Search results for: nutrition intervention
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2991

Search results for: nutrition intervention

1101 Evaluation of Food Safety and Security Practices in Midday Meal Programmes in Rural Areas of Beed District

Authors: Nuzhat Sultana M. B.

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Children are high-risk population in terms of food born illnesses. Food safety and security are the most important aspect of the success of midday meal programmes. Improper holding temperatures, cross-contamination and poor personal hygiene of food handlers are the main causes for the prevalence of pathogenic microbes in the food servicing areas. Two hundred and fifty preschool children in the age of 3 to 6 years from urban and rural anganwadies (pre school center) of Beed district were selected. Nutritional status of preschool children were assessed by anthropometrical and clinical measurement. The study assessed the food safety and security with the help of personal hygiene and other safety measures maintained by the food personnel working for midday meal programme, supplying mid meals to children in govt. anganwadies (pre school center). The hygiene level, sanitary condition and microbial quality of food and water, pathological health examination of food handlers were assessed with the help of checklist. A questionnaire was designed to evaluate knowledge, attitude, and practices of food handlers. Results of the study show that the nutritional and health status of rural and urban preschool children was very poor. Many of the food handlers were not aware of general knowledge and hygiene practices to be followed during food preparation areas. An intervention programme of education and importing training at workplaces has shown a positive impact on the outcome of safety and security practices and safe, hygienic practices of food handlers at workplace.

Keywords: food, health, preschool children, safety, security

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1100 Regulation on Macrophage and Insulin Resistance after Aerobic Exercise in High-Fat Diet Mice

Authors: Qiaofeng Guo

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Aims: Obesity is often accompanied by insulin resistance (IR) and whole-body inflammation. Aerobic exercise is an effective treatment to improve insulin resistance and inflammation. However, the anti-inflammatory mechanisms of exercise on epididymal and subcutaneous adipose remain to be elucidated. Here, we compared the macrophage polarization between epididymal and subcutaneous adipose after aerobic exercise. Methods: Male C57BL/6 mice were fed a normal diet group or a high-fat diet group for 12 weeks and performed aerobic training on a treadmill at 55%~65% VO₂ max for eight weeks. Food intake, body weight, and fasting blood glucose levels were monitored weekly. The intraperitoneal glucose tolerance test was to evaluate the insulin resistance model. Fat mass, blood lipid profile, serum IL-1β, TNF-α levels, and CD31/CD206 rates were analysed after the intervention. Results: FBG (P<0.01), AUCIPGTT (P<0.01), and HOMA-IR (P<0.01) increased significantly for a high-fat diet and decreased significantly after the exercise. Eight weeks of aerobic exercise attenuated HFD-induced weight gain and glucose intolerance and improved insulin sensitivity. Serum IL-1β, TNF-α, CD11C/CD206 expression in subcutaneous adipose tissue were not changed before and after exercise, but not in epididymal adipose tissue (P<0.01). Conclusion: Insulin resistance is not accompanied by chronic inflammation and M1 polarization of subcutaneous adipose tissue macrophages in high-fat diet mice. Aerobic exercise effectively improved lipid metabolism and insulin sensitivity, which may be closely associated with reduced M1 polarization of epididymal adipose macrophages.

Keywords: aerobic exercise, insulin resistance, chronic inflammation, adipose, macrophage polarization

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1099 Examining How Youth Use Mobile Devices for Health Information: Preliminary Findings of a Survey Study with High School Students in Croatia

Authors: Sung Un Kim, Ivana Martinović, Snježana Stanarević Katavić

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As more and more youth use mobile devices, such as tablets and smartphones, for information seeking in their everyday lives, the purpose of this study is to understand the behaviors of youth seeking health information on mobile devices. The specific objective of this study is to examine 1) for what health issues youth use mobile devices, 2) for what reasons youth use mobile devices to obtain health information, 3) in what ways youth use mobile devices for health information, and 4) the features of health applications that youth find useful. The researchers devised a questionnaire for this study. Four hundred eight students from two high schools, located in Osijek, Croatia, participated by answering the questionnaire (281 girls and 127 boys). The collected data were analyzed using descriptive statistics and content analysis. The results show that among all participants, about 85 percent (n = 344) reported having used mobile devices for health information. The most frequent health topic for which they had been using mobile devices is physical activity (n = 273), followed by eating issues and nutrition (n = 224), mental health (n = 160), sexual health (n = 157), alcohol, drugs, and tobacco (n = 125), safety (n = 96) and particular diseases (n = 62). They use mobile devices to obtain health information due to the ease of use (n = 342), the ease of sharing health information (n = 281), portability (n = 215), timeliness (n = 162), and the ease of tracking/recording/monitoring health status (n = 147). Of those who have used mobile devices for health information, three-quarters (n = 261) use mobile devices to search health information, while 32.8% (n =113) use applications and 31.7% (n =109) browse information. Those who have used applications for health information (n = 113) consider the alert feature (n=107) as the most useful, followed by the tracking/recording/monitoring feature (n =92), the customized information feature (n = 86), the video feature (n = 58), and the sharing feature (n =39). It is notable that although health applications have been actively developed and studied, a majority of the participants search for or browse information on mobile devices, instead of using applications. The researchers will discuss reasons that some of them did not use mobile devices to obtain health information, students’ concerns about using health applications, and features that they wish to have in health applications.

Keywords: Croatia, health information, information seeking behaviors, mobile devices, youth

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1098 Influence of Rational Emotive Therapy on Substance Abuse Among Secondary School Students in Benue State

Authors: Justina I. Reamen

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The study examined the influence of rational emotive therapy on the treatment of substance abuse among Senior Secondary School Students in Makurdi metropolis Benue State Nigeria. This research adopted youth self report scale which was distributed to 1,690 SSS Students drawn from Government day Secondary School Makurdi and Government Model College Makurdi. Afterwards, 200 who were identified to indulge in substance abuse were selected for the study, 100 each from the two schools. 100 were taken as the control group and 100 as the experimental group, (50 of each group from each school). The Rational Emotive Behavior Therapy (REBT) intervention program was presented to the experimental group for seven (7) weeks. The students were taught how to apply REBT’s cognitive, Emotive and Behavioral techniques on their problems. After which post test was conducted to find out the impact of REBT on the treatment of adolescent students with substance abuse problem. GLM repeated measures of ANOVA were used to analyze the data from the study. The study reveals that REBT has positive impact on the treatment of adolescent students that abuse substances in the study area. Between pretest to post-test scores, a significant difference was observed (F=26.939; P=000) in substance abuse where a decrease of 1.12 (pre-10.91, post-9.79) scores was noticed irrespective of the groups. However, when the decrease in substance abuse were analyzed group wise, (experimental control) again significant F value (F=38.782; P=000) was obtained. From the mean scores it is evident that experimental group decreased it means by 2.56 (Pre-10.04 - Post-8.83) scores compared to control group, which changed its scores by only 0.32 scores (pre 11.04 - Post 11.36). Recommendations were made based on the findings of the research.

Keywords: abuse, influence, substance, therapy, treatment

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1097 Maternal Awareness of Sudden Infant Death Syndrome: A Jordanian Study

Authors: Nemeh Ahmad Al-Akour, Ibrahem Alfaouri

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Objective: To examine the level of maternal awareness of SIDS and its prevention amongst Jordanian mothers in the north of Jordan, as well as to determine their SIDS-related infant care practices. Design: A cross-sectional design. Setting: The study was conducted in maternal out-patients clinics of two teaching hospitals and three maternal and child health clinic in three major health care centers in Northern Jordan. Participants: A total of 356 mothers of infants attending the maternal and child health clinics were included in this study. Measurements and findings: A self-administered questionnaire was used for collecting data study. In this study, 64%of mothers didn’t hear about SIDS, while only 7% of mothers were able to identify factors risk-reducing recommendations. Avoidance of prone sleeping was the most frequently identified recommendation (5%). There were 67.7% of mothers who put their infant in a lateral position to sleep, 61% used soft mattress surface for their babies sleep and 25.8% who shared a bed with their babies. Employed mother, mothers of higher age, and mothers living within a nuclear family were the only factors associated with maternal awareness of SIDS. Friends were the highest a source of knowledge of SIDS for mothers (44.7%). Key conclusions: There was a low level of awareness of SIDS and its associated risk factor among the mothers in Jordan. The mothers' misconception about smoking and sleeping position for their infants requires further efforts. Implications for practice: To ensure raising awareness of infant care practice regarding SIDS, a national educational intervention on SIDS risk reduction strategies and recommendations is necessary for maintaining a low rate of SIDS in the population.

Keywords: bed sharing, infant care, Jordan, sleep position, sudden infant death

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1096 Effectiveness of Group Therapy Based on Acceptance and Commitment on Self-Criticism and Coping Mechanism in People with Addiction

Authors: Mohamad Reza Khodabakhsh

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Drug use and addiction are major biological, psychological, and social problems. In drug abuse treatment, it is important to pay attention to personality problems and coping methods of patients. Today, the third-wave treatments in psychotherapy emphasize people's awareness and acceptance of feelings and emotions, cognitions, and behaviors instead of challenging cognitions. For this reason, this research was conducted with the aim of investigating the effectiveness of group therapy based on acceptance and commitment to self-criticism and coping strategies of people with drug use disorder. This research was a quasi-experimental type of research (pre-test-post-test design with an unequal control group), and the statistical population of this research included all men with drug use disorder in Mashhad, 174 of whom among the 75 people eligible for this research, 30 of them were selected by available sampling method and randomly assigned to two experimental and control groups. In this research, Gilbert's self-criticism scale was used to measure self-criticism, and Andler and Barker's coping strategies questionnaire was used to measure coping strategies. Therapeutic intervention (treatment based on acceptance and commitment) was performed on the experimental group for eight sessions of 90 minutes, and then post-tests were taken from both groups, and multivariate analysis of covariance (MANCOVA) was used to analyze the data. The results showed that treatment based on acceptance and commitment significantly reduced self-criticism and improved coping strategies used by patients with drug use disorder (p>0.01). Therefore, treatment based on acceptance and commitment has been effective in reducing self-criticism and improving the coping strategies of patients with drug use disorder due to teaching clients to accept thoughts and conditions.

Keywords: treatment based on acceptance and commitment, self-criticism, coping strategies, addiction

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1095 Leading with Skill Development: A Collaborative and Community Based Approach to Ending Open Defecation in Rural India via Computerized Technical Vocational Education and Training

Authors: Srividya Sheshadri, Christopher Coley, Roa. R. Bhavani

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India currently accounts for 60 percent of the open defecation that is practiced globally. While research in the domain of sanitation development makes it apparent that girls and women living in rural India are disproportionately affected, interventions to address this dilemma are lacking. An important but relatively unexplored connection with poor sanitation is that women living in rural India are not only the largest marginalized group without access to adequate sanitation facilities, they also represent a majority of India’s unskilled workers. By training women to build their own toilets, through an approach that has demonstrated success in empowering marginalized communities through technical and vocational education and training (TVET), a collaborative dynamic emerges that can engage entire communities in the movement towards total sanitation. Designed and implemented by Amrita University, this technology-enhanced, community-based approach to skill development, known as Amrita computerized Vocational Education and Training (or Amrita cVET), has begun to show promise in addressing the struggle to end open defecation, and raise sanitation awareness, as well as strengthen personal and community development among women living in rural India. While Amrita cVET project, known as Women Empowerment: Sanitation, is currently in implementation in seven states throughout India, this paper will discuss early stages of the intervention in rural villages within the Indian states of: Karnataka and Goa, where previous sanitation efforts have failed to take hold.

Keywords: community based development, empowerment studies, sanitation in India, computerized vocational training

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1094 Functional Feeding Groups and Trophic Levels of Benthic Macroinvertebrates Assemblages in Albertine Rift Rivers and Streams in South Western Uganda

Authors: Peace Liz Sasha Musonge

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Behavioral aspects of species nutrition such as feeding methods and food type are archetypal biological traits signifying how species have adapted to their environment. This concept of functional feeding groups (FFG) analysis is currently used to ascertain the trophic levels of the aquatic food web in a specific microhabitat. However, in Eastern Africa, information about the FFG classification of benthic macroinvertebrates in highland rivers and streams is almost absent, and existing studies have fragmented datasets. For this reason, we carried out a robust study to determine the feed type, trophic level and FFGs, of 56 macroinvertebrate taxa (identified to family level) from Albertine rift valley streams. Our findings showed that all five major functional feeding groups were represented; Gatherer Collectors (GC); Predators (PR); shredders (SH); Scrapers (SC); and Filterer collectors. The most dominant functional feeding group was the Gatherer Collectors (GC) that accounted for 53.5% of the total population. The most abundant (GC) families were Baetidae (7813 individuals), Chironomidae NTP (5628) and Caenidae (1848). Majority of the macroinvertebrate population feed on Fine particulate organic matter (FPOM) from the stream bottom. In terms of taxa richness the Predators (PR) had the highest value of 24 taxa and the Filterer Collectors group had the least number of taxa (3). The families that had the highest number of predators (PR) were Corixidae (1024 individuals), Coenagrionidae (445) and Libellulidae (283). However, Predators accounted for only 7.4% of the population. The findings highlighted the functional feeding groups and habitat type of macroinvertebrate communities along an altitudinal gradient.

Keywords: trophic levels, functional feeding groups, macroinvertebrates, Albertine rift

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1093 The Influence of Caregivers’ Preparedness and Role Burden on Quality of Life among Stroke Patients

Authors: Yeaji Seok, Myung Kyung Lee

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Background: Even if patients survive after a stroke, stroke patients may experience disability in mobility, sensation, cognition, and speech and language. Stroke patients require rehabilitation for functional recovery and daily life for a considerable time. During rehabilitation, the role of caregivers is important. However, the stroke patients’ quality of life may deteriorate due to family caregivers’ non-preparedness and increased role burden. Purpose: To investigate the prediction of caregivers' preparedness and role burden on stroke patients’ quality of life. Methods: The target population was stroke patients who were hospitalized for rehabilitation and their family care providers. A total of 153 patient-family caregiver dyads were recruited from June to August 2021. Data were collected from self-reported questionnaires and analyzed using descriptive statistics, t-tests, chi-squared test, one-way analysis of variance, Pearson’s correlation coefficients, and multiple regression with SPSS statistics 28 programs. Results: Family caregivers’ preparedness affected stroke patients’ mobility (β = .20, p < 0.05) and character (β = -.084, p < 0.05) and production activities (β = -.197, p < 0.05) in quality of life. The role burden of family caregivers affected language skills (β = .310, p<0.05), visual functions (β=-.357, p < 0.05), thinking skills (β = 0.443, p = 0.05), mood conditions (β = 0.565, p < 0.001), family roles (β = -0.361, p < 0.001), and social roles (β = -0.304, p < 0.001), while the caregivers’ burden of performing self-protection negatively affected patients’ social roles (β = .180, p=.048). In addition, caregivers’ role burden of personal life sacrifice affected patients’ mobility (β = .311, p < 0.05), self-care (β =.232, p < 0.05) and energy (β = .239, p < 0.05). Conclusion: This study indicated that family caregivers' preparedness and role burden affected stroke patients’ quality of life. The results of this study suggested that intervention to improve family caregivers’ preparedness and to reduce role burden should be required for quality of life in stroke patients.

Keywords: quality of life, preparedness, role burden, caregivers, stroke

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1092 Food Security Model and the Role of Community Empowerment: The Case of a Marginalized Village in Mexico, Tatoxcac, Puebla

Authors: Marco Antonio Lara De la Calleja, María Catalina Ovando Chico, Eduardo Lopez Ruiz

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Community empowerment has been proved to be a key element in the solution of the food security problem. As a result of a conceptual analysis, it was found that agricultural production, economic development and governance, are the traditional basis of food security models. Although the literature points to social inclusion as an important factor for food security, no model has considered it as the basis of it. The aim of this research is to identify different dimensions that make an integral model for food security, with emphasis on community empowerment. A diagnosis was made in the study community (Tatoxcac, Zacapoaxtla, Puebla), to know the aspects that impact the level of food insecurity. With a statistical sample integrated by 200 families, the Latin American and Caribbean Food Security Scale (ELCSA) was applied, finding that: in households composed by adults and children, have moderated food insecurity, (ELCSA scale has three levels, low, moderated and high); that result is produced mainly by the economic income capacity and the diversity of the diet on its food. With that being said, a model was developed to promote food security through five dimensions: 1. Regional context of the community; 2. Structure and system of local food; 3. Health and nutrition; 4. Information and technology access; and 5. Self-awareness and empowerment. The specific actions on each axis of the model, allowed a systemic approach needed to attend food security in the community, through the empowerment of society. It is concluded that the self-awareness of local communities is an area of extreme importance, which must be taken into account for participatory schemes to improve food security. In the long term, the model requires the integrated participation of different actors, such as government, companies and universities, to solve something such vital as food security.

Keywords: community empowerment, food security, model, systemic approach

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1091 A Case of Survival with Self-Draining Haemopericardium Secondary to Stabbing

Authors: Balakrishna Valluru, Ruth Suckling

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A 16 year old male was found collapsed on the road following stab injuries to the chest and abdomen and was transported to the emergency department by ambulance. On arrival in the emergency department the patient was breathless and appeared pale. He was maintaining his airway with spontaneous breathing and had a heart rate of 122 beats per minute with a blood pressure of 83/63 mmHg. He was resuscitated initially with three units of packed red cells. Clinical examination identified three incisional wounds each measuring 2 cm. These were in the left para-sternal region, right infra-scapular region and left upper quadrant of the abdomen. The chest wound over the left parasternal area at the level of 4tth intercostal space was bleeding intermittently on leaning forwards and was relieving his breathlessness intermittently. CT imaging was performed to characterize his injuries and determine his management. CT scan of chest and abdomen showed moderate size haemopericardium with left sided haemopneumothorax. The patient underwent urgent surgical repair of the left ventricle and left anterior descending artery. He recovered without complications and was discharged from the hospital. This case highlights the fact that the potential to develop a life threatening cardiac tamponade was mitigated by the left parasternal stab wound. This injury fortuitously provided a pericardial window through which the bleeding from the injured left ventricle and left anterior descending artery could drain into the left hemithorax providing an opportunity for timely surgical intervention to repair the cardiac injuries.

Keywords: stab, incisional, haemo-pericardium, haemo-pneumothorax

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1090 Fire and Explosion Consequence Modeling Using Fire Dynamic Simulator: A Case Study

Authors: Iftekhar Hassan, Sayedil Morsalin, Easir A Khan

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Accidents involving fire occur frequently in recent times and their causes showing a great deal of variety which require intervention methods and risk assessment strategies are unique in each case. On September 4, 2020, a fire and explosion occurred in a confined space caused by a methane gas leak from an underground pipeline in Baitus Salat Jame mosque during Night (Esha) prayer in Narayanganj District, Bangladesh that killed 34 people. In this research, this incident is simulated using Fire Dynamics Simulator (FDS) software to analyze and understand the nature of the accident and associated consequences. FDS is an advanced computational fluid dynamics (CFD) system of fire-driven fluid flow which solves numerically a large eddy simulation form of the Navier–Stokes’s equations for simulation of the fire and smoke spread and prediction of thermal radiation, toxic substances concentrations and other relevant parameters of fire. This study focuses on understanding the nature of the fire and consequence evaluation due to thermal radiation caused by vapor cloud explosion. An evacuation modeling was constructed to visualize the effect of evacuation time and fractional effective dose (FED) for different types of agents. The results were presented by 3D animation, sliced pictures and graphical representation to understand fire hazards caused by thermal radiation or smoke due to vapor cloud explosion. This study will help to design and develop appropriate respond strategy for preventing similar accidents.

Keywords: consequence modeling, fire and explosion, fire dynamics simulation (FDS), thermal radiation

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1089 Application of Metric Dimension of Graph in Unraveling the Complexity of Hyperacusis

Authors: Hassan Ibrahim

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The prevalence of hyperacusis, an auditory condition characterized by heightened sensitivity to sounds, continues to rise, posing challenges for effective diagnosis and intervention. It is believed that this work deepens will deepens the understanding of hyperacusis etiology by employing graph theory as a novel analytical framework. We constructed a comprehensive graph wherein nodes represent various factors associated with hyperacusis, including aging, head or neck trauma, infection/virus, depression, migraines, ear infection, anxiety, and other potential contributors. Relationships between factors are modeled as edges, allowing us to visualize and quantify the interactions within the etiological landscape of hyperacusis. it employ the concept of the metric dimension of a connected graph to identify key nodes (landmarks) that serve as critical influencers in the interconnected web of hyperacusis causes. This approach offers a unique perspective on the relative importance and centrality of different factors, shedding light on the complex interplay between physiological, psychological, and environmental determinants. Visualization techniques were also employed to enhance the interpretation and facilitate the identification of the central nodes. This research contributes to the growing body of knowledge surrounding hyperacusis by offering a network-centric perspective on its multifaceted causes. The outcomes hold the potential to inform clinical practices, guiding healthcare professionals in prioritizing interventions and personalized treatment plans based on the identified landmarks within the etiological network. Through the integration of graph theory into hyperacusis research, the complexity of this auditory condition was unraveled and pave the way for more effective approaches to its management.

Keywords: auditory condition, connected graph, hyperacusis, metric dimension

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1088 DUSP16 Inhibition Rescues Neurogenic and Cognitive Deficits in Alzheimer's Disease Mice Models

Authors: Huimin Zhao, Xiaoquan Liu, Haochen Liu

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The major challenge facing Alzheimer's Disease (AD) drug development is how to effectively improve cognitive function in clinical practice. Growing evidence indicates that stimulating hippocampal neurogenesis is a strategy for restoring cognition in animal models of AD. The mitogen-activated protein kinase (MAPK) pathway is a crucial factor in neurogenesis, which is negatively regulated by Dual-specificity phosphatase 16 (DUSP16). Transcriptome analysis of post-mortem brain tissue revealed up-regulation of DUSP16 expression in AD patients. Additionally, DUSP16 was involved in regulating the proliferation and neural differentiation of neural progenitor cells (NPCs). Nevertheless, whether the effect of DUSP16 on ameliorating cognitive disorders by influencing NPCs differentiation in AD mice remains unclear. Our study demonstrates an association between DUSP16 SNPs and clinical progression in individuals with mild cognitive impairment (MCI). Besides, we found that increased DUSP16 expression in both 3×Tg and SAMP8 models of AD led to NPC differentiation impairments. By silencing DUSP16, cognitive benefits, the induction of AHN and synaptic plasticity, were observed in AD mice. Furthermore, we found that DUSP16 is involved in the process of NPC differentiation by regulating c-Jun N-terminal kinase (JNK) phosphorylation. Moreover, the increased DUSP16 may be regulated by the ETS transcription factor (ELK1), which binds to the promoter region of DUSP16. Loss of ELK1 resulted in decreased DUSP16 mRNA and protein levels. Our data uncover a potential regulatory role for DUSP16 in adult hippocampal neurogenesis and provide a possibility to find the target of AD intervention.

Keywords: alzheimer's disease, cognitive function, DUSP16, hippocampal neurogenesis

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1087 The Impact of Continuous Exercise on Depression Levels Among Young Female Athletes in Hamadan Province, Iran

Authors: Mahboubeh Varmaziar

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Depression is a significant public health concern affecting people of all ages and genders. Physical activity has been shown to have a positive effect on mental health, particularly in alleviating symptoms of depression. This study aims to explore the impact of continuous exercise on depression levels among young female athletes in Hamadan Province, Iran. In this randomized controlled trial, 72 women aged 20 to 35 years attending sports centers in Hamadan Province were selected through convenient sampling and randomly assigned to either the control or experimental group. The experimental group participated in a continuous exercise program consisting of 20 sessions over six weeks, with each session lasting 30 minutes. In contrast, the control group maintained their usual daily activities at the sports center. Both groups completed demographic and Beck Depression Inventory questionnaires. Data were analyzed using descriptive and inferential statistics, including two-way ANOVA. The results of the two-way ANOVA, after controlling for the pre-test effect, revealed a significant difference in the mean depression scores between the control and experimental groups (p < 0.001). This suggests that the continuous exercise program significantly reduced depression levels in the young female athletes. The findings suggest that continuous exercise is an effective non-pharmacological intervention for reducing depression in young female athletes. Incorporating regular physical activity into treatment plans may serve as a complementary therapy alongside conventional treatments, offering a low-risk and beneficial approach to managing depression.

Keywords: depression, exercise, female athletes, yong women

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1086 Self-Management among the Ethnic Groups with Type 2 Diabetes Mellitus in Thailand

Authors: Siwarak Kitchanapaibul, Warren Gillibrand, Rob Burton

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The prevalence of diabetes mellitus has been rising all over the world. Self-management is required for diabetes mellitus patients. The objective of this study is to explore the self-management among the ethnic groups with type 2 diabetes mellitus in Thailand, an upper middle-income country which is located in South East Asia. The ethnic groups in Thailand are a minority group which has limited education and a different culture, language, costume and lifestyle from Thai people. The qualitative exploratory study was used in this study. In-depth interviews with semi-structured open questions were conducted by 20 participants from purposive sampling. These participants were the ethnic groups who have type 2 diabetes mellitus, received the services from a region hospital, understood Thai and were willing to participate. Content analysis was adopted for the study. The results showed that all of the participants controlled their diet before the appointment day and never miss their appointment. Only 3 participants did their exercise while 2 participants stated that they occasionally forgot to take medicine. 10 participants use the herbs for reducing the sugar level. 12 participants drank a lot of water after a lapse in the diet because they believed that water could dilute the sugar. The findings identified 5 themes; ‘controlling diet before appointment day’; ‘drinking water after a lapse in diet’; ‘medication being a vital importance’; ‘exercise is unimportant’; and ‘taking herbs for sugar reduction’. The results of this study are important to the health professionals to understand the self-management of Ethnic groups and use the data to create the appropriate intervention for promoting health among the ethnic groups with type 2 diabetes mellitus in Thailand. The findings will lead to the revision of health policy and the procedure for promoting health in this special ethnic groups.

Keywords: self-management, diabetes, ethnic groups, Thailand

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1085 Microbubbles Enhanced Synthetic Phorbol Ester Degradation by Ozonolysis

Authors: D. Kuvshinov, A. Siswanto, W. Zimmerman

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A phorbol-12-myristate-13-acetate (TPA) is a synthetic analogue of phorbol ester (PE), a natural toxic compound of Euphorbiaceae plant. The oil extracted from plants of this family is useful source for primarily biofuel. However this oil can also be used as a food stock due to its significant nutrition content. The limitations for utilizing the oil as a food stock are mainly due to a toxicity of PE. Nowadays a majority of PE detoxification processes are expensive as include multi steps alcohol extraction sequence. Ozone is considered as a strong oxidative agent. It reaction with PE it attacks the carbon double bond of PE. This modification of PE molecular structure results into nontoxic ester with high lipid content. This report presents data on development of simple and cheap PE detoxification process with water application as a buffer and ozone as reactive component. The core of this new technique is a simultaneous application of new microscale plasma unit for ozone production and patented gas oscillation technology. In combination with a reactor design the technology permits ozone injection to the water-TPA mixture in form of microbubbles. The efficacy of a heterogeneous process depends on diffusion coefficient which can be controlled by contact time and interface area. The low velocity of rising microbubbles and high surface to volume ratio allow fast mass transfer to be achieved during the process. Direct injection of ozone is the most efficient process for a highly reactive and short lived chemical. Data on the plasma unit behavior are presented and influence of the gas oscillation technology to the microbubbles production mechanism has been discussed. Data on overall process efficacy for TPA degradation is shown.

Keywords: microbubble, ozonolysis, synthetic phorbol ester, chemical engineering

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1084 Political Deprivations, Political Risk and the Extent of Skilled Labor Migration from Pakistan: Finding of a Time-Series Analysis

Authors: Syed Toqueer Akhter, Hussain Hamid

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Over the last few decades an upward trend has been observed in the case of labor migration from Pakistan. The emigrants are not just economically motivated and in search of a safe living environment towards more developed countries in Europe, North America and Middle East. The opportunity cost of migration comes in the form of brain drain that is the loss of qualified and skilled human capital. Throughout the history of Pakistan, situations of political instability have emerged ranging from violation of political rights, political disappearances to political assassinations. Providing security to the citizens is a major issue faced in Pakistan due to increase in crime and terrorist activities. The aim of the study is to test the impact of political instability, appearing in the form of political terror, violation of political rights and civil liberty on skilled migration of labor. Three proxies are used to measure the political instability; political terror scale (based on a scale of 1-5, the political terror and violence that a country encounters in a particular year), political rights (a rating of 1-7, that describes political rights as the ability for the people to participate without restraint in political process) and civil liberty (a rating of 1-7, civil liberty is defined as the freedom of expression and rights without government intervention). Using time series data from 1980-2011, the distributed lag models were used for estimation because migration is not a onetime process, previous events and migration can lead to more migration. Our research clearly shows that political instability appearing in the form of political terror, political rights and civil liberty all appeared significant in explaining the extent of skilled migration of Pakistan.

Keywords: skilled labor migration, political terror, political rights, civil liberty, distributed lag model

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1083 Suicide Prevention among Young People: Findings from the Evaluation of Youth Aware of Mental Health in Australian Secondary Schools

Authors: Lauren McGillivray, Michelle Torok, Alison Calear

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Suicide is the leading cause of death for Australians aged 15-24 years, with rates increasing over the past decade. As young people can be particularly vulnerable to mental health problems and suicidal behavior, they are an essential and obvious target for suicide prevention efforts. This study investigates the effectiveness of the universal mental health promotion and suicide prevention program, Youth Aware of Mental Health (YAM), to reduce suicidal ideation and attempts and increase help-seeking in young people. This trial took place in Australian schools across four regions in New South Wales that form part of LifeSpan, a larger multilevel suicide prevention research trial. The YAM program was delivered to Year 9 students in up to 78 schools over two years (from January 2017 to December 2019). All schools were invited to participate in YAM's evaluation, which included completing a student questionnaire at three time-points: baseline, 3-month post-intervention, and 6-month follow-up. The primary outcome is suicidal ideation severity. Secondary outcomes are new reports of suicide attempts, stigma towards suicide, knowledge about suicide, help-seeking intentions and behaviors, and depressive symptoms. Results from pre-post and follow-up data will be presented. These research findings are promising and will contribute to the evidence-based for YAM and suicide prevention programs in Australian schools. These findings are also expected to promote YAM's value and sustainability to be more widely delivered in Australian secondary schools.

Keywords: adolescent mental health, suicidal ideation, suicide prevention, universal program

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1082 Pragmatism in Adaptive Reuse of Obsolete Industrial Land in China

Authors: Yong Li

Abstract:

Major cities in China has experienced a shift from production based on manufacturing industry to tertiary industry. How to make a better use of existing obsolete industrial land within urban cores has become a difficult problem for many policymakers. City governments regard old manufacturing industrial land as an important source of land to facilitate the development of the cities. Despite the announcement of policies in promoting that, a large portion of industrial land is still not properly redeveloped and most of them became obsolete. The study uses the project of Xinyi International Club as a case to examine the process of adaptive reuse of obsolete industrial space in Guangzhou, China. It attempts to elucidate the underlying mechanisms by identifying the key forces from both the government and the private sectors in influencing the process. The study found that market forces in transforming industrial space are exerting a strong impact on the existing land use planning system in Chinese cities. Pragmatic relaxation of the formal land use the regulatory framework and government supportive land-use intervention have also been crucial towards achieving successful implementation of the restructuring project and making it a showcase. This study questions whether these extraordinary measures, in particular, the use of temporary land use permit, are sustainable in facilitating the transformation of derelict industrial land, and in informing future industrial land-use restructuring policies. It concludes that, while the land use regulatory system in China is becoming increasingly dynamic and flexible, it remains ill-equipped in responding positively to the market, which is characterized by an increasing bargaining power of the private sector. A comprehensive appraisal of the overall impacts of these adaptive re-uses on society is wanting.

Keywords: China, land alteration, obsolete industrial properties, urban planning

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1081 Consumer Knowledge of Food Quality Assurance and Use of Food Labels in Trinidad, West Indies

Authors: Daryl Clement Knutt, Neela Badrie, Marsha Singh

Abstract:

Quality assurance and product labelling are vital in the food and drink industry, as a tactical tool in a competitive environment. The food label is a principal marketing tool which also serves as a regulatory mechanism in the safeguarding of consumer well –being. The objective of this study was to evaluate the level of consumers’ use and understanding of food labeling information and knowledge pertaining to food quality assurance systems. The study population consisted of Trinidadian adults, who were over the age of 18 (n=384). Data collection was conducted via a self-administered questionnaire, which contained 31 questions, comprising of four sections: I. socio demographic information; II. food quality and quality assurance; III. use of Labeling information; and IV. laws and regulations. Sampling was conducted at six supermarkets, in five major regions of the country over a period of three weeks in 2014. The demographic profile of the shoppers revealed that majority was female (63.6%). The gender factor and those who were concerned about the nutrient content of their food, were predictive indicators of those who read food labels. Most (93.1%) read food labels before purchase, 15.4% ‘always’; 32.5% ‘most times’ and 45.2% ‘sometimes’. Some (42%) were often satisfied with the information presented on food labels, whilst 35.7% of consumers were unsatisfied. When the respondents were questioned on their familiarity with terms ‘food quality’ and ‘food quality assurance’, 21.3% of consumers replied positively - ‘I have heard the terms and know a lot’ whilst 37% were only ‘somewhat familiar’. Consumers were mainly knowledgeable of the International Standard of Organization (ISO) (51.5%) and Good Agricultural Practices GAP (38%) as quality tools. Participants ranked ‘nutritional information’ as the number one labeling element that should be better presented, followed by ‘allergy notes’ and ‘best before date’. Females were more inclined to read labels being the household shoppers. The shoppers would like better presentation of the food labelling information so as to guide their decision to purchase a product.

Keywords: food labels, food quality, nutrition, marketing, Trinidad, Tobago

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1080 Standards of Toxicity and Food Security in Brazil

Authors: Ana Luiza Da Gama E Souza

Abstract:

This article aims to discuss the problem of food insecurity in Brazil in what it refers to contamination of food by chemical substances such as herbicides, pesticides, and other contaminants. The issue will be faced by analyzing, on the one hand, the standards that guide the food system in the world and, on the other hand, human rights indicators whose purpose is to provide an effective monitoring of the State's obligations to guarantee food security, analyzing the implications of the former for the success of the latter. The methodology adopted in this article was bibliographic-documentary and consists of three moments of analysis. The first moment consists in the analysis of the reports of the Commission on Human Rights of the Organization of American States to identify the set of progress indicators developed by the Commission. This analysis will involve the new methodology used to evaluate the efficiency in monitoring food security in Brazil the case of using pesticides in the production of food at levels of toxicity not admitted by the inspection bodies. The second moment consists in evaluating the mechanism for monitoring food security in Brazil, which was initially established by the National Food Security Plan (PLANSAN) for 2012-2015 and improved by the II National Food Security Plan for 2016-2019. Those mechanisms were prepared by the Chamber (CAISAN), and have the function to compare the monitoring proposals with the results presented by CAISAN on the Indicators and Results Report of the National Plan for Food and Nutrition Security 2012-2015. The third moment was intended to understand, analyze and evaluate the standardization process of the agri-food system, especially regarding the level of toxicity standards, that is related to food safety monitoring as a guarantee of pesticide-free food. The results show the dependence between private standards of toxicity and the indicators of food safety that leads to inefficiency on monitoring that mechanism in Brazil.

Keywords: standards, indicators, human rights, food security

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1079 Low-Cost Monitoring System for Hydroponic Urban Vertical Farms

Authors: Francesco Ruscio, Paolo Paoletti, Jens Thomas, Paul Myers, Sebastiano Fichera

Abstract:

This paper presents the development of a low-cost monitoring system for a hydroponic urban vertical farm, enabling its automation and a quantitative assessment of the farm performance. Urban farming has seen increasing interest in the last decade thanks to the development of energy efficient and affordable LED lights; however, the optimal configuration of such systems (i.e. amount of nutrients, light-on time, ambient temperature etc.) is mostly based on the farmers’ experience and empirical guidelines. Moreover, even if simple, the maintenance of such systems is labor intensive as it requires water to be topped-up periodically, mixing of the nutrients etc. To unlock the full potential of urban farming, a quantitative understanding of the role that each variable plays in the growth of the plants is needed, together with a higher degree of automation. The low-cost monitoring system proposed in this paper is a step toward filling this knowledge and technological gap, as it enables collection of sensor data related to water and air temperature, water level, humidity, pressure, light intensity, pH and electric conductivity without requiring any human intervention. More sensors and actuators can also easily be added thanks to the modular design of the proposed platform. Data can be accessed remotely via a simple web interface. The proposed platform can be used both for quantitatively optimizing the setup of the farms and for automating some of the most labor-intensive maintenance activities. Moreover, such monitoring system can also potentially be used for high-level decision making, once enough data are collected.

Keywords: automation, hydroponics, internet of things, monitoring system, urban farming

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1078 Effects of Handgrip Isometric Training in Blood Pressure of Patients with Peripheral Artery Disease

Authors: Raphael M. Ritti-Dias, Marilia A. Correia, Wagner J. R. Domingues, Aline C. Palmeira, Paulo Longano, Nelson Wolosker, Lauro C. Vianna, Gabriel G. Cucato

Abstract:

Patients with peripheral arterial disease (PAD) have a high prevalence of hypertension, which contributes to a high risk of acute cardiovascular events and cardiovascular mortality. Strategies to reduce cardiovascular risk of these patients are needed. Meta-analysis studies have shown that isometric handgrip training promotes reductions in clinical blood pressure in normotensive, pre-hypertensive and hypertensive individuals. However, the effect of this exercise training on other cardiovascular function indicators in PAD patients remains unknown. Thus, the aim of this study was to analyze the effects of isometric handgrip training on blood pressure in patients with PAD. In this clinical trial, 28 patients were randomly allocated into two groups: isometric handgrip training (HG) and control (CG). The HG conducted the unilateral handgrip training three days per week (four sets of two minutes, with 30% of maximum voluntary contraction with an interval of four minutes between sets). CG was encouraged to increase their physical activity levels. At baseline and after eight weeks blood pressure and heart rate were obtained. ANOVA two-way for repeated measures with the group (GH and GC) and time (pre- and post-intervention) as factors was performed. After 8 weeks of training there were no significant changes in systolic blood pressure (HG pre 141 ± 24.0 mmHg vs. HG post 142 ± 22.0 mmHg; CG pre 140 ± 22.1 mmHg vs. CG post 146 ± 16.2 mmHg; P=0.18), diastolic blood pressure (HG pre 74 ± 10.4 mmHg vs. HG post 74 ± 11.9 mmHg; CG pre 72 ± 6.9 mmHg vs. CG post 74 ± 8.0 mmHg; P=0.22) and heart rate (HG pre 61 ± 10.5 bpm vs. HG post 62 ± 8.0 bpm; CG pre 64 ± 11.8 bpm vs. CG post 65 ± 13.6 bpm; P=0.81). In conclusion, our preliminary data indicate that isometric handgrip training did not modify blood pressure and heart rate in patients with PAD.

Keywords: blood pressure, exercise, isometric, peripheral artery disease

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1077 Impact of Water, Sanitation and Hygiene Interventions on Water Quality in Primary Schools of Pakistan

Authors: Jamil Ahmed, Li P. Wong, Yan P. Chua

Abstract:

The United Nation's sustainable development goals include the target to ensure access to water and sanitation for all; however, very few studies have assessed school-based drinking water in Pakistan. The purpose of this study was to characterize water quality in primary schools of Pakistan and to characterize how recent WASH interventions were associated with school water quality. We conducted a representative cross-sectional study of primary schools in the Sindh province of Pakistan. We used structured observations and structured interviews to ascertain the school’s WASH conditions. Our primary exposures of interest were the implementation of previous WASH interventions in the school and the water source type. Outcomes of interest included water quality (measured by various chemical and microbiological indicators) and water availability at the school’s primary drinking water source. We used log-binomial regression to characterize how WASH exposures were associated with water quality outcomes. We collected data from 256 schools. Groundwater was the primary drinking water source at most schools (87%). Water testing showed that 14% of the school’s water had arsenic above the WHO recommendations, and over 50% of the water samples exceeded recommendations for both lead and cadmium. A majority of the water sources (52%) had fecal coliform contamination. None of the schools had nitrate contamination (0%), and few had fluoride contamination (5%). Regression results indicated that having a recent WASH intervention at the school was not associated with either arsenic contamination (prevalence ratio=0.97; 95% CI: 0.46-2.1) or with fecal coliform contamination (PR=0.88; 95% CI: 0.67-1.17). Our assessment unveiled several water quality gaps that exist, including high heavy metal and fecal contamination. Our findings will help various stakeholders to take suitable action to improve water quality in Pakistani schools.

Keywords: WASH interventions, water quality, primary school children, heavy metals

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1076 Comparison of Growth Medium Efficiency into Stevia (Stevia rebaudiana Bertoni) Shoot Biomass and Stevioside Content in Thin-Layer System, TIS RITA® Bioreactor, and Bubble Column Bioreactor

Authors: Nurhayati Br Tarigan, Rizkita Rachmi Esyanti

Abstract:

Stevia (Stevia rebaudiana Bertoni) has a great potential to be used as a natural sweetener because it contains steviol glycoside, which is approximately 100 - 300 times sweeter than sucrose, yet low calories. Vegetative and generative propagation of S. rebaudiana is inefficient to produce stevia biomass and stevioside. One of alternative for stevia propagation is in vitro shoot culture. This research was conducted to optimize the best medium for shoot growth and to compare the bioconversion efficiency and stevioside production of S. rebaudiana shoot culture cultivated in thin layer culture (TLC), recipient for automated temporary immersion system (TIS RITA®) bioreactor, and bubble column bioreactor. The result showed that 1 ppm of Kinetin produced a healthy shoot and the highest number of leaves compared to BAP. Shoots were then cultivated in TLC, TIS RITA® bioreactor, and bubble column bioreactor. Growth medium efficiency was determined by yield and productivity. TLC produced the highest growth medium efficiency of S. rebaudiana, the yield was 0.471 ± 0.117 gbiomass.gsubstrate-1, and the productivity was 0.599 ± 0.122 gbiomass.Lmedium-1.day-1. While TIS RITA® bioreactor produced the lowest yield and productivity, 0.182 ± 0.024 gbiomass.gsubstrate-1 and 0.041 ± 0.0002 gbiomass.Lmedium-1.day-1 respectively. The yield of bubble column bioreactor was 0.354 ± 0.204 gbiomass.gsubstrate-1 and the productivity was 0,099 ± 0,009 gbiomass.Lmedium-1.day-1. The stevioside content from the highest to the lowest was obtained from stevia shoot which was cultivated on TLC, TIS RITA® bioreactor, and bubble column bioreactor; the content was 93,44 μg/g, 42,57 μg/g, and 23,03 μg/g respectively. All three systems could be used to produce stevia shoot biomass, but optimization on the number of nutrition and oxygen intake was required in each system.

Keywords: bubble column, growth medium efficiency, Stevia rebaudiana, stevioside, TIS RITA®, TLC

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1075 Understanding Tactical Urbanisms in Derelict Areas

Authors: Berna Yaylalı, Isin Can Traunmüller

Abstract:

This paper explores the emergent bottom-up practices in the fields of architecture and urban design within comparative perspectives of two cities. As a temporary, easily affordable intervention that gives the possibility of transforming neglected spaces into vibrant public spaces, tactical urbanism, together with creative place-making strategies, presents alternative ways of creating sustainable developments in derelict and underused areas. This study examines the potential of social and physical developments through a reading of case studies of two creative spatial practices: a pop-up garden transformed from an unused derelict space in Favoriten, Vienna, and an urban community garden in Kuzguncuk, Istanbul. Two cities are chosen according to their multicultural population and diversity. Istanbul was selected as a design city by UNESCO Creative Cities Network in 2017, and Vienna was declared an open and livable city by its local government. This research will use media archives and reports, interviews with locals and local governments, site observations, and visual recordings as methods to provide a critical reading on creative public spaces from the view of local users in these neighborhoods. Reflecting on these emergent ways, this study aims at discussing the production process of tactile urbanism with the practices of locals and the decision-making process with cases from İstanbul and Vienna. The comparison between their place-making strategies in tactical urbanism will give important insights for future developments.

Keywords: creative city, tactical urbanism, neglected area, public space

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1074 Between Efficacy and Danger: Narratives of Female University Students about Emergency Contraception Methods

Authors: Anthony Idowu Ajayi, Ezebunwa Ethelbert Nwokocha, Wilson Akpan, Oladele Vincent Adeniyi

Abstract:

Studies on emergency contraception (EC) mostly utilise quantitative methods and focus on medically approved drugs for the prevention of unwanted pregnancies. This methodological bias necessarily obscures insider perspectives on sexual behaviour, particularly on why specific methods are utilized by women who seek to prevent unplanned pregnancies. In order to privilege this perspective, with a view to further enriching the discourse and policy on the prevention and management of unplanned pregnancies, this paper brings together the findings from several focus groups and in-depth interviews conducted amongst unmarried female undergraduate students in two Nigerian universities. The study found that while the research participants had good knowledge of the consequences of unprotected sexual intercourses - with abstinence and condom widely used - participants’ willingness to rely only on medically sound measures to prevent unwanted pregnancies was not always mediated by such knowledge. Some of the methods favored by participants appeared to be those commonly associated with people of low socio-economic status in the society where the study was conducted. Medically unsafe concoctions, some outright dangerous, were widely believed to be efficacious in preventing unwanted pregnancy. Furthermore, respondents’ narratives about their sexual behaviour revealed that inadequate sex education, socio-economic pressures, and misconceptions about the efficacy of “crude” emergency contraception methods were all interrelated. The paper therefore suggests that these different facets of the unplanned pregnancy problem should be the focus of intervention.

Keywords: unplanned pregnancy, unsafe abortion, emergency contraception, concoctions

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1073 The Effects of Transcranial Direct Current Stimulation on Brain Oxygenation and Pleasure during Exercise

Authors: Alexandre H. Okano, Pedro M. D. Agrícola, Daniel G. Da S. Machado, Luiz I. Do N. Neto, Luiz F. Farias Junior, Paulo H. D. Nascimento, Rickson C. Mesquita, John F. Araujo, Eduardo B. Fontes, Hassan M. Elsangedy, Shinsuke Shimojo, Li M. Li

Abstract:

The prefrontal cortex is involved in the reward system and the insular cortex integrates the afferent inputs arriving from the body’ systems and turns into feelings. Therefore, modulating neuronal activity in these regions may change individuals’ perception in a given situation such as exercise. We tested whether transcranial direct current stimulation (tDCS) change cerebral oxygenation and pleasure during exercise. Fourteen volunteer healthy adult men were assessed into five different sessions. First, subjects underwent to a maximum incremental test on a cycle ergometer. Then, subjects were randomly assigned to a transcranial direct current stimulation (2mA for 15 min) intervention in a cross over design in four different conditions: anode and cathode electrodes on T3 and Fp2 targeting the insular cortex, and Fpz and F4 targeting prefrontal cortex, respectively; and their respective sham. These sessions were followed by 30 min of moderate intensity exercise. Brain oxygenation was measured in prefrontal cortex with a near infrared spectroscopy. Perceived exertion and pleasure were also measured during exercise. The asymmetry in prefrontal cortex oxygenation before the stimulation decreased only when it was applied over this region which did not occur after insular cortex or sham stimulation. Furthermore, pleasure was maintained during exercise only after prefrontal cortex stimulation (P > 0.7), while there was a decrease throughout exercise (P < 0.03) during the other conditions. We conclude that tDCS over the prefrontal cortex changes brain oxygenation in ventromedial prefrontal cortex and maintains perceived pleasure during exercise. Therefore, this technique might be used to enhance effective responses related to exercise.

Keywords: affect, brain stimulation, dopamine neuromodulation, pleasure, reward, transcranial direct current stimulation

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1072 The Effects of L-Arginine Supplementation on Clinical Symptoms, Quality of Life, and Anal Internal Sphincter Pressure in Patients with Chronic Anal Fissure

Authors: Masoumeh Khailghi Sikaroudi, Mohsen Masoodi, Fazad Shidfar, Meghdad Sedaghat

Abstract:

Background: The hypertonicity of internal anal sphincter resting pressure is one of the main reasons for chronic anal fissures. The aim of this study is to assess the effect of oral administration of L-arginine on anal fissure symptom improvement by relaxation of the internal anal sphincter. Method: Seventy-six chronic anal fissure patients (age: 18-65 years) took part in this randomized, double-blind, placebo-controlled trial study from February 2019 to October 2020 at Rasoul-e-Akram Hospital, Tehran, Iran. Participants were allocated into treatment (L-arginine) or placebo groups. They took a 1000 mg capsule three times a day for one month and were followed up at the end of the first and third months after receiving the intervention. Clinical symptoms, anal sphincter resting pressure, and quality of life (QoL) were completed at baseline and the end of the study. Result: The analysis of data was shown significant improvement in bleeding, fissure size, and pain within each group; however, this effect was more seen in the arginine group compared to the control group at the end of the study (P-values<0.001). Following that, a significant increase in QoL was seen just in patients who were treated with arginine (P-value=0.006). Also, the comparison of anal pressures to baseline and between groups at the end of the study showed a significant reduction in sphincter pressure in treated patients (P-value<0.001, =0.049; respectively). Conclusion: Oral administration of 3000 mg L-arginine can heal chronic anal fissures by reducing anal internal sphincter pressure with fewer side effects. However, a long-term study with more follow-up is recommended.

Keywords: L-arginine, anal fissure, sphincter pressure, clinical symptoms, quality of life

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