Background: Chronic kidney disease (CKD) affects over 35.5 million US adults. Serum α1-acid glycoprotein (α1-AGP), an acute-phase protein, exhibits anti-inflammatory properties in animal models, but its association with CKD in younger women remains underexplored. This study investigated the relationship between serum α1-AGP and CKD risk in US women aged 20–49 years. Methods: This nationally representative cross-sectional study used data on female adults in the US aged 20–49 years from the National Health and Nutrition Examination Survey 2015–2018 cycles. 2,137 individuals were included in the study after excluding individuals without serum α1-AGP, urine albumin, and creatinine data. Multivariate logistic regression models evaluated the association between serum α1-AGP and CKD. Moreover, we performed stratified and interaction analyses to see if the relationship was stable in different subgroups. Results: Among 2,137 participants (mean age 34.6 years, mean eGFR 111.7 mL/min/1.73 m²), CKD prevalence was 8.8% (n=188). Higher serum α1-AGP levels were associated with lower CKD risk in the fully adjusted model (OR 0.37, 95% CI 0.16–0.84, P = 0.017), with a dose-response trend across quartiles (P = 0.041). The association was stronger in women aged 40–49 years (OR 0.20, 95% CI 0.05–0.76) and Mexican Americans (OR 0.07, 95% CI 0.01–0.56), though interaction terms were not significant (P > 0.05). Conclusions: Higher serum α1-AGP levels are associated with lower CKD prevalence in young women, suggesting a protective role. Longitudinal studies are needed to confirm causality and explore α1-AGP as a biomarker for CKD risk stratification.

Background: Food security and dietary diversity are essential determinants of maternal health, particularly among pregnant women in refugee populations who face heightened vulnerabilities due to displacement and inadequate living conditions. This study examines the impact of food security on dietary diversity and nutritional intake among pregnant Rohingya women residing in the makeshift camps of Ukhiya, Cox’s Bazar. Methods: A descriptive cross-sectional study was conducted among 96 pregnant Rohingya women from June to September 2022. Data were collected using structured questionnaires assessing socio-demographic characteristics, food security, and dietary diversity. Food security was evaluated using the Household Food Insecurity Access Scale (HFIAS), while dietary diversity was assessed through a 24-hour dietary recall and a 7-day food frequency questionnaire. Data were analyzed using SPSS (Version 26) and Stata (Version 13), employing descriptive statistics and chi-square tests to examine associations. Results: Most participants (57.3%) were food secure, and 85.4% demonstrated high dietary diversity, consuming seven or more food groups. However, 21.9% of households experienced severe food insecurity, highlighting ongoing challenges in food access. The highest consumption was observed for starch, flesh foods, dark green leafy vegetables, and vitamin A-rich fruits and vegetables (99.0%), while dairy products (69.8%) and organ meat (34.4%) were consumed less frequently. Despite high dietary diversity, severe food insecurity persists, indicating gaps in food assistance programs. Conclusions: While food support programs appear to contribute to high dietary diversity among pregnant Rohingya women, severe food insecurity remains a significant concern. Strengthening food security interventions, improving access to diverse nutrient-rich foods, and integrating sustainable food assistance models are essential to addressing these challenges. Future research should explore long-term strategies to enhance food security and assess the impact of targeted nutritional interventions on maternal health outcomes in refugee settings.

Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among mothers of neonates in Sherpur District, Bangladesh, and identify factors associated with knowledge levels. Methods: A descriptive cross-sectional study was conducted from July to October 2020 at Sherpur Sadar Hospital. A total of 193 mothers of neonates were recruited using a non-randomized purposive sampling method. Data was collected through a pre-tested, semi-structured, interviewer-administered questionnaire. Knowledge levels were categorized as "Good" (>6) or "Poor" (≤6) based on responses to 10 structured questions. Statistical analyses, including chi-square tests and crude odds ratios (COR), were performed to identify socio-demographic factors associated with knowledge levels. Results: Of the 193 participants, 48.7% demonstrated "Good" knowledge, while 51.3% had "Poor" knowledge. Education level (p = 0.01), occupation (p = 0.02), family type (p < 0.001), and family size (p = 0.04) were significantly associated with knowledge levels. Mothers with higher education and those from joint families exhibited better knowledge. However, 28.5% of respondents were unaware of the typical umbilical cord-shedding timeframe, and 44% could not identify signs of infection. Unsafe practices, such as using medications (14.5%) or hot compression (7.2%) for drying the cord, were reported. Conclusion: The study reveals significant gaps in maternal knowledge regarding umbilical cord care in Sherpur District, driven by socio-demographic disparities and cultural practices. Targeted health education programs, emphasizing evidence-based cord care practices and leveraging local social structures, are urgently needed to improve neonatal health outcomes in similar resource-limited settings. Future research should evaluate the effectiveness of these interventions to inform policy and practice.

Introduction: Pain is considered as the fifth vital sign that should be considered in assessing patients. For clinicians to evaluate and determine the right pain interventions, there should be parameters such as pain scale. Our objective in this study is to determine factors affecting pain scale preferences in suburban and rural populations. The pain scales used in this study are FPS-R (Faces Pain Scale-Revised), VRS (Verbal Rating Scale), VAS (Visual Analogue Scale), and NRS (Numering Rating Scale). Method: This study uses observational design with an interview approach and a cross-sectional study. Areas covered are within Indonesia, which are marginal areas of Tangerang district border, and two rural areas in Serukam, West Kalimantan, and Soe, East Nusa Tenggara. Data collected will be analyzed using SPSS 25 software. Result: Populations within the suburban areas prefer NRS (52.08%) as their pain scale, and populations in rural areas prefer FPS-R 76.92%). Factors affecting pain scale preferences are location areas, as well as last education, with statistical significance of p<0.05. Discussion: Our study showed that the choice of several pain scales is not appropriate for specific demographics due to the complexity of these scales. Factors that should be considered are the location areas and education level, as some population in remote areas have better understanding of simpler pain scales. Conclusion: Complexity or simpler components may be an underlying reason for the preference of score selection to assess pain scales in some population. Therefore, the selection of pain scales should be adjusted to specific demographics so that clinicians can provide appropriate management with appropriate pain scales.

Background: Nursing students are exposed to significant stress due to academic and clinical demands, which can adversely affect their mental health, academic performance, and future clinical competence. Despite the global acknowledgment of this issue, limited research has been conducted to explore the prevalence and determinants of stress among nursing students in Bangladesh. Methods: This cross-sectional study was conducted from December 2023 to February 2024 among 372 nursing students enrolled in selected nursing colleges in Bangladesh. A purposive sampling technique was used, and data was collected using a semi-structured questionnaire. The questionnaire assessed socio-demographic characteristics, academic challenges, and psychological symptoms, with mental health stress measured using a Likert scale. Descriptive statistics and Chi-square tests were used to analyze the data, with a 95% confidence interval applied to all analyses. Results: The findings revealed that 31.7% of nursing students experienced severe stress, 23.9% reported moderate stress, and 16.7% had mild stress. Age, academic semester, and course load difficulties were significantly associated with stress levels (p < 0.05). Psychological symptoms such as anxiety, difficulty concentrating, and loss of interest in activities were also significantly linked to higher stress levels. Notably, students in their first semester and those reporting harder course loads were more likely to experience stress. However, gender was not significantly associated with stress levels. Conclusions: This study underscores the high prevalence of stress among nursing students in Bangladesh, driven by academic and clinical challenges and psychological symptoms. The findings highlight the need for targeted interventions, such as stress management training, enhanced mental health support, and policies to alleviate academic pressures. Future research should explore longitudinal trends in stress and evaluate the effectiveness of interventions to support a resilient nursing workforce.

This study aimed to assess the knowledge level of street food vendors on hygiene in the Tamale metropolis in the Northern Region of Ghana. The study employed the health belief model as the theoretical basis. Quantitatively, the study employed a descriptive cross-sectional study design to examine the microbial load of street-cut fruits and assess the knowledge and practice of vendors of cut fruits on personal and food hygiene in the study setting. The population consists of cut and vented pawpaw, watermelon, and street fruit vendors registered with the health directorate in the Tamale Metropolis. A convenient sampling technique was used to select 113 respondents for the study. The Yamane formula was used to determine the sample size to select one hundred and thirteen participants (113) out of one hundred and fifty-eight street fruit vendors in the Tamale Metropolis. The main instrument for data collection was a questionnaire. A questionnaire had close-ended questions which were developed using a 'Yes' and 'No' response, and a four-point Likert-type scale ranging from 1=Strongly Disagree (SD), 2=Disagree (D), 3=Agree (A) and 4= Strongly Agree (SA). The data were analysed using descriptive statistics (frequency, percentages, means and standard deviation). The findings revealed that the overall knowledge level of respondents is low. The findings also indicate that vendors do not control the rate at which their customers touch their vended fruits. It is recommended that Street fruit vendors and handlers be educated on fruit hygiene practices through engagement by the Health Directorate Unit of Tamale Metropolis and the Ministry of Health. To keep consumers safe, the Tamale Metropolitan Assembly must strictly enforce compliance with regulations on operation permits and health clearance certificates. Metropolitan sanitation officers must regularly monitor fruit vendors to ensure compliance with goods.

Background: There is paucity of data on health-related quality of life (HRQoL) among Health Information Managers/Health Record Officers (HROs) in the Nigeria health system. Hence, this study investigated the impact of the COVID-19 pandemic on health-related quality of life (QoL) among HROs in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria. Methods: A cross-sectional study was conducted in the University Hospital, where a total of 52 health record officers were purposively sampled. Relevant data were collected using the Short Form survey (SF-36v2) questionnaire. One-way ANOVA was used to determine mean group differences across the nine and the two QoL (physical and mental) summary domains based on respondents’ socio-demographics, while level of significance was set at 0.05. Results: All the QoL sections of the instrument used yielded an α-Cronbach’s score of > 0.70. Analysis of some QoL physical component dimensions showed that; Bodily pain (BP) was found to be significantly (P=0.032) associated with marital status, Physical functioning (PF) with gender (P=0.023), and general health (GH) with age group (P=00.025) and highest level of education (P=0.023). On the other hand, mental health component analysis revealed that Social Functioning (SF) was associated with age group (P=014), Role limitation (RE) with marital status (P=0.048), highest level of education (P=0.048) and years of service (P=0.015) etc. Conclusion: The QoL among HROs studied was generally above average, and demographic characteristics such as age, gender and marital status significantly influence QoL. Health managers and stakeholders should consider some of the factors identified in managing HROs.

A regular menstrual cycle is important to maintain a woman’s fertility. This cycle has been linked to optimal function of the thyroid gland in the production of its hormones. Disturbance of thyroid gland functions could result to female infertility due to changes in menstrual patterns. Aim of this research was to determine the correlation between thyroid gland functions and menstrual patterns amongst infertile and fertile women attending a tertiary care hospital in North-Central Nigeria. This comparative, cross-sectional study recruited 106 women who visited the hospital's Gynecology Clinic and Family Planning Clinic. 53 of the 106 patients were women with a history suggestive of either primary or secondary infertility and the remaining 53 women with no history of infertility served as the control. A well-structured questionnaire was used to obtain data on the patients’ menstrual patterns. Anthropometric data were measured and obtained. Collected blood samples were analyzed using Enzyme-Linked Immunosorbent Assay (ELISA) technique to determine the serum levels of thyroid hormones. All obtained data was analyzed, and the level of significance was set at p<0.05, at a 95% confidence interval. 33 patients had menstrual anomalies (78.8% infertile women; 21.2% fertile women who served as control, p=0.012). The incidence of menstrual anomalies in the infertile women group and control group was 7.5% versus 0.0% for amenorrhea; 20.8% versus 5.7% for menorrhagia; 9.4% versus 7.5% for oligomenorrhea; 7.5% versus 0.0% for hypomenorrhea; nil polymenorrhea for both groups; and 50.9% versus 86.8% for normal menstrual patterns. Ten (9.43%) patients were diagnosed with thyroid dysfunctions (80% in infertile group; 20% in control group, p=0.046). Six (18.2%) out of 33 women with menstrual anomalies were diagnosed with thyroid dysfunction. Five (83.3%) out of these 6 women with both menstrual anomalies and diagnosed thyroid dysfunction were infertile while only one (16.7%) was fertile. Thyroid gland dysfunction correlates strongly with abnormal menstrual patterns, which implies that it is vital to evaluate thyroid hormone levels in blood serum in the course of treating menstrual irregularities and female infertility. Early detection of thyroid dysfunction is important in achieving a positive treatment outcome for female infertility.

Background: The increasing prevalence of Diabetes Mellitus (DM) is closely tied to complications, particularly diabetic foot ulcers, which significantly raise the risk of lower extremity amputations due to infected, non-healing ulcers. This study aimed to assess diabetic foot prevention knowledge, practices and associated factors among patients at the Edward Francis Small Teaching Hospital (EFSTH), Banjul. Methods: In this cross-sectional study, we employed a convenience sampling technique to enroll 357 diabetic patients, both inpatients and outpatients, who were under the care of EFSTH. Data on diabetic foot prevention were collected through semi-structured interviews conducted by trained interviewers. Statistical analyses were carried out using SPSS, encompassing descriptive analysis, chi-square, Fisher exact tests, and logistic regression. Statistical significance was set at p<0.05, with a 95% confidence interval. Results: The mean age of the respondents was 47.3 years (±10.5), with women comprising 55.2% of the study population and 94.4% were married. About 73% demonstrated good knowledge of diabetic foot care and prevention, while 25.8% exhibited fair knowledge. A significant association was observed in bivariate analysis with patients’ educational level (P = 0.032). Specifically, patients with Madarasa (Arabic) education had a 68% lower likelihood 【aOR: 0.320, 95% CI: (0.103, 0.992), p = 0.048】 of practicing diabetic foot care and prevention compared to those with tertiary education. Conclusion: The study revealed that participants’ knowledge of preventing diabetic foot was high. However, the practice was poor. Therefore, there is a need for more health education on the practices that would emphasize diabetes management among diabetes patients.

Women must be aware of the risk factors of pregnancy complications and the negative maternal and fetal health consequences to take preventative measures and management strategies that will result in a successful pregnancy. This study aimed to assess the Level of Knowledge about obstetric warning signs and the associated factors among pregnant Saudi women attending antenatal care in a tertiary care maternity set-up in Riyadh City. Data for this cross-sectional study were obtained using a structured questionnaire from eligible pregnant women admitted to King Saud Medical City (KSMC) between August 2020 and March 2021. Data were analyzed using descriptive and inferential statistics. Out of a minimum estimated sample size of 170, researchers recruited 362 participants. As observed, only 92 people, or 25.4%, had enough knowledge about various educational levels. The majority (91.2%) lived in villages, had no history of chronic disease (74.0%), and said that it took them at least 30 minutes to commute from their home to the hospital (69.3%). Two hundred two (55.7%) lacked appropriate knowledge, although most women (76.2%) had one to four pregnancies. Poor psychological health resulted from 37 people's (10.2%) inadequate Awareness. Even though 139 (38.4%) had spent more than 15 minutes receiving education from medical staff and 200 (61.5%) had attended the prenatal care clinic more than four times, most lacked adequate knowledge. The variables education level (P=0.000), working status (P=0.022), and place of residence (P=0.044) showed a statistically significant association with the knowledge level, also only education level statistically significantly affected the likelihood of knowledge gaps. In conclusion, early identification of obstetric warning signs and associated risk factors of pregnancy complications is integral to prevention.

Introduction: Health-related quality of life in patients undergoing dialysis decreases over time, not only due to the treatment of the disease but also due to the reduction of physiological, psychological and social well-being. Aim: The aim of this research is to study social support and nursing care that patients with dialysis receive, their levels of fatigue and their quality of life. In addition, the effect of social support and nursing care on the patients'' levels of quality of life is examined. Methodology: A quantitative cross-sectional study was conducted using the questionnaires “Multidimensional Scale of Perceived Social Support”, Fatigue Assessment Scale (FAS), Missoula-VITAS Quality of Life Index and nursing care. The study involved 69 patients on dialysis. Results: Interpersonal relationships were associated with social support (p <0.01). Quality of life was associated with social support (p <0.05). Conclusions: It seems that there is a strong association between social support and quality of life in patients on dialysis.

Novel corona virus disease (COVID-19) pandemic, which started in China's Hubei province in 2019, has caused a significant loss of human lives globally. This study describes the epidemiologic and clinical profiles of COVID-19 related deaths among patients admitted to treatment centers in Sidama region, Ethiopia. A cross-sectional study of 186 in hospital COVID-19 related deaths that occurred from July 2020 to December 2021 in Sidama region were analyzed. Data was extracted from regional emergency operation center death report. Data was entered using Epidata v3.1 and analysis was done using SPSS v.20. Categorical data was summarized using frequency and percentage while continuous data was summarized using median and interquartile range. Association between variables was assessed using chi-square test. More than two-third of the deceased patients were male (135; 72.6%) and median age at death was 60. The majority of deaths (151; 81.1%) occurred in 2021, while April 2021 had the highest death records. Cough and shortness of breath were the main presenting symptoms occurring in 89.2% and 85.5% of deceased patients respectively. Most of the COVID-19 related deaths (64.5%) had associated comorbidities. Diabetes (50%) and Hypertension (39.2%) were the most prevalent comorbidities. Significant proportion of patients (74.73%) presented on severe end of disease spectrum (critical/ severe). Of the deceased patients, around two-third required Intensive care unit (ICU) admission and 111 of them were put on mechanical ventilator. Moreover, the median ICU stay was 4 days. Around half of the death (48.4%) occurred in the first 5 days. The median survival time from symptom onset was 11.5 days with most (43.5%) of the deaths occurring within the first 14 days of symptom onset. Age category was significantly associated with the number of days from onset to death (p=0.006). The case fatality rate was 1.87% which is lower than national and global reports. Unlike previous studies, the prevalence of asthma among deceased patients was low and there were no patients with documented COPD.

Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas in Kinshasa namely Centre Supérieur Militaire Mobikisi and Hopital Militaire Central. It is a cross-sectional study of analytical type having a correlational design. In fact, 114 mothers having children aged 6 to 59 months old who had experienced at least three diarrheal episodes were selected and this research was carried out in January 2020. Independent variables were socio-economic factors and dependent variables were biological factors. Descriptive statistical analyses of which frequency and percentage were performed to describe the sampling profile. To measure the strength of association between different variables, the Pearson's Chi-Square (X²) test was used. The findings showed that 57% live in a high socio-economic environment compared to 43% who have a low socio-economic environment responsible for the occurrence of acute diarrhea. It was observed that 67.7% of participants knew the importance of access to health care services, compared to 32.3% who did not know. Meanwhile, 50.8% lived in a healthy environment versus 49.2% who had an unhealthy environment. Furthermore, 53.8% were in an acceptable demographic and biological situation, compared to 46.2% who were in a precarious demographic and biological situation. Acute diarrhea in children aged 6-59 months is one of the causes of morbidity and mortality in Kinshasa city. Obstacles to effective care are related to the lack of quality service provision. Policy makers must therefore put in place interventions to address these challenges in order to reduce infant morbidity and mortality in this area.

Background: The sacroiliac joint (SIJ) plays a crucial role in transmitting axial loads and maintaining pelvic stability. Sacroiliac joint arthropathy (SIJA) accounts for 10%–30% of low back pain cases but remains underrecognized due to overlapping pain referral patterns and nonspecific imaging findings. Diagnosis relies primarily on characteristic pain distribution and provocative maneuvers, with image-guided intra-articular block serving as the diagnostic gold standard. This study aimed to characterize the clinical profile of block-confirmed SIJA, emphasizing referral pain distribution, triggering position, and provocative test responses. Methods: A cross-sectional study was conducted on 98 patients with diagnostic block–confirmed SIJA at Siloam Hospital Lippo Village, Indonesia. Demographic data, referral pain sites, sitting duration, and results of FABER, compression, and distraction tests were analyzed descriptively. Results: The mean age was 52.07 ± 14.17 years, with 72.4% females. Referral pain most frequently involved the lower back (28.6%) and thigh (28.6%), with occasional extension to the groin (8.2%) or calf (4.1%). Over half of patients (55.1%) reported sitting more than six hours daily. Pain was predominantly triggered during sit-to-stand transitions (85.7%) and while sitting (74.5%). SIJ tenderness (98.0%) and FABER positivity (75.5%) were most consistent. Conclusion: The dominant referral pain in SIJA involves the lower back and posterior thigh. Sit-to-stand transition is the most frequent triggering position, while FABER testing demonstrates the highest diagnostic yield among provocative maneuvers. These consistent patterns may serve as practical clinical indicators to improve diagnostic accuracy in suspected SIJ-related pain.

Introduction: Stroke remains one of the leading causes of death and disability worldwide, with ischemic stroke accounting for most cases. Structural vascular factors such as carotid artery tortuosity have gained attention as potential markers of vascular aging and cerebrovascular risk. The carotid tortuosity index (CTI), defined as the ratio of actual vessel length to the straight-line distance between two fixed points, provides a quantitative measure of arterial curvature. A CTI value of ≥1.2 indicates pathological tortuosity. Although noninvasive modalities such as CTA and MRA are frequently used, digital subtraction angiography (DSA) remains the gold standard for evaluating vessel geometry due to its higher spatial precision. This study aimed to determine the association of age, sex, and hypertension with CTI measured by DSA. Methods: A cross-sectional study was conducted from November to December 2025 at the Neurointervention Clinic, RS Pelni Jakarta, Indonesia, involving 61 adult patients who underwent carotid DSA. CTI was measured bilaterally using digital imaging software and classified as <1.2 (non-tortuous) or ≥1.2 (tortuous). Clinical data, including age, sex, and hypertension status, were collected from medical records and analyzed using bivariate tests. Results: Older age (≥65 years), female sex, and hypertension were significantly associated with higher CTI values on both carotid sides. Tortuosity was more common among hypertensive patients and elderly females, indicating the influence of vascular remodeling and chronic hemodynamic stress. Conclusion: Carotid tortuosity increases with age, hypertension, and female sex. DSA-based CTI measurement provides a reliable and precise approach for evaluating vascular changes associated with cerebrovascular risk.

Purpose: Although the effect of loss of a loved one on depression is well established, very limited knowledge exists on racial differences in this effect. Aim: In the current study we compared Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) Californians for the effects of loss of a loved one on depression in a representative sample of adults in California. Methods: This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Overall, 1603 people entered our study. We compared 901 (56.2%) NHB and 702 (43.8%) NHW adults (age 18 and older). Race/ethnicity, demographics (age and gender), socio-economic factors (education, income, employment, and marital status), religiosity, and health (self-rated health and number of chronic medical conditions), and depression were measured. To perform data analysis, we used logistic regression models. Results: In the pooled sample, loss of a loved one was not associated with self-reported depression, net of all covariates. Race, however, interacted with loss of a loved one on depression, suggesting a larger association for NHBs compared to NHWs. In race-specific models, loss of a loved one predicted depression for NHBs (OR = 1.54) but not NHWs (OR = 0.99). Conclusion: There are differences between NHBs and NHWs in the effect of loss of a loved one on depression. NHBs show a stronger association between loss of a loved one and depression than NHWs. This result is not in line with the NHB mental health paradox or with NHB resilience but is consistent with the notion that social relations may be more salient for NHBs than for NHWs.

Background: Tobacco control policies are implemented globally to reduce tobacco-related morbidity and mortality. Emerging evidence suggests that individual tobacco use may influence the level of support for these policies. However, the extent to which personal use affects policy endorsement remains underexplored, particularly among young adults in academic settings. Aims: This study aimed to examine whether college students who use tobacco exhibit lower support for tobacco control policies compared to their non-user counterparts. Methods: We conducted a multi-center, cross-sectional study involving 2403 college students from various provinces in Iran. Tobacco use was ascertained based on self-reported consumption of cigarettes, electronic cigarettes, and hookah. Attitudes toward tobacco control policies were evaluated using a structured survey instrument, and comparative analyses were performed to assess differences in policy support between tobacco users and non-users. Results: The analysis revealed that tobacco users demonstrated significantly lower support for tobacco control policies compared to non-users. This association was consistently observed across users of cigarettes, electronic cigarettes, and hookah, suggesting a systematic pattern irrespective of the type of tobacco product used. Conclusion: These findings indicated a clear association between tobacco use and reduced endorsement of tobacco control policies among Iranian college students. These results have potential implications for public health policy, emphasizing the importance of addressing individual tobacco use behaviors in the development and implementation of tobacco control strategies. Further research is needed to elucidate the underlying mechanisms of this relationship.

Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the poverty-to-income ratio (PIR), and CMD indicators—including obesity, diabetes, and cardiovascular disease (CVD)—among men and women using data from the National Health and Nutrition Examination Survey (NHANES). Methods: This cross-sectional study utilized NHANES data (1999-2018), adjusting for race/ethnicity and age. SES was operationalized using PIR, with CMD outcomes (obesity, diabetes, and CVD) as dependent variables. Generalized linear models (GLM) were employed to evaluate the main effects of SES on CMD, with gender included as a moderator. Results: Higher SES was associated with lower overall CMD risk. However, the protective effects of SES were more pronounced in women than in men for all outcomes. These findings suggest that gender-specific pathways may mediate the relationship between SES and CMD. Women may derive greater health benefits from higher SES due to factors such as reduced stress exposure, healthier behaviors, and increased healthcare utilization. Conversely, the weaker association observed in men may reflect differences in social hierarchy sensitivity, responses to unemployment, or other contextual factors. Conclusion: The findings highlight the importance of gender-specific considerations when addressing SES-related disparities in CMD outcomes. Policies and interventions aimed at reducing CMD burden should account for these gender differences to promote equitable improvements in cardiometabolic health. Further research is needed to unravel the mechanisms driving these differences and to inform targeted strategies.

Objective: To examine racial/ethnic differences in the associations of family socioeconomic status (SES), neighborhood SES, and inhibitory control with body mass index (BMI) in 9-10-year-old children using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods: This cross-sectional study included a diverse sample of children aged 9-10 years, representing non-Latino White, Black, Latino, Asian, and Other racial/ethnic groups. BMI was the primary outcome. Key predictors were family SES, neighborhood SES, and inhibitory control. Multivariable regression models were stratified by race/ethnicity to identify group-specific associations. Results: Race/ethnic groups differed in psychosocial correlates of childhood BMI at age 9 and 10. Among non-Latino White children, higher family income (B = -0.086, p < 0.001), higher parental education (B = -0.069, p < 0.001), and living in a married household (B = -0.079, p < 0.001) were associated with lower BMI. Additionally, the presence of healthy food options in the zip code (B = -0.030, p = 0.032) was linked to lower BMI, while lack of planning (B = 0.032, p = 0.030) was associated with higher BMI. For non-Latino Black children, positive urgency (B = -0.068, p = 0.022) was negatively associated with BMI, while other factors such as family SES and neighborhood SES did not show significant associations. For Latino children, higher family income (B = -0.093, p = 0.001) and parental education (B = -0.099, p < 0.001) were associated with lower BMI. In this group, male gender (B = 0.043, p = 0.033) was associated with higher BMI. Among Asian children, higher family income (B = -0.199, p = 0.006) and parental education (B = -0.144, p = 0.037) were significantly associated with lower BMI. For children in the "Other" racial/ethnic category, higher family income (B = -0.101, p = 0.023), living in a married household (B = -0.076, p = 0.026), and higher median income in the zip code (B = -0.083, p = 0.013) were associated with lower BMI. In this group, male children had lower BMI compared to females (B = -0.089, p = 0.001). Conclusion: The findings highlight substantial racial/ethnic differences in the psychosocial and socioeconomic correlates of BMI in children. There is a need for tailored interventions that target social determinants of childhood high BMI. One size does not fit all.

Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors contributing to these disparities. While higher socioeconomic status is generally associated with better health outcomes, this benefit may be diminished for racialized and minoritized populations. Objective: This study investigates the protective effects of educational attainment and income-to-poverty ratio on the prevalence of chronic medical conditions and examines whether these effects vary across racial and ethnic groups, specifically among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino White adults. Methods: Using data from the 2023 National Health Interview Survey (NHIS), this cross-sectional study analyzed the association between educational attainment and chronic medical conditions across racial and ethnic groups. Logistic regression models were employed to assess whether the strength of the relationship between education and chronic medical conditions differed by racial/ethnic group, controlling for key demographic and socioeconomic covariates. Sample size was 29,373 which was reflective of 256,566,689 US population. Results: Consistent with the theory of Minorities' Diminished Returns, findings showed that the protective effects of higher educational attainment on chronic medical conditions were significantly weaker for Black, Latino, and American Indian and Alaska Native adults than for their non-Latino White counterparts. Even among individuals with higher education, Black, Latino, and American Indian and Alaska Native adults faced elevated risks of chronic medical conditions. Conclusion: While educational attainment generally reduces the prevalence of chronic medical conditions, this protective effect is moderated by racial and ethnic background. Structural barriers limit the health benefits of educational attainment. This underscores the need for policies that address structural inequities—such as low-quality education and occupational segregation—that constrain the protective health effects of educational attainment for minoritized groups.

Background: Foodborne disease is a worldwide challenge. It causes a huge burden of diarrhea in children mostly in developing countries and this is common during the complementary feeding periods. As home serve as the proliferation ground for microbial pathogens, home- prepared complementary foods, coupled with unhygienic feeding practice and contamination, it is the cause of child morbidity and poor nutritional status. This is worse in slum households. However, recent evidence is very scarce and further study is very necessary. Objective: To investigate the microbiological quality of home-prepared complementary foods in slum households with children of 6-24 months in Addis Ababa, 2021. Methods: A community-based cross-sectional study design was used and a total of 91 households were included. Three sub-cities in Addis Ababa and slum settlements within each sub-city were randomly selected by lottery method. Households with children of age from 6-24 months were selected by systematic random sampling. Laboratory investigation was used for microbial identification and excel sheet was used for data entry and cleaning. SPSS V. 23 was used for data analysis. Result: The median and interquartile range of aerobic plate count, S.aureus, yeast, molds and total coliforms are log5.75cfu/ml, Log1.84cfu/ml; Log4.7cfu/ml, Log5.46cfu/ml; Log5.29 cfu/ml, Log3.68cfu/ml; Log4.17cfu/ml, Log4.70cfu/ml; and Log0, Log3.5cfu/ml, respectively. Fecal coliform and E.coli were observed in 19% and 10% of complementary food samples. Conclusion: The load of aerobic plate count, S.aureus, yeast, molds, and total coliform are high in samples of complementary foods. Therefore, intervention studies for further identification of contamination sources should be made in order to minimize contamination of complementary foods and associated infections.

Background: On the first of October 2018, the Egyptian Ministry of Health and Population (MOHP) launched an initiative; named “100 Million Healthy Lives”, for nationwide screening of hepatitis c virus (HCV) and non-communicable diseases (NCDs). Egypt has the highest prevalence of HCV infection in the world where about 10% of the Egyptian population is affected by the disease. NCDs are the leading cause of mortality in Egypt and account for about 84% of all deaths. This study was conducted to a) Estimate the prevalence of participation in the national campaign on viral hepatitis C and non-communicable diseases among administrative workers in Ain shams University (ASU), b) Estimate the self-reported satisfaction of these participants with the campaign. Subjects and Methods: A cross-sectional study was conducted on 400 administrative workers of ASU faculties between March and August 2019 in Cairo, Egypt. A multistage random sample was done. Results: The study showed that 96% of the study group participated in the campaign. “Evaluating health status” was considered the main reason for participation at 92%, followed by "desire to obtain follow-up card", at 36%. Non-participation rate was about 4% and the main cause of non-participation was “fear of needle prick". About 91% of the participants were satisfied with the provided services. Mass media played a major role in awareness about the campaign for 91% of participants. Conclusions: The majority of the study group participated and was satisfied with the campaign. Mass media played a major role in participant awareness of the campaign.

Background: Depression occurs in one-third of stroke patients, in what is known as post-stroke depression. The lesion sites in stroke have been associated with the degree of depression. However, studies have provided different perspectives, and this necessitates further clarification. This study investigates the relationship between the lesion sites and the severity of depression in ischemic stroke patients. Methods: This cross-sectional study was conducted between January and April 2020. All samples were obtained from admitted patients with ischemic stroke who agreed to participate in the study. Data were collected using Beck’s Depression Inventory-II (BDI-II), which was used to determine the severity of depression, and the lesion sites were based on radiological imaging interpretation. Results: The study showed a significant association between the lesion site and the degree of depression (OR = 5,368, p-value = 0,013). Lesions in the frontal lobe demonstrated stronger associations with the severity of depression. Conclusion: The location of the lesion, especially in the frontal lobe, was associated with more severe post-stroke depression.

Caesarean section is the most common surgical procedure in obstetrics, but also in pregnant women with dystocia. The purpose of this study is to identify factors that contribute to post-caesarean complications in emergency of gynecology-obstetrics service of Saint Joseph Hospital in Kinshasa. This is a descriptive cross-sectional study and was conducted at Saint Joseph Hospital in Kinshasa city for a month (1^st and 30^th July 2021). A questionnaire was used to collect different data namely socio-demographic characteristics and different variables important for the study. Independent variables were factors related to the parturient and the current pregnancy, the surgical procedure and the operational room. While the dependent variable was post-caesarean complications in gynecology-obstetrics service. Descriptive statistical analyses namely frequency and percentage were done to describe the sample profile. To measure the strength of association between different variables were estimated using Pearson's Chi-Square (X²) test and the p-value was 0.05. Data analysis was performed using SPSS version 20 software. The majority of participants are over 33 years of age, have secondary school skills, married and have 3 to 4 children. It was observed that 88.2% of participants have acute respiratory distress prior to caesarean section, 76.6% have a personal history of thromboembolic disease prior to caesarean section. All the participants who underwent caesarean section were victims of external ventilation through the windows of the operating room, which remained open before, during and after the surgery and benefited from antibiotic treatment without any para-clinical analysis before the caesarean section. Furthermore, 82.4% of participants had benefited from the caesarean section with sterilized care materials 48 hours before and after the intervention. While 47.1% of participants had caesarean sections with defective equipment for the operation (use of dry heat sterilization etc.). A better identification of these risk factors can reduce significantly rate of complications and can consequently improve the maternal-infantile prognosis. The obstacles to effective management are related to the provision of quality services.

Background: Reproductive health is a critical component of overall health and development. Unmet contraceptive needs are one of the regularly cited measures of the efficacy of family planning (FP) initiatives. This study set out to determine the magnitude and associated factors of unmet need for FP among women of reproductive-aged (15-49 years) in the provincial areas of The Gambia. Methods: The study used a community-based cross-sectional analytical design. A multistage sampling strategy, comprising simple random and cluster sampling, was utilized to obtain a sample of 643 childbearing women (15-49 years) from rural Gambia's sampled clusters. Data collection was conducted using pre-tested structured interview questionnaires. The association was examined using chi-square/fisher's exact test with a significance level of p<0.05. Binary logistic regression analysis was performed to examine the effect of sociodemographic and cultural determinants on unmet FP need, with corresponding computed adjusted odds ratios (aOR). IBM SPSS version 24 was used for data entry and analysis. Results: The unmet need for FP among the study participants was 25.2%; unmet need for spacing and unmet need for limiting was 17.4% and 7.8%, respectively. The total demand for FP was 59.4%, while the satisfaction of demand for FP was 57.6%. The significant predictors of unmet need for FP were woman’s age at first pregnancy (aOR=0.899, p=0.033), LGA of origin (aOR=0.240, p=0.001) and frequency of using contraceptives (aOR=1.587, p=0.032). Conclusion: The present study demonstrated a high unmet need for FP among rural women in The Gambia, with the most often cited reason for non-use being fear of side effects. Hence, it is necessary to concentrate FP services for rural populations, stressing education regarding contraceptive side effects, service quality, and gender equality. Additionally, the study suggests that male participation and religious leaders' involvement in FP programs be strengthened and mainstreamed, as well as the establishment of a communication program that specifically promotes inter-spousal communication.

Background: Everyone, irrespective of age, sex, colour, ethnicity, or present overall fitness level, can benefit from regular exercise. To improve one's health, one must engage in regular physical activity. People with underlying illnesses like long-term impairment can benefit from regular physical activity at the individual level, especially young women. Thus, the current study aimed to assess the prevalence and determinants of physical activity among female school-aged adolescents in the West Coast Region of The Gambia. Methods: The present study used an institutional-based cross-sectional analytical study to collect quantitative data from 384 female high school students in The Gambia. The study used a content-validated, pretested structured questionnaire that consisted of both open and closed-ended questions on physical activity. The data were processed and analyzed using IBM SPSS version 26.0. Descriptive statistics and Chi-square and/or Fisher exact test were used with a p-value <0.15 for inclusion in the logistic regression model. Adjusted odds ratios (aORs) and 95% confidence intervals were calculated, while p-value <0.05 was considered for statistical significance. Results: The proportion of female students involved in physical activity was 37.5%. The mean age of students was 18.8 years with a standard deviation of 1.7 years. Factors such as female students between 17 – 20 years (aOR:3.05, 95% C.I. (1.807 – 5.138)), father never been to school (aOR: 2.82, 95% C.I. (1.495 – 5.334)), primary education (aOR: 2.15, 95% C.I. (1.027 – 4.493)), upper basic school (aOR: 2.31, 95% C.I. (1.055 – 5.074)) and science major students (aOR: 2.21, 95% C.I. (1.203 – 4.047)) had increased odds of involving in PA. Furthermore, students who knew that exercise would strengthen bones (aOR: 2.62, 95% C.I (1.444 – 4.739)), do a planned brisk walking (aOR: 19.16, 95% C.I. (6.698 – 54.811)), basketball/football (aOR: 29.76, 95% C.I. (10.004 – 88.512)) and skipping with rope (aOR: 29.15, 95% C.I. (9.726 – 87.333)) had increased odds to involved in PA after controlling for confounders. Other factors such as students whose mother never been to school (aOR: 0.31, 95% C.I. (0.140 – 0.674)), primary level (aOR: 0.25, 95% C.I. (0.123 – 0.518)), senior secondary level (aOR: 0.42, 95% C.I. (0.189 – 0.935)), nuclear family (aOR: 0.23, 95% C.I. (0.119 – 0.458)) and extended family (aOR: 0.45, 95% C.I. (0.225 – 0.915)) had reduced odds of involving in PA. Conclusion: There is low physical activity among female adolescents in schools. For this, it is imperative that suitable interventions be implemented to raise the level of physical activity among secondary school students. A future intervention for school-aged adolescents could benefit from these findings.

Background: Everywhere in the world, Pregnancy and birth possess a risk to the life and health of women and newborns, regardless of whether a pregnancy was intended or unintended. The level of risk depends on a woman’s health before she is pregnant, her living conditions and the care she receives during delivery which is aggravated by lack of access to maternal health care services, leading to increase in the magnitude of death from preventable health problems. This paper therefore diagnostically assessed health promotion strategies for increasing access to maternal healthcare services in some remote districts in Anambra state. Methods: The study is a cross-sectional study and utilized a structured instrument which was validated by three experts in measurement and evaluation and health education and pilot tested on 20 pregnant women using test-retest in Ugwunagbor Abia state. The reliability yielded 0.84. Percentage, mean and standard deviation were used to answer the research questions. The population was 620 confirmed pregnant women from 4 to 9 months in the area of study in health centers in the state. A sample of 60 participants was selected using simple random sampling technique. Results: Findings show that antepartum, Intra-natal care, puerperium and family planning cares were prevalent in the local governments under study and that access to skilled delivery was associated with age, educational background, number of children and income level of the mother among other findings. Recommendations and conclusion: The researchers therefore recommended that there is urgent need to build healthy public policy, create supportive environments amongst others which can add to the effective measures of reducing maternal mortality in the longer term.

Background: Family planning is one of the key cornerstones of safe parenthood and a reproductive rights issue. In underdeveloped nations, women experiencing unmet FP needs formed a considerable proportion of all women of reproductive age and are ongoing public health concerns in The Gambia. The study was set out to explore the influence of socio-demographic and cultural factors on contraceptive uptake among rural women in The Gambia. Methods: The study used a community-based cross-sectional analytical design. A multistage sampling strategy, comprising simple random and cluster sampling, was utilized to obtain a sample of 634 childbearing women (15-49 years) from rural Gambia's sampled clusters. Data collection was conducted using pre-tested structured interview questionnaires. The association was examined using chi-square/fisher's exact test with a significance level set at p<0.05. Binary logistic regression analysis was performed to examine the effect of socio-demographic and cultural determinants on uptake of contraceptives, with corresponding computed adjusted odds ratios (aOR). IBM SPSS version 25 was used for data entry and analysis. Results: The uptake of contraceptives among the study participants was 30.4%. The total demand for FP was 59.4% while the satisfaction of demand for FP was 57.6%. The significant predictors of FP uptake were the age of women (aOR=1.097, p=0.014), reason for using FP (aOR=1.139, p=0.011), use of contraceptives before (aOR=24.416, p<0.001) and reason for not discussing FP with a partner (aOR=1.787, p=0.029). Conclusion: The study showed low contraceptive uptake among women in rural communities. Thus, spousal communications on FP concerns are key intermediate steps towards eventual acceptance and sustained usage of FP services. The program should focus on improving access to and availability of FP services in rural areas. The program should prioritize addressing women's needs through consistent community-based interventions including targeted home visits.

Online shopping is a growing phenomenon and social media namely Facebook has radically changed consumers online purchase behaviour; especially the interactive information system of consumers, peers, and vendors. Similar to other online purchasing products or services, e-cigarette marketing in Facebook has potential. This study aims to determine the association between individual’s online interaction and e-cigarette purchase intention from Facebook vape groups. A cross-sectional study was conducted among 214 respondents using the Facebook platform from September to December 2019. Data were collected via a self-administered questionnaire. The Chi-square test was used for data analyses using SPSS (version 25.0). Most of the participants were male; the mean age of the respondents was 27.41 ± 2.1. Total 93.9% (201 of 214) and 56.1% (120 of 214) respondents were vaper and smoker respectively. Among the non-smokers, most of the respondents were vaper (84 of 94, 89.4%). Consumers smoking and vaping status were associated with each other (χ2 = 6.11, P=0.01). There was an association between vaping status and purchase intention of e-cigarettes from the Facebook vape group (χ2 = 5.06, P=0.02). Online interactions, namely like (χ2 = 5.88, P <0.01), post (χ2 = 7.16, P <0.01) and sharing (χ2 = 10.14, P <0.01) of the e-cigarette related information or advertisements in social media were associated with purchase intention of e-cigarettes from Facebook vape group. This study revealed individuals vaping and online interactions were associated with an online purchase the intention of e-cigarette in Facebook. Public health researchers and policymakers might contemplate the regulatory environment of online marketing of e-cigarettes to curtail the uptake of e-cigarettes among non-smokers.

The popularity of e-cigarette is growing worldwide. Its health hazards and role in smoking cessation is controversial. There is no doubt that health care professionals can play a vital role in assisting patients who wish to use e-cigarettes to quit smoking but there is a gap in the evidence. The present study aimed to reveal the perception of e-cigarettes as a quit smoking tool and its health hazards among physicians in Bangladesh. A cross-sectional study was conducted by means of a survey via self-administered structured questionnaires in Bangladesh. Data was collected from September 2019 to February 2020 and analysed by descriptive frequency and chi-square test using SPSS. A total of 145 physicians have participated in this study, 88.9% provided professional advice on quit smoking to their patients. Total 51.7%, 51.9%, 41.3%, 52.4%, 42.8%, and 47.6% physicians mentioned that e-cigarettes may cause throat irritations, cough, headache, dryness of mouth, cardiovascular disease, and cancer respectively. Chi-square test revealed that there is no association between a physician’s professional advice for quit smoking and perception of e-cigarettes as a smoking cessation tool. The physician’s perception of e-cigarettes is crucial for reducing any type of tobacco consumption. Evidence based e-cigarette related public health intervention for physicians are required to mitigate the use of e-cigarette to quit smoking.