Search results for: cardiovascular interventions

Authors: Franco Van De Velde, Debora Esposito, Maria E. Pirovani, Mary A. Lila

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The physiology of various inflammatory diseases is a complex process mediated by inflammatory and immune cells such as macrophages and monocytes. Chronic inflammation, as observed in many cardiovascular and autoimmune disorders, occurs when the low-grade inflammatory response fails to resolve with time. Because of the complexity of the chronic inflammatory disease, major efforts have focused on identifying novel anti-inflammatory agents and dietary regimes that prevent the pro-inflammatory process at the early stage of gene expression of key pro-inflammatory mediators and cytokines. The ability of the extracts of three blackberry cultivars (‘Jumbo’, ‘Black Satin’ and ‘Dirksen’), and one strawberry cultivar (‘Camarosa’) to inhibit four well-known genetic biomarkers of inflammation: inducible nitric oxide synthase (iNOS), cyclooxynase-2 (Cox-2), interleukin-1β (IL-1β) and interleukin-6 (IL-6) in an in vitro lipopolysaccharide-stimulated murine RAW 264.7 macrophage model were investigated. Moreover, the effect of latter extracts on the intracellular reactive oxygen species (ROS) and nitric oxide (NO) production was assessed. Assay was conducted with 50 µg/mL crude extract concentration, an amount that is easily achievable in the gastrointestinal tract after berries consumption. The mRNA expression levels of Cox-2 and IL-6 were reduced consistently (more than 30%) by extracts of ‘Jumbo’ and ‘Black Satin’ blackberries. Strawberry extracts showed high reduction in mRNA expression levels of IL-6 (more than 65%) and exhibited moderate reduction in mRNA expression of Cox-2 (more than 35%). The latter behavior mirrors the intracellular ROS production of the LPS stimulated RAW 264.7 macrophages after the treatment with blackberry ‘Black Satin’ and ‘Jumbo’, and strawberry ‘Camarosa’ extracts, suggesting that phytochemicals from these fruits may play a role in the health maintenance by reducing oxidative stress. On the other hand, effective inhibition in the gene expression of IL-1β and iNOS was not observed by any of blackberry and strawberry extracts. However, suppression in the NO production in the activated macrophages among 5–25% was observed by ‘Jumbo’ and ‘Black Satin’ blackberry extracts and ‘Camarosa’ strawberry extracts, suggesting a higher NO suppression property by phytochemicals of these fruits. All these results suggest the potential beneficial effects of studied berries as functional foods with antioxidant and anti-inflammatory roles. Moreover, the underlying role of phytochemicals from these fruits in the protection of inflammatory process will deserve to be further explored.

Keywords: cyclooxygenase-2, functional foods, interleukin-6, reactive oxygen species

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Authors: Renu Kumari

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State sovereignty refers to the ability and power of a state to be independent and not to have any interference of external actors in its internal affairs. This phenomenon has been accepted by International Law, which gives rights to the state to maintain its autonomy and territorial integrity without the interference of other actors. In of 1980’s and 1990’s the world has witnessed the worst case of human rights violence for instance, Rwanda genocide, the conflict in former Yugoslavia, Kosovo, Burundi, and Chad so and so forth. Though human rights violence is not a new phenomenon, it has been present all over the world in different time and space. But in 1990’s after the devastation of these conflicts and violence the world community came up with the notion of humanitarian intervention in which some states took the responsibility of protecting human rights violations and on the in order to protect they can intervene in the internal matters of a state specifically during civil war where state is unable to protect its people. Later on these so-called world community realized that intervention itself is a negative term that was criticized also therefore they came up with a different notion that sounded positive which known as responsibility to protect. In 2005 onwards, the notion of responsibility to protect accepted and recognized by the United Nations and states at a larger level. In the case of Syria on the name of responsibility to protect foreign interventions took place and due to the internal war Syrian people were already facing many problems, the government was not able to protect them. External invasion caused many devastating outcomes to the country. This paper is an attempt to analyze various dimensions of invasion of external affairs of a particular state and the status of sovereignty. Firstly, it lays out the notion of humanitarian intervention and then the responsibility to protect. Secondly, it looks in the case of Syria since 2011, the conflict of Syria. Thirdly it focuses on various efforts made by international organizations and other actors. Lastly, it looks why and how other actors intervene in the internal matter of Syria.

Keywords: state sovereignty, external actors, intervention, responsibility to protect

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Authors: Joseph Mary Ssembatya, Blessing Michael Taremwa

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Background: Multiple schwannomas are typically associated with neurofibromatosis type 1 (NF1), but rare cases occur independently of neurofibromatosis. Schwannomas are benign, slow-growing tumors, primarily affecting the cervical and lumbar spine. When large, they may extend over multiple vertebral levels, posing surgical challenges. Case Presentation: A 13-year-old Ugandan Munyankore female patient, presented with a 6-year history of progressive quadriparesis, particularly in the lower limbs. Clinical examination showed hypertonia and hyperreflexia, with no indicators of neurofibromatosis or prior trauma. MRI revealed two “kissing” schwannomas extending from C2 to T2 in the cervical spine. Decompressive surgery was performed through laminoplasty and partial lesion resection, and histology confirmed schwannoma. Two weeks postoperatively, the patient experienced cerebrospinal fluid (CSF) leakage, neck pain, and headache, which required re-operation and duraplasty. Following these interventions, the patient’s neurological status stabilized, with noted improvement in lower limb strength. Discussion: “Kissing” schwannomas are most frequently documented in the cerebellopontine angle, rarely in the spine, and even more rarely in children. While multiple schwannomas are often associated with NF2, this case had no family history or clinical signs of the disorder. Giant invasive spinal schwannomas (GISS) that span multiple vertebrae demand intricate surgical approaches due to their proximity to neurovascular structures. Conclusion: This is the first reported case of kissing cervical schwannomas in a young patient from a low- to middle-income country. Surgical decompression, though challenging, is critical for neurological recovery in such advanced cases.

Keywords: kissing schwannoma, cervical spine, low resource, young, uganda

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Authors: Giannis Arnaoutis, Dimitra Efthymiopoulou, Maria-Foivi Nikolopoulou, Yannis Manios

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AIM: Nitrate-containing supplements have been used extensively as ergogenic in many sports. However, extract fractions from plant-based nutritional sources high in nitrate and their effect on athletic performance, has not been systematically investigated. The purpose of the present study was to examine the possible effect of acute consumption of a “smart mixture” from beetroot and rocket on exercise capacity. MATERIAL & METHODS: 12 healthy, nonsmoking, recreationally active, males (age: 25±4 years, % fat: 15.5±5.7, Fat Free Mass: 65.8±5.6 kg, VO2 max: 45.46.1 mL . kg -1 . min -1) participated in a double-blind, placebo-controlled trial study, in a randomized and counterbalanced order. Eligibility criteria for participation in this study included normal physical examination, and absence of any metabolic, cardiovascular, or renal disease. All participants completed a time to exhaustion cycling test at 75% of their maximum power output, twice. The subjects consumed either capsules containing 360 mg of nitrate in total or placebo capsules, in the morning, under fasted state. After 3h of passive recovery the performance test followed. Blood samples were collected upon arrival of the participants and 3 hours after the consumption of the corresponding capsules. Time until exhaustion, pre- and post-test lactate concentrations, and rate of perceived exertion for the same time points were assessed. RESULTS: Paired-sample t-test analysis found a significant difference in time to exhaustion between the trial with the nitrate consumption versus placebo [16.1±3.0 Vs 13.5±2.6 min, p=0.04] respectively. No significant differences were observed for the concentrations of lactic acid as well as for the values in the Borg scale between the two trials (p>0.05). CONCLUSIONS: Based on the results of the present study, it appears that a nutritional supplement derived from vegetable extracts rich in nitrate, improves athletic performance in recreationally active young males. However, the precise mechanism is not clear and future studies are needed. Acknowledgment: This research has been co‐financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH – CREATE – INNOVATE (project code:T2EDK-00843).

Keywords: sports performance, ergogenic supplements, nitrate, extract fractions

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Authors: Arash Parehkar, S. Jamshid Mousavi, Shoubo Bayazidi, Vahid Karami, Laleh Shahidi, Arash Azaranfar, Ali Moridi, M. Shabakhti, Tayebeh Ariyan, Mitra Tofigh, Kaveh Masoumi, Alireza Motahari

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Water resource systems modelling have constantly been a challenge through history for human being. As the innovative methodological development is evolving alongside computer sciences on one hand, researches are likely to confront more complex and larger water resources systems due to new challenges regarding increased water demands, climate change and human interventions, socio-economic concerns, and environment protection and sustainability. In this research, an automatic calibration scheme has been applied on the Gilan’s large-scale water resource model using mathematical programming. The water resource model’s calibration is developed in order to attune unknown water return flows from demand sites in the complex Sefidroud irrigation network and other related areas. The calibration procedure is validated by comparing several gauged river outflows from the system in the past with model results. The calibration results are pleasantly reasonable presenting a rational insight of the system. Subsequently, the unknown optimized parameters were used in a basin-scale linear optimization model with the ability to evaluate the system’s performance against a reduced inflow scenario in future. Results showed an acceptable match between predicted and observed outflows from the system at selected hydrometric stations. Moreover, an efficient operating policy was determined for Sefidroud dam leading to a minimum water shortage in the reduced inflow scenario.

Keywords: auto-calibration, Gilan, large-scale water resources, simulation

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Authors: Raziel Mojica

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This study delves into the challenging working conditions faced by physical education (PE) teachers in public schools, particularly during the transition to remote teaching due to the impact of the COVID-19 pandemic. Using a qualitative, hermeneutic phenomenological approach, the research involves in-depth interviews with PE teachers to gain profound insight into their lived experiences and to answer the main question: What is the essence of the lived experience of physical education? The study explores the following sub-questions: (1) How do the participants describe their lived experience regarding their working conditions as physical education teachers in the new normal setup?; (2) What themes emerge from the testimonies of Physical Education Public School teachers from the Division of Calamba?; (3) Based on the consolidated findings and reflection, what material may be produced to inspire the physical education public school teachers? The study identifies emerging themes such as professional growth, personal life boundaries, accessible facilities and equipment, time management, and school leadership. Framed by Frederick Herzberg's Work-Motivation Theory, the study emphasizes motivator and hygienic factors that significantly impact job satisfaction and dissatisfaction. As a result of the study, the teachers vividly identified the challenges they face, including the lack of resources, training, and support from school leaders, which have made it difficult for them to adapt to the new teaching environment. These findings underscore the urgent need to revise teacher training curricula and for school leaders to provide strategic support to PE teachers in remote learning contexts. In conclusion, the study recommends targeted interventions to address these challenges and better equip PE teachers for the new normal in education.

Keywords: PE teachers, COVID-19 pandemic, hermeneutic phenomenological, physical education, new normal

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Authors: Ofole Ndidi

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Context: Empirical studies show that through dual primary attachment mothers and fathers contribute to children’s development and behaviours. While the contribution of mothers is well documented in past researches, fathers’ involvement in Nigeria has received much less attention. As such, exploring fathers’ involvement in sexual behaviours will provide insight for policy implementation and programming designed to delay sexual debut among sexually inexperienced young people in Nigeria. Objective of study: This study examined the extent to which father involvement (father’s parenting style, attitude, father-child communication, father’s marital status, and father’s socio-economic status) could predict delay in sexual debut of a representative sample of Nigeria adolescents in lower secondary. Materials and Methods: Multistage sampling technique was adopted to draw a cross section of 1023 adolescents with the age range of 10-23 years and mean years of 12±2.1 who reported sexually inexperience from six geographical zones in Nigeria. Multiple Regressions was used to analyze the data collected with four standardized self-report measures at 0.05 level of significance. Results: Findings of this study revealed that the independent variables (father’s parenting style, paternal attitudes, paternal–child communication, paternal marital status and paternal socio–economic status) contributed significantly to the delay of sexual debut. However, fathers’ attitude made the most potent contribution (β = 0.255, P < 0.05). Conclusions: The outcomes of this study have implications for programs that are designed to reduce high-risk behaviors among adolescents. It concluded that sexuality education and interventions should involve the fathers in a more integrated and collaborative fashion.

Keywords: father, sexual debut, adolescents, Nigeria

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Authors: A. H. Taghdisi, M. Mirmohammadi, S. Kamali

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Evening primrose (Oenothera biennis L.) is a biennial and herbaceous and one of the most important species of medicinal plants in the world. due to the production of unsaturated fatty acids such as linoleic acid, alpha-linolenic acid, etc. in its seeds and roots, and compounds such as kaempferol in its leaves, Evening primrose has important medicinal efficiency such as reducing premenstrual problems, acceleration of wound healing, inhibiting platelet aggregation, sedation of cardiovascular diseases, and treatment of viral infections. The sap of the plant is used to treat warts, and the plant itself is used as a charm against mental and spiritual diseases and poisonous animals. Its leaves have significant antibacterial activity against yellow staphylococci. It is also used in the treatment of poisoning, especially the toxication caused by the consumption of alcoholic beverages, in the treatment of arteriosclerosis and diseases caused by liver cell insufficiency. Low germination and production speed are the problems of evening primrose growth and propagation. In the present study, extracts were obtained from four components (flowers, stems, seeds, leaves) of the evening primrose plant using the Soxhlet apparatus. To measure the antibacterial properties against MDR bacteria, microbial methods, including dilution, cultivation on a plate containing nutrient agar culture medium, and disc diffusion in agar, were performed using Staphylococcus aureus and Escherichia coli bacteria on all four extracts. The maximum antibacterial activity related to the dilution method was obtained in all extracts. In the plate culture method, antibacterial activity was obtained for all extracts in the nutrient agar medium. The maximum diameter of the non-growth halo was obtained in the disc diffusion method in agar in the leaf extract. The statistical analysis of the microbial part was done by one-way ANOVA test (SPSS). By comparing the amount of omega-3 in extracts of Iranian and foreign oils available in the market and the extracts extracted from evening primrose plant samples with gas chromatography, it is shown that the stem extract had the most omega-3 (oleic acid) and compared to the extract of the mentioned oils, it had the highest amount of omega-3 overall. Also, the amount of omega-3 in the extract of Iranian oils was much higher than in the extract of foreign oils. It should be noted that the extract of foreign oils had a more complete composition of omega-3 than the extract of Iranian oils.

Keywords: antibacterial activity, MDR bacteria, evening primrose, omega-3

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Authors: Tanima Chatterjee, Maitree Bhattacharyya

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The global challenge of type 2 diabetes mellitus is a major health concern in this millennium, and researchers are continuously exploring new targets to develop a novel therapeutic strategy. Type 2 diabetes mellitus (T2DM) is often coupled with dyslipidemia increasing the risks for cardiovascular (CVD) complications. Enhanced oxidative and nitrosative stresses appear to be the major risk factors underlying insulin resistance, dyslipidemia, β-cell dysfunction, and T2DM pathogenesis. Autophagy emerges to be a promising defense mechanism against stress-mediated cell damage regulating tissue homeostasis, cellular quality control, and energy production, promoting cell survival. In this study, we have attempted to explore the pivotal role of autophagy in T2DM subjects with or without dyslipidemia in peripheral blood mononuclear cells and insulin-resistant HepG2 cells utilizing flow cytometric platform, confocal microscopy, and molecular biology techniques like western blotting, immunofluorescence, and real-time polymerase chain reaction. In the case of T2DM with dyslipidemia higher population of autophagy, positive cells were detected compared to patients with the only T2DM, which might have resulted due to higher stress. Autophagy was observed to be triggered both by oxidative and nitrosative stress revealing a novel finding of our research. LC3 puncta was observed in peripheral blood mononuclear cells and periphery of HepG2 cells in the case of the diabetic and diabetic-dyslipidemic conditions. Increased expression of ATG5, LC3B, and Beclin supports the autophagic pathway in both PBMC and insulin-resistant Hep G2 cells. Upon blocking autophagy by 3-methyl adenine (3MA), the apoptotic cell population increased significantly, as observed by caspase‐3 cleavage and reduced expression of Bcl2. Autophagy has also been evidenced to control oxidative stress-mediated up-regulation of inflammatory markers like IL-6 and TNF-α. To conclude, this study elucidates autophagy to play a protective role in the case of diabetes mellitus with dyslipidemia. In the present scenario, this study demands to have a significant impact on developing a new therapeutic strategy for diabetic dyslipidemic subjects by enhancing autophagic activity.

Keywords: autophagy, apoptosis, dyslipidemia, reactive oxygen species, reactive nitrogen species, Type 2 diabetes

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Authors: Eve-Andree Laramee

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The aesthetics and ethics of the Nuclear Anthropocene are explored through artists responses to the impact of radioactive materials on ecological systems, global issues, energy policies and ourselves. This presentation tracks and reveals the invisible traces of the nuclear weapons complex and the nuclear energy industry, in relation to environmental justice. Radioactive pollution transgresses international borders, boundaries between land and water, contaminating ecological systems. Radioactive waste is never disposed of; it is dispositioned, placed out of sight and out of mind. These materials leave behind an invisible toxic legacy lasting millions of years. As we are learning post-Fukushima, when climate change occurs and vulnerability spectrums shift, nuclear sites and the life forms surrounding them are at increased risk. By visualizing this contamination through art installations, videos, and social-sculpture interventions, information is shared with the public, raising awareness, and activating community participation in remediation and nonproliferation efforts. The emerging Ecological Art genre proposes paradigms sustainable with the life forms and resources of our planet. It is comprised of artists, scientists, philosophers and activists devoted to these. EcoArt is distinguished by a focus on systems and interrelationships within our environment: the ecological, geographic, political, biological and cultural. This presentation will cover artworks addressing the recent Fukushima meltdowns, weapons proliferation, climate change, radioactive waste disposal and environmental justice. Possibilities for art-and-science collaborations will be discussed as projects that sharpen our ethics and politics in our behaviors and social interactions. The presentation will consist of a PowerPoint talk (paper presentation) accompanied by images and video clips.

Keywords: art, ecology, environment, anthropocene, nuclear

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Authors: N. E. Gallagher, C. E. Neville, N. Lyner, J. Yarnell, C. C. Patterson, J. E. Gallacher, Y. Ben-Shlomo, A. Fehily, J. V. Woodside

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Hearing loss is highly prevalent in older people and can reduce quality of life substantially. Emerging research suggests that potentially modifiable risk factors, including risk factors previously related to cardiovascular disease risk, may be associated with a decreased or increased incidence of hearing loss. This has prompted investigation into the possibility that certain nutrients, foods or dietary patterns may also be associated with incidence of hearing loss. The aim of this study was to determine any associations between dietary patterns and hearing loss in men enrolled in the Caerphilly study. The Caerphilly prospective cohort study began in 1979-1983 with recruitment of 2512 men aged 45-59 years. Dietary data was collected using a self-administered, semi-quantitative, 56-item food frequency questionnaire (FFQ) at baseline (1979-1983), and 7-day weighed food intake (WI) in a 30% sub-sample, while pure-tone unaided audiometric threshold was assessed at 0.5, 1, 2 and 4 kHz, between 1984 and 1988. Principal components analysis (PCA) was carried out to determine a posteriori dietary patterns and multivariate linear and logistic regression models were used to examine associations with hearing level (pure tone average (PTA) of frequencies 0.5, 1, 2 and 4 kHz in decibels (dB)) for linear regression and with hearing loss (PTA>25dB) for logistic regression. Three dietary patterns were determined using PCA on the FFQ data- Traditional, Healthy, High sugar/Alcohol avoider. After adjustment for potential confounding factors, both linear and logistic regression analyses showed a significant and inverse association between the Healthy pattern and hearing loss (P<0.001) and linear regression analysis showed a significant association between the High sugar/Alcohol avoider pattern and hearing loss (P=0.04). Three similar dietary patterns were determined using PCA on the WI data- Traditional, Healthy, High sugar/Alcohol avoider. After adjustment for potential confounding factors, logistic regression analyses showed a significant and inverse association between the Healthy pattern and hearing loss (P=0.02) and a significant association between the Traditional pattern and hearing loss (P=0.04). A Healthy dietary pattern was found to be significantly inversely associated with hearing loss in middle-aged men in the Caerphilly study. Furthermore, a High sugar/Alcohol avoider pattern (FFQ) and a Traditional pattern (WI) were associated with poorer hearing levels. Consequently, the role of dietary factors in hearing loss remains to be fully established and warrants further investigation.

Keywords: ageing, diet, dietary patterns, hearing loss

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Authors: Jang-Hwan Jo

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Implementing sustainable island forest management policies requires categorizing islands into groups based on key indicators and establishing a consistent management system. Building on the results of previous studies, a typology of forested islands was established: Type 1 – connected islands with high natural vegetation cover; Type 2 – connected islands with moderate natural vegetation cover; Type 3 – connected islands with low natural vegetation cover; Type 4 – unconnected islands with high natural vegetation cover; Type 5 – unconnected islands with moderate natural vegetation cover; and Type 6 – unconnected islands with low natural vegetation cover. An AHP analysis was conducted with island forest experts to identify priority ecosystem services (ESs) for the sustainable management of each island type. In connected islands, provisioning services (natural resources, natural medicines, etc.) assumed greater importance than regulating (erosion control) and supporting services (genetic diversity). In unconnected islands, particularly those with a small proportion of natural vegetation, regulating services (erosion control) requires greater emphasis in management. Considering that Type 3 islands require urgent management as connectivity to the mainland makes natural vegetation-sparse island forest ecosystems vulnerable to anthropogenic activities, the land-use scoring method was carried out on Jin-do, a Type 3 forested island. Comparisons between AHP-derived expert demand for key island ESs and the spatial distribution of ES supply potential revealed mismatches between the supply and demand of erosion control, freshwater supply, and habitat provision. The framework developed in this study can help guide decisions and indicate where interventions should be focused to achieve sustainable island management.

Keywords: ecosystem service, sustainable management, forested islands, Analytic hierarchy process

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Authors: Célia Barreto Carvalho, Carolina da Motta, José Pinto-Gouveia, Ermelindo Bernardo Peixoto

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Auditory hallucinations among the most invalidating and distressing experiences reported by patients diagnosed with schizophrenia, leading to feelings of powerlessness and helplessness towards their illness. In more severe cases, these auditory hallucinations can take the form of commanding voices, which are often related to high suicidality rates in these patients. Several authors propose that the meanings attributed to the hallucinatory experience, rather than characteristics like form and content, can be determinant in patients’ reactions to hallucinatory activity, particularly in the case of voice-hearing experiences. In this study, 48 patients diagnosed with paranoid schizophrenia presenting auditory hallucinations were studied. Multiple regression analyses were computed to study the influence of several developmental aspects, such as family and social dynamics, bullying, depression, and socio-cognitive variables on the auditory hallucinations, on patients’ attributions and relationships with their voices, and on the resulting invalidation of hallucinatory experience. Overall, results showed how relationships with voices can mirror several aspects of interpersonal relationship with others, and how self-schemas, depression and actual social relationships help shaping the voice-hearing experience. Early experiences of victimization and submission help predict the attributions of omnipotence of the voices, and increased hostility from parents seems to increase the malevolence of the voices, suggesting that socio-cognitive factors can significantly contribute to the etiology and maintenance of auditory hallucinations. The understanding of the characteristics of auditory hallucinations and the relationships patients established with their voices can allow the development of more promising therapeutic interventions that can be more effective in decreasing invalidation caused by this devastating mental illness.

Keywords: auditory hallucination, beliefs, life events, schizophrenia

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Authors: Zahra Khazaeipour, Ehsan Ahmadipour, Vafa Rahimi-Movaghar, Fereshteh Ahmadipour

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Research Objectives: Chronic pain is one of the common problems associated with spinal cord injuries (SCI), which causes many complications. Therefore, this study intended to evaluate the relationship between pain and demographic, injury characteristics, socio-economic and social support in individuals with spinal cord Injury in Iran. Design: Descriptive cross-sectional study. Setting: Brain and Spinal Cord Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran, between 2012 and 2013. Participants: The participants were 140 individuals with SCI, 101 (72%) men and 39 (28%) women, with mean age of 29.4 ±7.9 years. Main Outcome Measure: The Persian version of the Brief Pain Inventory (BPI) was used to measure the pain, and the Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Results: About 50.7% complained about having pain, which 79.3% had bilateral pain. The most common locations of pain were lower limbs and back. The most quality of pain was described as aching (41.4%), and tingling (32.9%). Patients with a medium level of education had the least pain compared to high and low level of education. SCI individuals with good economic situation reported higher frequency of having pain. There was no significant relationship between pain and social support. There was positive correlation between pain and impairment of mood, normal work, relations with other people and lack of sleep (P < 0.001). Conclusion: These findings revealed the importance of socioeconomic factors such as economic situation and educational level in understanding chronic pain in people with SCI and provide further support for the bio-psychosocial model. Hence, multidisciplinary evaluations and treatment strategies are advocated, including biomedical, psychological, and psycho-social interventions.

Keywords: pain, social support, socio-economic indicators, spinal cord injury

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Authors: Nisha Harry, Keshia Sing

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Orientation: The Multifactor Leadership Questionnaire (MLF) and the sense of coherence-29 (SCS) is an effective tools to assess the prevalence and underlying structures of empirically based taxonomies related to leadership and wellbeing. Research purpose: The purpose of the study was to test the psychometric properties of the SCS and Multifactor Leadership Questionnaire (MLQ) to screen for psychological wellness indices within the banking industry in South Africa. Motivation for the study: The contribution of these two instruments for the purpose of determining psychological wellness in a banking work environment is unique. Research design, approach, or method: The sample consisted of (N = 150) financial staff employed in a South African banking organisation. The age of the sample was: 37% (30 -40 yrs), 31% (20-30 yrs), 26% (40- 50 yrs), and 6% (50+yrs), of which 52% were males, 48% were females. The white race group was the majority at 29%, African at 26%, Coloured at 23%, and Indian was 22%. Main findings: Results from the exploratory factor analysis revealed a two-factor structure as the most satisfactory. Confirmatory factor analyses revealed the two-factor model displayed better good of-fit indices. Practical implications: The factor structure of the Sense of Coherence-29 scale (SCS), and the Multifactor Leadership Questionnaire (MLQ), have a value-added focus to determine psychological wellness within banking staff. It is essential to take into account these constructs when developing employee wellness interventions. Contribution/value add: Understanding the psychometric properties of the SCS, the self-reported form, and the MLQ questionnaire contributes to screening psychological wellness indices such as coping within the banking industry in a developing country like South Africa. Leaders are an important part of the implementation process of organisational employee wellness practices.

Keywords: factorial structure, leadership, measurement invariance, psychological wellness, sense of coherence

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Authors: Shravani Itkelwar, Deepak Tewari, Bhaskar Natarajan

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The energy consumption data plays a vital role in energy efficiency policy design, implementation, and impact assessment. Any demand-side energy management intervention's success relies on the availability of accurate, comprehensive, granular, and up-to-date data on energy consumption. The Building sector, including residential and commercial, is one of the largest consumers of energy in India after the Industrial sector. With economic growth and increasing urbanization, the building sector is projected to grow at an unprecedented rate, resulting in a 5.6 times escalation in energy consumption till 2047 compared to 2017. Therefore, energy efficiency interventions will play a vital role in decoupling the floor area growth and associated energy demand, thereby increasing the need for robust data. In India, multiple institutions are involved in the collection and dissemination of data. This paper focuses on energy consumption data management in the building sector in India for both residential and commercial segments. It evaluates the robustness of data available through administrative and survey routes to estimate the key performance indicators and identify critical data gaps for making informed decisions. The paper explores several issues in the data, such as lack of comprehensiveness, non-availability of disaggregated data, the discrepancy in different data sources, inconsistent building categorization, and others. The identified data gaps are justified with appropriate examples. Moreover, the paper prioritizes required data in order of relevance to policymaking and groups it into "available," "easy to get," and "hard to get" categories. The paper concludes with recommendations to address the data gaps by leveraging digital initiatives, strengthening institutional capacity, institutionalizing exclusive building energy surveys, and standardization of building categorization, among others, to strengthen the management of building sector energy consumption data.

Keywords: energy data, energy policy, energy efficiency, buildings

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Authors: Fasil Wagnew, Kerri Viney, Kefyalew Addis Alene, Matthew Kelly, Darren Gray

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Background: Undernutrition is a risk factor for tuberculosis (TB), including poor treatment outcomes. However, evidence regarding the effect of undernutrition on TB treatment outcomes is not well understood. We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multi-drug resistance (MDR)-TB. Methods: We searched for publications in the Medline, Embase, Scopus, and Web of Science databases without restrictions on geography or year of publication. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Two reviewers independently assessed the study eligibility, extracted the necessary information, and assessed the risk of bias. Depending on the nature of the data, odds ratio (OR) and hazard ratio (HR) with 95% confidence intervals (CIs) were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger’s tests. Results: Of 2358 records screened, 59 studies comprising a total of 31,254 people with MDR-TB were included. Undernutrition was significantly associated with a lower sputum culture conversion rate (HR 0·7, 95% CI 0·6–0·9, I2=67·1%) and a higher rate of mortality (OR 2·9, 95%CI 2·1–3·8, I2=23·7%) and unfavourable treatment outcomes (OR 1·8, 95%CI 1·5–2·0, I2=72·7%). There was no statistically significant publication bias in the included studies. Three studies were low, forty-two studies were moderate, and fourteen studies were high quality. Interpretations: Undernutrition was significantly associated with unfavourable treatment outcomes, including mortality and lower sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardised second-line TB drugs.

Keywords: undernutrition, MDR-TB, sputum culture conversion, treatment outcomes, meta-analysis

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Authors: C. O’Brien, Chloe Reiss

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While South Africa has been the chosen host country for over 1,2 million asylum seekers/refugees it has at the same time, been struggling to address the needs of its own people who are still trapped in poverty with little prospects of employment. This limited exploratory, qualitative study was undertaken in Cape Town with a purposive sample of 21 key personnel from various NPOs providing a service to asylum seekers/refugees. Individual in-depth face to face interviews were carried out and the main findings were: Some of the officials at the Department of Home Affairs, health personnel, landlords, school principals, employers, bank officials and police officers were prejudicial in their practices towards asylum seekers/ refugees. The major constraints experienced by NPOs in this study were linked to a lack of funding and minimal government support, strained relationship with the Department of Home Affairs and difficulties in accessing refugees. And finally, the strategies adopted by these NPOs included networking with other service providers, engaging in advocacy, raising community awareness and liaising with government. Thus, more focused intervention strategies are needed to build social cohesion, address prejudices which fuels xenophobic attacks and raise awareness/educate various sectors about refugee rights. Given this burgeoning global problem, social work education and training should include curriculum content on migrant issues. Furthermore, larger studies using mixed methodology approaches would yield more nuanced data and provide for more strategic interventions.

Keywords: refugees and asylum seekers, constraints of service delivery, non-profit organisations, refugee challenges

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Authors: Tri Wisudawati, Radita Dwi Putera

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The role of human resources is the basic capital in determining the purpose of a business place. Without the role of human resources, activities in the company will not run smoothly. Every business place always has a risk of accidents. The magnitude of the risk that occurs depends on the type of industry, technology, and risk control efforts made. Work-related accidents are accidents that occur due to work or while carrying out work. Welding MSMEs have a fairly high risk to health, safety and the environment both from the side of workers who can cause accidents and from the side of the work environment, which has the potential to become a hazard and risk. Participatory ergonomic intervention can be a feasible and effective approach to reducing exposure to work-related risk factors in developing country industries. Complaints about occupational health and safety experienced by workers in the welding workshop industry should be able to be overcome by implementing an ergonomic intervention approach. The analysis process includes HIRARC analysis, participatory ergonomics analysis, and SEM-PLS analysis. Hierarch analysis is carried out by assessing the level of severity and likelihood, as well as risk control. At the participatory ergonomics analysis stage, it is obtained from the organizational culture and organizational stakeholders. At the SEM-PLS stage, an analysis is carried out to see whether there is a strong relationship between the research variables in order to produce occupational health and safety (K3) and worker productivity in the welding shop better and in accordance with welding safety standards. So that the output of this study is how participatory ergonomics interventions affect working conditions to improve occupational health and safety and the productivity of welding workers.

Keywords: ergonomic partisipatory, health and safety, welding workers, welding safety

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Authors: Clesse C., Lighezzolo-Alnot J., De Lavergne S.

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Considered as the most common surgical procedure worldwide, episiotomy can be defined as an incision around the vulva performed to enlarge it, in the aim of preventing the traumatic rupture of the perineum during childbirth. Rather mediatized, this practice raises many questions in the field of mental health, relayed by different users and health professionals. Today, is topicality is moderately hectic since many queries about the prophylactic exercise of episiotomy are subject to a relative consensus, particularly since WHO advocated in 1996 that only 10% of childbirths should involve an episiotomy. This indicator appeared after the publication of numerous results from randomized clinical trials. Unfortunately, these papers seem mostly centered about somatic impacts of episiotomy. From the side of psychological studies, they mostly integrate a major clinical methodological bias, especially considering that every primiparous woman is identical to the others face to the experience of parturition. In the aim to fill this lack of knowledge, we developed a longitudinal research starting in the 7th month of pregnancy and ending one year after delivery. We are studying in a comparative way different possible psychological consequences inherent to the use of episiotomy. To do this, we use a standardized methodology which combines semi-structured clinical interviews (IRMAG, IRMAN ...), free clinical interviews, a projective test (Rorschach) and five questionnaires (QIC, EPDS, CPQ WOMBLSQ4, SF36). Therefore, we can comprehend with shrewdness the question of psychic impacts of episiotomy in a qualitative and quantitative way by comparing it to other obstetric interventions. In this paper, we will present the first results obtained about a population of twenty-two primiparous women by focusing on body image, sexuality, quality of life, depressive affects, post-traumatic stress disorder and investment of the maternal role. Finally, we will consider the different implications and perspectives of this research which could improve the public health policies in the field of perinatal care.

Keywords: assessment, episiotomy, mental health, psychical impacts

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Authors: Paul Narh Doku

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The relationship between parental HIV/AIDS status or death and child mental health is well known, although the role of child maltreatment as a confounder or mediator in this relationship remains uncertain. This study examined the potential path mechanism through child maltreatment mediating the link between HIV/AIDS family dysfunction trajectories and psychosocial problems. A cross-sectional survey was conducted in the Lower Manya Municipal Assembly of Ghana. A questionnaire which consisted of the Strengths and Difficulties Questionnaire (SDQ), Social and Health Assessment (SAHA), Rosenberg Self-Esteem Scale (RSES), and the Conflict Tactics Scale (CTS) was completed by 291 adolescents. Controlling for relevant sociodemographic confounders, mediation analyses using linear regression were fitted to examine whether the association between family dysfunction and psychosocial problems is mediated by child maltreatment. The results indicate that, among adolescents, child maltreatment fully mediated the association between being orphaned by AIDS and self-esteem, delinquency and risky behaviours, and peer problems. Similarly, child maltreatment fully mediated the association between living with an HIV/AIDS-infected parent and self-esteem, delinquency and risky behaviours, depression/emotional problems, and peer problems. Partial mediation was found for hyperactivity. Child maltreatment mediates the association between the family dysfunction trajectories of parental HIV/AIDS or death and psychosocial problems among adolescents. This implies that efforts to address child maltreatment among families affected by HIV/AIDS may be helpful in the prevention of psychosocial problems among these children, thus enhancing their well-being. The findings, therefore, underscore the need for comprehensive psychosocial interventions that address both the unique negative exposures of HIV/AIDS and maltreatment for children affected by HIV.

Keywords: child maltreatment, child abuse, mental health, psychosocial problems, domestic violence, HIV/AIDS, adolescents

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Authors: Tracy Smith-Carrier

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Burgeoning research extols the benefits of innovative experiential learning activities to increase participants’ engagement, enhance their individual learning, and bridge the gap between theory and practice. This presentation discusses findings from a multiple case study on poverty simulation events conducted with two samples: undergraduate students and community participants. After exploring the nascent research on the benefits and limitations of poverty simulation activities, the study explores whether participating in a poverty simulation resulted in changes to participants’ beliefs about the causes and effects of poverty, as well as shifts in their attitudes and actions toward people experiencing poverty. For the purposes of triangulation, quantitative and qualitative data from a variety of sources were analyzed: participant feedback surveys, qualitative responses, and pre, post, and follow-up questionnaires. Findings show statistically significant results (p<.05) from both samples on cumulative scores of the modified Attitudes Toward Poverty Scale, indicating an improvement in participants’ attitudes toward poverty. Although generally positive about their experiences, participating in the simulation did not appear to have prompted participants to take specific actions to reduce poverty. Conclusions drawn from the research study suggest that poverty simulation planners should be wary of adopting scenarios that emphasize, or fail to adequately contextualize, behaviours or responses that might perpetuate individual explanations of poverty. Moreover, organizers must carefully consider how to ensure participants in their audience currently experiencing low-income do not become emotionally distressed, triggered or further marginalized in the process. While overall participants were positive about their experiences in the simulation, the events did not appear to have prompted them to action. Moving beyond the goal of increasing participants’ understandings of poverty, interventions that foster greater engagement in poverty issues over the long-term are necessary.

Keywords: empathy, experiential learning, poverty awareness, poverty simulation

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Authors: Adalberto Gregorio Back

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Historically, the Pinheiros River, which crosses the urban area of the largest South American metropolis, the city of São Paulo, has been the subject of several interventions involving different interests and multiple demands, including the implementation of road axes and industrial occupation in the city, following its floodplains. the dilution of sewers; generation of electricity, with the reversal of its waters to the Billings Dam; and urban drainage. These processes, together with the exclusionary and peripheral urban sprawl with high population density in the peripheries, result in difficulties for the collection and treatment of household sewage, which flow into the tributaries and the Pinheiros River itself. In the last 20 years, two separate projects have been undertaken to clean up its waters. The first one between 2001-2011 was the flotation system, aimed at cleaning the river in its own gutter with equipment installed near the Bilings Dam; and, more recently, from 2019 to 2022, the proposal to connect about 74 thousand dwellings to the sewage collection and treatment system, as well as to install treatment plants in the tributaries of Pinheiros where the connection to the system is impracticable, given the irregular occupations. The purpose of this paper is to make a comparative analysis on the dynamics of conflicts, interests and opportunities of coalitions between the actors involved in the two referred projects of pollution of the Pinheiros River. For this, we use the analysis of documents produced by the state government; as well as documents related to the legal disputes that occurred in the first attempt of decontamination involving the sanitation company; the Billings Dam management company interested in power generation; the city hall and regular and irregular dwellings not linked to the sanitation system.

Keywords: depollution of the Pinheiros River, interests groups, São Paulo, water energy nexus

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Authors: Jaeyoung Lee, Minji Je

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Objectives: The adolescents not attending school are named out-of-school adolescents. They are more vulnerable to health management and are likely to be exposed to a number of risk factors. This study was conducted to investigate the problem behavior of out-of-school adolescents and analyze the difference caused by gender. Methods: In this study, the problem behaviors of out-of-school adolescents, the vulnerable class, were defined in 8 types and based on this definition, the survey on run away from home, drop out, prostitution, violence, internet game addiction, theft, drug addiction, and smoking was conducted. The study was conducted in a total of 507 out-of-school adolescents, including 342 males, and 165 females. The type, frequency and start time of the 8 problem behaviors were identified. The collected data were analyzed with chi-square test and t-test using SPSS statistics 22. Results: Among the problem behaviors of the subjects, violence ( =17.41, p < .001), internet game addiction ( =16.14, p < .001), theft ( =22.48, p < .001), drug addiction ( =4.17, p=.041), and smoking ( =3.90, p=.048) were more significantly high in male out-of-school adolescents than female out-of-school adolescents. In addition, the frequency of the problem behavior was higher in male out-of-school adolescents with statistical significance than in female out-of-school adolescents (t=5.08, p= < .001). In terms of the start time of the problem behavior, only internet game addiction was higher in male out-of-school adolescents with the statistical significance than in female out-of-school adolescents ( =6.22, p=.032). No statistically significant difference was found in other problem behaviors (p > .05). Conclusions: In this study, it was found that gender difference in problem behaviors of out-of-school adolescents exists, and its frequency and difference of types were identified. When the social countermeasures were provided for those adolescents, a distinguished approach is required depending on the patterns of problem behavior and gender. When preparing policy alternatives and interventions for out-of-school adolescents, it is required to reflect the results of this study.

Keywords: addictive behavior, adolescent, gender, problem behavior

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Authors: Rui Miguel Costa, Jose Pestana, David Costa, Paula Mangia, Catarina Correia, Mafalda Pinto Coelho

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There is lack of studies examining the relation of different heart rate variability (HRV) parameters with the risk of erectile dysfunction (ED) in younger men. Thus, the present study aimed at examining, in a nonclinical sample of men aged 19-39 years old (mean age = 23.98 years, SD = 4.90), the relations of risk of ED with the standard deviation of the heart rate (SD of HR), high and low frequency power of HRV, and low-to-high frequency HRV ratio. Eighty-three heterosexual Portuguese men completed the 5-item version of the International Index of Erectile Function (IIEF-5) and HRV parameters were calculated from a 5-minute resting period. Risk of ED was determined by IIEF-5 scores of 21 or less. Fifteen men (18.1%) reported symptoms of ED (14 with mild and one with mild to moderate symptoms). Univariate analyses of variance revealed that risk of ED was related to lesser SD of HR and lesser low-frequency power, the two HRV parameters that express a coupling of higher vagal and sympathetic tone. Risk of ED was unrelated to high-frequency power and low-to-high frequency HRV ratio. Further, in a logistic regression, the risk of ED was independently predicted by older age and lower SD of HR, but not by low-frequency power, having a regular sexual partner, and cohabiting. The results provide preliminary evidence that, in younger men, a coupling of higher vagal and sympathetic tone, as indexed by the SD of HR, is important for erections. Greater resting SD of HR might reflect better vascular and interpersonal function via vagal tone coupled with greater motor mobilization to pursue sexual intercourse via sympathetic tone. Many interventions can elevate HRV; future research is warranted on how they can be tailored to treat ED in younger men.

Keywords: erectile dysfunction, heart rate variability, standard deviation of the heart rate, younger men

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Authors: Chun Yu, Tahlia M. Farrant, Max G. Marschall

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Most of Australia’s school classrooms are equipped with operable windows and occupant-controlled air-conditioners that do not provide fresh air. This can result in insufficient ventilation and high indoor CO₂ levels, which comes at a detriment to occupant productivity and health. This paper reports on the results of an in-situ study capturing indoor CO₂ levels in classrooms at a school in Victoria, Australia. The study consisted of 3 measurement periods: First, CO₂ levels pre-pandemic were measured, finding that the readings exceeded the recommended ASHRAE threshold of 1000 ppm more than 50% of the time, with levels often rising as high as 5000 ppm. Then, after the staff had been informed of the poor indoor air quality and the Victorian government had put COVIDSAFE measures in place, a second data set was captured; the impact was significant, with now only about 30% of readings above the ASHRAE threshold, and values rarely exceeding 2500 ppm. Finally, devices were installed that gave the occupants visual feedback when CO₂ levels were high, thus prompting them to open the windows; this further improved the air quality, with now less than 20% of readings above the threshold and values rarely exceeding 1500 ppm. The study suggests that, while relying on occupants to operate windows can lead to poor indoor air quality due to insufficient ventilation, it is possible to considerably influence occupant behavior through education and feedback devices. While these interventions alone did not mitigate the problem of inadequate ventilation entirely, they were sufficient to keep CO₂ levels within a generally healthy range. Considering the large energy savings that are possible by foregoing mechanical ventilation, it is evident that natural ventilation is a feasible operation method for school buildings in temperate climates, as long as classrooms are equipped with CO₂ feedback devices.

Keywords: COVID, CO₂, education, feedback devices, health, indoor air quality, natural ventilation, occupant behaviour

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Authors: Chethika Gunasiri Wadumestrige Dona, Geetha Mohan, Kensuke Fukushi

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Solid waste in urban areas, especially from organic materials like garden waste, food, and degradable sources, can create health and environmental problems if not managed properly. Urban agriculture has emerged as a potential solution in developing countries to mitigate these issues. It offers the possibility of low-carbon economies and knowledge and innovation dissemination. Domestic composting is a significant aspect of urban agriculture, and its success relies on the attitudes of those who practice it. This study examines the perspectives of 402 urban farmers in the Colombo District, Sri Lanka, regarding domestic compost production. It aims to identify the factors that influence these perspectives. The research found that urban farmers are willing to participate in domestic composting because they believe that it facilitates effective recycling of organic waste within their households. The study used an ordinal regression model to determine the factors that shape farmers' perspectives. Age, family size, and crop preferences are significant determinants of the adoption of domestic composting practices among urban farmers in the Colombo District. These findings highlight the importance of understanding and addressing farmers' attitudes in designing effective waste management strategies. In addition, the study also emphasizes the need for tailored interventions that align with farmers' beliefs and preferences to enhance the adoption and implementation of domestic composting practices in urban areas. The insights gained from this study contribute to the academic discourse and offer practical guidance for policymakers and urban planners seeking to promote sustainable waste management practices and support the adoption of urban agriculture in the broader context of urban development.

Keywords: urban agriculture, domestic composting, farmers` perspectives, sustainable urban development

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Authors: Sumera, Sanila Amber, Fatima Javed Mirza, Amjad Ali, Saadia Zahid

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Glioblastoma multiforme (GBM) is a widely spread and fatal primary brain tumor with an increased risk of relapse in spite of aggressive treatment. The current procedures for GBM diagnosis include invasive procedures i.e. resection or biopsy, to acquire tumor mass. Implementation of negligibly invasive tests as a potential diagnostic technique and biofluid-based monitoring of GBM stresses on discovering biomarkers in CSF and blood. Therefore, we performed a comprehensive in silico analysis to identify potential circulating biomarkers for GBM. Initially, six gene and protein databases were utilized to mine brain-specific proteins. The resulting proteins were filtered using a channel of five tools to predict the secretory proteins. Subsequently, the expression profile of the secreted proteins was verified in the brain and blood using two databases. Additional verification of the resulting proteins was done using Plasma Proteome Database (PPD) to confirm their presence in blood. The final set of proteins was searched in literature for their relationship with GBM, keeping a special emphasis on secretome proteome. 2145 proteins were firstly mined as brain-specific, out of which 69 proteins were identified as secretory in nature. Verification of expression profile in brain and blood eliminated 58 proteins from the 69 proteins, providing a final list of 11 proteins. Further verification of these 11 proteins further eliminated 2 proteins, giving a final set of nine secretory proteins i.e. OPCML, NPTX1, LGI1, CNTN2, LY6H, SLIT1, CREG2, GDF1 and SERPINI1. Out of these 9 proteins, 7 were found to be linked to GBM, whereas 2 proteins are not investigated in GBM so far. We propose that these secretory proteins can serve as potential circulating biomarker signatures of GBM and will facilitate the development of minimally invasive diagnostic methods and novel therapeutic interventions for GBM.

Keywords: glioblastoma multiforme, secretory proteins, brain secretome, biomarkers

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Authors: Raul G. Angeles, Rowena R. De Guzman

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The future workforce for health in a globalized context highlights better health human resource planning. Health sciences students are challenged to develop skills needed for global migration. Advancing health sciences education is crucial in preparing them to overcome border challenges. The purpose of this mixed-method, two-part study was to determine the extent by which the current instructional planning and implementation (IPI) framework is reframed with teaching approaches that foster students' 21st-century skills development and to examine participants’ over-all insights on learner-centered teaching and learning (LCTL) particularly in health sciences classrooms. Participants were groups of teachers and students drawn from a national sample through the Philippine higher education institutions (HEIs). To the participants, the use of technology, practices driven by students’ interests and enriching learning experiences through project-based learning are the approaches that must be incorporated with great extent in IPI to encourage student engagement, active learning and collaboration. Participants were asked to detail their insights of learner-centered teaching and learning and using thematic content analysis parallel insights between the groups of participants lead to three emerging themes: opportunities, challenges and prospects. More contemporary understanding of LTCL in today’s health sciences classrooms were demonstrated by the participants. Armed with true understanding, educational leaders can provide interventions appropriate to the students’ level of need, teachers’ preparation and school’s readiness in terms of resources. Health sciences classrooms are innovated to meet the needs of the current and future students.

Keywords: globalization, health workforce, role of education, student-centered teaching and learning, technology in education

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Authors: Soori Nnko, Zaina Mchome, John Dusabe, Angela Obasi

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In sub-Saharan Africa, adolescent girls living in urban and periurban settings are among the groups at increased risk of getting sexually transmitted infections. One of the challenges to improve uptake of sexual and reproductive health (SRH) services among adolescents is linked to little appreciation about their vulnerability and the knowledge on availability of the SRH services. Objective: This study assesses adolescents’ perceptions on risks for SRH problems and the availability of services to prevent against SRH problems. Methodology: The study was conducted in March 2011 in Mwanza region, Tanzania. Data collection techniques included 18 Participatory Group Discussions and 17 In-depth Interviews with adolescents and young mothers aged 15-20 years. Results: Adolescents indicated that risk places included their homes, bushes, commercial centers, roadsides as well as school settings. Risk for having unprotected sex varied depending on where you are, and the time of the day. For example, collection of firewood in the bushes or water from the wells exposed girls to men who forced or lured them to have sex. The girls reported to encounter motorcyclists who offered the ride in exchange for sex. Girls also knew myriads places to seek SRH services, including public and private clinics, drug shops and traditional healers. Despite being aware of risky environment, and places to seek the services, access to SRH services were limited due to the stigma and negative attitude of community regarding adolescents’ utilization of SRH services. Conclusion: Adolescents are exposed to various risky environments, yet due to social stigma they have difficult to access the available SRH services.

Keywords: adolescent girls, sexual and reproductive health, AIDS, risk, opportunities, interventions, sub Saharan africa

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