Search results for: football association

Authors: Orkide Donma, Mustafa M. Donma

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Basal metabolic rate is questioned as a risk factor for weight gain. The relations between basal metabolic rate and body composition have not been cleared yet. The impact of fat mass on basal metabolic rate is also uncertain. Within this context, indices based upon total body mass as well as total body fat mass are available. In this study, the aim is to investigate the potential clinical utility of these indices in the adult population. 287 individuals, aged from 18 to 79 years, were included into the scope of the study. Based upon body mass index values, 10 underweight, 88 normal, 88 overweight, 81 obese, and 20 morbid obese individuals participated. Anthropometric measurements including height (m), and weight (kg) were performed. Body mass index, diagnostic obesity notation model assessment index I, diagnostic obesity notation model assessment index II, basal metabolic rate-to-weight ratio were calculated. Total body fat mass (kg), fat percent (%), basal metabolic rate, metabolic age, visceral adiposity, fat mass of upper as well as lower extremities and trunk, obesity degree were measured by TANITA body composition monitor using bioelectrical impedance analysis technology. Statistical evaluations were performed by statistical package (SPSS) for Windows Version 16.0. Scatterplots of individual measurements for the parameters concerning correlations were drawn. Linear regression lines were displayed. The statistical significance degree was accepted as p < 0.05. The strong correlations between body mass index and diagnostic obesity notation model assessment index I as well as diagnostic obesity notation model assessment index II were obtained (p < 0.001). A much stronger correlation was detected between basal metabolic rate and diagnostic obesity notation model assessment index I in comparison with that calculated for basal metabolic rate and body mass index (p < 0.001). Upon consideration of the associations between basal metabolic rate-to-weight ratio and these three indices, the best association was observed between basal metabolic rate-to-weight and diagnostic obesity notation model assessment index II. In a similar manner, this index was highly correlated with fat percent (p < 0.001). Being independent of the indices, a strong correlation was found between fat percent and basal metabolic rate-to-weight ratio (p < 0.001). Visceral adiposity was much strongly correlated with metabolic age when compared to that with chronological age (p < 0.001). In conclusion, all three indices were associated with metabolic age, but not with chronological age. Diagnostic obesity notation model assessment index II values were highly correlated with body mass index values throughout all ranges starting with underweight going towards morbid obesity. This index is the best in terms of its association with basal metabolic rate-to-weight ratio, which can be interpreted as basal metabolic rate unit.

Keywords: basal metabolic rate, body mass index, children, diagnostic obesity notation model assessment index, obesity

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Authors: Rubisha Adhikari, Rajani Shah

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Introduction: Aging is a natural, global and inevitable phenomenon every single person has to go through, and nobody can escape the process. One of the emerging challenges to public health is to improve the quality of later years of life as life expectancy continues to increase. Quality of life (QoL) has grown to be a key goal for many public health initiatives. Population aging has become a global phenomenon as they are growing more quickly in emerging nations than they are in industrialized nations, leaving minimal opportunities to regulate the consequences of the demographic shift. Methods: A community-based descriptive analytical approach was used to examine the quality of life and associated factors among elderly people. A mixed method was chosen for the study. For the quantitative data collection, a household survey was conducted using the WHOQOL-OLD tool. In-depth interviews were conducted among twenty participants for qualitative data collection. Data generated through in-depth interviews were transcribed verbatim. In-depth interviews lasted about an hour and were audio recorded. The in-depth interview guide had been developed by the research team and pilot-tested before actual interviews. Results: This study result showed the association between quality of life and socio-demographic variables. Among all the variables under socio-demographic variable of this study, age (ꭓ2=14.445, p=0.001), gender (ꭓ2=14.323, p=<0.001), marital status (ꭓ2=10.816, p=0.001), education status (ꭓ2=23.948, p=<0.001), household income (ꭓ2=13.493, p=0.001), personal income (ꭓ2=14.129, p=0.001), source of personal income (ꭓ2=28.332,p=<0.001), social security allowance (ꭓ2=18.005,p=<0.001), alcohol consumption (ꭓ2=9.397,p=0.002) are significantly associated with quality of life of elderly. In addition, affordability (ꭓ2=12.088, p=0.001), physical activity (ꭓ2=9.314, p=0.002), emotional support (ꭓ2=9.122, p=0.003), and economic support (ꭓ2=8.104, p=0.004) are associated with quality of life of elderly people. Conclusion: In conclusion, this mixed method study provides insight into the attributes of the quality of life of elderly people in Nepal and similar settings. As the geriatric population is growing in full swing, maintaining a high quality of life has become a major challenge. This study showed that determinants such as age, gender, marital status, education status, household income, personal income, source of personal income, social security allowance and alcohol consumption, economic support, emotional support, affordability and physical activity have an association with quality of life of the elderly.

Keywords: ageing, chitwan, elderly, health status, quality of life

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Authors: Atsuko Okazaki, Jurg Ott

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Some genetic diseases (‘digenic traits’) are due to the interaction between two DNA variants. For example, certain forms of Retinitis Pigmentosa (a genetic form of blindness) occur in the presence of two mutant variants, one in the ROM1 gene and one in the RDS gene, while the occurrence of only one of these mutant variants leads to a completely normal phenotype. Detecting such digenic traits by genetic methods is difficult. A common approach to finding disease-causing variants is to compare 100,000s of variants between individuals with a trait (cases) and those without the trait (controls). Such genome-wide association studies (GWASs) have been very successful but hinge on genetic effects of single variants, that is, there should be a difference in allele or genotype frequencies between cases and controls at a disease-causing variant. Frequent pattern mining (FPM) methods offer an avenue at detecting digenic traits even in the absence of single-variant effects. The idea is to enumerate pairs of genotypes (genotype patterns) with each of the two genotypes originating from different variants that may be located at very different genomic positions. What is needed is for genotype patterns to be significantly more common in cases than in controls. Let Y = 2 refer to cases and Y = 1 to controls, with X denoting a specific genotype pattern. We are seeking association rules, ‘X → Y’, with high confidence, P(Y = 2|X), significantly higher than the proportion of cases, P(Y = 2) in the study. Clearly, generally available FPM methods are very suitable for detecting disease-associated genotype patterns. We use fpgrowth as the basic FPM algorithm and built a framework around it to enumerate high-frequency digenic genotype patterns and to evaluate their statistical significance by permutation analysis. Application to a published dataset on opioid dependence furnished results that could not be found with classical GWAS methodology. There were 143 cases and 153 healthy controls, each genotyped for 82 variants in eight genes of the opioid system. The aim was to find out whether any of these variants were disease-associated. The single-variant analysis did not lead to significant results. Application of our FPM implementation resulted in one significant (p < 0.01) genotype pattern with both genotypes in the pattern being heterozygous and originating from two variants on different chromosomes. This pattern occurred in 14 cases and none of the controls. Thus, the pattern seems quite specific to this form of substance abuse and is also rather predictive of disease. An algorithm called Multifactor Dimension Reduction (MDR) was developed some 20 years ago and has been in use in human genetics ever since. This and our algorithms share some similar properties, but they are also very different in other respects. The main difference seems to be that our algorithm focuses on patterns of genotypes while the main object of inference in MDR is the 3 × 3 table of genotypes at two variants.

Keywords: digenic traits, DNA variants, epistasis, statistical genetics

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Authors: Yu Chen Su

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Introduction: Gestational diabetes mellitus (GDM) refers to impaired glucose tolerance in pregnant women, impacting both the mother and newborn with short and long-term effects. It increases risks of preeclampsia, hypertension, type 2 diabetes, cesarean section, and preterm birth. GDM is associated with fetal macrosomia, shoulder dystocia, neonatal hypoglycemia, and future type 2 diabetes risk. A study on 6,421 pregnant women found 12% experienced high stress, linked to maladaptive coping and depressive emotions. Women with high-risk pregnancies may experience greater stress and depression. Research suggests GDM increases depression prevalence. A study on 632 Hispanic women with GDM showed severe stress and depression tendencies. Involving 95 women with GDM, 33.4% exhibited depression symptoms. Another study compared 180 GDM women to 186 with normal glucose levels, revealing higher depression levels in GDM women. They found GDM women were 1.85 times more likely to receive antidepressants during pregnancy and 1.69 times more likely to experience postpartum depression. Maternal stress and depressive symptoms during pregnancy are significant factors. Early identification by healthcare professionals can greatly benefit GDM women, their infants, and their families. Objectives: The purpose of this study was to investigate the association between gestational diabetes mellitus (GDM) and the risk of depression. Methods: This study reviewed and analyzed relevant literature on gestational diabetes mellitus (GDM) and depression in 6,876 patients. The literature search followed PRISMA guidelines and included databases like Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library. Prospective or retrospective studies with relevant risk ratios and estimates were included, using a random-effects model for the analysis of depression risk correlation. Studies without depression data or relevant risks were excluded. The search period extended until October 2022. Results: Systematic review of 7 studies (6,876 participants) found a significant association (OR = 8.77, CI: 7.98-9.64, p < 0.05) between gestational diabetes mellitus (GDM) and higher depression risk compared to healthy pregnant women. Conclusions: Pregnancy is a significant life transition involving physiological, psychological, and social changes. Gestational diabetes poses challenges to women's physical and mental well-being. Sensitive healthcare professionals identifying issues early can greatly benefit women, babies, and the family.

Keywords: gestational diabetes, depression, systematic review, neta-analysis

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Authors: Cahyaningsih Cahyaningsih, Fu'ad Rakhman

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This study examines empirically the association between corporate social responsibility (CSR) and tax avoidance. This study also investigates the effect of earnings on the relation between CSR and tax avoidance. Effective tax rate (ETR) and cash effective tax rate (CETR) were used to measure tax avoidance. Corporate social responsibility fund (CSRF) and corporate social responsibility disclosure (CSRD) were used as proxies for CSR. Test was conducted for public firms which were listed in the Indonesia Stock Exchange during the period of 2011-2014. Based on slack resource theory, this study finds that the relation between CSR and tax avoidance is moderated by earnings.

Keywords: corporate social responsibility disclosure, corporate social responsibility fund, earnings, tax avoidance

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Authors: Mallikarjun Vaddenkeri, Suresh Jange

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This research study reports results of information behaviour by members of faculty and research scholars of various departments of social sciences working at universities with a sample of 300 and Members of Legislative Assembly and Council with 216 samples in Karnataka State, India. The results reveal that 29.3% and 20.3% of Social Scientists indicated medium and high level of awareness of primary sources - Primary Journals are found to be at scale level 5 and 9. The usage of primary journals by social scientists is found to be 28% at level 4, 24% of the respondent’s opined use of primary Conference Proceedings at level 5 as medium level of use. Similarly, the use of Secondary Information Sources at scale 8 and 9 particularly in case of Dictionaries (31.0% and 5.0%), Encyclopaedias (22.3% and 6.3%), Indexing Periodicals (7.0% and 15.3%) and Abstracting Periodicals (5.7% and 20.7%). For searching information from Journals Literature available in CD-ROM version, Keywords (43.7%) followed by Keywords with logical operators (39.7%) have been used for finding the required information. Statistical inference reveals rejection of null hypothesis `there is no association between designation of the respondents and awareness of primary information resources’. On the other hand, educational qualification possessed by Legislative members, more than half of them possess graduate degree as their academic qualification (57.4%) and just 16.7% of the respondents possess graduate degree while only 26.8% of the respondents possess degree in law and just 1.8% possess post-graduate degree in law. About 42.6% indicated the importance of information required to discharge their duties and responsibilities as a Policy Maker in the scale 8, as a Scholar (27.8%) on a scale 6, as a politician (64.8%) on a scale 10 and as a Councillor (51.9%) on a scale 8. The most preferred information agencies/sources very often contacted for obtaining useful information are by means of contacting the people of Karnataka State Legislative Library, listening Radio programmes, viewing Television programmes and reading the newspapers. The methods adopted for obtaining needed information quite often by means of sending their assistants to libraries to gather information (35.2%) and personally visiting the information source (64.8%). The null hypotheses `There is no association between Members of Legislature and Opinion on the usefulness of the resources of the Karnataka State Legislature Library’ is accepted using F ANOVA test. The studies conclude with a note revamp the existing library system in its structure and adopt latest technologies and educate and train social scientists and Legislators in using these resources in the interest of academic, government policies and decision making of the country.

Keywords: information use behaviour, government information, searching behaviour, policy makers

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Authors: Maria-Vittoria Carminati

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Conservations laws do not protect hybrids. From the United States’ Endangered Species Act to the European Union’s conservation policies to the International Union for the Conservation of Nature’s Red List, hybrids don’t get the benefit of human preservation efforts. This paper tests the hypothesis that this practice is a byproduct of the co-birth of eugenics and conservation as twin fields and that while the first has been discredited and abandoned, the latter still bears the marks of its unfortunate primordial association. The research explores historical perspectives from so-called conservation luminaries such as Madison Grant, Ernst Mayr, and Charles Davenport and sheds light on how these influences continue to shape contemporary conservation approaches. The paper provides a comprehensive analysis of the implications of these factors on biodiversity conservation and the ethical considerations surrounding hybrid species protection.

Keywords: conservation, hybridization, eugenics, speciation, evolution

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Authors: Iman Mohseni

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Current studies indicate that neglecting the effect of intermediate diaphragms might lead to highly conservative values for bending moment distribution factors and result in non-economic designs for skew bridges. This paper reports on a parametric study performed on 160 prototypes of straight and skew concrete multicell box-girder bridges. The obtained results were used to develop practical expressions to account for the diaphragm effects on American Association of State Highway and Transportation Officials formulas for live load distribution factors. It was observed that decks with internal transverse diaphragms perpendicular to the longitudinal webs are the best arrangement for load distribution in skew bridges.

Keywords: box bridges, truck, distribution factor, diaphragm

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Authors: Mustafa Metin Donma, Orkide Donma

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Obesity in children particularly draws attention because it may threaten the individual’s future life due to many chronic diseases it may lead to. Most of these diseases, including obesity itself altogether are related to inflammation. For this reason, inflammation-related parameters gain importance. Within this context, complete blood cell counts, ratios or indices derived from these counts have recently found some platform to be used as inflammatory markers. So far, mostly adipokines were investigated within the field of obesity. The liver is at the center of the metabolic pathways network. Metabolic inflammation is closely associated with cellular dysfunction. In this study, hematologic inflammatory markers and two major hepatokines, cytokines produced predominantly by the liver, fibroblast growth factor-21 (FGF-21) and fetuin A were investigated in pediatric obesity. Two groups were constituted from seventy-six obese children based on World Health Organization criteria. Group 1 was composed of children whose age- and sex-adjusted body mass index (BMI) percentiles were between 95 and 99. Group 2 consists of children who are above the 99ᵗʰ percentile. The first and the latter groups were defined as obese (OB) and morbid obese (MO). Anthropometric measurements of the children were performed. Informed consent forms and the approval of the institutional ethics committee were obtained. Blood cell counts and ratios were determined by an automated hematology analyzer. The related ratios and indexes were calculated. Statistical evaluation of the data was performed by the SPSS program. There was no statistically significant difference in terms of neutrophil-to lymphocyte ratio, monocyte-to-high density lipoprotein cholesterol ratio and the platelet-to-lymphocyte ratio between the groups. Mean platelet volume and platelet distribution width values were decreased (p<0.05), total platelet count, red cell distribution width (RDW) and systemic immune inflammation index values were increased (p<0.01) in MO group. Both hepatokines were increased in the same group; however, increases were not statistically significant. In this group, also a strong correlation was calculated between FGF-21 and RDW when controlled by age, hematocrit, iron and ferritin (r=0.425; p<0.01). In conclusion, the association between RDW, a hematologic inflammatory marker, and FGF-21, an inflammation-related hepatokine, found in MO group is an important finding discriminating between OB and MO children. This association is even more powerful when controlled by age and iron-related parameters.

Keywords: childhood obesity, fetuin A , fibroblast growth factor-21, hematologic markers, red cell distribution width

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Authors: Kunyanuth Kularbphettong, Kunnika Tenprakhon, Pattarapan Roonrakwit

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In this paper, we present a recommendation library application on Android system. The objective of this system is to support and advice user to use library resources based on mobile application. We describe the design approaches and functional components of this system. The system was developed based on under association rules, Apriori algorithm. In this project, it was divided the result by the research purposes into 2 parts: developing the Mobile application for online library service and testing and evaluating the system. Questionnaires were used to measure user satisfaction with system usability by specialists and users. The results were satisfactory both specialists and users.

Keywords: online library, Apriori algorithm, Android application, black box

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

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

Keywords: diabesity, obesity, diabetes, unhealthy diet

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Authors: Shahzad A. Mughal, Ameer A. P. Ghaloo, Faisal Laghari, Mohsin A. Mirza

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Job satisfaction and level of job stressors among employees of a university are considered as essential factors responsible for institutional success. Job satisfaction is usually believed as a single baseline variable for the evaluation of a university human resource area. The objectives of this study were to assess the level of job satisfaction and influence of job stressors among university teachers and their association with long term physical health of the employees in government sector universities in Pakistan. A cross-sectional study was conducted on university employees including faculty members and administrative staff of three government sector universities in Sindh province of Pakistan who have completed at least ten years of their job. The study period was six months. All the employees were randomly selected. The job satisfaction scale Questionnaire with yes and no options, together with questions regarding demographic factors, job stress or other working factors and physical health issues were administered in questionnaires. These questionnaires were handed out to 100 faculty members of both genders with permanent job and 50 non faculty staff of grade 17 and above with permanent employment status. Students’ T test and one way ANOVA was applied to categorical variables and Pearson’s correlation analysis was performed to evaluate the correlations between study variables. 121 successful responses were obtained (effective respondent rate 80.6%). The average score of overall job satisfaction was 65.6%. Statistical analysis revealed that the job satisfaction and work related stressors had negative impact on overall health status of the employees with resultant less efficacy and mental stress. The positive relation was perceived by employees for organizational support and high income with job satisfaction. Demographic features such as age and female gender were also linked to the level of job satisfaction and health related issues. The total variation among all responses regarding correlation between job satisfaction job stressors and health related issues was 55%. A study was conducted on University employees of government sector Universities in Pakistan, regarding association of job satisfaction and job stressors with long term physical health of the employees. Study revealed a moderate level of job satisfaction among the employees of all universities included in this study. Attitude and personal relations with heads of the departments and institution along with salary packages were considered as biggest job stressors related correlated directly with physical health. Demographic features and gender were associated factors for job satisfaction. Organizational support was the strongest factor for job satisfaction and results pointed out that by improving support level from University may improve the quality of job satisfaction and overall health of employees.

Keywords: job satisfaction, organizational support, physical health, university employees

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Authors: Mary Bernardin, Margie Batek, Joseph Moen, David Schnadower

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Background: Exposure to violence not only has negative psychological impact on children but is a risk factor for children becoming recurrent victims of violence. However, little is known regarding the degree to which child victims of violence are exposed to trauma at home and in their community, or its association with specific psychological diagnoses. Objective: The aims of this study were to perform in-depth characterizations of family, community and psychological wellness amongst pediatric victims of interpersonal violence. Methods: As standard of care at the Saint Louis Children’s Hospital pediatric emergency department (ED), social workers perform in-depth interviews with all children presenting due to violent interpersonal encounters. In this retrospective cross-sectional study, we collected data from social work interviews on family structure, exposure to violence in the community and the home, as well as history of psychological diagnoses amongst children ages 8-19 years who presented to the ED for injuries related to interpersonal violence from 2014-2017. Results: A total of 407 patients presenting to the ED for an interpersonal violent encounter were analyzed. The average age of studied youths was 14.7 years (SD 2.5). Youths were 97.5% African American ethnicity and 66.6% male. 67.8% described their home having a nonnuclear family structure, 50% of which reported living with a single mother. Of the 21% who reported having incarcerated family members, 56.3% reported their father being incarcerated, 15% reported their mother being incarcerated, and 12.5% reported multiple family members being incarcerated. 11.3% reported witnessing domestic violence in their home. 12.8% of youths reported some form of child abuse. The type of child abuse was not specified in 29.3% of cases, but physical abuse (32.8%) followed by sexual abuse (22.4%) were the most commonly reported. 14.5% had history of placement in foster care and/or adoption. 64% reported having witnessed violence in their community. 30.2% reported having lost friends or family due to violence, and of those, 26.4% reported the loss of a cousin, 18.9% the loss of a friend, 16% the loss of their father, and 12.3% the loss of their brother due to violence. Of the 22.4% youths with psychiatric diagnose(s), 48.4% had multiple diagnoses, the most common of which were ADD/ADHD (62.6%), followed by depression (31.9%), bipolar disorder (27.5%) and anxiety (15.4%). Conclusions: A remarkable proportion of children presenting to EDs due to interpersonal violence have a history of exposure to instability and violence in their homes and communities. Additionally, psychological diagnoses are frequent among pediatric victims of violence. More research is needed to better understand the association between trauma exposure, psychological health and violent victimization amongst children.

Keywords: community violence, emergency department, pediatric interpersonal violence, pediatric trauma, psychological effects of trauma

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Authors: Juan Li, Hui Tian, Min Wang

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In China, under the considerable pressure of 'Gaokao' –the highly competitive college entrance examination, high school teachers and parents often worry that doing physical activity would take away the students’ precious study time and may have a negative impact on the academic grades. There was a tendency to achieve high academic scores at the cost of physical exercise. Therefore, the purpose of this study was to examine the relationship between the physical fitness and academic achievement of Chinese high school students. The participants were 968 grade one (N=457) and grade two students (N=511) with an average age of 16 years from three high schools of different levels in Beijing, China. 479 were boys, and 489 were girls. One of the schools is a top high school in China, another is a key high school in Beijing, and the other is an ordinary high school. All analyses were weighted using SAS 9.4 to ensure the representatives of the sample. The weights were based on 12 strata of schools, sex, and grades. Physical fitness data were collected using the scores of the National Physical Fitness Test, which is an annual official test administered by the Ministry of Education in China. It includes 50m run, sits and reach test, standing long jump, 1000m run (for boys), 800m run (for girls), pull-ups for 1 minute (for boys), and bent-knee sit-ups for 1 minute (for girls). The test is an overall evaluation of the students’ physical health on the major indexes of strength, endurance, flexibility, and cardiorespiratory function. Academic scores were obtained from the three schools with the students’ consent. The statistical analysis was conducted with SPSS 24. Independent-Samples T-test was used to examine the gender group differences. Spearman’s Rho bivariate correlation was adopted to test for associations between physical test results and academic performance. Statistical significance was set at p<.05. The study found that girls obtained higher fitness scores than boys (p=.000). The girls’ physical fitness test scores were positively associated with the total academic grades (rs=.103, p=.029), English (rs=.096, p=.042), physics (rs=.202, p=.000) and chemistry scores (rs=.131, p=.009). No significant relationship was observed in boys. Cardiorespiratory fitness had a positive association with physics (rs=.196, p=.000) and biology scores (rs=.168, p=.023) in girls, and with English score in boys (rs=.104, p=.029). A possible explanation for the greater association between physical fitness and academic achievement in girls rather than boys was that girls showed stronger motivation in achieving high scores in whether academic tests or fitness tests. More driven by the test results, girls probably tended to invest more time and energy in training for the fitness test. Higher fitness levels were associated with an academic benefit among girls generally in Chinese high schools. Therefore, physical fitness needs to be given greater emphasis among Chinese adolescents and gender differences need to be taken into consideration.

Keywords: physical fitness; adolescents; academic achievement; high school

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Authors: Jolanta Uszko, Tomasz Wloch, Aneta Pirowska, Roman Nowobilski

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Introduction: Phantom phenomena are often reported by subjects who have undergone limb amputation. Mostly, patients feel the amputated part of the limb as if it was still attached to the body. Two types of phantom phenomena: painless (phantom sensation) and painful (phantom pain) were described. Triggers of phantom sensations and phantom pain, as well as fully effective treatment, have not been clearly described yet. Purpose: To assess the influence of psychosocial factors and some clinical conditions on the occurrence of phantom phenomena in amputee athletes. Subjects: 21 men (age: 31 years, SD = 7.5 years) after lower or upper extremity amputation, who regularly performed high-intensity sports (Amp Football Team Players) were included to the study. Method and equipment: In the research, the following method and tools were used: Questionnaire [Pirowska] adapted for athletes with disabilities, Numerical Rating Scale (NRS) - for phantom pain assessment, McGill Pain Assessment Questionnaire (short version), Beck's Depression Inventory (BDI), State Trait Anxiety Inventory (STAI): X-1 and X-2, shortened version of The World Health Organization Quality of Life (WHOQOLBREFF). Results: In the study group, the lower leg amputations with traumatic etiology were predominant. Phantom sensations were present in all subjects. Half of the respondents claimed to experience phantom sensations at least once a day, paroxysmally. There was a prevalence of phantom sensations characterized as incomplete, immobile limb. Phantom pain was reported by over 85% of respondents. The nature of phantom pain was frequently described as stabbing, squeezing, shooting, pulsing, tiring. There was a significant correlation between phantom pain intensity and anxiety, quality of life, depressive tendencies, perception of phantom pain as the obstacle in daily functioning and intensity of the limb pain before amputation. Conclusions: The etiology of phantom phenomena is complex. Psychological factors seem to have a significant influence on the intensity of the phantom pain. Particular attention should be paid to patients who complain about persistent limb pain before the amputation. These are patients with an increased risk of the phantom pain of relatively high intensity.

Keywords: amputation, phantom pain, phantom sensations, adaptive sports

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Authors: Nareshkumar Harale, B. B. Meshram

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The continued exponential growth of successful cyber intrusions against today’s businesses has made it abundantly clear that traditional perimeter security measures are no longer adequate and effective. We evolved the network trust architecture from trust-untrust to Zero-Trust, With Zero Trust, essential security capabilities are deployed in a way that provides policy enforcement and protection for all users, devices, applications, data resources, and the communications traffic between them, regardless of their location. Information exchange over the Internet, in spite of inclusion of advanced security controls, is always under innovative, inventive and prone to cyberattacks. TCP/IP protocol stack, the adapted standard for communication over network, suffers from inherent design vulnerabilities such as communication and session management protocols, routing protocols and security protocols are the major cause of major attacks. With the explosion of cyber security threats, such as viruses, worms, rootkits, malwares, Denial of Service attacks, accomplishing efficient and effective intrusion detection and prevention is become crucial and challenging too. In this paper, we propose a design and analysis model for next generation network intrusion detection and protection system as part of layered security strategy. The proposed system design provides intrusion detection for wide range of attacks with layered architecture and framework. The proposed network intrusion classification framework deals with cyberattacks on standard TCP/IP protocol, routing protocols and security protocols. It thereby forms the basis for detection of attack classes and applies signature based matching for known cyberattacks and data mining based machine learning approaches for unknown cyberattacks. Our proposed implemented software can effectively detect attacks even when malicious connections are hidden within normal events. The unsupervised learning algorithm applied to network audit data trails results in unknown intrusion detection. Association rule mining algorithms generate new rules from collected audit trail data resulting in increased intrusion prevention though integrated firewall systems. Intrusion response mechanisms can be initiated in real-time thereby minimizing the impact of network intrusions. Finally, we have shown that our approach can be validated and how the analysis results can be used for detecting and protection from the new network anomalies.

Keywords: network intrusion detection, network intrusion prevention, association rule mining, system analysis and design

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Authors: Haoming Ma, Guo Yu, Peiru Zhou

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Background: Previous studies show that dysglycemia, mostly hyperglycemia, hypoglycemia and glycemic variability(GV), are associated with excess mortality in critically ill patients, especially those without diabetes. Glycemic variability is an increasingly important measure of glucose control in the intensive care unit (ICU) due to this association. However, there is limited data pertaining to the relationship between different clinical factors and glycemic variability and clinical outcomes categorized by their DM status. This retrospective study of 958 intensive care unit(ICU) patients was conducted to investigate the relationship between GV and outcome in critically ill patients and further to determine the significant factors that contribute to the glycemic variability. Aim: We hypothesize that the factors contributing to mortality and the glycemic variability are different from critically ill patients with or without diabetes. And the primary aim of this study was to determine which dysglycemia (hyperglycemia\hypoglycemia\glycemic variability) is independently associated with an increase in mortality among critically ill patients in different groups (DM/Non-DM). Secondary objectives were to further investigate any factors affecting the glycemic variability in two groups. Method: A total of 958 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The glycemic variability was defined as the coefficient of variation (CV) of blood glucose. The main outcome was death during hospitalization. The secondary outcome was GV. The logistic regression model was used to identify factors associated with mortality. The relationships between GV and other variables were investigated using linear regression analysis. Results: Information on age, APACHE II score, GV, gender, in-ICU treatment and nutrition was available for 958 subjects. Predictors remaining in the final logistic regression model for mortality were significantly different in DM/Non-DM groups. Glycemic variability was associated with an increase in mortality in both DM(odds ratio 1.05; 95%CI:1.03-1.08,p＜0.001) or Non-DM group(odds ratio 1.07; 95%CI:1.03-1.11,p=0.002). For critically ill patients without diabetes, factors associated with glycemic variability included APACHE II score(regression coefficient, 95%CI:0.29,0.22-0.36,p＜0.001), Mean BG(0.73,0.46-1.01,p＜0.001), total parenteral nutrition(2.87,1.57-4.17,p＜0.001), serum albumin(-0.18,-0.271 to -0.082,p＜0.001), insulin treatment(2.18,0.81-3.55,p=0.002) and duration of ventilation(0.006,0.002-1.010,p=0.003).However, for diabetes patients, APACHE II score(0.203,0.096-0.310,p＜0.001), mean BG(0.503,0.138-0.869,p=0.007) and duration of diabetes(0.167,0.033-0.301,p=0.015) remained as independent risk factors of GV. Conclusion: We found that the relation between dysglycemia and mortality is different in the diabetes and non-diabetes groups. And we confirm that GV was associated with excess mortality in DM or Non-DM patients. Furthermore, APACHE II score, Mean BG, total parenteral nutrition, serum albumin, insulin treatment and duration of ventilation were significantly associated with an increase in GV in Non-DM patients. While APACHE II score, mean BG and duration of diabetes (years) remained as independent risk factors of increased GV in DM patients. These findings provide important context for further prospective trials investigating the effect of different clinical factors in critically ill patients with or without diabetes.

Keywords: diabetes, glycemic variability, predictors, severe disease

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Authors: Mohamed Shafi Bin Mahboob Ali

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Introduction: Synchronous tumor is defined as the presence of more than one primary malignant lesion in the same patient at the indexed diagnosis. It is a rare occurrence, especially in the spectrum of colorectal cancer, which accounts for less than 4%. The underlying pathology of a synchronous tumor is thought to be due to a genomic factor, which is microsatellite instability (MIS) with the involvement of BRAF, KRAS, and the GSRM1 gene. There are no specific sites of occurrence for the synchronous colorectal tumor, but many studies have shown that a synchronous tumor has about 43% predominance in the ascending colon with rarity in the sigmoid colon. Case Report: We reported a case of a young lady in the middle of her 30's with no family history of colorectal cancer that was diagnosed with a synchronous adenocarcinoma at the descending colon and rectosigmoid region. The lady's presentation was quite perplexing as she presented to the district hospital initially with simple, uncomplicated hemorrhoids and constipation. She was then referred to our center for further management as she developed a 'football' sized right gluteal swelling with a complete intestinal obstruction and bilateral lower-limb paralysis. We performed a CT scan and biopsy of the lesion, which found that the tumor engulfed the sacrococcygeal region with more than one primary lesion in the colon as well as secondaries in the liver. The patient was operated on after a multidisciplinary meeting was held. Pelvic exenteration with tumor debulking and anterior resection were performed. Postoperatively, she was referred to the oncology team for chemotherapy. She had a tremendous recovery in eight months' time with a partial regain of her lower limb power. The patient is still under our follow-up with an improved quality of life post-intervention. Discussion: Synchronous colon cancer is rare, with an incidence of 2.4% to 12.4%. It has male predominance and is pathologically more advanced compared to a single colon lesion. Down staging the disease by means of chemoradiotherapy has shown to be effective in managing this tumor. It is seen commonly on the right colon, but in our case, we found it on the left colon and the rectosigmoid. Conclusion: Managing a synchronous colon tumor could be challenging to surgeons, especially in deciding the extent of resection and postoperative functional outcomes of the bowel; thus, individual treatment strategies are needed to tackle this pathology.

Keywords: synchronous, colon, tumor, adenocarcinoma

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Authors: Sumi Manjipparambil Surendran, Subrata Majumdar

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Aim: The aim of the study is to find out if low PAPP-A (Pregnancy-Associated Plasma Protein A) levels in the first trimester are associated with adverse obstetric outcome. Methods: A retrospective study was carried out on 114 singleton pregnancies having undergone combined test screening. Results: There is statistically significant increased incidence of low birth weight infants in the low PAPP-A group. However, significant association was not found in the incidence of pre-eclampsia, miscarriage, and placental abruption. Conclusion: Low PAPP-A in the first trimester is associated with fetal growth restriction. Recommendation: Women with low PAPP-A levels in first trimester pregnancy screening require consultant-led care and serial growth scans.

Keywords: pregnancy, pregnancy-associated plasma protein A, PAPP-A, fetal growth restriction, trimester

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Authors: Mamoona Mushtaq, Komal Meher

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The COVID-19 pandemic, a global public health crisis, has triggered anxiety and fear of death in the public, particularly among health professionals. This study aimed to assess the direct and mediated associations between death anxiety, sleep quality, and subjective well-being in doctors working during the pandemic. Another aim was tested to analyze the interactive role of workplace locality in these associations. An indirect-effect model was tested on a sample of 244 doctors working during the pandemic. Findings revealed that the association between death anxiety and subjective well-being was mediated through depression. The theoretical and practical implications of the findings are discussed.

Keywords: death anxiety, depression, subjective well-being, working locality

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Authors: M. Achemo, O. Saito

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Jefoure land use system is one of the traditional landscape human settlement patterns, and it is a cultural design and peculiar art of the people of Gurage in Ethiopia via which houses and trees flank roads left and right. Assessment of the multiple benefits of the traditional road that benefit society and development could enhance the understanding of the land use planners and decision makers to pay attention while planning and managing the land use system. Recent trend shows that the Jefoure land use is on the threshold of change as a result of flourishing road networks, overgrazing, and agricultural expansion. This study aimed to evaluate the multiple ecosystem services provided by the Jefoure land use system after characterization of the socio-ecological landscape. Information was compiled from existing data sources such as ordnance survey maps, aerial photographs, recent high resolution satellite imageries, designated questionnaires and interviews, and local authority contacts. The result generated scientific data on the characteristics, ecosystem services provision, and drivers of changes. The cultural landscape has novel characteristics and providing multiple ecosystem services to the community for long period of time. It is serving as road for humans, livestock and vehicles, habitat for plant species, regulating local temperature, climate, runoff and infiltration, and place for meeting, conducting religious and spiritual activities, holding social events such as marriage and mourning, playing station for children and court for football and other traditional games. As a result of its aesthetic quality and scenic beauty, it is considered as recreational place for improving mental and physical health. The study draws relevant land use planning and management solution in the improvement of socio-ecological resilience in the Jefoure land use system. The study suggests the landscape needs to be registrar as heritage site for recognizing the wisdom of the community and enhancing the conservation mechanisms.

Keywords: cultural landscape, ecosystem services, Gurage, Jefoure

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Authors: Fatima Sohail, Faizan Iftikhar

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This paper studies the relationship between digital finance, renewable energy, and the economic development of Pakistan and least developed countries from 2000 to 2022. The paper used panel analysis and generalized method of moments Arellano-Bond approaches. The findings show that under the growth model, renewable energy (RE) has a strong and favorable link with fixed broadband and mobile subscribers. However, FB and MD have a strong but negative association with the uptake of renewable energy (RE) in the average and simple model. This paper provides valuable insights for policymakers, investors of the digital economy.

Keywords: digital finance, renewable energy, economic development, mobile subscription, fixed broadband

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Authors: Mom Bishwakarma

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This research traces out how the Dalit in Nepal evolved from the early 1950s to the current day, from invoking Dalit against caste discrimination through to the asserting proportional representation in state structures. The research focused most closely on the formation of Dalit association and resistance, as well as on the different struggles throughout this period. It then discusses the expansion of Dalit movement in NGOs, its internationalization and responses. The research sees that Dalit movement has been influenced by its network with the national and international civil rights movement particularly Dalit movement in India and argues that Dalit movement in Nepal have in many ways, challenged the orthodox based caste stratification for Dalit equality and justice. It can be seen that at the same time as Dalit participation was increasing, divisions by caste line also emerged. Rather reshaping the power structures, Dalit movement encircled into division and contentious politics.

Keywords: Dalit, equality, justice, movements, Nepal

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Authors: Yuliya Huseva

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To investigate the contents of tears to determine latent blood. Methods: Tear samples from 72 women were studied with the microscopy of tears aspirated with a capillary and stained by Nocht and with a chemical method of test strips with chromogen. Statistical data processing was carried out using statistical packages Statistica 10.0 for Windows, calculation of Pearson's chi-square test, Yule association coefficient, the method of determining sensitivity and specificity. Results:, In 30.6% (22) of tear samples erythrocytes were revealed microscopically. Correlations between the presence of erythrocytes in the tear and the phase of the menstrual cycle has been discovered. In the follicular phase of the cycle, erythrocytes were found in 59.1% (13) people, which is significantly more (x2=4.2, p=0.041) compared to the luteal phase - in 40.9% (9) women. In the first seven days of the follicular phase of the menstrual cycle the erythrocytes were predominanted of in the tears of women examined testifies in favour of the vicarious bleeding from the mucous membranes of extragenital organs in sync with menstruation. Of the other cellular elements in tear samples with latent haemolacria, neutrophils prevailed - in 45.5% (10), while lymphocytes were less common - in 27.3% (6), because neutrophil exudation is accompanied by vasodilatation of the conjunctiva and the release of erythrocytes into the conjunctival cavity. It was found that the prognostic significance of the chemical method was 0.53 of the microscopic method. In contrast to microscopy, which detected blood in tear samples from 30.6% (22) of women, blood was detected chemically in tears of 16.7% (12). An association between latent haemolacria and endometriosis was found (k=0.75, p≤0.05). Microscopically, in the tears of patients with endometriosis, erythrocytes were detected in 70% of cases, while in healthy women without endometriosis - in 25% of cases. The proportion of women with erythrocytes in tears, determined by a chemical method, was 41.7% among patients with endometriosis, which is significantly more (x2=6.5, p=0.011) than 11.7% among women without endometriosis. The data obtained can be explained by the etiopathogenesis of the extragenital endometriosis which is caused by hematogenous spread of endometrial tissue into the orbit. In endometriosis, erythrocytes are found against the background of accumulations of epithelial cells. In the tear samples of 4 women with endometriosis, glandular cuboidal epithelial cells, morphologically similar to endometrial cells, were found, which may indicate a generalization of the disease. Conclusions: Single erythrocytes can normally be found in the tears, their number depends on the phase of the menstrual cycle, increasing in the follicular phase. Erythrocytes found in tears against the background of accumulations of epitheliocytes and their glandular atypia may indicate a manifestation of extragenital endometriosis. Both used methods (microscopic and chemical) are informative in revealing latent haemolacria. The microscopic method is more sensitive, reveals intact erythrocytes, and besides, it provides information about other cells. At the same time, the chemical method is faster and technically simpler, it determines the presence of haemoglobin and its metabolic products, and can be used as a screening.

Keywords: tear, blood, microscopy, epitheliocytes

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Authors: Gabriela Silva-Maceda, Silvia Romero-Contreras

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Spanish is a more transparent language than English given that it has more direct correspondences between sounds and letters. It has become important to understand how decoding and linguistic comprehension contribute to reading comprehension in the framework of the widely known Simple View Model. This study aimed to identify the level of prediction by these two components in a sample of 1st to 4th grade children attending two schools in central Mexico (one public and one private). Within each school, ten children were randomly selected in each grade level, and their parents were asked about reading habits and socioeconomic information. In total, 79 children completed three standardized tests measuring decoding (pseudo-word reading), linguistic comprehension (understanding of paragraphs) and reading comprehension using subtests from the Clinical Evaluation of Language Fundamentals-Spanish, Fourth Edition, and the Test de Lectura y Escritura en Español (LEE). The data were analyzed using hierarchical regression, with decoding as a first step and linguistic comprehension as a second step. Results showed that decoding accounted for 19.2% of the variance in reading comprehension, while linguistic comprehension accounted for an additional 10%, adding up to 29.2% of variance explained: F (2, 75)= 15.45, p <.001. Socioeconomic status derived from parental questionnaires showed a statistically significant association with the type of school attended, X2 (3, N= 79) = 14.33, p =.002. Nonetheless when analyzing the Simple View components, only decoding differences were statistically significant (t = -6.92, df = 76.81, p < .001, two-tailed); reading comprehension differences were also significant (t = -3.44, df = 76, p = .001, two-tailed). When socioeconomic status was included in the model, it predicted a 5.9% unique variance, even when already accounting for Simple View components, adding to a 35.1% total variance explained. This three-predictor model was also significant: F (3, 72)= 12.99, p <.001. In addition, socioeconomic status was significantly correlated with the amount of non-textbook books parents reported to have at home for both adults (rho = .61, p<.001) and children (rho= .47, p<.001). Results converge with a large body of literature finding socioeconomic differences in reading comprehension; in addition this study suggests that these differences were also present in decoding skills. Although linguistic comprehension differences between schools were expected, it is argued that the test used to collect this variable was not sensitive to linguistic differences, since it came from a test to diagnose clinical language disabilities. Even with this caveat, results show that the components of the Simple View Model can predict less than a third of the variance in reading comprehension in Spanish. However, the results also suggest that a fuller model of reading comprehension is obtained when considering the family’s socioeconomic status, given the potential differences shown by the socioeconomic status association with books at home, factors that are particularly important in countries where inequality gaps are relatively large.

Keywords: decoding, linguistic comprehension, reading comprehension, simple view model, socioeconomic status, Spanish

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Authors: Shraddha Rane, Richard Warren, Stephen Eyre

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L-23 is a pro-inflammatory molecule that signals T cells to release cytokines such as IL-17A and IL-22. Psoriasis is driven by a dysregulated immune response, within which IL-23 is now thought to play a key role. Genome-wide association studies (GWAS) have identified a number of genetic risk loci that support the involvement of IL-23 signalling in psoriasis; in particular a robust susceptibility locus at a gene encoding a subunit of the IL-23 receptor (IL23R) (Stuart et al., 2015; Tsoi et al., 2012). The lead psoriasis-associated SNP rs9988642 is located approximately 500 bp downstream of IL23R but is in tight linkage disequilibrium (LD) with a missense SNP rs11209026 (R381Q) within IL23R (r2 = 0.85). The minor (G) allele of rs11209026 is present in approximately 7% of the population and is protective for psoriasis and several other autoimmune diseases including IBD, ankylosing spondylitis, RA and asthma. The psoriasis-associated missense SNP R381Q causes an arginine to glutamine substitution in a region of the IL23R protein between the transmembrane domain and the putative JAK2 binding site in the cytoplasmic portion. This substitution is expected to affect the receptor’s surface localisation or signalling ability, rather than IL23R expression. Recent studies have also identified a psoriatic arthritis (PsA)-specific signal at IL23R; thought to be independent from the psoriasis association (Bowes et al., 2015; Budu-Aggrey et al., 2016). The lead PsA-associated SNP rs12044149 is intronic to IL23R and is in LD with likely causal SNPs intersecting promoter and enhancer marks in memory CD8+ T cells (Budu-Aggrey et al., 2016). It is therefore likely that the PsA-specific SNPs affect IL23R function via a different mechanism compared with the psoriasis-specific SNPs. It could be hypothesised that the risk allele for PsA located within the IL23R promoter causes an increase IL23R expression, relative to the protective allele. An increased expression of IL23R might then lead to an exaggerated immune response. The independent genetic signals identified for psoriasis and PsA in this locus indicate that different mechanisms underlie these two conditions; although likely both affecting the function of IL23R. It is very important to further characterise these mechanisms in order to better understand how the IL-23 receptor and its downstream signalling is affected in both diseases. This will help to determine how psoriasis and PsA patients might differentially respond to therapies, particularly IL-23 biologics. To investigate this further we have developed an in vitro model using CD4 T cells which express either wild type IL23R and IL12Rβ1 or mutant IL23R (R381Q) and IL12Rβ1. Model expressing different isotypes of IL23R is also underway to investigate the effects on IL23R expression. We propose to further investigate the variants for Ps and PsA and characterise key intracellular processes related to the variants.

Keywords: IL23R, psoriasis, psoriatic arthritis, SNP

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Authors: Mazyar Taghavi

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This research examines middle-level managers’ involvement in strategy process in 15 manufacturing and service companies in Iran. We considered two dominant theoretical arguments for expecting a positive association. According to the first direction involvement improves organizational performance by improving the quality of strategic decisions. According to the second track, middle managers contribute to increased levels of performance through strategic consensus among them. Results indicate that involvement in the strategy is related to organizational performance. Involvement is associated with consensus (i.e. strategic understanding and commitment) among middle-level managers. However, findings indicate that consensus is not related to the organizational performance.

Keywords: middle-level management, strategy process, organizational performance, strategy consensus

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Authors: Ian Christopher Rocha

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This study aimed to determine the association of the quality of life (QOL) of the caregivers of children in need of special protection (CNSP) in child-caring institutions in Metro Manila with the levels of their role overload (RO) and role distress (RD). The CNSP in this study covered the orphaned, abandoned, abused, neglected, exploited, and mentally-challenged children. In this study, the domains of QOL included physical health (PH), psychological health, social health (SH), and living conditions (LC). It also intended to ascertain the association of their personal and work-related characteristics with their RO and RD levels. The respondents of this study were 130 CNSP caregivers in 17 residential child-rearing institutions in Metro Manila. A purposive non-probability sampling was used. Using a quantitative methodological approach, the survey method was utilized to gather data with the use of a self-administered structured questionnaire. Data were analyzed using both descriptive and inferential statistics. Results revealed that the level of RO, the level of RD, and the QOL of the CNSP caregivers were all moderate. Data also suggested that there were significant positive relationships between the RO level and the caregivers’ characteristics, such as age, the number of training, and years of service in the institution. At the same time, the findings revealed that there were significant positive relationships between the RD level and the caregivers’ characteristics, such as age and hours of care rendered to their care recipients. In addition, the findings suggested that all domains of their QOL obtained significant relationships with their RO level. For the correlations of their level of RO and their QOL domains, the PH and the LC obtained a moderate negative correlation with the RO level while the rest of the domains obtained weak negative correlations with RO level. For the correlations of their level of RD and the QOL domains, all domains, except SH, obtained strong negative correlations with the level of RD. The SH revealed to have a moderate negative correlation with RD level. In conclusion, caregivers who are older experience higher levels of RO and RD; caregivers who have more training and years of service experience the higher level of RO; and caregivers who have longer hours of rendered care experience the higher level of RD. In addition, the study affirmed that if the levels of RO and RD are high, the QOL is low, and vice versa. Therefore, the RO and RD levels are reliable predictors of the caregivers’ QOL. In relation, the caregiving situation in the Philippines revealed to be unique and distinct from other countries because the levels of RO and RD and the QOL of Filipino CNSP caregivers were all moderate in contrast with their foreign counterparts who experience high caregiving RO and RD leading to low QOL.

Keywords: quality of life, caregivers, children in need of special protection, physical health, psychological health, social health, living conditions, role overload, role distress

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Authors: Roger WUMBA

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The objective of this study was to determine the prevalence of intestinal parasites, with special emphasis on microsporidia and Cryptosporidium, as well as their association with human immunodeficiency virus (HIV) symptoms, risk factors, and other digestive parasites. We also wish to determine the molecular biology definitions of the species and genotypes of microsporidia and Cryptosporidium in HIV patients. In this cross-sectional study, carried out in Kinshasa, Democratic Republic of the Congo, stool samples were collected from 242 HIV patients (87 men and 155 women) with referred symptoms and risk factors for opportunistic intestinal parasites. The analysis of feces specimen were performed using Ziehl–Neelsen stainings, real-time polymerase chain reaction (PCR), immunofluorescence indirect monoclonal antibody, nested PCR-restriction fragment length polymorphism, and PCR amplification and sequencing. Odds ratio (OR) and 95% confidence intervals were used to quantify the risk. Of the 242 HIV patients, 7.8%, 0.4%, 5.4%, 0.4%, 2%, 10.6%, and 2.8% had Enterocytozoon bieneusi, Encephalitozoon intestinalis, Cryptosporidium spp., Isospora belli, pathogenic intestinal protozoa, nonpathogenic intestinal protozoa, and helminths, respectively. We found five genotypes of E. bieneusi: two older, NIA1 and D, and three new, KIN1, KIN2, and KIN3. Only 0.4% and 1.6% had Cryptosporidium parvum and Cryptosporidium hominis, respectively. Of the patients, 36.4%, 34.3%, 31%, and 39% had asthenia, diarrhea, a CD4 count of ,100 cells/mm³, and no antiretroviral therapy (ART), respectively. The majority of those with opportunistic intestinal parasites and C. hominis, and all with C. parvum and new E. bieneusi genotypes, had diarrhea, low CD4+ counts of ,100 cells/mm³, and no ART. There was a significant association between Entamoeba coli, Kaposi sarcoma, herpes zoster, chronic diarrhea, and asthenia, and the presence of 28 cases with opportunistic intestinal parasites. Rural areas, public toilets, and exposure to farm pigs were the univariate risk factors present in the 28 cases with opportunistic intestinal parasites. In logistic regression analysis, a CD4 count of ,100 cells/mm³ (OR = 4.60; 95% CI 1.70–12.20; P = 0.002), no ART (OR = 5.00; 95% CI 1.90–13.20; P , 0.001), and exposure to surface water (OR = 2.90; 95% CI 1.01–8.40; P = 0.048) were identified as the significant and independent determinants for the presence of opportunistic intestinal parasites. E. bieneusi and Cryptosporidium are becoming more prevalent in Kinshasa, Congo. Based on the findings, we recommend epidemiology surveillance and prevention by means of hygiene, the emphasis of sensitive PCR methods, and treating opportunistic intestinal parasites that may be acquired through fecal–oral transmission, surface water, normal immunity, rural area-based person–person and animal–human nfection, and transmission of HIV. Therapy, including ART and treatment with fumagillin, is needed.

Keywords: diarrhea, enterocytozoon bieneusi, cryptosporidium hominis, cryptosporidium parvum, risk factors, africans

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Authors: Andrew Green, Jiaming Liu, Kellathur Srinivasan, Raymond Chua

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Introduction: The size of Singapore’s online health product (HP) market (e-commerce) is largely unknown. However, it is recognized that a large majority comes from overseas and thus, unregulated. As buying HP from unauthorized sources significantly compromises public health safety, understanding e-commerce users’ demographics and their perceptions on online HP purchasing becomes a pivotal first step to form a basis for recommendations in Singapore’s pharmacovigilance efforts. Objective: To assess the prevalence of online HP purchasing behaviour among Singaporean e-commerce users. Methodology: This is a cross-sectional study targeting Singaporean e-commerce users recruited from various local websites and online forums. Participants were not randomized into study arms but instead stratified by random sampling method based on participants’ age. A self-administered anonymous questionnaire was used to explore participants' demographics, online HP purchasing behaviour, knowledge and attitude. The association of different variables with online HP purchasing behaviour was analysed using logistic regression statistics. Main outcome measures: Prevalence of HP e-commerce users in Singapore (%) and variables that contribute to the prevalence (adjusted prevalent ratio). Results: The study recruited 372 complete and valid responses. The prevalence of online HP consumers among e-commerce users in Singapore is estimated to be 55.9% (1.7 million consumers). Online purchasing of complementary HP (46.9%) was the most prevalent, followed by medical devices (21.6%) and Western medicine (20.5%). Multivariate analysis showed that age is an independent variable that correlates with the likelihood of buying HP online. The prevalence of HP e-commerce users is highest in the 35-44 age group (64.1%) and lowest among the 16-24 age group (36.4%). The most bought HP through the internet are vitamins and minerals (21.5%), non-herbal (15.9%), herbal (13.9%), weight loss (8.7%) and sports (8.4%) supplements. While the top 3 products are distributed equally between the genders, there is a skew towards female respondents (12.4% in females vs. 4.9% in males) for weight loss supplements and towards males (13.2% in males vs. 3.7% in females) for sports supplements. Even though online consumers are in the younger age brackets, our study found that up to 72.0% of HP bought online are bought for others (buyer’s family and/or friends). Multivariate analysis showed a statistically significant association between purchasing HP through online means and the perceptions that 'internet is safe' (adjusted Prevalence Ratio=1.15, CI 1.03-1.28), 'buying HP online is time saving' (PR=1.17, CI 1.01-1.36), and 'recognition of HP brand' (PR=1.21 CI 1.06-1.40). Conclusions: This study has provided prevalence data for online HP market in Singapore, and has allowed the country’s regulatory body to formulate a targeted pharmacovigilance approach to this growing problem.

Keywords: e-commerce, pharmaceuticals, pharmacovigilance, Singapore

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