Search results for: health care delivery

Authors: Evija Silina, Maris Taube, Maksims Zolovs

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Background: Type 1 diabetes mellitus (T1D) is the most common chronic endocrine pathology in children. The management of type 1 diabetes requires a strong diet, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose and is usually complicated and, therefore, may result in a variety of psychosocial problems for children, adolescents, and their families. Metabolic control of the disease is determined by glycated haemoglobin (HbA1c), the main criterion for diabetes compensation. A correlation was observed between anxiety and depression levels and glycaemic control in many previous studies. It is assumed that anxiety and depression symptoms negatively affect glycaemic control. Parental psychological distress was associated with higher child self-report of stress and depressive symptoms, and it had negative effects on diabetes management. Objective: The main objective of this paper is to evaluate the relationship between parental mental health conditions (depression and anxiety) and metabolic control of their adolescents with T1DM. Methods: This cross-sectional study recruited adolescents with T1D (N=251) and their parents (N=251). The respondents completed questionnaires. The 7-item Generalized Anxiety Disorder (GAD-7) scale measured anxiety level; The Patient Health Questionnaire – 9 (PHQ-9) measured depressive symptoms. Glycaemic control of patients was assessed using the last glycated haemoglobin (HbA1c) values. GLM mediation analysis was performed to determine the potential mediating effect of the parent’s mental health conditions (depression and anxiety) on the relationship between the mental health conditions (depression and anxiety) of a child on the level of glycated hemoglobin (HbA1c). To test the significance of the mediated effect (ME) for non-normally distributed data, bootstrapping procedures (10,000 bootstrapped samples) were used. Results: 502 respondents were eligible for screening to detect anxiety and depression symptoms. Mediation analysis was performed to assess the mediating role of parent GAD-7 on the linkage between a dependent variable (HbA1c) and independent variables (child GAD-7 un child PHQ-9). The results revealed that the total effect of child GAD-7 (B = 0.479, z = 4.30, p < 0.001) on HbA1c was significant but the total effect of child PHQ-9 (B = 0.166, z = 1.49, p = 0.135) was not significant. With the inclusion of the mediating variable (parent GAD-7), the impact of child GAD-7 on HbA1c was found insignificant (B = 0.113, z=0.98, p = 0.326), the impact of child PHQ-9 on HbA1c was found also insignificant (B = 0.068, z=0.74, p = 0.458). The indirect effect of child GAD-7 on HbA1c through parent GAD-7 was found significant (B = 0.366, z = 4.31, p < 0.001) and the indirect effect of child PHQ-9 on HbA1c through parent GAD-7 was found also significant (B = 0.098, z = 2.56, p = 0.010). This indicates that the relationship between a dependent variable (HbA1c) and independent variables (child GAD-7 un child PHQ-9) is fully mediated by parent GAD-7. Conclusion: The main result suggests that glycated haemoglobin in adolescents with Type 1 diabetes is related to adolescents’ mental health via parents’ anxiety. It means that parents’ anxiety plays a more significant role in the level of glycated haemoglobin in adolescents than depression and anxiety in the adolescent.

Keywords: type 1 diabetes, adolescents, parental diabetes-specific mental health conditions, glycated haemoglobin, anxiety, depression

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Authors: Elizabeth Russo, Angelica Terepka

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The present paper reviews literature examining trends among suicide, suicidal ideation, and mental illness rates in ethnic and racial minority student-athletes. While the rates of suicide amongst student athlete populations is lower than rates of suicide seen in the general student populations, there is a discrepancy amongst rates of suicide in student athletes; specifically, those identifying with racial and ethnic minority backgrounds endorse higher rates of suicidal ideation. The samples from the existing literature consisted of White, Black, Hispanic/Latinx, Asian/ Pacific Islander, Multiracial, and Native American student-athletes. Studies suggest that ethnic and racial minority students are more susceptible to suicide, depression, and other mental health concerns compared to their white counterparts. Across the literature, White student athletes appeared to have more social and academic support from fellow classmates, university administration and professors, and staff within their athletic departments. Student athletes who did not identify as White endorsed higher rates of loneliness, felt ethnically and racially underrepresented within their athletic department, and endorsed lack of appropriate medical treatment for injuries by athletic department medical staff. Additionally, non-White student athletes receive less peer support and must balance additional stressors such as discrimination in contrast to their White/non-Latinx peers. Recommendations for athletic departments and mental health providers supporting student athletes who identify as racial and ethnic minorities are discussed.

Keywords: racial and ethnic minority, suicide, student-athlete, suicidal ideation

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Authors: Neusa Fernanda Torres, Buyisile Chibi, Lyn E. Middleton, Vernon P. Solomon, Tivani P. Mashamba-Thompson

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Background: Self-medication with antibiotics (SMA) is a global concern, with a higher incidence in low and middle-income countries (LMICs). Despite intense world-wide efforts to control and promote the rational use of antibiotics, continuing practices of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and other undesirable antibiotic side effects. Moreover, it increases the health systems costs of acquiring more powerful antibiotics to treat the resistant infection. This review thus maps evidence on the factors influencing self-medication with antibiotics in these settings. Methods: The search strategy for this review involved electronic databases including PubMed, Web of Knowledge, Science Direct, EBSCOhost (PubMed, CINAHL with Full Text, Health Source - Consumer Edition, MEDLINE), Google Scholar, BioMed Central and World Health Organization library, using the search terms:’ Self-Medication’, ‘antibiotics’, ‘factors’ and ‘reasons’. Our search included studies published from 2007 to 2017. Thematic analysis was performed to identify the patterns of evidence on SMA in LMICs. The mixed method quality appraisal tool (MMAT) version 2011 was employed to assess the quality of the included primary studies. Results: Fifteen studies met the inclusion criteria. Studies included population from the rural (46,4%), urban (33,6%) and combined (20%) settings, of the following LMICs: Guatemala (2 studies), India (2), Indonesia (2), Kenya (1), Laos (1), Nepal (1), Nigeria (2), Pakistan (2), Sri Lanka (1), and Yemen (1). The total sample size of all 15 included studies was 7676 participants. The findings of the review show a high prevalence of SMA ranging from 8,1% to 93%. Accessibility, affordability, conditions of health facilities (long waiting, quality of services and workers) as long well as poor health-seeking behavior and lack of information are factors that influence SMA in LMICs. Antibiotics such as amoxicillin, metronidazole, amoxicillin/clavulanic, ampicillin, ciprofloxacin, azithromycin, penicillin, and tetracycline, were the most frequently used for SMA. The major sources of antibiotics included pharmacies, drug stores, leftover drugs, family/friends and old prescription. Sore throat, common cold, cough with mucus, headache, toothache, flu-like symptoms, pain relief, fever, running nose, toothache, upper respiratory tract infections, urinary symptoms, urinary tract infection were the common disease symptoms managed with SMA. Conclusion: Although the information on factors influencing SMA in LMICs is unevenly distributed, the available information revealed the existence of research evidence on antibiotic self-medication in some countries of LMICs. SMA practices are influenced by social-cultural determinants of health and frequently associated with poor dispensing and prescribing practices, deficient health-seeking behavior and consequently with inappropriate drug use. Therefore, there is still a need to conduct further studies (qualitative, quantitative and randomized control trial) on factors and reasons for SMA to correctly address the public health problem in LMICs.

Keywords: antibiotics, factors, reasons, self-medication, low and middle-income countries (LMICs)

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Authors: Jose Melena, Rosa Santander, Tanya Gonzalez, Richard Duque, Juan Illanes

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Ecuador is one of the countries with the greatest aquatic biodiversity worldwide. In particular, there are at least a dozen native marine species with great aquaculture potential locally. This research concerns one of those species. It has proposed to implement experimental protocols in order to induce spawning and to generate the early larval development of the penshell Atrina maura under controlled conditions. Bioassays were carried out with one adult batch (n= 26) with an average valvar length of 307,6 ± 9,4 mm, which were collected in the Puerto El Morro Mangrove (2° 42' 33'' S, 80° 14' 28'' W), Guayas Province. During a short acclimation stage, five adults of penshell A. maura were sacrificed in order to determine their sexual maturity degree and to estimate their sex ratio. Dissection showed that three were ripe females (60%) and two were ripe males (40%). Later, three groups (n= 7 by each) were tested with two treatments in order to induce the broodstock spawning: thermal stress, osmotic shock, and one control. Spawning induction was achieved by the immersion in water to 0 g L⁻¹ per 1 h and immersion in sea water to 34 g L⁻¹ per 1 h. After the delivery of gametes, it was achieved 1,35 × 10⁶ viable zygotes. As results, fertilized eggs had 60 µm diameter; while first and second cell divisions were observed to 1 h post-fertilization, with individual average length of 65 ± 4 µm and polar body. Latter cell divisions, including gastrula stage, appeared at 9 h post-fertilization, with individual average length of 71 ± 4 µm; and trochophore stage at 16 h post-fertilization with individual average length of 75 ± 5 µm. In addition, veliger stage was registered at 20 h post-fertilization with individual average length of 81 ± 5 µm. Umboned larvae appeared at day 8 post-fertilization, with individual average length of 145 ± 6 µm. These pioneering results in Ecuador can strengthen the local conservation process of the overexploited A. maura and to encourage its production for commercial purposes.

Keywords: Atrina maura, Ecuador, larval development, spawning induction

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Authors: Phimsupha Kokchang, Divine Ifransca Wijaya

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The energy transition is crucial for mitigating climate change and achieving sustainable development and resilience. As the energy transition advances, generation Z is entering the economic world and will soon be responsible for taking care of the environment. This study aims to investigate the factors influencing generation Z’s pro-environmental behavior to support the energy transition. The theory of planned behavior approach was combined with the pro-environmental behavior concept to examine generation Z’s support toward the energy transition through participating in activism, using energy from renewable sources, opting for energy-efficient utilities or vehicles, and influencing others. Data were collected through an online questionnaire of 400 respondents aged 18-26 living in Jakarta, Indonesia. Partial least square structural equation modeling (PLS-SEM) using SmartPLS 3.0 software was used to analyze the reliability and validity of the measurement model. The results show that attitude, subjective norms, and perceived behavior control positively correlate with generation Z’s pro-environmental behavior to support the energy transition. This finding could enhance understanding and provide insights to formulate effective strategies and policies to increase generation Z’s support towards the energy transition. This study contributes to the energy transition discussion as it is included in the Sustainable Development Goals, as well as pro-environmental behavior and theory of planned behavior literature.

Keywords: energy transition, pro-environmental behavior, theory of planned behavior, generation Z

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Authors: Kuan Yin Hsiao, Shyh Ming Kuo, Yi Jhen Wu, Chin Wen Chuang, Chuen-Fu Lin, Wei-qing Yang, Han Hsiang Huang

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Anti-tumor effects of natural products, like compounds from marine sponges and soft corals, have been investigated for decades. Polymeric nanoparticles prepared from biodegradable and biocompatible molecules, such as Hyaluronan (HA), Chitosan (CHI) and gelatin have been widely studied. Encapsulation of anti-cancer therapies by the biopolymeric nanoparticles in drug delivery system is potentially capable of improving the therapeutic effects and attenuating their toxicity. In the current study, the anti-bladder cancer effects of heteronemin extracted from the sponge Hippospongia sp. with or without HA and CHI nanoparticle encapsulation were assessed and evaluated in vitro. Results showed that IC50 (half maximal inhibitory concentration) of heteronemin toward T24 human bladder cancer cell viability is approximately 0.18 µg/mL. Both plain and HA nanoparticles-encapsulated heteronemin at 0.2 and 0.4 µg/mL significantly reduced T24 cell viability (P<0.001) while HA nanoparticles-encapsulated heteronemin showed weaker viability-inhibitory effects on L929 fibroblasts compared with plain heteronemin at the identical concentrations. HA and CHI nanoparticles-encapsulated heteronemin exhibited significantly stronger inhibitory effects against migration of T24 human bladder cancer cell than those exerted by plain heteronemin at the same concentrations (P<0.001). The flow cytometric results showed that 0.2 µg/mL HA and CHI nanoparticles-encapsulated heteronemin induced higher early apoptosis rate than that induced by plain heteronemin at the same concentration. These results show that HA and CHI nanoparticle encapsulation is able to elevate anti-migratory and apoptosis-inducing effects exerted by heteronemin against bladder cancer cells in vitro. The in vivo anti-bladder cancer effects of the compound with or without HA/CHI nanoparticle encapsulation will be further investigated and examined using murine tumor models. The data obtained from this study will extensively evaluate of the anti-bladder cancer effects of heteronemin as well as HA/CHI-encapsulated heteronemin and pave a way to develop potential bladder cancer treatment.

Keywords: heteronemin, nanoparticles, hyaluronan, chitosan, bladder cancer

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Authors: Solomon Sisay, Belete Mengistu, Woldargay Erku, Desalegne Woldeyohannes

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Background: Tuberculosis is still the leading cause of illness in the world which accounted for 2.5% of the global burden of disease, and 25% of all avoidable deaths in developing countries. Objectives: The aim of study was to assess impact of DOTS strategy on tuberculosis case finding and treatment outcome in Gambella Regional State, Ethiopia from 2003 up to 2012 and from 2002 up to 2011, respectively. Methods: Health facility-based retrospective study was conducted. Data were collected and reported in quarterly basis using WHO reporting format for TB case finding and treatment outcome from all DOTS implementing health facilities in all zones of the region to Federal Ministry of Health. Results: A total of 10024 all form of TB cases had been registered between the periods from 2003 up to 2012. Of them, 4100 (40.9%) were smear-positive pulmonary TB, 3164 (31.6%) were smear-negative pulmonary TB and 2760 (27.5%) had extra-pulmonary TB. Case detection rate of smear-positive pulmonary TB had increased from 31.7% to 46.5% from the total TB cases and treatment success rate increased from 13% to 92% with average mean value of being 40.9% (SD= 0.1) and 55.7% (SD=0.28), respectively for the specified year periods. Moreover, the average values of treatment defaulter and treatment failure rates were 4.2% and 0.3%, respectively. Conclusion: It is possible to achieve the recommended WHO target which is 70% of CDR for smear-positive pulmonary TB, and 85% of TSR as it was already been fulfilled the targets for treatments more than 85% from 2009 up to 2011 in the region. However, it requires strong efforts to enhance case detection rate of 40.9% for smear-positive pulmonary TB through implementing alternative case finding strategies.

Keywords: Gambella Region, case detection rate, directly observed treatment short-course, treatment success rate, tuberculosis

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Authors: Mustafa Jahanara

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The present research was carried out in order to investigate the relationship between meaning in life and hope with depression, anxiety and stress in Afghan Refugees in Alborz province in Iran. In this research, method of study is a descriptive correlation type. One hundred and fifty-eight Afghan refugees (64 male, 94 female) participated in this study. All participants completed the Meaning in Life Questionnaires (MLQ), Hope Scale (HS), and The Depression Anxiety Stress Scales (DASS-21). The results revealed that Meaning in Life was positively associated with hope, presence of meaning, search of meaning, and negatively associated with depression and anxiety. Hope was positively associated with presence of meaning and search of meaning, and hope was negatively associated with depression, anxiety, and stress. Depression, anxiety, and stress were positively correlated with each other. Meaning in life and hope could influence on mental health.

Keywords: Afghan refugees, meaning of life, hope, depression, anxiety and stress

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Authors: Jennifer Holbein, Maritza Wiedel

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Background: Aging is associated with an increased risk of falls in older adults, and as a result, falls have become public health crises. However, the incidence of falls can be reduced through healthy aging and the implementation of a regular exercise and strengthening program. Public health and healthcare professionals authorize the use of evidence‐based, exercise‐focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practices. The purpose of this study was to assess the feasibility of an intervention, A Matter of Balance, in terms of demand, acceptability, and implementation into current exercise programs. Subjects: Seventy-five participants from rural communities, above the age of sixty, were randomized to an intervention or attention-control of the standardized senior fitness test. Methods: Subject completes the intervention, which combines two components: (1) motivation and (2) fall-reducing physical activities with protocols derived from baseline strength and balanced assessments. Participants (n=75) took part in the program after completing baseline functional assessments as well as evaluations of their personal knowledge, health outcomes, demand, and implementation interventions. After 8-weeks of the program, participants were invited to complete follow-up assessments with results that were compared to their baseline functional analyses. Out of all the participants in the study who complete the initial assessment, approximately 80% are expected to maintain enrollment in the implemented prescription. Furthermore, those who commit to the program should show mitigation of fall risk upon completion of their final assessment.

Keywords: aging population, exercise, falls, functional assessment, healthy aging

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Authors: George Madalin Danila, Mihaiella Cretu, Cristian Puscasu

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Glycol-based anti-freeze liquids, commonly composed of ethylene glycol or propylene glycol, have important uses in automotive cooling, but they should be handled with care due to their toxicity; ethylene glycol is highly toxic to humans and animals. A fast, accurate, precise, and robust method was developed for the simultaneous quantification of 7 most important glycols and their isomers. Glycols were analyzed from diluted sample solution of coolants using gas-chromatography coupled with mass spectrometry in single ion monitoring mode. Results: The method was developed and validated for 7 individual glycols (ethylene glycol, diethylene glycol, triethylene glycol, tetraethylene glycol, propylene glycol, dipropylene glycol and tripropylene glycol). Limits of detection (1-2 μg/mL) and limit of quantification (10 μg/mL) obtained were appropriate. The present method was applied for the determination of glycols in 10 different anti-freeze liquids commercially available on the Romanian market, proving to be reliable. A method that requires only a two-step dilution of anti-freeze samples combined with direct liquid injection GC-MS was validated for the simultaneous quantification of 7 glycols (and their isomers) in 10 different types of anti-freeze liquids. The results obtained in the validation procedure proved that the GC-MS method is sensitive and precise for the quantification of glycols.

Keywords: glycols, anti-freeze, gas-chromatography, mass spectrometry, validation, recycle

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Authors: Petronella Jonck, Freda van der Walt

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Despite the benefits of innovation diffusion in the South African public service, implementation thereof seems to be problematic, particularly with regard to e-governance which would enhance the quality of service delivery, especially accessibility, choice, and mode of operation. This paper reports on differences between the public service and the private sector in terms of innovation diffusion. Innovation diffusion will be investigated to explore identified obstacles that are hindering successful implementation of e-governance. The research inquiry is underpinned by the diffusion of innovation theory, which is premised on the assumption that innovation has a distinct channel, time, and mode of adoption within the organisation. A comparative thematic document analysis was conducted to investigate organisational differences with regard to innovation diffusion. A similar approach has been followed in other countries, where the same conceptual framework has been used to guide document analysis in studies in both the private and the public sectors. As per the recommended conceptual framework, three organisational characteristics were emphasised, namely the external characteristics of the organisation, the organisational structure, and the inherent characteristics of the leadership. The results indicated that the main difference in the external characteristics lies in the focus and the clientele of the private sector. With regard to organisational structure, private organisations have veto power, which is not the case in the public service. Regarding leadership, similarities were observed in social and environmental responsibility and employees’ attitudes towards immediate supervision. Differences identified included risk taking, the adequacy of leadership development, organisational approaches to motivation and involvement in decision making, and leadership style. Due to the organisational differences observed, it is recommended that differentiated strategies be employed to ensure effective innovation diffusion, and ultimately e-governance. It is recommended that the results of this research be used to stimulate discussion on ways to improve collaboration between the mentioned sectors, to capitalise on the benefits of each sector.

Keywords: E-governance, ICT, innovation diffusion, comparative analysis

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Authors: Rabia Genc, Aysun Eksioglu, Emine Serap Sarican, Sibel Icke

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Today the habit of cigarette smoking is among one of the most important public health concerns because of the health problems it leads to. The most important and hazardous group to use tobacco and tobacco products is adolescents and teenagers. And one of the most effective ways to prevent them from starting to smoke is education. This research is a kind of educational intervention study which was carried out in order to evaluate the effect of peer education on the teenagers' knowledge about smoking. The research was carried out between October 15, 2013 and September 9, 2015 at Ege University Ataturk Vocational Health School. The population of the research comprised of the students that have been studying at Ege University Atatürk Vocational Health School, Midwifery Department (N=390). The peer educator group that would give training on smoking consisted of 10 people, and the peer groups that would be trained were divided into two groups via simple randomization as experimental group (n=185) and control group (n=185). Questionnaire, information evaluation form, and informed consent forms were used as date collection tools. The analysis of the data which were collected in the study was carried out on Statistical Package for Social Science (SPSS 15.0). It was found out that 62.5 % of the students who were in peer educator group had smoked in some period of their lives; however, none of them continued to smoke. When they were asked about their reasons to start smoking, 25% said they just wanted to try it, and 25% of them answered that it was because of their friend groups. When the pre-peer education and post-peer education point averages of peer educator group were evaluated, the results showed that there was a significant difference between the point averages (p < 0.05). When the cigarette use of experimental group and the control group were evaluated, it was clear that 18.2% of the experimental group and 24.2%of the control group still smokes. 9.1% of the experimental group and 14.8% of control group stated that they started smoking because of their friend groups. Among the students who smoke 15.9% of the ones who belongs to the experimental group and 21.9% of the ones who belong to the control group stated they are thinking of quitting smoking. It was clear that there is a significant difference between the pre-education and post-education point averages of experimental group statistically (p ≤ 0.05); however, in terms of control group, there were no significant differences between the pre-test post-test averages statistically. Between the pre-test post-test averages of experimental and control groups there were not any statistically significant differences (p > 0.05). It was found out in the study that the peer education programme is not effective on the smoking habit of Vocational Health School students. When the future studies are being planned in order to evaluate the peer education activity, it can be taken into consideration that the peer education takes a long term and the students in the educator group will be more enthusiastic and a kind of leader in their environment.

Keywords: midwifery, peer, peer education, smoking

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Authors: Yongrong Li, Ralf Domroes

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Due to significant energy savings, enablement of higher machining speed as well as environmentally friendly features, Minimum Quantity Lubrication (MQL) has been used for many machining processes efficiently. However, in the deep hole drilling field (small tool diameter D < 5 mm) and long tool (length L > 25xD) it is always a bottle neck for a single channel MQL system. The single channel MQL, based on the Venturi principle, faces a lack of enough oil quantity caused by dropped pressure difference during the deep hole drilling process. In this paper, a system concept based on a bypass design has explored its possibility to dynamically reach the required pressure difference between the air inlet and the inside of aerosol generator, so that the deep hole drilling demanded volume of oil can be generated and delivered to tool tips. The system concept has been investigated in static and dynamic laboratory testing. In the static test, the oil volume with and without bypass control were measured. This shows an oil quantity increasing potential up to 1000%. A spray pattern test has demonstrated the differences of aerosol particle size, aerosol distribution and reaction time between single channel and bypass controlled single channel MQL systems. A dynamic trial machining test of deep hole drilling (drill tool D=4.5mm, L= 40xD) has been carried out with the proposed system on a difficult machining material AlSi7Mg. The tool wear along a 100 meter drilling was tracked and analyzed. The result shows that the single channel MQL with a bypass control can overcome the limitation and enhance deep hole drilling with a small tool. The optimized combination of inlet air pressure and bypass control results in a high quality oil delivery to tool tips with a uniform and continuous aerosol flow.

Keywords: deep hole drilling, green production, Minimum Quantity Lubrication (MQL), near dry machining

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Authors: Mimoza Canga, Irene Malagnino, Gresa Baboci, Edit Xhajanka, Vito Antonio Malagnino

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Background: Diabetes mellitus is regarded as a very problematic chronic disease that has an effect on a considerable number of people around the world and it is straightforwardly associated with the oral health condition of the patients. Objective: The objective of this study is to analyze and evaluate the impact of diabetes mellitus on oral health. Materials and methods: In the present research were taken into consideration 300 patients with an age range of 11 to 80 years old. The study sample was composed of 191 males, respectively 63.7% of them and 109 females 36.3% of the participants. We divided them into seven age groups: 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, and 71-80 years.This descriptive and analytical research was designed as a longitudinal study. Statistical analysis was performed using IBM SPSS 23.0 statistics. Results: The majority of patients participating in the study belonged to the age range from 41 to 50 years old, precisely 20.7% of them, while 27% of the patients were from 51 to 60 years old. Based on the present research, it resulted that 24.4% of the participant had high blood sugar values 250-300 mg/dl, whereas 19 % of the patients had very high blood sugar values 300-350 mg/dl. Based on the results of the current study, it was observed that 83.7% of patients were affected by gingivitis. In the current study, the significant finding is that 22% of patients had more than 7 teeth with dental caries and 21% of them had 5-7 teeth with dental caries, whereas 29% of the patients had 4-5 dental caries and the remaining 28% of them had 1-3 dental caries. The present study showed that most of the patients, 27% of them had lost more than 7 teeth and 22% of the participants had lost 5-7 teeth, whereas 31% of the patients had lost 4-5 teeth and only 20 % of them had lost 1-3 teeth. This study proved that high blood sugar values had a direct impact on the manifestation of gingivitis and there it was a strong correlation between them with P-value = .001. A strong correlation was found out between dental caries and high blood sugar values with P-value ˂.001. Males with diabetes mellitus were more affected by dental caries and this was proved by the P-value= .02, in comparison to females P-value=.03. The impact of high blood sugar values affects missing teeth and the correlation between them was statistically significant with P-value ˂ .001. Conclusion: The results of this study suggest that diabetes mellitus is a possible risk factor in oral health for the reason that Albanian patients over 51 years old, respectively 43% of them have over 5 teeth with dental caries as compared with 49% of the patients who had over 5 missing teeth, whereas the majority 83.7% of them suffered from gingivitis. This study asserts that patients who do not have periodical check-ups of diabetes mellitus are at significant risk of oral diseases.

Keywords: dental caries, diabetes mellitus, gingivitis, missing teeth

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Authors: Maya Kagan, Michal Itzick, Patricia Tal-Katz

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Social workers hold a variety of roles and practices, and one of these involves the care, treatment, and rehabilitation of disabled people. The current study assesses the association between demographic factors, attitudes towards social workers, the stigma attached to seeking social worker help, perceived social support, and psychological distress - and the self-reported likelihood of seeking social worker help, among people with physical disabilities (PWPD) in Israel. Data collection utilized structured questionnaires, administered to a sample of 435 PWPD. Statistical analyses were done using SPSS software. The findings suggest that women, older respondents, people with more positive attitudes towards social workers, with higher levels of psychological distress and of social support, and with a lower level of stigma, reported a greater likelihood of seeking social worker help. The study's conclusion is that there are certain avoidance factors among PWPD that might discourage them from seeking professional social worker help. Therefore, it is important that social workers identify these factors and develop interventions aimed at encouraging PWPD to seek professional social worker help in case of need, and also develop practices adjusted to PWPD's unique needs.

Keywords: attitudes towards social workers, people with physical disabilities, perceived social support, psychological distress, seeking help, stigma

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Authors: Nguyen Thi Huong Nhai

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This paper examines how different motivations to engage in organic farming may impact the farmers’ subjective well-being using a survey database from the French Agence Bio. Three measures representing the subjective well-being of farmers brought by their involvement in organic farming are used in this study: feelings of pride, satisfaction, and feeling of happiness. We focus on the effects of two different types of motivations: intrinsic motivations, such as preservation of human health and public health, concern about the environment, and autonomy in farming decisions; extrinsic motivations, such as fair price, income, and demand incentives. Results show that not all intrinsic motivations can increase farmers’s well-being. The intrinsic motivation relating to environment concern and aspiration seems to have the highest positive impact on the three proxies of SWB in our study. It is interesting to find out that the two extrinsic motivations (profitable price, satisfying the incentive of consumer and cooperative) are proven to have a negative influence. Some comparisons, explanations, and practical implications are also indicated in this research.

Keywords: intrinsic otivation, extrinsic motivation, subjective wellbeing, organic farmers

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Authors: Mark Linden, Michael Brown, Lynne Marsh, Maria Truesdale, Stuart Todd, Nathan Hughes, Trisha Forbes, Rachel Leonard

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Background: Family carers of people with intellectual disabilities (ID) face ongoing challenges in accessing services and often experience poor mental health. Online support programmes may prove effective in addressing the mental health and well-being needs of family carers. This study sought to test the acceptability of a newly developed online support programme for carers of people with intellectual disabilities called Carers-ID. Methods A sequential mixed-methods explanatory design was utilised. An adapted version of the Acceptability of Health Apps among Adolescents (AHAA) Scale was distributed to family carers who had viewed the Carers-ID.com intervention. Following this, participants were invited to take part in an online interview. Interview questions focused on participants’ experiences of using the programme and its acceptability. Qualitative and quantitative data were analysed separately and then brought together through the triangulation protocol developed by Farmer et al (2006). Findings: Seventy family carers responded to the acceptability survey, whilst 10 took part in interviews. Six themes were generated from interviews with family carers. Based on our triangulation, four areas of convergence were identified, these included, programme usability and ease, attitudes towards the programme, perceptions of effectiveness, and programme relatability. Conclusions: In order to be acceptable, online interventions for carers of people with ID need to be accessible, understandable and easy to use, as carers time is precious. Further research is needed to investigate the effectiveness of online interventions for family carers, specifically considering which carers the intervention works for, and for whom it may not.

Keywords: intellectual disability, family carer, acceptability study, online intervention

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Authors: Nashaat Mazrui, Oarabile Mogobe, Barbara Ngwenya, Ketlhatlogile Mosepele, Mangaliso Gondwe

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Over the last several decades, the world has seen a rapid increase in activities such as deforestation, agriculture, and energy use. Subsequently, trace elements are being deposited into our water bodies, where they can accumulate to toxic levels in aquatic organisms and can be transferred to humans through fish consumption. Thus, though fish is a good source of essential minerals and omega-3 fatty acids, it can also be a source of toxic elements. Monitoring trace elements in fish is important for the proper management of aquatic systems and the protection of human health. The aim of this study was to determine concentrations of trace elements in sediment and muscle tissues of Clarias gariepinus at Lake Ngami, in the Okavango Delta in northern Botswana, during low floods. The fish were bought from local fishermen, and samples of muscle tissue were acid-digested and analyzed for iron, zinc, copper, manganese, molybdenum, nickel, chromium, cadmium, lead, and arsenic using inductively coupled plasma optical emission spectroscopy (ICP-OES). Sediment samples were also collected and analyzed for the elements and for organic matter content. Results show that in all samples, iron was found in the greatest amount while cadmium was below the detection limit. Generally, the concentrations of elements in sediment were higher than in fish except for zinc and arsenic. While the concentration of zinc was similar in the two media, arsenic was almost 3 times higher in fish than sediment. To evaluate the risk to human health from fish consumption, the target hazard quotient (THQ) and cancer risk for an average adult in Botswana, sub-Saharan Africa, and riparian communities in the Okavango Delta was calculated for each element. All elements were found to be well below regulatory limits and do not pose a threat to human health except arsenic. The results suggest that other benthic feeding fish species could potentially have high arsenic levels too. This has serious implications for human health, especially riparian households to whom fish is a key component of food and nutrition security.

Keywords: Arsenic, African sharp tooth cat fish, Okavango delta, trace elements

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Authors: Eseldin Keleb

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In the pharmaceutical industry particle size distribution is an important parameter for the characterization of pharmaceutical powders. The powder flowability, reactivity and compatibility, which have a decisive impact on the final product, are determined by particle size and size distribution. Therefore, the aim of this study was to evaluate the influence of processing parameters on the particle size distribution measurements. Different Size fractions of α-lactose monohydrate and 5% polyvinylpyrrolidone were prepared by wet granulation and were used for the preparation of samples. The influence of sieve load (50, 100, 150, 200, 250, 300, and 350 g), processing time (5, 10, and 15 min), sample size ratios (high percentage of small and large particles), type of disturbances (vibration and shaking) and process reproducibility have been investigated. Results obtained showed that a sieve load of 50 g produce the best separation, a further increase in sample weight resulted in incomplete separation even after the extension of the processing time for 15 min. Performing sieving using vibration was rapider and more efficient than shaking. Meanwhile between day reproducibility showed that particle size distribution measurements are reproducible. However, for samples containing 70% fines or 70% large particles, which processed at optimized parameters, the incomplete separation was always observed. These results indicated that sieving reliability is highly influenced by the particle size distribution of the sample and care must be taken for samples with particle size distribution skewness.

Keywords: sieving, reliability, particle size distribution, processing parameters

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Authors: Ravi Patel, Krishna K. Krishnan

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In global supply chains, appropriate and sustainable suppliers play a vital role in supply chain development and feasibility. In a larger organization with huge number of suppliers, it is necessary to divide suppliers based on their past history of quality and delivery of each product category. Since performance of any organization widely depends on their suppliers, well evaluated selection criteria and decision-making models lead to improved supplier assessment and development. In this paper, SCOR® performance evaluation approach and ISO standards are used to determine selection criteria for better utilization of supplier assessment by using hybrid model of Analytic Hierchchy Problem (AHP) and Fuzzy Techniques for Order Preference by Similarity to Ideal Solution (FTOPSIS). AHP is used to determine the global weightage of criteria which helps TOPSIS to get supplier score by using triangular fuzzy set theory. Both qualitative and quantitative criteria are taken into consideration for the proposed model. In addition, a multi-product and multi-time period model is selected for order allocation. The optimization model integrates multi-objective integer linear programming (MOILP) for order allocation and a hybrid approach for supplier selection. The proposed MOILP model optimizes order allocation based on manufacturing process and product tolerances as per manufacturer’s requirement for quality product. The integrated model and solution approach are tested to find optimized solutions for different scenario. The detailed analysis shows the superiority of proposed model over other solutions which considered individual decision making models.

Keywords: AHP, fuzzy set theory, multi-criteria decision making, multi-objective integer linear programming, TOPSIS

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Authors: Sutapa Som Chaudhury, Chitrangada Das Mukhopadhyay

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Alzheimer’s disease is a well-known form of dementia since its discovery in 1906. Current Food and Drug Administration approved medications e.g. cholinesterase inhibitors, memantine offer modest symptomatic relief but do not play any role in disease modification or recovery. In last three decades many small molecules, chaperons, synthetic peptides, partial β-secretase enzyme blocker have been tested for the development of a drug against Alzheimer though did not pass the 3rd clinical phase trials. Here in this study, we designed a PEGylated, aminogenic, tripeptidic polymer with two different molecular weights based on the aggregation prone amino acid sequence 17-20 in amyloid beta (Aβ) 1-42. Being conjugated with poly-ethylene glycol (PEG) which self-assembles into hydrophilic nanoparticles, these PEGylated tripeptides constitute a very good drug delivery system crossing the blood brain barrier while the peptide remains protected from proteolytic degradation and non-specific protein interactions. Moreover, being completely aminogenic they would not raise any side effects. These peptide inhibitors were evaluated for their effectiveness against Aβ42 fibrillation at an early stage of oligomer to fibril formation as well as preformed fibril clearance via Thioflavin T (ThT) assay, dynamic light scattering analyses, atomic force microscopy and scanning electron microscopy. The inhibitors were proved to be safe at a higher concentration of 20µM by the reduction assay of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) dye. Moreover, SHSY5Y neuroblastoma cells have shown a greater survivability when treated with the inhibitors following Aβ42 fibril and oligomer treatment as compared with the control Aβ42 fibril and/or oligomer treated neuroblastoma cells. These make the peptidic inhibitors a promising compound in the aspect of the discovery of alternative medication for Alzheimer’s disease.

Keywords: Alzheimer’s disease, alternative medication, amyloid beta, PEGylated peptide

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Authors: Junaid Ahmed, Nandita Shenoy

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Maintaining lifelong knowledge and skills is essential for safe clinical practice. Continuing Professional Development (CPD) is an established method that can facilitate lifelong learning. It focuses on maintaining or developing knowledge, skills and relationships to ensure competent practice.To date, relatively little has been done to comprehensively and systematically synthesize evidence to identify subjects of interest among practising dentist. Hence the aim of our study was to identify areas in clinical practice that would be favourable for continuing professional dental education amongst practicing dentists. Participants of this study consisted of the practicing dental surgeons of Mangalore, a city in Dakshina Kannada, Karnataka. 95% of our practitioners felt that regular updating as a one day program once in 3-6 months is required, to keep them abreast in clinical practice. 60% of subjects feel that CPD programs enrich their theoretical knowledge and helps in patient care. 27% of them felt that CPD programs should be related to general dentistry. Most of them felt that CPD programs should not be charged nominally between one to two thousand rupees. The acronym ‘CPD’ should be seen in a broader view in which professionals continuously enhance not only their knowledge and skills, but also their thinking,understanding and maturity; they grow not only as professionals, but also as persons; their development is not restricted to their work roles, but may also extend to new roles and responsibilities.

Keywords: continuing professional development, competent practice, dental education, practising dentist

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Authors: Rahaf Alasiri, Tarek Alghamdi, Abdullah Zarkan

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Background: Due to measures such as school closure, social distancing, and virtual teaching during the pandemic, primary school children's psychological well-being is greatly affected. These measures have short and long-term consequences on the children's well-being and mental health. Identifying these consequences is important. Aim: This study aimed to evaluate mood and behavior changes in children who attended school virtually. Subjects and methods: This is a cross-sectional study conducted among children and their parents who visited the outpatient clinic. A self-administered questionnaire was given to the parents of children aged between 6 to 14 years. The questionnaire includes socio-demographic characteristics, Conor's modifies scale to assess the attention deficit hyperactivity disorder (ADHD) of children, and the parental stress scale (PSS) to assess the stress symptoms of the parents. Results: Of the 66 surveyed children, 60.6% were aged between 10 to 14 years old, with the female being dominant (77.3%). The most common medical condition was asthma (7.6%), and nearly two-thirds (63.6%) indicated good health conditions during the pandemic. There was a significant inverse correlation observed between ADHD score and PSS score (r=-0.387). No significant differences are in ADHD and PSS scores in relation to the socio-demographic characteristics of the children, including age, gender, and having an associated medical condition (p>0.05). Conclusion: During the pandemic, children who attended virtual classes did not seem to affect even with restrictions. Most children indicated good health conditions during the pandemic. However, it is surprising to know that in spite of children’s high spirits during the pandemic, their parents were seen to have an increased level of stress. Strategies to address parents’ psychological disorders during the pandemic are warranted.

Keywords: children's mood, COVID-19, ADHD, parental stress

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Authors: Rahul Kumar

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Background: Under-FiveMortality Rate(U5MR)ofanationiswidelyacceptedandlong-standing indicators of well-beingofherchildren.They measuredtheprobability of dying before theageoffive(expressedper1000livebirths).TheU5MRisanappropriate indicator of the cumulative exposure totheriskofdeathduringthefirstfiveyearsoflife, and accepted globalindicator ofthehealthandsocioeconomicstatusofagiven population.Itisalsousefulforassessing theimpactofvariousintervention programmes aimed at improving child survival.Under-fivemortalitytrendsconstitutealeadingindicatorofthelevel ofchildhealthandoveralldevelopmentincountries. Objectives: The first aim of our research is to study the level, trends, and Pattern of Under-five mortality using different sources of data. The second objective is to examine the survival pattern of Under-five mortality by different background characteristics. Data Source and Methodology: SRS and NFHS data have been used forobservingthelevelandtrendofUnder-Five mortality rate. Kaplan Meier Estimate has been used to understand the survival Pattern of Under-five mortality. Result: WefindthatallmostallthestatesmadesomeprogressbyreducingU5MRin recent decades.During1992-93highestU5MR(per thousand live birth) was observed in Assam(142)followed by up(141),Odisha(131),MP(130),andBihar(127.5).While the least U5MR(perthousandlive birth)wasobservedinRajasthan(102). The highestU5MR(per thousandlive birth)isobservedinUP(78.1), followed by MP(64.9)and Chhattisgarh(63.7)which are far away from the national level(50). Among them, Uttarakhand(46.7)hadleastU5MR(perthousandlivebirth), followed by Odisha(48.6). TheU5MR(perthousandlivebirth)ofcombinedhighfocusstateis63.7whichisfar away fromthenationallevel(50). Weidentified thatthesurvivalprobability ofunder-fivechildrenfromadolescentmotherislessin comparisontootherchildrenbornby differentagegroupofmothers. thatduringneonatalperiodusually male mortality exceedsthefemale mortality butthisdifferentialreversedinthepostneonatalperiod. Astheirageincreasesand approachingtofiveyears,weidentifiedthatthesurvivalprobability ofbothsexdecreasesbut female’s survival probabilitydecrement is more than male as their ageincreases. The poorer children’s survival probability is minimum. Children using improved toilet facility has more survival probability throughout thefiveyearsthan who uses unimproved. The survival probability of children under five who got Full ANCis more than the survival probability of children under five who doesn’t get any ANC. Conclusions: Improvement of maternal education is an urgent need to improve their health seeking behavior and thus the health of their children. Awareness on reproductive health and environmental sanitation should be strengthened.

Keywords: under-five mortality, survival pattern, ANC, trend

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Authors: Hsuan Yu Lai, Hsuan Hsuan Chang

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The consumer decision process steps through problems by weighing evidence, examining alternatives, and choosing a decision path. Currently, the COVID 19 made the tourism industry encounter a huge challenge and suffer the biggest amount of economic loss. It would be very important to reexamine the decision-making process model, especially after the pandemic, and consider the differences among different generations. The tourism industry has been significantly impacted by the global outbreak of COVID-19, but as the pandemic subsides, the sector is recovering. This study addresses the scarcity of research on travel decision-making patterns among generations in Taiwan. Specifically targeting individuals who frequently traveled abroad before the pandemic, the study explores differences in decision-making at different stages post-outbreak. So this study investigates differences in travel decision-making among individuals from different generations during/after the COVID-19 pandemic and examines the moderating effects of social media usage and individuals' perception of health risks. The study hypotheses are “there are significant differences in the decision-making process including travel motivation, information searching preferences, and criteria for decision-making” and that social-media usage and health-risk perception would moderate the results of the previous study hypothesis. The X, Y, and Z generations are defined and categorized based on a literature review. The survey collected data including their social-economic background, travel behaviors, motivations, considerations for destinations, travel information searching preferences, and decision-making criteria before/after the pandemic based on the reviews of previous studies. Data from 656 online questionnaires were collected between January to May 2023 and from Taiwanese travel consumers who used to travel at least one time abroad before Covid-19. SPSS is used to analyze the data with One-Way ANOVA and Two-Way ANOVA. The analysis includes demand perception, information gathering, alternative comparison, purchase behavior, and post-travel experience sharing. Social media influence and perception of health risks are examined as moderating factors. The findings show that before the pandemic, the Y Generation preferred natural environments, while the X Generation favored historical and cultural sites compared to the Z Generation. However, after the outbreak, the Z Generation displayed a significant preference for entertainment activities. This study contributes to understanding changes in travel decision-making patterns following COVID-19 and the influence of social media and health risks. The findings have practical implications for the tourism industry.

Keywords: consumer decision-making, generation study, health risk perception, post-pandemic era, social media

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Authors: Segen Asayehegn

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Introduction: In Tigray, Ethiopia, next to cervical cancer, breast cancer is one of the most common cancer health problems for women. Objectives: This article is proposed to identify the prospective and potential risk factors affecting the time-to-first-recurrence of breast cancer patients in Tigray, Ethiopia. Methods: The data were taken from the patient’s medical record that registered from January 2010 to January 2020. The study considered a sample size of 1842 breast cancer patients. Powerful non-parametric and parametric shared frailty survival regression models (FSRM) were applied, and model comparisons were performed. Results: Out of 1842 breast cancer patients, about 1290 (70.02%) recovered/cured the disease. The median cure time from breast cancer is found at 12.8 months. The model comparison suggested that the lognormal parametric shared a frailty survival regression model predicted that treatment, stage of breast cancer, smoking habit, and marital status significantly affects the first recurrence of breast cancer. Conclusion: Factors like treatment, stages of cancer, and marital status were improved while smoking habits worsened the time to cure breast cancer. Recommendation: Thus, the authors recommend reducing breast cancer health problems, the regional health sector facilities need to be improved. More importantly, concerned bodies and medical doctors should emphasize the identified factors during treatment. Furthermore, general awareness programs should be given to the community on the identified factors.

Keywords: acceleration factor, breast cancer, Ethiopia, shared frailty survival models, Tigray

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Authors: T. Jivita, M. S. Salmiah

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The aims of this study were to determine the prevalence of smoking, reasons for tried smoking, factors that influence smoking, and knowledge level on health risk among male Tamil primary school students. Seven urban Tamil primary schools in Kuala Lumpur were identified based on cluster sampling. A cross-sectional study was conducted in May 2014 and a total of 380 male children in standard 4 and 5 were selected. Survey included information on history of ever smoking even a puff, smoking a whole cigarette, smoking every day at least for 7 days, reasons for tried smoking, potential factors of smoking and knowledge related to smoking and health. Fifty seven had previously smoked, with a prevalence of 15.0% (95% CI = 11.4, 18.6) and 17 had smoked a whole cigarette (4.5%, 95% CI = 2.42, 6.58) while 8 had at least smoked 7 days continuously (2.1%, 95% CI = 0.66, 3.54). The reasons for tried smoking were because of curiosity (63.2%), it is not allowed (42.6%), it is relaxing (35.2%), it is cool (33.3%), to lose weight (20.4%), style (1.8%), by mistake (0.5%), for prayers purpose (0.3%), given by uncle (0.3%), and introduced by elder brother (0.3%). None of these reasons were associated with age factors (p > 0.05). Of those who had smoked a whole cigarette, 42.9% were significantly influenced by father (χ2 (1) = 6.42, p = 0.040) and 47.8% were significantly influenced by friends (χ2 (2) = 6.27, p = 0.043). Overall 91.5% had good level of knowledge about smoking, where the majority knew that smoking was dangerous to their health. However only 61.7% and 63.1% of them knew that smoking can cause high blood pressure and stroke, respectively. There is no significant different in mean rank between 10 years old and 11 years old students (p=0.987 < 0.05) for level of knowledge, tested by Mann-Whitney U Test. Odds of smoking increased 1.37 times having seen actors smoking (95% CI= 1.01, 1.86), 1.55 times having a father who smokes (95% CI= 1.26, 1.92), 1.64 times having siblings who smokes (95% CI= 1.32, 2.04), and 10.55 times having friends who offered cigarette (95% CI= 4.17, 26.68). As a conclusion, cessation of smoking in family members, who are role models, so as to reduce rates to taking up smoking among children.

Keywords: factors influence, knowledge on smoking, prevalence on smoking, reasons

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Authors: Tamekloe Michael Kossivi, Kenichi Matsui

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Irrigation access is one of the essential rural development investment options that can significantly improve smallholder farmers’ agriculture productivity. Investment in irrigation infrastructural development to supply adequate water could improve food security, growth in income for farmers, poverty alleviation, and improve business and livelihood. This paper assesses smallholder farmers’ constraints and the needs to adopt small-scale irrigation for crops production in the South Tongu District of Ghana. The data collection involved database search, questionnaire survey, interview, and field work. The structured questionnaire survey was administered from September to November 2020 among 120 respondents in six purposively sampled irrigation communities in the District. The questions focused on small-scale irrigation development constraints and needs. As a result, we found that the respondents relied mainly on rainfall for agriculture production. They did not have adequate irrigation access. Even though the District is blessed with open arable lands and rich water sources for rice and vegetable production on a massive scale, water sources like the Lower Volta River, Tordzi River, and Avu Lagoon were not close enough to the respondents. The respondents faced inadequate credit support (100%), unreliable rainfall (76%), insufficient water supply (54%), and unreliable water delivery challenges on their farms (53%). Physical constraints for the respondents to adopt irrigation included flood (77%), drought (93%), inadequate irrigation technology (59%), and insufficient technical know-how (65%). Farmers were interested in investing in irrigation infrastructural development to enhance productivity on their farms only if they own the farmlands. External support from donors on irrigation systems did not allow smallholder farmers to control irrigation facilities.

Keywords: constraints, food security, needs, smallholder farmers, small-scale irrigation

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Authors: Alicia Carranza, Hildemar Dos Santos, W. Lawrence Beeson, R. Patti Herring, Kimberly R. Freeman, Adam Arechiga

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Early exposure to trauma can impact health-related behaviors later in life, which poses a considerable challenge for young adults transitioning into independence when they are lacking the necessary skills and support to live a healthy life. The study will be a non-experimental, mixed methods pre- and post-test (where subjects will serve as their own controls) to determine the impact of an eight-week trauma-informed healthy lifestyle program on self-efficacy for adopting health-promoting behaviors and health outcomes among young adults. Forty-two adults, ages 18-24 who are living in Orange County, CA will be recruited to participate in the eight-week trauma-informed healthy living program. Baseline and post-intervention assessments will be conducted to assess changes in self-efficacy for nutrition and physical exercise, sleep quality and quantity, body mass index (kg/m2), and coping skills used by comparing pre- to post-intervention. Some of the planned activities include cooking demonstrations, mindful eating activities and media literacy using Instagram. Frequencies analyses, paired t-test, and multiple regression will be used to determine if there was a change in coping skills. The results of this study can serve to assess the potential for mitigating the effects of Adverse Childhood Experiences (ACEs), or other toxic stress, experienced during adolescence across the lifespan. Young adults who learn how to cope with stress in a healthy way and engage in a healthy lifestyle can be better prepared to role model that behavior to their children.

Keywords: nutrition, healthy lifestyle, trauma-informed, stress management

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Authors: Simrin Kafle, Ulrika Enemark

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Catastrophic health expenditure (CHE) is a critical issue in low- and middle-income countries like Nepal, exacerbating financial hardship among vulnerable households. This study assesses the effectiveness of Nepal’s National Health Insurance Program (NHIP), launched in 2015, to reduce out-of-pocket (OOP) healthcare costs and mitigate CHE. Conducted in Pokhara Metropolitan City, the study used an analytical cross-sectional design, sampling 1276 households through a two-stage random sampling method. Data was collected via face-to-face interviews between May and October 2023. The analysis was conducted using SPSS version 29, incorporating propensity score matching to minimize biases and create comparable groups of enrolled and non-enrolled households in the NHIP. PSM helped reduce confounding effects by matching households with similar baseline characteristics. Additionally, a doubly robust methodology was employed, combining propensity score adjustment with regression modeling to enhance the reliability of the results. This comprehensive approach ensured a more accurate estimation of the impact of NHIP enrollment on CHE. Among the 1276 samples, 534 households (41.8%) were enrolled in NHIP. Of them, 84.3% of households renewed their insurance card, though some cited long waiting times, lack of medications, and complex procedures as barriers to renewal. Approximately 57.3% of households reported known diseases before enrollment, with 49.8% attending routine health check-ups in the past year. The primary motivation for enrollment was encouragement from insurance employees (50.2%). The data indicates that 12.5% of enrolled households experienced CHE versus 7.5% among non-enrolled. Enrollment into NHIP does not contribute to lower CHE (AOR: 1.98, 95% CI: 1.21-3.24). Key factors associated with increased CHE risk were presence of non-communicable diseases (NCDs) (AOR: 3.94, 95% CI: 2.10-7.39), acute illnesses/injuries (AOR: 6.70, 95% CI: 3.97-11.30), larger household size (AOR: 3.09, 95% CI: 1.81-5.28), and households below the poverty line (AOR: 5.82, 95% CI: 3.05-11.09). Other factors such as gender, education level, caste/ethnicity, presence of elderly members, and under-five children also showed varying associations with CHE, though not all were statistically significant. The study concludes that enrollment in the NHIP does not significantly reduce the risk of CHE. The reason for this could be inadequate coverage, where high-cost medicines, treatments, and transportation costs are not fully included in the insurance package, leading to significant out-of-pocket expenses. We also considered the long waiting time, lack of medicines, and complex procedures for the utilization of NHIP benefits, which might result in the underuse of covered services. Finally, gaps in enrollment and retention might leave certain households vulnerable to CHE despite the existence of NHIP. Key factors contributing to increased CHE include NCDs, acute illnesses, larger household sizes, and poverty. To improve the program’s effectiveness, it is recommended that NHIP benefits and coverage be expanded to better protect against high healthcare costs. Additionally, simplifying the renewal process, addressing long waiting times, and enhancing the availability of services could improve member satisfaction and retention. Targeted financial protection measures should be implemented for high-risk groups, and efforts should be made to increase awareness and encourage routine health check-ups to prevent severe health issues that contribute to CHE.

Keywords: catastrophic health expenditure, effectiveness, national health insurance program, Nepal

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