeding was practiced by 55 respondents (50.5%). Quantitative findings revealed that the norm or value factor was the strongest predictor of exclusive breastfeeding practices, with an odds ratio (OR) of 2.81 (0.87–9.87, p=0.090) after controlling for knowledge and belief variables, while knowledge and beliefs had a weaker association. Qualitative analysis identified key themes, including maternal motivation, pregnancy-related efforts to support breastfeeding, and expectations for health workers' guidance. These results suggest that both sociocultural norms and individual beliefs shape breastfeeding behaviors, highlighting the need for targeted interventions to support exclusive breastfeeding in this population. Norms and values significantly influence exclusive breastfeeding practices. Strengthening maternal education and healthcare worker support is crucial to improve exclusive breastfeeding rates in the watershed region.

Sun Hye Shin   and Ki Han Kwon   

Introduction: South Korea, which is expected to become a post-aged society by 2026, has seen the emergence of a new generation of elderly people, similar to active seniors, who actively participate in events and care about their appearance. We aimed to investigate the psychological characteristics of their event-specific make-up behavior. Methods: The Psychological Characteristics of Makeup behavior by Event Study questionnaire (N=529; aged 50-80 years) included 30 items related to emotional experiences, 45 items related to personality factors, and 60 items related to makeup behavior, which were divided into three event categories. Principal component analysis was used for factor extraction and the Vermax method for factor rotation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and this review was registered at PROSPERO (CRD420250651697). Results: Four factors with 12 items were examined for personality factors. Five factors with 18 items were examined for make-up behavior. Conscientiousness was the strongest correlation of personality factors and politeness was the strongest correlation of make-up behavior. Conclusions: The findings suggest that the new older generation has positive emotional experiences prior to participatory events, values social norms and harmonious relationships with others. Psychologically, we found that they have a strong psychological predisposition to actively participate in the events they attend and to seek out external beauty.

Susanti Niman   Yura Witsqa Firmansyah   Whisnu Trie Seno Ajie   Tina Shinta Parulian   and Friska Sinaga   

Non-communicable diseases (NCDs) remain a leading cause of death globally, driven largely by unhealthy lifestyles and low health literacy, particularly in semi-urban communities. This study aimed to develop and evaluate the effectiveness of a Healthy Behavior Knowledge Reinforcement Model to improve health literacy in semi-urban communities. A quasi-experimental design was applied in Dayeuhkolot Subdistrict, Bandung Regency, involving 138 adults divided equally into intervention and control groups. The intervention included interactive training, independent practice, and modular learning, grounded in reinforcement theory, health promotion, and community-based nursing. Pre- and post-intervention assessments were conducted using a validated instrument. The intervention group showed a statistically significant increase in mean knowledge scores (from 53.78 to 56.38; p = 0.005), while the control group experienced a decrease (from 53.26 to 52.68). Significant associations were observed between knowledge improvement and demographic factors such as gender, age, and marital status. These findings demonstrate that the model is effective in enhancing health behavior knowledge and supporting the use of structured, community-based interventions to promote sustainable health literacy improvements in semi-urban populations.

Anlin Jenisha   Prahankumar Rajendran   and Madonna J Dsouza   

Child sexual abuse (CSA) is a major public health concern that affects the children's physical, psychological, and emotional well-being globally. Parents play a crucial role in protecting children, but lack of knowledge and misconceptions often hinder their efforts. The aim of this study is to examine the level of parental knowledge, attitudes, and practices related to CSA prevention, explore the gender-based differences in CSA prevention approaches among parents of boys and girls and identify the key factors that influence parental involvement in prevention of CSA. A community-based cross-sectional survey was conducted from September 2024 to February 2025 among parents of children aged 5–12 years in rural Puducherry. A pre-validated, semi-structured questionnaire collected demographic data and assessed CSA-related awareness and practices. Descriptive statistics and binary logistic regression were used to identify predictors of CSA knowledge, attitude and prevention behaviors. The study revealed significant gaps in parental knowledge regarding CSA prevention. While 94% of parents understood that offenders repeat abuse and molestation is the offender's fault, misconceptions persisted, with 69.1% of parents incorrectly assuming females cannot sexually abuse children and 67.2% believing boys are not at risk. Parental attitudes were divided, with 50.1% not willing for CSA prevention education at school. Preventive practices were inadequate, with only 33.9% discussing body safety and boundaries with their child and 4.1% providing books or audiovisual materials. Parents of daughters were more proactive in CSA prevention than those of sons. Higher maternal education is linked to greater awareness and better preventive practices. The study highlights the gaps in parental awareness, attitudes, and practices regarding CSA prevention, particularly concerning gender disparities. This study states the need for tailored educational programs and engagement of parents in CSA prevention.

Ujang Maman   Junaidi   Asep Usman Ismail   Murodi   Masri Mansoer   Djawahir Hejazziey   Dundin Zaenuddin   Agus Nugraha   and Nindyantoro   

Awareness about hygiene and health in food consumption needs to be extended, especially for people in developing countries. Food security does not only require food availability and affordability, but also demands food health, and this is closely related to the awareness and consumption behavior. For this purpose, this research aims to explore hygiene and health awareness in heterogeneous communities based on socioeconomic characteristics, as a process to formulate appropriate extension models to develop healthy behavior in food consumption. Based on Lemeshow formula with 10% of error probability, the sample of this survey is one hundred beef buyers in Toko Tani Modern (TTM) - a cheap market as a program of the Ministry of Agriculture of The Republic of Indonesia in Jakarta, Indonesia - which are taken by accidental sampling technique. In the light of chi square test, this research found uniformity in hygiene awareness in the midst of socioeconomic characteristics diversity, but unfortunately the healthy awareness in food consumption - which is represented by desire to control beef fat - is varied depending upon socioeconomic characteristic. The age, marital status, and education level have a strong effect on restraining the meat fat. Therefore, in the model of extension, the extension targeting to increase health awareness in food consumption should be grouped based on age, marital status, education level and job variation. While, the extension planning to develop hygiene awareness should be supported by local wisdom, belief in the message which is supported by the interaction approach in communication process.

Shunmathi Babu   and Gladius Jennifer H   

Noise pollution is a growing public health concern since it may have serious consequences beyond only the auditory system. The purpose of this research was to determine how living in a noisy region in Chennai, India affects people's mental health. Three hundred persons (aged 18-60) living in regions with high ambient noise levels (>85dB) near major highways and railway lines in Chennai participated in cross-sectional research. A sound level meter was used to assess the ambient noise level. Data on demographics, noise discomfort, sleep disruption, and mental health problems were gathered using a questionnaire. The average noise level recorded in the study locations ranged from 86-96 dB. About 62% of participants reported high annoyance due to noise, and 57% reported sleep disturbance. Anxiety, irritability, headache and poor concentration were the most commonly reported mental health complaints. Noise sensitivity, noise annoyance and sleep disturbance showed significant positive associations with mental health issues. The study highlights high ambient noise levels and their impact on mental health status among the general population in Chennai. Stringent regulations on noise limits, noise mapping and interventions to reduce exposure are recommended to promote mental well-being.

Civilaiz Wanaratwichit   and Orawan Keeratisiroj   

In Thailand, addressing implementation challenges in district health boards (DHBs) involves practical aspects such as fostering integrated participation and collaboration, understanding DHBs' roles, and ensuring proper data management, including effective handling of working budgets and structural aspects. This study aims to assess the managerial capacity of DHBs and identify the factors influencing their managerial effectiveness. A cross-sectional self-report survey was conducted among members of DHBs in Health Service Region 2, located in the lower northern region of Thailand. The data were collected from 181 participants through a structured questionnaire. The overall mean score for the managerial capacity of DHBs was high (mean = 3.72, SD = 0.60). Factors influencing DHB managerial capacity included training on the role (β = 0.254), relationships among DHB members (β = 0.146), and perceptions of DHB roles (β = 0.553). The managerial capacity of DHBs demonstrates excellence in decision-making processes aimed at improving the health and quality of life in the district. It is recommended that training policies for DHB members, along with a focus on role perception and relationship-building among DHB members, be emphasized for further enhancement.

Sakchai Pattra   Sunan Siphai   Dusit Hirunwan   and Prachuab Lamluk   

Although caregivers play an important role in caring for the elderly today, their effectiveness depends on their communication skills. This study aimed to analyze and categorize the communication competencies of caregivers for dependent elderly. The population used in this study included 2,480 caregivers working in Chaiyaphum Province, Thailand. The measurement model for communication competence indicators for caregivers of dependent elderly comprises five components with 22 indicators. The model's structural validity is indicated by the following statistics: =146.936, df = 147, p-value = 0.4860, CFI = 1.000, TLI = 1.000, RMSEA = 0.000, SRMR = 0.026, and /df = 0.999. The highest average communication competence among caregivers was in self-awareness, with a mean of 4.05 and a standard deviation of 0.691. This was followed by communication skills, knowledge of communication processes, communication strategies, and motivation to communicate. The results of the latent profile analysis showed that the best-fitting model for categorizing the communication competencies of caregivers for dependent elderly is a four-group model (likelihood = -1186.095, AIC = 2428.190, BIC = 2531.896, ABIC = 2443.096, Ek = 0.879). Profile group 1 consisted of 144 individuals with self-awareness issues, profile group 2 included 36 individuals with communication strategies, profile group 3 comprised 28 individuals with communication skills, and profile group 4 included 92 individuals knowledgeable in communication processes. Therefore, to promote elderly caregivers to be able to work effectively, development guidelines should be established that are consistent with the characteristics of elderly caregivers in each group.

Muhammad Auliya Rahman   Mursid Raharjo   Nurjazuli Nurjazuli   and Sulistiyani Sulistiyani   

Water quality is a critical determinant of dermatological health; however, its direct association with specific physicochemical and microbiological water parameters remains underexplored in rural settings. This study aimed to elucidate the effects of dissolved oxygen (DO), water hardness, and total coliform contamination on the prevalence of self-reported skin disorders in Daren Village, Jepara District, Indonesia. Using a cross-sectional design, data were collected from 64 randomly selected respondents through structured interviews and dermatological assessments. The interviews included questions regarding water source usage and skin symptoms experienced during the past month. Dermatological complaints were classified using a checklist based on visible symptoms and verified through brief observations by trained health workers at a local community health centre. In-situ water quality testing was conducted on the household water sources used daily by the respondents. The results indicated that 39.1% of the participants reported skin complaints, most commonly dermatitis and eczema. Statistically significant associations were observed between skin disorders and low DO levels (mean 3.6 mg/L; p = 0.0001; PR = 5.64) and elevated water hardness (mean 626 mg/L; p = 0.005; PR = 2.38). Additionally, the presence of total coliforms co-occurred with deteriorating DO and hardness levels, suggesting synergistic contamination pathways. Field evidence indicated potential pollution from nearby tofu factory effluents that lack wastewater treatment facilities, contributing to the microbial and chemical degradation of groundwater. These findings, which expand beyond traditional microbiological concerns by highlighting physicochemical contributions, underscore the urgent need for integrated water safety interventions, such as improved industrial waste management, household water treatment technologies, and community-level education to reduce skin-related public health risks in rural areas.

Sofyan Indrayana   Tanti Asriza   Jarniah   Atsna Yusari Firdausia   M. Ischaq Nabil Asshiddiqi   Winda Rofiyati   Ngatini   Abror Shodiq   Erni Samutri   Mulyanti   Eka Nurhayati   and I Made Moh. Yanuar Saifudin   

Knowledge is fundamental for patients to improve foot care behavior and may change illness perception among people with Type 2 Diabetes Mellitus (T2DM). Diabetic Footcare Conversation Game (DFCG) might enhance their participation and knowledge retention. Hence, it may reduce the risk of diabetic foot ulcers. This study aimed to describe the experiences of using the Diabetic Foot Care Conversation Game and determine its effects on knowledge of foot care, illness perception, and foot care abilities among T2DM patients. This mixed method study comprised quasi-experiment research with one group pre and post-test design and an interpretive description. As many as 30 people with T2DM were recruited in the Baguntapan 2 Community Health Center, Bantul, Yogyakarta by purposive sampling technique. Quantitative data were collected by using the Foot Care Knowledge Questionnaire, Brief Illness Perceptions Questionnaire, and Diabetic Foot Care observation sheet. Socio-demographic and clinical data were collected by questionnaire. Qualitative data were obtained from semi-structured interviews of 30 respondents and 3 facilitators at the end of the intervention. To analyze the quantitative data, the Wilcoxon Signed Rank Test and Paired t-test were performed. Qualitative data were analyzed by interpretive description. This study found significant improvements in knowledge of foot care scores (p<0.001), foot care ability (p<0.001), and illness perception (p<0.001) after DFCG intervention. Qualitative findings revealed three main themes: DFCG is informative, delightful and engaging, and generates enthusiasm. Conclusions: DFCG demonstrates effectiveness as an innovative educational intervention for people with T2DM to improve knowledge of foot care, illness perception, and foot care abilities. The high levels of participant engagement and satisfaction suggest DFCG offers a promising approach to diabetes education that effectively addresses both educational and psychological aspects of diabetes self-management.

Noor Azizah   Hanifa M. Denny   Mateus Sakundarno Adi   and Sulistiyani Sulistiyani   

The transition to work after maternity leave creates anxiety in mothers, which elevates cortisol levels that decrease milk production and lead to early breastfeeding termination. The intervention of mindfulness helps mothers develop awareness while creating positive emotions. This study aimed to analyze the effectiveness of mindfulness in reducing anxiety and increasing self-efficacy among breastfeeding mothers returning to work. This quasi-experimental study employed a pretest and posttest design with a control group. A total of 84 mothers who resumed work after maternity leave were divided into two intervention groups and a control group. Participants were selected based on the criteria of having given birth to a full-term baby with normal birth weight. The intervention consisted of six sessions. Data were collected using the Generalized Anxiety Disorder (GAD) scale and Breastfeeding Self-Efficacy Scale Short Form (BSES-SF). The Wilcoxon test was used for the data analysis. The results indicated significant differences in anxiety and self-efficacy levels before and after the intervention in both the intervention and control groups (p < 0.05). Anxiety levels decreased following mindfulness training, whereas self-efficacy in breastfeeding improved. These findings underscore the crucial role of workplace counselors in promoting exclusive breastfeeding among working mothers.

Sooraya Ebrahim   Christo Bisschoff   Christoff Botha   and Anna-Marie Pelser   

The metaverse offers transformative potential for private higher education institutions (PHEIs) to enhance wellness initiatives through immersive digital environments. This study aims to systematically investigate how wellness dimensions can be incorporated into metaverse-driven frameworks within PHEIs. This systematic literature review (SLR) explores the integration of wellness dimensions into metaverse-driven frameworks within PHEIs. Guided by the Sustainable Development Goals (SDGs), the study focuses on the increasing importance of holistic well-being, particularly considering post-pandemic challenges affecting staff and faculty wellness. The review analyzes 21 peer-reviewed articles published from 2014 to 2024, including qualitative, quantitative, and mixed-methods research. The study identifies 12 wellness dimensions: physical, emotional, social, digital, environmental, occupational, intellectual, spiritual, financial, personal identity, professional, and cultural, with their application in metaverse contexts. It also examines the roles of virtual reality (VR), augmented reality (AR), and gamification in fostering interaction and resilience. The findings highlight the potential of metaverse-driven interventions to improve inclusion, accessibility, and engagement. However, gaps in empirical research and the absence of comprehensive frameworks for PHEIs remain. Leadership support and institutional culture emerge as critical success factors for digital wellness programs. Limitations, such as insufficient funds, stigma surrounding emotional wellness, technological barriers, and resistance to racial wellness initiatives, should be addressed in future research. This study contributes to the growing discourse on human-centered virtual environments, proposing a systematic, evidence-based wellness framework for the metaverse. Future research should explore digital wellness interventions' scalability, effectiveness, and ethical considerations in higher education.

Hasmi   and Semuel Piter Irab   

Papua has the highest prevalence of HIV in Indonesia, with a complex and multifactorial epidemic. HIV risk factors in Papua involve a combination of social, cultural, economic, and behavioral aspects. This study aims to uncover HIV risk factors in Papua through Mantel-Haenszel analysis and analysis of prevalence ratio, chi-square, and risk attribute; multivariate analysis with logistic regression; and also qualitative data analysis. This study uses a quantitative method with a cross-sectional design and a qualitative method of case study design. Based on quantitative data analysis, it is known that a significant variable as a risk factor for HIV and AIDS in Papua with the highest attribute risk value is having the number of sex partners > 1, which is 24.6%. The variable with the highest prevalence ratio was injection drug use, which was 3.571 with a CI of 95% (2.16-5.88). Meanwhile, from the results of the chi-square analysis, the significant variables for the incidence of HIV/AIDS are the variables of education, gender, occupation, ethnicity, marital status, number of sex partners, injection drug use, and non-urban areas. There was a significant association between injection drug use and HIV/AIDS incidence after controlling for the number of sexual partners, with the Mantel-Haenszel OR value of 5.5 (p =0.002) and the Mantel-Haenszel OR 21.9 (p = 0.000). From the design of the case study, it is known that the pattern of HIV transmission in Papua is dominated by the factor of changing partners who do not use condoms due to alcohol consumption. In addition, stigma on people with HIV and cultural factors (polygamy, tribal warculture, and kumbi culture) also play a role in the increase in HIV and AIDS cases in Papua. The government's strategy to reduce HIV and AIDS cases in Papua should focus on comprehensive education efforts, massive screening, and stopping alcohol and drugs, as well as reducing stigma and discrimination against people with HIV/AIDS.

Marcus L. Elam   Gwendolyn E. Ramirez   and David R. Edens   

Weight can often be seen as a major determinant of health and a critical factor influencing body image. This has led to numerous studies examining the biochemical and metabolic changes that occur from fad diets. Few studies have examined the long-term psychological implications and overall efficacy of common restrictive dietary practices. The current study examined the difference in scores of factors of uncontrolled eating (UE), cognitive restraint (CR), and emotional eating (EE) between past and current dieters compared to their non-dieting counterparts. The Three-Factor Eating Questionnaire (TFEQ), the Emotional Eater Questionnaire (EEQ), and a basic demographic and diet history survey were used. A series of -tests, ANOVAs, and linear regressions were performed among the groups to compare mean scores of UE, CR, and EE in groups of past and current dieters as well as non-dieters. We found that previous and current dieters had significantly higher mean scores of CR, UE, and EE (<0.01) compared to those who had not currently or previously dieted. There was no significant difference in scores based on the length of time dieting. However, those who chose a combination of diets in both the past and present were more likely to have higher EE and CR scores respectively. Younger individuals were also more associated with higher UE, CR, and EE scores. However, more research is required to further identify additional relationships between these findings including possible motivations behind dieting practices.

Ha Van Hoang   Pham Thi Kieu Duyen   and Nguyen Huu Minh   

Counseling and psychological counseling services in social work for students in schools contribute to enhancing students' capacity, thereby helping them solve problems in life and study. Applying Parasuraman's SERVQUAL model and scale consisting of 5 factors: reliability, responsiveness, service capacity, empathy and implementation conditions, this study analyzed and evaluated the level of teachers' satisfaction with the quality of counseling and psychological consultation services in social work for students in primary schools in the South Central Coast region, Vietnam. Quantitative and qualitative research methods were used through a questionnaire survey of 238 primary school teachers, in-depth interviews with 12 primary school teachers, 12 primary school administrators and 15 provincial social workers. The research results show that, although the quality of psychological counseling and counseling services in social work for students in primary schools in the South Central Coast region of Vietnam is rated at a satisfactory level (M=3.86, SD=0.80), there are still limitations related to the reliability and conditions for providing these services. The study also proposes some recommendations to contribute to improving the quality of counseling and psychological consultation services in social work for students in primary schools.

Solomon Sisay Marrye   and Simangele Shakwane   

Inadequate contact tracing poses significant challenges to leprosy case notification and treatment linkage activities in high-burden districts. This study aimed to design and implement community-based interventions to enhance leprosy case notification, contact tracing, and treatment linkage services in Ethiopia. A quasi-experimental study design was employed to evaluate the effectiveness of the intervention. Dickoff's survey list guided the intervention design. A modified checklist served as a data collection tool to gather baseline and end-point data from records and reports of selected healthcare facilities in high-burden districts. Data were entered and analysed using R programming R x64 3.6.1 packages by importing from Excel 2016. The average intervention effect was estimated through propensity score matching analysis. A p-value < 0.05 indicated statistical significance. The propensity score matching analysis showed that the implemented community-based intervention improved case notification for females affected by leprosy (Crud Odd Ratio [COR] (95% CI) = 3.8(1.8, 8.5)), treatment linkage among individuals with multi-bacillary leprosy (COR (95% CI) = 26.7(8.3, 125.8)), and contact tracing services (COR (95% CI) = 2(1.10, 3.8)) compared to healthcare facilities that did not receive the intervention. Therefore, the developed community-based intervention enhanced leprosy case notification, contact tracing, and treatment linkage activities at healthcare facilities in high-leprosy burden districts. The findings of this study will inform policymakers to incorporate these intervention activities into national guidelines to strengthen leprosy control in settings with a high burden of the disease.

Evicenna Naftuchah Riani   Zahroh Shaluhiyah   Dian Ratna Sawitri   and Muchlis AU Sofro   

Psychosocial support services play a critical role in enhancing the quality of life of people living with HIV (PLHIV), particularly in addressing the complex psychological and social challenges they face in everyday life. These services encompass psychological interventions, counseling, social support, and empowerment initiatives aimed at helping individuals cope with stigma and discrimination. Although widely implemented, the effectiveness and diversity of psychosocial intervention models have yielded inconsistent outcomes. This scoping review aims to systematically examine the existing literature on psychosocial support for PLHIV, identify the most effective approaches, and elucidate the impact of such interventions on psychological well-being, treatment adherence, and social integration. Utilizing the PICO framework and Arksey and O'Malley's methodological approach, we screened studies from Medline, CINAHL, Scopus, EBSCO, and ScienceDirect, ultimately selecting 12 experimental studies published between 2019 and 2024. Interventions were categorized at the intrapersonal, interpersonal, organizational, and community levels. The key findings reveal that psychosocial interventions not only improve psychological outcomes for PLHIV but also enhance antiretroviral therapy (ART) adherence and strengthen social networks. Peer support programs emerged as particularly effective, significantly improving ART adherence, emotional well-being, and reducing stigma. Integrated mental health services enhanced care delivery and addressed structural barriers, while community-based collaborations improved accessibility but were constrained by systemic limitations. Digital tools increased self-efficacy but encountered challenges related to stigma. These findings underscore the necessity of embedding psychosocial support within broader HIV care systems. Future efforts should prioritize scalable, peer-driven models with embedded mental health services to ensure sustained and equitable support for PLHIV. This review contributes to the field by offering evidence-based insights for policy development and practical interventions, with implications for enhancing the psychosocial and clinical outcomes of PLHIV.

Ma. Rosita A. Hernani   Jorjie U. Nepangue   Jovelito A. Canillas   Jerum B. Elumbaring   Priscilla P. Dagoc   Cheeze R. Janito   Marichu A. Calixtro   Rajesh Kumar   Rolito T. Imperial   Mark Anthony B. Rosario   Mark Dexter L. Reyes   Christine May T. Mangubat   Jenie Philip S. Saniel   Desiree Ann C. Tenebroso   and Ruben L. Tagare Jr.   

This study examines the efficacy of pedometer use in enhancing physical fitness among tertiary students, focusing on its capacity to promote more active and health-conscious lifestyles. In recent years, the global rise in noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and obesity has highlighted the critical need to address physical inactivity, especially among the youth. Students in higher education institutions are often at risk of adopting sedentary behaviors due to academic demands, technological distractions, and a lack of structured physical activity. As such, interventions that can be seamlessly integrated into daily routines are essential for promoting healthier habits. Wearable technologies, particularly wireless pedometers, have emerged as promising tools in encouraging individuals to move more throughout the day. Pedometers offer real-time feedback by tracking step counts, thus providing immediate insights into one's physical activity levels. This form of self-monitoring has been shown to improve motivation, raise awareness, and foster a sense of accountability, making pedometers a practical and accessible means to support health promotion among students. Users may feel empowered to incorporate more movement into their everyday lives by setting step goals and monitoring their progress. To assess the impact of pedometer use, this research employed a quasi-experimental design at one of the leading state universities in Cebu City, Philippines, focusing on college students with ages 18-25. Respondents were asked to use pedometers over a specific period, and data were gathered using structured questionnaires to record demographic details and measure physical activity outcomes. Key metrics examined in the study included weekly step counts, body weight, Body Mass Index (BMI), body fat percentage, and Basal Metabolic Rate (BMR). The findings revealed a significant increase in the number of weekly steps the students took, leading to modest yet meaningful improvements in their health metrics. The results support that pedometer-based interventions can positively influence student behavior, not merely for weight management, but more importantly, to encourage consistent physical activity and reduce sedentary lifestyles.

Rika Sepriani   Monica Dara Pratiwi   Yaslindo   and Yovhandra Ockta   

Aerobic endurance is crucial for sports students who rely on optimal respiratory health for sustained activity. This study investigates the impact of smoking, Body Mass Index (BMI), and lung function, specifically Forced Vital Capacity (FVC), on aerobic endurance. Conducted with a cross-sectional design, the study involved 35 sports students aged 19.23±0.92 years who met specific inclusion criteria. Data were collected through smoking behavior questionnaires, BMI measurements, spirometry for FVC, and beep tests for endurance. Results showed smoking did not significantly affect FVC (sig 0.460 > α = 0.05) or endurance (sig 0.089 > α = 0.05). BMI had a significant effect on FVC (sig 0.037 < α = 0.05), but not on endurance (sig 0.917 > α = 0.05). FVC itself did not significantly influence endurance (sig 0.684 > α = 0.05). Smoking and BMI accounted for 14.5% of the variance in FVC, while smoking, BMI, and FVC together explained only 9.51% of the variation in aerobic endurance. The study concludes that BMI significantly affects FVC, but neither smoking nor BMI directly impacts aerobic endurance. These findings highlight that endurance is influenced by more than lung capacity alone. Despite no immediate effects of smoking on endurance, its long-term risks remain concerning. Emphasis should be placed on cardiovascular and high-intensity training, along with weight management. Future research should explore factors like oxygen uptake, training intensity, and genetic predispositions to understand endurance performance better.

Abdessamad El Hamaoui   Younes Yassine   Hassan Saidi   and El Mahjoub Aouane   

Background: Diabetes is a leading risk factor for cardiovascular diseases, significantly increasing the risk of complications. It contributes to high rates of morbidity and mortality worldwide, particularly in individuals with poor glycemic control. Early detection and effective management are crucial to reducing the cardiovascular burden in diabetic patients. Methodology: This cross-sectional study aims to assess the impact of diabetes on cardiovascular complications and identify associated risk factors in patients followed at El Idrissi Hospital in Kenitra, Morocco. 100 diabetic patients (types 1 and 2) were included. Data were collected from medical records and supplemented by structured interviews, analyzing clinical and biological characteristics, as well as cardiovascular complications (hypertension, coronary heart disease, heart failure, and stroke). Results: The findings show high rates of hypertension (60%), heart disease (20%), heart failure (15%), and stroke (10%). The major risk factors are distributed as follows: A diabetes for a long duration of over 10 years (OR = 3.2), dyslipidemia (OR = 2.1), and poor glycemic control (HbA1c >8%; OR = 2.5). These data highlight the importance of early and rigorous management of diabetic patients. Targeted management and increased patient education are crucial in reducing the cardiovascular burden. Conclusions: This study highlights the significant impact of diabetes on cardiovascular complications in patients at El Idrissi Hospital, Kenitra. The high prevalence of hypertension, coronary heart disease, heart failure, and stroke underscores the importance of early detection and effective management. Key risk factors such as prolonged diabetes duration, poor glycemic control, and dyslipidemia were strongly associated with cardiovascular complications. These findings emphasize the need for targeted management strategies and enhanced patient education to mitigate the cardiovascular risks associated with diabetes and improve long-term patient outcomes.

Mohamed Suiyhi   Anouar Alami   Zineb Boumaaize   Hajar Darif   Asma Id babou   and Youssef El Madhi   

Depressive and anxiety disorders are significant global mental health concerns. In higher education, academic workload and stress make students particularly vulnerable to these disorders, especially in nursing, where training requirements are high. This study investigates the impact of academic workload and perceived stress on the prevalence of anxiety and depression among nursing students at the Higher Institute of Nursing Professions and Health Techniques (HINPHT) in Taza City, Morocco, using a quantitative correlational design involving a sample of 294 students. Data were collected using a self-administered questionnaire structured into three sections: 1) sociodemographic characteristics (gender, age, marital status, specialty, semester of study), 2) assessment of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and 3) assessment of perceived stress through the Perceived Stress Scale (PSS-10). The academic workload was calculated from the program description of the theoretical and practical modules in each semester and specialty, excluding personal work. Data were analyzed using IBM SPSS Statistics software through univariate, bivariate, and multivariate analyses to determine relationships between variables. The results of the multivariate analysis, using ordinal logistic regression, revealed that academic workload had a statistically significant but minimal effect on anxiety (p-value = 0.039; AOR = 1.004) but no significant effect on depression (p-value = 0.933). Perceived stress, on the other hand, emerged as a major predictive factor for both anxiety (p-value < 0.001; AOR = 1.234) and depression (p- value < 0.001; AOR = 1.157). Considering these results, recommendations include adjusting the academic workload to align with students' skills and needs, implementing stress management strategies, providing psychological support through listening services, and creating a less stressful theoretical and clinical learning environment to safeguard the mental well-being of nursing students.

Heayoung Lim   and Ki Han Kwon   

The investigation examined how appearance self-concept influences quality of life, with generativity serving as a mediator, in a sample of Korean women aged 50-59. While core values tend to shift from appearance to health with age, appearance remains a significant factor influencing later middle-aged women who experience physical, social, and psychological changes. Data were collected from 350 Korean women aged 50-59 through structured online surveys using Cash's Appearance Schemas Inventory-Revised, the Korean version of the Loyola Generativity Scale, and the WHOQOL-BREF. Analysis revealed that appearance self-concept (=3.20, =.67) significantly influences quality of life both directly (=.308, <.001) and indirectly through generativity as a partial mediator. Notably, motivational salience (=3.51, =.87) scored higher than self-evaluative salience (=2.99, =.78) and demonstrated stronger effects on quality of life (=.269 > =.242) with greater explanatory power (21.8% > 20.3%). These findings suggest that when appearance functions as a motivational resource for fulfilling personal values rather than as an object of social comparison, it more effectively enhances psychological well-being. This study contributes uniquely by examining appearance within a life-span developmental framework, introducing Erikson's concept of generativity as a mediating variable, and specifically focusing on women in their 50s within Korea's appearance-oriented sociocultural context. This study can help understand the psychological processes of middle-aged women striving to maintain a positive identity and quality of life despite physical aging, and may contribute to the development of programs that promote inner value enhancement and a positive body image.

Juana Cubas-Sancho   Nancy Huamán-Salazar   Teresa Vivas-Durand de Isla   and Walter Gómez-Gonzales   

Introduction: The COVID-19 pandemic created extraordinary challenges for healthcare systems worldwide, with nurses bearing the brunt of the crisis. In Peru, which experienced one of the highest mortality rates globally, nurses worked under extreme conditions including prolonged shifts, resource shortages, and constant exposure to infection. Objective: This study evaluated the psychological impact of COVID-19 on Peruvian nurses, measuring depression, anxiety, and stress levels, while identifying effective coping mechanisms. Methods: We conducted a quantitative, descriptive, cross-sectional study involving 311 nurses from three major Peruvian hospitals (Cayetano Heredia Hospital, Daniel Alcides Carrión Hospital, and Dos de Mayo National Hospital). Participants were selected based on their frontline COVID-19 care experience. Mental health was assessed using the validated DASS-21 scale (showing excellent reliability: depression α=0.92, anxiety α=0.79, stress α=0.89), while coping strategies were evaluated with the COPE-28 inventory (with avoidant coping showing lower reliability at α=0.45, noted as a study limitation). Data collection occurred via online surveys during the peak pandemic months. Results: Findings revealed alarming mental health impacts: 47.9% of nurses experienced anxiety, 30.5% depression, and 19% stress. Problem-focused coping strategies (e.g., active planning) and emotion-focused approaches (e.g., positive reframing) correlated with better outcomes (r = 0.150-0.276, p < 0.01). Younger nurses and those with less experience showed greater vulnerability. Conclusions: The study demonstrates the pandemic's severe psychological toll on Peruvian nurses, with anxiety being most prevalent. While adaptive coping strategies provided some protection, the results underscore the urgent need for institutional mental health support programs. Future research should explore longitudinal effects and specific interventions.

Mzolisi Abednigo Payi   Dominic Abaver   and Teke Apalata   

Social Determinants of Health (SDH) impact the incidence and progression of HIV and nutritional deficiencies in developing economies, particularly in Sub-Saharan Africa. While extensive research has focused on micro studies, it has neglected the macro impact. This review addresses these gaps by examining the literature on SDH's role in HIV and nutritional health, emphasising emerging determinants and gender-sensitive issues. Peer-reviewed studies from Google Scholar, Scopus, and Web of Science focused on six SDH indicators: income, education, employment, stigma and social exclusion, healthcare access, and housing and sanitation. Additional factors, including food security, food price fluctuations, and gender inequality, were examined. Findings reveal the connection between SDH and health impact. Structural determinants like income inequality, limited education, and poor housing conditions worsen HIV risks and nutritional deficiencies. Emerging determinants such as food insecurity and fluctuating food prices also influence HIV-related behaviours and nutrition, particularly in poverty regions. Gender inequality emerged as a determinant, with women disproportionately affected due to power imbalances, economic dependency, and restricted healthcare access. The review pointed out the gaps in macro-level analyses on how SDH may affect HIV and nutrition, stressing the need for expanded, gender-focused research. Policymakers and health practitioners should prioritise SDH interventions focusing on structural inequalities, emerging determinants like food security, and gender disparities to enhance sustainable health systems.

Puna Das   and Pradip Brahmachary   

Background: Women's ability to make decisions within households is crucial for better maternal and child health outcomes and for empowering women. This study examines the effect of women's decision-making autonomy on the number of ANC visits during pregnancy among reproductive-aged women aged 15-49 years in India. Methods: This study used data from National Family Health Survey (NFHS)-5 2019-21, a nationally representative survey. Women's decision-making autonomy was measured through women's participation in four key decisions within the households related to their healthcare, household major purchase, visits to family or relatives and use of husband's earnings. Binary logistic regression models were used to assess the effect of women's decision-making autonomy and likelihood of attending at least 4 or more ANC visits. Results: The findings reveal that women with medium and high decision-making autonomy were 1.3 times (AOR= 1.30, p<0.001) and 1.25 times (AOR= 1.25, p<0.001) more likely to attend at least 4 or more ANC visits compared to those with low decision-making autonomy within the households. Other socioeconomic factors, such as women's education, household wealth index, husband's presence during ANC visits, also influence attending adequate ANC visits. Conclusions: This underscores that to improve adequate ANC visits, policy makers should prioritize interventions that enhance women's decision-making autonomy, such as promoting education, financial independence, and gender sensitive healthcare programs.

Oman Hadiana   Dimyati   Ricki Yuliardi   Asep Mahpudin   Ahmad Fajri Lutfi   Asep Usamah   Yani Fitriyani   and Boby Agustan   

Bullying remains a serious issue in schools worldwide. Data from the Program for International Student Assessment (PISA) showed that Indonesia ranked the 5^th among the 78 countries with the highest prevalence of bullying cases against students. This study aimed to identify the factors contributing to school bullying by utilizing video monitoring technology in elementary school students during Physical Education lessons. This study employed a mixed-method approach, combining quantitative and qualitative methods with an explanatory design. The research sample consisted of 180 students from four elementary schools. The research instruments included observation, interviews, and questionnaires, while data analysis was conducted using Partial Least Squares-Structural Equation Modeling (PLS-SEM). Quantitative data analysis identified significant factors influencing bullying behavior, including family disharmony, gender, school policy, and student sports abilities. Meanwhile, qualitative data, gathered through observations utilizing video monitoring technology and interviews, revealed that students would likely bully peers with lower sports abilities or less proportional body sizes (e.g., obesity). Verbal teasing using inappropriate language was also frequently observed. The use of video monitoring technology in Physical Education lessons effectively recorded all student activities, enabling the identification of physical, verbal, and psychological bullying behaviors. Video monitoring technology, combined with respondents' perceptions obtained through questionnaires, provided a more comprehensive understanding of the factors contributing to school bullying.

Bouzini Ghizlan   Amzerin Mounia   Najdi Adil   and EL M'rabet Fatima Zahra   

For both sexes combined, colorectal cancer ranks third internationally. It is the second most common cause of cancer death. Significant associations between colorectal carcinogenesis and dietary habits have been confirmed by epidemiologic data from cancer research in different countries. In this context, we aim to review the published literature from North African countries investigating the associations between dietary factors and colorectal cancer. Through the PubMed, Scopus, sciencedirect, Web of Science and Springer databases, we conducted literature search using the following keywords: colorectal cancer, colorectal adenocarcinoma, risk factors, protective factors, nutrition, diet, Morocco, Algeria, Tunisia, Libya, Egypt, Sudan, and Mauritania. All papers with data related to the diet‒colorectal cancer association were selected without any restrictions regarding sample size, data sources, language or year of publication. A total of 21 retrospective papers were reviewed for relevant data extraction. Based on these findings, scientific consensus confirmed the association between diet and colorectal cancer. However, published data from North African countries remain insufficient and nuanced. Only processed meat, red meat, and alcohol were agreed as dietary risk factors and the Mediterranean diet, dairy products, whole grains, fruits and vegetables as dietary protective factors. Data on other dietary factors are inconsistent and sometimes paradoxical. This justifies the great interest in approaching this preventive dimension with more national, multicenter, prospective studies.

Sutthipong Wasusophaphon   Valanchaya Ketbumroong   Wongsa Laohasiriwong   and Chainarong Setthacheu   

The production of biomass energy in the Northeastern region of Thailand has impacted the health, social, and economic conditions of the local populace. The objectives of this research were to: (1) develop participatory public policy proposals for preventing and reducing impacts, and (2) analyze the methods for advancing these proposals for implementation. The research was conducted using participatory action research methodology from April 2020 to September 2023, involving 110 participants from various sectors. Data collection tools included group interviews, group meeting records, and health status data analysis. Content analysis was used for data interpretation. The results indicated that biomass power plants have significant health and environmental impacts. This led to the development of seven public policy proposals for participatory development that cover: (1) Strategic environmental assessment, (2) Improvement of impact assessment processes, (3) Enhancement of participatory impact assessment, (4) Reform of impact analysis mechanisms, (5) Establishment of monitoring committees, (6) Development of compensation systems, and (7) Support for health impact assessment mechanisms. These proposals were successfully pushed through the National Health Commission meetings, which approved: (1) the Ministry of Natural Resources and Environment to improve the environmental and health impact assessment systems for power plants of all sizes, (2) the Energy Regulatory Commission, Department of Energy, and Ministry of Energy to enhance the Code of Practice for power plants under 10 megawatts, (3) the establishment of area-based monitoring committees involving community participation, and (4) the development of more tangible compensation mechanisms for affected populations.

Yusuf Akyil   Tuncay Oral   Aykut Gunlu   and Beste Erdinc   

Life can sometimes present people with insurmountable obstacles that make it difficult to maintain a harmonious existence. Difficult obstacles can negatively affect concepts such as harmony in life and mental well-being. This study aims to examine the relationship between the concepts of harmony in life, mental well-being, self-transcendence, and the transformative power of suffering, and to highlight their implications for public health and community well-being. The data for this study were collected from 464 young adults who participated voluntarily. The instruments employed included the Harmony in Life Scale, the Transformative Power of Suffering Scale, the Mental Well-Being Scale, and the Self-Transcendence Scale. Data analysis and structural equation modeling were performed using SPSS and AMOS software. The results of the analysis indicated a positive correlation between harmony in life, mental well-being, self-transcendence, and the transformative power of suffering. In addition, the study revealed that the transformative power of suffering and mental well-being partially mediate the relationship between harmony in life and self-transcendence. The study suggests that achieving personal harmony in life can enable individuals to move beyond the pain associated with past distress, experience transcendence, and maintain optimism about their level of mental well-being. The ability to achieve harmony in life may foster constructive transformation and enhance mental well-being, both of which are essential for public health.

Md. Rabiul Islam   Harun Or Rashid   Raisa Rozana Khan   and Zenat Zebin Hossain   

There was a lack of primary research among urban adolescent students regarding the prevalence and factors of obesity. This study aimed to determine the prevalence and factors associated with overweight and obesity among urban school-going Bangladeshi adolescents. A descriptive cross-sectional study was carried out among 65 male and 48 female students, and the data were collected using a semi-structured questionnaire through a face-to-face interview method. Descriptive statistics were used to determine the prevalence of obesity, and a Chi-square test was performed to find out the factors associated with obesity. The study found that 23% of students were obese, 52.2% were overweight, and 17.7% were normal. More female students (64.6%) were overweight compared to male students (43.1%) (p=0.106). Age, gender, family income, body mass index (BMI), parental education and employment, physical activity, sleep patterns, and dietary behaviors, have no significant association with BMI. About half of the students did not participate in any sports over the last 12 months, with males engaging in sports more frequently than females (p=0.202). About 80.5% of students slept less than 8 hours daily, with females significantly (p=0.037) more likely to have insufficient sleep. Dietary behavior showed that 60.2% of participants skipped breakfast in the last 30 days, with females skipping more often than males (p=0.665). Furthermore, 64.6% of students did not bring lunch to school (p=0.428) and 36.3% consumed greasy food 3 times or more per day (p=0.304). No significant differences were found in dietary behaviors between male and female students. This study emphasizes considerable prevailing factors of the adolescents, particularly concerning their nutrition, physical activity levels, and sleep patterns.

P. Theboral   and V. Vijayalakshmi   

Working mothers around the world struggle to balance Motherhood and professional work, and their experiences differ depending on their cultural context. This phenomenological study investigates the real-life scenarios of 12 new mothers who are employed in a variety of fields, including marketing, banking, Information Technology, and academia. The research highlights five key themes: balancing work and family obligations, the value of support networks, postpartum patriarchal pressures, work-home spillover, and health effects. Study findings indicate that women are motivated to return to work by factors including financial security and career advancement, but these are frequently accompanied by stress, guilt, and insufficient physical and mental recuperation. Mothers struggle to satisfy responsibilities at work and home, which is made worse by the role of societal and familial expectations. Additionally, chronic stress, exhaustion, and health issues are caused by work-home spillovers. This research highlights the urgent need for comprehensive maternity policies, flexible work arrangements, and cultural shifts to better support new mothers. It contributes to the growing discourse on maternal health and work-life balance, providing insights for policymakers, employers, and researchers.

Iftikhar Ahmad Wani   Sneha Choudhary   Ab Majid Awan   Mehraj Ud Din Ganaie   Budru Nissa   Mohammad Muzamil Shah   Shaista Shafi   and Jigmat Dachen   

The present study aimed to develop and validate the Healthy Lifestyle Scale (HLS), a culturally and environmentally specific instrument designed to assess health-promoting behaviors in populations residing in climatically extreme and geographically isolated regions such as Jammu, Kashmir, and Ladakh. These areas experience long, cold winters, frequent snowfall, and dry summers, which pose significant challenges to maintain a healthy lifestyle. Existing lifestyle assessment tools are often developed for temperate urban contexts and fail to account for behaviors influenced by seasonal adaptation, isolation, limited access to fresh food, and restricted mobility. The HLS was constructed through a mixed-method approach involving literature review, expert consultation, and pilot testing, followed by rigorous psychometric evaluation to address this gap. A sample of 517 participants from the target regions completed the initial scale. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) supported a nine-factor model encompassing physical activity, healthy diet, stress management, hydration, substance use avoidance, preventive health, personal hygiene, environmental responsibility, and social well-being. The model demonstrated good fit indices (CFI = 0.93, IFI = 0.92, CMIN/DF = 3.645); all standardized factor loadings exceeded 0.50. The scale exhibited high test-retest reliability (r = 0.855, p < 0.001), indicating strong temporal stability. Expert review ensured content and criterion validity were confirmed via significant correlations with established health behavior instruments such as the HPLP-II, CSI, PEBS, DAST, and SSQ (r = 0.64 to 0.82, p < 0.001). Regression analysis supported predictive validity, with HLS scores significantly predicting real-world behaviors across multiple domains (β = 0.39 to 0.56, p < 0.001). The relevance of this scale is further reinforced by existing studies emphasizing region-specific interventions to promote health behavior, such as a health literacy initiative in Northern Thailand and research highlighting the role of healthy lifestyles in reducing anxiety during the COVID-19 pandemic. These findings underscore the importance of culturally responsive tools in guiding public health interventions. The HLS emerges as a reliable, valid, and practical tool for researchers, health professionals, and policymakers working in underserved or ecologically sensitive environments. Its future use may extend to other regions with similar challenges, supporting global efforts in personalized health promotion and sustainable lifestyle interventions.

Rekha Thapar   Nithin Kumar   Bhaskaran Unnikrishnan   Prasanna Mithra   Pravesh Chhillar   Jagriti Singh   Midhat Hyder   Maithili Agrawal   Rajshree Choudhary   and Harshita Jain   

Prolonged use of digital screen devices can lead to constellation of symptoms, collectively referred to as Computer Vision Syndrome (CVS). Medical students are particularly susceptible to CVS due to their high academic workload and the growing integration of technology in medical education. The aim of our research was to assess the prevalence of CVS among the medical students, and to study the associated factors for CVS. In this cross-sectional study, 130 undergraduate students of a medical college in Mangalore were assessed for CVS. Univariate analysis was carried out to assess the factors associated with CVS, and p < 0.05 was considered to be statistically significant. Unadjusted prevalence ratios (PR) and corresponding 95% confidence intervals (CIs) were reported. The prevalence of CVS in our study was 49.2% (n=64). Headache (n=42, 66.2%) was the most common symptom experienced by our participants. On univariate analysis, CVS was found to be significantly associated with total daily screen time and total day screen time. CVS was 2.1 times more prevalent among participants with a total screen time > 4 hours per day compared to those with a total screen time ≤ 4 hours per day (Unadjusted PR 2.1, 95% CI 1.13-3.89, p =0.019). Also, CVS was 1.6 times more prevalent among participants with a total day screen time > 3 hrs per day compared to participants with ≤ 3 hrs per day (Unadjusted PR 1.6, 95% CI 1.16-2.32, p=0.005). CVS is a significant problem in medical student community, and it is critical that the faculty and the students place a high priority on eye health and put effective preventative and management techniques into practice.

Made Indra Wijaya   Luh Gede Pradnyawati   Dewa Ayu Putu Ratna Juwita   and Anny Eka Pratiwi   

Tuberculosis (TB) remains a significant health issue in Bali, exacerbated by geographic and cultural challenges. Digital health technologies, including the "Sistem Informasi Tuberkulosis" (SITB) and "Wajib Notifikasi TB" (WIFI TB), were implemented to improve TB case management. This study evaluates the long-term impact of enhanced training sessions conducted in 2022 for healthcare providers on the use of these digital tools. A longitudinal, mixed-methods approach was used, involving quantitative surveys of 456 healthcare providers and qualitative interviews with 30 participants. Data were collected through follow-up surveys, health records, and thematic interviews from January to July 2024. Results showed a 23% increase annually in TB case detection, with significant gains sustained one-year post-training. Treatment adherence improved by 88%, particularly in rural areas. Although participants reported high usage rates and moderate proficiency, challenges such as system downtimes and limited technical support persisted. Qualitative findings emphasized the importance of refresher training, user-friendly updates, and robust technical support. Participants highlighted the need for tailored refresher sessions, real-time problem-solving scenarios, and public-private partnerships to ensure sustainable outcomes. Addressing these areas can optimize the integration of digital tools in TB management and contribute to better public health outcomes in similar regions.

Sulistiyani Sulistiyani   Yusniar Hanani Darundiati   Mursid Raharjo   Septiria Irawati   Aldi Prastya Kurniawan   Nethi Puspita Sari   Mia Setia Ningrum   Muhammad Auliya Rahman   and Jessyca Widya Pratiwi   

Tuberculosis (TB) is a significant global health challenge that continues to be the primary cause of death. This study aimed to analyze the spatial distribution and epidemiology of TB in Semarang City from 2022 to 2024, focusing on patient characteristics, major risk factors, and comorbid conditions, such as diabetes mellitus (DM). This study used a cross-sectional design with secondary data from the Tuberculosis Information System (SITB), covering 16 districts and 39 community health centers. The analysis revealed that of the 12,775 patients with TB, 53.6% were men and 46.4% were women, with 79.7% engaged in informal employment. Among 5,928 women patients, 0.4% were pregnant. Most patients did not have DM (89%) or HIV infection (99%). Spatial analysis identified East Semarang as the district with the highest TB incidence rate by 2023, reaching 426.43 per 100,000 population. These findings underscore the importance of risk-based strategies, including early detection, integrated TB-HIV services, and management of comorbid conditions such as DM. This study recommends strengthening TB control policies to support the goal of eliminating TB in Semarang City by 2028.

Witsanu Chankaew   Tienthong Takaew   Orathai Katkhaw   Taweewun Srisookkum   and Sunanta Wongrattanakamon   

Background: Knee osteoarthritis (KOA) causes joint pain and reduced mobility in older adults. This study examined factors predicting KOA severity among elderly individuals in rural Pong District, Phayao Province. Methods: A cross-sectional study using multistage random sampling was conducted on 384 individuals aged 60 and older residing in the Na Prang Subdistrict between July and September 2024. Clusters were formed based on social groups, followed by simple random sampling within clusters. Data were collected through questionnaires assessing demographics, health literacy, preventive behavior, and KOA severity using the Oxford Knee Score. Data analysis involved descriptive statistics, Pearson's correlation, and multiple linear regression. Results: The study indicated that most participants were female (59.4%), aged 60–69 years (66.1%, Mean = 68.18, SD = 6.45, Min = 60, Max = 91), with income of no more than 5,000 baht (90.4%), were married (73.4%), and had some level of education (91.5%). A majority (61.5%) suffered from severe knee osteoarthritis. Multiple regression analysis identified 4 key predictors of knee osteoarthritis severity: age (β=0.100, P< 0.05), osteoarthritis knowledge (β = 0.131, P< 0.05), preventive behaviors (β = -0.189, P< 0.001), and daily activity ability (β= -0.330, P< 0.001), explaining 17.4% of the variance (adjusted R² = 0.174, F = 60.839, p < 0.001). Conclusion: Enhancing health knowledge, preventive behaviors, and tailored rehabilitation can help older adults manage osteoarthritis and reduce severity through improved functionality, lifestyle, and older adult education.

Nisarat Auttama   Monchanok Choowanthanapakorn   Raweephun Sunanta   Keng Chaichana   Katekaew Seangpraw   Supakan Kantow   and Karnchanok Sukhabot   

Background: Herbal medicines are especially popular among patients with chronic diseases, and several factors have been identified as being associated with their use. Objective: The aim of this research study is to examine the factors influencing herbal usage behavior to reduce blood pressure levels among the elderly in Northern Thailand. Material and Methods: This is a cross-sectional study conducted among a group of 404 hypertensive elderly people, using a multi-stage sampling method. The interviews covered sociodemographic data, knowledge, self-efficacy, health literacy, and herbal use behavior to reduce blood pressure levels. Results: The mean age of the participants, of whom 66.8% were female and 33.2% male, was 70.26 years. Our analysis of the participants' knowledge about blood pressure and the use of herbs to reduce it found most of them had a high level of knowledge (45.5%). Most participants had a moderate level (78.7%) of self-efficacy, and a functional level of health literacy (63.1%). Regarding herbal usage behavior to reduce blood pressure, 49.9% of participants scored at a moderate level. The results of the linear regression analysis to identify factors related to herbal usage behavior found that financial status, complementary and alternative medicine, knowledge, self-efficacy, and health literacy were significantly associated with herbal usage behavior to reduce blood pressure, with statistical significance (R² = 37.5%). Conclusions: The study's results suggest herbs usage should be promoted more through health and community participation programs to help lower blood pressure among elderly. Furthermore, relevant organizations should advocate for and implement policies that encourage the use of herbs as alternatives for healthcare.

Elizabet Catherine Jusuf   Lisdayanti   and Mardiana Ahmad   

The aim of this study is to examine the effects of a combined prenatal yoga and cinnamon aromatherapy intervention on endorphin levels and the intensity of back pain in women during their second and third trimesters. This study utilized a quasi-experimental design with pretest and posttest, conducted at a maternity clinic in East Jakarta, Indonesia. Out of 66 patients, 60 met the criteria and were selected for the study. Data analysis was performed using SPSS version 26, with univariate analysis to describe variables and data were summarized using mean, median, and standard deviation. Bivariate analysis was then applied to investigate the effects of prenatal yoga and cinnamon aromatherapy on endorphin levels and back pain intensity. The findings indicated that both interventions significantly increased endorphin levels, but combined yoga with cinnamon aromatherapy produced a notably higher increase. Additionally, the study demonstrated that these interventions significantly reduced back pain intensity, shifting most cases from moderate and severe to mild pain. The practical implications of these results are substantial, suggesting that integrating prenatal yoga with cinnamon aromatherapy could be an effective non-pharmacological strategy for improving maternal well-being and managing pregnancy-related discomforts. Healthcare providers might consider this combined approach to enhance prenatal care and support better obstetric outcomes.

Zainab F. Albikawi   and Mohammad H. Abuadas   

Background: Psychiatric mental health education forms part of the clinical competencies that nursing students should be aware of. In this modern technological era, ChatGPT has emerged to play a leading role in developing education for all disciplines. Aim: Investigate nursing students' perspectives regarding the impact of ChatGPT utilization on psychiatric mental health learning and determine the related factors. Methods: A cross-sectional research design was conducted among 95 nursing students. The data collection was performed by utilizing the Perspective of ChatGPT Utilization Impact on Learning Scale (P ChatGPT UILS). Results: The average mean score of P- ChatGPT UILS was 3.46 ± 1.29, indicating a generally positive perspective. For every one-unit increase in use of ChatGPT to complete assignments, students reported a significantly higher positive perception toward the impact by 0.35 units (p = 0.008). Similarly, the use of ChatGPT in generating mental health case scenarios was associated with a positive increase of 0.33 units, with p = 0.015; however, the highest was the use of ChatGPT for understanding psychiatric-mental health case studies at 0.40 units, p = 0.002. These findings showed that the more the students used ChatGPT for these purposes, the stronger their perception of the supportive role it played in enhancing learning in psychiatric mental health nursing. Conclusions: ChatGPT has a positive influence on psychiatric mental health education according to the perception of nursing students. This will bring value to learning itself, since the integration of ChatGPT into educational approaches will make learning more engaging in an interactive manner and facilitate access to resources on mental health.

Muhammad Ikhtiar   Nasruddin Syam   Ulfa Sulaiman   Ayu Puspitasari   and Haeril Amir   

Background: Pesticides are chemical substances that, when not used according to prescribed standards, can negatively impact health and environmental quality, particularly soil and water ecosystems. Method: This study used a laboratory-based analytical observational design with a cross-sectional approach. The population consisted of 358 shallot farmers, with a sample of 188 selected through purposive sampling. Only farmers consenting to blood sampling were included in the study. OHS officers collected blood samples (0.01 cc each) using a cholinesterase test kit and subsequently analyzed at the Makassar OHS Laboratory. Data were analyzed using univariate and bivariate statistical methods. Results: The study revealed that 52.7% of respondents had normal cholinesterase levels, while 47.3% had abnormal levels. Regarding the pesticide dosage, 64.4% of respondents comply with recommended dosages, whereas 35.6% used improper dosages. 88.3% of respondents followed proper protocols for spraying techniques, while 11.7% did not. Correlation tests indicated significant associations among farmers between pesticide dosage and spraying techniques with blood cholinesterase levels. Conclusions and Suggestions: Pesticide exposure can manifest through observable symptoms, yet these signs are often underestimated, and individuals rarely seek medical attention. The potential impact of the research is preventive measure to pesticide exposure. The limitation of study is that the sampling technique still uses non-random sampling so that bias can occur. Further research is recommended to be a longitudinal study to see the long-term effects and measurements can be done several times.

Vivi Sri Saputri   Anwar Daud   Agus Bintara Birawida   Hasanuddin Ishak   Atjo Wahyu   and Aminuddin Syam   

Background: One of the basic needs of the community is the availability of clean water. Small islands with limited access to clean water are an area that is vulnerable to disease. The people of Barrang Lompo Island are experiencing difficulties regarding clean water due to its geographical conditions that make it difficult to access clean water. Purpose: To find an integrated clean water management model based on water sources, residential density, behavior towards water management and availability regulations on Barrang Lompo Island. Methodology: Research samples amounted to 285 respondents, taken randomly using a simple random sampling technique. This study is observational with a cross sectional design then continued with complex multivariate analysis to test a model based on the structural equation model (SEM) PLS approach. Results: Results of the SEM PLS analysis showed water source variables had a significant effect on the availability of clean water (0.000 < 0.05), water sources had a significant effect on clean water management regulations (0.000 < 0.05) and management regulations had a significant effect on the availability of clean water (0.024 < 0.05). Conclusions: The risk model found that water source variables have a strong influence on water management regulation variables, water availability.

Roqia Saleem Maabreh   Rami A. Elshatarat   Mahmoud H. Alrabab'a   Ghaida Shujayyi Alsulami   Majed S. Al-Za'areer   Bandar Naffaa Alhumaidi   Khulud Ahmad Rezq   Amal Ali Alasmari   Amal Ali Alharbi   and Hilana Ahmad Al-Kharouf   

Background: Breast cancer (BC) is a major public health issue worldwide, and early detection through practices like Breast Self-Examination (BSE) is critical. Nursing students, especially those in Saudi Arabia, play a key role in disseminating health information. Understanding their knowledge of BSE and associated factors is essential for enhancing educational programs. Purpose: This study aims to assess female nursing students' exposure to BC education, evaluate their general knowledge of BSE, investigate their understanding of breast health and BC, and identify significant factors influencing their knowledge of BSE. Methods: A cross-sectional design was employed among 384 female nursing students from various campuses in Saudi Arabia. Data were collected using a structured, self-administered questionnaire between April and May 2024. The questionnaire included sections on demographics, exposure to BC information, and knowledge of BSE. A convenience sampling method was used, and statistical analysis was conducted using t-tests, ANOVA, and Pearson correlation tests. Results: The study participants had an average age of 21.1 years, with most (85.9%) being single and spread across different academic years. Most (91.1%) had received education on BC, primarily through their nursing courses. A significant majority (91.9%) knew the BSE process, and 78.1% had performed BSE at least once, with 62.8% practicing it regularly. Knowledge of BSE was generally high, with 80.7% correctly identifying its purpose and 84.6% knowing it should be performed monthly. Significant factors influencing BSE knowledge included academic level, exposure to BC education, and family history of BC. Conclusions: Female nursing students in Saudi Arabia generally possess good knowledge of BSE, with education and academic exposure playing a significant role. Targeted educational interventions are recommended to address gaps and enhance the proactive health behaviors of future healthcare professionals.

Mukhlis   Sari Arlinda   Indang Dewata   Elsa Yuniarti   and Yura Witsqa Firmansyah   

Stunting is a chronic nutritional issue in children under five years old, characterized by a shorter height compared to their peers. Stunted children are more susceptible to illnesses and face a higher risk of degenerative diseases in adulthood. In West Sumatra Province, the stunting prevalence increased from 23.3% in 2021 to 25.2% in 2022. West Pasaman Regency is among the regions with stunting prevalence above the provincial average. Poor hygiene and sanitation, leading to infectious diseases, significantly contribute to stunting. This study aims to describe environmental conditions with a spatial approach in stunting case areas in West Pasaman Regency. The type of research is descriptive with a spatial approach. A cross-sectional study aimed to capture areas with stunting cases totaling 330 mothers (total sample) in the period January to December 2024. Data collection included observation, interviews, and wastewater quality measurements in selected samples. The findings reveal that total of 11 sub-districts in West Pasaman Regency do not meet good wastewater quality standards, while several sub-districts such as Ranah Batahan, Sungai Alur, Gunung Tuleh, and Pasaman have poor environmental conditions due to a lack of waste management and hygiene facilities. Community-based interventions, such as weekly community effort activities and educational programs, are recommended to improve awareness and management of wastewater facilities, thereby reducing stunting risks.

Joanna Caryl P. Esponja   Donnie M. Tulud   Jomar B. Esto   Jo-Ann D. Santos   Carmee Lyn B. Paylangco   Jemwell B. Francisco   Lara Ivanna C. Nadela   Marichu A. Calixtro   Priscilla P. Dagoc   Ruben L. Tagare Jr.   Michelle R. Dee   Lorralie F. Canape   Christian Jude Wariza   Desiree Ann C. Tenebroso   and Lyn Bicodo-Ortele   

This study investigates the relationship between social appearance anxiety and holistic self-esteem among students at a premier state university in the Southern Philippines. The purpose was to explore how social appearance anxiety, a psychological concern related to the fear of being judged on one's physical appearance, correlates with holistic self-esteem, encompassing security, identity, belonging, purpose, and competence. Using a quantitative research design, specifically descriptive correlation, the study involved 689 respondents selected through simple random sampling. Data were collected using the Social Appearance Anxiety Scale and a holistic self-esteem questionnaire, which were validated for reliability. Descriptive and inferential statistical methods, including the Pearson correlation coefficient, were used to analyze the relationship between the two variables. The results indicated that the respondents experienced moderate levels of social appearance anxiety (mean=2.53) and moderately high holistic self-esteem (mean=3.05). A significant negative correlation (r=-.322; p=.001) was found between social appearance anxiety and holistic self-esteem, suggesting that higher anxiety about one's appearance is linked to lower overall self-worth. These findings have important implications for understanding students' psychological well-being, particularly in terms of how body image issues may impact their broader self-esteem. The study highlights the need for a comprehensive approach to student support, where physical appearance concerns and self-esteem are addressed simultaneously. In conclusion, the research underscores the interconnectedness of body image and self-esteem, calling for further investigation into the factors influencing these variables and the potential for interventions to promote healthier student outcomes.

Ali Mohamed Ali Ismail   Mona Mohamed Morsy   Orchid Saber AbdelFadil Saber   Ahmed Mohamed Abdelhalim Elfahl   Asmaa Mohamed Ahmed   Sami Kamal Mohamed Elgendy   Alyaa Abdallah Atallah Ahmed Zaid   Amera S. Aly Yousef   and Asmaa M. Al-Emrany   

Objective: Oxidative stress is aggravated by the existence of type 2 diabetes mellitus. Baduanjin exercise and acupuncture are two traditional Chinese treatment methods that are commonly used to treat diabetes and its complications. This study aimed to compare the oxidative stress response to a 12-week electro-acupuncture versus Baduanjin exercise in patients with type 2 diabetes mellitus. Material and Methods: Sixty non-obese patients with type 2 diabetes mellitus were assigned randomly to the EA group (n=30) or Baduanjin-exercise group (n=30). EA group received a 2-Hz electro-stimulation to needles inserted in bilateral PC4 and PC6 acupoints for 40 minutes while the other group received Baduanjin exercise for 40 minutes. The 12-week treatment was performed daily (except Friday) in both groups. Besides the measurement of serum lipid hydro-peroxidase (as an oxidative stress marker), serum antioxidants such as superoxide dismutase and nitric oxide were assessed before and after 12 weeks. Results: Both EA and Baduanjin exercise produced a highly significant decrease in serum lipid hydro-peroxidase and an increase in serum superoxide dismutase and serum nitric oxide levels. Comparison of post-treatment lipid hydro-peroxidase, superoxide dismutase, and nitric oxide between Baduanjin exercise and electro-acupuncture groups did not show a significant difference. Conclusions: Both Baduanjin exercise and electro-acupuncture are good anti-oxidative therapeutic modalities to lower oxidative stress in patients with type 2 diabetes mellitus.

Chanoknun Fakmit   and Narongsak Noosorn   

The objectives of this descriptive research were to study the physical behaviours and factors affecting physical activities in elderly schools. The participants comprised 407 elderly people aged 60 years and older who were selected through simple random sampling. The instrument was a questionnaire, and the data were analysed by frequency, percentage, mean, standard deviation, and multiple regression analysis. Results: The study results showed that the physical activities at elderly schools in Phrae Province were influenced by physical movement according to the ability and preference of activities at school (= 2.80, S.D. = 1.780), spending free time at school to do hobbies such as making handicrafts and snacks (= 2.68, S.D. = 1.595), and physical activities/exercises in the morning before classes (= 2.65, S.D. = 1.589). Regarding the factors affecting physical activities at elderly schools in Phrae Province, the predictors were the perceived benefits of physical activities (β = 2.602), support from neighbouring members (β = 1.684), suitability of the area for physical activities (β=1.665), teaching quality (β = 1.446), knowledge about physical activities (β = 1.017), number of days per week for physical activities (β = 1.274), participation in planning physical activities (β = 1.141), policy for promoting physical activities at elderly schools (β = 1.121), gender (β = 1.124), policy concerning physical activities for specific groups (β = 0.974), attitude towards physical activities (β = 0.625), and activity stimulating physical activities (β = 0.702). These factors could co-predict at 64.7% with a statistical significance of 0.05. Conclusions: the promotion of physical activities at elderly schools should take into consideration personal, social, environmental, and policy factors as well as area adjustment, motivation, social support, and the participation of the elderly in designing activities that will increase success and sustainability in the promotion of physical activities.

Soumya Thankam Varghese   Md. Kamrul Hasan   and Jona Angeline   

Eco-anxiety, a growing area of concern in the realm of mental health, is exacerbated by various environmental factors. One such factor, often overlooked, is the prevalence of foggy climates. These conditions, characterized by limited visibility and persistent grey skies, can have significant impacts on mental clarity and overall well-being. This descriptive study aims to explore the intricate relationship between eco-anxiety and foggy climates. This research delves deeply into personal experiences and reflections documented in a diary, providing an understanding of how foggy weather conditions influence mental states. Using descriptive approach, the study analyzes reflective diary entries on the individual's emotional and cognitive responses to high foggy climates. The findings reveal a direct correlation between prolonged exposure to foggy climates and heightened eco-anxiety. The participant's diary entries frequently mention a sense of cognitive fog, characterized by difficulty in concentrating, reduced mental clarity, and a pervasive feeling of unease. The lack of visibility due to fog is noted as a significant contributor to these experiences, amplifying feelings of uncertainty and environmental dread. This study concludes that foggy climates can significantly exacerbate eco-anxiety, leading to cognitive challenges and emotional distress. By providing a detailed account of one individual's experience, this research adds a personal dimension to the broader discourse on eco-anxiety. It emphasizes the importance of considering local climate conditions in mental health assessments and interventions. The study's reliance on a single participant limits the generalizability of the findings. However, it opens avenues for further research involving larger, more diverse populations to validate and expand upon these insights. Mental health practitioners should consider environmental factors, such as foggy climates, when addressing eco-anxiety in their patients. Developing coping strategies tailored to specific climate-related stressors can enhance resilience and mental well-being. Raising awareness about the impact of foggy climates on mental health can foster community support and promote environmental changes to mitigate these effects. Public health initiatives that include climate considerations can better address the holistic needs of individuals affected by eco-anxiety.

Made Ayu Lely Suratri   Raharni Raharni   Gurendro Putro   Masdalina Pane   Mohammad Samsudin   Tri Ramadhani   Amir Suu'di   Lelly Andayasari   Endang Indriasih   Nurhayati Nurhayati   Lucie Widowati   Telly Purnamasari Agus   Ristrini Ristrini   and Rustika Rustika   

Background: Stunting remains a persistent nutritional issue caused by prolonged inadequate nutrient intake, leading to unmet dietary requirements. The COVID-19 pandemic has exacerbated access to healthcare and nutrition services, potentially affecting stunting prevalence. This study aims to identify the risk factors related to the incidence of stunting in children aged 12 to 59 months in the Special Region of Yogyakarta (DIY) Province during the COVID-19 pandemic era. Materials and Methods: This study analyzes the data from the 2021 Indonesian Nutritional Status Study (INSS) in the Yogyakarta Special Region Province (DIY) using a cross-sectional approach. A total of 2,391 toddlers aged 12 to 59 months who met the inclusion criteria were included. Logistic regression analysis was conducted to assess stunting prevalence and identify contributing risk factors. Results: The prevalence of stunting among children aged 12 to 59 months in DIY Province is 16.9%. Significant contributing factors include maternal education (OR = 1.39, 95% CI: 1.08–1.81), participation in child growth monitoring at integrated health post services (posyandu) (OR = 1.65, 95% CI: 1.05–2.59), and nutritional counseling for mothers of toddlers, which was associated with a lower risk of stunting (OR = 0.37, 95% CI: 0.24–0.56). Conclusion: Maternal education, child growth monitoring at posyandu, and nutritional counseling are crucial factors in preventing stunting, particularly during a pandemic. More intensive policies are needed to enhance maternal access to nutritional and child health services to reduce stunting rates further.

Pratik Salve   Sheela Upendra   Shital Waghmare   Dipali Dumbre   and Betsy Zacharias   

The agricultural sector holds significance in the economies of numerous countries and is a vital component of local communities, offering stable employment and a reliable source of income for many families. This pursuit necessitates farmers to embrace modernization with a particular emphasis on the application of pesticides to mitigate the impact of pests on crops. The immediate impacts of pesticides on human health, particularly those associated with widely used pesticides, are widely recognized. The objective was to explore the possible health effects due to pesticide exposure among farmers. Search was conducted on different research databases for the related researches using the keywords ‘Pesticides and Farmers health', along with the use of BOOLEAN operators for precise searches. Studies from across the globe between 2018 and 2023 were reviewed, scrutinized and selected. This review had identified the detrimental health impacts arising from occupational exposure to pesticides among agricultural workers globally. These conditions encompass alterations in haematological parameters, respiratory complications, disruptions in endocrine function, neurotoxic effects, infertility concerns, genetic alterations, and disturbances in sleep patterns. These results are an alarm to enhance regulations, farmer education, and compliance for safe pesticide use. Furthermore, application of strict policies to promote integrated pest management and organic farming through subsidies, technical support, and awareness to reduce chemical reliance, protecting human health, the environment, and ensuring sustainable agricultural practices is a necessity.

Mehdi Rahmaoui   Achraf Chakir Baraka   Ahssaine Bourakadi   Nada Yamoul   Hamid Khalifi   and Abdellatif Bour   

The analysis of food security indices in Morocco enabled the study to be specified in terms of forecasting the prevalence of undernourishment as a % of the population in Morocco during the period between 2001 and 2002, while also analyzing the post and past COVID-19 periods. In this context, the modeling of the prevalence of undernourishment as a % of the population using explanatory variables such as the inflation rate and the consumer price index (CPI) produced a very powerful model, characterized by a very high correlation coefficient of 95.2%, in addition to the very high significance of the explanatory variables as demonstrated by statistical tests. Moreover, the predictions were generated using an ARIMA model, specifically an AR(2) model. The ARIMA (AutoRegressive Integrated Moving Average) model is able to forecast time series by combining three components: AR (regression on past values), I (differentiation to stabilize the series), and MA (incorporating previous forecast errors). Consequently, these predictions rely on correlated data. The research emphasizes the significance of methodological decisions when evaluating the prevalence of undernourishment, as a percentage of the population, in Morocco. By comparing, the two approaches: multiple regression models, and ARIMA time series models, the results obtained indicate forecasts of 8.69% and 5.91% respectively for the year 2024. The notable difference between the two forecasts highlights the importance of understanding the context and limitations of each model. The 8.69% forecast of the multiple regression models could reflect expectations based on external factors of concern for the year 2024, while the lower 5.91% forecast of the time series may mean that the observed trend is more optimistic. All the data and results come respectively from the World Bank's official website and the R software.

Mira Sri Gumilar   Suhartono   and Andre Wilia Putra   

Malnutrition causes half of all deaths in children under the age of five. One of the most common malnutrition in children is stunting. It can lead to impairments in children's growth and development, including disruptions in oral health. Muaro Jambi Regency is one of the districts within Jambi Province with a stunting prevalence of 18.6 % in 2024. Many studies have demonstrated several risk factors for the development of dental caries including parental income, oral hygiene practices such as tooth brushing habits, consumption of sugary foods, intake of sweetened beverages, access to healthcare facilities, and formula milk feeding. This study aims to identify the association of risk factors for dental caries in children with stunting and to examine how these associated factors can predict the likelihood of dental caries in children with stunting. This research study was a quantitative analytical observational with a cross-sectional design study. The study was conducted in Muaro Jambi Regency from May 2024 to August 2024. The sample of this study was 65 stunted children. Dependent variables, def-t, were measured through a clinical examination of the oral region, while the independent variable was obtained from completing survey questionnaires. The research result in the last model of multiple linear regression analysis showed several variables were associated with the experience of dental caries index: the child's age, distance to healthcare facilities, frequency of consuming rich sugar foods, and duration of formula milk feeding. This research can support the government of Muaro Jambi Regency in reducing the risk of stunting comprehensively, including in dental and oral health aspects. Knowing the prediction of the caries experience index in stunted children will be the basis for carrying out dental and oral health promotion and education programs.

Emmanuel C. Ibrahim   Iyinami J. Afen   Olugbenga Ayeni   Ignatius O. Omuh   and Rapheal A. Ojelabi   

Exposure to indoor air pollution for a long time can negatively affect the health and well-being of university hostel users. This study assessed the concentrations of indoor air pollutants and perceived health risks in five (5) university hostels in southwestern Nigeria. The study used a self-assessment and field measurement approach to examine the health risks associated with Indoor Air Quality (IAQ) among university students. The concentrations of indoor air contaminants (CO₂, TVOC, CH₂O, PM1.0, PM2.5, and PM10) were measured using an IAQ monitoring device. A quantitative research design was used, with 103 (n=103) copies of the questionnaire used for analysis after retrieval from the 121 that were distributed to the student occupants. Findings from objective measurement revealed the mean temperature value ranged from 28.78℃ to 31.22℃ and the mean relative humidity values ranged from 88.00% to 91.66% across the hostels for the ground and upper floors respectively. For IAQ contaminants, the study revealed the highest mean concentration for CO₂, TVOC, CH₂O, PM 1.0, PM2.5, and PM10 to be 483.00 ppm, 99.33 μg/m³, 0.06 μg/m³, 25.11 μg/m³, 41.44 μg/m³ and 53.44 μg/m³ respectively. Findings from ANOVA revealed that there was a significant difference (P>0.05) in the mean concentration values of IAQ parameters between the hostel and floor levels. However, the findings from the health risk assessment revealed that during occupancy, the students reported major respiratory symptoms such as sore or dry throat, nasal congestion, and sneezing attacks. Also, general health symptoms include fatigue, unusual thirst, and headaches among others. The study concludes that the hostels' acceptability with the IAQ is average based on the subjective IAQ assessment. Based on the objective assessment, the mean concentrations of TVOC and CH₂O were found to be within an excellent class for acceptable IAQ across all the hostels except for particulate matter (PM2.5 and PM10) which are found to have exceeded the NESREA standard (PM2.5<2.5; PM10<20) for an excellent IAQ class across all the hostels. Therefore, the study recommended adequate particulate matter (PM2.5 and PM10) monitoring within the hostels, and the development and implementation of indoor air quality health risk mitigation strategies by the university authorities.

Kasil Rokhmad   Hari Basuki   and Stefanus Supriyanto   

Introduction: The finding of type 2 Diabetes Mellitus (DM) cases in 2021 in Tulungagung Regency at the age of ≥15 years only reached 0.08% (7182 cases out of a target of 833,529 people), a very small finding when compared to the 10.8% prevalence of Diabetes Mellitus (DM) in East Java. GESER JADI MANTUL program is an innovative breakthrough in Tulungagung for early detection of type 2 Diabetes Mellitus (DM) in ≥15 years old by finding the risk of type 2 Diabetes Mellitus (DM) and prediabetes. Aims: This study aimed to analyze the effectiveness of GESER JADI MANTUL implementation in increasing the early detection of type 2 Diabetes Mellitus (DM). Methods: Cross-sectional analytic study with data analyzed from GESER JADI MANTUL outcome reports at 32 Puskesmas in Tulungagung through t-test and simple linear regression. Results: The t-test results on the achievement of early detection of type 2 Diabetes Mellitus (DM) in 2021 and 2023 obtained a p-value = 0.003, indicating an increase in the achievement of early detection of type 2 Diabetes Mellitus (DM) before and after GESER JADI MANTUL. A simple linear regression test on the accomplishment of early detection of type 2 Diabetes Mellitus (DM) in 2023 against the findings of prediabetes in 2023 and the risk of type 2 Diabetes Mellitus (DM) obtained a value of p = 0.006 and p = 0.000, which means that there is a relationship between the achievement of early detection of Diabetes Mellitus (DM) with the findings of prediabetes and the risk of type 2 Diabetes Mellitus (DM). Conclusions: GESER JADI MANTUL effectively increases the achievement of early detection of type 2 Diabetes Mellitus (DM), the finding of type 2 Diabetes Mellitus (DM) risk and prediabetes.

Juanda   Tien Zubaidah   Syarifudin A.   Abdul Haris   and Satria Apriza   

Dermatitis is a prevalent skin condition that can significantly impact the quality of life. While various factors contribute to its development, personal hygiene and environmental sanitation roles have been increasingly recognized. This study explored the relationship between personal hygiene practices, environmental sanitation factors, and dermatitis incidence in Banjarmasin City, Indonesia. A cross-sectional survey was conducted with 62 respondents, assessing multiple aspects of personal hygiene (hand, foot, nail, and skin cleanliness) and environmental sanitation (waste disposal and water quality). Data were collected through structured questionnaires and observational checklists, followed by statistical analysis using chi-square tests. Results revealed that a substantial proportion of respondents exhibited poor hygiene practices, with 53.2% demonstrating inadequate hand hygiene, 48.4% showing poor foot and nail cleanliness, and 46.8% displaying suboptimal skin hygiene. Environmental factors were also concerning, with 61.3% of respondents having inadequate wastewater disposal facilities and 62.9% facing poor waste management systems. Statistical analysis indicated significant associations between these factors and dermatitis incidence (p < 0.05), with poor personal hygiene and inadequate environmental sanitation strongly correlated with higher rates of dermatitis. These findings underscore the importance of improving personal hygiene practices and environmental sanitation measures in reducing dermatitis incidence and promoting overall skin health. The study contributes to the growing body of evidence linking hygiene and environmental factors to dermatological conditions, offering valuable insights into public health interventions. However, limitations include the relatively small sample size and the focus on a single urban area, which may limit generalizability. Future research should consider more significant, diverse populations and longitudinal designs to establish causal relationships. Practical implications include the need for targeted education programs on proper hygiene practices and advocacy for improved urban sanitation infrastructure. From a social perspective, addressing these issues could significantly improve community health and well-being, particularly in rapidly developing urban areas facing sanitation challenges.

Andi Rafika   Syamsuar   Hasnawati Amqam   Erniwati Ibrahim   Wahiduddin   and Balqis   

Waste Organic consists of food scraps, agricultural waste, and other natural materials that can be decomposed and returned to the environment. Incinerators are one of the best technologies for waste management. Liquid smoke is a distillation or condensation of vapor from indirect or direct combustion of materials that contain a lot of carbon and other compounds. This study aims to analyze the quality of liquid smoke produced by smokeless waste combustion devices using organic waste. This research is a quasi-experiment, analyzing the quality of liquid smoke produced from burning organic waste based on the duration of burning time. Based on the duration of burning time of 15 and 25 minutes the results of the analysis on the parameters of total acid, total phenol, N-Total, phosphorus, potassium, C-Organic, and pH in the samples of straw waste, coconut pulp waste and food waste have no effect or no significant difference in the quality of the parameters tested. This can be seen from the significant value (sig) which has a value> 0.05. The quality of liquid smoke produced using a smokeless waste combustion device has not met the standards of the Decree of the Indonesian Minister of Agriculture number 261/KPTS/SR.310/M/4/2019 concerning minimum technical requirements for organic fertilizers. Smokeless waste combustion devices can be used to process waste but the liquid smoke produced cannot be used as liquid organic fertilizer.

Baha'a M. Abu Salma   Omar Albogai   and Mohammed O. Ibrahim   

Adolescents are increasingly using digital devices, leading to a sedentary lifestyle and unhealthy eating habits, which in turn increases the risk of obesity. The study explores the relationship between screening time exposure and the prevalence of obesity among adolescents. A cross-sectional study was conducted on (n = 511) adolescents. A structured questionnaire was used to determine socio-demographic data and dietary and physical activity patterns. Body mass index adjusted for age was used to determine obesity levels. Multiple logistic regression was used to predict the probability of obesity based on screen time. The prevalence of obesity was higher among late adolescents aged ≥ 18 years by 44.4%. The overweight group (84.9%) tended to consume more than four meals per day, and 47.3% practiced physical activity less than one time per week. In addition, there is a positive correlation between electronic screen time and body mass index, and the odds of being overweight are 4.5 times higher when exposed to 2-3 hours of smart screen time than in the unexposed group. Prolonged screen time contributes to a sedentary lifestyle, unhealthy eating habits, and increased risk of obesity among adolescents. Public health policies should limit school screen time activity and increase physical education.

Tria Astika Endah Permatasari   Yudi Chadirin   Ernirita Ernirita   and Munaya Fauziah   

The decline in stunting prevalence in Indonesia in the last three years has not met the target of 14% in 2024. In fact, the stunting prevalence in the current year is 21.5%. Early detection of stunting risk is needed by optimizing the use of digital technology to identify and prevent stunting quickly and accurately. The purpose of this study was to analyze the effectiveness of an Android-based application for stunting risk detection in children under five in urban and rural areas in West Java Province, Indonesia. A cross-sectional study was conducted during April-September 2024 on 384 mother-child pairs living in urban (Bogor City) and rural (Bogor Regency) areas in West Java Province, Indonesia, namely 192 mother-child pairs each were selected using a proportional random sampling technique. The android application was used to identify the risk of stunting based on indicators of mother-toddler characteristics, nutrition, and sanitation. The accuracy of the stunting risk detection using an Android-based application shows that the Area Under Curve (AUC) was used which was analyzed using the Receiver Operating Characteristics (ROC) Curve method. Of the 384 children involved in this study based on anthropometric measurements, the stunting rate is still high and not yet according to the target of 14%, where there are about one third of stunting children, which is 30.4%. From this figure, there are 28.6% of stunting children in urban and 32.3% in rural. This application has high accuracy for detecting stunting risk in both urban and rural areas, namely with sensitivity, specificity, and Area Under Curve (AUC) for each region of 92.4%, 89.6%, 90.1%, and, 89.8%, 87.7%, 89.9%, respectively. Android-based application is effective in detecting the risk of stunting with a higher level of accuracy in urban areas than in rural areas. The use of applications needs to be integrated with health services to facilitate prevention and handling of stunting quickly and accurately.

Dewi Puspitaningrum   Dian Nintyasari Mustika   Ani Amelia Zainuddin   and Dian Yunita Sari   

Background: According to the World Health Organization (WHO), young women in low and middle income countries experience significant knowledge gaps about reproductive health. In Indonesia, studies have shown that young women are unable to access adequate comprehensive reproductive health education. The GLOW program was established to address this challenge by providing accurate reproductive health education to young women. However, little is known about the specific needs and experiences of young women in relation to the program. This study aims to identify and explore young women's reproductive health needs through the GLOW Program. Materials and methods: Data were collected through semi-structured interviews with 50 young women aged 14-18 years who participated in the GLOW program perspective. Results: On average, 50% of young women very rarely get information about reproductive health; on average, 50% of young women are not comfortable when discussing it in class, because there are friends with different genders in the classes and reproductive health is a private matter, especially for young women who really need a program in schools in the form of reproductive health education that could form understanding and be interesting. Conclusion: Reproductive health programs for young women are an important part of health promotion efforts and need to be developed according to the young women. Based on the findings above, there are several important points that need to be studied in the context of services needed by young women in increasing knowledge, attitudes, beliefs, awareness, and reproductive health practices

K. Maheswari   R. Malathi   S. Rajeswari   and A. Sheik Abdul Salam   

Menopause impacts women differently, with variations based on factors like socioeconomic status and healthcare. The objective of this research is to investigate the economic situation and symptoms of menopausal women in Perambalur district. This descriptive research centered on menopausal females living in urban and rural parts of Perambalur district. 55 participants were selected using a purposive sampling technique. Information on demographics, menopausal symptoms, and their impact on everyday activities was gathered using a questionnaire. The findings were interpreted by SPSS software. Prior studies have emphasized the diverse range of menopausal symptoms and underscored the significance of acknowledging their frequency and effects on women's overall well-being. Symptoms like hot flashes, disrupted sleep, and psychological impacts have been observed in various groups, highlighting the importance of personalized treatment plans. The findings reveal that a substantial proportion of females experienced severe symptoms, with hot flashes (81.8%), vaginal dryness (92%), and lack of concentration (85.5%) being particularly prevalent. Notably, 41.8% of participants reported that their daily routines were significantly disrupted. This research emphasizes the importance of specific health interventions and support systems to tackle the difficulties experienced by menopausal women in India.

Piau Phang   Saira Aslam   Jane Labadin   and Vivek Jason Jayaraj   

The spatiotemporal correlation in disease incidence rates resulting from the spatial arrangement of neighboring geographical units is often conceptualized through constructing contiguity-based spatial weights. However, these weights specifications are not meant for capturing the spatial relationships across multiple spatial scales and disjoint spatial units. Modifications to existing spatial weights specifications are highly required. Hence, this study used supra-adjacency matrix in network science to analyze the spatial autocorrelation of COVID-19 incidence rates at Sarawak's district and Malaysia's state levels. Flight routes between these regions were embedded as spatial interaction submatrix to represent their inter-layer adjacency. Segmentation of data based on respective Sarawak's and Malaysia's daily cases was conducted to investigate the consistency in the spatial autocorrelation and the type of local clustering. When global spatial autocorrelations at state level were high, both the Sarawak districts' and Malaysia states' incidence rates became more spatially related with the inclusion of spatial interaction. Several districts, including Sibu, in Sarawak were now classified as high-high cluster with supra-adjacency weights. These high-high clusters can only be discovered with second-order contiguity weights in previous literature. The numbers of significant spatial clusters and outliers in district level were substantially greater than its state-level counterpart. This research provides evidence on how spatial dependencies of disease incidence rates between two spatial aggregation levels and geographically disjoint regions can be quantified using supra-adjacency matrix for disease surveillance. Capturing inter-layer spatial dependencies allows for more targeted interventions such as optimizing vaccine distribution and planning mobility restrictions during pandemics.

Wahyuningsih   Sri Sulistyowati   Retno Setyowati   and Sri Mulyani   

Pregnancy planning is one effort to achieve a quality family. However, pregnancy planning by women of reproductive age is still poor, such as an unmet need for family planning due to a lack of health promotion efforts. This study aims to identify the health promotion needs of women of reproductive age based on social capital in Bantul, Indonesia. This study employed a phenomenological approach. The number of participants was 19 people, consisting of women of reproductive age, representatives of the population control service, field instructors, midwives, and cadres. Data collection was carried out using semi-structured interviews, focus group discussions (FGD), and document recording from September 2022 to April 2023. Data analysis uses Colaizii. The results of this study show that the health promotion appropriate in rural areas is 1) strategy: mentoring by cadres and midwives through blended learning; 2) media: module; 3) method: discussion and independent learning; 4) material: quality families, family planning, pregnancy and reproductive health. The results of this study can be used as a health promotion strategy in improving pregnancy planning for women of reproductive age in rural areas.

Thonaeng Charity Molelekoa   and Abayomi Samuel Oyekale   

Health insurance is one of the major pillars of achieving the Universal Health Coverage, as emphasized in the Sustainable Development Goals (SDGs). However, in Mozambique, although the national health system is confronted by several limitations, uptake of health insurance is not emphasized by stakeholders in the health sector. This paper therefore analysed the determinants of health insurance subscription among women of reproductive age in Mozambique. The data were the 2022/23 data for the Demographic and Health Survey (DHS) which covered 9788 women in the 15-49 years age bracket. The data were analysed with Probit regression. The results showed a very low health insurance subscription (1.69%). Additionally, 31.50% of the women with higher education had health insurance. The Probit regression results showed that the probability of insurance subscription among the women was significantly promoted (p<0.05) by access to the internet, reading newspaper, perception of good, moderate and bad health status, ownership of bank account, working, and wealth index, while residence in some regions (Inhambane, Gaza, and Sofala), and religion affiliation (Evangelical/Pentecostal and no religion) reduced it. It was concluded that in the light of prevailing constraints confronting attainment of UHC in Mozambique, there is the need to create media and internet driven advocacies to promote health insurance subscription with more focus on the wealthy, working class, urban residents and educated women.

Heru Andika   Anton Komaini   Yayang Yulia Sari   Sri Gusti Handayani   Firunika Intan Cahyani   and Varhatun Fauziah   

This study aims to analyze how the environment and local culture influence the formation of the character of children in the interior (Mentawai) and urban children (Padang City). The research method used is quantitative using comparative analysis, involving a sample of 104, consisting of 52 children in the interior and 52 children in the city. Sampling using the purposive sampling method, the requirements for participants are children in the interior (Mentawai) and urban (Padang City) with an age range of 7-10 years. Data collection using questionnaires, after the data are obtained, data analysis is continued using the Smirnov Kolmogorov and Independent Sample t-Test using the IBM SPSS V24 program. According to the results of this study, it is conveyed that the local environment and culture have a positive influence on children's character as seen in the sig result 0.000 <0.05, then it can be conveyed that there is a difference in the average character of rural children and urban children, from 52 rural children 111.21 and 52 urban children 103.73, and from the average results, the character of rural children is better than urban children. Local culture has a positive impact on children's character, seen from rural children who are still thick with culture that shows the values of courage, togetherness and independence in their daily lives, in contrast to urban children who are predominantly individualistic and very dependent on existing technology. For future research, it can expand the sample such as getting representatives from various local cultures in Indonesia so that it can be generalized.

Haewon Byeon   

This study seeks to conduct an in-depth analysis of the key factors influencing the health-related quality of life (HRQoL) in patients suffering from both hypertension and diabetes, and to develop a predictive model based on these factors to propose personalized health management strategies for individual patients. In particular, the study seeks to address existing data imbalance issues and improve prediction accuracy using Cost-Sensitive Boosting techniques, thereby enabling a more precise evaluation of various health conditions. This research employed data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES) conducted by the Korea Disease Control and Prevention Agency from 2010 to 2012. A total of 1,240 patients diagnosed with both hypertension and diabetes were selected as the study subjects. A predictive model for HRQoL was constructed utilizing Cost-Sensitive Boosting techniques, and its performance was compared with traditional machine learning methods such as SVM, Bagging, Boosting, and Random Forest. Additionally, variable importance analysis was conducted to ascertain the key factors affecting HRQoL, and multiple quantile regression analysis was employed to deeply interpret the individual and interactive impacts of these components. The Cost-Sensitive Boosting model exhibited enhanced performance across all evaluation metrics compared to other models, achieving an accuracy of 0.85 and an F1 score of 0.86, indicating high reliability in HRQoL prediction. Variable importance analysis revealed that weight gain, depressive mood, activity limitations, perceived stress, and subjective health status were the most significant factors impacting HRQoL. Quantification of these factors' effects confirmed the need for intervention strategies focusing on weight management, mental health support, enhancing activity, stress reduction, and patient education. This study identifies the key factors affecting the HRQoL in patients with both hypertension and diabetes, providing crucial foundational data for future personalized health management and policy formulation. The high predictive performance of the Cost-Sensitive Boosting model suggests it can be a powerful tool for predicting and managing complex health conditions. These findings require further validation through longitudinal studies across diverse populations, which can contribute to the development of more sophisticated and effective health management programs.

Anju Shaju Areeckal   Nayanatara Arunkumar   and Anu Shaju Areeckal   

The incidence of obesity is increasing among the elderly population in India, potentially leading to a heightened incidence of non-communicable diseases. The purpose of this study is to compare general and central obesity between elderly men and women living in Mangalore city in South India. One hundred and sixty people, 60 years of age and older, participated in a community-based cross-sectional study. Anthropometric measurements are determined according to the standard guidelines of the World Health Organization. Body Mass Index (BMI) is computed and categorized using the BMI classification specific to the Asian population. Data are analyzed using SPSS software. The student's unpaired t-test is used to evaluate statistical differences across groups. The results indicate that 18.8% of elderly men and 37.5% of elderly women are classified as having general obesity or being overweight. The mean waist circumference is significantly higher in elderly women (88.54 ± 11.05 cm) compared to their male counterparts (84.69 ± 13.56 cm) with p < 0.05. Central obesity is prevalent in 66.2% of elderly men and 83.8% of elderly women. The findings underscore an increased prevalence of general obesity in older women when compared to elderly men in this urban cohort. Additionally, elderly women exhibit greater waist and hip circumferences than men. However, no significant difference is observed in the waist-hip ratio between the genders. These findings demonstrate the need for gender-specific interventions to address obesity and related health risks in the elderly urban population of India.

Bishweshwar Bhattacharjee   Bireshwar Bhattacharjee   and Santanu Choudhury   

A mobile phone is an electronic device designed for communication. Smartphones have become incredibly versatile and robust over time, enabling users to accomplish a wide range of tasks, which can often lead to excessive or improper use, which can harm health, especially causing various mental issues. This phenomenon is widespread among adolescents/students. Against this backdrop, the primary objective of the present study is to explore the link between smartphone addiction and mental health among graduate students in South Assam. This investigation is based on primary data collected from premier colleges of South Assam. To analyse the data, initially, the Chi-square test is applied, and then ordinal logistic regression, a more robust technique for examining the relationship between variables, is employed. We found that addiction levels varied, reflecting diverse usage habits integral to modern life. The Chi-square tests also indicated a significant association between smartphone addiction and mental health. Regression analysis further revealed a negative influence of mental health on smartphone addiction, suggesting the fact that better mental health correlates with lower addiction levels. So, promoting healthy habits and awareness of risks associated with smartphone use is crucial for building a healthy and sustainable society.

Amal A. Murad   

Background: Human papillomavirus (HPV) is a major contributor to cervical cancer worldwide, posing a significant public health concern. In Saudi Arabia, multiple studies have investigated the levels of awareness and attitudes regarding HPV vaccination; however, gaps in knowledge and willingness to vaccinate persist, particularly among young women. Aim: This study aimed to evaluate the awareness, attitudes, and willingness to receive the HPV vaccine among female university students in Saudi Arabia, with a focus on identifying factors influencing vaccine acceptance. Methods: A cross-sectional study was conducted from March to July 2023 using an Arabic-language electronic questionnaire. The study population comprised female Health Sciences students enrolled at Taibah University in Al Madinah, Saudi Arabia. Data were analyzed using the chi-square test and Pearson's correlation coefficient to identify associations between demographic variables and levels of awareness and attitudes toward HPV vaccination. Results: A total of 946 female students participated in the study. The findings revealed that 63.3% of participants demonstrated satisfactory knowledge regarding HPV and its vaccine, while 61.7% expressed positive attitudes toward HPV vaccination. Despite this, only 32.9% of respondents reported willingness to receive the vaccine. Significant associations were observed between participants' awareness and demographic factors, including age, academic year, and college type (p < 0.001). Conclusions: The awareness and attitudes of female university students play a pivotal role in shaping their willingness to receive the HPV vaccine. Enhancing educational efforts on HPV and its vaccine is essential to address misconceptions, improve knowledge, and increase vaccine uptake. This study underscores the importance of integrating targeted health promotion initiatives and nursing interventions to foster positive behavioral changes and improve vaccination rates.

N'Kpkingou Théodore Nadakou   Moussiliou Noel Paraïso   Maurice Agonnoude   Jean Blaise Yobo   Ounoussa Tapha   Charles Patrick Makoutode   Joel Sodjinou   and Éric Omar Adehossi   

Introduction: Malaria infection is prevalent in the West African region more than any other region of the continent. To effectively combat this pathology, Seasonal Malaria Chemoprevention (SMC) has been recommended by WHO since 2012. Our objective is to evaluate the extension of seasonal malaria chemoprevention to 5 cycles and to children aged 6 to 9 years in Niger. Method: We conducted an observational case-control study in which we formed two groups for each of the SMC extensions. It took place in the departments of Damagaram Takaya, Takéita and Zinder city town (Zinder region). Children under 5 and those aged 6 to 9, targets of this survey, were randomly selected. The Excel file was used for graphic representations and the SPSS file for coding and analyses. We used descriptive statistics, comparison analyses, chi-square and Fisher tests. Results: The incidence of malaria was 56.5% in children under 5 years of age in the control group compared to 3.5% to 4.5% in children in the intervention group. The extension of SMC to five cycles significantly reduced the risk of malaria infection in children under 5 years by between 72% and 96.4%. It caused 11.8% of side effects in children under 5 years of age and 26% in children aged 6 to 9 years. Conclusions: The extension of SMC to five cycles and to children aged 6 to 9 years significantly reduces malaria incidence among the targeted children. In view of the significant results from the pilot phase, the Niger NMCP can gradually implement the extension of SMC on a national scale.

Wanwisa Chaprasit   Phannathat Tanthanapanyakorn   Sirivimon Peekong   Nathnapa Nam-in   Sukanya Prasertnok   Orasa Bunmee   Nonlapan Khantikulanon   Sootthikarn Mungkhunthod   and Chaninan Praserttai   

Currently, the number of diabetes patients is increasing each year, and this may lead to complications if they do not engage in proper self-care behaviors. This research investigated the effects of a holistic self-care program on diabetes among patients with diabetes mellitus in a rural area of Sa Kaeo Province, Thailand. This research was a quasi-experimental study utilizing a two-group pretest-posttest design, which assessed outcomes before and after the intervention over three months. Participants were recruited from diabetes mellitus patients diagnosed by medical doctors and registered for treatment at the Khlong Kai Thuen Sub-district primary healthcare centers. These patients were over 35 years old and voluntarily participated in the program. The sample consisted of 70 participants, divided into intervention (n=35) and control (n=35) groups through simple random sampling based on participant identification numbers drawn by lottery. The control group received standard care and a self-care behavior booklet. In contrast, the intervention group engaged in a 12-week holistic self-care program, meeting bi-weekly for six sessions. Outcomes were measured using interview forms and blood glucose tests. The data were analyzed with descriptive statistics, paired t-tests, and independent t-tests. The findings indicated that after three months, the intervention group showed significantly reduced blood glucose levels and increased knowledge about diabetes and self-care behaviors compared to the control group (p < 0.001). Additionally, the intervention group demonstrated significantly reduced blood glucose levels and enhanced knowledge about diabetes and self-care behaviors compared with pre-intervention levels (p < 0.001). The holistic self-care program has proven effective in lowering blood glucose levels for diabetes mellitus patients. Healthcare providers can incorporate this program to change the behavior of diabetes patients, working alongside local administrative organizations to mitigate potential complications from chronic diseases.

Siti Fatmala Rezeki   Syahrir A. Pasinringi   Fridawaty Rivai   Lalu Muhammad Saleh   Irwandy   Ansariadi   and Balqis   

Hospitals must be able to understand the needs, wants, and expectations of customers and create value in providing services to patients. The purpose of this study is to identify various measures of potential value innovation in hospitals using a systematic review approach. A systematic review was from online journal databases that provide free journal articles in PDF format, such as: Google Scholar, ScienceDirect, and Pubmed indexed by Scopus. From 1402 articles identified in the search phase, 11 articles were eligible for inclusion in this review. The article revealed that value Innovation began to emerge from a strategy called Blue Ocean Strategy (BOS). BOS is a way that a company's strategy can create an irrefutable market space that makes competition irrelevant. Value innovation is the art of making the competition irrelevant by creating new value for customers and organizations, which can be in the form of new technologies, products or processes. Hospital innovation is the result of medical industry competition and is a necessary requirement for hospitals to maintain sustainable development. There are several dimensions for Value Innovation in general, including actors, resources, transformation, and exchange; beginners, adopters, experts, explorers, enablers, and advocates; meaningful work, risk-taking culture, customer orientation, agile decision-making, business intelligence, leadership, open communication, empowerment, business planning, learning organization, and innovation leadership.

Firda Fibrila   M. Ridwan   Herlina Herlina   I. Putu Suiraoka   and Andiyan Andiyan   

Body mass index is a measure used to assess whether a person is underweight or overweight. However, BMI does not take into account muscle mass and fat mass, making it less accurate for determining nutritional status values in this condition. The purpose of this study was to determine whether upper arm circumference has a correlation with BMI and to determine the threshold value for detecting undernutrition in adolescent girls aged 15 to 19 years. This study used a cross-sectional design involving 380 healthy adolescent girls. Anthropometric measurement procedures are implemented under strict supervision after obtaining consent from respondents. There is a strong correlation (r = 0.841) where the effect of MUAC variables on BMI variables was 70.7% (R square =0.707, p = 0.000), AUC of 0.899 (95% CI: 0.86 - 0.92) for MUAC on BMI, sensitivity = 0.896, specificity = 0.711, PPV = 0.869, and NPV = 0.761. The cutoff value was 23.7 cm and the Youden Index was 0.647, with a good accuracy value of 83.68%. MUAC has good accuracy and is supported by a strong correlation to detect nutritional status in adolescent girls aged 15 to 19 years, where the resulting sensitivity and specificity are high. This study also produced a cutoff value that was not much different, namely 23.7. Based on these results, MUAC can be recommended for early assessment in the detection of malnutrition in adolescent girls. The drawback of this study is the relatively small sample size.

Ghazwan Alhashem   

End-stage renal disease patients undergoing routine hemodialysis procedures are at high risk of mental health deterioration including depression. The objective of the current study is to assess the prevalence of depressive symptoms among Iraqi hemodialysis patient and their association with sociodemographic factors. A cross-sectional multi-center study was conducted at 5 major hemodialysis centers in Iraq from July to December 2023. PHQ-8 scale was applied to assess depression among study participants using a cut-off score of 10 to determine the presence of depression. Chi-squared and logistic regressions were performed to investigate the association between the presence of depression and other sociodemographic data. A total of 341 chronic renal failure patients undergoing hemodialysis were included. The sample comprised 211 (61.9%) males and 130 (38.1%) females, with age groups represented as follows: 244 (71.6%) adults and 97 (28.4%) elderly. Hemodialysis frequency included 157 (46.0%) once a week, 97 (28.4%) twice a week, and 87 (25.5%) thrice a week. Work problems due to hemodialysis were reported by 122 (35.8%) participants, while financial issues, side effects, and negative hepatitis tests were prevalent among the majority 269 (78.9%), 302 (88.6%), and 286 (83.9%) respectively. Different age groups experience adverse effects and negative hepatitis showed a significant association with the presence of depression (> 10 PHQ-8 score) in both chi-square and binary logistic regression tests ( < 0.05). The prevalence of depression among hemodialysis patients is higher than the global average. Elderly patients and coexistence of side effects showed a higher depression level, while, interestingly, depression seems lower in hepatitis-positive patients in the current study sample. Iraqi hemodialysis patients would benefit from mental health support, and further experimental studies are needed to comprehend the multifactorial causes of depression for such patients.

Myroslava Sadova   Galyna Lapshun   Viktoriia Savishchenko   Yana Raievska   and Hanna Voshkolup   

This study is focused on identifying effective psychological intervention methods for individuals in challenging circumstances. The aim is to evaluate the influence of these interventions on the emotional well-being and adaptive capacities of those in difficult life situations. To achieve this, we utilised the Beck Depression Inventory, Impact of Event Scale-Revised, and General Health Questionnaire as assessment tools. The interventions used were Eye Movement Desensitisation and Reprocessing, Emotionally-Focused Therapy, Rational-Emotive Behaviour Therapy, and Psychological First Aid. We conducted a statistical analysis using t-test and ANOVA. The results revealed a significant decrease in stress levels in the intervention groups. Group A saw a reduction from an average stress score of 35 at the start of the experiment to 22 at the end. In group B (emotion-focused therapy), the level decreased from 32 to 25, and in group C – from 30 to 24. Group A showed a decrease in anxiety levels from 55 to 42 (p = 0.003), while Group C experienced a reduction from 53 to 40 (p = 0.001). Both groups also reported better quality of life scores post-intervention, highlighting the effectiveness of their respective therapies. However, control group D (psychological first aid) slightly reduced from 33 to 31, indicating lower effectiveness than other methods. We found that short-term psychotherapeutic methods, such as eye movement desensitisation and rational-emotive therapy, significantly reduce anxiety, depression and social difficulties, unlike standard support. This study underscores the need for further research to enhance our understanding of the effectiveness of these interventions in diverse settings.

Anafrin Yugistyowati   Ari Probandari   Muhammad Akhyar   and Suminah   

Low birth weight (LBW) presents children with a higher risk of health problems and complications over their life course. Prevention efforts are largely carried out through health promotion programs for pregnant mothers, including monitoring those deemed to be at risk, measuring nutritional status, and ensuring timely prenatal care. These programs rely on community health workers—or ‘cadres' as they are known in Indonesia—who serve as intermediaries between the health system and the community. However, cadres often face challenges in carrying out their duties which can impact the effectiveness of LBW prevention program implementation. This study aimed to explore experiences and challenges in implementing LBW prevention programs for cadres. A qualitative study design with a descriptive phenomenological approach was used, which included a semi-structured interview guide. In-person interviews (n=11) were conducted with cadres who were active in the community and had at least one-year of experience. Interviews were recorded and transcribed, and analyzed using inductive content analysis. Our analyses revealed two main themes: (1) experiences associated with the implementation of LBW prevention programs and (2) perceived challenges. Unsurprisingly, we found that the perceived challenges faced by cadres in our sample greatly influenced the potential impact of LBW prevention programs for pregnant women in this community. There is great need to increase the capacity and continued education of cadres in order to support them in their role and prevent future LBW cases for mothers and infants.

Faith Oluyole   and Masoud Mohammadnezhad   

In the UK, cigarette use is most prevalent among individuals aged 18–34 years, and it is a time when young people, particularly university students move from smoking occasionally to smoking regularly. This study aimed to explore students' perceptions of smoking and its cessation. This study employed a descriptive qualitative method that used in-depth interviews to collect data from study participants, and 20 students from Anglia Ruskin University were recruited using purposive sampling. Interviews were conducted with a semi-structured, open-ended questionnaire. Thematic analysis of data revealed four main themes, including: influences and triggers for initiating smoking behaviour, perceived benefits and justification for smoking, university intervention for smoking cessation support, and participants' views on programs for quitting smoking. The result shows that family expectations, stress, social acceptability, and peer influence were the key triggers for initiating smoking behaviour among students. There were various myths held by smoking students to minimise the health risks of smoking, such as the belief that physical activity counters the harmful effects of smoking. In line with existing research on prevention and treatment initiatives for smoking among college students, participants supported the enforcement of smoking bans in school environment, provision of free or affordable replacement therapies and implementation of smoke-free educational campaigns. This study emphasizes the complexity of smoking behaviour and the need for comprehensive strategies to deal with the difficulties young adults face when starting, maintaining, and quitting smoking. Policymakers and health educators should develop targeted strategies to lower smoking rates and encourage healthier lifestyles among university students.

Haripin Togap Sinaga   Marni Siregar   Berlin Sitanggang   and Mincu Manalu   

Stunting remains a critical health challenge in Indonesia, affecting approximately 27.7% of children under five years old. Despite national efforts to combat this issue, accurate detection at the community level remains problematic. There is a clear need for improved tools that can enhance the accuracy, usability, and child-friendliness of length measurements in Posyandu settings. The development of a modified length measuring board that facilitates the immediate detection of stunting is needed, particularly in resource-limited areas where traditional tools may be inadequate to use effectively. This study evaluated the effectiveness of a newly designed length measuring board in improving stunting detection in community health posts. A mixed-methods study was conducted across three locations in North Sumatera, Indonesia, involving 120 mother-child pairs and 60 Posyandu caders. The intervention introduced a new design measuring board with integrated stunting thresholds and child-friendly features. Quantitative data on measurement accuracy, efficiency, and user satisfaction were collected through standardized assessments and surveys. This was complemented by qualitative interviews to understand user experiences and implementation challenges. Stunting detection rates increased significantly, 175% (p<0.001) across all study locations. Measurement time decreased from 95.4 to 62.4 seconds (p<0.001), indicating improved efficiency. High satisfaction scores were reported by mothers (mean 9.25-9.68) and cadres (mean 9.5-9.8). Qualitative data revealed themes of increased confidence among healthcare workers, enhanced satisfaction among mothers, and improved community engagement in growth monitoring activities. The new tool demonstrated particular effectiveness in rural areas where traditional measurement methods had been most challenging. The enhanced measuring board significantly improved stunting detection accuracy, efficiency, and user satisfaction in Posyandu settings, potentially contributing to Indonesia's national stunting reduction efforts. This improved tool could strengthen community-based growth monitoring programs and support early intervention strategies for stunting prevention.

Laura Zeffira   Rifkind Malik   Ranti Gemilastari   Ghaniyyatul Khudri   Widia Sari   Annisa Lidra Maribeth   and Kurnia Maidarmi Handayani   

Low birth weight (LBW) poses significant health risks globally, including in Indonesia, impacting neonatal health and mortality rates. Maternal factor includes gestational age and nutritional status. Upper arm circumference (UAC) is used as an indicator of maternal nutritional status because it correlates with muscle mass and subcutaneous fat, which are indicators of the body's protein and energy reserves. This study explores the correlations between gestational age, UAC, and LBW at Siti Rahmah Islamic Hospital. Medical records from Siti Rahmah Islamic Hospital in Padang spanning 2018 to 2021 were analyzed. Data from mothers who delivered LBW babies were collected, focusing on maternal age, gestational age, parity, UAC, and antenatal care (ANC) visits. Pearson correlation analysis was employed for data analysis. A total of 42 samples were included in the study. Significant correlations were found between parity (r= 0.362, p= 0.019), maternal age (r = 0.392, p = 0.010), UAC (r = 0.638, p < 0.05), gestational age (r = 0.739, p < 0.05), and ANC visits (r = 0.579, p < 0.05). Higher parity, younger or older maternal age, smaller UAC, shorter gestational age, and fewer ANC visits were associated with increased likelihood of LBW. Maternal factors significantly influence LBW risk, especially gestational age and UAC (which had a strong correlation). Strategies focusing on improving maternal nutritional status, extending gestational age, and enhancing ANC utilization are crucial in reducing LBW incidence and improving neonatal outcomes. These findings emphasize the importance of comprehensive prenatal care interventions tailored to mitigate LBW risks based on maternal characteristics.

Geonel Moluba   Cedric Harville II   Xin Huaibo   and Alice Ma   

Understanding the perception of mental illness is important to implement interventions to reduce stigma, especially in the Democratic Republic of Congo (DRC). In the DRC, attitudes and behaviors toward mental health tend to be shaped by cultural and spiritual beliefs. In this study, we examined the attitude and perception of mental illness and explored its relationship with depression and stress during the COVID-19 pandemic. This study was a cross-sectional study that used snowball sampling. A total of 267 participants completed an online survey, where 87% of the participants agreed that mental illness is a disease, 90% agreed that mental illness can be cured, while 57% agreed that mental illness has biological roots. In addition, 14% agreed that mental illness is caused by someone putting a spell on you, 80% agreed that mental illness is not caused by the possession of evil spirits, 60% agreed that mental illnesses such as depression are synonymous with sadness, and 97% agreed that mental illness is not caused by God's punishment. Moreover, 54% agreed that spiritual guidance is needed when one experiences mental health illnesses, and almost 50% agreed that mentally ill people are dangerous because of violent behavior. Participants who disagreed that mental illness was caused by someone putting a spell on them and disagreed that mental illness was caused by God's punishment reported higher stress levels during the pandemic (p=0.03 and p=0.04, respectively). Those diagnosed with COVID-19 during the lockdown period reported higher levels of depression compared to those without COVID-19 diagnosis (p=0.005 and p=0.02, respectively). These results enhance the need to incorporate culturally sensitive practices into promoting mental well-being in the DRC. This would result in the creation of tailored mental health interventions for individuals affected by COVID-19 in African countries, especially the DRC.

Annisa Lidra Maribeth   Rialta Hamda   Mutiara Anissa   Widia Sari   Hanifatul Maeriza Azzahra   Rada Tri Utami   and Ghaniyyatul Khudri   

Medical students often face high academic demands that result in numerous tasks, leading to increased anxiety. This study aimed to investigate the impact of anxiety on sleep quality and psychological well-being among medical students. A literature review was conducted, analyzing four journals that focused on sleep quality and mental health. The research process encompassed defining the review focus, formulating a review strategy based on the PICO framework (Population, Exposure, Comparison, and Outcomes), and organizing data using the PRISMA flowchart for systematic reviews. Data extraction involved compiling, summarizing, and reporting results based on identification, screening, inclusion, and eligibility criteria. The findings indicated a significant relationship between stress and poor sleep quality (p < 0.05), as well as a stronger association between sleep quality and mental health disorders (p < 0.05). These results suggest that poor sleep quality is a significant risk factor for mental health disorders among medical students. The study underscores the importance of monitoring stress and promoting good sleep quality to mitigate the risk of mental health issues.

Yeni Riza   Dina Adam   Yesie Christina   Ahmad Zacky Anwary   Netty   Eka Handayani   Husnul Khatimatun Inayah   Abdul Malik   Yoneta Oktaviani   and Ari Widyarni   

The prevalence of smoking-related diseases remains high in Banjarmasin, exacerbated by frequent violations of Smoke-Free Zone regulations and insufficient enforcement by authorities. This study aims to examine the relationship between the enforcement of Regional Regulation No. 7 of 2013 on smoke-free areas and public health outcomes within the unique cultural and geographical context of Banjarmasin. A cross-sectional, quantitative study was conducted with 264 male respondents aged ≥15 years, selected through purposive sampling. Questionnaires were used to gather data, and the chi-square test was used to analyze it at the significance level of p=0.05. Furthermore, a logistic regression multivariate analysis was carried out to determine the relationship between several independent factors and the dependent variable. The study found that 183 respondents (69.3%) had public health levels, 211 (79.9%) had positive public awareness, 162 (61.4%) understood regulations, 143 (54.2%) were unaffected by the social environment, and 166 (62.9%) received health education. Significant relationships were observed between public awareness (p=0.002) and health education (p=0.001) with health status, while regulatory understanding (p=0.244) and social environment (p=0.241) showed no significant impact. Multivariate analysis indicated that public awareness (p=0.007; OR=2.410) and health education (p=0.069; OR=1.671) were the most influential factors. Public awareness and health education are crucial in improving health outcomes. The study highlights the importance of culturally sensitive approaches, such as leveraging the community-driven spirit of gotong royong (community cooperation) and integrating local religious practices in health campaigns. It recommends intensifying awareness efforts on the dangers of smoking, reinforcing the enforcement of smoke-free zones, and expanding smoking cessation programs and carbon monoxide (CO) testing, with a focus on cultural relevance and community involvement.

Susanti Niman   Timothy Rothhaar   Ira Octavia Siagian   Windu Astutik   and Rita Rahayu   

Urban life is full of challenges. The challenges faced can affect psychological conditions. The research aims to determine the mental health of urban communities. The method used is the cross-sectional research method. The research sample used convenience and probability sampling and collected 431 respondents. The instrument used was the self-reporting questionnaire (SRQ) 29. Data analysis was performed by chi-square and Mann-Whitney U test. The respondents' gender is 31.8% male and 68.2% female. The average age of respondents is 25.98 years. Mental health data: 15.3% are mentally healthy, 42% have psychological problems, 2.6% use psychoactives/drugs, 39.7% have psychotic symptoms, and 59.9% have symptoms of post-traumatic syndrome disorder (PTSD). The results of the bivariate test for gender are associated with psychological problems (p-value = 0.006) and psychoactive/drug use (p-value = 0.009), age is related to psychological issues (p-value = 0.029), and PTSD symptoms (p-value = 0.0005). The conclusion is not all urban people are mentally healthy. There are psychological problems (anxiety and depression), psychoactive/drug use and PTSD. Psychological issues are related to age and gender. Psychoactive use is related to gender, and PTSD is related to age. There is a need for mental health interventions in urban communities to maintain, improve, and overcome mental health problems. Mental health nurses can play a role in carrying out preventive, promotive, and collaborative interventions in the community.

Kihyuk Lee   

The importance of the ratio of Omega-6 to Omega-3 polyunsaturated fatty acids (PUFA) intake has not been sufficiently elucidated for the prevention of sarcopenia. The purpose of this study was to identify the cut-off value of Omega-6 to Omega-3 PUFA intake ratio (Omega-6/3 IR) for sarcopenia prevention among individuals aged 55 and older at risk of sarcopenia, and to analyze the risk of sarcopenia according to the Omega-6/3 IR based on this cut-off value. Data from 2,331 individuals aged 55 to 64 were analyzed separately for male and female. Omega-6 and Omega-3 PUFA intake levels and nutrient data were obtained through food frequency surveys, and the presence of sarcopenia was determined based on hand grip strength. Data processing for this study included chi-square analysis, independent t-tests, receiver operating characteristic (ROC) curve analysis, and logistic regression analysis. The ROC curve analysis aimed at determining the Omega-6/3 IR for preventing sarcopenia in the elderly showed significant predictive capability only for female, with an AUC of 0.653 (p<.001). The cut-off value for female was 6.777. The groups based on the Omega-6/3 IR were divided using this cut-off value. Even after adjusting for various influencing factors, the odds of sarcopenia occurrence were 2.819 times higher in the high Omega-6/3 IR group compared to the adequate Omega-6/3 IR group among females (p = 0.029). These results suggest that among female aged 55 and older, an Omega-6/3 IR of 6.777 or higher increases the risk of sarcopenia.

Dali Kekelidze   Antoine Pogorzelski   Nina Lolashvili   and Iagor Kalandadze   

Lead has been used in batteries, paints, cosmetics, and medicine throughout history. Environmental exposures of lead are in soil, drinking water, air, dust, and even food. Lead poisoning can be dangerous to human health and cause anemia, kidney dysfunction, hypertension, ischemic disease, degradation of intellectual development, logopathy, abdominal pain, etc. This pilot study aimed to analyze lead poisoning knowledge and potential risks in Batumi, Georgian Autonomous Republic of Adjara. A street-based study was carried out among 196 adult respondents using a questionnaire to analyze socio-demographic data, sources of lead poisoning information, knowledge of lead impact on human health, and potential exposure risks. Results showed that social networks were the major information source for younger adults, while for older respondents, they were primarily accessed through television. Knowledge of lead poisoning's impact on human health was low among younger respondents. Most of the participants had jobs or hobbies involving lead exposure, which can be harmful to their health. The research results indicate the necessity of implementing educational campaigns among young people through social networks and among the elderly through television. The study highlights the need to conduct broader research on lead poisoning knowledge and risks across Georgia's different regions and age groups.

Meilla Dwi Andrestian   Darmayanti   Niken Widyastuti Hariati   Netty   Ardiansyah   and Elysabeth Agnes Jaairi Coot Mau   

South Kalimantan is one of the provinces in Indonesia facing a high prevalence of stunting. Presidential Regulation No. 18 of 2020, which contains the National Medium-Term Development Plan (RPJMN) 2020-2024, affirms that Regional Governments are among the implementers in reducing stunting to 14% by 2024. Therefore, it is crucial to conduct a nutrition policy analysis to identify and evaluate existing policies and suggest steps that can be taken to address the prevalence of stunting in South Kalimantan. This mixed-method study employed an ecological design with a quantitative approach. Quantitative data comprised secondary data from the most recent Regional Medium-Term Development Plan (RPJMD) documents that have been implemented, as well as other documents used as standard references. The research focused on specific nutrition intervention programs. Additionally, primary data were obtained through Focus Group Discussions (FGDs) with Health Offices across all districts/cities in South Kalimantan. The research location was South Kalimantan Province, with 13 districts/cities as research units. Program effectiveness and budget allocation were analyzed using the Spearman test (α=0.05). Correlation analysis among programs, involved Regional Government Organizations (OPDs), and budgets with stunting prevalence was necessary to assess the effectiveness of programs, OPDs, and budgets. Statistical analysis using Spearman correlation concluded that no significant relationship was found between the number of programs and budgets with stunting prevalence. Statistical analysis for the number of OPDs was not conducted as only one OPD was involved. There is no relationship between policy budgets and nutrition intervention programs contained in the district/city RPJMDs and the prevalence of stunting in districts/cities in South Kalimantan.

Oon Sopiah   Sekar Ayu Runggandini   Nelly Apriningrum   and Citra Ayu Resita   

The postpartum period is characterized by significant physiological and psychological changes in mothers, including uterine involution, digestive system adjustments like diastasis recti, and emotional challenges such as stress and anxiety. While postpartum exercise is known to provide various benefits, many mothers lack awareness of its importance. This study aimed to educate postpartum mothers and evaluate the impact of postpartum exercise on uterine fundal height (UFH), lochia discharge, diastasis recti, and symptoms of baby blues. Using a quasi-experimental design with a comparative pre-post analysis, the study assessed the effects of postpartum gymnastics. Results indicated that mothers who did not participate in exercise experienced a more gradual decrease in UFH, with the most significant changes occurring on the 11th and 14th days. Lochia alba changes were noted on the 14th day, while the longest changes were observed on the 17th day. Diastasis recti measurements varied, with lengths ranging from 0.5 cm to 6 cm and widths from 0.25 cm to 2 cm. Baby blues assessment scores ranged from 0 to 18. Conversely, mothers who engaged in postpartum exercise showed a quicker reduction in UFH, with significant changes noted by day 6 and continuing through day 11. The transition to lochia alba occurred by day 13, with the longest changes noted by day 14. Diastasis recti measurements improved significantly, with some mothers reporting complete resolution (0 cm) in both length and width by the last measurement. Baby blues scores for exercising mothers ranged from 0 to 14. In conclusion, postpartum exercise effectively accelerates the recovery of UFH, promotes the transition to lochia alba, reduces diastasis recti, and helps mitigate baby blues symptoms. However, challenges such as limited communication and time constraints due to childcare responsibilities hindered participation in exercise programs.

Nur Khafidhoh   S. A. Nugraheni   Ayun Sriatmi   and Sri Winarni   

Adolescent girls are vulnerable to nutrition related problems, ranging from anemia, chronic energy deficiency, undernutrition and overnutrition. Organizations focused on adolescent girls can be involved through a model of mentoring to prevent nutritional issues among adolescents. The purpose of this study was to analyze the effect of organization based mentoring on improving knowledge, attitudes and behaviors in preventing malnutrition in adolescent girls. The research design was a quasi experimental pre and post-test with control group. This study involved 196 adolescent girls who were divided into intervention and control groups. Respondents were selected based on specific criteria. The study was conducted for 10 weeks. Data were obtained through structured interviews. The data were analyzed using Independent T-test and paired t-test. The results showed that there was a difference between knowledge, attitude and behavior before and after the intervention between the treatment group and the control group with p < 0.05. There was a significant increase in knowledge, attitude and behavior in the intervention and control groups. Community organization-based mentoring proved to be effective in improving adolescent health. It is necessary to strengthen regulations concerning the role of community organizations, especially adolescents regarding adolescents, by providing structured/systematic assistance and education for vulnerable groups including adolescents.

Minarni Wartiningsih   Tatas Hardo Panintingjati Brotosudarmo   May Fanny Tanzilia   David Sukardi Kodrat   and Tri Astuti Sugiyatmi   

One of the health problems that can cause stunting is anemia, a condition where the function of red blood cells (RBC) is impaired, leading to reduced oxygen transport and resulting in complications. Studies show high rates of iron deficiency and anemia among pregnant women in highland areas, especially in elderly or high-risk women. This study aims to understand the differences in behavior, eating, and drinking habits between adolescent girls in highland and lowland areas, and to explore how these habits relate to anemia, which can cause stunting. The study used a descriptive-analytic, cross-sectional design, with data from observations, interviews, questionnaires, and hemoglobin tests. Random sampling was used to gather data from 253 respondents, 105 from highland areas and 158 from lowland areas. SEM-PLS 4.0 was used to analyze the effects of tea and coffee consumption on hemoglobin levels. The results show that topography affects anemia rates in Indonesia, and that daily habits of eating vegetables, fruits, and drinking tea or coffee influence hemoglobin levels. Low hemoglobin levels in pregnant women increase the risk of stunting in newborns. The government can improve iron tablet distribution in highland areas by increasing health posts for adolescents.

Jasmine Brahma   and Konita Basumatary   

Background: Fertility differentials arise due to socioeconomic status, education, ethnicity, religion, geographic location, and cultural beliefs. Fertility differentials are essential for understanding demographic trends and planning for resources, as they impact population growth, age structure, and economic development. In this study, different factors affecting fertility have been examined. Method: This study used primary data from the Kokrajhar and Udalguri districts, Assam. Multi-stage sampling techniques were employed to collect the required data for the sample survey. Thus, 400 households comprising married reproductive women are selected as respondents. Binary logistic regression was carried out to examine the effect of different factors on fertility. Results: The results revealed that the women's age and education, work status, religion, breastfeeding, and infant or child death were the most significant variables explaining the variation in fertility differential. This shows that the odds of having more than 2 children decrease as women are more engaged in work. Similarly, the odds of women with primary education were 2.744 times higher than those of women with secondary or higher education. Furthermore, it is found that fertility is higher among women who had the death experience of an infant or child compared to those women with no such experience. Conclusion: The study reveals differences in fertility rates across various groups, influenced by education levels, economic status, employability, and other factors. The findings may lead to suggestions for tailored family planning, education, and healthcare programs that consider the unique characteristics of Kokrajhar and Udalguri, aiming to balance population growth and improve family well-being in these areas. These insights help inform local policymakers and healthcare providers about the need for targeted interventions to manage population growth sustainably. However, this study presents only two districts' scenarios, thus, generalization at the national level may not be possible, and further analysis of the remaining districts is needed to capture the overall scenario of fertility differential in Assam and the national level.

Kritsanapong Daungsupha   Nattapon Pansakun   Taweewun Srisookkum   Manuchet Manotham   Natnapa Promma   Pornpana Somjit   and Pitipong Lidchiwwong   

Background: Physical activity (PA) is widely recognized as a key factor in promoting healthy aging. However, Thailand's rapidly growing older adult population is experiencing high prevalence of physical inactivity and sedentary behavior, contributing to an increasing burden of non-communicable diseases (NCDs). This study aims to assess the levels of PA and identify the factors influencing it among older adults with NCDs in this region. Method: A cross-sectional study was conducted between March and May 2024, using multistage sampling to recruit 404 older adults. Data were collected through structured interviews and standardized assessment forms. Statistical analysis was performed using SPSS version 29.0, with results presented through descriptive statistics. Simple and multiple linear regression analyses were employed to identify factors associated with PA, with p-values <0.05 considered statistically significant. Results: The study found that over one-third (39.1%) of participants reported low levels of PA, while only 23.5% engaged in high levels, with an average total PA of 1,286.5 MET-minutes per week. Multiple linear regression analysis revealed several factors significantly associated with PA, including age group (70–79 years: B = -481.68; over 79 years: B = -556.11, compared to the 60–69 years group), occupation category (general workers: B = 671.83; others: B = 1,073.80, compared to unemployed or retired individuals), higher personal income (B = 688.66), current alcohol consumption (B = 336.19), and self-rated health status (excellent: B = 905.42, compared to poor health). Conclusion: Older adults with NCDs exhibited low levels of PA, with significant associations observed between PA and factors such as age, occupation, income, alcohol consumption, and self-rated health status. These findings emphasize the importance of policymakers and healthcare providers taking these factors into account when designing strategies to encourage PA among older adults with NCDs. Tailored interventions will be essential to effectively meet the specific needs of this population.

Anahis Xiomara Palomino   Shiry Imelda Palomino   and Juan Morales   

The aim of the study was to assess the level of e-Health literacy among users of primary health care. Materials and methods: Quantitative approach study, cross-sectional descriptive design. The population consisted of users of primary health care located in the northern area of the city of Lima, Peru. The e-Health Literacy Scale (eHEALS) was used. Results: The study involved 400 subjects of both sexes, with a median age of 35 years (Q1=28, Q3=47, IQR=19, Min=18, Max=78). The median eHEALS scale score obtained by the respondents was 18 (Q1=14, Q3=22, IQR=8, Min=8, Max=40). A mere 18.2% (n=73) of health users demonstrated a high level of e-Health literacy. The e-Health literacy was significantly associated with educational level (p<0.001, 1-β=1, ω=0.41), frequency of internet access (p<0.001, 1-β=1, ω=0.51), and autonomy in the use of digital technology (p<0.001, 1-β=1, ω=0.40). The e-Health literacy was most strongly associated with possession of a university education (OR=12.662, IC95%: 0.962-523.566), frequency of Internet access [(OR=2.520, IC95%: 1.190-5.490), (OR=5.992, IC95%: 2.848-13.157)], and digital technology skills (OR=2.847, IC95%: 1.218-7.109). Conclusions: Low e-Health literacy is widespread among primary care users. However, the frequency of Internet access and the digital competence of individuals are the key factors in increasing the level of e-Health literacy among patients.

Susanti Niman   Yura Witsqa Firmansyah   Whisnu Trie Seno Ajie   and Tina Shinta Parulian   

This study contributes to identifying factors that influence knowledge about healthy living behaviors. This study used a correlational approach with a cross-sectional design. The study population included all semi-urban communities living in the Dayeuh Kolot Health Center working area. The sampling technique used was Convenience Sampling, with a total sample of 130 respondents who met the criteria: residents of the Dayeuh Kolot Health Center working area, over 18 years old, and willing to become respondents. The results of the factor analysis showed that demographic factors, which include gender and occupation, contributed 9.379% to the total variance. Variables with higher loading values, such as gender with a value of 0.840, showed a significant contribution to healthy behavior. In addition, external and internal factors contributed the most, at 33.757% of the total variance, where health workers play an important component in promoting healthy behaviors in the community. Entity factors, which contributed 14.874% to the total variance, included age as a key variable influencing the adoption of healthy behaviors. Overall, this study underscores the importance of demographic, external, and internal variables in shaping the healthy behaviors of semi-urban communities.

Rafazila Ramli   Md Mizanur Rahman   Gerraint Gillan   Ahmad Sofian   Rasitasam Safii   Jacey Lynn Minoi   Stephanie Chua Hui Li   and Lee Jun Choi   

The study aims to analyze the research trends, collaborative networks, and evolving themes in parent-adolescent sexual and reproductive health (SRH) communication research from 2010 to 2024. A bibliometric analysis was conducted using the Web of Science (WoS) Core Collection database. The search, completed on May 23, 2024, used the terms "parent-adolescent communication" and "sexual and reproductive health" as search criteria. We identified 29 documents and exported the data in RIS format for analysis. VOSviewer software was employed to visualize co-authorship networks, keyword trends, and research hotspots. The analysis revealed significant shifts in research focus over time, from communication dynamics in 2019 to a stronger emphasis on adolescent SRH issues by 2020. Key research areas included public health, paediatrics, and psychology, with notable contributions from institutions such as Bahir Dar University, The Centres for Disease Control and Prevention (USA), and Makerere University. Collaborative networks identified highly active research groups, with researchers like Kemigisha E and Nyakato VN playing central roles. Keyword trends indicated a growing interest in topics such as HIV prevention, mental health, and adolescent risk behaviours. This study highlights the dynamic nature of parent-adolescent SRH communication research, emphasizing the importance of addressing evolving SRH challenges. Despite its reliance on a single database, the analysis provides valuable insights into research trends and collaborations. Future studies should incorporate multiple databases and broader publication types to enhance understanding and support effective policy development.

Yash Alok   Eshwari K   Ashwini Kumar   and Ranjitha S Shetty   

With advancing age comes a decline in physical and cognitive health, often resulting in increased dependency among older individuals. Rapid urbanization has led to a growing reliance on old-age homes for support and care. However, the health profiles of the individuals in these facilities raise significant concerns that require careful attention. This study aimed to examine the socio-demographic and health characteristics of residents in old age homes and identify the factors that influence disease morbidity among them. A retrospective analysis was conducted using data collected from health screening activities held across various old-age homes in the district. Information regarding demographic features, lifestyle habits, disease prevalence, and blood parameters was collected and analyzed using SPSS 15.0. Results are presented as frequencies and proportions. Analysis of data from 268 residents revealed that 52.9% were female. One in four older adults had more than one chronic morbidity, while 7.5% had three or more comorbidities. Hypertension was prevalent in 40.3% of residents, and diabetes mellitus affected 25.4%. Males exhibited a higher prevalence of smoking and alcohol use compared to females (p<0.001). The findings underscore the importance of regular screening activities to diagnose common morbidities among older adults in the community, followed by appropriate treatment and ongoing follow-up. These measures are crucial for enhancing the overall health and well-being of this vulnerable population.

Meghana Kamble   Sheela Upendra   Satish Chand Bansal   and Mrudula Phule   

Gestational diabetes, a condition diagnosed during pregnancy, leads to carbohydrate intolerance in most affected women. However, this intolerance typically resolves postpartum. It is crucial for the diet of pregnant women with gestational diabetes to meet both their nutritional needs and those of their developing fetus. The aim of the study is to evaluate the knowledge of dietary patterns among pregnant women with Gestational Diabetes Mellitus (GDM) and to examine the association between their knowledge levels and socio-demographic variables. Methodology: This study employs a quantitative, descriptive, non-experimental design. Sixty participants with maternal diabetes mellitus in selected areas of Pune city, meeting specific inclusion criteria—pregnant women with GDM aged 18 to 45 who can read and write and are willing to participate—were selected. Exclusion criteria included conditions such as hypertension, thyroid disorders, anemia, mental illness, and chronic illnesses. Data were gathered using a self-structured questionnaire and convenience sampling. Result: The study investigated the correlation between knowledge levels on dietary patterns and socio-demographic factors among pregnant women with GDM. Chi-square analysis revealed no significant association between demographic variables and knowledge scores, except for one demographic variable where the chi-square value was less than the table value at a 0.05 significance level, leading to the rejection of the test hypothesis. For other variables, the p-value was greater than 0.05, indicating no significant association. Conclusion: The study concluded that most women with GDM have poor awareness of appropriate dietary patterns. This highlights the need for enhanced educational interventions to improve dietary knowledge among this group.

Alda Alfian   Erniwati Ibrahim   Syamsuar Manyullei   Hasanuddin Ishak   Masyitha Muis   Syahribulan   and Setiawan Kasim   

Objective: Dengue Hemorrhagic Fever (DHF) is caused by the dengue virus which is transmitted through the bite of the Aedes aegypti mosquito, which is a health problem in Indonesia where the number of sufferers tends to increase and its distribution is becoming more widespread. One of the factors causing this dengue fever incident is that 3M Plus has not been implemented by the community. The aim of this research is to analyze the relationship between 3M Plus and the presence of Aedes aegypti larvae in work area of Sewo Health Center, Soppeng Regency. Method: The research uses quantitative research methods with an experimental design. The sampling technique used proportionate stratified random sampling with a sample of 96 people. Result: The results of the research show that there is a significant relationship between the independent variables, namely (p-value = 0.045), sprinkling abate powder (p-value = 0.016), closing water reservoirs (p-value = 0.011), recycling used goods (p-value = 0.029), using mosquito nets (p-value = 0.045), using mosquito repellent (p-value = 0.022) on the presence of Aedes aegypti larvae in the Working Area Sewo Health Center, Soppeng Regency. Conclusion: The conclusion in this study is that there is a significant relationship between 3M Plus actions and the presence of Aedes aegypti larvae in the Working Area of Sewo Health Center. Suggestions for the Community Health Center are that there is a need for outreach regarding how to prevent dengue fever in the local community as well as outreach about the 3M Plus program.

Jeni Staykova   Iglika Simeonova-Brachot   and Galinka Pavlova   

Aim: This study aims to propose strategies for the promotion of the prevention of cervical and breast cancers using the health behaviors of women with regular, sporadic, and missing gynecologic follow-up in a Bulgarian population. Materials and methods: This study was a post-hoc analysis of data from the Countrywide Integrated Noncommunicable Diseases Intervention Health Monitor (CINDI). This study used data from 2010 and 2016 from eight representative areas in Bulgaria. A simple random sample of 1508 women and 1402 men aged between 25 and 64 years was analyzed. Results: The regular uptake of screening in Bulgaria was lower among older and single women with fewer years of education. In the non-regular attendance category, more frequent consumption of tobacco, salt, soda, and white bread was observed. Conclusions: As our study found more frequent tobacco consumption in the irregular screening participation category, we speculate that cigarette wrappers could supply synthetic health information regarding the prevention of cervical and breast cancer. The packaging of other products popular among inactive screening participants, such as salt, sodas, and white bread, could contain information regarding cancer screening programs in Bulgaria. Nevertheless, this suggestion necessitates governmental support and the expertise of the specialist group on the packaging policy of commercial products.

Rezky Handayani Asyhari   Syamsiar S. Russeng   Andi Zulkifli   M. Furqan Naeim   Lalu Muhammad Saleh   Muhammad Syafar   and Asyhari Asyikin   

Background: Contact dermatitis is one of the occupational diseases found in the construction sector. This disease is influenced by several factors and has an impact on worker productivity levels. Objective: This study aims to determine the effect of age, length of service, history of skin disease, personal hygiene, use of personal protective equipment, length of contact, and type of work on productivity through contact dermatitis complaints in workers in the construction project for the construction of the Makassar vertical hospital. Method: This study used cross-sectional research. The population in this study was 658 and the sample was 243 respondents. Results: This study shows that the variables of length of service (p=0.038), personal hygiene (p=0.010), length of contact (p=0.013) and type of work (p=0.016) have an indirect effect on productivity through complaints of contact dermatitis. Then age (p=0.934) and history of skin disease (p=0.064) have a direct effect on productivity without going through complaints of contact dermatitis. While the use of personal protective equipment (p=0.098) has no direct or indirect effect on productivity through complaints of contact dermatitis. Conclusion: Productivity in workers is indirectly influenced by work period, personal hygiene, length of contact, and type of work through complaints of contact dermatitis, while age and history of skin disease have a direct influence on productivity. Therefore, workers and company management must work together in implementing health programs to prevent and minimize the risk of work-related diseases that cause decreased productivity levels. Company management must improve the consistency of implementation and supervision of policies related to the use of PPE, record the need for PPE according to the type of work, record the location of occupational diseases and carry out rehabilitation by moving workers who experience contact dermatitis complaints to other types of work to minimize exposure to chemicals that trigger complaints.

Jisha M Lucca   Royes Joseph   Amjad Adil Almarzoug   Ali Saeed Alwayel   and Feras Mamduh Almusajen   

Paracetamol is responsible for approximately one-fourth of all medication-related toxicity. This cross-sectional study was designed to explore patient preferences for uses of paracetamol for other indications and to identify knowledge gaps among users in Saudi Arabia. The study utilized an online survey, administered through Question PRO, targeting both Saudi citizens and residents who had consumed paracetamol in the previous six months. Out of 584 participants who started the survey, 518 (88.7%) were using paracetamol at least once, with 113 (21.8%) acknowledging off-label usage, and 13.5% obtaining it without a prescription. Notably, 25% of respondents used it in combination with caffeine, codeine, and chlorpheniramine. Among those who used paracetamol off-label, nearly half n=52 (46%) were using it as a sleep aid and (21.2%) used it prophylactically to prevent illness during travel. Other than that, people also use paracetamol for calming infants and boosting energy levels. A small percentage of users mixed paracetamol with smoking devices (3.5%) or energy drinks (1.8%). The survey also revealed significant knowledge gaps among the public regarding paracetamol use. More than half (56%) of them were uncertain about the information that paracetamol and acetaminophen are the same. One quarter of the (25%) participants knew the maximum daily dose. This study highlights the prevalence of unconventional or unlicensed uses of paracetamol, as well as the substantial knowledge gaps regarding its proper use. The findings emphasize the need for healthcare professionals to provide more comprehensive patient education on the risks associated with paracetamol, especially given its widespread availability and usage.

Binda Godlove Aka   and Ed Gerrish   

This study evaluates the impact of Medicaid expansion resulting from the Affordable Care Act (ACA) in ten states in the U.S. using data from phone audits of prospective health care providers. We examine whether the implementation of the Affordable Care Act’s Medicaid expansion impacted hypothetical patients through responses to requests for appointments and the timeliness of those appointments. We used a difference-in-difference design, the objects of which are states that expanded early, states that expanded later, and states that never expanded Medicaid. Results indicate that Medicaid Expansion did not increase Medicaid recipients’ access to health care, nor did it harm access (results were not statistically different from zero). However, Medicaid recipients were more likely to receive a vague or hypothetical appointment compared to the period before Medicaid expansion. These results suggest that Medicaid Expansion has led to little change in appointment availability to access physicians for low-income individuals; perhaps a slight increase in a vague or hypothetical appointment but no change in a regular or timely appointment. We find that, despite warnings about the negative impact of Medicaid Expansion by many scholars, an audit study of such appointments did not find deleterious effects on Medicaid patients’ ability to make appointments. The study concludes that ACA Medicaid expansion has positively changed the dynamics of access to healthcare for low-income individuals in the United States by providing them with both insurance and access.

Syamsuar Manyullei   Ardalif Lulhaq Musbir   Muh. Fajaruddin Natsir   and Mochammad Al Anugerah Agus   

Problems that often occur in student housing are the provision of clean water, sewage, wastewater disposal, garbage and population density, so it is very possible for rats, which are the vectors of diseases that carry over to humans, such as yersiniosis, leptospirosis and salmonella, to be present. The objective of this study is to spatially analyze the description of the movement buffer of trapped rats and associated environmental factors. Method: This research was conducted by descriptive observation using accidental sampling. Data collection was carried out in April 2021, with a population of all rats caught in three public university student accommodation areas in Makassar City. Data analysis is carried out using SPSS data processing media. Spatial analysis of trapped rats was carried out with the buffer area technique using the Qgis program. Result: The installation of 135 traps that were in place for four days resulted in 29 rats of various types being caught. These were Rattus norvegicus (69%), R. tanezumi (17.2%), R. argentiventer (10.3%) and R. exulans (3.4%). The spatial results of the observation of the presence of refuse showed that there were 60% points at UIN, 62.2% points at UNM, and 80% points at Unhas, where refuse was scattered around the cottage. The results of temperature measurements showed that there were 73% points at Unhas, 82.2% points at UNM and 88.9% points at UIN that had optimum temperatures. The humidity measurements showed that there were 46.7% points at UIN, 4.4% points at UNM, and 26.7% points at Unhas. Conclusion: The spatial analysis of the presence of rats was found to have a relation with environmental risk factors, such as temperature, humidity and the presence of garbage. In addition, the rats found were R. norvegicus (69%), and most of them were found in UIN lodgings with the presence of refuse at 60%, with 88.9% points having optimum temperature and 46.7% points having optimum humidity. It is recommended that the landlord and the students who live in the dormitory maintain environmental conditions to prevent the presence of rats.

Mutia Permata Iryanti   Mursid Raharjo   Martini   Onny Setiani   and Tri Joko   

Dengue Hemorrhagic Fever (DHF) is an infectious disease transmitted by female Aedes aegypti. Batam City is one of the cities in the Riau Islands Province which is included in the endemic cities for DHF in Indonesia, with 902 cases and an IR = 56,12 in 2022. The method of this study is descriptive observation with a case-control study design. The case and control population consists of DHF sufferers and non-DHF sufferers in 2022 domiciled in Batam. The sampling was taken from 172 respondents. The results were analyzed using chi-square test, overlay analysis, distribution pattern analysis using ANN analysis and spatial patterns with Moran’s I Index analysis. The results show that there is a relationship between the air humidity (p = 0,01), CI (p = 0,0001) and the implementation of the Mosquito Nest Eradication (PSN) 3M Plus activities (p = 0,0001) with the incidence of DHF. The results of the ANN analysis are 0,402 (clustered pattern) and the results of the Moran’s Index analysis are 0,0214 (random pattern) which means that the spatial pattern of DHF cases is not autocorrelated. There are 9 sub-districts with a high risk of dengue fever due to high House Index (HI) (> 5%) and low Mosquito Larvae Free Number (ABJ) (<95%). The highest number of DHF cases during 2022 was in January, July, and August followed by low to moderate rainfall (51-300 mm/month).

Sangeeth Kumar A   Ramesh Kumar M   Jayapaul V. L   Christhuraj I   Devibala B   Bharathi Raj K   Emagulate Rani J   and Sowmiya V. B   

The COVID-19 pandemic has catalyzed a surge in self-harm, depression, anxiety, and suicide rates, largely attributed to excessive smartphone and internet usage. This digital dependency exacerbates health concerns such as obesity and nervous disorders as individuals increasingly disconnect from meaningful human interaction, falling victim to addiction within the confines of a virtual world. This study examines how digital dependence exacerbates health issues like obesity and undermines mental wellbeing, particularly among youth torn between gaming and social media. The study employed a qualitative approach, utilizing secondary sources and analyzing data using the discourse method. Findings revealed that reliance on digital devices inhibits awareness of physical changes. Young people, torn between gaming and social media, turn to these digital platforms for solace yet fail to address the underlying mental health challenges. In response to this pervasive issue, the study provides valuable insights and recommendations for directing the complexities of modern technology and promoting holistic wellbeing among the youth. Recommendations may include fostering awareness campaigns about digital addiction, promoting healthy screen time habits, and encouraging offline activities to facilitate genuine human connection. The implications of this study extend beyond individual wellbeing to societal concerns, emphasizing the need for a balanced approach to technology usage. By addressing the root causes of digital dependency and promoting a more mindful relationship with technology, interventions can mitigate the adverse effects on mental and physical health, fostering a healthier, more resilient society in the post-pandemic era.

Silvia SV   and J Balamurugan   

Child sexual abuse (CSA) is a worldwide public health issue and a violation of human rights that has negative effects on physical, mental, and social health. There are various forms of child sexual abuse, including teenage pregnancy, child marriage, and sexual harassment, among others. Additionally, children who have experienced these forms of sexual abuse at a young age may face serious concerns in their later lives. This study aims to determine the prevalence rate of various forms of child sexual abuse among Indian children. Furthermore, the research study analyzed the increased rate of sexual abuse among children in its diverse forms in the state of Tamil Nadu. An elevated incidence of child sexual abuse is indicative of extensive deterioration in adolescents’ development. Research used secondary data from the National Family Health Survey (NFHS-4 and 5), the State Crime Records Bureau (SCRB-TN), the National Crime Record Bureau (NCRB-India), Directorate of Public Health and Preventive Medicine (Tamil Nadu), Commissionerate of Social Welfare (Tamil Nadu) between the years 2021 and 2023 related to child marriage, teenage pregnancy, and registered cases of POCSO Act. The study found that Uttar Pradesh registered a high number of victims under the POCSO Act in India, while the district of Chennai has the highest number of victims registered under the POCSO Act in Tamil Nadu. Understanding the prevalence rate of sexual abuse against children is critical to preventing similar problems in the future.

Hedie Haxhiu   Malvina Hoxha   Bruno Zappacosta   Visar Malaj   and Najada Firza   

Background: Dietary and herbal supplements (DHS) have a widespread use in Albania, however, there is limited information on the reporting of their adverse effects by pharmacists and patients. This study aims to assess the reporting of suspected adverse reactions for dietary and herbal supplements by pharmacists and patients in Albania, as well as to evaluate the recurrence and occurrence of these reactions. Methods: A questionnaire-based survey was distributed online in Albania from January 2024 to March 2024 to patients and pharmacists with experience in direct patient care to evaluate their knowledge of the signaling of suspected adverse reactions of DHS. Results: A total of 113 pharmacists, and 159 patients in 9 and 12 different cities in Albania, respectively, consented to participate in the study. 69.91% of the pharmacists reported being informed about the necessity of reporting adverse effects associated with DHS during national conferences. However, only 8.85% have reported such effects to the responsible importers. Only 5.66% of patients have reported to their pharmacists about the adverse reactions of those products. Conclusions: The study highlights the need for improved education and training on reporting procedures for pharmacists and patients in Albania. By enhancing pharmacovigilance practices and promoting awareness among pharmacists and patients, we can lead toward a safer healthcare system in Albania.

El Mitouaa Mohammed   El Madhi Adil   Darif Hajar   El Madhi Youssef   and Selmaoui Karima   

Introduction: Several million people are exposed to foodborne illnesses every year. These diseases are therefore recognized as one of the most common problems worldwide. Aim: Our objective in this study is to assess the level of compliance of the state of hygiene in two prisons with the international's standards requirements relating to food safety. Methodology: In this study we adopted a qualitative, case-study approach based on the collected data from two penitentiary sites. Data were collected using a hygiene audit grid to assess the physical characteristics and hygienic condition of the two sites studied in relation to the technical requirements of international standards requirements relating to food safety. Results: The Overall compliance rates for the sites studied were 51.60% and 53.19% respectively at establishment n° 1 and n° 2. These results showed that certain hygiene dimensions were satisfactory. However, we recorded higher rates of non-compliance for other hygiene activities. Conclusion: This study has shown that the non-conformities observed in certain dimensions of hygiene in the two establishments studied, require the planning and implementation of corrective and preventive actions in order to eliminate the discrepancies raised and improve general hygiene conditions in line with the technical recommendations of international norms and standards.

Rusmilawaty   Tri Tunggal   Yuniarti   Norlaila Sofia   Nur Rohmah Prihatanti   Efi Kristiana   Hapisah   Evi Risa Mariana   and Anwar Mallongi   

In 2022, the prevalence of underweight children in South Kalimantan was higher than the national average, with Banjar District ranking third at 26.9%. Being underweight leads to impaired brain intelligence, decreased immunity, disrupted child growth and development, and affects human resources. This study aims to create a prediction model for underweight in children under five in Banjar District by identifying dominant influencing factors, including birth weight, birth length, history of infectious diseases, exclusive breastfeeding, immunization completeness, regular visits to integrated health center (IHC) (posyandu), number of family members, and family income. This study used an observational design with a case-control approach. The research sample consisted of 202 children under five years old in the work area of Aluh-aluh Community Health Center (CHC) (puskesmas) of Banjar District, selected using probability sampling with simple random sampling. The research location was in the work area of Aluh-aluh CHC of Banjar District. Data analysis was performed using logistic regression tests. There was a relationship between birth weight, exclusive breastfeeding, immunization completeness, and regular visits to integrated health posts with underweight status, with Odds Ratio (OR) values of 18.8, 1.97, 3.33, and 3.05 respectively. There is no relationship between birth length, history of infectious diseases, family income, and number of family members with underweight status. The most influential risk factors for underweight occurrences are birth weight and immunization completeness, with OR values of 20.13 and 2.58 respectively. The probability of underweight due to risk factors can be predicted as follows: 90.1% due to Low Birth Weight (LBW), 82.0% due to incomplete immunization, and 92.9% due to both LBW and incomplete immunization.

Ice Irawati   Hermansyah   Fitri Sari Dewi   Chinta Yolanda Sari   Wan Intan Parisma   Diina Maulina   Andi Sarbiah   and Azmen Kahar   

Occupational diseases are conditions caused by the work environment, and fishermen, as workers in the informal sector, are particularly vulnerable to these diseases. One of the common skin diseases among fishermen is contact dermatitis, which is an inflammatory condition of the skin due to direct contact with irritants or allergens. This study aims to identify factors associated with contact dermatitis among fishermen in Pulau Buluh, Batam. The methodology used was quantitative research with an observational approach, where the sample was taken with a purposive sampling technique with a total of 40 respondents. The research instrument used a questionnaire that had been tested for validity and reliability. The results showed a significant relationship between age, education level, and personal hygiene with complaints of contact dermatitis. The data showed that fishermen older than 55 years had the highest prevalence of contact dermatitis (50%). At the same time, those with low education levels (only primary to junior high school) were also more prone to contact dermatitis (62.5%). In addition, poor personal hygiene was significantly correlated with the incidence of contact dermatitis, with 65% of respondents with poor personal hygiene reporting dermatitis complaints. In contrast, no significant association was found between tenure and the incidence of contact dermatitis. This study concludes that age, education level and personal hygiene are the main determinants of the incidence of contact dermatitis in fishermen. These findings suggest the importance of improving personal hygiene awareness and practices among fishermen and providing ongoing education regarding the dangers of exposure to irritants and the importance of personal protection. It is recommended that fishers pay more attention to personal hygiene after fishing to prevent contact dermatitis. In addition, ongoing education programs on good hygiene practices should be improved to reduce the risk of dermatitis among fishing workers.

I Wayan Agus Gede Manik Saputra   Wayan Citra Wulan Sucipta Putri   Cokorda Bagus Jaya Lesmana   Ni Nyoman Sri Budayanti   and I Made Ady Wirawan   

Antimicrobial resistance (AMR) is widely recognized as a major issue in global public health. WHO has implemented awareness campaigns as a strategy to combat the issue of AMR. Nevertheless, it has been discovered that solely raising awareness is insufficient. As a result, a new approach involving community engagement has gained traction and is now widely utilized in developing nations. The systematic review seeks to address intervention to prevent AMR within the framework of community engagement utilizing a one-health approach. PubMed, Scopus, and Web of Science databases were searched in accordance with PRISMA guidelines. Following strict inclusion and exclusion criteria, a structured search protocol was employed to retrieve and screen the article. Out of 7730 studies (after duplicates were removed), twenty-six studies were discovered up to 2024. The study design was varied, and most of them were Randomized Control Trials (RCT), and study population were mostly conducted among the immediate community. In this synthesis, most studies emphasized community-oriented approaches based on WHO criteria in terms of community engagement. Current efforts to tackle antimicrobial resistance interventions mainly focus on human health and human needs. Community engagement can potentially address a wide range of AMR-related issues, providing a valuable opportunity for involvement. The success of community engagement heavily relies on the type of intervention offered to the community. Achieving behavioral changes is more difficult with complex interventions, but simpler interventions involving community leaders are more likely to lead to successful behavioral changes.

Ghozali Ghozali   Agus Setya Ningsih   Lisa Wahidatul Oktaviani   and Rusni Masnina   

Anxiety is the most common form of mental disorders among adolescents. Anxiety may influence adolescents' academic performance at school. In more severe conditions, it might lead to depression and even suicide. This study examined the relationship of self-efficacy, achievement motivation, and anxiety among junior high school students in a sub-urban area of Samarinda City, Indonesia. Apart from these variables, researchers also added the students' characteristics of age and gender in the analysis. This was a quantitative study with a correlational design. The data were obtained from 685 junior high school students that were randomly selected from 9 schools. The data were collected using questionnaires and analyzed using SPSS Statistics Software to determine the relationship between variables. Univariate, bivariate, and multivariate analyses were used in this study. The results of multivariate analysis using ordinal logistic regression revealed that gender, age, and self-efficacy were significantly associated with students' anxiety, and there was no significant association between achievement motivation and anxiety. A conducive learning environment, providing appropriate feedback, counseling services, and involving parents are steps recommended by researchers to increase students' self-efficacy and minimize anxiety.

Gbèmahon Roger Houssou   Colette Sylvie Azandjeme   Nadia Fanou   Clémence Germaine Metonnou   Charles Jérôme Sossa   Ella Compaoré   and Roch Mongbo   

Adequate nutritional intake during pregnancy and the preconception period is crucial for optimal fetal development and maternal health. The objective of this study was to describe the nutritional profile of pregnant women in the lake area of Cotonou. A cross-sectional analytical study was conducted among 230 pregnant women attending four health centers (two public and two private) in the lake area of Cotonou. Data were collected using a standardized questionnaire, food frequency questionnaire, 24-hour dietary recalls, and Household Hunger Index (HHS). The simplified index of socio-economic position (IPSE) was used to determine the socio-economic level of the participants. Data were analyzed using SPSS 21 software. The chi-square test was used to compare and identify relationships between variables of interest. Analysis of the nutritional status of the participants reveals that 9.1% suffer from malnutrition. The consumption of alcohol, coffee, and tobacco was 32.2%, 34.8%, and 1.7%, respectively. Worryingly, 75% of women do not wash their hands before handling food. The evaluation of the food intake of pregnant women highlights an average energy intake lower than the recommendations. Even more worrying, more than half (57.4%) of women have lower energy intake than average. Finally, the study reveals that 11% of pregnant women are food insecure. Faced with these findings, it is imperative to implement specific interventions aimed at optimizing the diet of pregnant women and their future babies. These interventions must take into consideration the socio-economic and demographic realities of the populations concerned, as well as issues related to food security.

Nur Inayah Adam   Andi Ariyandy   Irfan Idris   Werna Nontji   Sri Ramadhani   and Stang   

Due to the rising incidence of obesity, notably in Indonesia, it has become a major worldwide health concern. Obesity in pregnant women can cause various health complications for the mother and fetus. One powerful vasoconstrictor peptide that is implicated in many physiological and pathological processes, including endothelial damage, is endothelin-1 (ET-1). The purpose of this study is to compare the levels of ET-1 in the urine of obese and non-obese pregnant women. The present cross-sectional research was carried out in Gorontalo City and included a sample of pregnant women aged 25-30 who were overweight or obese, second-time mothers, third-time mothers, and in their second trimester of gestation, in additional to pre-pregnancy obese and GWG obese pregnant women. These females weren't overweight. The research sample included 75 individuals in total, and the Consecutive Sampling technique was used to divide them into three groups. The ELISA method was used to find ET-1 levels, and the sample was created using information from interviews and physical examinations. The data analysis used the Independent Sample T-tool statistical method to compare groups consisting of non-obese pregnant women, pre-pregnancy obese pregnant women, and GWG obese pregnant women. According to the results, pre-pregnancy obese pregnant women had greater ET-1 levels in their urine (137.85 ng/l) than non-obese pregnant women (109.39 ng/l) or GWG obese pregnant women (107.21 ng/l). Pregnant obese women who have high levels of ET-1 in their urine may be at risk for kidney injury.

Ahmad Albalawi   

Objective: The objective of this investigation was to compare the consumption of heme iron between Saudi adults with overweight and/or obesity and adults with normal weight, using data derived from seven-day food records. Design: A cross-sectional study was employed to assess heme iron consumption among the study participants. They were interviewed by a nutritionist and instructed to complete seven-day food records. Heme iron consumption was extracted from these records, and Body Mass Index (BMI) was categorized and compared between participants with and without overweight and/or obesity and their consumption of heme iron. Settings: The study was conducted in Tabuk City, Saudi Arabia. Participants were recruited through invitations via social media platforms and encountering in the streets of Tabuk City. Participants: The participants included Saudi adults with overweight and/or obesity as well as adults with normal weight. Results: Results revealed that participants with overweight and/or obesity had significantly lower heme iron consumption compared to participants with normal weight (Difference = 1.94, T-value = 2.10, p < 0.04). Additionally, after adjusting for several confounding factors, individuals with excess weight were found to be 9.5% less likely to consume heme iron in comparison to Saudis with normal weight (β= -0.10, χ² = 4.24, P< 0.04). Conclusion: Following adjustment for several confounding factors, the findings suggest that Saudi adults with excess weight tend to consume large portions of meals but were less likely to consume good sources of heme iron in comparison with those with normal weight.

Semuel Piter Irab   Maxsi Irmanto   Apriyana Irjayanti   Marlina Flassy   Evi Sinaga   Agus Zainuri   Oscar Oswald Wambrauw   and Rosmin Mariati Tingginehe   

Compound Halogens are very important in the field of nutritional science. One very important element is iodine. However, other elements such as Fluorine, Chlorine, Bromine, Astatine, and other elements in halogen compounds are very important for human health. The research aims to determine the phenomenon of halogen water sources, and the quality of halogen water through laboratory examinations, and to carry out experimental interventions on halogen water stored in the refrigerator and not stored in the refrigerator. The research uses phenomenological methods, laboratory examinations, and experimental interventions. The results of the research show that the mining area is a source of halogen water, in summer the quality of halogen compounds is better than in the rainy season, Papuan people consume halogen compounds, and laboratory examinations show that halogen water after processing has better quality than before processing, inorganic and organic chemical examinations show that halogen water after processing has better quality than before processing, halogen water processed and stored in the refrigerator has good quality, halogen water that is not stored in the refrigerator has low quality. Conclusion: native Papuans consume halogen water, halogen water after processing has better quality than unprocessed, laboratory tests show that halogen water after processing is better than before processing, and halogen water stored in the refrigerator is better than not stored in the refrigerator.

Abiodun F. Ipadeola   Olayemi O. Akinnola   Olatunji M. Kolawole   Timothy A. Attah   Tola Monday   Sophia O. Osawe   Ifeyinwa R. Okonkwo   Olushola D. Ojurongbe   Marycelin M. Baba   and Grace I. Olasehinde   

Introduction: This study aimed to investigate the prevalence and risk factors of malaria and arboviral infections in Nigeria. Method: Molecular techniques were used to test 1020 febrile patients in 10 hospitals in Lagos, Ogun, and FCT between 2022 and 2023. Blood samples were collected from study participants and tested for malaria using rapid diagnostics tests, microscopy, and polymerase chain reaction (PCR). In addition, the samples were tested for arboviruses using PCR. Statistical analysis was performed using Stata version 17, at a 5% level of significance. Result: Zika had the highest prevalence among study participants (23.3%) followed by malaria (12%), West Nile (5.8%), Chikungunya (5.7%), Dengue (3.3%), and yellow fever (2%). There were sixteen combinations of co-infection from this study, Chikungunya- Zika co-infection had the highest prevalence (4.6%) followed by Zika-West Nile co-infection (3.3%) and Chikungunya-West Nile co-infection (3.1%). Travel history was significantly associated with the prevalence of malaria (X²=6.52, P-value=0.001) and DenV (X²=4.91, P-value=0.027). Seasonality was also significantly associated with malaria (X²=10.28, P-value=0.001), DenV (X²=7.67, P-value=0.006), and ZikV (X²=6.54, P-value=0.011). State of residence was significantly associated with all vector-borne diseases (P<.05). Occupation was also found to be associated with malaria (X²=13.27, P-value=0.021), ChikV (X²=11.78, P-value-0.038), YFV (X²=21.03, P-value=0.001), ZikV (X²=17.31, P-value=0.004). Conclusion: This study reveals a higher prevalence of Zika than malaria and a significant prevalence of the investigated arbovirus infections and coinfections. These findings may inform surveillance and response to potential outbreaks of arbovirus disease in Nigeria.

Grace Glory Girikallo   Syamsuar Manyullei   Hasanuddin Ishak   Hasnawati Amqam   Healthy Hidayanty   Andi Ummu Salmah   Rudi Hendro Purtanto   Amir Su'udi   Adrianus Surianto Girikallo   and Setiawan Kasim   

Schistosomiasis is a neglected tropical disease caused by blood trematode worms from the genus Schistosoma. The prevalence in East Lore was high. Objective: It's important to comprehend the danger variables. In the Poso Regency East Lore District, a study was conducted to identify the risk factors for the incidence of Schistosomiasis. Method: This research uses a case control study design and is an analytical observational research project. There were 43 respondents of Schistosomiasis cases, and 43 respondents made up the control group, which was chosen at a 1:1 ratio based on respondents age and sex matching the cases. Environmental samples were measured using water quality test. Result: The distribution of Oncomelania hupensis lindoensis snail habitat was described by measured water temperature and pH was determined in the habitat. According to environmental measurements, rice field irrigation canals and brown plantation streams with water temperatures between 22°C and 27°C and pH values between 5.5 and 7.8 were discovered to contain cercarias snails. Bivariate analysis showed that the habit of open defecation (OR = 6.0; CI (95%) = (2.3 – 15.3), the habit of not using clean water (OR = 7.0; CI (95%) = (1.45 – 34.07), the distance from the house to the snail habitat were risk factor (OR = 28.3; CI (95%) = (8.23 – 97.6), not using PPE (OR = 10.9; CI (95%) = (4.02 – 30.0), and underutilization of Schistosomiasis health programs (OR = 11.3; CI (95%) = 4.08 – 31.2) are risk factors. The variable distance between the home and the snail habitat with OR = 40.7; CI (95%) = (5.064 – 328.02) is the most significant risk factor based on the results of multivariate analysis. Conclusion: The habit of open defecation, not using clean water, the distance between the house and the snail habitat, not using personal equipment and underutilization of Schistosomiasis health programs are risk factors (OR value is > 1) because variables with an OR value > 1 value greater than 1 are risk factors. Meanwhile, the most significant risk factor is the distance between the home and the snail habitat.

Urunbaeva Muqaddas   

The aim of this review is to examine the clinical and immunological aspects of AIT, emphasizing the need for further research to understand the specific clinical and immunological abnormalities in different forms of AIT. The paper covers studies from the last two decades, with a special focus on the clinical and immunological aspects of AIT. The review includes data from case-control studies, meta-analyses, and recent experimental studies, in particular those using advanced gene sequencing to identify susceptibility loci for GD and other forms of AIT. Inclusion criteria for the studies were based on their relevance to the clinical and immunological characteristics of AIT. Genetic studies have identified numerous susceptibility loci associated with GD, including genes involved in immune regulation and thyroid function, such as the HLA (Human Leukocyte Antigens) complex, CTLA-4 (англ.cytotoxic T-lymphocyte-associated protein 4; CD152), and PTPN22 (rs2476601 и rs2488457). Polymorphisms in the IL-2RA and FOXP3 (forkhead box P3 Homo sapiens (human)) genes, critical for T cell regulatory function, have been implicated in AIT. Epigenetic modifications and environmental factors, such as infections and stress, also contribute to the onset and progression of the disease. Despite significant advances, gaps remain in understanding the specific clinical and immunological abnormalities in the different forms of AIT. The mechanisms underlying the variability of autoantibody profiles and their impact on disease severity are not fully understood. The role of innate immune cells, such as mast cells and dendritic cells, in initiating and maintaining thyroid autoimmunity requires further investigation. These cells interact with adaptive immune cells to influence the immune response and clinical outcomes. The complexity of the pathogenesis of AIT involves multifactorial interactions between genetic, environmental, and immunological factors. Identification of susceptibility loci has provided insights into the molecular mechanisms governing AIT. However, the clinical implications are still unclear. Understanding specific clinical and immunological abnormalities may lead to more precise diagnostic markers and targeted therapy.

Lovie Edwin Seru   and Malebogo Moji   

Spontaneous discussions and interactions with the men in the villages revealed that many of them had developed gouty arthritis. The discussions also revealed that some of them had been advised against eating too much red meat by the local nurses. Despite the advice from the local nurses, red meat remained a popular dish with the men. This prompted the question: why do the men in the villages not embrace the advice to give up unhealthy eating habits? What means of communication are used to communicate messages about healthy eating to the men? To gather information on these questions, a semi-structured and unstructured interview methods were used. The results showed that the village men had a profound deficiency in the knowledge about foods. Also, the results showed that an effort to embrace and incorporate the cultural expressions of the villagers into the communication processes was made by the local nurses. It is recommended that frequent and intensified health campaigns be organized and that health promotion officials should adopt and utilize the Diffusion of Innovation Theory in the health campaigns on eating healthy foods that target the men in the villages.

Bharateesh Yadav H   Poornima Ajay Manjrekar   Anupama Hegde   Santhosh Rai   and Sindhu   

Background: HMGB1 (high mobility group box1 protein) extracellularly acts as a cytokine in response to free fatty acids (FFA) infusion to the liver in which TLR4 (toll-like receptor4) is a receptor for HMGB1 to generate the inflammatory response and it is responsible for the emergence of Non-alcoholic fatty liver disease (NAFLD). This study aimed to correlate the HMGB1 and TLR4 with lipid profile in NAFLD patients with dyslipidemia. Methods: This prospective study included NAFLD patients with dyslipidemia (n=87) with a mean age of 50.5±6.25, of which 54 were males and 33 were females. Data for the lipid profile and liver enzyme parameters except HMGB1 and TLR4 were collected from the data management system of the central laboratory. HMGB1 and TLR4 values were estimated by enzyme-linked immunosorbent assay (ELISA) method, statistically Karl Pearson's, spearmen's correlation and Independent t-test, Mann-Whitney U-test were applied to find the correlation and comparison of HMGB1 and TLR4 with lipid profile and liver enzymes based on the age group and gender respectively. Results: No correlation was observed with the HMGB1 and TLR4 with lipid profile in NAFLD patients. Additionally, it was noted that the comparison study of AST/ALT ratio with gender showed a significant difference but not with HMGB1 and TLR4. Conclusion: Males were affected earlier than females. The study group had significantly higher levels of LDL-cholesterol as against the treatment goals. Levels of extracellular HMGB1, which is a damage-associated molecular pattern (DAMP) were found to be elevated, similar to the findings with TLR4 levels which act as a receptor for HMGB1. However, we did not find a correlation of HMGB1 and TLR4 with lipid profile in non-alcoholic fatty liver disease.

Rishikesavan Ragupathy   Michal Ooi   Yu Chye Wah   and Elanchezhian Chinnavan   

Low back pain (LBP) is a prevalent condition, affecting 60-80% of individuals during their lifetime, with 23% experiencing chronic LBP. Due to the Malaysian Movement Control Order (MCO), numerous Malaysian residents were confined to their residences during the COVID-19 pandemic; consequently, the utilization of delivery services became more efficient and practical. As a result of the MCO, many individuals experienced job loss and transitioned to employment as commercial motorcycle riders, such as food delivery personnel, owing to the high demand for these services. Methods: This cross-sectional study employed a self-designed questionnaire comprising four sections: five questions on personal details, personal history, work history, and pain assessment. Convenience sampling was utilized in this investigation. Results: In a study of 207 respondents, 82.6% reported experiencing pain within the previous 12 months, with 58.9% specifically reporting pain in the lower back. Of the respondents, 47.3% were aged 24 – 29 years, 56.5% were current smokers, 60.9% had experienced motorcycles one to five times annually, 85% had previously been involved in motor vehicle accidents (MVA), 60.9% had worked as commercial motorcycle riders (CMR) for two to five years, and 60.9% worked for more than 10 hours per day. Conclusion: Low back discomfort is a significant issue for commercial motorcycle riders, with age, extended work hours, vibration exposure, smoking, motor vehicle accidents, motorcycle falls, and duration of employment as CMR serves as key risk factors.

Seeta Devi   Barkha Devi   Sonopant G Joshi   Dipali Dumbre   Surekha Sakore   and Lily Podder   

Preterm birth (PTB) is one of the most precarious obstetrical conditions, which is one of the leading causes of infant mortality. The capacity to predict PTB during both the first and second trimesters provides great promise for improving pregnancy outcomes. The objective of this study was to predict the preterm labor using various risk factors and machine learning models. Executing a novel methodology, researchers used risk factors of preterm labour and machine learning algorithms to predict premature labour. Our data was normalized using the continuous-discrete variables technique, resulting in a single feature value. Our investigation used various prediction models, such as Naïve Bayes, Neural Network (NN), Stochastic Gradient Descent (SGD), AdaBoost, Gradient Boosting (GB), CN2 rule inducer, and k-nearest neighbors (KNN), to predict PTB. This study includes a total of 300 samples for complete analysis. The results showed that GB, AdaBoost, and the CN2 rule inducer have better accuracy ratings of 0.950, 0.947, and 0.930, respectively, along with outstanding Area Under Curve (AUC) values of 0.996, 0.996, and 0.983. Furthermore, with Precision scores of 0.950, 0.947, and 0.930, these models showed strong performance in predicting the probability of PTB. To conclude, GB, adaboost, and CN2 rule inducer models accurately predict PTB, with high AUC and precision scores, making them useful tools for predicting PTB.

Mohammad Aljaradin   Abdurrahman Almekhlafi   and Athra Alkaabi   

With the increasing reliance on laptops and digital devices, Computer Vision Syndrome (CVS) has become a significant health concern for students. This study investigates the prevalence of CVS among cycle 3 students (secondary level comprising grades 9 to 12) at a public school in Sharjah, United Arab Emirates, using the validated CVS-Q web-based questionnaire to evaluate its impact on students' health, safety, and academic performance. Our findings reveal that 64% of the students suffer from CVS, with 51 out of 80 diagnosed with the condition. Common symptoms reported include headaches, burning eyes, excessive tearing, and decreased visual acuity. The study highlights the profound effect of CVS on students and emphasizes the urgent need for ergonomic improvements in digital learning environments. It provides empirical evidence on the prevalence of CVS and offers practical recommendations for enhancing digital learning ergonomics. Immediate intervention is necessary to redesign these environments to be more ergonomic and sustainable. Key recommendations include limiting laptop usage duration, optimizing ergonomic setups, using protective eyewear and screen filters, and encouraging regular eye exams. These measures can alleviate the adverse effects of prolonged digital device usage, thereby improving students' health and safety. Furthermore, promoting ergonomic practices supports environmental sustainability by fostering the design and use of energy-efficient and health-conscious digital devices. This study underscores the critical need for schools to implement comprehensive ergonomic strategies to support students' health, safety, and academic success in the digital age.

Rupal Vadher   Megha Patel   Rohan Bhatt   Lilavanti Vaghela   and Foram Patel   

Epidemiological studies could be useful in determining disease prevalence and identifying potential factors influencing disease patterns. Hence, the present study aimed to assess dental caries prevalence, unmet dental treatment needs and perceived parental barriers among 6-12-year-old school children of Gandhinagar, Gujarat. A total of 750; 6-12-year-old, Private and Government school attending children of Gandhinagar were selected through stratified random sampling methodology. Data was collected using WHO1997 survey methodology. Questionnaires including 10 close ended questions were distributed for assessment of parental barriers. Children were examined for caries prevalence using deft, DMFT index and modified treatment needs index was used to assess the required treatment needs. Chi square, Kruskal Wallis and Mann-Whitney U tests at 5% level of significance were used for statistical analysis. Prevalence of dental caries in government school was 81.60% whereas in private school it was 77.33 % (P=0.1987). Majority of the children had untreated decayed component. Major treatments needed were oral prophylaxis, one surface filling. Overall high cost of dental treatment and lack of awareness of dental diseases were potential barriers for parents in utilizing dental services for children. According to study results, Gandhinagar city has high dental caries prevalence and untreated caries indicates higher preventive and restorative treatment needs. Hence, to overcome above mentioned parental barriers, specialized educational programme to raise parental awareness along with Mobile dental-clinics, dental-camps and dental outreach initiatives may be effective ways to raise accessibility. School and community-based promotional, educational and preventative programme will indeed serve to improve existing situation immensely.

Haewon Byeon   

Suicide is a critical public health issue globally, with South Korea exhibiting the leading suicide rate within OECD nations. This study aims to identify factors influencing suicidal ideation among workers with mental disabilities using machine learning ensemble techniques, specifically Bagging and Boosting. Data from the 2022 Ministry of Health and Welfare's "Survey on the Employment Conditions of People with Mental Disabilities" were analyzed, involving 482 respondents. The study employed Odds Ratios (OR) and 95% confidence intervals (CI) to assess key predictors. Significant predictors identified included higher levels of depression (OR=1.10, 95% CI=1.03-1.15), lower mental health confidence (OR=0.95, 95% CI=0.92-0.98), disability registration (OR=1.80, 95% CI=1.20-2.70), discrimination experience (OR=1.06, 95% CI=1.02-1.10), and violence experience (OR=1.25, 95% CI=1.10-1.45). Both individual psychological factors and broader social determinants significantly influence suicidal ideation. The findings underscore the importance of addressing both individual psychological factors and social determinants in mental health interventions. Higher levels of depression and lower mental health confidence were significant predictors, indicating the need for mental health support and confidence-boosting initiatives. Additionally, disability registration, discrimination, and violence experiences emerged as significant factors, suggesting that social support and inclusive environments are crucial. In conclusion, this study highlights the multifaceted nature of suicidal ideation among workers with mental disabilities. Effective interventions should be comprehensive, addressing both personal and environmental influences to bolster their mental well-being and well-being. This study's findings can help develop targeted mental health interventions and assistance networks for this at-risk group.

Thonaeng Charity Molelekoa   and Abayomi Samuel Oyekale   

Background: Survival of children under-5 is among the foremost public health concerns that has been pursued in the Sustainable Development Goals (SDGs). A proper understanding of the correlates of child survival is of paramount relevance to health policy formulation and development of interventions to promote child's health outcomes. This study therefore analysed the determinants of the number of recorded child mortality and survival in Nigeria. Subject and Methods: The data were the Malaria Indicator Survey (MIS) that were collected in Nigeria in 2021. The samples were drawn with multi-stage sampling method following the 2023 Population and Housing Census sampling frame. A total of 14185 housing units were randomly selected of which 13887 were occupied and 13727 were successfully interviewed. In each household, all women belonging to the reproductive ages of 15-49 years were interviewed. A total of 14647 women were eligible, of which 14476 were successfully interviewed (Demographic and Health Survey (DHS), 2021). This study used information extracted for 7,222 children (dead or alive) that were under the age of 5. The data were analyzed using the Negative Binomial regression and logistic regression models. Results: The logs of the number of dead children were significantly higher (p<0.05) for mothers from North West and North East Nigeria, while children from these regions also had a significantly lower probability of surviving. The mothers from urban areas had a significantly lower log of dead children while urban children had a significantly higher probability of surviving. Mothers with secondary and tertiary education had a significantly lower log of dead children, while birth in the past five years and total children born reduced child's survival. Twin children also had a significantly lower probability of surviving while mother's maturity promoted child's survival. Conclusion: Promotion of child survival in Nigeria requires a concerted effort that disaggregates interventions across Nigerian zones with preferences for those in the north and rural dwellers. In addition, there is the need to promote interventions to assist women with multiple births, promote girl child education and discourage teenage pregnancies.

Krishna Priya Balachandran   and Mohanraj Bhuvaneswari   

Background: Evaluation and integration of family carers' health concerns into the treatment protocol are imperative. Caregivers of children diagnosed with neurodevelopmental disorders (NDDs) are often involved in extended periods of caregiving resulting in physical and mental exhaustion. The current study aims to examine the stress and health status of parents who are primary carers providing care for children with NDDs by evaluating the caregivers' experience of stress and immune functioning through self-report and biomarker measures. Methods: The study was conducted in two phases. The first phase involved the administration of self-report measures of caregiver stress and perceived immune status using the Kingston Caregiver Stress Scale and Immune Status Questionnaire respectively to 150 parents of children with NDDs. In the second phase, 30 parents who fulfilled the criteria and consented to participate in the blood testing were evaluated for biomarker profiles of stress and immune functioning through the cortisol, lymphocytes, and hemoglobin measures. Results: The results of the study revealed that of 150 parents 142 (94.6%) experienced moderate-severe stress and 70 (46.6%) perceived reduced or poor immune status. There exists a significant negative relationship between self-reported measures of caregiver stress and perceived immune status and there also exists a significant relationship between self-reported measures and biomarker measures. Conclusion: Caregivers of children with NDDs are constrained to navigate through the process of caregiving for an extended duration of their lives which could potentially result in compromised psychological and immune functioning in the long run. Therefore, it is vital to focus on care arrangements for family carers by centering a biopsychosocial model of care for caregivers to improve their well-being.

Nilapa Sukcharoen   Nuchanad Hounnaklang   Nanda Win   and Pankaew Tantirattanakulchai   

Patients having Type 2 Diabetes Mellitus (T2DM) face a substantial long-term challenge, impacting services, systems, communities, and individuals. Health literacy (HL) is acknowledged as a crucial skill in understanding individuals with T2DM. This study attempts to explore the association between age, gender, marital status, education level, individual income, family income, comorbidity and HL among individuals with T2DM receiving care at a tertiary hospital in Thailand. This research, employing a cross-sectional design, took place from March to August 2022, through a self-administered questionnaire which included participant characteristics and the 14-item Health Literacy Scale. We employed multiple linear regression analysis to investigate the pivotal factors that significantly forecast health literacy scores. Among the 159 adults diagnosed with T2DM, the mean health literacy (HL) score was 52.2 (SD 7.24), with 61.6% of participants demonstrating higher HL scores. Education level (B = 3.062, p = 0.012) and individual income (B = 4.318, p = 0.005) were found to be as significant predictors of HL. Comprehending health literacy (HL) can provide insights into the disparities observed among people having T2DM. In light of this understanding of its role, HL initiatives present an avenue to enhance diabetes nursing care. To enhance the quality of care and reduce morbidity and mortality rates among individuals with diabetes mellitus, nurses, healthcare providers, policymakers, and decision-makers must acknowledge and address the diverse health literacy needs.

Willy Tambunan   Sri Gunani Partiwi   and Adithya Sudiarno   

Objective: This paper aims to develop a sustainable intervention strategy for the Indonesian coal mining industry's implementation of total worker health. This implementation begins with a study of the starting circumstances, followed by the implementation of an intervention based on the findings of the prior analysis, and finally, the evaluation of the intervention's effects. Methods: To determine the impact of an intervention on a subject that has already been the subject of analysis, researchers employed experimental or interventional techniques. This article will outline a framework for applying interventions to promote total worker health. Results and Discussion: The conceptual model for implementing total worker health with an intervention approach in the Indonesian coal mining industry uses a two-way approach. The first uses government regulations to intervene in the coal mining industry, and the second is company intervention through the steering committee to intervene in workers. Based on the results of a literature review conducted by the authors, no intervention model uses a two-way approach from the government and enterprise. Research Implications: An essential asset is employee safety. The well-being of employees must be evaluated while implementing work safety regulations. A total worker health approach is one method that can be employed to reduce accident rates as well as improve the well-being of employees. Originality/Value: Government constraints are in place to enhance the well-being of workers because employment regulators and designers of employment regulations need to be able to confirm that enterprises have properly implemented occupational safety and health programs.

Christin Hiyana Tungga Dewi   M. Zen Rahfiluddin   Ayun Sriatmi   and Farid Agushybana   

Background: The role of husbands as the primary source of support in maternal and infant health is well-documented. However, there is still room for improvement in regards with their practical behaviour during the pregnancy care, including their participation in antenatal classes. The primary reasons of the husband's low participation in antenatal classes are time constraints and inconvenience. This study aims to determine the impact of online antenatal class methods implementation in regards with the husbands' behaviour in pregnancy care. Materials and Methods: A quasi-experimental study was conducted in Magelang City, Central Java with sample size of 170 husbands. The utilized data collection is validated and reliable questionnaires. Independent T-tests were used to assess the difference between the intervention and control groups. General Linear Model Repeated Measures (GLM-RM) tests were conducted to determine changes in the value of variables at three measurements. Results: The results demonstrated that the intervention group exhibited higher values than the control group in three measurements. The online husband class intervention was found to enhance their knowledge by 4.269 points, their belief by 1.940 points, the attitude by 5.442 points, their intention by 3.492 points, and lead to practice by 12.00 points compared to the control group. Conclusion: The participation of the husband in online antenatal classes positively influences the quality of pregnancy care behaviors. Online methods in antenatal classes for husbands are an effective strategy to increase husbands' engagement in antenatal education programs, and improve pregnancy care behaviors. This can inform in designing antenatal care programs that involve husbands.

Meghana Kamble   Sheela Upendra   and Shital Pimpalekar   

Kangaroo care is a nurturing method for infants, emphasizing skin-to-skin contact, usually with the mother. This adaptable guide helps health professionals implement kangaroo care effectively for optimal newborn outcomes. To explore parents' perceptions of Kangaroo Father Care, the study adopted a non-experimental quantitative exploratory research design with purposive sampling. The study took place in selected mother and child clinics in Pune City. The tool used had two sections: Part I included demographic variables, and Part II was a Likert scale assessing parents' perceptions of Kangaroo Father Care with 15 items on a three-point scale. The analysis showed that a majority of 52.5% of participants had a high level of perception, 44.3% had an average perception, and only 3.3% had a poor perception. A Chi-square test examined the link between demographic variables and parents' perception of Kangaroo Father Care. At a 5% significance level, only the infant's gender showed a significant association. Conclusion: A significant portion of participants exhibited positive perceptions of Kangaroo Father Care, acknowledging its benefits for the newborn's health, bonding with the child, and reducing neonatal mortality. However, some parents harbored negative perceptions about KFC, expressing concerns about discomfort to parents, potential harm, and hindrances to constant engagement with neonate. It is evident that fostering awareness and encouraging the adoption of Kangaroo Father care can contribute to the holistic well-being of both parents and infants, fostering a deeper connection within the family unit. Further research can be explored to promote the widespread acceptance and implementation of this valuable caregiving practice.

Agus Gumilar   Nuryadi   I Kadek Suardika   M Yamin Saputra   Mulyana   Sufyar Mudjianto   Helmy Firmansyah   Novrizal Achmad Novan   Eko Purnomo   Jajat Darajat Kusumah Negara   Lius Ruswanto   and Ricky Wibowo   

Various factors influence the quality of life of adolescents, including physical and psychological well-being, self-perception, autonomy, relationships with parents, home life, and lifestyle. Health and satisfaction with health status, personal appearance, and lifestyle are also important factors that influence the quality of life of adolescents. Apart from that, high fat mass and low physical activity are also important factors that influence teenagers' quality of life. This research used quantitative descriptive method, conducted by a survey of 408 respondents who are teenagers aged 14–21 years in the West Java province. Respondents were 306 teenagers from urban areas and 102 people from rural areas. The survey was conducted to analyze the quality of life of teenagers and see the impact of regional demographics (rural and urban) on the quality of life of teenagers. The results of this study show that the overall quality of life of teenagers in both rural and urban areas is in the high category. The analysis shows a significant difference in quality of life between teenagers in rural and urban areas with a significance value of 0.00; however, teenagers in rural areas have a better quality of life than teenagers in urban areas. Additionally, the study found that 3% of teens were obese, 32% were underweight, and 8% were overweight. To improve the quality of life of teenagers, both in cities and in rural areas, participation in sports is very important because it can significantly improve a person's quality of life, especially in terms of health.

Maria Magdalena Lino   David B. W. Pandie   Dominikus Fernandez   Hendrik Toda   and Yani Seran   

Stunting poses significant health and economic productivity challenges, impacting both short-term and long-term outcomes. East Nusa Tenggara (hereafter abbreviated NTT) has the highest number of stunting cases nationwide. In order to contribute to the integrative and holistic approach described in Presidential Regulation 72 of 2021, this research attempts to actualize a comprehensive policy backed by a variety of resources and stakeholder involvement. This study takes a qualitative approach using descriptive methodologies. The results show that, in spite of concerted efforts by the government, communities of Non-Governmental Organizations (NGOs), the media, academia, and businesses to address issues like the ownership of JKN/KIS cards or the National Health Insurance Healthy Indonesia Card, parenting awareness, nutritional intake, and sanitation problems in the North West Rote District, the stage of collaborative action planning reveals challenges in putting innovative policies into practice successfully. As a result, there are concerns that stunting rates may rise by February 2023 in Rote Ndao Regency. Stunting has detrimental effects on health, which can persist in both the short and long term. The high prevalence of stunting in NTT suggests that there may be significant health challenges faced by individuals in the region, including increased susceptibility to diseases and reduced overall well-being. Concerns regarding rising stunting rates in Rote Ndao Regency by February 2023 are speculative and lacking empirical evidence. Making precise future predictions is challenging without a thorough analysis of present trends and factors affecting stunting rates.

Linda Safura Mahama   and Adadow Yidana   

The infection of the Hepatitis B virus is a major issue of public health importance in Ghana, with a prevalence of 12.3%. Knowledge and attitude toward hepatitis B infection prevention among women of reproductive age are crucial in its prevention. The study identified predictors of knowledge and attitude toward hepatitis B virus among women of reproductive age. The study employed a community-based cross-sectional study design. The study selected 420 participants using a simple random sampling technique. The tool for the data collection was a questionnaire while STAT was used in the analysis. About 88% had knowledge with 73% positive attitude toward Hepatitis B virus infection. Couples with Tertiary education were 5.3 times more likely to know about the virus. Pregnant women aged 28-40 weeks were 10.3 times more likely to have good knowledge about the virus. Being a dressmaker or hairdresser was associated with 3.4 times more likelihood of exhibiting a positive attitude towards the virus. A household with 1-4 people was 5.7 times more likely to undertake a preventive practice towards the virus. Based on these revelations, the study concludes that tertiary partner educational attainment and gestational age of 28-40 weeks predict participants' knowledge. The study recommends that stakeholders in health should increase funding for sensitization using the media and health facilities to create awareness of hepatitis B infection and preventive measures.

Abiodun F. Ipadeola   Timothy A. Attah   Olayemi O. Akinnola   Olatunji M. Kolawole   and Grace I. Olasehinde   

Objective: Laboratory diagnosis for arboviral infection remains a significant public health challenge in Africa. This study reviews the disparities in the accuracy of diagnostic tests for arboviral infection in Africa. Methods: A systematic review of studies conducted within the last 10 years was carried out to assess the diagnostic accuracy of arbovirus test methods. Titles were screened for relevance which was followed by screening of abstracts and full texts using the PRISMA guideline. Results: A total of 8 full-text articles met the inclusion criteria and were finally selected for the review. 1Step multiplex real-time polymerase chain reaction (RT-PCR), RealStar® yellow fever virus RT-PCR and in-house immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (ELISA) when compared to their gold standards (RT-PCR and CDC ELISA) showed high sensitivity and specificity in the diagnosis of arboviral infection. Majority of the RDTs (RDT SD Bioline Dengue Duo 11FK46, Chembio DPP® ZCD IgM/IgG and SD Biosensor STANDARD Q Arbo Panel RDTs) also had high diagnostic accuracies with sensitivity and specificity >70%. Luminex technology used in the diagnosis of arboviral infection has also shown high diagnostic accuracy with sensitivity and specificity >80% in the diagnosis of DenV 1,2,3 and 4 nonstructural protein (NS1), and ChikV. However, the diagnostic accuracies for Luminex for DenV 1,2,3 and 4 DIII, and ChikV NS1 were poor. Conclusion: The result from this review can be used to stimulate further research and guide policymakers in adopting evidence-based diagnostic techniques to improve diagnosis of arboviruses, case management, and prevention of epidemics.

Hidayat   Anwar Mallongi   Agus Bintara Birawida   Anwar Daud   Sukri Palutturi   Lalu Muhammad   and Gurendro Putro   

The industry is a source of heavy metal pollution and, in the long term, can negatively impact the environment through air, soil and water. If ingested in excess and over an extended period, the effects of heavy metal contamination on well water in the vicinity of the cement industry will result in health issues. Objective: This study aimed to determine the concentration levels of heavy metals Cd and CrVI in well water, exposure duration, intake rate and frequency of exposure to Cd and CrVI in people who use well water around the Bosowa Cement Industry. Method: This study used purposive sampling method, while the number of samples in this study was calculated using the slovin formula which resulted in 80 human samples and 40 well water sampling points. This type of research is a quantitative descriptive study using the Environmental Health Risk Analysis (EHRA) method, where intake, excess cancer risk (ECR), and risk management analysis were carried out in this study. If the contamination has a carcinogenic risk then risk management is required based on ECR>4 calculations. Result: As a result, the environmental health risks from exposure to heavy metals Cd and CrVI are as follows: The ECR value of Cd in adult respondents is between 1x10^-4-2x10^-3, while in children respondents is between 1x10^-4-3x10^-3. The ECR value of CrVI for adult respondents is between 3x10^-6-6x10^-5, while for children, respondents are between 4x10^-6-9x10^-5. Risk management can be done by determining the safe consumption limit and the amount of safe consumption.

Atyaf Umi Faizah   Mursid Raharjo   Onny Setiani   Sulistiyani Sulistiyani   and Yusniar Hanani Darundiati   

Broiler chickens, one of Indonesia's promising ventures for food security, also serve as a livelihood for many people. Numerous workers engage in activities at these locations, with some dedicating up to 24 hours. This type of workplace carries various health risks, particularly concerning air quality. In Indonesia, there are three types of broiler chicken coops: Open, Semi-Enclosed, and Closed. The Closed type is claimed to be more promising and environmentally friendly. However, studies addressing these differences are still minimal. Air quality parameters such as temperature (℃), relative humidity (RH), PM₁₀ (mg/m³), Ammonia (NH₃), and total bacterial count (CFU/m³) were examined in 30 chicken coops in Banyumas Regency, Central Java, in close proximity. There were 11 open-type broiler chicken farms, 9 semi-enclosed farms, and 10 enclosed ones. The average values for temperature, relative humidity, and airborne bacterial count exceeded the limits set by the Indonesian government. As for PM₁₀ and NH₃ in all observed coops, they remained below this limit. There was a significant difference (∝=0.05) for the RH parameter (p = 0.017), PM₁₀ (p = 0.023), and total airborne bacterial count (p = 0.018) among the three coop types. The Spearman Rank test indicated a significant correlation between the number of chicken and PM₁₀ (p = -0.62) and Airborne Bacterial Count (p = 0.46), as well as temperature and RH (p = -0.56), temperature and NH₃ (p = -0.394), RH and NH₃ (p = 0.392). With values above the recommended limits, poultry farm managers must consider indoor disinfection and administratively regulate working hours. These efforts also aim to minimize the health risks to workers.

Akhila Doddamani   Kirthinath Ballala AB   Yash Alok   Ratna Jay   Manjula A.   Sanjay Kini B   Divya Arvind Prabhu   Ashwini Kumar   Rukmoni Balasubramanian   Aashna Bhatia   Nitika Khandekar   and Tarun Selvarajan   

Introduction: In India, the burden of diabetes mellitus is rising swiftly, mirroring a global trend that is being observed in both developed and developing countries. Examining the correlation between indices of glycemic status & thyroid and lipid parameters at different glycemic control levels was the goal of the present study. Methods: This case control study included 50 cases (HbA1c > 6.5 %) and 150 controls (HbA1C < 6.5) who were attending an executive health check up at a tertiary level health care hospital attached to a medical college in a coastal city in Southern India. Glycemic indices, thyroid profile and lipid profile were evaluated. Correlation analyses, t-tests, and chi-square tests were carried out. Results: Cases had a mean age of 57.80±10.71 years whereas controls had a mean age of 48.47±13.89 years. The cases and controls did not have discernable differences in the lipid profile characteristics. However, T4 and HbA1C (Glycated Hemoglobin), depicted a weak positive correlation with the value of correlation coefficient r= 0.211 (p= 0.014). With respect to T4, there was a higher mean rank contrast observed among the cases than that of controls (p=0.014). Conclusion: A positive association between thyroid hormone T4 levels and glycemic status was found in this study, even if no correlation was found between glycemic control and lipid profile. This research lays emphasis on closely observing thyroid function in addition to glycemic parameters for the all-encompassing control of diabetes mellitus.

Irma Wesprimawati   Hamam Hadi   Arif Sabta Aji   and Edi Sampurno   

Uremic malnutrition may happen to patients with kidney failure who underwent hemodialysis consistently. The aim of this study is to identify the adequacy of hemodialysis and its association with nutrition status. This was a cross-sectional study conducted in Ibnu Sina Gresik Hospital. Of 96 hemodialysis patients recruited, nutritional status such as body mass index (BMI), fat mass, fat-free mass, skeletal muscle mass, extracellular water, and visceral adipose tissues was assessed by the Medical Body Compose Analyzer (mBCA). Hemodialysis adequacy (Kt/V) and nutrition status association was tested by bivariate and multivariate analysis. The respondents' mean age was 50.28±10.28 years. Hemodialysis adequacy was in the category of ≥1.8 (61.46%). Demographic characteristics had no relationship with hemodialysis adequacy (p>0.05), and there was a relationship between hemodialysis adequacy and waist circumference (p=<0.001). All indicators of nutritional status were not significantly related to hemodialysis adequacy (p>0.05), except the total body water (p = 0.030). The multivariate analysis showed that hemodialysis adequacy had no significant relationship with the nutritional status in Multivariate Analysis of Variance (MANOVA) after a predictor (the other independent variable) was added. Hemodialysis analysis was significantly related to the total body water. Future research should conduct a comprehensive evaluation of nutritional status to prevent increased morbidity and mortality factors.

Arif Sabta Aji   Fui Chee Woon   Yit Siew Chin   Yoke Mun Chan   Nur Indrawaty Lipoeto   Yhona Paratmanitya   Siti Nurunniyah   Nenden Ayu Mutiara Fauziyah   and Alfina Ulfah Farhan   

In Southeast Asian countries, where vitamin D deficiency is common, available data on the association between low 25(OH)D concentrations and adverse pregnancy outcomes are limited. This study aimed to identify the relationship between vitamin D levels of pregnant women and pregnancy outcomes in Indonesia and Malaysia. The study applied a prospective cohort approach, including 775 mother-infant pairs from selected public health facilities in West Sumatra (Indonesia) and Selangor and Kuala Lumpur (Malaysia). Blood samples were collected to evaluate serum 25(OH)D concentrations during the third trimester of pregnancy. Generally, the mean concentration of 25(OH)D throughout pregnancy was 18.04 ± 9.97 ng/ml and the prevalence of the vitamin D deficiency, insufficiency, and sufficiency status were 30.50%, 40.10%, and 29.40%, respectively. Infants born to mothers with higher 25(OH)D concentrations had increased birth weight and head circumference (p<0.05), although no significant correlation was found with length at birth. Furthermore, a significant percentage of pregnant women in Indonesia and Malaysia had insufficient vitamin D status. Maternal vitamin D status is associated with newborn anthropometric measurements in birth weight and head circumference. However, additional studies are needed to confirm these results.

Keerthana Venkatesan   and S Prabakar   

Mental health is regarded as the state of mental well-being often referred to as subjective well-being, perception and evaluation of life enabling people to cope with life stressors, process of learning and unlearning their abilities and potentials towards community well-being. Social networking and a sense of connectedness are regarded as the key resources to assess and enhance mental well-being. It is a multi-dimensional construct affecting various social and structural determinants like poverty, educational challenges, peer rejection, isolation, inadequate family support and discrimination that combine to defend or challenge one's mental well-being. Failure to address the consequences of one's mental well-being can be destructive to the individuals' physical and mental health by limiting their opportunities to develop. Poor mental well-being not only impairs the individual's functioning but also confines their social role in society. While the study focuses on the degree of connectedness over social relations impacting the mental well-being of undergraduate engineering students. The study employs a cross-sectional quantitative research design with questionnaire as the tool of data collection. The data was analyzed using correlation and multiple regression using SPSS 25. The study reveals a bidirectional relationship between social connectedness and mental well-being, with higher social connectedness indicating greater social and mental wellness, emphasizing the importance of a healthy social environment.

V. S. Leena   and V. Vijayalakshmi   

Background: Every day, one million newly contracted sexual infections are acquired, and about 800 women die of averted pregnancy- and childbirth-related causes (WHO, 2023). Young people require accurate information about the physical, psychological, and social changes that occur during childhood and adolescence as well as self-awareness about themselves and the people they interact with to protect themselves from reproductive health issues and to lead healthy, responsible, and fulfilling lives. Objective: To understand the awareness of hostel girls on sexual health and educate them on body development after puberty. To make them understand the parts of sex organs and their growth and create awareness that sexual health is a sexual right. Methods: The study is quantitative selecting the respondents using purposive sampling. In-depth analysis of qualitative method is used by critical discourse analysis. Hostel girls at a private college in Chennai were selected. 13 hostel girls who are interested, participated in the (FGD) Focus Group Discussion (Pre-discussion, and Post-discussion). Conclusions: The study identified the perception and understanding that respondents have towards sexual health. The study also found that girls are influenced by their own culture and religious aspects knowing sexual health and sex organ development.

Bintang Tatius   Nabil Hajar   Yanuarita Tursinawati   Romadhoni   Mohammad Hafish Baihaqi   Kharisma Muhammad   Mohammad Isfa' Akmal   and Imam Maliki Ja'far   

Introduction: Maintaining physical health among medical students is vital, as it can significantly impact their cardiorespiratory fitness. The sedentary lifestyle of medical students can lead to concerning health problems in the future. Purpose: This study explored multiple aspects of medical students' well-being, including cardiorespiratory durability, physical fitness, blood pressure, chronotype, and body composition. We aimed to provide a holistic health profile for medical students. Methods: This cross-sectional analysis involved 142 medical students who met specific criteria. Data collection methods included questionnaires, various physical measurements, and Harvard step fitness tests. Statistical analyses of Spearman's rank, Mann-Whitney U, and Pearson correlation tests were used to assess the relationships between various health parameters. Results: Majority of study participants (80.3%) exhibit below normal cardiorespiratory fitness. Gender (p=0.009), physical activity (p=0.005), muscle mass (p=0.000), systolic (p=0.000) and diastolic blood pressure (p=0.001) exhibited positive correlations with cardiorespiratory fitness. Visceral fat (p=0.022) and body mass index (p=0.000) showed negative correlations with cardiorespiratory fitness. However, lung vital capacity showed no significant relationship (p=0.811). Sleep quality (p=0.995) and chronotype (p=0,100) also displayed no significant relationship. Conclusions: This study found complex relationships among gender, physical activity, body mass index, muscle mass, visceral fat, sleep quality, blood pressure, lung vital capacity, and chronotype in medical students. Enhancing physical activity, maintaining a healthy body mass index, and improving sleep quality are critical for students' overall well-being.

Kresna Febriyanto   Joana Cristina Cardoso Guedes   Luis João Rodrigues Das Neves Correia Mourão   Nida Amalia   Boy Putra Anggara Prasetyo   and Ferry Fadzlul Rahman   

Noise pollution is one of the newly emerging environmental issues associated with ships. Despite numerous efforts to reduce noise, noise levels on board remain above the threshold limit value (TLV). The aims of present study were to classify levels of occupational noise, hearing disturbances, and identify other factors that impact hearing loss. From July to August 2022, this cross-sectional study was enrolled among speedboat members. We used sound level meter as a noise measurement, and audiometer for assessing hearing problems. The questionnaires were used to support the data with the questions according to age, job position, Body Mass Index (BMI), years of working, work duration in a day, smoking and alcohol consumption, physical activities, and hobbies during leisure time. Chi-Square test was used to find out the relationship between the variables. The captain's position does not exceed the TLV (average noise level was 85.45 dBA). In contrast, six speedboats in the crew's location exceeded TLV based on the length of exposure duration. A total of 109 participants (83.8%) had hearing loss, with the majority suffering from mild (40.8%), moderate (39.2%), and severe (3.8%) levels. Except for job position, all independent variables were related to hearing impairment. Due to prolonged exposure to noise, high decibel levels, and other factors, members of speedboats are susceptible to hearing loss. Age, BMI, and other lifestyle factors such as smoking, alcohol consumption, recreational activities, and daily exercise will also contribute to their hearing problem.

Made Indra Wijaya   

This study, conducted in Kintamani, Bali, Indonesia, addresses the persistent challenge of stunting—a marker of chronic malnutrition and impaired child development. Employing the Social Ecological Model (SEM), this qualitative research explores the complex interplay of individual, interpersonal, community, institutional, and policy factors influencing stunting. Through interviews and focus group discussions with diverse stakeholders including healthcare professionals, parents, and community leaders, the study identifies significant barriers and facilitators at each SEM level. Key barriers include limited nutritional knowledge and traditional feeding practices at the individual and interpersonal levels, accessibility issues at the community level, variability in health service quality at institutional levels, and fragmented policies at the policy level. Conversely, facilitators such as targeted nutrition education, robust community support systems, and integrated health programs emerge as potent tools for combating stunting. The study underscores the necessity of a multi-level, integrated approach that bridges the gaps between understanding and practical intervention, highlighting the role of tailored, culturally sensitive community engagement. Research implications stress the need for comprehensive strategies that transcend traditional focus areas to include economic, social, and policy coherence. Practical implications call for enhancing local health services and ensuring consistent policy implementation across regions. Socially, the study advocates for community-driven, culturally informed initiatives that respect local traditions while promoting scientifically sound health practices. The findings contribute to the field by emphasizing the effectiveness of the SEM in dissecting the complexities of public health challenges like stunting. They also advocate for a shift towards multi-dimensional prevention strategies that address both the symptoms and underlying determinants of stunting. This research not only enriches the academic discourse on child nutrition and public health but also offers a replicable model for similar settings globally, making a case for the critical importance of contextualized health interventions.

Ella Kossouoh   Charles Sossa   Adolphe Kpatchavi   and Badirou Aguemon   

Around the world some children, far from living in a peaceful climate of protection and love, are victims of abuse from adults or older teenagers. The objectives of this work were to describe the level of knowledge of social professionals and parents of children and then to analyze the social aspects of minors sexual abuse in two communes in southern Benin. This was a cross-sectional study on social workers and parents of children who are victims or not of sexual abuse received in social promotion centers in the communes of Abomey-Calavi and So-Ava in southern Benin from 2018 to 2022. The study population consisted of 62 social workers, 129 parents of sexually abused children and 132 parents of children who were not victims. 45.18% of the social workers surveyed had an acceptable mastery of the subject, unlike the parents of children who were victims of sexual violence (20.16%) or not (8.33%), most of whom had an insufficient level. The most common behaviors of parents after the occurrence of sexual abuse on their children were reprimands (78.94%) and compassion (21.05%). The abuse is often committed in conducive family conditions (precariousness and family disorganization) that render children vulnerable and parents unable to protect them. Thus, factors that promote sexual violence against minors include poverty, promiscuity, and celibacy (single parents). An action plan that puts parental education at the heart of the theory of change based on an appropriate communication strategy, should therefore be developed at the national level, targeting the entire population, especially parents/tutors, social workers, children, teenagers, youth, and community child protection mechanisms.

Divya A Reddy   and Mahesh E   

India's disease burden patterns are shifting towards increased morbidity and mortality from Non-communicable disease and chronic diseases. This is one of the first studies conducted using the PRISMA guidelines and checklist to understand the role played by various determinants of health in this epidemiological transition happening in India. The search on 9 reputed bibliographic databases yielded 459 articles and finally 58 articles were selected based on carefully curated selection criteria. The results confirm the relation between India's demographic transition and the increasing disease burden from Non-communicable diseases (NCDs). 21 studies significantly associated urban residential status, increasing income, better living conditions and education with increasing NCDs' prevalence. 12 studies found that NCDs were more prevalent among women than men. Increased physical activity, a healthy diet and a lower hipto-waist ratio were observed to protect against NCDs. While 9 studies found smoking tobacco and alcohol consumption were not significantly associated with the prevalence of NCDs. It is of foremost importance that India's public health policy focus must shift towards inclusivity as there is an affluent gradient to the increased morbidity and mortality from NCDs.

Susiana Sariyati   AA Subiyanto   Sapja Anantanyu   and Supriyadi Hari Respati   

Maternal mortality is a global public health challenge. Maternal and child health is one of the problems that requires attention in Indonesia. This is because the maternal mortality rate in Indonesia is still high and has not yet reached the expected target in the Sustainable Development Goals (SDGs), namely below 70 per 100,000 live births in 2030. Providing education will bring change and increase knowledge in society in a short time so that pregnant women are expected to behave according to health values. The research aimed to determine the effect of Android-based health promotion on the motivation of pregnant women to consume iron tablets. The research method uses an experimental design. The research subjects were pregnant women in Bantul Regency with a research sample of 42 respondents using purposive sampling as the sampling technique. Data collection uses a questionnaire whose validity has been tested. Statistical tests use nonparametric tests because the data are not normally distributed, specifically the Mann-Whitney test. The research results showed that the characteristics of the respondents were mostly of healthy reproductive age, with secondary education and not working in both the intervention and control groups. Based on the Wilcoxon statistical test, the motivation of respondents in the control group showed a significant difference (<0.05) before and after being given health education. The P value was 0.013, while for the control group it was 0.032. Meanwhile, the Mann-Whitney test shows a p value of 0.033 (< 0.05). In conclusion, there is an influence of Android-based health promotion on the motivation of pregnant women to consume iron tablets. Every health service is expected to provide health promotion to increase motivation to take iron tablets.

Nenden Ayu Mutiara Fauziyah   Hamam Hadi   Effatul Afifah   and Arif Sabta Aji   

More than 30% of adolescents (15-24 years) have anaemia and problems in growth, development, and cognitive abilities, as well as susceptibility to infectious diseases due to anemia. The purpose of this research is to determine the prevalence of anaemia among adolescent girls in Cigalontang, Tasikmalaya, and to discover determinant variables, such as protein, iron, and vitamin C consumption, for anaemia status. The Cigalontang high school and vocational school female population was employed for this cross-sectional investigation. The cyanmethemoglobin test was used to detect Haemoglobin (Hb) levels, and the Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) was distributed to estimate food consumption levels. To determine which factors had the most impact on a person's anaemia, the researcher used STATA's Fisher exact test and logistic regression analysis. A total of 13.33% of adolescent girls have anaemia. Adolescent girls' anaemia status is substantially related to their protein and iron consumption (p<0.05), but not to their vitamin C intake (p>0.05). Among the several factors that determine whether or not teenage females have anaemia, iron consumption stands out as the most significant (OR: 12.59; 95% CI: 1.60 - 99.24; p=0.016). Prevention programmes for anaemia in students should be promoted jointly by schools and puskesmas.

Rosyanne Kushargina   Rimbawan Rimbawan   Mira Dewi   Evy Damayanthi   and Andi Eka Yunianto   

Nutritional and health status are important inputs to support work productivity and create a healthy, active, and productive society. Office workers are in a job that is vulnerable to health problems such as obesity, which can hamper worker productivity and directly increase the risk of non-communicable diseases (NCD's). This study aimed to analyze the relationship between nutritional status and the lipid profile of office workers in Jakarta. This research used a cross-sectional design using convenience sampling to select research subjects. The research involved workers from Jakarta aged 20–55 who have worked full time, are not yet menopausal women, are not pregnant or breastfeeding, and are not smoking. Nutritional status was evaluated using the Body Mass Index (BMI) (kg/m²). Plasma lipid profile tests include triglyceride (TG), total cholesterol (TC), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C) levels. Pearson correlation was used to analyze the relationship between nutritional status and the dependent variable lipid profile (TG, TC, HDL-C, and LDL-C). A total of 55 people participated in this research as subjects. The majority of subjects were in the adult category (56.36%), and 5.45% were pre-elderly. Most subjects (61.8%) had normal nutritional status; the remaining 21.8% were overweight, and 16.4% were obese. The results of statistical analysis showed that nutritional status was significantly related to TC levels (p<0.05), but not to TG, HDL-C, or LDL-C, while TC was significantly related to LDL-C and TG was significantly related to HDL-C (p<0.05). The nutritional status was related to TC levels. The authors concluded that maintaining normal TC levels can slow the increase in TG and decrease in HDL, so that the lipid profile is well monitored and can prevent the risk of NCD's in office workers and increase work productivity.

Yetri Ester Astryani Tangel   Hasanuddin Ishak   Erniwati Ibrahim   Syamsuar Manyullei   Isra Wahid   and Wahiduddin   

There were 65 occurrences of malaria episodes in the Tambelang Community Health Center in 2023. Objective: The purpose of this research was to examine the effects of the home environment and larval habitat on the occurrence of malaria in the Southeast Minahasa Regency's UPTD of the Tambelang Public Health Center. Method: This study uses a case control study design and is an analytical observational research project. There were 65 respondent samples of malaria cases, and 130 respondents made up the control group, which was chosen at a 1:2 ratio based on respondents age and sex matching the cases. Result: The results of the bivariate analysis indicate that the usage of wire gauze (OR=0.063), ventilation (OR=3.106), the density of larvae (OR=3.195), and the house wall (OR=3.167) are risk factors. With an OR=2.932 and CI (95%) = (1.514-5.679), multivariate analysis reveals that the state of the home's walls is the most significant risk factor for the incidence of malaria. Conclusion: The condition of the home's walls is the primary risk factor affecting the prevalence of malaria in Southeast Minahasa Regency. The density of larvae, the usage of wire gauze, ventilation, and an OR > 1 are additional risk factors.

Elanda Fikri   Syukra Alhamda   Riyana Husna   Yura Witsqa Firmansyah   Denis Oxy Handika   and Linda Yanti Juliana Noya   

Helminthiasis remains a prevalent health problem worldwide. School-aged children are particularly vulnerable to various infections, with helminthiasis being a common concern. Studies have shown a prevalence of helminthiasis as high as 85.9% among elementary school children. To evaluate the prevalence in its working area, Technical Center for Environmental Health and Disease Control (BTKLPP) Class II Ambon conducts surveillance activities. This study employed a descriptive observational design with a cross-sectional approach. It involved 60 elementary school students from grades III, IV, and V at Toisapu Elementary School in Ambon City with accidental sampling. Stool samples were analyzed using microscopy and the Nafis staining method. Interestingly, the study found that most participants were male (63.33%). Additionally, a significant portion of students reported deworming twice a year (53.33%), using private toilets (78.33%), and practicing good hygiene by washing hands before eating (86.67%). Notably, all students (100%) demonstrated knowledge about the signs and transmission of helminthiasis. Despite these positive findings, laboratory examinations revealed a lower prevalence of soil-transmitted helminth (STH) infection (2.1%). Only one female student in grade four tested positive for Ascaris Lumbricoides worms. These findings highlight the need for a comprehensive helminthiasis control strategy. This strategy should encompass health promotion and education initiatives, strengthened surveillance systems, targeted interventions to address risk factors, and effective case management.

Rehanna Mansor   Jannathul Firdous   Hani Nurdeena   Hannah   Iman   Kamal Imran Danish   Muhammad Hafiizhullah   and Rafiqah Zahidahan-Nur   

Period poverty refers to the lack of access to menstrual products. More than a billion women currently lack access to even the most basic supplies during their period, which can be linked to the inconveniences faced by women during their menstruation. The aim of this study was to evaluate period poverty issues among secondary school girls aged 15 to 17 in Ipoh, Malaysia. A cross-sectional questionnaire-based study was conducted among female secondary school students in Ipoh, Perak in order to determine the prevalence of period poverty and its consequences among adolescent girls. The study type was a convenient study, which involved distribution of questionnaires to the secondary school girls. Based on attitude adequacy on menstrual health practices, results showed students had good practices in maintaining menstrual hygiene and only 8.57% had an inadequate level of menstrual practices. Besides, period poverty is not prevalent among secondary school girls in Ipoh, Perak. This was due to that only 16.67% of students experienced period poverty. Moreover, previous study on period poverty showed how it affecting the students lifestyle. Results showed that 20.95% skipped the attendance in school, 37.62% experienced emotional stress and anxiety and 39.05% did not change their menstrual products due to unclean washing facilities and 54.76% experienced lack of participation in school activities.

Nataliya B. Pankova   Roman P. Buynov   Kirill V. Filchuk   Irina B. Alchinova   Anton B. Cherepov   and Mikhail Yu. Karganov   

Most studies on the adaptation of humans to extreme conditions of the polar regions were performed in Antarctic expeditions. Our research aims to study the same parameters in the Arctic. The study was conducted at the North Pole 41 drifting polar station (NP-41) and involved 14 men. The participants were divided into two groups: "ice" – working mainly outdoors (n=8), and "laboratory" – working mainly indoors (n=6). A semi-annual monitoring included assessment of the parameters of cardiac performance, heart rate variability (HRV), and blood pressure variability (BP). During the study, no significant changes were revealed in parameters of cardiac performance and HRV. In group "ice", according to the indicators of BP variability, a decrease in the pulse BP both at rest and under conditions of controlled respiration was noted during the first 3 weeks of overwintering. At later terms, no dynamics of this indicator was found. In group "laboratory", an increase in pulse BP was detected from the third week to 6 months of overwintering also at rest and under conditions of controlled respiration. The test with controlled respiration allowed us to demonstrate the contribution of the LF range power to BP change. Conclusions: the pattern of adaptive changes during overwintering in the North depends on the type of occupational activity.

Ahmad Syahid Ibrahim   Wan Mohd Zahiruddin Wan Mohammad   and Janizah Abd Ghani   

HIV remains a persistent public health challenge, with 81,000 cases in Malaysia in 2021. Late presentation (LP) of HIV cases is a significant barrier to achieving Sustainable Development Goal 3 of ending the AIDS epidemic by 2030. In 2021, 68% of new HIV cases in Malaysia presented late, emphasizing the urgency of addressing this issue. This study aimed to determine the trend and factors associated with LP of HIV cases in Pulau Pinang from 2017 to 2021, shedding light on the relationship between LP and the pursuit of SDG 3. A cross-sectional study was conducted utilizing secondary data from the National AIDS Registry and HIV/AIDS Registry Penang State Health Department. Data analysis was performed using descriptive analysis and logistic regression. Out of 1196 cases, 62.2% presented late. Late presenters included age above 50 years (80.4%), Chinese ethnicity (65.5%), unemployment (60.6%), intravenous drug users (68.2%), residing in the Timur Laut District (64.4%), and coinfected with Hepatitis C (72.5%) and Tuberculosis (81.4%). Over the study period, the late presentation rates increased from 57.6% to 64.4%. Factors associated with late presentation included age (30-49: AOR 1.91, 50 and above: AOR 4.0), ethnicity (Chinese: AOR 2.06; Malay: AOR 2.45), unemployment (AOR 1.40), and Tuberculosis coinfection (AOR 2.64). To advance SDG 3 and ensure inclusiveness in HIV care, addressing age, ethnicity, employment status, and Tuberculosis coinfection is essential. These findings call for targeted strategies to improve timely HIV case presentation and ultimately contribute to the ending of HIV/AIDS epidemic by 2030.

Namngern Chantaramanee   Sasivimol Bootsikeaw   Punyisa Pudpong   Taweewun Srisookkum   Poonyaphat Siriteerathitikul   Monticha Kunyalue   and Chitipat Mafu   

Pesticides impact Thai and minority farmers' health and quality of life. This cross-sectional study examined pesticide-related health symptoms, Thai and minority farmers' quality of life (QoL), and factors determining QoL. Pesticide-exposed 406 farmers in Phayao province's highlands district were sampled. Multi-stage cluster sampling randomized it. Descriptive analysis, Mann-Witney U, Kruskal-Wallist, and Enter binary logistic regression were studied. The average age of the samples is 53.25 years, with 68.5% Thai farmers and 31.5% minority farmers (Mein 18.2%, Hmong 13.1%). Cholinergic, CNS, neuromuscular, and general health issues existed. Thai farmers and minorities had considerably varied health symptoms, including red skin and muscle clamps (p< 0.05). Overall, 53.2% QoL was good. When domain and overall QoL scores were classified, minority farmers had a higher mean QoL than Thai farmers. One social relation component showed significant differences between Thai and minority farmers (p<0.01). The five independent variables that significantly predict farmers' QoL were listed in order of strength: socioeconomic status, ethnic group, underlying condition, farm hour labor duration, and health symptoms (OR=2.028, 95% CI=1.302-3.159, OR=1.651, 95% CI=1.016-2.681). This research should be used by health agencies and the agricultural district to improve farmers' lives, especially Thai farmers.

Sivanandhan Selleyitoreea   and Md Mizanur Rahman   

The rapid increase in electronic cigarette use presents new challenges and opportunities in public health and policy. Currently, emphasis has been placed on electronic cigarettes, and there is a high trend of use among the adult population. This study examines the structural pathways of using e-smoking by applying an integrated technology acceptance model and the theory of planned behaviour. This cross-sectional study was conducted among 446 adult e-cigarette smokers in the Samarahan and Kuching Divisions. Adults were selected from vape outlets orderly and interviewed face to face using a structured questionnaire. IBM SPSS version 29 and Jamovi version 2.3.26 were used for data analysis. A p-value <.05 was considered statistically significant. The structural pathway highlighted that the intention to use ECs strongly predicted actual use (β = 0.760, p < .001), with perceived usefulness (β = 0.239, p < .001), ease of use (β = 0.216, p < .001), and positive attitudes towards ECs (β = 0.392, p < .001) significantly contributing to this intention. Subjective norms did not significantly influence intention (β = 0.038, p = 0.494), indicating a negligible role of social influence in CEs uptake. Furthermore, knowledge of e-smoking was negatively correlated with subjective norms (β = -0.086, p = 0.002), suggesting that increased awareness could dampen the effect of social pressures. The study concludes that the transition to ECs is significantly influenced by individual attitudes and perceptions rather than by social norms. This highlights the importance of targeting these factors in public health interventions and policies designed to address the use of EC. However, the findings should be interpreted in the context of the limitations of the study, including its geographical and methodological scope. Future research should be extended to a broader demographic to validate these findings and guide comprehensive health policy planning.

Alprindo Sembiring Meliala   Ida Yustina   Z. Zulfendri   and S. Setiawan   

This study aims to explore patient safety in greater detail using bibliometric analysis to examine the landscape of patient safety literature over the past ten years (2014-2023), with a special focus on the 50 most cited documents. The analysis evaluates publication dynamics, impact of citations, collaborative authorship, and keyword patterns to provide an overview of changing concerns and impact of research on patient safety. A comprehensive bibliometric analysis was conducted using data from the Web of Science database. The search query included the keywords "patient safety" (title) and "Health Policy Services" (Web of Science Categories) for the period 2014-2023, limited to articles. The 50 most cited articles were identified for further analysis. The analysis revealed an average of 150 citations per article, indicating substantial involvement and relevance in patient safety research. The highest publication year was 2018, followed by a decline, suggesting more targeted research is emerging to address challenges. The articles were highly collaborative, with an average of 5 authors per article. Longitudinal thematic emphasis was evident in the fluctuations of Keywords Plus, particularly "adverse events," reflecting the dynamic challenges in healthcare systems. The results of this study have strong implications for setting research priorities, informing policy decisions, and guiding practical applications to improve patient safety in healthcare settings. With renewed research focus on patient safety, it should be possible to build a more resilient system capable of effectively meeting patients' requirements worldwide. Future research should address evolving safety concerns and leverage technological advances to improve patient safety.

Marsida Duli   Qamil Dika   Iris Mone   Enver Roshi   and Genc Burazeri   

Aim: The information about kidney diseases in the general population of Albania is scant and not well-documented. The aim of our analysis was to describe the trend of selected kidney diseases in Albania for the period 1990-2019. Methods: Our analysis was based on the estimates available from the Global Burden of Disease (GBD) studies, reported by the Institute for Health Metrics and Evaluation (IHME). For Albania, IHME uses the data mainly available from the National Institute of Statistics. Results: The age-standardized proportional mortality due to kidney dysfunction in Albania in 1990 was about 4.2% compared with 6.0% in 2019. There was evidence of a reduction in the past three decades in the mortality rate and burden of acute glomerulonephritis in the Albanian population. At a crude level, chronic kidney disease and its share attributable to hypertension exhibited a gradual increase from 1990 to 2019, whereas the age-standardized estimates were lower in 2019 than in 1990. Conclusion: Our analysis summarizes valuable information about the mortality rate and burden of kidney diseases in Albania, a post-communist country in Southeastern Europe characterized by a rapid and intensive process of political and socioeconomic transition. Similar to most of the countries worldwide, kidney diseases constitute a significant health challenge for the health care system in Albania.

Nilton David Vilchez Galarza   Giancarlo Villalva Lazaro   Jessenia Vasquez Artica   José Antonio Cuadros Espinoza   Jose Francisco Via y Rada Vittes   and Luis Angel Huaynate Espejo   

The objective was to determine the relationship between sexual knowledge and attitudes in students of the Faculty of Health Sciences of a university in Huancayo in 2023. A quantitative approach was used as the methodology. In addition, it was a basic type of research, which applied an observational, cross-sectional, and correlational research method, with a non-experimental design. The population consisted of all students in the health area, from which a sample of 361 university students was obtained, to whom two questionnaires were applied according to the variables. For the knowledge variable, there were 18 items, while the attitude variable consisted of 31 items, both with a Likert scale. A significant and positive correlation between the sexual knowledge and attitudes variables in Health Sciences students evidenced this. Likewise, a medium level of knowledge was found, represented by 36.9%; and a low level of attitude, represented by 33.7%. In conclusion, it was possible to establish the relationship between knowledge and sexual attitudes in students with a correlation of r=0.129 and a significance of p=0.013, which shows a significant and positive relationship between the variables.

Wanwara Tonkulrat   Wisit Chaveepojnkamjorn   Peeraya Ekcjariyawat   and Sirima Mongkolsomlit   

Carbapenem-resistant Klebsiella pneumaoniae infections (CRKPIs) are major health problems of drug resistance worldwide. The present study aimed to determine factors associated with CRKPIs among inpatients in a tertiary healthcare hospital. A hospital-based case-control study was based on the medical records of the patients who were infected with K. pneumoniae after being admitted for more than 48 hours in the Nopparat Rajathanee Hospital (NRH) from January 1, 2020 to December 31, 2020. 145 patients with CRKPIs were assigned as cases while 290 patients with carbapenem-susceptible K. pneumoniae infections (CSKPIs) as controls. Descriptive statistics and multivariable logistic regression were used in data analysis. The average age of the study subjects was 69.3 years (SD = 15.6) among cases. The mean length of hospital stay among cases was 22.2 days (SD = 14.9). Multivariable logistic regression showed significant associations with CRKPIs, renal diseases (Adjusted OR = 2.1; 95%CI = 1.1-3.8), previous hospitalizations (Adjusted OR = 2.1; 95%CI = 1.2-3.8), central venous catheterization (CVC) > 7 days (Adjusted OR = 2.7; 95%CI = 1.1-6.8), and urinary catheter > 7 days (Adjusted OR = 2.7; 95%CI = 1.1-6.4). Therefore, it should be a guideline for surveillance of risk factors of CRKPIs among inpatients. Additionally, the results of the study can be used to monitor and assess the risk of CRKPIs to prevent the complications of patients.

Nisrina Hasna Naura   Dwi Sarwani Sri Rejeki   Siwi Pramatama Mars Wijayanti   Sri Nurlaela   Devi Octaviana   Saryono   and Rosita Dwi Jayanti   

Banyumas Regency is a receptive area with imported cases of malaria mainly due to the rate of migration. To prevent the transmission of imported malaria, migration surveillance is crucial and community figures play a vital role in raising public awareness concerning this necessity. This study aimed to describe malaria prevention behavior among community figures and identify the influential factors in Banyumas. An analytical cross-sectional study was employed among the community figures using a questionnaire. The samples included 115 community figures in the malaria-receptive areas of Banyumas using a total sampling technique. Variables studied included age, knowledge, attitude, education, income, access to healthcare services, information exposure, and behavior. The analysis involved univariate, bivariate with chi-square test, and multivariate with logistic regression. The results showed that the malaria prevention behavior among community figures was categorized as good at 54.8%. Knowledge, attitude, education, access to healthcare services, and exposure to information were related to prevention behavior. The most influential factor was poor knowledge (p=0.000; POR=4.298; CI=1.701-10.860), posing a 4.298 times greater risk of having inadequate prevention behavior. Community leaders should actively seek information related to malaria and disseminate this information to their community.

Afifah Mohamed Abbas   Rahmath Nabila Cader   Fiza Imtiaj Desai   Syeda Juverial Hussaini   and Anusha Sreejith   

Diabetes is a multifaceted metabolic disorder marked by chronically high levels of glucose in the bloodstream. Family history is a significant risk factor for developing type 2 diabetes (T2D). The objectives of our study were to assess the association between maternal and paternal diabetes and risk of type 2 diabetes mellitus and to determine the sociodemographic characteristics associated with type 2 diabetes mellitus among the adults in the United Arab Emirates (UAE). A case control study was conducted among 141 adults (47 cases and 94 controls) by means of a validated, self-administered questionnaire in both English and Arabic languages distributed in printed format. Cases can be defined as participants with type 2 diabetes mellitus and controls can be defined as participants without type 2 diabetes mellitus. The study setting was a tertiary hospital in Ajman, UAE and the duration of the study was six months. Permission was obtained from IRB before conducting the research. SPSS Version 28 was used to analyze the data. Chi-square test was used to test the association between the variables, and significant factors were further analyzed using binary logistic regression. The estimated risk of diagnosis of T2D increases by almost 5 fold if there is a positive family history of T2D, OR=4.79 (2.08-11.02). It was also noted that subjects having a positive family history of mothers with gestational diabetes are OR=2.5 (1.04-6.41) times more prone to developing T2D. It has been implicated that maternal history of T2D has a higher likelihood of being passed on to the next generation. Additionally, age, gender and marital status have been found to be risk factors in the development of T2D. The study revealed that family history is a strong independent risk factor for T2D. Among history of other chronic illnesses in the family, history of gestational diabetes remains a significant risk factor for T2D. Additionally, among the sociodemographic variables, age, gender and marital status were found to be significant risk factors.

Shauli Sengupta   and Vishal Khandelwal   

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting a substantial proportion of women worldwide, with a significant impact on reproductive, metabolic, and psychological health. In recent years, the prevalence of PCOS in different ethnic populations has gained considerable attention, particularly in India, a country with diverse ethnic groups. This review paper aims to provide a comprehensive analysis of the available literature on PCOS in various ethnic populations of India through a meta-analysis of relevant studies. The paper focuses on the prevalence, clinical manifestations, genetic factors, and the impact of environmental and lifestyle factors on PCOS among different ethnic groups in India. Furthermore, potential areas for future research and interventions to address the unique challenges faced by each ethnic population have been discussed. The research findings underscore the need for ethnically diverse studies to provide accurate prevalence rates, identify unique genetic variations, and tailor interventions for different ethnic groups. This review has also shed light on the challenges faced by women with PCOS from diverse backgrounds, including misdiagnosis, cultural stigmatization, and limited access to healthcare. The implications of this research for policy and healthcare are far-reaching. Policymakers can use the evidence to develop inclusive healthcare policies, improve awareness, and promote equitable access to healthcare for women with PCOS. By working together, collaborative efforts among researchers, healthcare institutions, community organizations, and policymakers can pave the way for a brighter future, where all women with PCOS receive the support and care they need to lead healthier lives, regardless of their ethnic backgrounds.

Jacob Corell   and Alexandra Dailey   

The associations between tobacco and many cancers, including lung cancer, have been extensively studied and reported; however, rates of these cancers in Appalachia have remained largely unchanged for years. This discrepancy could be influenced by factors like healthcare access and health literacy, defined as the extent to which individuals can find and use information to make decisions about their health. This study quantifies perceptions of personal cancer risks from smoking cigarettes among people in Eastern Kentucky. By comparing these results to predicted risks, knowledge about smoking-related health hazards in this community is described, representing an important opportunity for patient education. Adult smokers at Highlands ARH Regional Medical Center in Prestonsburg, Kentucky were approached randomly and received a 16-item validated survey tool to rate the perceived risk of developing certain cancers due to smoking. There were 183 total participants. Respondents were first screened with a verbal script explaining the study and asking if they were current everyday smokers. Predicted risk values were developed using information reported by the American Cancer Society. Kruskal-Wallis and Mann-Whitney U tests were used to calculate statistical differences across demographic groups. The results showed that the average perceived risk of lung cancer was 3.73 and the estimated risk value was 5. The estimated risk of bladder cancer was 5, but the average perceived risk was 2.02. Gastric and pancreatic cancer replicated this trend, each scoring a perceived risk of 2.31 when the estimated risks for both were 4. Women respondents rated brain cancer significantly higher than men did (p=.019). There were no other significant differences in any demographic variables in all 12 cancers. The results of this study show that low health literacy may contribute to the disproportionately high cancer rates in Appalachia from preventable causes such as smoking. A brief educational intervention using visual tools to discuss personal risks of developing cancers from smoking may be an effective form of patient education in this population.

Sri Raghavi Vasudevan   and Mohanraj Bhuvaneswari   

Infertility is a prominent concern, particularly in patriarchal societies such as India, that imposes considerable strain on couples seeking natural conception. However, medical advancement in Assisted Reproductive Technology (ART) helped these couples achieve their aspirations of becoming parents through biological conception. Yet, procrastination in seeking assistance from a healthcare practitioner, particularly in women over the age of 35, amplifies the likelihood of remaining infertile. This study explores the barriers associated with timely initiation of fertility treatment among infertile couples using a qualitative approach. Employing the purposive sample technique, this study included 19 individuals from a private reproductive clinic in Chennai. Semi-structured interviews were conducted to gather detailed case narratives from the participants, and the data were analyzed using content analysis. Four main categories were discerned through content analysis: social challenges, accessibility challenges, psychological hurdles, and lack of work-life balance. The current study discovered that major barriers to fertility treatments include perceived stigma, lack of spouse cooperation, financial burden, geographical barriers, fatalistic approach, increased optimism, work commitments, and time constraints. This study can assist health educators, physicians, policymakers, and psychologists in recognizing and implementing appropriate measures. Additionally, it may help couples recognize the importance of prompt intervention.

Almonther Abdullah Hershan   and Moufag Mohammed Saeed Tayeb   

Background: Unhealthy lifestyles can lead to a deficiency in vitamin D, as it is found in few food sources. Objective: To investigate the characteristics of vitamin D deficiency in the people of Jeddah City, especially in relation to obesity. Methods: Vitamin D level was assessed for 141 visitors to university clinic in year 2023, including 107 females and 34 males. Vitamin D level and body mass index (BMI) were assessed for each visitor. Immunoassay was used to measure vitamin D level. Vitamin D levels were divided into phases following clinical practice recommendations. Data were recorded in an Excel sheet and three tables were extracted. Results: Visitors aged between 20 and 50 years are the most interested to measure vitamin D as 70.4% of total number of cases are mostly between 40 and 50 years and 43 are visitors (30.6%), followed by young population between 20 and 30 years with 34 visitors (24.1%), and then 30s population with 22 visitors (15.7%). Females are the most frequent visitors as 105 (74.5%). Most of the cases are vitamin D-deficient with 122 patients (86.5%). Mild deficiency is the most common in 60 individuals (42.5%) followed by moderate deficiency with 57 patients (40.5%). Most of Jeddah population have high BMI with 59.6% of total cases. Most of the cases are overweight with 43 patients (30.5%) and class I obesity with 25 patients (17.7%). Conclusion: Most of Jeddah City citizens have minor vitamin D deficiency between 30 and 40 ng/mL, particularly middle-aged women. The highest interest in measuring vitamin D is among people aged 20 -50 years, mostly 40–50 years. Most of Jeddah residents are overweight or have first-degree obesity in their late 30s. The relationship between BMI and vitamin D level is inverse. These results are consistent with the Saudi findings, and obese Saudi females are considered as the highest risk for vitamin D deficiency. The most important clinical action which can give a huge positive effect is health education. To our knowledge, this is the first study which relates vitamin D deficiency with obesity in Jeddah city.

Dimitrios Antonoglou   and Kostas Rontos   

The purpose of this study is to analyze and evaluate the geographical distribution of available services within the National Health System - both public and private - for the diagnosis (primary care) and treatment (secondary care) of oncology patients. The goal is to examine whether there are disparities in infrastructure among the respective Health Regions of Greece, confirming inequalities in the access of cancer patients to effective treatment. The research is based on data from the statistical database of the Ministry of Health, Presidential Decrees on the Operation of Public Hospitals and information from the Hellenic Association of Private Clinics. The study revealed that the majority of available oncology services are concentrated in the larger urban centers of the country, primarily in Athens and Thessaloniki. This reflects the fact that dynamic oncological facilities are mainly located in the regions where medical schools and corresponding university hospitals are based. It is worth noting that the geographical imbalance of available facilities is internationally recognized as a key factor contributing to disparities in access to healthcare services. Finally, the research could in the future be extended to investigate the effectiveness of the health services offered, using the appropriate effectiveness formulas to assess the inputs and outputs of the services.

Soumya Thankam Varghese   Navya Gubbi Sateeshchandra   and Roopa Patavardhan   

This study redefines the exploration of Intimate Partner Violence (IPV) by emphasizing psychological pain as the pivotal element of trauma, shifting away from focusing solely on aftermath experiences. Psychological pain has been considered as a core area for this research through the lens of biopsychosocial model and unbearable psychache. These theoretical approaches examine psychological pain as the foundational factor in subsequent victim experiences and reactions involved in intimate partner violences (IPV). Utilizing an in-depth case study method, it rigorously analyzes a victim's narrative within the IPV realm, detailing the intricate connection between psychological pain and resulting trauma. The participant of this study is visually impaired and the perceived pain and its intensity in the context of disability have also been analyzed. This pain significantly influences victimization and exacerbates physical suffering. IPV, trauma, and visual impairment intersect, creating complex challenges for individuals and communities. The paper discusses pain and IPV in the context of informal institutions and their complementary or challenging roles. By emphasizing psychological pain as the core of trauma dynamics, this research redefines the understanding of pain involved in IPV. The insights gained can contribute to the crucial implications for interventions among survivors in the realm of intimate partner violence.

Iha Nursolihah   Dian Agnesa Sembiring   Sabrina   Salma Khoerunnisa   and Annisa Rahma Audia   

Diabetes Mellitus is a rapidly growing health concern that affects almost every country in the world. Currently, there are 537 million cases of diabetes worldwide, and this number is projected to increase to 643 million by 2030. Indonesia is the only Southeast Asian country included among the top 10 nations globally, with the highest number of people diagnosed with diabetes mellitus. Therefore, this study aims to assess the survival rate of patients with diabetes in Indonesia. This study utilized data from the "BPJS Kesehatan," the Indonesian National Health Insurance. The data pertained to a contextual diabetes participant sample. The data was analyzed using survival analysis, which involved univariable analysis, a proportional hazards assumption test, and bivariable analysis using the Cox Regression test. According to the research findings, out of the total sample of 143,496 diabetes patients observed from 2019-2022, the survival rate for diabetes patients in Indonesia was 0.7945. If analyzed by province, the survival rate ranged from 0.7496 to 0.8565. Moreover, this study found that children aged 0-5 had the highest mortality rate with a hazard ratio of 1.9 when compared to those aged 18-40. Additionally, men were found to be at a higher risk than women, with a hazard ratio of 1.5. According to the treatment class, patients in class II had the highest mortality rate, with a hazard ratio of 1.1 when compared to class I patients. On the other hand, based on participant segmentation, independent participants (PBPU) had the highest mortality rate, with a hazard ratio of 2.8 times higher than premium assistance beneficiaries (PBI) participants from the annual national budget (APBN). Finally, patients with diabetes had a higher mortality rate at General Practitioner health facilities than at Primary Clinics, with a hazard ratio of 1.1. In conclusion, the survival rate of patients with diabetes in Indonesia has witnessed a decline from 2019 to 2022, which indicates an increase in the annual mortality rate. It is imperative to address other risk factors that contribute to the decline in the survival rate of patients with diabetes.

Olufemi Timothy Adigun   Olumide Otekalu   Chidi Topaz Olujie   and Faisat Adekilekun Tijani   

This study investigated hearing health in Lesotho based on the knowledge, understanding and attitudes of Basotho people in tertiary institutions towards hearing loss and hearing aid users. The Health Belief Model framed the study. Data generation in the study was achieved through a mixed method approach using both a closed-ended structured questionnaire administered to 272 participants and a semi-structured interview with 6 respondents who were randomly selected from the 272 participants who responded to the closed-ended questionnaire. Data generated were analysed using descriptive (frequency count, simple percentage, mean and standard deviation), and inferential statistics (Chi-square) at p < 0.05. Also, a thematic analysis was used to analyse the transcribed semi-structured interviews. The findings showed that participants had a good understanding and knowledge of hearing health in relation to the implications of excessive noise and wax in the ear which may lead to hearing difficulties, as well as the need for ear checks at accredited ear clinics/centres; however, they still engage in risky hearing healthcare behaviours. Participants also had a higher negative attitude towards hearing loss as a condition but necessarily towards individuals with hearing loss. An association was identified between knowledge about hearing health and hearing in the study. Another association was recorded between gender and attitude towards persons with hearing loss and hearing aid users. Appropriate recommendations were made with respect to the findings.

Putri Zulaeka   Syamsuar Manyullei   Erniwati Ibrahim   Anwar Mallongi   Lalu Muhammad Saleh   Shanti Riskiyani   and Setiawan Kasim   

Introduction: A Health Information System (HIS) is a system that collects data from the health sector and other related sectors in public health, analyzes the data and ensures its overall quality, relevance and timeliness. The aim of this research is to analyze the effectiveness of implementing the Environmental Health Program Monitoring Information System on management, system quality and information quality in implementing Environmental Health program monitoring (TEMU-KL) at Community Health Centers at the Baebunta Community Health Center, North Luwu Regency. Methods: The type of research used is RnD (Research and Development) and Quasy Experiment research. The population and sample in this study were Health Workers and Environmental Health cadres in villages throughout the Baebunta Community Health Center working area. The data analysis used is univariate and bivariate analysis. Results: Respondents in the intervention group after being treated with the TEMU KL information system were effective in monitoring the environmental health monitoring program with a p value of 0.000. Meanwhile, respondents in the control group after being treated with the E-Monev information system were not effective in monitoring the environmental health monitoring program with a p value of 0.810. Conclusion: The Environmental Health Program Monitoring Information System (TEMU-KL) is suitable as an effort to monitor the quality of the Environmental Health Program at the Baebunta Community Health Center based on the assessment of expert validators. The Environmental Health Program Monitoring Information System (TEMU-KL) is effective in monitoring program quality and the quality of environmental health program management.

Nitin Joseph   Animesh Jain   Naila Ibrahim   Shweta Nair Jaishankar   Ashita Nallapati   Tina Mary Cherian   and Stuti Bagga   

Swimming is recommended for its several health benefits. However, swimmers are at risk of acquiring several diseases. This could be both due to constant exposure to water and non-usage of swimming gear. This study was hence done to study the morbidities, the usage patterns of swimming gear and its determinant among swimming pool users. This cross-sectional study was conducted among 162 swimmers visiting eight public swimming pools in Mangalore. The minimum sample size of 122 was calculated using the formula , at 95% CI and 15% relative precisions. Data were collected using a semi-structured interview schedule. Chi-square test and Fisher's Exact test were used to test association. A p value less than 0.05 was considered a statistically significant association. Swimming caps, goggles, ear plugs, and nose clips were always worn by 121(74.7%), 104(64.2%), 19(11.7%), and 2(1.2%) participants respectively over the past year. The most common self-reported morbidities related to swimming reported in nearly half of the participants were redness and burning sensation in the eyes over the past year. These were significantly more among swimmers who did not always wear goggles, and among occasional swimmers. Burning sensation in the eyes was seen more among those who started swimming ≤1 year ago while redness of the eyes was seen more among those who were swimming for more than 5 years. There was a statistically significant association between not always wearing swimming cap and males, not always wearing goggles, swimming for more than 5 years, occasional swimmers, and swimming for half an hour or less on each occasion in a day over the past year. There was a statistically significant association between not always wearing goggles and occasional swimmers and swimming for half an hour or less on each occasion in a day over the past year. Several participants in this study did not always wear the personal protective swimming gear. This was associated with certain common morbidities and various swimming-related characteristics among the swimmers. Hence there is a need to periodically screen swimmers for various morbidities and to educate them and encourage them to wear swimming gear on every occasion.

Aulia Asman   Novita Mansoben   Heriyana Amir   Henny Kaseger   Widya Astuti   Dwi Yogo Budi Prabowo   Faris   I Kadek Dwi Swarjana   Akbar Nur   Icca Presilia Anggreyanti   Ratna Sari Rumakey   Indang Dewata   and Siti Fatimah   

This research aims to provide an overview of the competency of nurses in dealing with the disaster response phase at the Community Health Centers (CHCs) in Padang City. The research uses an exploratory descriptive approach with data collection techniques using a questionnaire in the form of a dichotomous scale. The sample was taken by total sampling from all nurses at two CHCs, namely Kuranji and Andalas in Padang City, totaling 40 people. The results of the analysis showed that the majority of respondents were women (80.81%), who had a Diploma III in Nursing (90.48%) and worked in General Polyclinics and Emergency Rooms (26.19%). Most respondents (78.04%) had never attended disaster training. However, 91.86% of respondents had disaster response competence at the CHC in the good category. It was concluded that the majority of respondents had good service competence in responding to disasters, both in services to individuals and families as well as in handling psychological problems and vulnerable groups. Nurses who respond quickly to disasters have an important role in reducing the impact of disasters and improving people's quality of life.

Camille Jane Salvador   and Nasser B. Ebrahim   

We examined the association between women's decision-making autonomy and the use of maternal healthcare services among Filipino women. Adequate access to maternal services is essential for optimal health and women's well-being during pregnancy and childbirth. Maternal healthcare services such as antenatal care, skilled birth attendance, and delivery at a health facility are crucial in preventing maternal mortality. Women's decision-making autonomy plays a vital role in the utilization of maternal healthcare services. For the study, we used the Philippines Demographic and Health Survey 2022 dataset (n=7136). Survey design effects were accounted for, and sampling weights were applied. Descriptive statistics and multivariate logistic regressions were run in SPSS ver. 27.0 to analyze the data. The results showed that most Filipino women had 4 or more antenatal care (ANC) visits, gave birth in a health facility, and received the assistance of skilled health personnel during delivery. Also, the majority of Filipino women had high decision-making autonomy. Women with high levels of decision-making autonomy exhibited significantly higher odds of having 4 or more ANC visits than women with fewer ANC visits. However, no significant association was observed between women's decision-making autonomy and skilled birth attendance or health-facility delivery. Among the sociodemographic factors, education, wealth index, and region were significantly associated with maternal healthcare service use. Thus, women's empowerment is essential in enhancing maternal healthcare utilization. Moreover, to achieve equitable maternal health care service use, it is important to target poor women and women with low levels of education in the Philippines.

Hassan M. Bukhari   

Saudi Arabia is going through a nutritional transition that is affecting dietary habits negatively, which increases diseases related to poor nutrition, particularly poor breakfast consumption. The aim is to identify the dietary habits of the adult population. A cross-sectional study was run in 2018–2020, collecting data from 4062 healthy males and females aged 18–60 years. A questionnaire that includes sociodemographic status and dietary habits has been measured. Results were analysed by SPSS version 26 for the Chi-square test at a significant level of 0.05. The study found that about 60% consumed 3-4 meals per day, while 36% consumed two or fewer. The eating habits were divided between healthy and unhealthy choices (53% vs. 43%). Females consumed fewer meals than males. 43% of both genders consumed a harmful snack. The snack types were varied, with females consuming fries and vegetables as snacks more frequently than males (18% vs. 9%). In contrast, males consumed more meat sandwiches and leftover cooked food (24% and 19% versus 16% and 13% for females). Equal proportions of men and women consume fruits and nuts. Breakfast is consumed by the highest percentage (36%). 40% of men always consume breakfast, while only 32% of women do so. 32% of individuals of both genders skip breakfast. In conclusion, the poor eating habits of the participants were discovered. These findings are useful for designing nutrition education programs promoting nutritious snack consumption, which might be affected by the nature of breakfast consumption.

Ahmed K. Hassan    Khaled M. Zahran   Mohammed S. Alibrahim   Majed M. Alhumaid   Sobhi Noureldin Ata   Hussam K. Aldawsari   Mohamed Frikha   Hatem Abd Elmonem Saleh Eldiasty   Naglaa Radwan   and Badry E. Hammad   

Psychological problems are the main problem for mothers who have special kids. Caring for a child with a disability is stressful, disappointing, and frustrating, as a parent may be compelled to attend to the ill child for a long period and receive regular treatment. Aims: The study aimed to ascertain how cardio exercise affected the psychological stress experienced by mothers of special needs children. Methodology: The study adopted an experimental design, choosing a sample of 40 women, aged 25 to 46, to be regular visitors of the Association for People with Special Needs (APSN) in Al-Ahsa City, the Eastern Province of the Kingdom. Two groups of participants were randomly assigned: twenty mothers in the experimental group and twenty mothers in the control group. What distinguished the experimental group was the fact that it not only took part in the association's psychological awareness sessions but also in its aerobic fitness program. A psychological stress scale was evaluated. Findings: Mothers of children with special needs who were in the experimental group had significantly lower psychological stress levels than those in the control group (P<0.05), suggesting that the experimental group was superior to the latter. Mothers who participated in the cardio exercise program saw a reduction in psychological stress. Several suggestions for further study and application might be offered considering the study's findings. Initially, to confirm the findings, it is critical to repeat this study with a sizable sample. Furthermore, it would be helpful to understand the processes by which cardio exercise lowers psychological stress. According to scientific research, stress reduction can be achieved by including cardio exercise programs in support services for moms of children with special needs. Studies indicate that engaging in physical activities, including cardiovascular exercise, might help enhance mental well-being and lower stress and anxiety levels. The research paper advises that institutions modeling support for mothers of special needs, children should include cardio exercises in their weekly routines. This inclusion attempts to achieve this by alleviating the severity of psychological pressures such as mothers' experience.

Marina Sousa   Maria Nascimento Cunha   and José Rodrigues   

Triage protocols are indispensable for the seamless operation of Emergency Departments (Eds). This research focused on patient experiences in EDs employing the Manchester Triage System (MTS), a widely used protocol across Europe. Use a phenomenographic approach and an in-depth qualitative analysis through semi-structured interviews. Results revealed three categories to describe the qualitatively different ways that patients experience the contact with EDs: "Healthcare Professionals Roles", "Waiting Time to be Cared" and "Triage Protocol". Patients expressed confidence in the competence of health professionals, especially nurses, in the effective application of the triage protocols. However, more studies are needed to confirm this result as part of the research on patient satisfaction. However, interviewees also expressed concern about extending waiting time, attributing not to the triage process but to delays in receiving medical attention. The outcomes emphasize the pivotal role of the MTS in managing patient flow within EDs, stressing the need for swift triage and prioritization to enhance resource distribution and patient throughput. Despite a substantial trust in healthcare workers, there's an evident demand for better communication with patients, improvements in ED infrastructure, and strategies to reduce waiting times. Additionally, the preference to bypass ED visits was also mentioned, opting instead of primary care services for non-critical needs, while acknowledging the indispensability of EDs for serious conditions. This attitude on the part of patients suggests a possible strategy to diminish ED stress by improving primary care accessibility and educating patients on the appropriate use of EDs. This research contributes to the existing literature by providing a nuanced perspective on patient experiences in EDs, especially regarding the MTS. It highlights the imperative of a patient-focused approach, an enhanced communication, and the improvement of patient waiting conditions. These findings are relevant for healthcare professionals, administrators, and policymakers dedicated to improving patient satisfaction with the services provided in an ED.

Eni Adriani Abidin   Anwar Mallongi   Hasnawati Amqam   Agus Bintara Birawida   Apik Indarty Moedjiono   Hidayanty Healthy   and Setiawan Kasim   

Background: Bumi Tamalanrea Permai is a housing complex with all the dynamic problems of typical Metropolitan City residents. One of them is the activities of street vendors who sell close to the road shoulder, which makes the vendors vulnerable to exposure to emissions from passing motor vehicles. The aim of the study was to quantify the health hazards that street sellers face from being exposed to carbon monoxide (CO), nitrogen dioxide (NO₂), and total suspended particles (TSP). Method: Six ambient air sampling stations at BBLK were analyzed, and a total of 68 respondents were involved. Intake, RQ, and THQ values were calculated as part of the data analysis process. Risk management must be implemented if RQ is greater than 1. Results: The average concentration of Nitrogen Dioxide is 13.3 mg/Nm³, Carbon Monoxide 7953 mg/Nm³ and Total Suspended Particles 89.7 mg/Nm³. The morning intake values are for Nitrogen Dioxide 10.03 mg/Nm³, Carbon Monoxide 28.9 mg/Nm³ and Total Suspended Particles 10.7 mg/Nm³ while the average evening intake value for Nitrogen Dioxide is 23.7 mg/Nm³, Carbon Monoxide 28.9 mg/Nm³ and Total Suspended Particles 10.2 mg/Nm³. Quantitative data explained by calculating RQ and THQ Quotient both real time and lifetime is still safe. Conclusion: The findings indicate that street sellers in Bumi Tamalanrea Permai are not in danger of developing health issues as a result of being exposed to NO₂, CO, and TSP.

Dwi Sapta Aryantiningsih   Nizwardi Jalinus   and Linda Rosalina   

The success of tuberculosis (TB) treatment is significantly dependent on patient adherence. Moreover, ensuring treatment adherence is crucial for pulmonary TB patients, as it improves positive treatment outcomes and prevents drug resistance. To enhance health literacy, self-efficacy, and treatment adherence, the current use of digital media offers a distinct opportunity for disseminating information. Therefore, this research aimed to develop EduTB as an online health information application to enhance knowledge and adherence to TB treatment. The design of EduTB included the combination of the PRECEDE-PROCEED and MATCH models, serving as a health promotion model starting with the analysis stage. This was followed by designing a TB health education model, namely Partnership Online Learning (POL). In the design stage, the model and educational product have been developed. The supporting products for the education model and testing instruments for development include validity and practicality testing on small and larger groups. The results showed that the EduTB application has been successfully developed, with a validity testing of 0.84, categorized as valid, and the practicality of 83%, classified as practical. The practicality result was based on the perception of educators in the experimental group, which was 91%, categorized as highly practical.

Mai Nhu Uyen Le   Jianlin Zhou   Dinh Phu Cuong Le   and Dong Wang   

As reported by the World Health Organization, breast cancer is recognized as the most popular disease in women. Thus, the need for early and accurate detection of this cancer for effective treatment is highly demanded. In this paper, a novel machine learning-based method is proposed to improve the success of breast cancer prediction. To be specific, Extreme Gradient Boosting (XGBoost), which is an efficient machine learning algorithm to deal with large datasets, is applied with the help of the Linear Discriminant Analysis (LDA) algorithm, which is often used for dimensionality reduction by fusing the original multidimensional data features, to create the cancer predictive model. From the experimental results, with the LDA, it is shown that the XGBoost classifier can help to improve the classification accuracy by 2.7 % compared to the classifier without using LDA. Moreover, when compared to other machine learning methods, the proposed method also shows a better classification result with the root mean squared error of 0.115, which means that its error is at least 2.6 % lower than others. The proposed method aims to support doctors in enhancing clinical application as well as improving medical quality, especially when detecting the very first moment of breast cancer.

Elnur Rustamov   Narinj Rustamova   and Gulay Mammadzada   

The impact of the COVID-19 pandemic on healthcare professionals worldwide has been significant, affecting both their physical and emotional well-being. This has led to the emergence of a major concern known as occupational stress or burnout syndrome characterized by emotional exhaustion, depersonalization, and feelings of reduced personal accomplishment. The present research is driven by the need to understand the specific factors contributing to post-pandemic burnout in Azerbaijani medical doctors and identify potential interventions to mitigate its adverse effects. The aim of the study was to investigate the mediating role of hope in the relationship between the psychological resilience of medical doctors and the level of job burnout. Brief Psychological Resilience Scale, Maslach Burnout Inventory Scale, and Dispositional Hope Scale were used to measure the outcome of interest. A total of 303 medical doctors, with a mean age of 39 years (SD 10.25), participated in our study, and a significant majority (79.5%) of them were female. Almost 80% of participants reported being married and 73.2% were working in the central hospitals. Correlation analyses showed that job burnout is negatively related to psychological resilience and hope. On the other hand, psychological resilience was positively associated with hope. In addition, structural equation modeling revealed that hope played a mediating role in the relationship between psychological resilience and burnout sub-dimensions (emotional exhaustion, depersonalization, and personal accomplishment). Based on the results of this research, increasing the level of psychological resilience during the period when individuals experience burnout and become desensitized may be curative. The findings from this study may have practical implications for the development of interventions and support systems tailored to the unique needs of Azerbaijani medical doctors.

Ankita Sharma   and Monika Mathur   

Despite government efforts to achieve Universal Immunization Programme (UIP) targets in India, there is a significant disparity between targets and actual results for immunization coverage. Over two-fifths of children receive all recommended vaccinations, and the rate of complete immunization coverage remains constant. However, partial immunization has increased, reflecting wide regional and socio-economic variations in fully immunized children. The present study investigates socio-economic inequality in the UIP for children aged 0-5 years across India. The study analyzed 75th round of the NSS data conducted from July 2017 to June 2018. Expenditure incurred by households on the immunization of children was considered a dependent variable and analyzed by government and private health facilities. To investigate the extent of inequality among socio-economic groups in the distribution of government subsidies and type of government health centers, we used a Benefit Incidence Analysis (BIA) approach. Also, concentration curves (CC) and concentration indices (CI) were further calculated to disclose inequalities. The study's findings show the variation in the utilization rates for healthcare facilities based on quintile class, urban and rural areas. The poorest section of households utilizes government health centers more than the richer section of households. Gender inequality was seen in terms of the utilization of private and government health centers. The mean expenditure on immunization of children aged 0-5 years in government and private health centers varies across quintile class, rural and urban areas. The CC and CI disclose inequalities in the utilization of healthcare facilities and expenditure incurred by households for immunization of children aged 0-5 years across India. The overall benefit incidence was the highest among the richer section of households in urban areas compared to the poorer section in rural areas. Inequalities in benefit incidence and subsidy impact exist due to the distribution of benefits among the richer sections of households. As a result, the government needs to launch awareness campaigns, improve rural health infrastructure, reduce financial burden through insurance coverage and subsidies and focus on states with high socio-economic inequalities. It will ensure equitable distribution of benefits among poorer socio-economic groups in both rural and urban areas.

R. Robert   and S. Meenakshi   

The escalating prevalence of Alzheimer's disease and dementia in our aging population presents a formidable challenge. This empirical study aims to investigate the prophylactic potential of foreign/second language acquisition in mitigating Alzheimer's disease and dementia among older adults. It explores the cognitive advantages and neurobiological impacts associated with foreign/second language learning in aging individuals. To achieve this, the study utilized a sample of 150 elderly participants and employed language activities focused on vocabulary retention and memory, with the IELTS Band Score as a rubric for pre- and post-test measurements. The study employs a quantitative research approach, focusing on adult learners in language institutions. Two academies in the Vellore District, India, comprise the control (63 participants) and experimental groups (87 participants) aged above 60. The collected data were analyzed based on IELTS Band Scores on a 1-9 scale. The research spanned two months, commencing in August 2023. The statistical outcomes suggest a positive impact of foreign language acquisition on vocabulary retention and memory among older adults. The post-test scores of the experimental group indicated a statistically significant difference (p < 0.001) between groups. This proved that engaging in language-related activities deepens understanding of the complex relationship between language acquisition and the aging brain network, offering a pathway to preserve cognitive health in later life.

M. El Alami   S. El khabbazi   and F. de Arriaga   

Autism is defined as a group of basic behaviors, containing difficulties in social reciprocity, communication, and limitations in behavioral flexibility. Children with autism spectrum disorder (ASD) have problem in understanding the minds of others, their emotions, feelings, beliefs and thoughts. Autistic children usually go through a diagnostic process, as soon as their difficulties or problems arise. The diagnosis usually agrees with any of the existing medical and psychological recommendations; it only determines that a certain level of problems are reached, and the child must be considered autistic. However, the diagnosis does not evaluate all the problems and severities that the child presents, nor its detailed individual intensity, and as it is not usually repeated, it is not able to determine the appearance of new symptoms or deficiencies with age, nor the changes of intensity. The diagnosis also does not determine the affective states associated with these deficiencies, nor the intensity of these associations. Therefore, the aid offered to the autistic child cannot achieve greater efficiency, due to ignorance of these factors. The mental representation of autistic children or mental model, as we conceive it, contains all the deficits and tasks that they cannot perform, and their intensities; it goes further than diagnostic. So far, no autism mental model has been developed, according to our knowledge. The present article proposes a fuzzy affective mental model of autism, in correspondence to DSM-V, taking into account the child's affective states. The model contains all his/her particular deficiencies, intensities or severities, frequencies, and associated affective states. This evaluation is made according to affective computation and fuzzy logic, in order to take into account affection and uncertainty. The mental model can be obtained by means of a serious games methodology we have previously developed, and it can be obtained any time, in the form of a fuzzy cognitive map or a fuzzy graph. This mental model can be used to develop new techniques to improve learning of autistic children, and to integrate them into social life. Those improvements constitute our immediate future work.

Oscar Radyan Danar   

In recent years, the COVID-19 pandemic has occurred in multiple waves with a prolonged duration. Then, since the pandemic has different characteristics compared to other kinds of natural disasters, it is crucial to have a more efficient disaster management system. The experience of past disasters has highlighted the suffering and long-term impact on society in terms of economic, social, and communication patterns to the policies taken in handling them. Therefore, this research comprehensively examines the pattern of handling COVID-19 in South Korea, Japan, and Indonesia; thus, it is expected to reduce the risks and obstacles that hinder disaster preparedness in the future, especially those related to COVID-19 or other SARS mutations. This study employed a systematic literature review methodology followed by a Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) approach to generate data from all relevant studies from electronic databases (all January 2020 to 2023). The review found that each country has different approaches to intergovernmental relations, risk communication, mitigation & preparedness, and sustainable recovery from COVID-19 affect policy choices, such as the decision to adopt an agile and proactive approach or cautious and self-restraint-based approach. Furthermore, it is suggested that these countries restructure the legal framework, accurately quantify their existing resources, enhance coordination mechanisms with functional differentiations among stakeholders, and identify entry points to healthcare to provide better preparation for future disasters.

Oleksandr Mozolev   Oksana Romanyshyna   Oleksandr Alieksieiev   Ihor Tomkiv   Oleksandr Binkovskyi   Valentina Miroshnichenko   Ludmila Kravchuk   and Oleksii Pidmurnyak   

Quarantine restrictions of COVID-19 and the transition to distance learning have significantly affected the ability of teachers to conduct physical education classes and develop functional and motor abilities of students. Establishing the state of physical health of students allows the teacher to systematize the received information and, based on it, make a choice of forms, methods and means of physical education. 889 students aged 17-19, who studied for the 1st year at Khmelnytskyi Humanitarian-Pedagogical Academy (697 women and 192 men) took part in the research. The goal is to conduct a comparative analysis of changes in physical health indicators of students after the end of the quarantine of СОVID-19. Methods: analysis of scientific and methodological sources; survey; pedagogical observation; methods of studying the functional state of students; comparative analysis; methods of mathematical statistics. Results: women showed the following changes: increase in body weight (BW) +4.09%; increase in chest girth (ChG) +5.2%; decreased vital capacity of the lungs (VC) -4.51%; deterioration of the life index (LI) -8.77%; deterioration of the index of the reserve and the efficiency of the cardiovascular system (IR) +5.81%; increase in the rate of recovery of the cardiovascular system after physical exertion (RI) +7.93%. Men showed: increase in body weight (BW) +3.71%; increase in chest girth (ChG) +3.22%; decreased vital capacity of the lungs (VC) -3.36%; deterioration of the life index (LI) -6.84%; deterioration of the index of the reserve and the efficiency of the cardiovascular system (IR) +6.88%; increase in the rate of recovery of the cardiovascular system after physical exertion (RI) +7.31%. Conclusions: the comprehensive comparative analysis of the average statistical indicators of young people's state of health showed anthropometric, functional and morphofunctional changes in students' state of health, which indicate the appearance of excess weight, the deterioration of indicators of the work of the cardiovascular and respiratory systems, and as a result – decrease in the energetic potential of working capacity of girls and boys.

Ahmed Ibrahim Abdeltawwab Hussein   Rosnani Hashim   Zainol Akbar Zainal   Shairyzah Ahmad Hisham   Syamhanin binti Adnan   Preethi Raghavan   Siti Azdiah Binti Abdul Aziz   and Noorlina Binti Nordin   

Introduction: Despite the established effectiveness of highly active antiretroviral therapy (HAART) in reducing HIV-related morbidity and mortality, concerns are rising regarding the emergence of metabolic syndrome (MetS). However, there is inadequate evidence regarding the incidence of MetS among adults starting first-line HAART regimens in Malaysia. Objectives: This study was conducted to determine overall incidence of MetS in HIV patients on first-line HAART regimens and to assess the association between first-line HAART and incidence of MetS at 6-month and 9-month follow-ups among studied subjects. Methodology: This was a prospective cohort study involving adult patients (≥ 18 years old) diagnosed with HIV from January 2023 till May 2023 and on first-line HAART regimen with or without integrase strand transfer inhibitor (INSTI) for at least 6 months undergoing follow-up at infectious disease (ID) clinic at a tertiary Malaysian hospital. The study subjects were screened and recruited using purposive sampling after being selectively allocated into 2 groups according to inclusion and exclusion criteria. The patients' profiles were screened via the electronic hospital information system (eHIS) using a pre-prepared data collection form. Results: A total of 210 patients were included in this study with median and interquartile range (IQR) of age of 36 (14) years. The majority of the participants were males (n= 193, 91.9%) and Malays (n= 99, 47.1%). The study results showed that overall incidence of MetS was seen the most in about one fourth of studied subjects (n= 48, 22.9%) at 9-month follow-up, whereas only 5 (2.4%) patients had MetS at 6-month follow-up. This study also found a significant association between first-line HAART and incidence of MetS at 9-month follow-up, where there was a significant increase in MetS among patients on non-INSTI regimen (29.2%) compared to those on INSTI regimen (16.3%). Conclusion: This study found that initiation of first-line HAART regimens, particularly regimens without INSTI, in individuals with HIV has been associated with an increased incidence of MetS. Thus, promoting health education and consistently monitoring patients' clinical and laboratory parameters during each visit, while implementing appropriate measures, are deemed ideal.

Limna Mahaboob   Hilal Alrahbi   Sabitha Sadanandan   and Gopi Suresh Vankudre   

Nosocomial infections are hospital- acquired medical emergencies that have equal impacts on patients, healthcare workers (HCW), and the entire healthcare system. The current rise in health care associated infections (HAI) rates worldwide indicates a better periodic education and training of HCWs. The objectives of this study were to (1) assess the current knowledge level of nursing students on prevention of nosocomial infections, and to (2) find out the efficacy of structured teaching intervention on knowledge regarding the prevention of nosocomial infections among nursing students. A one-group pretest-posttest, Quasi experimental design was adapted to determine the efficacy of structured teaching intervention for nosocomial infections. A total of 56 nursing students from the University of Buraimi were enrolled in the study using a convenient sampling approach. A self-designed structured, validated questionnaire was used to assess the knowledge of the nursing students. The impact of the intervention was evaluated after seven days of intervention using the identical questionnaire. The results revealed a statistically significant improvement after intervention from (4.68 ±1.597) to (7.11 ± 1.997), a statistically significant (p<0.05) improvement. Before the intervention, only one student (1.79%) had good knowledge, 14 (25%) had average knowledge, and 41 (73.21%) had poor knowledge. After the intervention, eight (14.29%) had good knowledge, 38(67.86%) had average knowledge, and only 10 (17.86%) had poor knowledge. It can be concluded that the post-intervention participant population with good and moderate knowledge related to nosocomial infection increased from 1.79% and 25% to 14.29% and 67.86%, respectively. Hence, the researchers suggested that the structured teaching program in the present study plays a crucial role in improving nursing students’ knowledge of the prevention of nosocomial infections and enables the students to practice infection control measures during their clinical placement.

Bintang Yinke Magdalena Sinaga   Diandra Angelia Az Zahra   Maria Magdalena Simatupang   and Arlinda Sari Wahyuni   

Pulmonary tuberculosis (TB) can significantly affect a person's quality of life, but the extent varies depending on several factors. The study aimed to analyze the quality of life and related factors among pulmonary TB patients aged 18 years or older, newly diagnosed, and undergoing treatment at Prof. Dr. Chairuddin P. Lubis Universitas Sumatera Utara Hospital, Medan, Indonesia. This is a cross-sectional study of 100 pulmonary TB patients selected using consecutive sampling. Primary data were collected through in person interviews using the WHOQOL-BREF questionnaire. The chi-square and logistic regression tests were used for data analyses. The multivariate regression test showed a significant association between intensive treatment phase and physical domain deterioration, a significant association between reduced family income and psychological domain deterioration, a significant association between males and having comorbidity with social relationship domain deterioration, in which comorbidity was the most affecting factor and a significant association between low education level and reduced family income with environmental domain deterioration, in which low education level was the most affecting factor. In conclusion, patients in the intensive phase of treatment, with reduced family income, sex of male, having comorbidity, and being less educated should be a priority for families, health workers, and the government in addressing the quality-of-life deterioration among pulmonary TB patients.

Laila Qanawati   Rama Alasir   Yazan Gammoh   and Reeman Marzouqah   

Purpose: This study aimed to explore the association between marriage consanguinity and hearing loss in a Jordanian demographic. Methods: A retrospective analysis was conducted on medical records from Al-Ahliyya Amman University Hearing and Speech Center between 2020-2023. The study included 416 patient records, all under the age of 18. Diagnostic methods included Pure-tone audiometry, Distortion product Otoacoustic emissions, Auditory brainstem response, and Immittance metering. Statistical analysis involved chi-square tests and logistic regression, considering marriage consanguinity, sex, and family history. Results: A total of 416 children were included in the study (58.18% males). The average age of the sample was 59 months (±45). A positive family history of hearing loss was observed in 77.88% of the children. Marriage consanguinity was reported in 38.46% of the sample population. Logistic regression indicated an increased risk of hearing loss in consanguineous marriages (log odds=0.895, p=.029), with a significant interaction between consanguinity and family history (log odds=0.362, p=.007). A marginally lower risk of hearing loss in females than in males was also observed (log odds= -0.498, p=.050). Conclusion: The study identified a significant association between consanguineous marriages and the incidence of sensorineural and mixed hearing loss, underscoring the genetic risks associated with consanguineous marriages and the importance of genetic counselling and audiological screenings in such populations.

Lendra Lendra   Jermias Tjakra   Febry Handayani   Lelo Sintani   and Vivi Friskila Angela   

Construction projects still experience a high rate of work accidents despite prior research on occupational safety and health's impact on worker performance. This study aims to analyze the variables that influence Occupational Health and Safety (OHS) policies for enhanced performance of construction workers in Palangka Raya City and build a regression model of the influence of OHS policies on worker performance. Data were collected through literature studies and questionnaires, then analyzed with various statistical methods. The benefits of this research are to reduce the number of work accidents and improve the application of OHS. The literature study identified four variables: Occupational Safety, Occupational Health, OHS Regulations and Procedures, and Implementation of Health Protocols - which were broken down into 39 factors that affect worker performance. The regression model indicates that occupational safety and health policies have a positive impact on worker performance, showing that Occupational Safety, Occupational Health, OHS Regulations and Procedures, and Implementation of Health Protocols are crucial factors. Moreover, the better implementation of these policies leads to improved performance. The most influential variables on worker performance based on the Standardized Coefficient Beta value are Implementation of Health Protocols (94.8%), OHS Regulations and Procedures (18.2%), Occupational Safety (10.9%), and Occupational Health (5.9%).

Dodoh Khodijah   Ida Yustina   Sarma N Lumbanraja   and Fikarwin Zuska   

Eclampsia cases in North Sumatra were 3.2%, and this figure is higher than the national figure of 2.7%. Eclampsia is an obstetric emergency condition in the form of seizures. Eclampsia appears as an indicator of poor labour and complication preparedness in the community. Family involvement of preeclamptic pregnant women without severe features in preventing eclampsia is needed through preparedness. This study aims to design a model of family preparedness of preeclamptic pregnant women without severe features to prevent eclampsia in Deli Serdang Regency. The study was qualitative with a phenomenological approach. Data were collected through in-depth interviews involving 23 families of preeclamptic women without severe features. The data were analysed using interpretative phenomenology analysis. A model of family preparedness of preeclamptic pregnant women without severe features in preventing eclampsia was found, consisting of 10 subcategories of 4 main categories, namely "knowledge and attitudes about preeclampsia," "utilization of health services," "preeclampsia emergency plan" and "resource mobilization". This model is an appropriate step in caring for preeclamptic pregnant women without severe features by families as the frontline in the prevention of eclampsia in the community before getting medical services in the hospital. The findings of this study serve as a guideline for the preparedness of families in the community.

Sheetal Barde   Sheela Upendra   Jasneet Kaur   and Ranjit Kumar   

Background: Plastic bags have become a ubiquitous part of daily life, but their accessibility comes with environmental and potential health hazards. While the health concerns associated with plastic bag use are not as widely studied as their ecological influence, there are some concerns worth considering. Objective: The purpose of this study was to delve into the collective comprehension of the general populace regarding the potential health hazards associated with the utilization of plastic bags within residential premises. Additionally, it sought to explore the prevailing dispositions towards embracing substitute options within specific localities of Pune City. Methodology: The current study used a non-experimental descriptive design. The sample size of 100 adults living in the specified Pune Urban Area was determined using a simple random selection procedure. The tool included an organized knowledge survey and an attitude questionnaire about the health risks of using plastic bags in the home and attitudes regarding the usage of alternatives. Results: 65 percent had insufficient knowledge, 35 percent had enough knowledge, and none had sufficient knowledge. Regarding attitude, 44% had an adverse mindset, 53% had an unbiased viewpoint, and three percent had a good attitude about using alternatives. Conclusion: The community health nurse must continually concentrate her efforts on raising women's understanding of the health dangers associated with domestic use of plastic through health education, media coverage, education programmes, and other ways.

Sheela Upendra   Jasneet Kaur   and Sheetal Barde   

The most frequent, expensive, and devastating pregnancy problem is delivery occurring prior to the completion of 37 weeks of pregnancy. The major cause of infant death and a significant fraction of all birth-related short- and long-term illnesses is preterm birth. A descriptive phenomenological approach was adopted. Mothers of new-borns admitted to neonatal units, as well as having premature twins babies delivered before 37 weeks of gestation, were eligible to participate in the research. The mothers of premature children with congenital defects or severe illnesses were not included in the investigation. Up to data saturation, seven mothers were included in a purposeful sampling. Information was verified by reading the transcripts while listening to the audio after each tape was transcribed. Significant measures were made to safeguard the anonymity of participants and the information they submitted. By utilizing methods like reflexivity, triangulation, peer debriefing, and member checks, the validity and reliability of the data acquired were enhanced. The criteria of credibility, confirmability, dependability, and transferability were used to assure trustworthiness. The lived experiences of the participants are described under four themes namely: emotional state, parenting concern, need for Help and Desire. Under Emotional state – Uneasiness, Anxiety and unpreparedness, and fear of health issues of the new-born were the subthemes. Mother-baby relationship subtheme was under the parenting concern theme. Under the need for help theme, three subthemes emerged: need for help from the health team professional, need for help from family members, and spiritual support. Constantly monitoring the babies was the subtheme under the Desire theme. Mothers of premature twins reported feeling anxious, fearful, and helpless for both babies and babies' admission at the NICU. Mothers required a lot of encouragement and support from the medical team to begin caring for their infants' basic needs.

Dipali Dumbre   Ranjana Chavan   and Seeta Devi   

Background of the research: The detrimental consequences of noise pollution on the health of motorists are examined in this article. Numerous health hazards associated with noise pollution, a major environmental issue in cities, can have a negative impact on people who spend a lot of time driving. In order to comprehend the potential effects of noise pollution on drivers' physical and mental health, the study evaluates pertinent literature. It also examines several research approaches used in earlier studies to examine the connection between noise pollution and driver health. Purpose: The primary goal of the study is to determine how noise pollution has increased over time to an unsettling degree due to the fast advancement of technology, industrialization, urbanization, and other communication and transportation systems. Since it is commonly known that noise affects almost every living thing on the planet negatively, reducing noise levels is a top priority for safeguarding the health of people and animals alike. Techniques: by going over the techniques used in various studies, talking about the benefits and drawbacks of each, and maybe even emphasizing the ones that are most suitable for the subject at hand. Result: The study findings show that the impact of noise pollution like high blood pressure, sleeplessness, nausea, heart attack, depression, dizziness, headache, and induced hearing loss can be seen in car drivers. A vehicular noise is the result of the vibrating body of the sound of the car's engine running. The results emphasize the necessity for efficient measures and laws to reduce noise pollution and protect the health and welfare of vehicle drivers. Conclusion: The harmful consequences of noise pollution on the health of motorists are highlighted in this article.

Somkid Juwa   Kamollak Wongnoy   Taweewun Srisookkum   Busarin Juwa   Anukool Manoton   and Suthichai Sirinual   

Background: Health literacy improves outcomes, especially for socially bound aging (SBA) who become homebound. This study aims to create novel activities to encourage SBA to adopt health behaviors (HB) that improve their quality of life. Method: This action research created and assessed the northern Thailand SBA health literacy (HL) program. Purposive and two-stage cluster sampling selected 10 supporters, 192 participants, and 8 university researchers from 210 participants. Research has three phases: look, think, and act. Data were collected through in-depth interviews, workshops, questionnaires, program evaluations, and post-action reviews. Descriptive, Friedman, and content analysis were used. Results: The look phase showed a society with 42.7% low-level aging and a decline in health literacy. SBA think phases last 6 weeks and include 6 activities. The program's brochure, handbook, and self-regulation form promote health decision-making, media literacy, and health communication and management. Implementing the program significantly increased HL, HB, and QoL scores during the act phase (p-value <0.001). AAR also found that SBA reflected QoL-improving programs and understood the content better. Conclusions: The SBA health literacy program improved HL, HB, and QoL. They should be used by health agencies to plan SBA activities in the study area and similar demographic areas.

Shivani Jandhyala   and Navin Kumar   

Background/Purpose – Every individual has an interpersonal style of communication (aggressive, passive, passive-aggressive, and assertive) and the skills that need to be practiced in different situations (language and body language to be maintained), the scope of assertiveness, and areas that serve assertiveness skills for a better physical, mental, and social wellbeing. Materials/Methods – A systematic search was conducted using the relevant keywords assertiveness training filtering out for Randomized Controlled trials resulting in 112 articles for the inclusion of this review. 12 articles out of 112, were considered in composing the article. The following database was searched Scopus, Psych INFO, Google Scholar, PubMed, and Research Gate. Results – The majority of the studies reported the positive effects of assertiveness training on improving lifestyle. Studies suggested that the quality and intensity of the training program varies with the impact of assertiveness improvement. Studies also showed that there is great improvement seen when assertiveness complements Cognitive Behavior Therapy (CBT), Role-play exercises, and communication skills. Conclusions – Beyond improving or inculcating the Assertive skill, the training has a good impact on Self-esteem, Confidence levels of an individual, and interpersonal relationships with a broader impact on mental well-being.

Kiruthiga E   and G. Christopher   

Fluency is essential for effective and precise communication. It refers to the effortless nature of speech, encompassing language and speech functioning. Fluency disorders, like stuttering and cluttering, disrupt communication and affect anyone, regardless of age, gender, or background. Genetics and environmental factors can disrupt the development of speech and language fluency, which leads to fluency disorder. Therefore, it is crucial to identify and address these factors in order to improve speech fluency. People with fluency disorders tend to develop negative conditioning, resulting in unhelpful thinking and avoidance behaviours. This research follows a qualitative methodology and draws on various secondary sources, including current medical research publications, psychology research papers, case studies, and medical blogs. The article focuses on fluency disorders such as stuttering and cluttering, discussing available treatment options and strategies for managing these disorders. Stuttering is a fluency disorder that disrupts speech flow and rhythm, causing repetitions or blocks. It is the most common type and affects social, emotional, and academic functioning of an individual. There are three primary forms: developmental, neurogenic, and psychogenic. Genetic factors, neurophysiological differences, and neurochemical imbalances contribute to stuttering. Cluttering is characterized by a fast or irregular speech rate, leading to disorganized speech that is difficult to understand. This condition may also impair word finding and thought organization. Treatment options include fluency-shaping therapy, stuttering modification therapy, cognitive-behavioural therapy (CBT), mindfulness-based approaches, and pharmacotherapy. Mobile applications are becoming popular tools for managing fluency disorders. The study's findings indicate that early intervention, recovery therapies, and rehabilitation strategies remain crucial in treating fluency disorders, and they can significantly improve an individual's quality of life. This article contributes a comprehensive analysis of fluency disorders and its psychological aspects in the field of human healthcare and development.

Bolarinwa Balikis Omoyemi   Ong Swee Leong   Khatijah Lim Abdullah   Intan Suhana Munira Binti Mat Azmi   Soh Kim Lam   Soh Kim Geok   and Zakariyah Ummulkhair Omolabake   

Background: Breastfeeding plays a crucial role in promoting optimal health and development for infants. However, immigrant populations often encounter unique challenges that can hinder successful breastfeeding practices, such as language barriers, lack of social support, and unfamiliarity with healthcare systems. Despite this pressing issue, limited research has been conducted on the specific experiences and barriers faced by immigrant mothers in Malaysia, particularly those originating from Nigeria. Objectives: In this research, we conducted a qualitative study to explore the experiences and barriers related to breastfeeding among Nigerian immigrant mothers residing in Kuala Lumpur, Malaysia. Methods: A descriptive qualitative approach was used to explore the in-depth experiences of mothers using semi-structured interview guide through purposive sampling. Face to face interview was conducted at the home of the participant (n=12). The interview was recorded, transcribed, and analyzed using induced content analysis. Results: Our study sample comprised 12 mothers aged between 17 and 45 years. Thematic analysis of the interviews revealed 2 primary themes: breastfeeding practices and barriers to breastfeeding. Within these themes, we identified 11 sub-themes, encompassing aspects such as importance of breastfeeding initiation, duration, exclusivity, socio-economic factors, language barriers, lack of support, limited knowledge, postpartum stress, feelings of embarrassment, and misconceptions. Conclusions: Our findings underscore the significant impact of breastfeeding barriers on the practices of Nigerian immigrant mothers in Malaysia. We recommend that healthcare professionals and relevant stakeholders extend support to this population, including the provision of affordable and accessible healthcare services, as well as the availability of trained interpreters to overcome language barriers. These insights can guide the development of targeted interventions aimed at improving breastfeeding rates and fostering the overall well-being of immigrant mothers and their infants.

Vitaliy Kamkhen   Dinara Aidasheva   Saltanat Mamyrbekova   Zhanar Zhagiparova   and Elmira Auyezova   

Morbidity, prevalence, and mortality are key epidemiological indicators that help to assess the health of young people and draw conclusions about the state of their well-being. The aim of this study is to determine the main trends in morbidity, prevalence, and mortality among youth aged 14 to 28 years for the period from 2018 to 2021. Based on population-based data on cases of diseases and fatalities in the age group 14-28 years in the Republic of Kazakhstan for the period 2018-2021, the dynamics of morbidity (total and primary) and mortality rates were analysed and studied. The period from 2018 to 2021 in the Republic of Kazakhstan is characterized by a decrease in prevalence (from 72,267.9 to 62,112 per 100,000; b=-3,770.6; p=0.05) and morbidity (from 46,117.4 to 37,648.6 per 100,000; b=-3,035.4; p=0.029), and an increase in mortality (from 52.7 to 75.8 per 100,000; b=7.67; p=0.153). The main conclusion that can be drawn is that in the dynamics in the period of 2018-2021 in the youth population of the Republic of Kazakhstan, there is a reliable decrease in the prevalence and morbidity rates and a statistically insignificant increase in the mortality rate. Data on the health status of the young generation can be applied to the development and implementation of preventive programmes and educational activities aimed at minimizing risks and raising awareness of young people about a healthy lifestyle.

Nilufar Komilova   Lolakhon Karshibaeva   Umriniso Egamberdiyeva   and Khusniddin Egamkulov   

This article discusses the nosoecological situation in the Syrdarya region and territorial aspects of public health. Natural conditions, economic-social and historical-geographical aspects of the territory were analyzed from a nosoecological point of view. The geographical position of the region, natural conditions, population, economy, and indicators of morbidity of the population are highlighted. The incidence rates of certain species and groups of the population in the Syrdarya region were identified by districts. The study provides a brief overview of the function of medical demography, and its role in the system of sciences. The main attention is paid to the medical and demographic state of the Syrdarya region. Separate demographic processes of the population of the republic and the Syrdarya region, including maternal and infant mortality, and general mortality rates, are considered. In this regard, in particular, scientific research is important to identify and analyze the relationship between the morbidity of the population of the Syrdarya region and the ecological situation on the territory. Monitoring the water and soil composition, as well as identifying the influence of winds blowing on its territory on certain types and groups of diseases of certain areas (Khavast, Bayaut), developing a prognosis, improving health becomes important.

Poonam Garg   Gargi Sharma   Himani Sharma   and Chirmi Acharya   

In the realm of child psychology and juvenile delinquency, conduct problems have been consistently linked to delinquent behavior. The goal of this study was to find out how juvenile offenders' conduct issues were affected by oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). According to statistical data, juvenile offenders with and without ADHD and ODD have significantly different levels of conduct issues. These findings suggest that both ADHD and ODD may contribute to the development of conduct issues among young offenders. Therefore, early identification and management of these disorders are crucial for preventing the onset of delinquent behavior. This study emphasises the need of early detection and treatment of ADHD and ODD symptoms in children at risk of behavioural issues and criminal behaviour. The results of this study have important ramifications for the prevention and treatment of behaviour issues and criminal activity in children at risk. By addressing ADHD and ODD early on, professionals can work towards reducing the likelihood of conduct problems and promoting positive outcomes for juvenile delinquents.

Marzhan Myrzaly   

Teenagers living in dysfunctional families face difficulties in maintaining a healthy lifestyle. Understanding the relationship between the social status of the family and the healthy lifestyle of the younger generation is important in the context of the Republic of Kazakhstan. The purpose of this study is to demonstrate the relationship between the social status of the family and the healthy lifestyle of the younger generation in the Republic of Kazakhstan. A survey and questionnaire of 1,200 adolescents from disadvantaged families in the Mangystau Region of the Republic of Kazakhstan were conducted and a thorough statistical analysis of the results was carried out. The analysis showed that the level of self-assessment of adolescent health does not depend on the social status of the family or other factors considered that affect their healthy behavior. However, family affluence has an impact on life satisfaction in boys, and in girls, a link was found between the frequency of brushing teeth and family affluence. The boys also found a link between injuries requiring medical intervention and family wealth. However, the level of family wealth does not significantly affect other aspects of a healthy lifestyle, such as the frequency of breakfast consumption, consumption of sugary soft drinks, fruit consumption, smoking, and physical activity. The results of this study have practical significance for the development of social support for adolescents living in dysfunctional families. They can be used to develop protocols and programs aimed at improving the health and well-being of the population according to the economic stratification of the population in the Republic of Kazakhstan with an emphasis on clusters of people with below-average income.

Sirigala Lavanya   and Prathiba Ramani   

Background: YSR Kadapa district is identified as one of the districts in Andhra Pradesh having high fluoride levels in groundwater by the central government of India. Fluorosis is an endemic disease that mainly affects the mineralized tissues of the human body, the teeth, and the bone. This study aimed to assess the effects of chronic toxicity of fluoride in consumable water on teeth and skeletal system in adults in rural YSR Kadapa district, Andhra Pradesh, India. Materials and Methods: A cross-sectional study was conducted in the villages in YSR Kadapa district in adults over the age of 21. A general physical examination was done for skeletal fluorosis and an oral examination for tooth fluorosis. Tooth fluorosis was assessed as per Dean’s Fluorosis Index and skeletal fluorosis was assessed as per the guidelines given in the National Programme for Prevention and Control of Fluorosis in India (2014). Descriptive statistics, Pearson correlation coefficient tests, and the Chi-square test of independence were used for the statistical analysis of data. Results: Study results revealed a prevalence of 55.08% of teeth fluorosis and 23.82% of osteofluorosis in the adults in rural YSR district. Prevalence of both dental fluorosis and osteofluorosis was higher in males than females. There was a negative correlation between water fluoride levels in water samples and urinary fluoride levels in urine samples from the subjects in the study areas. There was a positive correlation between fluoride levels in water and prevalence of teeth fluorosis and osteofluorosis. The prevalence of osteofluorosis increased with age. Osteofluorosis was also observed in individuals without dental fluorosis. Conclusion: This study observed the presence of dental fluorosis and osteofluorosis in adults in the YSR Kadapa district. These observations provide the evidence for the chronic fluoride toxicity on teeth and the skeletal system in adults, even in areas where the mean level of fluoride in consumable water was 1.5 mg/l. Precautionary measures are needed for the supply of Defluoridated water in the community to prevent the fluoride toxicity in humans in the YSR district by the local administration. District health departments need to take measures to treat fluorosis affected adults.

Ratna Dewi Puspita Sari   Sutyarso   Dyah Wulan Sumekar Rengganis Wardani   Samsul Bakri   Tugiyono   and Hendri Busman   

Maternal mortality is an important indicator of national health. The Sustainable Development Goals (SDGs) target reducing maternal mortality to a maximum of 70 per 100,000 live births by 2030. No country can accept a doubling of the maternal mortality rate. Maternal mortality is caused by distant, intermediate, and immediate factors. Given the high rate, the Lampung Health Service prioritizes addressing maternal mortality. This study evaluates the factors that contribute to maternal mortality as variables that influence its prevalence and analyzes the equation model in Lampung, Indonesia. This study was conducted in Lampung Province, using analytical descriptive method with case-control approach. The population was divided into case and control groups, using a complete and proportional randomly selected sample from 87 community health centers in 90 sub-districts in Lampung. Each case and control group consisted of 97 samples. Distant determinants included socioeconomic and environmental health issues; intermediate determinants included maternal health status, access to health services, and use of those services; while immediate determinants were pregnancy complications. In this study, SPSS (Statistical Package for the Social Sciences) and PLS-SEM (Partial Least Squares - Structural Equation Modeling) were applied for data analysis. The results of the analysis identified 11 path hypotheses, with 7 of them having a significant effect on maternal mortality. In Lampung Province, socioeconomic factors, environmental health, utilization and access to health services, maternal health conditions, and pregnancy complications contributed to maternal mortality. Socioeconomic factors and access to health services contributed 97.79% to maternal mortality. The findings suggest the importance of hand hygiene promotion, job creation in the community, diversification of food choices, improved access to delivery facilities, and implementation of better health practices. In addition, prevention, health promotion and treatment of conditions such as preeclampsia/eclampsia need to be prioritized.

Ni Made Sri Dewi Lestari   I Made Ady Wirawan   Pande Putu Januraga   I Wayan Weta   and Putu Adi Suputra   

Introduction: Obesity is a worldwide health problem. There are several ways to deal with obesity including surgery, pharmacotherapy, behavior modification, diet and increased physical activity. Physical activity, diet, and behavior modification can be changed through health education, either actively or passively. However, it is not yet clear what type of health education is effective for obese patients so that weight loss occurs, with the aim of dealing with obesity. Objective: This study aims to describe effective types of health education to deal with obesity. Method: This systematic review uses the Pubmed and Science direct search database with keywords: (health education model for obesity) OR (health education model for obese) OR (health education model for overweight). Result: There were 4 studies that used web-based program interventions, 3 studies that used health coaching studies as an intervention for weight loss in obesity and 3 studies that used education based on behavioral theory as an intervention. 7 studies found significant results from the treatment group on weight loss, increased physical activity, and diet. Only 3 studies had no significant results in weight loss between the treatment and control groups. All studies that used health education based on behavioral theory as an intervention have significant results compared to controls. Conclusions: health education based on behavioural theory has a positive influence on obese individuals. All studies that used this method had significant outcomes when compared to control. However, the intervention must at last least 6 months.

Miftahul Falah   Tukimin Bin Sansuwito   Regidor III Dioso   Lilis Lismayanti   Nina Pamela Sari   and Faridah Mohd. Said   

In recent years, tuberculosis (TB) has emerged as a persistent global health challenge, demanding continuous attention and comprehensive efforts to mitigate its impact. The prolonged and demanding nature of TB treatment places a considerable burden on patients, affecting various dimensions of their well-being, encompassing the physical, psychological, social, and environmental domains. This study focuses on unraveling the intricacies of the Quality of Life (QOL) experienced by TB patients, with a specific lens on those receiving treatment at the Purbaratu public health center in Tasikmalaya. Employing a descriptive quantitative approach, this research aims to provide a comprehensive portrayal of the QOL among TB patients. The study encompasses the entire active TB patient population under treatment from October 2022 to June 2023, constituting a total of 48 individuals. To capture the nuanced aspects of their well-being, the WHOQOL-BREF questionnaire serves as the principal instrument for data collection. The findings emanating from this investigation indicate that individuals afflicted with TB exhibit a QOL falling within the intermediate stratum, as underscored by an average WHOQOL-BREF score of 264.3 among a cohort of 40 participants, representing 83.3% of the population studied. Consequently, it is anticipated that healthcare services and the nursing profession can proactively engage in health education initiatives with the aim of ameliorating the QOL for individuals affected by TB. The conclusion suggests a potential avenue for improvement in the well-being of individuals with TB through targeted health education initiatives. It implies a call to action for health services and nursing professions to engage in proactive measures aimed at enhancing the overall QOL for TB patients in the specified community.

Deivanai Gurusamy   Midhunchakkaravarthy Janarthanan   and Prasun Chakrabarti   

The prevalence of stress and depression is rising among students. Current research acknowledges that academic burden is a source of stress for students and evaluates physiological parameters during academic activities by deliberately introducing stressors or stress. Nonetheless, schoolgirls perceive sexual, physical, and emotional abuse as the primary source of stress nowadays. This study gathered information from fifty schoolgirls via an in-house oral questionnaire to identify those concerned about academic pressure and maltreatment. This questionnaire was designed to disclose the psychological state through oral, behavioural, and physiological responses without instigating stress unnaturally. The prepared dataset was analyzed using multinomial logistic regression, decision tree (C4.8), Naive Bayes, and k-NN algorithms for three-class classification (normal, academic, and abuse stress). The weighted average F1-score of the leading models from each classifier was 89.9%, 89.2%, 89.5%, and 88.6%, respectively. The results indicate that logistic regression performs marginally better than other methods. When separating normal and academic stress samples, the same classifier achieves an F1-score of 94.9% and 69.0%, respectively. In identifying the abuse stress classes, k-NN achieved the maximum F1-score of 88.8%. In addition, the normal, academic, and abuse stress classes achieved sensitivities of 98.4%, 65.4%, and 98.4% and specificities of 71.7%, 98.4%, and 100%, respectively. The categorisation models constructed from the research can identify schoolgirls with internalised conflict for earlier intervention.

Seok-Min Hwang   Yu-Min Kwon   and Suk-Hyun Hwang   

The crucial factor in utilizing Internet search volume data to study various health issues is the representativeness of the collected data concerning the actual prevalence of the disease. Thus, we aimed to evaluate if there are seasonal patterns in the incidence of cellulitis cases by analyzing data from the Korean Health Insurance Review & Assessment Service database, along with Internet search volume data related to cellulitis. Furthermore, we investigated the correlation between these datasets. The monthly number of cases of cellulitis was collected from the Korean Health Insurance Review & Assessment Service for the period from January 2016 to December 2022. Additionally, DataLab, an Internet search query trend service provided by the Korean portal website Naver, was used to obtain the monthly relative search volumes for three keywords related to cellulitis during the same timeframe. To determine the seasonality of monthly case numbers and corresponding search volumes, we conducted a Cosinor analysis. We utilized Pearson correlation analyses to evaluate the relationship between these variables. The incidence of cellulitis cases and the associated search volume for cellulitis-related terms both presented significant seasonality, with peaks in the summer and lows in the winter months. The seasonality was evident in both the incidence of cellulitis cases and the related Internet search data, with summer months registering the highest frequency. Significant correlations were found between Internet search volumes for cellulitis-related keywords and seasonal shifts in cellulitis incidence, suggesting that big data from the Internet is a valuable complementary resource for cellulitis research and monitoring.

Thekra Alawamleh   and Walaa AlKasasbeh   

Physical activity (PA) and healthy dietary intake (HDI) play pivotal roles in preventing noncommunicable diseases. With the growing influence of information and communication technologies, electronic health (eHealth) interventions have emerged as a promising avenue for primary prevention in healthcare. These interventions leverage digital platforms to disseminate information and foster positive behavior changes related to PA and HDI. This narrative review aims to provide a comprehensive overview of the current landscape of eHealth interventions targeting PA and HDI, delving into contemporary trends, identifying challenges, and presenting recommendations for future research directions. The review culminates in a synthesis of major conclusions drawn from the collective evidence, emphasizing novel or crucial aspects discovered through the research. Additionally, we highlight the contributions of eHealth interventions in the broader context of preventive healthcare, emphasizing their potential to mitigate the burden of chronic diseases. By providing a nuanced understanding of the current state of eHealth interventions for PA and HDI, this review aims to guide future research endeavors and contribute to the ongoing discourse on leveraging technology for public health advancement.

Rakshitha R Shenoy   Sneha Deepak Mallya   Deepak Sudhakaran   Akhilesh Kumar Pandey   Muralidhar M Kulkarni   and Suma Nair   

Background: India is currently undergoing a rapid transition with respect to demography and lifestyle which has led to a change in magnitude and pattern of diseases across the country. There is an increase in the prevalence of non-communicable diseases (NCDs) with an increase in the prevalence of multimorbidity due to ageing population and longevity. Objective: The objective of our study was to estimate the prevalence of multimorbidity and its determinants among the rural and semi-urban population in a coastal region of Karnataka. Methods: A retrospective analysis of the health and socio-demographic data available from the five peripheral health centres attached to a medical college was carried out. A total of 31,817 study participants above the age of 18 years were included in the study. Univariable and multivariable logistic regression analysis was done to check the association between socio-demographic characteristics and multimorbidity with p<0.05 being taken as statistically significant. Result: Out of the 31,817 study participants, 6.4% had multimorbidity. People >60 years were at sixty times higher odds of having multimorbidity as compared to people <60 years which was statistically significant. Multimorbidity were significantly higher among people belonging to minority religions [(Muslim: adjusted odds ratio (AOR)=1.51; 95% confidence interval (CI)=1.24-1.83 and Christian: AOR=1.34; 95% CI=1.09-1.64)], those with 1-10 years of schooling (AOR=1.22; 95% CI=1.06-1.41), those who were currently unemployed/homemaker [(currently unemployed: AOR=2.14; 95% CI=1.88-2.45 and homemaker: AOR=2.21; 95% CI=1.88-2.59)] and residing in semi-urban area (AOR=1.28; 95% CI=1.15-1.44). Conclusions: Considering the higher proportion of multimorbidity among the aged and the vulnerable group there is an urgent need to devise screening guidelines and targeted interventions for chronic conditions among this specific population.

Hassan Saidi   Zakaria Abidli   Abdessamad El hamaoui   Joumana El turk   Amri Abdeslam   Abdelmajid Soulaymani   and Abderrazzak Khadmaoui   

Introduction: Bacterial meningitis in children, constitutes a serious public health problem in Morocco. The aim of this work was to describe the epidemiological, bacteriological and evolutionary profile of bacterial meningitis in patients admitted to the Cherif Idrissi Hospital of kenitra. Methods: This is a retrospective study of children with meningitis with an average age of less than 5.55±0.25 years (minimum= 1 year and less; maximum= 12 years), from 2010 to 2018. Results: We collected 200 cases. The median age was 6 years, with a male predominance. The main germs isolated were Neisseria meningitidis (25%) and Streptococcus pneumoniae (33.5%). The case fatality rate was estimated at 8%. Conclusion: The results of our study have confirmed the important lethality of meningitis. Therefore, the health authorities must organize diagnosis and treatment campaigns especially in the environment at risk and make sure to carry out epidemiological studies around each case, and chemoprophylaxis for contacts, in order to reduce the mortality rate related to this pathology, without forgetting the fight against meningitis in an endemic country like ours.

Anambir Singh   Mohd Shannawaz   Karuna Nidhi Kaur   Mandeep Kaur   and Archana Koul   

Oral health serves as a pivotal component of overall well-being, functioning as a gateway to the broader realm of bodily health. Yet, the field of dentistry, often marginalized within the healthcare landscape, grapples with significant challenges. On one hand, it caters to the demands of affluent individuals seeking expensive cosmetic treatments, while on the other, millions of underprivileged individuals in developing nations lack access to even basic dental care. The prevailing, costly, and unsustainable approach in dentistry, often described as "drill and fill (and bill)," calls for a fundamental shift towards a more affordable and evidence-based focus on prevention. The ultimate goal is to empower individuals to preserve their natural teeth and oral health throughout their entire lives. Patient safety, a concept inherently intertwined with healthcare, has recently evolved into a distinct and multidimensional field encompassing economic, social, cultural, and organizational dimensions. In the realm of dentistry, patient safety remains a developing area, characterized by limited comprehension of effective tools and interventions to enhance safety and mitigate adverse events. The global COVID-19 pandemic has exerted profound effects on dental education, presenting formidable challenges to scholars and educators across various clinical and non-clinical training domains. These challenges extend to adapting to accessible and informative online educational content, as well as addressing partial hands-on dental experiences. This review underscores the pressing need for dental institutions to adapt proactively to the evolving landscape of dental education, ensuring they can effectively meet the demands and uncertainties of the future.

Christian Wiradendi Wolor   Datu Razali Datu Eranza   Mahmoud Ali Rababah   Ahmad Nurkhin   and Eka Ary Wibawa   

Sexual harassment remains a prevalent type of mistreatment of employees that frequently transpires within the confines of the workplace. The present study endeavors to address the lacuna in prior research and examine the effects of sexual harassment on employee depression, employee satisfaction, and turnover intention. The research employs a quantitative methodology utilizing structural equation modeling (SEM) to scrutinize the gathered data. The study's sample comprises 406 employees who have encountered incidents of sexual harassment in Indonesia. The SmartPLS 3 program was utilized to analyze questionnaires that were distributed to 406 employees via Google Forms. The results show that sexual harassment affects depression (p = 0.000), sexual harassment does not affect job satisfaction (p = 0.209), depression affects job satisfaction (p = 0.001), depression affects turnover intention (p = 0.000), and job satisfaction affects turnover intention (p = 0.001). The implication of this research is that organizations must take action to prevent sexual harassment in the work environment and reduce its negative effects by making sexual harassment prevention training and rules related to sexual harassment.

Hesri Mintawati   Ria Lubis   Tantu Usman   Jhoni Albert   Saimi Saimi   and Marhaeni Fajar   

Water is very important for the whole community, including children, because it is necessary for life and cleaning. However, the increasing global issues of water pollution pose a significant risk, exposing community to various waterborne diseases such as cholera, intestinal disorders, and other infectious diseases. Stunting can be promoted by poor water sanitation and hygiene practices through various mechanisms, including recurrent diarrhea, infection pathways, and gut environment dysfunction. Therefore, the objective of this study is to investigate the prevalence of stunting among toddlers aged 0-2 years using analytical observation, with a cross-sectional design and chi-square data analysis. The population was all toddlers aged 0-2 years, with a total sample size of 41 toddlers. The result showed that 17 toddlers experienced stunting due to poor water sanitation, with 28 being malnourished, and 7 underweight. Approximately 38.1% used refillable water, 26 (61.9%) depended on pumped water for drinking purposes, and all forty-two (100%) toddlers managed water before consumption. Based on proximity, 22 (53.4%) had toilets <10 meters away and 20 (47.6%) were >10 meters away. Furthermore, 14 (33.3%) experienced good sanitation and 28 (66.7%) had poor sanitation. Based on the z score, 30 (71.4%) had an average height, while 12 (28.6%) were classified as short. The results are expected to become a reference for Indonesian society, particularly in improving water sanitation to support nutritional status of toddlers under five.

Alfiah Hasanah   Sutyastie Remi   Bayu Kharisma   Asep Muhammad Adam   and Maman Setiawan   

This research addresses two investigations regarding the impact of pandemic COVID-19 on children's health in West Java, a province with the second highest number of children registered orphaned due to COVID-19. First, this study examines the probability of delayed immunization for children under 2yo and second it observes the health conditions of children aged below 5yo during pandemic in the same survey area. This research was conducted through a telephone survey of 500 respondents spread across 14 districts and 7 municipalities in West Java, a province that ranked number five among the provinces in Indonesia with the highest number of COVID-19 cases, with Bandung Metropolitan Area (BMA) indicating the largest number of cases after the Jakarta Greater Area. The analysis is estimated using probit regression for both models. The result shows parents are more likely to delay their children’s immunization because they feel it is not safe to bring their children to a health facility. Increases in age of children positively contribute to probability of delayed immunization. Having a community health center close to home contributes to not delaying immunization. Investigations on the health conditions of children aged 5yo show that vaccinated toddlers were less likely to have health issues, particularly if they had regular meal frequency and had a habit of drinking milk. Mothers’ education positively contributes to low health issues of children. Pandemic disrupts children's access to health care services particularly immunization. Children are more likely to have health issues when they do not receive basic immunization as well as internal factors such as dietary habits and mothers’ education.

Indhumathi S.   and Binu Sahayam D   

Background: Aging is a physiological process and it is an inevitable part of life. According to the Census of India, reports from 2001 and 2011 highlight the increase in the elderly population from 70.6 million to 104 million. It will keep increasing, but that does not necessarily mean they live healthier. Gender is one of the significant factors in geriatrics, as elderly people of different genders face unique challenges related to aging, due to differences in biological, psychological, and social experiences. Objective: To understand the difficulties faced by the elderly based on gender perspectives in health care. Methodology: Qualitative case study methodology was applied in this study using an in-depth interview guide, and the data were analyzed analyzed thematically. The researcher interviewed 30 elderly people using a convenient sampling method. Descriptive design was used to describe the existing problems of elderly people such as lack of health care, mental health issues, social security issues, financial insecurity, and difficulty with everyday tasks and mobility in Chennai based on their gender. Model: A “bio-psychosocial model” was used to understand the complex interactions between the factors and their impact on gender differences in health outcomes. The current study discussed gender differences and their influence on biological, psychological, and social factors of elderly people. Findings: The findings revealed biological factors such as Cognitive function, and Longevity, psychological factors such as Mental health disorders, coping with loss, and social factors such as Social roles and expectations, and social support networks of the elderly people based on their gender. From the study, both the elderly men and women face unique challenges related to their health. Conclusion: This study focused on developing an in-depth analysis to examine relevant issues, challenges, and areas that require further attention from governments on the impact of gender norms and roles in the realities and experiences of elderly people.

Elanda Fikri   Tantin Retno Dwijartini   Evan Puspitasari   Enny Chalimah   Siti Amaliyah   and Yura Witsqa Firmansyah   

This research is needed to know and get clear information about the effects of radiation on enamel, in the form of density, microstructure, morphology, and element content in the tooth enamel layer. This type of research is correlated with a before-and-after with control group experimental design that is in vitro the effect of ionizing radiation on tooth enamel samples (n = 18). The samples were irradiated with doses of 20Gy, 30Gy, 40Gy, 50Gy, and 70Gy. Then the density of tooth samples, the content of calcium and phosphorus constituents, as well as surface morphological analysis and pores on the teeth were observed. The results density in enamel samples has a significant average difference with the t-paired test in the pre-irradiated and post-irradiated groups of 30 Gy radiation dose (P = 0.035), and 40 Gy (P = 0.001). The content of calcium and phosphorus constituents in molar tooth enamel samples has a significant average difference with the One-way Anova test in the control and treatment groups (P = 0.001) and (P = 0.006). Reactions that occur in water molecules and organic substances produce more significant morphological changes in the interprismatic region. These microstructural changes result in a decrease in microhardness, and teeth become more brittle and cracks develop. Patients exposed to ionizing radiation must get specialized oral care to improve oral health.

Maharishi Ranganathan   Abin Jacob   Ashifa Kariveliparambil Mohammed Ashraf   Ganesh Kumar J   Madalaimuthu Anthony   Vijay M   Rupashree Brahma Kumari   and Sadananda Reddy Annapally   

Prolonged exposure to stress can cause impairments in various brain functions including cognition. Attention is one such important cognitive function that is required for our daily life and work-related activities. Chronic stress can have an impact on attention networks such as alerting, executive control, and orienting. The effects of naturalistic, persistent psychosocial stress on several attention networks were explored in this study. Parents of children with neurodevelopmental disorders (NDD) and parents of children with typical development (TD) were given an attention network test (ANT). Overall the stressed group (M= 564.623, SD= 75.484) was found to have a quicker reaction time in all the target and cue conditions when compared to the non-stressed group (M= 588.874, SD= 101.575). Both groups had similar accuracy in all the conditions. When comparing the three attention network scores, no significant difference was found in either group. However, in the stressed group, there was a significant beneficial relationship between the alerting and orienting networks (p=.006) and a high negative correlation between the alerting and executive control networks (p=.028). No significant correlation was found between the attention networks in the non-stressed group.

Udeme Samuel Jacob   Naseem Akorede Raji   Jace Pillay   Habeeb Omoponle Adewuyi   and Ojuolape Mumud Olabode   

Poor mental health impairs an individual’s functioning and cognitive processes, reducing their social role and output in society. The study investigated factors that determine mental health predictors among secondary school students in southwestern Nigeria. The study used a correlational-descriptive research approach. A total of 1000 secondary school pupils from southwestern Nigeria were chosen using a multistage sampling procedure. Three study questions were addressed at a 0.05 significance level utilizing frequency distribution, percentage, Pearson product-moment correlation, and multiple regressions. The findings of the study showed that self-esteem (r =.202, p<0.05), self-efficacy (r =.207, p<0.05), social integration (r =.275, p<0.05), gender (r =.138, p<0.05) and parental socioeconomic status (r =.207, p<0.05) have a significant relationship with mental health among secondary school students in southwestern Nigeria. In contrast, age (r =.047, p>0.05) has no significant relationship. All the independent variables jointly accounted for a 10.2% variance in predicting mental health among secondary school students in southwestern Nigeria. Also, self-esteem (β =.182, t = 2.049, p<0.05), self-efficacy (β = 138, t = 2.548, p<0.05), social integration (β =.122, t = 2.751, p<0.05), gender (β =.104, t = 1.944, p<0.05) and parental socioeconomic status (β =.457, t = 3.181, p<0.05) had a relative influence on mental health among secondary school students in southwestern Nigeria, while age (β =.069, t = 1.701, p>0.05) had no relative influence. In conclusion, there should be rehabilitation and counselling services available to students of this category. Trained special educators should be posted to all secondary schools to guide them through transitioning and help them manage stress.

Mongbo Virginie   Sossa-Jerome Charles   Damien Barikissou Georgia   Alladjo Fréazel Noce   Sopoh Ghislain   and Ouendo Edgard-Marius   

Introduction: Globally, there is an increasing concern about obesity as a public health issue. It has emerged as one of the world's non-infectious pandemics. The aim of the present study was to determine the factors associated with overweight among public officials in the city of Porto-Novo, Benin, in 2019. Methods: This cross-sectional and analytical study was carried out from January to February 2019. It covered all public officials in 13 utilities chosen by simple random selection from the 26 in the city of Porto-Novo. Data collected by observation and administration of a questionnaire were analyzed using STATA 14 software. Overweight (overweight and obesity) was the dependent variable, defined as a body mass index greater than or equal to 25kg/m2. Associated factors were identified by bivariate and multivariate analysis, at a 5% threshold of significance. Results: A total of 230 officials were surveyed, with a male/female sex ratio of 1.55. Out of these, 45.65% were of normal weight and 3.94% lean; 28.26% were overweight and 22.15% obese (i.e., 13.48%, 5.65% and 3.04% moderate, severe and morbid obesity respectively). The prevalence of overweight was therefore 50.41%. Associated factors were gender, age and lunchtime. Conclusion: Notwithstanding the biological factors identified, efforts to combat overweight among public officials are essential. This will involve awareness-raising with a view to changing behavior on unidentified modifiable factors to which workers are exposed.

Maryse N. Akolbout-Manguilla   Edith-Sophie Kombo Bayonne   Norcely Makela   Valchy Miegakanda   Laure Ghoma Linguissi   Rocide Moukouba   Merlin Isidore Diafouka   and Jean Félix Peko   

Genital Human Papillomavirus infection and HIV infection are both sexually transmitted infections. High-risk genotypes (HR-HPV) predispose patients to cancer development. This study aims to determine the prevalence of HR-HPV in cervix specimens and to identify factors associated with the presence of HR-HPV in women living with HIV (WLHIV). This was a cross-sectional study conducted from April 2021 to March 2022 at the Outpatient Treatment Center, and at the National Public Health Laboratory in Brazzaville. WLHIV aged over 17 years were included. Socio-demographic data, history, clinical data, and biological data were collected. The identification of HR-HPV genotypes was performed from endocervix samples by the real-time PCR technique. Statistical analyses were carried out using SPSS Statistics software. A total of 276 WLHIV were enrolled. The mean age was 44.6 (SD 8.9) years. The prevalence of HR-HPV was 44.2%. In multivariate analysis, the level of primary education (p=0.034; CI 95%; ORa=2.62 [1.07–6.39]) was identified as a factor associated with HPV/HIV co-infection, and a CD4 count greater than or equal to 200 cells/mm³ as a protective factor against HR-HPV infection (p=0.04; CI 95%; ORa=0.28 [0.07-0.87]). This study reveals a high prevalence of HR-HPV among WLHIV. It shows a significant association between the low level of education and genital infection by HR-HPV, as well as the protective role of the CD4 count greater than 200/mm³, in this population group. This suggests the establishment of a systematic screening of HPV-HR in women affected by HIV and the strengthening of preventive measures for sexually transmitted infections. The means of communication used for prevention must be adapted to the target populations' level of education.

Sunisa Chaiklieng   

The working processes of electronics assembly and manufacturing include machine operation, assembly and fine work inspection of products with a microscope. This study aimed to assess lighting intensity at the inspection, operation, and assembly workstations of the electronics assembly work process. A total of 167 electronics workstations in one electronics assembly and manufacturing site were analyzed. The measurement of lighting intensity was performed with a lux meter by spot sampling, and a three-zone measurement method was used. The zones were zone 1 (eye-focusing zone), zone 2 (within an arm's length) and zone 3 (outside an arm's length). Zone 2 and zone 3 refer to the materials pick-up distance next to zone 1 and zone 2, respectively. Four types of job function, i.e., machine operation, assembly of parts, and two inspection types, namely, moderate fine work under a lamp or with a monitor/ profile projector and very fine work under a microscope, were measured. The results show that insufficient lighting intensity was found in the highest proportion in very fine product inspection with a microscope, followed by inspection with a monitor/ profile projector. Insufficient lighting intensity was mostly identified within an arm's length (zone 2), followed by outside an arm's length (zone 3), when the eye-focusing zone (zone 1) was adjusted to >2,000-5,000 lux (81.12%), followed by the site of inspection with a monitor (64.29%). The light monitoring method will be useful for identifying solutions to lighting requirements regarding future eye-focusing zone adjustment of fine product inspection workstations.

Norhidayah Mohd Adenam   Engku Mardiah Engku Kamarudin   Nor Azzatunnisak Mohd Khatib   Zaida Nor Zainudin   Yusni Mohamad Yusop   and Wan Norhayati Wan Othman   

The COVID-19 pandemic has impacted populations worldwide, including rural residents in Malaysia. Confronting such a formidable battle, this outbreak's potential mental health consequences are profoundly concerning. So, this study aimed to examine the relationship between financial well-being and resilience and their influence on the mental health issues experienced by 278 rural adults in the aftermath of COVID-19. Pearson Correlation and multiple linear regression analyses were employed to analyse the data. The findings revealed a significant negative correlation between financial well-being and mental health issues, indicating that poorer financial conditions were associated with higher mental health problems. Conversely, resilience exhibited a positive correlation with mental health, signifying that higher levels of resilience were linked to better mental health outcomes. Furthermore, the regression analysis demonstrated a significant negative effect of financial well-being on mental health issues and a positive impact of resilience on mental health problems. Consequently, the findings suggest that both resilience play influential roles in determining the respondents' mental health. These results have important implications, as they can guide the development and implementation of appropriate risk management strategies to mitigate financial hardships, thereby enhancing the community's capacity to withstand this ongoing threat. This discovery holds significance for the rural population under investigation and other local communities seeking to bolster their resilience against post-COVID-19 and improve their financial stability.

Sibiya PK   Sithole PK   Nkwane ST   Mphasha MH   and Tleane DMR   

At the healthcare facilities, especially in hospitals where vulnerable patients are treated, personal hygiene and food safety procedures are of the utmost importance. Food safety is a public health issue and as such, foodservice workers need to have in-depth knowledge. Conversely, poor personal hygiene and food safety practices may lead to contamination and subsequently foodborne diseases. The goal of this study is to determine knowledge on food safety and personal hygiene among foodservice staff at Mokopane and Voortrekker hospitals foodservice units in Mogalakwena Municipality. The purpose is to pinpoint and outline areas that may need improvement to guarantee provision of hygienic and safer meals. Twenty-one food service employees in the hospitals participated in a qualitative e cross-sectional study. One-on-one interviews were held, and observations and audio recordings were made. For analysis, inductive, descriptive of open coding methods using Tesch's eight phases were employed. Results indicated that participants were knowledgeable about food safety practices, including frequent hand washing and cleanliness, as well as personal hygiene behaviours. Employees in the hospital kitchen/ foodservice unit showed that they understood the value of maintaining cleanliness, good hand hygiene, and correct food handling. The study recommends education and training programs to reinforce knowledge of food safety, appropriate food handling methods, and personal hygiene practices however, participants' abilities to put this knowledge into practice are hampered by challenges such as lack of enforcement of food safety compliance, inadequate staffing, and time restraints. The prevention of foodborne illnesses and infections was also emphasized. Employees in the hospital kitchen/ foodservice unit showed that they understood the value of maintaining cleanliness, good hand hygiene, and correct food handling. The study recommends education and training programs to reinforce knowledge of food safety, appropriate food handling methods, and personal hygiene practices. Therefore, strong enforcement procedures, adequate staffing and effective time management are required.

Prachi Jadhav   Jasneet Kaur   and Sonopant G. Joshi   

Sarcopenia is widespread, progressive condition of the skeletal muscles known as sarcopenia which increases the likelihood of adverse events like falls, functional decline, frailty, and death while also causing an accelerated loss of muscle mass and function. It is a typical ageing process that affects older adults and is influenced by both present risk factors and long-term hereditary and lifestyle factors. As the population ages, sarcopenia, which is common and has serious negative health implications, will become more prevalent. The approach of research study was quantitative research design. Pre-intervention and Post-intervention method is used in this study. The data were collected by using a Non-probability Convenience sampling technique and the sample size taken for this study was 100 and reviewed for the period of seven days after the intervention of Awareness program was given. The target population was geriatric group (65 years and above). This study was conducted in the Urban area of Pune City that is at Pashan. The knowledge and preventive questionnaire were discussed with the demographic variable. According to the intervention, the group's pre-intervention knowledge consisted as follows: 24% had outstanding knowledge, 44% had weak knowledge, and 30% had average knowledge. The group's knowledge is revealed by the research result. 67% population were having good knowledge where as 19% were having average knowledge and only 12% people were having poor knowledge after giving intervention. The current study concludes that the effectiveness of Awareness program on knowledge of Sarcopenia and its prevention has a positive impact on the urban community of selected area of Pune City (Pashan). This conclusion was drawn as a result of the findings of the study.

Reguia Cherroun   and Fateh Debla   

This study aims to discuss the Hospital at Home service (HAH) as an innovative service offered by Biskra Hospital "Hakim Saadane", a public healthcare institution in Algeria. In addition to the document analysis submitted by the department of the HAH, an interview was conducted with the department head and the medical staff to analyze and describe the main requirements to implement this innovative tool to provide high-quality and less-cost healthcare services for the benefit of patients especially old people and those who have chronic diseases. It also aims at identifying the obstacles faced by the medical staff to implement the HAH in their daily program, and the way to improve it through introducing new digital tools. The study concluded the existence of an increasing interest in this service according to the enormous number of patients in need of HAH service. However, there are a remarkable shortcoming regarding the necessary tools and equipment, in addition to the lack of adequacy of the medical staff. Numerous patients have difficulties consulting their doctors in hospitals and clinics due to many reasons, such as inability to move, chronic diseases, and overcrowding in hospitals…etc. Therefore, it becomes a necessity to rethink offering alternatives to hospital care through innovating new services that allow the patient to obtain required healthcare at home to avoid complications while moving to hospitals and clinics.

Zadrian Ardi   Chiedu Eseadi   Elsa Yuniarti   Frischa Meivilona Yendi   and Arina Widya Murni   

Functional gastrointestinal disorders (FGIDs) and generalized anxiety disorders (GADs) are widespread chronic illnesses associated with a reduced quality of life, social burdens, and low treatment rates. They affect adults, adolescents, and children. The main objective of this study was to examine the literature on the potential benefits of using cognitive behavioral therapy (CBT), local wisdom, and online counseling approaches for the treatment of FGIDs and GADs in adolescent girls of college age. The existing research on the possible advantages of these approaches was reviewed and analyzed using a narrative–descriptive literature review methodology. The results of this review demonstrated the effectiveness of the three approaches in reducing the symptoms of GADs and FGIDs, enhancing patients' access to evidence-based care, patient self-care, and participation in therapeutic activities that improve their health. These therapeutic strategies are acceptable, possibly cost effective, and most importantly, they can help individuals, including teenage girls with GADs and FGIDs, enhancing their overall functioning and quality of life. It can also be argued that these interventions, particularly online therapy, offer comparable levels of client satisfaction to traditional face-to-face therapies while being more dependable, offering greater program fidelity, being easier to develop, and reaching a wider audience. Treatments used in the studies evaluated, especially those that included local wisdom counseling techniques, are successful in raising overall functioning levels and, to some extent, patients' quality of life by encouraging self-care. The benefits of the three approaches in the treatment and management of GADs and FGIDs are still expanding, though, and longer-term studies with more robust sample sizes are advised to draw more reliable conclusions and clinical practice implications.

Sri Idaiani   and Jeffry Raja Hamonangan Sitorus   

A country's happiness index (HI) reflects its welfare and quality of life. Indonesia has assessed HI thrice, but the results have not been reviewed from a health perspective. This study aimed to compare the HI of the Indonesian population in 2017 and 2021 and determine the health status that affected the HI in 2017 and 2021. This study used data from the Happiness Level Measurement Survey (SPTK) reports 2017, 2021, and Health Statistics reports 2017, 2021. The SPTK was conducted in 34 provinces. There were 75,000 subjects with provincial-level representation who participated. Sample selection used two-stage one-phase sampling. Data were compiled and transferred to data entry and processed using the SPSS version 15 statistical program. Linear regression was used for analysis. Based on the analysis of the Indonesian HI in 2017 and 2021, there was an increase of 0.8 points, specifically in 2021, having health complaints and outpatients in the last month affecting the population's HI, namely β=-302, p=0.047, and β=-0.117, p=0.036 consecutively. This finding is also consistent with the dimensions of life satisfaction and affect. Meanwhile, health complaints experienced in the last month only affected the eudaimonia dimension, namely β=-0.322, p=0.057. In contrast to 2017, in the affect dimension, there was a relationship between health status, namely outpatient and inpatient, β=-0.129, p=0.052, and β=1.52, p=0.006, respectively. Concerning health status, there is a difference in the HI between 2021 and 2017, and one event that should be considered is the COVID-19 pandemic. Undergoing outpatient treatment during a pandemic reduces happiness and affect. For this reason, it is necessary to improve the health system which allows people who are sick or need health assistance to still be able to visit their health facilities.

Tambwe Willy Muzumbukilwa   Manimani Riziki Ghislain   Edith Mofo Pascal   Rajesh Vikram Vagiri   and Manimbulu Nlooto   

Background: Numerous authors were interested in investigating and identifying the quality indicators for assessing clinical care in HIV and AIDS management. Most of these indicators were established in developed countries settings. Nevertheless, an appropriate fundamental core set of quality indicators for assessing clinical care in HIV and AIDS management for low and middle-income countries' settings is crucial. This study aims to identify existing quality indicators for monitoring and evaluating HIV and AIDS clinical care and propose a fundamental set of quality indicators, considering indicators' local usefulness and relevance. Methods: The authors used CINAHL, PubMed, Google Scholar, and Cochrane database, along with the official websites of organizations dedicated to HIV and AIDS care, aiming to identify relevant articles and information about HIV and AIDS clinical care quality indicators. All studies only based on services set and/or patient insight were excluded, as well as articles without available full text. Each study was assessed using the appropriate Critical Appraisal Skills Programme. (CASP) checklist. The GRADE methodology was applied to rate the quality of evidence. Results: A total of 180 studies were identified through this study; among them, 20 were selected as relevant studies, and 88 AIDS AIDS clinical care quality indicators were retrieved. These quality indicators were distributed in domains as follows: Functional organizational structure (9), initial evaluation and diagnosis (14), screening for opportunistic diseases (17), prevention (7), immunization (5), HIV monitoring (20), and therapy (16). Conclusions: In summary, developing a core set of quality indicators for assessing AIDS AIDS clinical care is important in promoting high-quality healthcare services. It can help to standardize the evaluation of care quality, promote transparency and accountability, and identify areas where improvements are needed. However, careful consideration must be given to ensure that the indicators chosen are relevant, feasible, and reliable.

Nor Hamizah Abdullah   Marina Abdul Manaf   and Ruhaya Hasan   

Cohort studies in the past have shown that a high-fat diet is a major risk factor for excessive weight gain. The Malaysian Dietary Guidelines 2020 also recommend reducing the intake of foods high in fat and limiting the intake of saturated fat. Thus, this study was conducted to identify the fat intake behavior among staff at the Health Campus, Universiti Sains Malaysia. This is a cross-sectional study, in which respondents were recruited by convenience sampling. A questionnaire was used to assess the behavior of respondents regarding their fat intake practices. Principal component analysis (PCA) was applied to the questionnaire items to identify significant components. The results show that PCA has successfully identified six components of the fat intake behavior with eigenvalues greater than 1, which accounted for 62.9% of the variance. The components can be summarized as snacking on foods high in fat, consuming desserts associated with fat, using oil in the cooking method, consuming fatty portions in a meal, selecting healthier choices of food products, and consuming creamy foods. This study found that the mean values for all items ranged between 0.97 and 2.71, which falls under the category of negative fat intake behavior, reflecting high-fat consumption. The results suggest that more nutritional intervention is needed to increase awareness of healthy dietary practices among Malaysians.

Satyajit Pattnaik   Satyajit Sundar Ray   Bikash Chandra Nayak   Dhananjaya Sharma   Murali Mohan Rao   and Saptarshi Bose   

Background: Safe drinking water and proper sanitary facilities can go a long way in preventing many infectious diseases. Children are the worst affected by inadequate sanitary facilities as well as unsafe water source. NFHS-5 reveals that 72% of population in rural areas in Andhra Pradesh has improved sanitary facilities. There is no separate data for the tribal areas. The present study was aimed at finding the number of tribal families who had access to better sanitation and drinking water facilities. Methodology: This cross-sectional study was undertaken in 10 villages in a tribal dominated block in Srikakulam district of the state of Andhra Pradesh in India. A total of 350 households were surveyed (35 households in each village). A pre validated questionnaire developed and used by WHO/UNICEF was used for data collection. Results: It was found that all households used "improved" drinking water source. But only 69% of households had "improved" sanitary facility at home. The rest 31% of households still practice open air defecation. Open air defecation was significantly associated with lower level of education and occupation. Further occupation was found to be significantly associated with the practice of open air defecation. Conclusion: Tribal households in this district have access to safe drinking water but not to sanitary facilities.

Wissam Ghach   Sara Abou Ibrahim   Areej Merhi   Vanessa Buhamdan   Nermeen Bou Ghannam   and Rina Salhab   

To reduce the spread and transmission of the SARS-CoV-2 virus, the application of disinfectants and household cleaning products became a common practice worldwide during the pandemic. However, the literature revealed that these practices were associated with limited knowledge of chemical safety and resulted in several health hazards. This pilot study aims to assess the awareness and the performance of the Lebanese community regarding the safe use of household disinfectants and cleaners during the COVID-19 spread. This cross-sectional study was performed to evaluate the extent, to which the public community in Lebanon safely handles disinfectants and household cleaning products. An Awareness-Performance questionnaire was adapted from the CDC Morbidity and Mortality Weekly Report and Arabic-translated [1]. 922 respondents (aged ≥ 18 years old) participated electronically, and their data was analyzed using SPSS descriptive analysis and the Chi-Square test for significant differences (p < 0.05) among the studied variables. The study population showed lower percentages of awareness than performance regarding the safe usage of disinfectants and household cleaners. The highest percentages with significant differences (p < 0.05) were detected among females, university graduates, younger people, and participants who had not been previously diagnosed with the COVID-19 virus. Consequently, the study recommends additional investigations and awareness initiatives to be implemented in Lebanon.

Bikash Chandra Nayak   Jigyansa Mohapatra   Choudhury Sumitra Swain   and Gurukrushna Mohapatra   

Background: Dengue is a vector borne disease transmitted by the infective bite of Aedes aegypti mosquito and causative agent is dengue virus. Man develops sign and symptoms of disease after 5-6 days of an infective bite. It occurs in two forms dengue fever which is a severe flu-like illness and dengue haemorrhagic fever (DHF) which is a more severe form causing death. Objective: To assess awareness regarding Dengue and Dengue Haemorrhagic Fever among common people through cognitive, affect, behaviour (CAB) model. Methods: This is a community-based cross-sectional study carried out during the period November 2021 to April 2022. Sample size calculated was 384 and the OPD register was taken as a sampling frame. A semi-structured pretested questionnaire was used as a study instrument. Descriptive and inferential statistics are used for analysis. Results: A total of 390 patients were interviewed. Among those, 43% belonged to the age group of 18-29yr. The female participants were 50.3%. Regarding knowledge about dengue, 77% of participants had heard about it and 69% opined mosquitoes as a causative vector. Only 18% of participants knew the daytime biting nature of mosquitoes. Overall, the respondents had a good attitude as 65% of respondents considered that dengue could be a serious illness. Nearby 83% said that they had no risk of getting dengue. As preventive practice against mosquito bites, the majority (59%) used mat/coil. Conclusions: As there is no specific treatment for dengue, everybody should be aware of the early diagnosis, hospitalization for treatment and preventive practices against breeding mosquitoes.

Iwan Setiawan   Lisna Anisa Fitriana   I Ketut Adnyana   Kusnandar Anggadiredja   Nazhifa Ufamy   Irma Darmawati   Lina Anisa Nasution   Suci Tuty Putri   Upik Rahmi   Septian Andriyani   Komarudin   Ria Maria Theresa   and Aih Cahyani   

Menopausal women are prone to cognitive disorders. Various therapies that have been developed to overcome this problem are the administration of Indian Pennywort (Centella asiatica) and exercise. Both have positive effects on cognitive function, but previous studies have not examined the combined effect of the two on the brain-derived neurotrophic factor (BNDF), cognition, and physical fitness among menopausal women. Methods: This study used a pre and post-test design. Subjects consisted of 64 people who were divided into four groups, consisting Indian pennywort/IP group (500 mg daily), an exercise group (2x90 minutes per week), a group combination of IP-exercise (IP 500 mg daily and exercise for 2x90 minutes per week), and the control group. The intervention was given for 12 weeks. Results: The study showed that Indian Pennywort, exercise, and its combination can increase plasma BDNF, cognition, and physical fitness in menopausal women (p<0.05). Mann-Whitney test showed that the combination of Indian Pennywort and exercise caused the highest increase in plasma BDNF (∆=236; p=0.007), MoCA (∆=3.5; p<0.001), right-hand strength (∆ =4.6; p=0.001), left-hand strength (∆=3.5; p=0.001), and lower extremity strength (∆=6; p<0.001). Conclusion: Overall results showed that Indian Pennywort, exercise, and the combination of the two above were effective in ameliorated plasma BDNF, cognition, and physical fitness in menopausal women, but the combination provides a maximum effect compared to other groups.

Ferry Fadzlul Rahman   Herni Johan   Siti Noorbaya   Khusnul Khatimah   and Susilo Nur Aji Cokro Darsono   

Indonesia faced significant challenges in managing the COVID-19 outbreak. The nation's extensive population and geographic distribution posed significant challenges to implementing conventional healthcare delivery approaches during periods of lockdown and restricted mobility. Telemedicine has emerged as a feasible approach to deliver healthcare services with reduced reliance on face-to-face contact. This study aims to determine the relationship between Knowledge, Attitude, Length of Using the Internet, Accessibility and Social Support of Telemedicine users with skills in using Telemedicine applications in Indonesia's Primary healthcare during the COVID-19 pandemic. This research uses quantitative research with a cross-sectional research design. Data was obtained by observation using a Telehealth Usability Questionnaire (TUQ). The research samples are people who use telemedicine applications in the primary healthcare area using multiple linear regression methods to evaluate telemedicine skills. The results showed a significant association between the length of internet use, accessibility, social support and skills in telemedicine applications during the COVID-19 pandemic. The right advice on the strategy of employing telemedicine is to achieve health services uniformly throughout the country's population, enhance service quality, particularly in distant locations, reduce expenses compared to conventional ways, and improve health status.

Putu Adi Suputra   I Made Jawi   Susy Purnawati   and I Made Muliarta   

Introduction: In both children and adults, obesity is frequently correlated with low levels of vitamin D. The metabolic syndrome and insulin resistance have both been linked to people with low vitamin D levels. Low vitamin D levels and a higher prevalence of vitamin D deficiency were found in obese individuals, according to several epidemiological and clinical research. Objective: This study aims to determine the status of vitamin D in the population of Buleleng, Bali, and its relationship with body fat composition. Method: Cross-sectional research with a total of 50 subjects who satisfied the inclusion and exclusion criteria was conducted. Data analysis used independent t-test and one-way ANOVA to test the differences between groups. The Pearson correlation test is used to analyze the relationship between variables. Result: Of all these subjects, 7 people (14%) had normal serum levels of vitamin D (25 (OH) D), 15 people (30%) were insufficient, and 28 people (56%) were deficient. Analysis of vitamin D levels in each subgroup, such as sex, waist circumference (WC), visceral fat, subcutaneous fat, and body mass index (BMI), found significant differences in vitamin D levels (p <0.05). Although there was no significant difference in vitamin D levels in the normal, high, and very high body fat groups (p=0.063), there was a significant inverse relationship between vitamin D levels and body fat (p=0.000). There is also a significant inverse correlation between levels of vitamin D and BMI, body weight, WC, body fat, visceral fat, and subcutaneous fat (p<0.05). Conclusion: The prevalence of vitamin D deficiency is still high. Vitamin D levels significantly inversely correlate with BMI, body weight, waist circumference, body fat, visceral fat, and subcutaneous fat.

Jonah Angeline   and Maya Rathnasabapathy   

Background: Parenting can be challenging and crucial in child's development. Parenting becomes more complicated when the child has impulsivity and attention issues. Mothers are the child's primary caregivers and they play an essential role in caring for the child. Due to the challenges they face, mothers have stress, which affects their psychological well-being. Social support from friends and family can act as a layer of protection to ease the pressure of parenting and enhance the mother's psychological well-being. Mothers need good psychological well-being, happiness, and good health. Objective: To study the effect of parenting stress [PS] on Psychological well-being and the mediating effect of perceived social support[PSS]. Methodology: A cross-sectional was conducted among 131 mothers who have a child diagnosed with attention deficit hyperactivity disorder (ADHD). A regression analysis and structural equation model are run to see the relationships between the variables and the mediation effect. Results: The results indicate that there is a negative relationship between parenting stress and psychological well-being among mothers of children with ADHD, and Perceived social support mediates the relationship between parenting stress of the mother and the psychological well-being of the mothers of children with ADHD. Conclusion: Improving perceived social support and good interpersonal relationships will enhance better management of parenting stress resulting in positive psychological well-being.

Apri Sulistianingsih   Istikomah   Wahyu Widayati   Indah Cahyaning Sasih   Rissa Uhmul Khasanah   and Anisa Lestari   

Indonesia's most common labor complications are restlessness or severe pain at 53.5%, prolonged labor at 40.6%, and not strong enough to push 10.3%. In Islamic studies, dates fruit has been used for childbirth. The effects of consuming dates fruit on pregnancy outcomes are not fully understood as to the mechanisms and hormones that play a role in them. This study examines the effect of consumption of dates fruit at term pregnancy on hormone oxytocin and labor outcome in Independent Midwifery Practice, Pringsewu District, Lampung Province, Indonesia. A quasi-experiment was used in the study. 60 normal-term pregnant women (37-38 weeks) were divided into treatment and control groups. 70-75 g of dates consumed daily for 14 days. Measurement of oxytocin levels uses ELISA. Measures of birth outcomes are monitored from the time the pregnant woman enters the delivery room until the completion of standard delivery care. T-test and Chi-square test analyses were employed in this investigation. Manova test-based multivariate analysis is used. The results revealed that consuming dates fruit affects labor oxytocin levels, colostrum excretion, duration of contractions, labor pain, and duration of first, second, and third stages of labor compared with the control group. (p-value <0.05). Meanwhile, anxiety, intact membrane, number of contractions, APGAR score in the first minute, and complete placenta did not show significant differences (p-value > 0.05). Dates fruit can be an alternative to a Mother's pregnant term to increase labor outcome.

Ni Luh Gde Ari Natalia Yudha   Ni Made Kurniati   Putu Ayu Indrayathi   Cokorda Bagus Jaya Lesmana   Susy Purnawati   and I Made Ady Wirawan   

Chronic diseases are one of the leading causes of mortality worldwide. People with chronic diseases are at high risk of experiencing psychological problems. The Indonesian government created a chronic disease management program called Prolanis (Chronic Disease Management Program). Prolanis, which is currently implemented, has not provided efforts to overcome anxiety problems in its participants. This study aimed to determine the prevalence of anxiety in the Prolanis participants. This study was a cross-sectional study involving 384 participants. The research instrument used the Zung Self-Rating Anxiety Scale questionnaire to measure the patient's anxiety level. Data collected through surveys were analysed bivariate with the chi-square test and multivariate with the ordinal logistic regression test. The study found that most elderly participants experienced mild anxiety. Based on the bivariate analysis, factors that influence the anxiety level of the participants are gender and education attainment. From multivariate analysis, education attainment was significantly associated with anxiety. Patients with chronic diseases are prone to anxiety, which impacts efforts to adopt a healthy lifestyle. Female prolanis participants and participants with low education are more likely to experience anxiety. These findings can be used as recommendations for developing mental health programs in prolanis programs.

Ramesh Holla   Sushmitha S Shetty   Mithun Rao   and Jobinse Jose   

Introduction: Menstrual health is defined as a state of complete physical, mental, and social well-being and not mere absence of disease or infirmity in relation to the menstrual cycle. As per the recent National Family Health Survey (NFHS-5), 77.3% of young women in India use hygienic methods. Objectives: To assess the knowledge, attitude, and practices regarding menstruation among school-going adolescent girls. Methods: A community-based cross-sectional study was carried out among 4 high schools for a period of 6 months. Sample size was calculated to be 350. Among the selected 4 schools, 90 students (45 students studying in 9th std. and 45 students studying in 10th std) were chosen from each school based on convenient sampling method. The data was collected by self-administration of a pre-tested, semi-structured questionnaire that contained questions on demographic characteristics, perception, source of information, and hygiene practices. The collected data was entered into Microsoft Excel and analysed using SPSS version 20.0. Results: 62.9% of study participants were studying in 9th standard. Majority of the study participants answered that the normal age at menarche is 11-15 years (77.7%, n=272), the menstrual cycle normally occurs once a month (92.9%, n=325) and menstruation doesn't occur during pregnancy (87.14%, n=305). 82.85% (n=290) of study participants agreed that sanitary pad is the ideal absorbent material during menstruation. Majority of (80.3%, n=281) study participants used sanitary pads as absorbents during menstruation. 31.70% (n=111) of the adolescent school girls had to miss their school due to menstruation. Conclusion: Although the knowledge about menstruation is high among the participants, it is of great concern to us that the usage of cloth as an absorbent still prevails among the participants and most of them practice restrictions during menstruation.

Ahmad Rajeh Saifan   Rami A. Elshatarat   Ateya Megahed Ibrahim   Khaled M. Al-Sayaghi   Nora H. Elneblawi   Samia Mahmoud Teleb   Khaldoun M. Hamdan   Mohammad Mashaqbeh   Ahmad Alabbadi   Bayan Oleimat   Bandar Naffaa Alhumaidi   and Nabeel Al-Yateem   

Introduction: Patients with chronic obstructive pulmonary disease (COPD) and asthma often face a significant symptom burden and reduced health-related quality of life (HRQoL). Understanding the factors influencing HRQoL in this population is essential for developing effective interventions. Purpose: This study aimed to assess the perceived symptoms, physical limitations, and impacts on HRQoL among COPD and asthma patients in Jordan. Additionally, we aimed to identify factors correlated with HRQoL in this population. Methods: A cross-sectional survey was conducted among 120 patients, utilizing the St. George's Respiratory Questionnaire for COPD patients. Participants reported their recent respiratory symptoms, limitations in physical activity, and impacts on daily life. Correlation analyses were performed to investigate the associations between various factors and HRQoL. Results: The survey revealed a high prevalence of symptoms, including cough, phlegm production, breathlessness, and wheezing, with the symptoms significantly impacting patients' physical activity and overall well-being. Young age, a higher level of education, perceived excellent or very good health status, increased sleep duration, and a high Forced Expiratory Volume (FEV1) were found to be positively and significantly correlated with higher HRQoL. In contrast, smoking, higher BMI, the presence of comorbidities, a high respiratory rate, and mental health symptoms such as anxiety and depression were positively and significantly correlated with lower HRQoL. Conclusion: This study provides valuable insights into the factors affecting HRQoL among patients with COPD and asthma in Jordan. The findings underscore the need for comprehensive interventions addressing both physical and emotional aspects to improve the well-being of this patient population. Further research is warranted to explore and implement targeted interventions for enhancing HRQoL in these patients.

Songsee Singkun   Wisit Chaveepojnkamjorn   Peeraya Ekcjariyawat   and Sirima Mongkolsomlit   

Introduction: Healthcare-associated infections (HAIs) are a major health problem issue in patients during the care process after hospital admission globally. The present study aimed to determine the length of stay related to HAIs among inpatients in the Bangkok Metropolitan- Administration Latkrabang (BMAL) Hospital from January 1, 2015-December 31, 2020. Methods: A hospital-based case-control study was conducted among inpatients of a secondary health care hospital in Bangkok. The data recording form was used to gather information from 300 medical records of inpatients who were hospitalized between 2015 and 2020 including 100 cases and 200 controls. Analysis was conducted using conditional logistic regression. Results: Hospital-acquired pneumonia (HAP) was the most frequently encountered site of HAI (42.4%), followed by catheter-associated urinary tract infection (CAUTI) (20.8%). Conditional logistic regression showed that a length of stay of 8 - 14 days, 15 - 21 days, and > 21 days were 3.56, 10.70 and 22.33 times at risk of HAIs compared with those of ≤ 7 days, respectively. Most of the bacteria were collected from sepsis/bloodstream infections of the cases, dominated by Acinetobacter baumannii (28.7%) and Klebsiella pneumoniae (19.5%). Conclusion: The result from this study can be used as a basic guideline for improving the clinical practice guideline and the policy of infectious prevention and control for patient safety.

A. Erieka Novianti   Atjo Wahyu   Ridwan Amiruddin   Fridawaty Rifai   Nurmala Sari   Sukri Palutturi   Djazuli Chalidyanto   M. Alimin Maidin   and Sudirman Nasir   

The World Health Organization (WHO) promotes three key points to ensure that the global community receives adequate health services: equality in health access, quality of health services, and protection of patients' financial risks. The problems with the ongoing health development in Indonesia are essentially the same as those that the government of West Sulawesi is dealing with, namely the lack of optimum access, affordability, and quality of healthcare services. This study aims to determine the needs of users to design intervention media in the form of e-patient development at the West Sulawesi Regional General Hospital. The research was conducted using a qualitative approach with in-depth interviews and focus group discussions (FGD) conducted from January to February 2023. Thematic analysis was performed using n-Vivo. The result of the study shows that users of hospital services benefit greatly from the e-patient application, which reduces waiting times. Therefore, it must be improved in terms of the application's form and appearance/display. There are chat services that enable interaction with doctors, and the development of e-patients has been made simple so that it is easily understood and accessed by society from various educational backgrounds. In conclusion, it is vital to develop e-patient applications while considering the needs of the patients.

Rami Azmi Elshatarat   Barbara J. Burgel   and Ahmad Mahmoud Saleh   

Introduction: Taxi drivers face unique challenges that can impact their health and safety, including driving behaviors, cardiovascular disease (CVD) risk factors, road traffic crashes (RTC), and fatigue. This study aimed to investigate the associations between these factors and fatigue in urban taxi drivers. Aims: To examine the relationship between driving behaviors, CVD risk factors, RTC, and fatigue in urban taxi drivers and to determine the prevalence of RTC and fatigue levels in this population. Methods: This is a cross-sectional study. A convenience sampling method was used to recruit 130 taxi drivers in San Francisco, United States. Data were collected using structured questionnaires that assessed demographic information, work factors, health characteristics, driving behaviors, and fatigue levels. Statistical analyses, including chi-square tests, were performed to explore associations between variables. Results: The majority of taxi drivers were middle-aged, primarily male, and worked an average of 41 hours per week. About 22% of drivers reported at least one RTC in the past year. Based on perceived fatigue scales (0-10), the mean level of fatigue in the prior week was 3.93 (±2.50), fatigue before bedtime was 5.2 (±2.60), and fatigue upon awakening was 3.5 (±2.40). The overall fatigue level (the sum of the 3 fatigue scales) was 12.7 (±5.98). Perceived high fatigue levels were significantly associated with shorter sleep duration (X²=6.66, p=0.01), good or poorer self-rated health (X²=9.53, p=0.003), and higher mental exertion (X² = 9.51, p=0.002). However, overall fatigue levels were not significantly associated with self-reported RTC. The findings of this study showed that high mean CVD risk factors (≥ 4 risks out of 9). Past and present medical history variables and family history of CVD variable are not statistically associated with abnormal sleep or perceived high fatigue. Conclusion: This study highlights the challenges faced by urban taxi drivers, including high workloads, stress, shorter sleep duration, and fatigue. While perceived high fatigue was associated with certain factors, such as sleep duration and mental exertion, no significant association was found with self-reported RTC. Interventions focusing on sleep hygiene, fatigue management, and policy changes are warranted to improve the health and safety of taxi drivers. Further research with larger samples and longitudinal designs is needed to enhance our understanding of these associations and inform targeted interventions in this population.

Mohammad Abduz Zaher   Marjia Sultana   Sonia Zebsyn   Progati Bakshi   Towhid Hasan   Abu Naim Mohammad Bazlur Rahim   Shireen Nigar   and A. K. Obidul Huq   

Healthy life expectancy in elderly people largely depends on their dietary behavior. This study aimed to investigate the gender differences in food consumption patterns among elderly outpatients in a renowned hospital in Dhaka, Bangladesh. A total of 85 elderly outpatients (56 male and 29 female) from the Bangabandhu Sheikh Mujib Medical University (BSMMU) participated in this descriptive cross-sectional study. A convenience sampling technique was employed to choose the respondents, and a pre-tested structured questionnaire was used to collect socioeconomic, anthropometric and dietary information. A seven-day food frequency questionnaire (FFQ) was used to collect the consumption frequencies of 11 food groups. Female outpatients were observed to be significantly more malnourished than their male counterparts. On the contrary, male outpatients were significantly more overweight and obese than female respondents. The prevalence of chicken and sea fish consumption was significantly higher among female elderly outpatients. In contrast, the prevalence of organ meat, milk, colored fruits and colored vegetables consumption was higher among male counterparts. Animal food items were preferable among both genders compared to vegetables. Male elderly outpatients were observed to consume foods from different food groups regularly. Conversely, regular consumption of food from various groups was less prevalent among female elderly outpatients. The findings of this study suggested that gender differences affect the food consumption patterns of elderly outpatients, thereby influencing their nutritional status. However, strategic management and proper nutritional education may lessen the gender differences among them regarding their food consumption patterns.

Md. Tanvir Ahmed   and Md. Al Amin   

Despite achieving tremendous success in controlling infectious diseases in recent years, Bangladesh has experienced an unprecedented resurgence of dengue fever, necessitating the country to reassess the potential risks and reshape the relevant abatement interventions. This paper examines whether there is any difference in how men and women perceive the risks associated with dengue fever and whether they respond to it differently. The efficacy of mitigation strategies largely depends on the level of compliance, which further requires proper recognition of risks and conformity with related adaptation prescriptions. Gender is deemed a critical factor in understanding the severity of a public health problem and in pursuing appropriate preventive measures. Using cross-sectional survey data collected randomly from urban areas of the Barishal division in Bangladesh, this study employed socio-demographic analysis and logistic regressions to evaluate the gendered perspectives of dengue fever risk and coping measures. The findings from the analysis show that the overall risk perception is very low among respondents. In addition, females consider the threat of dengue fever more seriously than their male counterparts do. Furthermore, a similar trend was observed when adaptation strategies were analyzed; female participants also appeared to be more proactive and careful in taking precautionary measures and following preventive guidelines. As a result, the outcome of this study underscores that gendered insights are crucial for realizing the intensity of a public health threat and thus should be included in designing reduction policies to prevent further diffusion of this dangerous malady.

Finta Isti Kundarti   I Nengah Tanu Komalyna   Ira Titisari   Kiswati   and Jamhariyah   

Introduction: The perinatal period is a transitional period for pregnant women in terms of physiological, psychological, and social changes. These changes cause anxiety during pregnancy. Mindfulness-based intervention is a new intervention that can help reduce anxiety during pregnancy and cortisol is a biomarker of stress or anxiety. The purpose of this research was to determine the degree of anxiety and blood cortisol levels in pregnant women. Patients and Methods: This research used a Randomized control study involving 70 participants which was split into two groups, with intervention group using MBI (n = 35 participants) and the control group without MBI (n = 35 respondents). The MBI was given over 8 weeks for 2 hours each session. Data collection on anxiety and blood cortisol was carried out 2 times, namely at the beginning of the study (pretest) and at the end of the 8^th week (posttest). Anxiety assessment used the perinatal anxiety screening scale (PASS) and the ELISA test to assess blood cortisol. SPSS 25 was also used to analyze the data. Results: In terms of anxiety, there was a statistically significant difference in mean scores between the intervention group and the control group (12.83±8.29 vs 30.69±16.39) P < 0.000, cortisol (14.30±5.29 vs 19.51±8.46) p=0.003. Conclusion: MBI can be suggested to promote reduction of anxiety and blood cortisol levels of pregnant women.

Oon Sopiah   Nelly Apriningrum   Sekar Ayu Runggandini   and Citra Resita   

Postpartum exercise has an important role in maternal health. Apart from having a good psychological effect, postpartum exercise can also improve the physical condition of the mother after the delivery and speed up the healing process. However, most postpartum mothers have low knowledge about postpartum exercise. This problem is exacerbated by the low knowledge and skills of health cadres as the extensions of health workers in assisting postpartum exercise. This study aims to determine the most effective media in increasing the cadre's knowledge and skills in assisting postpartum exercise. This study used a comparative pre-post experimental design to analyze the differences in the effect of training with videos and modules on the cadre's knowledge and skills in performing the postpartum exercises. The majority of the cadres aged >35 years, 81% of whom received the module and 71% of whom received the video. Most cadres who received the module had high school education (42%) and university graduates (6%), while in the group receiving the video, 38% of cadres had high school education, and 1% were university graduates. This study found that videos and modules can improve the knowledge and skills of all cadres. In the knowledge test with images, it was found that the cadres who were given the module had a significant increase in knowledge by 25% and a 19% increase in those who were given the video. As for the post-test results of the skills test, a 90% increase in knowledge was experienced by cadres who were given modules and a 70% increase in those who were given videos. This study concluded that the increase in knowledge and skills in cadres provided with the module is better than those provided with the video. This may be due to cadre's the level of education in the group provided with the module being better than those provided with the video. This study can be a basis for creating an effective media for postpartum exercise training.

Mahamane Bello Hadiza   Damien Barikissou Georgia   Alkassoum Ibrahim   Mamoudou Zakaria   and Aguemon Badirou   

Introduction: Cardiovascular diseases, particularly strokes are a public health issue in Niger, a lower middle-income country. The study aimed to identify the risk factors associated with the occurrence of stroke at Niamey's national and general referral hospitals. Method: A cross-sectional study was carried out in the Niamey referral hospitals over the period January 1st, 2019 to December 31, 2021. A multivariate logistic regression model was used to identify potential predictors of stroke. Results: A total of 2,352 patients were included in the study, of whom 1,034 were diagnosed with stroke. The mean age of the patients was 59±15 years. The M/F sex ratio was 1.18. Factors associated with the occurrence of stroke were: elder age (p=0.038), female (p=0.001), unemployed (p<0.0001), lowest monthly-income (p<0.0001), family history of stroke (p=0.003), high blood pressure (p<0.0001), diabetes (p<0.0001), obesity (p=0.001), smoking (p=0.002), and hypercholesterolemia (p<0.0001). Conclusion: Socio-demographics characteristics, family history, high blood pressure, diabetes, obesity, smoking, and hypercholesterolemia increased the occurrence of stroke in Niger. It is necessary to raise public awareness of the potential predictors of stroke and to improve the technical platform for patient management.

Sri Aryanti   Dyah Wulan Sumekar Rengganis Wardani   Jhons Fatriyadi Suwandi   Samsul Bakri   Tugiyono   and Adella Putri Apriliani   

Context: Evidence shows that in rural areas, the risk factors for hypertension are caused by a high-risk lifestyle. Objective: to identify the significance of the determinants of hypertension in rural areas, especially in North Lampung district, Lampung province, Indonesia. Methods: A case and control study in November-December 2022 involved 76 samples of people aged >18 years living in rural areas of North Lampung district, Lampung province, Indonesia. Subject and method: Latent variables consist of Hypertension variables, Environmental Variables, Lifestyle Variables, Health Facilities Variables, Genetic Variables, and hypertension variables which are measured through appropriate indicators. Data was through observation, in-depth interviews and questionnaires. Statistical analysis used: data analysis used the Structural Equation Modeling (SEM) method with Partial Least Square software. Results: The determinant variables of Genetics and Lifestyle have a significant relationship to the incidence of hypertension by 39.5% in rural areas of North Lampung Regency, they also show that physical activity, BMI, and fiber adequacy are the strongest indicators in explaining the related latent variables. Conclusion: The hypertension control program must be integrated with screening detection activities in the community to identify lifestyle intervention efforts so that hypertension does not occur in rural areas. This program must be supported by stakeholders from both health institutions and other institutions. The findings of hypertension risk factors will provide benefits in efforts to control hypertension, especially in rural areas at the global level, especially in Indonesia.

Supakan Kantow   Nattapon Pansakun   Punyisa Pudpong   and Natnapa Promma   

Background: Schools play a crucial role in education, health promotion, and students' overall well-being. As such, adequate first aid facilities in schools are essential for student safety and well-being. However, limited research exists on the quality of first aid rooms in rural schools, especially in northern Thailand. Therefore, this study aims to comprehensively assess the quality of first aid rooms in rural primary and secondary schools in the region. Method: A cross-sectional study was conducted from June to August 2022, involving the quota sampling of 79 participating schools. Data was collected using structured interviews and data assessment forms. Statistical analysis was performed using SPSS version 29.0, and the results were presented via descriptive statistics. The Kruskal-Wallis test was used to compare multiple independent groups, with p-values < 0.05 considered significant. Results: The study revealed that 96.2% of the participating schools had first aid rooms. The most commonly reported health issues were the common cold, headaches, and fever (96.2%), with analgesics and antipyretics being the most commonly dispensed medications (96.2%). Nearly two-thirds (63.2%) of the first aid rooms were classified as having a moderate level of quality. The characteristics and location domain scored high in quality, while the essential equipment domain had a lower quality score. Significant differences in overall quality were observed between the secondary and primary schools (p-value < 0.001). Almost all the subdomains showed statistically significant differences, except for the first aid cabinet subdomain. Conclusions: The findings of this study emphasize the importance of well-equipped first aid rooms in schools for addressing common student health issues. Policymakers and school administrators should address deficiencies in essential equipment to enhance first-aid services. The insights gained from this study can guide decision-makers in prioritizing improvements to first aid facilities, ultimately promoting student health and overall well-being.

Muhammad Siddiq   Md Mizanur Rahman   Sabrina Binti Lukas   Kamarudin Bin Kana   Merikan Bin Aren   Rudy Ngau Ajeng   and Mohd Faiz Gahamat   

Anti-smoking initiatives in Malaysia have the potential to reduce adolescent smoking, but their effectiveness and the need for research support remain important considerations. This study aimed to examine the efficacy of two smoking cessation interventions, the 5A's and 3A's, in reducing smoking among male adolescents in Samarahan, Sarawak. From September 2020 to June 2021, twelve communities were randomly assigned to the 5A's, 3A's, or control groups. A total of 519 participants aged 13-17 years provided data on demographics, smoking habits, nicotine dependency, motivation, carbon monoxide levels, and monthly cigarette consumption. The interventions' effectiveness was evaluated at 1, 3, 6 and 9 months. Analysis of covariance revealed no significant main effects of time or group on nicotine dependence, although age had a significant effect. Post hoc analyses showed significant group differences at multiple time points. For motivation, there was a significant main effect of time, with Group 5A consistently demonstrating higher means. Significant group differences were observed at specific time points. Analysis of carbon monoxide levels indicated significant main effects for group and time, with Group 5A consistently exhibiting the lowest mean levels. Significant group differences emerged by the 6th month. Regarding the number of cigarettes smoked, significant group differences were found, with both Group 5A and Group 3A reporting lower levels compared to the control group. Our findings add to the existing body of knowledge on the success of initiatives aimed at reducing smoking rates among young people. However, there is still a need for additional investigations in this field to further advance our understanding.

Tuan Pah Rokiah Syed Hussain   and Hamidi Ismail   

The practice of hygiene care in the environment is vital in human life since it can cause a variety of difficulties, particularly those related to health. This study focused on the issue of low environmental hygiene practices which cause the outbreak of dengue epidemics in a population area. This is important because previous studies did not explain a certain level of practices among communities. Thus, the objective of this study was to look at the correlation between environmental hygiene care practices and awareness among the community. Several residential areas in the Alor Setar City Council were selected as a study sample, involving the residential areas of Flat Tongkang Yard, Taman Berjaya, Taman Sultan Badlishah, Taman Indah and Kampung Tok Pasai. A total of 302 samples or respondents were taken to examine their practices and awareness of environmental hygiene practices to avoid dengue outbreaks. The analysis technique used is Pearson correlation to examine the level of relationship between the variables in the study. The results of the study found that the aspect of awareness significantly affects hygiene care practices with a value of r = 0.703 and p≤0.01; and the strength of the relationship through the value of the correlation coefficient is about 70 percent. This explains that the aspect of community awareness determines the occurrence of a dengue epidemic because the analysis shows that there is a positive relationship between the two variables. Therefore, control and prevention measures need to be implemented consistently, such as intensifying awareness campaigns for the public about the dangers of dengue epidemics and the importance of environmental protection.

Fatema Aouda Abbas   Shatha Ahmed M. A.   and Ali Hussein Al-Hafidh   

Background: Osteoporosis is a degenerative, systemic skeletal condition, differentiated by a depletion of bone density which predisposes to fragility fractures. Osteoporotic fractures affect patients' life quality and place a huge financial strain on the healthcare system. Patients and method: A cross sectional survey was conducted among 240 Iraqi males and females selected through consecutive samples from those attending the dual-energy X-ray (DXA) Unit in Baghdad Teaching Hospital. The data collection tool was developed based on prior research and theoretical frameworks, and information on the participants' basic demographic characteristics, educational attainment, and lifestyle factors was obtained. International Physical Activity Questionnaire Short Form, was used to assess patients' physical activity. Results: This study enrolled 240 patients with a mean age of 56.49±12.63 years, 18 (7.5%) males and 222 (92.5%) females. The mean spine T score in patients with no- and low- activities was -3.13±0.67; and -3.12±0.68, respectively; while it was -3.05±0.70 in moderate activity mean, and -2.93±0.26 in those who practiced vigorous physical activity. Conclusion: The study concluded that physical activity is crucial for healthy bones and the avoidance of osteoporosis. The promotion of optimal nutrition and physical activity to decrease the severity of osteoporosis in communities, especially in the older population, is essential for a healthy life.

Mayuree Wongpratate   Pee Phisutseranee   Suttahathai Paengpassa   and Nipaporn Muangchan   

This study aimed to investigate the prevalence and association between abnormal eating attitudes combined with related factors and risk for developing eating disorders among senior high school students. A cross-sectional descriptive study was performed on senior high school students in Ubon Ratchathani Province. The Eating Attitudes Test-26 Thai version was used to assess abnormal eating attitudes and behaviors. Participants who had scores of 12 or higher were presumed to have abnormal eating attitudes and behaviors. Univariate analysis was used to evaluate the relationship between abnormal eating attitudes combined with related factors and the risk for developing eating disorders. A total of 227 of 315 participants completed the questionnaires (72.06%). The prevalence of abnormal eating attitudes was 24.3%. Participants who had relatively low body weight showed a 4.46-fold higher risk of eating disorders [CI = 1.13-18.71, p = 0.0090] than participants with normal body weight. Participants who had both low and relatively low body weight had a 3.18-fold increased risk of eating disorders [CI = 0.88 - 11.30, p = 0.0328]. Female students who had a relatively low body weight had a 3.52-fold higher risk of developing an eating disorder [CI = 0.82 - 15.57, p = 0.0400]. There were no correlations between body mass index and body weight for height and eating disorder risk. This study revealed that participants who had relatively low body weight were related to an increased risk of developing eating disorders, especially female students.

Juan Morales   

Objectives: The aim was to determine the level of eHealth literacy and its associated factors among users of primary health care services. Methods: Analytical cross-sectional descriptive study. The population consisted of users ≥ 18 years of age of the "Mi Perú" Health Center, Lima-Peru. The study variable was eHealth literacy, which was measured with the "eHealth Literacy Scale" (eHEALS). Results: A total of 405 subjects of both sexes participated, with a median age of 31 years (Q1=25, Q3=40; IQR=15). Regarding eHealth literacy level, 26.2% (n=106) obtained elementary level, 24.7% (n=100) low level, 27.9% (n=113) medium level, and 21.2% (n=86) high level. A significant difference was found between the level of eHealth literacy and the age of users (p<0.001), sex (p=0.048), educational level (p<0.001), Internet access through a desktop computer and laptop (p=0.027 and p=0.009, respectively), use of the Internet for health information search purposes (p<0.001) and autonomy in the use of the Internet (p<0.001). Conclusion: In the Peruvian context, only one-fifth of the users of the first level of care reveal a high level of eHealth literacy. Young people, women, higher level of education, access to the Internet through a computer, use of the Internet for health information search purposes and autonomy to use the Internet were the factors associated with a higher level of eHealth literacy. It is recommended that other alternatives based on digital technology be explored to contribute to improving the health status of the population.

Mada Gautama   and Sri Mulyani   

Individuals who experience HIV/AIDS are referred to as people living with HIV/AIDS (PLHIV), and one approach to prevention involves direct involvement of the community as part of community empowerment. Those who volunteer to participate in this effort are known as Citizens Program for HIV/AIDS Care and are recognized in the Minister of Health of the Republic of Indonesia's Regulation No. 21 of 2013 concerning HIV and AIDS Control. This empirical juridical research analyzes primary and secondary data qualitatively to identify internal and external factors that have hindered the implementation of the Citizens Program for HIV/AIDS Care. These factors stem from weak juridical aspects, cultural stigma and discrimination, ideological beliefs, government policies, financing, and human resource constraints. The current regulation governing the Citizens Program for HIV/AIDS Care is the Minister of Health's Regulation No. 82 of 2014. To strengthen this regulation, it is recommended that Article 26 paragraph (1)(e) should be revised to form a forum for the community to care about the prevention of infectious diseases and for Citizens Program for HIV/AIDS Care. Another way to strengthen the regulation is by adding a new paragraph to Article 52 of the Minister of Health No. 21 of 2013, which requires regional leaders to establish and develop the program at different levels within their jurisdiction.

Yohanis Manfred Mandosir   Semuel Piter Irab   Genoveva Mollet   Maxsi Irmanto   Devi Palela   Dorthea Renyaan   Nova Falentina Rumaropen   Tangkudung Albert Wolter Aridan   Sugiharto   Evi Sinaga   and Rodhi Rusdiyanto Hidayat   

Malnutrition is a condition where there is a lack of nutritional food intake for a certain period caused by the major factors, specifically food and infectious diseases, as well as, family food security, parenting style, education, and the number of family members. The study aimed to determine the factors influencing undernutrition in toddlers aged 12-59 months in Koya Koso Village, Jayapura City. This research is descriptive analytics with a cross-sectional study approach. The population in this study were 325 mothers who had toddlers aged 12-59 months in Koya Koso Village, and the number of samples was 74 toddlers. Nutritional status was measured by anthropometry based on the weight/age index. If the measurement result shows z-score -0.3 SD to < -2.0 SD, it indicates toddlers are malnourished. If the result shows z-score -2.0 SD to 1.0 SD, it indicates toddlers are in good nutrition category. The number of family members in one household was measured with questionnaire. It was then categorized into 2, "many" if the members are > 4, "few" when the members are < 4. Nutrient intake was obtained through the 1x24 hour food recall method. It was then categorized into two categories, firstly, "less intake": <80% recommended dietary intake; "good" category when the intake is more than or equal to 80% recommended dietary daily intake. Infectious diseases were measured by questionnaire. Yes, if in the past 1-month, the toddler had an infectious disease. None, if in the last 1-month, the toddler had not suffered from an infectious disease. Data were collected and analyzed using the chi-square test. The results showed that the factors influencing malnutrition were the number of family members with ρ-value = 0.027, intake of nutrients (energy and protein) with ρ-value = 0.035 and infectious diseases with ρ-value = 0.045. In conclusion, the number of family members, intake of nutrients and infectious diseases were found as factors influencing malnutrition. Nutrition education and counseling are required to prevent and manage malnutrition through the contributing factors. Further research might add other variables related to the incidence of malnutrition in toddlers.

Mohammad Al-Tamimi   Walaa Isied   Hamza Othman   Dania Aldajeh   Abdelrahman Altarazi   Rima Salameh   Toqa Abu-Muhaisin   Fatma Qazzaz   Ahmad Jaber   and Deema Al-Namora   

Background: Hospital-acquired infections are a global health concern that affects the morbidity and mortality of admitted patients, especially critically ill patients. Understating the epidemiology, risk factors, and outcomes of bacterial infections among intensive care units (ICUs) at the national level is important in guiding prevention and treatment strategies. Aims: To determine the prevalence, risk factors, and clinical outcomes of bacterial infections among ICU patients across Jordan. Methods: This prospective observational study was conducted on 133 confirmed bacterial infection cases from ICUs across 12 referral hospitals in Jordan. Bacterial isolates were identified, and a survey was used to collect demographics, risk factors, clinical, laboratory, and outcome data among participants. In addition, statistical analysis was used to determine frequencies and associations between variables. Results: Of the total 177 isolates, 47 (26.6%) were Gram-positive including Staphylococcus (18.0%) and Enterococcus (6.2%), while 123 (69.5%) were Gram-negative including Klebsiella (22.6%), Escherichia (17.5%), Acinetobacter (16.4%), and Pseudomonas (6.2%), and 7 (4%) were mixed. The primary infection site was the lung (33.1%), blood (27.8%), and urinary tract (22.6%). A significant association between Gram-positive bacteria with blood and gastrointestinal tract infections, elevated WBCs, and elevated red cell distribution width can be noted. While a significant association between Gram-negative bacteria with a central line, ventilator, nasogastric tube, bedridden patients, lung and urinary tract infections, and increased frequency of complications were noted (P≤0.05). Conclusion: This study showed a high prevalence of Gram-negative bacterial infections led by Klebsiella species in ICUs across Jordan. Preventive measures to reduce risk factors associated with Gram-negative infections are recommended.

Mou Pramanik   Navaraj Chelliah Rajkumar   Masilamani Elayaraja   Hemantajit Gogoi   and Karuppasamy Govindasamy   

Background: Worldwide, obesity has become a significant health problem among adolescents; the prevalence of obesity has been steadily increasing among these age groups. It has been shown that lifestyle interventions can help manage obesity and improve body composition, such as yoga practice and dietary modifications. However, little research has compared the effect of both the interventions on obese female adolescents. Therefore, the present study aimed to examine how yoga and diet intervention affect body composition in obese female adolescents. Methods: Sixty female obese adolescents (age: 19.4 ± 7.2 years; height: 162.3 ± 8.4 cm; weight: 72.25 ± 9.1 kg) were randomly assigned to three equal groups (n = 20): a yoga practice group (YG), a diet group (DG) and a control group (CG). Experimental groups: yoga practice and diet interventions were followed up for 12 weeks. All measurements were taken 24 hours before and after the first and the last interventions. Results: As a result of the study, both experimental groups showed significant improvements in various body composition parameters when compared to the control group (p˂0.05). Both the yoga practice group and the diet group (p˂0.05) experienced significant changes in weight, body mass (BFM), and body fat percentage (BFP) during the pre-to-post interaction period. SMM (skeletal muscle mass) did not change significantly in any of the groups. Conclusion: The study demonstrates that yogic practice and diet intervention both are effective in improving body composition, notably reducing weight, BMI, body fat mass, and percentage, thereby enhancing overall health in obese female adolescents.

Promotha Sriramulu   Ramana Kameswaran   Vinodhkumar Ramalingam   Kumaresan Aabathsagayam   Vignesh Srinivasan   Rajesh George Nadhar   and Ling Shing Wong   

Work-related low back pain (LBP) is the most frequent musculoskeletal condition among tailors. Prolonged working in a sitting position with a poor ergonomic pattern of the trunk can elevate the risk of LBP. The gluteus medius (GM) is important for lumbar spine stability while doing work in a sitting position over a period of time. The study aimed to find out the efficacy of proprioceptive neuromuscular facilitation (PNF) for gluteus medius muscle with elastic tubing resistance exercises to improve gluteus medius activation for LBP among tailor populations. In total, 48 participants were involved in this study, which were divided into 2 groups, experimental group (EG) (n = 24) and control group (CG) (n = 24). EG received PNF with elastic tube resistance exercises, and the CG received PNF without elastic tube resistance exercises. Electromyography (EMG) and the numerical pain rating scale (NPRS) were taken as baseline measures in both groups before the intervention and post-values were taken after 4 weeks of intervention in order to know the effectiveness of the intervention. The elastic tubing resistance and PNF combined intervention exhibited a substantial improvement in the post-test, suggesting that the elastic tubing resistance would enhance GM activation. In terms of clinical efficacy, a spiral diagonal D2F movement pattern and elastic tubing with an average peak tension of roughly 90% body mass may be used to boost GM muscle activation on both stance and movement patterns at the same time to overcome low back pain among the tailor population.

Behailu Gebremariam   Shimelis Assefa   and Worku Jimma   

Background: Social media serves as a valuable repository of healthcare information, holding significant potential for enhancing healthcare quality. This study aims to investigate how graduate students perceive and utilize health-related information from social media to manage their health. Objective: The research explores methods, through which graduate students discover and employ health-related information from social media for personal healthcare management, while also examining their perceptions. Methods: A cross-sectional study design was adopted, involving a sample size of 282 students from various universities in Ethiopia, including Jimma, Mizan-Teppi, Adama, and Bonga. Data were collected and entered into Microsoft Excel, and statistical analysis was performed using SPSS version 20. Independent variables with a p-value of <0.05 were deemed statistically significant. Results: The data analysis demonstrated that respondents aged 25 to 30 years were approximately four times more likely (OR 3.972, 95% CI [2.342-6.738]) to utilize social media for managing chronic diseases, while those aged 31 to 35 years were nearly two times more likely (OR 1.814, 95% CI [1.094-3.009]). However, overall, students showed limited use of social media to obtain information about chronic diseases. Facebook emerged as the preferred platform among respondents for accessing healthcare content related to diet advice and walking techniques. Conclusion: The findings indicate that students use social media primarily in a constrained manner to acquire information about chronic diseases. Although Facebook is favored for specific healthcare content, other aspects of personal health management through social media require more attention and encouragement.

Victor Kaufusi   

This grounded theory qualitative study explored the dietary patterns of 12 Tongan American participants. Central themes such as (a) cultural adaptation, (b) socioeconomic impacts on food choices, and (c) the overlap of cultural norms and health beliefs were identified. These themes facilitated the creation of a conceptual framework, highlighting the interconnection between primary factors shaping dietary behaviors among Tongan Americans. Given the high rates of obesity within this group, understanding these contextual influences is critical for fostering healthier dietary behaviors. Findings from this study can inform culturally tailored strategies, interventions, and policies to address the increasing rates of obesity among Tongan Americans, emphasizing the necessity for efficacious public health strategies. This research enhances existing literature by offering a more nuanced understanding of dietary behaviors among Tongan Americans. It underscores the interconnectedness of cultural, socioeconomic, and contextual factors, providing valuable insights for developing targeted public health strategies to address escalating obesity rates. This study also emphasized the need to address unique, influential factors to improve health outcomes within the Tongan American population.

Mykhailo Zhylin   Viktoriia Mendelo   Svitlana Makarenko   Olga Samara   and Yevhenii Ishchenko   

The growing drug addiction rates in the world require an immediate solution to the issue of overcoming addiction and reducing the number of relapses. Identifying the impact of the type of psychotropic substances on the emotional intelligence of drug addicts will contribute to their more effective socialization. The aim is to reveal the influence of different types of psychotropic substances on the emotional intelligence of drug addicts. Methods: The study included standardized psychometric tests. Descriptive statistics and univariate analysis of variance (ANOVA) were used. Results: The research showed that the studied drug addicts have a medium level of emotionality (M=6.72±3.34), medium emotional stability (M=15.76±5.32), and a low level of emotional intelligence (M=34.12±15.84). It was also established that the studied indicators are the lowest in persons using cocaine and opioids. No gender or age differences were found. Conclusions: The study showed that the heavier the psychotropic substance, the lower the emotional intelligence of drug addicts. Cocaine addicts have the lowest level of emotionality, emotional intelligence, and emotional stability. Prospects: The obtained data make it possible to differentiate drug addicts according to the level of required psychological assistance and support. This will enable building corrective programmes for the development of emotional intelligence and reducing the possibility of relapse.

Nor Shafrin Ahmad   Aziah Ismail   Wan Marzuki Wan Jaafar   and Brenda Julianose   

A crisis disrupts a person's normal and stable state, to the point where previously known coping and problem-solving strategies are ineffective. This study investigated the relationship between crisis symptoms and crisis intensity and how coping mediates this relationship. A total of 531 respondents participated in this study. The instruments used were crisis intensity, crisis symptoms, and collective coping style. Pearson's r coefficient and Multiple Linear Regression were used to analyze the data. Crisis intensity ranged from mild to severe. The correlation results showed a moderate positive relationship between crisis intensity and physical crisis symptoms, r(2) = .56, p = .01; a moderate positive relationship between crisis intensity and emotional crisis symptoms, r(2) = .67, p = .01; a moderate positive relationship between crisis intensity and behavioral crisis symptoms, r(2) = .53, p = .01; and a moderate positive relationship between crisis intensity and cognitive crisis symptoms, r(2) = .59, p = .01. Coping mediates the relationship between crisis symptoms and intensity. This study shows that Coping is an important skill that can help to overcome challenging crises.

Nur Afni Amir   Balamurugan Tangiisuran   Sulastri Samsudin   Noor Afiza Abd Rani   Ahmed Ibrahim Fathelrahman   Fahim Mohamed   and Nur Azzalia Kamaruzaman   

This is an analysis of the intentional and non-intentional poisoning-related calls involving adolescents with a special focus on intentional pharmaceuticals-related exposures. The study consists of descriptive and comparative analyses of calls made to the Malaysia National Poison Centre between 2010 and 2020. Bivariate analyses were made using cross-tabulation with Chi-square test and binary logistic regression was used for multivariate analysis. A p value of <0.05 was considered statistically significant. Of 48355 poisonings reported, 4632 (9.6%) cases were adolescents. This analysis was performed on 3991 cases with complete information, of which 3133 were intentional. Of all intentional poisoning cases, 44.2% involved pharmaceutical substances. Female adolescents were more likely to be involved in intentional pharmaceutical poisoning than males (70.5% vs 29.5%, p<0.000). Analgesics were the most often pharmaceutical agents ingested by adolescents (11.3%), followed by psychiatric drugs (7.6%), and mixed pharmaceutical agents (5.4%). Paracetamol was the most frequently ingested single agent involved in 345 cases. Suicidal intent was the most frequent reason for intentional poisoning (85.8%), followed by misuse, unknown, and drug abuse, accounting for 5%, 4%, and 3.4% instances, respectively. Analgesics appeared to be the most common drug class, with paracetamol representing the highest single agent used in poisoning among adolescents. Incidence rates for poisoning exposure among adolescents were declining in general from 18.3 per 100,000 population in 2010 to 6.9 per 100,000 population in 2020. However, there were periods of increases in 2014 and 2018 followed by declining rates. Multivariate analysis indicated that intentional exposures were more associated with female gender, Indian and Chinese ethnicities, and pharmaceutical ingestions (all p value, 0.001). These findings emphasize the importance of developing customized prevention strategies in collaboration with stakeholders to ensure that appropriate interventions are considered at multiple levels of intervention.

Soon-Hee Ryu   and Yun-Jeong Kim   

In the flow of globalization, social, economic, and political changes have created uncertainties and risks, while at the same time opened up new opportunities. Marriage migration has become common for various reasons, and with it, new family forms that are different from that of before are being formed. While the formation of global households accelerating like this, different cultures come into contact within a single family, causing acculturation stress in the process of adaptation and thus causing depression. In the past, acculturative stress has mainly focused on studies on those who have moved to a new society, such as immigrants, international students, refugees, and certain ethnic groups of Latino or Asian descent in Korea. There have been many studies mainly targeting married migrant women, but the fact that a family is a unit and stress in one part affects stress in other parts is overlooked. So, this study aims to verify the effects of acculturation stress on depression among parents-in-law, as well as the mediating effects of multicultural receptivity and the moderated mediating effects of Korean communication skills of foreign daughters-in-law on the relation between acculturation stress and depression of parents-in-law. The subjects of this study are Korean parents-in-law with foreign daughters-in-law. From January to March 2022, a survey was administered through family support centers of Korea. 315 collected questionnaires were utilized for the analysis. First, when the acculturation stress of parents-in-law from multicultural families was higher, depression was high. Second, it was verified that increasing multicultural receptivity reduced depression caused by acculturation stress among parents-in-law. Third, Korean communication skills of foreign daughters-in-law were found to have significant moderated mediating effects on the relations of acculturation stress, depression, and multicultural receptivity of parents-in-law from multicultural families. Therefore, this study suggests that in order to reduce depression caused by acculturation stress of parents-in-law, policy support for both parents-in-law and foreign daughters-in-law is necessary. In other words, it is argued that the adaptability of multicultural families will be improved by increasing the multicultural acceptance of parents-in-law and improving the Korean communication ability of foreign daughters-in-law.

Sanchita Mehrotra   Areena Zainub Mirza   Govind Ji Pandey   and Keshav Patel   

Social media applications like Instagram have the potential to promote menstrual products and provide sustainable choices. The objective of the study was to determine the influence of Instagram on sustainable menstrual choice use intention. The research heavily relies on the self-efficacy of the consumers managing menstruation by using the Unified Theory of Acceptance and Use of Technology Model (UTAUT 3). A purposive sampling technique was used to select respondents from menstruating females willing to fill out the questionnaires. The questionnaire was divided into three sections and each item was scored on a 5-point Likert scale, (1) strongly disagreed and (5) strongly agreed. A statistical analysis method based on Structural Equation Modelling (SEM) Partial Least Squares (PLS) was used for data analysis. The respondents were 310 female college students from government and private universities of Lucknow City, Uttar Pradesh and Noida City, National Capital Region of India. The conclusion drawn from the study suggests that performance expectancy, effort expectancy, social influence, facilitating conditions, habit, and personal innovativeness play a crucial role in the user's Behavioral Intention (BI) and Use Behavior (UB). The study recommends that the information related to sustainable menstrual choices on social media applications like Instagram can help achieve menstrual equity by empowering women to make choices regarding their menstrual health and well-being.

Fatin Nor Amalina Othman   Raja Zirwatul Aida Raja Ibrahim   Azlina Abu Bakar   Siti Sarawati Johar   Zainuddin Abu Bakar   and Jumadil Saputra   

Today, suicide is a significant, urgent and serious issue in public health. Studies on suicide ideation in Malaysian young adults were rarely conducted for the public due to cultural and religious factors. Numerous studies on depression and suicide among young people in Malaysia have often been conducted in developed and high-population densities such as Kuala Lumpur, Selangor, Pulau Pinang, Sabah, and Sarawak. In contrast, states on the East Coast of Malaysia recorded fewer studies on suicide and depression by researchers. Thus, this study investigates the relationships and predictive effects of depression and self-esteem on suicide ideation among undergraduate students. Data were gathered from a sample of 439 (18.5% male; 81.5% female) undergraduate students aged 19-26 with an average age of 22 (SD=1.33) who completed measures on depression, self-esteem, suicide ideation and socio-demographic profiles. In addition to descriptive statistics, quantitative data employed correlation and regression analysis using SPSS software. The results found a significant relationship between depression, self-esteem, and suicide ideation. Furthermore, regression analysis revealed that depression and self-esteem were predictive factors of suicide ideation among students. This study contributes to the corpus of literature on the predictor factors for suicide ideation in the context of Malaysian students. Furthermore, the current study's findings offer a better understanding of how relevant parties should be aware of the importance of mental health promotion and help-seeking behaviour, especially in the educational setting.

Cita RS Prakoeswa   Nur Hidayah   Arlina Dewi   Faradillah Mutiani   and Melinda Masturina   

Background: Patient satisfaction will affect the hospital service quality and vice versa. Evaluating the patient's satisfaction is necessary for a healthcare service provider in maintaining and improving hospital quality. Objective: To analyze the patient satisfaction indicators in the main referral hospitals for 4 years and develop an index of satisfaction. Methods: This study was a retrospective cohort study conducted from 2017 to 2020 in Surabaya, Indonesia. We used proportional stratified random sampling to collect data. Data collection is carried out in the form of a Community Satisfaction Index (CSI) regularly every year. A total of 46 work units each year were included in this study. Data were presented in diagrams and tables. Data analysis was performed using IBM SPSS version 23. Result: The highest composite value of the CSI was in 2020 (80.14), followed by 2018 (77.97), 2019 (77.95), and 2017 (75.08). In group 2018 vs 2019, only one indicator (complaint handling) had a significant difference between those two years (p= 0.020). However, in the comparison group of 2019 vs. 2020 and during 4 years, almost all indicators showed a significant improvement, except for officer behavior (p>0.05). Conclusions: Our study provides an overview of Indonesia's health care system and identifies areas for improvement, particularly with regard to the country's present universal health coverage program. Evaluating patient satisfaction regularly is necessary in improving hospital performance and service quality.

Enkeleda Berberi   Ilir Lloha   Ervin Shishmani   and Arta Hallaci   

According to World Health Organization, non-communicable diseases (NCDs) represent a significant health concern in Albania and account for 94% of the deaths of population in 2022, hence, their prevention and control are one of the main goals of the Health System and Government Strategic Health Program in Albania. This study aims to explore the perspective of educated young adults on nutrigenomics and also to analyze some of the factors that will influence the decision making to undergo a genetic test for personalized nutrition or not. The data presented in this study were extracted from a cross-sectional survey that was conducted through a questionnaire. The participants in the study were undergraduate and graduate students at the Agricultural University of Tirana. Before submitting the questionnaire, the heads of the departments were informed, and permission was requested for the questionnaires to be distributed during the lecture hours in order to obtain a larger sample. Furthermore, before handing out the questionnaire, students were informed about the aim of the study and their right to decline participation. Questionnaires were codified with cardinal numbers and then grouped based on the students' major. A total of 848 students with different educational backgrounds completed the questionnaire from April to July 2019. Our findings suggest that there are statistically no sex-based differences between participants and the information they possess on nutrigenomics or personalized genetic tests (one way ANOVA, F_(1,845)=0.254, р=0.614). However, we found a statistically significant difference in the means of the student's educational background and their perception toward nutrigenomics and personalized genetic tests. There is a significant difference in the means of the student's major and their perception that nutrigenomics science or personalized genetic tests are going to improve people's lifestyle (F_(7,840)= 34.980, р<0.001). The majority of the participants (46%) considered family history diseases as the main factor that will influence the decision to undertake a personalized genetic test. Studies that consider more inclusive samples and a wider range of factors are necessary in the near future for a smoother implementation of personalized genetic test in the public health sector in Albania.

E. Efrata   Evawani Y. Aritonang   Etti Sudaryati   N. Nurmaini   and Ida Yustina   

Maternal mortality is a health problem still receiving global attention, especially in developing countries. The Indonesian government has made efforts to improve the health status of pregnant and childbirth women, yet an acceleration is needed so that the targets to decrease maternal mortality can be achieved. A total of 315 mothers with children aged 0–11 months old were randomly selected using cluster sampling. Data were collected through questionnaires and interviews upon respondents' consent. Questionnaires included the husband's support, mother's behavior, access to health services, mother's psychology, and healthy childbirth variables. Statistical analysis was performed using SmartPLS version 3.2.9, and a multivariate non-parametric statistical approach was employed. Our study observed a significant direct effect among all variables, namely: husband's support (β= 0.266, t= 5.454, and p= 0.001), mother's behavior (β=0.110, t= 2.159, and p= 0.031), access to health services (β= 0.106, t= 2.209, and p= 0.028), mother's psychology (β= 0.405, t= 8.054, and p= 0.001), and healthy childbirth. The husband's support indirectly influences healthy childbirth through the mother's behavior (β= 0.022, t= 1.990, and p= 0.047) and her psychology (β= 0.103, t= 3.683, and p= 0.001). However, there was no significant effect between the husband's support and healthy childbirth through access to health services (β= 0.014, t= 1.804, and p= 0.072). A healthy childbirth model based on the husband's support could be used to increase maternal health and prevent maternal death in poor families.

Amira Permata Sari Tarigan   Albiner Siagian   Etti Sudaryati   and Rahayu Lubis   

Deaths from diabetes are very high in Indonesia. This shows that the resilience of people with diabetes is very low. Low resilience is a result of poor self-care behavior in people with diabetes. This study aimed to produce an educational model based on Health Belief Model, and determine the effectiveness of the educational model to increase the resilience of people with type-2 diabetes mellitus (T2DM). This study used mixed methods with an experimental embedded design. Informants in the qualitative study totaled seven people. The qualitative study was conducted to explore the health belief model as well as identify the risk and asset factors associated with the resilience of people with T2DM. The educational model designed from a qualitative study was tested on 28 respondents in Pancur Batu District, Indonesia. Before being given education, the assessments of behavioral resilience (diabetes self-care) and health resilience (HbA1c levels) were carried out. Diabetes self-care behavior was measured using the summary diabetes self-care activities (SDSCA) instrument. Diabetes self-care and HbA1c levels were measured again after three months and six months from the baseline to see the effectiveness of the educational program. The Cochran test showed that there was a significant increase in the resilience of people with T2DM after taking the HBM-based education program (p<0.01). The educational model based on HBM is effective in increasing the resilience of people with T2DM; therefore, this educational model should be applied to increase the resilience and quality of life of people with diabetes at health centers.

Almira Sitasari   Weni Kurdanti   Rina Oktasari   Astrid Herlinda Puspitasari   and Sakinah Harith   

Life expectancy in Indonesia is improving in the last decades resulting in an aging population. Older adults are at high risk of getting micronutrient deficiency and malnutrition. The competency of registered dietitians and nutritionists (RDNs) in assessing deficiencies and malnutrition is very important so that older adults can be given appropriate nutrition interventions. This study aims to determine the practice of physical examination (NFPE) among RDNs. This study was a cross-sectional study of 97 RDNs who take care of older adults in clinical and community settings in the Special Region of Yogyakarta. Dietitians and Nutritionists were asked to complete the online self-administered questionnaire on NFPE knowledge perception and its barriers to micronutrient deficiencies, hydration, and malnutrition in older adults. Mann-Whitney analysis was used. The majority of RDNs were knowledgeable in assessing micronutrients of vitamin C (41.2%) and Fe (40.2%); hydration status on dehydration (56.7%) and edema (53.6%); and malnutrition related to fat mass (39.2%). The majority reported barriers were lack of proper training (58.8%) and insufficient time practicing NFPE (36.1%). There were differences in knowledge of physical examination related to vitamin C deficiency, hydration, dehydration, edema, ascites, muscle mass, and fat mass (p<0.05) between those who perceived and did not perceive the barrier "lack of time". Participants who perceived a lack of proper training have less knowledge of physical examination related to vitamin D, vitamin E, vitamin B, vitamin C, hydration, and muscle mass (p<0.05). Barriers to "outside the scope of practice" and "confidence" were not statistically significant to NFPE practice. Specific training on NFPE is needed to increase the capacity of RDNs. A reasonable workload will allow NFPE to be carried out by RDNs.

Laksanee Boonkhao   Pongsak Rattanachaikunsopon   Thitima Saenrueang   and Warisil Baukeaw   

When employing the Pesticide Exposure Risk Assessment Form for Farmers (Nor Bor Kor. 1-56) under the guidelines of the Bureau of Occupational and Environmental Diseases in the Department of Disease Control, previous studies have found that the majority of farmers face low level of health risks from pesticides (organophosphate and carbamate) exposure. However, the opposite result was frequently observed when cholinesterase levels were examined in the farmers' blood. It is of interest to find out whether or not these two risk assessment methods are in agreement. This study aims to compare two pesticide-associated health risk assessment methods: the health risk assessment questionnaire (Model 1) and blood cholinesterase level examination (Model 2). The participants were 195 vegetable farmers from Khi Lek Subdistrict, Ubon Ratchathani Province, Thailand. By the questionnaire method, the risks of pesticide exposure among the farmers were assessed based on their acute symptoms. By the blood cholinesterase level test method, the risks were assessed and divided into four levels: normal, safe, at-risk, and unsafe. These data together with data on pesticide use behavior were then used to assess the health risks of the participants. The results obtained from Model 1 and Model 2 were compared using the Stuart-Maxwell test. The findings show that the results obtained from Model 1 and Model 2 were statistically different (p-value <0.001). Therefore, it is important to consider that evaluating farmers' health risks based entirely on a questionnaire may not be appropriate. Blood cholinesterase level tests should be taken into account.

Omar Ala' Alajjuri   Hommam Algebail   Ahmed Alomari   Noor Almfaddi   Hanin Dawani   and Amal Hussein   

Background/Aim: According to the World Health Organization (WHO), the percentage of overweight and obese people in UAE in 2016 was 70.6% and 34.5% respectively. Current evidence links obesity to unhealthy eating habits. This study aims to assess the awareness of nutritional information about fast food among adults in the UAE. Methods: A cross-sectional study was conducted among 462 subjects aged 18 and above through an interview or a self-administered questionnaire. A pilot study was conducted on 15 subjects and necessary changes were done to the questionnaire. Data was entered and analyzed using SPSS 25. Frequency and percentage of subjects correctly identifying the caloric content and harms and diseases associated with the consumption of each type of fast food were calculated. Bar graphs were used to compare and demonstrate the results of the study. Results: 44.2% of the subjects were able to correctly identify the caloric content of fast food. 53.5% of the subjects were able to correctly identify the diseases and harms associated with fast food consumption. 87% of the subjects believe that nutritional labels should be implemented in fast food restaurants. After the correct caloric content of each fast food was shown to the subjects, 44.35% were not willing to change their fast-food consumption habits, with the reason being the good taste of the food in 65.38% of the subjects. Conclusion: Less than half of the community has adequate knowledge about the caloric content of fast food. Almost half of the community has inadequate knowledge about the diseases and harms associated with fast food consumption. Most of the community think that nutritional labels should be implemented at fast food restaurants.

Rahma Labatjo   Imran Tumenggung   and Agus Hendra Al Rahmad   

Overweight and obesity are the causes of health problems. This condition is detrimental to growth in adolescents. Furthermore, being overweight and obese can affect insulin performance, visceral fat levels, and vitamin D status in the body. This study aimed to investigate the relationship between overweight in adolescents and insulin resistance, visceral fat, and vitamin D. This study was cross-sectional. All samples were purposively selected. Types of data in the form of anthropometric data (age, weight, and height) include fasting glucose levels, TyG index value, visceral fat composition, and vitamin D. The study was conducted in Gorontalo city, with the research sample being teenagers with overweight problems. Data were analyzed using univariate analysis in the form of the mean value. Meanwhile, the multivariate analysis employed the Spearman Rank correlation. The results showed that body weight was significantly correlated with visceral fat content (p-value = 0.000), bone density (p-value = 0.007) and vitamin D (p-value = 0.000). Visceral fat content was correlated with vitamin D (p-value = 0.000) and insulin resistance (p-value = 0.013).

Ardia Putra   Hajjul Kamil   Andara Maurissa   Mirna Wulan Sari   Rachmah   and Mayanti Mahdarsari   

Health services provided by healthcare workers, especially nurses, place nurses and patients at risk and cause occupational accidents. Accidents at work must be observed, and their causes must be identified to prevent similar incidents from occurring again. This survey aims to investigate the perceived ability to implement Occupational Health and Safety Standards (OSHS) at Puskesmas/PHC in Banda Aceh, Indonesia. It is a quantitative study with a cross-sectional plan involving 11 primary health facilities in the Banda Aceh region. The sample for the analysis comprised 67 respondents, who were selected through purposive sampling. The study tool used was an up-to-date questionnaire which was tested for its validity and reliability. Data were collected by distributing questionnaires directly to respondents, followed by data analysis using the descriptive statistical method. The results indicated that the perceived ability to implement OSHS at PHC was in the "High" category (50 respondents/74.6%). The most significant element (89.6%) is the Cultivation of Clean & Healthy Living, in the "High" category. And the management system is the minor element, with 52.2% of respondents classified as "Low." It is hoped that the head of the PHC will be able to socialize the application of OSHS sustainably, especially in the management of Hazardous and Toxic Materials (HTM) and HTM waste, operational procedures, proper domestic waste management, preparation of OSH programs, and preparation of an effective management system. The local government must be committed to providing adequate facilities and infrastructure to facilitate occupational health and safety administration training for all PHS officers.

Sehee Han   

Suicide is a significant public health issue in South Korea. An increasing number of researchers have begun to consider social capital as a protective element against suicide. The major aim of the research was to scrutinize the impact of social capital on suicide rates using panel data in South Korea. All data used in this research, except for the social capital variable, were obtained from the Korean Statistical Information Service. The social capital variable was acquired from the website of the Ministry of the Interior and Safety. Panel data were constructed using administrative-district level data from South Korea spanning from 2009 to 2018. The fixed-effect Poisson quasi-maximum likelihood estimator was applied. The findings showed that higher levels of social capital were related to lower suicide rates (B = -.046, p < .001). Thus, a one-unit increase in nonprofit organizations was related to an approximately 4.5% decrease in suicide mortality. However, community center was not statistically associated with suicide rates. The current research provides further evidence that the implementation of a public intervention that can formulate civic society, encourage citizens to articulate and share their concerns, and promote interactions among members of the society for advancing a public interest may have a protective effect on suicide.

Indah Sukmawati   Afdal Afdal   Miftahul Fikri   Rezki Hariko   Zikra Zikra   Gusni Dian Suri   and Denia Syapitri   

The lack of knowledge about reproductive health makes Indonesia face various health risks. This is because information about reproductive health is still considered taboo by most Indonesian people. The purpose of this study is to improve research, especially on reproductive health and describe the understanding of reproductive health in adolescents in Indonesia. The instrument used is the Indonesian Reproductive Health Scale (IRHS) which is valid and reliable. The sample in this study was 2506 adolescents in Indonesia, who were tested using a purposive random sampling technique. Data were analyzed using a t-test and ANOVA techniques. The results showed that the understanding of reproductive health based on male gender (48.50%) and female (68.24%) was in the moderate category, and there were significant differences in the understanding of reproductive health. Adolescent girls have a higher understanding of reproductive health than adolescent boys. Another result found that there was a significant difference in the understanding of adolescent reproductive health based on domicile, where adolescents who lived in the sub-district had the highest percentage (66.37%) compared to adolescents who lived in cities (54.11%), and in villages (45.91%). Research findings can be input for teachers, especially for guidance and counseling services to increase students' understanding of reproductive health in rural areas of Indonesia.

Rim Taleb   Maria El Tannir   Ghina Akoum   Rayyan Sakr   Rawan Koleilat   Zeina Barakat   and Raghad Daaboul   

Dysmenorrhea is a prevalent condition that has physical, psychological, and social impacts on females. Although it is mostly perceived as a healthy part of a well-functioning reproductive system, it may indicate underlying pathologies. Nevertheless, dysmenorrhea's acknowledgement and discussion are culturally frowned upon, particularly among men in different communities. This study aims to assess the knowledge and attitude of health professions students, both males and females, at Beirut Arab University (BAU) regarding dysmenorrhea. Using a cross-sectional study, 493 students in the health professions faculties at BAU participated in the survey. The health professions faculties included medicine, dentistry, pharmacy, and health sciences (nursing, medical laboratory, physical therapy, nutrition). It was conducted during the period extending from September 2019 till February 2021. Results show 84% of participants were females and 16% were males. Females had a mean score of knowledge (14.31 +/-3.13) out of 24 that was significantly higher than males (12.75 +/- 4.54). The most chosen sources of knowledge about dysmenorrhea were the Internet (57.4%), mothers (47.9%), and schools (47.3%). The correlation between age and knowledge showed that as age increases, knowledge increases (r=0.244). All Participants had a negative attitude towards discussing menstrual symptoms with strangers or friends publicly. Our study also revealed that the majority of participants would discuss menstruation and menstrual pain with their future daughters. Unfortunately, the perception of dysmenorrhea as a topic that should not be discussed openly has led to poor knowledge regarding dysmenorrhea and even caused misconceptions. This is even more seen in males especially in Middle Eastern countries that tend to be more conservative.

Alchinova I. B.   Pankova N. B.   Kovaleva O. I.   and Karganov M. Yu   

Widespread and constant use of digital devices has become a daily reality of modern life for both adults and children. Computers are mandatorily used in the educational process, even in the elementary school. The spectrum of damaging effects on the health of children and adolescents also increases with increasing the screen time. Functional strain of the body's systems manifested in an impairment of mental and physical performance and an increase in psychological stress, as well as disturbances in the regulation of heart rhythm, peripheral circulation, respiration, and psychomotor and metabolic processes caused by increased computer loads are usually not associated with specific diseases, but accompany the load itself, due to which they are recorded by health services only in case of manifestations of clinical signs of various diseases. Here we use the method of laser correlation spectroscopy/dynamic light scattering to assess the presence and direction of metabolic shifts in elementary school students experiencing different levels of school and out-of-school computer loads. Oropharyngeal washout fluid is used as the material for the study. The results are presented in the form of diagrams of the semiotic classifier. It is found that regular computer loads at school in accordance with hygienic standards significantly increase the percentage of normological shifts and significantly reduce the proportion of allergy-like shifts. In girls, increased out-of-school computer loads enhance the contribution of allergy-like and autoimmune-like shifts. These shifts reflect the predominance of anabolic processes over the catabolic ones. Evaluation of the combined effect of school and out-of-school loads in the elementary school reveals different responses of boys and girls to increased computer screen time. We observe an increase in the relative contribution of catabolic shifts in girls and anabolic shifts in boys. Assessment of the direction of metabolic shifts in screening studies can be useful in the development of preventive methods aimed at minimizing the negative consequences of uncontrolled computer loads.

Adrian Hoti   Alketa Ymeri   Edmond Gashi   Fatjona Kraja   Aldo Shpuza   Eda Hoti   Xhesika Xhetani   Carol Jabari   and Enver Roshi   

Aim: This study was aimed at assessing the diagnostic accuracy of ultrasound (US) in patients suspected of having breast cancer and confronting diagnosis by US imaging with histopathological diagnosis in patients of different ages. Methods: We performed a prospective case series of 280 patients suspected of having breast cancer, and referred to the tertiary University Hospital of Tirana ("Mother Teresa") for further evaluation, during January 2021-December 2021. These patients were diagnosed with US imaging, using the Breast Imaging Reporting and Data System (BI-RADS) as a tool for evaluating cancer risk. Subsequently, histopathology was carried out (used as a gold standard for diagnosis). The accuracy of US was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV); the performance of US was evaluated by Receiver Operator Curve (ROC), and different associations between variables were assessed by conducting a chi-square test and binary logistic regression. Results: With increased age, BI-RADS 2 or 3 cases decreased [48.1% (15-40 years) vs 35.6% (40-49 years) vs 21.4% (50-59 years) vs 9.2% (60-69 years) vs 6.3% (over 70 years)], (p<0.001), while BI-RADS 4 or 5 increased (51.9% vs 64.5% vs 78.6% vs 80.8% vs 93.8%), (p<0.001), respectively in the above-mentioned age groups. Similarly, with increased age, benign diagnosed cases in histopathology decreased (72.2% vs 57.6% vs 44.3% vs 43.1% vs 21.9%), (p<0.001). There was an increase in malignancies according to histopathology amongst older patients, (27.8% vs 42.4% vs 55.7% vs 56.9% vs 78.1%, (p<0.001), respectively. In terms of US cancer diagnosis accuracy, our findings showed high sensitivity and NPV (97.9%, 95.7%), not very high specificity (48.2%), and satisfactory PPV and accuracy (65.7%, 73.2%). Meanwhile, the ROC curve showed an Area under the Curve value of 0.81, p<0.01. Conclusion: The US, using BI-RADS, is a good tool for detecting malignant breast cancer in patients of all ages. The accuracy of US is satisfactory for tertiary diagnostic service, nonetheless, all components must be considered to ensure that the US diagnosis always coincides with the histopathological diagnosis of malignant breast cancer.

Rami Azmi Elshatarat   and Barbara J. Burgel   

Introduction: Road traffic crashes (RTC) and road traffic injuries (RTI) are major health problems facing taxi drivers. Shorter sleep duration (≤7 hours/day) and sleepiness during driving are two risk factors for RTC and RTI. Aims: Identify the associations between shorter sleep duration and sleepiness during driving a taxi and RTC in taxi drivers. Methods: A cross-sectional design and convenience sampling method were used to recruit a total of 130 taxi drivers in San Francisco (California, United States). Data was collected from taxi drivers via interview, using a structured questionnaire. Results: Based on the Epworth Sleepiness Scale (ESS) total score, 14% of the subjects had abnormal sleepiness (ESS >10). On average, the subjects slept 7 hours daily, with 64% reporting sleeping ≤7 hours/day. About 22% of participants (n=29) reported at least one crash in the prior 12 months while driving their cab, totaling 45 crashes. Factors associated with abnormal sleep (≤7 hours/day) included not taking pain medication ≥1 time/week, not attending a health and safety training session for taxi driving, and not eating five cups of fruits and vegetables each day. Shorter sleep duration, overall fatigue and higher ESS scores were not significantly associated with RTC. Conclusion: Drivers reported abnormal sleep duration. Twenty-two percent of taxi drivers reported at least one crash in the prior 12-months; 11.5% RTI were reported in the prior 12-months. There were no significant bivariate associations between RTC and ESS, and abnormal sleep. There are opportunities to further explore interventions to enhance sleep hygiene in professional drivers. Clinical Relevance: Recognition of sleepiness in professional drivers is an important public health measure. The most important countermeasure to mitigate drowsy driving is to begin a work shift after sleeping more than 7 hours. Frequent rest breaks, drinking coffee, chewing gum, and opening a car window to refresh air are additional evidence-based countermeasures.

Julio Cjuno   Patricia Ordóñez León   Sara Richard   Damaris Quinteros   and Ronald M. Hernández   

Violence against women during the pandemic has become a problem that has affected the world and to date has caused the death of many women. Although mental health has shown a growing interest in research, it is still very susceptible to being affected. This research described the scientific literature on the challenges in the psychotherapeutic approach in victims of violence against women during the COVID-19 pandemic in Latin America. A narrative review was carried out with a search of documents in the Scopus, Web of Science and PubMed databases, using descriptors for women, violence against women, COVID-19 and Latin America. As a result, 12 studies were included, which reported that the use of helplines, digital platforms of care and teletherapy were advantageous in several Latin American countries during the pandemic; difficulties were found in the accessibility of care for cases, collapse of telephone lines, technical problems of the system and the need for training for health professionals and service providers. It can be concluded that the coping strategies most used during the pandemic were the help services, through telephone and virtual care; there was difficulty in following up and monitoring the case in the medium and long terms, so further studies could focus on it. The main limitation of this work is methodological, since a number of studies could have been excluded from the searches for not including some of the terms in the search equation.

Laktionova Mariya   Kulzhanov Maksut   Aringazina Altyn   Baimuratova Mairash   Askerov Arsen   and Barmanasheva Zauresh   

Background: Due to the high incidence of genital prolapse surgery in women, the relapse rate, and the lack of clear recommendations for postoperative management, the approach of pelvic floor rehabilitation has had to be developed. Material and methods: A randomized controlled trial has enrolled sixty patients with grade II anterior and posterior vaginal prolapse and grade III stress urinary incontinence. The patients of both groups have undergone surgical treatment in the form of anterior and posterior colpotomy, colporrhaphy with perineolevatoroplasty. In the main group, thirty patients underwent a 6-month course of pelvic floor training in 2 months after surgery to assess the effect of this regimen on muscle contractile strength and a muscle strength thresholding to predict recurrence in primary care organizations; furthermore, all patients followed the general recommendations. Thirty patients in the control group had only surgical treatment and general recommendations. Results: At 8 months after surgery, the strength of the pelvic floor muscles and early manifestations of prolapse were statistically different between the groups. Statistically significant inverse correlations between pelvic floor muscle strength and prolapse symptoms were established. The threshold value of pelvic floor muscle strength at the cut-off point tots up to 62.5 mm Hg. Conclusions: The regular training of the pelvic floor muscles after surgery resulted in a significant increase in pelvic floor muscle strength, which served a protective function in preventing relapse. The threshold value of pelvic floor muscle strength can be employed in clinical practice to assess the risk of prolapse recurrence in women after surgery.

Mohammad Ala' Alajjuri   Mariam Eltabbakh   Mouaz I. Y. Oudih   Amna Saeed Ali AlKetbi   Heba Mohamad Abou Ali   Lamya Alhajeri   Amal Hussein   and Asima Karim   

Introduction: World Health Organization (WHO) reports show that choking is a leading cause of unintentional death complicated by respiratory tract obstruction in both children and adults. Objectives: We aimed to measure choking prevalence and the correct knowledge regarding its management in United Arab Emirates (UAE). Methods: A cross-sectional study was conducted among 404 adults ≥18 years across public places in the UAE. People with swallowing-related medical problems were excluded. Data about the prevalence, knowledge, and management of choking were collected using a self-administered questionnaire. Results: Among the participants, 43.3% (175) of adults experienced choking and 52.7% (212) witnessed a by-standing choking episode in an adult due to food. Only 23.7% (94) correctly knew that putting hands around the throat is the most appropriate sign of choking. Forty-seven percent (188) of participants correctly identified coins as the most dangerous item a child can choke on. Moreover, 62.7% (251) knew that choking management differs between children and adults where 63.0% (254) correctly chose applying pressure on the stomach for adults and 84.8% (341) correctly chose to hit on the back for children. Male gender, lower age, and lower education were identified as the factors associated with lower knowledge of choking. Conclusion: Altogether, the exact knowledge of choking and management techniques is insufficient. We recommend awareness campaigns, specifically targeting men, younger adults, and illiterate people.

Iryna Dyakiv   Anna Kryzhanivska   Yurii Savchuk   and Andrii Belegai   

Surgical treatment is the primary approach recommended by American and European guidelines for patients with uterine cancer, with the goal of individually tailoring the surgical intervention and deciding on the necessity of lymph node dissection. However, the issue of lymph node dissection remains a subject of debate, and its optimal role in the management of endometrial cancer is still under investigation. This article aims to provide a comprehensive review of the background, purpose, methodologies, principal results, and major conclusions pertaining to the assessment and surgical management of endometrial cancer. It emphasizes the importance of accurate staging using advanced imaging techniques to guide treatment decisions and prognostic evaluation. The limitations and implications of current research are discussed, highlighting the need for further studies to address the controversies surrounding lymph node dissection and refine the selection criteria for this procedure. The findings of this study contribute to the field by providing a comprehensive overview of the current state of knowledge in endometrial cancer management. The insights gained from this research have practical implications for clinicians involved in the treatment of endometrial cancer patients, helping them make informed decisions regarding surgical interventions and lymph node dissection. Moreover, this article raises awareness about the increasing incidence of endometrial cancer and the importance of early detection and accurate staging, thereby emphasizing the social implications of improved management strategies for this disease. This review underscores the significance of imaging modalities and individualized surgical treatment in the management of endometrial cancer. It calls for further research to address the controversies surrounding lymph node dissection and refine the selection criteria, ultimately improving patient outcomes and contributing to the advancement of knowledge in this field.

Mathar Mohideen Nagoor Thangam   

Background: Insomnia is the most ignored problem among healthcare students. The complexity of the healthcare courses gives more academic pressure. The pandemic had significantly affected health, the educational system, and students' habits. The pre-pandemic studies reported more sleep problems among healthcare students. So this study is essential to identify the current status of insomnia among students. Aim: The major aim of this study was to identify the prevalence and severity of insomnia among healthcare students after the COVID-19 pandemic and to examine the association between insomnia and selected variables. Materials and methods: This cross-sectional web-based survey was conducted among 300 healthcare students at the University of Tabuk, Saudi Arabia. Students were surveyed using the Insomnia Severity Index (ISI) to identify the prevalence of insomnia. Results: The prevalence of insomnia among healthcare students is as follows: No insomnia (17.33%), subthreshold insomnia (49.33%), moderate insomnia (31.33%), and severe clinical insomnia (2%). The mean score on the ISI was 12.37±4.77. 77% of the students reported that academic load affected their sleep patterns. The usage of social media and online games at night was high among students. Participants' age, sleep hours, quality of sleep, academic load, drinking coffee or tea before bedtime, snoring, medical problems, smoking, and usage of social media & online games at night had a significant effect on the sleep pattern. Conclusions: The results of this study emphasized the necessity of sleep education and sleep hygiene among medical students. There is an urgent need for further studies to focus on health status and sleep disturbance, sleep patterns and learning capabilities, and interventional studies to improve sleep patterns. Enhancing sleep self-awareness among medical students is necessary for managing this issue.

Laksanee Boonkhao   Supakan Kantow   Nittaya Kunhayat   Nipaporn Boonkla   and Pongsak Rattanachaikunsopon   

Several poorly controlled occupational hazards, such as ergonomic issues, are present in informal workers. This research aimed to investigate ergonomic risk factors among informal workers who are handwoven cotton weavers in the Northeast of Thailand (Khemarat District). Ergonomic risks were analyzed among 34 weavers. The Rapid Upper Limp Assessment (RULA) was used to measure work posture, and a questionnaire was utilized to gather data on the workers' personal characteristics and work-related information. The data were analyzed using descriptive statistics; percentage and inferential statistics using Fisher's exact test at the 95% confidence level. The findings showed that handwoven cotton weavers were exposed to a level 4 ergonomic risk (50.00%), with weaving and cotton planting accounting for 32.36% and 8.82% of that exposure, respectively. The types of tasks and working hours were found to be related to the level of ergonomic risks, with statistically significant p-values of 0.001 and 0.014, respectively. It is crucial for relevant agencies to concentrate on addressing ergonomic concerns for informal workers. Weaving groups, who collaborate to revive and carry on the forgotten craft of Ikat Khemarat weaving, should also be encouraged to promote healthy sleep and exercise habits.

Basuki Rachmat   Rachmalina Soerachman   Felly Philipus Senewe   Rina Marina   Roy Glenn Albert Massie   Doni Lasut   and Made Ayu Lely Suratri   

Background: Increased community involvement has become a topic in global malaria control and eradication plans. This study aimed to examine a method or system of community involvement in developing Bacillus thuringiensis H-14 with coconut media for malaria control in the Central Bangka District. Method: The quasi-experimental research design with qualitative observation method involving 30 participants. Selected participants received training on Bacillus thuringiensis culture in coconut and guidance in assessing the population density of Anopheles larvae in ponds containing mosquito larvae before and after administration of Bacillus thuringiensis. Results: The use of local coconuts as a breeding medium for Bacillus thuringiensis H-14 was able to mobilize the community members to participate voluntarily. Participants were able to easily practice Bacillus thuringiensis H-14 culture using local coconut media and determine the location of ponds with Anopheles larvae and assess the population density of larvae in ponds few days after sowing Bacillus thuringiensis H-14. Conclusion: The intervention proved successful in mobilizing participants in malaria prevention and control in malaria-endemic areas. The intervention consisted of local organizational structure, education, and utilization of local wisdom as well as encompassing problem identification, planning, and evaluation elements. This method can be applied in other archipelagic areas that are still endemic to malaria.

Wida Winarno   Sandra Fikawati   Rita Damayanti   Ahmad Syafiq   Marthin Nanere   and Amadeus Driando Ahnan-Winarno   

Diverse complementary foods (DCF) play a significant role in meeting the nutritional needs of infants aged 6-23 months to avoid malnutrition. However, local beliefs (e.g., socioeconomic, and religious beliefs) can determine the success of such public health intervention programs, especially in highly diverse regions. Selecting the most critical factors in the community to undergo intervention programs is also tricky. This study investigated mothers' beliefs in providing DCF to evaluate their understanding of the importance of DCF with purposive sampling. A quasi-experimental study involving forty-one mothers in a stunting-impacted area of Bogor, West Java, Indonesia, was undertaken. Data were obtained via 3-phase interviews conducted by trained enumerators until saturation condition was reached. For the first phase, the mother's beliefs were identified using questionnaires based on the Planned Behavior theory. The second phase separated the subjects based on their beliefs in giving DCF. The third phase was determining the significance of differentiating beliefs between the groups using a statistical T-test and pinpointing the most significant concerns. Based on their practical understanding, twenty-two mothers were classified as DCFs (mothers who made and served DCF containing fresh ingredients to their infants) and nineteen as non-DCFs. The seven most differentiating core beliefs were identified: the factors of economy, children's pickiness in eating, husband's support, motivation, instant food consumption, places to shop, and availability of various foods around the house. This study demonstrated that distilling critical intervention points, i.e., core beliefs in complex public health interventions, can be done by applying the Planned Behavior theory.

OGUNLADE Temitope Olu   OGUNMILORO Oluwatayo Michael   OGUNYEBI Segun Nathaniel   OBAYOMI Adesoji Abraham   FADUGBA Sunday Emmanuel   ADEBAYO Kayode James   HALID Omobolaji Yusuf   FAWEYA Olanrewaju   OLUBIYI Adenike Oluwafunmilola   BALOGUN Kayode Oguntuase   OGINNI Omoniyi Israel   AJIBADE Felix Damilola   and OGUNBOYO Ojo Femi   

In this study, we develop a mathematical model to explore the impact of awareness and lack thereof on the spread of meningitis within human populations, framed within a complex network context. The model's equilibrium solutions are used to ascertain its asymptotic stability, revealing that a meningitis-free equilibrium is locally and globally asymptotically stable when the basic reproduction number, R_mg, is below one. Conversely, a meningitis-endemic equilibrium is stable when R_mg exceeds one. To verify the model, we utilize parameters derived from existing literature on meningitis prevalence in Nigeria for simulation and prediction purposes. A sensitivity analysis of these parameters demonstrates that contact rates related to meningitis transmission affect R_mg, subsequently increasing infection rates within the population. Our simulations also indicate that the absence of awareness contributes to elevated meningitis transmission levels, suggesting that additional control measures are necessary to curb the spread of the disease.

Emmanuel Udomiaye   Edidiong Ukpong   Okoro Nwenyi   and Remigius Muoghara   

The physical living and work spaces (open spaces, healthcare facilities, schools, residential buildings, streets, and road networks) constitute the built environment. Epidemiologically, the built environment connotes the extrinsic factors that affect the agent and the opportunity for exposure. Though the relationship between the built environment and infectious disease prevention and control is gaining recognition, evolving the knowledge of efficiently adopting design strategies for infectious disease control remains a huge task in developing countries. Thus, the paper aims to appraise the nexus between infection transmission, control, and the built environment from the architect's perspective, with the view of identifying the architect's role in a pandemic. The objectives are, to identify the effects of the built environment on infection control from the historic perspective, built environment metrics associated with disease transmission, the mode of disease transmission in the built environment, and the duty of urban planners/architects in infection mitigation within the built environment. The paper relied on the existing literature, interviews, and interactions with public health officers. Five key built environment metrics that are critical for infection control were identified and the case for adopting the concepts of architectural and urban designs in infection prevention and control was established.

Bama Rajanayagam   Manikandan Sundaramahalingam   and Nag Anand   

Objectives: Quarry is an unorganized sector that involves various processes that produce dust particles of silica and heavy metals. Inhalation of these dust particulates causes serious respirational difficulties. Irrespective of its ill effects, negligence of protection still persists due to mere ignorance of the workers that paves the way to debilitating effects on their respiratory health. Methods: This current study was undertaken to evaluate and compare the respiratory functions of actively exposed quarry workers and to regulate the associated risk factors with respect to time duration. Results: In Thiruvannamalai district, a comparative cross-sectional study that involves 75 quarry workers had been carried out. Residents of 45 non-exposed workers were recruited for the study, and pulmonary functional testing (PFT) and peak flow metre testing were conducted on the participants. Independent tests and Univariate correlation were performed for statistical analysis. Our finding suggested that the test subject showed a significant reduction in the PFT measures of forced vital capacity (FVC) (3.05 L vs. 3.59 L) (p = 0.001**), mean Forced expiratory volume (FEV) (2.30 L vs. 3.19 L) (p = 0.001**). Similarly, forced expiratory flow (FEF) 25-75% (3.12L and 4.15L), Peak expiratory flow rate (PEFR) (59.15%) and Maximal voluntary ventilation (MVV) consecutively decreased in relation to the control subject with respect to duration of exposure which suggests a higher proportion of airflow obstruction. Conclusions: Early diagnosis with the help of a spirometer and early intervention can be of great importance to quarry workers as our study suggests that obstructive or restrictive lung diseases increased with continuous exposure to dust and duration of work in the quarry.

I Wayan Suardana   Ahmad Yusuf   Rachmat Hargono   and I Gede Juanamasta   

People in their later years frequently struggle with mental health issues, particularly depression. This is especially common in people who have reached older ages. Having a spiritual coping mechanism is one of the factors that might prevent someone from developing depression. On the island of Bali, Tri Hita Karana's philosophy is put into practice in daily life. In light of the COVID-19 pandemic, the purpose of this study was to investigate older adults' cultural involvement in the spiritual coping strategies known as Tri Hita Karana. Methods of qualitative description were utilized to accomplish this study's objectives. Five of the older adults who took part in the research were asked detailed questions during in-depth interviews. The subject of the thematic analysis was chosen with inductive reasoning as the guiding principle. The investigation discovered that the primary concepts revolved around "a sense of hopelessness" and "enlightening our path". The categories "a sense of hopelessness" encompassed "Inguh/Sebet", "connection through the mind," "human social nature," and "nature surrounding us." The contribution to the enlightenment includes the "pathway to parahyangan", the "sharing live and life of pawongan", and the "calmness of palemahan". Tri Hita Karana is a method of spiritual coping that is practiced on a daily basis among older people in Bali. Tri Hita Karana, when practiced, transforms into a potent spiritual coping enhancement that can assist in preventing depression. Support for the utilization of social capital in the management of stress is provided by the indigenous philosophy that is ingrained in day-to-day life.

Rusmiati   and Rosmawati   

Tooth brushing after breakfast and before bedtime is an essential factor in reducing the risk of disease of the hard and soft tissues of the teeth. Dental caries is the primary harmful effect of mistakes in brushing teeth. The research objective was to analyze the determinants of appropriate tooth-brushing behaviour in elementary school students. This is a cross-sectional observational analytic study involving 240 respondents which was conducted in 4 elementary schools in the Jelutung sub-district, Jambi city, Indonesia. Data analysis used the chi square test. Statistically, there is a significant relationship between knowledge about the right time and appropriate brushing behaviour, where P-value = 0.018. A significant relationship exists between attitude about brushing time and proper brushing behaviour with P-value = 0.001. There is a significant relationship between the availability of tooth brushing facilities and brushing behaviour with a P-value = 0.004. There is a significant relationship between parental supervision in brushing teeth and brushing behaviour appropriately, with P-value = 0.026. As many as 143 people (59.6%) behaved correctly. Appropriate tooth-brushing behavior is related to knowledge, attitudes, facilities and parental supervision.

Valanchaya Ketbumroong   and Sutthipong Wasusophaphon   

The use of pesticides in agriculture among community farmers has greatly affected the health and the environmental system. Therefore, this research Objective: study to coordinate mechanisms and processes of partners network, and to develop a participatory model of partners network in preventing health impacts from the use of chemical pesticides by farmers in the community. This research is participatory action research. Materials and methods: The target groups were farmers, community leaders, religious leaders, local government organizations, government sector, private sector, and civil society networks in Phutsa Sub-district, Muang District, Nakhon Ratchasima province. The tools and processes used were the target group survey and brainstorming group meeting minutes to analyze problems and solutions. Data analysis used an induction qualitative analysis. Quantitative data used descriptive statistics to analyze general data. Conclusion: The research results found that the target groups who took part in solving the problems were from three sectors (government, academic, and civil society) most were female 67.0%, and farmers 72.2%. The partner network in preventing health impacts from the use of chemical pesticides by farmers in the community starts with 1) creating awareness and understanding of the situation, problems, and its impacts; 2) organizing participation mechanisms of stakeholders; 3) organizing the problem analysis process to assess health impacts and prepare proposals as academic measures, local community measures; 4) hearing opinions and make decisions together through public forums; 5) preparing joint action plans and support budgets for joint operations between organizations; 6) implementing proposals into action at both the policy level of government/local organization; 7) follow up, exchange, learn and evaluate empowerment. Prevention and solution of problems affecting farmers' health community members as well as consumers from the use of chemical pesticides, there must be mechanisms and processes for all sectors to continually participate in the goals at every step from the common perception of the problem and its impact, having a joint action plan between sectors, policy advocacy of local government organizations along with using social measures to motivate creativity to follow and receive benefits that occur in the community together.

Lindita Agolli   and Aida Bendo   

Aim: The aim of this study is to identify the level of knowledge and the ability to manage critical situations in sports among sports students in Tirana, the Albanian capital. Material and methods: This was a cross-sectional study. A questionnaire was administered to 418 students. The questionnaire was divided into 2 parts; the general knowledge about medical emergencies and their knowledge of how to manage the critical situations in sports. The source of information was asked in the questionnaire as well as demographic questions. Students who participated in the questionnaire were divided into two groups: Gr. A sport students and Gr. B non-sports students. This questionnaire was carried out before the start of the medical emergency program. The applied method is observation and comparison. Spearman's correlation coefficient was used to assess linear associations and paired t-test was employed to compare matched/paired numerical variables. Results: From the questionnaire, 86% of students answered that they had general knowledge about medical emergencies and 47% of them had partial knowledge in management of them but only 3.6% thought that they could apply their knowledge. 72% of students answered that they had information about head injury where 36% knew how to manage and only 1.5% could apply their knowledge. Even for heart disease, asthma attack, allergic reaction; students answered that they had general information, but less than 2% of them could apply this knowledge in an emergency situation. Conclusions: Sports students are more informed about emergencies in sports compared to non-sports students. They also have more knowledge of medical emergency in sports management. Very few of all students think they're good at managing them. The main sources are school curriculum, first aid course. There is insufficient knowledge about medical emergencies in sports and non-sports students. This situation obliges us to do more extensive study. By collecting data in a more significant number of cases, more reasonable conclusions should be reached to carry out training with teachers, sportsmen, as well as the possibility of opening a new curriculum in study programs.

Iyakrus   Wahyu Indra Bayu   Meirizal Usra   Hartati   Soleh Solahuddin   Herri Yusfi   Arizky Ramadhan   and Muslimin   

This study aims to determine the Body Mass Index (BMI) and Physical Activity (PA) level of Physical Education (PE) teacher candidates in Palembang during COVID-19 pandemic lockdown. A total of 552 participants (M: 307; F: 245) with minimum age of 19 years (21.27±1.66) participated in this study. This study was based on the method and used IPAQ-SF to assess PA and energy expenditure levels based on MET. The data were collected by measuring the height and weight and observing the PA behavior of the participants with an online survey using a Google form. The results of this study show that for BMI, the results showed that 247 (49.64%) were in the underweight category, 239 (43.30%) were in the normal category, 25 (4.53%) were in the overweight category, and 14 (2.54%) were in the obese category. As for the results of physical activity levels, 62 (11.23%) were in the low category, 242 (43.84%) were in the medium category, and 248 (44.93%) were in the high category. The conclusion of this study is that the physical activity level of prospective physical education teachers is in the high category, although it was also found that there were several research subjects who had low physical activity categories. There are several factors that may produce such results. However, additional studies are needed to understand these factors.

Camila Duarte De Mello   Chennyfer Dobbins Abi Rached   and Márcia Mello Costa De Liberal   

Aging is a physiological process that presents an increase in the incidence and prevalence of chronic degenerative diseases, including diabetes. This study is relevant given the increase in life expectancy at a global level. The main objective of this study is to show the benefits of physical activity for the elderly, especially those with diabetes mellitus. The methodology used to carry out the research was based on retrospective studies based on bibliographic research, namely, the investigation of theoretical material on the subject. The main result obtained has shown that the regular practice of physical exercises provides health and prevents the complications of diabetes in the elderly, in addition to providing healthier aging and improving self-esteem, due to the increase in muscle strength, cardiopulmonary reserve, balance, and flexibility, thus contributing to the maintenance of autonomy and independence of this older population. Physical activity also helps in the control of hypertension, obesity, and dyslipidemia in these individuals who are always associated with diabetes mellitus, thus contributing to the reduction of the risk of cardiovascular diseases in the elderly with this metabolic pathology. Physical activities are also responsible for the social integration of the elderly.

Erni Samutri   Nandia Septyorini   Anafrin Yugistyowati   Wahyuningsih Wahyuningsih   Suci Kurniawati   and Herwinda Kusuma Rahayu   

One of the efforts to control the spread of COVID-19 in Indonesia is a vaccination program for all community groups, including pregnant and lactating women. There are responses of acceptance or rejection related to vaccination policies that can affect the COVID-19 vaccination in Indonesia. This study aims to identify the COVID-19 vaccination in pregnant and lactating women in Indonesia, as well as identify the determinant factors so that effective strategies can be done to increase the vaccination. This study was an online cross-sectional study conducted in February-March 2022 to identify the vaccination status in pregnant and lactating women and its determinants. Data collection used a snowball sampling technique. Ordinal logistic regression was conducted to determine the association between socio-demographic characteristics and perceived psychological distress and vaccination status. The results of this study indicate that the highest coverage of vaccination in pregnant and lactating women was identified in the first dose (95%). Vaccination was significantly higher in pregnant women of age 26-35 years (96.6%), working as private-sector employees (98.6%) or civil servants (96.4%). In lactating women, vaccination was significantly higher in women working as private-sector employees (98%). The COVID-19 vaccination for pregnant and lactating women in Indonesia was already high. However, it still requires a strategy to increase the uptake, especially in booster doses. Socio-demographic and perceived psychological distress were determinant factors influencing the COVID-19 vaccination. The findings can be used to develop education-based strategies sensitive to the diversity of women's sociodemographic characteristics.

Alfons Maryono Letelay   Felly Philipus Senewe   Kristina L. Tobing   Nikson Sitorus   Noer Endah Pracoyo   Helper Sahat Parulian Manalu   Raflizar   Shinta   Roy Glenn Albert Massie   Dina Bisara Lolong   Nelwan Filipus Tando   Marthino Robinson   Andre Yunianto   and Basuki Rachmat   

Introduction: Although many studies were published during the COVID-19 pandemic's early stages, we still do not know much about the severity of COVID-19 in terms of clinical evidence about signs and symptoms and specific clinical characteristics. When exposed, even asymptomatic (OTG) patients have a terrible prognosis. This study aimed to examine the connection between clinical features and COVID-19 poverty during the 2020 pandemic at the Covid-19 referral hospital in Bogor City, Indonesia. Methods: The research is cross-sectional. Data extended from the National Institute of Health Research and Development's ongoing research into comorbidities and COVID-19 prevention behavior in Bogor (NIHRD). The respondents in the study were validated by PCR swabs based on reports from the COVID-19 task force in Bogor. Samples were gathered from 148 suitable respondents for analysis. COVID-19 severity, supportive examination results (blood tests, radiography, and ECG), signs and symptoms, and demographic factors were all assessed. In the statistical study, simple and multivariate logistic regressions were used. Results: We found that 50.0% of respondents experienced severe symptoms as a result of COVID-19 exposure; symptomatic respondents 78.4%, blood group O 56.10%, age group 8-59 years 71.0%; male 56.1%; impaired blood glucose profile 18.3%, impaired erythrocyte sedimentation rate profile 14.9%, impaired leukocyte profile 64.9%, impaired lymphocyte profile 54.8%, impaired platelet profile 16.4%, impaired AST (ASPARTATE AMINOTRANSFERASE) profile 16.2%, impaired creatinine profile 9.5%, 67.6% of X-ray with GGO/infiltrates. Several risk factors were associated with the severity of COVID-19, including symptom factors (OR 12.59, p-value 0.002, 95% CI=1.46-55.20). ECG examination factor (OR 8.31, p-value 0.002, 95% CI=3.51-107.88) was also associated with severity. Conclusion: Therefore, to avoid the severity of COVID-19, clinical characteristics must be assessed as soon as feasible.

Paul MacDonald   Enam Alsrayheen   Claudette Taylor   Robert Baillie   and Carol Ferguson   

Cardiovascular disease (CVD) significantly impacts rural communities due to the high CVD prevalence rates compared with urban communities. This study aimed to assess the effectiveness of a community-based screening program for CVD risk factors by employing established risk factor scoring in a rural community. In this descriptive cross-sectional study, 1582 participants aged 20 and above participated in the screening program. Data was collected using a self-report questionnaire and measuring other CVD risk factors directly. The metabolic syndrome score and Framingham risk score (FRS) for 10-years of risk of developing heart attack and death were calculated for all participants. Then the level of follow-up with family physicians (FPs) following a screening program for CVD risk factors and a brief one-on-one educational intervention from a Registered Nurse to modify their risk factors was evaluated. The result revealed that 77% of the participants had 1 to 3 risk factors, and 52.7% followed up with FPs. Hypertension and abdominal obesity were the most common risk factors, with 51.1% and 55%, respectively. This study showed that 36.2% of the population had moderate to high FRS (death/MI>20%), and 30% had a high metabolic syndrome score. Community-based CVD risk factor screening successfully identified a high ratio of participants with high CVD risk factors and FRS. The screening program and educational interventions were beneficial in increasing public awareness of CVD risk factors, and a high percentage of participants with high FRS followed up with their FPs.

Nasser B. Ebrahim   

This study aims to examine the inequalities in coverage of skilled birth attendants among Ethiopian women. Access to skilled birth attendants, a key indicator for reducing maternal mortality, is a closely monitored parameter. Data from the World Health Organization's Health Equity Monitor database (HEAT) were analyzed and disaggregated by residence type, economic status, education, and subnational regions. Inequality summary measurements and the magnitude of skilled birth attendants for subgroups were calculated. The data were based on Ethiopia's Demographic and Health Surveys (EDHS) of 2000 (n=14072), 2005 (n=14500), 2011 (n=17817) and 2016 (n=16650). The results showed that the inequality gap between rural and urban residents has significantly increased, and access to skilled birth attendants improved with higher economic status and educational levels. Although the disparities among regions were small, they persisted. To achieve equitable progress towards universal coverage of births attended by skilled health personnel, targeted efforts and resources should be directed towards underserved poor and rural women, particularly those living in regional states. Health inequalities cannot only harm disadvantaged subpopulations, but also hinder a country's progress towards equitable health outcomes. The contribution of these findings is that it provided a comprehensive analysis of inequities in relations to accessing skilled birth attendants by Ethiopian women and identified highly disadvantaged groups. The results have highly relevant practical implications to reducing the gap in accessing skilled birth attendants that may ultimately contribute towards universal and equitable access to skilled birth attendants among Ethiopian women. Achieving equity in accessing skilled birth attendants will ultimately reduce maternal mortality rates, improve quality of life for women, and may lead to greater productivity and contribution of women to the society.

Rudy Ngau Ajeng   Md Mizanur Rahman   Asri Bin Said   Mohamed Ameenudeen   Greta Miranda Goh Kim Choo   Abg Safuan Bin Adenan   Muhammad Siddiq Bin Daud   and Mohd Faiz Gahamat   

Socioenvironmental elements could explain the primordial and primary prevention of Rheumatic Heart Disease (RHD) in the local context. A well-planned, encompassing way to deal with RHD in the local setting is essential. Therefore, this study sought to investigate the socioenvironmental determinants of RHD among school-going children and to investigate the aetiology of RHD in the local setting. This study was conducted as a sequential explanatory mixed-methods design. A cross-sectional study was conducted in the first phase, followed by a qualitative study based on the grounded theory approach. The study was conducted in Kuching, Samarahan and Miri divisions in Sarawak among primary and secondary school-going children. The cross-sectional data collection was conducted via face-to-face interviews, while the qualitative phase was conducted via in-depth interviews. There was a preponderance of low socioeconomic status and large family size with RHD. Based on the grounded theory approach, the causes of rheumatic heart disease were classified into internal and external factors. After integrating the findings, the qualitative findings confirmed the quantitative results by confirmation and expansion without discordance. The findings would be vital for the management of RHD in terms of implementations in practice, theory, and subsequent research, as the factors were explained in the local context.

Anu Bansal   Jasobanta Sethi   Raju K Parasher   and Manisha Tomar   

Background: Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting up to 22.5% of women of reproductive age. Women with PCOS experience high rates of depression and anxiety. Settings and Design: Cross sectional study design. Objective: Primary objective of study was to estimate the prevalence of depression, anxiety and stress among women with PCOS. Secondary objective was to analyze association of psychological factors (depression, anxiety and stress) with sociodemographic factors and clinical aspects among Indian women with PCOS. Methods: One hundred and four women in the reproductive age group (18–45 years) diagnosed with PCOS as per Rotterdam criteria, without any pre-existing psychiatric illness were interviewed for depression, anxiety and stress using DASS21 scale. Result: Out of 104 women with PCOS 46.16% suffered from mild to moderate levels of depression, 64.42% experienced (mild to extremely severe) anxiety while 53.85% reported varying degrees of stress. Women with higher BMI (overweight and obese), hirsutism scores and having acne were more susceptible to being depressed. The odds ratio for women experiencing depression were as follows: hirsutism scores was 1.113, being overweight, 5.023 (1.359 to 18.566), being obese was 3.298 (1.167 to 9.314), and having acne was 3.29 (1.267 to 8.541). Conclusion: It is observed a large percentage of women with PCOS suffer from psychological factors such as depression, anxiety and stress. Also, BMI, hirsutism and acne were found to be significant contributors to depression among women with PCOS. It is suggested that clinicians and healthcare practitioners develop and utilize a comprehensive approach in the management of PCOS based on biopsychosocial model of health.

Eftiola Pojani   Silvi Bozo   Ervisa Sado   Irsida Mehmeti   and Elena Capparelli   

The evolving role of dermocosmetics in skincare has changed people's approach toward skin physiology and pathology. The proper choice of dermocosmetics is crucial in the control and prevention of many skin diseases. In this study, we aim to report the consumption levels of different dermocosmetics from community and hospital pharmacies that operate in the Albanian territory. Methods: We analyzed the frequency of purchase orders for dermocosmetics, from Pharma One Shpk, a pharmaceutical distributor based in Tirana. Data were obtained from different pharmacies in the period from 1 January 2019 up to 31 December 2020. Results: It was observed a high interest in dermocosmetics throughout the Albanian territory. Precisely, in the southern part of Albania, during 2019, Dexeryl Cream 250 g (Pierre Fabre), was one of the most purchased products (12.6%). During the same year, in Tirana, the most required preparation was Belosalic ointment (Belupo) (40.7%). In 2020, the purchase frequency order for Cicabio Cream (Bioderma), increased in Durrës compared to a year before. Sensibio DS+ Cream 40 ml (Bioderma) and Sensibio AR Cream 40ml (Bioderma) were widely requested by the pharmacies in both 2019 and 2020. Meanwhile, Silsen Acne Skin Cream 75 ml (Unipharma) was one of the least ordered products in 2019 and 2020. Conclusions: Analyzing the frequency of purchased orders, it is evident that dermocosmetic products are widely required in Albania. Currently, efforts are made to identify possible pathologies connected to visual appearance, which could be a big step in the direction of early diagnosis.

Siti Wafiah Hanin Mohd Zulkifli   Humaida Banu Samsudin   and Noriza Majid   

Several studies reported various factors associated with length of stay in the hospital due to respiratory diseases. This study aims to select the best Generalized Linear Models (GLM) for predicting LOS and identify the effects of clinical and demographic factors on LOS. The study was carried out using data on registered admission and discharge at the government hospitals for central region states in Malaysia. A total of 526,511 cases were classified under diseases of respiratory systems coded J00 to J99 and factors such as gender, age group, ethnicity, marital status, discharge condition and diagnoses of the patients were used in this study. Two regression models were used to predict LOS: GLM Zero Truncated Poisson regression (ZTP) and GLM Zero Truncated Negative Binomial (ZTNB). The best count fit model was chosen according to Akaike’s Information Criteria (AIC) and Bayesian Information Criterion (BIC). The median length of stay in the study was four days (Interquartile Range: three to six days). According to statistical comparisons, the best model for count data is GLM Zero Truncated Negative Binomial. The outcome of the model found that there were significant changes in log LOS for each predictor except for unknown marital status and patients diagnosed with other diseases of the respiratory system that were insignificant in ZTP but significant in ZTNB. ZTNB model helps to identify factors contributing to the log length of stay so that hospitals are well equipped with the facilities and prepared for the expenditures and resources.

Lauren Cole   and Shireen Mohammad Kanakri   

The study presents the struggles healthcare workers went through during the outbreak of the COVID-19 pandemic. Many providers themselves were immuno-compromised, immune-deficient, and taking medications. In addition to these genuine concerns about their physical safety, they were simultaneously worried about inadvertently infecting family members and the long-term mental health effects of watching patients suffer and, in some cases, die from COVID-19. Their traumas are associated with soldiers returning home from far-flung battlefields. A quantitative method was used in this study. The data was collected through an anonymous survey. The study findings revealed that healthcare workers prefer flexible furniture design with a larger space that allows for emotional distance and efficiency; safety protocol must be included that shows the organization’s care for their employees, accessible and enough resources available for the workers. Employees should place safety first to retain qualified staff, and perceived safety must be taken into consideration. Perception of safety has proven to be critical in the shape of the environments that medical staff occupy and can affect the clinical team's ability to provide quality care for patients.

Khairun Nisa Berawi   Dewi Ayu Puspaningrum   Samsul Bakri   Reni Zuraida   Evi Kurniawaty   and Helvi Yanfika   

Severity of stunting is frequently associated as a result of the effects of environmental factors, such as ecological differences, poor quality sanitation, and potential effects on parental livelihood. Knowledge about the effect of sanitation and parental livelihood at three ecological zones on stunting severity at South Lampung Regency is unknown. The aim of this study is to determine the effect of ecological zones, sanitation performance, and parental livelihood on stunting severity in toddlers aged 0-59 months at South Lampung Regency, Indonesia. The cross-sectional study was conducted in a sample of 182 households that were spread over the hilly zone, 82 lowland zones, and 49 coastal zones at South Lampung Regency, Indonesia. Data were collected using a structured questionnaire that captured the sanitation performance and parental livelihood. Toddler’s heights were measured using a standard procedure and categorized manually according to national references. The ordinal logistic regression model was used to claim the effect. The higher probability of toddlers to be stunting was found significant on lowland zone, coastal zone, and clean water from drilled wells source, while lower probability significant on gallon drinking water, standard latrines, wastewater sewerage construction materials from cement and pipes, managed solid waste, ventilation not all rooms, bright lighting in rooms, and father's livelihood as a civil servant and entrepreneur. Stunting severity at South Lampung Regency is affected by ecological zones, sanitation performance, and father’s livelihood. The results of our study are expected to assist the government in developing appropriate stunting reduction policy programs, especially comprehensive intervention by adjusting the ecological zone.

Sri Umijatil   and Susilowati Andajani   

The risk factor model of maternal care in maintaining the nutritional status of children 0-6 months needs to be found. A total of 86 mothers who had babies aged 0-6 months were sampled in this cross-sectional study. We conducted interviewing and observed parenting risks and measured the child's weight and height. Next, the data were analyzed using Lisrel for Windows 9.1 program. The risk factor model of maternal care in maintaining the nutritional status of children 0-3 months consists of the child's birth weight (t=10.14, γ=0.71 for WAZ and t=2.23, γ=0.37 for LAZ), the incidence of sick child (t=-4.43, γ=-0.28 for WAZ and t=2.48, γ=0.36 for LAZ) and sick child care (t=-10.28, γ=-0.68 for WAZ), while the model for children aged 4-6 months consisted of birth weight (t=2.59, γ=0.31 for WAZ, and t=3.32, γ=0.36 for WLZ) and sick child care (t=2.95, γ=0.31 for WLZ). The risk factor model of maternal care in maintaining the nutritional status of children 0-6 months mainly consists of the child's birth weight and care for sick children. The results of this study are the first step to improve the mother's parenting ability to maintain her child's nutritional status.

Caroline Muringazuva Makovere   and Hamidi Ismail   

Cholera remains a major public health threat in developing countries and communities where safe water and sanitation facilities are inadequately available. The disease is becoming endemic in Zimbabwe and Chegutu town hasn’t been spared. The study was set to examine community factors associated with repeated cholera outbreaks in Chegutu town. A quantitative cross-sectional study was conducted to assess knowledge, experiences, and hygiene practices. Kobo collect was used for data collection and Epi Info Version 7 for analysis. A total of 385 participants were selected from five residential areas in Chegutu town. Seventy-two percentages were females, 41.30% were in the 18-35 age group whilst 21% were in the 50+ age group. Statistically significant factors associated with repeated cholera outbreaks were, being in the 18-35 age group OR 0.24(0.15-0.42) p value 0.00002, being 50+ OR 1.83(1.05-3.16) p value 0.03, knowing what cholera was OR 2.74(1.53-4.88) p value 0.0005, having attained primary school OR 2.03(1.02-4.03) p value 0.04, being widowed or divorced 2.21(1.05-4.60) p value 0.03, and staying in Pfupajena OR 0.50(0.04-5.62) p value 0.0001. Risky practices included not boiling untreated water 71%, not washing hands after handling waste 51%, not washing hands before preparing food 26%, and not washing fruits before eating 32%. Seventy-eight percentages were using contaminated water, 14% drinking unsafe water and 18% not cooking food thoroughly. Major risk factors associated with repeated cholera outbreaks were community unhygienic practices including drinking unsafe water, using contaminated water and not having a culture of handwashing. Targeted community's health awareness should be strengthened.

Sadono Setyoko   Ummul Hairat   Basuki Rachmat   and Anton Suryatma   

Informal recycling of lead-acid batteries produces uncontrollable pollution with a negative impact on health, particularly for children living near recycling areas. This study aimed to determine the correlation between blood lead levels (BLL), the gold standard to measure lead levels in human body, and hair head levels (PbH) as an alternative indicator. The study was conducted in 2014 as part of environmental pollution research. The research was focused on informal recycling of lead-acid batteries with cross-sectional design involving children (aged 7 to 13 years) who lived close to lead-acid battery recycling activities in Depok City, Indonesia. Blood lead level was measured using anodic stripping voltammetry method and hair lead level using atomic absorption spectrometry. The measurements resulted in an average BLL of 8.22 µg/dL and PbH of 8.23 µg/g. The correlation between blood level and hair level is strong with coefficient correlation of 0.543 (p<0.05). The linear equation displays a positive pattern (y=1,573x-4,705), suggesting that when BLL increases, PbH increases as well. Hair lead levels can be used as an alternative indicator to measure lead levels in children.

Usoro I.E   Idigo F.U   Ogunboyo O.F   Agbana R.D   and Akhigbe R.O   

Aging is characterized with its own challenges. Geriatric patients have been identified with behavioural changes and motor function impairment in many studies across the globe and Nigeria is not an exception. A prospective cross-sectional design was adopted while a primary method of data collection was used to elicit information from the geriatric patients, who had presented for CT scan of the brain between January 2019 and December 2019. Descriptive and inferential statistics were employed to analyze the data collected. Findings indicate that the distribution for behavioural changes as well as motor function impairments was 15.4% and 84.6% respectively. The major behavioural changes observed were outburst and mistrust (10.8%) and severe memory lapses (4.8%). The major motor function impairments observed were sudden collapse/loss of consciousness (42.7%), paraplegia (26.1%), right-sided body weakness (7.5%), difficulty in walking (4.0%), slurred speech/aphasia (3.0%) and left-sided body weakness (1.1%). There was significant association between the gender of the geriatrics and the behavioural changes and motor function impairments observed (x2 = 17.312, df = 4, P = .002). Chronic cerebral atrophy was suggested as the possible cause of behavioural changes among the geriatrics while cerebral infarct and cerebral haemorrhage were suggested as the possible causes of the motor function impairments among the geriatrics. There is substantial empirical evidence showing strong association between CT presentation of geriatric brain and behavioural changes and motor function impairments in geriatrics and age-related factors. Thus, urgent care and attention should be given to geriatric population in Nigeria to facilitate a healthy life while they age.

Halid O.Y   Ogunboyo O.F   Akinyele T.W   Adejuwon S.O   Ogunlade T.O   and Halid T.I   

Background: Voluntary counselling and testing has always been one of the HIV prevention and treatment techniques. Its awareness and knowledge have been well documented in most studies. High level HIV/AIDS related awareness and knowledge as well as that of VCT have not been translated into optimum utilization of VCT especially in HIV highly prevalent regions. However, this study examined the associated factors that correlate with VCT uptake among sexually active adults in Taraba State, one of Nigeria’s HIV most prevalent states. Method: The study consists of participants randomly drawn from five local government areas of Taraba State. Four hundred questionnaires were administered to obtain responses on level of VCT utilization, HIV-related awareness and knowledge, VCT-related awareness and knowledge, as well as other associated factors. Uptake of VCT was considered as the outcome variable with dichotomous response. Relationships between demographic characteristics and baseline factors against the outcome variable were cross-tabulated using Chi-square. Also, a multiple logistic regression analysis was performed to determine associated factors which have significant effects on VCT uptake. Results: Our findings showed a very low VCT utilization level (40.9%) relative to the awareness level (97.7%). Results also showed that all the six factors considered in the study except one are statistically associated with VCT uptake at 0.05 level of significance. Conclusion: It is concluded that high level of awareness does not transcend to high utilization of VCT in the region, and effort must be intensified to improve update of HCT in the grossly affected areas.

Jilly Philippa Joel Premkumar   Daniella Delali Sedegah   Michael Tuffour   Maxwell Ayindenaba Dalaba   and Isaac Orleans Boham   

Water, Sanitation and Hygiene is one of the Sustainable Development Goals (SDGs) which places emphasis on Clean Water and Sanitation. The importance of Water, Sanitation and Hygiene was highly recognized in the context of the COVID-19 pandemic. There has been decline in COVID-19 cases in Ghana resulting in the lessening in restrictions as announced by the Government. Therefore, hand washing behaviour is also slowly reducing among the people. This study seeks to assess the hand washing practices among the school adolescent boys. This study adopts cross sectional design and uses questionnaire to analyze the hand washing practices among school going boys (228) from eight schools in two districts in the Eastern Region of Ghana. The study reveals that only half of the respondents wash their hands with soap before eating, after urinating, after playing, and after returning home and two thirds of the respondents wash their hands with soap after visiting the restroom. One-fifth of the students do not wash their hands at school for a variety of reasons including ‘it is not necessary,’ ‘laziness,’ ‘no time,’ and ‘no water or soap available to wash’. Significant variables influencing hand washing practice were age of students less than 14 years, in lower forms (form 1 and 2), living in rural areas and as well as availability of veronica buckets always at the schools. The study recommends students’ hand washing behaviour must be monitored and educated on a regular basis targeting the identified variables.

Khaldoun Aldiabat   Enam A. Alsrayheen   and Carole-Lynne Le Navenec   

Death anxiety is a worldwide phenomenon among diverse populations, including older adults. However, few studies were located in a literature review that examined how the Covid-19 pandemic influenced the perception of death anxiety among the older adult population. Therefore, the purpose of this scoping review article is two-fold: (1) to provide an introductory discussion, based on the literature, regarding how the Covid-19 pandemic and its precautionary measurements provoke death anxiety, including its sub-category of predatory death anxiety, among older adults; and (2) to identify non-pharmacological interventions specific to death anxiety management for gerontological nurses to use during the Covid-19 pandemic or similar pandemics in the future. An intended outcome of this discussion paper is an enhanced understanding of ways to provide effective psychological care to older adults. The focus of discussion includes: the role of sociocultural factors, predatory death anxiety and Terror Management Theory, salient nursing assessment parameters and non-pharmacological interventions to address death anxiety among this population of older adults. In conclusion, gerontological nurses need to demonstrate evidence-based practice taking into consideration their own definition and perceptions of death, the reasons for their beliefs, and the cultural, situational, and spiritual context, in which they practice.

Nita Bandyopadhyay   Tuhin Das   Ankur Biswas   and Abhijit Koley   

Sleep disturbances and poor sleep quality are more common in the elderly, and they are frequently ignored and untreated. As pharmacological treatments are not free from health hazards, nowadays, community-based non-pharmacological treatments are gaining huge acceptance for managing health issues. Yoga is one of the most feasible and cost-effective non-pharmacological means to manage sleep quality. The current systematic review aims at investigating the effects of yoga on the sleep quality of the elderly. So, the review was conducted on the basis of experimental investigations by using key words such as "effect of yoga", "sleep quality", "sleep disorder", "insomnia", and "older adults" published in English across four databases such as Scopus, ScienceDirect, PubMed, and PubMed Central. The risk of bias in selecting the studies was assessed by CASP. Four randomized controlled trials (RCTs), one pre-post study, one cross-sectional study (CS), and one longitudinal study (LS) met the inclusion criteria, with a total of 524 participants aged between 40 and 95 years from three different countries. Six out of seven studies used subjective tools to assess sleep quality, of which five used the Pittsburgh Sleep Quality Index (PSQI) and one used a sleep rating questionnaire, while the remaining one used an objective method to assess sleep quality through polysomnography. All seven studies reported significant improvements in sleep quality in the intervention group. Cohen's d effect size could be calculated for four studies, ranging from 0.55 to 1.88, whereas for the remaining three studies it could not be calculated because of insufficient data. So, the current review concludes that yoga can improve the sleep quality of the elderly population. Further, it is recommended that yoga can be adopted as a cost effective, community-based, non-pharmacological means to promote sleep quality among the elderly.

Grygoriy Griban   Olha Zablotska   Serhii Kudin   Liudmyla Zavatska   Hanna Zhara   Iryna Nikolaieva   Pavlo Tkachenko   Roman Golovashchenko   Oleksandr Lavrentiev   Mykola Puzdymir   and Kostiantyn Prontenko   

Today, smoking has become a pandemic not only in the medical aspect, but also psychological, economic and social. This problem is especially acute today for the female part of the world's population, as the female body is more susceptible to the negative effects of nicotine. Women's refusal to smoke will reduce the risk of developing diseases and improve their health. The aim of the article is to explore women's motivation to tobacco smoking and quitting this addiction. We conducted a sociological survey among female smokers who visit beauty salons in order to find out the prevalence of smoking among women and assess their motivation to quit this addiction. The survey involved 150 women of different age groups. It was determined that solving the problem of tobacco smoking among female smokers requires taking into account their individual and age characteristics in order to correctly select the motivational factors for smoking cessation. It was found that despite active preventive measures taken by public health bodies in every country of the world, the rates of smoking among women, mainly of reproductive age, are increasing, which poses a threat to human health in general and requires revision and improvement of approaches to counteracting the involvement of women in the use of tobacco products. Based on the results of the research, practical recommendations have been developed to improve the smoking counteraction system in the direction of individual work undertaken by public health professionals with women, taking into account their motivation to smoking and quitting it.

Zainab Fatehi Albikawi   

Background: Students go through a period of significant personal and social growth during their enrollment at university. It is essential to investigate the factors that affect the health of university students. Relatively little research has been done on how they are affected by factors such as practicing physical exercise, insufficient sleep, and effective management of stress. Aim: To investigate female nursing students' levels of perceived stress, practicing physical activity, and insomnia and examine related relationships. Methods: The sample for this descriptive and correlational study included 290 consenting female nursing university students. The students completed the following questionnaires: a sociodemographic questionnaire, the perceived stress scale, the Bergen insomnia scale, and the international physical activity questionnaire. Results: There were 32.19% of inactive students, 44.13% of minimally active students, and 23.68% of sufficiently active students. Insomnia affected 42.70% of them. High levels of perceived stress were reported by the student (22.54±7.16). Students with bad family support experienced insomnia more frequently than students with very good family support (OR = 1.41; 95% CI: 1.06-2.16). Students who used their mobile phones before sleep experienced insomnia (OR = 1.67; 95% CI: 1.17–2.63). High-stress students were also more likely to have insomnia (OR = 1.74; 95% CI: 0.95–0.98). Conclusion: insomnia is more common among students who experience high levels of stress, have bad family support, or use their phones before sleep. Promoting physical activity, sleep, and reducing perceived stress among university students requires preventative and therapeutic measures supported by scientific evidence.

Teo Kok Wei   and Mohd Shahril Abdul Rahman   

By 2044, Malaysia will have been leaning towards an "aged society" with 14 percent of the population above 65 years of age. As such, it is increasingly important that public parks accommodate recreation activity for senior citizens, offering various passive and energetic outdoor activities. The physical element in public parks should complement the performance of certain activities. The seating area in an open environment is one of the physical features that must exist, accommodate and be a catalyst for another activity. A human can conduct an activity in several ways through possibilities provided by the environment, which is explained by the affordance hypothesis. Taman Bermain Taman Midah, a mini-park located in Cheras, Kuala Lumpur provides facilities to allow for outdoor activities. The study will include a literature analysis as well as observation of visitors to determine how they used the space at the mini-park and how it may provide both passive and active enjoyment to senior citizens.

Piau Phang   Ming Yan Yap   Syerrina Zakaria   and Jane Labadin   

The state government of Sarawak with the help of the Sarawak Disaster Management Committee (SDMC) has continuously made the updated information on the state COVID-19 situation and its ensuing control measures available to general public in the form of daily press statements. However, these statements are merely providing textual information on daily basis though the data are in fact rich in temporal and spatial properties. Since the onset of COVID-19 pandemic, spatiotemporal analysis becomes the key element to better understand the spread of COVID-19 in various spatial levels worldwide. Hence, there is an urgent need to convert this textual information into more valuable insights by applying geo-visualization techniques and geospatial statistics. The paper demonstrates the prospect of retrieving geospatial data from publicly available document to locate, map and analyze the spread of COVID-19 up to division level of Sarawak. Specifically, map visualization and geospatial statistical analysis are performed for the list of exposed locations, which are indeed locations visited by COVID-19 patients prior to being tested positive in Kuching division, using open-source geospatial software QGIS. It is found that these exposed locations concentrate on the build-up areas in the division and are in south-west to north-east direction of the center of Kuching in September and October 2021. Despite the number of exposed locations published is relatively small compared to the number of confirmed cases reported, both are nearly strongly correlated. The insights gained from such geospatial analysis may assist the local public health authorities to impose applicable disease control interventions at division level.

Watanyoo Kaewsuphan   Arporn Popa   Sompong Maneesakprasert   Anurakpopop Meeton   and Bhuvanard Pimboon   

This research aimed to examine the health behaviors and recreational activities of the elderly and investigate the relationships between the physical, mental, emotional/intellectual, and the social aspects of the elderly in the elderly schools. The samples were 400 elderly people, who had been recruited via the Multi-Stage Random Sampling method. The data collection was completed by using a questionnaire developed by the researcher. It consisted of 3 parts: Firstly was The respondents' General Information, Secondly was The respondents' Recreational Activity Needs, and lastly was The Elderly Health Behavior Assessment, which had a 5-level rating scale. The questionnaire was rated with reliability of 0.924. The statistics used for data interpretation included means, percentages, standard deviations (S.D.), and Pearson's Product Moment Correlation Coefficient. The results presented that there were more females than males, with the average age range of 60-69 years. The elderly's needs for physical recreation activities with the three highest average scores were Stick exercises, and Yoga. Regarding the mental activities, the two highest average scores were Tree planting, and Gardening. The needs for emotional/intellectual health were Basketry, and Weaving. The highest average scores for the needs of the elderly on the social aspect were Rhythmic activities, and Singing. The overall physical health of the elderly was rated at a low level, while the overall scores for the mental, emotional/intellectual, and social health aspects were at moderate levels. The relationship between health promotion activities and the health quality of the elderly in the elderly schools was statistically significant at a level of 0.01.

Rasha Aly Mohamed Aly   

Fertility levels are generally lower in countries with high rates of using contraceptive methods. One of the aspects that determines the rates of women's use of these methods is their knowledge of them and the issues surrounding the reproductive process and their attitudes towards them, and then, transforming all of those into behavior. This study was conducted to assess the Egyptian women's level of "knowledge, attitudes, and behaviors" towards reproduction and family planning through an index that combines all these aspects (the KABRF Index) and by examining some of the related factors and how they are connected. The study included a sample size of 8293 women in EDHS 2014 and applied the Correspondence Analysis method. It was found that nearly one-third of the sample was rated at the lowest level of the index under study. These women are mostly the uneducated, the least educated, the poorest, the least empowered, the most exposed to spousal violence, residing in the frontier governorates and Upper Egypt, and with five or more children. Improving the position of the Egyptian women in the indicator under study requires the efforts of some state ministries to raise awareness and follow a motivation policy through granting privileges to families committed to having two children at the most and enforcing compulsory education until the completion of the secondary school.

Michael Arthur Ofori   Amos Kipkorir Langat   Youssouf Bouzir   and Mohamed Adam Suliman Ishag   

The study analyzed the contributing factors associated with Mild Cognitive Impairment (MCI) in Ghana using the WHO study on Global Ageing and Adult Health (SAGE) data from Ghana. The data consisted of 5011 participants. The respondents were asked to indicate their difficulty in concentrating or remembering things in the last 30 days. The study categorizes the response into two (None and Some difficulty) and analyzes using logistic regression. We found that a little above 40% of the people have MCI. The females were more vulnerable in experiencing MCI with odds exceeding those of males by more than 29%. MCI is more common among people experiencing severe or moderate vision problems. Also, it was discovered that those with higher degrees of education tend to have better memory than people with lower levels of education or no education. Again, MCI is susceptible among aged people who do not engage in physical activities like working or exercising as well as those that are depressed. The logistic regression model found age, sex, educational level, difficulties seeing, depression, SBP, HR, exercise, employment status, and tribe to be statistically significant in factors associated with MCI.

Jannathul Firdous   Emdadul Haque   Anis Lyanna   Auni Nawwarah   Fatin Najihah   Norzahidah   Nur Iffah Zakiah   and Nur Syahirah   

Medical students are prone to sleep deprivation and poor sleep quality. Insomnia and stress are commonly the cause of lack of sleep among students. This systematic review aimed to assess sleep quality that affects the academic performance among medical students by determining the components that help in identifying sleep quality in medical students, to identify how sleep quality affects the academic performance of medical students and determines the factors that cause sleep deprivation in medical students. We conducted a comprehensive screening through various database sources to extract data about the prevalence of poor sleep quality among medical students and its impact on students' academic performance. Findings of the studies showed that the academic performance was significantly affected by sleep deprivation among the medical students and there was a significant correlation between sleep quality, academic performance and the factors affecting sleep quality. These findings calling for immediate attention in order to improve the students sleep quality as poor sleep quality is significantly correlated to their low academic performance. One study showed no significant difference between sleep and academic performance of students but sleep quality is significantly associated with elevated levels of stress. However, longitudinal study is needed to conclude for more certainty.

Methaq H. Alogaili   Luma K. Mohammed   Atheer J. Alsaffar   and Afnan A. Alsallami   

The FDA-approved vaccine against the novel coronavirus developed by Pfizer and BioNTech became widely popular in Iraq. The study aims to evaluate the incidence of vaccine adverse reactions, and severity after first and second doses and to link some of the demographic criteria of recipients. This study included 850 adults (16 years and older), and the sample was collected from a randomly selected vaccination center in Baghdad, Iraq for the period January to March 2022. Study Participants were directly interviewed while taking the first dose. Later on, phone calls were used to monitor participants’ self-reported local or systemic adverse reactions for one week after the first dose and second dose. The participants’ age range was (19-76 years) with a mean of (46.2 ± 15.8) years. 59.9% were males. The mean body mass index (BMI) was (27.7 ±2.9). The incidence of vaccine adverse reactions after first and second doses were: first dose (local 17%, systemic 27%), second dose (local 27%, systemic 35%). Ordinal logistic regression analysis after adjusting for age, sex, and past medical history (PMHx) showed a higher incidence and severity in females and those with PMHx in nearly all the types of reactions except for chills (second dose) and PMHx (two doses), muscle or joint pain (two doses). Spearman’s Rank test showed an insignificant correlation with any type of reaction. The vaccine is generally safe and adverse reactions are mild and tolerable in the majority of cases.

Sllavka Kurti   Petrit Dollani   and Rezarta Kalaja   

The evaluation of patients' experiences with hospital healthcare is crucial in identifying important aspects that help in improving such experiences. Recognizing the importance of patient empowerment incorporating the latter voice in healthcare decision making can lead to improvements in health services, health outcomes, and hospital performance. This cross-sectional study aims to propose a validated instrument to evaluate and identify key hospital care aspects that influence patient satisfaction with the quality of the care provided. For a three-month period, 307 randomly selected patients hospitalized in Albanian public hospitals were invited to participate in this study. Respondents' experiences with the quality of healthcare services during their hospitalization are collected using a validated instrument, an adapted version of the Patient Satisfaction Questionnaire, PSQ-III. The instrument collects patient experiences related to ten aspects of hospital care. Statistical analysis revealed that five out of ten considered dimensions have a significant impact on patient satisfaction: Interpersonal relationships, technical quality, communication with medical staff, financial aspects, and administrative procedures are all significant factors. The findings of the study provide hospital management and medical staff with information about aspects that enhance or hinder patient satisfaction. It serves as the basis for developing strategies that may enhance the level of patients' satisfaction with the healthcare provided by public hospitals.

Made Agus Sugianto   I Ketut Suyasa   I Wayan Weta   Anak Agung Wiradewi Lestari   I Made Bakta   Bambang Wirjatmadi   I Made Jawi   I Made Ady Wirawan   and Pande Putu Januraga   

Introduction: In assessing the nutritional status of toddlers, stunting is an indicator of nutritional problems in toddlers. The purpose of this study was to determine the binary logistic regression model of the stunting rate in Garbasari village, and the factors associated with the stunting rate. Methods: This study uses secondary data from the reporting of Community-Based Nutrition. The samples in this study were all villages in the Badung Regency area, totaling 62 villages. Results: Villages with a low percentage of the population receiving health insurance assistance tend to have a low stunting rate of 2,657 times compared to those with a high percentage. Likewise, the high percentage of clean water coverage tends to have a lower stunting rate of 3.746 times. Furthermore, the high percentage of budget realization has a tendency of 7.989 times, the high percentage of pregnant women's class attendance has a lower tendency of 7.916 times and the high percentage of mothers' class attendance tends to be 6.654 times lower than those with low percentages. Conclusion: the percentage of budget realization, the class attendance of pregnant women, and the class attendance of mothers under five have a relationship with the stunting rate in Garbasari village.

Agus Gumilar   Amung Ma'mum   Nuryadi   Jajat Darajat Kusumah N   and Burhan Hambali   

The implemented outdoor activity restrictions throughout the COVID-19 pandemic have caused a change in people's lifestyles. The significant changes that can be seen are the reduced number of people's participation in physical activities and the change in their dietary patterns [1]. This condition also affects the anxiety of everyone. A lifestyle related survey was conducted on 274 students at the University of Education Indonesia using the Fantastic Instrument developed by Dr. Douglas Wilson from the Department of Family Medicine, McMaster University Canada. The lifestyle itself here includes conditions from sports activities, rest periods, and feelings of anxiety during the COVID-19 pandemic. The results of the analysis show that there is a significant influence of life on feelings of anxiety with a sig (2-tailed) value of 0.046 < 0.005, while the coefficient of determination (R Square) of 0.11 means that lifestyle variables have an effect of 11% on anxiety, the rest is influenced by other factors. The implementation of activities during the Covid-19 period had a real impact on the lifestyle of students at the Indonesian Education University, significantly reducing feelings of anxiety for those who applied a good lifestyle and vice versa, feelings would increase when the lifestyle was not good.

Ratnawati   and Yoga Putra Prameswari   

This study aimed to determine the influence of patriarchal culture in the family on the stunting incidence in children. Stunting has always been explained to occur due to health factors, although recent studies showed that non-health factors also play a role. The methodology involved case studies, focus group discussions (FGD) conducted with key informants, in-depth interviews, and documents. Furthermore, the documents were used to confirm the primary data that was previously obtained through the triangulation mechanism to ascertain valid data and information. The results showed that patriarchal culture as a non-health factor affects stunting in children because it creates gender inequality in children care. This is a new perspective in explaining the incidence of stunting. Also, some limitations only apply to people with a strongly patriarchal culture. The theoretical implication is to fill in the gaps in the stunting theory which can be explained by non-health factor. The practical implication involves a change in the community mindset. Therefore, the husband or man must also be responsible for the upbringing of children.

Chadaphim Photphanloet   Siriprapa Ritraksa   Sherif Eneye Shuaib   Arthit Intarasit   and Pakwan Riyapan   

A dynamical model for COVID-19 spread relating to non-pharmaceutical interventions and vaccination is mathematically generated by adding a gradual vaccination compartment for the susceptible population and considering only a symptomatic infectious stage. In our model, there are seven compartments dividing a given population into susceptible , vaccinated , exposed , infected , quarantined , recovered and death groups, respectively. Then, theoretically analysis is given by investigating the COVID-19 free and endemic equilibrium points, and computing the vaccination reproduction number of this model denoted as using the next generation matrix. If , then the COVID-19 transmission increases exponentially and depends on vaccine efficacy. On the other hand, if , then there occurs the COVID-19 disease eradication. The risk from infection can be importantly reduced whenever the intake of COVID-19 vaccines exceeds one dose. The numerical results reveal that the nonpharmaceutical ways and the administered COVID-19 vaccines can be effective against the current variants of COVID-19, and the additional efforts such as a third vaccine booster shot should be considered and implemented to greatly mitigate the risks of emerging variants of the COVID-19 virus. Moreover, combining different types of COVID-19 vaccines can be appeared as a possible way to give better protection against COVID-19 as well.

Juan Morales   Elizabeth María Yovera-Sandoval   and Marlene Raquel Basilio-Rojas   

Objectives: To assess the effect of multidisciplinary community health services on reducing blood lead in children. Material and methods: Retrospective observational study, before-after type. The information of an intervention program in the “Mi Peru” district was analyzed. The population consisted of 1,191 children of both genders who had results of blood lead level and who were evaluated during 2016 and 2017. The sample consisted of 187 children with blood lead levels ≥10 μg/dL. Community health services had three components: comprehensive multidisciplinary care, health education and house calls. Results: The blood lead level at the start of the intervention, 88.5% (n=139) belonged to category II and 11.5% (n=18) belonged to category III. At the end of the intervention, 66.9% (n=105) resulted in category I, the proportion of lead levels belonging to categories II and III was reduced to 29.9% (n=47) and 3.2% (n=5) respectively. In relation to the blood lead level at the beginning of the intervention and at the end of the intervention, the initial mean of 13.96 μg/dL was reduced to 8.96 μg/dL and the median from 12.40 μg/dL to 8.20 μg/dL (p<0.001). Conclusions: Community health services reduced blood lead levels in children with elevated blood lead levels. It is suggested to promote and strengthen the comprehensive house calls and health education about the risks of lead exposure.

Cerika Rismayanthi   Abdul Alim   Krisnanda Dwi Apriyanto   Rizki Mulyawan   and Yulvia Miftachurochmah   

Objective: This study aims to determine the relationship between self-efficacy and outcome expectation of the Body Mass Index in the elderly population. Methods: This research is an analytical observational study conducted with a cross-sectional approach. Sampling was done by consecutive sampling technique with a total of 118 samples (61.7 ± 8.3 years; 153.7 ± 8.3 cm; 60.5 ± 12.7 kg; BMI = 25.5 ± 4.6 kg/m²). Data analysis in this study uses the Pearson product-moment correlation technique. Results: The results of this study show a significant negative relationship between self-efficacy dimension 1 and BMI because of the value of sig. < 0.05, r count is negative and r count < r table -0.1809. There is a significant negative relationship between self-efficacy dimension 2 and BMI because of sig value. < 0.05, r count is negative and r count < r table (-0.203 < 0.1809). There is a significant negative relationship between 3rd dimension self-efficacy and BMI because of the value of sig. < 0.05, r count is negative and r count < r table -0.278 < -0.1809. There is a significant negative relationship between the outcome expectation (positive) and BMI because of the sig. < 0.05, r count is negative and r count < r table -0.205 < 0.1809. There is a significant positive relationship between the outcome expectation (negative) and BMI because of the sig. < 0.05, r count is positive and r count > r table (0.523 > 0.1809). Conclusion: It can be concluded that self-efficacy in doing physical activity and understanding the benefits obtained after doing sports has a significant relationship with BMI values in the elderly.

Purbianto Purbianto   and Khayan Khayan   

Carbon monoxide (CO) pollution to the environment hurts health. The ability of Hb to bind CO is stronger than O₂, which hurts humans in a CO-polluted environment. This condition impacts CO levels in the body and increases with low oxygen levels in the blood. The CO content in the body that exceeds the threshold triggers symptoms of headaches, prolonged fatigue, and even death. This study aimed to determine the effect of exposure to CO in free air with levels of COHb and health complaints on parking attendants and traders in the lower market terminal of Bandar Lampung City. This study used a retrospective cohort design. The population in this study were traders and parking attendants who worked at the Pasar Bawah Terminal in Bandar Lampung City, amounting to 152 people, and parking attendants totaling 35 people divided into two shifts. The sample size is 127 people. Data were taken from measuring COHb levels and using a questionnaire regarding health complaints that respondents often felt. Data analysis used chi-square. The average exposure to CO levels in the market terminal under the basement of the Tanjungkarang supermarket was 23.68 ppm, with the highest level of 25.87 ppm. Most of the respondents are male, aged over 35 years, and have worked for more than three years. Most respondents do not wear masks when working in the exposure area; the COHb level in the blood is above 5%, and most have complaints of health problems. There is a significant relationship between COHb levels in the blood with CO exposure, length of work, and health problems and no significant association with age and habits of using personal protective equipment (PPE).

Savitha Satish   Sushma Rudraswamy   Jai Shankar Puttabuddi Hommerhalli   Nagabhushana Doggalli   Sunitha S.   and Sowmya Srinivas   

This study aims to evaluate, through a questionnaire, general public awareness preference regarding mouth wash and their perceptions of the importance of self-care to control the disease. Methods: General public completed a 20-item questionnaire that aimed to assess the following: their profile, knowledge, and awareness of the mouthwash, preferences on mouthwashes in terms of their constituent ingredients, short- and long-term side effects, and their attitude towards the use of mouthwashes as plaque control agents. Data tabulation and the frequency distribution using tables and graphics were done. Results: The data showed that 134 participants answered the google form, out of which 56% of participants did not use mouthwash, and 64% gave reasons why it was unnecessary to do so. While another 14.7% were unaware that mouthwash is an adjunct in aiding oral hygiene, and 15% of participants said they did not have enough time to use it. The remaining justifications included difficulty in mouth washing and finding it costly. Conclusion: We conclude with this questionnaire-based survey during the pandemic COVID-19 regarding the public perception and preference of mouth wash, the general public becomes motivated to promote self-care when the dentist promotes proper instruction. The present study throws light on the fact that widespread usages of herbal products now need to be advocated and prescribed. Hence more evidence pertaining to the usage of herbal product needs to done with a greater number of clinical and randomized control trials on a larger scale to continue their development and usage at grassroots level.

Syarifatul Izza   La Ode Abdul Rahman   Afrizal Firman   Ferry Fadzlul Rahman   Dewi Gayatri   Krisna Yetti   Maria Franciska Vianney Boro   and Sri Agustin Tabara   

The pandemic period forces many changes, including achieving competencies in practical learning in the laboratory. Simulation-based education (SBE) provides learners with experiences in real patient care environments, where they can safely practice making decisions and providing care without causing harm. Virtual Reality Simulation (VRS) is a virtual simulation practice method that can increase nursing students' enthusiasm for learning. This study aims to determine undergraduate students' reaction to implementing post-appendectomy wound care practicum using Virtual Reality Simulation in the Faculty of Nursing, Universitas Indonesia. This study used a quasi-experimental design to determine the students' reactions when using VRS for the first time. A user reaction questionnaire was used after testing its validity and reliability. The questionnaire contains 24 items that consist of 11 positive questions and 13 negative questions. The sample in this study was 30 undergraduate nursing students in semesters II and IV. The results of this study indicate that the respondents were enthusiastic about doing a practicum using VRS for post-appendectomy wound care. The post-practicum questionnaire survey results evidenced this study: 53.3% of the respondents were enthusiastic, and 46.7% were not enthusiastic; the cut-off point was 91.2. The nursing students enthusiastically conducted a post-appendectomy wound care practicum using VRS. This study recommends that VRS be further developed and tested using a larger sample size.

Aluko O.   and Mwambi H.   

The rate of survival of human immunodeficiency virus (HIV) positive individuals resume to ameliorate with the usage of highly active antiretroviral therapy (HAART), yet pulmonary disease prevalence is growing unstopped amongst some of them. Handling missing data was a difficult challenge in the health data concept. We compared the effect of marginal to the proposed ordinal negative binomial models in handling intermittent missing observations for better numerical performance. The data used was characterised by monotone missing observations due to patients’ failure to declare their pulmonary conditions (lung infections and complications) and other vital health information. The use of multiple imputations is one of the latest techniques for handling missing observations, and this technique is relevant to different missing data mechanism assumptions, but occasionally profiles with the complication of the kind of parameters to be imputed and the mechanism underlying the incomplete data. This study focuses on the importance and application of the methods of handling missing health data. The proposed ordinal negative binomial model performs greatly than other models in adjusting for monotone missing data without imputation. In a real application, the proposed ordinal negative binomial model produces low estimates as against direct likelihood, mixed effects proportional odd, and MI-GEE models.

M. Ivan Ariful Fathoni   Gunardi   Fajar Adi-Kusumo   Susanna Hilda Hutajulu   and Ibnu Purwanto   

The insurance model in the form of Critical Illness (CI) is generally structured by a multi-state model that allows us to describe changes in insurance policies based on status changes experienced. The model in this study discusses the Markov process, which describes the critical illness insurance policy in each state for a continuous-time. Critical illness of breast cancer is modeled by several states consisting of is healthy or disease-free, is early cancer, is cancer increase after chemo, and is dead from cancer. This condition is based on the response to treatment after chemotherapy. The first steps in this study are to assign a function to the transition intensity from state to state and the transition probability. The transition probability of the multi-state model is the solution of the Kolmogorov forward differential equation. The following discussion is to create a formula for calculating the pure premium rate based on age intervals. A case study based on medical record data at dr.Sardjito Hospital is applied to calculate insurance premiums based on policies and age groups. A case study based on medical record data at dr.Sardjito Hospital is applied to calculate insurance premiums based on policies and age groups. The premium generated in this study is assumed to only depend on the number and time of state transfers. This insurance model can be an alternative to a more accurate insurance calculation based on the incidence of displacement of critically ill patients, especially breast cancer patients.

Aldara Henderson   and Huaibo Xin   

This study aims to examine the specific health challenges experienced by cancer patients and survivors during the COVID-19 crisis. It's a descriptive mixed-methods study with 317 participants recruited from multiple sources. Participants were asked to complete an online anonymous 35-question semi-structured questionnaire. Data was analyzed both quantitatively and qualitatively. During the COVID-19 pandemic, 56% of the participants felt their medical care was disrupted or delayed. About 85% believed healthcare providers were taking the necessary measures to address COVID-19, yet, 50% of the participants felt they had received adequate information from healthcare providers. Participants had 49% satisfaction with general healthcare provided through telehealth, while only 33% were satisfied with telehealth cancer care. Common themes of challenges confronted by cancer patients during COVID-19 also include, delays in testing and treatment leading to cancer metastasis; lack of family and general support in hospitals/office visits, and feelings of isolation as a result of the quarantine; limited access to mental healthcare services; limited communication with medical personnel. There is an urgent need for medical and oncological institutions to create streamlined protocols for cancer treatment, appointments, and communication to minimize the number of challenges endured by cancer patients during a health pandemic.

Mariya Malachynska   Anastasiia Barzylovych   Serhii Buravchenko   Vitalii Zvirych   and Marina Votiykova   

The influence of globalization and the strengthening of Ukraine's aspirations to successfully integrate into the European Union and become a full member of the international community necessitate the reform of the health care system and the payment of considerable attention to primary health care. In this context, the issue of effective management of primary health care facilities, increasing the capacity of their managers and determining the role of local governments towards them takes on increasing importance. The purpose of the research lies in substantiating the theoretical and applied principles for studying the management of primary health care facilities in Ukraine and assessing the impact of decentralization reforms on them. The general and special methods of economic analysis have been used in the research, in particular as follows: scientific abstraction and historical method, analysis, synthesis, analogies, comparisons, systematization, generalization, graphic method. Regarding the results of studying the state and trends in the management of primary health care facilities in Ukraine and the impact of the decentralization reform on them, their direct interaction has been established, which consists in obtaining additional opportunities for the implementation of managerial functions based on accessibility, openness, timeliness and effectiveness. It has been revealed that the volume of financing primary health care in Ukraine in the amount of 13 283 800,00 thousand UAH in 2018, 15 314 892,9 thousand UAH in 2019 and 20 667 909,1 thousand UAH in 2020 is in deficit and constitutes an average 4,1 % of the country's GDP (in the Netherlands – 9,9 %; Denmark – 9,6 %; France – 9,0 %; Austria – 8,7 %; Germany – 8,6 %; the USA – 8,1 %; Sweden – 7,9 %; Great Britain – 7,8 %; Italy – 7,2 %; Poland – 4,7 %). It has been proven that the mechanism for managing primary health care facilities requires revision and improvement, which is proposed to be carried out taking into account the level of development of a particular region in which these institutions operate within the capabilities of local governments and their financial solvency.

Phuong Thi Hang Nguyen   Dung My Le   Van Van Bui   Son Quang Le   and Lan-Anh Thi Le   

Anxiety is always a critical component of a person's mental health in any given circumstance. Anxiety is a frightened state of mind that is triggered by events that are either frightening or stressful. This is a natural reaction to a potentially dangerous situation, but it could be a sign of an anxiety issue if it becomes overwhelming or if it continues. This study took a look at the female faculty members working in Danang's universities. Based on the analysis of the data, the study revealed three key points: causes of anxiety among female officers from an intimate relationship, children, and family (i); causes of anxiety among female officers connected to health and finances (ii); and female officers' coping mechanisms for anxiety (iii). At the University of Danang in Vietnam, 80.9% of the subjects were investigated in their roles as lecturers, 16.2% were examined in their roles as office workers, and 2.9% were examined in their roles as female office people. They had advanced to become heads of subjects, departments, or faculties at this point. The fact that these results are preliminary does not change the fact that they will serve as an essential basis for establishing measures to ease anxiety among female staff members, particularly those working in institutions.

Madonna Castro-Gonzales   

A resounding call for more contemporary research on the correlates of physical activity in low and middle-income countries has been documented over the years. It was, therefore, the aim of this study to examine the correlates of physical activity in terms of endurance, body mass index, and motivation. Study participants involved 257 students, specifically male (n=137) and female (n=120), ranging from 9 to 11 years old preadolescent Filipinos. The physical activity levels were determined by the Physical Activity Questionnaire for Children (PAQ-C), while the cardiorespiratory endurance was assessed by a 3-minute step test. A body mass index (BMI) was calculated and classified using the World Health Organization criteria. Both Behavioral Regulation in Exercise Questionnaire (BREQ) and the PAQ-C were used to measure motivation in physical activities. An interview was also conducted for data triangulation. This research yielded the following results: First, endurance (x1) had no direct positive effect on physical activity (y) (β=-.069). Second, BMI (x2) had no direct positive effect on Physical activity (y) (β=.023). Third, motivation (x3) had a direct positive effect on physical activity (y) (β=.237). Next, endurance (x1) had no direct positive effect on motivation (x3) (β=-.116). Subsequently, BMI (x2) had a direct negative effect on motivation (x3) (β =-.301). Finally, endurance (x1) had a direct positive effect on BMI (x2) (β =.515). Endurance-BMI was considered the most remarkable relationship, garnering the highest standard estimate score of .515. The results also showed that BMI (x1) positively affected endurance (x2). It suggests that higher levels of working heart rate are associated with higher BMI scores of overweight and obese Filipino preadolescents. They had a lower endurance level due to excess body weight.

Indri Joviani Lumentut   and Ferdi Antonio   

There is a challenge in treating patients with cancer in the hospital, especially patients with terminal cancer who are concerned about their quality of life. Hospital administration should focus on improving care quality while looking for organizational outcomes. However, there was limited research on how the quality of care for patients with advanced cancer well-being could merit a hospital's reputation. This study aimed to analyze the five key elements of quality of care on patients' well-being and their impact on a hospital's reputation in the inpatients with advanced cancer at the cancer hospital. This study used a quantitative survey method with a cross-sectional data approach to analyzing five key elements of quality of care: effective communication, family-centered care, attentive care, supportive setting, and inter-professional team. The measurement of patient well-being is divided into physical and psychological well-being. One hundred sixty-seven patients completed the questionnaire. Most patients were females, 50–60 years old, with advanced breast cancer. Then, the data were analyzed using the partial least square-structural equation modeling (PLS-SEM). This study found that effective communication, family-centered care, attentive care, and the inter-professional team significantly positively affect patient well-being. Communication shows the strongest influence on patients' well-being. Overall, patients' well-being showed a strong direct influence on the hospital's reputation. In conclusion, patient well-being has been proven important for predicting a hospital's reputation. Hospital managers, clinicians, and nurses should continuously manage and improve the quality of care concerning communication with cancer patients.

Susilo Hariyanto   

In the pandemic situation, Clinic Mitra Sehat Sukoharjo has become a forefront health facility to maintain the health of society. During the last three years, the number of patients visited has reached 142.792 people. With that large patient visitation, it is necessary to provide everything to serve patients well. This study will provide estimation data results that can be used by the Mitra Sehat Clinic, which previously only made preparations without data. This study will estimate the Number of Outpatient Patient Visits Using ARIMA at Mitra Sehat Clinic in the next few months. ARIMA or Autoregressive Integrated Moving Average is a forecasting method that will be used to predict the number of patient visits at the next time, so that in the future, Mitra Sehat Clinic can prepare matters related to serving the visiting patients optimally. The steps for using the ARIMA method are using data from the required sample from patients visiting in January 2019-December 2021, determining the type of time series data pattern, then conducting a stationarity test, determining the ARIMA model, calculating and analyzing the accuracy of the model used, and then forecasting the number of outpatient visits. And the best ARIMA model for this forecasting based on the calculation is (1, 0, 1) with an error value of 334183.

Upik Rahmi   Hanna Goenawan   Nova Sylviana   Setiawan   Septian Andriyani   Suci Tuty Putri   and Lisna Anisa Fitriana   

The hippocampus has a function in forming memory mediated by the BDNF neurotrophic that has been induced by physical exercise. Several studies have been conducted to determine the effect of exercise on BDNF and cognitive function (learning, memory, and executive function). The effect of exercise is influenced by the type, intensity, and duration. Purpose: To review the effect of physical exercise by type, intensity, and duration on BDNF and cognitive function in adults and the elderly. This study used the literature review method from several databases, including PubMed, Science Direct, and Cinahl, from 2010 to 2021. Certain keywords were used to search articles; PICO was also used in screening articles, extract, and analysis of data. Results: There are eleven articles included in this literature review. Aerobic exercise increases blood circulation to the heart and brain, so VO₂max increases. Training intensity causes hemodynamics, cellular metabolism, and memory formation, while exercise time influences the hypothalamic response. These mechanisms were interrelated in the effect of exercise on the concentration of BDNF as a mediator of synaptic plasticity. Conclusion: BDNF and cognitive function in the hippocampus are affected by physical exercise, especially the type, intensity, and duration of training.

Lisna Anisa Fitriana   Irma Darmawati   Suci Tuty Putri   Septian Andriyani   Slamet Rohaedi   I Ketut Adnyana   Kusnandar Anggadiredja   Iwan Setiawan   and Upik Rahmi   

Increasing tumor necrosis factor-alpha (TNF-alpha) and decreasing quality of life (QoL) are associated with cognitive deterioration. Exercise and Gotu kola (Centella Asiatica) can improve memory and antiinflammation, but their combination has not yet been revealed. This study aimed to see how exercise and Gotu kola extract affected TNF-alpha, quality of life, and executive functions in women with cognitive impairment. This study used an experimental design with a control group with a 12-week pre and post-test in women with cognitive impairment. The Montreal Cognitive Assessment (MoCA) was used to screen for cognitive impairment. The participants in the study were 64 women with a mean age of 53.3 (4.8) years. The subjects were divided into four groups: Gotu kola/GK extract capsule (1x500 mg/day), exercises (2x75 minutes per week), a GK-exercise combination, and the control group. The WHO-QoL questionnaire was used to assess the quality of life. The Trail Making Test-B (TMT-B) was used to assess executive functions. The study found that Gotu kola might increase QoL in the physical domain (p=0.028) and environmental domain (p=0.016). Exercise and a GK-exercise combination could improve QoL: physical, psychological, social, and environmental domain (p<0.05). According to the Mann-Whitney test, the GK-exercise combination was the most helpful in enhancing TNF-alpha (Δ=-10.5; p=0.003), MoCA (∆= 4.6; p=<0.001), and TMT-B (Δ=-21.4; p=0.023). Discussion: Physical activity is one of the factors that can play a role in cognitive function through several mechanisms. To conclude, exercise, Gotu Kola, and their combination can effectively decrease inflammation and increase the quality of life and cognitive function in women with cognitive impairment. This study expected that exercise and Gotu Kola could be priority interventions in treating cognitive impairment.

Nataliya B. Pankova   and Mikhail Yu. Karganov   

The purpose of our study was to search for possible changes in the parameters of the cardiovascular system in adolescents during the period from 2004 to 2020 against the background of the introduction of digital technologies into the educational environment. Methods: A comparative analysis of the parameters of the cardiovascular system in female and male adolescents aged from 13.9 to 15.4 years was carried out (57 adolescents in 2004 and 53 adolescents in 2020). We used a spiroartheriocardiorythmograph allowing recording of heart rate (HR) and blood pressure (BP) and spectral parameters of HR variability and variability of systolic (sBP) and diastolic (dBP) BP. The parameters were recorded at rest in the sitting position for over two min. All studies were performed during school hours in February-March. Results: An increase in the mean sBP values and an increase in the proportion of adolescents with BP in the "hypertension" range to 55% were found in 2020. The total power of HR variability spectrum remained constant, while the relative power of the LF range increased and the absolute power of the VLF range tended to decrease. In the sBP variability spectrum, an increase in the total power and all its ranges was detected, but the relative power of the LF range decreased. In the dBP variability spectrum, the absolute power of the VLF range decreased, while the total power remained constant. No changes in the stress index and alpha index were detected. The dynamics of the parameters in male and female adolescents were similar. Conclusion: These findings indicate significant shifts in the parameters of the cardiovascular system in adolescents from 2004 to 2020 recorded during school hours analysis of the parameters of heart rate and BP variability reflecting the mechanisms of regulation of the cardiovascular system, suggests that the identified shifts were caused by psycho-emotional stress. We associate this state with the use of digital educational technologies. This trend requires the close attention of school health professionals. It would be expedient to establish the practice of BP measurements at school and share hygienic recommendations on working with digital technologies for students and their parents.

Sapriadi S   Tahir Kasnawi   Muhammad Syukur   and Syamsu A Kamaruddin   

The Measles and Rubella (MR) vaccination was declared haram by the Indonesian Ulema Council. However, it can still be used in an emergency. This makes parents hesitate to vaccinate their children with measles and rubella vaccine. In addition, various effects of Measles and Rubella vaccination like autism, fever, and death are also spread on social media. Vaccination is one of the interventions in the health sector that is expected to reduce mortality from preventable diseases by vaccination, including measles and rubella. This study used a qualitative descriptive research method with a participatory approach, carried out from October to December 2020, in Tompobulu and Tinggimoncong Sub-District, Gowa District South Sulawesi. The research informants were 32 people consisting of parents who had children aged 9-30 months old. The results showed that the parental decision to vaccinate their children with MR depended on the understanding obtained (source of information), attitudes and beliefs of parents, social capital, and lifestyle. An appropriate understanding encouraged parents to do MR vaccination on their children. Negative attitudes might influence parents to refuse MR vaccination. It is expected that health workers will conduct socialization and provide appropriate information regarding vaccinations given to children.

Anastasia Tri Yuli Susanti   Sarsintorini Putra   and Anggraeni Endah K.   

Tuberculosis has become an infectious disease with a high prevalence in developing countries, requiring serious handling from all stakeholders. Public health centers in this context have a critical role in relation to their function as first-level health care facilities. This study seeks to analyze the empowerment of the role of public health centers in the control of drug-resistant tuberculosis (DR-TB) in Central Java, Indonesia. This study was conducted using a field research method through a survey with the method of observation and interviews with respondents. The analysis technique is done by using the mixing method. Quantitative techniques are extracted from data related to the treatment of tuberculosis in Central Java, and are equipped with qualitative methods to get feedback from doctors and nurses at public health centers regarding strategies and challenges in treating tuberculosis. The results of the study show opportunities for empowering the role of public health centers through regulatory channels to give greater authority to the public health center to handle drug-resistant TB. The results of this study are practically useful for stakeholders and policymakers to elaborately place the important functions of the public health center in handling drug-resistant TB.

Redi Myshketa   Rezarta Kalaja   and Sllavka Kurti   

Patient satisfaction is an important factor, which should be considered by health care managers, to evaluate the quality of hospital service. This analysis aims to show the relationship between socio-demographic variables, such as gender, age, level of education, level of income, and patient satisfaction regarding the quality of private and public hospital service in Albania, as well as to determine which of these variables has the major impact, and if there are differences between different groups. The study was conducted in five public and three private hospitals in two of the biggest cities of Albania, Tirana and Durres, where 480 patients were interviewed, over 18 years old who had received services in the five largest hospitals in terms of number of patients, from March to June 2019. The questionnaire was constructed according to the SERVQUAL model with its five main dimensions, and ANOVA analysis of variance and Tukey procedure was used as the method to test the hypotheses. The results showed that the socio-demographic factors that affected patient satisfaction in Albania were mainly age and educational level, results confirmed also from the literature review, while no relationship with gender was observed. In terms of income level, we can say that as revenue increases, the level of patient satisfaction decreases. The results of this study are important to understand the behavior of patients in relation to their satisfaction with health services in Albania, so that different categories receive the appropriate importance when providing health care. The study provides important data for health managers to take measures in improving service quality.

Pardi Affandi   M. Ahsar K   Eko Suhartono   and Juhriyansyah Dalle   

Dengue Hemorrhagic Fever (DHF) is a disease caused by an arbovirus that enters the human body through the Aedes aegypti mosquito. Dengue Hemorrhagic Fever is characterized by symptoms, headache; reddish skin that looks like measles; and muscle and joint pain. The spread of dengue hemorrhagic fever (DHF) globally has tended to be higher in the last 50 years, thus giving rise to ideas for systematic prevention. Many factors cause this dengue fever, climate factors, weather, residential density, and other factors. The Epidemiological Model of DHF can provide a pattern of prevention against dengue outbreaks so that this problem can be modeled mathematically and through the stability of the equilibrium point, the dynamics or behavior of the model can be determined. The spread of DHF can be suppressed by providing control in the form of vaccines, eradication with insecticides and treatment. This review article aims to provide a systematic description of the causative factors, a mathematical model of DHF with an epidemiological approach. To get the right model related to the SIR epidemiological mathematical model and its modifications which can be an alternative solution to describe and analyze the model mathematically. The methodology used is to systematically search for journals and articles from August 2021 to April 2022. This is done by accessing electronic journal portals such as: Elsevier, Springer, ResearchGate, google scholar, Scient direct and so on. Other references also use national journals and information on the Ministry of Health's website. The results of a review of factors that cause dengue fever are physical environmental factors that have a significant influence on rainfall and air temperature. Mathematical models with Optimal Control can be used as an alternative to mathematical analysis which is expected to help solutions to reduce the spread of dengue fever. The recommendation given is to investigate the disease-causing factors from the chemical aspect related to the chemical effect in water that influences the growth of mosquito larvae in water which can indirectly affect DHF disease and involves these parameters in mathematical models and optimal control.

Nasser B. Ebrahim   and Madhu S. Atteraya   

Attitude towards domestic violence and child corporal punishment contributes to child maltreatment, however, the interplay of these violent practices is not well researched in Africa. Thus, we sought to examine the association between child emotional and physical maltreatment, and women's attitude towards wife-beating and child physical punishment among Somali women. We used data collected in the 2011 Somaliland Multiple Indicator Cluster Survey (MICS) from 4,820 households. We analyzed data from married/partnered women with children (n=1471) who were 15-49 years old. Bivariate associations were assessed by Chi-square test and multivariate logistic regressions were fitted to determine independent associations of women's attitude towards wife-beating and child physical punishment to child maltreatment variables. Overall, the proportion of children who experienced psychological aggression, moderate, or severe physical assaults were 71.5%, 70.2%, and 42.7%, respectively. Women's attitude towards wife-beating was not significantly associated with child maltreatment. However, we found significant associations between child maltreatment and women's attitude towards physical punishment. Health education programs focusing on changing cultural parenting beliefs may be useful in cultivating sound and effective childrearing strategies among Somali parents.

Mohammad F. Alharbi   

Currently, government employees in Saudi Arabia receive free healthcare services from the public healthcare system. Moreover, health services are provided to private-sector employees through mandatory cooperative health insurance of the employer. In the future, the government plans to introduce employment-based health insurance for those working in the public sector. In this research, the willingness of those working in the public sector to pay for employment-based health insurance has been examined. We interviewed 1230 participants from Qassim region using an auto-administration online questionnaire from February 3^rd to February 28^th, 2022. Altogether, 49.6% of participants reported that they would be willing to pay (WTP) for employment-based health insurance, with a mean monthly contribution of SAR 166.47 (US$.44.4) per family. Moreover, the findings of this research revealed that participants' willingness to pay for health insurance is impacted by a number of socioeconomic factors including age, gender, household size, prevalence of chronic diseases in the family, possession of private health insurance policies, and satisfaction with healthcare (p<0.05). The findings of this research can serve to help policymakers develop employment-based health insurance initiatives with acceptable premiums.

Hala Zaiton   Lise Hounsgaard   Lis Wagner   Rami A. Elshatarat   Mohammed S. Aljohani   Khadega A. Elhefnawy   Naif S. Alzahrani   and Zyad T. Saleh   

Background: The responsibilities of critical care nurses for mechanical ventilation (MV) management may differ among countries, particularly in the weaning process. Aim: To identify nurses' perceptions, roles, and challenges regarding the weaning process for patients in intensive care units (ICUs) in Denmark, Egypt, and the Kingdom of Saudi Arabia (KSA). Methods: This study was a qualitative study using a phenomenological-hermeneutic design. Results: Nurses in Egypt and the KSA were more likely to independently adjust ventilator settings. They used body language, facial expressions, and eye contact to communicate with patients. They prepared patients for the weaning process following physicians' orders. They provided routine nursing care with no specific nursing guidelines or protocols for the weaning process. In contrast, the nurses in Denmark checked the ventilator settings frequently, assessed the consistency of secretions, and frequently performed endotracheal suctioning. They used body language, facial expressions, and eye contact, and they used low technology devices (e.g. word or picture charts, alphabet boards and rewritable magnetic boards) and advanced technological devices (e.g. electronic voice output communication aids through a computer) to communicate with their patients. Moreover, the criteria for weaning and the protocol were used to wean patients from MV. Unfortunately, no protocol was applied for patients with long-term MV. Therefore, the weaning of these patients was conducted by consultation between the nurses and physicians. Conclusion: The use of weaning protocols in Danish settings is an excellent example of collaborative teamwork to apply the best practices in MV weaning processes. It is recommended that nurses in Arab countries apply this experience.

Thanh Thao Nguyen   Ngoc Thanh Hoang   Van Chung Le   Thao Van Nguyen   and Thi Hien Ha   

Background and Objective: Under the impact of the global Covid-19 pandemic, in-hospital training for radiologic technologist students meets several difficulties. The specificity of radiography sciences requires numerous practical exercises. We conducted a tutorial lesson for radiologic technologist students using X-ray simulation software to learn how to operate X-ray machines. The study aimed to evaluate students' satisfaction with the teaching method based on simulation software in radiological sciences. Method: 57 third-year radiologic technologist students were enrolled. All the students joined practical classes onsite from May to August 2021. The main training topic was routine X-ray radiography with in-house X-ray simulation software that was built by Hue University in collaboration with Duy Tan University. The satisfaction of students was evaluated following Likert 5 scale with 14 specific items. Descriptive statistics and a one-sample t-test were performed with SPSS Version 20 (IBM, USA). Result: The findings show that 68% of students were satisfied with the hypothetical clinical situation given in the simulation-based training class. One-sample t-test suggests that the average score of all the criteria is greater than 3, from 3.49 to 4.07. Most of the students wanted to participate further in a similar simulation-based training class in the future (91.23%). Simulation-based training software improves students' experience, radiograph creation ability, and image quality evaluation. Conclusion: Simulation-based training improves clinical skills, enhances visual thinking ability, and clinical practice ability of radiologic technologist students. This teaching method seems to be the appropriate solution for medical imaging technology training in the Covid-19 pandemic. However, further studies with a larger population are needed to comprehensively evaluate the effectiveness of the computer-based simulation teaching approach compared to conventional methods.

Khalid E Husein   Mohanad E Abugarga   and Elsiddig E Mahmoud   

Objectives: The overall aim of this study is to evaluate the incidence of acetabular dysplasia in asymptomatic Sudanese adults. Methods: This is a cross-sectional population-based study, which includes radiographic examination of the Hip. A total of 240 hips are studied in scout view which is routinely done in patients undergoing CT KUB. The morphology of acetabulum is assessed by measuring the center edge angle (CEA), acetabular angle, acetabular depth to width ratio. Results: The study shows that the mean center edge angle is 36.07° (SD±5.74°), 36.01° (SD ±3.37°) for the Rt and Lt hips respectively. Mean acetabular angle is 37.5° (SD±3.7°) for the Rt and 36.9° (SD±3.9°) for the Lt hip, mean depth to width ratio is 0.3 (SD±0.03) and .29 (SD±.03) for the both hips respectively. The CEA is dysplastic in 1.7%, the acetabular depth/width ratio in 19.2% and the acetabular angle in 0.8% of the hips. The study shows statistical significant relationship between male gender and abnormal acetabular angle. Also, there is statistical significant relationship between left side and center-edge angle dysplasia. Conclusions: the incidence of hip dysplasia in Sudanese population is found to be higher when compared to South Asian and Indian population and lower than Sami and other Asian population.

Irma Meškauskaitė   Agota Vaitkienė   Erstida Ulvidienė   and Vincentas Giedraitis   

Although previous research in Lithuania has indicated the construction of the diagnosis and treatment of mental illness through historical and cultural chapters, a considerable amount of research has been published in foreign literature that has emphasized the role of the pharmaceutical industry in diagnosing and treating mental illness. In this paper we examine the relationship between the pharmaceutical industry (pharmaceutical and medical device manufacturing companies), healthcare professionals and healthcare organizations in the mental health field. The relationship between the pharmaceutical industry (pharmaceutical and medical devices manufacturing companies) and healthcare professionals can be analyzed in two ways: research-oriented interactions and promotion practices. This relationship is inevitable and can be beneficial, however, conflicts of interest arise, which create a risk of potential harm to users and patients (e.g. as receiving suboptimal or unsuitable treatment, or waste of private and public money). This research analyzes both the relationship between the diagnosis and treatment of mental illness and the pharmaceutical industry market in Lithuania in 2010-2020, as well as the efforts of Lithuanian health care institutions in restructuring the mental health care system. Based on the analysis of the literature and statistical data, we state that after the restoration of independence, the main method of mental health treatment in Lithuania is still medical treatment, i.e., patients with mental illnesses and behavioral disorders are treated with medication. The main factors determining the still dominant method of medical treatment of mental illness are the following: first of all, the Soviet legacy (the paradigm of medical treatment - the Soviet paradigm); secondly, the restoration of independence in our country has created excellent conditions for Western pharmaceutical companies to develop their activities and increase sales of medicines, including psychotropic drugs; and third, medical treatment is cheaper for the state than complex treatment. This study draws on an analysis of the social origins of mental illness, while reviewing the previously unappreciated role of the interests of pharmaceutical companies in expanding their markets for the treatment of mental illness with drugs.

Adji Achmad Rinaldo Fernandes   Solimun   Ananda Ajeng Puspitasari   Avida Zahra   Carmelia Nabila Permatasari   Henida Ratna Ayu Putri   Mamlu'atul Marchamah   and Tamara Rezti Syafriana   

This study wants to examine the effect of the Benefits of Vaccines and the Ease of Getting Vaccines on the Intention to get vaccinated against Covid-19 and Covid-19 Vaccinated Behavior, while originality in terms of application lies in the analysis of Intention and Covid-19 Vaccinated Behavior. The approach used in this research is descriptive, exploratory, and explanatory using a mixed-method. This study uses several analytical methods, DNA is used to compose the questionnaire, cluster analysis is used to group several data sets that have been obtained, and path analysis is used to model Intention and Covid-19 Vaccinated Behavior. The variables in this study are the Benefits of Vaccines, Ease of Getting Vaccines, Intention to get vaccinated against Covid-19, and Covid-19 Vaccinated Behavior. The source of data used in this research is DNA by crawling data from various information in cyberspace, either in the form of articles, online news, journals, or content on social media. The location of this research will be carried out in the area of Malang City, Indonesia. The research will be carried out from July to September 2021 by taking primary data, in the form of assessments or perceptions from respondents, so that a survey is carried out with enumerators submitting questionnaires directly to the community as respondents. The population used in this study is the community throughout the city of Malang with a total of 635575 residents. The sampling technique used is simple random sampling.

Shadia Hamoud Alshahrani   Talal H. Alshahrani   Premalatha Paulsamy   and Eva Lobelle Ederango   

Background: Patient-centred care (PCC) helps multidisciplinary health teams to follow informed decision-making practices, and improved healthcare treatments are ensured for patients. The need for significant changes in the healthcare system can be identified with the help of centred patient care, and new healthcare systems are designed and revolve around patient needs. The purpose of the review was to evaluate patient-centred care and the concept of centeredness. Review results: PCC assists in meeting the targets of healthcare settings for patients. This aids the health team to ensure that patient nutrition, cleanliness, emotional, physical comfort, and psychological needs are fulfilled. PCC contributes to reducing the length of patient stay at the hospital, and chances of future admission to the hospital are also lowered. The review may assist to develop better insight into patient-centred care, its dimensions, possible benefits of PCC and perspectives of centeredness. Conclusion: patient-centred care aids to meet the objectives of improved patient care outcomes, lower treatment costs, and increased satisfaction with the quality of health care facilities cared for in the health sector. Healthcare organizations have begun to focus on individualised-oriented care, and they no longer follow traditional procedures to meet the needs of patients. The patient-centred care model showed that health care providers could be dedicated to their work and ready to meet the health expectations set for patients. PCC reduces patients' length of stay in the hospital, and the chances of recovery from chronic illness also increase. This review contributes to the field of health by highlighting important aspects of patient-centred care that would create cost-effective care, improve hospital services, emphasise communication and promote aspects of patient caring skills.

Niveen I. EL-Zayat   Omnia K. Helmy   and Ahmed M. Gad   

Multilevel survival models can be applied where the data have the hierarchical nature. Three common models are used in this case. They are the discrete time survival models with mixed effects, the Cox proportional hazard model with mixed effects and the Weibull survival model with mixed effects. The Egyptian Demographic Health Survey (EDHS 2014) data target 21,762 ever-married women aged 15-49. This article aims to determine the factors that may affect the time from the last birth of a woman to the first use of contraceptives. Due to the hierarchical nature of EDHS data, multilevel survival analysis is employed. The above three models are applied to EDHS 2014 data. The Weibull survival model with mixed effects proved to be the best model to fit the survival time. Moreover, it is found that only 25% of the sampled women have not used contraceptives until almost one year from their last birth. In addition, attaining higher education, increasing the age at first sex and breastfeeding contribute to the more efficient use of contraceptives. In addition, the article recommends enhancing family planning campaigns which have a powerful impact on the behavior of women in Egypt for the optimal use of contraceptives.

Andrina Addalia   and Ferdi Antonio   

The growth of clinics in the emerging country has experienced a high increase, consequently creating a competitive environment for specialized clinics. A positive clinic image could significantly improve the intention to visit the clinic, however, limited studies focused on the antecedents of the clinic image. The modified research model was carried out using a cross-sectional data approach with a quantitative survey method. The data regarding antecedents were collected via google forms and processed by partial least squares structural equation modeling. Overall, there were 235 responses whereas the majority was 26 - 35 years old (104, 44, 26%). There were five out of six antecedents (social media marketing activities) of clinic image that were proven to have an impact. Attractiveness in social media was followed by functional information, interaction, trendiness, and electronic word of mouth. Surprisingly, customization had not proven to have an impact. The findings of this study proved the positive impact of clinic image on visit intention. In addition, personality traits such as agreeableness and consciousness were found to have an impact on the relationship between clinic image and visit intention. Agreeableness had a negative effect on visit intention, in contrast, consciousness had a positive effect on visit intention. In conclusion, there was an effect between antecedents of clinic image and there was an impact on visit intention with agreeableness and consciousness of personality traits. This research stimulates a new mindset and promotes new research in addition to introducing a comprehensive framework in health promotion. Furthermore, managerial implications can be drawn for the development of visit intention at the sports medicine center. In this research, there is a limitation that can be identified. For the personality trait, the researcher only took two personality traits (agreeableness and consciousness) as representative of personality traits. Furthermore, the recommendation is to input all of the personality traits or add more personalities as a moderator of the dependent variables.

Omar M. Al Nozha   and Rami A. Elshatarat   

Objectives: Identify the association between online H.I. seeking behavior and the self-care practice among patients with diabetes mellitus (DM) in the Kingdom of Saudi Arabia (KSA). Methods: This is a descriptive cross-sectional study. A convenience sampling method was used to recruit 406 patients with DM. A structured questionnaire was used to collect the data. Results: A total of 211 of the participants used the internet and/or social media to seek H.I. Most of the participants (44.4%) had been using the internet for the last 6 to 10 years. The majority used YouTube (72.7%) and Twitter (55.2%) when seeking H.I.. Significant association between seeking online H.I. and practicing self-care activities, includes testing blood sugar, drinking juice to treat hypoglycemia, having a glucagon kit at home, doing interventional action in case of severe hyperglycemia, checking their feet regularly, and visiting their doctors' clinic periodically. Conclusions: Older age and low -educated people are less likely to seek online H.I. about DM management. The participants who were seeking online H.I. were more likely to do self-care activities to manage DM disease and prevent DM complications.

Arun Balasubramaniam   Mohan Gandhi V   Punitha Kumar R K   Rajkumar Krishnan Vasanthi   and Vinosh Kumar Purushothaman   

Physical inactivity [sedentary] is one of the significant concerns in young adults in various developing countries. College students show a marked reduction in physical activity and have adapted to the sedentary lifestyle due to the substantial transformation from school to college life. This study aims to compare myofascial release therapy versus muscle energy technique on hamstring flexibility in physically inactive college students. An experimental study design with 60 volunteers was assessed with sit & reach test and included in the study. Of twenty students, each participated in the myofascial release group (MFR), Muscle energy technique (MET) group, and passive stretching (PSG) group. All the students underwent 24 sessions of treatment in their respective groups allocated. Sit and reach test was used for measuring the hamstring length; measurements at baseline (pre-test), in the middle of the session (4th week), and at the end of the program (8th week- post-test) were taken. All the values were collected and analyzed using SPSS 24.0. One-way ANOVA was used to analyze the difference between the duration and the Tukey HSD Post Hoc test to identify the number of differences in each group with the critical value of p < 0.05. When comparing the MFR with MET, the Tukey HSD shows 1.18 with p<0.43; when comparing MFR with PSG, the Tukey HSD is 5.63 with p=0.001, and when compared MET with PSG, the Tukey HSD shows 5.23 with p=0.001. This study concludes that the Muscle energy technique and the Myofascial release therapy have shown effectiveness in improving hamstring flexibility.

Anatolij Konokh   Volodymyr Naumchuk   Andriy Konokh   Olena Konokh   and Tetyana Shafranska   

One of the leading factors that enables the successful functioning of the pharmaceutical industry is staffing. Proper training of specialists, along with the formation of their professional characteristics, should also include the development of spirituality and morality. The purpose of this study is to substantiate and experimentally test the model of formation of deontological culture of future pharmacists in higher education institutions. The level of formation of deontological culture was determined by a set of methods using an integrative indicator. A total of 180 students and 26 teachers from medical colleges and 19 pharmacy staff took part in the study. At the formative stage of the pedagogical experiment, 61 applicants for higher education were involved. Our research has shown that deontological culture is associated with a system of values, professional and personal formations of the specialist, through which their moral consciousness is manifested in professional activities. The structure of the deontological culture of the pharmacist is determined by the humanistic worldview, empathy, communicative activity and personality qualities. The model of formation of deontological culture of future pharmacists includes a set of interconnected components that determine the semantic construction of this purposeful process, and its effectiveness is ensured by the implementation of organizational and methodological conditions such as organizational and pedagogical, specialized, mutually formative and cognitive and advanced. The results of the experimental test showed the effectiveness of the proposed model and the corresponding organizational and methodological conditions.

Yun-Jeong Kim   

GGI is an indicator of the gender gap in each country, and GGI values closer to 1 indicate more gender equality. Korea's Gender Gap Index (GGI) as of 2020 is 0.672, thus Korea can be seen to have a high gender gap. Gender sensitivity refers to one's sensitivity to detecting sexist elements in daily life and their understanding of gender imbalance. Unlike GGI, it has the advantage of being able to measure an individual's gender equality consciousness. The purpose of this study was to investigate whether the interaction between gender and rank affects gender sensitivity by targeting public officials and public institution employees who play an important role in the implementation of laws and policies related to gender sensitivity. A survey was conducted with 500 people in May 2021 by targeting Korean public officials and public institution employees. Allocation sampling was performed by dividing gender and rank into four groups. After excluding questionnaires with many non-responses, 480 copies were ultimately used for analysis. First, overall gender sensitivity, misogyny susceptibility, hostile sexism susceptibility, and passive sexism susceptibility were all higher in females than males as well as higher in team members than team managers or higher. Second, among the gender sensitivity sub-factors, there were no significant differences in gender or rank in sexual violence susceptibility. Third, the interaction between gender and rank had a significant effect on overall gender sensitivity, misogyny susceptibility, passive sexism susceptibility, and hostile sexism susceptibility. Therefore, the result of the study shows that an important task for the future development of Korea's gender sensitivity is not simply the issue of men and women, but also the need to explore ethical relationships with others.

Rihab Ahmad Banisaeed   Karimah Suleiman Aljedayah   Haneen Ahmad Al Qudah   Elham Mahmoud Rababa   and Mohammad Omar AL-Momani   

Learned disability is the state of passivity and surrender that appears among abused women who believe that they are unable to control the conditions of their environment. This learned disability affects aspects of a woman's life, her thoughts, emotions, and behaviors. The phenomenon of violence against women is considered a global phenomenon. It is not limited to a particular society or social segment, but rather an issue related to human existence and the relationship between men and women. Its severity varies from one society to another, being connected with the progress of awareness of the women's important role in building society. Women are a key partner for men in the comprehensive development process in any society. Therefore, this study aimed to identify the level of learned disability in abused women. The study used the descriptive method as the method of correlational studies in the light of the study variables and its objectives. It is the most appropriate method for studying the correlational relations between the variables, and describing and analyzing this phenomenon. The sample of the study was deliberately chosen which was 100 women between the age of 18-50 years. The study also developed a learned disability scale that complies with the nature of the study and its variables. The results indicated that the level of learned disability of abused women, in Jordan, came to the average mean at an average level. This result comes from the abused woman's belief or realization that she is unable to repel violence and defend herself. This belief often occurs as a result of repeated attempts and experiences in which she failed to change situations or control her life or fate. Here she may indirectly learn not to control situations and lose control of the situation, making her feel low in self-esteem due to the state of disability she feels. Besides, the feeling of disability may extend to despair and the expectation of failure in the future. Therefore, it makes her lose the motivation that motivates her to confront violence and deal with the abuser, as she has already condemned herself to failure. Also, there were no differences in all dimensions at the level of (a=0.05) in the level of learning disability among abused women following the age, social situation, and educational level variables. This result may be natural due to the similarity of the nature of the social environments and conditions experienced by abused women in Jordan.

Valanchaya Ketbumroong   Witchaya Phetliap   Jiraporn Prathumyo   Wararat Sangwalee   and Sutthipong Wasusophaphon   

The quality of life improvement of people and communities with sustainable development, is important. This research aims to study happiness, stress and life quality levels, to study factors related to the quality of life of the people in the Lam Ta Khong Wind Turbine Project area, Khao Yai Thiang Community, Sikhio District, Nakhon Ratchasima Province, Thailand. This study is survey research. The samples were 353 people determined by using CDC's Epi Info program in Survey Confidence Level = 95%. Data were analyzed by using a packaged computer program SPSS (Version 25). The statistics used in the research were frequency, percentage, and Spearman's correlation coefficients. The instruments used were the World Health Organization Quality of Life (WHOQOL), Thai happiness indicators, and stress assessment of the Department of Mental Health. Data were analyzed by descriptive statistics and Spearman correlation coefficient statistics. The results of the study found that most of the people in the area Project were less happy than the general population of 51.8%, moderate stress level of 71.1%, and overall life quality at a moderate level of 68.3%. The factors related to the quality of life of the people in the project area were age, educational status, religion, occupation, life income, congenital disease, happiness, stress from seeing and hearing noise from the wind turbine, physical and mental life quality, social and environmental relations statistically significant (P < 0.01,0.05). In conclusion, the overall quality of life of the people in the area was low to moderate, but it is better from the development of occupation and income in the community. There must be plans, monitoring measures and surveillance of environmental quality and health, including social development, creating jobs and incomes for continuously and in parallel with the development of the project. This will result in overall sustainable better quality of life for the people.

Akara Essona Matatom   Tchalla Abalo Agballa Mébiny-Essoh   N'djao Akawulu   Assane Hamadi   and Tchamdja Toï   

The aim of antiretroviral treatment (ART) is to achieve viral load suppression in every Human Immunodeficiency Virus (HIV) infected person. In low- and middle-income countries like Togo, the disparity in accessibility to ART facilities happens to be one of the most causes of lack in follow-up of infected patients, exposing them to ART failure. This study aims at describing the epidemiological profile of ART outcome and its associated factors in a context of low accessibility to viral load testing facilities in Haho health district in Togo. A cross sectional descriptive and analytical study using a questionnaire filled by reviewing patient's files, was conducted from January to December 2019. The study included all the HIV-positive patients that came for their routine check-up and have been assessed for viral load and have their laboratory results out during this period. The results showed a prevalence of 28.5% of virological failure among patients under ART in Haho health district. The independent associated factors found were not living in couple (AOR=3.4; CI=[1.6-7.3]; p=0.002), not being adherent to ART (AOR=2.8; CI= [1.2-6.4]; p=0.015), being under ART for four years and less (AOR=2.4; CI= [1.1-5.3]; p=0.037) and having 50 years and less (AOR=6.4; CI=[1.4-30.2]; p=0.019). Healthcare practitioners implicated in the follow-up of HIV infected patients under treatment need to develop new strategies like reinforcing adherence to ART through communication, to improve outcome at an early stage.

Amansisa Embabo   Worku Jimma   and Chala Diriba   

The topic of drug interactions has received great attention worldwide recently. If a drug is not administered in appropriate quantity with an appropriate combination of the drug with drug or other substances, the result will be a high risk of dangerous interactions which lead to potentially harmful side effects which are ranging from treatment failure, economic degradation, and death due to lack of drug information and maladministration of drugs among health professionals. Thus, this study was initiated with the main aim to develop a self-learning knowledge-based system to mitigate the impact of drug interactions. To develop this system, design science methodology with the integration of knowledge engineering method was used; and semi-structured interview, document analysis to acquire knowledge; questionnaire to grasp users' feedback, and purposive sampling technique to select domain experts were used. The acquired knowledge was then represented using a production rule and modelled using a decision tree. The system was implemented using PROLOG on SWI-PROLOG editor and evaluated using system performance and user acceptance testing. The developed system was evaluated and 96% of the users were satisfied. As well as the performance of the system was evaluated and recorded 80% accuracy, thus it can be concluded that the system achieves good performance. However, in order to make the system fully applicable in the domain area, further research work to incorporate adequate knowledge, develop online knowledge-based systems and mobile applications were recommended to enhance the accessibility of the developed system.

David Kwamena Mensah   Francis Eyiah-Bediako   and Samuel Assabil   

The performance of a Kernel density-based approach for the detection of normal physiological vital signs can be affected drastically by the smoothing parameter that controls the underlying density. As a result, its application in practical (critical) areas such as public health, clinical trials and digital therapeutics (DTx), require some modifications for accurate and intelligent decisions. In this regard, this paper introduces a compendium of novel tunable data-driven smoothing parameter statistics together with tuning schemes for detecting normal systolic blood pressure (SBP) observations from continuously monitored SBP data. The tuning is designed based on both the entire data and observation-specific levels, using statistics that are by-products of the developed detector model, thereby allowing the smoothing parameters to adapt appropriately to the dynamics of the SBP data. A real systolic blood pressure data application illustrates the utility of the proposals, with significant improvement in overall performance over its well-known counterparts, the smoothed cross-validation bandwidth selector (HSCV), normal scale bandwidth selector (Hns), and Plug-in bandwidth selector (Hpi), implemented in standard statistical packages such as R. In particular, it turns out that observational-level tuning of smoothing parameters ensure better improvement in detection performance over the entire data tuning. Though performance assessment focused on accuracy, various problem-specific detection solutions can be designed for use in some application areas such as the pharmaceutical industries. For example, solution(s) based on sensitivity and specificity can be considered for early-stage clinical trials, for which several tuning proposals are evidently up to the task.

Aniza Ismail   Saperi Sulong   and Leny Suzana Suddin   

Self-monitoring blood glucose (SMBG) practice had been recognized as one of the important components in the management of patients with T2DM. It was found that this practice was associated with improved glycemic control and decreased risk of disease complications that lead to improvement in quality of life (QOL). In the era of rising healthcare costs and the increasing prevalence of T2DM, an economic evaluation of this practice is needed. Therefore, the main purpose of this study was to measure the cost-effectiveness of SMBG practice among T2DM patients by using the decision analytical model. An economic evaluation in the form of a cost-effectiveness analysis study was conducted among hospitalized T2DM patients in a teaching hospital. Data collection was conducted using a costing checklist and case report form. The costing analysis was conducted using a decision analytical model which involved theoretical model building and testing of primary data from a prospective cross-sectional study. A total of 100 patients participated in this study. The estimated mean for the total annual patients' cost for the patient not practicing SMBG and practicing SMBG was RM 76.82 (SD + RM2.43) and RM 609.83 (SD + RM 2.66), respectively. The cost difference was statistically (t [98] = -11.1, p=<0.05). The incremental cost-effectiveness ratio (ICER) was RM 10,165.19 per quality-adjusted life year (QALY). Sensitivity analysis showed that the probability of improvement in glycemic control with SMBG practice was the key parameter in this model. Therefore, the SMBG practice in T2DM patients was found to be cost-effective and should be advocated among T2DM patients. Despite its limitation in terms of the structural uncertainty, the finding from this study would provide valuable information to policymakers in the aspect of health care financing allocation. Future research by using complex cost modeling is recommended to explore other cost determinants for SMBG practice.

Nataliia Kasianova   Vasyl Matviyiv   Maksym Zabashtanskyi   Maksym Dubyna   Andrii Rogovyi   and Oksana Lashuk   

In the research, modern models of the health care financing are studied, and features and drivers of their digitalization are determined. The state funding system is based on budget guarantees for medical care and institutional regulation. The private market financing model operates under the conditions of the market of medical services and insurance, private financing and regulation of business processes. The socially-oriented model of the health care financing combines compulsory health insurance with a state guarantee of the level of medical services. The aim of the study is to substantiate the directions of improving the system of financial support for digital development of health care. The author proposes to use digititalization drivers for each model, which will optimize information and financial flows. In accordance with the sequence of implementation of the medical reform in the domestic health care system, the following changes have been introduced: funding is implemented on the principle of "money follows the patient"; electronic systems for communication and information analysis were formed; new regulatory institutions were created for the distribution of financial flows and the implementation of the public policy; there was a reform of primary medicine; new systems of distribution and financing of medical devices, control over their circulation have been formed. Also, the achievements of the medical reform include a large-scale campaign to declare patients and assign them to primary care physicians, concluding agreements with privately owned medical institutions, which allows liberalizing the medical services market. Research trends in the health care financing reflect the growing volume of targeted disbursement of funds in accordance with the volume of declaration and provision of medical services. During the period of the health care reform in Ukraine, unified digital platforms and technologies for communication between state fund managers and medical institutions, and the latter with doctors and patients, have already been introduced.

El Ghouddany Safouane   Bour Abdellatif   Yamni Khalid   Mouri Misk   Boudraine Mehdi   and Khal Layoun Soad   

Introduction: Obesity is defined as an excess of body fat resulting in a high cardiovascular risk. Its pandemic development spares no country. This study aims to analyze the trend of nutritional status (obesity and overweight) depending on gender and age in Kénitra region, the Northwest of Morocco, from 10 December 2020 to 25 January 2021. Methods: This work focused on a sample of 100 subjects over the age of 18. The obesity assessment was based on Body Mass Index (BMI), the weight and height measurements taken according to criteria recommended by the World Health Organization (WHO). Results: The studied parameter is the body mass index (BMI) that revealed to be higher in men than women with 25.94 kg/m² and 23.77 kg/m², respectively. In addition, the age groups of 50-60 years and 40-50 years represent a maximum BMI (body mass index) respectively with 27.93 kg/m² and 27.23 kg/m². Conclusion: The results of our study show that obesity affects men more than women and specifically the age groups between 40 and 60 years, which requires an adequate strategy to fight obesity in this sample population.

Ali Mofleh Alshahrani   Fatimah Alshelawi   Nawal Alrobaie   Taghreed Alotaibi   Bashayer Althobaiti   Maram Althobaiti   Mona Yaser Alsheikh   Ahmed Ibrahim Fathelrahman   and Ahmed M Ashour   

Background: Cosmetics and Personal care products are substances used to improve human appearance. Community pharmacists play essential roles in dispensing and counseling. Objective: The study aimed to compare the attitudes and practices of community pharmacists in the Southern and Eastern regions of Saudi Arabia regarding personal care products services. Method: A cross-sectional study was conducted between September 2019 and March 2020. Community pharmacists from the Southern and Eastern regions of Saudi Arabia responded to an online survey. Results: Two hundred and two community pharmacists from the Southern and one hundred and six from the Eastern regions have completed the questionnaire. Most of the respondents in both areas were males (96% & 99%, respectively). Most of them were aged between 23 and 35 years old (91% & 83%, respectively). The number of non-Saudi pharmacists was slightly higher in the Eastern region (97%) is compared with the Southern part (91%). The responses of pharmacists from the two areas were comparable. More than (40%) of participating pharmacists in both regions have six to ten years of experience. More than (98%) communicate directly with customers. More than half of pharmacists serve approximately one hundred customers daily (51.89 in eastern and 57.92 in southern). Pharmacists from Eastern regions spend more time counseling than their counterparts. They were more likely to agree that their customers were willing to listen to counseling about their products. However, a higher proportion of them reported workload as a barrier for counseling (34.9% versus 23.76%). Most pharmacists from both regions strongly agree that they must keep developing their communication skills with customers/patients. Conclusion: Community pharmacists in both Eastern and Southern regions have comparable good practices about personal care products. It is essential to continue the development of both educational and communication methods.

Jonathan Tsetimi   Marcus Ifeanyi Ossaiugbo   and Augustine Atonuje   

The optimal control of pneumonia disease is very important in the management of the disease within a given population. Pneumonia is one of the leading causes of death worldwide, especially among children below 5 years old, the elderly above 65 years old and people with a weaker immune system. In this research work, the basic mathematical properties of a deterministic SEIR model for pneumonia disease were first presented. These properties include the invariant region, disease free equilibrium, basic reproduction number and the disease endemic equilibrium. The optimal control problem, which is the main focus of this work, was ushered in and thoroughly dealt with using the Pontryagin's Maximum Principle. The control measures include the prevention effort of the susceptible class, the vaccination intervention strategy and the treatment intervention strategy. The Hamiltonian of the control problem was defined and used together with the adjoint equations to obtain the optimality system and the optimal values of the controls. Numerical simulations were carried out using various combinations of these control measures (prevention, vaccination and treatment). The results were presented and compared to determine the best strategy that should be taken in order to eliminate the disease from a given population within a desired period of time. It is observed that the combination with all three controls gives the best intervention strategy for the elimination of the disease.

Diajeng Tyas Pinru Phytanza   Erick Burhaein   Carla Cristina Vieira Lourenço   Budiman   Jamaludin Yusuf   Angkit Kinasih   Maharani Fatima Gandasari   and Bangkit Seandi Taroreh   

This study aims to find out the nutritional status of students based on height and weight. Study participants were randomly selected from two countries: Indonesia and Portugal. This study is a quantitative descriptive study using survey methods, instruments for the calculation of weight index by height in children aged 6-17 years. The study used measurements of weight and height. Data collection techniques using anthropometric measurements that include measurements of weight and height are then calculated based on data analysis techniques using quantitative descriptive with percentages. The results of the above study and discussion concluded that the nutritional status of children aged 6-17 years during the COVID-19 pandemic was reviewed and the weight index by height was the majority in the normal category. This study has implications for 1) Helping children understand the importance of nutritional status for development and growth, especially for those who do not fall into the normal category and; 2) Children are expected to maximize the role of physical activity to improve the physical freshness and nutritional status of students. Then, this study contributes to future research that is the need to include certain free variables to be known the dominant variables in affecting nutritional status in children.

Mohammed Moniruzzaman Bhuiyan   

Early onset of menopause results in the loss of fertility of women and creates many health complications. The aim of the study is to explore the determinants of the early onset of menopause of the women living in Chittagong district of Bangladesh. A total of 160 postmenopausal women over the age of 30 years participated in our cross-sectional study as respondents. In the study, the mean age of onset of menopause was observed to be 45.70 years. Chi-square test of association and binary logistic regression analyses were performed to reveal the predictors of early menopause. Crude odds ratio and adjusted odds ratio are obtained to find the likelihood of onset of menopause and to compare each category of the variable with the reference category. The result shows that age at marriage, use of contraceptives, regularity of period, type of food preferred, number of children in the family, and level of education of the respondents are significantly associated when crude odds ratios are obtained. On the other hand, adjusted odds ratio shows that use of contraceptives, regularity of period, level of education, and type of food preferred are significantly associated with early onset of menopause of the women of Chittagong district in Bangladesh.

Hanny L. Zahroh   Yenni Zuhairini   Siska Wiramihardja   and Amillia Siddiq   

Background. Gestational weight gain (GWG) is an important factor of the well-being of both mother and fetus. Latest recommendation by Institute of Medicine (IOM) was issued in 2009 based on women population in United States, and is classified based on World Health Organization (WHO) body mass index (BMI) cutoffs. Recommendation for Asian population is not currently available. This review aims to review the evidence of the application of said guidelines in Asian population. Method. Articles were searched using Google Scholar and PubMed. Articles published in 2016 or above, with single pregnancies and unlimited to pre-pregnancy BMI categories were selected. Of 1,239 potential articles, 29 were chosen for full-text screening and 9 were included in this review. Result. Mixed trends were found when assessing adequacy of GWG in relation to pre-pregnancy BMI. Article analyzing optimal GWG showed a higher and wider range compared to IOM. Inadequate GWG is associated with a higher risk of small for gestational age (SGA) while excessive GWG is associated with large for gestational age (LGA). Significant differences were found when different categorizations of BMI are used with IOM guidelines. Conclusion. Asian women rarely gain adequate weight by IOM standard. This might lead to increased risk of adverse pregnancy outcomes, such as SGA and LGA. Further researches are needed to study appropriate optimal GWG for Asian population, and/or to modify IOM guidelines to be applied better in Asian population.

Yetty Machrina   Ambrosius Purba   and Dwi Rita Anggraini   

Background: Previous study had found that adherence of patient Diabetes type-2 in moderate to vigorous continuous exercise was poor. Meanwhile regularly exercise needs to control fasting plasma glucose in T2DM. Exercise moderate interval (EMI) shows a significant effect to reduce insulin resistance in metabolic syndrome patients. But, studies to find the effect of EMI or EMC to muscle insulin receptor distribution are still limited. So, the purpose of this study is to compare the effects of EMI vs EMC in increasing insulin receptors and reducing insulin resistance in T2DM rat models. Methods: An experimental study was conducted in T2DM rat models. According to the treatments, rats were randomly assigned into the following 3 groups: sedentary group (SG), exercise moderate continuous (EMC) and exercise moderate interval (EMI). Each training session was performed on treadmill for eight weeks, three times weekly. Insulin receptor was assessed by immunohistochemistry. Meanwhile, insulin resistance was determined by Homeostatic Model Assessment for Insulin (HOMA-IR) score measured before and after completing the training session. Results: This study found that the insulin receptors in EMI = 184% and EMC= 158%. Both insulin receptors in the treatment groups had a significant difference to the sedentary group (p=0.002), but there was no significant difference in insulin receptors between EMI and EMC group (p=0.222). HOMA-IR in EMI group was 16.6±4.0 significantly different with HOMA-IR in EMC group such as 43.3±8.6 (p=0.000). There was a negative correlation between insulin receptor and insulin resistance (p=0.047, r =-0.520). Conclusion: Both exercise moderate interval and exercise moderate continuous could increase insulin receptors on skeletal muscle, but exercise moderate interval showed better improve insulin sensitivity after eight weeks' exercise. We suggested exercise moderate interval as an alternative exercise for Type 2 Diabetes Mellitus.

Ju Hyung Park   

This study is a comparative study examining the effects of conversation-based reminiscence therapy combined with gymnastics and occupation based reminiscence therapy on cognitive function, depression, and quality of life of non-demented elderly in the community. A total of 53 normal elderly subjects in the community were divided into an experimental group (n=27) and a control group (n=26). The experimental group received occupation-based reminiscence therapy for 1 hour once a week for a total of 8 weeks, and the control group received 20 minutes of gymnastic exercise and 40 minutes of general conversation-oriented reminiscence therapy. Pre- and post-intervention evaluations of the subjects were performed using the Montreal Cognitive Assessment Korean Version (MoCA-K), a Short Form of the Geriatric depression Scale-Korean Version (SGDS-K), and the Geriatric Quality of Life (GQOL). After the intervention, significant improvements in MoCA-K, SGDS-K, and GQOL were observed in the experimental group (p<0.05), and significant differences were also observed in comparison with the control group (p<0.05). The results of this study suggest that occupation-based reminiscence therapy can be more effective in cognitive function, depression, and quality of life of the non-demented elderly in the community compared to conversation-based reminiscence therapy combined with gymnastics.

Kaushik Chanda   Sandip Roy   Haraprasad Mondal   and Rajesh Bose   

At present the pandemic situation caused by Corona virus syndrome 2019 which is abbreviated as COVID-19, has made the lifespan of men at stake. Not only has it affected the economic condition and created health hazards of the peoples all over the world but also it tells upon their mental state. It is surprising but very difficult to assess the frequency. There are various reasons behind this mental disorder. They are recession from work, confined in house strategy, getting afraid of corona virus, and some more. In this paper, we focus on the use of Natural Language Processing (NLP) procedure to analyze tweets with regard to mental state. Training of significant prototypes has been provided to categorize all tweets into the emotions mentioned below: covid19, covid, COVID-19, covid 19, flu, virus, hantavirus, fever, cough, social distance, lockdown, pandemic, epidemic. We build the EmoCT (Emotion-Covid19-Tweet) dataset to train physically, tagging 1,500 English tweets. In addition to it, two procedures are suggested and distinguished to explore the causes which are creating melancholy and disquiet.

Aldara Henderson   and Huaibo Xin   

The purpose of this study is to examine U.S. cancer patients' preparedness for a disease outbreak like COVID-19 and understand cancer patients' perceived resilience, and how their preparedness has affected their resilience. It's a cross-sectional study with a national sample of 317 participants. Participants completed an anonymous online survey that consisted of 42 questions on a 5-point Likert scale, addressing different levels of preparedness during a pandemic, and overall individual resilience and COVID-19 resilience. Data were analyzed quantitatively. Results suggested 72% of the participants somewhat/strongly agreed, individually, they were prepared to respond to a health pandemic. Approximately, 84% of the participants felt their households had the knowledge to respond to a pandemic. Participants felt their oncologists had enough training (71%) but not enough knowledge to respond to a pandemic (58%). Only 43% felt healthcare institutions had enough supplies for a health pandemic. Participants somewhat/strongly agreed they were able to recognize thoughts and situations could make them feel stressed or upset about COVID-19 (85%) and practice their coping skills effectively. There were significant correlations between different levels of preparedness and resilience. Public health preparedness interventions/guidelines tailored towards cancer patients are needed to increase their resilience to a global pandemic.

Lina Cardenas-Pineda   Editt Orellana-Jesus   Tula Guerra-Olivares   Doris Quispe   Jenny Mendoza   Antonio Picoy-Gonzales   and Alicia Alva Mantari   

This quantitative exploratory study analyzes the hemodynamic status of pregnant women attended at the first level of medical care in Lircay - Huancavelica, 2018. Methodology: observational, retrospective, and longitudinal research with a sample of 85 pregnant women, document review was used as a technique, descriptive statistics were used. Results: pregnant women were young women aged 20 to 30 years (79%) and adolescents aged 16 to 19 years (31,76%), 50,59% were first-time mothers and 25,88% were multiparous; 85,88% received full supplementation with ferrous sulfate 60mg, plus 400 ug of folic acid. The hematocrit decreased from 43,52% ± 4,84 in the first trimester to 42,45% ± 4,25 in the second trimester, decreasing to 42,26% ± 3,57 in the third trimester; 50% of the pregnant women had a hematocrit lower than 43,80% in the first trimester, 42,90% in the second trimester and 39,90% in the third trimester. The corrected hemoglobin found was 12,33 g/dL ± 1,10 in the first trimester, which dropped to 11,95 g/dL ± 1,02 in the second and 11,77 g/dL ± 1,08 in the third trimester; 50% of the pregnant women had hemoglobin below 12,30 g/dL in the first trimester, 12,00 g/dL in the second and third trimester. Regarding the total, the 3,53% presented mild anemia in the first trimester, rising to 9,41% in the second trimester and up to 15,29% in the third trimester, moderate anemia was minimal 1,18%. Conclusions: the hemodynamics of the pregnant women have suffered decreases in hematocrit and hemoglobin; anemia increased from the first trimester to the third, the hemoglobin reached in the third trimester is a risk factor for puerperal anemia.

Iis Aisyah  Ayu Prameswati Kusuma Astuti  Tedi Supriyadi  Enjang Yusup Ali  and Dini Saraswati Handayani  

The caring characteristics have been considered a fundamental element of nursing as it has been studied in a variety of patient care and educational contexts for many years. To teach and cultivate caring as a character value in nurse candidates, a character education model is required. To answer this issue, this study aims at developing caring characteristics learning model for nurse candidates through a basic human needs class. This study employs a 4D design reflecting its stages: defining, designing, developing, and disseminating by involving 168 participants consisting of 4 lecturers, 41 nurses, 3 experts, and 120 nurse candidates from one of universities in Sumedang, West Java. 18 characters were recognized as significant values for a nurse, and the I-CARE paradigm was used to include these values in the learning process. It was found that the I-CARE learning paradigm is efficient in instilling caring characteristics in nurse candidates. This study adds to the body of knowledge on how to develop human resources in the health care sector.

EL Ghouddany Safouane  Yamni Khalid  Mouri Misk  Aderdour Tarik  El Arabi Fatine  Khal Layoun Soad  and Bour Abdellatif  

Introduction: The objective of this study is to study the correlation between obesity, physical activity and sedentary behavior in a sample of the population in Kénitra, Morocco. Materials and methods: The obesity assessment was based on Body Mass Index (BMI), which pertains to sedentary time and physical activity. A questionnaire was completed by participants with respect to covid-19 precautions. The level of physical activity was evaluated with the International Physical Activity Questionnaire (IPAQ) short version. Results: Our study included 100 subjects (50 women and 50 men), the average age was 33.83±14.72 years. Our sample showed that 32 percent of individuals who are pre-obese and 9 percent who are obese. The IPAQ score showed that 41% of individuals had high physical activity and 37% low physical activity and 22% moderate physical activity with an insignificant relationship between physical activity and BMI (p=0.664). Our study showed that 50% of individuals had sedentary activity times below 20 hours/week, and 28% had sedentary activity times between 20 and 30 hours/week, and 18% had sedentary activity times between 30 and 40 hours/week, and 4% had a significant relationship between sedentary time and BMI (p=0.017). Conclusion: Our results have shown that there are inconveniences of containment on the health of individuals, requiring the intervention of specialists to find suitable solutions.

Devi K   Harshini S   and Mageswari R   

Smartphones are mobile phones with advanced features over and above those of basic phones. Smart phone addiction has been an emerging problem in modern era. But the existing knowledge about excessive use of smartphone still remains insufficient. The objective was to determine the prevalence of smartphone addiction, its predictors and details on smartphone use among medical college students in Puducherry, South India . A cross sectional study involved 253 second and third year medical college students in a Government medical college in Puducherry, South India was carried out. Data were collected using a validated, pretested, structured, and self-administered questionnaire. Appropriate statistical methods such as descriptive statistics, mean and standard deviation were performed for demographic variables. Logistic regression analysis was done to determine demographic and health-related predictors of smartphone addiction. In this present study, the prevalence of smartphone addiction among medical students was 54.2%. Addiction to smart phone had influenced various effects on health such as physical, psychological and social effects. Independent factors such as usage of smart phone for more than two hours, avoiding daily tasks and duties, not being punctual in day-to-day activities were significantly associated with smart phone addiction. To conclude Smart phone as a self-learning tool is essential. But overuse results in addiction. Increased awareness and standardized measures for identification of smart phone addiction and appropriate intervention for those in need of help might alleviate this problem

Ahmed M Ashour   

Background: In the past few years, knowledge of COVID-19, its management, patients' care, and its learning curve have been challenging for the professionals in charge of managing the pandemic. Since community pharmacists were the important health care providers who remained the first point of contact during the pandemic, they played a pivotal role in providing counselling services, care, support, and infection control to the public. COVID-19 vaccine remained an important public health measure in curbing COVID-19. Despite its effectiveness in preventing the spread of the disease, a large proportion of the population is unwilling to be vaccinated owing to the lack of adequate knowledge regarding its effectiveness. Purpose: The present study aimed to investigate the perception, attitude, and knowledge of community pharmacists regarding the COVID-19 vaccine. Methods: A cross-sectional survey was conducted using questionnaires to collect data from the community pharmacists in Saudi Arabia. The questionnaire is comprised of four sections: socio-demographic, knowledge, attitude, and practices. Results: Most of the respondents were young adults between the ages of 23 and 34 years (73.0%). The study had more male participants (89.4%) than female participants (10.6%). Most of the male respondents were non-Saudi nationals (77.9%). The overall percentage of positive responses to the perception questions was 29.9%. The overall percentage of positive responses to the attitude questions was 21.2%. The overall percentage of positive responses to the knowledge questions was 57.4%. No significant difference is recorded between the respondents' intention on taking the vaccine and the age groups (χ² (9) = 7.134, p > 0.05 = 0.623). However, the remaining characteristics of the test showed significant differences. Conclusion: The findings confirmed that the level of knowledge regarding the COVID-19 vaccine amongst the community pharmacists was high enough to offer reliable advice to patients. However, less than 50% of the participants had adequate knowledge of the vaccine.

Rika Arimoto   and Hiroya Matuo   

As maternal mental health is related to postpartum depression; it is essential to reduce anxiety in pregnant women. However, little information is available on the health care effect provided by health professionals on maternal mental health. This study aimed to investigate the health care provided by health professionals during check-ups and its influence on maternal mental health in Japan. This was a cross-sectional study. Participants were 105 first-time mothers with a gestational age of 20 to 27 weeks. Data on participants' demographics, healthcare services received, participants' understanding of health care were collected, and mental health was assessed using the Edinburgh Postnatal Depression Scale, State-Trait Anxiety Inventory-Form JYZ, and Prenatal Attachment Inventory. Results reveal that women who understood their physical condition and fetal conditions were less likely to experience state anxiety than those who did not (p<.01 and p<.05, respectively). An understanding of fetal condition and growth were also associated with a significantly increased fetal attachment (p<.01 and p<.001, respectively). The understanding of "better lifestyle" in the midwife-led care group was significantly higher than that in the group that did not receive midwife-led care (p<.01). Understanding health care might be necessary for promoting fetal attachment and reducing anxiety during pregnancy. Therefore, health professionals must sufficiently explain relevant conditions to pregnant women.

Rachid Ismaili   Ahmed Nejmeddine   Hind Mimouni   Imane El Haouachim   Abderraouf Hilali   Bouchra Haddou Rahou   Rachid Bekkali   and Leila Loukili   

Background: The consequences of therapeutic interventions for cancer have a negative impact on the patient's relationship and sexuality with his spouse. Purpose: This study aimed to investigate the impact of sexual life determinants on quality of life in Moroccan survivors of breast and lung cancers two years after diagnosis. Methods: This cross-sectional study was conducted between May 1, 2019 and September 30, 2020. The sample consists of 304 breast cancer survivors and 77 lung cancer survivors. Data were collected using EORTC QLQ - C30 questionnaire and questions on the sexual life component inspired by the living conditions questionnaire. Results: The GHS/QOL of lung cancer survivors as well as the physical, role, and emotional functional scales are severely impaired compared to those of breast cancer survivors. In contrast, social and cognitive functions were good for both types of cancer. In addition, there is a significant correlation between the GHS/QOL of survivors of both cancers and the effect of health status on the couple's relationship and the negative effect of the disease on the sexual relationship. Whereas, the GHS/QOL of breast cancer participants also correlated with spouse change. The effect of health status on couple's relationship (p=0.000) and negative effect of disease on sexual relationship (p=0.000) were significant predictors of GHS/QoL (QLQ-C30) in breast cancer survivors. Whereas, the negative effect of disease on sexual relationship (p=0.020) was a significant predictor of GHS/QoL (QLQ-C30) in lung cancer survivors. Conclusion: The data suggest that sexual health education should be integrated into Medical and nursing curricula. In addition, health professionals should include an assessment of the effects of medical and surgical treatments on the sexuality of breast and lung cancer survivors.

Ali. A. A Rawabdeh   

Nosocomial infections (NIs) are hospital-acquired infections that occur after 48 hours of admission or discharge, which have ended up a major issue to the hospital industry. The purpose of this study was to examine the economic burden of Nosocomial infection at PBH. It was a retrospective study for the purpose of providing structured opportunities for PBH to reduce the economic burden, prevention, and management of NIs. To measure the cost of NI indorsed, a random sample of 700 patient records was considered in 2019 and retrospectively studied, coordinated with the essential highlights. The cost was estimated and calculated by using a step-down method, and the unit cost was measured in terms of additional hospitalization days. Among 22772 admissions to PBH in 2019, the distribution of 137 conceivable nosocomial contamination cases was found. The internal medicine and surgical wards were seen as the main host of NI in the hospital (medical ward 59.12% and 22.63% in the surgical ward). Escherichia coli was ranked the most prevalent infectious pathogen and discovered in 31 (22.63%); MRSA was found the least dominant (4.38%) of the infected patients. The evidence demonstrates obviously the economic burden of Jordanian Dinar JD10232.53 in PBH in Year 2019, the additional cost of NI in PBH annual budgeted financial requirements, which have to be considered avoidable cost in case of compelling infection control program worked successfully. Compliance with local and global standards for sanitization and sterilization to prevent the spread of hospital-acquired infections need to be investigated carefully.

Jayaprakash Jayavelu   Jasobanta Sethi   Sahil kohli   and Tariq Matin   

Recovery of upper extremity after stroke is always challenging because of various factors. The purpose of this study was to find out the effect of tongue stimulation on upper extremity recovery in stroke patients. Fifty-four stroke patients with informed consent were screened and included in the study after they met the inclusion and exclusion criteria. They were randomly divided into experimental (N=26) and control group (N=28) using computerized randomization method followed by comprehensive assessment. Randomization was done by independent assessor. All patients were administered one hour of stroke rehabilitation program in both groups. In experimental group, periglossal electrical stimulation was done for 15 minutes along with upper limb retraining. Patients' functional scores were assessed in both groups at the time of enrolment into the study, which includes modified Rankin Scale and Barthel index, whereas the motor functions were assessed using Fugl-Meyer Assessment Scale. They were reassessed after 4 weeks and 8 weeks of the study. Data analysis was done using SAS software. Test of normality was done to find out the normality of the data. Within group analysis was done using paired t test or Wilcoxin Signed Rank test and between group analysis was done using independent t test or Mann-Whitney U test depending on the normality of the data. Twenty-five stroke patients in control group and twenty-three stroke patients in experimental group completed the study. There was significant improvement in modified Rankin Scale, Barthel index and Fugl-Meyer Scale in both the groups (P<0.05). Between group analysis revealed that there is significant improvement in modified Rankin Scale, Barthel index, Fugl-Meyer upper extremity and lower extremity scale in experimental group compared to control group (P<0.05). Tongue stimulation was found to be effective in improving the upper limb functions in stroke patients. This is also cost effective and easy to administer for the benefit of the patients.

Gayatree Nayak   Sanat Kumar Bhuyan   Ruchi Bhuyan   Akankshya Sahu   Ananya Kuanar   and Dattatreya Kar   

Marine algae have gained substantial attention from various scientific and commercial fields. The reason behind its importance is due to the rich source of bioactive compounds like proteins, carbohydrates, lipids, and other pigments. Marine algae-derived carrageenans polysaccharides are used in food, medicine, cosmetic items, gelling, emulsifying, and stabilizing agents. The carrageenan has also photoprotective activity as it protects against the UVB-induced apoptosis in HaCaT cells and inhibits skin aging and cancers. Marine algae-derived macromolecules including polysaccharides and proteins have anticoagulant and photoprotective activities. The marine algae used in health sector is not limited to a food supplement only, rather, the derivatives from it are increasingly used in the biomedical application too. Different biological activities of marine algae as immunomodulatory, anti-tumor, anti-viral, anti-cancer, anti-aging, anti-oxidant, and anti-diabetic are discussed in this review. This mini-review is comprehensively based on the bioactivities materials from brown, red, green, and blue-green algae used in various biomedical fields.

Prosper Tafadzwa Denhere   Munyaradzi Zhou   and Ephias Ruhode   

Contemporary health information systems have moved to become electronically supported. This has presented the need for these eHealth systems to exist as an ecosystem that allows for healthcare service collaboration amongst service practitioners. In this research paper, the aim is to form an understanding of the healthcare practitioner readiness for Health Information Systems (HIS) interoperability in Zimbabwe. Some qualitative interview and quantitative 5 point Likert scale questionnaires were used to gather the data concurrently before the data were analysed both qualitatively and quantitatively. The HIS interoperability readiness survey was captured from responses made by 71 practitioners. The assessment was aimed at assessing factors which were healthcare practitioner readiness, technological infrastructure ownership readiness, policy readiness, core readiness and financial readiness. The findings presented indicate that healthcare practitioners and patients are ready to exist and function as part of an interoperable HIS although some enabling factors were identified in terms of policies needed to support its existence and functionality. Recommendations towards interoperability of HISs achievement were suggested.

Massimo Cavacece   

Purpose This paper analyses the predisposing factors that affect the time response of the hand–arm system. Predisposing factors are the method of tool use, tool type, source of power, the mass of tool, workpiece held in hand, dimensions of the handle, grip force and push force, and dynamic and thermal properties of handgrips. Methods This research considers the variability of the time response of the hand–arm system with respect to predisposing factors evaluated in 5 working conditions. The mathematical model consists of a distributed parameter representation in the form of a beam characterized by a continuous distribution of the mass, damping, and elasticity of the physical properties of the human and–arm system. The mathematical model considers the action of the extensor muscles of the elbow. The experimental investigations evaluate the forced vibrations of the human hand–arm system in work conditions. Novelty in research The analysis of predisposing factors on the human hand–arm response with flexed and extended elbow positions of workers subject to different sources of vibrations represents the novelty in this research. Operators assume different human hand–arm postures when using manual power tools. The human hand–arm with flexed and extended elbow positions are the postures of workers evaluated in this research. The research on postures of workers aims to provide an evidence base for prevention. Another important objective is to provide a better overview of the extent of the occupational burden of workers. Work-related diseases include musculoskeletal disorders. Results Posture factors of the human hand–arm system and predisposing of occupational hand–transmitted vibration exposures are considered to estimate the response of human hand–arm positions in the time domain. Conclusions Mathematical model and experimental investigations provide a better evaluation of health risks and muscle actions associated with exposure to hand–transmitted vibration from power tools in work conditions.

Yun-Jeong Kim   

Divorce in Korean society is a phenomenon that occurs in the early years of marriage or in old age, and the increase in divorce in the old age has been a distinct phenomenon in the last 10 years. The purpose of this study was to identify the structural connection between depression, health status, and self-esteem, focusing on the difference between divorced elderly and married elderly. For this purpose, data of the 14th Korea Welfare Panel were used in this study. In this study, only divorced and married elderly people aged 65 and over were selected and used for analysis. 3,076 people were subjects (177 divorced and 2,899 married elderly). Frequency analysis, reliability analysis, correlation analysis, and t-test were performed using SPSS Win version 21.0 and SPSS MACRO No. 4 model was used to determine the mediating effect of self-esteem in the effect of depression of divorced and married elderly on their physical health. The main results are summarized. First, divorced elderly had higher depression and lower self-esteem than married elderly. However, there was no difference in physical health between divorced and married elderly. Second, the mediating role of self-esteem in the effect of depression on physical health was verified in both divorced and married elderly. In other words, it was found that the negative effect of depression on physical health was alleviated by self-esteem.

Musiana   Hamidah Rahman   Rosmila Tuharea   and Zubair Saing   

Traditional medicine (TM) is still used by some tribes in Indonesia to treat and cure a variety of diseases, including maternal and child health care. A Biang, or Woman Traditional Healer (WTH), is a woman who uses herbal plants to practice TM for the health of mothers and children. Indeed, the herbs and ingredients used are frequently undocumented, putting the sustainability of TM in jeopardy. TM practices are also practiced on Ternate Island, and no research has been conducted to date on the identification and documentation of local knowledge of WTH in the use of herbal plants. The purpose of this study was to identify the characteristics of the WTH who practice on Ternate Island, as well as to identify local knowledge of WTH and to document herbal plants used in caring for the health of mothers and children. The descriptive explanatory research method was used, and data were collected using a semi-structured questionnaire guide. Snowball sampling was used to obtain respondents, and the data were analyzed using descriptive statistics. The average age of the thirty-eight WTH respondents was fifty-three years old. They have a primary school education (92.1%), and some have attended traditional medicine training (60.5%). All WTH use herbs in traditional medicine practice (100%), and their healing skills were entirely inherited from their parents. WTH used 32 herbal plants, with postnatal care receiving the most attention. Given the significance of TM using herbal plants, more research is needed to determine the safety of these plants.

Wisit Chaveepojnkamjorn   Sureeporn Songroop   Pratana Satitvipawee   Supachai Pitikultang   and Suruchsawadee Thiengwiboonwong   

Introduction: Child stunting is one of the global public health problems and breastfeeding is one of the modifiable maternal factors protecting against child stunting. The current study aims to determine the prevalence of breastfeeding and its association with child stunting among adolescent mothers. Methods: A cross-sectional study was conducted in Phra Nakhon Si Ayutthaya province. Using multi-stage stratified sampling method, 250 participants were recruited. Data were collected using structured interview questionnaires in 6 districts from August 2016 to March 2017. Descriptive and analytic statistics were used to analyze data. Results: 16.4% of children were stunted and 22.4% were breastfed for ≥6 months. Univariable logistic regression disclosed significantly associated factors of stunting included age at delivery, educational level, family members, weight gain during pregnancy, birth weight, complete immunization, recent illness, breast feeding and complementary feeding (p-value < 0.05). After adjusting multivariable logistic regression analysis for potential confounders, babies breastfed <4 months were 1.83 times at risk compared with those breastfed ≥6 months (OR=1.83, 95%CI=0.41-8.30) but without significance. Conclusion: Efforts to reduce child stunting should include surveillance systems of stunting which should be conducted accompanied by providing perspectives on maternal and child health care, implementing health literacy regarding breastfeeding among adolescent mothers and prevention programs to reduce and prevent child stunting.

Rajan Shastri   Rakesh Mohanty   and Surjeet Sahoo   

Background: Unconscious defenses and dissociative experiences have always been related to stressful life events. A stressful life event has a role to play both in normative and pathological dissociation. These events can be desirable and undesirable and both acute and chronic events can lead to dissociative phenomena Aims: To assess the dissociative experiences and type of stressful life events and also to correlate the events with dissociative disorders. Methodology: A detailed history was obtained along with the application of Dissociative Experiences Scale (DES) and Presumptive Stressful Life Event Scale (PSLES) to know the type of dissociative experiences and the type of stressors. Their correlation was studied using SPSS-20 software. The scores of dissociative experiences and stressful life events were also calculated to find any relation between the scores and the type of dissociative presentation. Results: The majority of people diagnosed with dissociative disorders were females, although there is no gender difference in the DES scores. The mean age of presentation is 25.21±9.12 years. We found out that any subtype of patients can have any score on DES scale. The PSLES scores did not determine the type of dissociative presentation (subtype). Conclusion: Dissociative experiences are related to stressful events in last year, and it acts as a precipitating factor for people with poor coping mechanisms. The scores do not predict the subtype of dissociation.

Muhammad Fadli   Muhammad Ikhsan Syafri Amir Nasution   Dina Keumala Sari   Rina Amalia Carolina Saragih   and Dewi Masyithah Darlan   

Background: Sport is a physically demanding activity that has a positive impact on the body. Exercise, in addition to maintaining physical fitness and being useful to one's health, it may protect a person from negative things such as stress and can be utilized as a kind of leisure. However, there are still many people who do not exercise properly. It is not necessarily excellent exercise for those who have good exercise knowledge, and it is not necessarily poor exercise for people who have less exercise knowledge. Exercising also disregards a person's age; people of all ages, young and old, are allowed to participate in sports they enjoy, such as aerobic and anaerobic activities. As previously said, in addition to maintaining physical fitness and being helpful to one's health, students should exercise to relieve tension induced by lectures. However, many students are overworked and do not consider exercise to be vital because they do not have spare time to participate in sports. Students will become unfit and unable to concentrate on the lecture subject as a result of this. Purpose: This study aims to determine whether there is a correlation between knowledge and attitudes towards the habit of exercising in students of the Faculty of Medicine, Universitas Sumatera Utara. Method: The research that will be conducted is an observational analytic study with a cross-sectional study approach. The sample to be studied in this study was 260 students of the Faculty of Medicine, Universitas Sumatera Utara who met the inclusion criteria. The data used is primary data that will be obtained from questionnaires filled out online through the Line, WhatsApp, and Instagram applications. Results: Based on the data obtained using the chi-square method, then the results obtained were p = 0.202 and p = 0.706 (p <0.05). Conclusion: Based on these results, H₀ is accepted, so there is no correlation between knowledge and attitudes towards the habit of exercising in USU Medical Faculty students.

Payal Bose   Samir Kumar Bandyopadhyay   Amiya Bhaumik   and Sandeep Poddar   

Diabetes, also known as Diabetic Mellitus, is a metabolic disease that affects the body's natural blood glucose levels. It is a non-contagious illness with numerous serious health risks. The said illness is rapidly growing in India. It is a chronic disorder that happens when the human body unable to create enough insulin hormone to keep blood sugar levels under control. Several characteristics that cause diabetes were investigated in this study, and multiple machine learning techniques were used to predict whether or not an unknown substance had diabetes. PIMA diabetes detection for female patients was employed for this purpose. For prediction, six distinct classification models were applied. This research presented a comprehensive performance assessment of the multiple factors in the PIMA dataset. Based on all factors of the PIMA dataset, a full discussion was made to demonstrate how diabetes is affected. Finally, in order to forecast the best automated diabetic prediction model, a thorough analysis of many classification approaches was undertaken. It was discovered that the Support Vector Machine (SVM) model delivers the best prediction result, with a reliability of 83.5 percent. Interestingly, Random Forest (RF) Classifier produced the second-best prediction result, with a reliability of 82.76 percent. The study's findings demonstrate that machine learning models produce efficient solutions. The accuracy of the two best machine learning models is 82-83 percent, which can be used for subsequent improvement of the autonomous forecasting tool. The accuracy of these techniques can be improved further by integrating diverse variables for prediction and classification.

Tapaswini Mishra   Manika Bose   Prajyoti Behera   Dipti Mohapatra   Arati Meher   Priyambada Panda   and Mitu Mohanty   

Background: With the advancement in technology and use of multiple electronic devices and decreasing duration of sleep, adolescents are more prone to obesity, i.e., increased BMI (body mass index). Objectives: The objectives of the study were to determine the association between sleep duration, use of electronic devices, and obesity in medical students. Methods: Medical students between the age groups 17-22 years were recruited. The study design was cross-sectional. The main study variables were the type and duration of use of various electronic devices during daytime and bedtime. The independent variable used in the study was the subjects' self-reported average number of hours of sleep obtained per night based on the questionnaire. To calculate the BMI, height and weight were obtained. Results: There is a significant association between short sleep duration and prolonged use of electronic devices. (p<0.01) Those who engaged in electronic devices for a longer period had significantly higher BMI (obesity) p < 0.001. Maximum use of mobile phones was found during bedtime. The males were using more mobile phones for video gaming than female medical students. Conclusions: Reducing bedtime use of electronic devices and improving sleep hygiene in adolescents could decrease the prevalence of obesity in adolescents.

Polina Mavrenkova   Natalia Pankova   Marina Lebedeva   and Mikhail Karganov   

Under conditions of inclusive education, students with health limitations, in particular, children with neurological and mental disorders, have the opportunity to study at a general school. The goal of this study was to assess the possibility of using analysis of heart rate variability (HRV) as a relatively simple tool for evaluation of the adaptive resources in students with mental disorders and for early detection of dysfunctions in the neuroregulatory mechanisms in healthy students. We compared the spectral parameters of HRV and peripheral blood pressure in healthy adolescents (n = 70) and adolescents with neuropsychiatric disorders (n = 58). Electrocardiogram was recorded for 2 minutes in a sitting posture, wearing a spirometric mask with voluntary breathing. Adolescents with mental disorders demonstrated a high total power of the HRV spectrum, an increased high-frequency power (0.15–0.4 Hz), a decreased low frequency / high-frequency ratio, and reduced total power and low frequency spectral power of systolic blood pressure variability. The revealed differences were observed mainly in males. The presented data demonstrate an increased vagal tone in adolescents with mental disabilities. Our findings support the idea that HRV can be used in schools to identify risk groups of vulnerability to mental disorders.

Tadang Minu   Anil Mili   Dipika Basumatary   Vivek Kumar Singh   Poli Borah   and Hemantajit Gogoi   

Objective: Recently, Indian has adopted many policies to promote health, wellness and sports culture in the country. Though these policies have been implemented nationally, limited research is available about the health-related fitness status of children in the Indian Himalayan region. Therefore, the present study was conducted to survey the health-related fitness status of school-going girls in the Indian Himalayan region. Materials and methods: A total of 563 school-going girls had participated in the study, 166 were from the age group of 10-12 years, 164 from the age group of 13-15 years and 233 from the age group of 16-18 years. Administration manual of Khelo India Fitness Assessment in Schools-version 2.0 was followed for data collection for five health-related physical fitness components. Simple descriptive statistics and One-Way ANOVA test were employed as statistical tools for the study. Results: The study showed a moderate level of health-related fitness among school-going girls in the Indian Himalayan region. The height and weight of the participants were found at lower 50 percentiles as per the growth chart of IAP. One-Way ANOVA test and pairwise comparison revealed the presence of variance in the fitness components between different age groups. Conclusion: It was suggested to involve parents and elders to change the sedentary habits of the children. Proper execution of sports infrastructure development programmes can further help in promoting health, wellness and sports culture in the region.

Mausum Ranjan Behera   Tushar Bhutada   Kundan Kumar Sahu   and Sarita Otta   

Background: Laryngoscope is an instrument to facilitate placement of endotracheal tube which finds its use both in OTs and in crash carts for emergency resuscitation of patients. The blade of the instrument comes in contact with the mucosal surface during this procedure. Yet, there is an absence of clear cut guidelines for disinfection of different parts (blade and handle) of this instrument. Materials and methods: This observational prospective study was conducted over a period of 5 months on previously used and disinfected laryngoscopes placed in the crash carts of various areas (emergency, ICUs) of our hospital. Swabs were collected from three different parts of each laryngoscope: surface of the blade (A), front part of the handle top (B), and front part of the handle's knurled surface (C). Bacterial growth and identification were noted using standard microbiological techniques. Data were entered and analyzed using standard MS Excel sheet. Results: In the study, 213 samples (71 each from A, B, C sites) were obtained from laryngoscopes from various areas of the hospital of which 32.4% were contaminated. The highest percentage of contaminated laryngoscopes belonged to Emergency department, a known high throughput area. Swabs from blades were positive in 16.9% (12/71) cases, from light in 14.08% (10/71) cases and from handle in 18.3% (13/71) cases. Among the organisms isolated, Coagulase negative Staphylococcus was the commonest (37.1%) followed by MSSA (22.9%) and MRSA (20%) from various sites of the laryngoscopes. Conclusion: A sensitization towards proper cleaning of laryngoscopes from crash carts is a must. Centralized disinfection services of all the parts of this instrument are a must for ensuring proper sterility.

Huaibo Xin   and Ajlina Karamehic-Muratovic   

This study explored the role of bonding, bridging, and linking aspects of social capital among Bosnian refugees in the U.S. and their impact on the community's mental health. Using snowball sampling and criterion sampling, a total of 74 Bosnian refugees resettled in the U.S. participated in a cross-sectional study and responded to the modified online Personal Social Capital Scale. Most of the participants resided in Missouri, Illinois, New York, Georgia, Florida, California, and Virginia. They reported modest levels of bonding, bridging, and linking social capital; Married participants had higher levels of both bonding and bridging social capital than single, divorced, and widowed participants (p = 0.036; 0.013); religious neutral/not religious participants had a higher level of bridging social capital (p = 0.018) than religious/very religious participants; males had a higher level of linking social capital than females (p = 0.047). Age and the number of years living in the U. S. also made significant differences in participants' social capital. Bonding and overall social capital were significantly associated with participants' mental health, although the relationships did not appear to be strong. Multi-level social capital building interventions/approaches tailored to Bosnian refugees are recommended, and their long-term mental health effects should be further examined.

Gangu Naidu Mandala   Kavitha Desai   Jerlin Jose   Elizabeth Renju Koshy   and Macherla Bhagyalakshmi   

The primary motivation behind this exploration study targets introducing a portion of the CRM ideas and components, CRM procedure to take proactive measures towards the customer to Health supplier to improve patients' satisfaction, loyalty fabricates a decent connection with patients and increment income. Patients' consideration, needs, and making associations with patients is an everyday schedule action in a well-being supplier. CRM is fundamental in this foundation customer satisfaction, the customer saw worth and customer relationship the board upgrade the relationship of the customer with the support up the general execution of the Hospital. The exploration configuration depends on quantitative examination, hence the information was gathered through an organized poll, five Likert-scales, SPSS, relapse, and SEM Model were utilized to figure out the results. This audits and distinguishes fundamental service quality, framework, the executives, and correspondence is identified with patients' satisfaction and loyalty in the private clinics in Andhra Pradesh. This investigation features the degree of service quality of the clinic services chosen by the test respondents. This paper is an endeavour to discover connections between patients' views of customers' satisfaction and customers' loyalty and to propose ideas to have better CRM rehearses.

Mohd Kamal Mohd Nawawi   Jafri Zulkepli   Ruzelan Khalid   and Norhaslinda Zainal Abidin   

The nature of the healthcare system is crucial and requires health authorities worldwide to ensure every decision is made correctly and efficiently. Simulation modeling which is among the decision-making techniques,is generally used to represent the real systems of healthcare for the authorities to evaluate prior to any modification. A holistic understanding of the issues related to simulation types in healthcare is required. This paper reviews and summarizes publications related to various types of computer simulation tools in the healthcare domain, using the Scopus database. Based on healthcare applications and issues, this paper finalized five main types of simulations: 1) discrete-event simulation; 2) system dynamics; 3) agent-based modeling; 4) Monte Carlo simulation; and 5) hybrid systems. All of these types have continued to contribute to healthcare simulation modelling in recent years and more are expected in the future. In general, this review argues that future studies should focus on framework development that will support the selection of simulation types based on the problem.

Olga Urzha   and Tatyana Evstratova   

The health of the nation is the key to the successful development of any state. Therefore, taking care of the health of each citizen and creating conditions for its preservation are the key objectives of authorities at all levels. To develop and implement the organizational and methodological measures aimed at solving this problem, it is necessary to create a complex system of measures accounting for the specific features of the country as a whole, its territory, climatic conditions, historical traditions, demographic and economic situation, i.e. to develop a scientific approach to the creation of the National Project of the healthy lifestyle of citizens. The development of the project has to take into consideration the social structure of each municipality, the presence of all age and gender groups, the state of citizens' health and their potential opportunities to engage in particular types of sports, the dynamics and perspective of changes. It is also necessary to take into account the typology of the country's municipalities, i.e. its administrative and territorial structure since Russia is a huge country with extremely diverse specifics of individual territories. In addition, it is necessary to take into consideration the priorities in the choice of mass types of sports for different social groups; providing staffing for physical culture and sports work in the field; developing a system for the promotion of physical culture and sports as an important component of a healthy lifestyle. Of critical importance is also the study of positive practices in this sphere since Russia has a great experience of past and contemporary examples of organizing citizens' healthy lifestyle that have to be generalized and disseminated.

Vishavadia Krunal   Seema Singh   and Sandip Solanki   

Background: The promotion of a pharmaceutical product is based on the effective collaboration between medical representatives (MR) & physicians. Pharmaceutical companies are following many doctor-consulting strategies and have found a way to promote their products through MR. But it's only possible if the MR communicates the brand's benefit effectively to the doctor. Aims and Objectives: To identify the personal and professional qualities of MRs that affect doctors' prescribing behavior. The impact of three variables like product detailing of MR, MR's attire, and MR's knowledge has been measured on doctor's prescription behavior. Methodology: Three personal and/or professional qualities of MR have been identified (effective detailing, personal attire, and scientific knowledge of MRs) and studied the influence of these qualities on physician's prescribing habits. Responses were collected through self-administered questionnaires from general practitioners, physicians, gynecologists, pediatricians, and dentists. ANOVA & regression analysis models were used to analyze the hypothesis. Result: Eighty-seven percent of the doctors agreed that pharmaceutical companies should train MRs properly about the detailing of brand and product knowledge, 64% of doctors agreed-upon personal attire of MRs attract their attention, and 92% agreed that MR knowledge plays a crucial role in influencing their prescribing behavior. The hypothesis was accepted for detailing, personal attire, and scientific understanding of MRs regarding their influence on doctor's prescription. Conclusion: The role of detailing, personal attire, and scientific knowledge of MR is well established to influence the practice of physicians. Pharmaceutical companies should train their sales team properly, starting from personal grooming to every aspect of brand and therapy for practical in-clinic discussion and doctor conversion.

Norsuhaily Abu Bakar   Jumadil Saputra   Mohammad Shaban Al-smadi   Mohd Hamidi Solahudin   Azni Yati Kamarudin   and Zulfa Izza Hashim   

Adapting to the kids has been hinted at as having declining impacts as the disabled develops. Along these lines, this is an issue that could influence the whole family climate, particularly the moms' monetary state and enthusiastic equilibrium. The primary purpose of this paper is to examine the psychological, physical indications, and stress of emotional wellbeing for Parents of children with intellectual and developmental disabilities. This study used a quasi-experimental research design, with quantitative data being used to infer research conclusions. The results of CBTCF's Mann-Whitney demonstrated that CBTCF pre-experimental and pre-controlled moms, specifically of intellectually and developmentally disabled children had a pre-delivery. When examining the findings of all three distributions of questions, it became obvious that children in the experimental group did significantly better as those in the control group had parents of intellectual and developmentally disabled children. The Wilcoxon Signed Rank Test findings showed a major difference in the experimental group before, after, and after the system exposure, and the minimal difference for the control group was investigated. In children with intellectual and developmental difficulties, the plan is also an effective therapy for behavioral problems with intellectual and developmental challenges that have behavioral issues.

Iryna Kychko   Svitlana Kovalchuk   Yuliia Kopochynska   Oksana Glynyana   and Inna Zub   

In the article, the need to form and implement a health-centrists policy of the health care system, which is implemented with the active involvement of companies in preventive measures in the development of corporate social responsibility, sponsorship and patronage, is substantiated. It is argued that the basic components of the health-centrists policy of the health care system should be the following ones: a high level of income sufficient for expanded reproduction; increasing the national income of the country based on the production of goods with high value added; prevention of sale on the territory of Ukraine of low-quality, counterfeit products; prevention of diseases, and injuries through their preventive measures at the enterprise level. Methodical approaches to assessing the impact of corporate social responsibility on the functioning of the health care system and the development of labor relations are used. They are based on the use of the SWOT-analysis from the standpoint of comprehensive understanding of prospects for improving public health on the principles of prevention, or reduction of injuries and mortality. It is substantiated that the health-centrist policy of the health care system should be formed and implemented comprehensively, involving the population of Ukraine, companies, authorities and government by actively promoting a responsible attitude to their health; activation of social responsibility at the level of the companies and the use of state financial, administrative, organizational levers of the influence on companies and individuals.

S. Priyadharshini   

Purpose: Long-term follow up and determination of visual acuity in the community is seldom carried out to examine the outcome of medical intervention, but the same is routinely assessed after cataract surgery [short-term] in medical camps and hospitals. Setting: Rural areas in Chidambaram town, Cuddalore district, Tamil Nadu, South India. Design: Cross-sectional study. Methods: All patients who underwent cataract surgery with intraocular lens (IOL) implantation were included in this study. With a 5.4% prevalence of cataract operated cases in the community, 95% confidence limit and 5% absolute precision, sample size was calculated as eighty-two. Door-to-door survey was conducted to obtain the sample. Data was collected using proforma and visual acuity was assessed using Snellen's chart. Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 18. Chi-square test was used to assess the association between different parameters and determine the visual acuity status. The obtained p value of < 0.05 was considered significant. Results: Uncorrected, present visual acuity in the first cataract-operated eye, 53 [64.6%], 25[30.5%] and 4 [4.9%] of operated eyes had poor vision, near normal vision and normal vision, respectively whereas it was 14[31.2%], 29 [64.4%] and 2 [4.4%] in the second. Long-term subjective visual outcome was reported to be good in the postoperative period in 51[62.2%] of cases. Conclusion: In the course of the long-term follow up, it is revealed that a majority of the operated cases have near normal or poor vision [uncorrected]. Vision can be improved by the simple correction of refractive error.

Kartika Setyaningsih Sunardi   and Evi Martha   

Positive deviance is an uncommon condition where the behavior or activities of a person or group in a population can unconsciously be a protective factor for a problem. Positive deviance behavior can occur in Sleman Regency with a stunting incidence rate of 11%, because it still has a sub-district with a relatively higher incidence of stunting than the average of Sleman Regency. This study discusses the analysis of feeding behavior, parenting behavior, hygiene behavior, and health care behavior as positive deviance (PD) behaviors in low economic status families with non-stunting incidence in Sleman Regency, Yogyakarta. This study is a qualitative study conducted in Sendangarum Village, Minggir District, Sleman Regency in the period between June and July 2020 for low economic status families who have children aged 1-2 years with not stunting incidence. The results of this study indicate positive deviance behavior in families with low economic status with non-stunting namely feeding behavior, parenting behavior, and hygiene behavior. The results of this study were important to analyzed PD behavior in Sendangarum Village, so that the officials could make an intervention by considering the findings to prevent stunting. The conclusion of this study found that positive deviance behavior in families with low economic status with non-stunting incidence were: 1) feeding behavior with a frequency of three times a day for main meals and side meals, 2) food ingredients consumed by children with good nutritional value with main meals a four-star menu and a snack, 3) the quantity of time parents spend with their children, 4) the role of parents when with children, 5) joint activities before bedtime, and 6) the behavior of maintaining the child's body hygiene, such as brushing teeth before bed.

El Ghouddany Safouane   Yamni khalid   Bour Abdellatif   and Khal Layoun Soad   

Introduction: Several studies show that there is a relationship between obesity and individual eating habits. Objective: To describe the relationship between dietary behavior and staturo-ponderal status in individuals of Kénitra. Materials and methods: This work was developed in Kénitra (February 01 to March 30, 2021), it was carried out on a sample of 100 subjects including both sexes with an age range between 18 and 65 years. Data are collected through a questionnaire that includes anthropometric measurements, dietary habits, age and gender. Results: Individuals who had three meals per day had a high BMI average (36.41 kg/m²) with a significant difference (p=0.0404) between BMI and the number of meals per day. As well as individuals who consumed high-fat foods, their mean BMI was high (36.41 kg/m²) with a significant difference (p=0,0120) between intake of high-fat foods and BMI. Conclusion: It is shown that there is a relationship between obesity and eating behavior, and obesity and eating high-fat foods, suggesting that controlling eating behavior helps individuals reduce body weight and have a normal high weight.

Narinderjeet Kaur   Wafaak Esa   Yanti Zahlan   Jiloris F Dony   Syed Sharizman Syed Abdul Rahim   Mohammad Saffree Jeffree   Khamisah Awang Lukman   Mohd Faizal Madrim   and Zulkhairul Naim Sidek Ahmad   

Introduction: Up to 70% of the food-water related illness is related to food services hygiene and safety standard. An important and crucial enforcement operation conducted by this division is the inspection of premises and food sampling. This is of paramount importance as food premise grading is directly related to consumers' health and safety which is in line with the third United Nations Sustainable Developmental Goal of good health and wellbeing. Aim: This study aims to identify the components and factors that are commonly related with food premises that do not obtain an "A" grading. Methodology: A cross-sectional study was conducted in 2017 among 315 food premises in Kota Kinabalu, Sabah that were under the jurisdiction of The Kota Kinabalu City Hall. Data from the food premise inspection forms were reviewed and analysed via multivariate analysis. Results: Premises that were non-compliant with health checks on all food handlers (OR 36.72, 95% CI 10.00-135.44), poor condition of the toilets (OR 6.96, 95% CL 2.35-20.63), ineffective fly control (OR 10.35, 95% CI 1.91-56.02), no availability of garbage cans (OR 3.01, 95% CI 1.01-9.01) and no separate storage for food items and chemical (OR 3.11, 95% 1.06-9.07) were significantly associated with not obtaining "A" grading. Conclusion: More focus and attention need to be paid to these factors not only for premises to attain "A" grading but also to improve the safety and hygiene of food that is consumed by the public.

Ntaoleng Mohlabane   and Sphiwe Madiba   

Children and adolescents with Perinatal Acquired HIV (PHIV) face many challenges to remain adherent to long-term Antiretroviral Therapy (ART). Among adolescents, adherence is often not static but changes over time due to the circumstances of the individual. The study assessed the ART adherence levels and patterns of adolescents with PHIV who were receiving long-term ART. This quantitative cross-sectional study was conducted in Mohale's Hoek, a rural Health District in Lesotho between May and December 2018. Adolescents aged 10-19 years who were aware of their HIV status were recruited from selected youth-friendly HIV clinics. Adherence was measured through a self-report of the last pills missed, based on 30 days recall. Stata version 13 was used for analysis. The sample consisted of 130 adolescents, 57% were females, the mean age was 15 years, the mean age of ART initiation was nine years, and the mean ART duration was four years. Self-reported adherence was very high at 92%, and 88% reported not delaying taking ART. Self-reported optimal ART adherence was achieved by 85% of the adolescents, 15% were non-adherent, and 92.3% had not missed clinic appointments in the past 30 days. Episodes of non-adherence among those who delayed taking ART on time occurred in the evenings, mornings, weekdays, and weekends. Non-adherence episodes for 59% occurred more in the evenings than other periods of the day. Conclusion: The results suggest that despite high self-reported adherence, adolescents take medication inconsistently and have situational adherence patterns. The dosing of medication and regimens should be flexible and take into consideration the context of the adolescents.

Nurmarni Athirah Abdul Wahid   Jamaludin Suhaila   and Haliza Abd. Rahman   

Hand, foot, and mouth disease (HFMD) has become an important public health problem worldwide due to its tendency to cause outbreaks and human death. The outbreak of HFMD with clinical and fatal complications has been noticed in the Asia Pacific region since the late 1990s. The increasing evidence of climate change effect on HFMD has motivated the need for further investigations. Numerous previous studies conducted in several countries have established a significant association between climate factors and HFMD. However, there are currently only a few studies in Malaysia addressing these issues. Therefore, this study aimed to examine the link between climate factors and the occurrences of HFMD in five states representing each region of Malaysia by using a generalized linear model approach. The weekly HFMD cases and four climate variables, including temperature, humidity, rainfall, and wind speed, were examined. The findings indicate that climate variables significantly influence HFMD in Malaysia; however, it varies between states as different states experience different climates. Additionally, the results revealed that humidity and temperature were the primary climate factors affecting the incidence of HFMD in Malaysia. This study could guide policymakers, health agencies, and local communities in determining the most effective prevention and control strategies.

Aiedh Mrisi Alharthi   Muhammad Hisyam Lee   and Zakariya Yahya Algama   

Early diagnosis of breast cancer helps improve the patient's chance of survival. Therefore, cancer classification and feature selection are important research topics in medicine and biology. Recently, the adaptive elastic net was used effectively for feature-based cancer classification, allowing simultaneous feature selection and feature coefficient estimation. The adaptive elastic net basically employed elastic net estimates as the initial weight. Nevertheless, the elastic net estimator is inconsistent and biased in selecting features. Therefore, the regularized logistic regression with the adaptive elastic net (RLRAEN) was used to handle the inconsistency problem by employing the adjusted variances of features as weights within the L1- regularization of the elastic net model. The proposed method was applied to the Wisconsin Breast Cancer dataset of the UCI repository and compared to the other existing penalized methods that were also applied to the same dataset. Based on the experimental study, the RLRAEN was more efficient in terms of feature selection and classification accuracy than the other competing methods. Therefore, it can be concluded that RLRAEN is a better method in breast cancer classification.

Kana Nishino   Sayaka Kotera   and Arbkhanok Tongtham   

Thailand is one of the most aging countries in Southeast Asia. While family support for Thai older adults is dominant, mutual support in communities is needed in response to the demographic shifts. The purpose of this study was to explore the impact of individual social capital on health-related quality of life (QOL) as a health outcome of older adults living in rural Thai communities. The questionnaire comprised the following: general characteristics, the Shortened and Adapted Social Capital Assessment Tool (SASCAT) and other items of social capital, the 12-Item Short-Form Health Survey (SF-12), and life satisfaction. We collected data from 202 older adults who participated in elderly clubs. After controlling for confounding effects, logistic regression analysis revealed that less group membership and more support from individuals were significantly associated with better physical QOL. Feeling safe in the community was significantly associated with mental QOL. However, other components of SASCAT, such as citizenship activities and cognitive social capital, had no significant associations. This study suggests that health-related QOL of Thai older adults may be improved by increasing mutual support of community members and perceived neighborhood safety through feeling supported by a community. However, it should be noted that multiple active memberships may adversely affect the health of older adults in Thailand.

Fosu-Mensah BY   Ofori A   Ofosuhene M   Ofori-Attah E   Nunoo FKE   Tuffour I   Gordon C   Arhinful D   Nyarko AK   and Appiah-Opong R   

Fish is an important source of protein, however as human impacts on the environment through industrialization, mining and farming among others is resulting in increased concentration of toxic metals in them. The levels of copper (Cu), arsenic (As), zinc (Zn), lead (Pb), cadmium (Cd), mercury (Hg), and selenium (Se) were analysed in fish samples from the southwestern coast of Ghana using acid digestion and atomic absorption spectrophotometer method. A total of 71 fish species were sampled where 35 species were collected in the wet season (October, 2014) whereas 36 species were collected in the dry season (March, 2015). The average levels of heavy metals detected in the wet season were 1.08 mg/kg for Cu, 9.79 mg/kg for Zn, 4.80 mg/kg for Se, 0.06 mg/kg for Pb, 0.03 mg/kg for Hg, 0.02 mg/kg for As, and 0.01 mg/kg for Cd. The average values of heavy metals in fish samples analysed in the dry season were 2.17 mg/kg for Cu, 4.55 mg/kg for Zn, 8.13 mg/kg for Se, 0.06 mg/kg for Pb, 0.03 mg/kg for Hg, 0.09 mg/kg for As, and 0.005 mg/kg for Cd. The results showed that the average levels of toxic metals analysed in the wet season increased in the order of Cd < As <Hg <Pb <Cu < Zn < Se whereas the dry season increased in the order of Cd < Hg < Pb < As <Cu < Zn < Se. The levels of all seven heavy metals were below the FAO/WHO Maximum Permissible Limits (MPL), Australia New Zealand Food Standards, EU, Australian National Health and Medical Research Council (ANHMRC) standards. Hence the consumption of these fish poses no public health concern. The estimated daily intake of the various toxic metals analysed were lower than the daily intake of their respective toxic metals. The non-carcinogenic health risk to adults and children showed that the Total Targeted Hazard Quotients (TTHQ) was less than 1 ( <1) hence poses no health risk to humans.

Eun Ju Jang   and Byung Soo Chang   

The purpose of this study is to verify the triple mediating effect of appearance satisfaction, body image, and hope in the relationship between appearance management behavior and happiness in 234 adults working in highway rest areas nationwide. Data analysis was performed using SPSS PC+ 25.0 and SPSS PROCESS macro3.5, and triple mediating effect analysis was performed using frequency analysis, reliability analysis, correlation analysis, and bootstrap analysis: This study was conducted to verify the triple mediating effect of appearance satisfaction, body image and hope in the relationship between appearance management behavior and happiness. The conclusions of the study are as follows. First, in the correlation analysis between the major variables, there were mostly significant positive correlations between appearance management behavior, appearance satisfaction, body image, hope, and happiness, but there was no correlation between body image and happiness or appearance satisfaction and happiness. Second, appearance management behavior had a significant positive effect on appearance satisfaction, appearance satisfaction had a significant positive effect on body image, body image had a significant positive effect on hope, and hope had a significant positive effect on happiness. Thus, appearance satisfaction, body image, and hope had a triple mediating effect in the relationship between appearance management behavior and happiness. As described above, few studies have dealt with this precise issue, and the discussion of these relationships needs to be expanded. Our results imply that improving one's appearance through various behaviors in order to appear more beautiful to others leads to changes in appearance and increased satisfaction with appearance. Thus, appearance management behavior not only changes one's appearance, but also results in positive psychological changes. In the end, such changes may promote happiness. The results of this study can be used as a new model for happiness improvement through appearance management behavior in office workers.

Ali Rawabdeh   and Ali Ahamd Awad Rawabdeh   

Health care systems around the globe suffered from inefficient delivery and financing systems. This paper aims to introduce and measure insights into the typology of efficiency of the health care system in Jordan and the like to improve and enhance the healthcare outcomes (Health Status). The researcher screened the typology and likely measures of efficiency in the health care industry in the published materials and characterized potential measures accordingly. In addition to that, the researcher consulted highly experienced colleague experts in different fields to generate and abstract information. This descriptive and analytical study utilized descriptive statistics to evaluate the six types of efficiency in the health sector and primarily employed a comparison between the neighborhood and universal figures of three epochs (the 1990s to 2020) based on worldwide authorized database records (World Bank). The 25% wastage of health expenditures in Jordan is compared favorably with the worldwide trend of 20-40%. Progressing efficiency within the health system can reduce the rising cost; provide equitable services to the penniless. Hence, prioritizing among available choices (70% curative and 30% preventive) ought to be based on health problems, social and financial-related components. Unequivocally, addressing priority setting is imperative to make more efficient strategies of allocation for scarce productive health resources. Despite the remarkable productive, technical, social with minimal vertical and horizontal efficiency capabilities of the Jordanian health care delivery and financing systems founded, a thoroughly enforced reform strategy can way better fit to attain the national key objective (health for all Jordanians in 2025). There were no majestic studies or other implications coupled with a lack of information to recognize the importance of efficiency in health systems encourage in selectivity and prioritization of health services delivery conveyance to the total mass in an efficient manner. In this manner, this paper came to recognize essentially pertinent six sorts of efficiency that could be utilized and measured in health systems, suggesting all over the maximization of outputs for a given level of inputs indicators. Subsequently, presenting efficiency into healthcare systems is profoundly approved because it can offer room for advancing equity and esteem in healthcare.

Mohamad Ichwan   Haerul Anam   Samuel Y. Sir   Sudarkam R. Mertosono   and Rita Yunus   

Health demand of Grossman Model recognizes three determinant factors in estimation model such as wage, education, and age. This study intends to examine the role of wage on health demand using measurement of total sick days and that of health days as measurement for health demand applying Econometrics Model in the form of Ordinary Least Squares (OLS) Technique. It employed household data from National Social Economy Survey Panel containing reports on the two areas examined among respondents in urban area. We found that the number of respondents who were ill was 6.642 and those who were not was 9.895. We also found that increase on wage reduced sick day total among working class families but not for middle class families, and it also triggered health time for both middle-working class families. Low Elasticity Coefficient indicated inelastic health demand which needs one-fold wage increase to improve one percent of health demand. Such inelasticity in demand can increase the price of medical services in long term and is potential for health stock disparity for the people. To avoid this, health insurance is needed to cover the people in order to improve health time of the people.

Chairun Nasirin   and Andries Lionardo   

Purpose: This study aims to know the implementation of good performance of local governance in improving the quality of health administration, especially the future of neglected children who live in urban areas to access the health facilities provided by the Government. Method: This study uses a kind of naturalistic qualitative research aimed at obtaining an overview of the phenomenon that occurred in the neglected children in Mataram. Data collection is conducted through a depth interview of the key informant who has the relevance of knowledge that is relevant to the problem of neglected children. Result: The results of this study showed that the problem of neglected children is a real phenomenon in the city of Mataram. The issues faced by local governments regarding the difficulty of local governments to overcome health problems for neglected children. So that whenever child neglect has a severe health problem, they should have to ask compassion for other people to help. Conclusion: The issue of neglected children is a real phenomenon that generally occurs in urban areas, and neglected problems occur influenced by the poverty factor. The implementation of local government functions has not been running correctly. The social development planning of local government is not functioning optimally due to the lack of clarity regarding health policy for neglected children who have social problems in the urban area.

Jayaprakash Jayavelu   Jasobanta Sethi   Sahil Kohli   and Tariq Matin   

Tongue is unique and each half of the tongue is represented bilaterally in brain and is being used as an effective interface to send signals to central nervous system. Tongue movements and tongue stimulation have been used in various types of rehabilitation. The purpose of this study is to review all articles related to tongue stimulation. All studies including reviews, case, cohort and experimental studies, which dealt with tongue stimulation, periglossal stimulation, or hypoglossal stimulation during the period between 1981 to 2020 were screened and a total of 41 studies comprising of 9 review articles, 30 experimental studies and 2 case reports were included for review. The methodology quality of the experimental studies has been analyzed using PEDro score and level of evidence measure. Electrical stimulation of the tongue was performed on normal subjects to find out the taste sensation and its similarity with other liquids. Hypoglossal stimulation has been found to stimulate the muscles of the tongue and it stiffens the posterior aspect of tongue and walls of the pharynx, thereby reducing the symptoms in obstructive sleep apnea. Stimulation of the muscles of the tongue also improves swallowing functions in dysphagia patients. Tongue stimulation, using a variety of devices and in combination with balance exercises, has also been used to improve balance in stroke, multiple sclerosis and spinal cord injury patients by inducing activity in cerebellum and brainstem, which process the balance networks. Tongue movements and tongue stimulation along with upper limb rehabilitation, have also been used in improving upper limb functions in stroke patients based on the principles of Hebbian theory. Thus, tongue stimulation along with targeted exercise program becomes a novel mode of therapy in inducing neuroplasticity and can be used in wide variety of patients in rehabilitation. This review will input to the clinicians and researcher for conducting further research on tongue stimulation. Further long-term follow-up studies can also be done to find out the neuroplastic changes in brain following tongue stimulation.

Volha Paulava   Tetyana Kamenska   Olena Terzi   and Viktoriia Borshch   

The research was aimed to develop a set of recommendations on maintaining public health within student community. For the practical achievement of the research goal, there were studied: students' self-perceived health status and their physical and moral reaction to COVID-19; their thoughts while onlooking relatives' reaction in the conditions of self-isolation, and students' opinion on new interaction with tutors in frame of online education. This part of the research was carried out from November, 2020 till May, 2021. Respondents were the students of South region of Ukraine, who study disciplines with some risk for public health system, namely, future seafarers and medical workers. In our work we drew on theoretical and practical conclusions made by the American, European and Ukrainian researchers of public health system and of cooperation between a teacher and a student in the conditions of COVID-19 pandemic. The theoretical aspect devoted to specification of such concepts as "public health", "public health within student community", is connected with the practical one, and allows to elaborate the unique research tooling and to reflect its components during a sociological poll with the help of questionnaire analysis. Application part of work is based on an empirical social research of transformations of students' feelings and opinions under the influence of pandemic, drawing on the analysis of moral difficulties that the students of higher educational institution faced in terms of sudden and drastic change to a remote format of learning being fully separated from an educational group. Recommendations and conclusions are made by the authors in order to safeguard public health within student community.

Sung-Joon Yun   

This study investigated the effects of WALKBOT robotic-assisted gait training (RAGT) on lower extremity strength, functional ability, balance, and gait in patients with acute neurologic disorders. Twenty-six patients with acute hemiplegia, paraplegia, or quadriplegia resulting from cerebrovascular accident (n = 14) or spinal cord injury (n = 12) received RAGT 10–15 times over 2 weeks (up to 5 times or 20 min per day), combined with neurodevelopmental treatment. The main outcomes were pre- and post-intervention Motricity Index (MI), Berg Balance Scale (BBS), and Functional Ambulation Category (FAC). The secondary outcomes were comparison of combined pre- and post-intervention scores for all patients (spinal cord injury and cerebrovascular accident) on 14 items in the BBS. There were significant improvements in MI, BBS, and FAC scores after WALKBOT RAGT (p < .001). After WALKBOT RAGT, the BBS scores on items 1–11 increased for all patients with acute neurologic disorders (p < .05); no significant differences were observed for items 12–14 (p > .05). WALKBOT RAGT improves balance and gait in patients with acute neurologic disorders.

Martirosova T.   Poboronchuk T.   Kokova E.   Doroshenko O.   and Ivanitsky V.   

The purpose of the study is to organize physical therapy classes and develop a program that includes an adapted method of health-improving walking for rehabilitation in the post-covid period. This means of physical culture can provide the maximum level of functional and physical characteristics to achieve high performance, emotional mood, and healthy life activity. The study involved bachelors in the Siberian State Scientific and Technical University named after M. F. Reshetnev, who had been ill with COVID-19. Classes of therapeutic physical culture will allow to reveal the great adaptive potential of the human body, to form a long-term adaptation, which consists in the restructuring of the body at the molecular, cellular level, in tissues, organs, organ systems and intersystem level, which determines the positive morphological and functional features of the trained organism as a manifestation of the biological norm. The frequency, intensity, direction of physical exercises, their duration and combination, the level of fitness, individual characteristics of those engaged and a number of other factors determine the nature and degree of these changes in the body. In future studies, we plan to use health-improving walking for rehabilitation in the period after AIDS for university teachers aged 50-59 years, as the most vulnerable during the COVID-19 pandemic. In conclusion, it should be noted that when exposed to physical exertion, muscle fibers are regenerated, becoming overgrown with a larger amount of protein material than it was originally. That is why the physical capabilities of the muscles are improved, due to the distribution of the load on a larger amount of muscle tissue. The synthesis of more muscle fiber requires the delivery of more oxygen and nutrients to the cells not only of the muscles, but also of all body systems. Increased blood flow contributes to an increase in the lumen of blood vessels, which increases the efficiency of the cardiovascular system, which is especially important during rehabilitation in the post-covid period.

Hasyim Ali Shahab   and Khoirunurrofik Khoirunurrofik   

A recent report by Indonesia's Ministry of Health shows that diabetes prevalence is doubled in the last decade, and it happens globally. Unhealthy food consumption is alleged to be the cause, and imposing taxes on unhealthy food to reduce its consumption. This study aims to analyze optimal taxation for unhealthy foods as a policy alternative to reduce the surge increase of diabetes in Indonesia. The study analyzes Indonesian consumption data on several types of food that fall into the unhealthy category by the World Health Organization. By estimating household demand for unhealthy food using the Almost Ideal Demand System (AIDS) and categorizing them based on income, we could simulate the optimal tax rate for unhealthy food and contemplate the pros and cons. The findings identified three food groups that fall into the unhealthy category: snacks, instant noodles, and processed meat, and all the groups have inelastic demand elasticity. Applying the Ramsey rule, this study estimates the optimal tax rate for each food at 12-13% and can increase the state revenue by IDR 4 trillion annually. Nevertheless, it is noteworthy that most instant noodle consumers were households in the bottom 40% of incomes, contrary to snacks and processed meat. The study advises considering income distribution when the excise tax will be applied by looking at a combination of food demand analysis with a tax-imposition simulation.

Klaudia Kukurová   Dilsad Ahmed   Jian Wang   Min Liu   Raul Calderon   Suporntip Pupanead   Yongkoo Noh   Rui Gao   Jiaxi Hu   Yi Zhao   Yang Yang Xie   Wilfred Wong   Walter Ho   and Patrick Ip   

The number of people with overweight and obesity issues has been increasing rapidly worldwide. This increase is related to many factors including physical activity, social background, economic development, cultural practices, etc. This study examined the body mass index (BMI) of 25,373 children, aged 6-12 years, from four Asian cities to assess children's health status and the association of geographical location with BMI issues. BMI data were calculated and classified according to the WHO criteria. Differences in height, weight, and BMI were calculated for boys and girls from different cities. Cross-city analyses revealed significant differences: children from the cities in higher latitudes had the highest chances of problems with overweight and obesity, compared with those in latitudes close to equator. There were a greater number of obese boys than girls. The most rapid increase of overweight and obesity issues in children occurred from ages 8-10 years, suggesting that this was a critical period in their development. Our findings suggest a geographical trend of a gradual increase in overweight and obesity issues from south to north. Weight management and physical activity programs for children aged 8-10 years could be effective for easing the increase among overweight and obesity.

Ugwoke Chinyere Kate   Ogbuanya Theresa Chinyere   and Agbo George Chibuike   

The study aimed at the Ergonomic analysis of work-related musculoskeletal risks associated with electrical hazards among radio and television technicians. The objectives of the study were to determine the factors that facilitate electrical hazard among radio and television technicians, and to examine the factors that prevent electrical hazard among radio and television technicians. The total population of the study was 42, comprising 24 technicians, 8 workshop attendants and 10 workshop supervisors in radio and television stations in Enugu State Nigeria. Survey research design was adopted. Random sampling was used to select the supervisors. Structured questionnaire containing a total of 18 items was the instrument for data collection. The instrument was validated by three experts and reliability coefficient of 0.89 was obtained using Cronbach's Alpha. The way radio/television stations in Enugu are structured has an impact on how technicians handle working instruments like pliers, screw drivers, chisels, and hammers, as well as other possible workplace hazards like nails, pieces of iron, bare conductors, and so on. There should be a standard building with well labeled shelves where tools and equipment are packed so as to promote their efficiency in the workplace. Technicians should also be aware of specific attitudes they have in the workshop and understand their role in hazard management to ensure that they stay fit and healthy throughout their careers. Occurrence of work related musculoskeletal problems should be minimized among radio/television technicians in Enugu.

Nur Syamimi Muhamad Fauzi   Maznah Mat Kasim   and Nor Hasliza Mat Desa   

The ambient of air quality in Malaysia is described in terms of Air Pollutant Index (API) which is calculated based on the maximum value of sub-index values of each of the six air pollutants (Sulphur Dioxide (SO₂), Nitrogen Dioxide (NO₂), Carbon Monoxide (CO), Ozone (O₃), particulate matter with aerodynamic diameter less than 10 micrometres (PM₁₀) and particulate matter with aerodynamic diameter less than 2.5 micrometres (PM_2.5). It is argued that the existing API cannot give the true picture of how harmful the pollution is towards humans' health because the hazardous levels of these pollutants are not considered in the API development. Therefore, the aim of this study is to determine the weights of the air pollutants according to their levels of hazardous in three selected cities in Malaysia; Putrajaya (PJ), Tawau (TW) and Alor Setar (AS). The study applies Shannon entropy method to weigh the air pollutants where the entropy values of the pollutants are the proxy measure of the pollutants' weights. The pollutants with higher weights would contribute more to air pollution and vice-versa. The study found different weights of the pollutants according to different cities where PJ shows SO₂ at the top ranking with 48.16% of the air pollutants' weight. Meanwhile, TW and AS show PM_2.5 at the first rank with 36.31% and 31.79% respectively. However, the analysis on the overall data shows that PM_2.5 and PM₁₀ are at the most and second most hazardous pollutants respectively that contribute to the air pollution. The effect of these two particulate matters is said to be more serious since SO₂ that is associated with both particulate matters are difficult to breakdown and bring harmful effects in human life as compared to the other air pollutants. This study signifies a new perspective in measuring the hazardous levels of the air pollutants and the results could be used to improve the existing API in monitoring the air quality in Malaysia.

Zakiyah Zain   Nazrina Aziz   Lim Jia Qian   and Goi Jia Shun   

The pertussis disease, which is termed as the "100-day cough", the incidences of which has dramatically increased over the years. This article reports the number of pertussis patients in all of the states in Malaysia from the year 2011 to the year 2018 and relative risk estimation for all of the states in 2018. Disease mapping is used in this article to visualize the risk area in Malaysia. The relative risk for every state in Malaysia is estimated using the standardized morbidity ratio (SMR) and a disease map is created using the ARCGIS software to demonstrate the relative risk of pertussis disease for every state more clearly. From the result, Johor is shown to be the lowest-risk area while Terengganu and Kedah are shown to be the highest-risk areas of the pertussis disease. Based on the map, the implementation of actions for controlling the disease is needed for the areas with very high risk of pertussis disease.

Aguemon Badirou   Adounkpè Ferdinand   Damien Barikissou Georgia   Elegbede Fidélia O   and Awédé Bonaventure   

Introduction: Consumption of shisha is an increasingly popular form of smoking among young people around the world. This study aimed to determine the epidemiological profile of shisha consumers in Cotonou as well as socio-demographic associated factors with this practice. Methods: A cross-sectional survey was conducted in Cotonou from May to November 2020 among shisha consumers. The sample size was 427. Non-probability convenience sampling with exhaustive selection of all consumers willing to participate in the study was performed. A questionnaire and an interview guide were administered to active and passive consumers respectively. A few samples of substances consumed by means of the shisha were collected and then analysed by Thin Layer Chromatography (TLC). Results: The mean age of the respondents was 22.38 years ± 6.40. The sex ratio (Male/Female) was 9.6. 55.3% of those surveyed began to use shisha between the ages of 15 and 25. They were mostly students (59.5%) with a low monthly income. Up to 70% of respondents have already sought medical assistance for symptoms like cough (36.84%), chest pain (32.33%), sore throat (27.83%), and abdominal burns ((3.0%). About 28% of respondents claim to become nervous after consumption. Substances such as tobacco (35%), cannabis alone (24%), cannabis/marijuana (18%), cocaine (16%), and alcohol (7%) have been identified in the products consumed. Conclusion: This investigation highlighted consumption of illicit drugs with shisha and the negative socio-health impacts linked to the consumption of shisha. The drug regulatory authorities should improve the control of shisha consumption in Benin especially among adolescents and youth.

Nor Azah Samat   Noor Azlin Muhammad Sapri   Adzmel Mahmud   and Shazlyn Milleana Shaharudin   

Contraceptive use among women remains an important public health intervention. Imperatively, the equality of family planning access between rural and urban areas allows all women to have the same opportunities to receive family planning service towards better well-being of families. The study aims at comparing the family planning preferences among women aged 15 to 49 throughout Malaysia in 2018 according to the geographical locations of rural and urban areas. This is important for resource planning and allocation to the National Population and Family Development Board (NPFDB) clinic based on the locations. The data were collected from 49 NPFDB clinics throughout Malaysia. A total of 3668 married women aged 15 to 49 years used the family planning service in this NPFDB clinic in 2018. In this study, descriptive, Chi-Square, and logistic regression analyses were carried out to compare the patterns and preferences of contraceptive use. The results analysis shows that implant is the most popular method among all other contraceptive methods provided by the NPFDB clinics. Specifically, in both rural and urban areas, the three most popular contraceptive methods among married women in Malaysia in 2018 are implant, pill, and condom. Findings of the analysis based on the Chi-Square test show that age group, education levels, and different types of contraception methods were identified to have a significant association with the locations of either rural or urban areas. In conclusion, this study found that women who used implants as a method of contraceptives were often younger, better educated, and lived in an urban area. Therefore, the family planning providers especially NPFDB clinics play a key role in providing information, educating couples, and promoting the use of different family planning methods so that better family well-being could be achieved.

Badirou Aguemon   Barikissou Georgia Damien   Charles Jérôme Sossa   Sètondji Géraud Roméo Padonou   and Mondukpè Jennifer Marie-Géraud Olofindji   

Introduction: Cervical cancer is an important public health issue worldwide and the number of cervical cancer is increasing in Benin country. The study aimed to evaluate the level of knowledge and degree of participation of women with regard to screening, as well as the factors associated with it. Methods: A cross-sectional survey was conducted between August and September 2020. A sample of 474 women was selected by three-stage cluster sampling. The women selling in the Dantokpa market, aged 25 to 65 were interviewed. Results: The mean age of the women was 40.20 years±10.66. The mean score for knowledge level about cervical cancer was 3.01±2.77 and that for knowledge level about screening was 2.72±3.07. The family history of gynecological cancers (p<0.0001), the level of knowledge about cervical cancer (p<0.0001), and the level of knowledge about cancer screening (p<0.0001) were significantly associated with the practice of screening. Conclusion: In order to increase the use of cervical cancer screening by market women, it is necessary to carry out large information campaigns to improve the level of knowledge of women in the market on the disease development and benefice of screening.

Catherine D. MacDonald   and Audrey Steenbeek   

Indigenous women have higher rates of cervical cancer and lower rates of Papanicolaou (Pap) smear screening than non-Indigenous in Canada. Healthcare providers are well positioned to address the inequities in access to Pap screening that many Indigenous women continue to experience. The purpose of this study was to explore healthcare providers' experiences and perspectives about Mi'kmaq women's access to Pap smear screening in Eastern Canada, and to consider the broader historical, economic, and sociopolitical contexts that shape healthcare experiences. The methodology is a qualitative, community-based participatory action research approach that embodied Indigenous approaches to knowledge development and post-colonial theoretical perspectives in a two-eyed seeing approach. In-depth semi-structured in-person interviews were conducted with five healthcare providers twice, in two First Nations communities in Nova Scotia. Findings revealed two major overarching themes: a) Understanding the Realities of Indigenous Women's Lives; which involved recognition of the impact of history, and socioeconomic and political factors; and b) Fostering Indigenous Women's Access to Pap Smear Screening, through fostering trusting relationships, cultural safety, addressing confidentiality issues and optimizing processes to improve experiences. Conclusions indicated approaches to foster Mi'kmaq women's access to Pap screening included a social women's day, targeting youth, explaining step-by-step during screening, providing Pap results to women and having nurse practitioners perform screening. Implications for practice comprised addressing confidentiality issues in community health centres, involving the community in Pap screening decision-making, acknowledging the impact of historical trauma on access to screening and optimizing processes to address and improve inequitable access to screening. This study highlights the importance of healthcare providers' participation in understanding and encouraging Indigenous women's access to Pap smear screening. Healthcare providers need to consider a wider view of the realities of Canadian Indigenous women's lives, and acknowledge the impact of historical trauma, socioeconomic factors, and racism on women's accessing of Pap smear screening. Healthcare providers can implement collaborative and culturally safe screening approaches, while acknowledging Indigenous community strengths to improve inequities in healthcare access and health outcomes.

Victoriia Overchuk   Julia Kushnir   Оksana Shportun   Lyudmila Matokhniuk   Zhanna Sydorenko   Kateryna Vasyuk   Viktoriya Shevchuk   and Ihor Bloshchynskyi   

The article considers fundamental aspects of ensuring the quality of life of persons with disabilities in Ukraine, recognition of their rights to a full life in society and the creation by the state of appropriate conditions for their rehabilitation and social integration. There have been significant changes in attitudes towards people with disabilities in recent decades. The basis of such changes is the recognition of their rights to a full life in society and the creation of appropriate conditions for their rehabilitation and social integration, but, despite the positive changes, the quality of life of people with disabilities lags far behind and does not meet today's requirements. Today in Ukraine, the employment of people with disabilities is part of vocational rehabilitation, the purpose of which is to provide them with work directly. The article is devoted to the study of the development and supports system of vocational training of persons with disabilities in Ukraine. Particular attention is paid to the structure of state and non-state institutions, through which vocational training of persons with disabilities is carried out. The critical shortcomings of the vocational education system of persons with disabilities in Ukraine are selected. In particular, in terms of financing such education, logistics for certain groups of persons with disabilities, as well as educational institutions and enterprises that need to adapt their place of study or work to the needs of persons with disabilities. The feasible analysis also indicates the shortcomings of the Procedure for choosing a profession for people with disabilities with the participation of medical and social expert commission (MSEC). Recommendations for overcoming these shortcomings are formulated separately.

Tabitha Mallampati   

The objective of this study was to examine the risk factors, knowledge, attitudes, and practices of type 2 diabetic patients attending three health care facilities (Industry and Campbellville Health Centers and the West Demerara Regional Hospital) in Guyana, May and June 2019. This study utilized a quantitative, descriptive and cross-sectional approach. The sampling technique used was non-probability and purposive sampling. The participants included 114 diabetic patients attending three selected health centers in Guyana. The study used a pretested questionnaire to collect survey data. Data were analyzed using SPSS version 20.0. Statistical analysis methods were mean, median, standard deviation, percentages, cross-tabulation, p-value, chi-square, ANOVA and Friedman test. Study results indicated that risk factors such as age, ethnicity, family history, BMI had no significant relationship with the onset of diabetes among the study population. Findings revealed that the mean average of participants' RBS, BP, fasting blood sugar, HbA1C and lipid profile were high. Participants demonstrated an inadequate level of knowledge and practices. Some of the participants had challenges accessing specific laboratory tests and Insulin. Findings concluded that there is a critical need for improving diabetic knowledge and healthy practices among diabetic patients. Establishing culturally oriented and multi-sectoral diabetic self-care management programs is imperative to manage diabetes effectively.

Nik Nur Fatin Fatihah Sapri   Wan Fairos Wan Yaacob   Yap Bee Wah   and Syed Sharizman Syed Abdul Rahim   

Dengue fever is a well-known vector-borne disease caused by Aedes aegypti mosquito. It has become a major burden to economy and society of affected country. In Malaysia, dengue incidence in Selangor has been worsening and alarming. The aim of this study is two-fold; to examine the trend and behaviour of dengue incidence across time and districts in Selangor and to cluster the endemic areas in Selangor using Wards hierarchical clustering method. The spatial and temporal analysis found that the dengue incidence is worsening in the early and middle of the year. The Wards minimum variance method was able to cluster Selangor's endemic area into high endemic areas (Gombak, Hulu Langat, Klang and Petaling), medium endemic area (Sepang) and low endemic areas (Hulu Selangor, Kuala Langat, Kuala Selangor, SabakBernam). The findings of the study are significant to respective local authorities in providing information for monitoring and planning the early dengue warning systems. This is important to reduce the dengue incidence in hot spot areas and to safeguard the community from dengue outbreak.

Norsuhaily Abu Bakar   Mohammad Shaban Alsmadi   and Ibrahim Mohammad Sulaiman   

Cognitive Behavioral Therapy for Psychosis (CBTP) is a patient-centered talking therapy mostly concentrating on the way an individual's behaviors, emotions, and thoughts are connected. Recent literature has shown that CBTP is likely to reduce positive symptoms while improving the negative symptoms and functioning. Also, several studies suggest that the use of CBTP therapy is very effective in delaying or preventing the change to full psychosis whenever applied to persons known as being at risk of developing psychosis. Therefore, this research tends to determine the impact of CBTP on mothers of youngsters with cerebral palsy and propose the most efficient and supportive method for dealing with their stress management. Using a quasi-experimental research methodology, we obtained quantitative data to infer the results of the research. The Mann-Whitney results for CBTP was obtained and presented which illustrates a substantial difference in the pre-control and pre-experimental groups of pre-distribution. The paper on new child birth with cerebral palsy problem is the first quasi-experiment of many researches on this topic (concerning comparable variables and procedures) in numerous centuries. It highlights vital ways of sustaining the initiative is a successful intervention in Youngsters with cerebral palsy to cope with behavioral issues. The government is also suggested to have further training sessions, employ the collaborative operation as an out-of-class task, and track the process carefully.

Jacques W. Saïzonou   Alphonse M. Affo   Virginie Mongbo   Robert Zannou   Patrick Makoutodé   Alphonse Kpozèhouen   Thierry Tossou Boco   Soulemane Zan   Léopold Ouédraogo   and Edgard-Marius Ouendo   

Despite global commitments of policy makers to improve maternal health through capacity strengthening and provision of high-quality reproductive health services, family planning services still face great challenges in Africa. A nationwide cross-sectional study conducted in 2019 in Benin involving health facilities showed gaps in Knowledge Attitudes and Practices (KAP) in meeting family planning guidelines. A total of 446 health providers were interviewed. Data analysis relied on the calculation of tertiles and chi-square tests were computed to assess the differences at 5% level of significance. Results reveal that most health providers (92.9%) showed a good knowledge of the standard guidelines of FP, one fourth (23.4%) showed a wrong knowledge of the advantages and about half (51.6%) of them lacked extended knowledge of FP methods. Results also underscore discrepancies between most providers' attitudes and existing FP guidelines which were in line with the inadequate practices showed by half of respondents. Results underscore the need for the development and implementation of basic training programs and capacity strengthening interventions toward health providers in order to improve performances of FP services in Benin.

Munezero Florence   Ahanhanzo Glele Yolaine   Sossa Jerome Charles   and Bazira Leodegard   

In order to strengthen the Information System, the medical record project has been initiated since 2014. The objective of this study was to assess the Hospital Information System in the context of using the Electronic Medical Record (EMR) to highlight the factors to be strengthened. This is a cross-sectional survey carried out in October 2019 in 11 hospitals equipped with a Hospital Information System based on OpenClinic GA software. The evaluation was carried out using the Health Metrology Network (HMN) tool covering the components of the Health Information System. Data entry and analysis were carried out with the Excel tool transposed to the HMN tool format. The calculation of the scores and the thresholds used are based on the same HMN tool. The score was 61% for resources, 60% for indicators, 41% for data sources, 51% for data management, 55% for information product and 67% for information dissemination and use. According to the period of time when the EMR was first used, the 7 hospitals computerized in 2017 had an overall score of 57% compared to 53% of the 4 hospitals computerized in 2015 (p= 0.7055). District hospitals had an overall score of 61% while regional hospitals had an overall score of 50% and national hospitals had an overall score of 52% (p=0.1441). In conclusion, the results show that two components namely source of the data and data management have shortcomings. Corrective strategies should be considered to support the ongoing hospital information system strengthening reforms.

Dewi Dolifah   Diding Kelana Setiadi   Delli Yuliana Rahmat   and Tedi Supriyadi   

One of the attempts to prevent stunting requires the implementation of new intervention, especially in upgrading a mother’s education. A mother’s substandard education is a vital risk factor in child growth. Therefore, this study aims to educate mothers in terms of improving a mother's understanding of stunting prevention through Bina Keluarga Balita (helping family with toddler) program as part of the Kampung Keluarga Berencana (family planning village) program initiated by the government. Action research method was employed as the design of this study by involving 100 mothers of toddlers as research participants. This study was conducted in one of the areas in Sumedang - West Java that carried out the Kampung Keluarga Berencana program. This study resulted in several findings, including: 1) Mothers lack education concerning stunting issue; 2) The need for parenting intervention related to toddler’s nutritional intake; and 3) There are 5 steps abbreviated to I-CARE, serving as the framework to educate mothers regarding stunting prevention. Through this model, this study showed a rise in mothers’ insights and understanding regarding stunting prevention efforts. Hence, it can be concluded that the I-CARE model comprises reflective and solution steps that can be implemented to educate mothers regarding stunting prevention and government program succession efforts through Kampung KB program.

Juan Fernando Matajudios Carmona   and Cristian Fernán Muñoz Muñoz   

The aim objective of this research was to develop and measure the effectiveness of a cognitive behavioral program developed by the authors based on a cognitive behavioral model, in order to counter burnout syndrome in teachers dedicated to the primary and secondary education sector of the city of Pereira, which consists of eight sessions that took place over a period of two months (8 weeks) lasting two hours for each session and applied in a population of eighty primary and secondary teachers from a private school in the city of Pereira, Colombia, during the second half of 2019. The study consisted of a quantitative methodology and quasi-experimental model, with pretest and postest measurements. With a control group of 36 teachers an experimental group consisting of 44 teachers, a sociodemographic labor questionnaire and the Maslach Burnout Inventory were used. The formation of the experimental and control groups was carried out in a homogeneous way with teachers presenting high, medium and low level of burnout. The realization of the statistics was done through the SPSS25 program in its version for Windows and effectiveness results were found for the intervention with demonstrative significance greater than 50% in its three components, Emotional Exhaustion, Low Personal Realization and Depersonalization.

Mykola Zhurba   Yuliia Bokhonkova   Dmytro Marchenko   Nataliia Buhaiova   and Marharyta Zhurba   

There were three main reasons for choosing the topic for this empirical research. The first reason was that the world faced a global threat of the COVID-19 pandemic. The second one was that the new university offering the relative share of e-learning equals 100% must meet students' needs as educational services buyers. The third reason was that the sudden transition to 100% of e-learning could affect the mental and physical health of students. The goal of this empirical research was to study whether public decisions on student health care during the COVID-19 pandemic era in Ukraine meet students' needs. The authors have used powerful research methodologies such as literature review, analysis of public decisions on student health care during the COVID-19 pandemic era in Ukraine, experiment planning, questionnaire survey, primary processing and grouping of the results and verification of statistical hypotheses. The study surveyed 142 respondents in seven groups. The authors put forward the key hypothesis: public decisions on student health care during the COVID-19 pandemic era in Ukraine meet student needs in e-learning. This empirical study gives us six new scientific results. Mainly, the comparison of public decisions on student health care during the COVID-19 pandemic era and student needs in e-learning shows that the difference is statistically significant. The alternative hypothesis was accepted: student needs in e-learning are not equal to 100% if random deviations will not be taken into account. This main scientific result is highly statistically significant (0,01). Additionally, the new scientific result is that the theory of learning should be adjusted taking into account that the share of e-learning equals 100%. Implementation of these and the rest of the new scientific results will improve public decisions on student health care in Ukraine during the COVID-19 pandemic. One of the tasks for the next exploration is to study how the sudden transition to 100% of e-learning affected mental and physical student health.

Emmanuel Kobina Mesi Edzie   Klenam Dzefi-Tettey   Philip Narteh Gorleku   Adu Tutu Amankwa   Ewurama Andam Idun   Edmund Kwakye Brakohiapa   Eric Aidoo   Julius John Essoun   Frank Quarshie   Henry Kusodzi   and Abdul Raman Asemah   

The patient management team includes a wide category of healthcare workers, who in one way or the other interact to render services, including radiation-based services. It becomes imperative that every healthcare worker must have appreciable knowledge and opinions on radiation issues for effective service delivery. Hence, this study assesses the perception of non-radiation healthcare workers about radiation. This was a prospective questionnaire-based study involving 340 consented participants from four hospitals in Cape Coast. A stratified sampling method was employed for the number of respondents from each hospital. The responses obtained from Google Forms WhatsApp-administered questionnaires, were systematically selected to obtain the sample size. Data obtained were analysed with Statistical Package for Social Sciences (SPSS Inc., Chicago, IL version 20.0) and the results were presented in appropriate tables and charts. Statistical significance level was set at p≤0.05. The majority of the 340 participants were males. The average age was 32.26±7.618 years. Nurses constituted majority 166 (48.8%) of respondents, followed by allied health professionals. The knowledge of participants about radiation issues was high with over 65% of responses. There were statistically significant associations between gender, educational level, work experience and willingness to accept postings to radiology departments. We conclude that, the majority of non-radiation healthcare workers had a high level of knowledge about radiation issues. The perception of non-radiation healthcare workers was positive from suggestions and recommendations they offered.

Prosper M. Bernard   

Obesity is an important health issue in the current day and age. As it has been reported by many studies on the COVID-19 pandemic, individuals with excess weight and people with poor health are at a higher risk for COVID-19 severity. The purpose of this research is to give a model for losing weight by selecting a plant-based diet and by the progress measuring every day. The methodology is a case study with observations over three years. A case study is used to analyze the model and to teach in many disciplines in universities such as medicine, management, chiropractic, dentistry, psychology. Based on the findings of prior empirical studies, the subject made dietary and behavioral changes and was able to lose 45 kg (95 pounds) in approximately 18 months and maintain the proper weight for two years. The main conclusion is that by following this model including nutrition changes and regular measuring, people can reduce their weight to the normal level and keep it for a long period, hopefully, for the rest of life. This study shows how to change to plant-based food, avoid processed food, and measure the progress every day to adjust the behavior. Furthermore, the study shows that it is not a special diet but a long-term lifestyle. This study has limitations because a case study is not the same as a study with a randomized large sample. However, it contributes to the field of nutrition by showing that with a plant-based diet and a minor behavioral change, one can greatly improve his or her health by staying at a normal weight. This type of nutrition has a major social impact especially at this time of the COVID-19 pandemic because it affects particularly people in poor health conditions.

Matthew Sasaki   Mary Parianos   and Saleh Rahman   

Background: In 2019, cancer was found to be the second leading cause of death with an economic cost of over $90 billion in the United States. Cancer affects all population groups in the United States; however, certain populations may bear a disproportionate burden of cancer compared with other populations. In this study, we have examined cancer data from 1981-2015 on the top five cancers in Florida for predictors of advanced stages of diagnosis of each cancer. Materials & Methods: This study is a secondary analysis via data from the Florida Cancer Data System database. The odds for advanced stages of cancer regressed with demographic, insurance, and socioeconomic predictors. Results from the last 34 years and the last 15 years were compared to see the changes during this time. Results: Considerable differences were found in multiple factors for each type of cancer in this study. Most notably, breast cancer yielded a discrepancy for every category, including insurance status, race, and socioeconomic status. In contrast, the least number of identifiable disparities existed with melanoma of the skin. Conclusion: Although many interventions over the past 15 years have been aimed at reducing disparities in cancer outcomes, it appears that social determinants such as race, ethnicity, insurance, income, and geographic location still play a significant role as predictors of the advanced stage of a cancer diagnosis for lung, breast, prostate, colorectal, and melanoma of skin at initial diagnosis for Florida residents.

Igor Turski   Hanna Mashika   Tetiana Tkachenko   Maryna Khmara   Igor Komarnitskyi   and Mariia Oliinyk   

Medical tourism is a relatively popular area of tourism, and the primary purpose is to organize the treatment of a patient abroad. It differs from usual tourism in that rest abroad is combined with medical services, which are ready to provide the world's leading centres and clinics. The study is devoted to developing recommendations for ensuring the sustainable development of Ukrainian medical tourism, based on the analysis of international tourism achievements. In their study, the authors similarly considered the very concept of medical tourism, its features and main directions, namely, the authors deemed such directions as diagnostic, therapeutic, rehabilitation, health-improving and non-traditional tourism. The authors examined the leading countries of inbound medical tourism, as well as the key incentives for such tourists. Analysis of the growth dynamics of medical tourists by year and the main directions of medical tourism in Ukraine allowed the authors to highlight the most promising Ukrainian medical tourism destinations. In conclusion, the authors analyzed the benefits of international and Ukrainian medical tourism. Summing up, the authors concluded that medical tourism in Ukraine is only at the initial stage of its development; however, certain regions have significant potential for its successful formation.

Ahmet Ozyigit   

Dementia is a group of neurodegenerative disorders with multifactorial and complex etiologies. While a specific pathway is not identified, a number of associations have been reported in an attempt to understand the complexity of the condition. There is robust evidence both from cohort and case-control studies regarding the possibly protective effects of years of schooling on developing dementia later on in life. While theories exist why increased educational attainments may protect our cognitive abilities, the relevant literature suffers from a gap in formal empirical cross-country evidence. Recent literature on clinical dementia also suggests a role for cold exposure in development of dementia in the old age, possibly creating a geographic gradient between colder and warmer countries. This study aims to empirically test the relationship between years of schooling and dementia prevalence rates in the 28 EU countries (UK included) with further focus on climate differentials, using panel data estimation. Results from this study provide evidence in favor of a significant negative relationship between years of schooling and dementia prevalence rates in the EU-28. Climate differentials, on the other hand, only provide a weak association. Further research on broader geographic areas can shed more light on this possible association with broader range of temperatures observed.

Mohammed Hasan   Marie Ma’abreh   and Anas Ramadan Ibrahim Al-Masri   

The study aimed to reveal the relationship between the attitude towards Coronavirus disease (Covid-19) and optimism and pessimism among a sample from Irbid city. It also aimed to identify the nature of the differences between the degree of optimism and pessimism and the attitudes (affective, behavioral, cognitive) between the participants according to demographic and personal variables (gender. age, marital status, educational level, economic status, number of children). The study sample consisted of (600) male and female residents in Irbid city, who were chosen randomly. The findings showed that: there is a positive statistically significant relationship between the behavioral and cognitive attitudes towards the Corona pandemic (Covid-19) and optimism. And there is a negative statistically significant relationship between the attitude (affective, behavioral) towards the Covid-19 and pessimism. The results also showed statistically significant differences in the degree of optimism and pessimism attributed to the age variable and the differences are in the degree of optimism for the age group "from 25-35 years" and the differences in the degree of pessimism came in favor of the age group "35-36 years". Also, there are no statistically significant differences in the degree of optimism and pessimism due to a variable (gender, marital status, educational level, economic level, number of children). The results showed that there are no differences in the attitude (affective, behavioral, cognitive) attributable to the variables (gender, age, educational level, economic status, number of children). The results also indicated that there are statistically significant differences in the social status at the cognitive attitude and the differences came in favor of the Married group.

Daniel Terry   Blake Peck   and Swapnali Gazula   

There is a need to understand Workplace Based Assessment programs in Australia to improve future offerings. This paper evaluates the efficacy of a Workplace Based Assessment program at a single regional Australian healthcare location using a mixed-method approach to collect data from three sources. Tools included Mini-Clinical Evaluation Exercise, case-based discussion and in-training assessment, and structured face-to-face interviews with eighteen key-stakeholders. The Workplace Based Assessment program itself was evaluated against a number of indicators, including the psychometric properties assessed by each of the tools used. In addition, the adequacy of the current program and specifically the tools used within it to determine the clinical competence and safety of International Medical Graduates was examined. Lastly, satisfaction of key-stakeholders with program preparation and usability of tools was investigated. The results indicate that the tools currently used within the Workplace Based Assessment program continue to be reliable, and assessors are assessing International Medical Graduates with a high degree of consistency across the program. In addition, this study found that both International Medical Graduates and assessors remain satisfied with regard to confidence, usability and user perception of the current Workplace Based Assessment methods to provide a more meaningful experience for those being assessed. Overall, this evaluation provides insights into the current Workplace Based Assessment program and makes recommendations for future improvements. These include clearer program guidelines; greater opportunities for support of International Medical Graduates, feedback for and further training of assessors.

Blake Peck   Daniel Terry   and Kaye Ervin   

Childhood injury is the leading cause of death and ongoing disability worldwide. While a cornerstone of injury prevention is education, current injury surveillance data is insufficiently nuanced to inform judgement of their effectiveness. A subsequent dearth of research evidence in the domain of childhood injury means that debate continues in regard to the most appropriate age or developmental stage of the child, as well as the most effective pedagogical approach. When considered together these issues culminate in programs that risk being inadequately targeted that are unable to justify their success in reducing injury and consequently are not sustainable. This paper reports the outcomes of a narrative synthesis approach to the review of literature in the area if childhood injury prevention programs targeted at pre-school children. Three studies met the inclusion criteria. The included studies were of poor quality and lacked convincing evidence of effectiveness due to the methods of evaluation, which in turn have shown to impact on the overall sustainability of each specific program. This paper culminates in recognition that there is insufficient evidence of the effectiveness of childhood injury prevention programs for pre-school children, requiring further high-quality studies to determine their overall effectiveness and longer-term sustainability.

Yuko Tanaka   Geraldine Ordonez Araullo   Maria Teresa Tuliao   Tadashi Yamashita   Kikuko Okuda   Elizabeth C. Baua   and Hiroya Matsuo   

Cases of sexually transmitted infections (STIs) and teenage pregnancy have been increasing among adolescents in the Philippines. School nurses (SNs) are expected to deliver quality healthcare services and provide relevant sexual health education for students. This study explores the current situation of providing sexual health education by SNs in Muntinlupa City toward health promotion and gains understanding of school health issues in the Philippines. This study employed a cross sectional research design using anonymous self-administered questionnaires, which were distributed to 23 SNs. Then, a semi-structured interview was conducted with them in Muntinlupa City. Among the 23 SNs, 30.4% of them were affiliated to high schools. The most frequent health issues experienced by primary school students were malnutrition, gastrointestinal pain due to hunger, upper respiratory tract infection, and poor hygiene. In high schools, the most frequent health issues were poor mental health, malnutrition and early pregnancy. SNs lacked knowledge on STI, mental health, sex education, safe sex, teenage pregnancy and nutritional care for children. In conclusion, SNs lack knowledge about sex education (early pregnancy and STIs) and mental health. Therefore, seminars should be provided for all SNs to gain adequate knowledge and skills to teach students of all types of school.

Azandjeme Colette Sylvie.   Sossa Jerome Charles   Sopoh Ghislain   Ahanhanzo-Glele Yolaine   Degbegni Hermance   Paraiso Noel. Moussiliou   Metonnou Clémence   Agueh Victoire   and Ouendo Edgard-Marius   

The objective of this research is to study the nutritional status and the diet quality of vegetarians in two main cities of Benin, Cotonou and Porto-Novo in order to contribute to the improvement of their diet. Data were collected from 101 vegetarians selected by commodity in vegetarian restaurants. BMI, waist circumference, energy intake from macronutrient, micronutrient intakes, alcohol consumption, physical activity level, and blood levels of iron, calcium and albumin are the main variables. Analyses were set using SPSS and ALIMENTHEQUE software. Associations were tested using Fisher and Chi square tests. Inadequate nutritional status is obesity (6.93%), overweight (26.73%) and under nutrition (4.95%). People with a low daily fiber intake was higher among those with a BMI greater than 25 compared to those with a BMI less than 25 (82.3% vs 61.1% with p=0.03). As the diet becomes stricter, the prevalence of people with low daily vitamin B12 intakes significantly increases: presco/semi-vegetarians (8.23%), lacto-vegetarians (27.05%), vegans (52.94%) ovo-lacto-vegetarians (3.8%) p=0.04. In general, a lack of balance in macronutrient intake (only 18.81% of normal carbohydrate, fat and protein intake) was noted, leading to problems of obesity (abdominal obesity=23.7% Micronutrient intakes were low for the majority of subjects (vitamin B12=84.16%, zinc= 73.27%, calcium= 65.35%) except for iron (32.6%), with normal serum levels except for iron (deficiency=19.5%). Fiber intakes were also low for the majority (68.3%), which has a negative effect on BMI and therefore on nutritional status. The vegetarian diet in this context is therefore related to nutritional problems.

Sossou Justin Adanmavokin   Sossou Gilles Armand   Igué Babatounde Charlemagne   and Ouendo Edgard-Marius   

To assess the operational capacity of human resources in maternal and child health services, in order to provide equitable and sustainable universal health coverage in Benin, the Workload Indicators of Staffing Need (WISN) study was conducted. Method: A total of 487 health facilities and public hospitals were sampled, representing 75% of the public health facilities. Health professionals involved in maternal and child health care were exhaustively included. Results: Overall, 487 health facilities with 3,870 human resources of all categories were evaluated for their workloads. The analysis shows that the country does not have the necessary manpower to handle the workload. The time spent by the health professional on activities changes according to the type of activity. Finally, it is noted that there is work pressure on health professionals which changes according to the type of activity. Discussion: The shortage situation leads to inequity in the distribution of human resources and is a reason for allocative and technical inefficiency. It is observed that qualified human resources devote little working time to the main activities, which explains the observed high morbidity and mortality rates, particularly for mothers and children. In conclusion, the analysis of the results shows that the pressure of work is greater in rural areas than in urban areas for the professional categories most encountered in rural areas and that the health system is fragile in the country.

Zeina Ghossoub   Relly Nadler   and Naim El-Aswad   

Burnout is an epidemic among physicians, nurses, and healthcare workers. Unique to burnout is its severe morbidity and mortality consequences on professionals and patients alike. Solutions to combat burnout are either focused on antecedent factors, or on the individual professional. Of the individual approaches, coaching, emotional intelligence, self-leadership and self-care skills and tools have shown promise in creating a positive impact. Several obstacles linked to cost, time restraints, and delivery methods have led to limiting the potential effects of these approaches. In 2018, a group of 70 nurses and allied healthcare professionals underwent a 6-hour workshop focusing on burnout and the above-mentioned approaches. Subjective evaluation of the immediate impact was analyzed. 7 months later, another subjective survey was conducted to test the impact of the workshop on its desired goals. The results show a measurable positively powerful change that was maintained throughout. Discussion of the importance of coaching, its delivery method, and the reasons for its success follows. The results show that using group coaching while honoring the adult learners' characteristics and relying on intrinsic motivation are very powerful tools that the healthcare industry and coaches alike can use to help in fighting the epidemic of burnout.

Manal Rajab Al-Shawakh   Nisreen Mohie Mostafa   and Linda Mohamed Saleh   

Objective: This study aimed to assess the knowledge and practice of nurses about family planning counseling in health care centers- Lattakia city to identify gaps in nurses' information and practice. Design: This was a purposive analytical study using a structured questionnaire that assessed the demographic characteristics of the nurses, and the nurses' knowledge about family planning counseling, and observation checklist to assess the practice of nurses during family planning counseling sessions. The data were analyzed with the SPSS software version stata 6.0. Settings: This study was conducted at the reproductive health clinics of health care centers, Lattakia. Subjects/participants: All nurses who work in reproductive health clinics in the time of the study (n= 29). Results: The nurses who had a good and medium level of knowledge constituted (62.07%, 37.93%) respectively, none of them had low level. The nurses who had a low and medium level of practice constituted (62.07%, 37.93%) respectively, none of them had a good level. Knowledge and practice about family planning counseling were statically connected. A significant statistical relation was found (P= 0.015). Conclusion: The nurses had a good level of knowledge and a low level of practice about family planning counseling, so they need training programs and a guide on family planning counseling.

Andrea Rucska   and Anna Perge   

In Hungary, the rate of adoption is much lower compared to the number of children living in institutional care. Adoption provides an opportunity for ceasing the negative factors in the personality development of children in institutional care and reaches a better quality of life. The aim of the research is to reveal whether children's age and the time of adoption affect the development of personality, regarding the attachment relationship between children and parents. Additionally, we would like to map how the personality of adopted children changes after getting to a family, and what the characteristics of its development are. For the retrospective study, an interview method was used, it happened by the adopting parents in case of all the ten included families. The interviews covered the following subjects: the reason for adoption, thoughts related to children, uncertainty factors in connection with adoption, acquaintance periods, the events of the family's home and the difficulties of the family socialization process. The interviews were analyzed by content analysis. The possibility of adoption came up in most of the families included in the research after medical interventions and the acceptance of infertility. The incorrigible and severe health damage of the child was a reason for exclusion in association with the child to be adopted. Four couples had no criteria about the origin. All families reported about uncertainty and fear before adoption. In the moment of adoption, the youngest children were newborns, and the oldest child was six and a half years old when getting to the adopting family. In respect of the examined families, the interval between the submission of the application and getting to the family was between two months and two and a half years. The initial difficulties were greatly different in the cases of newborns and children adopted to an older age. Parents defined the first six weeks as the hardest in case of newborns. The support of the family's background and friends after adoption could be detected in case of eight families, two families experienced the rejection of the grandparents. It is indisputable that adoption as early as possible is the ideal for children. If we know the case history, in case of experiencing a crisis, the arising problems can be treated effectively only by teamwork with the parents and the representatives of related professions. Children have the right to health, a healthy lifestyle, and we should always strive to create optimal conditions.

François Agossou   Jacques Saizonou   Virginie Mongbo   Blasselle Houssou   and Edgard-Marius Ouendo   

Motorcyclists are among vulnerable road users and account for 28% of road traffic fatalities worldwide. In Benin, the problem is accentuated in large cities such as Cotonou and Parakou, where road transport is dominated by motorized two-wheelers. This paper aimed to study the epidemiological profile of RTAs involving motorized two-wheelers in Cotonou and Parakou (Benin), from 2016 to 2017. This was a retrospective study based on the database of the National Centre for Road Safety. This is a public institution in charge of implementing the road safety policy and road traffic accident surveillance at the national level. Logistic regression was applied to assess the associations between independent variables and the outcome variable. The level of statistical significance was set at p < 0.05. From 2016 to 2017, 1,628 road traffic accidents involving motorized two-wheelers were recorded in Cotonou and Parakou, of which 62 (3.81%) were fatal. RTAs recorded in Parakou (AOR = 2.52, 95% CI = 1.29 – 4.93), single-vehicle crashes (AOR = 7.73, 95% CI = 2.70 – 22.07), collisions between motorized two-wheelers and trucks (AOR = 12.42, 95% CI = 6.16 – 25.04), collisions between motorized two-wheelers and pedestrians (AOR = 6.46, 95% CI = 2.70 – 15.47) and time slot from midnight to 6 a.m. (AOR = 3.88, 95% CI = 1.61 – 9.34) were significantly more deadly. Measures targeting motorcyclists should be undertaken such as the implementation of an integrated model of communication strategies.

Ann–Sofie Paulander   and Louise Eulau   

Although effective pain management interventions and programmes exist, provision of these services is regarded as inconsistent. There is evidence that multi–disciplinary methods are cost–effective in the treatment of pain, addressing the psychosocial, behavioral and biomedical aspects of pain states. It has been reported that music therapy and/or listening to music has a positive effect on the autonomic nervous system by reducing stress, focusing attention and effecting emotions, which in turn reduces pain experiences. The most effective way of pain reduction has been recorded while listening to self–selected music chosen for enjoyment or desired personal effect. This paper elaborates on phenomenologically describing an interdisciplinary method, Person–centered music (PCMusic), a complementary pain reducing treatment where music is a key component. A secondary goal is that the method can be used in other areas than pain management. The adopted concept integrates knowledge and methods from multiple disciplines viz. music therapy, caring science and Integrated Mental Training (IMT). PCMusic is discussed from a phenomenological perspective followed by a discussion of the music therapist role as a provider in care. The question of self–management and the use of preferred or self–selected music in pain management are also addressed.

Nadège Corine Yessito Houehanou   Ariyoh Salimanou Amidou   Arnaud Joël Djidjoho Sonou   Gwladys Gbaguidi   Latifath Ibouraïma   Philippe Lacroix   and Dismand Houinato   

Hypertension mortality could be reduced by compliance with treatments and hygienic rules. The study aimed to assess the knowledge, attitudes and practices (KAPs) towards hypertension among hypertensive patients at Tanvè (Benin) in 2018. Materials and Methods: This was a cross-sectional study. It included, people aged 25 and over, followed in Tanvè Health Study and screened hypertensive during the 2017 visit. An individual interview was used for the data collection in 2018. The evaluation of the KAPs was made by questions with two optional answers, marked 0 or 1: 24 for knowledge, 8 for attitudes and 12 for practices. The level was rated good when the score was ≥ 3rd quartile of the theoretical score. Results: A total of 380 people were surveyed, 67.9% of whom were women; the mean age was 52.4 ± 16.5 years. Among them, 22.6% had a good level of knowledge and 89.7% had good attitudes. Only 50.1% of the respondents were aware of their history of hypertension. Few of them (5.2%) had good practices towards hypertension. Conclusion: This study shows a low level of knowledge and practices towards hypertension. Interventions for the therapeutic education of hypertensive patients would be effective within the target population.

Bilkis Banu   Sayed Asaduzzaman   Nasrin Akter   Sarder Mahmud Hossain   and Touhid Bhuiyan   

Concurrent Field Practice-based teaching methods (CFPTM) have commenced globally parallel with the traditional teaching methods (TTM). The effectiveness of CFPTM in Bangladeshi educational settings has not been adequately studied yet. This study was undertaken to test the hypothesis that CFPTM is effective teaching method as compared to the TTM for Bangladeshi postgraduate public health students. Under a comparative interventional design two groups of postgraduate students [n=40 for each group], were selected purposively from the department of public health of the Daffodil International University, Dhaka, Bangladesh. Data were collected during pre and post intervention based on a topic that had been chosen to conduct the intervention followed interactive lecture method with CFP. Overall knowledge score (percentage) showed a significant increase in both the CFPTM (Baseline vs. Final, M±SD, 27±12 vs. 83±8, p<0.001) and TTM (27±18 vs. 40±17, p<0.001) among the groups. CFPTM showed a significantly higher knowledge score (p<0.001) as compared to TTM at the final time point. Analysis on individual components showed a result similar to the overall knowledge score. CFPTM seems to be superior and effective to TTM as a short-term interventional tool. CFPTM has been identified as an effective tool for postgraduate education in public health, which offers a new approach to equipping students with appropriate knowledge and skills that they need not only in their learning period but also in their service life.

Moussa Bachabi   Badirou Aguemon   Fernand Guédou   Rene Keke   Chaffa Oloukoi   and Edgard Marius Ouendo   

The aim of the study was to identify factors associated with successful HIV treatment amongst cases seeking care and treatment in Cotonou Health Center 1. This was a crossectional study design in which 297 people living with HIV (PLWH) enrolled for care and treatment at the Cotonou Health Center, were followed over a period of 13 months from November 2017 to December 2018. Cotonou 1 Health Center, is a reference center for the treatment and care of the people living with HIV and key populations in Benin. The objective was to identify the factors associated with the therapeutic success at the Cotonou 1 Health Center. The average age of the respondents was 42.60 ± 10.69 years with extremes ranging from 19 to 78 years; the average weight was 61.13 ± 13.50 kg with extremes ranging from 37 to 115 kg. Successful HIV treatment has been defined by a VL<1000 copies/ml. The main factors associated with successful HIV treatment were geographical accessibility, age, gender, socio-economic level, whether or not traditional medicine is used, adherence to treatment, the value of CD4 to initiation of ARV treatment and reception. Four potential predictors have been identified by the logistic regression model: economic level (p <5%); compliance (p <10%); age (p <5%) and sex (p <5%). To conclude our study, we can say that the UNAIDS 90-90-90 targets will be achieved by 2020 in Cotonou I Health center. However, this center needs to improve on crucials factors identified during our study such as economic level, compliance of patients and sensitization of young people (15-24 years) and male to reach this goal.

Putu Mastiningsih   

Anxiety disorders can be interpreted as a heightened tension that results in feelings of helplessness, loss of control and excessive subjective judgment of the interpersonal communication process. Anxiety disorders an ongoing basis often haunt the health of those who have reached a late age (the elderly). However, the elderly in the Tresna Werdha Foundation area, Blahkiuh village, Abiansemal, Badung Regency, Bali Province did not. They are known to love singing the Wargasari. They do not appear to have anxiety disorders about health as the elderly in general. The purpose of this study was to analyze the effectiveness of Wargasari as therapy in dealing with anxiety disorders among the elderly in the Tresna Werdha Foundation area, Blahkiuh village, Abiansemal, Badung Regency, Bali Province. This type of research is quantitative with a pretest-posttest one-group pre-experimental design. A sample of 67 elderly, who experienced anxiety and selected in total sampling, data were analyzed with the Wilcoxon Signed Rank Test. The results showed that the average anxiety before giving Wargasari therapy was 36.90 (severe anxiety), and after being given Wargasari therapy, the average was 23.00 (moderate anxiety). The p-value of 0.001 <α (0.05) means, there is a significant influence between Wargasari on anxiety. The results of this study are used as adjunctive therapy in the management of anxiety in the elderly. Based on these results, it can be concluded that the Wargasari has a significant effect on the anxiety level of the Elders in the Tresna Werdha Foundation area, Blahkiuh village, Abiansemal, Badung Regency, Bali Province. This research output is dedicated to enrichment in public health studies and cultural studies. The results of this study are expected to be useful for researchers interested in researching anxiety disorders, Balinese cultural traditions and health behaviors of the elderly.

Laila Hussein   Mahmoud. Ali Mohammad   K. S. Kuhn   and Peter Furst   

The study was carried on a small sample size of lactating Egyptian mothers from Urban Giza, who gave birth either to full-term or preterm babies. Mature milk was collected manually and was subjected to fatty acid analysis by gas chromatographic technique and the results were expressed as % concentration of total FAs. The results showed the wide mean ratio (30:1) of the essential FA linoleic (16.27 %) to alphalinolenic (α-ALA) (0.5 %) acid concentrations, which exceeds the respective worldwide average (WWA) of 0.32 %. Conclusion: The milks of Egyptian lactating mothers, the only nutrient supply of breast infants is deficient in its DHA. This deficiency may have future adverse effects on learning and scholastic performances. A national strategy is urgently warranted for supplementing pregnant and lactating women with oily fish rich in DHA content to achieve the target 2 of the sustainable development goal2030.

Jacob Setorglo   Philip Narteh Gorleku   Frederick Sarpong   Christiana Buxton   Francisca Naana Arthur   Bismark Anin Agyei   and Matilda Steiner-Asiedu   

Background: Iodine Deficiency Disorders (IDDs) continues to be a problem in Ghana after several years of salt fortification with iodine. Sustainable IDDs prevention requires a well-informed population and their willingness to use iodized salt. This study determined the levels of knowledge of men on iodized salt, IDDs iodized salt usage. Methods: This was a cross-sectional study involving 400 men (18 years and above) sampled conveniently at Nungua in the Ledzokuku Krowor Municipality of the Greater Accra Region, Ghana. Data on socio-demographics, knowledge, use of iodized salt and IDDs were collected. We computed descriptive statistics for socio-demographic data, knowledge of iodized salt, usage of iodized salt and knowledge on IDDs. We grouped scores for knowledge on iodized salt into poor and good. Scores for knowledge on IDDs were split into tertiles and labeled as low, moderate, and high. Chi-Square (χ²) test and multinomial logistic regression were performed to determine the association between socio-demographic characteristics, good knowledge on iodized salt and high knowledge about IDDs. Results: Majority of respondents (37.5%) were aged between 26 and 41 years. About 97.8% have heard about iodized salt and 69.3% first heard about iodized salt through the media. About 70.5% used iodized salt in cooking and 76.8 % of the respondents would encourage women to use salt in cooking. When knowledge level was split into two groups, the higher proportion (266 out of 400) had poor knowledge on iodized salt and in tertiles, the majority (184 of 400) had low knowledge on IDDs. There were statistically significant differences between age, marital status and educational level and knowledge on IDDs all at P< 0.001. Those with Junior High School education had 54% less chance, OR= 0.465; 95% CI: (0.244, 0.884) of obtaining good knowledge on iodized salt compared with those who had University education. Conclusions: Knowledge on iodized salt was low, and knowledge on IDDs was low among the men. There is a difference in the level of knowledge of IDDs among the socio-economic groups but not knowledge on iodized salt and its use. The more educated the men are, the more likely they are to use iodized salt.

Azandjeme Colette   Sossa Jerome Charles   Kandissounon Rosemonde   Patrick Makoutode   Sopoh E. Ghislain   Noël M. Paraïso   Glele Ahanhanzo Yolaine   and Ouendo Edgard-Marius   

High blood pressure (HBP) is a public health problem with high prevalence and serious medical consequences. The objective of this study was to determine the prevalence of high blood pressure and its associated factors in adults aged 25 to 64 in the health district of Aplahoué in Benin. This was a cross-sectional study carried out in 2016. The study involved 540 participants randomly selected by cluster sampling techniques. A questionnaire was used to collect data on dietary patterns, lifestyles and socio-economic conditions. The multivariate logistic regression model was used to identify factors associated with HBP. The median age of participants was 40 years old with an interquartile range of [32-51.5] years. Mean systolic and diastolic blood pressure were 133.56 ± 20.68 and 83.26 ± 13.29 mmHg, respectively. The prevalence of HBP was 29.94%. The urban environment, the high frequency of salt consumption, the low frequency of fruit and vegetable consumption, the habit of smoking, physical inactivity, and being overweight were found to increase the risk of HBP. Interventions to promote healthy lifestyles are timely in the health district of Aplahoué.

Huaibo Xin   

Mental health stigmas have been predominantly prevalent among different refugee populations resettled in both western and non-western countries. It significantly affects refugees' mental healthcare seeking behaviors. The current narrative review is to examine the anti-stigma strategies/interventions/programs that specifically address refugees' mental health stigma. Twenty-six out of 711 peer-reviewed journal articles, book chapters, commentaries, reports, dissertations, and theses published in 2019 or prior in English were included in the final themes analysis. Results were organized using a socio-ecological multilevel framework (intrapersonal, interpersonal, institutional, community, and policy levels), which include increasing refugee individuals' awareness of mental health and improving their attitudes and perceptions towards mental disorders; enhancing interpersonal interactions between refugee patients and people who can encourage them to seek mental healthcare and can provide them with culturally competent mental health services; delivering mental healthcare through schools and ethnic organizations; developing community-based bottom-up interventions and mobilizing community assets to destigmatize and normalize mental illnesses within refugee communities; and advocating for a change of social norm towards mental illnesses and mental health treatment. There is a significant lack of studies designed to explore the effectiveness of anti-stigma approaches among refugees, which leads to an urgency of developing these studies and supporting evidence-based practice.

Elizabeth Kateta   Josephine De Villiers   and Hermine Iita   

Ensuring that patients in chronic care and treatment such as tuberculosis adhere to medications has implications for their quality of life, health care costs and society at large. The purpose of this study was to assess and describe the knowledge, attitudes and practices of patients diagnosed with tuberculosis (TB) related to their treatments in Keetmanshoop district in Karas region, Namibia. A quantitative, cross sectional study was done among 76 patients who were receiving their TB treatment at various treatment centres in the district. Probability systematic random sampling method was used to select the participant for the study. Data was collected using a structured questionnaire, which was administered by trained interviewers. Data was analyzed using Epi-info software version 7. Analysis was done by means of a univariate and bi-variate analysis and association were explored using chi-squared test. The respondents were 18 to 60 years old of which 57.89 % were male and 42.11% were female. The findings of the study revealed that the respondents had a good knowledge on tuberculosis with regards to signs and symptoms of the disease. There was poor knowledge and misperceptions exist on the risk factors associated with transmission of tuberculosis such as shaking hands and drinking from the same cup with others. One third of the respondents (33 %, n=25) had missed their treatment and the main reasons given for interrupting the medication were forgetting to take the pills, long distance to health facility and not enough food to eat before taking pills. Treatment adherence is a big challenge in management and control of tuberculosis. Therefore, community and patient education and material support to patients remain important to ensure adherence to tuberculosis treatment. Stakeholder contributions and support are required to stem the scourge of TB in Namibia and globally.

Jeong-ah Kim   Daniel Terry   Sunny Jang   Hoang Nguyen   Julia Gilbert   and Mary Cruickshank   

Background: Research into patient safety has largely focused on healthcare organisations bureaucratic routines, with little research available regarding the impact of patient perceptions on clinical practice. Acknowledging and openly discussing patient perceptions of medical errors may result in improved quality of healthcare. The research study aimed to gain a better understanding of the public's perception of medical errors to drive a structured approach to improve healthcare outcomes. Methods: In this study, we examined the public experiences of medical errors using an anonymous on-line survey to collect empirical data from April to December 2018. A total of 407 responses were obtained with 303 participants meeting the criteria for inclusion in the study. Results: The majority (74.9%) of these participants identified that they had experienced a medical error during receiving healthcare in Australia and 73% of these confirmed that they were harmed as a result of these errors. Conclusion: Findings from this study indicate that many participants have experienced medical errors when accessing healthcare in Australia. These findings provide information and a deeper understanding of patient experiences and perceptions of healthcare service delivery which can be used by healthcare organisations to improve healthcare services and promote patient participation in their care.

Onuorah Samuel   Okafor Gerald   and Nwankwo Joseph   

Crude and refined oil contamination of the aquatic environment is one of the major environmental problems that lead to unmanageable loss of biological life that impacts negatively on global economy particularly in the areas of petroleum production and transportation. Bioremediation potential of Chlorella vulgaris isolated from a pond in Uwani, Enugu State, Nigeria was studied using standard methods. The organism utilized crude oil heavily, kerosene moderately and petrol minimally as shown by the varying degree of turbidity produced during fourteen days of growth in mineral salts- oil medium. Biodegradation experiment was carried out for forty-two days and the results showed that there was a decrease in pH and an increase in the absorbance of the mineral salts - oil medium. The percentage of degradation of the crude oil, kerosene and petrol by the organism was 80%, 70% and 60% respectively. There was a reduction in the peak numbers and peak areas of the gas chromatograms of the total petroleum hydrocarbons and polyaromatic hydrocarbons of the residual crude oil as well as the residual kerosene and petrol. This work therefore indicated that the microalga C. vulgaris can be used for the bioremediation of crude and refined oil - polluted aquatic environments.

Agonnoude T. Maurice   Houeto S. David   Sambieni N. Emmanuel   Adoukonou T. Thierry A   and Aguessy Constant   

Toward the end of that scaling up of performance-based financing (PBF) started in Benin since 2015, it's important to realize whether the impacts in terms of performance improvement of health facilities (HFs) will still be confirmed or not, especially as far as family planning (FP) is concerned. A longitudinal retrospective study covered by the period of 14 quarters of a year (Q1 2014 to Q2 2017), was conducted including all public and private functional HFs of the two health district. The outcome variable (performance of HFs in FP) was the increase rates of new acceptance for any modern contraceptive method through the study period. The independent variables were the quality of the structure, the quality of the process and the context. A linear regression model was adjusted to find out the explanatory variable of the performance; the significance threshold was 5%. 55 HFs participated to the study. There was no improvement in supplying process of FP services (p=0.308). There was no improvement in both trained staff (p=0.67) and midwifery staff (p=0.75); however, there was a significant improvement in the rest of the structure at the risk of 10% (p=0.063) and the performance in FP (p<0.001). In multivariate analysis, the evolution of the structure was the only explanatory variable (p=0.029) of HFs performance in FP; in rural areas, the structure-process interaction (p=0.038) was the explanatory variable of HFs performance in FP, whereas in suburban and urban areas, the models were not significant. PBF should act not only on the structures but also on the processes of supplying services, taking into account the context.

Daniel Terry   Hoang Nguyen   Alicia J Perkins   and Blake Peck   

This paper examines the notion of clinical supervision and takes a close look at what it means from the perspective of both the supervisee and the supervisor, considering how it can be of benefit to the learner, the teacher and the patient. Clinical supervision has been shown to be vital for the development and consolidation of undergraduate and postgraduate education, while having a positive impact on patient outcomes and as such is a fundamental component in healthcare education. Central to supervision is achieving the best outcomes for the supervisee, and effective supervision ensures the development of confidence, professional identity, and the consolidation of therapeutic knowledge. Clinical supervision provides a platform for extending the supervisor-supervisee relationship beyond the student-teacher model to one of mutual personal development in contemporary knowledge and skills for clinical practice. Despite the perceived importance of clinical supervision for healthcare more broadly, there is evidence to suggest that few supervisors are adequately prepared with the theory and practice of clinical supervision to adequately fulfill the expectations that the role entails. It follows therefore, that in many cases, there is an expectation that the health professionals will supervise without adequate preparation. This paper, although not a panacea, may assist those who are supervising and who seek or require some guidance and support.

Motomi Otsuka   and Hiroya Matsuo   

This study aimed to investigate whether medical care and health services provided during pregnancy and childbirth influence the satisfaction with pregnancy and childbirth in Japanese mothers residing in the UK. The participants (N=41) were members of the Japanese child-rearing group in London, UK, who had experienced antenatal to postpartum care in the UK. The questionnaire contained the background of the Japanese mothers residing in the UK, pregnancy and childbirth, difficulties in the UK's hospital visiting, satisfaction with health care service, adviser and evaluation scales for pregnancy and childbirth. Almost all participants consulted their Japanese friends residing in the UK, or husbands/partners, and they obtained the information on pregnancy and childbirth from the Internet written in Japanese and Japanese friends who were living and had experienced childbirth in the UK. Approximately 80% of Japanese mothers were satisfied with pre-natal clinic and childbirth in the UK. They were satisfied with the health care provided by midwife and home visiting service after discharge from the hospital. The satisfaction with pre-natal clinics in Japanese mother residing was related to intercultural understanding, while the satisfaction with childbirth was related to understanding of medical system, cross-cultural understanding and trust of medical stuff.

Gouthon Gilchrist Fabrice   Bio Nigan Issiako   Paraïso Moussiliou   Tévoedjrè Doréana   Gouthon Polycarpe   Ouendo Edgard-Marius   and Ahodéhou Marlyse   

Children are an important part of any society. During the educational process, it is useful for them to enjoy a life of good quality in order to participate in the development of their community. Objective: This study aims to determine the quality of life of secondary school students in Dangbo in south-eastern Benin. Method: A total of 318 adolescent students (157 girls, 161 boys) from the 6th, 5th and 4th grade classes were selected according to the non-random method and the convenience technique answered a questionnaire that takes into account the five basic human needs: food, shelter, clothing, health and education. Results: A total of 159 (50.0%), 227 (71.4%), 318 (100.0%), 311 (97.8%) pupils met the criteria of good levels of educational conditions, housing, food and clothing respectively. Only one student, or 0.3% of the respondents, met the criteria for good levels of health conditions. The good quality of life resulting from the good living conditions was observed in only 122/318 or 38.4% of the students surveyed. Conclusions: Since health is the weak link in the quality of life of these students, an epidemiological diagnosis is necessary to identify the modalities of effective management.

Christiana Asiedu   

The purpose of the study was to assess the effects of socio-cultural and physical factors on the use of SBAs in the Central Region of Ghana. Among socio-cultural and physical factors which may influence use of SBAs with current pregnancy were money for transport and health care (65%), distance (58%), knowledge about signs of labor (51%), and need for closer attention from relatives (51%). The differences from the two logistic regression model analysis that were done were statistically significant (χ²=7.06, p=0.0079). The odds of SBA utilization for mothers who needed closer attention from relatives were 1.6 times higher (OR=1.56, 95% CI=1.05-2.34, p-value=0.027) than mothers who did not need closer attention. It was recommended that health service providers should ensure client and family-centered care is provided to make the health facilities user-friendly.

Muyiwa Lawrence Akinluyi   Folusho Charles Awe   Oluwatoyin Olugbenga Adeleye   and Mayowa Paul Ogunruku   

This study appraised the influence of design characteristics of the paediatric hospital physical facilities with a view to develop the physical facilities design characteristics policies for paediatric hospital designers, managers and policy makers. In this study, the hospital physical facilities are defined by the spaces used by the professional staff, equipment, the building form, their furniture and fixtures. Also, the design characteristics of the hospital physical facilities are defined by the building proximity, privacy, wayfindings, flexibility and adaptability. The notable paediatric hospital selected in the developed country is Emma Kinderziekenhuis Pediatric Hospital in Amsterdam, Netherland because it has developed a remarkable work in the healthcare settings with a deep concern on child-centred design, which were informed, implemented and accompanied by architects. Also, Peadiatric department of University College Hospital (UCH), Ibadan Nigeria was selected because it is the largest city in Nigeria which can be used to generalize what is obtained in peadiatric hospital physical facilities in southwestern Nigeria. Through analysis of one of the notable hospitals in both the developed and developing worlds, the design characteristics of selected hospital were examined using case study method such as the use of building plans, the site layout and the use of photograph among others. The results of the investigation show that hospital design characteristics have a great influence on both the patients and staff including the visitors. However, the planning and design characteristics of the physical facilities in the Netherland Children Hospital were found to be very good compared with its counterpart in Southwestern Nigerian University Teaching Hospital. It is, however, concluded that, the Nigerian University Teaching Hospitals should learn from the design characteristics appraised from the Netherland Children Hospital. The result of this study will be useful as a design policies standard for the Nigerian government, healthcare developers and children hospital designers in southwestern, Nigeria.

Anvoh Koutoua Yves Blanchard   Agbo Adouko Edit H   Koko Anoma Casimir   Diabagaté Hadja Fatim   Houroupou Mbambai Jacques   and Brou Kouakou   

Glycosylated haemoglobin (HbA1c) is a form of haemoglobin that is measured primarily to identify the average plasma blood glucose concentration prolonged periods previous 120 days. Cardiologist used to treat patients generally when glucose level is over 1.26g/l. Unfortunately, Haemoglobin A1c was seldom controlled. The objective of this study was to detect persons with type 2 diabetes risks by the correlation between HbA1c levels and random glucose one and propose a good management by lifestyles. Methods: This descriptive study included 216 patients selected randomly with cardiovascular complications and ocular diseases but none diabetes diagnosed. Glycaemia and HbA1c measurement were done. Results: All the patients were not diabetes diagnosed. There was a low correlation between the blood glucose levels and the glycated haemoglobin r=0.2761). Hypocaloric diet applied to type 2 diabetes management decreased glycaemia and Haemoglobin Hba1c. The decreasing of Hba1c was estimated from 14% to 17% of the initial values. Conclusions: Glycaemia must not only be considered to manage cardiovascular complications at Cardiology Institute of Abidjan. The contribution of hypocaloric diet with high vegetable and one fruit intake a day lead to better type 2 diabetes management.

Taslima Begum   

The aim of the study was to examine parents' current level of knowledge, attitudes and practices related to early childhood development (ECD). The findings found that few parents have good knowledge and practices regarding ECD although most of them have good level of attitude. These results indicate gaps among knowledge attitude and practices. Regarding child's health and nutrition about 55% of infants were exclusively breastfed. Moreover, 45% infants received complementary liquids foods (typically around 4-5 months) and 12% were given infant formula. Interestingly, mothers engaged both controlling and indulgent feeding behaviors toward their child. Moreover, most of the mother used negative disciplinary techniques to guide their children. Finding on parental support for early learning found that 54% of households engaged in early and school readiness activities with their child. Only 25%, 3 to 5 year's old children attended kindergarten school among them 92% children recognized letter or numbers. Only 8% parents perceived their child had some type of physical or learning difficulty despite most of them (94%) did not consult with others. However, 18% children had been seriously injured when parents leaving their child to someone else.

Tévoédjrè Doréana Frida   Paraïso Moussiliou   Gouthon Polycarpe   Gouthon Fabrice Gilchrist   Tonon Affidéhomé Brigitte   and Ouendo Edgard-Marius Dona   

Measuring health-related quality of life (HRQoL) facilitates the monitoring and evaluation of the population's health status, and country's public health policies. Studies undertaken in the Republic of Benin on this issue are quite rare. Objective: The objective is to study the level of HRQoL in people with chronic communicable or non-communicable diseases at the Ouémé department in Benin. Method: This is a cross-sectional and analytical survey conducted at this department in 2018. Medical Outcomes Study SF-36 questionnaire was administered to 523 people over 15 years of age who were suffering from chronic disease, and they were selected by the snowball technique. The level of HRQoL defined in three modalities was determined from the four dimensions of each of its physical and mental components. Results: In the Ouémé department, eight chronic diseases were identified and the level of HRQoL appeared higher in rural areas for hypertension, sickle cell disease and sinusitis. In total, 73.8% of people with chronic diseases had high levels of HRQoL. The level of HRQoL was higher in rural areas than in urban areas (85.2% versus 64.8%; p < 0.0001). Interventions on HRQoL at the Ouémé department must take into account the disparities between urban and rural areas.

M Ohiduzzaman   R Khatun   S Reza   M A Kadir   S Akter   M F Uddin   M A Rahman   R Mallick   M A Samad   M M Billah   and M M Ahasan   

Thyroid uptake and scintigraphy using Tc-99m pertechnetate has proven to be more advantageous than with I-131 iodide, since the images have better quality, the procedure is faster and the patient is submitted to a lower radiation dose. Tc-99m has been used worldwide to study the thyroid function because of a number of advantages such as short half-life, short biological half-life, short effective half-life, short retention in gland and no Beta (β-) radiation, providing low dose to gland (10,000 times less than that of I-131), low cost and readily availability. Otherwise, I-131 with its high radiation burden (1-3 rad/mCi) has long half-life and causes Beta (β-) particle emission. Its main gamma photon has high energy (364 keV) which also causes poor image quality. The experiment is carried out at the Institute of Nuclear Medicine and Allied Sciences (INMAS), Bangladesh Atomic Energy Commission, Dhaka Medical College Hospital Campus, Dhaka-1000. In the present work, the study consists of 109 patients (76 female and 33 male) with ages ranging from 14 to 66 years. The patients studied with Tc-99m found to be hyperthyroid of 57 and in case of I-131, the findings were 60. The agreement between I-131 and Tc-99m is 95% and the correlation coefficient, r between Tc-99m & I-131 is = 0.879, which indicates strong correlation between them. So, it is statistically significant and makes a good agreement. The outcome of this study may provide valuable information about thyroid treatment and also may play important role in the management of thyroid patient.

Eric N. Windsor   William D. Zelenty   Blake M. Bodendorfer   Richard Verstraete   and Mark W. Zawadsky   

BACKGROUND: There has been an increase in total hip arthroplasty in obese patients and surgical complication rates are known to be higher in this population. This retrospective study evaluated complication rates for obese patients undergoing total hip replacement compared to non-obese patients. Additionally, we compared complication rates for direct anterior approach (ATHA) versus posterior approach (PTHA). METHODS: This study was an IRB approved retrospective review of 210 patients undergoing ATHA and 201 patients undergoing PTHA during the same time period by 2 total joint surgeons. Non-obese patients were compared to obese patients using body mass index (BMI) classification. Minor and major complications were reviewed as well as length of stay, disposition, and other short-term outcome measures. RESULTS: The non-obese cohort (BMI < 30) had lower complication rates (2.8% major, 4.4% minor) compared to the obese cohort (8.7% major, 9.9% minor). Major complications by obese class were: Class I 8.6%, Class II 7.1% and Class III 11.5%. The non-obese ATHA cohort had lower complication rates (0.8% major, 5.0% minor) compared to the PTHA cohort (5.0% major, 6.7% minor). Obese patients had 6.3% major and 9.9% minor complication rates in ATHA, compared to 11.1% major and 10.0% minor complication rates in PTHA. Lastly, the evaluation of short-term outcomes showed more favorable results for ATHA for both obese and non-obese patients. CONCLUSION: Obesity was associated with an increased risk of complications and less favorable short-term outcomes following THA. Direct anterior THA was associated with lower complication rates and more favorable short-term outcomes.

Mauricio Fuentes A.   Antonio Marzzano R.   and Karla Yohannessen V.   

The purpose of this study was to examine the association between exposure to high traffic noise levels in housing and the proportion of high annoyance and self-perceived health problems, through a survey applied to comparable groups of individuals with and without exposure, selected in residential buildings from urban Santiago, Chile. It was an observational, cross-sectional study. Buildings with sides exposed and unexposed to high traffic noise levels were considered. In each building, independent samples of dwellings from each side were selected. A questionnaire consisting of three parts was applied: socio-demographic and related characteristics, self-perceived health state, and annoyance caused by different sources including traffic noise. To assess association between exposure to traffic noise and each self-perceived health response (including high annoyance), multiple logistic and log-binomial regression analyses were applied, adjusting by sociodemographic and related variables. Four residential buildings were included, achieving a total of 425 respondents, 200 living in exposed dwellings and 225 living in unexposed dwellings. Adjusted significant association was found between exposure and high annoyance, high degree of problems with concentration, sleeping and feeling rested, presence of head or neck ache, and feelings of depression, anguish or neurosis.

Septime Hessou   Yolaine Glèlè Ahanhanzo   Alphonse Kpozèhouen   Tranquilin Yadouleton   Odile Sodoloufo   Virgile Capo-chichi   Bruno Doussoh   Bernard Gnahoui-David   Alphonse Biaou   and Colette Azandjèmè   

Transgender individuals are recognized globally as a key population that is at heightened risk than the general population for transmitting and contracting sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). One of the social outcomes of the gender transition process is the adoption of risky behaviours as coping strategies. Examining the unique health-related needs of transgender individuals in Benin, this study describes the experience of being transgender, along with the social and community ramifications associated with this identity. The research team conducted a cross-sectional study in 2017. Study participants were recruited via respondent-driven sampling among networks across Benin. Inclusion criteria included self-identifying as transgender and being over 15 years of age. Data were collected via questionnaires regarding individuals' management of the gender transition, reactions within their community and social spheres, and engagement in risky behaviours. A total of 326 transgender individuals were identified with a majority of participants being born biologically male (89.57%). The average age was 24.13±4.88, with a strong representation of students (36.50%). In 64.72% of cases, participants' families were informed of their transgender identity. The overall attitude of families was of acceptance/support in 7 cases out of 10. Stigmatization and discrimination were reported by 50% of the subjects and 59.02% were subjected to at least one assault. Among these, half were unable to pursue legal action in response, with the main reason being a lack of knowledge of their options for legal recourse. Having multiple sexual partners was the most common risky behaviour among participants, occurring in 81.54% of the cases. Transgender individuals constitute a population with specific needs in Benin. The services and interventions dedicated to this population must integrate the prevention of STIs and HIV, along with providing legal, social and psychological support.

Chenjoh Joseph Nde   Alice Raymond   Ndong Ignatius Cheng   Guy Roger Etoundi   Yauba Saidu   Johannes Tabi Atemnkeng   and Wilfred Fon Mbacham   

Cameroon faces significant income and health inequalities, due to the health sector's reliance on out-of-pocket spending for 70% of healthcare financing. To solve this problem, the government in 2015 began reflections for the putting in place of a universal health coverage (UHC) scheme. However, a number of planning, budgeting and resource management processes must be strengthened to facilitate this reform. This paper aims at reviewing the structure of resource allocation within the ministry of health to assess if it reflects the government's desire to enhance service availability and readiness for the impending UHC. Data was derived from finance laws (chapter 40) of 2014 to 2018. The data was analyzed using Microsoft Excel. The results reveal a high centralization of the budget in favor of the central administration to the detriment of the operational level. Allocations to the regional and district levels are insensitive to the size and needs of the population of the regions and districts. As a consequence, there are great disparities between the regions and between urban and rural areas, leading to inequity in service delivery. In order to increase the quantity and quality of primary care in an effort to reach UHC, we recommend that more resources be directed to the operational level while district managers are capacitated to effectively and efficiently use these funds.

Angélica Ojeda García   Bernardo Turnbull Plaza   Jaime Fuentes Balderrama   Cinthia Cruz del Castillo   and Alison K. Cohen   

Poverty is one manifestation of inequality: it is often a consequence of an unequal distribution of social resources, especially in urban settings. The lack of resources can impact people's quality of life and provoke a spiral that reinforces the cycle of poverty. The concept of resilience can be a useful framework for understanding a person's positive adaptations to urban poverty's environmental stressors. This paper seeks to comprehensively understand how urban poverty influences the social functioning and well-being of individuals in urban areas. We conducted a systematic review to identify the risk factors that limit or increase vulnerability and the resilient responses that promote development and psychological functioning among those experiencing urban poverty. We explore how resilience can help overcome the vulnerabilities urban poverty creates and identify the coping strategies some families experiencing urban poverty use. We encourage researchers and practitioners to take a strengths-based approach to understanding individuals' resilient responses and community involvement as they socially adapt to unequal conditions in diverse and myriad ways.

Adella Campbell   Vanesa M. Tennant   and Fitzroy Henry   

There is an ongoing discussion between governments, international agencies, and advocacy groups on whether user fees imposed at government health facilities in poor countries should be removed. Proponents argue that abolition of charges would lead to greater access for the poor, therefore offering the underserved the opportunity to access health services. There are limited studies that examined how health practitioners, an important stakeholder are affected. This research examined the impact of the 2008 removal of charges for health services on health practitioners in Jamaica. Using a mixed method evaluation design, we found that main health practitioners - nurses, doctors and pharmacists were not satisfied with the policy change. When compared to that before removal of charges, 10% less practitioners felt that performance on the job was good. Health practitioners alluded to increased workload, negative effects on their physical and emotional status and dissatisfaction with their work environment. Other problems encountered by health practitioners included unavailability of resources, shortage of staff, lack of equipment and lack of administrative support. The lesson learned for policymakers is that the critical problems identified will eventually outweigh the substantial health gains if adequate resources (financial and human), administrative support as well as improved service management are not soon injected into the public health system.

Carolyn Mornane   Michelle Franc   Maureen Waddington   Blake Peck   and Daniel Terry   

Twinning programs in health have gained increased recognition as a WHO preferred strategy for providing a sustainable strategy for enhancing the delivery of best practice healthcare globally. The Tonga Twinning Program (TTP), represents a longstanding relationship of some twenty-five years between The Ministry of Health in Tonga and St John of God Hospital, Ballarat, Australia and provides a compelling example of what can be achieved. This article presents the findings from a longitudinal exploration of the experiences and perceptions of the TTP through the voices of those key-stakeholders situated in Tonga who have engaged with the program. Informed by the tenets of hermeneutic phenomenology, a modified thematic analysis highlighted two major themes, ‘A shared mission' and ‘The outcomes are more than the tangibles', which supported by a series of sub-themes, identify the core components of the experience of the TTP. This study suggests that the TTP has supported a collective sense of bringing the very best available knowledge and skills to the people of Tonga and has fostered a genuine and open dialogue between partners as a mechanism for change that goes well beyond simply a capacity to replicate skills and instead has establish a genuine reciprocity akin to being a family.

Kerry Brodbeck   and Nancy Duphily   

The role of the nurse is often associated with healing and helping bring people back to health. While this is a large aspect of the nursing profession, the nurse also cares for patients who are dying. The care delivered at this time revolves around the comfort of the patient, as well as ensuring that all of the patient's needs are met, including any cultural or spiritual needs. In order for the care of the patient to transition from curative to comfort measures, it is necessary for a diagnosis of dying to be made. This diagnosis should then be communicated with the patient and family. When the diagnosis of death is not communicated in a timely manner, it has been found that the patient's do not receive quality end of life care. This diagnosis surpasses all other diagnoses and shifts the focus towards the comfort and well-being of the patient. Care at the end of life includes pain management, discontinuation of routine vital signs and laboratory tests and coordinating care with other professionals to ensure the best quality care is being offered. Since the end of life is a new experience for most, it is important that the nurse informs the patient and the family of interventions that will occur and all resources available to them. Palliative care is a resource that can be implemented along curative measures at any stage of a disease, which assists the patient with pain and symptom management. As the disease course continues and the patient's life expectancy is less than six months, hospice care is a resource that should be offered. The nurse, along with the rest of the care team, should ensure that these resources, along with legal documents such as advanced directives or healthcare proxy forms are available to the patient. At the end of life, the nurse is on the front lines to ensure that the patient is receiving the best quality care possible. This is done by communicating and listening to the patient and developing a therapeutic relationship with them.

Guilherme Jose de Paula Oliveira   Samuel Ferreira   and Andre Barbosa   

In this article we report a case of Abernethy malformation, also known as congenital extrahepatic portosystemic shunt (CEPS). It is a rare vascular malformation in which the portal vein drains into a systemic vein, diverting it from its normal path to the liver. The clinical presentation is variable and most commonly the shunt is diagnosed during the propaedeutic for investigation of the symptoms. Discussion and diagnosis: R.B.S.R, 21 years old, male, with history of liver disease and previous diagnosis of multiple liver adenomatosis from 9 years of age, was hospitalized for pre-transplant liver evaluation. In the medical history, he presented delayed neuropsychomotor development, congenital scoliosis, neurogenic bladder and single kidney, and had also undergone two surgeries. His initial laboratory tests showed increased transaminases and canalicular enzymes. Ultrasonography, radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were performed, which enabled us to identify and confirm important points for diagnosis. Conclusions: It is important that the radiologist recognize the findings early. CT and MRI are fundamental in the management of the syndrome, since they provide the information for diagnosis, planning, intervention and follow-up, as well as the identification of complications.

Ndapeua Shifiona   Marie Poggenpoel   and Chris Myburgh   

The aim of this study was to explore and describe the lived experiences of individuals living with chronic mental illness, and the experience of those caring for them. A qualitative, explorative, descriptive, and contextual research design was used. Data was collected from four (4) multiple case studies which comprised of twenty-four (24) participants, utilizing in-depth phenomenological interviews with individuals living with chronic mental illness; one focus group interview with family members from each case, community members and health care workers. Interviews and focus group discussions were tape-recorded and transcribed verbatim. Data was analyzed by means of Tesch's open coding method. Three (3) main themes were identified; (a) experience of ineffective individual coping related to living with chronic mental illness, (b) experience of alteration in family processes related to the presence of long term mental illness, and (c) experience of individuals' impaired social interaction related to substance abuse and dysfunctional system evidenced by verbalized discomfort in social situations. The study concluded that an understanding of patients' experience by mental health nurses will enable them to facilitate the development of constructive interaction between individuals living with chronic mental illness and caregivers.

Chenjoh Joseph Nde   Alice Raymond   Yauba Saidu   Ndong Ignatius Cheng   Divine Nzuobontane   Johannes Tabi Atemnkeng   and Wilfred Fon Mbacham   

Access to health care is a fundamental human right, which places a legal obligation on states to ensure access to quality, timely, acceptable, and affordable health care for its citizens. However, many states struggle to meet this basic right for their citizens given that every year about 100 million people are pushed into poverty, while 150 million people suffer financial catastrophe due to out of pocket payments for health. In Cameroon, studies have shown that about 64% of households cannot access healthcare, because they perceive the cost of care to be high. In 2012, the National Health Accounts (NHA) estimated that about 70% of the Total Health Expenditure (THE) for the country was borne by households. Compared to its peers, the contribution of Cameroonian households is the third highest in Sub-Saharan Africa, where the average is 34%. To remedy this situation, Cameroon has initiated reflections aimed at establishing a universal health coverage (UHC) scheme for its population. This paper therefore aimed at providing a synthesis of Cameroon's progress and assessing if the country is on track to achieving UHC by 2035.

Huaibo Xin   

The Community-based Participatory Research (CBPR) has been well defined and widely applied to different study populations in a variety of health topic areas to address the urgency of translating research into practice, reducing health disparities, improving health equity, and advocating for health policy changes. The current study aims to systematically examine how CBPR has been applied to improving underserved refugee populations' health and identify the successes and challenges of CBPR utilization among refugees. A total of 930 peer-reviewed journal articles, reports, commentaries, theses, dissertations, books, and book chapters in English, retrieved from several major databases (e.g., EBSCO, ERIC, PubMed, PsycINFO, CINAHL Plus, and Google Scholar) were initially reviewed. Fourteen peer-reviewed journal articles were finally selected and analyzed using the theme analysis. Results showed that successes of utilization CBPR in refugee health studies were achieved in areas of shared learning, trust, recruitment, methodological rigor, advocacy, sociocultural determinants, dissemination/ sustainability, ethics, cultural competency, and stigma. However, the CBPR practice was also challenged by issues emerging from institutional culture and structure, clinical procedures, non-probability sampling, self-reflection, and repetition. Current literature suggests that overcoming these challenges requires both institutional restructure and policy changes, and changes in the focus of both internal and external funding mechanisms.

Eremutha Awasighe Francis   Okosun Onaburekhalen Thankgod   Gabriel Veronica Chizoba   and Diakpomrere Oghenevweta Vincent   

A substantial number of Nigerian women/ girls have unwanted pregnancies due to their low contraceptive prevalence. Many of these pregnancies are resolved through unsafe abortion. Unsafe abortion constitutes a huge burden to women's health and reproductive lives especially in Nigeria where it is perceived illegal. The media plays a significant part in shaping public perceptions of health issues, and abortion attracts continued media interest. The objective of this research was to explore the context of abortion stigma on campus using University of Benin as a reference point, through qualitative and quantitative research at baseline/ endline. In achieving this, related youth concerns on the campus that fuels unplanned pregnancy and unsafe abortion such as rape, none use of contraception, drug abuse and cultism were equally assessed to determine the level of stigmatization placed on perceived offenders. Findings were used to develop an intervention strategy on stigmatizing attitudes and beliefs about abortion. Following airing of 24 episodes radio drama on abortion and related concerns, findings were scored and interpreted using the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS). Our findings showed significant decrease in the negative dimensions and improvement in positive discuss of abortion following increased awareness and education on abortion and related concerns.

Liciana Vaz de Arruda Silveira   Alberto Rubén Osella   María del Pilar Díaz   and José Eduardo Corrente   

Non-Communicable Chronic Diseases (NCCDs) are the leading causes of ill health in elderly populations and are associated with increased risk of death. Then, the aim of this paper is to estimate the effect of High Blood Pressure on all-causes mortality among subjects aged ≥65 years old in three scenarios with different socio-economic backgrounds and urbanization processes by using flexible parametric survival models. Three cohorts coming from Brazil (n=365, 8 years of follow-up), Argentina (n=1800, 10 years of follow-up) and Italy (n=2472, 30 years of follow-up) were considered and only subjects older than 64 years included. Time to death (months) from enrolment and all-causes mortality were considered. Statistical analysis included Frailty Cox's Model and Flexible Parametric Survival Analysis. Due to the two-level structure of variability (subjects nested into cohorts), multilevel mixed-effect survival regression models were fitted. For modeling purposes, only the first twelve years of follow-up were considered. Frailty Cox model showed significant positive effects of age and an effect modification of High Blood Pressure and Non-communicable diseases, but not effects proportionality. Multilevel modeling evidenced a positive statistically significant effect of Age, Non-Communicable Chronic Diseases and Smoking. There was also an effect modification of Non-Communicable Chronic Diseases on High Blood Pressure. High Blood Pressure and Non-Communicable Chronic Diseases are important causal components and strong risk factors of cardiovascular mortality in these countries.

Eremutha Awasighe Francis   Gabriel Veronica Chizoba   and Olumide Adesola   

Sexual and Reproductive Health (SRH) issues are important aspects of adolescent health and development. Increasing access to newer mobile technologies such as computers and cell phones makes it possible to reach adolescents with sexual, reproductive and other health messages via these media. The study was designed to determine young people's knowledge and use of media technologies in the provision of SRH information and services. A cross-sectional study that employed a mixed methods approach was conducted. This involved both quantitative and qualitative methods. 1342 young persons were questioned: 53.1% males and 46.9% females with an overall mean age of 17.1 ± 3.5 years. Almost 66% of the adolescents had access to the internet and mostly at home (87.3%). More of those in the rural (approximately 70.5%) then urban (61.4%) had internet access and <50% of all the young people were aware that one could obtain information on locations of youth friendly centres from electronic media. Desires to improve their knowledge on the SRH issues were some reasons mentioned by the young persons for their choice of the internet as a source of SRH information. The findings shows that it is imperative for potential providers to ensure that SRH information made available through these mobile technologies is accurate and up-to-date and that information on reliable sources of care are also provided to facilitate linkages to reliable SRH care.

C. G. Metonnou-Adanhoume   V. Agueh   C. S. Azandjeme   C. J. Sossa   A. Kpozehouen   J. Hessou   J. Darboux   and M. N. Paraïso   

This study aims to determine the performance of the FINDRISC tool for screening adults at risk for type 2 diabetes in an African population in southern Benin. This retrospective study included 536 subjects aged 25 to 65 years. The FINDRISC questionnaire score was calculated using seven components: age, body mass index, waist circumference, regular practice of 30 minutes of physical activity, regular consumption of five portions of fruits and vegetables, the family history of diabetes and the presence of high blood pressure. The performance of the tool was determined from the FINDRISC score and fasting blood glucose The "Receiver Operator Characteristic" (ROC) Curve of the FINDRISC score was used to define the optimal cut-off value of the tool for. The FINDRISC threshold-optimal value for detecting T2D risk in southern Benin was 8.5 with 77% sensitivity, 89% specificity, 45% positive predictive value and 71% negative predictive value. The area under the ROC curve was 0.86 (95% CI: 0.81-0.90). This study revealed that the optimal threshold value for detecting the medium or high risk of T2D observed in Benin is lower than Finland's one. Further studies including larger and more representative samples need to be carried out to confirm this finding.

Rola A Halabi   Wafaa Abou-Zeineddine   and Margaret Ann Breakenridge   

Diabetes is a chronic disease state affecting millions of patients, many of which have uncontrolled diabetes and not under a physician's care. The economic and health impacts that a pharmacist can have on patients overall health is well known. As an increasing number of patients suffer from uncontrolled diabetes and its complications which makes the role of pharmacists more important than ever to provide patients with knowledge of the many therapeutic options available, appropriate self-testing techniques, and other important lifestyle modifications. The role of pharmacists has expanded to include ambulatory care in an outpatient setting. The purpose of this study is to evaluate the impact of pharmacist involvement in diabetes management in an ambulatory clinic, where there previously has been no pharmacist participation. Comparing data from a pilot study performed without pharmacist involvement, pharmacists have been able to achieve better Hgb A1C reductions than the pilot study performed in fiscal year 16 (FY16) at an average of 3.36 ± 1.76. Although the sample size of patients was small at only 5, these are promising results of the impact that in depth patient education can have on improving outcomes.

Abigail Odozi Ogwezzy-Ndisika   and Tommy Solomon   

This study examined the knowledge, attitudes and practice of hand washing among mothers of children 0-59 months of age in Lagos Nigeria. The descriptive survey method was used to gather data for the study. The study was conducted in three local government areas of Lagos. The local government areas are Eti-Osa, Lagos Mainland and Alimosho. 934,886 female residents of the three local government areas formed the population of study while 406 respondents formed the sample size. Purposive sampling technique was used to select the respondents. The study found that 7 in 10 mothers of children 0-59 months of age had high exposure to the campaign about the danger of dirty hands (73.8%). About 6 in 10 of them similarly had high knowledge of the subject matter and as a result, mothers who were knowledgeable about hand washing practiced it. It concluded that has been a gap between recommendations on improving hand washing practice and actual actions on such recommendations. Hence, this study recommends that intervention efforts should address the infrastructure gaps that negatively impact on the availability of these hand washing-boosting factors, particularly, access to water, if improvement is to be achieved in terms of practice.

Muatsim Ahmed Mohammed Adam   Salma Faroug   Rasha Sayed   Adel Elduma   Hamdan Mustafa   and Eltahir Awad Gasim Khalil   

Proper shipping of infectious materials is an important practice to prevent healthcare workers (HCWs), other people and environment from spread of biological threats. The main purpose of this study was to determine healthcare providers' knowledge, and practices about transportation of infectious substances. A self-administered designed questionnaire was used to collect relevant data from study respondents. Primary data were double entered and analyzed by using statistical package for social sciences (IBM SPSS statistics 20). Descriptive, in addition to the effects of predictors on dependent variables were applied. Multiple logistic regression model was used to assess the association between dependent variables and predictors. It has been found that; the overall mean percentage of knowledge was 57.1 (95 CI: 54.1, 60.2), while mean percentage of practice was 68.9 (CI: 95% 66.7 – 71.1). Response reliability scale was 89.0% based on Cronbach's alpha. The highest knowledge regarding transportation of infectious substances was observed among laboratory specialist (33.9%) and doctors (25.4%) respectively. High percentage of practice was observed among laboratory specialist was (34.6%) and low percentage was among public health officers and doctors (15.9%). Majority of study respondents did not receive training in transportation of infectious substances (70.9%). Knowledge and practice on transportation of infectious substances among health care providers are low. More efforts are needed to fill the gap in knowledge and practice by applying effective training programs that can lead to increase skills and awareness of health care providers.

Eremutha, Francis   and Veronica Chizoba Gabriel   

Youth represent a tremendously valuable asset to the society therefore working with them to make a healthy transition to adulthood is critical to the world's development now and in the future. The issue of youth-friendly health service has become a matter of concern as many young people still do not have access to such in the country. The community survey was designed to generate increased understanding of the barriers that limit youth access to sexual and reproductive health services(SRH) offered by Primary Health Care (PHC) facilities in Nigeria. Stratified and Purposive Sampling with qualitative and quantitative research methodology was adopted. Qualitative data were obtained through 12 Focus Group Discussions (FGDs) and 48 Key Informant Interviews (KIIs). For the quantitative component, an interviewer-administered questionnaire was used to elicit information from 300 randomly selected adolescents and youth. The mean age of respondents was 18.9 ± 4.4 years. Reported barriers to youth's access to SRH services were lack of awareness (67.3%), cost of services (46.7%), negative attitude of health care providers (39.7%) and fear of parents and what people will say (32.0%). The results shows that community mobilization for awareness creation and support on SRH issues (59.3%), will support youth to better access SRH services in PHC facilities

Gabriel Brito Barbosa   Lucas Santos Pimentel   Arthur Ribeiro Costa Carvalho   Thais Ribeiro Costa Carvalho   and Ana Rita Marinho Ribeiro Carvalho   

Background: Neuroendocrine tumors are rare, but when coexisting with Multiple Endocrine Neoplasia Type 1 Syndrome in the same patient, the literature shows 80 to 100% association. Represents an autosomal dominant disorder due to mutations in tumor suppressor gene MEN1 and it's defined as the development of two or more tumors from the main three endocrine sites: the parathyroid glands, the pancreatic islet and the Pituitary gland. We present a case of a patient with a compatible family history and classic imaging findings for MEN1 Syndrome. Case report: Male, 28 years old patient genetically diagnosed with the MEN 1 Syndrome who presented to our image service for abdominal tumors' screening. Submitted through multiples imaging exams such as CT, MRI, PET/CT to follow up the diagnosis, in which was found a pancreatic mass measuring over 3 cm, with another 3 little pancreatic lesions as well. The patient received indication to surgery, with further anatomopathological and immunohistochemistry studies confirming the well- differentiated neuroendocrine tumor. Conclusion: Due to the wide range of malignant potential, it's recommended annual screening, as minimum, with biochemical and image techniques. Surgery is the only treatment capable of tumor's eradication, which consists on a pancreatectomy (lesions sized more than 1-2 cm).

Bruno Sousa Dos Santos   Maya Wielert   Ieva Krieva   Kathryn Mullan   Sandra Seimane   Aleksejs Visnakovs   and Olegs Sabelnikovs   

Several studies in recent years have identified the importance of developing a more standardized diagnostic approach to patients suspected of acute pulmonary embolism (PE). Still many doctors prefer a theoretical approach to the diagnosis of PE without the use of pre-test clinical predictive tools. Through the process of audit, we collected data available from the files of patients who underwent computer tomography pulmonary angiography (CTPA) and tested this data within the pre-test probability tool "Wells criteria score". Additionally, other important variables that were previously validated as well as those with possible diagnostic value were also analysed, as these may prove to be useful indicators to further develop the pathway towards a more efficient diagnosis of PE. The results within this study were compared to similar studies. With the aim of understanding the possible benefits of a more purposely structured approach, this study ultimately intends to support the development of PE protocols towards a more standardized approach to its diagnosis. Subsequently, it seeks to promote improvement in patient safety and accuracy in diagnosis as well as clinical decision-making. The main results in this study show a clear correlation between Wells criteria score risk levels with an increased predictive likelihood of a positive PE. Dyspnea and chest pain proved to be the most frequent clinical findings outside wells criteria. The age-adjusted D-dimer in this study data demonstrated to be a candidate for further evaluation with great potential for clinical application. Electrocardiogram S1Q3T3 findings displayed a specificity of 92,86% and positive predictive value 69,70%. The conclusion of this study reveals that a standardized approach that includes Wells criteria together with an age-adjusted D-dimer may avoid unnecessary steps and examinations in diagnosis of PE, namely that of D-dimer tests and CTPA.

Moussiliou N. Paraïso   Alphonse Kpozèhouen   Yolaine Glèlè Ahanhanzo   Camara Facely   Charles Sossa-Jerome   and Achille Massougbodji   

Untreated or poorly treated malaria case is reported to progress to the severe form over time. Studies showed a high prevalence of untimely utilization of health service in low-income countries. The objective was to identify the determinants of late use of malaria treatment in children under five years of age in Ouidah, Benin. The study was cross-sectional and carried out during June 2017. Data on sociodemographic characteristics and malaria management were collected in randomly selected 450 couple mother-child pairs using a questionnaire. A multivariate analysis using a logistic regression and the stepwise digressive method was used to identify the determinants of late use of malaria treatment in children under five years of age. The prevalence of delayed utilization of health facilities for malaria management in children under 5 years was 87.8% (95% CI: 81.6% - 92.8). Delays in health care utilization depended on whether mothers were married (OR = 4.4, 95% CI: 2.2-8.8), they used the motorcycle as a means of travel to health facilities (OR = 2.3, 95% CI: 1.1-5.2), complained about the high cost of transport (OR = 2.4, 95% CI 1.2-4.7), or believed in the possibility of preventing malaria (OR = 2.4, 95% CI: 1.2 - 4.7). When health care costs are paid by both the parents or by grandparents at the same time, then children were less likely to experience a delay (OR = 0.4, 95% CI: 0.2 - 0.7). The prevalence of delays in health care utilization for malaria treatment (HCUMT) in children under five years is high in Ouidah in Benin south setting. Organization of simple malaria management through community training, regular and continuous supply of inputs (medicines and diagnostic tests) for malaria control would reduce the delays in HCUMT in children in Ouidah, Benin.

Loveline Ndi   

Sub-Saharan Africa and Cameroon in particular are experiencing a persistence and consistency in the incidence rates in chronic sexual infections such as HIV and HBV. The prevalence rates stands between 8-10% for HBV and 4.3% for HIV in the general population. Surveys on therapeutic results show more challenges in the management of HIV than HBV. This disparity is due to the differences in perceptions and representations, although similar in pathogenic forms, modes of transmission and chronicity. A call to compare these differences that creates fear, shame and guilt towards HIV compared to HBV, thus, preventing many patients from disclosing their HIV statuses and exposing uninfected partners. A health education system that embraces health beliefs highly needed to demystify the mystery around HIV. This study explains the reasons for negative perceptions with stigma resulting to therapeutic challenges in the management process. A qualitative study that uses in-depth interviews and participant observations on a sample population of about 250 patients undergoing therapeutic education sessions, collected data, analyzed and interpreted using the content analyzes model. Findings show that, negative perceptions towards HIV are the cause of therapeutic challenges. Need to integrate socio-cultural realities in strategies to demystify this prejudice around HIV.

Miller Erin   Morris Jamie   Watson Daniel   and Goss Donald   

Two-dimensional (2D) video is often used to evaluate running gait. Cost effective and clinically applicable methods have not been validated. The objective of this study was to evaluate the concurrent validity and agreement of methods used to determine step rate (SR) and foot strike pattern (FSP) during running using 2D video. We observed excellent agreement assessing SR from a 30 Hertz (Hz) video for 10 seconds (s) and multiplying it by 6. We observed excellent interrater agreement assessing FSP for 10s at 240 Hz. These 10s methods for assessing running may be used to inform clinical decision making when evaluating running gait. Key point's Two-dimensional video assessment at 30 Hz demonstrated high intra- and interrater reliability for detecting step rate; the 10-second method is valid and reliable for detecting step rate when compared to the 60-second method; Detecting foot strike using a 2-point scale is more reliable at 240Hz rather than 30Hz.

Mariko Gunchi   Yuko Tanaka   Maria Teresa Reyes Tuliao   Geraldine Ordonez   Elsi Dwi Hapsari   and Hiroya Matsuo   

The objectives of this study were to determine the knowledge and attitude toward STI prevention, and actual situation of infections (chlamydia and gonorrhea infections) among out-of-school youth in the Philippines. As many as 129 out-of-school youth age 13-20 years old were participated in this study in September 2017. A self-administered questionnaire was used to assess characteristics, knowledge of STIs; sexual behavior; counselors for sexual problems; access to the internet; concerns about STIs; coping with STI symptoms using the scenario setting; sexual risks for STIs; and opinion. The presence or absence of chlamydia and gonorrhea infections in urine was determined with using Aptima Combo 2 Assay. Data was analyzed statistically with using mean, standard deviation, percentage, Mann-Whitney U, and Chi-square. p Value of <0.05 were considered statistically significant. The subjects were concerned about STI and had basic knowledge toward STI prevention but negative attitude toward safer sex. On the urine test, ten out of 126 participants (7.9%) had positive reactions about chlamydia and three of them were co-infection with gonorrhea. Female participants were much more likely to get infected (12.8%) than male (3.2%). In conclusion, the knowledge toward STI prevention had no correlation with their attitude. Therefore, sexual education is not enough to focus on STI knowledge but also put more emphasis on practice to promote safer sexual behavior.

Ndi Loveline   

The emergence of chronic STIs in Africa has been a nightmare to medical and social scientists, making infected persons to show differences in clinical, therapeutic and social histories. Medical history shows that HIV/AIDS and HBV are the only chronic STIs in the world for now. This study presents social modifications within this community as persons infected with HIV/AIDS and HBV live their experiences in the context of Cameroon. It presents the traumatic experiences of these infections on the social lives of the infected and affected persons with their entourage. A contribution enriches the current literature on the social history of chronic STIs in Africa. A qualitative study that used the techniques of in-depth interviews, FGD and participant observations to collect data from a sample population of 108 persons living with HIV/AIDS, HIV/HBV co-infections, and HBV presenting therapeutic complications in the UTHY Cameroon. A FGD carried out with patients who are members of social networks and associations. Data analyzed and interpreted using a content analysis and the Social Dynamic Analysis of George Balandier. Persons living with HIV/AIDS have life-experiences that are quite traumatizing and differ from those with HBV. From the 80s till date, HIV patients lived a life of shame, fear, rejection and stigmatization causing a good number of suicidal deaths. This has caused many patients to die due to the refusal to seek medical care. Ignorance around HBV makes it stigma-free and more deadly as compare to the former. Coping strategies developed by these patients result in social modifications of this community.

Abdul Rahman Ali A Alsogair   Yousef Duhaim A Al-Rashdi   Thamer Z Aldugieman   Saleh Hadi Alharbi   Fahad A. Alateeq   Ibrahim Bin Ahmed   and Hussain Gadelkarim Ahmed   

Background: Recruitment of safe blood donors is challenging in many countries, worldwide. Assessment of knowledge and attitude towards blood donation is a cornerstone in implementing a sustainable blood donation system. Therefore, the aim of the present study was to assess the factors leading to reluctance of blood donors from blood donation in Saudi Arabia. Methodology: This is a cross-sectional descriptive study conducted in city of Hail, Northern Saudi Arabia. Data about blood donation were obtained from 711 Saudi volunteers living in of Hail. Results: Approximately 293/711(27%) of the participants believed that absence of awareness campaigns is a major reluctance factor for blood donation. Around 143/711(20%) of the participants believed that Lack of awareness in the media is a major reluctance factor for blood donation. Conclusion: Addressing the factors leading to donor's reluctance towards blood donation can improve the development of positive attitude towards blood donation among Saudi population. Factors leading to donor's reluctance towards blood donation should be considered when designing a competent program for sustainable, safe and sufficient blood donation system.

Bennett J. Doughty   Eric J. Kuszewski   and Seth T. Cioffi   

Purpose: The purpose of this project is to demonstrate the impact of pharmacy interventions and interdisciplinary care on the treatment of hepatitis C virus (HCV) within the outpatient liver clinic at VA Connecticut Healthcare System (VA CT). Methods: This project consisted of a retrospective analysis of patient data conducted from 1/1/2014 – 8/1/2016 within the outpatient liver clinic at VA CT. The following information was collected and analyzed for patients referred to the clinic through the initial consult notes within the VA’s Computerized Patient Record System (CPRS): HCV genotype, human immunodeficiency virus (HIV) status, cirrhosis status, treatment history, adherence pattern per refill histories and appointment attendance, initially requested therapy, pharmacist approved therapy, drug-drug interactions (DDIs) identified by a pharmacist, and sustained viral response at 12 weeks (SVR12). Patients excluded from the above data collection included those that were not chosen to begin treatment after referral to the clinic due to issues such as significant DDIs, history of non-adherence, etc. After data collection, pharmacist recommendations were quantified over the study population and compared to the primary endpoint of SVR12 status. All data was analyzed and presented as percentages in this frequency analysis, requiring no formal statistical analysis software. Results: After comparing the initially requested regimens to those prescribed, 20% of the total 510 regimens were adjusted by a pharmacist. Changes were made for various reasons, including guideline changes, resulting labs (i.e. hemoglobin, platelets, etc.), side effects, and adherence. Approximately 73% of patients had at least one drug interaction identified. Of these identified, 31% of the interacting medications were adjusted by the provider. Finally, SVR12 status through 3/2016 was achieved in 94% of the total patient population, excluding those who did not initiate or complete therapy. Conclusion: This study concludes that the pharmacists involved in patient care within the outpatient liver clinic at VA CT have been a valuable asset to patient care and should continue to provide pharmacy services in a provider role to patients.

Onwujekwe Emmanuel Chijioke   Agbo Angela   and Ezemba Constance Chinyere   

This study was to determine the bacteria that are prevalent in Urinary tract infections and the sensitivity of organisms isolated from the urine of adolescent and adult women of 8- 52 years old in Ogbete Coal camp in Enugu metropolis, south east Nigeria. A total of 218 individuals, both in and out patients were investigated, 197 (90.3%) women were diagnosed for Urinary tract infections. Therefore, incidence of UTI were prevalent in the age groups of 13-17 and 18-22, with P value (p=0.047 and S.D of ± 5.6). The microorganisms implicated in infection were bacteria, fungi, yeast and protozoa. Among the bacteria, two were identified as Gram positive cocci i.e. Staphylococcus aureus and Staphylococcus saprophyticus, while Gram negative bacilli were Escherichia coli, Klebsiella, Proteus, Pseudomonas aeruginosa. Yeast like fungus Candida albican, protozoan (Trichomonas vaginalis) was also identified. The isolated organism which was prevalent was Staphylococcus aureus (48.2%); followed by Escherichia coli (34.5%). Also, Pseudomonas aeruginosa, Proteus and Klebsiella were isolated. Factors responsible for frequent cases of Urinary tract infections among diagnosed women include shortness of urethra among the females, lack of personal hygiene, sexual intercourse, socio economic challenges in various homes and others. Sensitivity profiles revealed that Augumentin was highly susceptible to Staphylococcus aureus (65%) while Escherichia coli were highly resistant to commonly used drugs such as Ampicillin, and Cloxacillin while Gentamycin was the most active against bacteria isolates.

Mbozi, Parkie   Anastasia J. Gage   Munukayumbwa Munyima   and Mubiana Macwang'wi   

ZAMBIA’S nation-wide adult Human Immunodeficiency virus (HIV) prevalence stood at 13.3 percent in 2014. In Southern Province, 12.8 percent of adult men and women aged 15-49 years were HIV positive. The prevalence was higher in women than in men (15.1% compared to 11.3%). The most recent data also suggested that key populations were disproportionately infected with HIV compared to the general population. The Measure Know Your Response (KYR) study took place from September 2013 to July 2014 in the Southern Province of Zambia. The aim was to map and characterize the HIV response among both government (health and none health) and non-government organizations (NGOs). The purpose was to identify gaps in the response, in particular in terms of the geographical areas and the key populations attended to and those disproportionately missed. This paper focuses on the results from the mapping of NGOs involved in HIV and AIDS response. For this aspect of the mapping data were collected using the NGO Sector Questionnaire. Focus was interventions of NGOs and their services to target populations across all the 12 districts of the Southern Province. All program implementers working in a given district were asked questions to assess the extent to which their HIV-prevention activities in the district included strategies to address all key populations, including gender issues. Data from the quantitative questionnaires was analyzed using STATA version 12.0 and Microsoft Excel. The results of the pilot test revealed gaps in both geographic spread and content of programs in the NGOs run HIV-prevention response. For instance, hardly any NGOs worked in the new and smaller districts of Pemba, Siavonga, and Zimba. Similarly, certain services, such as mass media campaigns, interpersonal education and persuasion programs were being implemented across all the districts. Further, fewer than three of the 93 organizations surveyed targeted key populations, notably sex workers, incarcerated populations, men who have sex with men (MSM), transgender people and injective drug users. With respect to gender, about 25% of the organizations did not integrate gender issues into their HIV-prevention activities. From a methodological standpoint, the pilot test revealed the need to examine dimensions of program content, quality and intensity. In spite of these limitations, the study permits us to know which interventions are being implemented by the NGO sector, contributing to new knowledge in Zambia about geographic gaps in the availability of HIV-prevention interventions.

Habiba Jiri-Musa   Gidado Abubakar Auta   Bobga Bala Ishaya   Arziki Simeon Zoaka   and Lumsami Shadrach   

Vaccine preventable diseases are the commonest cause of mortality in children under five years of age. Therefore, immunizing a child significantly reduces cost of treating diseases and subsequently provides a healthy childhood. The objective of this study was to assess the knowledge, attitude and practice of caregivers to immunization of children under five years of age. This study was conducted over a period of four weeks with four hundred interviewer-based questionnaires given to our respondents, in a College Hospital at the North Eastern region of Nigeria. A cross sectional descriptive study was carried out using convenience sampling method. The data obtained was analyzed using Epi info software. The result of the study showed that 63% of children were fully immunized while 27% were either partially vaccinated or not vaccinated at all. It also showed that 72.9% of children delivered in the hospital were fully vaccinated as against the 35.2% of children who were delivered at home. A major concern that affects vaccination practices is the requirement for good storage and transportation of vaccines. Implementation of policies that will encourage both hospital delivery and strict adherence to the immunization schedule is an important step towards achieving adequate immunization.

Zeina Ghossoub   Relly Nadler   and Naim El-Aswad   

Physician burnout is a malignant, contagious phenomenon with significant morbidity and mortality for providers and patients alike. Major problems with physician burnout include lack of awareness, decreased ability to recognize symptoms and poor knowledge in combating the disease. Over 50% of students, residents and physicians are affected by severe burnout. Medical knowledge, practice approaches, and technical proficiency are taught and learned in residency training programs. This is also when self-care habits and work/life balance need to be taught and learned. The literature has shown that medical schools and residency programs/directors need two key ingredients in training that help prevent burnout and mitigate its effects: emotional intelligence (EI) and self-care. Another key factor in the development of physicians and combating burnout is leadership skills. The art and science of teaching medicine is hindered by the susceptibility of the trainers themselves to burnout and its consequences without having the tools to diagnose and combat it. For a residency-based intervention program that targets burnout, it has to start with its leaders/directors. Study: In 2016, 6 program directors from the Houston area underwent a two-day workshop that utilized emotional intelligence, wellness/self-care techniques, and leadership skills training to help them become aware of burnout, acknowledge, and identify it within them and their residents, and take action to combat it. Results: The study showed that the results of the intervention were not only qualitatively significant but were sustained 9 months later. Awareness of burnout, the acknowledgement and actions taken against had helped the directors on a personal, professional and leadership level. The overall average improvement/impact across the 15 items studied was 4.6/5. Conclusion: Training directors using the unique combination of emotional intelligence, self-care techniques and leadership skills maybe an effective intervention against combating burnout in residency programs.

James Larkin   Ivana Pericin   Brian O'Mahoney   Karina Hull   and Claire Collins   

Securing sensitive patient information has become increasingly important after cyber-attacks on healthcare systems. Many current forms of communication such as fax and letter are insecure. Effective cybersecurity can increase patient safety. Healthmail is a secure email service which acts as a means of transferring patient information. Healthmail is available to a range of Irish medical workers. An online survey was sent to Healthmail account holders and to general practitioners (GPs) in Ireland. Self-declared GP account holders' responses were examined to evaluate their usage of Healthmail, opinions on Healthmail's merits and suggestions for improving Healthmail. The response rate was 19.5% (276/1415). Over half (51.5%) of respondents sent at least one Healthmail email in the previous week. Overall, 64.7% (n=178) of respondents said Healthmail improves patient care. Also, 58.7% (n=155) of respondents said Healthmail should be expanded to other disciplines. Many respondents (40.5%) said they would be happy to communicate with patients using secure email. These results suggest that Healthmail's perceived utility is high and could increase. Therefore, Healthmail has the potential to become part of mainstream communication between healthcare workers.

Jungok Yu   Yuko Tanaka   Yuko Yamaguchi   and Hiroya Matsuo   

This study explores coping with STIs and related factors including knowledge, sexual behavior, and sex education among Korean adolescents. Anonymous self-administered questionnaires were distributed to 135 male and 150 female high school students. The results showed that 2.1% of participants had had sexual experience. Males had less information than females (p<0.05); 38.5% of males did not consult anyone. In contrast, females acquired information from and consulted with their parents. Although females' sexual abstinence behavior was higher than that of males (p<0.001), there were no significant differences in the STI knowledge test. Regarding sex education, 32.4–59.5% of students had received education on STIs. Students' degree of satisfaction with sexual knowledge was 10.2%, their understanding of STIs was poor, and they could not cope with having a checkup. In conclusion, high school students receive insufficient education to protect themselves from STIs. Their knowledge was not related to sexual abstinence behavior and coping behavior. Therefore, schools in Korea should provide high school students with appropriate education on STI prevention and coping behavior. In addition, an environment that facilitates consultation and clinics for helping young people deal with sexual problems should be provided.

Maya Tueni   Afifee Mounayar   and Ines Birlouez-Aragon   

Objective: To compare the results of a food frequency questionnaire (FFQ) of traditional Lebanese dishes with a weekly dietary recall (WDR). Methods: A food list of 56 traditional Lebanese dishes was constructed with color photographs to quantify portion sizes. 566 Lebanese, aged 20–62 years completed a FFQ before a WDR in the same day. Results: The FFQ overestimated the intakes of most food groups (10%) and nutrients (7%) in both sexes. Spearman correlation coefficients ranged from 0.22 for vegetables with meat to 0.95 for cereals, pastries and dairy products in men and from 0.30 for fish to 0.86 for dairy products in women (median: 0.53 for 10 food groups). 10% or less of participants were misclassified in opposite extreme quartiles (except for vegetables with meat in men 14.6% and fish in women 22.7%). Spearman correlation coefficients ranged from 0.66 for retinol to 0.87 for folates in men and from 0.58 for PUFA to 0.69 for energy, fat, folates and potassium in women (median: 0.69 for 21 nutrients). 10% or less of participants were misclassified in opposite extreme quartiles. Conclusions: The FFQ of traditional food intake with a photographic atlas seems a reliable tool for dietary assessment in Mediterranean regions.

Charles Milligan   

Many older citizens are besieged with chronic ailments that are associated with becoming older. Activities conducted as a young adult can play a significant role in your condition, later in life. Olecranon enthesophytes (bone spurs) of the elbow are one of those chronic health issue that can be quite debilitating and we really have no idea how long it takes the condition to develop. This is a case study that involves dating an olecranon posterior enthesophyte (bone spur) to determine the growth rate and associated behaviors that were more likely than not, responsible for the condition. A growth rate of .11mm per month was determined as a starting point for investigating causes for enthesophyte development. With organized fitness becoming more and more a part of everyday life, understanding growth rates of enthesophytes can allow for earlier detection. Most enthesophytes are asymptomatic; until they become major alignments. Policy makers, coaches, school athletic coordinators, the military and parents can make informed decisions about participating in risk associated behaviors. Health education that focuses on prevention in our younger children and adults as they become more and more athletically oriented and susceptible to sustaining injuries, may avoid later chronic ailments.

Hilda Nyatete   Carolyne Lisanza   Anne Masika   George Obiero   Teddy Chakee   Calvin Otiu   Peter Kiama   and Karen Abbs   

This article discusses Group Therapy Model in addressing the long term effects of torture as applied in resource poor setting in an emerging democracy in Sub Saharan Africa. The group therapy model was implemented by the Independent Medico Legal Unit (IMLU), working with 56 ex Kenya Air-force soldiers who were subjected to brutal torture following a botched coup attempt in 1982 in Kenya. The model engaged 9 survivors as peer counselors who worked hand -in-hand with trained trauma counsellors to support their counterparts in the Nyanza region of western Kenya. IMLU, - one of the leading centers against torture in Africa, provides psychological rehabilitation, medical treatment and legal support to about 500 survivors and victims of torture and their families annually, through national network of 53 trauma counselors, 70 medical doctors and 100 lawyers across Kenya. Historical torture leaves its mark, and survivors struggle to cope with the impact of torture, up to decades later. The long term psychological and social impact of torture include ongoing PTSD symptoms (flashbacks, nightmares, anxiety, and depression), substance abuse, suicidal ideation, hopelessness, family breakdown and lack of integration into society (Blanchard et al., 1997) [1]. In addition, torture leaves scars even decades later, affecting families, even communities as was evidenced working with the group of soldiers' spouses. As part of IMLU's support, full medical assessments were conducted to determine the extent of the torture on the 56 ex Kenya Air-force soldiers. By the end of the 10-week group therapy, there was a 42% reduction in symptoms across all categories of physical, behavioral, PTSD, Anxiety and Depression- A clear indication that group therapy, coupled with medical, legal and social assistance played a pivotal role in the healing process for the ex-soldiers.

Eha Rüütel   Ivar Vinkel   and Moonika Laanetu   

This study was motivated by the development of a new model of vibroacoustic (VA) therapy device which, in terms of its design and characteristics, could be used in various health promotion and treatment environments. In the case of VA therapy, a bed or lounge chair is used to transmit special low frequency sounds for the purpose of affecting the whole body. In the review of previous studies, the results of applying VA therapy in the case of somatic and functional disruptions are described. In this study a new VA device prototype was used. The study was carried out at a health resort where, over the course of a two month period, visitors had the opportunity to participate in VA therapy. Twenty-six volunteers participated in the study. Data was collected through self-rate scales, which were completed at the beginning and end of the VA treatment session. The results of the study indicated an improvement in feeling – a reduction in muscle tension, pain, fatigue, anxiety – as well as the suitability of the device and therapy for health improvement related purposes, integrated with other health services.

Huaibo Xin   

Literature has highly emphasized the importance of social capital on health and mental health. This study aimed to identify the patterns of the structures and relations of social capital among refugee populations through a systematic review so as to promote their health by fostering the growth of their social capital in their resettlement countries. A total of 1,476 peer-reviewed journal articles, book chapters, reports, theses, dissertations, and commentaries, related to refugees' social capital building were thoroughly reviewed. Thirty-seven articles were included in the final theme analysis. Information was organized based on the three categories: bonding capital, bridge capital, and linking capital. Findings indicated that refugees in their resettlement countries commonly relied on religious practice, their ethnic organizations, school/workplaces, social and sports events, and social media to develop all three categories of social capital. Additionally, they built both their bonding and bridging capital through family, neighbors, and friends. They were further linked to a broader spectrum through both government and non-government organizations, and transnational network. Literature also revealed barriers that refugees encountered in capital building. The needs of both a policy change and research in identifying more effective and innovative strategies of helping refugees in social integration should be addressed.

Mbonu, Ebere Ogonna   

Background: Maternal mortality still remains a major challenge in developing countries. In sub-Saharan Africa, one out of every sixteen women dies of pregnancy-related causes. Birth preparedness and complication readiness is the process of planning for normal birth and anticipating the actions needed in case of an emergency .This is a study to assess the knowledge, attitude and practice of birth preparedness and complication readiness. Methodology: This is a descriptive cross-sectional study to assess the knowledge, attitude and practice of birth preparedness and complication readiness among antenatal care attendees in Eti-Osa local government area of Lagos State. A systematic sampling technique was used to select the respondents .The data used for this study were collected from pregnant women attending antenatal care in Six Primary Health Care centers in Eti-Osa local government area of Lagos State, using a structured pretested English language, interviewer-administered questionnaire. Results: The mean age of the respondents was 28.9 years, with standard deviation of 5.3 years. The proportion of respondents who have been prepared for birth and for its possible complication was 124 (33.4%). A higher proportion of the married women 212 (72.6%) were better prepared for birth and ready for its possible complication. 120 (83.9%) of pregnant women who had attended tertiary education were prepared for birth and for its complications (p=0.001) Conclusion: Few pregnant women had made adequate arrangements in anticipation for a safe normal delivery.

Hassan M. Bukhari   

Colorectal cancer (CRC) is the third most common disease in males and second in females. A negative attitude about information such as prevalence, screening tests and poor dietary factors might increase risk. The aim was to measure knowledge and beliefs about screening test and some dietary factors. A cross-sectional study with 2564 participants was done. A validated questionnaire was used. SPSS (version 16) was used. The majority (60-80%) did not have knowledge about the risk of CRC. Only 25% knew it is widely occurring, about 22% knew it is higher in western society. Only about 5% men and 13% women realized the correct order to have CRC for their gender. Of total, 21% recognized that it is most common in men, yet, men scored better than women (23% vs 18%). Approximately 12% vs 17%, of men and women resp, have chosen FOBT as the screening test for CRC. Both genders understand the role of high fiber to reduce CRC (54% vs 63% men and women resp). In comparison, only about 10-13% of both genders do not believe that nor does cooking type neither obesity affect CRC risk negatively. More health programs to increase the awareness and changing wrong beliefs should be done.

Mekuanint Taddele   Dube Jara   and Alebachew hunie   

Background: World Health Organization defines adolescents as those in the age group of 10-19. While parent-adolescent sexual and reproductive health communication is one potential source of sexual and reproductive health information for adolescents. But, it appears to be inadequately practiced in Ethiopia. Objective: To assess level of parent adolescent communication on sexual and reproductive health issues and associated factors among Debre Markos preparatory school students in Debre Markos Town, East Gojjam Zone, Ethiopia. Methods: An institution-based cross-sectional study was conducted among preparatory school students from 22 sections in Debre Markos Town from December 15/2016-March to 15/2017. Simple random sampling technique was used to select 394 participants from 1653 total students. Self-administered questionnaire was employed. Results: A total of 394 students were participated in our study from Debre Markos preparatory school. Of these, 232 (58.9%) were males and 162 (41.1%) were females. The study showed that communication between adolescence and parent was 114 (28.9%), from this majority of students preferred to discuss with their mothers (42.1%) than others. Knowledge about reproductive health issues [AOR= 4.106 95% CI: 2.328, 7.243)] and knowledge about contraceptive [AOR=2.119 95% CI: (1.107, 4.054)] had significant association .Conclusion: This study revealed that parent adolescent communication on sexual and reproductive health issues is inadequate. Therefore, there is a need to equip and educate parents and students on different sexual and reproductive health issues to prevent adolescences from risk sexual behaviors.

A. H. Al-Ghamdi   

The concentrations of natural radioactivity of ²²⁶Ra, ²³²Th and ⁴⁰K were measured in nuts and seeds samples consumed in Saudi Arabia. A high-resolution HPGe detector was used for the natural radionuclides measurement. The results indicate that ⁴⁰K was detected in all samples, whereas ²²⁶R and ²³²Th were found only in Brazil nut sample. The average concentration of ⁴⁰K in the investigated samples was 363.82 Bq kg^-1. The estimated annual effective dose due to ingestion of nuts and seeds was 0.068 mSvy^-1 lower than the annual dose limit of 1 mSv y^-1 for public exposure. This indicates that no risk is expected by the intake of the studied nuts and seeds samples. The radionuclide concentrations were compared with those reported from different countries.

Jay Brown   and Saleh M. M. Rahman   

Though incidence rates of female breast cancer has declined since 1975 to 2014, in women of ages 20-59 years old, breast cancer is the leading cause of cancer-related deaths in the United States. Early detection of breast cancer via screening mammography has been shown to improve options for treatment, outcomes, and survival. Despite the success of screening mammography, screening adherence remains critical for clinical outcomes. This study explored the effect of a reminder system with educational materials on breast cancer knowledge and screening practices among primarily African-American women in North Florida. The participants were divided into two groups: the experimental group, which received this reminder system, and a control group, which did not. Both groups were surveyed using a questionnaire that included nine true or false questions regarding breast cancer facts, statistics, and screening guidelines. The experimental group scored significantly higher [t (138) = 2.60, p < .010] than the control group regarding breast cancer knowledge. Based on this study, a reminder system can be recommended as an effective intervention for increasing breast cancer knowledge.

Tekin Karsligil   and Mervat Saeed   

Hepatitis A is the most common form of acute viral hepatitis in the world. Major geographical differences in endemicity of hepatitis A are closely related to hygienic and sanitary conditions and other indicators of the level of socioeconomic development. In this study we aimed to investigate the seroprevalence of hepatitis A for adults and pediatric in university hospital- Gaziantep, and to demonstrate the relationship between various socio-demographic data and seropositivity. Serum samples were investigated by ELISA method for Anti HAV IgG and Anti HAV IgM. A total of 102 individuals, 55 male and 47 female, were included in the study. Anti HAV IgG positivity was detected in 87(85.3%), anti HAV IgM positivity was detected in 2 (2.0%). There weren't any significant gender differences in HAV IgG. By analysis according to the age, Anti-HAV IgG seropositivity increased with age. Although there was no significant difference in HAV IgG seropositivity according to the types of drinking water supply, HAV IgG seropositivity was detected in a less percentage in individuals who drink the commercial water. In Turkey HAV infection has been shifted to older ages than younger age. The disease is more complicated in advanced age than younger people. We recommend the importance of applying the vaccine.

Theopilus Wilhelmus Watuguly   

Objective: The Polyphenol compound of Phaleria macrocarpa has potential as an anticancer agent, and it has shown to inhibit lung carcinogenesis. The objective of this study was to elucidate the role of polyphenol induced apoptosis via caspase-8 and caspase-9. Methods: Balb/c mice were randomly divided into 2 groups: Group 1: control group with administration of sterile aquades and group 2: treatment group with administration of 50 mg polyphenols. The development of lung tumors was confirmed by observing post-operation tissue at week 8, 17 and 26. The expression of caspase-8 and caspase-9 were assayed. Data was analyzed using Kruskal-Wallis, Mann-Whitney, one way ANOVA, Post hoc LSD test, with a significance level of p < (0.05). Results: Administration of 50 mg polyphenols from P. macrocarpa extract, showed inhibition of lung carcinogenesis through increased expression of caspase-8 and caspase-9 in the treatment group at week 8, 17 and 26 (p = 0.000). Conclusion: The administration of poliphenol from P. macrocarpa extract was shown to effectively inhibited lung carcinogenesis through increased of caspase-8 and caspase-9 in mice strain Balb/c.

Graziella Aghilone   and Massimo Cavacece   

Aim: The intra–subject variability is evaluated by a deterministic acceleration model in the frequency content between walking and running activities. The usefulness of this research is to explore the dependence of peak acceleration of foot on different pedestrian's velocity. Method: The mathematical model can be represented in time domain as a sum of Fourier harmonic components. The mathematical approach is applied to fit the accelerations of the foot, acquired during the impact shock of the human body on treadmill during walking and running activities at different speeds. Spectral analysis evaluates the frequency field of impact shock during walking and running activities. Results: The fitting of experimental data, by a mathematical approach, offers the analysis of the peak force of the foot on the ground, the dynamic acceleration factor (DAF) and the activity rate harmonics during walking and running activities. Conclusion: Marked differences in vertical accelerations are illustrated between walking and running activities. Recommendations could be deducted with regard to the dose of impacts that can be beneficial or detrimental to human health.

Tuğba Kocahan   Bihter Akınoğlu   Çağlar Soylu   Özge Çoban   and Necmiye Ün Yıldırım   

Problem Statement: In joint movement, agonist and antagonist muscle strength, as well as the length and the shortness of these muscles is an important parameter. Muscle shortness is one of the factor that responsible of sports injuries. Shoulder is one of the most injured joint in Judo. In this joint, determination of the relationship between muscle shortness and agonist-antagonist muscles strength will be effective to increase muscle strength, sportive performance and prevent sports injuries. Purpose of Study: This study was conducted to determine the relationship between pectoralis minor (PM) muscle length and shoulder internal(IR)/external(ER) rotation isokinetic muscle strength in Judo athletes. Methods: The study included 80 (56 males, 24 female) professional Judo athletes aged between 14-25 (mean 17,31±2,51). Isokinetic muscle strength was assessed by ISOMED 2000^® device. Pectoralis minor length was evaluated using a flexible tape measure in resting position. The assessments were made bilaterally. Findings and Results: There was a strong and statistically significant correlation between the PM length and the shoulder IR and ER peak torque values at both angular velocities and both sides (p <0,01). Conclusions and Recommendations: It was determined that the relationship between the length of the PM muscle and the internal and external rotator muscle strength of Judo athletes. Therefore, we think that by increasing shoulder muscle strength to enhance sportive performance, stretching exercises for PM muscle shortening should be added to training programs.

Kenneth M Komorny   Amy Rosenberg   and Emily McCleary   

A daily huddle was tested in an academic medical center pharmacy department to see if it resulted in a positive impact on the safety culture and communication. The huddle is a short daily briefing conducted at shift change in a main pharmacy area with a dial in number for those not present in the main pharmacy area. The purpose of the huddle is to raise awareness of any current safety or operational issues. The effectiveness of the huddle was primarily tested through a targeted survey and the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Survey results. A survey evaluating daily huddle effectiveness had a 24% response rate. The majority of respondents indicated positive feelings towards the huddle: 58.7% indicated effective communication of information between shifts, 67% indicated effective communication of safety events, and 63% indicated effective communication of daily operational issues. Additionally, the department's AHRQ Patient Safety Culture Survey results improved following the huddle implementation. Departmental staff gave their work unit an overall safety score of the top possible answer, excellent, (vs. very good, acceptable, poor, failing) 11% of the time before the huddle began. Eight months after the huddle started, the number of respondents answering with the top possible score increased to 23% (p<0.05). This positive impact sustained to the next year as well (25% top possible score). Additional positive results are discussed. Implementation of a safety huddle positively influenced measures of communication and safety culture in the Department of Pharmacy Services.

Suleiman, M. S.   

A study to appraise HIV/AIDS information and its usefulness among senior secondary students in Zaria town, Kaduna State of Nigeria was undertaken. Senior secondary school students in Nigeria are mostly teenagers and are more often than not interested in sexual relationships. The adolescents at this period may want to test sex without much consideration of the end result of engaging in such actions. It may be noticed that HIV/AIDS is one of the greatest challenges to sustainable economic, socio-cultural and political development of any civilization. It is acknowledged fact that the adolescents of today are leaders of tomorrow; therefore, for a meaningful sustainable development to be attained in any society, young people are required to live healthy lives. Therefore, social survey research was adopted for this research work. A sample of 240 students, across 8 selected senior secondary schools in Zaria town was used as the population sample. The questionnaires were coded and analyzed using the SPSS software. The data collected was then subjected to simple descriptive statistical analysis. The study revealed that majority of the respondents had knowledge of HIV/AIDS, but are reluctant to submit themselves to HIV/AIDS test. Most of the respondents are aware of the various mode of transmission of HIV/AIDS as well agreed that use of condom as a mode of prevention. It was also noted that the students' sources of information and their effectiveness were through posters and pamphlets. The study concluded by recommending that the government and other stakeholders should technically strategize on HIV/AIDS campaign initiative in secondary schools. HIV/AIDS policy should be initiated and implemented for sustainable development. As a matter of policy, all secondary schools in the state should have a functional HIV/AIDS club.

Carlos Mauricio da Costa Ramos   Raquel Barbosa Teixeira   and José Luiz Mendes Ripper   

This experimental research is inserted in the universe of people with special needs and intends to develop a new technology to design the structure of wheelchair. This structure consists of a tensegrity module composed of bamboo sticks and tensioned cables and adopts all the anthropometric standards with the observance to the ergonomic studies and individual needs of the use of the wheelchair users. This new concept of structure design, as it is unprecedented, results in an innovative product and allows new interpretations and unfolding. This research also initiates a new interpretation of tensegrity by its application to orthotics for rehabilitation that is currently widely diffused in the plastic arts, architecture, but incipient in product design. The use of tensegrity can meet some needs as a favorable body adaptation due to the malleability of the structure that absorbs the more sudden movements that can cause discomfort, injury and bad accommodation of the user to the wheelchair, besides providing a product of low cost and of easy production , because the structure is assembled by fit and wired.

Das Suman   Banerjee Debamalya   and Mukherjee Shankarashis   

Analysis of work posture of workers is an effective research area in manufacturing sector in India. Manufacturing plays a significant role to develop a country. Lots of human involvements are required to successfully execute the various operations involved in this area. Long manual working hours with traditionally designed tools and un-ergonomic work posture can cause musculoskeletal disorders and other occupational health problems among welders. Prolonged working hours exceed the physical capacity of the workers that causes' discomfort, physical fatigue, joints pain, swelling, strain, sprain of ligaments and soft tissues. Work related musculoskeletal disorders (WRMSD) in the form of repetitive motion injuries, cumulative trauma disorders, body fatigue and strain injuries are very common health problems of workers of different small & medium scale welding units in our country. The productivity and cost benefits of welding units are highly related with the physical comfort of the welders. The data of musculoskeletal disorder of workers of welding units was collected evaluated and validated by using RULA, OWAS and Discomfort Questionnaire and a design solution suggested.

Bradley Y. Bartholomew   

It is common ground that the practice of hatha yoga will yield many health benefits, both physical and mental. Much of the recent research on hatha yoga has focused on Bikram Yoga, which differs from other forms of hatha yoga by virtue of it being practiced in an elevated ambient temperature which occasions profuse sweating, and is generally referred to as 'hot yoga'. Much of the recent research tends to be negative about this form of yoga, for instance Bikram yoga doesn't assist in removing impurities from the body, doesn't increase aerobic fitness and doesn't yield any more benefits, physically or mentally, than other schools of hatha yoga. This article reviews the sweaty rituals that have evolved throughout human history, principally the Buddhist and Hindu practices, the Greco-Roman baths, the Finnish Sauna, Russian Bania, Islamic Hammam, Japanese Mushi-Buro, the African sweat huts, Irish sweat mounds and the Native-American & Eskimo sweatlodge, and it is shown that most of these sweaty traditions have a purification, rejuvenation and spiritual significance, and that human beings have a primary and primeval need to sweat. The fact that Bikram yoga resonates with this primeval need elevates it to a higher level than other schools of hatha yoga. The health benefits (both physical and mental) of profuse sweating are also presented, in particular that it rids the body of toxins such as arsenic, cadmium, lead, mercury and some pesticides and thus is a cleansing and rejuvenating process. But over and above the health benefits profuse sweating as a purification ritual is a major morale booster; it is a natural way to make us feel good and to make us feel good about our lives.

Aguemon Badirou   Sossa Jérôme Charles   Sopoh Ghislain Emmanuel   Damien Barikissou Georgia   Saizonou Jacques   Houeto David   Gado Thalouth A A   and Ouendo Edgard Marius   

Background: HIV infection for children is mainly due to mother-to-child transmission (MTCT) that can occur during pregnancy, childbirth and breastfeeding. In Benin, the residual rate of HIV transmission from mother to child remained high. The objective of the study was to describe a ten-year-trend of HIV prevalence in pregnant women in Benin. Methods: A retrospective study was carried out from 2006 to 2015 across the country and consisted in reviewing the reports of the annual surveys of HIV infection among pregnant women. Chi square test was used to assess the trend over time of HIV prevalence among pregnant women. Equations of regression lines of HIV prevalence trend graphs were estimated to determine the direction of the trend. Results: A total of 138,319 pregnant women participated in the annual HIV surveys from 2006 to 2015. The prevalence of HIV infection from 2006 to 2015 for pregnant women decreased significantly in the group of women aged 20-29 years, in the group of craftswomen and in the group of women with their first pregnancy. In contrary, the prevalence of HIV increased significantly for women with at least four past pregnancies and those writing in local language. Conclusion: The National AIDS control program may take these results into account by maintaining the epidemiological surveillance in HIV, and reinforce interventions for the vulnerable groups where the prevalence increased.

Carrie Tilton   Mary Subramanian   Lauren Wyatt   Elizabeth Woods   and Derek A. Williams   

Objective: To compare the efficacy of warfarin management by a pharmacist-managed group to a cardiologist-managed group (usual care) in an outpatient pediatric population. Methods: Fourteen patients with an international normalized ratio (INR) goal determined by a cardiologist were included. The pharmacist-managed group included twelve patients. There were seven patients in the cardiologist-managed group. Prior to the transition to a pharmacist-managed service in September 2014, cardiologists managed anticoagulation. For the cardiologist-managed group, INR values were recorded for six months. Following a washout period of three months, INR values were obtained for the pharmacist-managed group for the subsequent six months. Patients were included in each analysis if they were followed for more than 3 months. A protocol guided dose adjustments, recommended monitoring, and allowed for pharmacist-managed warfarin. Results: The median number of INR tests per patient was not significantly lower in the cardiologist-managed group compared to the pharmacist-managed group (28 versus 36 measurements, p=0.06). The median percentage of time in therapeutic range using the Rosendaal method was not significantly higher in the pharmacist-managed group compared to the cardiologist-managed group (55.5% versus 54%, p=0.93). The median percentage of values in therapeutic range using the traditional method was also not significantly higher in the pharmacist-managed group compared to the cardiologist-managed group (41.9% versus 36.8%, p=0.93). Conclusion: Warfarin management in a pharmacist-managed group compared to a cardiologist-managed group provided similar care. Differences in time in therapeutic range and median values in therapeutic range were not found between the pharmacist-managed group and cardiologist-managed group. These results describe and provide support that pharmacist-managed anticoagulation of pediatric cardiology patients is safe and effective in the outpatient setting.

Felicia A. Oyekanmi   Kennedy Eborka   and Olusegun Temilola   

Antenatal care attendance is an essential component of maternal health and critical to reducing high maternal and child mortality in Nigeria. This study focused on factors that influence maternal healthcare services utilization at the conjugal level. The study was carried out among ever-married men and women in Shomolu, Lagos State, between March and June, 2017. Both quantitative and qualitative approaches were adopted to implement the study. At the quantitative level, cross-sectional survey was adopted while In-Depth Interview (IDI) was used at the qualitative level. The probability sampling technique was adopted to select a sample size of 480 respondents for the quantitative aspect of the study, while 36 participants were purposively selected for the qualitative aspect. The study examined the relationship between men's perception of the influence of antenatal clinic attendance on pregnancy outcome and their approval of wives' antenatal clinic attendance. It equally investigated the relationship between educational attainment and perception of non-attendance of antenatal clinic among women, and the relationship between requirement to obtain husband's permission and number of antenatal care attendance among women. Results showed that no relationships exist between men's perception of antenatal care attendance and their approval for wives' attendance of antenatal care facility. However, educational attainment among men was found to be positively related to their perception of antenatal clinic attendance. Similarly, test result showed a relationship between women's perception of antenatal care attendance and number of attendance, with t(83.395) = 7.718, p<0.001.

Septime Hessou   Yolaine Glèlè Ahanhanzo   Tranquillin Yadouléton   Victorien T. Dougnon   Odile Sodoloufo   Rhéal Drisdelle   Moussa Bachabi   Clément Ahoussinou   Bernard Gnahoui-David   Nelson Magalie   Bernabé Yaméogo   Christian R. Johnson   and Marcel Djimon Zannou   

HIV remains a serious global health problem. In Benin, intravenous drug users (IDUs) are at higher risk for HIV infection and are one of the groups the National AIDS Control Council (CNLS) has focused on in its strategic planning. The present study was conducted to estimate the rate of HIV prevalence among IDUs in Benin and identify potential risk factors. To this end, the 2013 and 2015 directives issued by the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) regarding Second generation surveillance were followed. In total, 386 IDUs participated in the study from all departments of Benin, 3.1% of them were women. The average age of participants was 35 (±10.7). The median length of time that participants had been using drugs was 10 years (range: 0 - 45) and cocaine was the most frequently consumed substance (56.0%). During their last injection, 90.9% of respondents used sterile injecting equipment. The HIV prevalence rate among IDUs was 4.7% (95% CI: 2.63% - 7.11%), compared to 1.2% within the general population. The results of this study highlight the need to implement continual HIV surveillance systems and develop prevention tools that specifically address the needs of IDUs.

Rossini, Gisella   Concia Valentina   Cagetti Maria Grazia   Campus Guglielmo   and Strohmenger Laura   

Objectives of the study: This study is a qualitative evaluation of a teaching method. The 2015 Summer School organized by the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan took place in Sardinia. The educational objectives of the first day included: make an informal conversation with other members of the summer school; create an interesting exchange of ideas and experiences also between new, "habitué" and beginners with senior professionals of this event; make a group for the works in the next days. Considering the different professional roles, age and context of origin, the purpose of the Pedagogists was to create a positive, relaxed but intimate atmosphere using the pleasure of "informal" conversation, through a creative and practical method: The World Cafè. Materials & methods: The Pedagogists' first task focused on: caring of the location and the physical setup of the table, creating relevant questions to the concerns of the group, establishing the rules, managing the process to encourage participants to have a non- formal learning experience consequently improving thinking, speaking and listening skills. Finally the participants answered self-administered questionnaire to write about their emotions and cognitive processes that went out during the World Cafè. Results: The analysis of the questionnaires was carried out with Interpretative Phenomenological Analysis (IPA), The interpretative steps identified two emerging themes: "different vs peer" and "discovering vs practicing". Conclusions: The World Café experience improves learning by connection; thinking and learning become dynamic processes instead of learning outcomes.

Marie O'Shea   and Claire Collins   

Cancer survivors may experience a wide range of complex health issues as a result of their cancer type and treatment. With increased rates of health care utilisation compared to non-cancer patients, the transition back into the primary care setting post-cancer treatment can be difficult for both GPs and patients to navigate. To identify the current barriers encountered by GPs in Ireland in the area of cancer survivorship, an online survey of GPs was undertaken. A total of 514 completed surveys were analysed, a response rate of 18.2%, which is typical of response rates from GPs in Ireland and internationally. The majority of GPs had never attended a survivorship course, conference or workshop. Only 17.2% and 19.7% of GPs respectively considered that they had enough information on the possible long-term issues from cancer treatments. Further education on cancer survivorship and improved access to services for GPs is necessary in order for the healthcare system in Ireland to be prepared to provide improved cancer survivorship care.

Edward W. Ansah   Joseph K. Mintah   and Joseph K. Ogah   

The purpose of this study was to determine the level of psychosocial safety climate (PSC) at fuel stations in Accra and test the paths via which PSC predicts health and safety of the attendants. We surveyed 876 conveniently sampled attendants from four major Oil Marketing Companies (OMCs). A questionnaire derived from three pre-existing ones (PSC-12, Job Content Questionnaire and Short Form Health Survey) was used for data collection. It yielded composite reliability between 0.91 and 0.95. Partial Least Squared-Structural Equation Model was used for analysis. Results shows a high risk of (36.08) PSC perception among the attendants. PSC directly, and indirectly, via the path of job resources, predict health and safety of the attendants. Job demands have significant direct influence on health and safety with its path being the strongest (r = -0.66) and most significant (t = 39.48, p = 0.00) compared with PSC (r = 0.16) and job resources (r = -0.12). The health, safety and well-being of the fuel station attendants appears to be preserved where management takes practical steps to raise PSC of the fuel stations and supervisor provides increased support for the attendants. An increase in PSC is most likely to cause increase in supervisor support to the attendants. In such stations, daily productivity is more likely to increase due to well-being of the workers.

Shahed Ashraf   Jamshed Alam   Jahangir Alam Sarkar   Faiz Ahmed Khondaker   Yusuf Farhana   and Naila Atik Khan   

Background: Despite the benefit of lifestyle changes, there is no standard treatment for Fibrotic NASH. However the concept of reversibility of liver fibrosis and cirrhosis with various natural biologically active compounds and antioxidant micro-nutrients is not new. Aim: The aim of this study was to compare effectiveness of Viusid^® (a nutritional supplement) and Vitamin E in reducing steatosis and liver fibrosis score in patients with fibrotic NASH. Methods: 52 patients diagnosed with nondiabetic and noncirrhotic NASH on liver fibroscan were divided into 2 groups randomly and given Viusid^® 3 sachets daily to 25 patients or Vitamin E 800 IU daily to 27 patients along with a hypocaloric diet and exercise for 3 months. Results: After 3 months treatment with Viusid^®, as compared with Vitamin E, was associated with a significant reduction of both mean steatosis score (CAP value reduces from 286±16.3 to 208±18.5 dB/m in Viusid^® group vs. from 278±14.4 to 253±12.1 dB/m in Vitamin E group; p<0.00001) and fibrosis score (E value reduces from 6.8±0.5 to 5.1±0.7 kPa in Viusid^® group vs. from 6.9±0.5 to 6.5±0.4 kPa in Vitamin E group; p<0.00001). Similarly, the mean alanine transaminase (ALT) levels also significantly decreased from 114±25.9 U/L to 43±9.1 U/L in Viusid^® group compared to from 105±15.5 U/L to 55±11.7 U/L in vitamin E group (p>0.00001). Conclusions: Viusid^® was superior to Vitamin E in reducing steatosis & fibrosis score in nondiabetic and noncirrhotic NASH patients. However, further large scale trial is needed to better assess the value of Viusid^® for fibrotic NASH management.

Hanna Horiguchi   and Minato Nakazawa   

The maternal mortality ratio has decreased in many countries since 2000, but in the republic of the Philippines. World Health Organization recommends that the standards of antenatal care (ANC) should start as early as possible in the first trimester, while only 63.4% of pregnant women began the ANC within the first trimester. This study aimed to clarify socio-economic status and current situation regarding pregnancy, and to explore the factors associated with the timing of the first ANC in Leyte by comparing the women who took first ANC within first trimester (early ANC group) with the women whose first ANC delayed after 4 months of pregnancy (late ANC group). We visited 108 women who had pregnancy experience by opportunistic sampling and conducted the semi-structured interview. The early ANC group and the late ANC group were 76 and 27 respectively. Only one person did not take any ANC and 4 people did not remember the timing of first ANC. Monthly income and consultation with husband significantly differed between 2 groups. Around 15% women did not have accurate knowledge about determining pregnancy. In conclusion, it is necessary to spread the right and practical information about pregnancy and antenatal care in the community.

Nurul Umirah Abdul Manaf   Aryati Ahmad   and Noor Aini Mohd Yusoff   

Various diets with different macronutrient compositions have been designed and practiced to achieve desirable weight loss. However, evidence on the benefits and risks of these diets over long- term duration on weight loss and fasting serum lipid is still scarce with different opinions and perspectives. A systematic literature search for relevant eligible trials was conducted on randomized controlled trials (RCTs) with parallel design that examined the effects of weight loss diet on body weight and fasting serum lipid, in overweight or obese adults aged 18 to 50 years old; focusing on calorie restriction with specific macronutrient distribution. Nine trials with a total of 1016 individuals fulfilled inclusion criteria. After 12 months, low carbohydrate diet (LC) showed significant increment in body weight (weighted mean difference, 1.22kg: 95% confidence interval (CI), 0.17 to 2.28, P=0.02) and triglyceride (TG) value (weighted mean difference, 0.11mmol/L, 95% CI: 0.02, 0.19, P=0.01). Low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein (HDL-C) did not significantly change after both diets. In conclusion, the long term use of LC should be reconsidered due to unfavorable effect of LC on weight changes and TG. Nevertheless, more long term studies are warranted to confirm the efficacy and safety of these weight loss diets.

Arely Vergara-Castañeda   María de los Angeles Peña-Farfán   Donovan Raúl Ríos-Hernández   Laura Martino-Roaro   Edgar Vergara C   César Jesús Sandoval-García   and Ma. Rosario Ayala Moreno   

Low drinking water intake in Mexico is considered a public health problem due to its linkage with some other negative factors related to lifestyle and eating behavior. Choosing beverages is the result of the interaction between physiological mechanisms, common knowledge and social context; including social interaction, availability, convenience, marketing, peer pressure and cultural practices. Until recently, there was limited interest on these ecological factors related to water consumption in Mexican children and adolescents. Understanding the relationships among this population habits and psychosocial or environmental factors, which shape drinking behavior, will enable the identification of specific populations at the risk of low water intake and allow to understand the problem of low drinking water consumption and the need to consider this factors while planning an strategy or policy to improve water intake among children and adolescents. In Mexico, one sixth of the population has no access to drinking water and almost 40% lack basic sanitation. These figures are worse in marginalized vulnerable urban communities where it has been suggested that only 18% of children and adolescents reach water consumption recommendations. As this population spends most of their time in schools and home, these places should been considered key places to promote water consumption as long as the availability, quality of water, sociodemographic conditions, water security, and social norms/cultural behaviors being ensured. Despite drinking water promotion has gained a global spotlight and even though numerous campaigns and policy interventions to promote water intake has been considering for creating population-wide improvements in health behavior, there is a need to innovate campaigns and widespread government public health initiatives through a novel approach which involves multicomponent environmental modification. Thus, in this paper, we provide an overview of the major environmental and psychosocial factors related to water consumption behavior that should be considered to guarantee a better impact of drinking water policies.

Claudia Jorge de Sousa Oliveira   Helena José   Alexandre Castro Caldas   and Carolina Gonçalves Venda   

The objective of this review is to identify the effectiveness of health information technology on promoting medication adherence in adults with diabetes mellitus type 2. More specifically, the review questions are: What is the effectiveness of health information technology on promoting medication adherence in adults with diabetes mellitus type 2? What is the effectiveness of health information technology for enhancing medication adherence in adults with diabetes mellitus type 2 on quality of life? What is the effectiveness of health information technology for enhancing medication adherence in adults with diabetes mellitus type 2 on hospital readmissions?

Firdous Jahan   P.J.Joseph Francis   Rizwan Qasim   Zaid Mukhlif   and Zoya Shaikh   

Objective: Dietary assessment to describe eating practices and asses the nutritional status of students in relation to the cognitive performance of students by Mini-Mental State Examination. Methods: A cross-sectional study was conducted using a food frequency questionnaire, Mini mental state examination, anthropometric measurements, and blood analysis for measuring hemoglobin(Hb) and glucose levels. Third year medical students of Oman medical college Sohar campus (Sample size, N=80) were involved in this study. Statistical Analysis was done using the food frequency, MMSE and blood analysis data to study the dietary patterns, nutrition status and cognitive performance of the students. Results: The data revealed low intake of legumes, eggs and red meat (mutton/beef), hence low protein intake by majority of students. 47.5% of the students consumed only two meals in a day. 20.9% of the students were underweight, 13.4% were overweight and 9% were obese. Physical inactivity was present in 51.2% of the students. Low hemoglobin (Hb<12mg/dl) and low glucose level (<3.9mmol/L) was observed in 32% and 28.7% of study sample respectively. Low MMSE score among 11.6% subjects indicated mild cognitive impairment. A significant correlation existed between MMSE and glucose level (p<0.05). Conclusion: A strategy is required to monitor the nutrition of young Omani adults in order to improve health status and prevent deficiency diseases. There is an urgent requirement to promote healthy food choices and lifestyle among medical students.

Razia Khatun   Abdul Jabbar Howlader   Shamim Ahmed   Nazrul Islam   Khorshed Alam   Shariar Haider   Mohammad Showkat Mahmud   and Md. Amirul Hasan   

Drug residues in poultry and poultry products are becoming an alarming or burning concern for public health because of improper use of drugs/feed additive, or failure to observe drug withdrawal period, non-existence of restrictive legislation and lack of consumer awareness in the poultry industry. The declared withdrawal periods and safe level/tolerance level of any antibiotics will be stay in same points. The aim of the study was to validate the declared withdrawal periods and to see whether there is any alteration of these declared withdrawal periods that farmers are practicing in in-situ and ex- situ condition in Bangladesh context. For this, a total of 2100 broilers and 2100 eggs were collected from different markets of poultry rich area in seven divisions of Bangladesh. Seven different drugs such as Enrofloxacin, Oxytetracycline, Ciprofloxacin, Sulfonamide, Chloramphenicol, Gentamycin, Furazolidone were used as Maximum Residue Limit (MRL). In case of Enrofloxacin, Ciprofloxacin and Sulfonamides residues persist in broiler meat after the declared withdrawal periods, on the other hand Oxytetracycline, Cloramphenical and Gentamycin maintains the withdrawal period as per stated but the Furazolidone disappears for broiler meat before the declared withdrawal periods. It was found that 55% poultry samples remain above MRL during 1-3 interval period's in the validation of withdrawal period indicates not safe for human health. It can be concluded that lack of observation of withdrawal period might be a common practice given the high level of antibiotics in the poultry farm of Bangladesh.

Muhammad Abdul Shakoor   Imtiaz Ahmad Khan   Hajira Ahmed   Mahpara Safdar   Zaheer Ahmed   and Asma Afreen   

Aim: To assess the magnitude of worm infections, their type and to correlate the impact of worm infections in children with their body mass index. Method: The study was carried out on school going children for 5-10 years of age in Tehsil Narowal, District Narowal, and Pakistan. They were of different age groups with lower socio economic status. 406 children randomly selected from various government and private schools from the various union councils for both genders (male and female). Early morning fresh stool samples were collected in sealed labeled plastic containers with lid and analyzed microscopy for the presence of eggs/ova/larvae or worm infections in laboratory. Anthropometric measurements were taken at the spot by using measuring scale for weight and height along with their mid arm circumferences. Body Mass Index was calculated and compared with standard percentile charts for age and gender. Results: 145 (35.71%) children found with various types of worm infection. 56 (35.67%) and 89 (35.74%) children were positive with helminthes male and female respectively in the studied population. Sixth and seventh year of age in both male and female were more susceptible for the infestation. Taenia saginata was the more common found organism in gastrointestinal tract of male population and Giardia lamblia in female among the children of studied area. 137 (94.48%) children were infected with the single intestinal worm while only 8 (5.52%) children with more than one intestinal worm. 57.24% had lower, 41.4% had normal and only 1.4% had above normal BMI among infected children. Majority (65.9%) had normal, 27.2% had lower than normal, and 6.9% had above normal BMI found among non-infected children. Conclusion: From the results of present study it can be concluded that intestinal worms play significant role in reducing anthropometric measurement of school going children. The factors including personal hygiene, dietary habits, type of drinking water, animals and pets keeping, overcrowded and congested living environment, large family members, toilet facility, toilet trainings, personal hygiene awareness, PICA habits and lack of de-worming contributes largely towards the worm burden in the children. A single cause is not only the attributing factor to reduce the anthropometric measurements.

Adetoun Tayewo Akinwusi   and Olusola Jacob Odelola   

Skeletal muscles contract to produce body movement. Essentially, skeletal muscle activities affect the health of other organs such as heart, adipose tissue, brain. Engaging in physical exercise enhances proper functioning of body organs, thus promoting healthy living. Nigerian secondary school principals are not known to engage in physical exercise, probably due to poor awareness of its importance to their health. Meanwhile, a life of inactivity otherwise called sedentary lifestyle is a risk factor to cardiovascular disease. In recent times, cardiovascular disease has led to a significant increase in deaths among administrators in Nigeria. Therefore, this study examined impact of Health Education on awareness of sedentary life style as predisposing factor to cardiovascular diseases among secondary school principals in zone 4, Oyo State, Nigeria. The study adopted a single group pre-test-post-test quasi experimental research design. Participants were given Health education on sedentary lifestyle and related diseases as its resultant effect. A split plot analysis of variance (SPANOVA) was employed to find the difference in pre-test-post-test scores of the participants. The result showed that, health education given was effective. The participants' awareness level increased, thus willing to refrain from sedentary lifestyle and adopt a sporting lifestyle. It was recommended that, the Ministry of Education should mandate school managements to create time during the school hours for principals and members of staff to engage in physical exercises. Also, health education in which disease prevention will feature prominently should form part of the agenda during meetings of school principals.

Marsigit J   Wibowo JA   Basir R   Devi JBP   Kaligis AD   Nurhisan L   and Werdhani RA   

Background: Based on Indonesian Ministry of Health Regulation no. 74 year 2014, Voluntary Counseling and Testing (VCT) is an obligatory national program for all lung tuberculosis (TB) patients. However, according to annual report year 2016 of Pulogadung Sub-District Primary Health Care, East Jakarta, Indonesia; there were only 175 out of 237 (73.8%) TB patients who have been checked for their Human Immunodeficiency Virus (HIV) status, but the target of the program was 100%. However, a community diagnosis to investigate this shortage for about two years has not been done before. Objective: To explore related-factors that causes the low number of VCT among TB patients in Pulogadung Sub-District Primary Health Care. Methods: In-depth individual interviews were performed on twenty TB patients that had not done VCT along with Focus Group Discussion (FGD) on eight TB officers from seven villages under Pulogadung Primary Health Care. Thematic keywords were found and analyzed qualitatively. Results: From the TB patients, it was found that the majority of them knew about TB but only some of them knew about HIV. Most of them did not know the correlation between TB and HIV. Patients were not willing to take VCT because they felt that they were not in the risk of HIV. Meanwhile, there were still TB officers who only gave HIV education to risky TB patients. Conclusion: In conclusion, TB patients who had not done VCT felt they did not have risky behaviors to HIV. This was also because of lack of HIV counseling from TB officers to TB patients.

Babajide Sadiq   and Perry Brown   

The purpose of this study was to determine the effect of climatic factors on malaria cases among pregnant women in Ogun State. A zero-truncated negative binomial regression was used to analyze the effect of meteorological variables and malaria cases among pregnant women using a 10 year historical data from January 2004 to December 2013. A bivariate analysis shows an association between rainfall ((0.000935), 95% CI 0.00026-0.00161, p-value 0.0070), humidity ((0.007698), 95% CI 0.00054-0.01486, p-value 0.0353), and maximum temperature ((-0.04628), 95% CI -0.08037- -0.01219, p-value 0.0082) and malaria cases among pregnant women. There is a significant relationship between meteorological variables and malaria cases among pregnant women in Ogun State, Nigeria.

Alessandra Rampini   Elisa Mariani   Rosanna Giordano   Licia Veronesi   Matteo Goldoni   Giuliano Ezio Sansebastiano   and Maurizio Impallomeni   

Objective is the evaluating of news concerning the incinerator in Parma and assessing any potential information gap, which could be addressed by institutional communication. Articles from both online and printed newspapers were selected, then underwent to double-blind review and were further evaluated also by a non-partisan expert. 2,390 articles were found through 'Google News' (incinerator, waste-to-energy plant, Parma); 96 of these were selected according to the relevance of the theme, then they were categorized as 'informative', 'scientific', 'political', 'socio-political' and 'economic' by all three evaluators. Such classification was finally contextualized depending on the type of newspaper. The agreement was considered using Cohen's kappa statistic. Within the 96 articles, 3 were economic, 34 political, 29 socio-political, 28 informational and only 2 scientific. The articles were further categorized by type of newspaper: 1% economic, 1% political, 5.2% environmentalist, 15.6% self-defined independent, 35.4% national and 41.7% local newspapers. This review shows that both local and national press are interested in the topic at issue, nevertheless it reveals a lack of scientific information. This analysis has not found articles in which the institutions directly involved have been consulted. Thus it would be desirable to have a greater mutual cooperation between the press and such institutions.

Hao Duong   Son Nguyen   Ray Shiraishi   Hung Trinh   Hanh Vo   Thu-Van Tieu   Hung Van   Thinh Tran   Marta Ackers   and Siobhán O'Connor   

This study assessed associations between hepatitis B and C virus (HBV, HCV) and increases in CD4 count and survival among 4316 HIV-infected patients on non-tenofovir (TDF)-based antiretroviral treatment (ART) in Ho Chi Minh City, Vietnam during 2006-2010, using mixed-effects model and survival analysis. More than half of patients (52.4%) participating in the study were HBsAg-negative/anti-HCV-negative, 9.0% HBsAg positive/anti-HCV-negative, and 38.6% anti-HCV-positive. Anti-HCV-positive males had smaller increases in CD4 count during the first two years of ART, but larger increases between two and three years after ART initiation than anti-HCV-negative females (regardless of HBsAg status) and HBsAg-negative/anti-HCV-negative males. Magnitude of the differences was small. Overall mortality rate was 15 per 1000 person-years; HBsAg and anti-HCV status were not significantly associated with mortality. Co-infection with HBV (HBsAg-positive) and/or exposure to HCV (anti-HCV-positive) does not seem to have substantial effects on outcomes of patients on non-TDF-containing ART during a median follow-up of 1.72 years. It may take a longer time for assessing effects of co-infection with HBV and/or HCV on ART outcomes. Such assessments should focus on those with positive HCV RNA, instead of positive anti-HCV.

Iryna Vakalyuk   

Aim of the study was to evaluate the contribution of nonalcoholic fatty liver disease in predicting risk of major cardiovascular events by cumulative proportion surviving depending on the SYNTAX score II in patients with stable coronary heart disease. Materials and methods: Patients with stable coronary heart disease with and without nonalcoholic fatty liver disease underwent clinical examinations, electrocardiography, echocardiography, liver elastography, liver ultrasound, evaluation of the liver functional state. Then SYNTAX score I and II were calculated to all patients. Results: The two-year death-free survival (100.00% vs. 60.00%; P = 0.0165), and a repeated nonfatal myocardial infarction-free survival (85.36% vs. 33.33%; P = 0.0045), and a stroke-free survival (88.95% vs. 37.85%; P = 0.0021), and a repeated revascularization-free survival (85.83% vs. 31.81%; P = 0.0006) in patients with SS II ≥29 and without nonalcoholic fatty liver disease were significant higher than in those with nonalcoholic steatohepatitis. Conclusions: the long-term prognosis of the patients with stable coronary heart disease is a most prognostically unfavorable on the background of SYNTAX score II ≥29 and nonalcoholic steatohepatitis combination.

Laura M. Ramzy   Danielle M. Jackman   Adam Soberay   and Jamie Pledger   

The purpose of the current study was to examine the contribution of behavioral health treatment and several contextual factors – employment, English language proficiency, family separation, and local family support -- to psychological distress among newly resettled refugees over one year. Pre- and post-data were collected between July 2014 and January 2016 at an integrated care refugee clinic located in the western United States. The sample (N = 77) consisted of a diverse group of refugees, most of whom recently arrived from Burma, Iraq, Bhutan, Democratic Republic of Congo, and Somalia. The Refugee Health Screener-15 (RHS-15) was used to measure psychological distress at the initial screening and at 12 months for refugees who indicated distress at baseline. Findings indicated a significant increase in psychological distress for those who were employed, and a significant decrease in distress for those with at least some English language proficiency and for those who have family residing in or near their country of origin. Research recommendations include using a larger sample size and more robust assessment tools to further understand the influence of family separation on psychological distress. Practice recommendations include providing advanced employment options and increasing host country language class access for newly arrived refugees.

Apicella G   El Nakadi B   and Joris M   

Objective: This study aims to evaluate the feasibility and short-term outcomes of a novel surgical technique, named 'the nine stress-free stitches technique' for aortic valve replacement (AVR) in patients with aortic valve disease. Methods: From May 2013 to October 2015, 63 consecutive patients underwent aortic valve replacement with the nine stress-free stitches technique, using the Magna Ease bioprosthesis (Edwards Lifesciences, Irvine, CA, USA). Demographics, clinical and echocardiographic data were collected retrospectively. The primary endpoints were paravalvular leak, pacemaker insertion, and mortality. Results: There was one case of moderate paravalvular leak. 2 patients required permanent pacemaker implantation. In-Hospital mortality was 6.3%. All deaths were in redo or combined procedure patients. Conclusion: This preliminary series demonstrates that the nine stress-free stitches technique is an acceptable technique for aortic valve replacement. The potential advantages are reduced ischemic time, especially in combined procedures, with easy replication.

Fadahunsi, J. T.   Kufoniyi, O.   and Babatimehin, O. I.   

The study examined the distribution patterns and developed a model for determining the optimum location of healthcare facilities in Osun State, Nigeria. These were with a view to improving the spatial distribution of and equitable access to healthcare facilities in the State. Primary and secondary data were used in the study. The primary data comprised the geographic coordinates of all the healthcare facilities in the State, while the secondary data included the list of all the healthcare facilities in the State. The cartographic model for determining the optimum location of healthcare facilities was developed. The data were analysed using percentage and Geographical Information System (GIS) analysis tools such as nearest neigbour ratio (NNR), buffering, overlay and query. The study identified 919 healthcare facilities of four categories, namely, primary (603, 65.6%), private (262, 28.5%), secondary (51, 5.6%) and tertiary (3, 0.3%) in the State. Primary and private healthcare facilities depicted clustered patterns of distribution; while secondary and tertiary depicted random distribution patterns. Using the secondary healthcare facilities as a case study, the developed cartographic method revealed both the optimum number and locations of additional facilities required, at 10km buffer distance to meet the set standards. The study identified that additional seven secondary healthcare facilities are required in four of the 30 LGAs of the State. The model also holds for primary, private and tertiary healthcare facilities by simply varying the buffer distance at 5km, 5km and 20km respectively. The study concluded that there were inequalities in the spatial distribution of healthcare facilities in the study area.

Nil E. Binbay   and Berrin Ziyadanoğulları   

Here we report, comparison of two different saturation pulse types with different shapes, Gaussian pulse and Reburp pulse. Pulses are comparatively used in a series of STD-NMR experiments for determine which one is more effective for saturation and also saturation transfer for ibuprofen and COX1 mixture. Both pulses have been comparatively studied, and they are applied to identical samples in identical experimental conditions to see the difference. Also they are examined over different pulse parameters, like lengths and powers. Finally it is shown that, re-burp pulse gives more intensive STD-NMR signals than Gaussian pulse shape under same conditions and same samples. That means Reburp pulse shape causes more effective saturation than Gaussian pulse shape for COX enzyme and ibuprofen. Results are in accordance with literature.

Dragan Janković   Manda Herceg   Dunja Stolnik   Nikola Volarić   Sanja Bekić   and Ljiljana Majnarić Trtica   

Introduction: Systematical calculation of cardiovascular risks with middle aged persons is not recommended, but in that age start of measures of primary prevention is recommended. Methods: Retrospective research study. Laboratorial data were used from persons aged 40 to 50 who have done a physical examination for working employees in the private Medical Centre for Occupational Medicine during 2014. Results: There were 54% of overweight examinees, 17% really obese, with a greater representation of men. Higher systolic blood pressure was found with 24% of males and 10% of females, a diastolic with 28% of males and 8% of females. High total and LDL cholesterol were found with 71% of examinees, while low HDL cholesterol and high triglycerides were found with 21% i.e. 25% of examinees, regardless of gender. Conclusion: Register of physical examinations of employees should be used as a source of information on representation of cardiovascular risks with middle aged persons, which would allow a timely start of measures of primary prevention.

Ayesha Akhter   Bruno Giorgio   Adebayo Adeyemi   and Md Rafiqul Islam   

Placenta praevia is one of the obstetric emergencies, which can cause life threatening hemorrhage. Time interval to access support for these patients from emergency retrieval team are often challenging. Also, dilemmas may appear on taking decision for in-utero versus ex-utero transfer of neonates to tertiary hospital. In this case study, the patient presented with a life threatening antepartum hemorrhage (APH) in a low neonatal resourced regional hospital at 29 weeks of gestation. She was extremely needle phobic that delayed the resuscitation process. The overall situation and the patient's clinical condition were inappropriate for road transfer. Moreover, considering the weather condition on the day, air ambulance was grounded. Eventually, in-utero transfer of the neonate to tertiary hospital was impossible. As a result, she was delivered by an uncomplicated caesarean section and an initial resuscitation of the newborn was provided by the pediatric team of the hospital. Emergency neonatal retrieval team was able to arrive 3 hours after the birth for transferring the premature neonate to a tertiary center.

Kazimierz Kopczyński   Marta Gajek   and Aneta Michałowska   

Hospitalization is always a difficult situation for a child as well as for its parents. It is also a new situation, accompanied by fear and negative emotions. Child's adaptation to hospital conditions and reduction of fear are not always taken into consideration properly, as the whole process of hospitalization is concerned. The most significant issues are diagnosis and treatment, most often pharmacological or surgical. Usually, there is also not enough qualified personnel (clinical psychologist, special educator), who could provide necessary support to a child and his or her parents. Not much however, has been written so far regarding the subject of our research, that is why, in our opinion, there is an urgent need of conducting further studies based on theory and developing appropriate model of prevention and psycho-correction, which would take into consideration an individual approach towards the child, depending on its age, family situation, type of disease, the length of hospitalization, as well as child's interests and talents. In our research on children from the age of pre-kindergarten to older schoolchildren, we chose the monographic method to conduct a conversation and an interview (most often with the parents), observation, analysis of the child's works and the gap-test (version for children). The aim of our research was to familiarise with the child's history and its psychic activity, with emphasis on cognitive factors which make the child aware of the whole situation concerning disease, help to estimate losses and benefits, the role of the parents and the child itself. While doing our research, in relation to the examined children, we made psycho-corrective proceedings of enhancing their adaptive capabilities to hospital conditions. One of integrative plays we used, was called Guess the emotions. We also used an exercise called Paint the feelings moreover, forming the attitudes of positive thinking and self-acceptance as well as development of interests were also introduced. Individual approach to ill children considering mentioned above effects, presented in the article have become a part of so called integrated therapy which may turn out to be the most promising and effective form of therapy developed in future.

David Odali   and Yohane Gadama   

Option B+ was developed in Malawi in 2010 and adopted in 2011 in response to the impracticality of implementing the World Health Organization (WHO) 2010 guidelines on prevention of mother-to-child transmission (PMTCT) of HIV. The approach was deemed very ambitious in a Malawian setting given the ongoing service delivery challenges. Major challenges included shortage of human resources (qualified health staff), lack of proper infrastructure, stigma associated with taking antiretroviral drugs, shortages of HIV test kits and related accessories. Amidst these challenges, civil society organizations like Umunthu Foundation (UMUFO) partnered with government to better serve mothers living with HIV. UMUFO actively worked with communities to enhance awareness of Option B+ and aide in retaining women in care once initiated on ART. UMUFO has particularly been working with two public health facilities (Limbe and Bangwe Health Centers) in providing HIV testing services, infrastructural needs and hiring health workers. With these services, UMUFO has managed to maintain a significant increase of women tested and started on Option B+ by almost 200% (from 408 in 2014/2015 to 1219 women in 2016/2017) in 3 years. The impact UMUFO has had on rolling out of Option B+ clearly demonstrates the critical role civil society organizations can have in meeting national and global public health targets.

Boyé Gnandé Roméo   

The purpose of this article is to identify the macroeconomic determining factors of health crises. In order to reach our purpose, we use a logit model on a panel of 25 countries in sub-Saharan Africa from 1995 to 2012. The main results of this study indicate that international migration flows, the ratio of short-term debt by currency reserves, and the organization of the health care system explain health crises. These results imply that the poor management of information related to unforeseen events, the ability of reimbursement of the short-term debt, and the privatization of health services make most sub-Saharan African countries vulnerable to unforeseen events. This study suggests a better management of information related to unforeseen events, the increase of exportations and the improvement of the access to health services to all people during any unforeseen events outbreak.

Christian Gerdesköld   Eva Toth-Pal   Inger Wårdh   Lars-Erik Strender   and Gunnar H. Nilsson   

Objective: The primary aim of this study was to explore the use of clinical knowledge sources among junior doctors in relation to their learning styles. The secondary aim was to describe how junior doctors value different qualities of knowledge sources in clinical situations. Methods: A cross-sectional study among 63 junior doctors in a Swedish hospital. A questionnaire was used to collect information about the use of knowledge sources, to identify learning styles according to Kolb and to record the value of qualities of knowledge sources in clinical situations. The 1-Sample Sign Test and the Mann-Whitney test were used to analyse the non-parametric data. Results: The most frequently used knowledge sources were personal contacts with colleagues (n=14, p=0.0002) followed by internet-based guidelines (n=14, p=0.0034) and printed reference literature (n=14, p=0.0225). Learning styles aggregated into two main clusters, converging (54%) and assimilating (30%). Access was the most valued quality of knowledge sources. Conclusions: Although personal contacts were most frequently used, internet-based sources reached almost the same level. Learning styles among junior doctors were in accordance with the findings in previous studies. Convergers seemed to use computer-based knowledge sources less than the assimilators. This needs further investigation. Access should be addressed in the design of knowledge tools since this was overall the most valued quality in clinical situations.

Shu Wen Xu   Rafiqul Islam   and Arup Bhattacharya   

Coeliac disease diagnosis requires adequate testing, and insufficient testing may increase complications. This pilot study determined the prevalence of appropriate testing for coeliac disease among eligible in-patients admitted in a regional Australian hospital. A retrospective review of all admissions were conducted between August 2012 and January 2013 in the medical, surgical and geriatric divisions for the patients diagnosed with haematinic-deficiency anaemia due to unspecified causes, protein-energy malnutrition due to unspecified causes and irritable Bowel Syndrome. Secondarily an extended review between February 2012 and February 2013 was also conducted to review all serology test requests for coeliac disease to identify the positive serology testing. We observed that, except for Iron Deficiency Anemia (IDA) and Irritable Bowel Syndrome (IBS), a very small proportion of unspecified anaemia and Protein Energy Malnutrition (PEM) patients were investigated (15.6% and 11%, respectively) for celiac disease. Invasive testing such as histopathology was requested only for about 52% of serology positive cases. Low diagnostic test requests for coeliac disease warrants the demand for availability of specialist gastroenterologist services and telemedicine support in regional Australia. Training for practicing doctors and continuing medical education around this may help adequate testing and diagnosis.

Vasudha Iyengar   and Md Rafiqul Islam   

Biomedical waste, contaminated sharps, and general garbage disposal is a huge problem in many developing countries including India. There are different waste management rules in India for managing different kinds of waste. These rules were revised in 2016. However, the application and practice of handling different kinds of waste as per the rules are still inadequate. Mixing general and medical waste together for disposal accentuates the situation, especially as a significant threat for sharp or needle-stick injuries. India's waste production is huge and traditional management of these mixed and contaminated wastes is a serious public and population health issue. It is also creating massive environmental concerns. Adequate hospital or biomedical waste management policy enforcement, strong public health promotional research and media campaigns, safe practice and personal hygiene education via social and mass media may alleviate the spread of serious contagious diseases. India has a high social media utilization and excellent wireless and broadband coverage. These can be used as an educational or health promotional tools to keep the public away from contagious diseases. In addition to enforcement of practicing waste management rules or guidelines, a global public health campaign on many levels is urgently required to ensure India is able to contain potential pandemics of blood borne conditions due to poor medical waste disposal practices.

Sorgho R   Franke J   Simboro S   Barteit S   Phalkey R   and Sauerborn R   

Worldwide, 50 million children under five are acutely malnourished, while 16 million amongst them suffer from severe wasting. Chronic malnutrition is more common and accounts for an estimated 159 million children, approximately 23.8% of all children under five worldwide are stunted. The proportion of stunted children has decreased worldwide between 1990 (39.6%) and 2014 (23.8%), but the progress has been imbalanced: While Asia as a whole reduced stunting by half (-47.0%) between 1990 and 2014, there are still 78 million stunted children in South Asia alone. Unlike Asia, Africa has reduced stunting by one quarter (24.0%). In contrast, the absolute number of stunted children in Africa has increased, from 47 million in 1990, to 58 million in 2014. Under-nutrition is caused by a complex web of interdependent environmental/climatic, agricultural and socio-economic factors. Climate change has recently been identified as a major risk factor for childhood undernutrition, although there scientific evidence base is weak. Studies that simultaneously combined the well-known drivers of undernutrition with climate change while being grounded in one population in one-time and in one location, , are prerequisite for the relative attribution of the various risk factors, including climate chance, as causes of childhood undernutrition. An exploratory study was conducted employing multiple methods applied to 20 randomly selected households in the village of Bourasso in rural Burkina Faso, where more than 80% of the population are subsistence farmers. Well-tested methods, such as household-level agricultural and nutritional surveys, anthropometric measurement of undernutrition with innovative methods, measuring household level-crop yields, were combined. This was done by participatory mapping of each household's plots. Remote sensing algorithms were applied to RapidEye satellite scenes covering the study area in order to map the actual cultivated area and to derive qualitative harvest estimates for the surveyed micro-fields. Weather data were obtained from a research meteorological field station, about 20 km away from Bourasso. In addition to bringing together field methods from different sectors through the lens of a household, one further advanced method was integrated: The linkage between each household plot and satellite scenes making it possible to estimate crop yields at the plot level for each household and linking this to the nutritional status of that specific household. Thus the exploratory study produced the following results: High-resolution remote sensing data can assist studies on malnutrition in Burkina Faso; RapidEye is a promising data source in regard to the spatial resolution for micro-field assessments; The strong inter-annual variation of malnutrition is suggestive that climate is a casual factor in the absence of other explanatory factors (political unrest, price shocks of inputs, epidemics). Population-based studies replicating the described multi-sectoral toolbox should be up-scaled to larger sample sizes and longer observational time series. This could contribute to generating crucial climate-health impact functions, in this case for malnutrition.

B. Odume   I. Pathmanathan   S. Pals   K. Dokubo   D. Onotu   O. Obinna   D. Anand   Okuma J   E. Okpokoro   S. Dutt   E. Ekong   N. Chukwurah   P. Dakum   and H. Tomlinson   

Background: Nigeria has a high burden of HIV and tuberculosis (TB). To reduce TB-associated morbidity and mortality, the World Health Organization recommends that HIV-positive TB patients receive antiretroviral therapy (ART) within eight weeks of TB treatment initiation, or within two weeks if profoundly immunosuppressed (CD4<50 cell/µL). Methods: TB and HIV clinical records from facilities in two Nigerian states between October 1^st, 2012 and September 30^th, 2013 were retrospectively reviewed to assess uptake and timing of ART initiation among HIV-positive TB patients. Healthcare workers were qualitatively interviewed to assess TB/HIV knowledge and barriers to timely ART. Results: Data were abstracted from 4,810 TB patient records, of which 1,249 (26.0%) had HIV-positive or unknown HIV status documented, and the 574 (45.9%) HIV-positive TB patients were evaluated for timing of ART uptake relative to TB treatment. Among 484 (84.3%) HIV-positive TB patients not already on ART, 256 (52.9%, 95% CI: 45.0-60.8) were not initiated on ART during six months of TB treatment. 30.0% of 273 patients with a known CD4≥50cells/µL started ART within eight weeks, and 14.8% of 54 patients with a known CD4<50cells/µL started within the recommended two weeks. Only 42% of health workers interviewed reported knowing to interpret guidelines on when to initiate ART in HIV-positive TB patients based on CD4 cell count results. CD4 cell count significantly predicted timely ART uptake. Conclusion: A large proportion of HIV-positive TB patients were not initiated on ART early or even at all during TB treatment. Retraining of staff, and interventions to strengthen referral systems should be implemented to ensure timely provision of ART among HIV-positive TB patients in Nigeria.

Charlotte Cliffe   

Obesity is increasing throughout the world's population and has been associated with a number of diseases, from cardiovascular disease, diabetes and stroke to cancer and respiratory diseases [1, 2]. In the United Kingdom, an astonishing 62% of the population was classified as obese or overweight in 2015 [3]. Complications of obesity have resulted in high rates of morbidity and mortality. The announcement last year that the UK government is to impose a tax on sugar is an attempt to tackle this problem; therefore, it is a timely moment to discuss the justifications and ramifications of this, from a moral point of view. This essay will analyse whether obesity can be considered a public health matter and discuss the ethical challenges and criticisms that paternalistic interventions, designed to combat this epidemic may encounter, focusing on the sugar tax.

Gemma Oberth   Mary Ann Torres   Olive Mumba   and Michael O'Connor   

The Joint United Nations Programme on HIV/AIDS estimates that ending AIDS by 2030 will cost $25 billion a year. About a quarter (26%) of this amount is required for HIV prevention. The Global Fund to Fight AIDS, Tuberculosis and Malaria is a major financier of African HIV responses and a vital source of prevention investments. A search was performed for Global Fund funding requests and signed grants from a sample of African countries over the 2014-2016 funding cycle to see if the Global Fund is investing "a quarter for prevention". Funding requests were accessed for 23 countries and signed grants were accessed for 15 countries. Some documents were not publicly available. Among the funding requests examined, an average of 16% was dedicated to HIV prevention. Wealthier countries requested more money for HIV prevention, as did countries with greater numbers of annual new infections. Of the grant agreements examined, an average of 15% of the total funding invested was dedicated to HIV prevention. For the Global Fund to achieve its HIV prevention targets in its new strategy (2017-2022) it must increase its investments in HIV prevention in Africa from current levels towards the UNAIDS benchmark of 26%.

Timiun, Godwin Aondohemba   and Timothy Scrase   

In 2013, the prevalence and incidence rates of HIV/AIDS infection in Nigeria were 3,229,757 and 220,394 respectively. Despite the fact that the influence of alcohol consumption on unsafe sexual behaviours and HIV risk in Nigeria has been documented, gaps still exist in knowledge on the roles of drinking places. This paper examines the roles of drinking places in enhancing illicit, risky sexual behaviours (irregular condom use and having sex while drunk) and the spread of HIV. A sample of 1,621 (864 women; 757 men; 815 HIV seropositive; 806 HIV seronegative) respondents who participated in survey and in-depth interviews were selected from 2 clinics and 2 other locations using multi-stage and purposive sampling methods. SPSS (version 21) software was used for quantitative data analysis. Drinking places are meeting points for lovers, alcohol consumption, verbal pornography and negotiations for illicit sexual activities with high risk of HIV infection. Understanding, and then addressing the impact of drinking places on risky sexual behaviours would assist in reducing the spread of HIV/AIDS amongst the Tiv people. Consequently, there likely would be an improvement in the sexual wellbeing of individuals and the public in Nigeria more generally.

Yener Aksoy   Soner Çankaya   and M. Yalçın Taşmektepligil   

This study was conducted to investigate the depressive state and loneliness in a total of 219 male adolescents between the ages 11 and 13 who were registered at the summer school of the Vezirköprü Provincial Directorate of Youth Services and Sports based on whether or not they participated in recreational and sports activities during the summer holiday. One hundred and fifteen of the participants participated in recreational and sports activities organized during the summer, while 104 did not. Information about the depressive states of the participants was collected via the Beck Depression Scale, while information about their loneliness was collected with the UCLA Loneliness Scale. High total scores on both scales indicated that depression and loneliness levels were high. The Cronbach's alpha internal consistency coefficient was calculated to determine the reliability of the answers given by the participants to the items of Beck Depression Scale and UCLA-LS. In the statistical assessment of the research results, it was found that the error terms were not normally distributed (P<0.05). Thus, the differences between the group that participated in recreational activities and the group that did not were shown via a Mann-Whitney U-test. In addition, the association between the total scores on both scales was calculated using Kendall's tau b correlation coefficient. At the end of the study, the Beck Depression scores of the adolescents who did not participate in any recreational or sports activities during the summer holiday (13 weeks) were found to be significantly higher than the scores of those who did. Thus, while the depression levels of individuals who did not participate in recreational or sports activities were high, the levels of individuals who regularly participated in these activities were low. Similarly, the loneliness scores of individuals also differed based on participation in these activities. The loneliness scores of adolescents who did not participate in the related activities were found to be significantly higher than those who did. In short, the reason for these low levels of depression and loneliness following participation in sports activities is understood to result directly from participation in these activities. Also, a strongly positive significant association was found between the Depression and Loneliness Scale scores of adolescents who did engage in sports. An increase was seen in the Beck Depression scores of the participants as their loneliness scores increased. In other words, as Beck Depression scores increase, so do the levels of loneliness. Thus, engaging in regular recreational and sports activities over extended periods of time can be said to be effective in eliminating the depressive and lonely feelings of adolescents. Educational institutions should include such programs within regular education.

Bakides Sofoclis   Kushitashvili Nino   and Sakellariadis George   

Diabetes prevention is possible and a lot of strategies have been implemented worldwide. Unfortunately, we lack systematic efforts of combined Type 2 Diabetes risk factors screening with the concept for patients knowledge and evaluation of health information. This is true in semi-urban Greek areas stricken by the socio-economy crisis. We used the FINDRISK questionnaire and a knowledge attitude and perceptions questionnaire for cardiovascular risk factors. Totally 358 people were recruited from March to June 2014. Young doctors examined the patients and filled in the questionnaires after their fully informed consent. We have found 75 people (20,95%) with score >15. Mean age: 52,14 years and mean BMI: 27,43kg/m² Accordingly their knowledge about health risk factors >90% knew the significance of high blood cholesterol, Diabetes, bad diet, exercise, smoking, obesity and hypertension, but over 60% underestimated their exact mortality impact on cardiovascular events. In our area pilot study, the burden of the problem for future development of T2D is probably heavy. Although health risk factors knowledge is growing, there are gaps in the field of person oriented methodology approach for enhanced health literacy. We need the development of targeted intervention programmes towards interdisciplinary working, transparent decision-making and active health-literated involvement of patients.

Jenna Dixon   Susan J. Elliott   and Ann. E. Clarke   

End-user involvement in research through collaborative research models, known as Integrated Knowledge Translation (IKT) in Canadian health, can improve recruitment, quality, relevance and acceptability of research. Despite potential benefits, application to biomedical research remains rare. This study aims to explore baseline knowledge, attitude and practices of Canadian biomedical scientists towards IKT as a foundation for a funded program of research related to causes and treatments of an emerging public health epidemic. A qualitative methodology was used. Semi-structured in-depth interviews were conducted with all 16 scientists on the GET-FACTS project. Interviews were audio-recorded and transcribed verbatim. Thematic content analysis was performed on the data. Findings highlight the limited exposure of biomedical scientists to IKT activities. Though Knowledge Translation (KT) was a term familiar to participants, most described it as end of grant activity (not 'integrated'). A majority of participants expressed that their research could take on a new direction or focus with the input of end-users, would prove to be a valuable research tool, and that IKT could help researchers think creatively about problems. All participants acknowledged challenges associated with this approach to research. We argue that biomedical scientists are open and eager to engaging in IKT but are held back by a lack of concrete examples and experiences to draw on. Integrating end-users and research scientists is an important step in ensuring end-users receive the research knowledge they require and that research is created to address their pressing needs.

Virpi Ruohomäki   Emmi Reijula   and Jori Reijula   

Hospitals will be expected to work more efficiently in the upcoming years due to several factors, one of which is aging population groups. Meanwhile, healthcare resources are dwindling, as is the amount of available personnel. This paper examines interviews and questionnaires that were conducted to assess the experiences and effects of Lean implementation in two university hospitals. Several factors, such as emphasis on the participatory, user-centric design approach and integrating Lean as an integral part of the operational facility design process in both target hospitals have proven to be beneficial. This study delivers promising evidence from the two university hospitals, which supports the implementation of Lean in the healthcare sector for improving facility design and work processes.

Paulina Wróbel   

Introduction: Type 1 diabetes mellitus is a chronic disease strongly affected physical and psychical aspects of patient life. It requires self-discipline and regular active participation in the management of the condition. Diabetes is obliged to face a lot of stress and restrictions caused by daily living with disease. Objective: to examine correlates of coping styles in young women with type 1 diabetes mellitus. The aim of the study was particularly concerned with characteristics, which are known to be connected with coping: self-esteem, illness representation, affect, social support and metabolic control. Material and methods: 32 young women (aged 19-30) with type 1 diabetes mellitus were included into the study. The participants completed MSEI, IBS, PANAS, CISS and BSSS. The metabolic status was assessed by HbA_1C. Results: There were connections between coping styles and self-esteem, illness representation, metabolic control and social support. Relationships between coping styles and affect were not confirmed. Conclusions: The results indicate that the individual characteristics and preferences of young diabetic women such as: their styles of behavior in difficult situations, self-confidence, sense of disease-control, belief in efficacy of medical recommendations and constant necessity of health control should be taken under consideration in the treatment of diabetes.

Chenjoh Joseph Nde   Ndong Ignatius Cheng   Johannes Tabi Atemnkeng   and Wilfred Mbacham   

Diarrhoea remains a major public health concern of our times with bad drinking water and frequent poor disposal of human waste matter. Caused by a variety of conditions, it spans from diarrhoea which are of viral bacterial to sometimes metal intoxication. In Cameroon, it is one of the 10 major causes of illness. To assess the burden and lost income due to diarrhoea, the study quantified how much households in the Bamenda Health District (BHD), North West Region (NWR) of Cameroon are losing because of the incidence of diarrhoea related infections. A cluster sampling technique was used to select 8 Public Integrated Health Centres in 8 Health Areas, with an estimated population of about 189,730 people. Data for all reported diarrhoea cases for 2011 and 2012 was collected from the Health Centres. The Cost of Illness (CoI) methodology was used to quantify the direct and indirect cost of diarrhoea infections. It was estimated that about USD22, 361 and USD37, 198 was lost by households in general in 2011 and 2012 respectively. The economic burden over the two years was estimated at USD53, 602.3. If this amount were projected over 10 years it will imply that about USD260, 000 will be lost to the treatment of diarrhoea infections.

Tunde Maiyaki Ibrahim   and Christine Pang   

Background: Febrile neutropenia (FN) remains one of the most concerning complications of cancer chemotherapy, and is a major cause of morbidity and mortality, consuming significant healthcare resource .This audit was carried out to determine the pattern of microbial pathogens responsible for FN in our institution as this will result in the appropriate choice of empirical antibiotic(s) for treatment of FN in the future. Methods: This is a retrospective audit of adult patients with cancer admitted with FN post chemotherapy in Goulburn valley base hospital, Shepparton, Australia between 2011- 2013.Only patients who met the diagnostic criteria of FN as defined by the Infectious diseases society of America (IDSA) were included in the audit. Results: Twenty six patients presented with 31 episodes of FN between January 2013 and January 2014. 65 blood cultures (BC) were obtained with an average of 2.5 sets of BC per patients, 10.8% of these were positive. 66.7% of the BC yielded Gram Positive Cocci (GPC) (50% of which were coagulase positive staphylococci), 33.7% of the BC yielded gram negative bacilli (GNB) and 2 yielded multiple organisms. The mean neutrophil count on admission for all the 26 patients was 0.303 ± 0.25/ul. Those with positive BCs had significantly higher hs-CRP with the mean value of 223.83±94.27 mg/l, compared to those with negative BCs with 89.37±79.53 mg/l (t-test = -3.489, p=0.002).The most common malignancies were hematological and breast cancers with 8 patients each. The presumed focus of infection was mostly in the respiratory tract accounting for 42% of the cases. 30.8% of the 26 patients with FN had central venous access device(CVAD) in-situ but all had negative BCs however the odd ratio of developing FN if CVAD is present is high at 4.3(95% CI 1.01-18.0). Conclusions: the prevalence rate of bacteremia in post chemotherapy FN in our center is relatively low and GPC are the most commonly isolated organisms. Our study also support the notion that hs-CRP may be a sensitive biomaker of bacterial infection in cancer patients with post chemotherapy FN as it is significantly higher in those with positive BC.

Marcia Alves   Maria Helena de Agrela Gonçalves Jardim   and Bárbara Pereira Gomes   

The increase in longevity and incidence of chronic diseases reveals an increased importance in terms of public health. The oncologic illness is a debilitating and progressive pathology with need for prevention and symptomatic relief. In order to find the answer to the question: "What is the effect of massage therapy in cancer patients?" we have reviewed the empirical literature indexed in databases online, finding only 21 articles published between 1990 and 2015. It was possible to verify some of the effects of massage therapy, particularly in relieving pain, decreased anxiety, depression and nausea and increased well-being. However, it was not found the effect of this intervention on the relief of suffering and the quality of life of patients. With the heterogeneity of methodologies, studies suggest the development of more homogeneous research, materials and methods to assess the effects of massage therapy in cancer patients.

Sahar Ellouze   Jihène Aloulou   Najla Halouani   Afef Ben Thabet   Amira Bouraoui   Abdellatif Gargouri   and Othmen Amami   

Preterm delivery is a particularly challenging experience that can be experienced by mothers as a traumatic event, causing dissociative reactions and authentic post-traumatic stress disorder (PTSD). In this work, we proposed to study the prevalence of perinatal dissociation and PTSD in mothers of preterm babies compared to a control group of mothers of term babies and to identify factors that may contribute to the occurrence of perinatal dissociation and PTSD following premature childbirth. We conducted a cross-sectional and comparative study, including 97 mothers of premature babies and 80 controls. We used the Perinatal Posttraumatic Stress Disorder Questionnaire to screen for PTSD, the peri-traumatic dissociation questionnaire to measure the level of perinatal dissociation, and the Perinatal Risk Inventory to assess perinatal risk. Compared to mothers of term infants, mothers of preterm infants had significantly higher rates of peri-traumatic dissociation and PTSD. Our results are consistent with previous studies, and add additional credit to the traumatic nature of preterm delivery. Setting up specific support modalities seems essential in the case of premature births in order to ensure a better quality of mother-child interactions and optimal development of the child.

Alvin Lim   Vasudha Iyengar   Daniel Terry   and Rafiqul Islam   

Clinical severity of Acute Pancreatitis (AP) following the use of Aspirin is inconclusive in previous studies. This study investigated predicting the severity of AP using Ranson criteria at admission and at 48 hours and, the length of hospital stay by prior aspirin use. Medical records of first-presentation AP patients during the five years between 2010 and 2015 were examined in the Goulburn Valley Base Hospital, Victoria, Australia. Uses of aspirin at admission with some co-morbidity, Ranson criteria at admission and at 48 hours, duration of hospital stay including other information were collected. A total of 245 AP medical records were reviewed, of them, 178 used and 67 did not use aspirin prior attending to the hospital. In simple regression analysis, Ranson score was 60% higher at admission (P< 0.001) and 64% higher at 48 hours (P <0.01) among aspirin users compared to non-aspirin users. These findings remained statistically significant after adjusting for other potential indicators. Aspirin use was also found associated with a longer hospital stay both in the unadjusted and adjusted analysis (P<0.01). Further studies using revised Atlanta classification instead of Ranson scoring for the diagnosis of AP severity in aspirin users are critical for clinical guidance.

Vesna Velikj Stefanovska   Miodraga Stefanovska-Petkovska   Marjan Bojadziev   and SonjaBojadzieva   

The last two decades have been marked by increased attention towards patient satisfaction as a valuable tool for quality improvement in health care organizations and delivering patient-centred care. However, few articles have investigated the factors of patient's satisfaction among outpatients and inpatients, especially in developing economies. This cross-sectional, quantitative research contributes by analysing patient satisfaction in the context of a developing country and its public health care system among 1318 patients from the Clinic for Plastic and Reconstructive Surgery in Skopje. The study had two main objectives. The first was to analyse factors that influenced patient's satisfaction. The second objective was to analyse the differences in the reported patient satisfaction between outpatients and inpatients within the Clinic for Plastic and Reconstructive Surgery in Skopje. The results indicated higher satisfaction among outpatients scores compared to inpatients. The findings confirm the importance of socio-demographic variables and health status on patient's satisfaction. Improved awareness of these factors may improve the patient experience and increase therapeutic benefits. Furthermore, this research provides an initial insight and understanding into the drivers of patient's satisfaction in the context of developing countries.

Celestine A. Okang   and Oyugi Henry   

Maternal and child mortalities can be reduced if all women deliveries are attended by trained and skilled birth attendants that can provide Emergency obstetric care. Community health strategy has been put in place as an intervention to reduce maternal mortalities. In the urban slum of Kisumu a third (34.7%) mothers still use unskilled attendant. This study set out to investigate characteristic of households with women using unskilled birth attendants in urban slum of Nyalenda, kisumu, Kenya. The study was comparative in design in which all the households with women who used unskilled attendants during their last delivery included in the study as cases, next nearest, neighboring households with women who used skilled attendants in the last delivery, included as controls, at a ratio of 1:1. Therefore, a total of 1033 cases and 1033 controls were analyzed with a total sample of 2066 as valid cases. The study showed age group 35 and above was higher among the mothers using unskilled delivery (14%) as compared to those using skilled attendants (10.3%), while mothers who had secondary and above level of education were less likely to have unskilled birth attendant odds ratio (OR) = 0.420 (95% CI=0.257- 0.685) as compared to mothers with primary level of education OR= 0.552 (95% CI=0.470- 0.649). Based on the study results, the odds ratio showed minimal difference on the household characteristic with only individual characteristic showing some significant results on, age, education level and ante natal clinic (ANC). The study found that older mothers do not go for skilled attendance, despite the fact that most young mothers go for skilled attendance, it is a concern that the older mothers who should attend skilled delivery tend not to go yet they are a risk factor in terms of delivery and childbirth, and hence they need to use maternity health care services from skilled health personnel.

Yuko Tanaka   Cecilia L. Llave   Maria Teresa Reyes Tuliao   Tadashi Yamashita   and Hiroya Matsuo   

The purpose of this study is to determine the current knowledge, behavior and attitude toward STI prevention among out-of-school youth in the Philippines. Anonymous self-administered questionnaires were distributed separately to 28 out-of-school youth (15 male, 12 female, one unspecified). The mean age of the subjects was 18.0 ± 3.0 years, with an overall age range of 15 to 24 years. The female respondents were younger than the male respondents on average. The out-of-school youth obtained information on STIs mainly from the media, and had fewer information sources than in-school students. Although the out-of-school youth had insufficient knowledge of STIs compared to the students, they were fairly knowledgeable about cervical cancer. They were also more sexually active than the students. The out-of-school youth consulted their parents on STI prevention, but received insufficient knowledge on STI prevention from just this source. It was concluded that out-of-school youth could constitute a high risk demographic for STIs, and health education may be essential to help them protect themselves from STIs.

Rozita Hod   Humadevi Sivasamy   Sharifa Ezat Wan Puteh   Azmawati Mohammed Nawi   Idayu Badilla Idris   Izzah Syazwani Ahmad   Chamhuri Siwar   and Mohd Raihan Taha   

Community empowerment plays an important role in adapting and preparing towards flood risks and impacts. The flood which occurred in 2014 had severely affected three states in the east coast of Peninsular Malaysia and left a significant mark on the communities residing in those areas. A cross sectional study was conducted in 2015 by distributing a validated semi guided questionnaires among flood victims in three worst affected districts in Pahang. The objective was to assess the status of community empowerment and its associated factors. The Individual Community Related Empowerment (ICRE) tool was used to assess the community empowerment. A total of 602 respondents participated in this study. The majority of the respondents were males of Malay ethnic, residing in rural villages. Their ages ranged from 19 to 88 years old, with an average age of 48 years old. The community empowerment domains in our study were self-efficacy, intention, participation, motivation and critical awareness. Younger age was associated with higher self-efficacy. Males were found to have higher participation and motivation. Those who experienced more health symptoms were positively significantly correlated with all domains of empowerment except for self-efficacy. In conclusion, low status of empowerment is seen in all domains except for motivation and critical awareness.

Jacob Suñol   Josefa María Panisello   Eudald Castell   Pedro Juan Tárraga López   Carme Sánchez   and Víctor Pérez   

Objective: The present article is aimed at describing the development process of Medtep DBT, a native app and web platform, based on Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder (BPD) patients and their therapists. Materials and Methods: The development of Medtep DBT involved five steps: Analysis of the current mobile apps related to DBT and BPD. Development of a beta version of Medtep DBT in collaboration with psychiatrists, psychologists and BPD patients in knowledge of DBT. Testing the beta version by other BPD patients and introducing changes based on provided feedback. Content validation of the final version by mental health professionals. Results: Content validity has been granted by psychologist and psychiatrist whose experience with the use of the platform has been satisfactory. Feedback from BPD patients has also been positive. Discussion: Medtep DBT can be very useful for both, BPD patients and psychologists and psychiatrists; besides being built on evidence-based DBT standards, it is reinforced by BPD patients' and mental health professionals' feedback and collaboration. Even though its content validity has been granted, a pilot study is being carried out to assess its effectiveness. Conclusion: Medtep DBT facilitates BPD patients the accessibility to digital therapeutic tools to register all the information related to the therapy in a more patient-friendly manner versus paper. Moreover, therapists can provide personalized care in a timely manner. So far, Medtep DBT provides a patient-therapist approach like no other app available in the market.

Sossa Jérôme C   Sopoh GE   Ogoudjobi OM   Issoufou Namassa F   Jacques Saizonou   Aguemon B   Alphonse Kpozehouen   Mongbo V   Azandjemè C   Aguey V   Ouendo EM   and Ouédraogo TL   

Rising caesarean birth rates in recent decades are an issue of public health. Potential harms for mothers and newborns are associated with caesarean delivery. Determinants of caesarean birth rates in Benin are unknown. The objective was to assess changes in caesarean rate and compare its indications before and during the implementation of policy of caesarian section fee exemption (PCSFE) in an urban district hospital in Cotonou, Benin. This cross-sectional study conducted at Suru Léré hospital, Cotonou, in 2014. Data on caesarean section were collected from completed medical records of 2104 women who underwent caesarean section before and during the implementation of the PCSFE. Caesarean rates by quarter varied between 17% and 26% (p=0,133) before the PCSFE while the rate increased significantly from 28% to 48% (p<0,001) during the implementation PCSFE. During the period of implementation of PCSFE, frequencies of "placenta prævia" (p=0.022) and excessive uterine height (p<0.001) were significantly higher while frequencies of "uterine pre-rupture syndromes" (p=0.017) and generally contracted pelvis (P=0.013) decreased compared to period prior the PCSFE. Caesarean section rate increased during the implementation PCSFE and some caesarean section indications increased during the PCSFE. Further prospective studies are needed to follow the evolution of indications of caesarean section to inform preventives measures in urban district hospital Suru Léré Cotonou.

Farzad Jalali   Seyedeh Fatemeh Hashemi   Ali Babaei   Hassan Abbaspour   Alireza Hasani   and Heshmat Shakeri   

This study aims to determine the effectiveness of the SCP (MI+NRT) for smoker prisoners living with HIV. The study design was semi-experimental with pre-test, post-test, follow-up, and a control group. As many as 34 smoker prisoners living with HIV were selected by convenience sampling and randomly assigned to an experimental group and a control group. The experimental group received the SCP, while the control group received no treatment. The research measurement instruments comprised FTND and BMS. MANCOVA models were employed to test the hypothesis. The results showed that the indicators of 'quit smoking' reduced among prisoners in the experimental group.

Syed Ijlal Ahmed   Syeda Beenish Bareeqa   Munazza Suherwardy Obaid   Saad Qureshi   Samra Khan   and Sara Memon   

Background: Since 2005 Neagleria Flowri infection appeared as a major health issue in Karachi, Pakistan. Most infections were acquired due to swimming in fresh water, ablution with fresh stagnant water. Our objective was to assess the knowledge of medical students regarding this important health issue and to highlight any deficiencies in medical education system. Material and methods: It was a prospective cross sectional study conducted at a medical college of Karachi, Pakistan. The sample size was calculated and sampling technique was randomized stratified sampling. Knowledge of the students was assessed through designed questionnaire. The data was recorded and analyzed on SPSS vs 21. Results: Our study included 250 medical students from five years of medical school. The highest response was recorded from final year regarding type of organism and habitat. Regarding treatment of Naegleria most correct response was from 4th year MBBS. Most final years answered correctly regarding the ablution as risk factor. The knowledge of medical students regarding incubation period of Neagleria was generally low. Conclusion: The knowledge of medical students regarding this significant medical issue appears low. The response of medical students was generally poor regarding treatment of infection, incubation period of infection and earliest presenting symptom of infection. Important measures should be taken to improve the knowledge of medical students regarding this significant health issue.

T.S Murwira   A.M Amosu   and L.H Nemathaga   

Food safety is becoming a key public health priority because a large number of people consume their meals outside their homes. As a result, they are exposed to food borne illnesses that originate from food stalls, restaurants and other food outlets. Hence the study focused on level of compliance of food handlers with national regulations on food hygiene and safety practices. The method used to collect data was participant observational checklist where the researcher had to go round with the workers during their daily chores. Simple random sampling was used to select 122 food handlers as participants in the study. Fast food outlets were also evaluated according to codified regulations and sixty food premises were observed for compliance using a checklist and compared with standards and the requirements prescribed by in Foodstuffs, Cosmetics and Disinfectants Act of 1972, regulation Data analysis involved descriptive statistics (frequencies and percentages) and analysis was made based on the standards and the requirements prescribed by Regulation R962 of November 2012. The findings showed that food handlers observed personal hygiene by wearing clean uniforms, covering their heads with hair nets, and washed their hands, indicating that food handlers maintained accepted standards in terms of personal hygiene regulations.

Huaibo Xin   Ajlina Karamehic-Muratovic   and Nicole Aydt Klein   

This pilot study aimed to reduce Bosnian refugees' vulnerability to and severity of mental disorders and sustain their mental health through adopting culturally appropriate and tailored physical activity. The study used the Community-Based Participatory Research approach and the quasi-experimental study design. A total of 35 participants in the intervention group received 12-week regular physical activity while 35 participants in the control group received 12-week educational materials concerning mental health. The effectiveness of the intervention was measured by the validated and culturally and linguistically competent instrument, Mental Health Inventory (MHI)-38. At the end of the study, both intervention and control groups demonstrated statistically significant improvement on the scales of MHI-38 either within or between groups. The study served as a non-clinical example to sustain, replicate, and expand the current intervention activities among the rest of the Bosnian community and other refugee/immigrant populations in the U.S. regarding their mental health well-being.

Charles Sossa Jérome   Maurice Togbédji Agonnoudé   Moussiliou Noel Paraiso   Ali Imorou Bah-Chabi   Amédée de Souza   Moussa Bachabi   Gratien Gbetowenonmon   and Victoire Agueh   

Adherence to antiretroviral treatment (ART) is critical for suppression of viral replication, repletion of CD₄ cells, avoiding viral resistance, improving immune response and slowing HIV infection progression. This study sought to measure adherence to ART and to determine its associated sociodemographic, lifestyle and nutritional factors in HIV-infected adults taking antiretroviral (ARV). Using a cross-sectional study design, medical records of 991 HIV positive patients who started antiretroviral therapy from July, 1^st 2011 to June, 30^th 2012 were reviewed. Data were collected in 2014 in 46 HIV/AIDS therapy centers across Benin, The independent variables were sociodemographic, lifestyle, nutritional and therapeutic factors. The main dependent variable was the adherence to the ART. Chi-square test was used to determine the association between dependent and independent variables. A p-value < 0.05 was considered statistically significant. Out of 991 PWLHIV, 30.2% showed poor adherence to ARV. Factors associated with ART adherence were social network (p<0.001), gender (p=0.020) and nutritional status based on body mass index (p=0.006). The prevalence of non-adherence to ART was high in PLWHA taking ARV. Efforts are needed to improve adherence to antiretroviral therapy in PLWHA in Benin. Intensive adherence counseling should be provided to all patients before initiation of antiretroviral therapy. Health care providers must contribute to social networking in patients and ensuring nutritional support to them.

Laureen Turner   Courtney Keeler   Daniel Long   and Vernon Newton   

Introduction: A review of the literature demonstrates a paucity of research relating to faculty and student experiences regarding prelab. Given the increasing number of students entering nursing programs and the finite number of clinical sites, educators must weigh the relative benefits of each component of the clinical experience, including pre-laboratory (or "prelab") activities. Methods: The research team designed and administered a descriptive study exploring prelab practices and attitudes in one pre-licensure baccalaureate program among students and instructors. Mean comparison tests were used to assess differences in perceptions across the two groups. Results: The results emphasized a disconnection between student and faculty views on several critical indictors, including the impact of prelab on stress, anxiety, and sleep. Conclusion: While stress and anxiety are natural components to any learning process, students may gain more from prelab if stress or anxiety were reduced.

Airi Takashima   and Hiroya Matsuo   

To improve Japanese nurses' ability to take care of foreign patients, we developed an active learning education program and examined whether it had any effect on their nursing skills and attitudes toward foreign patients. Our education program consisted of three sessions, conducted at two general hospitals in Osaka Prefecture. Thirty-nine nurses joined the education program (comprising the education group), while 138 nurses completed the questionnaire (comprising the control group). The questionnaire consisted of questions on demographics, attitudes toward foreign patients, and self-efficacy. For the education group, questionnaires were evaluated at three time points, and for the control group, at two time points. The study demonstrated that both nurses' understanding of and communication with foreign patients were significantly improved after taking the education program. Nurses' anxiety levels regarding foreign patients likewise showed a decrease, and nursing care to foreign patients significantly improved, after taking the education program. On the GSES scale, the "Very high" responses increased in the education group. We concluded that the active learning education program had positive effects on nurses' understanding of and communication with foreign patients as well as the alleviation of nurses' anxiety, thereby enabling nurses to acquire nursing care skills necessary for foreign patient care.

Sevilay Hintistan   and Burcu Topcuoglu   

Although there has long been a focus on professionalism in nursing in many countries, it is just now gaining importance in Turkey. In fact, few studies on this topic have been conducted in our country, and this is the first study carried out in the Eastern Black Sea region of Turkey. The aim of the current study was to determine professionalism characteristics of nurses working in the internal medicine clinics of a university hospital located in Trabzon Province. This descriptive study was done with 103 nurses between Feb.1 and Feb. 28, 2015. The data were gathered using a "Personal Information Form" and a "Professionalism Information Form" through face-to-face interviews. To assess the data, numbers, percentages and arithmetical means were employed. In the current study, 95.1% of the participating nurses were female. Their mean age was 31.54±7.42 years, 66.0% of them had an undergraduate degree, 85.4% were clinic nurses, and their average work duration was 8±6.2 years. This current study determined that nurses thought the most important professionalism characteristics were "taking individual responsibility in nursing practices (92.2%)" and "paying attention to using a simple and clear language by establishing a good communication with patients and team members (90.3%)". The characteristics of "becoming a member of a nursing association (24.3%)" and "feeling the necessity to use the titles of specialist nurse, doctorate nurse (19.4%)" were less meaningful to our study participants.

Olubunmi Omowumi Olopha   and Bolaji Egbewale   

Improving maternal and child health care is one of the most utmost priorities of every responsible society. Civilization is adjudged by the level of assistance and help a society renders to its most vulnerable groups. Under-five children constitute an important population group in terms of vulnerability to health conditions that could adversely affect their health and well-being. Diarrhoea disease has been reported to be one of the most common causes of infant deaths especially in the developing countries of the world. Oral rehydration therapy (ORT) with oral rehydration solution (ORS) is the appropriate management of diarrhoeal dehydration and is the single most effective strategy in preventing diarrhoeal deaths in children. The extent to which mothers of under-five children can adopt this therapy is tied to their level of knowledge on its efficacy and preparation. This study was designed to examine awareness and knowledge of ORS in diarrhea home management among mothers of under-five in Ibadan. The cross-sectional descriptive survey was employed in the study and data was generated from households using a self-developed and validated questionnaire. Generated data were analysed using descriptive statistics of frequency counts and percentages. Findings showed that while awareness of ORS in diarrhea prevention was high, knowledge relating to its preparation and use was found to be low. Population-specific intervention to improve knowledge of under-five mothers on diarrhea home management was recommended.

Thérèse Kearns   Felicity Ward   Stefanie Puszka   Roslyn Gundjirryirr   Bonnie Moss   and Ross Bailie   

Anaemia is a critical public health problem in Australian Aboriginal and Torres Strait Islander people for which the health literacy of community members and health practitioners is unknown. Worldwide, pregnant women and children have the highest anaemia rates and are the major groups targeted for screening and intervention programs. In the Northern Territory, Australia, 15% of Aboriginal mothers are anaemic during pregnancy and up to 25 % of children aged 0-5 years are anaemic, with the highest prevalence of 31% identified in those aged 6-11 months. Anaemia can have adverse effects on physical and cognitive development in the early years and has long-term implications for the development of chronic diseases later in life. The aim of this study was to assess anaemia health literacy of community members and health practitioner's knowledge of anaemia best practice guidelines in a remote Aboriginal community where English is not the first language. Focus groups and individual interviews were conducted with 39 community members and 12 health practitioners. Among community members there were mixed levels of anaemia health literacy with the majority assessed as having 'good' literacy. Health practitioners had a 'very good' level of anaemia knowledge that was excellent for one group.

Claudia Jorge de Sousa Oliveira   Helena José   and Alexandre Castro Caldas   

Currently, demographic trends, at a global level, are characterized by an increase in the older age group. Associated to advanced age, older people are more prone to chronic diseases, and they are confronted with the need to adhere to an often complex medication regimen. Non-adherence has a negative impact at individual and global level. The purpose of this systematic review was answering the question "What are the nursing interventions able to improve in medication adherence in aged people with chronic disease?". The search was conducted in PubMed (including MEDLINE), CINAHL, LILACS, SciELO and EMBASE, on January 2015, without time limit; the articles were selected according to the inclusion and exclusion criteria. It was used the PICOS method for the critical analysis. The electronic search identified 9 articles meeting the inclusion criteria. Interventions to improve medication adherence among the elderly should be complex and adapted to the factors of non-adherence. Strategies to improve medication adherence in older adults include educational and behavioral approach. Nurses need to lead the way in researching interventions that can affect medication adherence in older people, working with the current generation to develop plans that meet their needs and using interventions that make sense to them.

M. Amoudi   R. Anabtawi   A. Bzoor   S. Keelani   and W. Abu Hassan   

Background: Physiotherapist has to communicate on a daily basis with clients and their families, friends, and other health care professionals. Physiotherapists assist patients with their pain in primary care settings aiming at relieving their pain, and improving their quality of life. Studies showed that poor communication often results in many negative consequences. However, few studies provide sufficient evidence to support the use of positive communication skills in reducing pain among orthopedic patient. Objectives: Examine the effectiveness of positive communication skills in reducing pain among orthopedic patient during physiotherapy sessions in 20 Palestinian rehabilitation centers dispensers on several areas and through an investigative program for the views of the orthopaedic patients among interview questionnaire for the inclusion of positive communication skills in the treatment session and its impact on relieving their pain. Methods: The current study employed non-experimental design by conducting a self-report questionnaires has approved by 3 of academic in the physiotherapy section at AAUJ, the study group covered a total number of (96) orthopaedic patients used a normal distribution to calculate an optimum sample size randomly selected from 20 centers in different Palestinian regions; 48 were male and 48 were female. Results: There was statistically significant change in intensity of pain in correlation with integration positive communication skill among orthopedic patients regardless of nature of disease during physiotherapy sessions indicate that (sig. =0.00, p< 0.05). Non-significant correlations were evident between patient's demographic factors, pain and disease related factors, and change in the intensity of pain. Validity and reliability of the instrument were tested and the total instrument reliability test (Cronbach's Alpha) was 0.732. Conclusion: Physiotherapist communication skills play an essential role during treatment sessions to relive patient's pain. Our data showed high impact of positive communication skills in reducing pain among orthopedic patient during physiotherapy session. The results show positive impact on patient's psychology and physiologies which are inseparable. However, results showed there are no statistical variances between study samples according to the independent variables.

Shiwakoti R   Devkota MD   and Paudel R   

Under-nutrition is one of the leading causes of morbidity and mortality among children. Since women are often the primary caregivers, their empowerment can influence nutritional status of their children. The objective of the study was to assess relationship between women's empowerment and nutritional status of their children. A cross-sectional descriptive study was carried out in randomly selected five villages of Bhaktapur district. A total of 402 children aged six to 59 months were selected using systematic random sampling and their mothers were interviewed. Women's empowerment was assessed using composite index. Anthropometric measurements were obtained using height board and digital scale. Multivariate logistic analysis was carried out. The results show that among 402 mothers, 18 percent were low empowered whereas 27 percent were highly empowered. The prevalence of underweight, stunting and wasting of children was 13, 19 and 7 percent respectively. Low empowerment of women was found to be positively associated with underweight (AOR=5.070; 95 percent CI: 1.885-13.638), stunting (AOR=3.031; 95 percent CI: 1.281-7.141) and wasting (AOR=10.056; 95 percent CI: 1.127-89.693) of their children. Women with low empowerment had children that were more underweight, stunted and wasted. These results suggest that improving women empowerment could have a positive impact on nutritional status of their children.

Susan Aruwa   Andrew Opondo Otieno   and Francis Owino Rew   

For a long time, community based alternative methods of treating illnesses/conditions has not been given much weight that it deserves, as it is also contributing considerably towards health care and many people in the communities are using the alternative ways. In Kenya nearly 80% of the populations including the Maasai are still dependent on herbal medicine; it remains an important source of treatment, particularly for rural communities. The World Health Organization's global strategy includes popularizing and incorporating herbal medicine in the national health systems of member countries. However, knowledge on community based alternative management of fibroids is still not well understood by many in the population. The purpose of the study was to determine the various methods of alternative fibroid management using nutritional and herbal supplements at community level and their effectiveness at eliminating uterine fibroids. The main objective of the study was to find out the types of community based nutritional and herbal supplements that women use to manage fibroids. There was therefore the need to find out the activities of the alternative medicine practitioners with specific interest on nutritional and indigenous herbal supplements treatment and determine whether the supplements and herbal medicines being administered were effectively eliminating uterine fibroids. There was an existing gap in the naming of the local herbs being used, quantities of drug being administered, the ratios of different drugs mixed in a given concoction, effectiveness and documentation of the local herbs used for alternative management of fibroids in this country.

Lamidhi Salami   Edgard-Marius Dona Ouendo   and Benjamin Fayomi   

The performances generated by results based financing (RBF) raise questions about the quality of data used to measure them. This study was carried out to evaluate the RBF contribution to the quality improvement of maternal and child health data. Sixty seven health facilities are sampled randomly in three strata (RBF_PRPSS, RBF_PASS, No_ RBF) gathering health zones in Benin. The strata comparison with maternal and child health data for the first halves 2014 and 2011 revealed that timeliness and completeness have improved in the strata exposed to results based financing compared to unexposed (p <0.05). Compared to No_RBF stratum, accuracy deteriorated in RBF_PRPSS stratum, with a 52% decrease in the proportion of concordance reports between 2011 and 2014. In 2014, recorded discrepancies are largely under-reported in the RBF_PRPSS stratum, and over-reported in RBF_PASS stratum. The accuracy of National Health Information and Management System (SNIGS) data compared to RBF's validated data was low, verification factors varying between 30% and 97%. In total, the data quality was globally poor in most areas in Benin and it is not improved by the results based financing models implemented between 2011 and 2014. There is a need to target data quality in RBF models and to use SNIGS as a unique system of reporting.

Marek Merhaut   

Allergies to a certain food are most likely to occur in children under six years of age; however, they can develop later, even into adulthood. Ironically, the most common allergens in older children and adults are the foods that we consider to be healthy or even necessary, such as nuts, cheese, fish, poppy seeds, or aromatic fruit and vegetables [1]. A food allergy is an oversensitive reaction by the organism to a food or foods, where the body may exhibit one or more symptoms from a relatively wide range of symptoms. It affects 2-3% of people, and in infants and children up to three years of age it affects upwards of 5-8% (with some sources saying more than 10%). Food allergies cause an adverse reaction to a food and involve a conditional response by the immune system. This definition is important because there is also the possibility of adverse reactions to foods that may be caused by something other than the immune system (e.g., lactose intolerance or irritation when digesting certain foods, such as coffee or ripened cheeses). An allergy is a hypersensitive reaction of the immune system to common substances, allergens, to which it often comes into contact. School canteens should strive to offer a varied and balanced diet, especially to our children, so that they get everything necessary to support their successful development and overall health. The composition of the menus should include the recommended amounts set to fulfill the daily requirement of essential nutrients. Activities of school canteens in the Czech Republic are governed by Act no. 561/2004 Coll., on preschool, primary, secondary, vocational and other training, in particular the provisions of § 119, section 11, with the relevant implementing rules and regulations [3].

Xueyan Liu   and Peiru Zhou   

Aim: To develop a specific nursing work assessment scale for diabetes liaison nurses to standardize their practice. Background: Currently, there are no validated tools to assess the special practices of diabetes liaison nurses; therefore, the efficacy of these nurses cannot be evaluated properly. Design: The Delphi method, using 12 nurse experts from 8 tertiary hospitals in China, was used to construct the diabetic liaison nurse work assessment scale based on the Hamric Model of Advanced Practice Nurses. The scale was then tested on 21 diabetic liaison nurses. Method: An expert panel participated in 2 rounds of Delphi exercises to develop the assessment scale for diabetic liaison nurses by consensus using a Likert scale to indicate whether a dimension or item should be included in the assessment scale. The initial scale was then revised based on the suggestions from the experts' importance ratings. The final version of the scale was formed after 2 Delphi rounds and was tested for applicability in a preliminary test with 21 diabetic liaison nurses. A convenience and cluster sample of 426 diabetes liaison nurses from 25 hospitals in Guangdong province was invited to participate and complete the scale. Results: Experts reached consensus on a scale with 4 dimensions and 13 items. The item-level content validity index was 1 for 10 items and ≥ 0.75 for 3 items, and the scale-level content validity index was 0.96. The reliability was high; Cronbach's alpha was 0.851, and the retest reliability was 0.822. Construct validity was supported by the results of factor analysis; the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.822, and Bartlett's Test of Sphericity was statistically significant (P < 0.0001). Four components with eigenvalues > 1 accounted for 69.93% of the total variance. The results of the Rotated Component Matrix demonstrated that the factor loading of 12 items was > 0.6. Conclusion: The content validity of the scale was high; The specific nursing work assessment scale for diabetes liaison nurses is a promising tool that can be used to evaluate the specific nursing practices of diabetes liaison nurses. Relevance to clinical practice: Diabetes liaison nurses have been appointed at many hospitals to improve diabetes management of hospitalized patients. The specific nursing work assessment scale for diabetes liaison nurses is a validated tool that can be used to assess the special practices of diabetes liaison nurses.

Reshmy Radhamony   

Acquired Brain Injury (ABI) of different forms represents one of the major public health problems for the world. Numerous neuropsychiatric disorders are associated with brain Injury including depression, anxiety disorder, irritability and aggression and mania which makes the presentation of these patients complex. The dual diagnosis of ABI and mental illness is often missed making the management of these patients difficult. Review of literature, websites and case study examples are used to illustrate the implications on care needs and discharge planning of these patients post rehabilitation phase. Majority of the models reviewed in Australia have advanced approaches for rehabilitation of clients with brain injury but none of them other than the brain disorders programme in Victoria offers rehabilitation services to clients with dual diagnosis of acquired brain injury and mental illness. Despite of the evidence that ABI can often result in ongoing mental health problems, there are a few facilities that provide for this dual diagnosis and there is not even a single model of rehabilitation which can cater for the needs of these patients. Current and existing models offer alternative approaches that are particularly applicable to person with disabilities. These include the strength-based and empowerment approaches as well as case management and independent living models.

Damian G. Laki   

In Tanzania, health information-seeking behavior among health care providers is not yet fascinating enough to provide high quality health services. Little is known about how health care providers integrate what they find from various information sources, to improve both preventive and curative health services. The purpose of the study was to determine factors influencing health information-seeking behavior and utilization of ICT resources among health care providers to provide high quality health services. A cross sectional study was conducted in July 2008 among 202 health care providers in Tanga region. The results show that health care providers located in urban areas were more likely to search health information and use it than those in rural areas (OR =14.18; 95% CI: 1.96, 288.6). Health care providers in both urban and rural health facilities should continuously be trained on how to search and use health information.

Ulfat Omar   Akram Aloqbi   Marwa Yousr   and Nazlin K. Howell   

Introduction: punicalagin, a hydrolysable tannin polyphenol from pomegranate, reported to have a protective effect against many diseases due to its high antioxidant and free radical scavenging activities. Aim, this study investigated the potential antihypertensive activity of punicalagin in human derived EA.hy926 endothelial cell model, via two mechanisms. In first mechanism, punicalagin enhance the nitric oxide production through scavenging reactive oxygen specious (ROS) and activating the endothelial nitric oxide synthase enzyme (eNOS). In second mechanism, punicalagin showed effect activity by inhibiting the angiotensin converting enzyme (ACE). Methods: The effect of different concentrations (1-100 µM) of punicalagin on EA.hy926 cells was measured using MTT assay. Induction of ROS was done using Ang II and scavenging activity of punicalagin was assessed by flow cytometer and fluorimeter. NO production was measured in order to determine the effective dose of punicalagin followed by measuring the ability of punicalagin to induce eNOS activity and the enzyme expression by Western blotting cellular Ca²⁺ concentration and ACE inhibition were also determined. Results: Punicalagin (1-60 µM) reduced ROS production in EA.hy926, which induced by added angiotensin II, as shown by flow cytometry and by fluorometry. In addition, at the same concentration the nitric oxide production was increased in a dose-dependent manner due to increased eNOS activation. The activation of eNOS enzyme was promoted by an increase of cellular calcium concentration at the tested concentrations. Examined punicalagin concentrations significantly inhibited ACE activity, possibly due to zinc binding. Conclusion: punicalagin clearly exhibits the potential for reducing hypertensive activity by a dual mechanism of nitric oxide synthase induction by increasing nitric oxide levels, and ACE inhibition.

Maureen K. Johnson   Mark C. McInerney   Wan-Ju Yen   and Matthew D. Hutchins   

Because of its association with obesity, excessive "screen time" is a concern. Children and adolescents with autism spectrum disorders (ASD's) have been found to spend much of their free time watching television more than children and adolescents without ASD's. Thus, the purpose of the current study was to determine if the time spent watching television, videos, playing video games and using other electronic devices contributed to overweight and obesity status among children and adolescents with ASD's compared to children and adolescents without ASD's. The current study analyzed data (n = 95,677) that had been previously collected through the 2011/2012 National Survey of Children's Health (NSCH). Children and adolescents with an ASD had significantly higher odds of being overweight or obese than children and adolescents without an ASD. Time watching television was a predictor of overweight/obesity status for children and adolescents both with ASD's and without ASD's. However, only children and adolescents with ASD's who used electronic devices four or more hours per day were significantly more likely to be overweight/obese than those who did not use electronic devices. A discussion of the results and limitations of the study are also provided.

Panaveyi Vicky Malou Adom   Charles Patrick Makoutode   Edgar Marius Ouendo   Takpaya Gnaro   Gado Napo-Koura   and Michel Makoutode   

The resolution of health problems at the community level requires firm political will on the part of governments and the effective participation of communities in co-management programs and health activities. The objective of this work is to study the role of Community Health Workers (CHWs) in solving health problems at the community level in Bénin and Togo, from 2009 to 2015. This is an evaluative study of the quasi-experimental type, with its variant 'here elsewhere'; it was conducted in six health zones in Bénin and five health districts in Togo, ail randomly chosen from the list of districts and zones within the regions or departmental directions covered. The study involved 385 community health workers and 6150 heads of households. Female heads of households were predominant. The community health workers were predominantly male and their level of education was secondary school and up. Only level of education, marital status and the matrimonial régime of heads of households were not significantly correlated to their level of knowledge in both Bénin and Togo (p>5%). The heads of households had an acceptable knowledge of community health workers and their activities, but the subsequently expected favorable behavior towards health remained low. Thus, the role of CHWs in solving health problems was perceived as weak. For a visible impact of the actions of this new class of agents at the community level, a strong political will is needed from the countries in the implementation of World Health Organisation's recommendations on community health.

Yi-Chia Shan   Jih-Huah Wu   Wei-Hao Chen   Shau-Ming Tseng   and Wei Fang   

Background: Nowadays people usually have higher work pressure and faster life rhythm. In the long-term stress environment, easily lead to autonomic nervous system (ANS) disorders and lead to physiological or psychological problems. To resolve the problem, we propose an embedded system which integrates ANS monitoring and low energy light stimulation. When the ANS was detected abnormal, a recommended low energy infrared light was activated to stimulate the subject to balance ANS. Materials and Methods: The experiment instruments included electrocardiogram (ECG) module, LED array and the embedded system. ECG module received ECG signal, and then transferred analog signal to digital data. The microprocessor calculated time-domain and frequency-domain data of heart rate variability (HRV), and analyzed the time-domain data, and power spectral density data. The autonomic nervous system (ANS) of the user can be monitored by this device we developed. When the calculated values are out of the criteria, the system will alert the user to turn on infrared light to stimulate and balance ANS. LED wavelength is 850 nm, the default output power is 10 mW, and the default repetition rate is 10 Hz. Result: Wu et al. proposed that using low level laser to stimulate on Neiguan point (PC6) was used to adjust the ANS of the night shift workers. And in other studies, Laser array and LED array were used to stimulate the palm of the subjects with open eyes in different clinical trial, the alpha powers were both increased significantly. So the combination of ANS monitoring and light therapy was useful and feasible. Besides ECG monitoring, LED irradiation and HRV calculation, the data of the embedded system can be transmitted by UART to the remote PC for storage, display and analysis. Furthermore, the embedded system can receive the setting value from PC. For example, adjusting the irradiated dosage, LED operation rate and duty cycle to find out the influence factor of the ANS. Conclusion: an embedded system with ECG monitoring and LED infrared stimulation was realized, it combined physiological state monitoring and light stimulation, it make the ANS feedback and real time adjustment possible.

Vancini C.   De Falco Alfano D.   Abousiam R.N.   Totaro M.   Murri Dello Diago N.   and Giganti M.   

Aim: To compare the diagnostic accuracy of different radiological criteria used in the assessments of antiangiogenic response in patients with metastatic Renal Cell Carcinoma (RCC). Methods: 44 patients were retrospectively evaluated from January 2007 through September 2014, the patients had histologic diagnosis of RCC, existence of target lesions, in therapy with Sorafenib or Sunitinib assumed continuously for 4 weeks for a total of 6 cycles and went through multiphase CT before and 3 months after the therapy. Results: Out of the 44 patients, 21 had Progression Free Survival (PFS) > 250 days. In this group of patients, all the radiological criteria had high predictive value with slightly higher sensitivity for the RECIST 1.1 criteria (sensitivity 100%). In the remaining group of 23 patients (with PFS < 250 days), RECIST criteria also showed slightly higher specificity values by identifying 9 patients (60.86%) compared with Choi, MASS and SACT who identified respectively 56.52%, 52.17% and 56.52% of the patients as having stable disease or indeterminate response to the therapy. Conclusion: All studied radiological criteria had high predictive value with slightly higher sensitivity results for the RECIST 1.1 criteria.

Andrejs Ivanovs   Ieva Salmane-Kulikovska   and Ludmila Viksna   

Tuberculosis (TB) is commonly linked to poverty, overcrowding and malnutrition. It was known earlier that TB more frequently attacks the most vulnerable part of the society – people who have lower socioeconomic status and harmful habits. Being aware of determinants of TB, attenuation of morbidity can be accomplished. This paper identifies impact of socioeconomic risk factors and risk conditions on prevalence of TB in Latvia, using the Four Layers of Health Determinants Model. The impact of risk factors and risk conditions is analysed in two levels – individual and societal. The results of the study show that the strongest risk factors and risk conditions are HIV positive, homelessness, experience of imprisonment and underweight. BMI, drug abuse and unemployment are the strongest TB predictors. TB prevention programmes should be redesigned to involve additional factors that may contribute to the onset of TB.

Jomama One Jomama Lual   Constatin Loum   and Richard Mugga   

Some of the expected impacts of households' health education on usage of malaria prevention methods include increase in use of insecticide treated bed nets and subsequent reduction in households' reported malaria. This study intended to measure impacts of health education on usage of insecticide treated nets and reported malaria, from November 2012 to June 2013, among rural households in five districts in Western Kenya. At baseline, 1,898 responded to questions on ITN use and 1,016 households responded at end line. At baseline 1,083 households responded to question on households' reported malaria whereas 1,002 responded at end line. Statistical analysis was done using SPSS version 17.0. This study found that there was significant increase in ITNs use (baseline 90.3% (1714/1898); end line 94.9% (964/1016); p-value = 0.0001; OR = 0.36; 95% CI = 0.4- 0.7). However, it found that there was insignificant reduction in households' reported malaria (baseline 61.7% (668/1083); end line 58.6% (587/1002); p-value = 0.149; OR = 1.14; 95% CI 0.95-1.36. The study concluded that, while households' health education resulted in a significant increase in use of insecticide treated nets, significant increase in ITN usage did not significantly lower households' reported malaria in Five Districts in Western Kenya.

Rachel Williams   Geoff Middleton   Jacquelyn Allen-Collinson   Ros Kane   and Adam Coussens   

Health Trainers constitute an emergent occupational group in the Public Health system in England with the key purpose to reduce health inequalities by helping or 'nudging' people in local communities to adopt healthier lifestyles. Whilst primarily supplying health-related information and support regarding smoking cessation, diet, alcohol, physical activity and mental wellbeing issues, the role also requires awareness of, and sensitivity toward the specific needs of local communities. This literature review charts current research on the occupational context of the Health Trainer role since its implementation in the English Public Health system. It provides a critical examination of current literature whilst highlighting the theoretical basis of Health Trainers' roles, the potential boundary-crossing nature of their work, along with professional development issues.

Hambisa Mitiku   Worku Jimma   and Chala Diriba   

This study aimed to investigate the extent to which knowledge management approaches can be used to manage indigenous knowledge (IK) of corrective and preventive cares in local communities of Horro Guduru Wollega zone. This study used descriptive research design through qualitative research method to collect reliable data about perception of disease and its main cause, the types of IK of traditional healthcare practice, indigenous self-medication and required from traditional healthcare practitioners. The respondents were chosen from local communities (traditional healthcare practitioners and community members) and stakeholders (Health Bureau, Agricultural Bureau and NGO). Accordingly, 84 key respondents were chosen through purposive sampling. The qualitative data was analyzed using thematic content analysis. The analysis results have shown that, people in the local community conceptualize disease as the disequilibrium between body and spirit; whereas God, ancestral spirit and witches and sorcerers are the main cause of disease. The above cause's related diseases can be treated by using traditional healthcare IK such as by traditional medicine, physiotherapy treatment and spiritually treatment by self-medication and traditional healthcare practitioners. Therefore, there is a need to capture and manage IK of traditional healthcare practices to save it from loss by local community, community leader and elders, young generations, governments, higher education institutions and researchers.

Vincent Icheku   and Chinelo Icheku   

The World Health Organization (WHO) on 1 February 2016 declared the Zika virus outbreak is a global public health emergency. Zika virus is thought to have led to more than 11,000 deaths and nearly 4,000 cases of microcephaly in Brazil since the start of the outbreak in May 2015. WHO predicted that, in 2016, as many as four million people may be infected with the virus. [1] Health experts have warned that the risk of transmitting Zika virus in the United Kingdom (UK) is very high because South America has become an increasingly popular tourist destination for UK travellers. [2] Given the declaration of Zika virus outbreak as a global public health emergency, this study explores Zika virus travel-related transmission and review current travel advice to minimise health risks to UK travellers. The evidence from our initial literature review showed that there is a paucity of research information on the recent Zika virus outbreak. Thus, the evidence used in this study was gathered from surveillance reports published by the European Centre for Disease Prevention and Control (ECDC), the United States Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Public Health England (PHE), Fitfortravel (NHS Scotland) and NHS Choices reports were reviewed for Zika virus outbreak alerts and travel advice. The study finds that Zika virus, which originated in East Africa, is now transmitted in South and North American countries and the Caribbean islands through travel and, to prevent the disease epidemic in the UK, health care professionals are required by PHE to offer advice to travellers to and from the Zika-affected countries. [3] As travel advice is likely to change as more information becomes available, we recommend that professionals supplying this service should be checking on the National Travel Health Network and Centre (NaTHNaC) website to stay abreast of the latest Zika virus updates.

Okeke, Sylvester Reuben   Okeke-Obayemi   and Deborah Oluwatosin   

Adolescence is a stage in life that is considered very turbulent as the psychological and physiological changes that accompany this period predispose young people to risky sexual behaviour. Therefore, finding out factors that predict sexual behaviour among this group is an important issue for research. It is against this backdrop that this study was designed to investigate psychological predictors of premarital sexual relationships among in-school adolescents in a western Nigerian city. The descriptive survey research design was adopted in the study. A multi-stage sampling technique was used to select 675 respondents for the study although analysis was based on the 643 questionnaires that were returned from the field and found useful for analysis. Data was collected using a self-developed and modified instrument from standardized scales. The questionnaire was examined for reliability using the Cronbach alpha which yielded 0.81 coefficients. On the spot administration technique was used to collect data and the generated data were analysed using inferential statistics of regression models at 0.05 alpha level. The findings of the study showed that all the psychological variables investigated were found to significantly predict premarital sexual relationships among the respondents. Findings showed that self-esteem (R = 0.290, Adj. R² = 0.080, F_(1,641)= 19.508, p = 0.000<0.05), self-efficacy (R = 0.290, Adj. R² = 0.080, F_(1,641) = 19.508, p = 0.000<0.05), and attitude towards premarital sex (R = 0.290, Adj. R² = 0.080, F_(1,641) = 19.508, p = 0.000<0.05) significantly predicted premarital sexual relationships among the respondents. It was therefore concluded that modifying psychological factors of self-esteem, self-efficacy and attitude towards premarital sex can be effective in regulating involvement in premarital sexual relationships among in-school adolescents in the city. Scaling up the level of school counseling especially in the area of sexual adjustment and modification of the psychological variables investigated were recommended.

Kovácsné Bobály Viktoria   Makai Alekszandra   Kiss Gabriella   Szilágyi Brigitta   Ács Pongrác   and Jaromi Melinda   

The aim was to examine the anthropometric parameters of representatives of different dance styles, the strength and extensibility of trunk muscles, and whether low back pain influences performance during a show or stage appearance. According to our hypothesis, low back pain and deviations in the functional conditions of the spine are common in dancers aged 9-18, and can have a negative effect in their performance on stage. In addition, we assume that weakness can be experienced in the strength of the trunk muscles, their extensibility is not appropriate even in spite of regular training.92 dancers (average age: 14,15± 2,95 years) participated in the examination: 30 ballet dancers, 32 ballroom dancers, and 30 hip-hop dancers. The anthropometric data was measured with OMRON KaradaScan body composition monitor, the level of the negative effect of low back pain on stage performance was measured by visual analogue scale, and the strength and extensibility was measured with a Kraus-Weber test. On the basis of the anthropologic evaluation, we received a significant difference concerning each examined parameters (body weight: p=0,000, height: p= 0,000, muscle mass: p= 0,001, BMI: p=0,000, body fat percentage: p=0,000), the reason of which was the fact that the different dance styles have different physical requirements for the dancers. In accordance with data measured by the visual analogue scale, no significant difference was received (p=0,104) between the examined groups, although the hip-hop dancers reported the highest percentage (10,54%) of the occurrence of low back pain that negatively affects their stage performance. On the basis of the Kraus-Weber test, in the case of both abdominal muscle exercises the hip-hop group had significantly better performance (K-W A.: p=0,016, K-W B.: p=0,001) than the other two groups. Concerning muscle extensibility, (K-W F.: p= 0,030) the ballet group had significantly better results. In the case of all three examined groups it can be claimed that despite regular training, low back complaints occur at a very young age, which also have negative effects on stage performance.

V. Agueh   C. Sossa Jerome   D. Nyametso   M.N. Paraiso   C.S. Azandjemè   C. Metonou   and Laurent T. Ouédraogo   

The objective was to evaluate the performance of the expanded immunization programme's (EPI) supply chain of and logistics management in Comé health district in 2015. This cross-sectional and evaluative study concerned the central deposit of vaccines and 19 health care centers randomly selected. Data on the performance of EIP supply chain of and logistics management were collected from 5 to 30 March 2015 using direct observation, document exploitation, questionnaire and individual interview in 20 health workers directly involved in EIP activities and 59 mothers of children aged 0-11 months. The performance of the supply chain and logistics management was assessed through three components "structure", "process" and "results" using predetermined score of two scales seeking for achievement of criterions included in components. The overall performance of the EIP's supply chain and logistics in the health district of Comé was rated fair (score = 75.2%). The performance level was good for "structure" (score = 90.3%), acceptable for the "process" (score = 79, 85%) and poor for the "results" of the management of supply chain and logistics (score = 59.48%). The level of performance EIP supply chain and logistics was sub-optimal. Adequate measures should be considered to improve the component "result" of the EIP supply chain and logistics management in the health district of Comé.

Early J.O.   Breckwich Vásquez, V.A.   and Sylvia Elena Sobrinho Herrera   

The Affordable Care Act recognizes Community Health Workers (CHWs) as lay health professionals that promote positive health behaviors and outcomes for patients in medically underserved communities. Despite this validation, there remains a lack of awareness, and some controversy, about the role of CHWs, the value of their work, and ultimately how their roles relate to primary care. The purpose of this feature article is to increase awareness about the contributions of community health workers to primary prevention and to report several key issues identified in the literature and from organizations working with CHWS about their evolving and multifaceted role in improving primary care and population health.

Ernest Darkoh   Ebrahim Variava   Shuabe Rajap   Bongani Nkosi   and Fiona de Korte   

South Africa has the largest number of people living with HIV globally, and the world's largest antiretroviral therapy (ART) programme with over 2 million people estimated to have received ART by 2013 [2,3]. Recognizing the significant constraints on public sector resources to meet increasing public demand and need for ART initiation, BroadReach Healthcare and the North West Province Department of Health (DOH) implemented the private General Practitioner (GP) 'Down Referral' Model commencing in 2005 and ongoing, to provide HIV treatment and care for patients stable on ART. Implementation of this model leverages existing capacity within the private sector, shifting delivery of ART in stable patients from hospitals to lower-level private health facilities, and allowing public facilities to focus on initiating new ART eligible patients and managing complex cases. Over 10 years, the model has proved highly successful where the probability of patient survival at 12 and 48 months is 99% and 89% respectively, and retention at 48 months remains high at 94% [7]. This model is a simple, robust, evidence based and easily replicable model for rolling out a defined health service at scale, and further demonstrates potential for public private partnerships in addressing the burden of chronic disease.

Andrea Rishworth   Susan Elliott   Jenna Dixon   and Ann Clarke   

Collaboration among researchers and knowledge users, referred to as integrated knowledge translation (iKT), (potentially) enhances the relevance and use of research, leading to improved policies and practice. However, iKT is often applied in idiosyncratic ways, limiting integration of both knowledge creation and action. Further, iKT is rarely used at the stage of knowledge creation. Rather, it is typically used at the stage of knowledge synthesis or dissemination. This paper reports results of one part of a larger research program undertaking iKT through the integration of knowledge users and scientists in the process of knowledge creation around food allergies in Canada. A focus group discussion with 14 knowledge users involved in an ongoing biomedical research project was conducted with the purpose to: (1) share results of recent national survey data describing the prevalence and determinants of food allergy in Canada; and (2) elicit input into the next wave of survey activity in order to ensure the relevance of the next round of data collection. Stakeholders reported a lack of relevant, credible data sources to establish accurate understandings of food allergy for constituents. Confusion and doubt around information resources underline issues of insufficient knowledge translation, hindering knowledge user's credibility as providers of important public health messages. Integrating knowledge users in the process of knowledge creation is essential to facilitate stronger communication between researchers and knowledge users, help modify approaches, and improve population health outcomes; in short, iKT makes science useful.

Cristina Lavareda Baixinho   and Maria dos Anjos Dixe   

Falls are a public health problem, which directly contribute to functional decline, increased dependency and increased complications associated with immobility syndrome. The investigation has been productive in biophysiological identification of risk factors, but less successful to identify environmental risk and even less to identify behavioral risk factors. This methodological study aimed to build and validate an instrument to assess management practices and behaviors for risk of falls. The Scale of Practices and Behaviors for Institutionalized Elderly to Prevent Falls has two dimensions: 1 – communication practices and behaviors between elderly and different professionals from the institution (α=0.881; KMO=0.775), 2- safety practices and behaviors adopted by elderly (α=0.817; KMO=0.727). The instrument has good psychometric characteristics and it can be used for investigation and for clinical practice to identify practices and behaviors related to fall risk.

Ammar Hassan Abdelgadir   Mohamed Hamid Awadelsied   Emadeldin Mustafa Elbushra   and Yasir Noureldaim Gashi   

Unstable intertrochanteric fractures in osteoporotic bones of elderly patients was a real challenge that face orthopedic surgeon because of difficult anatomical reduction, poor bone quality and complication of prolonged bed redden or limited ambulation. The aim of study was to assess the clinical outcome of cemented bipolar as primary management of comminuted intertrochanteric fracture femur in elderly Sudanese patients. Material and methods: (30) Elderly Sudanese patients with unstable intertrochanteric fractures (kyle type III or IV) treated by primary hemiarthroplasty using a cemented bipolar prosthesis. Suture or wire fixations were used for reconstruction of greater trochanter fracture. Harris hip score was used for the clinical evaluation. Result: There was a significant relation between age and kyle classification (p value 0.05). According to Harries hip score 17 out of 30 had a good to excellent result (56.7 %) If the patients with a fair result were also included, the percentage goes up to (93.4%). Conclusion: The primary cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients' dose provide staple, pain free with early mobilization, better range of motion and less complication rate in short term follow up.

Loty Pierre Jean-Daniel   

Use of biomass cooking fuel is a known risk factor of child Acute Respiratory Infections (ARI). However, studies so far did not focus on rural areas where biomass fuel use is common. The purpose of this study was to measure the effect of biomass fuel on child ARI in rural areas of Cameroon and Gabon. The analysis was based on DHS national surveys. Logistic regression helped to estimate the risk of suffering from ARI among rural children living in households using only biomass fuel compared to children living in households using a mix of gas and biomass fuel, after controlling for several confounders. In both countries, the relationship was significant, although ARI prevalence in Gabon was twice higher. In Cameroon, the effect was stronger and regional differentials were striking, rural children from the North West region being 23 times more affected than those from rural areas of Littoral.

Yumi Oshita   

This article aims to present and discuss an innovative narrative social work theory, and to demonstrate its effectiveness through a case study of liberating a client who was dominated by HIV/AIDS discourse. The innovative construction entails four components: basic theory, clinical theory, intervention skills, and a measurement method. The selected basic theory, derived from Foucault's theory of the power of knowledge as well as Bateson's theory of difference, is aimed at theorizing a process that could help an individual to construct a new story by activating a force of differentiation in the vertical and horizontal feedback loops. Clinical theory, which provides a practical framework for problem solving, was formulated as the generation of a difference within the circular process of horizontal and vertical feedback loops. This article identifies a set of intervention skills and their effective application for generating a difference in a strategic direction. Circular questions are considered as key skills for generating a difference, while the categorization of each skill indicates a strategic application. The measurement method is theorized using modified Bales' theory to demonstrate the dynamics of the transformation process. Three-dimensional graphs are used to visualize the activation of the force of the difference.

Shamima Nasrin   and Faisal Ahammed   

This article presents the description of changes in terms of maternal, neonatal and child health due to the initiatives of Manoshi Project by Bangladesh Rural Advancement Committee (BRAC). Analysis of changes is also highlighted here. BRAC started the Manoshi Project to bring skilled care into the informal settlement of six major cities in Bangladesh in 2007. Three core methods including social mapping, census tacking and community engagement were adopted to achieve the aims of Manoshi project. This project has successfully reached to the most vulnerable women and children with very low cost and minimum infrastructure. The Manoshi Project has empowered the community through social mobilization, advocacy and communication.

Akiva Turner   

This paper compares and contrasts two different public health case studies in which public health authorities sought to address HSV-1 infection in Orthodox Jewish communities following ritualized circumcision. Using these cases, the author critiques the use of a governmental regulatory approach when public health authorities target a minority community for a practice which is not valued by the dominant political culture. Lastly, the author describes the benefits of community engagement in addressing such non-emergent public health concerns, particularly if the community involved is a religious minority one.

Tzvetina Arsova Netzelmann   Savka Savova   Silvia Vassileva   Joyce Dreezens-Fuhrke   and Elfriede Steffan   

Multiple social determinants e.g. poverty, lower education, unemployment aggravate the health inequities that the Roma population experiences in many European countries. Marginalized Roma communities in Central and Eastern Europe (CEE) face particular societal discrimination and limited access to health/social care, not least due to lacking health insurance. As a consequence young Roma suffer adverse health problems, including problematic drug use harms. The WEDworks project (Women, Ethnic Minorities, Drug-help Services) implemented a qualitative drug study among 123 Roma young people, 44 Roma parents and 23 local experts in Bulgaria, Latvia, Romania and the Slovak Republic. Based on its results gender-sensitive and needs-driven prevention actions were piloted. The interventions combined comprehensive setting-based approach on individual, family, and community levels with participatory behavior-change methods (popular-opinion-leader, peer drama and life-skills trainings) for prevention of drug use, HIV/STI and sexual health promotion. The main results were sensitization and mobilization of Roma community social networks for drug prevention and direct involvement of community young people in the co-shaping of the behavior-change process. Both research and prevention produced community- and resource-building effects and fostered inclusion and empowerment of vulnerable Roma youth. The formulated practice-driven recommendations support successful further roll-out of the piloted community-based model.

Natascha Sánchez Hövel   

End-stage renal disease requires replacement therapy including renal transplant. Far from being a matter of biomedical criteria or individual choice, the decision whether preferring a dead or a living donor depends on availability. In Spain, cadaveric donation has been the hegemonic practice with an only recent introduction of living donation. The present paper focuses on the logics in the process of decision-making and negotiation between medical professionals and living donors while shaping, developing and giving meaning to an emerging social practice. Concepts of blood, courage, legitimacy and nature are central in the discourse of decision-making inserted in traditional constructions of kinship.

Erwin W. Hohn   

One Health offers the veterinary community the opportunity to re-evaluate the paradigms underpinning animal health care delivery systems. To be more effective animal health care delivery, especially as traditionally viewed by small animal practitioners, needs to be broadened and move away from a primarily technologically led clinical curative approach. Improved access to clinical care does not result in improvements in the health status of populations. The distinction between Primary (Medical) Care and Primary Health Care (PHC) is made. An overview of Community Health and, in particular PHC, as practiced in human health care is provided. For this approach to have relevance and be impactful on service users (and communities), the undergraduate curriculum needs to be community oriented and community based. Veterinary Community Health (including veterinary PHC) needs to become a recognised specialty and provide the overriding context within which the more traditional specialties are presented to the student. A model that will allow for cost effective, holistic and integrated animal health care is proposed. This provides opportunities for the profession to expand it role and influence as well as collaborate with allied stakeholders.

H J Moller   L Saynor   H Bal   and K Sudan   

Public health models of wellness care embracing holistic models of mental health are currently needed that are, protocol-driven and have the capacity for standardization without losing a personalized human-centred intention and execution. Increasing evidence is pointing towards the health benefits of leisure: freely chosen, intrinsically motivated and self-directed "flow states", often environment-directed and quite probably with the potential to enact potent changes of consciousness. Our group has been exploring the phenomena of immersive induced "Leisure" and "Wellbeing" in clinical and research endeavours in recent years, allowing for optimized development of both therapeutics and diagnostics to support these efforts. This update offers a review of our optimized wellness care, designed for maximum effectiveness and minimal invasiveness. Optimal leisure experiences are thought to result in enhanced mental wellbeing, positive affect and transformational learning states that carry over into effectively coping with daily routines, stresses and roles. Our group has developed and researched the medically supervised administration of standardized simulated leisure-state meditation experiences in the context of pleasant, hedonic sensory input incorporating multiple sensory channels (visual, auditory, haptic) to promote broad-spectrum wellbeing in mental health care. In this brief report, we report on a novel clinical mental health methodology: TEMM- a technology-enhanced multimodal meditation stress-reduction program with a broad-spectrum mental health benefit, analogous to conventional Mindfulness Based Stress Reduction (MBSR) programs, and a therapeutic risk-benefit margin possibly superior and often preferred by patients to medication therapy attending the PRAXIS holistic health centre. We touch upon seamless diagnostic evaluation and clinical utility of Wellpad, our Electronic Medical Record (EMR) system developed using an iterative Inclusive Design approach. We place our multisensory TEMM meditation therapy within the scope of Virtual Environment Therapy (VET) and suggest the mechanism of action as an induced leisure or flow state to potentiate relaxation, stress-reduction, resilience and personal transformation. The relevance of leisure states to wellbeing and specifically positive experiential learning through inspirational/motivational shifts in consciousness delivered via multimodal immersive environments are described as an important health promotion avenue to pursue and the public mental health research community to consider as new improved, paradigms are developed, aimed at maximizing efficacy and cost-efficiency while minimizing iatrogenic outcomes.

Susan T. Njau   

Prevention of illness amongst school going children is crucial in enabling access and participation in learning. Educational achievements can be linked to healthy behavior, a healthy body and a healthy living environment. There is need to ensure that schools maintain good hygiene in order for the learners to be able to be in school and continue to learn. Quality education entails that children have a holistic learning which includes the emotional, physical psychomotor as well as the academic aspects. Learners should be made to be responsible for their well being both in school and while out of school. It is therefore expected that the school administration, the parents and the community should strive to maintain good hygiene. Schools should put in place measures such as school sanatorium, adequate and appropriate sanitation facilities, provision of clean safe water to ensure that students are in good health.

Adrian D. Meehan   and Linn Brosché   

Objective: Hospital physicians in Sweden most often decide do-not-resuscitate orders (DNR) without collaboration. Systematic pre-arrest indicators of cardiopulmonary resuscitation (CPR) do not exist. Therefore, new, and for the first time, national ethical guidelines on CPR have recently been published in Sweden. We aimed primarily to investigate if doctors and nurses knew about the guidelines and thereafter to gauge their attitudes concerning DNR. Methods: An anonymous questionnaire was conducted of 48 doctors and 45 nurses (n=93) at surgical, medical and geriatric clinics at Örebro University Hospital, Sweden. A response rate of 62% was achieved. The questionnaire contained 17 questions; four about background information and 13 questions about procedures concerning DNR-orders where responses "yes, always", "normally", "seldom", "no, never" and "don't know" were most often available. Respondents were also invited to leave explanatory remarks. Results: Eighty percent of doctors knew about the new ethical guidelines, in contrast to 42% of nurses. Twenty-seven percent of doctors discussed with patients DNR-orders "normally", though 31% did it "seldom". Whereas nurses did this either "seldom" (40%) or "never" (58%). Ninety-one percent of nurses were in favour of patient involvement in decision-making concerning DNR-orders. Conclusion: While a moderate level of knowledge of the ethical guidelines existed, especially in doctors, the present study highlights a possible discrepancy between the awareness of the guidelines with the prevailing hospital praxis and the general attitudes of respondents. The study questions to what extent the guidelines are in fact implemented. Greater involvement of nurses, other paramedic staff and patients may lead to improve in-hospital patient care. Further descriptive and qualitative studies would be useful to explore these issues.

Stacey A. Pilling   and Larissa J. Estes   

The purpose of this qualitative study was to examine the barriers that may inhibit migrant women farmworkers' management of perinatal care while working in Northern Ohio. Face-to-face interviews were conducted with 15 migrant women farmworkers who had experienced at least one gestational period while working in the Midwest agricultural stream. Participants were voluntarily recruited using purposeful sampling. All participants reported several occupational and access barriers that hindered them from receiving perinatal care while working in the fields. These findings may inform public health providers and migrant healthcare clinicians of the barriers migrant women farmworkers' experience while working in Northern Ohio; results can also be used to influence local and national migrant healthcare policies on developing comprehensive maternal healthcare.

Afsana Al Sharmin   and Munima Haque   

Diabetes is a buzzing word nowadays in Bangladesh as well as the world. The prevalence and incidence of type-2 diabetics is also increasing in Bangladesh. Secondary data is used in this study. It is anticipated that most patients will fall in the age range of 20-75 years. All patients, who are newly detected diabetes patients, from the year of 2012 of the BIRDEM General hospital in Bangladesh are requested to fill up a form of the Patients History Sheet. The study use bivariate analysis and a multiple regression analysis considering fifteen risk factors as covariates controlling one by one and two hours before fasting blood glucose of type-2 diabetic patients as a response variable. After controlling one by one fifteen risk factors, it is examined that there is relationship between age and type-2 diabetes. Moreover, fifteen models are considered by controlling individual outcomes to find out the confounding factors. Physical activities, occupation, family history of diabetic patients, Systolic Blood Pressure (SBP) (>140mm Hg), and Diastolic Blood Pressure (DBP) (<70 mm Hg) are confounders for the association of diabetes and age among Bangladeshis. None of the model showed the significant effect of sex, marital status, number of family members and smoking status on the relationship.

Alexandra S. Olarnyk   and Susan J. Elliott   

With the prevalence of food allergies within Canada estimated at approximately 7%, researchers have sought a variety of perspectives to inform our understanding of food allergy risk and perception (Soller et al., 2012). However, university students' perception of food allergies is an area of little research that needs prompt attention in light of a recent death (2015), due to anaphylactic shock, of an 18-year old Canadian university student (Vuchnich, 2015b). Since the perception that the prevalence of food allergies is increasing, investigation into the risks involved when transitioning into university with a food allergy are needed (Harrington et al., 2012). This study explores the experiences and perceptions of food allergic undergraduate students of the University of Waterloo, Canada. The two main objectives include: (1) to understand how food allergic university students experience and perceive food allergy risk on campus; and (2) to understand their management and coping strategies. Five focus groups were conducted with a total of twenty participants. Focus groups were audio-recorded and transcribed verbatim for subsequent thematic analysis. Results are organized into three themes: perceptions and experiences, coping and management, and changes and improvements. The key findings indicate that participants are experiencing difficult transitions into university and social isolation as a result of their food allergy, which has caused them to engage in risk-taking behaviours. This sets the stage for serious policy implications that the university should undertake in order to create a context that is inclusive for students with food allergies.

Jomama One Jomama Lual   Dan Owino Kaseje   James Aggrey Oloo   and Peter Sumba Odada   

Plasmodium falciparum is said to be yet sensitive to artemether-lumefantrine (AL) among all age groups in Kisumu County, despites report of its isolated strain with reduced sensitivity in Kilifi and reported reduced sensitivity to artemisinins in South East Asia. This trial intended to compare Plasmodium falciparum clearance failure rates among children (6-11 years) with uncomplicated falciparum malaria randomly allocated to artesunate-mefloquine or generic artemether-lumefantrine. We conducted a two arms open label randomized controlled trial with a fourteen day follow up and a sample size of 130 children with uncomplicated falciparum malaria in government primary schools of Kisumu East Sub County. This study showed Plasmodium falciparum clearance failure rates significantly higher (P = 0.02) with generic artemether-lumefantrine than with artesunate-mefloquine on day one of treatment. However, no significant difference (P = 0.999) was observed between the two arms on day seven and day fourteen of treatment. Thus, Plasmodium falciparum was less likely to fail to clear as it responded to artesunate-mefloquine than to generic artemether-lumefantrine on day one of treatment. Nevertheless, it was unlikely to fail to clear as it responded to both artesunate-mefloquine and generic artemether-lumefantrine on day seven and day fourteen of treatment.

Diriba Gebeyehu   Bitiya Admassu   Makida Sinega   and Merga Haile   

Background: Increasing legal access to abortion is associated with improvement in sexual and reproductive health. Conversely, unsafe abortion and related mortality are both highest in countries with narrow grounds for legal abortion. The objective of this study was to determine the prevalence and reasons for terminations of pregnancy at Jimma university teaching hospital. Methods: A retrospective cross sectional study was conducted at JUTH from June15-28, 2015, a total of 194 cards of women who came for abortion services from January 2012-January 2014 were included by systematic random sampling with inclusion and exclusion criteria. Chi square (x2) test calculated to analyze the statistical association between abortion types and other variables, p-value less than 0.05 was considered statistically significant. Result: According to this study, of the total calculated 194 sample size from clients admitted for both spontaneous and induced abortion 125(64.4%) were spontaneous and 69(35.6%) were induced abortion. 28(14.4%) of incomplete spontaneous abortion occurs between age of 25-years.one of the most common complication in this study was sepsis 23(11.9%). This study revealed that the main reason for induced abortion was due to rape and economic problem which holds 30(15.5%) and 16(8.2%) respectively Occupation and marital status are strongly associated with types of abortion with p-value of P<0.001. Conclusion and recommendation: The study concludes that majority of abortion were spontaneous abortion which almost hold all septic abortion and majority of induced abortion were teenage, single students and most of them presented after 2nd trimester of pregnancy which increases the complication of abortion. Thus, health education on dangers of induced abortion, spontaneous abortion and utilization of contraceptive methods services to all women are highly recommended.

Mukhwana Eugine Sundays   Ayuku D O   and Baliddawa J   

The purpose of this study was to assess levels of knowledge on HIV/AIDS, attitudes towards PLWHAs and programs to prevent HIV infection of community members of Navakholo in Western Kenya. This was a cross-sectional study that used quantitative data collection methods. Three hundred and eighty four (384) Household Heads randomly selected from the study area were interviewed using a questionnaire. Data obtained was analyzed using SPSS computer software program Version 18. ANOVA was used to check for probable differences between core variables of HIV/AIDS knowledge, attitude, and perceptions against gender, education and age. Study findings revealed that the level of knowledge was high (92% of the respondents had high levels of knowledge, although some gaps in knowledge and misconceptions about HIV infection and AIDS were also evident). Attitudes towards PLWHAs and programs to prevent HIV infection were varied with 34% of the respondents displaying stigmatizing attitudes. The study concluded that gaps in knowledge, misconceptions about modes of HIV transmission as well as negative attitudes are an impediment to the community's efforts to control the spread of AIDS. The study recommends intensive HIV/AIDS education to members of the community to fill the gaps in knowledge and to correct the misconceptions noted. The education should be tailored to help improve on attitudes towards PLWHAs and programs to prevent HIV infection.

Lorie Donelle   Ebony Rempel   and Jodi Hall   

This research assessed criminalized women's health literacy skills. Health literacy is conceptualized as one's ability to access, understand, appraise, communicate, and act upon health information. Estimates of health literacy skill for criminalized women in Canada do not exist. The research question that guided this study was: what are the assessed health literacy skills of criminalized women? A cross-sectional survey design assessed participant demographics, health information preferences, and health literacy skills. The Newest Vital Sign (NVS) was administered to incarcerated women in Ontario, Canada. Descriptive statistics of demographic data and assessed health literacy skills were reported. Eighty-five women with a mean age of 29 years participated. The majority (N= 50, 65%) reported an income less than $14,999 (CAN) and 81% (N=68) reported their education level as a high school diploma or less. A range of health literacy skill [inadequate (51%), marginal (15%), adequate (34%)] were documented with a mean NVS score of 2.79± 1.75/6. The results demonstrated participants' had limited health literacy skills, which have far reaching implications for the development of health resources that strive to accommodate diverse health literacy skill and lived complexity. The results support population level reports of limited health literacy skill among marginalized Canadians.

Yuko Yamaguchi   Punpilai Sriareporn   Prueksalada Khiaokham   Piyawan Numtapong   Yuko Tanaka   and Hiroya Matsuo   

The objectives of this study were to examine the current state of knowledge and sexual behavior concerning the prevention of Sexually Transmitted Infections(STIs), and to evaluate attitudes toward safe sex and coping with STIs. We performed a self-administered questionnaire and focus group interview among 197 high school students in Northern, Thailand. We also determined the presence or absence of chlamydia and gonorrhea infections in urine samples taken from 70 students. The participants were actively concerned with emotional relationships and homosexuality, but held negative attitudes toward sexual behavior including premarital sex and kiss, and had less chance for sex education along with their developmental stages. Consciousness of sexuality, knowledge level of STI prevention, self-efficacy toward safe sex, and coping ability with STIs were significantly higher in females than in males. In the urine test, all of the participants as a sub-set of those surveyed had negative results for STIs. In conclusion, the knowledge level of the participants on STI prevention correlated with self-efficacy toward safe sex and coping ability with STIs. Thus, the authors of this study conclude that sex education is effective for students to get comprehensive knowledge about STI prevention, and educators need to consider students' individual sexual issues.

Hong Zhu   Hong-Peng Sun   Chen-Wei Pan   and Yong Xu   

We sought to determine whether average age at menarche (AAM) declined in Chinese girls during the past decades, and whether there were any differences of AAM among urban and rural girls in the mainland of China. The analysis of the study was based on Han schoolgirls aged 9 to 18 years in 22-30 provinces during 6 cycles (1985, 1991, 1995, 2000, 2005 and 2010) of Chinese National Survey on Students' Constitution and Health. The average AAM overall was determined using probit analysis and compared between urban and rural areas. Correlation analyses and line regression models were used to explore the relationship of socioeconomic factors with AAM. In 1985-2010 the median AAM decreased rapidly at the speed of 3.9 months/decade for urban girls from 13.17 year (95% CI, 13.14-13.20) to 12.35 year (95% CI,11.65-13.01) and 5.95 months/decade for rural girls from 13.83 year (95% CI, 13.80-13.85) to 12.59 years (95% CI, 12.36-12.82). The urban-rural difference reduced continuously from 0.66 year in 1985 to 0.24 year in 2010. The average AAM in southeastern areas was lower than that in the northwest, both in urban girls and rural girls. Higher relative Gross Domestic Product per capita and residents' consumption level was consistently associated with increased likelihood of having reached menarche; the strength of associations for rural girls was stronger than that for urban girls. Our findings suggested presence of an obvious downward trend of AAM in Chinese girls from 1985 to 2010, both in urban and rural areas. The urban and rural distribution, regional difference and socioeconomic factors should be considered when interpreting trends in age at menarche in China.

Akil Hossain   Quazi Zahangir Hossain   Qazi Azad-uz-zaman   and Farzana Rahman   

Long term smoking poses many health hazards that most of the teenagers know, but many do not care. Once they start smoking, struggle to cease throughout the lifespan. Peer pressure is one of the main causes of initiating smoking observed by many studies. The research was mainly carried out to explore the factors influencing the teen to initiate smoking in south-west region of Bangladesh. A number of 408 students from level 7 to 12 were interviewed using a semi-structured questionnaire during February to November, 2014. The curiosity of the teen and 'to get rid of frustration' is the two main reasons of initiating smoking. Some other acknowledged reasons are peer pressure; desire to fit with friends, fun making, copying parent or elderly, and to relief from mental stress. More than half of the teens smoke to overcome psychological stress. Some others are smoking to keep relaxed from study load, to keep away family problem as well as for outlook and personality. Many of the teen smokers used to smoke because of reasonably priced and easy to obtain. To overcome the situation, academic institutes can arrange workshop or seminar regarding the consequences of smoking on health. Health effects of smoking can also be added in the curriculum so that the teen can understand and re-think about their harmful habit.

Susan J Elliott   Nancy Fenton   C-L Joanna Sinn   and Ann Clarke   

Severe food allergy, or anaphylaxis, is an immediate and severe allergic reaction that may cause difficulty breathing, hypotension, unconsciousness, and even death. Given there is no cure, managing life-threatening reactions is limited to strict avoidance of implicated foods and provision of medication for symptomatic treatment of an adverse reaction. A key piece of this management is the regulatory frameworks used in public spaces such as schools. This paper explores the perceptions and experiences of 'school' as a safe place for students with anaphylaxis and their parents in two Canadian provinces with very different regulatory environments in order to assess the impact of alternative regulatory environments on the quality of life of affected individuals. A qualitative research design involving draw-and-tell exercises along with in-depth interviews with elementary school-aged children (n=45) and their parents in the provinces of Ontario and Quebec, Canada was used. Results indicate that these very different regulatory environments had differing impacts on kids and parents. Ontario parents found security in the Ontario legislation, while the heterogeneity of the Quebec school regulatory environments resulted in reported stress and anxiety among the parents interviewed. The kids themselves just wanted to feel normal and not be teased or bullied.

Izuogu C. U   

This study evaluated environmental hazard effects as a critical issue relating to agricultural production of rural households in Imo State, Nigeria. Multi- staged purposive and random sampling techniques were used to choose the samples. The study determined the farming activities of the respondents, ascertained the respondents knowledge of the effects of environmental hazard on agricultural production among respondents and analysed the relationship between environmental hazard and agricultural production of respondents. Primary data collected from 116 respondents were used for the study. Data analysis was carried out with the use of descriptive statistics and multiple regression analysis. Results from the study show that majority (76.54%) of the respondents were engaged in cassava production as their major cash crop. A mean score of 2.18 on a three point likert-liked scale showed that majority of the respondents were aware of the effects of environmental hazard on their agricultural production. Results from the regression analysis shows that flood, oil pollution, erosion and wind storm were significant and negatively related to the agricultural production. Oil explorations that go on in the rural areas should be adequately monitored to reduce its negative effect on the rural environment. It was therefore recommended that more efforts should be made to mitigate the effects of environmental hazard on agricultural production of rural dwellers. This could be achieved by providing agricultural insurance schemes for farmers, paying compensation to farmers over losses arising from environmental hazards.

Ouendo Edgard-Marius   Sossa Jerome Charles   Saizonou Jacques   Guedegbe Capo-Chichi Justine   Mongbo Ade Virginie   Mayaki Alzouma Ibrahim   and Ouedraogo T. Laurent   

Antenatal care services for pregnant women improve maternal and child health outcomes. It is recognized that antenatal care services are underutilized in developing countries. The objective of the study was to identify the determinants of low utilization of antenatal care services during the first trimester of pregnancy in southern Benin rural setting. The cross-sectional and analytical study included 301 pregnant women, 29 husbands and 21 health workers in Athiémé municipality (southern Benin rural setting) and was conducted from 14 April to 14 July 2014. Data on sociodemographic and antenatal services characteristics were collected using questionnaire, semi-structured interviews and focus groups. Determinants of low utilization of antenatal care services were identified using logistic regression model. Among 301 pregnant women, only 24.6% utilized antenatal care services during the first trimester of the pregnancy. Five independent determinants of low utilization of antenatal care services were identified: low education level of pregnant women, OR= 3.3 [95%CI= (1.534:7.071)]; wrong knowledge of the required period for the first attendance to antenatal care service during pregnancy, OR=5.131 [95%CI= (1.972:13.353)]; adequate knowledge of the benefits of the antenatal care service, OR=4.031 [95%CI= (1.401:11.594)]; participation in the behavior change communication sessions, OR=0.059 [95%CI= (0.028:0.125)]; adequate patient-welcome in antenatal care services, OR= 0.162 [95%CI= (0.051:0.513)]. Sociocultural reasons were also mentioned. Pregnant women underutilize free antenatal care services in Athiémé municipality. Effective interventions taking into account the identified determinants may contribute to improve the utilization of antenatal services in southern Benin rural setting.

Nikiema Leon   Sossa Charles   Agueh Victoire D.   Dedewanou Magloire   Metonnou Clemence   Colette Azandjeme   Noel M. Paraiso   Ouedraogo T. Laurent   Michel Makoutode   and Houinato Dismand   

The dietary approach to stop hypertension (DASH) is an effective nutritional strategy to prevent and treat cardiovascular disease. Optimal benefit from dietary recommendations in management of hypertension depends on the compliance. This analytic cross sectional study aimed at establishing determinants of DASH among adults with hypertension treated at hospital in Benin. The study included 150 hypertensive adults selected during medical visit for blood pressure monitoring at hospital Saint-Luc in Cotonou from June 3^rd to July 1^st, 2014. Data on consumption of sodium, fruits and vegetables, alcohol, saturated and trans fat rich products were collected by questionnaire. A score of adherence to DASH was built. Determinants of adherence to DASH were identified using logistic regression model. Only 20% of subjects showed adherence to DASH. Better knowledge on hypertension OR=5.18 (95%IC 1.98-13.22) and healthy dietary habits and lifestyle prior to diagnosis of hypertension OR=4.26 (95%IC 1.67-13.18) increased the likelihood of adherence to dietary recommendations for hypertension management. Nutrition education and information of patients on hypertension and its complications during medical consultations may increase their adherence to dietary recommendations for management of the disease.

Izabela Nawrolska   

Health care systems evolve at the same time in many different ways: in area of developing technologies, the development of the medical knowledge, because of demographical changes and particularly - aging of the society. This induces modifications of the priorities of the health policy, new methods of organization and more complex funding mechanisms. Individual components of the health care system: illness prevention and health promotion, basic health care, hospital care have different contribution into the health care systems of different countries. The worlds growing awareness that for keeping and improving the population health the governments must create effective and efficient health system leads to the effective illness prevention. It shouldn't be expected that the health effects and economic efficiency of the health care system will improve, without appropriate expenditures on actions which delay or prevent illness, and also allow early diagnosis and effective (usually cheaper) treatment. In the first part of the paper there will be discussed issues connected with modern health conceptions which create the fundaments of the approach to the illness prevention. Health care is the specific public goods. This induces the choice of criteria, used by policy makers, to allocate public sources. In the second part the crucial significance is to specify the determinant of the changes of the health benefits structures financed from the public means. The last part of this elaboration, based on gathered empirical data, will discussed experiences of the selected European countries on prevention of the selected illnesses, indicating the links between expenditures and the effects of the prevention activities.

Sloane Burke Winkelman   Jody Oomen Early   Ashley D. Walker   Lawrence Chu   and Alice Yick-Flanagan   

The number of Internet users around the word is at an all-time high. The majority of North Americans are internet users and over two-thirds participate in some kind of social network (i.e. Facebook, Twitter, etc.). Social networks and mobile technology enable individuals to connect instantaneously or asynchronously, across geographic boundaries publicly or anonymously. Few studies exploring cyber harassment have been conducted, primarily because these technologies are relatively recent. The purpose of this descriptive study was to examine U.S. women's experiences with and attitudes toward cyber harassment by way of an anonymous electronic survey. A total of 293 adult women (mean age 24.6) recruited from popular social networking sites participated in the research. The majority of participants (58.5%) reported being a student enrolled at a college or university. Close to 20% repeatedly received an unsolicited sexually obscene message and/or sexual solicitation (excluding Spam messages for all categories) on the Internet. More than 10% (11.5%, n = 33) repeatedly received pornographic messages from someone they did not know. More than a third of those who did experience some form of cyber harassment reported feeling anxious. One- fifth indicated they noticed changes in their sleeping and eating patterns as well as feeling helpless because of the harassment. Implications and recommended strategies for health education and personal safety in the online environment are provided.

Mukhwana Eugine Sundays   Ngaira J. K   and Mutai C   

Low and middle-income countries have extended state sponsored Social Health Insurance (SHI) to people outside the formal sector to enhance access to healthcare. However, in spite of the relatively low costs of signing up and the benefits offered by SHIs, up-take rates are very low among the informal sector populations. The objective of this study was to investigate factors affecting participation of people in the informal sector in the National Hospital Insurance Fund (NHIF) scheme in Kakamega County, Kenya. This cross-sectional study was conducted in Kakamega County in Western Kenya. The study employed a mixed methods designs approach. In the first phase of the study, 400 participants were recruited using both probability and non-probability sampling methods; 400 persons engaged in informal sector activities were recruited through random sampling. In the second phase of the study, 24 key informants and 5 groups consisting of 8-12 persons were purposively selected for in-depth interviews and Focus Group Discussions respectively. The study established that people in the informal sector with higher income (> Kshs.10, 000) are more likely to enroll (odds ratio 2.21 with 95% CI: 1.07 to 4.03) compared to those with low incomes and similarly, higher level of education was significantly associated with enrolment in NHIF scheme (odds ratio 31.07 with 95% CI: 17.19 to 87.94). Rigid scheme design features create difficulties for people in informal sector to participate. In conclusion, policy decisions should focus on interventions directed at educating poor populations, people with low educational levels and those working outside formal employments on the benefits of subscribing to the NHIF scheme in Kenya. The study recommends subsidies or waivers to increase affordability of participation in the NHIF scheme, particularly for people with low monthly incomes.

Zee Ying Lim   Ai Ling How   and Jing Ming Zhao   

Background: Smoking prevalence in Singapore has increased from 12.6 % in 2006 to 14.3% in 2011 despite restrictions on tobacco advertising and promotion act, largely due to the strategies of the tobacco industry such as cigarette packaging suggesting lower tar content to target the young and the health conscious. Objectives: To review the perception of health risks of different types of cigarettes across smoking status, age-group and gender, and to determine if smokers perceive differences in health risks based on the taste of cigarettes alone. Method: 240 smokers and 240 non-smokers were presented with cigarette boxes a pair each time and were asked a series of questions on perception of tar content, taste and perceived health risk. Participants who identified themselves as smokers were blindfolded and asked to take 2 puffs of each cigarette type and asked to rate for 'Presence of tar', 'Smoothness of taste' and 'Health risk'. Results: A significant majority of the participants selected 'regular' cigarettes as delivering more tar than 'light' and 'menthol' cigarettes, while 'lights' and 'menthol' cigarettes were perceived as smoother-tasting and being able to reduce health risks. Non-smokers were more susceptible to perceive 'lights' cigarettes as a 'healthier' choice, compared to smokers, but not females or adolescents. Smokers, based on taste alone, rated regular cigarettes to be higher in health risks compared to both 'lights' and 'menthol' cigarettes, which were similarly rated. Discussion: The perception of health risks across different types of cigarettes are affected by the deceptive descriptors on the packaging, but the local increase in prevalence of youth and female smoking cannot be explained by their susceptibility to packaging influences. Taste of cigarettes seems to affect smokers' perception of health-risks as well; hence bans on deceptive descriptors on cigarette packaging may not totally eliminate differences in perception of health risks of different types of cigarettes.

Mukhwana Eugine Sundays   Ngaira J. K   and Mutai C   

Social Health Insurance (SHI) has been preferred form of financing health care to reduce out of pocket expenditure on health care. Most countries are extending SHI programmes to people outside the formal sector in an effort to increase access to healthcare. However, this approach faces challenges of enrolment of sufficient numbers of people into a common risk pool and collection of contributions. The objective of this study was to evaluate strategies to enhance participation of people in the informal sector in Kakamega County in the National Hospital Insurance Fund (NHIF) Scheme for access to health care. This was a descriptive qualitative study with sample units purposively selected. Ten Focus Group Discussions were conducted and several Key informants interviewed. Data obtained was scrutinized for emerging themes. The study established that people in the informal sector in Kakamega County were aware of the value of the NHIF cover for accessing health care but lack accurate information on the insurance function of the NHIF cover. Rigid scheme design features also discourage subscription. Major recommendations included policy review of rigid scheme conditions, making the scheme attractive and increasing registration centers. Policy decisions should focus on educating people working outside formal employments on insurance functions of the NHIF cover.

Huaibo Xin   Ajlina Karamehic-Muratovic   and David Cluphf   

This study explored Bosnian refugees' attitudes and beliefs about how to cope with a potential natural disaster. A total of thirty-three Bosnian adult refugees participated in the study. Face-to-face, in-depth individual interviews were conducted. The findings indicated that Bosnian refugees developed a number of coping skills for survival and sustainability through their previous disaster experiences and emergency trainings. Their preparedness for a natural disaster can be characterized by strong leadership qualities, with more economic and social resources to draw on for coping, and close ties to local community. In case of an emergency, they would likely be calm, optimistic, and emotionally independent. Given the development of this group's coping skills, Bosnian refugees have a strong potential for serving as volunteers in disaster preparedness, response, and recovery. Particular attention should be paid, nevertheless, to these refugees' emotional and mental health needs in the aftermath of a natural disaster.

Dennis Butto   and Samuel Mburu  

The Contraceptive Prevalence Rate for West Pokot County is estimated to be at a low of 23% compared to the national prevalence which stands at 43%. This analytic cross sectional study was aimed at establishing the male factors associated with family planning in West Pokot County, Kenya. A total of 266 married men were involved and household was the unit of analysis. The findings of this study demonstrated that 48% of the respondents were not involved at all in family planning and only 6% of men were using a family planning method. The age of respondents, educational level, number of children, and type of marriage, knowledge and ease of access to family planning services were all significantly associated with male involvement. Having no education made a man 89% less likely to be highly involved in family planning (OD 0.117; 95% CI: 0.03-0.454). The study concludes that the level of male involvement in family planning in the county is still low despite interventions both by the government and other nongovernmental organizations. Therefore, more efforts should be made to improve education standards especially for men and to reorient family planning services to make them more accessible to men.

Nega Chufamo   Hailemariam Segni   and Yibeltal Kiflie Alemayehu   

Background: Antepartum haemorrhage complicates three to five percent of pregnancies contributing to perinatal and maternal morbidity and mortality. Timely access to quality obstetric services is the major determinant of both maternal and newborn outcomes after antepartum haemorrhage. In Ethiopia, the magnitude and consequences of antepartum haemorrhage are not well studied. The objective of this study was to determine the incidence, factors associated with and maternal and perinatal outcomes of antepartum haemorrhage in Jimma University Specialized Hospital. Methods: A hospital-based prospective cohort study was conducted in Jimma University Specialized Hospital, from January 1 to December 31, 2013. Data were collected by reviewing medical records and interviewing mothers. Cumulative incidence of antepartum hemorrhage among mothers who gave birth and odds of adverse outcomes among mothers with and without antepartum hemorrhage were calculated. Odds ratio was calculated to estimate the effect of antepartum hemorrhage on maternal and new born adverse outcomes. Results: Between January and December 2013, 3854 women gave birth in JUSH. The incidence of antepartum hemorrhage was 5.1% (n=195) in 2013. The major causes of antepartum hemorrhage were abruptio placentae and placenta previa occurring in 127(65.1%) and 52(26.7%) of cases, respectively. Six (3.1%) of the patients with antepartum hemorrhage died. Of the 206 babies born, 63 (30.6%) were stillborn and additional 13 (6.3%) newborns died during the first seven days of life making perinatal mortality rate of 36.9%. Conclusion: Antepartum hemorrhage is a common complication of pregnancy and cause of maternal and perinatal mortality in Jimma University Specialized Hospital. The risk of adverse outcomes is very high compared to other countries. Efforts to improve access and quality of comprehensive emergency obstetric care services are required.

Ryan Alexander   John A. Hay   Jian Liu   Brent E. Faught   Joe Engemann   and John Cairney   

Purpose: To determine whether physical fitness mediates the relationship between academic performance and motor proficiency in children. Methods: The academic achievement of 1864 students (F:926, M:938, age 11.91 (SD:0.34) from the Niagara Region of Ontario was derived from the average of provincial standardized tests for reading, writing, and mathematics. The Bruininks-Oseretsky Test of Motor Performance (short-form) determined motor proficiency. Fitness (peak oxygen uptake) was established with the 20-metre shuttle run multistage test. Results: Hierarchical linear modeling identified several significant predictors of academic performance. After controlling for age (p=0.7002), gender (p<0.0001), and parental education (p<0.0001), both motor proficiency (p<0.0001) and physical fitness (p=0.0004) remained significant. The addition of physical fitness to the model reduced the point estimate of motor proficiency from 0.004 to 0.003, a reduction of 25%. However, further examination of the 95% confidence intervals suggests that this reduction is not significant. Conclusions: These results suggest that aerobic fitness does not mediate the relationship between motor proficiency and academic performance. Both physical fitness and motor proficiency have independent roles in predicting academic performance.

Ning Tang   and Colin MacDougall   

Background: Health status change of the immigrants is of particular interest to health researchers and policy-makers, because it can impact population health outcomes; English, French and Chinese speaking immigrants are main immigrant sub-groups in Canada. Objectives: The multicultural study aims at examining general Health Status Change of English, French and Chinese speaking immigrants in Ottawa and Gatineau, Canada, and identifying demographic factors that correlate with the change and impact the change. Methods: In total, 810 English, French and Chinese speaking immigrants in Ottawa and Gatineau, Canada were recruited by purposive-sampling. Using self-reports, respondents answered questions regarding general Health Status and Demography in a Multicultural Lifestyle Change Questionnaire of English, French or Chinese version. Data in Health Status Change were analyzed statistically in percentage, significance of difference, correlation and regression. Results: Immigrants of different gender, language and category sub-groups exhibited different Health Status Change Rates, Health Status Improving Rates and Health Status Declining Rates, but no statistical difference between the rates. Immigrant general Health Status Change was correlated positively with Age and Primary Occupation, and negatively with Income. Mother Tongue, Primary Occupation and Income significantly impacted Health Status Change. Conclusion: Immigrants of different sub-groups in Canada experienced different health status change. The results supported "healthy immigrant effect". The "decline in immigrant health status" over time existed in some of immigrant sub-groups. Data of immigrant health status change can provide evidence for health policy-making and policy-revising in Canada.

Diana S. Mombo   and Dan C. O. Kaseje   

Background: Attaining universal access to primary healthcare services require radical changes in human resource and retention strategies. Hence, the task shifting is introduced. This is a process of delegation whereby tasks are moved to the most appropriate but less specialized level of Community Health Workers (CHWs). Effective planning to enhance scaling up of this strategy however, needs evidence which according to many researchers is vital but lacking. Methodology: This study provides such data for evidence based health policy decision making through the health services consumers' perceptions on task shifting in relation to CHWs current roles and responsibilities. The study was qualitative with fifteen focus group discussions held with health service consumers linked to the CHWs services. Ethical approval was gained through the Moi University and Great Lakes University of Kisumu Ethical Review Board and Committee respectively. Results: Short duration training programs, with mostly promotional, preventive and some curative tasks were suggested to be shifted to CHWs with a relatively strong monitoring and supervision mechanism. Consumers agreed that task shifting had significantly increased access to health services and improved health outcomes. Conclusion: Task shifting if well implemented could play a major role in improving access to, and equity in provision of primary healthcare services. However, there is the need to recognize, and carefully plan and implement task shifting. Failure to do so could result in it becoming a parallel health system competing with the formal healthcare system but with compromised quality. Hence, the Ministry of Health and other relevant stakeholders need to institute quality assurance frameworks, including standardized training, supervision, certification and regular assessments for effective task shifting models.

Gabriel Asare Okyere   Richard Tawiah   and Kwaafo Awuah-Mensah   

In most epidemiological data sets one cannot be certain that all risk factors are measured or observed. This paper studies the risk for mortality associated with diseases and deals with heterogeneity in mortality owing to unobserved covariates. We extracted medical records of 186 hospitalized patients from an urban health facility in Ghana. Patients with at least 2 diagnoses of chronic diseases were considered multimorbid. Using age of patients at death as survival time we executed our analysis with and without incorporating frailty effect to Cox proportional hazards (PH) model. The Cox PH model with Gaussian frailty fitted the data better when compared to the standard Cox PH model and Cox PH model with gamma frailty. On average patients were aged 62.3 15.3 years, with 66.1% being multimorbid. Varying degrees of mortality risks were found for different diseases, with the highest associated with having pulmonary valve disorders (HR 7.99, 95% CI 1.45-44.0). Heterogeneity in mortality resulting from unmeasured factors was insignificant. This study demonstrates that patients share similar risk with respect to unobserved factors, but varying risk when conditioned on observables.

Jenifer Li   Nancy Fenton   Stephanie Thayer   Caryl Russell   and Monica Gray   

The increasing rate of obesity among children and youth is a major health concern for the Canadian population. Although exercise-based intervention programs have shown significant improvements in clinical markers, maintenance and management of these improvements are often stunted or reversed due to barriers relating to negative attitudes and lack of motivation towards exercise. The Self-Determination Theory suggests a shift in motivation towards physical activity, from lack thereof to autonomous, can occur within supportive environments. It is thus crucial to explore the perceptions and experiences of overweight adolescents enrolled in fitness-nutrition programs. This research attempts to go beyond the biophysical markers of health to provide insight on individual experiences that affect attitudes towards exercise and making healthy choices. In-depth interviews were conducted with adolescents (aged 12-16years) to discuss their experience(s) in a referral-based fitness-nutrition program. Results from this study revealed that participants' attitude and perception of exercise shifted from apprehension to full engagement/enjoyment and were associated with individuals gaining self-confidence. These attitudes further translated to individual lifestyle changes outside of the program, illustrating the shift in motivation from external to internal. These results suggest that a potential key to enhancing physical activity and making healthy choice among overweight adolescents lie in shifting individual attitudes from a motivation to autonomous motivation in pressure-free supportive environments.

Vincent Icheku   and Nike Arowobusoye   

Uptake of breast cancer screening is lowest in areas of London with many hard to reach communities. This report evaluates two interventions to improve uptake of breast cancer screening in the Royal London Borough of Greenwich with many hard to reach communities. The interventions involved splitting 2,004 women eligible for screening into two groups. Group 1 who were sent letter only invites has a target group (n=1,452) and eligible women screened were (n=878). Whilst, group 2 who were sent letter invites combined with Short Message service (SMS) reminder has a target group (n=552) and eligible women screened were (n=376). The result shows a significant difference in attendance rates between the two invitation methods. The screening uptake by the women who received invitation letter only had an attendance rate of 60 percent (table1). The screening uptake by the women who received invitation letter and SMS reminder was 68 percent (table 2). This amounts to 8 percent differential rate, which translates to an additional 44 women who were screened, as a direct result of receiving an SMS reminder. Applying the achieved result to the “Letter Only” group indicates that an additional 12 women would theoretically have been screened if the ‘Letter only’ invites were also sent with SMS reminder. An overall 2.54 percentage point increase in screening outcome was achieved when compared the uptake in the months of the project (July to Dec 2011) with the uptake in similar months in 2010. Finally, the results prove that intervention by letter invite combined with SMS reminder is the most effective method of improving uptake of breast cancer screening in the borough with many hard to reach communities.

Lofty-John Chukwuemeka Anyanwu   Barnabas Danborno   and Wilson O. Hamman   

Congenital anomalies are abnormalities of prenatal origin, and their prevalence varies worldwide. The objective of this study was to determine the prevalence and spectrum of overt congenital anomalies in live born neonates in selected hospitals in the Kano metropolis of North western Nigeria, as well as the associated maternal, paternal and neonatal risk factors. A descriptive study design was employed. All live born neonates in three major hospitals in Kano metropolis were prospectively studied from April 2013 to December 2013. Detailed family history and clinical data were recorded in a structured questionnaire for each child. A total of 1456 live born neonates were recruited into the study, of which 41 (28.15 per 1000 live births) had overt congenital malformations with 5 (12.20%) having multiple system involvement and 36 (87.80%) having a single system affectation. The most common system involved in neonates with isolated single system malformations were the central nervous system (10 cases) and the genitourinary system (10 cases). The consanguinity rate in the study was 17.83%. Birth weight of the neonates had a significant but negative association with the likelihood of being born with a congenital malformation [OR = 0.374; (95% CI 0.196 – 0.711) P = 0.003]. Given the high frequency of potentially preventable central nervous system malformations in this study, emphasis on the primary prevention of congenital malformations by encouraging periconceptional use of folic acid containing multivitamin supplements is recommended.

S. Twumasi-Ankrah   J. T. Ashaolu   and Isaac Ankrah   

This study examines the impact of HIV/ AIDS scourge on economic growth of some selected Sub-Sahara African countries. The three sub-Sahara African regions (Southern, West and Eastern) are categorized into lowest and highest HIV prevalence rate, using the global report of the UNAIDS 2012 data. In each region, the lowest and the highest HIV prevalence rate countries are selected respectively. Thus, we consider a panel of three countries in each category over a period from 1995 – 2012. We used these data to estimate the cross-country level regressions of these two categories, using panel data models. Thus, our results are in twofold: For lowest HIV prevalence rate category, the pooled OLS model was the “best” model. This pooled OLS model indicated that, for one unit increase in HIV prevalence rate, the gross domestic product per capita of countries is expected to decrease by US$23.46, holding all other variables constant. Again for highest HIV prevalence rate category, the fixed effect model was the “best” model. The fixed effect model revealed that, one unit increase in HIV prevalence rate will cause the gross domestic product per capita of countries to decrease by US$9.98, holding all other variables constant. Generally, for a unit increase in HIV prevalence rate, the impact of HIV on the economy is two-thirds larger in lowest HIV prevalence rate countries than that of the highest HIV prevalence rate countries.

Kristin M. Brown   and Susan J. Elliott   

In 2005, the Ontario Ministry of Education implemented the Daily Physical Activity (DPA) Policy to provide every elementary student with at least 20 minutes of sustained moderate to vigorous intensity physical activity each day. This exploratory research sought to understand the factors shaping DPA implementation in schools and classrooms, from the perspective of elementary school teachers and principals. Semi-structured interviews were conducted with Ontario grade 1-8 teachers (n=14) and elementary school principals (n=5) regarding DPA implementation, facilitators, barriers, perceived outcomes, and suggestions for change. The majority of participants stated that students were not meeting the requirements daily. However, participants shared activities and techniques for incorporating physical activity into instructional time. Facilitators and barriers to implementation were organized using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework in order to identify factors acting at four environmental levels. The facilitators and barriers identified indicate that staff and resources within individual schools strongly influence implementation. Although many positive outcomes for students were identified, increased fitness was not mentioned, highlighting additional benefits above physical health. The findings suggest DPA is not being implemented as intended, as school staff are finding it difficult to meet the time and intensity requirements. Policy makers must consider the local school environment and the roles of school staff when designing school-based health policies.

Fikadu Tadesse   

Multi-Drug resistant Tuberculosis (MDR-TB) is becoming a major challenge of the tuberculosis (TB) control program in Ethiopia. The objective of the study was to investigate risk factors for MDR-TB in Addis Ababa. Comparative cross-sectional study was conducted to determine the risk factors for MDR-TB in Addis Ababa. MDR and non MDR-TB cases were compared on key socio-demographic and patient related clinical features for multidrug-resistance. A total 439 (113 MDR-TB and 326 non MDR-TB) were enrolled in to the study. Standard data abstraction instrument were used. Data were entered and analysed using SPSS version 18 for windows. Initial descriptive analyses of all variables of interest, odds ratio, univariate and subsequent multiple regression analysis was carried out. Male sex (OR 2, 95%CI 1.4-5), younger age of 15-34 years (OR 2.8, 95%CI 1.7–6.4), twice or more episodes of TB treatment (OR 14, 95%CI 1.3-9), treatment category of failure after re-treatment (OR 4, 95%CI 2.5-6.83), pulmonary TB (OR 2, 95%CI 1.7-5) and TB/HIV co-infection (OR 2.66, 95%CI 1.32-5.6) were associated with the risks of becoming ill with MDR-TB. The national TB prevention and control programme should be given priority for routine Line Probe Assay to make early diagnosis of MDR-TB particularly among those identified risk groups.

Quynh Lê   Stuart Auckland   Hoang Boi Nguyen   and Daniel R Terry   

Teenage pregnancy is associated with adverse social, economic and health outcomes for both mother and child. The factors frequently associated with teenage pregnancy or related sexual health issues include teenagers' knowledge, attitudes, and beliefs about sex and other social-economic factors such as levels of poverty, academic success or failure, and parents' education. This paper reports on the evaluation of a teenage pregnancy program conducted in the Southern and North Western regions of Tasmania to address the high levels of teenage pregnancy and sexually transmitted infection (STIs) in these regions. The aim of the study was to examine the effectiveness of the Teenage Pregnancy Programs by examining any evidence for a community change in attitudes and behaviours, and any changes in youth awareness about sexual health. The study adopted a qualitative approach and data were collected from a total of 25 participants (17 who were interviewed and eight who participated in focus groups) residing in the target regions. Data were analysed using thematic analysis using Nvivo 9.0. The study results indicated that the program was well managed and delivered. There were reported changes in the awareness, attitudes and behaviours regarding sexual health within the target communities, which were considered necessary for young people to make well informed choices. The evaluation of the program provides valuable knowledge regarding the processes and outcomes that may have application in future community based sexual health initiatives may be delivered into regional communities.

Anwar-ul-Haq   Hameed Mumtaz Durrani   Ramesh Kumar   and Salma Mumtaz Durrani   

Introduction: Maternal behaviour regarding child health care has been recognized as an important social and anthropological factor explaining high mortality rates among children under five years of age. Delays in seeking appropriate health care is known to be the largest risk behaviour which contribute large number of child deaths in developing countries especially in Pakistan. Mothers are mostly responsible for their child health, however, the importance of knowledge among mothers while in identifying the danger sign in their child are very imperative for preventing their illness. Method: A cross sectional study was conducted in an urban setting in Karachi city. The objective of study was to assess the knowledge of mother's regarding danger signs in their child illness and their care seeking behavior with aims to improve the neonatal and child health in Pakistan. Results: The majority of respondent mothers (81.5%) were literate, housewives (90%). Regarding child care the mothers are responsible for the immediate needs of their child. In the context of breast feeding and immunization of the infants, majority of the mothers were aware of practicing early initiation and uses of colostrum because of its importance. Although a large proportion of mothers (90.1%) sought 'appropriate' care for childhood illness, generally care was sought from private doctors (69.4%) instead of government medical practitioners. Conclusion: Study concluded that the Health seeking behviour of mothers has been found appropriate, however, their knowledge regarding the danger signs and illness of their children was reported low. It is recommended that some urgent awareness intervention by the policy makers for reducing the child death should be given to increase their knowledge on the danger sign of child diseases in Pakistan.

Kristin M. Brown   Nancy E. Fenton   Larry D. Lynd   Carlo A. Marra   Mark J. Fitzgerald   Stephanie S. Harvard   Meagan Rosenthal   Bonnie Y. L. Chow   Ann E. Clarke   and Susan J. Elliott   

It is estimated that 50% of Canadian households are directly or indirectly affected by food allergies. Since accidental exposure to food allergens can cause life-threatening reactions, the need for accurate allergen labelling is key. In Canada, new food allergen labelling guidelines were mandated in August 2012. While a substantial improvement, gaps remain. This study explored the perspectives of directly affected individuals as well as members of the general public regarding their needs and preferences for precautionary labelling, allergen symbols, and suggestions for improving labelling practices in Canada. Eight qualitative focus groups were conducted with directly affected (n=27) and general public (n=24) consumers in Vancouver, Canada. Focus groups were audio recorded and transcribed verbatim for subsequent thematic analysis using NVivo9. Although "may contain" is recommended by Health Canada, it was the least preferred precautionary statement among research participants. Both participant groups described how many consumers' purchasing habits are indirectly affected by food allergy; hence, their views should be considered in addition to those of directly affected individuals when developing allergen labelling policies. The findings identify future policy needs: 1) mandating and standardizing precautionary/allergen statements and symbols, 2) increased monitoring, and 3) increasing food allergy education and awareness among consumers and manufacturers.

Vincent Icheku   

The recent Ebola Virus Disease (EVD) outbreak in West Africa is so far the largest and deadliest in recorded history. The rapid spread of the disease in the region and its potential for international spread prompted the World Health Organization to declare the outbreak a public health emergency of international concern. [1] This paper assesses the potential for the spread of the disease across international borders by returnee travelers and humanitarian health workers, given that the disease spreads through physical contact. The surveillance data published by both the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) were reviewed to identify the EVD epidemiological situation in West Africa from March 2014 to September 2014. The risk assessment data published by Public Health England (PHE) and CDC travel updates were reviewed to identify travel group(s) most at risk of transmitting EVD across international borders. Studies focusing on West African cultural practices were also reviewed to identify aspects that carry risk of EVD transmission. The study found that the risk of travelers transmitting EVD across international borders is low and would remain so on two conditions. First, all travelers must avoid direct physical contact with a sick or dead person or animal infected with EVD. Second, international humanitarian health workers in affected areas of West Africa who will eventually return to their home countries must work in safe environments with adequate protective equipment. The risk of travelers acquiring EVD is considered very low, yet there is serious concern that the disease may spread further within West Africa and across international borders. Local burial practices exacerbate the disease spread while poor working environments and inadequate supply of equipment increase risk of exposure to EVD of humanitarian workers. This researcher recommends addressing the issues through local awareness, pre-travel advice and capacity investment in the healthcare infrastructure in the EVD affected areas.

Amber S Linde   and Gudeta Fufaa   

Sleep loss is an important determinant of health status owing to its relationships with molecular, immune, and neural changes; these changes, in turn, are important etiological mechanisms for the development of cardiovascular, metabolic diseases and increased risk of accident related injuries. While the association between sleep loss and risk of weight gain is established, studies on the association between sleep loss and nutrition and physical activity are limited. The purpose of this research was to determine if there are significant associations between reported sleep variations and nutrition and physical activity level while recognizing the association between body mass index (BMI) and sleep loss. Data from the 2011 sleep-related questions captured by the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) was used to identify possible behavioral indicators related to sleep loss in women. Multiple logistic regression was used to assess the hypothesized associations between sleep loss and fruit and vegetable consumption and physical activity levels. The odds ratios for the association between fruit/vegetable intake and sleep loss and that of BMI and sleep loss were (OR =0.761, 95% CI =0.651, 0.889) and (OR = 1.108, 95% CI =0.972, 1.262), respectively. The odds ratio for the association between physical exercise and sleep loss was (OR = 0.991, 95% CI =0.864, 1.137). Having adjusted for relevant covariates, consumption of fruits and vegetables was significantly associated with sleep loss; physical activity was not significantly associated with sleep loss.

Madelyn P. Law   John Hay   Brent E. Faught   and John Cairney   

This study examined the extent to which the measurement of waist circumference (WC) can categorize overweight/obesity status similarly to BMI in children. Height and weight were measured and BMI was calculated for participants' age 9 to 11 years old. Children were classified as either normal-weight, overweight, or obese. WC was measured twice and the average of these measures recorded. Receiver-operator characteristic curves were computed for each age and gender for both overweight and obese using BMI as the standard. For each analysis the area under the curve was used as an overall indicator of agreement between the two measures. WC achieved very strong sensitivity for both overweight and obesity for both genders, ranging from .90 to .93. Specificity for obesity for both genders was very strong, ranging from .89 to .93 for girls and from .90 to .93 for boys. While specificity for obese remains high for both genders (.89 - .93) across all three years, the specificity for overweight fell to .68 to .84 for boys and to .66 to .74 for girls. Due to low levels of health literacy in the population, using WC may provide an easy to understand measure of obese or overweight status.

Kathryn Barnsley   Haydn Walters   and Richard Wood-Baker   

The aim was to examine bureaucratic barriers to implementing strategies for tobacco control in Tasmania. We analysed documents provided by government agencies under Right to Information legislation; documents provided by non-government organisations (NGOs), newspaper reports, websites and Hansards relevant for the period 1997 to 2010. Responsible Tasmanian bureaucratic organisations have had a culture of avoiding responsibility for high smoking rates, their processes being excessively complex, under-resourced in expertise and funding for mass media campaigns, having poor accountability mechanisms, failed to adhere to international standards in dealings with the tobacco industry, failed to follow evidence-based public policy despite being aware of its existence, were distracted by immediate needs, experienced passive and active obstruction from other government agencies, and did not adequately inform the Parliament about measures which might reduce smoking rates. The operation and culture of the Tasmanian bureaucracy has been a significant barrier to evidence-based tobacco control public policy. This deficiency was not confined to the Department of Health and Human Services, but also included the Departments of Premier and Cabinet and Treasury. Major barriers to evidence-based tobacco control have existed within the bureaucratic systems in Tasmania in the period 1997 to 2010. They were excessively process-driven, complex structures, with lack of "evidence transfer", antipathetic in culture and had scant resources. Similar barriers exist in some other jurisdictions. All this served to undermine the effectiveness of public-health expert-driven action.

Mohsen Haddadi   Seyed Abolfazl Zakerian   Mahmoud Mahmoudi   Gebraeil Nasl Saraji   Zohreh Parsa Yekta   and Abolfazl Aliyari   

Background and Objectives: Chronic Fatigue Syndrome (CFS) is a severe, debilitating disorder. Permanent chronic fatigue that affects the daily routine activities at least for six months and4 of the 8 patients reported symptoms associated with this disorder (problems of memory / concentration, restless sleep, joint pain, swollen lymph nodes, muscle pain, headache, sore throat, weakness due to work) and the absence of any underlying disease is the another sign of this disorder. One of the important things that are noticeable about the syndrome, is causing physical and mental disabilities in the person that will lead to approximately 50% reduction in his job performance. Methods: This study has been conducted through self-reported questionnaire and field and library studies. So the desired randomly set of 78 nurses have been selected to answer the two demographic information and symptoms questionnaires CFS (DSQ. revised)which it's reliability and validity has been verified. These questionnaires have been adjusted to the patient's preliminary data record and their symptoms. In the second stage, each individual job performance questionnaire was completed by department head. Results: The information obtained from the chronic fatigue syndrome questionnaire shows 14.1% prevalence of CFS. In discussing the relationship between CFS and indicators of job performance, it was cleared that people with the syndrome has lower job performance than those are healthy. Conclusions: In many similar studies, the effects of CFS on overall job performance in subjects were discussed and in most cases have been verified. The only differences are in subdivisions of job performance which are considered in this research

Yaho Yamamoto   Hiroya Matsuo   and Kuniyoshi Mori   

The aim of this study is to evaluate the current status of child health in deprived areas of the Philippines and to investigate the influence of poverty on health outcomes. Children and parents belonging to a preschool leaning center in Malabon city participated in this study over a five-year period. A questionnaire survey answered by parents concerning characteristics, child-rearing anxieties, and hygiene was undertaken. Kaup index was measured and medical checkups were performed by Japanese medical staff. The ratio of underweight children was 0%-3.8%, while those with obesity were 2.4%-7.7%. The ratio of students with dental caries was 54.8%-74.4%. Parents had various child-rearing anxieties. Poverty affected the Kaup index, caries, and hygiene. It is suggested that children in deprived areas had problems of nutrition, earwax plugs, caries, and hygiene and there might be an influence from poverty on health outcomes.

Matlooba ALZadjali   

This review article explores the complexity and importance of heart failure globally as well locally. We attempted to study the current situation of heart failure in Oman by using very limited data from the Ministry of Health annual health report. This data were concentrating mainly on the number of cases admitted in the regional hospitals, and it showed that in 2010 the number of beds occupied by heart failure patients in the hospitals in certain Regions in Oman namely; Muscat Region (Royal hospital), ALDakhalia Region and North ALBatina was high. The data is convincing enough to think of having a comprehensive heart failure program at the national level in order to decrease the burden on tertiary care, save number of beds and ultimately the budget of the health economy.

Dejenie Seyoum   Abebaw Gebeyehu   and Zemichael Gizaw   

Unintended pregnancies continue to be a major global tragedy for millions of women and abortion is an issue which affects every country in the world. The World Health Organization estimates that 20 million unsafe abortions take place each year, in which 80,000 maternal deaths occur due to complications. Cross- sectional study was employed to assess post abortion contraceptive intention and associated factors among abortion clients in Gondar town, Northwest Ethiopia 2013. Six hundred thirty study subjects were included in the study by using a simple random sampling technique. The collected data entered and analyzed by using SPSS version 20.0 software packages. The degree of association between independent and dependent variables were assessed using odds ratio with 95% confidence interval and p-value ≤0.05. The data analyzed using bivariate and multivariate logistic regression. A total of 630 study participants with abortion were assessed. The extent of the post abortion contraceptive intention among 630 clients was (73.5%). Divorced/widowed women [AOR: 0.277, 95% CI :( 0.151, 0.508).] was a factor negatively associated with the post abortion contraceptive intention whereas married women [AOR: 1.747, 95% CI :( 1.046, 2.916)], abortion from unintended pregnancy [AOR: 3.430, 95% CI (1.597, 7.366) and post abortion contraceptive counseling [AOR: 2.627, 95% CI: (1.366, 5.049)] were factors positively associated with post abortion contraceptive intention. Generally, the post abortion contraceptive intention found in this study was low as compared with others study. Variables like married women, divorced/widowed, abortion from unintended pregnancy and post abortion contraceptive counseling were significant predictors of the post abortion contraceptive intention.

Khaldoun M. Aldiabat   Nasir A. Matani   and Carole-Lynne Le Navenec   

University students worldwide are at risk for mental health disorders because of the range of stressors they experience. The aim of this background paper is to convey salient evidence about this issue to university administrators, educators, and healthcare providers, and to offer a few illustrative examples of interventions they might consider to address it. It is hoped this paper will evoke outcomes such as increased awareness of this issue and creation of a supportive academic environment on the part of the three groups mentioned above. Content in this background paper includes some facts about prevalence, risk factors, and consequences of mental health issues among university students, as well as the reasons expressed by these students for not seeking help. It is expected that these data will provide insights for administrators, educators, and healthcare providers in academic institutions for both preventing mental illness and promoting mental health among their students by developing collaborative, multidimensional, and culturally sensitive preventive mental health programs, which in turn will facilitate the development of a more supportive academic context, and enhanced psychosocial well-being and productivity among the university student population.

Avier Mesfin   Walelegn Worku   and Zemichael Gizaw   

Introduction: Health care wastes are of great importance due to its potential environmental hazards and public health risks. The ineffective handling and segregation of healthcare waste can result additional costs related to the disposal of waste if not segregated appropriately. Objective: To assess health care workers practice and associated factors towards health care waste segregation in Gondar University hospital Gondar, Ethiopia, 2013.Methods: Institutional based cross- sectional study was employed and Study participants were selected by stratified random sampling using profession category. Pretested standardized questionnaire and observational check list were used. Result: This study showed that 173 (46.3%) of the respondents had correctly practiced health care waste segregation. Being a nurse profession (AOR =0.27; 95% CI= 0.15-0.51), working more than eight hours (AOR =0.28; 95% CI= 0.17-0.47) and unavailability of color coded containers (AOR =0.18; 95% CI= 0.08-0.38) were factors influencing the practice of health care waste segregation. Conclusion: This study showed that health care workers practice towards segregation of health care waste in university of Gondar hospital is poor. Profession, working hours in a day and availability of color coded containers were factors that affect the health care waste segregation practice.

Christopher Onyango   

In Kajiado Central District, the proportion of births delivered in a health facility is as low as 28% compared to the Kenya national average of 43% despite implementation of the community strategy in the area. The main objective of this study was to determine the factors associated with the uptake of health facility based skilled delivery in Kajiado Central District in Kajiado Kenya. This cross-sectional study used data from the project "Strengthening the Health System through Collaborative Research to Address Factors Influencing Scaling up of the Community Strategy towards Millennium Development Goals in Different Contexts in Kenya". The unit of analysis was women of reproductive age 15-49 years (n=714). Knowledge of HIV status, use of modern family planning methods, ownership of livestock and education levels had significant associations with health facility delivery. The odds of a mother without livestock delivering in a health facility was 2.5336 times the odds of a mother with livestock (OD: 2.5336: 95% CI 1.818-3.533). More training should be done for the Community Health Workers in the area on health facility based skilled delivery with emphasis on the role of pastoralism on skilled delivery among the women of reproductive age.

Quynh Lê   Stuart Auckland   Hoang Boi Nguyen   and Daniel R Terry   

There are a number of risk factors which increasingly impact the health and wellbeing of Australians, particularly in rural communities. To address the health and wellbeing of communities, local governments are taking on a more focused role by supporting healthy community initiatives (HCI). This paper presents local council partners perceptions concerning a regional-scale health promotion initiative that was undertaken in rural Tasmania, Australia. The evaluation provides insight into the future decisions and strategies that may be developed to improve processes, methods and outcomes of health initiatives undertaken by local governments. The study used a mixed methods approach collecting data through a questionnaire, focus group discussions and interviews with stakeholders and participating councils to provide an understanding of the effectiveness and success of, and barriers to, the health promotion initiative. It was found that there was an emphasis by local councils on programs that promoted physical activities, while programs that focused on healthy food and other health promotion topics, such as quit smoking and healthy workplaces were less emphasised. Overall, the health promotion initiative was perceived to be effective; however, there was little measureable evidence as to the outcomes of the various projects within the initiative and there was concern regarding the sustainability of the initiative beyond the funding timeframe. Community based, health promotion interventions are complex. Local government are suitably placed to deliver health promotion initiatives, as they have a greater understanding and can affect the greatest change by investing in projects with the highest priority among those communities within their boundaries. Nevertheless, sustainability of projects beyond funding allocation, while building and improving partnerships among local governments, and service agencies to pool resources and capture specific target groups must be central to ongoing initiatives.

Gunnel Balaile   Frida Kingazi   and Anna-Berit Ransjö Arvidson   

The aim of this study was to explore the perspectives of health care providers on voluntary counseling and testing (VCT) patients for human immunodeficiency virus (HIV) or counseling those living with the virus. Semi-structured interviews were conducted with 12 Tanzanian HIV counselors in different health service clinics in Dar es Salaam, Tanzania. The interviews were analyzed using a qualitative method. Three themes emerged from the interviews: a person-centered approach is necessary to build trusting relationships to negotiate behavioral change; challenges in the variations in counseling sessions as well as the maintenance of confidentiality; and the requirement for privacy and disclosure only with the patient/client's consent. The health care providers, who all had considerably long experiences of VCT, showed confidence in the counseling situation and were aware of the many challenges and barriers they encountered at work as a counselor. They stressed that the basis for creating a trusting relationship between a counselor and a patient was a person-centered approach. Patient confidentiality was an important factor in the counseling work, but confidentiality could also be a challenge and dilemma to protect both the patient and sexual partners at risk, and this should be taken into consideration in counseling guidelines.

Mamdouh M. Shubair   Meck Chongo   and Jamie Reschny  

The workplace is notable as an optimal setting for health promotion programs. The workplace offers a natural convenient environment to support the promotion of health and wellness of workers in organizations. Adult men (18 years of age or over) in natural resource industries who work full-time spend more of their waking hours at work, away from their families due to shift work, hectic hours, and busy lifestyles. The workplace setting can therefore be harnessed to offer workers frequent and sustained exposure to effective interventions during prime hours. The purpose of this Scopus review paper is to assess the magnitude of type 2 diabetes (T2D) and depression among working men in resource-based occupations (trucking; logging; mining; oil and gas; and forestry). The paper proposes a settings-based workplace health promotion (WHP) framework to be adapted from a community-based perspective. We argue the proposed framework can be applied to effect individual worker’s lifestyle behaviours, and from a socio-ecological perspective to influence organizational change and health policy. We propose WHP programs for men recognizing that gender has an important role in influencing one's lifestyle and overall health. From a socio-ecological perspective, the environment also plays a pivotal role in affecting lifestyle choices by supporting or hindering behaviours that occur in 'settings' such as family, school, workplace, or community environments. While arguing for WHP interventions, the paper recognizes the importance of upstream policy initiatives that should enhance and cultivate such interventions at organizational and community levels.

Aïssata DIAKITE   Blandine GADEGBEKU   Sébastien Djédjé DANO   Hélène YAPO ETTE    Koffi BOTTI    AngladeKla MALAN   and Bernard LAUMON   

In Côte d’Ivoire alcohol and drugs consumption in the general population is a serious issue. However, their role in Road Traffic Accidents (RTAs) has never been investigated. Our study aimed to estimate the prevalence of alcohol-impaired road users at the time of the RTA and report psychoactive drug use, in various categories of casualties, and in various circumstances of the crash. We conducted a cross-sectional study including 893 casualties involved in fatal or non-fatal RTAs and admitted at the Emergency Room or the Forensic Institute from March to September 2012. Blood alcohol dosage (BAC) and urine drug screening were carried out, and results were linked with hospital and police crash report data. The mean BAC in positive cases indicated heavy drinking before the crash: drivers (1.9 g/L), pedestrians (2.1 g/L), passengers (1.5 g/L). The prevalence of alcohol-impairment was significantly higher in drivers (41%) and riders (27%) compared to pedestrians (17%) and passengers (13%). Over 75% of casualties that tested positive for alcohol had a BAC largely above the legal limit. Psychoactive drug use was twice more prevalent in alcohol-impaired drivers than in sober drivers (20% vs 10%). Binge drinking is an emerging issue in African countries, which should be taken into account in the management or prevention of road traffic injuries.

Daniel Pelletier   Frances Wildhaber   Pierre Collerette   and Michael M.G. Heberer   

Pooling resources, knowledge and technologies is a necessity in the health sector. Many hospitals do so through alliances with compatible establishments, which have been studied from the organizational perspective for many years. However, many alliances are reported to fail and the conditions which could foster their success are still not well known. The aim of this exploratory study was to identify the administrative and governance structures of hospital alliances associated with reported positive outcomes. A questionnaire was mailed to hospital administrators and directors from Germany, Switzerland, Austria and Canada. Administrative and governance practices were ascertained and correlated with reported outcomes. Management practices pertaining to initiation, formalization, steering and operations of alliances were correlated with financial, treatment and corporate outcomes. Characteristics significantly linked to perceived positive alliance outcomes include: clearly defined targets and their monitoring, governance by executive management and involving the board of directors, rather formal coordination mechanisms, a project champion and a written contract including conflict resolution mechanisms.

David Wainwright   and Anne Christine Hanser   

The gap between the demand and supply of organs for transplantation is a worldwide phenomenon that continues to tax policy-makers. We consider recent policy reforms in Germany, drawing on evidence from Spain and Austria for comparison. Our analysis adopts Kingdon’s multiple streams model which suggests that windows of opportunity for policy change open when an issue of public concern combines with a plausible solution and favorable political circumstances. Evidence is central to this process, but the type of evidence and the ways it is used, differ from technocratic formulations of evidence based policy-making. Scientific evidence may contribute to the rational appraisal of options, but this and other forms of evidence are also used rhetorically to generate political will and public support for change. We conclude by considering what the formation of organ donation policy in Germany reveals about the processes of policy-making under the competing imperatives of rationalism and democracy.

Kofoworola Odeyemi   Babajide Odeyemi   and Folu Olatona   

Alcohol consumption has been linked to the risk of developing cancers and other Non communicable diseases. The knowledge, attitude and practices of alcohol use among the next generation of health care professionals will affect efforts to prevent alcohol related diseases. The aim of this study was to assess the knowledge, attitude and practices of medical students regarding alcohol consumption. It is a descriptive cross-sectional study conducted among a representative sample of 240 students using self administered questionnaires. Majority (83.3%) of the respondents had good knowledge about alcohol however less than half (46.6%) recognized that alcohol was a risk factor for cancer. About a third (33.3%) of the respondents drinks alcohol. The majority (73.8%) of the respondents who consumed alcohol did so “to have fun with friends”. Most (66.3%) of the respondents that did not consume alcohol did not do so because it is against their religion. The senior level students had better knowledge on alcohol than the junior students (p<0.05). However, this did not influence their practice. (p<0.05). Alcohol consumption was more prevalent among males than females (p<0.05). Education on alcohol needs to be given more emphasis to prepare them for work in alcohol control.

Leonard Smith   Larry Katz   Herbert Emery   Jackie Sieppert   Zoe Polsky   and Kimberly Nagan   

It may come as a surprise to the public and to medical practitioners that the most common infectious disease in young children is dental decay and that oral health is the most prevalent unmet healthcare need of children. Children who present with early childhood caries (ECC) can suffer from pain, sleeplessness, malnutrition, difficulty playing, struggles in school, and toxic stress. Although it is almost completely preventable through low-cost preventive measures, prevalence is very high in Canada affecting over one quarter of children. Several factors interact on different levels (child, family and community) to create a situation in which ECC prevails. Recommendations for prevention are presented and include early visits to a dentist, dental care as part of prenatal care, interdisciplinary collaboration across health and social services, as well as many others.

Aline Hamadé   Sandra Bhanini   Theresa Saade   YoumnaFakih   Chadi Fakih   Rita Azzi   Mira Hazouri   and Francine Rizk   

Background: The role of the steroid hormone Vitamin D (VD) and its nuclear receptor (VDR) in skeletal metabolism is well known. Furthermore, research suggests that VD plays a role in female and male reproduction. However, semen quality status is not clear in infertile men with different VD serum concentrations. The aim of this study is to measure serum VD levels in infertile Lebanese men, to investigate semen quality parameters and their correlation to serum VD levels and polymorphic variations in the VDR. Materials and methods: From March to April 2013, 40 men presenting to an IVF center located in Mount-Lebanon to undergo IUI or ICSI procedure were recruited to our study. VD in serum was evaluated using ELISA method. The polymorphic regions were amplified using PCR followed by digestion with restriction enzymes FokI(rs10735810), ApaI G/T(rs11168271), TaqI T/C(rs731236). Results: No correlation was found between the ApaI and FokI polymorphismsand both VD levels in serum (P= 0.367, P=0.75 respectively) and sperm count (P=0.919).Positive correlation was found between ApaIpolymorphisms and the number of non progressive and immotile spermatozoa (P=0.012, P=0.033 respectively). Also, positive correlation was found between TaqIpolymorphisms and VD serum levels (P= 0.038). Conclusions: More studies on VD could be relevant of a potential VD supplementation that might improve semen quality of involuntary infertile men and would be beneficial both for the infertile couples and the society in general. VD supplementation can opens for a safe treatment of some cases of "idiopathic" impaired semen quality.

Alexander G. Bachinsky   and Lily Ph. Nizolenko   

The outbreaks of infectious diseases caused by natural factors or bioterrorism acts are, unfortunately, quite real threats for the overall population. Planning of an efficient response to an outbreak of an infectious disease requires coordinated efforts of various services aimed to most efficiently utilize the limited resources. This paper describes a model that optimizes utilization of resources when preparing to counter the bioterrorism threats or responding to epidemics caused by epidemiologically dangerous or socially significant pathogens. The model computes the volume of limited resources as well as the particular control activities (isolation, ring vaccination, or mass vaccination) necessary to minimize the optimization criterion, comprising the total number of infected persons, number of lethal cases, and several other characteristics. The model is available remotely via WEB-interface at http://vector-epimod.ru.

Christelle Senterre   Alain Levêque   Michèle Dramaix   and Danielle Piette   

Few studies have addressed the patterns of injuries in Africa, and most of them were based on hospital data. The objectives of this study were to describe, on the basis of the "First Survey Health Young People" performed in 2008 in Cameroon, the prevalence and the patterns of injuries and to investigate the relationship between these injuries and some health behaviors. The dataset included 47327 pupils, aged 9 to 25 years, with a sex-ratio close to one. The prevalence of reported injuries during the past 12 months was 50.8% for boys and 42.1% for girls. Most injuries occurred at home for girls (43.6%) and during sports for boys (22.5%). Multivariable models, by gender, showed that age, alcohol consumption, exercise performed during free time, feelings about school, truancy, happiness, feeling alone, number of close friends, feeling of kindness and helpfulness of the other pupils, possibility to talk with parents or tutors, perception about one’s own health, feeling tired on the morning of schooldays and some violent behaviors (fights, racket events and number of times students reported taking a weapon at school) were all associated with the occurrence of injuries. These results increase the knowledge of the epidemiology of injuries in Africa (in terms of morbidity and associated factors) and should lead to an integrated approach of the health behaviors in injury prevention.

Shwetha H.L   and Padma K. Bhat   

The way in which healthcare is financed is critical for equity in access to healthcare. A common feature of all health systems is the distinction between public and private health care. This distinction refers to both the finance and the provision of health services. Before launching any major health initiative, there ought to be a well articulated vision of health care system for the country, and public health policy must be devised to realise that vision. Ideally, certain basic health services, including inpatient care, must be made available to every member of the society[19]. These services must be paid through insurance, which means that every member must have health insurance cover or at least have access to health insurance, with government subsidising insurance premium, in full or in part, for those who cannot afford it. Health insurance gives the insured population an entitlement to health services. It is therefore important to ensure that the health infrastructure exists to provide those services and that there is some incentive to comply with the insurance. Skill-building for the personnel involved, and capacity-building of all the stakeholders involved, would be a critical component for ensuring the success of any health insurance programme.

Georgios L. Thanasas   

In this paper an attempt is made to determine the additional costs being undertaken by the University Hospitals of Greece in relation to those of General Hospitals. To determine the additional cost of University Hospitals, called teaching impact cost, a model of eight factors was constructed. The sample of examined Hospitals consists of fifty-three (53) Hospitals in Greece which issued financial statements for the years 2008-2009. This effort is intend to a direct comparison of the results that incurred in Greece, to other similar efforts that made in other European Countries. The results showed that the University Hospitals of Greece, similar to other European University Hospitals, face a higher operational cost compared to General Hospitals, which is due to education of the future health professionals.

Castro Bedriñana Jorge  and Chirinos Peinado Doris  

Objectives. To Identify and analyze the distribution of Z-scores of anthropometric indices of children between 36-60 months of age in the province of Huancayo, Peru, which were calculated based on the NCHS-1977, CDC -2000 and WHO-2006 references. Methods. We analyzed a database of 2640 children (1268 males and 1372 females) collected between 1992-2007. The Z-scores were determined using the Anthro V.3.0 and the EpiInfo 6.04. The data were divided into four chronological periods: First, 1992 with 532 data; Second, from 1993 to 1997 with 370 data; Third. From 1998 t0o 2002 with 494 data, and Fourth from 2003 to 2007 with 1244 data. Results. The weight-for-age, height-for-age, weight-for-height and body mass index Z-scores were different for each assessment standard. The mean+SD of the weight-for-age, height-for-age, weight-for- height and BMI Z-scores with NCHS were -0.85+0.88, -1.29+1.07, -0.04+0,84 and 0.05+1.05 respectively, with CDC the values were -0.79+0.95, -1.08+1.05, -0.12+1.00 and 0.05+0.91 and with WHO the values were -0.75+0.84, -1.40 +1.02, 0.15+0.91 and 0.21+0.91, correspondingly. With the new WHO standard it was obtained lower Z-scores of height-for-age than with NCHS, being the farthest curve from the median. The new WHO standard would be the most accurate and realistic standard used to determine the Z-scores, because was determined in a multicentric study to world level, and it should be officially adopted for the nutritional assessment in children under 5 years.

KWOK Sin Tung   WONG Wai Ning   and Kris, LEE Tse Yan Alexander   

The objectives of the study were to examine the level of perceived stress, emotional syndromes and quality of life among students and evaluate if personal resources is associated with students’ stress level. All students were invited to participate. Socio-demographic characteristics and outcome measures including students’ physical and psychological well-being and their personal resource/resilience (optimism, perceived control and self-esteem) were assessed via validated self-reporting questionnaires. Although only half of the student participants experienced some form of emotional symptoms, about 86.8% of the students still reported to have endured higher to much higher than average level of perceived stress. Significantly higher level of perceived stress was experienced by engineering students and those with lesser level of [poorer] resilience. Stressed students reported to have significantly poorer physical, psychological, social and environmental health. Results indicated that personal resilience affect the level of perceived stress experienced, and in turn affecting students’ general well-being and hence, quality of life. In conclusion, a high level of stress and psychological symptoms associated with poor personal resilience in withstanding stress, as well as poor quality of life and general health among students were reported. Regular monitoring students’ stress level and implementing appropriate intervention are recommended.

Rizk Francine   Salameh Pascale   and Hamadé Aline1a   

Objective: The aim of this study is to assess the incidence, types and correlates of congenital anomalies (CA) among stillborn and liveborn infants in two Lebanese hospitals in Mount-Lebanon. Methods: In this cross-sectional study, all the newborns who were born during 9 months period from January to December 2009 (n=1000) at two hospitals setting in Mount-Lebanon hospital, Lebanon were studied. The newborns were assessed for CA. Neonatal data were extracted from medical records of the nursery. The classification of malformations was based upon the anatomical system affected according to the WHO classification of CA. Results: Of the all 1000 single births, 24 (2.4%) were diagnosed as being congenitally malformed. Cardiovascular system defects and limbs anomalies (4/1000) were mostly detected, followed by genitourinary system (2/1000), nervous system (2/1000), respiratory system (2/1000) malformations and chromosomal anomalies (1/1000). A marked association of parental consanguinity and alcohol consumption of the mother during the pregnancy with increased CA rates was found (p= 0.015 and p=0.027 respectively). Conclusions: The frequency of malformations in the study was approximately similar to previous investigations. The increased incidence of CA in cases of parental consanguinity prompts the necessity of establishing educational programs to avoid these complications in the offspring.

Lauri Wright   and James Epps   

Due to the prevalence and impact of childhood undernutrition, the objective of the study was to investigate causes of malnutrition and evaluate the effectiveness of a Nutrition-Supplementation Program (NSP) in rural Dominican Republic with and without nutrition counseling. Causes of undernutrition were examined by qualitative interviews conducted with parents. Program effectiveness was measured by comparing children’s pre- and post-percentage goal weight/age. The most prevalent contributors of malnutrition found were food insecurity, disease, poor maternal and child health policies, and lack of knowledge. Children who received only milk and vitamin supplementation did not improve % goal weight/age (MEAN pre=77.3; MEAN post=78.1; t=0.21; p<.83). Children who had both nutrition counseling and supplementation improved markedly (MEAN pre=67.2, MEAN post=78.2; t=3.01; p<.07). Because of the complexity of malnutrition, programs are most successful when multiple interventions including nutritioncounseling are provided.

Mamdouh M. Shubair   

Smoking is a major public health concern among the Aboriginal Canadian Population. The age-adjusted smoking-attributable death rates are two times those of other Canadians; 20% of adult deaths among Aboriginal Canadians is attributable to smoking. There is no research that implemented and examined interventions of smoking cessation in Aboriginal Canadians, particularly in Northern British Columbia. This paper represents a critical review of some of the successful smoking cessation programs conducted in different jurisdictions. It is evident that little consideration is given to Aboriginal knowledge transfer in program development and delivery. This review indicates that in order for an Aboriginal cessation strategy to be successful, culturally relevant criteria must be identified and implemented. Without consideration of culture, there will always be limited success in tobacco cessation initiatives. To be effective, smoking cessation programs need to be comprehensive. Social determinants of health and socio-economic disparities that influence health status outcomes need to be considered as they have major influence in adopting smoking among Canadian Aboriginals. These factors have implications for public health policy.

Sergey Pankratov   and Tatiana Znamenskaya   

The value of mHealth for sustainable healthcare is discussed. It is projected that mHealth can become a disruptive technology that is set out to radically transform the current state of medical disciplines. In particular, the mHealth solutions can provide better understanding of the organism stability margins and of the emergence of diseases as well as ensure more patient safety under drug and physiotherapy prescription. The issue of measuring the physiological quantities is addressed, with the conventional yet complex task of quantitative accuracy evaluation being discussed. The concept of complexity and its relevance for the physiological parameters defining both the health state and disorders is accounted for. The principles of body area networking and the relevant standards are briefly overviewed, with a focus on security issues. The concept of biofeedback implemented through mHealth sensor technologies is examined. Basic requirements to facilitate market acceptance and response are analyzed. Selected case studies of pervasive health monitoring are presented. Possible current and future mHealth applications are considered. Since some general problems of healthcare are touched upon in the article, it is intended to provoke a controversy.

Stella Babalola   Amrita Gill-Bailey   and Mathurin Dodo   

This manuscript uses large-scale survey data to examine the prevalence and correlates of intimate partner violence (IPV) in the eastern part of the Democratic Republic of the Congo (DRC), namely in North Kivu and South Kivu provinces. We examine two form of IPV: physical and sexual. The data show that two of every five women and more than one quarter of men had reportedly ever experienced physical IPV while one quarter of women and 15.7 percent of men reported ever experiencing sexual IPV. The correlates of IPV differ for men and women and depend on the type of IPV. For men, the strongest correlates of physical IPV include current employment, education and recent experience of sexual IPV. The strongest correlates for experiencing sexual violence among men were young age, problematic use of alcohol, gender-equitable attitudes, province of residence, and recent experience of physical IPV. For women, young age, low education, gender-equitable attitudes, partner problematic use of alcohol, partner controlling behaviors, recent experience of sexual IPV, and recent experience of public humiliation were the correlates of physical IPV. The strongest correlates of sexual IPV for women include province of residence, partner problematic use of alcohol, partner controlling behaviors, and recent experience of physical IPV. The programmatic implications of the findings are discussed.

Maureen K. Johnson   and Florence Uruakpa   

Health impairments in special health care needs (SHCN) children with diabetes were compared with those of SHCN children without diabetes. Data from the 2009/2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) were analyzed. Demographic and health impairment variables were measured in terms of their association with ever being diagnosed with diabetes by a medical professional. Demographic variables included sex, ethnicity/race, and age group. Health impairment variables included difficulties with: swallowing/digesion/metabolism; coordination/movement; difficulties using hands or fingers; vision; hearing; breathing; and circulation. Multivariate logistic regression analysis and adjusted odds ratios (OR) were used to determine associations. The variables of sex, age group, swallowing/digestive/metabolic impairments, vision difficulties, and circulation impairments were significantly associated with ever having been diagnosed with diabetes. Findings from the current study suggest that SHCN children with diabetes have specific health impairments beyond those of other SHCN children without diabetes.

Cindy Sin U Leong   

The purpose of this study was to compare and discuss the modified policy for nursing staff in the public sector in Macao Chinese society. This study compared the past and present modifications in the bill of the Rank and Grade System in the public sector. The greatest concerns of the nursing staff included the old bill of rights, the grading system for the nursing staff, which needed to be modified, and improvements, especially with regard to salary, employee benefits and rank for promotion. The essential elements of the updated policy regarding salary (increasing from 22 to 43%), employment benefits (increasing more than 100% based on tenure), on-shift allowance (flexible) and rank for promotion (number of ranks added) were adjusted. These improvements are not only beneficial on a personal and professional level but are also beneficial at the healthcare institution level, society level and academic nursing school level. Multiple levels of benefit detailed in the present study may provide a good impetus to end the nursing manpower shortage in the near future.

Melvena N. Wilson   Saleh M.M. Rahman   Ivette A. Lopez   Gabre E. Kiros   Delores C.S. James   and Mark B. Dignan   

Overweight in childhood is a serious public health concern. Approximately 31% of 6-19-year-old children in the United States are obese, overweight or at risk of overweight. The sample (N=721) consisted of students between the ages of 9-14 years of age enrolled in grades 4th-8th in Leon and Gadsden Counties, Florida. Using a multinomial regression model, analyses revealed that students with increased perceived self-efficacy were approximately 1.4 times more likely to be overweight than their counterparts, and those who lived in Gadsden County were 1.7 times more likely to be overweight. Those enrolled in the free/reduced lunch program were 7% less likely to be overweight than their counterparts. The purpose of this study was to explore the relationship of weight with sedentary behavior, self-efficacy in sedentary behavior avoidance, perceived parental support and socio-environmental factors among African American children. The study findings contradict much of the literature in terms of perceptions about the relationship of perceived self-efficacy and behavior and underscore the need for additional research to better understand possible differences between African American and White children.

Dhelia M. Williamson, Ph.D   Laurie Wagner, M.P.H.   and Judy P. Henry, Ph.D   

Formative research (i.e. focus groups and key informant interviews) was conducted to understand risk perceptions and identify barriers to participation in a case-control study of environmental exposures and genetic susceptibility as risk factors for multiple sclerosis (MS). Individuals with MS were recruited to participate in a focus group discussion and individual interviews. Participants were asked to review and comment on study materials and process including participation, interview, genetic testing, confidentiality, and questionnaire. A structured discussion guide was used with all participants to ensure uniformity and coverage of all predetermined topics. Participants reported an increased likelihood of participation if they were informed about the study by their neurologist and not a government agency. All participants expressed willingness to provide a blood sample for genotyping but disagreed about the setting for the blood draw (at home or in a lab). Participants were concerned that they would not receive their individual genotyping results. The study protocol and materials were revised based on comments from the focus group participants. Formative research is an under-utilized resource for researchers conducting epidemiologic studies. Even with limited resources, piloting study materials with individuals similar to the proposed study population can provide opportunities to make modifications to effectively meet the needs of participants and promote participation and retention.

Rashidul Alam Mahumud  Golam Hossain   Ripter Hossain   Nurul Islam   and Lal Rawal   

Life expectancy is one of the major key indicators of population health condition and economic development of a country. The main objective of this study was to find determine the impact of the life expectancy on changes of economic growth and health care expenditure, and also to find examine the sex difference trend of life expectancy according to the sex difference. Using We used multiple regression models are fitted to estimate the impact of the life expectancy on economic growth and health care expenditure and also to estimate elasticity of life expectancy on health care expenditure and economic growth. Results shows female life expectancy was more than male over the past 15 years. The higher Gross Domestic Product (GDP) per capita was seen in a longer life expectancy. i.e., one dollar increasing in GDP per capita will change in an average the life expectancy by 33 days, and also one unit increase in per person Health Expenditure Per Capita (HEPC) will increase the life expectancy in an average of 8 days in a year. one dollar increasing in GDP per capita by 33 days will also increase life expectancy, for Health Expenditure Per Capita (HEPC), by 8 days by one year on average. The higher proportion of total expenditure on health as a percentage of GDP and direct personal expenditure on health by household as a share of private expenditure on health results in also longer life span. The study has some policy implications for Bangladesh, we conclude that the increased life expectancy has direct impact on increase in per capita real income and higher expenditure on health., population planning and equity for health important for life expectancy. This study has policy implications for Bangladesh, in particular the needs for increased per capita real income and planning for future health and population policies/programs. Therefore, political stability, adequate and suitable social sector policies and government interventions are required to increase life expectancy and economic growth. There is also a need for involvement of health human force in macro and micro policy-makings and critically examine other determinant of health care expenditure.

T. Mark Peterson, D.D.S   Thomas W. Peterson, D.D.S.   Sarah Emerson, B.S.   Eric Regalbuto, Meredyth A. Evans, M.A.   and Leonard A. Jason, Ph.D.   

Little is known about the extent to which chronic fatigue syndrome (CFS) is covered within medical schools in the United States (U.S.) The current study is an exploration of the extent that CFS is covered in the areas of treatment, research, and curricula in U.S. Medical Schools. Surveys were sent to personnel at 132 accredited U.S. medical schools and a total of 71 schools responded. The extent of coverage across the three domains was extremely limited. Only 29.6% of schools met the clinical criterion, 28.2% met the curricula criterion, and 15% met the research criterion. Only four of the 71 (5.6%) responding schools met criteria for all three domains. While the current study is preliminary, it points to significant gaps in the coverage of CFS among medical institutions, which is likely impacting the ability of physicians to fully acknowledge, understand, effectively treat, and find a cure for CFS.

Jyotsna Lal ,Ph.D   

Burning tobacco is the main source of indoor pollution in the developed world. Tobacco smoke contains about 4,000 chemicals including carcinogens, irritants and toxic gases. The health impact of breathing environmental tobacco smoke is well documented. Tobacco smoke contains over 4000 chemicals in the form of particles and gases. Many potentially toxic gases are present in higher concentrations in sidestream smoke than in mainstream smoke and nearly 85% of the smoke in a room results from sidestream smoke. The particulate phase includes tar (itself composed of many chemicals), nicotine, benzene and benzo(a)pyrene. The gas phase includes carbon monoxide, ammonia, dimethylnitrosamine, formaldehyde, hydrogen cyanide and acrolein. Some of these have marked irritant properties and some 60 are known or suspected carcinogens (cancer causing substances). The Environmental Protection Agency (EPA) in the USA has classified environmental tobacco smoke as a class A (known human) carcinogen along with asbestos, arsenic, benzene and radon gas.[WHO 2004] Breathing other people's smoke is called passive, involuntary or secondhand smoking. The non-smoker breathes "sidestream" smoke from the burning tip of the cigarette and "mainstream" smoke that has been inhaled and then exhaled by the smoker. Secondhand smoke (SHS) is a major source of indoor air pollution. In the longer term, passive smokers suffer an increased risk of a range of smoking-related diseases.Non-smokers who are exposed to passive smoking in the home, have a 25 per cent increased risk of heart disease and lung cancer.This paper deals with study of various effects of passive smoking on human health as well as how adolescent school and college students are most influenced by tobacco use around them and get initiated easily in smoking .

P. Qasimah Boston, MPH, DrPH   Saleh M.M. Rahman, MD, PhD, MPH   C. Perry Brown, MSPH, DrPH   Ivette A. Lopez, PhD   Mitwe Musingo, PhD   and Coumba Mar Gadio, PhD   

Food insecurity is a daily reality for millions globally and persists in rural northern Ghana. Being more a problem in resource poor countries, it challenges the wellbeing of children, adults, families and communities by creating public health problems including; low birth weight babies, mental health conditions, diabetes and obesity. This research examined associations between social networks and social support and women’s ability to overcome household food insecurity. A two-phase mixed method quantitative and qualitative data collection technique was applied. A 24-item instrument was developed, pilot tested, validated and administered among women responsible for food preparation in the household (n=241). Measures of household food insecurity, socio-demographic, social network, and perceived social support were constructed and analyzed using SPSS 19®. Women in northern rural Ghana who were married, with higher social supports and social networks were more likely to experience low household food insecurity. Of 241 women, 88% were married, 39% had co-wives, 80% did not have formal education, the average age was 40 years and the average number of adults per household was 7. Correlation analysis and logistic regression models revealed social networks, perceived social support, marital status and years living in the village were significantly associated to the experience of low household food insecurity.

Daniel R Terry   and Quynh Lê   

An Australian wide shortage of doctors has led to an increased reliance on International Medical Graduate (IMG) recruitment. However, there is very little research regarding the acculturation of IMGs as they reside in the rural Tasmanian context. This paper explores from the perspective of IMG informants, the experiences and challenges of IMGs living and working in rural and remote Tasmania and how it informs the acculturation process. It identifies the barriers facing IMGs as they work and live in Tasmanian communities. It is part of a larger doctoral study looking at IMGs in Tasmania. The study adopted a qualitative research approach. Twenty-three semi-structured interviews were conducted with IMG informants in the North, South and North West of Tasmania. Informants were recruited through purposive snowball sampling. The findings indicate that Tasmanian based IMGs encounter both professional and social challenges. These challenges include vulnerability due to fear of job security, and loss of status, discrimination and communication challenges within the workplace. Additional challenges include spouse employment, obtaining high quality academic access for children, and cultural and religious connectivity. These challenges influence IMGs and their families to stay or relocate. In addition, a number of identified needs have been identified to improve retention of IMGs within Tasmania. The study adds to existing knowledge and identifies three factors which further determine the retention of IMGs. These factors include, job opportunities, vocational training and greater commensurate support provided to IMGs and their families.

Doris Maritza Chirinos Peinado and Jorge Jorge Isaac Castro Bedriñana 

Objective. The aim is to compare the three references used for the classification of the nutritional status of 36 to 60 month-old children in Huancayo province (Peru). For a long time, NCHS-1977 reference has been used for child growth monitoring, recently the new WHO-2006 Child Growth Standards is being used, and CDC-2000 reference usage has been restricted. Methods. Data collected from 2640 children over the period 1992 to 2007 served as basis for determining the nutritional children status using Anthro V.3.0 and EpiInfo 6.04. Internationally cutoff points used in every assessed reference system helped to determine the nutritional status and to calculate the Z-scores of height-for-age, weight-for-age, weight-for-height and body mass index differentiated by sex. Results. The underweight, stunting and wasting percentages (period 992-2007), determined with NCHS-1977 reference were 8.4%, 28.8% and 0.9%; with CDC-2000 reference were 10.2%; 19.1% and 3.3%, and with WHO-2006 standard were 6.6%, 33.9% and 1.4% respectively. The overweight and obesity percentages determined with CDC-2000 standard were 11.4% and 4.20%, and with WHO-2006 standard were 8.0% and 0.9%, respectively. Conclusions. A more realistic and accurate detection of malnutrition prevalence in 36-to-60 month-old children from Huancayo province was carried out using the new WHO Child Growth Standard. Using the CDC-2000 standard is recommended in overweight monitoring cases.

Md. Mizanur Rahman Vincentas Rolandas Giedraitis Leslie Sue Lieberman Mrs. Tahmina Akhtar and Vaida Taminskienė 

Despite unplanned and haphazard expansion of shrimp cultivation that immensely affects on the coastal regions of Bangladesh, the exploration of its adverse effects has not received significant attention from the researcher community yet. There were few researches and studies in Bangladesh conducted to elicit the colossal effects of shrimp production at different times that did not particularize its focus on proposing an ecological design of shrimp production. In order to elicit the concomitant impacts and propose an ecological model of shrimp cultivation based on secondary data, the present study was conducted by applying ‘Systematic Review and Content Analysis’ as research method. The study findings manifest that the continuous and unregulated shrimp farming has immense impacts on human health, ecology, environment and sustainability though few of them directly benefit the shrimp farmers and the people who live around them. The extensive farming systems negatively expedite the processes: infringement of mangroves, intrusion of salinity, degradation of land, de-stabilization of coastal ecosystems. The major socio-economic effects challenge the patterns of livelihood pattern, displacement of family and social structure, internal migration, and livestock. The coastal regions suffer from environmental degradation due to increased salinity of soil, canals and ponds within dams, reduction in grazing field and livestock, changes in the cropping calendar and its pattern, bio-diversity. Ecological aspects and sustainability are also overlooked during the shrimp cultivation. In conclusion, proper implementation of the resilient strategies designed in an ecological model can minimize the adverse effects on the coastal dwellers and local environment, and improve the unplanned shrimp cultivation process in similar areas of Bangladesh.

Roopa Siddegowda and Rani. M.S 

Many population surveys have been carried out in different parts of the world with the objective of estimating prevalence of malocclusion and orthodontic treatment needs. Malocclusion is still considered a dental problem in developing country like India and often neglected because more priority is given to the problems of dental caries and periodontal diseases. Most malocclusion cases are still not treated properly because due to ignorance of patients and parents, inadequacy of dental resources, lack of dental workforce and many of the other factors that have influenced the availability of services. This survey was formulated to investigate the same and to provide strategies for prevention, corrective treatment and to create awareness of orthodontic treatment.

Getu Kassa and Tadesse Anteneh 

Background: Recognition of HIV/STI co infection has tremendous contribution for targeted intervention. Sexually transmitted infections have far reaching health, social and economic consequences. Sexually transmitted infections are very important because of their potential complication and interaction with HIV/AIDS. By evaluating the HIV/STI co infection it will be a signal to know the affected groups and major determinants. In doing so, the study finding would help in the planning, resource allocation and designed targeted prevention and control program. Objective: To determine the prevalence and determinants of HIV among symptomatic STI cases. Methods: Cross-sectional survey was conducted for HIV Sero prevalence and determinants among 415 symptomatic new STI cases that had been attended for treatment in eight hospitals in SNNPR, Ethiopia from November, 2011 to February, 2012. Standard rapid HIV antibody test was used to screen the sample blood following the national rapid HIV testing algorithm. Results: The overall HIV sero positivity was found to be 10.6%. Among 415 samples 371(89.4%) were negative and 44(10.6%) turned out to be positive.( Table 4) The rate varies among the major STI syndromes, namely, Urethral discharge syndrome (18.2%), vaginal discharge syndrome (56.8%), genital ulcer syndrome (15.9%), and lower abdominal pain (9.1%). (Table 4)Limitation of the study: Limitation of this study is the use of rapid HIV test kits which fails to detect recent infection. Moreover, the study is hospital based it can’t be representative of the whole population, Conclusion and Recommendation: High prevalence of HIV in STI patients is explained by the role of STI in predisposing for HIV transmission which offers a unique opportunity for strengthening the prevention of HIV/STI co infection putting in place routine HIV test. Furthermore, public health intervention on consistent condom use and partner notification and referral should be given due emphasis targeted to the most at risk population.

Piddennavar Renuka and Krishnappa Pushpanjali 

Health education can be effective with audiovisual aids. However, oral communications often fail because they are misunderstood and/or forgotten. Therefore, information leaflets could be considered as a way of supplementing health education. Numbers of guidelines for producing written information have been produced over the last few years; these include advice on planning, writing and design but also emphasize the importance of obtaining evidence-based information, and involving both medical personnel, patient groups and members of public. The evaluation of information leaflet, however an essential part of this process is and is often neglected or inadequate. The aim of this review is to describe the steps involved in the production and evaluation of information leaflet. The present review has been attempted to describe methods, which can be employed to prepare and evaluate written patient information leaflet.

Su-I Hou and Peng-Hsi Hou 

Purpose: As the world population rapidly aging, especially in Asia, and “the graying of the Internet”, opportunities of eHealth communication among middle-and older-age adults warrants more attention. Methods: The eHealth communication survey was administered to employee age 40+ in two major worksites in Taiwan. The development and validation of a 7-item eHealth communication belief inventory (eHealth-BI) by age groups were examined. Results: A total of 533 employees participated (mean age = 46.21 (SD=5.01) years). The reliabilities of the eHealth-Pros (4-items) and the eHealth-Cons (3-items) measured by Cronbah alphas were satisfactory in both age groups (40-49 and 50-64 years), demonstrating sufficient internal consistencies among items. Confirmatory factor analysis showed that all items were loaded significantly on these two eHealth-BI sub-scales with good model fits. Males and those with college education overall were more likely to perceive higher benefits and lower barriers towards eHealth communication. Conclusion: Findings provide needed validation on this new theory-based bi-lingual eHealth-BI tool. Results provide health researchers and practitioners an important tool to measure beliefs towards eHealth communication for better understanding of system design needs, and for effective eHealth communication intervention development among middle-and older-age Chinese adults.

Lachlan Smith Scott Pedersen and Dean Cooley 

Desk-based worksites are increasingly the focus of workplace health and wellbeing interventions. These interventions often utilize an educational session prior to participants engaging, yet limited studies have specifically examined the effect education has on compliance. The purpose of this study was to investigate the effect pre-intervention participant education had on the odds of compliance to a passive e-health software program designed to increase non-exercise activity thermogenesis throughout the workday. Participants in the experimental group (n=46) were exposed to multifaceted pre-intervention participant education one day prior to initiating the e-health software intervention for an eight-week study period. The control group (n=33) also received the intervention for eight weeks, however these participants received no education prior to initiation. The e-health software had a self-report progress recording function, which recorded all logged movement entries to gain frequency counts of per day usage. The experimental group logged more active days, more movements per day and was significantly more compliant to the e-health software (OR=1.87, 95% CI = 1.56-2.24). A pre-intervention participant education session, coupled with a passive e-health software program, was an effective mechanism for decreasing prolonged employee sedentary periods and increasing movement throughout the workday.

Juanita L Bonner Jessica Hopper Linda Gore Martin and Penelope Caldwell 

This research, performed in Agua Salada, Honduras, was done to help identify ethical issues perceived by the recipients of short-term medical missions and to examine how these issues differ between volunteers and patients. Using the four principles of medical ethics (non-maleficence, beneficence, autonomy, and justice) as a guide, patient-participants and brigade volunteers were surveyed using open-ended questions on the ethical aspects of taking western medicine to an underdeveloped region. Both the patient-participants (n=58) and brigade volunteers (n=12) agreed that medical missions should come to Honduras. Interestingly, with questions related to the benefit of medical mission work, volunteers were more likely to report benefit to themselves (60.3%) than to patients. In conclusion, patients and volunteers primarily share common perceptions of beneficence and justice while volunteers are more likely to be concerned with non-maleficence and undervalue indicators of autonomy.

Elizabeth Lai Le Trac and Annesha Lovett 

Today pharmacists are using their clinical skills to serve the community through vaccinations, emergency preparedness and response, drug education, health screenings, medication therapy management (MTM), and counseling services. This article provides a summary of why the pharmacist’s role should be expanded in the public health arena. It is essential to realize the capability of pharmacists and further expand their role in the public health arena in order to improve the quality of care and control costs of the nation. Pharmacists are more accessible to patients than any other healthcare professional and are well-trained to further advance the mission of public health: to promote health, wellness and prevention.

Doaa Abdel-Hady Noha Eladawi and Abdel-Hady El-Gilany 

Objective: to highlight the knowledge of female medical students about breastfeeding in general and in special situations. Subjects and methods: A descriptive cross-sectional study on female medical students enrolled in the academic year 2011/2012 in Mansoura Faculty of Medicine from first to final years using self-administered questionnaire. Results: A total of 631students participated with 258 in the preclinical and 373 in the clinical grades. Generally, the majority of students were more aware about initiation, duration and advantages of breastfeeding than correct breastfeeding practice in some special situations. Conclusion: Educational stage is a significant variable in the level of knowledge and medical students and the joiner year’s curricula must include more knowledge about breastfeeding.

Saleh M.M. Rahman Selina Rahman Helen Vilme and Monica Hayes 

Diabetes poses severe disease and economic burden in the United States of America as well as in Florida State. The study aimed at evaluating eight community-based diabetes disparities projects funded by FDOH ‘Closing the Gap’ initiatives. This three-phase evaluation included evaluability assessment, process, immediate outcome and impact evaluation using qualitative assessment, case study approach, survey, document analysis, and face-to-face interviews. In 2006-2007, 2007-2008, and 2008-2009 total 3,764; 3,280; 1,691 individuals participated in the programs respectively. In 2006-07 to 2007-08, the proportion of participants referred for the wellness program decreased 8.64%, and participants enrolled in the wellness program decreased 3.4%. On the other hand, DSME and wellness program referrals, enrolment, and completions increased significantly from the 2007-08 to 2008-09 program year (12.6+8.64=21%, 3.4+36.1=39.5%, and 31.8-2.2=29.6%, respectively). The largest increase happened in the DSME with a change of (51.2-8.7= 42.5%). From the 2006-2007 to 2007-2008 funding year, with the largest increase in pre and post-test score, HbA1c, eye-exam etc. participation and in 2008-2009 participation of females in the diabetes program increased significantly. Overall, the diabetes program successfully recruited minority populations and had immediate positive outcomes and impact on minorities, hard-to-reach populations, and women which are good indicators of the program’s success.

Melinda J. Ickes and Kira M. Slagle 

Children living in rural and Appalachian communities are at high risk for childhood obesity. The purpose of this manuscript was to review existing childhood and family obesity interventions targeting Appalachian and rural communities to explore recommendations for intervention development. Peer-reviewed studies were selected through a systematic literature search. Seventeen studies met inclusion criteria. Cultural, economical and geographical characteristics of rural and Appalachian communities often make it difficult to reduce childhood obesity. Future research should aim to promote sustainable solutions to complications of childhood obesity in rural and Appalachian communities.

Melissa M Terry Daniel R Terry Ha Hoang and Chona Hannah 

The National Primary Health Care Strategy in Australia recommends primary health care services need to be clinically and culturally appropriate and delivered in a timely and affordable manner. However simultaneously recognised, access is still inequitable in among various population groups and many areas of Australia. Geographical Information System (GIS) have been used to explore geographical health disparities, planning health care service delivery and provide data in a meaningful way to inform public health strategies. Moreover, GIS has also been used to spatially analyse, measure and provide insight into a population’s accessibility to health care services. A literature search was conducted to identify studies which examined primary health care accessibility using GIS techniques among various urban and rural populations. A limited number of studies demonstrated in addition to distance; time; and location, low socioeconomic status, Culturally and Linguistically Diverse (CALD) background among other factors influences health care access. In addition, other factors were identified to impact health care access, which is an individualised process, influenced by individual characteristics, beliefs, attitudes, and an individual’s activity space. As health care accessibility becomes more prominent within policy, among practitioners and increasingly researched, it has the potential to move beyond recognising areas of poor accessibility among individuals and communities. With a greater integration of both spatial and aspatial data, the process has the likelihood, to provide greater insight into patient behaviour, public perception, amelioration service quality and improve population health and wellbeing.

OYEBODE    and Oluwadare Joshua 

Public health is a fundamental requirement to human existence. Waste is directly linked to human development, both technologically and socially, some components of waste have economical value and can be recycled once correctly recovered. Effects of poor environmental hygiene on public health were studied in the precarious living quarters of Lagos state in Nigeria. This study examined the waste management; identified the challenges facing its operation; proffered possible solutions necessary for the growth of the waste market, and also the need to harness the inherent economic and environmental benefits. Data collected in various centers in the town on cases of morbidity, revealed that malaria is much contracted by populations with 58% cases against 14% for diarrhea and 28% for acute respiratory infections. Under-five children are much affected with 24% of the patients among which 43% were cases of the diarrheic diseases. Also, malaria and respiratory infections are more important during rainy seasons, in contrast to diarrheal diseases caused by poor hygiene of people. It has been ascertained that the level of education affects the public health. The concept transformation of waste from an exhausted utility to a valuable commodity as a mechanism for effective solid waste management is yet to be properly utilized in Lagos State.

Seyed Ali Rahimi and Behzad Nikpour 

Exposure to radon is the second leading cause of lung cancer after smoking. Radon is an odorless, tasteless and invisible gas produced by the decay of naturally occurring uranium in soil and water. The amount of radon in the air is measured in "picocuries per liter of air," or "pCi/L." There are many kinds of low-cost "do-it-yourself" radon test kits you can get through the mail and in some hardware stores and other retail outlets. In this study to measure radon in homes in the province of Sari by dosimeters DOSEman (SARAD GmbH company). Population of the city of Sari 495,369 people and the urban population of village of forty to sixty is the degree of concentration of 116.5 people/ km2. A percentage of the total household population of Sari in areas geographically different samples is selected. Radon measuring in four different seasons (in one year) at home for sampling was done. Sensors 60-minute room bedroom or living at an altitude of 50 to 90 cm from the floor, away from windows and sunlight placed howe dose rate and radon gas in homes has been measured. Amount of radon in your home in spring 28.615Bq m-3, in summer Bq m-3 27.20, in autumn 27.07Bq m-3 in winter Bq m-3 36.95 measures. Both dose levels in spring .0032 μSv, in the summer 0.026 μSv, in the autumn 0.037μSv in winter 0.056 μSv is measured. Annual dose equivalent to approximately 0.0151μSv / year .Radon measurement results show that the average radon concentration is higher in winter than other seasons. This difference could be due to lack of air movement and stillness, and the dose of radon indoors in winter.

Dean Cooley Karla Kubitz Scott Pedersen and Andrew Williams 

The purpose of this study was to test the effect of a brief telephone intervention based on the principles of motivational interviewing to reduce pre-treatment attrition in an Australian cardiac rehabilitation centre. The study was an intact comparison randomly trial. Twenty-eight adult patients diagnosed with symptoms associated with cardio-vascular disease, who were noncompliant to an initial appointment, were randomized to receive either a standard cue call or a motivational interview-based recruitment call. Compliance was measured as attendance at a booked session at the cardiac rehabilitation center. Results showed that patients who received a motivational based telephone call had 6 times the odds as those who received a standard cue telephone call for attending a booked appointment. Reducing pre-treatment attrition from cardio-vascular rehabilitation centers can be accomplished with a brief telephone intervention, which incorporates the spirit of motivational interviewing.

Quynh Lê Stuart Auckland Hoang Boi Nguyen Daniel R Terry and Dustin V.A. Lê 

The quality and usefulness of patient held logbooks as a record to improve communication between healthcare professionals providing cancer care was evaluated. Its aim was to facilitate greater coordination and information sharing between patients, carers, clinicians and other health professionals. A mixed-method exploratory study conducted 12-week post distribution of logbooks to patients undertaking cancer care. Data was gathered through questionnaires returned by 66 participants (response rate of 57.4%) and interviews with five clinical oncology nurses at a Tasmanian hospital. The logbook quality was evaluated against two sets of indicators, including content and layout. The general effectiveness of the patient logbook was also assessed based on its usefulness, usability, efficiency and satisfaction. The logbook was considered useful among 63 (95.1%) participants. They acknowledged the logbook enabled them to be better informed, created a feeling of empowerment and greater control over their medical condition. The logbook was observed to improve communication between clinicians, their patients and families. The evaluation generated rich, in-depth information and provided useful insights into the general quality and usefulness of the logbook for cancer care. The strengths and weaknesses of the logbook were highlighted and how to better utilise its functions in the current medical system.

Eleni Jelastopulu Pania Karnaki Christos Bartsokas Panagiotis Plotas and Aris Sissouras 

The aim of this study is to provide a profile of cervical cancer screening practices among the women in Patras and to assess factors associated with cervical cancer screening uptake. Data from a representative sample of 873 women were analyzed. 67.2% had at least one Pap test in their life, with 54.4% having been tested in the previous three years. Women aged 35-44 and 45-54 years were more likely to have had a recent Pap test (OR>3) as well as married/partnered women (OR=2.4). Unemployed women and women with the lowest educational level were less likely to have had a recent Pap test. Compared to women with a monthly household income of <500€, those with higher income were more likely to have had a Pap test. The prevalence of Pap testing in Patras is very low. Our findings support the necessity of implementation of national screening programs or targeted screening interventions mainly in the identified under-screened population subgroups, i.e. women with socioeconomic disadvantages.

Ha Hoang Quynh Lê Daniel Terry Sue Kilpatrick and Jacqueline Stuart 

This study investigates Tasmanian maternity health providers’ and rural women’s experiences and views of continuity of care in the public health system and the feasibility of this model is explored. Semi-structured interviews were conducted with 22 women who had childbirth experiences in six rural areas in Tasmania in the past five years. In addition 20 multidisciplinary maternity health providers currently employed by the health care system were also interviewed. Multidisciplinary maternity health providers and rural women believed that continuity of carer would help them build up relationship with each other and contribute to their satisfaction with care. However, both Tasmanian maternity health providers and rural consumers recognised the challenges of providing continuity of carer in the current public health system due to the constraints of human resources. Given the human resource constraints in the public hospital system, women would be happy with the quality of care provided by the team of health professionals.