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Dec 2025 DOI 10.14302/issn.2641-4538.jphi-25-5886
Y. Talbert PatriciaCorresponding author
Objective Diabetes poses significant public health challenges, with many individuals remaining undiagnosed and at risk of complications. This study aimed to evaluate the performance of decision tree ensemble methods for predicting diabetes onset using the Framingham Heart Study Teaching Dataset and to explore sex-specific risk patterns relevant to AI-driven interventions. Methods We analyzed data from 11,627 participants, incorporating demographics, vital signs, smoking status, medication use, and laboratory measures. Random Forest classifiers were developed to predict diabetes incidence at approximately 6-year (Period 2) and 12-year (Period 3) follow-ups. Class imbalance was addressed using undersampling, oversampling, and the Synthetic Minority Over-sampling Technique (SMOTE). Results The models demonstrated robust performance, achieving an Area Under the Curve (AUC) of 0.856 in Period 2, and moderate predictive ability in Period 3 (AUC = 0.732 in males, 0.786 in females). Key predictors included glucose level, BMI, systolic blood pressure, age, and heart rate. Notably, differences emerged in predictive accuracy between men and women, suggesting potential sex-specific vulnerabilities that merit further study. Conclusion Machine learning approaches, particularly Random Forests, show promise for medium- and long-term diabetes risk prediction, supporting early identification and intervention efforts. Future work should focus on hyperparameter tuning and explainability techniques, such as SHapley Additive exPlanations (SHAP) values, to improve model precision, interpretability, and fairness. Equity-focused strategies remain critical to ensure AI-driven tools benefit diverse populations and do not exacerbate existing disparities in diabetes care.
Dec 2025 DOI 10.14302/issn.2574-612X.ijpr-25-5849
Yılmaz GülsümCorresponding author
Bipolar disorder is a chronic condition marked by episodes of mania and depression, significant functional impairment, and challenges with treatment adherence. Current guidelines highlight the importance of both medication and psychosocial approaches in treatment. This review explores the primary psychosocial interventions for bipolar disorder. Psychoeducation helps recognize early symptoms, improves medication compliance, and prevents relapses. It is simple to implement and cost-effective. Family-Focused Therapy (FFT) enhances family communication, reduces emotional expression, and lowers the frequency of depressive episodes. Interpersonal and Social Rhythm Therapy (IPSRT) supports maintaining social stability by addressing disturbances in biological rhythms. Cognitive Behavioral Therapy (CBT) decreases depressive symptoms and boosts treatment adherence by restructuring automatic thoughts. Additionally, cognitive and functional rehabilitation programs improve attention, memory, and executive functioning. Peer support groups and digital e-health tools, though supportive, have limited evidence of effectiveness. In summary, multicomponent psychosocial interventions serve as a valuable addition to medication, helping to prevent relapses, improve functioning, and enhance quality of life in individuals with bipolar disorder.
Dec 2025 DOI 10.14302/issn.2643-2811.jmbr-25-5731
Mukeredzi InnocentCorresponding author
Background Typhoid fever remains a significant public health issue in Harare City, Zimbabwe, exacerbated by recurrent outbreaks between 2018 and 2020. Key challenges, including inadequate water supply and sanitation infrastructure, high population density, and limited healthcare access, have intensified the disease burden. Understanding the key transmission drivers and assessing the impact of various interventions are essential for informing policy and health strategies. Objectives This study aimed to: 1: To predict future trends in typhoid fever cases Harare City typhoid hot areas. 2: To develop a mathematical model to simulate the spread of typhoid fever incidence under different intervention scenarios and recommend evidence-based strategies for reducing the disease burden in Harare City. Methods A dynamic compartmental SIR-based model, adapted from the Pitzer Vaccine Effectiveness (VE) framework, was employed to simulate disease transmission. This model accounted for both short-cycle (human-to-human) and long-cycle (environmental) transmission pathways. Data from Harare City (2018–2020) were used for model calibration and forecasting, and sensitivity analysis was performed to assess the impact of different intervention levels. Findings The model identified inadequate sanitation, contaminated water sources, and low health- seeking behaviors as primary drivers of typhoid transmission. In the absence of interventions, the model projected a sustained high rate of transmission. However, treatment and WASH interventions could reduce the disease burden by 50–60%, while combined strategies incorporating vaccination and education led to an 80% reduction in cases. Sensitivity analysis indicated that treatment and WASH interventions were particularly impactful at moderate coverage levels. Conclusion Mathematical modeling effectively demonstrated the multifactorial drivers of typhoid fever transmission in Harare. Integrated interventions that combine WASH, vaccination, treatment, and education present the most promising approach for long-term control of the disease. The findings offer a solid, data-driven foundation for public health decision-making and resource allocation.
Dec 2025 DOI 10.14302/issn.2997-1977.jd-25-5754
Valentine Olagunju GraceCorresponding author
With more than 150,000 affected infants annually, Nigeria bears the largest burden worldwide of sickle cell disease (SCD), making it a significant public health concern. The management of SCD in Nigeria is challenging, despite advancements in medical research and increased knowledge. This review examines the numerous issues surrounding SCD in the nation, including the financial burden on affected families, the lack of specialized care facilities, the absence of newborn screening programs, the sociocultural stigmatization of SCD, and restricted access to high-quality healthcare. Additionally, inadequate public health education and a lack of coordinated national policies result in delayed diagnosis and suboptimal treatment outcomes. We also highlighted recent efforts and recommendations aimed at improving early detection, comprehensive care, and community support. Addressing these challenges through expanded health education and enhanced healthcare infrastructure is essential to reducing morbidity and mortality associated with SCD in Nigeria.
Oct 2025 DOI 10.14302/issn.2641-4538.jphi-25-5661
Rashwan NaglaaCorresponding author
The World Health Organization emphasizes the importance of international collaboration to save lives and improve health at national and global levels. However, significant challenges face those engaged in international collaborations such as language barriers, cultural differences, different rules and regulations, and limited resources. This paper discusses the use of cultural humility theory to support an international collaboration between stakeholders from different countries with diverse cultural backgrounds working together to optimize a novel middle and high school curriculum intended to promote peaceful coexistence in the Kingdom of Bahrain. We use the attributes of cultural humility as a framework to reflect on lessons learned while navigating cultural differences, conclude by recommending the use of this framework during international collaborations, and provide practical examples about how to operationalize the attributes of cultural humility to inform international collaborations attempting to promote global public health.
Jun 2024 DOI 10.14302/issn.2381-862X.jwrh-24-5099
Schwarz SilkeCorresponding author
Parents' and siblings’ role model motivation and function could play an important role in positively influencing both their own media behavior and that of family members. To investigate whether parents and siblings consciously take on this role model function, their intentions were being evaluated with a standardized questionnaire before a 6-week media fasting intervention. 135 pairs of parents and 178 pairs of children were included. A major component of the parents' media fasting intention to media fast was to be a role model for their children. This was particularly related to the idea that media fasting has something cleansing about it, as well as the hope of becoming more attentive and calm as a family. These parents seem to want to strengthen family cohesion and climate and protect their children from excessive media consumption. Children who want to be role models for their parents also intend to have a positive influence within the family and want to be role models for their siblings. Regression analyses revealed several predictors of the parents' intent for role model function: the hope of becoming more attentive and calm as a family, the view that media fasting has something cleansing about it, and the perception that it is good for one's children to use less digital screen media, and, inversely, age (R2 =.35). The best predictors of the corresponding intention among the children were the desire to be a role model for their siblings, for the family to do more together again and, as for the parents, a younger age (R2=.57). The intentions of both groups are different, but the possibility of using less media is perceived as sensible. The role model function appears to be a relevant motivating and influencing factor regarding the conscious use of digital screen media and regulation of screen time. This should be taken into account when developing interventions.
Feb 2024 DOI 10.14302/issn.2998-4211.jalr-23-4813
del Carmen Teruel Hernández EstherCorresponding author
This study systematically reviews the literature on non-pharmacological interventions for disrupted sleep-in people meeting established criteria for moderate-severe dementia, and to analyze the methodological quality of the included studies. The PubMed, PEDro, Cochrane, Virtual Health Library, APA PsycInfo databases were searched using a systematic literature review approach to identify various types of non-pharmacological treatments that improve disrupted sleep-in subjects with moderate-severe dementia. In accordance with the inclusion criteria, eight studies were systematically reviewed and analyzed according to the type of non-pharmacological treatment carried out. This systematic review showed that 50% of the studies used bright light therapy, 12.5% the use of manual therapy, and 37.5% sleep hygiene or walking or a combination of these interventions. Based on the results of the present study, although there is some evidence to support these strategies, it is not significantly supported and highlights variation in the way the interventions were delivered. Disrupted sleep is highly prevalent in people with dementia and have a negative impact on the quality of life of the sufferer and the caregiver. Non-pharmacological approaches to its treatment are increasingly popular as an alternative to drugs, whose efficacy and side effects have raised concerns among the population. Currently, there is a need to carry out more future research to establish its effectiveness and to be able to provide clear guidelines at the time of clinical practice.
Nov 2023 DOI 10.14302/issn.2997-1969.ijhs-23-4628
S. Oluwafemi OyamakinCorresponding author
Gene alterations that are essentially present in every cell in the body cause many hereditary diseases. As a result, these ailments frequently impact many bodily systems, and the majority of them are incurable. To treat or manage some of the accompanying symptoms, there might be methods available. When monitored up to the age of 25, it is estimated that 5.3% of babies will experience a genetic disease. In order to build a modified intervention program for people with genetic disorders, this paper reviewed existing programs and interventions for people with genetic disorders. It did this by using information about sickle cell disease. Data was gathered at the sickle cell clinic at the State Hospital, Adeoyo, Ibadan, Oyo state, where all sickle cell patients receive care. 53.3% of the survey participants were male (n=81), whereas 46.7% of the participants were female (n=71). In terms of age, 59.2% (n=90) of the respondents are under 20 years old, 27.6% (n=42) are between 21 and 26 years old, 9.9% (n=15) are between 26 and 30 years old, 1.3% (n=2) are between 31 and 35 years old, and 0.7% (n=1) of the respondents are each in the age brackets of 36 to 40, 41 to 45, and over 45. This demonstrates that the age range between 0 and 30 years old has the highest percentage of respondents, whereas people older than 30 are infrequently found. The respondents' marital status was also taken into account; 91.4% (n=139) of them are single, 7.2% (n=11) are married, and 1.3% (n=2) are separated.
Sep 2022
K Al Miraj ACorresponding author
Research Assistant, Department of Vascular Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU)Dhaka, Bangladesh.
Background Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients worldwide. In the developing countries like Bangladesh it has been increasing with time. Due to life style, food habits and urbanisation. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Materials and Methods From July 2020 we included 152 patients with IHD purposively in Cardiology department of Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh undergone PCI who were divided into 2 groups according to age: e” 75 years (n = 51) and <75 years (n = 101). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint was Renal impairment, MI, LVF, emergency revascularization and death. Results Very elderly patients were more frequently male (86.2%) and nonsmoker at present (41.1% vs. 63.3%, p=0.003), had higher prevalence of hypertension (60.7% vs. 50.4%, p<0.13), and more often presented with NSTEMI (54.9% vs. 23.7%, p<0.001). Elderly group had higher incidence of TVD and LM disease (37.2% vs. 26.7% and 9.8% vs. 2.9%, p=0.07) and more incidence of ostial (17.6% vs.5.9%,p=0.007) and calcified lesions (31.3% vs. 14.8%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (96% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.8% vs.5.9%, 7.8% vs.3.9%, 5.8% vs.5.9%, 9.8% vs. 4.9% and 5.8%vs.3.9%,p=0.07), whereas emergency revascularization were higher in younger group (5.8% vs. 6.9%, p=0.07). Conclusion Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group.
May 2022 DOI 10.14302/issn.2641-4538.jphi-22-4167
Ozichu Ekama SabdatCorresponding author
Clinical Sciences Department, Nigerian Institute of Medical Research 6 Edmund Crescent P.M.B 2013, Yaba, Lagos Nigeria
Objectives This study aims to evaluate the challenges of implementing non-pharmaceutical interventions, assess adherence, accessibility to prevention materials and identify requirements for the control of the spread of COVID-19 among individuals living in a slum-setting in Lagos, Nigeria. Methods This is a five-month cross-sectional study conducted in Makoko, Lagos an urban-slum community. Data on sociodemographic characteristics, living conditions and adherence to COVID-19 prevention strategies were obtained with a semi-structured questionnaire. Logistics-regression model was used to determine factors associated with adherence to COVID-19 preventive measures. Results There was a total of 357 participants who had a mean age of 45.8 ± 12.9 years. Majority were males (62.2%), married (83.8%), self-employed (66.4%), and had secondary education (31.4%). Most participants (93.8%) had no space for self-isolation as majority lived in a one-room apartment (72.8%), shared toilets/kitchen space (64.4 %), had no constant source of water supply (61.9%) and buy water (62.5%). About 98.8% are aware of the COVID-19 pandemic but only 33.9% adhered. Most of the participants disclosed inability to purchase face masks/ hand sanitizers (68.9%). After adjusting for covariates, the ability to afford facemasks/hand sanitizers (P < 0.0001, aOR 6.646; 95% CI: 3.805-11.609), living alone (P < 0.0001, aOR 3.658; 95% CI: 1.267-10.558), and ability to buy water (aOR: 0.27; 95% CI: 0.14-0.50), had greater odds of association with adherence to the non-pharmaceutical COVID-19 preventive measures. Conclusion The lack of isolation space among majority of the respondents calls for concern. Inability to purchase prevention materials is a major factor influencing poor compliance to COVID-19 prevention strategies.
May 2022 DOI 10.14302/issn.2576-9383.jhhr-21-3994
Yadav RavinderCorresponding author
Medical Social Welfare Officer Department of Medical Record Government Medical College and Hospital, Sector-32, Chandigarh, India
In this article the author reviews research on high risk factor of Human Immunodeficiency Virus in homosexuals and how lack of awareness & unprotected anal sex contribute substantially to new infections among this population. current HIV prevention efforts by providing insight into the patterns of Indian MSM behavior and sexual partnerships, and the specific cultural, social inequality, the gaps and lack of knowledge and psychological context in which HIV risk is occurring. And the need to develop effective awareness programs for well-functioning prevention of HIV and considerable understanding of the logistical and socio-cultural barriers MSM experience while accessing HIV prevention services. And in last will put light on therapeutic interventions for Human Immunodeficiency Virus, behavioral interventions that are socially and culturally appropriate for the population or community being prioritized and addressing multilevel psychosocial factors, including skills building and strategies to foster self-acceptance and increased social support for MSM. At the same time, prevention messages need to be designed and adapted to the knowledge level and culture of people.
Mar 2022 DOI 10.14302/issn.2692-1537.ijcv-21-3757
Muhammed YahyaCorresponding author
Department of Sociology, School of Arts and Sciences, University of The Gambia. Banjul, The Gambia, West Africa
Background The pandemic has disrupted the lives of many globally including persons with disabilities. These disruptions are universal. However, the vulnerable communities are more affected. Purpose The study examines impacts on persons with disabilities to share knowledge and inform interventions that ensure persons with disabilities are supported. Methodology The study is a systematic literature review using different search engines to search for scholarly articles all over the globe. Results Persons with disabilities have been negatively impacted in numerous ways: lack of access to healthcare services, inadequate rehabilitation services, increased human rights violation, stigmatization and discrimination, increased risk of dying, being subjected to violence, losing financial income, lack of access to education and treatment, increased in neglect and traumatization, poverty, lack of access to food, decreased in community support; and worse of all, in comparison with the overall population, the death of persons with disabilities during the Covid-19 is higher. These impacts were precipitated by inaccessible built environment and sense of touching, lack of disability sensitive policies, increased prevalence of risk factors, difficulties in adhering to WHO recommendations, pervasiveness of underlying health conditions, lack of disability-friendly information and inclusive intervention, national budget cuts; and poorly funded institutions. Conclusion Persons with disabilities have been negatively impacted due to many risk factors peculiar to them.
Oct 2021 DOI 10.14302/issn.2379-7835.ijn-21-3908
B. Oluwole OluwatoyinCorresponding author
Food Technology Department, Federal Institute of Industrial Research, Oshodi, Lagos, Nigeria
Colorectal cancer (CRC) is a menace in the global public health system. According to GLOBOCAN reports, colorectal cancer is the second most diagnosed cancer in the world with more than 1.9 million cases and 935,000 deaths in 2020 alone. Diet plays a key role in exposing humans to environmental carcinogens and anti-carcinogens, consequently mitigating or aiding in the development of various cancers. CRC is most prevalent in western countries with a high intake of saturated fats, refined carbohydrates, and processed meat. CRC was an extremely rare disease in Africa some decades ago, but the situation is fast changing. The traditional African diet consists of leafy, roots and cruciferous vegetables, fruits, roots, tubers and plantains, legumes, whole grains, and spices, all of which have been shown to possess protective effects against CRC. However, the effect of urbanization has contributed to the shift of dietary choices among the African population to consuming more ultra-processed foods with high levels of unhealthy components that have originated from colorectal cancer prevalent regions. This review evaluates the current nutritional challenges of the African diet to colorectal cancer and the potential roles of the traditional African diets and lifestyle modification in the prevention and management of colorectal cancer.
Feb 2021
E.E. Enwereji,Corresponding author
College of Medicine Abia State University, Uturu, Nigeria.
Introduction Risk reduction intervention is meant to provide enhanced and desirable interventions for HIV prevention among adolescents especially the in-school. Adolescents have been identified as the most vulnerable groups that can easily acquire human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). Therefore, adolescents are the appropriate target for HIV prevention efforts. Most interventions for adolescents focus on providing AIDS-related education with the assumption that improving knowledge would enable adolescents to protect themselves from sexually transmitted infections. Numerous studies have shown that using class-room education alone is insufficient in reducing adolescents’ risky sexual behaviours. Therefore, this study used role-plays and peer facilitation for the study. Materials and Method The study used role-play and peer facilitation for the intervention strategy. The theme of the role-play was ‘My Future is My Choice’ (MFMC) intervention which was aimed to reduce HIV risk behaviours among sexually inexperienced adolescents. The role-play was carried out by 4 peer leaders who were trained in the theoretical framework of role-plays and peer facilitation by a consultant. With mastery and experience they carried out the role play in a regular classroom section for over 3 class periods, co-facilitated with the assistance of a volunteer teacher. A unique feature of this intervention was the dual focus on strategies that influenced both individual risk factors (i.e., attitudes, behavioural skills) and social environments (e.g., peer resources). A school was chosen by simple random sampling for the intervention. In the school chosen, a total sample of 65 students in senior secondary classes 2&3 ( SS2&3) were included in the study. These were the students considered to be sexually active who can respond to the questions in the questionnaire. Self-administered pre-and post-questionnaire were completed by the students. The results were analysed using frequency tables, descriptive and inferential statistics. Results The students studied were between the ages of 13-18 years. There was evidence that the role play ‘My Future is My Choice’ (MFMC) intervention created positive effects on reduction of HIV risk behaviours among the sexually inexperienced participants aged 13–18. Perceptions on methods of preventing risk reduction behaviours were also positively impacted by the intervention as 12(18.5%) and 34(52.3 %) of the respondents realized after post- intervention that having sex with someone outside marriage and being transfused with infected blood respectively Will constitute risk to HIV infection. Conclusion The role play which used the theme ‘My Future is My Choice’ (MFMC) intervention provided safer choices for reducing one or more measures of sexual risk behaviours among the sexual inexperienced respondents. It created the opportunity for the students to recognize that engaging in unprotected sex constitutes high risk for HIV, other sexually transmitted infections and pregnancy.
Dec 2019 DOI 10.14302/issn.2641-5518.jcci-19-3133
Sanikidze TamarCorresponding author
Tbilisi State Medical University, Tbilisi, Georgia
To demonstrate that percutaneous coronary intervention (PCI) may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of multivessel coronary artery disease including left main coronary artery (LMCA) quadrifurcation. Methods For safety reasons, PCI was done in 2 separate sessions (staged PCI). Stenting of the LMCA quadrifurcation was performed using different stenting techniques in combination: modified balloon mini crush stenting technique was used - for LMCA and intermediate artery (IMA) stenting; modified balloon crush stenting technique was used for LMCA, circumflex artery (CX) and first obtuse marginal branch (OM1) stenting; provisional stenting technique was used for CX stenting, followed by sequential kissing balloon post-dilatation technique between LMCA and every branch; proximal optimization technique (POT) was performed in the LMCA. Left anterior descending artery (LAD), intermediate artery, circumflex artery, first obtuse marginal branch, left main coronary artery and its quadrifurcation were stented with 5 drug-eluting stents (DES) (Resolute Integrity, Medtronic); right coronary artery (RCA) was stented with 3 bare-metal stents (BMS) (Rebel, Boston Scientific). Results The interventions ended without complications, the ejection fraction increased from 35% to 48%, congestive heart failure functional class decreased to class I. Subsequent coronary angiography, eight months after the last PCI, revealed patent stents with mild, nonsignificant restenosis. More than three years after the intervention, the patient has no complaints (according to MACE). Conclusions It should be considered that in case of the selection of suitable patients and the use of the appropriate revascularization technique, LMCA quadrifurcation lesion can be successfully treated with PCI.
Oct 2019 DOI 10.14302/issn.2641-5518.jcci-19-3039
Sanikidze TamarCorresponding author
Tbilisi State Medical University, Tbilisi, Georgia
Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is rare on the angiograms; Coronary Artery Bypass Grafting is the standard method of its revascularization. To demonstrate that PCI may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of chronic total occlusion of the LMCA, left anterior descending artery (LAD), and circumflex artery (CX). Methods Recanalization of the occluded LMCA and LAD was performed by utilizing the support-balloon technique, and CTO wires (Miracle 3™ wire, Abbott Vascular; Runthrough® NS Intermediate wire, Terumo); LAD, CX, LMCA, and its bifurcation, were stented with 3 drug-eluting stents (Resolute Integrity DES, Medtronic); the "Culotte Stenting " technique was used for bifurcation stenting, followed by "Kissing Balloon" post-dilatation technique; proximal optimization technique was performed in the LMCA. Results The intervention ended without complications. 2 months after stenting, the ejection fraction increased from 20% to 38%, improved almost all parameters of the heart, Congestive Heart Failure functional class decreased to class I. Conclusions It should be considered that LMCA CTO lesions can be successfully revascularized with PCI in case of the selection of the suitable patient and appropriate revascularization technique.
Aug 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2797
A Best-Popescu CatherineCorresponding author
University of Illinois College of Medicine, Urbana-Champaign, Urbana, IL, USA (Barry J. Riskin, MD)
Background There is substantial evidence, from well-conducted epidemiological studies, that low vitamin D levels are correlated with increased risk for MS, and multiple case control studies have implicated the involvement of vitamin D deficiency in MS etiology. Narrow-band Ultraviolet B (NB-UVB; 300nm - 311 nm) induced vitamin D production has not previously been studied in a multiple sclerosis (MS) randomized placebo-controlled trial (RCT). Objectives To investigate NB-UVB induced vitamin D production, immunomodulation and MS symptomology following NB-UVB phototherapy in a MS cohort. Methods Using a blinded RCT study design, twelve individuals 18 years or older with MS were enrolled and assigned (1:1) into individualized NB-UVB dose (10-30kJ/m) phototherapy, or into placebo treatment, delivered 3 times per week, for 8-weeks. Serum vitamin D levels, walking performance, strength, cognitive function, mood and circulating progenitor cells (CPCs: CD34+CD45dim), monocyte populations (Intermediate CD14+CD16+, Classical CD14+CD16-), and T regulatory cell (CD4+/CD25+/FoxP3+Tregs) count were assesed. The data were analyzed by 2 x 3 mixed factor ANOVA. Results A statistically significant condition by time interaction on vitamin D levels (F=7.14, p<.005, partial η2=.42) was identified. NB-UVB phototherapy may provide immunomodulation in a select group of MS individuals. Conclusion UVB phototherapy corrects vitamin D deficiency. This study adds to the growing research investigating UVB treatment in MS.
Mar 2019 DOI 10.14302/issn.2640-690X.jfm-19-2726
Spencer-Harper LucyCorresponding author
Combat Stress, Leatherhead, UK.
Background Research has demonstrated that partners living alongside veterans with mental health difficulties are at high risk of developing mental health difficulties themselves and secondary trauma. A variety of interventions have been developed to support partners. Research to date has relied on quantitative methodologies to evaluate the efficacy of such interventions with less emphasis on learning about the experiences of individuals on the courses. Objective The aim of this qualitative paper was to understand the experiences of partners who engaged in a five-week structured support intervention, ‘The Together Programme’ (TTP) which had been piloted across UK cities. This programme involved tailored psycho educational materials adapted to the needs of veteran’s partners living alongside PTSD. Further the potential mechanisms of change for participants engaged with the programme were explored as well as the impact of treatment on their relationships. Methods Eight female partners were recruited from an original sample of 57 partners who were intimate relationships with treatment seeking veterans with mental health difficulties. These participants had completed TTP. Qualitative data was collected using a semi structured interview and explored using Interpretative Phenomenological Analysis. Results Three key themes emerged from the data, these were self-growth, changing role in relationships and connecting with others. The themes included several sub themes. Self-growth sub-themes were mastering the ‘inner judge’, ‘confidence in ability to cope’ and ‘taking care of my needs’. Changing role in relationship sub-themes were ‘acceptance and understanding’ and ‘improved communication in relationship’. Connecting with others was described by the sub-themes of ‘knowing I am not alone’, ‘peer support’ and ‘hope’. Conclusions This study suggeststhere were three key areas where thestructured evidence-based support programme had an impact on participants experiences. These were factors that helped participants to normalise their experiences and increase participants understanding and interpersonal skills that promote changes in relationship functioning with the veteran.
Mar 2018 DOI 10.14302/issn.2639-3166.jar-18-1987
Narain PremCorresponding author
Professor and Independent Researcher, 29278 Glen Oaks Blvd. W., Farmington Hills MI 48334-2932
The scientific and technological interventions for attaining precision in plant genetics and breeding since Mendel’s discovery of genetic laws have been critically reviewed in terms of cloning technology and reverse genetics, chip technology, genetically modified organisms and CRISPR-based gene editing technology. Their roles in further refining the plant genetics and breeding practices particularly their exploitation in creating variations and their use for development of superior genotypes in model crops like wheat and rice have been discussed. It is stressed how such interventions could prove to be promising for meeting future crop improvement program in terms of climate change, bio-fortification, imaging technology, statistics, big data revolution and deep learning.
Jul 2017 DOI 10.14302/issn.2577-2279.ijha-17-1587
Bueno Bergantin LeandroCorresponding author
Department of Pharmacology – Universidade Federal de São Paulo
This review explores crosstalk between Ca2+ and cAMP signaling and its therapeutic implications for neurodegeneration and aging. It summarizes candidate interventions and translational challenges.
Jul 2017 DOI 10.14302/issn.2574-4518.jsdr-16-1413
Harada TetsuoCorresponding author
Laboratory of Environmental Physiology, Graduate School of Integrated Arts and Sciences, Kochi University
Purpose: An intervention program was performed to improve meal habit, sleep habit and academic marks at school. This program was called “Super Meal Educational Program” which was supported by Japanese Ministry of Arts, Sports, Sciences and Education. Effects of the intervention were evaluated by comparing an integrated questionnaire study held both before and after the intervention of a half year. Method: The intervention program consisted of a lecture on sleep health and diurnal rhythms on children by an university professor, a series of lectures and practical classes by elementary school teachers on foods which can be collected nearby, and also practical courses as excursions to learn traditional meals and several foods resources which are products nearby. Integrated questionnaire study and also government official academic achievement test were performed before and after the intervention for 6 months in May to November, 2015. An integrated questionnaire was administrated to elementary school students of grades 1 to 6 (7-12 years old). For the younger students aged 6-9 years old, parents (mostly mothers) answered the questionnaire instead of their children. The participants consisted of 40 to 55 students in each grade from the first to the six one of the elementary school. The rate of answer to the questionnaire was more than 95% and the number of data used for statistic analysis was 295 before and 286 after the intervention. The integrated questionnaire included questions on the diurnal type scale (DTS), sleep habits, meal habits, and other questions on their environments and life-habits. Result: In the histogram on distribution of the diurnal type scale scores (DTS) before intervention, the students which occupied 25% evening-typed significantly shifted to more morning-typed ones after the intervention (p<0.001). There was significantly negative correlation between DTS scores before intervention and the amount of increased change in DTS during the intervention period (r=-390, r<0.001). For all students in the elementary school, there were no significant changes in sleep quality, bedtime in weekdays, wake up time and sleep hours before and after the intervention period. There was negative correlation between sleep hours in weekday before intervention and increased amount in sleep hours before and after that (r=-0.545, p<0.001). The longer the sleep hours were shifted longer during intervention, the better the academic achievement mark of mathematics was after the intervention (students in the second, third and fifth grades: p=0.001). Conclusion: At least for the students who had been originally evening-typed, the intervention on meal habits may be effective for longer sleep hours and improved school achievement and marking for especially mathematics in elementary schools.
Mar 2017 DOI 10.14302/issn.2476-1710.jdt-16-1332
Petrowski KatjaCorresponding author
Department of Psychotherapy and Psychosomatic Medicine, Dresden, Germany University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Fetscherstr.
Background: Unemployment is a chronic stressor which is associated with higher levels of impaired physical and mental wellbeing, e.g. reduced heart rate variability (HRV) and decline in self-esteem and self-efficacy. The present study investigated the effectivity of a HRV-biofeedback-training in increasing HRV and general self-efficacy. Method: A total of n = 22 unemployed individuals with adjustment disorder participated in this study (14 females, mean ages 42.53 ± 8.88 years). All participants performed randomized the “stress tests” for heart rate (HR) and HRV assessment: timed breathing, d2-attention-stress-test and math-test drawn from the Trier Social Stress Test (TSST). Four sessions HRV-biofeedback à 20 min within 2 weeks were administered. HR and HRV were assessed before and after biofeedback training. ECG preprocessing and analysis were performed with the Stressball software program (BioSign GmbH, Ottenhofen, Germany). The RMSSD time domain measure was calculated as HRV index. Clinical outcome measures were the ADNM total score and the general self-efficacy scale (GSE). Results: Participants were well matched in terms of demographic and clinical characteristics. ANOVA didn’t demonstrate significant time x group interaction effects neither for HRV parameters (HR, RMSSD) nor for psychological parameters (ADNM, GSE). Conclusion: Our findings do not indicate that HRV-biofeedback can increase HRV nor general self-efficacy in unemployed subjects with adjustment disorder. Implications for future studies are discussed.
Nov 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1198
Dolores Gil-Llario M.Corresponding author
Department of Educational and Developmental Psychology. University of Valencia.
Spain is one of the countries with the highest incidence of HIV within the European Union. Multiple and complex factors influence HIV infection in young people. This study aims to determine the influence of sexual sensation seeking, sexual compulsivity and perceived sexual pleasure variables in condom use. A total of 424 heterosexual youth were evaluated (M age = 20.62; SD = 2.62) distributed into a risk group (60.7%) and a no-risk group (39.3%). Sexual Sensation Seeking Scale, AIDS Prevention Questionnaire, Sexual Compulsivity Scale, and Sexual Pleasure Perceived Scale were administered. Results indicate statistically significant differences in sexual sensation seeking (p=.001), failure to control sexual impulses (p=.030), perceived sexual pleasure with a condom (p=.027) and without a condom (p=.001). The regression analysis revealed that three factors explained about 14% of the variance in condom use: sexual sensation seeking and sexual pleasure perceived without a condom (risk factors), and sexual pleasure perceived with a condom (protective factor). It is necessary to incorporate these variables into HIV prevention programs to reduce the number of infections in young people.
Nov 2016
Robst JohnCorresponding author
Department of Mental Health Law & Policy Florida Mental Health Institute, University of South Florida 13301 Bruce B Downs Blvd Tampa
The purpose of this paper is to review the literature linking schizophrenia with chronic inflammation and gluten sensitivity. In addition, the paper discusses the need for dietary interventions that may improve multiple health outcomes for patients. Individuals with schizophrenia are at much greater risk for the development of additional autoimmune disorders. Second generation anti-psychotic medications are the most effective treatment for schizophrenia, but there are numerous potential side effects to the medications. More specifically, individuals with schizophrenia who are treated with SGAs are at increased risk for obesity, diabetes, as well as elevated lipids and blood pressure. An effective evidence-based dietary intervention has the potential to improve numerous outcomes for individuals with schizophrenia.
Sep 2016 DOI 10.14302/issn.2324-7339.jcrhap-16-1227
Martina .C EzeamaCorresponding author
Department of Nursing science, Imo state university, P.M.B 2000 Imo State , Nigeria.
Introduction: Human Immuno-deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) constitute public health challenge in Nigeria and adolescents are increasingly becoming vulnerable. It is necessary to provide adolescents in schools with risk-reduction educational interventions so as to expose them on the need to protect themselves from getting infected. This study used risk-reduction interventions (Class-room Instruction and Drama) to encourage risk-reduction practices among in-school adolescents. Materials and Method: Quasi-experimental design using 165 students randomly selected from three convenient co-educational secondary schools in the rural areas was adopted. Two experimental groups, class room instruction (CI) and drama (DR) were used. Baseline data using semi-structured questionnaire with 27- point risk reduction practices were collected. Data were analysed with descriptive statistics, t-test and ANOVA at p =0.05. Result: Scores for HIV risk reduction practices among the adolescents at baseline, classroom instruction (CI), drama (DR) and control respectively were 18.5±4.6, 19.8 ± 5.8 and 17.0 ± 4.8 . The mid-term scores obtained were 23.8 ± 3.4, 23.6 ± 3.4 and 17.7 ± 5.1. The scores obtained for CI, DR and control groups at follow-up were 24.9 ± 2.6, 26.7 ± 1.1 and 17.0 ± 5.3 respectively. The results showed more effective risk reduction practices among the intervention groups than control group. Conclusion Drama intervention yielded more positive outcomes in risk-reduction practices than others. Drama is therefore recommended as the best HIV and AIDS intervention programme for in- school adolescents.
Aug 2016 DOI 10.14302/issn.2474-9273.jbtm-16-1202
V.J. Basso RobertCorresponding author
RSW Faculty of Social Work, Wilfrid Laurier University
Our objective was the early identification, assessment and treatment of aggression by primary school children four to eleven years old, with the goal of preventing school expulsion. The children were identified by teachers and other professionals for their aggressive behavior. Children were assessed for five symptoms which are linked to the development and persistence of social and/or physical aggressive behaviors: inattention, hyperactivity, anxiety, poor social functioning, and oppositional behavior. Long term follow-up continued for up to 9 years. Conners’ Scales for parents and teachers were used to assess the severity of predisposing symptoms and emotional lability. The children were treated with psychosocial and pharmacological interventions by social workers and a physician, in addition to utilizing community and school resources. Teachers reported a reduction in some of the predisposing symptoms: hyperactivity, emotional lability, oppositionality, and improved social functioning. Parents reported improvements in all five of the children’s physically aggressive behaviors. Early intervention for children’s aggressive behaviors was found to be effective. None of the children in the study were expelled from school.
Mar 2016 DOI 10.14302/issn.2329-9487.jhc-13-332
P. Desai ArpanCorresponding author
Interventional Cardiologist, Vadodara, Gujarat, India.
Objective: The objective of this study was to evaluate the efficacy of patent haemostasis in avoiding radial artery occlusion after transradial catheterization. Background: Radial artery occlusion is an infrequent but discouraging complication of transradial access. It is related to factors such as sheath to artery ratio and is less common in patients receiving heparin. Despite being clinically silent in most cases, it limits future transradial access. Patients and Methods: 130 patients undergoing transradial catheterization were prospectively enrolled in the study. 65 patients were randomized to group I, and underwent conventional pressure application for haemostasis. 65 were randomized to group II and underwent pressure application confirming radial artery patency using Barbeau’s test. Radial artery patency was studied at 24 hr and 30 days using Barbeau’s test. Results: There was Statistically significant difference found in rate of radial artery occlusion of both the groups at 24 hours (24.61% vs. 4.61% ,X2(1)=4.44, P<0.05) and at 30 days(20% vs. 3%,X2(1) =4.03, P < 0.05). Patients with Higher age and smaller radial artery diameter were at significantly higher risk of radial artery occlusion. No other procedural variables were found to be associated with radial artery occlusion. Conclusion: Patent haemostasis is highly effective in reducing radial artery occlusion after radial access and guided compression should be performed to maintain radial artery patency at the time of haemostasis, to prevent future radial artery occlusion.
Jan 2015 DOI 10.14302/issn.2379-7835.ijn-14-536
Su XiaoCorresponding author
Centre for Chronic Disease Prevention and Management, College of Health and Biomedicine,Victoria University, Melbourne, Victoria 8001, Australia.
The risk levels of chronic diseases are increasing among Asian migrants in Western countries compared to their origin-country counterparts. This study evaluates the impact of an 8-week nutrition and lifestyle intervention on cardio-metabolic risk factors in Korean migrants living in Melbourne, Australia. Thirty participants aged 32-62 years completed the program. Self-reported food intake and physical activity, anthropometric and blood pressure measurements, and biomarkers of cardio-metabolic risk were assessed. An initial training session and four consequent nutrition advice sessions were provided for all participants. There was a significant reduction in the waist and hip circumferences. Positive changes were also observed in plasma lipid profiles, calcium intake and frequency of physical activities. These findings demonstrate that a culturally appropriate nutrition and lifestyle intervention can be successfully delivered to reduce the cardio-metabolic risk factors and improve the health and wellbeing of Korean adult migrants.
Feb 2014 DOI 10.14302/issn.2374-9431.jbd-13-312
M. Mann DevinCorresponding author
Section of General Medicine, Boston University/Boston Medical Center, Boston, MA, USA
Objective: This study assessed the baseline knowledge, perceptions, attitudes and behaviors of prediabetes patients in order to tailor a new technology-enhanced primary care-based lifestyle modification intervention. Methods: Patients with a diagnosis of prediabetes were enrolled in a randomized, controlled pilot study, Avoiding Diabetes Thru Action Plan Targeting (ADAPT), a technology-based intervention to promote action plan discussions around patient-selected behavior change goals. Results: A total of 54 adults (82% female) were enrolled in the pilot study. Most (89%) had comorbid conditions and mean BMI was 36. Participants exhibited significant levels of diabetes risk knowledge and diabetes risk perception, as well as high levels of willingness to make changes to decrease diabetes risk. Number of daily steps was inversely correlated with perceived physical activity (r=-0.35082, p<0.001). Poorer scores on diet quality were inversely correlated with BMI. Conclusion: Participants in this sample demonstrated requisite levels of knowledge, self-efficacy, motivation and risk perception for effective behavior change. These data suggest that primary care-based prediabetes interventions can move beyond educational goals and focus on enhancing patients’ ability to select, plan and enact action plans.
Jun 2026
De Coninck LeenCorresponding author
Background A persistent gap remains between evidence-based health care and its application in routine practice. This challenge is particularly prominent in allied health professions like occupational therapy (OT), where interventions are complex, individualized and centred on patients' daily functioning. Objective To identify barriers, facilitators, and implementation strategies for integrating evidence-based OT interventions in multiple sclerosis (MS) rehabilitation. Methods A mapping review was conducted using searches in five databases. Eligible studies included adults with MS, examined OT interventions, and reported on factors influencing implementation. Data were extracted and categorized using Grol’s framework for barriers/facilitators and Mazza’s taxonomy for implementation strategies. Results Fifteen studies met inclusion criteria. Barriers and facilitators were identified at multiple levels of Grol’s framework: 1-Innovation-level: accessibility, feasibility, and perceived attractiveness supported implementation, particularly when interventions incorporated holistic approaches, gamification, or printed manuals. 2-Professional-level: therapists’ competencies and alignment between interventions and patients’ priorities. 3-Patient-related: facilitators included motivation, readiness to change, and peer support, whereas fatigue, pain, and cognitive challenges served as barriers. 4-Social and organizational: effective teamwork, resource availability, and flexible scheduling facilitated successful adoption. 5-Economic or political: no studies. Implementation strategies focused on using manuals, patient empowerment, gamification, and organizational supports. No financial or structural policy-level strategies were identified. Conclusion Successful implementation of evidence-based OT for MS requires multifaceted, context-sensitive strategies addressing innovation, professional, patient, and organizational determinants. Practical approaches enhance uptake, while substantial gaps persist at economic and policy levels. Strengthening these areas may improve longterm integration and sustainability of evidence-based OT in MS rehabilitation.
Jun 2026 DOI 10.14302/issn.2379-7835.ijn-25-5909
Bisai SamiranCorresponding author
The high prevalence of anemia among children and adolescents in India is still an overwhelming problem. Not only that, there is also a considerable deficiency of various micronutrients such as Vitamin A, Vitamin B12, Vitamin D, serum ferritin, Zinc and Folate etc. in children. These micronutrients have several functional roles for the normal growth and development of children. Unfortunately, recent studies on public health and nutrition intervention have so far focused less on these micronutrition and more on anemia and nutrition. Data for this study obtained from the Comprehensive National Nutrition Survey (CNNS 2016-18), a nationally representative survey covering different age group. Specifically, it includes information on 9767 children aged 1-4 years. Out of these surveyed children biomarker data for hemoglobin, serum ferritin, zinc, folate, vitamin A, vitamin B12 and Vitamin D were collected from 8242 children. Micronutrient deficiencies were identified based on WHO and other established cut-off criteria. Wealth quintiles were computed to identify household economic inequality. The prevalence of anemia at the national level was 40.7%. Among micronutrients, folate (22.9%) and zinc (18.7%) deficiencies were most commonly observed, followed by vitamins A (18.3), vitamin B12 (13.8%) and vitamin D (14.0%). Iron deficiency as measured by ferritin was present in 31.6% of children. It is alarming that nearly one in three children (32.8%) suffer from deficiencies in two or more micronutrients. Clear socioeconomic disparities were observed for all micronutrient deficiencies (MND); children in the poorest groups had significantly higher levels of micronutrient deficiencies than children in the richest groups. Among the states, Gujarat and Madhya Pradesh had the highest overall micronutrient deficiencies, while West Bengal and Kerala had the lowest. This clearly shows that a large proportion of preschool children in India suffer from anemia and MND, with the prevalence being even more alarming in lower socio-economic settings. This study suggests that there is a need to move beyond single-nutrient interventions and implement comprehensive, multi-micronutrient supplementation or food fortification strategies seamlessly into the existing national health and nutrition programs.
Jun 2026 DOI 10.14302/issn.2574-4496.jtc-26-6304
Elshafie OmaymaCorresponding author
Objective To evaluate the treatment outcomes of patients with Differentiated thyroid cancer (DTC) who underwent total thyroidectomy followed by RAI therapy at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC) in Oman. Methods This is a retrospective observational clinical study conducted at SQCCCRC. The study included all patients diagnosed with DTC who were admitted to SQCCCRC between June 2021 and November 2023. A total of 255 patients were identified and met the inclusion criteria for this study. Results The mean age at diagnosis was 39.9 ± 12.4 years (range: 14–79), with 78% of patients being female. The mean BMI was 30.3 ± 6.4 kg/m², with nearly half of the cohort (48.2%) classified as obese (BMI ≥ 30). Most patients had papillary thyroid carcinoma (92.9%), while follicular and Hürthle cell carcinoma accounted for 5.9% and 0.8% of cases, respectively. Based on the American Joint Committee on Cancer (AJCC) staging, 86.3% of the patients were classified as stage I and 3.9% as stage II. Six patients (2.4%) had stage IVB disease. According to American Thyroid Association (ATA) risk stratification the majority were low-risk. Patient age was strongly associated with disease stage. The distribution of metastatic cases varied by region, with the highest proportion observed in Dhofar. Most patients (87.1%) received a single dose of radioactive iodine (RAI), with a median cumulative dose of 3.7 mCi). At six months post-treatment, 70.2% of patients had a TG level < 0.2 ng/mL. Conclusion The outcome of therapy in majority of our patients is favorable with 72% having excellent biochemical response at last follow up. None of the patients with distant metastasis achieved excellent response and a high proportion of them came from the Dhofar governorate, a targeted intervention would be of benefit. Low risk patients require special attention and may need radioactive iodine during follow up, unlike other regions and hence warrant very close follow up and further review to establish the best practice guidelines in our region.
May 2026 DOI 10.14302/issn.2574-4518.jsdr-25-5773
Peres de Sousa LucasCorresponding author
Introduction Sleep quality is a fundamental determinant of human health and well-being. Modified Intravascular Laser Irradiation of Blood (ILIB), a non-invasive therapeutic modality, has emerged as a potential intervention for sleep-related disturbances. Proposed mechanisms include reduced blood viscosity and platelet aggregation, activation of superoxide dismutase, increased oxygen bioavailability, enhanced microcirculation, elevated serotonin levels, and decreased cortisol concentrations—physiological processes intricately involved in sleep regulation, mood modulation, and the stress response. Objective To evaluate the effects of Modified Intravascular Laser Irradiation of Blood (ILIB) on sleep quality in individuals with self-reported sleep disturbances. Methods A randomized, placebo-controlled clinical trial was conducted with participants who reported poor sleep quality. Subjects were randomly assigned to one of two groups: the intervention group received ILIB using a 660 nm red laser, while the control group received a placebo treatment (light emission with sub-therapeutic power, <1 mW). Both groups underwent the same treatment schedule. Sleep quality was assessed at baseline and after six treatment sessions using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Results Participants in the ILIB group showed statistically significant improvements in the primary outcome of global sleep quality. PSQI scores decreased from 10.24 at baseline to 6.47 post-treatment. ESS scores showed a non-significant change from 10.44 to 10.12. These results suggest enhanced overall sleep quality and reduced sleep latency, although the observed reduction in daytime sleepiness did not reach statistical significance. Conclusion Modified Intravascular Laser Irradiation of Blood appears to be a promising non-invasive approach for improving sleep quality. The clinical outcomes observed are comparable to those reported in both pharmacological and behavioral sleep interventions, particularly in terms of PSQI improvements. These preliminary findings support the need for further research to clarifyunderlying mechanisms, optimize treatment parameters (e.g., dosimetry and duration), and expand outcome assessments to include biomarkers and polysomnographic data.
May 2026 DOI 10.14302/issn.2690-4837.ijip-26-6169
Ershova JuliaCorresponding author
Introduction The risk of exposure to M. tuberculosis among healthcare workers (HCW) remains a public health concern worldwide. During the COVID-19 pandemic, the Biomedical Research and Training Institute supported the Zimbabwe Ministry of Health and Child Care in strengthening infection prevention and control (IPC) practices in healthcare facilities (HCF), integrating tuberculosis (TB) infection control (TBIC) into the intervention strategy. We describe the impact of this intervention on TBIC practices and HCW screening outcomes. Methods The strategy, implemented from June 2021–September 2022, included IPC mentorship training, competency assessments, and use of a standardized risk assessment tool for progress monitoring. For the training purposes, the project developed eight practical problem-solving IPC modules including an occupational health component. Trained mentors conducted bi-monthly site support visits (SSV), used a checklist to track compliance, and assessed competencies of HCW at the targeted facilities. Facility-based risk assessments were conducted three times during the project implementation. Results During the intervention, 1,865 HCW from 105 facilities were trained. Availability and use of personal protective equipment improved by 49% and 42%, respectively. The proportion of HCF with designated areas for sputum collection increased by 43%. The proportion of HCF that screened HCW for TB increased by 42% with 3,761 HCW screened during the project period. Fourteen were diagnosed with TB and referred for care, resulting in 372 new cases per 100,000. Conclusion The implemented strategy of training, mentorship, and regular SSV strengthened TBIC measures, improved TB screening practices and case finding among HCW. Improving and maintaining practices is critical for effective TBIC.
Apr 2026 DOI 10.14302/issn.2641-9467.jgrc-26-6123
Jana SnehasisCorresponding author
The objective of this study was to improve the growth and yields of bottle gourd plants after exposure with spiritual blessing energy treatment (SBET) to the seeds and land. Twenty-one morphological traits of leaves, fruit, seed, and twenty-eight phenological parameters were employed to evaluate bottle gourd’s growth and yields after SBET. Results of bottle gourd showed a diversifiable characteristic of leaves, fruits, and seeds. Nine qualitative traits exhibited with distinct differences in the biofield-energy treatment group compared to the control. At harvest, growth-related phenological parameters such as plant vine length, number of branches, internodal length, and leaf width were significantly improved in the treatment group by 65.43% (p ≤ 0.001), 51.78% (p ≤ 0.01), 49.40% (p ≤ 0.001), and 40.82% (p ≤ 0.001), respectively, compared to the control. Additionally, yield-related parameters such as number of female flowers, number of fruits per vine, and fruit yield per hectare were significantly increased by 47.73% (p ≤ 0.05), 26.52% (p ≤ 0.001), and 38.99% (p ≤ 0.05), respectively, with respect to the control. With distinct qualitative variations and high statistical significance, these results suggest that SBET may serve as a potent non-traditional intervention for optimizing phenological development and agricultural output of bottle gourd.
Mar 2026 DOI 10.14302/issn.2574-4518.jsdr-26-6010
Marmann PeterCorresponding author
Background/Aim Sleep disturbances are common and are associated with impaired daytime functioning, reduced quality of life, and increased health risks. Non-pharmacological neuromodulatory interventions have gained interest as alternatives to hypnotic medication. Pulsed electromagnetic field (PEMF) therapy has been proposed as a non-invasive approach to improve sleep quality and recovery, but evidence from large, well-controlled trials remains limited. The objective of this study was to evaluate the efficacy and safety of pulsed magnetic field therapy (PMT) on sleep quality, sleep-related symptoms, daytime functioning, and well-being in adults with heterogeneous sleep complaints. Materials and Methods In this remote, randomized, double-blind, placebo-controlled trial, 217 adults reporting non-restorative sleep, difficulties initiating sleep, or frequent nocturnal awakenings were assigned to active PMT using a PEMF device (Night Harmony Female/Male protocol) or a sham application for three weeks. Primary outcomes were changes in the Pittsburgh Sleep Quality Index (PSQI) global score and self-rated sleep satisfaction, restfulness, and sleep initiation difficulties. Secondary outcomes included sleep diary measures, daytime functioning, well-being (WHO-5), symptom burden (MYMOP), and daytime sleepiness (Epworth Sleepiness Scale). Analyses followed the intention-to-treat principle using ANCOVA with baseline values of the respective parameter as covariate. Results Both groups showed significant improvements over time in global sleep quality and most secondary outcomes (p < 0.001). Between-group differences in PSQI global score were not significant (p = 0.314). However, active PMT resulted in significantly greater improvements in subjective sleep satisfaction (p = 0.02) and restfulness (p = 0.02), particularly among participants with moderate to severe baseline sleep disturbances (p < 0.001 for both). Sleep continuity measures improved similarly in both groups. No serious adverse events were reported. Conclusions PMT produced modest but significant improvements in subjective restorative aspects of sleep beyond placebo effects and was well tolerated. Further studies using objective sleep measures and longer follow-up are warranted.
Feb 2026 DOI 10.14302/issn.2473-1005.jdoi-25-5935
Romulus Calin FodorCorresponding author
The aim of this article is to present alternative possibilities for corrective intervention using corticobasal implants, following the failure of treatment with two stage implant in cases of extensive edentulism, multi-segmented edentulism, and the development of peri-implantitis 1 at the level of these implants. For this purpose, a case was selected involving a patient treated with two stage implants in a multi-segmented manner, in the distal regions of the maxilla and mandible, where the implants were affected after 12 years by peri-implantitis in proportions ranging from 20% to 100% in different areas of bone, with a predominance in the vestibular area. The decision was made to remove the affected two stage implants, as well as the remaining deciduous teeth, with or without periodontal conditions, but whose position on the arch made improperly rehabilitation, both functionally and aesthetically impossible, and made the second rehabilitation with polished corticobasal and compressive implants in immediate loading 2. Function and aesthetics of the gnathological apparatus were restored through definitive fixed metal-ceramic prosthetics on the support of corticobasal and compressive implants within 4 days from the beginning of the treatment, with the result being monitored over a period of 3 years and 3 months, and this evaluation is to continue over time. From a surgical perspective, for secondary rehabilitation with polished corticobasal and compressive implants, strategic positions in the maxillary and mandibular bones were used as follows: the fusion area of the maxillary bone with the sphenoid bone, the nasal cortex, the sinus cortex the lingual cortex distal to the mylohyoid line, and the interforaminal mandible area.34 These areas correspond to methods described in Consensus Number 6 in the IF The Foundation of Knowledge 5. In conclusion, the treatment with corticobasal, compressive polished implants is successful even in the case of a difficult clinical scenario like the one described for this patient 6. The reduced treatment time, along with the absence of the need for sinus lifts or bone grafts, makes it the ideal solution in any situation. The use of corticobasal implants, with fixation in the second/third cortical layer and an immediate loading protocol, should represent the primary solution in treating cases with poor bone representation, and no only as a “Corrective Intervention with Corticobasal® Implants”7.
Jan 2026 DOI 10.14302/issn.2470-0436.jos-25-5905
Al-Yarabi MohammedCorresponding author
Purpose To report a rare case of Mooren’s ulcer in a healthy young male without systemic autoimmune disease, and to highlight the effectiveness of conjunctival resection as therapy for cases unresponsive to medical management. Case report A 34-year-old immunocompetent male presented with progressive peripheral corneal ulceration in the left eye. Extensive systemic and infectious evaluations, including rheumatologic, immunologic, and microbiological testing, were unremarkable. Human leukocyte antigen genotyping was DR17(03)-negative and DQ2-positive. Rheumatological evaluation yielded no definitive systemic diagnosis. Despite immunosuppressive therapy with adjuvant medications, the epithelial defect and stromal inflammation persisted. The patient underwent conjunctival resection, resulting in marked reduction in inflammation, rapid re-epithelialization, and structural stabilization of the cornea. Histopathology of excised conjunctiva showed nonspecific inflammation without granulomatous changes, vasculitis, or neoplastic features. During follow-up, patient remained in remission with visual acuity preserved at 6/6 bilaterally and no recurrence. Conclusion Mooren’s ulcer is rare but vision-threatening. Early recognition, comprehensive evaluation, and timely surgical intervention can be vision-saving. This case highlights the role of a multidisciplinary approach and supports conjunctival resection as a useful adjunct in refractory disease. Long-term follow-up is essential.
Dec 2025 DOI 10.14302/issn.3070-5835.jcpn-25-5939
Tamre SosinaCorresponding author
Objective To assess knowledge, attitude and willingness towards organ donation of nurses in Tibebe-Ghion Specialized Hospital, Bahir Dar, Ethiopia, 2023. Method A hospital based cross-sectional study was conducted from March 1 to May 30, 2023, using a census of all eligible nurses (N=215). Data were collected with a structured questionnaire adapted from validated tools. Binary logistics regression was used to identify factors associated with willingness to donate, with results presented as adjusted odds ratios with 95% confident intervals. Results The overall response rate of this study was 98% (n=206). The mean age was 29.5 (±4.8) years, and 55.8% were male. Overall, 61.7% (95% CI: 54.9-68.5) of nurses had good knowledge, and 45.6% (95% CI: 38.8-52.5) had a favorable attitude. In multivariable analysis, female sex (AOR=3.50, 95% CI: 1.18-3.92, p<0.001) and greater years of experience (AOR=2.15, 95% CI: 1.18-3.92, p=0.012) were independent predictors of willingness. Conclusion While a majority of nurses were willing to donate organs, significant gaps in knowledge and legal awareness persist. Female nurses and those with more experience were more willing to donate. Targeted educational interventions are recommended to address knowledge deficits and foster a more supportive environment for organ donation advocacy.
Dec 2025
Darvishzadeh Nooshabadi GolnazCorresponding author
Intensive Short-Term Dynamic Psychotherapy (ISTDP) has proven effective in over 120 outcome studies, particularly for anxiety, depression, and personality disorders. This conceptual paper proposes a theoretical integration of ISTDP with Solution- Focused Brief Therapy (SFBT) and clinical hypnosis. Each modality offers unique strengths—ISTDP enables rapid emotional processing, SFBT builds client resilience and solutions, and hypnosis enhances neuroplasticity and emotional receptivity. Drawing on existing empirical and neuroscientific literature, this paper synthesizes these modalities into a unified clinical framework. The integrated model emphasizes accelerated change through emotional access, strategic future orientation, and unconscious facilitation. Case examples illustrate the framework's practical applications across complex clinical presentations. The integration addresses gaps in single-modality treatments and provides a cost-effective, neurobiologically supported method of intervention. This article offers clinicians structured decision- making strategies and practical tools for real-time integration, while outlining future directions for empirical research.
Dec 2025 DOI 10.14302/issn.2691-5014.jphn-25-5577
Gormley MarkCorresponding author
Infants with single ventricle (SV) physiology are at increased risk of undernutrition, which can contribute to adverse outcomes. This is a retrospective case series examining factors associated with undernutrition in patients with SV physiology at one year of age. It includes 56 infants from a single institution who underwent SV palliation between 2003 and 2023. Undernutrition was defined as a weight-for-length z-score (WLZ) below -1, based on World Health Organization (WHO) normative data. Independent variables included surgical interventions, cardiorespiratory factors, and nutritional interventions. Associations between these variables and nutritional status were assessed using Fisher’s exact test. At one year, a total of nine infants (16%) were undernourished. Undernutrition rates significantly declined after 2013 (p=0.02), demonstrating improvements in nutritional outcomes over our study period. Those who used supplemental oxygen or pulmonary medications were undernourished at lower rates. While this difference was not statistically significant, the number of undernourished patients in the cohort may have limited the study’s power. Our findings suggest that early respiratory interventions may provide nutritional benefits in infants with SV physiology.
Dec 2025 DOI 10.14302/issn.2641-4538.jphi-25-5613
de Dieu Harerimana JeanCorresponding author
Background Domestic violence among HIV discordant couples poses significant public health challenges, affecting treatment adherence and HIV transmission risks. This study examined factors contributing to domestic violence among HIV discordant couples in Kicukiro District, Rwanda. Methods A cross-sectional study was conducted among 384 HIV discordant couples from eleven health centers using stratified systematic sampling. Data were collected through structured face-to-face interviews and analyzed using descriptive statistics and bivariate analysis. Results Domestic violence prevalence was 41.1% physical violence, 34.2% sexual coercion, and 52.3% emotional abuse. Key socio-demographic risk factors included female gender (56% vs. 29% males, p<0.001), older age (61% in ≥55 years vs. 32% in 18-24 years, p=0.004), unemployment (55% vs. 34% formal employment, p=0.014), and financial hardship (63% vs. 25% comfortable situations, p=0.002). Behavioral factors included alcohol use (58% vs. 38%, p=0.021), substance abuse (62% vs. 35%, p<0.001), and poor conflict resolution (72% vs. 25%, p<0.001). Contextual factors like hostile HIV disclosure reactions (68% vs. 34%, p<0.001) and HIV-related stigma (60% vs. 35%, p<0.001) significantly increased violence risk. Conclusions Domestic violence among HIV discordant couples is multifactorial, driven by socio-economic, behavioral, and HIV-related factors. Integrated interventions addressing economic empowerment, conflict resolution skills, stigma reduction, and couple-centered counseling are urgently needed.
Dec 2025
Liu LipingCorresponding author
The incidence rate of melasma is notably high among patients with anxiety disorders. Aromatherapy primarily influences the physiological and psychological states of individuals through the inhalation or application of essential oils, thereby facilitating the treatment or alleviation of various conditions. This study aims to explore the action mechanism of complex lemon-angelica sinensis -boswellia essential oil (CEO) in treating anxiety disorders with melasma. We investigated the active ingredients, targets, and pathways of CEO in relation to anxiety and melasma using network pharmacology. We employed cell assays and conducted nebulized essential oil inhalation tests on CUMS mice to validate the intervention effects of CEO on anxiety. A total of 28 active components, including neryl acetate, 3-butenylphthalide and octyl acetate, and 26 cross-targets, such as ESR1, CCND1 and PIK3CA, were identified. GO and KEGG pathway analyses indicated that these cross-targets were primarily involved in endocrine regulation, cell proliferation, and apoptosis, specifically through PI3K/Akt signaling pathway and calcium signaling pathway. The experimental results demonstrated that CEO significantly reduced the secretion of NO, TNF-a and IL-6, as well as the mRNA expressions of ESR1, CCND1 and PIK3CA in cells compared to the inflammatory cell model. Furthermore, CEO notably decreased the forced swimming immobility time of mice and the levels of IL-1β, ESR1 and CCND1 in hippocampus when compared to model mice. These findings suggest that CEO may regulate ESR1, CCND1 and PIK3CA through its citral, 3-butylphthalate and neryl acetate, thereby influencing endocrine function, cell proliferation and apoptosis, inhibiting inflammation and anxiety-like behavior in CUMS-induced mice.
Dec 2025 DOI 10.14302/issn.2324-7339.jcrhap-25-5715
Couture LucyCorresponding author
Recruitment for research studies focused on communicable diseases such as HIV (Human Immunodeficiency Virus) has historically been challenging, particularly among populations who have been underrepresented in media messaging, yet maintain a significant vulnerability to new HIV cases, like Black women. This study examines the recruitment strategies utilized in Aim 2 of pilot study at the University of Texas Health Science Center (UTHealth) in Houston, Texas that was funded by the Ujima Mentoring Program to develop, implement, and evaluate a video log (vlog)-based intervention. The overarching goal of the pilot study was to promote the uptake of pre-exposure prophylaxis (PrEP) among cisgender Black women in Harris County, Texas. Aim 2 involved the creation of a culturally relevant vlog for use in Aim 3, which sought to educate and motivate participants to consider PrEP as an HIV prevention strategy. With the growing role of digital platforms in public health outreach, social media was employed alongside traditional recruitment methods such as flyers and word-of-mouth referrals. Despite an expanded online reach, engagement remained low, and participation rates did not increase proportionally to the number of individuals who viewed recruitment materials. The reluctance to participate was largely attributed to stigma surrounding HIV and concerns about being publicly associated with an HIV prevention study based on participants feedback to the research team. Even the availability of research incentives to encourage participation did not significantly improve recruitment accrual goals, particularly among healthcare providers who experienced limitations with eligibility due to institutional policies. This study underscores the need to better understand the social and cultural barriers that prevent Black women and healthcare providers from engaging in HIV prevention research. While digital recruitment strategies can enhance visibility to a larger audience, they must be supported with trust-building efforts, community partnerships, and culturally competent messaging to encourage meaningful participation. These findings point to the critical need for multi-faceted recruitment strategies that go beyond social media campaigns and actively build trust within communities, ensuring that HIV prevention research and interventions are both accessible and culturally resonant.
Dec 2025 DOI 10.14302/issn.2381-862X.jwrh-25-5447
J. Factoriza OliviaCorresponding author
Objective This study aimed to explore the respondents’ reproductive health profiles, examining the physiological and psychosocial perimenopausal symptoms affecting productivity, and identifying occupational needs. It also determined the relationship between menopausal symptoms and the productivity and occupational needs of peri-menopausal women. Methodology A descriptive cross-sectional design was used, surveying 50 women over 40 years old with a validated four-point Likert scale instrument. The instrument undergone content validation, reliability test, and ethical approval. Survey was administered personally and online using purposive sampling. Statistical treatments included weighted mean, F-test, T-test, Pearson r correlation, and ranking. Key results The majority of participants had their first menstruation between 11 to 15 years old and experienced regular menstrual cycles. Most had one child, with an equal number of cesarean and normal deliveries, and reported no pregnancy complications. The study found that participants seldom experienced physiological and psychosocial menopausal symptoms. They agreed on the occupational needs during the perimenopausal period. It was found that physiological symptoms were influenced by factors such as early menarche, cesarean delivery, and pregnancy complications. Additionally, psychosocial symptoms varied based on menstrual status, the number of children, and pregnancy complications, with those experiencing earlier menstruation or complications reporting more intense symptoms. The study revealed a significant relationship between both physiological and psychosocial perimenopausal symptoms, which negatively impacted productivity and increased occupational needs. Women with higher menopausal symptoms expressed a greater need for workplace policies that support perimenopausal women, highlighting the need for tailored workplace interventions for this demographic. Future Direction The study recommends including pap smears and mammograms in annual exams for peri-menopausal women, offering awareness seminars on managing perimenopausal symptoms to reduce workplace disruptions, and suggests future research exploring additional variables affecting perimenopausal women’s health and productivity
Dec 2025
Haider RehanCorresponding author
The journey from personalized medicine to customized nutrition represents a significant paradigm shift in healthcare, emphasizing the holistic method for a person's or girl's well-being. in this transition, the know how of the unique genetic makeup , metabolic profile, and way of lifestyles elements of everybody will become paramount. customized medicinal drug has long centered on tailoring scientific remedies to the genetic and physiological traits of sufferers, optimizing efficacy, and minimizing detrimental effects. Now, custom-designed nutrients increase this idea further, recognizing that weight reduction plays an essential function in health and disease prevention. Key to this evolution is the mixing of advanced technology together with genomics, metabolomics, and microbiomics, allowing the suitable identification of dietary styles and nutritional requirements tailored to a person's particular desires. This summary explores the trajectory of this adventure, highlighting the pivotal characteristic of interdisciplinary collaboration among healthcare professionals, nutritionists, and researchers. With the useful resource of leveraging slicing facet generation and records-pushed strategies, personalized vitamins keep the promise of revolutionizing knowledge we method nutritional interventions, moving some distance from generalized guidelines towards targeted strategies tailored to all people's precise organic make up and way of life. expertise, traumatic conditions which include accessibility to this technology, ethical issues, and the desire for sturdy, proof-primarily based practices remain. In conclusion, the shift from customized treatments to personalized nutrient expertise is a transformative generation in healthcare, empowering people to take proactive management of their health through tailor made nutrition interventions. This summary underscores the importance of endured studies and collaboration in figuring out the entire functionality of personalized vitamins in selling health and well-being.
Dec 2025 DOI 10.14302/issn.2997-2108.jcc-25-5518
Steven KikonyogoCorresponding author
Cervical cancer is the fourth most common cancer in women globally, with 660,000 new cases and 350,000 deaths in 2022. The burden is disproportionately high in low- and middle-income countries (LMICs), particularly sub-Saharan Africa. Despite proven interventions like HPV vaccination and screening, uptake remains low. While cervical cancer screening has been studied in the general population, little is known about uptake among refugee women in Uganda, which hosts approximately 1.7 million refugees. This study examines cervical cancer screening uptake and associated factors among refugee women in Uganda. Methods We conducted a cross-sectional secondary analysis of the 2021 Uganda Refugee Population-based HIV Impact Assessment (RUPHIA) survey, focusing on women aged 21–49 in refugee settlements in the West Nile and South-Western regions, which host 90% of Uganda’s refugee population. The primary outcome was self-reported cervical cancer screening status. We used descriptive statistics and logistic regression to identify factors associated with screening uptake. Results Among 731 women, only 72 (9.8%) reported undergoing cervical cancer screening. The mean age of screened women was 37 years (±7), compared to 32 years (±8) for unscreened women. Screening uptake was significantly higher among women aged 31–39 years (AOR = 2.67, 95% CI: 1.32–5.52, p = 0.007), married women (AOR = 12.0, 95% CI: 1.76–163, p = 0.03), and those in polygamous relationships (AOR = 4.76, 95% CI: 1.96–11.1, p < 0.001) Conclusion Cervical cancer screening uptake among refugee women in Uganda is critically low. Integrating culturally sensitive screening programs into refugee health services and addressing socio-economic barriers could improve access and utilization.
Dec 2025 DOI 10.14302/issn.2641-4538.jphi-25-5852
Anirudhan RanjaniCorresponding author
South Asian female college students in the United States face mental health challenges shaped by intersecting experiences of discrimination and violence. This study examined how discrimination and violence contribute to depression in this population. An anonymous, cross-sectional, web-based survey (N=673) was distributed nationally through South Asian organizations, listservs, and social media. Validated measures assessed day-to-day discrimination, college-based discrimination, experiences of violence during college, and depression (PHQ-9). Bivariate analyses and multivariate linear regression examined associations, adjusting for sociodemographic factors. Over half of participants (51.1%) reported college-based discrimination, 66.1% reported experiencing violence during college, and 25.7% met the criteria for depression. In adjusted models, day-to-day discrimination (β=0.261, p<0.001) and college violence (β=0.207, p<0.001) were significant predictors of depression. Bisexual and questioning/unsure students also reported higher depression scores than heterosexual peers. Discrimination and violence are key social determinants of mental health among this population. Findings underscore the need for culturally responsive mental health services, intersectional campus policies, and evidence-based interventions to promote health equity among minority women in higher education.
Nov 2025 DOI 10.14302/issn.2379-7835.ijn-24-5360
Alam RashedCorresponding author
Background Malnutrition is a significant public health issue in Bangladesh, particularly impacting women and children. Rajshahi, marked by socio-economic disparities, offers a distinctive context to explore the nutritional status and health outcomes of these vulnerable groups. Objectives This study aims to assess the nutritional status of women and children in Rajshahi and investigate associated health outcomes. Additionally, it seeks to identify socio-economic and cultural factors that influence nutrition. Methods A mixed-methods approach was utilized, incorporating a cross-sectional survey of 460 households and in-depth interviews with mothers and caregivers. Anthropometric measurements were taken to evaluate the nutritional status of women and children, while dietary assessments measured nutrient intake and diversity. Logistic regression analysis was performed to determine the likelihood of malnutrition based on socio-economic characteristics, thereby identifying key risk factors. Results The findings indicate a troubling prevalence of malnutrition, with 36% of children under five classified as stunted and 25% as underweight. The analysis highlights critical factors contributing to chronic undernutrition, including maternal education, employment, and dietary diversity. Notably, mothers aged 27-37 exhibit a lower risk of undernutrition, and urban households with secure food access demonstrate better nutritional outcomes. Discussion Maternal education and employment were positively associated with better nutritional outcomes, as educated and employed mothers had higher chances of maintaining a normal BMI. Regular ANC visits (≥4 visits) were crucial for improved maternal nutrition. Household food security emerged as a significant determinant, with food-secure households showing better maternal nutritional status. Safe water access and adequate dietary diversity were also linked to improved maternal BMI. Additionally, factors such as child birth weight, exclusive breastfeeding, and childhood diarrhea significantly influenced maternal nutrition. Moreover, frequent antenatal care visits and a diverse diet are vital in mitigating undernutrition risks among children. Conclusion This study emphasizes the urgent need for targeted interventions to combat malnutrition in Rajshahi. Recommendations include implementing community-based nutrition education programs and improving access to healthcare services. By addressing the socio-economic and cultural determinants of nutrition, stakeholders can enhance health outcomes for women and children in the region, ultimately contributing to broader public health objectives in Bangladesh.
Nov 2025 DOI 10.14302/issn.2470-0436.jos-25-5503
H. Nelson MarkCorresponding author
Purpose Create a new diagnostic and therapeutic framework for patients with Exudative Age-Related Macular Degeneration (ARMD) and choroid imaging biomarkers of non-neovascular choroidal pathology who have persistent neovascular exudation during the course of monotherapeutic interventions. Methods Retrospective, longitudinal case series study of 25 eyes from 23 patients with the referral diagnoses of treatment resistant Exudative ARMD who had persistent neovascular exudation despite various monotherapies. Inclusion criteria required choroidal imaging biomarkers of non-neovascular pathology including a thickened subfoveal choroid (greater than 300 microns) and vessels (subjectively dilated choroidal vessels in Haller’s layer) on Optical Coherent Tomography (OCT), choroidal neovascularization on IVFA and OCT Angiography (OCTA), as well choroidal leakage noted on indocynanine green videoangiography (ICG). Treatment consisted of OCTA and ICG - Directed Photodynamic Therapy (PDT) Triple Therapy, hereafter described as Combination Therapy, to areas of choroidal hyperpermeability and choroidal neovascularization. Combination therapy consisted of an anti-Vascular Endothelial Growth Factor (VEGF) intravitreal injection on Day 0 followed by half-fluence PDT and 2 mg intravitreal triamcinolone acetonide on Day 3-14. Results All study patients had treatment resistant Exudative ARMD defined as persistent subretinal and/or intraretinal fluid during their course of monotherapeutic interventions. Complete resolution of all exudation occurred in 23 eyes (92.0%) at 8 weeks. The mean duration of action was 155.6 weeks, with 72.0% of eyes leak free greater than 100 weeks. The mean vision at baseline was 0.46 ± 0.42 LogMAR, best corrected visual acuity (BCVA). 8 weeks after treatment, the vision was 0.35 ± 0.38 LogMar, an improvement of over one line, and this was maintained at one year. The baseline central subfield thickness (CST) was 296.4 ± 136.1 microns and improved by 111.4 ± 105.4 microns at 8 weeks after treatment. Treatment duration was negatively associated with the Caucasian race. Conclusions Patients with subretinal and/or intraretinal fluid secondary to Exudative ARMD should have a complete baseline multimodality imaging study to confirm the presence of neovascularization and whether choroidal hyperpermeability coexists. This study shows that patients with Exudative ARMD and persistent neovascular exudation despite monotherapuetic interventions often have choroidal biomarkers of non-neovascular choroidal pathology and that ICG and OCTA-directed PDT Triple Therapy resulted in complete resolution of all exudation in 92.0% of patients at 8 weeks with a reduction in central subfield thickness (CST) of 111.4 microns. The vision improvement at 8 weeks was 0.11 ± 0.38 LogMar and was sustained over 1 year. The mean duration of action was 155.6 weeks, with 72.0% of eyes leak free greater than 100 weeks. Additionally, this study shows that the treatment that addresses both pathological processes is successful and should be considered as a primary protocol when the biomarkers are present at baseline or as a secondary protocol if indeed the neovascular leakage is persistent despite monotherapy. Summary Patients with an Exudative ARMD with persistent neovascular exudation despite anti-VEGF monotherapy and who have imaging biomarkers of non-neovascular choroidal pathology often have two pathophysiological processes: choroidal hyperpermeability and angiogenesis. A proposed framework provides the rationale for OCTA and ICG-directed PDT Triple Therapy which successfully resolves 92% of the leakage that was persistent after various monotherapeutics.
Nov 2025 DOI 10.14302/issn.2694-2283.jsem-25-5730
A. Heinrich EmilyCorresponding author
Objective The goal of this systematic review is to identify common themes amongst acute spinal cord injuries (SCI) in equestrian athletes. Design A systematic review was performed using PubMed, CINAHL Plus with Full Text (EBSCO), Cochrane Library, and Scopus with pre-determined MESH terms. The initial search returned 354 studies. Following PRISMA guidelines, 13 articles were included. Exclusion criteria included injuries to the horse only, non-English language, cauda equina, and case reports. Data extraction was completed, and common findings were evaluated narratively due to heterogeneity of data. Results Seven manuscripts listed specific horse-related activities that caused SCI, with fall from horse as the highest percentage of injury. Nine articles identified the injury region, with large variations and no clear dominant area of injury. Five articles identified the length of hospital stay with ranges from 1 to 82 days. Four articles looked at the association of professional vs non-professional riders. Only two articles evaluated helmet use at time of injury, with one article showing 81% of those with SCI used helmets, and the other showing only 35.6% utilized this safety measure. Conclusion SCI in equestrian athletes can have a wide presentation, with large variation on location of injury, length of stay, and other factors. However, non-professional riders are at greater risk of SCI and individuals are more likely to sustain injury from a fall from a horse rather than a kick or another modality of injury. Future study can elicit presenting symptoms, types of surgical intervention used, and long-term outcomes and recovery.
Nov 2025 DOI 10.14302/issn.2693-1176.ijgh-25-5745
Poole JolyonCorresponding author
Background Healthcare worker stress, anxiety, burnout, and trauma have been widely documented across global healthcare systems. Staff in maternal and neonatal units frequently encounter emotionally distressing events and work under high pressure with limited resources. In Zambia, despite some gains in reducing maternal and neonatal mortality, fatality rates remain above national targets, exposing staff to repeated occupational trauma. Objective(s) This study aimed to assess the psychological well-being of staff in maternal and neonatal intensive care units, identify specific needs and stressors, and develop practical recommendations to improve resilience and support staff mental health. Methods A mixed-methods cross-sectional study was conducted at Ndola Teaching Hospital (NTH) and Arthur Davison Children's Hospital (ADCH), two major tertiary hospitals in Zambia. Data were collected over four days in February 2025. The study included 87 (out of 161) healthcare professionals, including nurses, midwives, and doctors. The Goldberg Anxiety and Depression Scale (GADS) and the Professional Quality of Life Scale Version 5 (ProQOL 5) were used to collect quantitative data, which were analysed using descriptive statistics and 95% confidence intervals (CI). Open-ended survey questions provided qualitative data, which were analysed using thematic analysis. Ethical approval was granted by the hospital ethics committee. Results High rates of clinical symptoms were observed. The overall prevalence of symptoms in the past 30 days was: anxiety (62%), depression (68%), burnout (50%), and secondary traumatic stress (46%). Junior doctors demonstrated the highest rates of depression (83%) and burnout (67%). The obstetrics and gynaecology and labour wards had the highest rates of secondary traumatic stress symptoms. Key qualitative themes identified were professional stressors, team and leadership issues, and the emotional burden of the work. Conclusion This study highlights an urgent need for both psychological and organizational support for maternal and neonatal healthcare staff in Zambia. The findings indicate that burnout and secondary traumatic stress are highly prevalent, particularly among junior doctors and those in high-risk wards. Targeted interventions at both systemic and individual levels are necessary to protect the well-being of healthcare workers and improve patient outcomes.
Sep 2025 DOI 10.14302/issn.2768-0207.jbr-25-5706
Nakamura YusukeCorresponding author
Artificial Intelligence (AI) is emerging as a transformative force across many sectors, with healthcare representing both one of the most promising and most challenging areas of application. This review summarizes current and future applications of AI in healthcare, focusing on its potential to improve diagnosis, therapy, chronic disease management, and overall patient care, while also alleviating physicians’ workload. Recent literature demonstrates that AI systems can reduce diagnostic errors/delays by mitigating cognitive biases, support imaging and pathology through improved accuracy and speed, and prevent prescribing errors by integrating pharmacogenomic and clinical data into decision-support systems. In chronic disease management, AI-powered wearable devices enable continuous monitoring and early detection of conditions such as atrial fibrillation, thereby reducing the risk of stroke and long-term disability, particularly in elderly people. Therapeutic applications include AI-driven drug discovery, personalized oncology, and tailored medicine that integrates multi-omics and lifestyle data. Beyond direct medical intervention, AI contributes by automating routine tasks, optimizing workflows, and facilitating greater patient–clinician interaction. Despite these benefits, significant challenges remain, including issues of data quality, privacy, security, equity, and the need for transparency and trust in “black box” systems. Looking ahead, the integration of multimodal data, digital twins, and robotics is expected to advance more comprehensive, equitable, and human-centered care. We conclude that, when applied ethically and responsibly, AI should not replace clinicians but rather serve as a powerful partner that enhances medicine by restoring empathy and humanity.
Aug 2025 DOI 10.14302/issn.3066-8042.jac-25-5652
Amiri DavoudCorresponding author
Background Attention-deficit/hyperactivity disorder (ADHD) in adulthood is increasingly recognized not only as a psychiatric condition but also as a trait with behavioral and occupational implications—particularly in high-stakes, fast-paced financial environments. Traits such as impulsivity, sensation seeking, and altered reward sensitivity may influence decision-making among individuals engaged in stock trading or high-risk investment professions. Objective This systematic review and meta-analytic synthesis aims to investigate the relationship between ADHD, impulsivity, gender differences, and financial risk behavior, with a particular focus on decision-making outcomes in real or simulated trading contexts. Methods Seventeen peer-reviewed studies published between 2008 and 2025 were included. Studies employed behavioral experiments, fMRI paradigms, neurochemical analysis (e.g., glutamate levels), and ecological financial assessments to examine impulsive traits and investment behaviors among adults with and without ADHD. Both clinical samples and occupational cohorts (e.g., brokers, retail investors) were analyzed. The analysis followed PRISMA 2020 guidelines. Results ADHD symptoms—particularly impulsivity and reward hypersensitivity—were associated with increased delay discounting, higher risk-taking, and diminished cognitive control in financial tasks. Neuroimaging data revealed hypoactivation in prefrontal control regions and hyperactivation in reward-related circuits (e.g., ventral striatum). Gender-stratified analyses showed that males with ADHD displayed stronger preference for immediate rewards, higher portfolio turnover, and greater volatility. Preliminary evidence also suggests an overrepresentation of ADHD traits in high-frequency trading roles. Conclusion ADHD-related impulsivity significantly modulates financial risk behavior, particularly in high-stakes and fast-paced contexts such as trading. A convergence of behavioral, neurobiological, and ecological findings suggests that males with ADHD are disproportionately prone to rapid, high-risk financial decisions, whereas females may demonstrate greater regulatory control. These insights underscore the need for gender-sensitive interventions, occupational screening, and tailored psychoeducation. As financial environments become increasingly automated and fast-paced, understanding the neurocognitive vulnerabilities of individuals with ADHD may not only protect personal outcomes but also enhance systemic financial stability.
Jul 2025 DOI 10.14302/issn.2641-4538.jphi-25-5580
Ina Grant Sagnia PhebianCorresponding author
Comprehensive Sexuality Education (CSE) is a school-based intervention aimed at correcting misinformation surrounding sexual education among youth, often influenced by social media, peer groups and misleading online content. In The Gambia, the Ministry of Basic and Secondary Education has developed and introduced a national framework to integrate CSE from Grade 4 (primary school level) to Grade 12 (senior secondary school level). This study explores the perceptions and recommendations of 50 secondary school teachers from 43 public and private schools in Region 1 on the implementation of CSE in schools. While some teachers expressed concerns that CSE might promote perverted and lewd early sexual behavior, others saw it as essential for increased awareness and youth well-being. Cultural, religious, and societal norms pose significant implementation barriers towards the implementation of CSE in schools. Teachers’ insights are vital for successful CSE delivery and educational strategy improvements.
Jun 2025 DOI 10.14302/issn.2324-7339.jcrhap-25-5559
Gamba PerryCorresponding author
Background HIV status disclosure is a complex process influenced by multiple factors beyond health system support. Understanding these factors is essential for developing comprehensive interventions to promote disclosure and improve HIV prevention and care outcomes. Methods A descriptive cross-sectional study was conducted in 10 health facilities offering comprehensive HIV/AIDS care in Mukono district, Uganda. Data was collected from 317 clients through interview-guided questionnaires. Data was entered using EPI data and analyzed using SPSS version 16, including logistic regression to identify factors associated with disclosure. Results Multiple factors influenced HIV status disclosure. Individual factors included knowledge about HIV (OR=2.34, 95% CI: 1.45-3.78), self-efficacy (OR=3.12, 95% CI: 1.87-5.21), and psychological readiness (OR=2.89, 95% CI: 1.76-4.75). Relationship factors included relationship quality (OR=3.56, 95% CI: 2.13-5.94), communication patterns (OR=2.78, 95% CI: 1.65-4.69), and anticipated partner reaction (OR=4.23, 95% CI: 2.54-7.05). Community factors included perceived stigma (OR=0.34, 95% CI: 0.21-0.56), cultural norms (OR=0.45, 95% CI: 0.27-0.75), and religious beliefs (OR=1.87, 95% CI: 1.12-3.14). Structural factors included economic dependence (OR=0.38, 95% CI: 0.23-0.63) and access to support services (OR=2.45, 95% CI: 1.47-4.08). Conclusions HIV status disclosure is influenced by a complex interplay of individual, relationship, community, and structural factors. Effective interventions to promote disclosure must address these multiple levels of influence, going beyond health system support to create enabling environments for disclosure at the individual, relationship, community, and structural levels.
May 2025 DOI 10.14302/issn.2694-2283.jsem-25-5529
Al-saeed NawafCorresponding author
Background Septic arthritis is a potentially limb or life-threatening joint infection that requires prompt recognition and intervention to reduce morbidity and mortality. While intra-articular joint injections are commonly performed for osteoarthritis and other arthropathies, they carry a rare but significant risk of iatrogenic infection, particularly when performed in the presence of unrecognized joint or periarticular infection. Case Presentation We report a case of a 52-year-old female with a history of traumatic brain injury and chronic right knee pain who developed severe knee swelling, pain, and systemic symptoms following an intra-articular corticosteroid injection performed without ultrasound evaluation/guidance. Post-procedure, she presented with fever, elevated inflammatory markers, and purulent knee effusion. Operative washout revealed a purulent tract extending from the knee joint capsule to the lateral thigh. Cultures from joint aspiration and intraoperative samples grew Streptococcus dysgalactiae. Blood cultures were negative. The patient reported frequent cat scratches to the affected knee and described an unusual sensation of the injection needle tracking laterally during the joint injection. She was treated with surgical drainage and a four-week course of amoxicillin, with full clinical recovery. Discussion This case highlights an unusual presentation of septic arthritis with extra-capsular extension likely due to iatrogenic needle tracking during joint injection. The causative organism, S. dysgalactiae, is an uncommon pathogen in septic arthritis, and the presumed source was contiguous spread from untreated cellulitis, possibly related to cat scratches/bites. The absence of predisposing comorbidities and negative blood cultures further support a local rather than hematogenous source. The case emphasizes the importance of thorough clinical evaluation and consideration of infection prior to joint injections, as well as the potential benefits of ultrasound guidance to minimize procedural complications. Conclusion Careful history, physical examination, and appropriate imaging are essential prior to joint interventions to avoid iatrogenic complications. This case illustrates the rare but serious risk of extra-capsular extension of septic arthritis following intra-articular injection and emphasizes the need for vigilance in identifying underlying infection before proceeding with invasive procedures.
May 2025 DOI 10.14302/issn.2574-612X.ijpr-25-5516
Rothenberg AlbertCorresponding author
This conceptual paper proposes that form and structure in the creative process provide a basis for psychotherapy interventions. It illustrates how framing, pattern, and iteration can support change within different modalities.
May 2025 DOI 10.14302/issn.2641-5518.jcci-25-5522
Qureshi AbidCorresponding author
Background In adult males, non-communicating hydroceles are non fluctuant scrotal swellings that are formed when there is an imbalance of fluid secretion and absorption between the parietal and visceral layers of the tunica vaginalis. Giant hydroceles are a rare manifestation and have previously been classified as hydroceles that drain more than 1000 mL of fluid. In this report, we describe a case of a giant hydrocele requiring surgical management and highlight a review of the literature. Case Presentation A 34-year-old male presented with complaints of large right-sided scrotal swelling, accompanied by scrotal discomfort. Ultrasound of the right testicle revealed a large hypoechoic space with a complex collection and posterior displacement of the testicle, indicating a possible hydrocele. The patient was taken to the operating room for a right hydrocelectomy. Approximately 2 liters of fluid were drained from the sac. Discussion Hydroceles are defined as straw-colored fluid collections within the parietal and visceral layers of the tunica vaginalis. Giant hydroceles, defined as fluid collections within the tunica vaginalis exceeding 1000 mL, are rare and the management of such cases is sparsely documented in the literature. While most asymptomatic fluid collections resolve spontaneously, larger collections with inflammatory changes within the testicular wall may require surgical intervention, either laparoscopic or open.
May 2025 DOI 10.14302/issn.2639-3166.jar-25-5495
Mekonnen Adare ZenebeCorresponding author
Enset (Ensete ventricosum) is a vital food security crop cultivated in South and South-western parts of Ethiopia. However, enset production and the farming families have been threatened by Xanthomonas wilt and its spread in the farming system. Thus, this study was conducted to investigate the soil fertility and plant management practices association on the incidence of Enset Xanthomonas wilt. Data on soils fertility and diseases from enset based farming clustered into inner, outer and outfield farm zone were sampled and surveyed. The result indicated that soil chemical properties significantly (p≤0.05) varied from inner to outfield farm zone. Significantly maximum nutrients store revealed in inner enset farm zones. Disease incidence reduced from inner to the outfield enset farm zone. Disease prevalence and disease incidence scored 28.5% and 11.6%, respectively depending on altitude and genotypes. Soil fertility levels in the enset inner and outfield plots were varied purposely to cultivate enset products as kocho, bulla or amicho (cooking type). The variations in soil fertility and Xanthomonas wilt incidence was associated with management practices applied for desired enset products. Therefore, management practices in enset based farming, soil fertility and location of enset planting zones found to be major indicators for disease incidence addressing to device control interventions.
Apr 2025 DOI 10.14302/issn.2379-7835.ijn-25-5463
Fokou ElieCorresponding author
Iron deficiency is a major public health problem worldwide. It affects a significant proportion of the population, and is responsible for around 50% of anemia cases worldwide. Cameroon in general and Lekie Division in particular, is very highlyaffected by this problem. However, early detection of the problem can prevent the fatalities associated to it. The objective of this study was to provide up-to-date, detailed data on the markers of iron status in these populations, so that treatment can be better targeted. A two-month cross-sectional study was conducted in the Lekie Division in collaboration with local health centres in both urban and rural areas. The study sample consisted of 361 participants of all age groups and sexes. A questionnaire was issued to obtain information of the participants socio-demographic status, then 3 to 5ml of blood were collected and a number of markers of the participants iron status were studied. Of all the hematological markers studied, hemoglobin concentration in the study population was below normal in both men and women. Biochemical markers were good for all socio-demographic parameters. The mean values of biochemical and hematological markers in the population of the Lekie Division were good for all socio-demographic parameters, with the exception of hemoglobin concentration, which remains critical, requiring particular attention in this locality, but above all urgent intervention lest the situation aggravates further.
Feb 2025 DOI 10.14302/issn.2641-4538.jphi-25-5436
J Johnson RalphCorresponding author
High rates of workplace psychological stress and burnout have been chronic among Healthcare Practitioners. Research shows that Healthcare Practitioner psychological stress / burnout is related to poor quality of care and a high probability of making medical errors and mishaps resulting in harm to patients and even workers themselves. In response, relatively impactful programs have been developed to address Practitioner burnout. To derive a better understanding of the subject and inform best practices and policy regarding the problem and its fixes, this article reports findings from a novel study of a systematic (PRISMA-based) literature review of current (circa ~10 years <) literature reviews; or a distillation of reviews already at 100 proof then undergoing a further distillation into a review of 200 proof.* This study employed a grounded theoretic qualitative methodology to iteratively generate and enumerate descriptive themes from the study’s literature review articles. This article reports on what is currently known regarding the precipitants of Health Practitioner Burnout, Burnout itself, its relationship to Safety lapses and mishaps, and Programmatic Interventions (i.e., Fixes). The primary conclusion is that Health Practitioners are the foundation of healthcare organizations and key to quality care and management / leadership should be concerned for their wellbeing; and this article provides a general blueprint in terms of addressing burnout and safety. Study Limitations and Future research are also discussed.
Feb 2025 DOI 10.14302/issn.2641-4538.jphi-25-5420
Nagaraj NitashaCorresponding author
South Asian women in the United States face disproportionate health challenges, including higher rates of intimate partner violence as well as higher rates of Type 2 diabetes and gestational diabetes compared to other racial and ethnic groups. This cross-sectional study examines the association between intimate partner violence (psychological, physical, and sexual) and the diagnosis of gestational diabetes and type 2 diabetes. A web-based survey recruited 2,634 South Asian women in the U.S., collecting data on socio-demographics, intimate partner violence experiences, stress levels, and diabetes diagnosis. Logistic regression models adjusted for significant sociodemographic factors revealed that women with a history of intimate partner violence were 5.82 significantly more likely to report a type 2 diabetes diagnosis and 3.91 more likely to report a gestational diabetes diagnosis. Furthermore, stress as measured by the perceived stress scale, was also higher among women with intimate partner violence, potentially moderating the relationship between intimate partner violence and adverse health outcomes through cortisol dysregulation. Despite high levels of educational attainment and employment, the prevalence of intimate partner violence was alarmingly high (66.7%), highlighting its pervasive impact on socioeconomic strata. These findings underscore the urgent need for culturally tailored interventions addressing intimate partner violence and its health consequences within South Asian communities. Further research is warranted to elucidate causal pathways and inform integrated public health strategies to mitigate disparities in chronic disease and intimate partner violence-related health outcomes.
Dec 2024 DOI 10.14302/issn.2474-9273.jbtm-24-5317
Ndje Mireille NdjeCorresponding author
Adolescence in Cameroon, as in many parts of sub-Saharan Africa, is often marked by early childbearing. Studies have shown a national prevalence of adolescent deliveries to be around 14.2% - 14.4%, a higher rate than the average for sub-Saharan Africa This presents a unique challenge for young mothers, who must navigate the complex process of identity reorganization while still navigating their own adolescence with its multiple changes. This article explores the experiences of primiparous (first-time) Cameroonian adolescents as they transition from daughters to mothers. The objective of this article is to understand how identity reorganization takes place among primiparous Cameroonian adolescents who pass without transition from the status of daughter to the status of mother. Drawing on qualitative data from semi-structured interviews, with seven participants chosen on the basis of selection criteria, the article examines the psychological, social, and cultural factors that shape this identity shift. An interview guide with three main themes made it possible to collect verbatim comments from the participants. The thematic analysis highlights the challenges faced by these young mothers, such as navigating social stigma, managing emotional upheaval, and balancing motherhood with their own developmental needs. The findings of this study highlight the complex and multifaceted nature of identity reorganization among primiparous Cameroonian adolescents. The social stigma associated with early childbearing, coupled with the emotional and practical demands of motherhood, can pose significant challenges to these young women. However, a study on a larger sample could reveal the resilience and resourcefulness of some adolescents, who find support within their communities and employ various coping mechanisms to navigate this transition. Finally, the article discusses the implications of these findings for adolescent maternal health interventions and social policy in Cameroon.
Nov 2024 DOI 10.14302/issn.2574-4518.jsdr-24-5271
Kovila RajivCorresponding author
Background/Aim Obstructive Sleep Apnea (OSA) is a prevalent disorder characterized by recurrent respiratory disturbances during sleep. Patients with Type 2 Diabetes Mellitus (T2DM) and obesity exhibit a substantial susceptibility to OSA (23%–86%). People with OSA have a high risk of several comorbidities like insulin resistance, cardiovascular disease, depressed mood and hypertension. Thus, the objective was to comprehensively evaluate the risk of OSA among T2DM patients in India. Materials and Methods A cross-sectional survey was conducted across four cities in India involving 2,000 T2DM patients. The survey gathered data on patient demographics, clinical endpoints, and estimated the risk of OSA using an app which included the STOP BANG questionnaire. Multivariate logistic regression analysis was used to evaluate the association between OSA risk and key variables such as age, gender, BMI, and HbA1c. Result Overall, 63.9% of T2DM patients were identified as high risk and 27.3% were at intermediate risk for OSA development. Results of the multivariate logistic regression demonstrated that patients with high BMI ≥35 had significantly greater odds (OR: 5.70; p<0.00) of developing OSA; males had 2.75 times higher odds (p<0.00) and patients with HbA1c value >8% had higher odds (OR: 1.22; p<0.00) of developing OSA. Conclusion OSA risk and prevalence are significantly higher in T2DM patients than in the general population with a notable escalation in patients who are overweight/obese, older, and have prolonged diabetes duration. Early screening using digitalization with a highly sensitive, cost-efficient, and valid tool like STOP-BANG followed by appropriate intervention for OSA can not only reduce the eventual economic burden but can improve patient outcomes.
Oct 2024 DOI 10.14302/issn.2688-5328.ijp-24-5319
Puri NivritiCorresponding author
Chronic pain affects over 30% of the global population, and reliance on external drugs for treatment has led to major issues, including the present opioid epidemic. A healthier option is necessary, which is why music therapy’s analgesic effects have been extensively studied within the last 20 years. Not only is music relatively harmless but given that chronic pain patients require repeated treatment, musical intervention is far more accessible and economical. While the mechanisms underlying music-induced analgesia are relatively unclear, the production of endogenous opioids while listening to music through both the descending pain modulatory circuit and the limbic system, is postulated to play this role. This review describes the brain regions and pathways by which music may trigger the release of endogenous opioids such as enkephalins, endorphins, and dynorphins. More importantly, it discusses the cellular mechanisms through which these neuropeptides are thought to mediate pleasure-induced analgesia in chronic pain patients.
Oct 2024 DOI 10.14302/issn.2574-4518.jsdr-24-5287
Hast MichaelCorresponding author
Background/Aim This study aimed to examine the relationship between loneliness and bedtime procrastination in young adults in Germany, offering critical insights into the development and maintenance of both conditions. Specifically, it sought to test a new model that connects these two psychological constructs. Materials and Methods A quantitative online survey was conducted with 500 young adults (Mage = 23.3, 83.6% female). Loneliness was assessed using the UCLA Loneliness Scale, while bedtime procrastination was measured using the Bedtime Procrastination Scale. Results The results show a significant positive correlation between loneliness and bedtime procrastination in young adults. Sleep quality was also found to significantly correlate positively with loneliness as well as with bedtime procrastination. Conclusion The findings provide a crucial framework for understanding the relationship between the two psychological constructs of loneliness and bedtime procrastination. Implications for possible future interventions are discussed.
Sep 2024 DOI 10.14302/issn.2693-1176.ijgh-24-5233
Fiona AtimCorresponding author
In response to the rising burden of non-communicable disease (NDC), the World Health Organization (WHO) developed tools to enable early detection and management of NCDs in Primary Healthcare centers (PHC). Globally, the prevalence of NCDs remains alarmingly high with 41 million deaths annually. Of these, 17 million people die before the age of 70, and 86% of these premature deaths occur in low-and middle-income countries. This narrative review aimed to assess the effect of PHC services on health-related quality of life (HRQoL) of older persons with NCDs, to critically analyze the potential of the existing literature in informing improvements in PHC services. We searched various databases (PubMed, Springer, Scopus, and ScienceDirect) for relevant literature. Peer-reviewed articles on the influence of PHC services on HRQoL among older persons with NCDs written and published in English between January 2013 and May 2024 were considered. The review indicates that effective PHC services are linked to good HRQoL. However, PHC services are sub-optimal and poor in low- and middle-income countries, hence more health interventions are essential to improve PHC services to enhance HRQoL of older persons.
Sep 2024 DOI 10.14302/issn.2577-137X.ji-24-5207
Olutola AyodotunCorresponding author
COVID-19 vaccine hesitancy has emerged as a major challenge to global efforts to control the pandemic, particularly in Nigeria, where hesitancy to other effective vaccines such as polio and measles has been widely reported. Several individual, societal, and structural factors contribute to this behaviour and prevent the effectiveness of COVID-19 prevention efforts. Objectives This study sought to identify the predictors of COVID-19 vaccine hesitancy in the seven states of North-Central, Nigeria. Methods A population-based cross-sectional online survey was conducted among residents using a semi-structured questionnaire adapted from the WHO SAGE vaccine hesitancy scale and distributed via social media networks over 8-weeks. Results A total of 1,429 responses met the inclusion criteria and were analysed. Among the respondents, 60.7% were males, 47.5% were between the ages of 26 and 45, and 80.1% had postsecondary education. A total of 421 respondents (29.5%) were hesitant and unwilling to receive the vaccine. The reasons for hesitancy were concerns about side effects (37.1%), doubt about the existence of COVID-19 (11.0%), and the perception of time required to receive the vaccine (9.6%). Post-secondary education (AOR: 0.49, 0.36-0.66) and people of the Islamic faith (AOR: 0.68, 0.52-0.90) were found to be associated with lower levels of hesitancy. Conclusion The study found that vaccine hesitancy is a complex problem that is linked with multiple social determinants of health as lower educational attainment, lower income and Christian faith were found to be predictors of vaccine hesitancy. Confidence, Complacency and Convenience factors were expressed by respondents as concerns about side effects, doubt about the existence of COVID-19 and time required to receive the vaccines were the most prominent reasons for unwillingness to receive the vaccine. In order to protect the public health of communities, targeted interventions are required to increase vaccine acceptance by cultivating trust in vaccines, disseminating accurate information, and engaging with community stakeholders including religious groups.
May 2024
Almekhlafi KaylaCorresponding author
This exploratory study investigates factors and consequences of underdiagnoses or late diagnoses of attention deficit hyperactivity disorder (ADHD) in females favoring males in the referral, diagnosis, and treatment processes resulting in gender disparities. A literature review in PubMed, PsychINFO, PsychArticles, and PsychiatryOnline from 2010 to 2023 underscores significant implications of delayed ADHD diagnosis in females, hindering timely access, support, and interventions during critical developmental years. Factors associated with underdiagnosis of ADHD among girls include gender differences in symptomology presentation, comorbidity, and gender bias among parents, teachers, and healthcare providers. We highlight the role of ethnicity and cultural factors. This bias prevents girls from receiving necessary ADHD support and treatment, impacting their health, social, and economic outcomes into adulthood. We summarize strategies to urgently address gaps in ADHD research and practice. Raising awareness among communities, healthcare providers, educators, and parents is vital to alleviate these gender disparities. By illuminating factors contributing to delayed diagnoses, the study informs policymakers and stakeholders, facilitating targeted interventions to improve early detection and treatment outcomes for females with ADHD.
May 2024 DOI 10.14302/issn.2470-5020.jnrt-24-5100
T. Adebisi AbdulyekeenCorresponding author
Exploring the dynamic dimension of functional connectivity in dementia, this article departs from traditional static studies to capture the ever-changing brain networks. Investigating temporal connectivity patterns yields valuable insights into disease progression, individualized treatment, and early intervention. Additionally, the concept of cognitive reserve, therapeutic interventions, and machine learning integration are pivotal in revolutionizing dementia research and care.
May 2024 DOI 10.14302/issn.2998-1506.jpa-24-5058
Shrestha SwatiCorresponding author
Wheat is a staple grain crop in the United States and around the world. Weed infestation, particularly grass weeds, poses significant challenges to wheat production, competing for resources and reducing grain yield and quality. Effective weed management practices, including early identification and targeted herbicide application are essential to avoid economic losses. Recent advancements in unmanned aerial vehicles (UAVs) and artificial intelligence (AI), offer promising solutions for early weed detection and management, improving efficiency and reducing negative environment impact. The integration of robotics and information technology has enabled the development of automated weed detection systems, reducing the reliance on manual scouting and intervention. Various sensors in conjunction with proximal and remote sensing techniques have the capability to capture detailed information about crop and weed characteristics. Additionally, multi-spectral and hyperspectral sensors have proven highly effective in weed vs crop detection, enabling early intervention and precise weed management. The data from various sensors consecutively processed with the help of machine learning and deep learning models (DL), notably Convolutional Neural Networks (CNNs) method have shown superior performance in handling large datasets, extracting intricate features, and achieving high accuracy in weed classification at various growth stages in numerous crops. However, the application of deep learning models in grass weed detection for wheat crops remains underexplored, presenting an opportunity for further research and innovation. In this review we underscore the potential of automated grass weed detection systems in enhancing weed management practices in wheat cropping systems. Future research should focus on refining existing techniques, comparing ML and DL models for accuracy and efficiency, and integrating UAV-based mapping with AI algorithms for proactive weed control strategies. By harnessing the power of AI and machine learning, automated weed detection holds the key to sustainable and efficient weed management in wheat cropping systems.
Apr 2024 DOI 10.14302/issn.2998-4211.jalr-24-4926
Bahadur Khan FaizaCorresponding author
This article has been retracted on 20 March 2025. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2998-4211.jalr-25-5855) The research is focused on neuroinflammation a normal physiological process which is known to be associated with neurodegenerative diseases could be the potential targeted therapy via the microglia cells, it starts with defining Alzheimer’s; a neurodegenerative disease which causes deposition of Aβ (amyloid beta) protein in the cerebral cortex as well as NFT (neurofibrillary tangles) in the hippocampus and basal ganglia. The paper then describes process of neuroinflammation, microglia’s role, apolipoprotein E4 gene in relation to Alzheimer’s, which leads to different stem cell research and how pruning microglia as well as targeting microglia receptors in the brain is being used in current research trials, we included multiple meta-analysis showing microglia receptors being targeted currently by emerging drugs like propofol, antibodies CSF1R inhibitor etc, which are currently under trial phase, the research ends with concluding potential diagnostic markers like sirt1 considered to be an anti-aging protein which can be used as therapeutic interventions and Lps effect on Sirt 1. A Microglia initiated target therapy in Neuroinflammation for Alzheimer’s Patients.
Apr 2024 DOI 10.14302/issn.2994-6743.ijstd-24-5006
Khatoon Hossein Mehdi Poor NargisCorresponding author
Objectives This study explores the clinical characteristics, associated infections, and management outcomes of syphilis within a specific population over the years 2018 to 2022. With a focus on the frequency, clinical manifestations, and co-infections of syphilis, the research addresses a critical gap in understanding the nuanced dynamics of this sexually transmitted infection and its impact on public health. Methods The study employs a retrospective analysis of data collected from 2018 to 2022, utilizing three key serological tests (Syphilis AB, RPR/VDRL, and TPHA) to characterize syphilis infections within the population. Clinical manifestations and associated infections, including HIV, HBV, HCV, Chlamydia, Gonorrhea, and HPV, are systematically assessed. Treatment rates and re-infection patterns are also analyzed, providing a comprehensive overview of syphilis epidemiology within the studied timeframe. Results The frequency of syphilis, particularly indicated by the Syphilis AB test, exhibited a marked increase in 2020, reaching 96%, suggesting a heightened frequency within the population. RPR/VDRL test results demonstrated consistent frequency, emphasizing the persistent presence of active syphilis infections. Clinical manifestations, such as chancre, skin rashes, alopecia syphilitica, and lymphadenopathy, displayed dynamic patterns over the study years. Co-infection rates varied, with fluctuations observed in HIV, Chlamydia, Gonorrhea, and HPV, while HBV and HCV showed infrequent but stable frequency. The management of syphilis cases demonstrated commendable treatment rates, but an increase in re-infection rates in 2021 highlights the need for continued vigilance. Conclusion This study provides a comprehensive evaluation of syphilis epidemiology, clinical characteristics, and associated infections within the studied population. The results offer valuable insights into the dynamic nature of syphilis and its co-infections, informing public health initiatives and interventions. The findings contribute to our understanding of the epidemiological landscape and underscore the importance of sustained efforts in both prevention and treatment to curb the transmission of syphilis and its associated infections. The study, however, calls for continued vigilance and research to address the evolving trends and challenges in syphilis management within the specified population.
Apr 2024 DOI 10.14302/issn.2997-2086.jfs-23-4651
Osama Siddiqui MuhammadCorresponding author
This article has been retracted on April 10, 2025. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2997-2086.jfs-25-5857) Myelomeningocele (MMC), a class of spina bifida is a type of neural tube defect. According to the U.S. Centers for Disease Control and Prevention, each year approximately 1,400 babies born in the United States have spina bifida. The disease manifests with the lack of skin and bone covering the caudal part of the spinal cord. The patient developing such a condition often develops lifelong impaired lower limb mobility accompanied by hydrocephalus, and urinary and bowel incontinence. The available interventions include prenatal and postnatal surgery to fuse the dura. Prenatal surgery performed before 26 weeks of gestation reduces the risk of death or the need for ventriculoperitoneal shunting. It also enhanced results on a comprehensive index for mental and motor function. When compared to postnatal surgery, prenatal surgery reduces the manifestation of several secondary outcomes, including the degree of hindbrain herniation seen in the Chiari II malformation. Stem cell therapy for MMC on animal models of chick, ovine, and rodents with reported cases 15/63, 15, and 136, respectively, using human Embryonic Stem Cells (hESCs), Neural Stem Cells (NSCs), Mesenchymal Stem Cells (MSCs) showed significant coverage of MMC defect and slight neurogenesis was also observed. With an understanding of medical literature about in-utero regenerative capacity, it is to be appreciated that placental stem cells surgically seeded within a biocompatible scaffold of the cell patches can play a part in alleviating the spinal cord manifestation associated with MMC. Documented animal studies show that incorporating Placental Mesenchymal Stem Cells in prenatal surgery has reported improved neurogenesis and lower limb mobility. In an ovine myelomeningocele model, the development of in-utero myelomeningocele repair with human Placental Mesenchymal Stem Cells seeded onto an extracellular matrix (PMSC-ECM) enhances motor findings. The clinical trial for the first stem cell therapy on human subjects known as the “CuRe Trial: Cellular Therapy for In Utero Repair of Myelomeningocele.” is expected to be finished by 2030. So far, the cases undergoing treatment have shown significant leg movement and a greater degree of bowel and urinary control. This FDA-approved clinical trial is envisioned to be the future of treating MMC.
Apr 2024 DOI 10.14302/issn.2994-6743.ijstd-24-5005
Khatoon Hossein Mehdi Poor NargisCorresponding author
Objectives This study examined the frequency and dynamics of syphilis in the United Arab Emirates (UAE) between 2018 and 2022. Recognizing the significance of understanding syphilis trends, this study intends to conduct further research on sexually transmitted diseases in the context of the UAE. Methods This was a retrospective cross-sectional study. This study focused on patients who underwent syphilis screening between January 2018 and December 2022. Cases were classified as conclusive only if they passed the first screening and subsequent confirmatory tests. Results The findings demonstrate that Syphilis frequency varied throughout the UAE during the study period. Demographic trends and sex variations were discovered, providing insight into how syphilis patterns change. Additionally, this study identified a broad spectrum of clinical manifestations, confirming the complexity of the disease. It was also noted that males had a higher frequency of syphilis than females. Conclusion Understanding the complexity of the frequency of syphilis is critical for developing effective public health interventions. Variations in frequency, demographic trends, sex disparities, and clinical manifestations indicate the need for personalized preventive and control measures. This study provides important information that may be utilized to motivate focused initiatives to address the difficulties associated with syphilis in the UAE, thus enhancing overall public health.
Mar 2024 DOI 10.14302/issn.2577-2279.ijha-23-4886
Garapati SupriyaCorresponding author
Introduction The foramen ovale is located in the area where intracranial and extracranial structures meet. Procedures involving trigeminal neuralgia and mandibular nerve anaesthesia require an understanding of the foramen ovale's morphometry and anatomy. Our present study was conducted to define mean values and anatomical variations in foramen ovale. Aims 1. To establish the mean length, breadth and the Area of the foramen ovale. 2. And also to study different shapes and special features of the foramen ovale. 3. To compare the values of the present author with the previous studies. Methodology The study was carried out on100 foramen ovale using 50 dry adult human skull bones of unknown sex. Maximum transverse diameter, antero-posterior diameters of the foramen were measured with the help of vernier calipers. and the different shapes of foramen were noted. The data was analysed by using unpaired T test. Results The mean anteroposterior diameter on left side was 6.59±1.37 mm and on right side was 6.99±1.44 mm. The mean transverse diameter on the left is 4.09±0.74 mm and 4.17±0.76 mm on the right side. Incidences of various shapes of the foramen ovale were oval 70%, almond 11%, round 9%, elongated 6%, pear shaped 2 % and irregular 2%. Conclusions The findings from the current study may be useful for understanding the variations of these foramina for interventions in middle cranial fossa.
Feb 2024 DOI 10.14302/issn.2379-7835.ijn-24-4938
Suh MinaCorresponding author
Public health interest in vaccinations and immune protection has increased with the COVID-19 pandemic. Dairy products are an important source of protein and other nutrients, and there are unresolved research questions regarding the potential health impact of dairy products on the enhancement of immune response. A systematic literature review was conducted to synthesize the published literature reporting the effects of dairy interventions on: 1) the vaccine-specific immune response and 2) immunoglobulins in the absence of vaccination. To assess study validity and quality, we used the Academy of Nutrition and Dietetics Quality Criteria Checklist. Sixty-one studies (59 clinical trials, 1 cohort, 1 cross-sectional survey) were included, spanning 1983-2017. Ten trials evaluated the effect of dairy intervention on vaccine-specific IgG, IgA, IgM, vaccine-specific antibody titers, seroprotection rates, or seroconversion rates. Of these, 7 reported significant increases with dairy interventions for post-vaccine tetanus antibodies, mean change in tetanus antibody level, total antibody titers to flagellin from Salmonella Adelaide, mean antibody titers to influenza B, influenza-specific IgA and IgG levels, and seroconversion or seroprotection rates for influenza A and B. Fifty-six studies evaluated dairy’s effects on immunoglobulins without vaccinations. The results were heterogenous, with some studies reporting significant enhancement of immunoglobulins (IgA, IgE, or IgG), while others observed no differences between groups. Clinical relevance of the immunoglobulin changes was not investigated in these studies. Dairy products and their components could enhance the efficacy of vaccines. This review highlights the evidence gaps and provides a potential roadmap for additional research.
Feb 2024 DOI 10.14302/issn.2641-4538.jphi-23-4871
Mba-Oduwusi NnennaCorresponding author
Background This study evaluates the effectiveness of quality improvement (QI) strategies in mid-level private healthcare facilities in Lagos State, with a focus on the structural components, healthcare processes, and healthcare outcomes. Employing the Donabedian model, the research aims to comprehensively assess and enhance healthcare service quality in these facilities. Methods A before-and-after study design was employed, involving a baseline assessment of 321 health facilities and endline assessment of 239 healthcare facilities, and a subsequent 10 - 12-month quality improvement intervention. Data were collected using facility assessments, client exit interviews, and interviews with key stakeholders. The analysis included a before and after analysis of the structural components, healthcare processes, and healthcare outcomes. Results The study demonstrates positive outcomes in mid-level private healthcare facilities in Lagos State following quality improvement (QI) interventions. Structural components, including, improved equipment availability, and enhanced compliance with standards, showcased significant improvements. Renovations and heightened registration compliance further underscored commitment to regulatory standards. Challenges in service availability, particularly in family planning and laboratory services, were identified. Importantly, the implementation of a QI scoring system revealed an overall positive impact, with the average score rising from 69% to 74%, signifying enhanced quality across diverse priority areas. Implications These findings highlight the success of QI interventions in transforming healthcare processes and structural components. Despite notable progress, persistent challenges in specific services call for targeted interventions. The substantial increase in patient satisfaction and overall QI scores underscores the transformative potential of sustained efforts and tailored interventions in mid-level private healthcare facilities in Lagos State. Conclusions This research comprehensively evaluates the effectiveness of quality improvement strategies implemented in mid-level private healthcare facilities in Lagos State, Nigeria, utilizing the Donabedian Model as a guiding framework. The findings provide valuable insights for policy recommendations, with the aim of aligning healthcare services with the Donabedian model to ensure the provision of high-quality care in mid-level private healthcare facilities in Lagos State. This study contributes to the ongoing efforts to improve healthcare quality in Lagos State. Contribution to Knowledge The research provides empirical insights into the effectiveness of quality improvement strategies in mid-level private healthcare facilities, particularly within the context of Lagos State, Nigeria. It highlights the significance of addressing structural components, optimizing healthcare processes, and monitoring healthcare outcomes to enhance the quality of care provided, aligning with the Donabedian model. These findings offer a valuable basis for policy recommendations and further research efforts aimed at improving healthcare quality in similar settings.
Jan 2024 DOI 10.14302/issn.2692-5257.ijgp-23-4772
M. G. D. V. K KiridanaCorresponding author
Childhood obesity is on the rise, mostly in the low-income regions in South Asia including Sri Lanka. Simultaneously, undernutrition also continues to be an ongoing public health issue. The coexistence of childhood obesity with undernutrition has resulted in a double burden of malnutrition in these countries. Management of obesity in a community already affected by undernutrition is a challenging situation. At present, management of childhood obesity occurs as a hospital-based lifestyle modification intervention which cannot address all tiers in the community alike. Although national level multifaceted strategies are in place, implementation is limited due to financial constraints. In this context, the general practitioners can be considered as an important group of medical professionals who can reach families in the community. In many households in Sri Lanka, an overweight child is considered as normal and well-nourished in comparison to an underweight child. Unhealthy eating habits and force feeding have become norms in the society. Changing mindsets of people need significant time and commitment. General practitioners, in the community would be able to achieve this target through effective communication based on a nutrition sensitive approach. While uplifting the infrastructure facilities, steps have to be taken to update the knowledge and communication skills of the general practitioners on managing childhood obesity in a community affected with double burden of malnutrition. The well-equipped GP is an asset to modify the attitudes and thinking patterns of parents with regard to child nutritional problems. Childhood obesity is on the rise, mostly in the low-income regions in South Asia including Sri Lanka. Simultaneously, undernutrition also continues to be an ongoing public health issue. The coexistence of childhood obesity with undernutrition has resulted in a double burden of malnutrition in these countries. Management of obesity in a community already affected by undernutrition is a challenging situation. At present, management of childhood obesity occurs as a hospital-based lifestyle modification intervention which cannot address all tiers in the community alike. Although national level multifaceted strategies are in place, implementation is limited due to financial constraints. In this context, the general practitioners can be considered as an important group of medical professionals who can reach families in the community. In many households in Sri Lanka, an overweight child is considered as normal and well-nourished in comparison to an underweight child. Unhealthy eating habits and force feeding have become norms in the society. Changing mindsets of people need significant time and commitment. General practitioners, in the community would be able to achieve this target through effective communication based on a nutrition sensitive approach. While uplifting the infrastructure facilities, steps have to be taken to update the knowledge and communication skills of the general practitioners on managing childhood obesity in a community affected with double burden of malnutrition. The well-equipped GP is an asset to modify the attitudes and thinking patterns of parents with regard to child nutritional problems.
Dec 2023 DOI 10.14302/issn.2329-9487.jhc-23-4848
Dangwe Temoua NaibeCorresponding author
Introduction Rheumatic heart disease is mostly common in low-income or developing parts of the world, such as Sub-Saharan Africa, with a high morbidity and mortality rate. There are few data that are available in Chad on rheumatic heart disease. Our objective was to study the clinical, echocardiographic, therapeutic, and progressive aspects of rheumatic heart disease at the Renaissance University Hospital Center and the National Reference Teaching Hospital in N’Djamena, Chad. Patient and methods This was a prospective, multicenter and observational cohort study, covering a consecutive series of patients consulted and/or hospitalized for rheumatic heart disease, documented by an echocardiogram from January 2015 to January 2021. Results Among the 4456 patients consulted and/or hospitalized, 398 cases of rheumatic heart disease (8.9%) were collected, and 364 patients had met the inclusion criteria. The mean age was 31.2 ± 14.4 years, and 193 patients (53%) were female. On admission, heart failure was present in 214 patients (58.8%), ischemic stroke in 10 patients (2.7%) and supraventricular arrhythmias such as atrial fibrillation in 94 patients (25.8%) and atrial flutter in 6 patients (1.6%). Mitral regurgitation was observed in 49.7% (n=181) of cases, aortic regurgitation in 33.2% (n=121), mitral stenosis in 31.3% (n=114), and aortic stenosis in 7.7% (n=28). At least two valvular disorders were combined in 48.4% of cases. A surgical intervention such as a heart valve replacement and/or valvuloplasty was performed in 80 patients (22.2%). At least one rehospitalization was noted in 56.9% of patients. Forty-two of the 150 patients free of heart failure at inclusion (28%) had experienced the first episode of decompensated heart failure during follow-up. On the other hand, in 119 patients (55.6%), it was the second episode of decompensated heart failure. Other progressive complications included atrial fibrillation (13.8%), thromboembolic complications (6.3%), infective endocarditis (6.0%) and prosthetic valve dysfunction (1.4%). Altogether, the mortality rate was 10.4%. It was 9.9% in non-operated patients compared to 12.5% in operated patients (p=0.49). Conclusion The present study shows that morbidity and mortality of rheumatic heart disease remain high in our context and often affect children, young adults, and women. Treatment is essentially based on cardiac surgery which is not available in Chad.
Aug 2023 DOI 10.14302/issn.2641-5518.jcci-23-4646
Issa Abdulhamid SayedCorresponding author
Introduction The idea of HLSSM2 is to get the least easy surgical intervention, as arthroscopic surgery begins with examining the shoulder joint, and the location and size of the lesion are determined, then open over the lesion with an open surgical approach that is very limited for surgical repair; not using arthroscopic instruments but conventional surgical instruments in the second step. Figure 1 Figure 1. Methods Clinical experience with this technique consists of 44 cases over a period of thirty-one months, this study was from September 2020 to May 2023. All cases were done as outpatients and under general anesthesia. Results The mean duration of the operation was 35 minutes, and the minimum duration was 25 minutes. There was no major nerve or vascular injury in all cases. This technique is simple, safe, and good cosmetically satisfactory for all patients after full recovery about three months after the procedure, and it is cost-effective. One 43-year-old female patient suffered pain and stiffness during the first six months after surgery and was not very satisfied, she did not stop visiting us till now, she was not happy because of shoulder pain and tenderness. Conclusion It can be used by experienced hand surgeons in shoulder arthroscopy and in Mini Lateral Shoulder Approach (MLSA)3, especially in countries where shoulder arthroscopic release and repair with suture anchors are expensive4 or not available. This technique is not very simple but is available, safe, cosmetically satisfactory, and cost-effective.
Aug 2023 DOI 10.14302/issn.2688-5328.ijp-23-4624
James AndersonCorresponding author
Periauricular Vagus Nerve Stimulation (pVNS) has been proven safe and effective in reducing chronic pain and related comorbidities in numerous clinical studies. This multicenter, interventional study used a non-randomized, interrupted time-series analysis to test the efficacy of an 8-week treatment protocol using the Stivax neurostimulator device. Subjects (n=33, 15 F, 18 M, age 40-77) were recruited at 3 clinic sites in California and Colorado. All subjects had long-term chronic pain and had failed other treatments. Subjects were treated with the Stivax device 3 times (2 weeks on, 1 week off). Subjective assessments of pain (Visual Analog Scale), disability (Oswestry Disability Index), depression (PHQ-9), and activity (IPAQ-E) were collected at baseline and weekly. Objective blood levels of pain-related cytokines collected at the end of weeks 2 and 8. Most subjects reported reduced pain, disability, and depression, with increased activity levels. At the end of week 8, subjects reported an average reduction in pain by 38.5% (3 subjects reported no pain), depression by 43.6% (2 subjects reported no depression), disability by 38.6% (2 subjects reported no disability), and an average 26.1% increase in activity level (5 subjects doubled their activity level). Levels of the pain-related cytokines IL-1ꞵ, IL-2, IL-3, IL-7, IL-10, IL-15, IL-17α, IL-21, TNF-α, IFN-γ, and FLT3-ligand showed improvement at week 8. pVNS is believed to “reset” central sensitization underlying chronic pain and other central sensitization syndromes, engaging the body’s pain modulation systems. Our results indicate that pVNS can clinically significantly improve chronic pain and associated morbidities without adverse effects.
Jul 2023 DOI 10.14302/issn.2574-450X.jom-23-4654
Hodges StephanieCorresponding author
Background Nearly 40% of the adult population in the United States are considered obese by current standards, which equates to approximately 93 million people. Obesity is a chronic disease that is linked to more than 40 other diseases, including hypertension, heart disease, stroke, diabetes, and at least 13 distinct types of cancers. The direct and indirect costs of obesity have been estimated at up to $210 billion annually. Local Problem In Cumberland County, North Carolina, 34% of the adult population was considered obese. The aim of this quality improvement study was to increase effective care (screening, patient engagement, and referral to treatment) in adult patients with a BMI greater than 30 kg/m2 to 75% within 90 days. Methods A rapid cycle plan-do-study-act framework was used to evaluate four focus areas concurrently over 8 weeks with a small test of change completed in each 2-week cycle. Interventions An expanded screening with a checklist, shared decision-making tools (SDMTs), and a referral to treatment checklist were implemented. Activities from the team engagement plan were initiated. Results The effective care of patients increased by 42 percentage points while engaging both the patients and the staff. Conclusions Utilizing standardized communication, SDMTs, checklists, and management plans improved effective care while motivating and enabling patients to take control of their care and make sustainable lifestyle changes that enhance overall health.
May 2023 DOI 10.14302/issn.2574-4488.jna-23-4545
Papiashvili N.A.Corresponding author
This study aimed to analyze pharmacological actions of phenolic compound luteolin on the renal and cardiac hypertrophy, blood pressure (BP), baroreflex sensitivity (BRS), levels of epoxyeicosatrienoic acids (EETs), prostaglandin E-2 (PGE-2) and endothelin-1 (E1) in plasma in the 2 kidney - 1 clip (2K-1C) model of renovascular hypertension (RVH). All animals, were randomized into 2 groups: control (normal) I - sham-operated, II- RVH male Wistar rats, which after 4 weeks of surgical intervention secondly randomized to control II group, treated 0.1% dimethyl sulphoxide (DMSO) and main group - with luteolin in 15 DMSO, 3 mg/kg body weight, intraperitonially, during 2 weeks. ET-1, EETs and PGE2 levels investigated in carotid artery blood plasma and analyzed using ELISA kits. All data statistically analyzed using the SPSS-10.0 program. In RVH rats BP increased by 32%, cardiac and right kidney hypertrophy and reduction in parasympathetic component of BRS by 40% and sympathetic by 39%. The plasma level of total trans-EETs and PGE2 in RVH rats decreased by 44% and 50% respectively, while the level of ET-1 increased by 67%. Two weeks treatment with luteolin lowered BP, improved parasympathetic, without marked changes in sympathetic component of BRS. Deremodeling of cardiac and renal hypertrophy under prolonged treatment with luteolin accompanied with increasing in the level of EETs by 44%, PGE-2 by 50% and markedly reducing of plasma content of ET-1 (by 60%). Inhibition of EET hydrolase using low doses of luteolin provides beneficial cardio and renoprotective action in experimental model of RVH.
Apr 2023 DOI 10.14302/issn.2644-1101.jhp-23-4549
Mary Anne DeVivioCorresponding author
This article argues that collecting school data on bullying and harassment must be paired with transparent analysis and targeted interventions. It outlines governance, feedback loops, and practical steps to translate data into safer environments.
Apr 2023 DOI 10.14302/issn.2474-7785.jarh-23-4550
Marks RayCorresponding author
Aim This review examines the research base concerning hand osteoarthritis and changes in muscle mass and quality known as sarcopenia and the possible use of vitamin-D supplementation for reducing this potentially adverse functionally disabling state. Methods Publications detailing a possible link between hand osteoarthritis manifestations and sarcopenia, plus those discussing vitamin D as a possible intervention strategy for minimizing sarcopenia in the older adult were systematically sought and reviewed. Results Collectively, data reveal hand osteoarthritis in the older population is common, and is possibly affected by age as well as disease associated muscle mass declines. Vitamin D, a powerful steroid required by the body to foster many life affirming physiological functions may help reduce the degree of any prevailing sarcopenia and thereby some degree of hand osteoarthritis disability. Conclusions Older individuals with hand osteoarthritis, as well as healthy older adults at risk for sarcopenia are likely to benefit physically from efforts to clarify the extent of this association and if indicated, to examine and intervene thoughtfully to maximize muscle composition as well as safe vitamin D levels where subnormal. Researchers can make highly notable impacts in multiple spheres in this regard and are encouraged to do so.
Mar 2023
Md. Shafat KarimCorresponding author
Moyamoya disease is a very rare chronic circulatory occlusive disorder of the blood vessels of the brain, in which patients complain of headache, seizure, weakness, and sometimes paralysis. A 5 years old female child with a complaint of headache and seizure was admitted elsewhere and during the treatment, she was diagnosed with Moyamoya disease. Further, she went to AIIMS Patna, where the neurosurgeon advised Digital Subtraction Angiography (DSA) and after the final diagnosis, they suggest the surgical intervention of the brain. During the search for an alternative treatment, they consulted my center for Unani treatment. We advised a semiliquid Unani polyherbal formulation containing Gule Banafsha (Viola odorata), Ustukhuddoos(Lavandula stoechas), and Nilofer (Nymphaea alba Linn) for three months. After the completion of the treatment schedule, she went for DSA again in Patna AIIMS and they find that there is no sign of occlusion in the blood vessels of the brain. The patient has no complaints and the report also showed that she gets improved.
Mar 2023 DOI 10.14302/issn.2379-7835.ijn-22-4116
Shuja SabaCorresponding author
Background In Low Middle-Income Countries (LIMCs), malnutrition, especially undernutrition is one of the leading causes of childhood mortality and morbidity. Poor complementary feeding practices are among the most notable contributors to poor nutritional indicators in children under five. This article provides an output of secondary data analysis of the Cost of Diet (CoD) and Optifood component of National Complementary Feeding Assessment conducted by UNICEF Pakistan along with Pakistan Demographic Health Survey (PDHS) 2018. Methods For correlation of Optifood data and CoD data with PDHS data of CF, GraphPad software, MS Excel was used along with manual quantifications. The analysis of DHS-2018 data was conducted using STATA software. Univariate analysis included comparison of categorical variables i.e. various individual, household and community level parameters with that of outcome variables of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum dietary diversity (MAD) using chi-square test. Findings The overall rate of MMF was 56.6% among children of 6-23 months of age with MDD in 18.6% and MAD in 13.8% of children. Percentage of annual cost spent on nutritious diet for MDD, MMF and MAD varies from 27.86% to 43.08% across all the provinces. Children aged 6–8 months and 9–11 months often consumed infant milk and cereals, while children aged 12–23 months often consumed eggs and grain products. Consumption of dairy products was highest in Punjab, Sindh, AJK, and Islamabad, that of grains roots and tubers was highest in KPK, FATA and GB. Conclusion Considering CF practices in Pakistan are inadequate as indicated by poor MDD, MMF, and MAD, therefore it is imperative that a holistic approach using both communication and non-communication based interventions is to be employed through active stakeholder engagement.
Dec 2022 DOI 10.14302/issn.2324-7339.jcrhap-22-4371
L. Nacht CarrieCorresponding author
San Diego State University, School of Public Health, San Diego, CA
Although pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, only around 25% of at-risk individuals in the United States have accessed a prescription. One way to increase PrEP uptake is through the sexual health screening of patients and linkage to PrEP in primary care settings. The objective of this analysis was to assess the barriers and implementation strategies during a screening and linkage to PrEP pilot intervention. Primary care patients were screened for PrEP indication during routine primary care visits. Of the 1,225 individuals screened, 1.8% (n=22) were eligible for PrEP and from those, 77.3% (n=17) attended the specialist appointment and were prescribed PrEP. Primary care patients (n=30) and providers (n=8) then participated in semi-structured interviews assessing their experience with the pilot intervention. Using an applied thematic analytic approach, patients and providers identified barriers and related improvement strategies that could be classified into four main categories: 1) Financial Barriers: Individual- vs. Clinic-level Considerations 2) The Role of Stigma, Discomfort, and Cultural Factors 3) Logistical Hurdles and Streamlining the Intervention, and 4) The Lack of PrEP Knowledge and the Need for Education. Findings support the accepatability and feasibility of screening for PrEP in primary care along with appropriate implementation strategies. This study suggests that because of the high volume of patients seen in primary care, sexual health screenings and linkage to PrEP interventions have the potential to reduce new incident HIV infections among diverse sexual minority men.
Dec 2022 DOI 10.14302/issn.2576-9383.jhhr-22-4397
J Johnson RalphCorresponding author
Research PA-C/Research Coordinator, University of Texas MD Anderson Cancer Center
Despite vast improvements in chemo-therapeutic interventions extensively extending the life span of patients with chronic and terminal diseases, there also is the unhappy extension of side- effects and adverse events. Thus, Health-Related Quality of Life (HR-QoL) becomes equally as important as length of life. Accurately, reliably, validly, and representatively measuring the on-going pulse beat of HR-QoL means ensuring optimal responses and response rates, which in turn means fostering and maximizing Survey Participants’ continued rapport, enlistment, engagement, and participation regarding HR-QoL research survey studies. This is generally true regarding all human subjects’ research. HR-QoL survey work at a nationally renowned Cancer Center recently identified an example of Potlatch or gift-giving (i.e., gifting), and its surrounding nuances, that were calculated and appear to evoke enhanced reciprocal engagement in a HR-QoL survey. This work involves continuous, iterative marketing study. The intent of this field note is to describe the methodological phenomenon that may have epistemological and theoretical relevance for ubiquitously advancing the interest of health survey research. Specifically, the contention will be that considered, and tactically deployed Potlatch can serve as a mechanism for facilitating and enhancing health survey research as well as enhancing stronger social engagement in research and treatment for patients undergoing medical care for long-term, chronic illness. First, it can rejuvenate and refocus Survey Participants’ involvement. Second, it can serve as an entrée and springboard to further forge a social connection in the interest of research. Lessons Learned and implications are reported.
Nov 2022 DOI 10.14302/issn.2644-1101.jhp-22-4273
J. Grant Coke MoniqueCorresponding author
Canada
The purpose of this topic is to add to the body of good teaching and learning that helps create the conditions for more critical thinking and practice skills that enable, keep students interested, and consistently motivate them. Teachers now have a greater focus on implementing motivational learning and studying strategies that are more relevant to the processes of teaching and learning thanks to new methodologies, which have further enhanced instructional strategies for teaching and learning. Positive school cultures that are long-lasting will result from these new methods and strategies. According to the authors, educators have been impacted by evidence-based practice and data-based decision making within the educational system. As a result, there is a growing need for educators to learn more about these resources that are relevant to students and can lead to greater success. These applicable interventions have a positive effect on students, and the information that helps them make decisions increases their response.
Nov 2022 DOI 10.14302/issn.2474-7785.jarh-22-4354
Marks RayCorresponding author
Department of Health and Behavior Studies, Columbia University, Teachers College New York, USA.
Background Osteoarthritis, the most common joint disease and one affecting a large number of older adults is not always amenable to the use of passive interventions such as surgery or pharmacologic interventions, but even then, to maximize any desirable intervention approaches, a trustworthy and supportive partnership with the sufferer is strongly indicated. Complicating this process are emerging equity and persistent health literacy issues, as well as post COVID-19 service associated ramifications and persistent disease risks. Aim This mini review was designed to examine what current data reveal as regards the presentation of osteoarthritis and its pathology among the older adult as of the current post COVID-19 pandemic period in 2022, and how health literacy and equity issues are likely implicated in some degree with the disease presentation and its outcomes and will be likely to continue, unless remediated. Methods Peer reviewed published articles on this topic were sought from multiple data bases using the key words- osteoarthritis, health equity, health literacy, prevention, and intervention. Results As in prior years, osteoarthritis continues to induce considerable physical disability and consistently impedes the attainment of a high life quality for many older adults. Although not studied to any degree, attention to health equity and literacy issues appear to pose additional osteoarthritis intervention challenges, especially among the long COVID affected older adults and those with low income and educational levels. Conclusions Many behaviourally oriented and necessary osteoarthritis management approaches and interventions may fail to reduce the functional disability and pain experienced by older people with any form of osteoarthritis to any meaningful degree if a) the provider does not tailor their recommendations in light of possible prevailing health literacy, economic, and educational challenges; b) the patient does not understand how their health behaviours impact joint disease as well as COVID-19 risk status, and are not empowered to undertake these.
Oct 2022 DOI 10.14302/issn.2641-4538.jphi-22-4281
Nakachwa MariaCorresponding author
School of Post Graduate Studies and Research, Nkumba University, Entebbe 237, Uganda
Uganda still grapples with a high maternal mortality rates of 336 deaths per 100,000. Expectant mothers across the country lack awareness about the availability of antenatal care services; yet attendance of antenatal care services during pregnancy is crucial in protecting the health of women and unborn children. This article describes a protocol for investigating the effectiveness of mobile telephone communication interventions on the utilization of antenatal care services among expectant mothers in the districts of Kyotera and Rakai Districts in Uganda. Under the protocol, 28 health facilities in the districts of Kyotera and Rakai will be selected using simple random sampling and allocated into the intervention and control arms at a ratio of 1:1. A total of 2224 expectant mothers receiving antenatal care from the sampled health facilities will be recruited using systematic sampling. Expectant mothers receiving antenatal care from facilities allocated into the intervention arm will receive mobile telephone voice and text messages reminders for scheduled ANC visits. The mobile telephone messages will further provide maternal health information and availability of ANC services on a fortnightly basis. On the other hand, expectant mothers receiving antenatal care from facilities allocated into the control group will not get any reminders for scheduled ANC visit and maternal health information through the mobile telephone communication platform. Expectant mothers in the control arm will receive standard maternal health care without reminders. Expectant mothers in both groups will provide baseline data, midterm data will be obtained from the ANC registers at 6 moths while end of term data will be collected after an intervention period of 12months. The data collected will include the number of antenatal care visits attended, antenatal care services obtained from the health facilities, sociodemographic factors and mobile telephone usage, ownership and knowledge. The anticipated outcomes are; increased awareness and utilization of ANC services.
Oct 2022 DOI 10.14302/issn.2641-4538.jphi-22-4329
Adejoh Attah TimothyCorresponding author
National Space Research and Development Agency, Obasanjo Space Centre, Umaru Musa Ydar'adua express way, P.M.B. 437, Lugbe, Abuja
Introduction Malaria in pregnancy is a serious public health concern that could result in detrimental health outcomes for pregnant women and their foetuses. In Nigeria, there is still a significant risk of the disease epidemic and adverse effects especially in pregnancy. The aim of this study is to assess the socio-demographic factors associated with Intermittent Preventive Treatment and health seeking behaviours for malaria in pregnancy among women of reproductive ages in Nigeria Methods Using the National Demographic Survey (NDHS) 2018 data, a cross sectional study was conducted to assess socio-demographic factors associated with Intermittent Preventive Treatment (IPT) for Malaria among Nigerian women of reproductive ages. Result Majority were between ages 30-39 years (39.5%), married/cohabiting (91.8%), Muslims (59.5%), from the north (68.9%), uneducated ( 49.9%), poor (47.5%), and grand parous (65.7%). 63.4% of the women had taken fansidar for malaria in pregnancy while only 6.1% had received healthcare for malaria from informal sources. Except for marital status, all socio-demographic variables (regions, highest educational level, wealth index, age group, religion and parity) were significantly associated with intake of IPT. Additionally, region, education, wealth index, age group, marital status and religion were associated with health seeking behaviour for malaria in pregnancy (P<.05). After control for other variables, wealth index, highest educational level, married/cohabiting marital status and religion was significantly associated with intake of IPT while region, primary and secondary education, poorer and richest wealth index, widowed/separation influenced health seeking for malaria in pregnancy (P<.05). Conclusion The National Malaria Elimination programme should evaluate existing policies that develop interventions that are centred on high risk population in order to prevent malaria in pregnancy while improving health seeking behaviours of women of reproductive ages.
Oct 2022 DOI 10.14302/issn.2381-862X.jwrh-22-4315
Nazempour AnahitaCorresponding author
OB/Gynecologist, fellowship of infertility and IVF, Sarem fertility and infertility research center (SAFIR), Sarem women’s hospital, Tehran, Iran.
Background Polycystic ovary syndrome (PCOS) is a serious multifactorial disorder. This study intended to assess the effect of cinnamon supplementation on estradiol level, and fasting- and two-hour (2 hpp) insulin and sugar levels in women with PCOS. Material and Methods This study was a double-blinded randomized clinical trial (RCT), conducted between January 2019 until December 2020, at Gynecology Clinic Sarem Women’s Hospital in Tehran, Iran. Patients with PCOS, 130 subjects (65 person/ group) were diagnosed using Rotterdam diagnostic criteria. All participants received daily treatment consisting of 1500 mg metformin and 1000 mg cinnamon per day for 12 weeks. An evaluation of serum AMH level was conducted before and after the completion of therapy. Results Cinnamon supplementation significantly reduced the estradiol, fasting glucose and 2hpp glucose, fasting insulin and 2 hpp insulin, BMI and weight levels after intervention. The highest reduction was observed in fasting glucose, 2 hpp insulin, and estradiol groups after intervention (P<0.05). There was a significant difference between the means of BMI (P<0.01), fasting sugar (P<0.01), and 2 hpp glucose (P<0.01) before and after intervention. Conclusion Cinnamon supplementation, as a safe herbal product, can be prescribed with metformin to improve the symptoms and complications of PCOS.
Jul 2022 DOI 10.14302/issn.2324-7339.jcrhap-22-4204
Samson Jegede OluwatosinCorresponding author
LAUTECH Teaching Hospital, Ogbomoso, Nigeria
Introduction Pre-exposure prophylaxis (PrEP) is an element of the biomedical interventions of Human Immunodeficiency virus (HIV) prevention. The level of protection is strongly correlated to PrEP drug adherence. In Nigeria, the prevalence of HIV among female sex workers (FSW) is 15.5%. The 2020 integrated biological and behavioral surveillance survey did not report on PrEP adherence among FSW. This study therefore assessed the level of adherence to PrEP and its predictors among FSW in South-Western Nigeria. Methodology This cross-sectional analytical study was conducted in 2021. Study population were brothel-based FSW at Gambari Ogbomoso and Lagos, Nigeria. A total of 156 FSW participated in the study. Data was collected using interviewer-administered semi-structured questionnaire and analyzed using IBM SPSS Version 25. Results One hundred and forty-nine properly completed questionnaires were analyzed. Ninety-nine respondents (66.4%) have been working for more than 5years as a FSW and 65(43.6%) had initiation of sex work before 18 years of age. Respondents’ sexual behavior showed that 55 (36.9%) of total respondents had consistent use of condom. One hundred and thirty-four respondents (89.9%) had good knowledge of PrEP, 97 (65.1%) had good attitude towards PrEP while 111 (74.5%) had good perception of risk of HIV infection. One hundred and thirty-two (88.6%) reported to be taking PrEP and 119 (79.9%) had good adherence to PrEP. Predictors of adherence to PrEP were educational status, age of commencement of sex work and monthly income. It was found that educated sex workers were 2.67 times more likely to adhere to PrEP (OR=2.67, 95% CI=1.280-5.591, p=0.019). Those who commenced sex work after clocking 18 years of age were 75% times less likely to adhere to PrEP (OR=0.251, 95% CI=0.106-0.597, p=0.001) while those with average monthly income more than #10,000 were 1.65 times more likely to adhere to PrEP (OR=1.65, 95% CI=0.674-4.042, p=0.0275. Discussion and Recommendation The level of adherence to PrEP is considerably high and underscores a positive effect of the efforts of the Government of Nigeria in controlling HIV as a threat by 2030. Further studies would be useful to understand the behavioral factors associated with low adherence to PrEP among FSW who have spent more than 5 years in sex work.
May 2022 DOI 10.14302/issn.2692-1537.ijcv-22-4174
Jaafar Kadhim Al-Ameri RawaCorresponding author
Family Medicine Specialist, AlMustansiriyah University, Iraq
Introduction: Covid 19 pandemic affected all aspect of life, particularly schools attending. Students replaced their presentational lessons by on line distance learn. Ministry of health decisions varied between complete electronic study and attendance several days per week depending on the number of cases of the whole population. In Iraq, total cases till 15 of September, 2021, reached 1.963,264 and total death 21,631. Highest percent of confirmed cases in age group (30-39) years; 24.7%, while in children aged (0-9) years only 1.6%, and in older age group (10-19) years; 7.5%. Cases of covid19 at lower percent in small children and in school age children and tend to increase with age as it reached to 22.6% in age group (20-29). Objectives: Prevalence of covid 19 in students attending AL-dora medical center lab. Comparisons in number of cases of students before and after the school lock –down. Methods: It is a cross sectional study, included the records of schools health unit and lab records of VTM nasal or pharyngeal swab and rapid test in Al-Dora family health center from 1/10/2020 to 15/7/2021. Results: The study included 1711 students, the mean age group was 15.7 (± 4.9) years. The study showed the prevalence of covid19 in students attained the lab was 23.4%, highest percent was in age group >18 years and the lowest percent was in age group 6-12 years. The percent of vaccinated students in academic year 2020/2021 was 0.3 %( 3/1000). There is no significance difference in age group 6-12 years and age group >18 years before closing schools and colleges and after closing while age group 13-18 years showed a significant increase in positive cases after closing schools as cases increase from 18.1% to 25.9% after closing schools. Positive cases showed no significance difference with sex before and after closing. Discussions: The educational path of students in different age groups had broken down. Fear of parents could be justified but it could be exaggerated. School closures were applied almost around the world trying to decrease the potential spread of disease despite early studies suggested this would have less impact than most other non-pharmacological interventions.
May 2022 DOI 10.14302/issn.2641-4538.jphi-22-4189
Rutayisire ErigeneCorresponding author
Department of public Health, Mount Kenya University Rwanda Kigali Rwanda
In Rwanda, CVDs accounts around 14% of all death. Studies on knowledge, attitude, and practice (KAP) would be of great value in helping public health professionals develop targeted programs and measure the effectiveness of interventional programs. The main objective of this study was to analyze the KAP about CVDs among adult patients attending public health centers located in the City of Kigali, Rwanda. A total of 384 adult patients were enrolled in this study. A structured questionnaire was used. Data entry and analysis was done using SPSS version 21. Findings were presented as frequencies and percentages in tables. For determining the KAP-levels, the overall scores were determined for each respondent by adding up the scores through the KAP-related questions. The mean age was 36.4 years, primary school (57.3%), married (62.8%), self-employed (40.9%), and females predominated (61.5%). The knowledge mean score was 14.2 and 76% had high level of knowledge of CVD risks and prevention. The average attitude score for all respondents was 17.6 and 22.9% of the respondents showed negative attitude towards CVDs prevention. Research findings revealed that 36.5 % were not practicing physical activity and exercise. The mean practice score for all respondents was 3.9 and 70% of respondents had negative practice towards CVDs prevention. Poor CVDs prevention practices were observed among the study participants. Therefore, it is necessary to establish more effective educational interventions intended to promote positive health behaviors related CVD prevention
May 2022 DOI 10.14302/issn.2474-7785.jarh-22-4191
Marks RayCorresponding author
Department of Health and Behavior Studies, Columbia University, Teachers College New York, USA.
Background The origin of osteoarthritis, the most common disabling disorder of older adults remains uncertain. Aim This mini review examines the possible role played by various neuromuscular deficits in the osteoarthritis etiopathogenic process. Methods and Procedures Articles that haveaddressed the current topic of interest and were located in the PUBMED,Google Scholar, and Web of Science electronic data bases as of 2017-2022 were carefully sought and examined. Results Various neuromuscular mechanisms may have a bearing on the development and progression of osteoarthritis, but the data are largely unrelated and observational in nature. Conclusion More research to examine this issue is sorely needed and could have considerable merit in light of the growing populations of older adults at risk for disabling osteoarthritis in the face of few intervention options to help them to achieve an optimal functional level.