Search results for: health risk factors

Authors: Manal Sultan Alhussein, Xiang Michelle Liu

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Telehealth is an advanced technology using digital information and telecommunication facilities that provide access to health services from a distance. It slows the transmission factor of COVID-19, especially for elderly patients and patients with chronic diseases during the pandemic. Therefore, understanding patient perspectives on telehealth services and the factors impacting their option of telehealth service will shed light on the measures that healthcare providers can take to improve the quality of telehealth services. This study aimed to evaluate perceptions of telehealth services among different patient groups and explore various aspects of telehealth utilization in the United States during the COVID-19 pandemic. An online survey distributed via social media platforms was used to collect research data. In addition to the descriptive statistics, both correlation and regression analyses were conducted to test research hypotheses. The empirical results highlighted that the factors such as accessibility to telehealth services and the type of specialty clinics that the patients required play important roles in the effectiveness of telehealth services they received. However, the results found that patients’ waiting time to receive telehealth services and their annual income did not significantly influence their desire to select receiving healthcare services via telehealth. The limitations of the study and future research directions are discussed.

Keywords: telehealth, patient satisfaction, pandemic, healthcare, survey

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Authors: Mahdi Fakoor, Seyed Mohammad Navid Ghoreishi

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Initiation and propagation of cracks may cause catastrophic failures in rotating disks, and hence determination of fracture parameter in rotating disks under the different working condition is very important issue. In this paper, a comprehensive study of stress intensity factors in rotating disks containing 3D semi-elliptical cracks under the different working condition is investigated. In this regard, after verification of modeling and analytical procedure, the effects of mechanical properties, rotational velocity, and orientation of cracks on Stress Intensity Factors (SIF) in rotating disks under centrifugal loading are investigated. Also, the effects of using composite patch in reduction of SIF in rotating disks are studied. By that way, the effects of patching design variables like mechanical properties, thickness, and ply angle are investigated individually.

Keywords: stress intensity factor, semi-elliptical crack, rotating disk, finite element analysis (FEA)

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Authors: Fouad M. Bendimerad, Jerome B. Zayas, Michael Adrian T. Padilla

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With the increasing scale of severity and frequency of disasters worldwide, the performance of governance systems for disaster risk reduction and management in many countries are being put to the test. In the Philippines, the Disaster Risk Reduction and Management (DRRM) Act of 2010 (Republic Act 10121 or RA 10121) as the framework for disaster risk reduction and management was tested when Super Typhoon Haiyan hit the eastern provinces of the Philippines in November 2013. Typhoon Haiyan is considered to be the strongest recorded typhoon in history to make landfall with winds exceeding 252 km/hr. In assessing the performance of RA 10121 the authors conducted document reviews of related policies, plans, programs, and key interviews and focus groups with representatives of 21 national government departments, two (2) local government units, six (6) private sector and civil society organizations, and five (5) development agencies. Our analysis will argue that enhancements are needed in RA 10121 in order to meet the challenges of large-scale disasters. The current structure where government agencies and departments organize along DRRM thematic areas such response and relief, preparedness, prevention and mitigation, and recovery and response proved to be inefficient in coordinating response and recovery and in mobilizing resources on the ground. However, experience from various disasters has shown the Philippine government’s tendency to organize major recovery programs along development sectors such as infrastructure, livelihood, shelter, and social services, which is consistent with the concept of DRM mainstreaming. We will argue that this sectoral approach is more effective than the thematic approach to DRRM. The council-type arrangement for coordination has also been rendered inoperable by Typhoon Haiyan because the agency responsible for coordination does not have decision-making authority to mobilize action and resources of other agencies which are members of the council. Resources have been devolved to agencies responsible for each thematic area and there is no clear command and direction structure for decision-making. However, experience also shows that the Philippine government has appointed ad-hoc bodies with authority over other agencies to coordinate and mobilize action and resources in recovering from large-scale disasters. We will argue that this approach be institutionalized within the government structure to enable a more efficient and effective disaster risk reduction and management system.

Keywords: risk reduction and management, recovery, governance, typhoon haiyan response and recovery

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Authors: Linghua Kong, Xinxia Chen, Mika Gissler, Catharina Lavebratt

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Background: Prenatal exposure to preeclampsia has been associated with an increased risk of offspring attention-deficit/hyperactivity disorders (ADHD), autism spectrum disorder (ASD), and intellectual disability. However, little is known about the association between prenatal exposure to severe preeclampsia and neurodevelopmental and psychiatric disorders in offspring. Objective: This study aimed to assess the risk of maternal preeclampsia combined with perinatal problems, specifically low birth weight and prematurity, on offspring neuropsychiatric disorders. Methods: All singleton live births in Finland between 1996 and 2014 (n=1 012 723) were followed up in nation-wide registries until 2018. Main exposures included pre-eclampsia, small for gestational age, and delivery before 34 gestational weeks. Offspring neurodevelopmental and psychiatric disorders (ICD-10 codes) were examined as outcomes variables. Offspring birth year, sex, maternal age at delivery, parity, marital status at birth, mother's country of birth, maternal smoking, maternal gestational diabetes, maternal use of psychotropic medication during pregnancy, and maternal systemic inflammatory diseases were used as covariates. Risks for neurodevelopmental and psychiatric disorders were estimated using Cox proportional hazards modeling. Results: Of the 1 012 723 offspring, 25 901 (2.6%) were exposed to preeclampsia, and 93 281 (9.2%) were diagnosed with a neuropsychiatric disorder. Compared to births unexposed to preeclampsia, small for gestational age or delivery before 34 gestational weeks, those exposed to preeclampsia only had a 21% increase in the likelihood of any neuropsychiatric disorders after adjusting for potential confounding (adjusted HR=1.21, 95% CI: 1.15-1.26), while exposure to preeclampsia combined with small for gestational age or delivery before 34 gestational weeks had a more than twofold increased risk of having a child with neuropsychiatric disorders (adjusted HR=2.16, 95% CI: 2.02-2.32). The adjusted HR for neuropsychiatric disorders in offspring with small for gestational age or delivery before 34 gestational weeks only was 1.79 (95% CI: 1.73-1.83). In addition, the risk estimate in offspring exposed to both preeclampsia and perinatal problems was greater than those only exposed to preeclampsia for having personality disorders (adjusted HR=1.66; 95% CI: 1.07-2.57), intellectual disabilities (adjusted HR=3.47; 95% CI: 2.86-4.22), specific developmental disorders (adjusted HR=2.91; 95% CI: 2.69-3.15), ASD (adjusted HR=1.75; 95% CI: 1.42-2.17), ADHD and conduct disorders (adjusted HR=2.00; 95%CI: 1.76-2.27), and other behavioral and emotional disorders (adjusted HR=2.09; 95% CI: 1.84-2.37). Conclusion: In utero exposure to severe preeclampsia increased the risk of several neurodevelopmental and psychiatric disorders in offspring. Our findings are relevant to women with hypertensive disorders with regard to pregnancy consultation and management and may yield effective clues for the prevention of neurodevelopmental and psychiatric disorders in childhood.

Keywords: low birth weight, neurodevelopmental disorders, preeclampsia, prematurity, psychiatric disorders

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Authors: Waraporn Wimuktalop

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This research will select regions which are vulnerable to flooding in different level. Mathematical principles will be systematically and rationally utilized as a tool to solve problems of selection the regions. Therefore the method called Multiple Criteria Decision Making (MCDM) has been chosen by having two analysis standards, TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) and AHP (Analytic Hierarchy Process). There are three criterions that have been considered in this research. The first criterion is climate which is the rainfall. The second criterion is geography which is the height above mean sea level. The last criterion is the land utilization which both forest and agriculture use. The study found that the South has the highest risk of flooding, then the East, the Centre, the North-East, the West and the North, respectively.

Keywords: multiple criteria decision making, TOPSIS, analytic hierarchy process, flooding

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Authors: Sam Weber, Deepak Mishra, Susan Wilde, Elizabeth Kramer

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The frequency and severity of cyanobacteria harmful blooms (CyanoHABs) have been increasing over time, with point and non-point source eutrophication and shifting climate paradigms being blamed as the primary culprits. Excessive nutrients, warm temperatures, quiescent water, and heavy and less regular rainfall create more conducive environments for CyanoHABs. CyanoHABs have the potential to produce a spectrum of toxins that cause gastrointestinal stress, organ failure, and even death in humans and animals. To promote enhanced, proactive CyanoHAB management, risk modeling using geospatial tools can act as predictive mechanisms to supplement current CyanoHAB monitoring, management and mitigation efforts. The risk maps would empower water managers to focus their efforts on high risk water bodies in an attempt to prevent CyanoHABs before they occur, and/or more diligently observe those waterbodies. For this research, exploratory spatial data analysis techniques were used to identify the strongest predicators for CyanoHAB blooms based on remote sensing-derived cyanobacteria cell density values for 771 waterbodies in the Georgia Piedmont and landscape characteristics of their watersheds. In-situ datasets for cyanobacteria cell density, nutrients, temperature, and rainfall patterns are not widely available, so free gridded geospatial datasets were used as proxy variables for assessing CyanoHAB risk. For example, the percent of a watershed that is agriculture was used as a proxy for nutrient loading, and the summer precipitation within a watershed was used as a proxy for water quiescence. Cyanobacteria cell density values were calculated using atmospherically corrected images from the European Space Agency’s Sentinel-2A satellite and multispectral instrument sensor at a 10-meter ground resolution. Seventeen explanatory variables were calculated for each watershed utilizing the multi-petabyte geospatial catalogs available within the Google Earth Engine cloud computing interface. The seventeen variables were then used in a multiple linear regression model, and the strongest predictors of cyanobacteria cell density were selected for the final regression model. The seventeen explanatory variables included land cover composition, winter and summer temperature and precipitation data, topographic derivatives, vegetation index anomalies, and soil characteristics. Watershed maximum summer temperature, percent agriculture, percent forest, percent impervious, and waterbody area emerged as the strongest predictors of cyanobacteria cell density with an adjusted R-squared value of 0.31 and a p-value ~ 0. The final regression equation was used to make a normalized cyanobacteria cell density index, and a Jenks Natural Break classification was used to assign waterbodies designations of low, medium, or high risk. Of the 771 waterbodies, 24.38% were low risk, 37.35% were medium risk, and 38.26% were high risk. This study showed that there are significant relationships between free geospatial datasets representing summer maximum temperatures, nutrient loading associated with land use and land cover, and the area of a waterbody with cyanobacteria cell density. This data analytics approach to CyanoHAB risk assessment corroborated the literature-established environmental triggers for CyanoHABs, and presents a novel approach for CyanoHAB risk mapping in waterbodies across the greater southeastern United States.

Keywords: cyanobacteria, land use/land cover, remote sensing, risk mapping

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Authors: Tianyou Wang

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Students' own intrinsic motivation is the main source of energy for learning activities, and their self-efficacy becomes a key factor affecting the learning effect. In today's increasingly common situation of online vocal music teaching, virtualized teaching scenarios have brought a considerable impact on students' personal efficacy. Since personal efficacy is the result of the interaction between environmental factors and subject characteristics, an empirical study was conducted to investigate the changes in students' self-efficacy, influencing factors, and characteristics in online vocal teaching scenarios based on the three dimensions of teachers, students, and technology. One hundred valid questionnaires were studied through a quantitative survey. The results showed that students' personal efficacy was significantly lower in online learning environments compared to offline vocal teaching and showed significant differences due to factors such as gender and class type; students' self-efficacy in online vocal teaching was significantly affected by factors such as technological environment, teaching style, and information technology ability. Based on the results of the study, it is recommended to pay attention to inquiry and practice in the teaching design, use singing projects as the teaching organization, grasp the learning process with the orientation of problem-solving, push the applicable vocal music teaching resources in time, lead students to explore and refine the problems and push students to learn independently according to the goals and plans.

Keywords: vocal pedagogy, self-efficacy, online learning, intrinsic motivation, information technology

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Authors: Yusra Pintaningrum, Ilma Fahira Basyir, Sony Hilal Wicaksono, Vito A. Damay

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Background: Coronary artery calcium (CAC) scores play an important role in improving prognostic accuracy and can be selectively used to guide the allocation of statin therapy for atherosclerotic cardiovascular disease outcomes and potentially associated with the occurrence of MACE (Major Adverse Cardiovascular Event) and MI (Myocardial Infarction). Objective: This systematic review and meta-analysis aim to analyze the findings of a study about CAC Score and statin treatment effect on MI and MACE risk. Methods: Search for published scientific articles using the PRISMA (Preferred Reporting, Items for Systematic Reviews and Meta-Analysis) method conducted on PubMed, Cochrane Library, and Medline databases published in the last 20 years on “coronary artery calcium” AND “statin” AND “cardiovascular disease” Further systematic review and meta-analysis using RevMan version 5.4 were performed based on the included published scientific articles. Results: Based on 11 studies included with a total of 1055 participants, we performed a meta-analysis and found that individuals with CAC score > 0 increased risk ratio of MI 8.48 (RR = 9.48: 95% CI: 6.22 – 14.45) times and MACE 2.48 (RR = 3.48: 95% CI: 2.98 – 4.05) times higher than CAC score 0 individual. Statin compared against non-statin treatment showed a statistically insignificant overall effect on the risk of MI (P = 0.81) and MACE (P = 0.89) in an individual with elevated CAC score 1 – 100 (P = 0.65) and > 100 (P = 0.11). Conclusions: This study found that an elevated CAC scores individual has a higher risk of MI and MACE than a non-elevated CAC score individual. There is no significant effect of statin compared against non-statin treatment to reduce MI and MACE in elevated CAC score individuals of 1 – 100 or > 100.

Keywords: coronary artery calcium, statin, cardiovascular disease, myocardial infarction, MACE

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Authors: Tanya Kaur Bedi, Shankha Pratim Bhattacharya

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The US Environmental Protection Agency defines indoor air quality as “The air quality within and around buildings, especially as it relates to the health and comfort of building occupants”. According to the 2021 report by the Energy Policy Institute at Chicago, Indian residents, a country which is home to the highest levels of air pollution in the world, lose about 5.9 years from life expectancy due to poor air quality and yet has numerous dwellings dependent on natural ventilation. Currently the urban population spends 90% of the time indoors, this scenario raises a concern for occupant health and well-being. The built environment can affect health directly and indirectly through immediate or long-term exposure to indoor air pollutants. Health effects associated with indoor air pollutants include eye/nose/throat irritation, respiratory diseases, heart disease, and even cancer. This study attempts to demonstrate the causal relationship between the indoor air quality and its determining aspects. Detailed indoor air quality audits were conducted in residential buildings located in Kolkata, India in the months of December and January 2021. According to the air pollution knowledge assessment city program in India, Kolkata is also the second most polluted mega-city after Delhi. Although the air pollution levels are alarming year-long, the winter months are most crucial due to the unfavorable environmental conditions. While emissions remain typically constant throughout the year, cold air is denser and moves slower than warm air, trapping the pollution in place for much longer and consequently is breathed in at a higher rate than the summers. The air pollution monitoring period was selected considering environmental factors and major pollution contributors like traffic and road dust. This study focuses on the relationship between the built environment and the spatial-temporal distribution of air pollutants in and around it. The measured parameters include, temperature, relative humidity, air velocity, particulate matter, volatile organic compounds, formaldehyde, and benzene. A total of 56 rooms were audited, selectively targeting the most dominant middle-income group. The data-collection was conducted using a set of instruments positioned in the human breathing-zone. The study assesses indoor air quality based on factors determining natural ventilation and air pollution dispersion such as surrounding environment, dominant wind, openable window to floor area ratio, windward or leeward side openings, and natural ventilation type in the room: single side or cross-ventilation, floor height, residents cleaning habits, etc.

Keywords: indoor air quality, occupant health, urban housing, air pollution, natural ventilation, architecture, urban issues

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Authors: Adaku Thelma Olatise

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Mental health disparities among women from diverse ethnic, cultural, and religious backgrounds remain a pressing concern, particularly as current psychotherapeutic models often fail to address the unique challenges these groups face. This is of particular concern since epidemiological studies across various countries and cultures consistently demonstrate higher prevalence rates of common mental disorders amongst these groups of women because of a lack of access to culturally oriented psychotherapeutic services. This literature review aims to examine how CCAs in psychotherapy can address the specific ethnic, cultural, and religious challenges women encounter in accessing mental health care. A search of relevant articles was conducted through PsycARTICLES and PubMed databases, using terms such as ‘mental health’, ‘women’, ‘culture’, and ‘ethnic minorities’. Supplementary searches on Google Scholar were also performed to capture literature not covered by traditional databases. While the importance of cross-cultural approaches in psychotherapy has become more apparent because people from diverse ethnic backgrounds inevitably perceive the world through different lenses, influencing their interpretations of human behavior and norms, there is a notable gap in the literature in understanding the influences of using of CCAs in psychotherapy amongst women of an ethnic minority. This gap not only reflects a poor understanding of the complex stressors faced by these women—such as familial, communal, and societal expectations—but also highlights the lack of support and culturally adapted interventions available to them. Even though scholars have posited that aligning treatment approaches with patients' cultural backgrounds is important to enhance therapeutic effectiveness, and the acknowledgment of culture is crucial in psychotherapy theory and practice. As well as the increasing global focus on psychotherapy applications that integrate non-Western practices, such as spiritual healing and community-based interventions, the adaptation of these approaches in mainstream mental health care has remained limited. This review found that the expectations and experiences of ethnic minority women were heavily influenced by family and community pressures. However, there were limited evidence-based, culturally oriented psychotherapeutic interventions tailored to ethnic minority women. This gap extends to inadequate representation of minority groups in clinical research, as well as a lack of culturally validated mental health outcome measures. Furthermore, studies have shown that psychotherapeutic models have largely been Western-oriented and Euro-centric because of socially constructed hierarchies. The origin of psychology from the Western world has predominantly reflected Western cultural traditions, shaped by historical, linguistic, and sociopolitical influences. These factors have led to a lack of recognition of therapeutic approaches from minority ethnic groups and the biases that emanate from hegemonic cultural beliefs and power dynamics influence the decisions about which psychotherapeutic modalities to integrate and practice. Therefore, this plethora of factors adds to the challenges women from ethnically and culturally diverse backgrounds face in accessing mental health services at the individual, familial, community, and societal levels. In conclusion, a cross-cultural approach is urgently needed within psychotherapy to address these challenges, ensuring that treatment frameworks are both culturally sensitive and gender responsive. Only by considering the lived experiences of minority women, particularly in relation to their cultural and religious contexts, can mental health services provide the appropriate care necessary to support their well-being.

Keywords: mental health, women, culture, ethnicity

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Authors: Puti F. Marzuki, Adrianto Oktavianus, Almerinda Regina

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Interface problems among interacting parties in Indonesian construction projects have most often led to low productivity and completion delay. In the midst of this country’s needs to accelerate construction of public infrastructure providing connectivity among regions and supporting economic growth as well as better living quality, project delays have to be seriously addressed. This paper identifies potential causes factors of interface problems experienced by construction projects in Indonesia. Data are collected through a survey involving the main actors of six important public infrastructure construction projects including railway, LRT, sports stadiums, apartment, and education building construction projects. Five of these projects adopt the design-build project delivery method and one applies the design-bid-build scheme. Interface problems’ potential causes are categorized into contract, management, technical experience, coordination, financial, and environmental factors. Research results reveal that, especially in railway and LRT projects, potential causes of interface problems are mainly technical and managerial in nature. These relate to complex construction execution in highly congested areas. Meanwhile, coordination cause factors are mainly found in the education building construction project with loan from a foreign donor. All of the six projects have to resolve interface problems caused by incomplete or low-quality contract documents. This research also shows that the design-bid-build delivery method involving more parties in construction projects tends to induce more interface problem cause factors than the design-build scheme.

Keywords: cause factors, construction delays, project delivery method, contract documents

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Authors: Khadije Khazaeli, Farzane Saberi

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Spinal cord injury is one of the traumatic events which has a great impact on the quality of life. spirituality has been used to improve many disorders and abnormalities in recent years and positive results have been seen; accordingly, the present study investigated the relationship between spirituality and quality of life in these patients. This study is a cross-sectional study of the correlation type was conducted on 100 people with spinal cord injury in Isfahan province in 2016 by the available sample method. Spirituality was assessed through the Spiritual Attitude Questionnaire and quality of life through the World Health Organization Quality of Life Questionnaire. Pearson correlation and regression tests were used to analyze the data. The results of this study showed that spirituality has a significant relationship with the quality of life of patients with spinal cord injury. It was also proved that all sub-units of spirituality, including attitude and spiritual ability, can affect all components of quality of life. The findings suggest that spirituality, along with other factors, can lead to a significant improvement in quality of life and, ultimately, general health of patients with SCI.

Keywords: spinal cord injury, quality of life, spirituality, patients

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Authors: K. M. G. T. R. Waidyarathna, S. M. Vidanagamachchi

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Public Health System exists in Sri Lanka has a satisfactory complete information flow when compared to other systems in developing countries. The availability of a good health information system contributed immensely to achieve health indices that are in line with the developed countries like US and UK. The health information flow at the moment is completely paper based. In Sri Lanka, the fields like banking, accounting and engineering have incorporated information and communication technology to the same extent that can be observed in any other country. The field of medicine has behind those fields throughout the world mainly due to its complexity, issues like privacy, confidentially and lack of people with knowledge in both fields of Information Technology (IT) and Medicine. Sri Lanka’s situation is much worse and the gap is rapidly increasing with huge IT initiatives by private-public partnerships in all other countries. The major goal of the framework is to support minimizing the spreading diseases. To achieve that a web based framework should be implemented for this application domain with web mapping. The aim of this GIS based public health system is a secure, flexible, easy to maintain environment for creating and maintaining public health records and easy to interact with relevant parties.

Keywords: DHIS2, GIS, public health, Sri Lanka

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Authors: Stephen Rulisa, Aimee Nyiramahirwe

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Background: Strategies to increase the uptake of contraception services have been adopted in Rwanda, but the unmet need for family planning remains high. Women in the postpartum period are at higher risk for unintended pregnancy due to the silent conversion from lactational amenorrhea to reactivation of ovulatory cycles. The purpose of this study was to explore the role of male partners in the uptake of postpartum contraception. Methods: A prospective cross-sectional study was conducted among women who delivered at the University Teaching Hospital of Kigali for a period of 3 months with random sampling. A questionnaire was used to collect socio-demographic and antenatal data, information on male companionship, and intent to use postpartum contraception at admission. Participants were contacted six weeks later to collect data on contraceptive use. The outcome variables were uptake of postpartum contraception and types of contraceptives taken (long-acting vs. short-acting), controlling for male companionship during the antenatal period. A Chi-square test was used and a p-value ≤0.05 was considered significant. Results: A total of 209 women were recruited with a mean age of 30.8±5.2 years. The majority (60.9%) were multigravida, and 66.5% were multiparous. More than half (55%) had male partner companionship, 18.3% had companionship for four antenatal visits, and 28.2% had education on contraception with their male partner. Factors significantly associated with uptake of postpartum contraception were: age above 30 years, owning or heading a business, multigravidity, multiparity, antenatal care at a health center or district hospital, cesarean delivery, and previous utilization of contraception. Male companionship significantly increased the intent to use contraception, uptake of modern contraception in general, and uptake of long active contraceptives but did not predict the uptake of short-acting contraceptives. Conclusions: Our study demonstrates a positive association between male companionship during antenatal care, labor and delivery with the uptake of postpartum family planning. Our study suggests more sensitization to involve the male partners, improving the education on contraception during antenatal care and further research to assess the sustained uptake of contraception beyond the postpartum period.

Keywords: postpartum, family planning, contraception, male partner, uptake

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Authors: Birtukan Atinkut Asmare, Bernhard Freyer, Jim Bingen

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Though it is possible to transform the farming system towards a healthy, sustainable, and toxic-free food system by reducing pesticide use both in the field and postharvest, pesticides, including those that have been banned or severely restricted from use in developed countries, are indiscriminately used in African agriculture. Drawing on social practice theory, this study is about pesticide use practices in smallholder farms and its adverse impacts on women’s health and the environment, with reference to Africa, with an empirical focus on Ethiopia. Data have been collected via integrating diverse quantitative and qualitative approaches such as household surveys (n= 318), focus group discussions (n=6), field observations (n=30), and key informant interviews (n=18), with people along the pesticide value chain, including sellers and extension workers up to women farmers. A binary logistic regression model was used to investigate the factors that influence the adoption of personal protective equipment among female headed households. The findings show that Female-headed households carried out risky and unsafe practices from pesticide purchasing up to disposal, largely motivated by material elements (such as labor, income, time, and the provisioning system) but were notably shaped by competences (skills and knowledge), and meanings (norms, values, rules, and shared ideas). The main meaning or material aspect for pesticide purchasing were the perceptions of efficacy on pests, diseases, and weeds (65%), cost and availability in smaller quantities (60.7%), and a woman’s available time and mobility (58.9%). Pesticide hazards to human health or the environment seem not to be relevant for most female headed households. Unsafe practices of pesticide use among women led to the loss of biodiversity and ecosystem degradation, let alone their and family’s health. As the regression results show, the significant factors that influenced PPE adoption among female headed households were age and retailer information (p < 0.05). In line with the empirical finding, in addition to changing individual competences through advisory services and training, a foundational shift is needed in the sociocultural environment (e.g., policy, advisory), or a change in the meanings (social norms), where women are living and working.

Keywords: biodiversity, competences, ecosystems, ethiopia, female headed households, materials, meanings, pesticide purchasing, pesticide using, social practice theory

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Authors: Juliana Bom-Tempo

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The proposed composition occurs between images, performances, clinics and philosophies. For this enterprise we depart for what is not known beforehand, so with a question as a compass: "would it be in the creation, production and implementation of images in a performance a 'when' for the event of a poetic clinic?” In light of this, there are, in order to think a 'when' of the event of a poetic clinic, images in performances created, produced and executed in partnerships with the author of this text. Faced with this composition, we built four indicators to find spatiotemporal coordinates that would spot that "when", namely: risk zones; the mobilizations of the signs; the figuring of the flesh and an education of the affections. We dealt with the images in performances; Crútero; Flesh; Karyogamy and the risk of abortion; Egg white; Egg-mouth; Islands, threads, words ... germs; Egg-Mouth-Debris, taken as case studies, by engendering risks areas to promote individuations, which never actualize thoroughly, thus always something of pre-individual and also individuating a environment; by mobilizing the signs territorialized by the ordinary, causing them to vary the language and the words of order dictated by the everyday in other compositions of sense, other machinations; by generating a figure of flesh, disarranging the bodies, isolating them in the production of a ground force that causes the body to leak out and undo the functionalities of the organs; and, finally, by producing an education of affections, by placing the perceptions in becoming and disconnecting the visible in the production of small deserts that call for the creation of a people yet to come. The performance is processed as a problematizing of the images fixed by the ordinary, producing gestures that precipitate the individuation of images in performance, strange to the configurations that gather bodies and spaces in what we call common. Lawrence proposes to think of "people" who continually use umbrellas to protect themselves from chaos. These have the function of wrapping up the chaos in visions that create houses, forms and stabilities; they paint a sky at the bottom of the umbrella, where people march and die. A chaos, where people live and wither. Pierce the umbrella for a desire of chaos; a poet puts himself as an enemy of the convention, to be able to have an image of chaos and a little sun that burns his skin. The images in performances presented, thereby, were moving in search for the power of producing a spatio-temporal "when" putting the territories in risk areas, mobilizing the signs that format the day-to-day, opening the bodies to a disorganization and the production of an education of affections for the event of a poetic clinic.

Keywords: Experimentations , Images in Performances, Poetic Clinic, Risk

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Authors: Kazi Ashief Mahmood

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Geographically Bangladesh is located in a natural hazard prone area. Compared to the rest of the areas, the coastal sub-districts are more vulnerable to climate variability and change. However, the hydro-geophysical reality of the sub-districts predominantly determines their contexts of vulnerability and its nature differs accordingly. Intriguingly enough, the poorest of the areas appear to be the most cornered among the different vulnerable sectors. Among of these deprived segments; however, the women, the persons with disability and the minorities are generally more vulnerable and they face a high risk of marginalized. The most threatening hydro-geophysical climate vulnerability have been created by prolonged dry season as observed at Koyra Upazilla in Khulna districts and Shyamnagar in Satkhira districts. The prolonged dry season creates severe surface salinity by which farmers cannot produce or use their to cultivate. The absence of land-based production and employment in the area has led to severe food insecurity. As a result, farmers tend to change their livelihood option and many of them are forced to migrate to the other areas of the country in search of livelihood. Besides salinity intrusion, water logging, drought and different climate change induced hazards are endangering safe drinking water sources and putting small-holders out of agriculture-based livelihoods in the Koyra and Shyamnagar Upazilla. A sizeable fraction of small-holders are still trying to hold on to their small scale shrimp production, despite being under pressure to sell off their cultivating lands to their influential shrimp merchants. While their desperate effort to take advantage of the increasing salinity is somewhat successful, their families still face a greater risk of health hazards owing to the lack of safe drinking water. Unless the issues of salinity in drinking water cannot be redressed, the state of the affected people will be in great jeopardy. Most of the inhabitants of oKyra and Shyamnagar Upazilla are living under the poverty line. Thus, poverty is a major factor that intensifies the vulnerability caused by hydro-geophysical climatic conditions. The government and different NGOs are trying to improve the present scenario by implementing different disaster risk reduction projects along with poverty reduction for community empowerment.

Keywords: assessment, climate change, climate induced hazards, coastal zone

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Authors: Mohammad Qasim Mohammadi, Mohammad Arif Rohman

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Although socially sustainable building is becoming increasingly popular worldwide, past studies indicate that when policymakers support sustainable building development, the social dimension is often given insufficient attention or entirely disregarded. There are not many studies that focus on the problems of socially sustainable buildings in Afghanistan. This research investigates the factors that may hinder social sustainability implementation in residential building construction. The study will gather data from construction professionals by purposive sampling and employ Exploratory Factor Analysis (EFA) and Varimax for analysis. The results will undergo rigorous examination and thorough discussion. The expected results in this research will analyze the underlying barrier structure (factors) that hinder social sustainability, and each of these factors will represent a set of observed variables. In addition, the factor loadings show which barriers pose the greatest challenges. The primary goal of this study is to provide valuable insights into the impediment factors of social sustainability within the residential building environment, aiming to inform decision-making in the industry and encourage the adoption of more socially sustainable construction practices.

Keywords: social sustainability, residential building, barriers, drivers, afghanistan, factor analysis

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Authors: Jerome Michael J. Sadullo, Jamaica Lois A. Torres, Trisha Muriel T. Valino

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In the Philippines, Central Luzon is one of the regions at high risk in terms of volcanic eruption. In fact, last June 15, 1991, which were the Mount Pinatubo has erupted, the most affected provinces were Zambales, Olangapo, Pampanga, Tarlac, Bataan, Bulacan and Nueva Ecija. During the Mount Pinatubo eruption, Castillejos, Zambales, has recorded the most significant damage to both commercial and residential structures. In this study, the researchers aim to determine and analyze the various impacts of ashfall on roof structures in Concepcion, Tarlac, during the event of a volcanic eruption. In able for the researcher to determine the sample size of the study, they have utilized Cochran's sample size formula. With the computed sample size, the researchers have gathered data through the distribution of survey forms, utilizing public records, and picture documentation of different roof structures in Concepcion, Tarlac. With the data collected, Chi-squared goodness of fit was done by the researcher in order to compare the data collected from the observed N (Concepcion, Tarlac) and expected N (Castillejos, Zambales). The results showed that when it comes to the roof constructions material used in Concepcion, Tarlac and Castillejos, Zambales. Structures in Concepcion, Tarlac were most likely to suffer worse when another eruption happens compared to the structures in Castillejos, Zambales. Yet, considering the current structural statuses of structure in Concepcion Tarlac and its location from Mount Pinatubo, they are less likely to experience ashfall.

Keywords: risk assessment, Concepcion, Tarlac, Volcano Pinatubo, roof structures, ashfall

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Authors: Mohammed-Hareef Asunramu, Sana Hashemi, Raja Ohri, Luc Worthington, Nadia Zaman, Junkai Zhu

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Background: The 2012 Health and Social Care Act committed to a ‘parity of esteem between mental and physical health services. Although this investment, aimed to both increase the quality of services and ensure the retention of mental health staff, questions remained regarding its ability to prevent mental health problems. One possible solution is a focus on the social determinants of health which have been shown to impact mental health. Aim: To examine the relationship between the index of multiple deprivations (IMD) and the prevalence of common mental health disorders (CMD) for CCGs in NHS England between 2019 and 2020. Design and setting: Cross-sectional analysis of 189 CCGs in NHS England. Methods: A multivariate linear regression model was utilized with CMD as outcome variable and IMD, age and ethnicity as explanatory variables. Datasets were obtained from Public Health England and the latest UK Census. Results: CCG IMD was found to have a significantly positive relationship with CMD. For every 1-point increase in IMD, CMD increases by 0.25%. Ethnicity had a significantly positive relationship with CMD. For every 1% increase in the population that identifies as BME, there is a 0.03% increase in CMD. Age had a significantly negative relationship with CMD. For every 1% increase in the population aged 60+, there is a 0.11% decrease in CMD. Conclusion: This study demonstrates that addressing mental health issues may require a multi-pronged approach. Beyond budget increases, it is essential to prioritize health equity, with careful considerations towards ethnic minorities and different age brackets.

Keywords: deprivation, health inequality, mental health, social determinants

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Authors: Yi-Ting Chen, Yu-Fang Huang, Pei-Wei Wang, Hai-Wei Liang, Chun-Hao Lai, Mei-Lien Chen

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Background: Bisphenol A (BPA) is commonly used in consumer products, such as inner coatings of cans and polycarbonated bottles. BPA is considered to be an endocrine disrupting substance (EDs) that affects normal human hormones and may cause adverse effects on human health. Pregnant women and fetuses are susceptible groups of endocrine disrupting substances. Prenatal exposure to BPA has been shown to affect the fetus through the placenta. Therefore, it is important to evaluate the potential health risk of fetal exposure to BPA during pregnancy. The aims of this study were (1) to determine the urinary concentration of BPA in pregnant women, and (2) to investigate the association between BPA exposure during pregnancy and birth outcomes. Methods: This study recruited 117 pregnant women and their fetuses from 2012 to 2014 from the Taiwan Maternal- Infant Cohort Study (TMICS). Maternal urine samples were collected in the third trimester and questionnaires were used to collect socio-demographic characteristics, eating habits and medical conditions of the participants. Information about birth outcomes of the fetus was obtained from medical records. As for chemicals analysis, BPA concentrations in urine were determined by off-line solid-phase extraction-ultra-performance liquid chromatography coupled with a Q-Tof mass spectrometer. The urinary concentrations were adjusted with creatinine. The association between maternal concentrations of BPA and birth outcomes was estimated using the logistic regression model. Results: The detection rate of BPA is 99%; the concentration ranges (μg/g) from 0.16 to 46.90. The mean (SD) BPA levels are 5.37(6.42) μg/g creatinine. The mean ±SD of the body weight, body length, head circumference, chest circumference and gestational age at birth are 3105.18 ± 339.53 g, 49.33 ± 1.90 cm, 34.16 ± 1.06 cm, 32.34 ± 1.37 cm and 38.58 ± 1.37 weeks, respectively. After stratifying the exposure levels into two groups by median, pregnant women in higher exposure group would have an increased risk of lower body weight (OR=0.57, 95%CI=0.271-1.193), smaller chest circumference (OR=0.70, 95%CI=0.335-1.47) and shorter gestational age at birth newborn (OR=0.46, 95%CI=0.191-1.114). However, there are no associations between BPA concentration and birth outcomes reach a significant level (p < 0.05) in statistics. Conclusions: This study presents prenatal BPA profiles and infants in northern Taiwan. Women who have higher BPA concentrations tend to give birth to lower body weight, smaller chest circumference or shorter gestational age at birth newborn. More data will be included to verify the results. This report will also present the predictors of BPA concentrations for pregnant women.

Keywords: bisphenol A, birth outcomes, biomonitoring, prenatal exposure

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Authors: Bagweneza Vedaste, Rugema Joselyne, Twagirayezu Innocent, Nikuze Bellancille, Nyirazigama Alice, Ishimwe Bazakare Marie Laetitia, Kaberuka Gerard, Mukeshimana Madeleine

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Background: Teen pregnancies have dramatically increased across the country in the past few years. Teen mothers usually face difficulties accessing the reproductive health (RH) services due to different reasons that include fear of getting discriminated or seen by other people. Some teen mothers do not also know their rights regarding the RH services, and they sometimes get discriminated. Little is known in Rwanda regarding how these teen mothers access the RH services compared to the general population, and views of teen mothers on their rights to access these services have not been clearly documented in the country. Specific Aims: To explore baseline information about SRH services among teen mothers; to explore factors that contribute to the use of SRH services among teen mothers; to identify strategies to increase awareness on SRHR (Sexual and Reproductive Health and Rights) among teen mothers in targeted area; and to explore views of teen mothers on rights for SRH services. Research design/Methodology: The qualitative exploratory descriptive research will be used among the teen mothers in five selected health centers of Rwamagana district. The study will use the qualitative descriptive study design. Setting: The study will be conducted in five selected health centers of Rwamagana district, which has been chosen due to a higher number of adolescent pregnancies in Eastern Province according to the DHS 2019-2020. Participants: The participants in this study will be teenage mothers who conceived after turning 11 but have delivered before turning 19. As the upper age for teenage is 19 years, this means that the researchers anticipated that those conceiving at 19 years may deliver in their twenties, which was the upper age limit in this study. Data collection measures: A semi-structured interview guide will be used to gather information from the respondents in focus group discussions. Significance: The findings of this study will provide a picture regarding the access of teen mothers to SRHS and their rights to SRH services. They will increase their awareness regarding SRH services and rights. Finally, the findings may help to address barriers faced by teen mothers to reach, pay and utilize SRHS.

Keywords: sexual and reproductive health services, inclusiveness, qualitative study, adolescent mothers

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Authors: Stephanie A. Schauder, Gosia Sylwestrzak

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Overweight and obese women report avoiding preventive care due to fear of weight-related bias from medical professionals. Gynecological exams, due to their sensitive and personally invasive nature, are especially susceptible to avoidance. This research investigates the association between body mass index (BMI) and screening rates for breast and cervical cancer using claims data from 1.3 million members of a large health insurance company. Because obesity is associated with increased cancer risk, screenings for these cancers should increase as BMI increases. However, this paper finds that the distribution of cancer screening rates by BMI take an inverted U-shape with underweight and obese members having the lowest screening rates. For cervical cancer screening, those in the target population with a BMI of 23 have the highest screening rate at 68%, while Obese Class III members have a screening rate of 50%. Those in the underweight category have a screening rate of 58%. This relationship persists even after controlling for health and demographic covariates in regression analysis. Interestingly, there is no association between BMI and BRCA (BReast CAncer gene) genetic testing. This is consistent with the narrative that stigma causes avoidance because genetic testing does not involve any assessment of a person’s body. More work must be done to determine how to increase cancer screening rates in those who may feel stigmatized due to their weight.

Keywords: cancer screening, cervical cancer, breast cancer, weight stigma, avoidance of care

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Authors: Anietie J. Atangwho, Udeme E. Asibong, Item J. Atangwho, Ndifreke E. Udonwa

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Diabesity, a syndrome where diabetes and obesity occur simultaneously in a single patient, has emerged as a recent challenge to the medical world and is already at epidemic proportion in some countries. Therefore, this study aimed to determine the prevalence of diabesity among adult patients attending the General Outpatient clinic of three healthcare facilities in Calabar in a bid to improve healthcare delivery to patients at risk. A cross-sectional descriptive study design was employed using a mixed method approach that comprised quantitative and qualitative components i.e., Focused Group Discussion (FGD) and Key Informant Interview (KII). One hundred and ninety (190) participants aged 18 to 72 years and body mass index (BMI) ≥ 30kg/m2 were recruited as the study population for the quantitative study using systematic random sampling technique and analysed using SPSS version 25. The qualitative component performed 4 FGDs and 3 KIIs. Results of sociodemographic variables showed respondents aged 35 – 44 as highest in number (37.3%). Of this number, 83.7% were females, 76.8% married, and 3.7% earned USD1,110.00 monthly. Whereas majority of the participants (65.8 %) were within class 1 obesity, only 38% considered themselves obese. Diabesity occurrence was found to be 12.6% (i.e. BMI ≥ 30 to 45.2kg/m2 vs FBS ≥ 7.0 – 14.8mmo/l), with 38% of them being previously undiagnosed. About 48.4 % of the respondents ate two meals only per day; with 90.5% eating between meals. Snacking was predominant, mostly pastries (67.9%), with 58.9% taking cola drinks alongside. Sixty-one percent participated in one form of exercise or the other, with walking/trekking as the most common; 34.4 % had no regular exercise schedule. Only about 39.5% of the participants spent less than an hour on devices like phone, television, and laptops. Additionally, previously known and newly diagnosed hypertensive patients were 27.9% and 7.2%, respectively. Qualitative assessment with KII and FGDs showed eating unhealthy diets and lack of exercise as major factors responsible for diabesity. The bivariate analysis revealed significant association between diabesity with marital status and hypertension (p = 0.007 and p = 0.005, respectively). Also, positive association with diabesity were eating snacking (p = 0.017) and number of times a respondent snacks per day (p = 0.035). Overall, the study has revealed the occurrence of diabesity in Calabar at 12.6 % of the study population, with 38 % of them previously undiagnosed; it identified unhealthy diets and lack of exercise as causative factors as well as hypertension as snacking associatory indicators of diabesity.

Keywords: diabesity, obesity, diabetes, unhealthy diet

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Authors: Lei Ye, Min Liu, Yong-Li Gao, Jun Zhang

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Purpose: The aims of the study are to investigate the status of health-promoting lifestyle and to compare the healthy lifestyle of emergency nurses in different levels of hospitals in Sichuan province, China. The investigation is mainly about the health-promoting lifestyle, including spiritual growth, health responsibility, physical activity, nutrition, interpersonal relations, stress management. Then the factors were analyzed influencing the health-promoting lifestyle of emergency nurses in hospitals of Sichuan province in order to find the relevant models to provide reference evidence for intervention. Study Design: A cross-sectional research method was adopted. Stratified cluster sampling, based on geographical location, was used to select the health facilities of 1389 emergency nurses in 54 hospitals from Sichuan province in China. Method: The 52-item, six-factor structure Health-Promoting Lifestyle Profile II (HPLP- II) instrument was used to explore participants’ self-reported health-promoting behaviors and measure the dimensions of health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management. Demographic characteristics, education, work duration, emergency nursing work duration and self-rated health status were documented. Analysis: Data were analyzed through SPSS software ver. 17.0. Frequency, percentage, mean ± standard deviation were used to describe the general information, while the Nonparametric Test was used to compare the constituent ratio of general data of different hospitals. One-way ANOVA was used to compare the scores of health-promoting lifestyle in different levels hospital. A multiple linear regression model was established. P values which were less than 0.05 determined statistical significance in all analyses. Result: The survey showed that the total score of health-promoting lifestyle of nurses at emergency departments in Sichuan Province was 120.49 ± 21.280. The relevant dimensions are ranked by scores in descending order: interpersonal relations, nutrition, health responsibility, physical activity, stress management, spiritual growth. The total scores of the three-A hospital were the highest (121.63 ± 0.724), followed by the senior class hospital (119.7 ± 1.362) and three-B hospital (117.80 ± 1.255). The difference was statistically significant (P=0.024). The general data of nurses was used as the independent variable which includes age, gender, marital status, living conditions, nursing income, hospital level, Length of Service in nursing, Length of Service in emergency, Professional Title, education background, and the average number of night shifts. The total score of health-promoting lifestyle was used as dependent variable; Multiple linear regression analysis method was adopted to establish the regression model. The regression equation F = 20.728, R2 = 0.061, P < 0.05, the age, gender, nursing income, turnover intention and status of coping stress affect the health-promoting lifestyle of nurses in emergency department, the result was statistically significant (P < 0.05 ). Conclusion: The results of the investigation indicate that it will help to develop health promoting interventions for emergency nurses in all levels of hospital in Sichuan Province through further research. Managers need to pay more attention to emergency nurses’ exercise, stress management, self-realization, and conduct intervention in nurse training programs.

Keywords: emergency nurse, health-promoting lifestyle profile II, health behaviors, lifestyle

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Authors: Barry Aifesehi Aiworo, Henry Oriakhi

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This paper, examines the analysis of access pattern to school and travel risks among school children in Benin City, Edo State, Nigeria. The risk includes accident, molestation (sexually) and kidnapping. The objective of this paper are to examine the various means (modes) of transport to school; determine the type and incidences of risk experienced by school children in the study area; examine the risk incidences and ages of school children in the study area. Hypothesis which states that the types of risks encountered by school children are independent of means of transport was tested using the chi-square test (X2). A sampling ratio of twelve percent (12%) was taken from 396 schools in Benin City. By implication, 49 schools were randomly selected in Benin City for this research. A total of 42,053 students in the 49 schools constitute the sample frame for the research. Two percent (2%), 841 students were taken as the sample size. The use of stratified sampling method was applied by stratifying the study area (Benin City) into local governments- Egor, Ikpoba-Okha and Oredo. Thereafter, the lists of schools in the various local governments were obtained from the Ministry of Education before the schools for research were randomly chosen from each local government area. The analysis revealed that 6.7% of the total students interviewed have been involved in road accidents. 1.04% of the total respondents said at one time or the other that they have been kidnapped. Finally, the research found that travel is comparatively safe and believes this may be partly attributable to safer route to schools and school children being more familiar with the school journey. The research indicates that children aged between eleven and fifteen are most at risk of hit or knocked down on Benin City’s roads. These findings may help in planning and targeting road safety initiative (education, campaigns) in Benin City.

Keywords: accident, molestation (sexually), kidnapping, pedophile, pedestrian

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Authors: Mariko Nishikawa, Masaaki Yamanaka, Ayami Kondo

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Background: International visitors to Japan are at a risk of travel-related illnesses or injury that could result in hospitalization in a country where the language and customs are unique. Over twelve million international visitors came to Japan in 2015, and more are expected leading up to the Tokyo Olympics. One aspect of this is the potentially greater demand on healthcare services by foreign visitors. Nurses who take care of them have anxieties and concerns of their knowledge of the Japanese health system. Objectives: An effective distribution of travel-health information is vital for facilitating care for international visitors. Our research investigates whether a four-minute digital animation (Mari Info Japan), designed and developed by the authors and applied to a survey of 513 nurses who take care of foreigners daily, could clarify travel health procedures, reduce anxieties, while making it enjoyable to learn. Methodology: Respondents to a survey were divided into two groups. The intervention group watched Mari Info Japan. The control group read a standard guidebook. The participants were requested to fill a two-page questionnaire called Mari Meter-X, STAI-Y in English and mark a face scale, before and after the interventions. The questions dealt with knowledge of health promotion, the Japanese healthcare system, cultural concerns, anxieties, and attitudes in Japan. Data were collected from an intervention group (n=83) and control group (n=83) of nurses in a hospital, Japan for foreigners from February to March, 2016. We analyzed the data using Text Mining Studio for open-ended questions and JMP for statistical significance. Results: We found that the intervention group displayed more confidence and less anxiety to take care of foreign patients compared to the control group. The intervention group indicated a greater comfort after watching the animation. However, both groups were most likely to be concerned about language, the cost of medical expenses, informed consent, and choice of hospital. Conclusions: From the viewpoint of nurses, the provision of travel-health information by digital animation to international visitors to Japan was more effective than traditional methods as it helped them be better prepared to treat travel-related diseases and injury among international visitors. This study was registered number UMIN000020867. Funding: Grant–in-Aid for Challenging Exploratory Research 2010-2012 & 2014-16, Japanese Government.

Keywords: digital animation, health promotion, international visitor, Japan, nurse

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Authors: Yananda Siraphatthada

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The objectives of this research were to study the level of influencing factors, leadership, supply chain management, innovation, competitive advantages, business success, and affecting factors to the business success of the mobile phone system service providers in Bangkok Metropolitan. This research was done by the quantitative approach and the qualitative approach. The quantitative approach was used for questionnaires to collect data from the 331 mobile service shop managers franchised by AIS, Dtac and TrueMove. The mobile phone system service providers/shop managers were randomly stratified and proportionally allocated into subgroups exclusive to the number of the providers in each network. In terms of qualitative method, there were in-depth interviews of 6 mobile service providers/managers of Telewiz and Dtac and TrueMove shop to find the agreement or disagreement with the content analysis method. Descriptive Statistics, including Frequency, Percentage, Means and Standard Deviation were employed; also, the Structural Equation Model (SEM) was used as a tool for data analysis. The content analysis method was applied to identify key patterns emerging from the interview responses. The two data sets were brought together for comparing and contrasting to make the findings, providing triangulation to enrich result interpretation. It revealed that the level of the influencing factors – leadership, innovation management, supply chain management, and business competitiveness had an impact at a great level, but that the level of factors, innovation and the business, financial success and nonbusiness financial success of the mobile phone system service providers in Bangkok Metropolitan, is at the highest level. Moreover, the business influencing factors, competitive advantages in the business of mobile system service providers which were leadership, supply chain management, innovation management, business advantages, and business success, had statistical significance at .01 which corresponded to the data from the interviews.

Keywords: mobile service providers, facilitating factors, Bangkok Metropolitan, business success

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Authors: Warsi A. Ibrahim, Qureshi A. Ambrina, Younus M. Anjum

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Introduction: Oral lesions related to commercially available Smokeless Tobacco (ST), such as, Pan, Gutka, Mahwa, Naswar is considered a serious challenge for dental health care providers in Pakistan. Majority of labored Pakistani population consume ST, where public transporters and drivers are no exception. It was necessary to identify individuals of this particular population group and screen their oral health and early signs of pre-cancerous lesions so that appropriate preventive measures could be taken to reduce the burden on health providers. Aim of Study: To estimate Prevalence of ST consumption and perception of use, and to evaluate Oral Health status among public drivers of Karachi. Material & methods: A cross-sectional study survey was conducted over duration of 2 months, through convenient sampling. Sample size (n=615) of public drivers (age > 18 years) all over Karachi was gathered. A structured proforma was used to record socio-demographics, addiction profile, perception of use and oral health status (oral lesions, oral sub-mucosal fibrosis and dental caries) of study participants. Data was entered and analyzed using SPSS version 16.0 using descriptive statistics only. Results: Prevalence of ST consumption among the study participants was figured to 92.5%. Out of these almost 70% suffered from one or the other form of oral lesion(s). Four major types of ST consumption were observed out of which 60 % of oral lesion were related to Gutka chewers showing early signs of oral cancer. In addition, occurrence of Oral sub-mucosal fibrosis (OSF) was found to be significantly high around 54.8%. Overall dental caries status was also high, showing on an average 5 teeth of an individual were decayed, missing or filled deviating from WHO normal criteria (mean < 3). It was thus proven from the study that public drivers relied on oral tobacco consumption because it helps them ‘Improve consciousness’ (p-value: < 0.01; using chi-square test). Multivariate analysis showed that there were higher prevalence of smokeless tobacco among highway drivers versus local drivers (A.O.R: 2.82 [0.83-9.61], p-value: < 0.01) Conclusion: Smokeless tobacco (ST) consumption has a direct effect on oral health. However, the type of ST, the duration of consumption are factors which are directly related to the severity. Moreover, Gutka may be considered as having most lethal effects on oral health which may lead to oral cancer and affect individual’s quality of life. Specific preventive programs must be undertaken to reduce the consumption of Gutka among public transporters and drivers.

Keywords: smokeless tobacco, oral lesions, drivers, public transporters

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Authors: C. Fernandez-Plaza, I. Abad, E. Diaz, I. Diaz

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Births occurring before the 37th week of gestation are considered preterm births. A threat of preterm is defined as the beginning of regular uterine contractions, dilation and cervical effacement between 23 and 36 gestation weeks. To author's best knowledge, the factors that determine the beginning of the birth are not completely defined yet. In particular, the incidence of sleep habits on preterm births is weekly studied. The aim of this study is to develop a model to predict the factors affecting premature delivery on pregnancy, based on the above potential risk factors, including those derived from sleep habits and light exposure at night (introduced as 12 variables obtained by a telephone survey using two questionnaires previously used by other authors). Thus, three groups of variables were included in the study (maternal, fetal and sleep habits). The study was approved by Research Ethics Committee of the Principado of Asturias (Spain). An observational, retrospective and descriptive study was performed with 481 births between January 1, 2015 and May 10, 2016 in the University Central Hospital of Asturias (Spain). A statistical analysis using SPSS was carried out to compare qualitative and quantitative variables between preterm and term delivery. Chi-square test qualitative variable and t-test for quantitative variables were applied. Statistically significant differences (p < 0.05) between preterm vs. term births were found for primiparity, multi-parity, kind of conception, place of residence or premature rupture of membranes and interruption during nights. In addition to the statistical analysis, machine learning methods to look for a prediction model were tested. In particular, tree based models were applied as the trade-off between performance and interpretability is especially suitable for this study. C5.0, recursive partitioning, random forest and tree bag models were analysed using caret R-package. Cross validation with 10-folds and parameter tuning to optimize the methods were applied. In addition, different noise reduction methods were applied to the initial data using NoiseFiltersR package. The best performance was obtained by C5.0 method with Accuracy 0.91, Sensitivity 0.93, Specificity 0.89 and Precision 0.91. Some well known preterm birth factors were identified: Cervix Dilation, maternal BMI, Premature rupture of membranes or nuchal translucency analysis in the first trimester. The model also identifies other new factors related to sleep habits such as light through window, bedtime on working days, usage of electronic devices before sleeping from Mondays to Fridays or change of sleeping habits reflected in the number of hours, in the depth of sleep or in the lighting of the room. IF dilation < = 2.95 AND usage of electronic devices before sleeping from Mondays to Friday = YES and change of sleeping habits = YES, then preterm is one of the predicting rules obtained by C5.0. In this work a model for predicting preterm births is developed. It is based on machine learning together with noise reduction techniques. The method maximizing the performance is the one selected. This model shows the influence of variables related to sleep habits in preterm prediction.

Keywords: machine learning, noise reduction, preterm birth, sleep habit

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