Search results for: mental health and wellbeing

Authors: Zaman Jawahar, Anne Rouve-Khiev, Elizabeth Hoban, Joanne Williams

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Ensuring access to timely obstetric care is essential to prevent maternal deaths. Geographical barriers pose significant challenges for women accessing quality reproductive and maternal health services in rural Cambodia. This policy brief affirms the need to address the issue of transportation and cost (direct and indirect) as critical barriers to accessing reproductive and maternal health (RMH) services in four provinces in Northeast Cambodia (Kratie, Ratanak Kiri, Mondul Kiri, Stung Treng). A systemic search of the literature identified 1,116 articles, and only ten articles from low-and-middle-income countries met the inclusion criteria. The ten articles reported on transportation and cost related to accessing RMH services. In addition, research findings from Partnering to Save Lives (PSL) studies in the four provinces were included in the analysis. Thematic data analysis using the information in the ten articles and PSL research findings was conducted, and the findings are presented in this paper. The key findings are the critical barriers to accessing RMH services in the four provinces because women experience: 1) difficulties finding affordable transportation; 2) lack of available and accessible transportation; 3) greater distance and traveling time to services; 4) poor geographical terrain and; 5) higher opportunity costs. Distance and poverty pose a double burden for the women accessing RMH services making a facility-based delivery less feasible compared to home delivery. Furthermore, indirect and hidden costs associated with institutional delivery may have an impact on women’s decision to seek RMH care. Existing health financing schemes in Cambodia such as the Health Equity Fund (HEF) and the Voucher Scheme contributed to the solution but have also shown some limitations. These schemes contribute to improving access to RMH services for the poorest group, but the barrier of transportation costs remains. In conclusion, initiatives that are proven to be effective in the Cambodian context should continue or be expanded in conjunction with the HEF, and special consideration should be given to communities living in geographically remote regions and difficult to access areas. The following strategies are recommended: 1) maintain and further strengthen transportation support in the HEF scheme; 2) expand community-based initiatives such as Community Managed Health Equity Funds and Village Saving Loans Associations; 3) establish maternity waiting homes; and 4) include antenatal and postnatal care in the provision of integrated outreach services. This policy brief can be used to inform key policymakers and provide evidence that can assist them to develop strategies to increase poor women’s access to RMH services in low-income settings, taking into consideration the geographic distance and other indirect costs associated with a facility-based delivery.

Keywords: access, barriers, northeast Cambodia, reproductive and maternal health service, transportation and cost

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Authors: Beryl Apondi Obola

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Introduction: Mosquitoes are known to transmit various diseases such as malaria, dengue fever, and Zika virus. Mosquito repellents are commonly used to prevent mosquito bites. However, some of these repellents contain chemicals that can be harmful to human health and the environment. Therefore, there is a need to find alternative mosquito repellents that are safe and effective. Objective: The objective of this research is to investigate the effectiveness of banana leaves as an alternative mosquito repellent on Plasmodium falciparum and Plasmodium vivax. Methodology: The research will be conducted in two phases. In the first phase, the repellent properties of banana leaves will be tested in a laboratory setting. The leaves will be crushed and mixed with water to extract the active ingredients. The extract will be tested against mosquitoes in a controlled environment. The number of mosquitoes that are repelled by the extract will be recorded. In the second phase, the effectiveness of the banana leaf extract will be tested in the field. The extract will be applied to the skin of human volunteers, and the number of mosquito bites will be recorded. The results will be compared to a commercially available mosquito repellent. Expected Outcomes: The expected outcome of this research is to determine whether banana leaves can be used as an effective mosquito repellent. If the results are positive, banana leaves could be used as an alternative to chemical-based mosquito repellents. Conclusion: Banana leaves have been used for various purposes in traditional medicine. This research aims to investigate the potential of banana leaves as an alternative mosquito repellent. The results of this research could have significant implications for public health and the environment

Keywords: banana leaf extract, mosquito repellant, plasmodium falciparum, public health

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Authors: Rashed Shah, Jeanne Koepsell, Dixmer Rivera, Eric Swedberg, David Marsh

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Success of primary health care goals of health promotion and disease prevention may well be determined by community based health workers’ overall job satisfaction. It is also important to understand the ways community health workers perceive their jobs and the importance they give to the various factors influencing their job satisfaction, which is critical before making a decision for task-shifting and for expanding their scope of work. Although brigadistas are unpaid volunteers, they are formally recognized and receive support and supervision from the Ministry of Health in Nicaragua. Brigadistas are responsible for classifying and diagnosing illnesses, administering treatment, counseling mothers and care givers within the community, encouraging referral in case of serious illness and making follow-up visits at home. Some brigadistas provide more technically advanced services, including treatment for pneumonia, diarrhea, malaria and tuberculosis and/or distribution of contraceptives. Expanding brigadistas’ duties could threaten their heretofore ‘job satisfaction’. This study primarily aims to report on job satisfaction of brigadistas in Nicaragua before expanding the scope of their work by adding more responsibilities. The study was guided by the following research questions: 1) What aspects of their job made the brigadistas satisfied or dissatisfied? 2) What is the job satisfaction level of brigadistas in Nicaragua? This cross-sectional study was conducted during March – July 2014, to assess brigadistas’ job satisfaction, prior to deciding on inclusion of care for sick newborns and young infants (<2 months of age) to brigadistas’ existing service package of community case management for children of 2-59 months of age. Following stratified random sampling strategy, 15 brigadistas were randomly selected from each of the following four strata: [(1) females under 25 years of age, (2) females over 30 years of age, (3) males under 25 years of age, and (4) males over 30 years of age. Out of 45 completed in-person interview with eligible and available brigadistas, 20 (44.4%) were with female and 25 (55.6%) were with male respondents; the mean age (±sd) was found as 32.0 (±3.2) years. About 53% (24/45) brigadista mentioned “Training” as the most helpful for performing their job. Another 31% (14/45) mentioned that “feeling of doing good, supporting community, women and children” was helpful to perform their job well. When asked about difficulty, about 35.5% (16/45) brigadistas mentioned about “Lack of time” due to their responsibilities in family, farm, other work places, study and such time constraint made their job performance difficult. Measured on a 0-5 scale, estimated average job satisfaction was 4.2. Current trends in task-shifting and integrated program delivery require community health workers (like the brigadistas) to deliver several essential services, including maternal, newborn and child health, and family planning, and thereby increasing their responsibilities. Given the reported level of job satisfaction among brigadistas (4.2 out of 5), and the mentioned difficulty in performing their current job (as ‘Lack of Time’) in this study results, the policy makers and program managers in MOH should be cautious enough before making a decision to expand current scope of work for brigadistas in Nicaragua.

Keywords: Brigadisata, job satisfaction, Nicaragua, task-shifting

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Authors: Wen-Hsien Huang, Hsu-Ting Hsu

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While advertisers often use animal metaphors to promote product performance, representing through the use of a product image together with an animal-like messenger to imply the undesirable health states of not using the product, the effect of such metaphors on persuasion remains unclear. The current research addresses this issue by investigating how consumers perceive and react to animal metaphor advertising in the context of product promotion. Three studies are carried out using field and experimental data. The findings demonstrate that animal metaphor ads are less persuasive than non-metaphor ads and that ads with animal-like messengers (as opposed to human messengers) activate stronger dehumanization perceptions, which in turn lead to lower product choice, product evaluation and purchase intention, regardless of whether the animal metaphors are presented visually in the picture or verbally in the headline. Furthermore, when the metaphorical pairing includes a more disliked animal, consumer reaction was less favorable. The implications of the findings for advertisers considering the use of animalized messengers are discussed.

Keywords: animal metaphor, dehumanization, product evaluation, health communication

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Authors: Arpita Paul

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Wang Yang-ming introduced a revolutionary dimension to Japanese thought through his philosophy on intuitive moral consciousness. Post-Meiji Restoration,Emerson struck a chord with the Japanese due to the striking similarities his theories on transcendentalism had with doctrines of Wang Yang-ming'sschool of thought (Yōmeigaku), as pointed out by HomeiIwano (1873-1920). Wang's philosophy, chiefly anchored in the idea of the fundamental unity of thought and action, resembles the non-dualistic aspect of Brahman, a subject of Emerson's deep interest. Kitamura Tōkoku's (1868-1894) ardent reading of Emerson corroborated what he had learned in Wang Yang-ming's philosophy. This essay shall begin with a discussion on Emerson's discoveries of Vedanta that later, on a parallel ground with Yōmeigaku, significantly influenced Tōkoku. This essay will then demonstrate how Tōkokutransforms these philosophies to portray the advent of modern consciousness in Japan in his magnum opus"Naibuseimeiron." In his attempt to undo the blindfold of past feudalism,Tōkoku repeatedly championed the mental process of a self-reliant individual in his essays which showcase the metamorphosis of Japanese individualism in the final decades of the Meiji Period. In seeking to express Japan's budding intellectual enterprise,Tōkoku asserts securing one's vantage point in the world through an awakened consciousness. In his desire to articulate this, Tōkoku becomes, as argued in this paper's penultimate and final sections, a fascinating merging point of the philosophical doctrines of Vedanta, Yōmeigaku, and Emerson, a rare depiction in the existing scholarship.

Keywords: meiji intellengtsia, yomeigaku, vedanta, modern consciousness

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Authors: Ayantika Biswas

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Hypertension still remains one of the most important preventable contributors to adult mortality and morbidity and a major public health challenge worldwide. Studying regional and rural-urban differences in prevalence and assessment of the contributions of different indicators is essential in determining the drivers of this condition. The 2015-16 National Family Health Survey data has been used for the study. Bivariate analysis, multinomial regression analysis, concentration indices and decomposition of concentration indices assessing contribution of factors has been undertaken in the present study. An overall concentration index of 0.003 has been found for hypertensive population, which shows its concentration among the richer wealth quintiles. The contribution of factors like age 45 to 49 years, years of schooling between 5 to 9 years are factors that are important contributors to inequality in hypertension occurrence. Studies should be conducted to find approaches to prevent or delay the onset of the condition.

Keywords: hypertension, decomposition, inequalities, India

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Authors: Asma Ammar, Nabiha Bouafia , Asma BenCheikh, Mohamed Mahjoub, Olfa Ezzi, Wadiaa Bannour, Radhia Helali, Mansour Njah

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Background: The objective of the present study was to identify factors associated with vaccination against Hepatitis B virus (HBV) among healthcare workers (HWs) in the University Hospital Center (UHC) Farhat Hached Sousse, Tunisia. Methods: We conducted a descriptive cross-sectional study all licensed physicians (n= 206) and a representative sample of paramedical staff (n= 372) exercising at UHC Hached Sousse (Tunisia) during two months (January and February 2014). Data were collected using a self-administered and pre-tested questionnaire, which composed by 21 questions. In order to determinate factors associated with vaccination against hepatitis B among HWs, this questionnaire was based on the Health Belief Model, one of the most classical behavior theories. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify the determinants of the use of vaccination against HBV. Results: The response rates were 79.8%. Fifty two percent believe that HBV is frequent in our healthcare units and 60.6% consider it a severe infection. The prevalence of HWs vaccination was 39%, 95% CI [34.49%; 43.5%]. In multivariate analysis, determinants of the use of vaccination against HBV among HWs were young age (p=10-4), male gender (p = 0. 006), high or very high importance accorded to health (p = 0.035), perception membership in a risk group for HBV infection (p = 0.038) and very favorable or favorable opinion about vaccination against HVB (p=10-4). Conclusion: The results of our study should be considered in any strategy for preventing VHB infection in HWs. In the mean time, coverage with standard vaccines should be improved also by supplying complete information on the risks of VHB infection and on the safety and efficacy of vaccination.

Keywords: Hepatitis B virus, healthcare workers, prevalence, vaccination

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Authors: Getachew Adugna

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Background: Chronic energy malnutrition and human immune deficiency virus among pregnant women are highly prevalent in Sub-Saharan Africa, and they are interrelated in a vicious cycle. However, the prevalence of chronic energy malnutrition and its determinant factors among human immune deficiency virus-positive pregnant women is not well studied in Ethiopia and Addis Ababa in particular. Objective: To determine the prevalence & associated factors of chronic energy malnutrition among human immune deficiency virus-positive pregnant women in health centres of Addis Ababa Ethiopia. Methods: An institution-based cross-sectional study was conducted and a systematic random sampling technique was used to select study subjects. A total of 253 study subjects were enrolled in the study—a structured and pre-tested questionnaire collected sociodemographic, maternal health-related, and nutritional-related variables. MUAC measurements were taken and medical charts were reviewed. Bi-variable and multi-variable logistic regression analyses were used to assess the effect of different factors on chronic energy malnutrition. Result: The overall prevalence of chronic energy malnutrition was 32.0%. It was significantly associated with dietary counselling (AOR: 0.062; 95%CI: 0.007, 0.549), CD4 level (AOR: 0.219; 95%CI: 0.025, 1.908), and clinical stage (AOR: 0.127; 95%CI: 0.053, 0.305). Conclusions: The prevalence of chronic energy malnutrition among Human Immune deficiency virus-infected pregnant women in Addis Ababa was high and Nutritional Intervention should be an integral part of the HIV care program.

Keywords: chronic energy malnutrition, HIV, MUAC, Addis Ababa

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Authors: A. Ham, A. Kuckert-Wostheinrich

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Demographic changes, like the ageing population in European countries and shortage of nursing staff, the increasing number of people with severe cognitive impairment, and elderly socially isolated people raise important questions about who will provide long-term care for ageing citizens. Due to the so-called refugee crisis in 2015, some health care institutions for ageing citizens in Europe invited first generation immigrants to start a nursing career and providing them language skills, nursing training, and internships. The aim of this ethnographic research was to explore the social processes affecting workforce integration and how newcomers enact good care in ageing citizens in a German nursing home. By ethnographic fieldwork, 200 hours of participant observations, 25 in-depth interviews with immigrants and established staff, 2 focus groups with 6 immigrants, and 6 established staff members, data were analysed. The health care institution provided the newcomers a nursing program on psychogeriatric theory and nursing skills in the psychogeriatric field and professional oriented language skills. Courses of health prevention and theater plays accompanied the training. The knowledge learned in education could be applied in internships on the wards. Additionally, diversity and inclusivity courses were given to established personal for cultural awareness and sensitivity. They learned to develop a collegial attitude of respect and appreciation, regardless of gender, nationality, ethnicity, religion or belief, age sexual orientation, or disability and identity. The qualitative data has shown that social processes affected workforce integration, like organizational constraints, staff shortages, and a demanding workload. However, zooming in on the interactions between newcomers and residents, we noticed how they tinkered to enact good care by embodied caring, playing games, singing and dancing. By situational acting and practical wisdom in nursing care, the newcomers could meet the needs of ageing residents. Thus, when health care institutions open up nursing programs for newcomers with refugees’ backgrounds and focus on talent instead of shortcomings, we might as well stimulate the unknown competencies, attitudes, skills, and expertise of newcomers and create excellent nurses for excellent care.

Keywords: established staff, Germany, nursing, refugees

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Authors: Andrea Parisi, Samantha Vilkins, Luis Furuya-Kanamori, John A. Crump, Benjamin P. Howden, Darren Gray, Kathryn Glass, Martyn Kirk

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Objectives: Salmonella is a leading cause of foodborne enterocolitis worldwide. Nontyphoidal Salmonella (NTS) infections that are Multi-Drug Resistant (MDR) (non-susceptible to ≥1 agent in ≥3 antimicrobial categories) may result in more severe outcomes, although these effects have not been systematically examined. We conducted a systematic review and meta-analysis to examine impacts of MDR NTS on health in high-income settings. Methods: We systematically reviewed the literature from scientific databases, including PubMed, Scopus and grey literature sources, using PRISMA guidelines. We searched for data from case-control studies, cohorts, outbreaks, reports and theses, imposing no language restriction. We included only publications from January 1990 to September 2016 from high income countries as classified by World Bank. We extracted data from papers on duration of illness, hospitalisation rates, morbidity and mortality for MDR and non-MDR NTS strains. Results: After removing duplicates, the initial search revealed 4258 articles. After further screening, we identified 16 eligible studies for the systematic review, and 9 of these were included in meta-analysis. NTS serotypes differed among the reported studies but serotype Typhimurium, Enteritidis, Newport and Heidelberg were among the most often reported as MDR pathogens. Salmonella infections that were MDR were associated with excess bloodstream infections (OR 1.63; 95%CI 1.18-2.26), excess hospitalisations (OR 2.77; 95%CI 1.47-5.21) and higher mortality (OR 3.54; 95%CI 1.10-11.40). Conclusions: MDR NTS infections are a serious public health concern. With the emergence of MDR Salmonella strains in the high-income countries, it is crucial to restrict the use of antimicrobials both in animals and humans, and intervene to prevent foodborne infections.

Keywords: Antimicrobial Resistance, Bloodstream Infection, Health Outcomes, Hospitalisation, Invasive Disease, Multi-Drug Resistance (MDR), Mortality, Nontyphoidal Salmonella

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Authors: Hamad M. Alnagran, Mohammed S. Imbabi

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Particulate matter (PM) in the air we breathe is detrimental to health. Overcoming this problem has attracted interest and prompted research on the use of PM filtration in commercial buildings and homes to be carried out. The consensus is that tangible health benefits can result from the use of PM filters in most urban environments, to clean up the building’s fresh air supply and thereby reduce exposure of residents to airborne PM. The authors have investigated and are developing a new large-scale Permeodynamic Filtration Technology (PFT) capable of permanently filtering and removing airborne PMs from outdoor spaces, thus also benefiting internal spaces such as the interiors of buildings. Theoretical models were developed, and laboratory trials carried out to determine, and validate through measurement permeodynamic filtration efficiency and pressure drop as functions of PM particle size distributions. The conclusion is that PFT offers a potentially viable, cost effective end of pipe solution to the problem of airborne PM.

Keywords: air filtration, particulate matter, particle size distribution, permeodynamic

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Authors: Faisal G. Khamis, Ghaleb A. El-Refae

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Many researchers have studied socioeconomic, health, and security variables in the developed countries; however, very few studies used multivariate analysis in developing countries. The current study contributes to the scarce literature about the determinants of the variance in socioeconomic, health, and security factors. Questions raised were whether the independent variables (IVs) of governorate and year impact the socioeconomic, health, and security dependent variables (DVs) in Jordan, whether the marginal mean of each DV in each governorate and in each year is significant, which governorates are similar in difference means of each DV, and whether these DVs vary. The main objectives were to determine the source of variances in DVs, collectively and separately, testing which governorates are similar and which diverge for each DV. The research design was time series and cross-sectional analysis. The main hypotheses are that IVs affect DVs collectively and separately. Multivariate and univariate analyses of variance were carried out to test these hypotheses. The population of 12 governorates in Jordan and the available data of 15 years (2000–2015) accrued from several Jordanian statistical yearbooks. We investigated the effect of two factors of governorate and year on the four DVs of divorce rate, mortality rate, unemployment percentage, and crime rate. All DVs were transformed to multivariate normal distribution. We calculated descriptive statistics for each DV. Based on the multivariate analysis of variance, we found a significant effect in IVs on DVs with p < .001. Based on the univariate analysis, we found a significant effect of IVs on each DV with p < .001, except the effect of the year factor on unemployment was not significant with p = .642. The grand and marginal means of each DV in each governorate and each year were significant based on a 95% confidence interval. Most governorates are not similar in DVs with p < .001. We concluded that the two factors produce significant effects on DVs, collectively and separately. Based on these findings, the government can distribute its financial and physical resources to governorates more efficiently. By identifying the sources of variance that contribute to the variation in DVs, insights can help inform focused variation prevention efforts.

Keywords: ANOVA, crime, divorce, governorate, hypothesis test, Jordan, MANOVA, means, mortality, unemployment, year

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Authors: Thidilweli Denga, Bessie Malila, Lucretia Petersen

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The Coronavirus Disease of 2019 (COVID-19) pandemic should be taken as a wake-up call on the importance of hearing health care considering amongst other things the electronic methods of communication used. The World Health Organization (WHO) estimated that by 2050, there will be more than 2.5 billion people living with hearing loss. These numbers show that more people will need rehabilitation services. Studies have shown that most people living with hearing loss reside in Low-Middle Income Countries (LIMC). Innovative technological solutions such as digital health interventions that can be used to deliver hearing health services to remote areas now exist. Tele-audiology implementation can potentially enable the delivery of hearing loss services to rural and remote areas. This study aimed to establish the concurrent validity of the tele-audiology practice in school-based hearing screening. The study employed a cross-sectional design with a within-group comparison. The portable KUDUwave Audiometer was used to conduct hearing screening from 50 participants (n=50). In phase I of the study, the audiologist conducted on-site hearing screening, while the synchronous remote hearing screening (tele-audiology) using a 5G network was done in phase II. On-site hearing screening results were obtained for the first 25 participants (aged between 5-6 years). The second half started with the synchronous tele-audiology model to avoid order-effect. Repeated sample t-tests compared threshold results obtained in the left and right ears for onsite and remote screening. There was a good correspondence between the two methods with a threshold average within ±5 dB (decibels). The synchronous tele-audiology model has the potential to reduce the audiologists' case overload, while at the same time reaching populations that lack access due to distance, and shortage of hearing professionals in their areas of reach. With reliable and broadband connectivity, tele-audiology delivers the same service quality as the conventional method while reducing the travel costs of audiologists.

Keywords: hearing screening, low-resource communities, portable audiometer, tele-audiology

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Authors: Hari Krishna Ayyappa, Reenu Singh

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Rising population and restricted land for development has led towards the growth of vertical buildings and small complexes. It provides many possibilities to change the shape and size of internal space in addition to the social impacts on the commercial spaces. With the increased volatility of necessities of people, the need for mental and physical comfort has continuously increased. . Living in a small space musts minimalist and space- saving cabinetwork results to sustain mortal good. This paper attempts to explore the Influence of Using Minimalist Furniture on the Efficiency of the commercial Space interiors by means of the variable resulting from preceding studies based on literature. A literature review was conducted on research articles to understand the contributing variables in a well designed small commercial spaces. A questionnaire survey was conducted to understand the layout of small commercial spaces with respect to Environmental impact, material, Design elements, Modern approach, Layered lightings, and colours. The problem of small spaces can be resolved by some ways; it's still needed for cabinetwork to develop to be more innovative to accommodate small living spaces. Since cabinetwork is a necessity and not luxury, everybody is in need of it. The spatial factors affecting overall satisfaction at a detailed position were bandied. The variable helped in proposing design ideation and mock ups to explore improved interiors. This paper concludes that most of the principles of the minimalist approach have been overlooked at, which had an impact on the space efficiency in commercial spaces like storage rooms, office area, retail stores, restaurants, and other spaces where business is conducted.

Keywords: materials, modern approach, space efficiency, tall commercial buildings

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Authors: A. K. Srivastva

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Body weight is considered as an important factor in health and fitness. It is an index of one's health. Considering significance of body weight and its wider application in various fields in general and sports in particular, it is made a point of enquiry in the present study. The purpose of the study to observe over all weight pattern of Indian youths in the age group of 15 through 20 years. Total 7500 samples pooled from ten Indian states ranging in their age 15 to 20 years were examined in six age categories. Conclusion: 1. The period between 15 to 20 year of age is a growing period and that body weight is gained during this period. 2. Statewise difference is observed in body-weight during the period, which is significant. 3. PRG indicated by higher rate of weight gain varies from state to state. 4. Sportsman possess comparatively higer level of body-weight than other student of same age group. 5. Tribal youths show comparatively better status in their weight gain than the untrained uraban dwellers.

Keywords: PRG (period of rapid growth), HG (heterogeneous group), WP (weight pattern), MBW (mean body weight)

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Authors: B. Bergström, A. Ladd, A. Jones, L. Rosso, P. Michael

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Attitudes toward treatment manuals serve as a meaningful predictor of general attitudes toward evidence-based practice. Despite demonstrating high effectiveness in treating many mental disorders, manualized treatments have been underutilized by practitioners. Thus, one can assess the state of the field regarding the adoption of evidence-based practices by surveying practitioner attitudes towards manualized treatments. This study is an adapted replication that assesses psychology graduate student attitudes towards manualized treatments, as a general marker for attitudes towards evidence-based practice. Training programs provide future clinicians with the foundation for critical skills in clinical practice. Research demonstrates that post-graduate continuing education has little to no effect on clinical practice; thus, graduate programs serve as the primary, and often final platform for all future practice. However, there are little empirical data identifying the attitudes and training of graduate students in utilizing manualized treatments. The empirical analysis of this study indicates an increase in positive attitudes among graduate student attitudes towards manualized treatments (within the United States), when compared to past surveys of professional psychologists. Findings from this study may inform graduate programs of barriers for students in developing positive attitudes toward manualized treatments and evidence-based practice. This study also serves as a preliminary predictor of the state-of-the field, in regards to professional psychologists attitudes towards evidence-based practice, if attitudes remain stable. This study indicates that the attitudes toward utilizing evidence-based practices, such as treatment manuals, has become more positive since year 2000.

Keywords: exposure therapy, evidence based practice, manualized treatments, student attitudes

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Authors: Fawad Ali

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Toxic heavy metal contamination has a negative impact on soil quality which ultimately pollutes the agriculture system. In the current work, we analyzed uptake of various heavy metals by dietary vegetables grown in wastewater irrigated areas of Swabi city. The samples of soil and vegetables were analyzed for heavy metals viz Cd, Cr, Mn, Fe, Ni, Cu, Zn and Pb using Atomic Absorption Spectrophotometer. High levels of metals were found in wastewater irrigated soil and vegetables in the study area. Especially the concentrations of Pb and Cd in the dietary vegetable crossed the permissible level of World Health Organization. Substantial positive correlation was found among the soil and vegetable contamination. Transfer factor for some metals including Cr, Zn, Mn, Ni, Cd and Cu was greater than 0.5 which shows enhanced accumulation of these metals due to contamination by domestic discharges and industrial effluents. Linear regression analysis indicated significant correlation of heavy metals viz Pb, Cr, Cd, Ni, Zn, Cu, Fe and Mn in vegetables with concentration in soil of 0.964 at P≤0.001. Abelmoschus esculentus indicated Health Risk Index (HRI) of Pb >1 in adults and children. The source identification analysis carried out by Principal Component Analysis (PCA) and Cluster Analysis (CA) showed that ground water and soil were being polluted by the trace metals coming out from industries and domestic wastes. Hierarchical cluster analysis (HCA) divided metals into two clusters for wastewater and soil but into five clusters for soil of control area. PCA extracted two factors for wastewater, each contributing 61.086 % and 16.229 % of the total 77.315 % variance. PCA extracted two factors, for soil samples, having total variance of 79.912 % factor 1 and factor 2 contributed 63.889 % and 16.023 % of the total variance. PCA for sub soil extracted two factors with a total variance of 76.136 % factor 1 being 61.768 % and factor 2 being 14.368 %of the total variance. High pollution load index for vegetables in the study area due to metal polluted soil has opened a study area for proper legislation to protect further contamination of vegetables. This work would further reveal serious health risks to human population of the study area.

Keywords: health risk, vegetables, wastewater, atomic absorption sepctrophotometer

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Authors: Aboubakr Mashali

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Context: The paper focuses on the relationship between architecture and nature, emphasizing the importance of incorporating natural elements in design to reconnect individuals with the natural environment. It highlights the positive impact of a harmonious architecture on people's well-being and the environment, as well as the concept of sustainable architecture. Research aim: The aim of this research is to showcase how nature can be integrated into architectural designs, ultimately reestablishing a connection between humans and the natural world. Methodology: The research employs an in-depth approach, delving into the subject matter through extensive research and the analysis of case studies. These case studies provide practical examples and insights into successful architectural designs that have effectively incorporated nature. Findings: The findings suggest that when architecture and nature coexist harmoniously, it creates a positive atmosphere and enhances people's wellbeing. The use of materials obtained from nature in their raw or minimally refined form, such as wood, clay, stone, and bamboo, contributes to a natural atmosphere within the built environment. Additionally, a color palette inspired by nature, consisting of earthy tones, green, brown, and rusty shades, further enhances the harmonious relationship between individuals and their surroundings. The paper also discusses the concept of sustainable architecture, where materials used are renewable, and energy consumption is minimal. It acknowledges the efforts of organizations such as the US Green Building Council in promoting sustainable design practices. Theoretical importance: This research contributes to the understanding of the relationship between architecture and nature and highlights the importance of incorporating natural elements into design. It emphasizes the potential of naturefriendly architecture to create greener, resilient, and sustainable cities. Data collection and analysis procedures: The researcher gathered data through comprehensive research, examining existing literature, and studying relevant case studies. The analysis involved studying the successful implementation of nature in architectural design and its impact on individuals and the environment. Question addressed: The research addresses the question of how nature can be incorporated into architectural designs to reconnect humans with the nature. Conclusion: In conclusion, this research highlights the significance of architecture being in harmony with its surrounding, which in turn should be in harmony with nature. By incorporating nature in architectural designs, individuals can rediscover their connection with nature and experience its positive impact on their well-being. The use of natural materials and a color palette inspired by nature further enhances this relationship. Additionally, embracing sustainable design practices contributes to the creation of greener and more resilient cities. This research underscores the importance of integrating nature-friendly architecture to foster a healthier and more sustainable future.

Keywords: nature, architecture, reconnecting, greencities, sustainable, openspaces, landscape

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Authors: Aaron Akinloye

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this research focuses on the impact of jungle justice on the emotional health challenges experienced by residents in the Lagos metropolitan city in Nigeria. Jungle justice refers to the practice of individuals taking the law into their own hands and administering punishment without proper legal procedures. The aim of this study is to investigate the influence of jungle justice on the emotional challenges faced by residents in Lagos. The specific objectives of the study are to examine the effects of jungle justice on trauma, pressure, fear, and depression among residents. The study adopts a descriptive survey research design and uses a questionnaire as the research instrument. The population of the study consisted of residents in the three senatorial districts that make up Lagos State. A simple random sampling technique was used to select two Local Government Areas (Yaba and Shomolu) from each of the three senatorial districts of Lagos State. Also, a simple random sampling technique was used to select fifty (50) residents from each of the chosen Local Government Areas to make three hundred (300) residents that formed the sample of the study. Accidental sampling technique is employed to select a sample of 300 residents. Data on the variables of interest is collected using a self-developed questionnaire. The research instrument undergoes validation through face, content, and construct validation processes. The reliability coefficient of the instrument is found to be 0.84. The study reveals that jungle justice significantly influences trauma, pressure, fear, and depression among residents in Lagos metropolitan city. The statistical analysis shows significant relationships between jungle justice and these emotional health challenges (df (298) t= 2.33, p< 0.05; df (298) t= 2.16, p< 0.05; df (298) t= 2.20, p< 0.05; df (298) t= 2.14, p< 0.05). This study contributes to the literature by highlighting the negative effects of jungle justice on the emotional well-being of residents. It emphasizes the importance of addressing this issue and implementing measures to prevent such vigilante actions. Data is collected through the administration of the self-developed questionnaire to the selected residents. The collected data is then analyzed using inferential statistics, specifically mean analysis, to examine the relationships between jungle justice and the emotional health challenges experienced by the residents. The main question addressed in this study is how jungle justice affects the emotional health challenges faced by residents in Lagos metropolitan city. Conclusion: The study concludes that jungle justice has a significant influence on trauma, pressure, fear, and depression among residents. To address this issue, recommendations are made, including the implementation of comprehensive awareness campaigns, improvement of law enforcement agencies, development of support systems for victims, and revision of the legal framework to effectively address jungle justice. Overall, this research contributes to the understanding of the consequences of jungle justice and provides recommendations for intervention to protect the emotional well-being of residents in Lagos metropolitan city.

Keywords: jungle justice, emotional health, depression, anger

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Authors: Ertuğrul Yılmaz

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One of the most important occupational groups in the food chain from farm to fork is a veterinary medicine. This occupational group, which has important duties in the prevention of many zoonotic diseases and in public health, takes place in many critical control points from soil to our kitchen. It has important duties from mycotoxins transmitted from the soil to slaughterhouses or milk processing facilities. Starting from the soil, which constitutes 70% of mycotoxin contamination, up to the TMR made from raw materials obtained from the soil, there are all critical control points from feeding to slaughterhouses and milk production enterprises. We can take the precaution of mycotoxins such as Aflatoxin B1, Ochratoxin, Zearalenone, and Fumonisin, which we encounter on farms while in the field. It has been reported that aflatoxin B1 is a casenerogen and passes into milk in studies. It is likely that many mycotoxins pose significant threats to public health and will turn out to be even more dangerous over time. Even raw material storage and TMR preparation are very important for public health. The danger of fumonisin accumulating in the liver will be understood over time. Zoonotic diseases are also explained with examples. In this study, how important veterinarians are in terms of public health is explained with examples. In the two-year mycotoxin screenings, fumonisin mycotoxin was found to be very high in corn and corn by-products, and it was determined that it accumulated in the liver for a long time and remained cornic in animals. It has been determined that mycotoxins are present in all livestock feeds, poultry feeds, and raw materials, not alone, but in double-triple form. Starting from the end, mycotoxin scans should be carried out from feed to raw materials and from raw materials to soil. In this way, we prevent the transmission of mycotoxins to animals and from animals to humans. Liver protectors such as toxin binders, beta-glucan, mannan oligosaccharides, activated carbon, prebiotics, and silymarin were used in certain proportions in the total mixed ratio, and positive results were obtained. Humidity and temperature controls of raw material silos were made at certain intervals. Necropsy was performed on animals that died as a result of mycotoxicosis, and macroscopic photographs were taken of the organs. We have determined that the mycotoxin screening in experimental animals and the feeds made without detecting the presence and amount of bacterial factors affect the results of the project to be made. For this, a series of precautionary plans have been created, starting from the production processes.

Keywords: mycotoxins, feed safety, processes, public health

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Authors: Swadhin Mondal

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While safe drinking water is an effective defense against the infection of water borne diseases, a large number of populations suffering from these diseases do not have access to safe drinking water due inadequacy of supply. Private entrepreneurs entered this sector and made bottled drinking water available by supplying various kinds of bottled water. In this study we found that the bottled drinking water industry has experienced a spectacular growth over the past two decades and it has a huge growth potential because of rising demand for safe drinking. High profit margin (217 %) is the main attraction to the entrepreneur to invest in this industry. Health awareness, lack of safe drinking water facilities, rising income, urbanization, migration and rising trend in tourism industries are the major influencing factors of demand for bottled drinking water (BDW). This industry also partially fulfills the demand for drinking water. More than 2 percent of household’s demands were met by this industry and many more households (additional 4 percent) coping with BDW during water crisis. Poor households spend around 4 percent of their total monthly household’s consumption expenditure on BDW which may have an adverse impact on household because households could have spent this for purchasing other goods. Like other developed counties, a large section of Indian households are shifting from their traditional sources of water to BDW. However, there are some concerns about the quality of BDW. Many cases, BDW contains chemical toxins at more than permissible level that can be harmful for health. Hence, there is an urgent need for appropriate intervention to regulate price, reduce potential harm and improve the quality of water provided by this industry.

Keywords: drinking water, public health public failure, privatization, development, public policy

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Authors: Siew Ming Thang, Wong Hoo Keat, Chee Hao Sue, Fung Lan Loo, Ahju Rosalind

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There are numerous studies that explored young learners’ literacy skills in Malaysia but none that uses the eye-tracking device to track their cognitive processes when reading picture storybooks. This study used this method to investigate two groups of prereaders’ cognitive processes in four conditions. (1) A congruent picture was presented, and a matching narration was read aloud by a recorder; (2) Children heard a narration telling about the same characters in the picture but involves a different scene; (3) Only a picture with matching text was present; (4) Students only heard the reading aloud of the text on the screen. The two main objectives of this project are to test which content of pictures helps the prereaders (i.e., young children who have not received any formal reading instruction) understand the narration and whether children try to create a coherent mental representation from the oral narration and the pictures. The study compares two groups of children from two different kindergartens. Group1: 15 Chinese children; Group2: 17 Malay children. The medium of instruction was English. An eye-tracker were used to identify Areas of Interest (AOI) of each picture and the five target elements and calculate number of fixations and total time spent on fixation of pictures and written texts. Two mixed factorial ANOVAs with the storytelling performance (good, average, or weak) and vocabulary level (low, medium, high) as between-subject variables, and the Areas of Interests (AOIs) and display conditions as the within-subject variables were performedon the variables.

Keywords: eye-tracking, cognitive processes, literacy skills, prereaders, visual attention

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Authors: Catelyn Coyle, Helena Kwakwa

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Objective: As novel and better tolerated therapies become available, effective HCV testing and care models become increasingly necessary to not only identify individuals with active infection but also link them to HCV providers for medical evaluation and treatment. Our aim is to describe an effective HCV testing and linkage to care model piloted in a network of five community health centers located in Philadelphia, PA. Methods: In October 2012, National Nursing Centers Consortium piloted a routine opt-out HCV testing model in a network of community health centers, one of which treats HCV, HIV, and co-infected patients. Key aspects of the model were medical assistant initiated testing, the use of laboratory-based reflex test technology, and electronic medical record modifications to prompt, track, report and facilitate payment of test costs. Universal testing on all adult patients was implemented at health centers serving patients at high-risk for HCV. The other sites integrated high-risk based testing, where patients meeting one or more of the CDC testing recommendation risk factors or had a history of homelessness were eligible for HCV testing. Mid-course adjustments included the integration of dual HIV testing, development of a linkage to care coordinator position to facilitate the transition of HIV and/or HCV-positive patients from primary to specialist care, and the transition to universal HCV testing across all testing sites. Results: From October 2012 to June 2015, the health centers performed 7,730 HCV tests and identified 886 (11.5%) patients with a positive HCV-antibody test. Of those with positive HCV-antibody tests, 838 (94.6%) had an HCV-RNA confirmatory test and 590 (70.4%) progressed to current HCV infection (overall prevalence=7.6%); 524 (88.8%) received their RNA-positive test result; 429 (72.7%) were referred to an HCV care specialist and 271 (45.9%) were seen by the HCV care specialist. The best linkage to care results were seen at the test and treat the site, where of the 333 patients were current HCV infection, 175 (52.6%) were seen by an HCV care specialist. Of the patients with active HCV infection, 349 (59.2%) were unaware of their HCV-positive status at the time of diagnosis. Since the integration of dual HCV/HIV testing in September 2013, 9,506 HIV tests were performed, 85 (0.9%) patients had positive HIV tests, 81 (95.3%) received their confirmed HIV test result and 77 (90.6%) were linked to HIV care. Dual HCV/HIV testing increased the number of HCV tests performed by 362 between the 9 months preceding dual testing and first 9 months after dual testing integration, representing a 23.7% increment. Conclusion: Our HCV testing model shows that integrated routine testing and linkage to care is feasible and improved detection and linkage to care in a primary care setting. We found that prevalence of current HCV infection was higher than that seen in locally in Philadelphia and nationwide. Intensive linkage services can increase the number of patients who successfully navigate the HCV treatment cascade. The linkage to care coordinator position is an important position that acts as a trusted intermediary for patients being linked to care.

Keywords: HCV, routine testing, linkage to care, community health centers

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Authors: Ilona Krone

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Maternal smoking during pregnancy increases the risk of perinatal/postnatal negative health outcomes; however, only 1 in 5 pregnant smokers quit smoking. That is a clinical and public health problem. Pregnant smokers have negative paternal support, and higher levels of perceived stress than non-smokers and quitters return to smoking in a stressful situation. A crisis like the COVID-19 outbreak causes significant uncertainty and stress. For pregnant women, additional stress may increase due to concerns for their fetus. Strategies targeting maternal stress and isolation may be particularly useful to prevent negative outcomes for women and their fetuses. Within the post-doctoral study, cooperating with leading specialists, an innovative program for pregnant smokers will be developed. Feasibility for reducing craving, distress intolerance, Covid 19 related stress, and fear in pregnant women in Latvia will be assessed.

Keywords: COVID 19, mindfulness, motivation, pregnancy, smoking cessation

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Authors: Sandhya Rao

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Kevin Lynch’s Theory on Imeageability, let on explore a city in terms of five elements, Nodes, Paths, Edges, landmarks and Districts. What happens when we try to record the same data in an Indian context? What happens when we apply the same theory of Imageability to a complex shifting urban pattern of the Indian cities and how can we as Urban Designers demonstrate our role in the image building ordeal of these cities? The organizational patterns formed through mental images, of an Indian city is often diverse and intangible. It is also multi layered and temporary in terms of the spirit of the place. The pattern of images formed is loaded with associative meaning and intrinsically linked with the history and socio-cultural dominance of the place. The embedded memory of a place in one’s mind often plays an even more important role while formulating these images. Thus while deriving an image of a city one is often confused or finds the result chaotic. The images formed due to its complexity are further difficult to represent using a single medium. Under such a scenario it’s difficult to derive an output of an image constructed as well as make design interventions to enhance the legibility of a place. However, there can be a combination of tools and methods that allows one to record the key elements of a place through time, space and one’s user interface with the place. There has to be a clear understanding of the participant groups of a place and their time and period of engagement with the place as well. How we can translate the result obtained into a design intervention at the end, is the main of the research. Could a multi-faceted cognitive mapping be an answer to this or could it be a very transient mapping method which can change over time, place and person. How does the context influence the process of image building in one’s mind? These are the key questions that this research will aim to answer.

Keywords: imageability, organizational patterns, legibility, cognitive mapping

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Authors: A. Marais

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A challenging aspect of teaching cello to novice adult learners is finding adequate lesson material and applying relevant teaching methodologies. It could play a crucial role in adult learners' decision to commence or stop taking music lessons. This study contributes to the theory and practises of continuing education. This study is important to lifelong learning, especially with the focus on adult teaching and learning and the difficulties concerning these themes. The research problem identified for this study is we are not aware of adults' life stories; thus, cello lesson material is not always relevant for adult's specific needs for motivation and goals for starting cello lessons. In my experience, an adult does not necessarily want to play children songs when they learn a new instrument. They want material and lessons fitted to adult learners. Adults also learn differently from younger beginners. Adults ask questions such as how and why, while children more readily accept what is being taught. This research creates awareness of adults' musical needs and learning methods. If every adult shares their own story for commencing and continuing with cello lessons, material should be created, revised, or adapted for more individually appropriate lessons. A number of studies show that adults taking music lessons experience a decrease in feelings of loneliness and isolation. It gives adults a sense of wellbeing and can help improve immune systems. The purpose of this research study will be to discover the life stories of adult amateur cellists. At this stage in the research, the life stories of amateur cellists can generally be defined as personal reflections of their motivations for and experiences of commencing and continuing with individual lessons. The findings of this study will contribute to the development of cello lesson material for adult beginners based on their stories. This research could also encourage adults to commence with music lessons and could, in that way, contribute to their quality of life. Music learners become aware of deep spiritual, emotional, and social values incorporated or experienced through musical learning. This will be a qualitative study with a narrative approach making use of oral history. The chosen method will encapsulate the stories of amateur individual adults starting and continuing with cello lessons. The narrative method entails experiences as expressed in lived and told stories of individuals. Oral history is used as part of the narrative method and entails gathering of personal reflections of events and their cause and effects from an individual or several individuals. These findings from this study will contribute to adult amateur cellists' motivations to continue with music lessons and inspire others to commence. The inspiring life stories of the amateur cellists would provide insight into finding and creating new cello lesson material and enhance existing teaching methodologies for adult amateur cellists.

Keywords: adult, amateur, cello, education, learning, music, stories

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Authors: Mohammad Zainie Bin Hassan

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Background: Erectile dysfunction (ED) is a complication commonly seen among men with diabetes which can be assessed based upon International Index of Erectile Function (IIEF-5) questionnaire. Creatinine level is a blood test that indicates kidney functionality. Object: To evaluate the association between ED, determined by the IIEF-5scores and Creatinine level in diabetic men attending Temerloh Health Clinic, Pahang, Malaysia.Hence, to identify raising Creatinine level related with ED or not. Methods: All married diabetic patients will be investigated face to face after consented for answering the IIEF-5 questionnaire. Creatinine level will be taken by using standard method.Patients with no sexual partner, refuse to answer the questionnaire, cancer, stroke, heart disease and language barrier will be excluded.Data obtained from IIEF-5 score and Creatinine level will be analyzed by using Pearson correlation. All statistical value determined by p=0.05. ED will be categorized accordingly to IIEF-5 scores: no ED (22-25), mild (17-21), moderate (12-16), severe (8-11) and very severe (1-7). Results: A total of 450 patients were investigated with 385 patients were included (85.6% respondant rate) and 65 patients were excluded in this study with age range from 29 to 85 years old. 7% had no ED, 28% mild ED, 34% moderate ED, 16% severe ED and 15% had very severe ED. There was a significant negative correlation between Creatinine level and IIEF-5 scores (r=-0.218, p <0.001). This result implicated that poor kidney function which indicated by high Creatinine level associated significantly with erectile dysfunction. 93% had ED with a different range of severity which triggers for appropriate aggressive ED management among diabetics. Conclusion: The high level of Creatinine is associated with erectile dysfunction among diabetics in Temerloh Health Clinic.

Keywords: correlation, creatinine level, erectile dysfunction, ED, diabetes

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Authors: Souhir Chelly, Chahida Harizi, Aicha Hechaichi, Sihem Aissaoui, Leila Ben Ayed, Maha Bergaoui, Mohamed Kouni Chahed

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Introduction: The International Classification of Primary Care (ICPC) is part of the morbidity classification system. It had 17 chapters, and each is coded by an alphanumeric code: the letter corresponds to the chapter, the number to a paragraph in the chapter. The objective of this study is to show the utility of this classification in the coding of the reasons for demand for care in Primary health care (PHC), its advantages and limits. Methods: This is a cross-sectional descriptive study conducted in 4 PHC in Ariana district. Data on the demand for care during 2 days in the same week were collected. The coding of the information was done according to the CISP. The data was entered and analyzed by the EPI Info 7 software. Results: A total of 523 demands for care were investigated. The patients who came for the consultation are predominantly female (62.72%). Most of the consultants are young with an average age of 35 ± 26 years. In the ICPC, there are 7 rubrics: 'infections' is the most common reason with 49.9%, 'other diagnoses' with 40.2%, 'symptoms and complaints' with 5.5%, 'trauma' with 2.1%, 'procedures' with 2.1% and 'neoplasm' with 0.3%. The main advantage of the ICPC is the fact of being a standardized tool. It is very suitable for classification of the reasons for demand for care in PHC according to their specificity, capacity to be used in a computerized medical file of the PHC. Its current limitations are related to the difficulty of classification of some reasons for demand for care. Conclusion: The ICPC has been developed to provide healthcare with a coding reference that takes into account their specificity. The CIM is in its 10th revision; it would gain from revision to revision to be more efficient to be generalized and used by the teams of PHC.

Keywords: international classification of primary care, medical file, primary health care, Tunisia

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Authors: Ghoul Rachid Brahim

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Introduction: Back pain is a real public health problem with a significant socio-economic impact. It is the consequence of a degeneration of the lumbar intervertebral disc (IVD). This often asymptomatic pathology is compatible with an active life. As soon as it becomes symptomatic, conservative treatment is recommended in the majority of cases. The physical or functional disability is resistant to well-monitored conservative treatment, which justifies a surgical alternative which imposes a well-studied reflection on the objectives to be achieved. Objective: Evaluate the indication and short and medium term contribution of surgery in the management of painful degenerative lumbar disc disease. To prove the effectiveness of surgical treatment in the management of painful lumbar degenerative disc disease. Materials and methods: This is a prospective descriptive mono-centric study without comparison group, comprising a series of 104 patients suffering from lumbar painful degenerative disc disease treated surgically. Retrospective analysis of data collected prospectively. Comparison between pre and postoperative clinical status, by pain self-assessment scores and on the impact on pre and postoperative quality of life (3, 6 to 12 months). Results: This study showed that patients who received surgical treatment had great improvements in symptoms, function and several health-related quality of life in the first year after surgery. Conclusions: The surgery had a significantly positive impact on patients' pain, disability and quality of life. Overall, 97% of the patients were satisfied.

Keywords: degenerative disc disease, intervertebral disc, several health-related quality, lumbar painful

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Authors: Sakkaphat T. Ngamake, Arunya Tuicomepee, Panrapee Suttiwan, Rewadee Watakakosol, Sompoch Iamsupasit

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Generally, 'positive' emotion regulation strategies such as cognitive reappraisal have linked to desirable outcomes while 'negative' strategies such as behavioral suppression have linked to undesirable outcomes. These trends have been found in both the elderly and professional practitioners. Hence, this study sought to investigate these trends further by examining the relationship between two dominant emotion regulation strategies in the literature (i.e., cognitive reappraisal and behavioral suppression) and well-being outcomes among the elderly (i.e., successful aging) and their caregivers (i.e., satisfaction with life), using the actor-partner interdependence model. A total of 150 elderly-caregiver dyads participated in the study. The elderly responded to two measures assessing the two emotion regulation strategies and successful aging while their caregivers responded to the same emotion regulation measure and a measure of satisfaction with life. Two criterion variables (i.e., successful aging and satisfaction with life) were specified as latent variables whereas four predictors (i.e., two strategies for the elderly and two strategies for their caregivers) were specified as observed variables in the model. Results have shown that, for the actor effect, the cognitive reappraisal strategy yielded positive relationships with the well-being outcomes for both the elderly and their caregivers. For the partner effect, a positive relationship between caregivers’ cognitive reappraisal strategy and the elderly’s successful aging was observed. The behavioral suppression strategy has not related to any well-being outcomes, within and across individual agents. This study has contributed to the literature by empirically showing that the mental activity of the elderly’s immediate environment such as their family members or close friends could affect their quality of life.

Keywords: emotion regulation, caregiver, older adult, well-being

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