Search results for: population and covid-19 impact on mental health

Authors: Benbelil-Tafoughalt Saida, Tababouchet Meriem

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The main goal of this study was to investigate the impact of anthropogenic activities on soil quality using the land snail Cantareusapertus as a bioindicator of heavy metal accumulation. Concentrations of cadmium, copper, and zinc were measured in various body organs, viz: viscera and foot of the land snail Cantareusapertus. The snails were collected from two different sites in the Bejaia region (Northeastern Algeria), exposed to different sources of contamination by trace metals. The first sampling site is an urban areas, and the second is characterized by heavy industry, a potential source of soil pollution via heavy metal contamination. The concentrations of heavy metal in all viscera and foot samples were measured using an atomic absorption spectrophotometer. Bioconcentration of the trace metals Cu, Zn, and Cd varied between the viscera and the foot with the viscera having the highest concentration (µgg-1) of all metals than the foots; Cu, 2.03 – 5.8 (Viscera), 0.05 – 3.30 (Foot), Zn, 23.64 – 45.02 (Viscera), 1.87 – 15.15 (Foot) and Cd, 0.36 – 15.26 (Viscera), 0.18 – 13.73 (Foot), which suggest that ingestion may be the main uptake route of these essential metals. On the other hand, the levels of heavy metals varied significantly among the sampling area (P<0.001). in fact, in the foots as well as in the viscera, the concentrations of all studied metals is significantly higher in the snails sampled from sites closest to potential sources of pollution compared to those collected from urban areas characterized by moderate pollution.

Keywords: anthropogenic activities, Bioconcentration, Cantareus apertus, trace metals

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Authors: Amenah Galo, Mohammed Farid, Kareem Alsharkawy, Robert Warner, Karthikeyan Srinivasan, Haitham Khalil, Ruth Waters

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Introduction: The cessation of elective surgery, particularly breast reconstruction, continue to be affected by the COVID-19 pandemic. The restructuring of medical services and staff redeployment severely affected the ability to return to normality for surgical specialties. The aim of this study is to determine the decline in breast reconstruction affected by the COVID-19 pandemic in a tertiary center. Methods: A retrospective review of breast reconstruction cases (autologous, non-autologous) or mastectomies Pre- COVID (March 2019-March 2020) and during COVID (March 2020- March 2021) at Queen Elizabeth Hospital, Birmingham, were collated. Data included patient demographics, BMI, previous and recent reconstruction, length of hospital stay, and mastectomies, including risk-reducing. Results: The number of patients who had breast reconstruction was significantly lower during COVID (n=62) compared to pre-COVID (n=199). The mean age (pre-COVID 51, COVID 59 years), BMI (Pre-COVID and COVID = 27), previous reconstruction (pre-COVID n=101, 51%, COVID n=33, 53%) and length hospital stay was less during COVID (3 days) compared to Pre-COVID (4 days). The proportion of risk-reducing mastectomies and reconstruction during COVID (32%, n=20) were higher than pre-COVID (21%, n=41). A higher proportion rate of autologous reconstruction (DIEP 56, TRAM 17) Pre-COVID compared to COVID (DIEP 22, TRAM 7). Implant reconstructions were higher during COVID (n=19, 31%) than pre-COVID (n=31, 16%). Conclusion: The lack of regular provision for breast reconstruction continues to decline during the pandemic. This will have a tremendous impact on waiting lists without a timeline for reconstruction to offer patients. An international survey highlights the disparities in offering breast reconstruction and strategies to rectify this issue.

Keywords: breast reconstruction, COVID-19 pandemic, mastectomy, autologous, implant

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Authors: Feng Huang, Carlos G. Ochoa, Haitao Zhao

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Poyang Lake, the largest freshwater lake in China, is located at the middle-lower reaches of the Yangtze River basin. It has great value in socioeconomic development and is internationally recognized as an important lacustrine and wetland ecosystem with abundant biodiversity. Impacted by ongoing climate change and anthropogenic activities, especially the regulation of the Three Gorges Reservoir since 2003, Poyang Lake has experienced significant water regime evolution, resulting in challenges for the management of water resources and the environment. Quantifying the contribution of hydrologic and topographic changes to water regime alteration is necessary for policymakers to design effective adaption strategies. Long term hydrologic data were collected and the back-propagation neural networks were constructed to simulate the lake water level. The impacts of hydrologic and topographic changes were differentiated through scenario analysis that considered pre-impact and post-impact hydrologic and topographic scenarios. The lake water regime was characterized by hydrologic indicators that describe monthly water level fluctuations, hydrologic features during flood and drought seasons, and frequency and rate of hydrologic variations. The results revealed different contributions of hydrologic and topographic changes to different features of the lake water regime.Noticeable changes were that the water level declined dramatically during the period of reservoir impoundment, and the drought was enhanced during the dry season. The hydrologic and topographic changes exerted a synergistic effect or antagonistic effect on different lake water regime features. The findings provide scientific reference for lacustrine and wetland ecological protection associated with water regime alterations.

Keywords: back-propagation neural network, scenario analysis, water regime, Poyang Lake

Procedia PDF Downloads 132

Authors: Ling-Lang Huang, Yih-Jer Wu

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Empathy is crucial for a patient-physician relationship and medical professionalism. Internet activity, gaming, or even addiction, have been more and more common among medical students. However, there’s been no report showing whether internet behavior has a substantial impact on empathy in medical students to our best knowledge. All year-2 medical students taking the optional course 'Narrative, Comprehension, and Communication' were enrolled. Internet behaviors are divided into two groups, 'internet users without online gaming (IU)' and 'internet users with online gaming (IG)', each group was further divided into 3 groups according to their average online retention time each day (< 2, 2 - 6, > 6 hours). Empathy was evaluated by the scores of the reports and humanities reflection after watching indicated movies, and by self-measured empathy questionnaire. All students taking the year-2 optional course 'Narrative, Comprehension, and Communication' were enrolled. As compared with students in the IU group, those in the IG group had significantly lower scores for the reports (81.3 ± 3.7 vs. 86.4 ± 5.1, P = 0.014). If further dividing the students into 5 groups (IU < 2, IU 2-6, IG < 2, IG 2 - 6, and IG > 6 hours), the scores were significantly and negatively correlated to online gaming with longer hours (r = -0.556, P = 0.006). However, there was no significant difference between IU and IG groups (33.0 ± 5.4 vs. 34.8 ± 3.2, P = n.s.), in terms of scores in the self-measured empathy questionnaire, neither was there any significant trend of scores along with longer online hours across the 5 groups (r = -0.164, P = n.s.). To date, there has been no evidence showing whether different internet behaviors (with or without online gaming) have distinct impacts on empathy. Although all of the medical students had a similarly good self-perception for empathy, our data suggested that online gaming did have a negative impact on their actual expression of empathy. Our observation has brought up an important issue for pondering: May IT- or gaming-assisted medical learning actually harm students’ empathy? In conclusion, this data suggests that long hours of online gaming harms expression of empathy, though all medics think themselves a person of high empathy.

Keywords: empathy. Internet, medical students, online gaming

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Authors: Toledo-Fernandez Aldebaran

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Introduction: One of the least explored cognitive functions in relation with depression is the one related to musical stimuli. Music perception and memory can become impaired as well. The term amusia is used to define a type of agnosia caused by damage to basic processes that creates a general inability to perceive music. Therefore, the main objective is to explore performance-based and self-report deficits in music perception and memory on people with major depressive disorder (MDD). Method: Data was collected through April-October 2021 recruiting people who met the eligibility criteria and using the Montreal Battery of Evaluation of Amusia (MBEA) to evaluate performance-based music perception and memory, along with the module for depression of the Mini International Neuropsychiatric Interview, and the Amusic Dysfunction Inventory (ADI) which evaluates the participants’ self-report concerning their abilities in music perception. Results: 64 participants were evaluated. The main study, referring to analyzing the differences between people with MDD and the control group, only showed one statistical difference on the Interval subtest of the MBEA. No difference was found in the dimensions assessed by the ADI. Conclusion: Deficits in interval perception can be explained by mental fatigue, to which people with depression are more vulnerable, rather than by specific deficits in musical perception and memory associated with depressive disorder. Additionally, significant associations were found between musical deficits as observed by performance-based evidence and music dysfunction according to self-report, which could suggest that some people with depression are capable of detecting these deficits in themselves.

Keywords: depression, amusia, music, perception, memory

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Authors: Bahareh Montakhabi

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Earthquake is known as one of the deadliest natural disasters, with a high potential for damage to life and property. Some of Iran's cities were completely destroyed after major earthquakes, and the people of the region suffered a lot of mental, financial and psychological damage. Tehran is one of the cities located on the fault line. According to experts, the only city that could be severely damaged by a moderate earthquake in Earthquake Engineering Intensity Scale (EEIS) (70% destruction) is Tehran because Tehran is built precisely on the fault. Seismic risk assessment (SRA) of cities in the scale of urban areas and neighborhoods is the first phase of the earthquake crisis management process, which can provide the information required to make optimal use of available resources and facilities in order to reduce the destructive effects and consequences of an earthquake. This study has investigated strategies to promote safety and reduce the vulnerability of worn-out urban textures in the District 12 of Tehran to the potential risk of earthquake aimed at prioritizing the factors affecting the vulnerability of worn-out urban textures to earthquake crises and how to reduce them, using the analytical-exploratory method, analytical hierarchy process (AHP), Expert choice and SWOT technique. The results of SWAT and AHP analysis of the vulnerability of the worn-out textures of District 12 to internal threats (1.70) and external threats (2.40) indicate weak safety of the textures of District 12 regarding internal and external factors and a high possibility of damage.

Keywords: risk management, vulnerability, worn-out textures, earthquake

Procedia PDF Downloads 191

Authors: Jakub Elbl, Lukáš Plošek, Antonín Kintl, Jaroslav Hynšt, Soňa Javoreková, Jaroslav Záhora, Libor Kalhotka, Olga Urbánková, Ivana Charousová

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This work presents the first results from the long-term laboratory experiment dealing with impact of drought on soil properties. Three groups of the treatment (A, B and C) with different regime of irrigation were prepared. The soil water content was maintained at 70 % of soil water holding capacity in group A, at 40 % in group B. In group C, soil water regime was maintained in the range of wilting point. Each group of the experiment was divided into three variants (A1 = B1, C1; A2 = B2, C2 etc.) with three repetitions: Variants A1 (B1, C1) were controls without addition of another fertilizer. Variants A2 (B2, C2) were fertilized with mineral nitrogen fertilizer DAM 390 (0.140 Mg of N per ha) and variants A3 (B3, C3) contained 45 g of Cp per a pot. The significant differences (ANOVA, P<0.05) in the leaching of mineral nitrogen and values of saturated hydraulic conductivity (Ksat) were found. The highest values of Ksat were found in variants (within each group) with addition of compost (A3, B3, C3). Conversely, the lowest values of Ksat were found in variants with addition of mineral nitrogen. Low values of Ksat indicate an increased level of hydrophobicity in individual groups of the experiment. Moreover, all variants with compost addition showed lower amount of mineral nitrogen leaching and high level of microbial activity than variants without. This decrease of mineral nitrogen leaching was about 200 % in comparison with the control variant and about 300 % with variant, where mineral nitrogen was added. Based on these results, we can conclude that changes of soil water content directly have impact on microbial activity, soil hydrophobicity and loss of mineral nitrogen from the soil.

Keywords: drought, microbial activity, mineral nitrogen, soil hydrophobicity

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Authors: M. C. Schloesser

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The purpose of this paper is to explore the use and impact of business analytics in European football. Despite good evidence from other major sports leagues, research on this topic in Europe is currently very scarce. This research relies on expert interviews on the use and objective of business analytics. Along with revenue data over 16 seasons spanning from 2004/05 to 2019/20 from Manchester City FC, we conducted a time series analysis to detect a structural breakpoint on the different revenue streams, i.e., sponsorship and ticketing, after analytical tools have been implemented. We not only find that business analytics have indeed been applied at Manchester City FC and revenue increase is the main objective of their utilization but also that business analytics is indeed a good means to increase revenues if applied sufficiently. We can thereby support findings from other sports leagues. Consequently, professional sports organizations are advised to apply business analytics if they aim to increase revenues. This research has shown that analytical practices do, in fact, support revenue growth and help to work more efficiently. As the knowledge of analytical practices is very confidential and not publicly available, we had to select one club as a case study which can be considered a research limitation. Other practitioners should explore other clubs or leagues. Further, there are other factors that can lead to increased revenues that need to be considered. Additionally, sports organizations need resources to be able to apply and utilize business analytics. Consequently, findings might only apply to the top teams of the European football leagues. Nonetheless, this paper combines insights and results on usage, objectives, and impact of business analytics in European professional football and thereby fills a current research gap.

Keywords: business analytics, expert interviews, revenue management, time series analysis

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Authors: Endalew Fufa Kufi

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Every married person aspires to be a parent regardless of the situation in which s/he lives. Such aspiration meets with reality when the destined parent is able to give adequate supports and services to his/her children, whether the latter are got by birth or through adoption. The adequacy of services parents provide their children is both enriched and tempted by the work on which they involve. On the one hand, parents need to work and earn a living in order to support their family. On the other hand, they must spend most of their time outside home to do the work, which shortens the time and might they spare to care for their children. Where the sufficiency of services parents owe their children could be ascertained by in terms of life skills, physical care and related provisions, the role of working fathers and mothers in providing such supports could be diverse across cultures and work traditions. Hence, this research deals with the investigation of working mothers’ parental practices, challenges they face in providing parental services and the implication for the future progress of the parents and their children. Target of the study will be Arsi University in Oromia Regional State of Ethiopia. Descriptive survey design in holding the research, and data for the research will be collected in the form of experiential self-report from 150 working mothers selected from the entire working women population of Colleges of Agriculture and Environmental Studies and College of Health Sciences through stratified random-sampling. Instruments of data collection will be closed and open-ended questionnaire. Complementary data will also be collected from purposively selected samples through semi-structured interview. Data for the research will be collected through questionnaire first and then through interview. Data analysis will also follow the same procedure. The collected data will systematically be organized and statistically and thematically analyzed in order to come up with indicative findings. The overarching thesis is that, working mothers in the study area bear a lot of responsibilities both at home and at work place which leave them very little time for parenting services. Unless due attention is given to the way they can spare time for their children, they are more likely to be tense between work-life and family care services, which tempt them in different directions.

Keywords: challenges, mothers, practices, university, working

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Authors: Gholam Reza Parvizi, Hossein Azad, Ali Reza Kargar

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This article investigated the impact of task-based language teaching (TBLT) on writing performance of the Iranian intermediate EFL learners. There were two groups of forty students of the intermediate female learners studying English in Jahad-e-Daneshgahi language institute, ranging in age from thirteen to nineteen. They participated in their regular classes in the institute and were assigned to two groups including an experimental group of task-based language teaching and a control group for the purpose of homogeneity, all students in two groups took an achievement test before the treatment. As a pre-test; students were assigned to write a task at the beginning of the course. One of the classes was conducted through talking a TBLT approach on their writing, while the other class followed regular patterns of teaching, namely traditional approach for TBLT group. There were some tasks chosen from learners’ textbook. The task selection was in accordance with learning standards for ESL and TOFEL writing sections. At the end of the treatment, a post-test was administered to both experimental group and the control group. Scoring was done on the basis of scoring scale of “expository writing quality scale”. The researcher used paired samples t-test to analyze the effect of TBLT teaching approach on the writing performance of the learners. The data analysis revealed that the subjects in TBLT group performed better on the writing performance post-test than the subjects in control group. The findings of the study also demonstrated that TBLT would enhance writing performance in the group of learners. Moreover, it was indicated that TBLT has been effective in teaching writing performance to Iranian EFL learners

Keywords: task-based language teaching, task, language teaching approach, writing proficiency, EFL learners

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Authors: Tzong-Ying Hao, Mohammad T. Rahmani

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This article presents the structural health monitoring (SHM) method based on changes in wave traveling times (wave method) within a layered 1-D shear beam model of structure. The wave method measures the velocity of shear wave propagating in a building from the impulse response functions (IRF) obtained from recorded data at different locations inside the building. If structural damage occurs in a structure, the velocity of wave propagation through it changes. The wave method analysis is performed on the responses of Torre Central building, a 9-story shear wall structure located in Santiago, Chile. Because events of different intensity (ambient vibrations, weak and strong earthquake motions) have been recorded at this building, therefore it can serve as a full-scale benchmark to validate the structural health monitoring method utilized. The analysis of inter-story drifts and the Fourier spectra for the EW and NS motions during 2010 Chile earthquake are presented. The results for the NS motions suggest the coupling of translation and torsion responses. The system frequencies (estimated from the relative displacement response of the 8th-floor with respect to the basement from recorded data) were detected initially decreasing approximately 24% in the EW motion. Near the end of shaking, an increase of about 17% was detected. These analysis and results serve as baseline indicators of the occurrence of structural damage. The detected changes in wave velocities of the shear beam model are consistent with the observed damage. However, the 1-D shear beam model is not sufficient to simulate the coupling of translation and torsion responses in the NS motion. The wave method is proven for actual implementation in structural health monitoring systems based on carefully assessing the resolution and accuracy of the model for its effectiveness on post-earthquake damage detection in buildings.

Keywords: Chile earthquake, damage detection, earthquake response, impulse response function, shear beam model, shear wave velocity, structural health monitoring, torre central building, wave method

Procedia PDF Downloads 360

Authors: L. Krpalkova, N. O' Mahony, A. Carvalho, S. Campbell, S. Harapanahalli, J. Walsh

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The objective of this study was to determine the effects of environmental stressors on the performance of lactating dairy cows and discuss some future trends. There exists a relationship between the meteorological data and milk yield prediction accuracy in pasture-based dairy systems. New precision technologies are available and are being developed to improve the sustainability of the dairy industry. Some of these technologies focus on welfare of individual animals on dairy farms. These technologies allow the automatic identification of animal behaviour and health events, greatly increasing overall herd health and yield while reducing animal health inspection demands and long-term animal healthcare costs. The data set consisted of records from 489 dairy cows at two dairy farms and temperature measured from the nearest meteorological weather station in 2018. The effects of temperature on milk production and behaviour of animals were analyzed. The statistical results indicate different effects of temperature on milk yield and behaviour. The “comfort zone” for animals is in the range 10 °C to 20 °C. Dairy cows out of this zone had to decrease or increase their metabolic heat production, and it affected their milk production and behaviour.

Keywords: behavior, milk yield, temperature, precision technologies

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Authors: Runlang Zhu, Weijun Gao, Yinqi Zhang, Gangwei Cai

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In order to deal with issues such as the environmental problems and aging of the population, the Japanese government wanted to achieve goals like 'a city where everyone wants to live' and 'a city full of energy for everyone' by creating environmental, social, and economic values in the process of urban development. They began to promote the concept of 'Environmental Future City' in 2010, aiming to create cities and regions with excellent environments, sustainable economic development, and social systems. After taking a look at the history, concept, and development of environmental future cities, the paper will discuss the evaluation system of them, introduce representative cases, and point out what other cities can learn from their development process.

Keywords: environmental future city, city concept, CASBEE, environmental performance assessment

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Authors: Alireza Nikbakht Shahbazi

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There are various factors that affect climate changes; drought is one of those factors. Investigation of efficient methods for estimating climate change impacts on drought should be assumed. The aim of this paper is to investigate climate change impacts on drought in Karoon3 watershed located south-western Iran in the future periods. The atmospheric general circulation models (GCM) data under Intergovernmental Panel on Climate Change (IPCC) scenarios should be used for this purpose. In this study, watershed drought under climate change impacts will be simulated in future periods (2011 to 2099). Standard precipitation index (SPI) as a drought index was selected and calculated using mean monthly precipitation data in Karoon3 watershed. SPI was calculated in 6, 12 and 24 months periods. Statistical analysis on daily precipitation and minimum and maximum daily temperature was performed. LRAS-WG5 was used to determine the feasibility of future period's meteorological data production. Model calibration and verification was performed for the base year (1980-2007). Meteorological data simulation for future periods under General Circulation Models and climate change IPCC scenarios was performed and then the drought status using SPI under climate change effects analyzed. Results showed that differences between monthly maximum and minimum temperature will decrease under climate change and spring precipitation shall increase while summer and autumn rainfall shall decrease. The precipitation occurs mainly between January and May in future periods and summer or autumn precipitation decline and lead up to short term drought in the study region. Normal and wet SPI category is more frequent in B1 and A2 emissions scenarios than A1B.

Keywords: climate change impact, drought severity, drought frequency, Karoon3 watershed

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Authors: Patricia Huedo, Maria José Ruá, Raquel Agost-Felip

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Ensuring sustainable development of urban environments means guaranteeing adequate environmental conditions, being resilient and meeting conditions of safety and inclusion for all people, regardless of their condition. All existing buildings should meet basic safety conditions and be equipped with safe and accessible routes, along with visual, acoustic and tactile signals to protect their users or potential visitors, and regardless of whether they undergo rehabilitation or change of use processes. Moreover, from a social perspective, we consider the need to prioritize buildings occupied by the most vulnerable groups of people that currently do not have specific regulations tailored to their needs. Some residential models in operation are not only outside the scope of application of the regulations in force; they also lack a project or technical data that would allow knowing the fire behavior of the construction materials. However, the difficulty and cost involved in adapting the entire building stock to current regulations can never justify the lack of safety for people. Hence, this work develops a simplified model to assess compliance with the basic safety conditions in case of fire and its compatibility with the specific accessibility needs of each user. The purpose is to support the designer in decision making, as well as to contribute to the development of a basic fire safety certification tool to be applied in inclusive residential models. This work has developed a methodology to support designers in adapting Social Services Centers, usually intended to vulnerable people. It incorporates a checklist of 9 items and information from sources or standards that designers can use to justify compliance or propose solutions. For each item, the verification system is justified, and possible sources of consultation are provided, considering the possibility of lacking technical documentation of construction systems or building materials. The procedure is based on diagnosing the degree of compliance with fire conditions of residential models used by vulnerable groups, considering the special accessibility conditions required by each user group. Through visual inspection and site surveying, the verification model can serve as a support tool, significantly streamlining the diagnostic phase and reducing the number of tests to be requested by over 75%. This speeds up and simplifies the diagnostic phase. To illustrate the methodology, two different buildings in the Valencian Region (Spain) have been selected. One case study is a mental health facility for residential purposes, located in a rural area, on the outskirts of a small town; the other one, is a day care facility for individuals with intellectual disabilities, located in a medium-sized city. The comparison between the case studies allow to validate the model in distinct conditions. Verifying compliance with a basic security level can allow a quality seal and a public register of buildings adapted to fire regulations to be established, similarly to what is being done with other types of attributes such as energy performance.

Keywords: fire safety, inclusive housing, universal accessibility, vulnerable people

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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: Amritanshu Sandilya, M. V. Shah

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Collapsible soils such as loess are a common geotechnical challenge due to their potential to undergo sudden and severe settlement under certain loading conditions. The need for filling engineering to increase developing land has grown significantly in recent years, which has created several difficulties in managing soil strength and stability during compaction. Numerous engineering problems, such as roadbed subsidence and pavement cracking, have been brought about by insufficient fill strength. Therefore, strict control of compaction parameters is essential to reduce these distresses. Accurately measuring the degree of compaction, which is often represented by compactness is an important component of compaction control. For credible predictions of how collapsible soils will behave under complicated loading situations, the accuracy of laboratory studies is essential. Therefore, this study aims to investigate the energy transfer in collapsible soils during laboratory Proctor compaction tests to provide insights into how energy transfer can be optimized to achieve more accurate and reliable results in compaction testing. The compaction characteristics in terms of energy of loess soil have been studied at moisture content corresponding to dry of optimum, at the optimum and wet side of optimum and at different compaction energy levels. The hammer impact force (E0) and soil bottom force (E) were measured using an impact load cell mounted at the bottom of the compaction mould. The variation in energy consumption ratio (E/ E0) was observed and compared with the compaction curve of the soil. The results indicate that the plot of energy consumption ratio versus moisture content can serve as a reliable indicator of the compaction characteristics of the soil in terms of energy.

Keywords: soil compaction, proctor compaction test, collapsible soil, energy transfer

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Authors: Ricardo Chaves, Carlos Vasconcelos

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Candidates to join the Naval Academy have to take a set of physical tests, which is crucial for a high level of physical fitness. Thus, the planning of physical exercises for candidates to the Naval School must take into account the improvement of their physical fitness. The aim of this study was to investigate the impact of a 6-month exercise program to improve the physical fitness of an individual who will apply for the Naval Academy. This was a non-experimental pre-post-evaluation study. The patient was male, had 18 years old, and a body mass index of 21.1 kg.m². The patient participated in a 6-month aerobic and strength exercise program (3 sessions per week, 75 minutes duration each session). Physical fitness tests were performed according to the physical fitness requirements for entry into the Naval academy (muscle strength [maximum number of lifts and maximum number of sit-ups for 1 minute]; aerobic fitness [2.4 km run and 200 m swimming test]) before (baseline) and after the exercise intervention (6 months). Regarding muscle strength, in the abdominal test, the improvements between the pre-test (39 abdominals.) and post-test (61 abdominals) were 56.4%. For elevations, there was an increase in its number by 150% between the pre-test (4 elevations) and post-test (10 elevations). With regard to aerobic fitness, in the 2.4 km race, there was an evolution of 32.0% between the pre-test (16.46 min.) and the post-test (12.42 min.). For the 200-meter swimming test, there was a negative variation of 2% between the pre-test (2.25 min.) and post-test (2.28 min). A 6-month aerobic and strength exercise program leads to a positive evolution in the muscular strength of the patient. Regarding aerobic fitness, opposite results were found, with a positive evolution in the 2.4 km running test and a negative evolution in the swimming test. In future exercise programs for the improvement of the physical fitness of candidates for the Naval Academy, more emphasis has to be done on specific swimming training.

Keywords: case study, exercise program, Naval Academy, physical fitness

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Authors: Muhammad Afiq Anaqi Bin Baharudin, Muhammad Izamuddin Bin Mohd Nasir, Syarifuddin Bin Sujuanda, Muhammad Syahmi Rusyaidi Bin Sham Suddin, Danish Hakimi Bin Kamaruzaman, Muhammad Haqimi Nazim Bin Hasmanizam, Mohammad Akmal Zakwan Bin Amran, Muhammad Alparizi Bin Latif

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By improving efficiency and production, information technology (IT) has transformed working environments, but it has also created new threats to occupational safety and health (OSH). This study evaluates the literature that has already been written on the subject of IT and OSH, identifies major findings and discussion points, and highlights gaps in the material that call for additional research. The study's findings, which look at how IT affects OSH in a sizable multinational organization, are also presented in the report. According to the report, IT poses a number of OSH problems, such as ergonomic dangers, eye strain, dangers related to cybersecurity, and psychological hazards. The report suggests using tactics like providing comfortable workstations, encouraging a healthy balance between work and life, and putting strong cybersecurity safeguards in place to reduce these dangers. The implications of these findings for OSH and IT are discussed in the paper's conclusion, and it emphasizes the need for more study and action to address these dangers and promote healthy and secure working environments in the age of digitization.

Keywords: information technology, occupational safety and health (OSH), ergonomic, hazards, workplace.

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Authors: Navah Z. Ratzon, Shlomit Cohen, Sigal Portnoy

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This work focuses on posture and risk factors for the musculoskeletal disorder in guitarists, which constitutes the largest group of musicians today. The source of the problems experienced by these musicians is linked to physical, psychosocial and personal risk factors. These muscular problems are referred to as Playing Related Musculoskeletal Disorder (PRMD). There is not enough research that specifically studies guitar players, and to the extent of our knowledge, there is almost no reference to the characteristics of their movement patterns while they play. This is in spite of the high prevalence of PRMD in this population. Kinematic research may provide a basis for the development of a prevention plan for this population and their unique characteristics of playing patterns. The aim of the study was to investigate the correlation between risk factors for PRMD among guitar players and self-reporting of pain in the skeletal muscles, and specifically to test whether there are differences in the kinematics of the upper body while playing in a sitting or standing posture. Twenty-five guitarists, aged 18-35, participated in the study. The methods included a motion analysis using a motion capture system, anthropometric measurements and questionnaires relating to risk factors. The questionnaires used were the Standardized Nordic Questionnaire for the Analysis of Musculoskeletal Symptoms and the Demand Control Support Questionnaire, as well as a questionnaire of personal details. All of the study participants complained of musculoskeletal pain in the past year; the most frequent complaints being in the left wrist. Statistically significant correlations were found between biodemographic indices and reports of pain in the past year and the previous week. No significant correlations were found between the physical posture while playing and reports of pain among professional guitarists. However, a difference was found in several kinematic parameters between seated and standing playing postures. In a majority of the joints, the joint angles while playing in a seated position were more extreme than those during standing. This finding may suggest a higher risk for musculoskeletal disorder while playing in a seated position. In conclusion, the results of the present research highlight the prevalence of musculoskeletal problems in guitar players and its correlation with various risk factors. The finding supports the need for intervention in the form of prevention through identifying the risk factors and addressing them. Relating to the person, to their occupation and environment, which are the basis of proper occupational therapy, can help meet this need.

Keywords: body posture, motion tracking, PRMD, guitarists

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Authors: Mandeep Kaur, K. C. Sharma, P. L. Sharma, R. S. Chandel

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Cauliflower is an important vegetable crop grown throughout the world and is attacked by a large number of insect pests at various stages of the crop growth. Amongst them, the cabbage aphid, Brevicoryne brassicae (Linnaeus) (Hemiptera: Aphididae) is an important insect pest. Continued feeding by both nymphs and adults of this aphid causes yellowing, wilting and stunting of plants. Amongst various management practices, the use of resistant cultivars is important and can be an effective method of reducing the population of this aphid. So it is imperative to know the complete record on various biological parameters and life table on specific cultivars. The biology and life fertility of the cabbage aphid were studied on five cauliflower cultivars viz. Megha, Shweta, K-1, PSB-1 and PSBK-25 under controlled temperature conditions of 20 ± 2°C, 70 ± 5% relative humidity and 16:8 h (Light: Dark) photoperiods. For studying biology; apterous viviparous adults were picked up from the laboratory culture of all five cauliflower cultivars after rearing them at least for two generations and placed individually on the desired plants of cauliflower cultivars grown in pots with ten replicates of each. Daily record on the duration of nymphal period, adult longevity, mortality in each stage and the total number of progeny produced per female was made. This biological data were further used to construct life fertility table on each cultivar. Statistical analysis showed that there was a significant difference ( P  < 0.05) between the different growth stages and the mean number of laid nymphs. The maximum and minimum growth periods were observed on Shweta and Megha (at par with K-1) cultivars, respectively. The maximum number of nymphs were laid on Shweta cultivar (26.40 nymphs per female) and minimum on Megha (at par with K-1) cultivar (15.20 nymphs per female). The true intrinsic rate of increase (rm) was found to be maximum on Shweta (0.233 nymphs/female/day) followed by PSB K-25 (0.207 nymphs/female/day), PSB-1 (0.203 nymphs/female/day), Megha (0.166 nymphs/female/day) and K-1 (0.153 nymphs/female/day). The finite rate of natural increase (λ) was also found to be in the order: K-1 < Megha < PSB-1 < PSBK-25 < Shweta whereas the doubling time (DT) was in the order of K-1 >Megha> PSB-1 >PSBk-25> Shweta. The aphids reared on the K-1 cultivar had the lowest values of rm & λ and the highest value of DT whereas on Shweta cultivar the values of rm & λ were the highest and the lowest value of DT. So on the basis of these studies, K-1 cultivar was found to be the least suitable and the Shweta cultivar was the most suitable for the cabbage aphid population growth. Although the cauliflower cultivars used in different parts of the world may be different yet the results of the present studies indicated that the application of cultivars affecting multiplication rate and reproductive parameters could be a good solution for the management of the cabbage aphid.

Keywords: biology, cauliflower, cultivars, fertility

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Authors: B. Gepts, E. Meex, E. Nuyts, E. Knaepen, G. Verbeeck

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The importance of resource efficiency and environmental impact assessment has raised the interest in knowing the amount of materials used in buildings. If no BIM model or energy performance certificate is available, material quantities can be obtained through an estimation or time-consuming calculation. For the interior wall area, no validated estimation method exists. However, in the case of environmental impact assessment or evaluating the existing building stock as future material banks, knowledge of the material quantities used in interior walls is indispensable. This paper presents a validated method for the estimation of the interior wall area for dwellings based on easy-to-collect building characteristics. A database of 4963 residential buildings spread all over Belgium is used. The data are collected through onsite measurements of the buildings during the construction phase (between mid-2010 and mid-2017). The interior wall area refers to the area of all interior walls in the building, including the inner leaf of exterior (party) walls, minus the area of windows and doors, unless mentioned otherwise. The two predictive modelling techniques used are 1) a (stepwise) linear regression and 2) a decision tree. The best estimation method is selected based on the best R² k-fold (5) fit. The research shows that the building volume is by far the most important variable to estimate the interior wall area. A stepwise regression based on building volume per building, building typology, and type of house provides the best fit, with R² k-fold (5) = 0.88. Although the best R² k-fold value is obtained when the other parameters ‘building typology’ and ‘type of house’ are included, the contribution of these variables can be seen as statistically significant but practically irrelevant. Thus, if these parameters are not available, a simplified estimation method based on only the volume of the building can also be applied (R² k-fold = 0.87). The robustness and precision of the method (output) are validated three times. Firstly, the prediction of the interior wall area is checked by means of alternative calculations of the building volume and of the interior wall area; thus, other definitions are applied to the same data. Secondly, the output is tested on an extension of the database, so it has the same definitions but on other data. Thirdly, the output is checked on an unrelated database with other definitions and other data. The validation of the estimation methods demonstrates that the methods remain accurate when underlying data are changed. The method can support environmental as well as economic dimensions of impact assessment, as it can be used in early design. As it allows the prediction of the amount of interior wall materials to be produced in the future or that might become available after demolition, the presented estimation method can be part of material flow analyses on input and on output.

Keywords: buildings as material banks, building stock, estimation method, interior wall area

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Authors: Antònio Inês, Davide Silva, Filipa Carvalho, Luís Filipe-Riberiro, Fernando M. Nunes, Luís Abrunhosa, Fernanda Cosme

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The presence of mycotoxins in foodstuff is a matter of concern for food safety. Mycotoxins are toxic secondary metabolites produced by certain molds, being ochratoxin A (OTA) one of the most relevant. Wines can also be contaminated with these toxicants. Several authors have demonstrated the presence of mycotoxins in wine, especially ochratoxin A. Its chemical structure is a dihydro-isocoumarin connected at the 7-carboxy group to a molecule of L-β-phenylalanine via an amide bond. As these toxicants can never be completely removed from the food chain, many countries have defined levels in food in order to attend health concerns. OTA contamination of wines might be a risk to consumer health, thus requiring treatments to achieve acceptable standards for human consumption. The maximum acceptable level of OTA in wines is 2.0 μg/kg according to the Commission regulation No. 1881/2006. Therefore, the aim of this work was to reduce OTA to safer levels using different fining agents, as well as their impact on white wine physicochemical characteristics. To evaluate their efficiency, 11 commercial fining agents (mineral, synthetic, animal and vegetable proteins) were used to get new approaches on OTA removal from white wine. Trials (including a control without addition of a fining agent) were performed in white wine artificially supplemented with OTA (10 µg/L). OTA analyses were performed after wine fining. Wine was centrifuged at 4000 rpm for 10 min and 1 mL of the supernatant was collected and added of an equal volume of acetonitrile/methanol/acetic acid (78:20:2 v/v/v). Also, the solid fractions obtained after fining, were centrifuged (4000 rpm, 15 min), the resulting supernatant discarded, and the pellet extracted with 1 mL of the above solution and 1 mL of H2O. OTA analysis was performed by HPLC with fluorescence detection. The most effective fining agent in removing OTA (80%) from white wine was a commercial formulation that contains gelatin, bentonite and activated carbon. Removals between 10-30% were obtained with potassium caseinate, yeast cell walls and pea protein. With bentonites, carboxymethylcellulose, polyvinylpolypyrrolidone and chitosan no considerable OTA removal was verified. Following, the effectiveness of seven commercial activated carbons was also evaluated and compared with the commercial formulation that contains gelatin, bentonite and activated carbon. The different activated carbons were applied at the concentration recommended by the manufacturer in order to evaluate their efficiency in reducing OTA levels. Trial and OTA analysis were performed as explained previously. The results showed that in white wine all activated carbons except one reduced 100% of OTA. The commercial formulation that contains gelatin, bentonite and activated carbon reduced only 73% of OTA concentration. These results may provide useful information for winemakers, namely for the selection of the most appropriate oenological product for OTA removal, reducing wine toxicity and simultaneously enhancing food safety and wine quality.

Keywords: wine, ota removal, food safety, fining

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Authors: R. Ravisankar, Tholkappian A. Chandrasekaran, Y. Raghu, K. K. Satapathy, M. V. R. Prasad, K. V. Kanagasabapathy

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The coastal areas of Tamilnadu are assuming greater importance owing to increasing human population, urbanization and accelerated industrial activities. sIn the present study, sediment samples are collected along the east coast of Tamilnadu for assessment of heavy metal pollution. The concentration of 13 selected heavy metals such as Mg, Al, Si, K, Ca, Ti, Fe, V, Cr, Mn, Co, Ni and Zn determined by Energy dispersive X-ray fluorescence (EDXRF) technique. In order to describe the pollution status, Contamination factor and pollution load index are calculated and reported. This result suggests that sources of metal contamination were mainly attributed to natural inputs from surrounding environments.

Keywords: sediments, heavy metals, EDXRF, pollution contamination factors

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Authors: Andreas Aceranti, Simonetta Vernocchi, Marco Colorato, Massimo Briamo, Giovanni Abalsamo

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Most of the benefits of sport come from related physical activity, however, there are secondary psychological positive effects. There are also obvious disadvantages, high tensions related to failure, injuries, eating disorders and burnout. Depressive symptoms and illnesses related to anxiety or stress can be preventable or even simply alleviated through regular activity and exercise. It has been shown that the practice of a sport brings physical benefits, but can also have psychological and spiritual benefits. Reduced performance in male individuals has been linked to sexual activity before competitions in the past. The long-standing debate about the impact of sexual activity on sports performance has been controversial in the mainstream media in recent decades. This salacious topic has generated extensive discussion, although its high-quality data has been limited. Literature has, so far, mainly included subjective assessments from surveys. However, such surveys can be skewed as these assessments are based on individual beliefs, perceptions, and memory. There has been a long discussion over the years but even there objective data has been lacking. One reason behind coaches' bans on sexual activity before sporting events may be the belief that abstinence increases frustration, which in turn is shifted into aggressive behavior toward competitors. However, this assumption is not always valid. In fact, depriving an athlete of a normal activity can cause feelings of guilt and loss of concentration. Sexual activity during training can promote relaxation and positively influence performance. The author concludes that, although there is a need for scientific research in this area, it seems that sexual intercourse does not decrease performance unless it is accompanied by late night socialization, loss of sleep or drinking. Although the effects of sexual engagement on aerobic and strength athletic performance have not been definitively established, most research seems to rule out a direct impact. In order to analyze, as much as possible without bias, whether sexual activity significantly affects an athletic performance or not, we sampled 5 amateur athletes, between 22 and 25 years old and all male. The study was based on the timing of 4 running races of 5 champions. We asked participants to respect guidelines to avoid sexual activity (sex or masturbation) 12 hours before 2 of the 4 competitions, and to practice before the remaining 2 races.In doing so, we were able to compare and analyze the impact of activity and abstinence on performance results. We have come to the conclusion that sexual behavior on athletic performance needs to be better understood, more randomized trials and high-quality controls are strongly needed but available information suggests that sexual activity the day before a race has no negative effects on performance.

Keywords: sex, masturbation, male performance, soccer

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Authors: Antonio Lopez-Villegas, Daniel Catalan-Matamoros, Remedios Lopez-Liria

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Objectives: The purpose of this study was to analyze clinical data, health-related quality of life (HRQoL) and functional capacity of patients using a telemonitoring follow-up system (TM) compared to patients followed-up through standard outpatient visits (HM) 5 years after the implantation of a pacemaker. Methods: This is a controlled, non-randomised, nonblinded clinical trial, with data collection carried out at 5 years after the pacemakers implant. The study was developed at Hospital de Poniente (Almeria, Spain), between October 2012 and November 2013. The same clinical outcomes were analyzed in both follow-up groups. Health-Related Quality of Life and Functional Capacity was assessed through EuroQol-5D (EQ-5D) questionnaire and Duke Activity Status Index (DASI) respectively. Sociodemographic characteristics and clinical data were also analyzed. Results: 5 years after pacemaker implant, 55 of 82 initial patients finished the study. Users with pacemakers were assigned to either a conventional follow-up group at hospital (HM=34, 50 initials) or a telemonitoring system group (TM=21, 32 initials). No significant differences were found between both groups according to sociodemographic characteristics, clinical data, Health-Related Quality of Life and Functional Capacity according to medical record and EQ5D and DASI questionnaires. In addition, conventional follow-up visits to hospital were reduced in 44,84% (p < 0,001) in the telemonitoring group in relation to hospital monitoring group. Conclusion: Results obtained in this study suggest that the telemonitoring of users with pacemakers is an equivalent option to conventional follow-up at hospital, in terms of Health-Related Quality of Life and Functional Capacity. Furthermore, it allows for the early detection of cardiovascular and pacemakers-related problem events and significantly reduces the number of in-hospital visits. Trial registration: ClinicalTrials.gov NCT02234245. The PONIENTE study has been funded by the General Secretariat for Research, Development and Innovation, Regional Government of Andalusia (Spain), project reference number PI/0256/2017, under the research call 'Development and Innovation Projects in the Field of Biomedicine and Health Sciences', 2017.

Keywords: cardiovascular diseases, health-related quality of life, pacemakers follow-up, remote monitoring, telemedicine

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Authors: Damaris Estrella Castillo, Zacil ha Vilchis Zapata, Leydi Peraza Gómez

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Hearing loss is an etiologically heterogeneous condition, where almost 60% is genetic in origin, 20% is due to environmental factors, and 20% have unknown causes. However, it is now known that the gene, GJB2, which encodes the connexin 26 protein, accounts for a large percentage of non-syndromic genetic hearing loss, and variants in this gene have been identified to be a common cause of hereditary hearing loss in many populations. The literature reports that the etiology in deafness helps improve family functioning but low-income countries this is difficult. Therefore, it is difficult to contribute the right of families to know about the genetic risk in future pregnancies as well as determining the certainty of being a carrier or affected. In order to assess the impact of genetic counseling and the functionality, 100 families with at least one child with profound hearing loss, were evaluated by specialists in audiology, clinical genetics and psychology. Targeted mutation analysis for one of the two known large deletions of upstream of GJB2/GJB6 gene (35delG; and including GJB2 regulatory sequences and GJB6) were performed in patients with diagnosis of non-syndromic hearing loss. Genetic counseling was given to all parents and primary caregivers, and APGAR family test was applied before and after the counseling. We analyzed a total of 300 members (children, parents) to determine the presence of the GJB2 gene mutation. Twelve patients (carriers and affected) were positive for the mutation, from 5 different families. The subsequent family APGAR testing and genetic counseling, showed that 14% perceived their families as functional, 62 % and 24 % moderately functional dysfunctional. This shows the importance of genetic counseling in the perception of family function that can directly impact the quality of life of these families.

Keywords: family dynamics, deafness, APGAR, counseling

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Authors: Hrudaya Kamasani

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The cultural prevalence of vigilante justice is sustained through the social sanction for foregoing a judicial trial to determine guilt. Precisely due to its roots in social sanction, it has repercussions as more than just being symptomatic of cultural values that condone violence. In the long term, the practice of vigilante justice as a response to incidents of sexual violence, while veiled in civic discontent over the standards of women’s security in society, can adversely affect the discourse on sexual violence. To illustrate the impact that acts of vigilante justice can have in prematurely ending a budding discourse on sexual violence, the paper reviews three cases of heinous crimes committed against women in India that gained popular attention in the discursive spaces. The 2012 Nirbhaya rape and murder case in Delhi demonstrates how the criminal justice system can spur a social movement and can result in legislative changes and a discourse that challenged a wide range of socio-cultural issues of women’s security and treatment. The paper compares it with two incidents of sexual violence in India that ended with the suspects being killed in the name of vigilante justice that had wide social sanction. The two cases are the 2019 extrajudicial killing of Priyanka Reddy rape and murder case suspects in Hyderabad and the 2015 mob lynching of an accused in a rape case in Dimapur. The paper explains why the absence of judicial trials in sexual violence cases results in ending any likelihood of the instances inspiring civic engagement with the discourse on sexual violence.

Keywords: sexual violence, vigilante justice, extrajudicial killing, cultural values of violence, Nirbhaya rape case, mob violence

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Authors: Shuji Fujimoto, Fumiko Kojima, Mika Shigematsu

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Biorisk management (Biosafety/Biosecurity) is required for anyone working in a clinical laboratory (including medical/clinical research laboratories) where infectious agents and potentially hazardous biological materials are examined/stored. Proper education and training based on international standards of biorisk management should be provided not only as a part of laboratory safety program in work place but also as a part of introductory training at educational institutions for continuity and to elevate overall baseline of the biorisk management. We reported results of the pilot study of biorisk management education for graduate students majored in laboratory diagnostics previously. However, postgraduate education is still late in their profession and the participants’ interview also revealed importance and demands of earlier biorisk management education for undergraduates. The aim of this study is to identify the need for biosafety/biosecurity education and training program which is designed for undergraduate students who are entering the profession in clinical microbiology. We modified the previous program to include more basic topics and explanations (risk management, principles of safe clinical lab practices, personal protective equipment, disinfection, disposal of biological substances) and provided incorporating in the routine educational system for faculty of medical sciences in Kyushu University. The results of the pre and post examinations showed that the knowledge of the students on biorisk control had developed effectively as a proof of effectiveness of the program even in the undergraduate students. Our study indicates that administrating the basic biorisk management program in the earlier stage of learning will add positive impact to the understanding of biosafety to the health professional education.

Keywords: biorisk management, biosafety, biosecurity, clinical microbiology, education for undergraduates

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Authors: Julie Mariam Abraham, G. J. Melendez-Torres

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Background. Maternal mortality is disproportionately higher in low- and middle- income countries (LMICs) compared to other parts of the world. At the current pace of progress, the Sustainable Development Goals for maternal mortality rate will not be achieved by 2030. A variety of factors influence the increased risk of maternal complications in LMICs. These are exacerbated by socio-economic and political factors, including poverty, illiteracy, and gender inequality. This paper aims to use realist synthesis to identify the contexts, mechanisms, and outcomes (CMOs) of maternal health interventions conducted in LMICs to inform evidence-based practice for future maternal health interventions. Methods. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in LMICs published in the last five years. We used open and axial coding of CMOs to develop an explanatory framework for intervention effectiveness. Results. After eligibility screening and full-text analysis, 44 papers were included. The intervention strategies and measured outcomes varied within reviews. Healthcare system level contextual factors were the most frequently reported, and infrastructural capacity was the most reported context. The most prevalent mechanism was increased knowledge and awareness. Discussion. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences, and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilisation and involvement to enable tailored interventions with optimal contextual fit.

Keywords: maternal mortality, service delivery and organisation, realist synthesis, sustainable development goals, overview of reviews

Procedia PDF Downloads 74