International Journal Of Community Medicine And Public Health

Investing in preventive and promotive mental health: a call for public financing reform in India’s primary health care

Balasankar J. M. — 2025-12-31

Mental health is a critical aspect of overall well-being, yet it imposes a significant burden on healthcare systems globally. In India, one in eight individuals suffers from mental disorders, with anxiety and depression being the most prevalent. Despite policies emphasizing comprehensive, community-based support, budgetary trends disproportionately prioritize palliative-rehabilitative care over preventive and promotive measures. This article highlights the challenges of translating policy visions into actionable, fundable programs, given that mental health allocations constitute less than 1% of the national budget. It emphasizes the need for strengthening intersectoral collaborations, optimizing resource allocation, and fostering innovative research to evaluate cost-effective interventions. Prioritizing preventive and promotive mental healthcare is essential to address the escalating burden of mental health conditions. Achieving equitable and sustainable mental health outcomes in India requires integrating services and funding across sectors while ensuring robust policy implementation and community-based care.

From depression to hypomania: antidepressant-triggered switching in a bipolar patient with phenotypic mitochondrial features

Parinda Parikh — 2025-12-31

Antidepressant-induced mania (AIM) is a recognized complication in bipolar disorder, particularly in patients with neurobiological vulnerabilities. Mitochondrial dysfunction, which impairs neuronal energy metabolism, has been implicated in both bipolar pathophysiology and antidepressant sensitivity. We report the case of a 25-year-old woman with bipolar disorder who presented with a two-month history of worsening depressive symptoms. Her medical history included exercise intolerance since adolescence, recurrent migraine headaches. Given her persistent low mood, sertraline was initiated. Within 10 days, she developed pressured speech, decreased need for sleep, and increased goal-directed activity, consistent with hypomania. The antidepressant was discontinued. She remains stable on lurasidone with maintenance ketamine infusions every 7 weeks. This case illustrates the potential role of mitochondrial dysfunction as a biological amplifier for polarity switching in bipolar disorder. Systemic features of mitochondrial impairment may warrant greater caution with antidepressant use, with emphasis on mood stabilizer-centered regimens and close monitoring for early signs of mood elevation.

Unique cardiac involvement in a patient with squamous cell lung cancer

Ragad A. Alwakeel — 2025-12-31

Cardiac metastasis from lung tumors is rare, and often asymptomatic, making diagnosis challenging. Herein this report presents a case of a 69-year-old male with squamous cell carcinoma of the lung with cardiac metastasis to the left ventricle. Two days post chemotherapy, he developed symptoms of chest pain and mild hemoptysis. An electrocardiogram revealed ST-segment elevation in the inferior leads, suggesting a possible inferior ST-segment elevation myocardial infarction (STEMI). His symptoms improved with Nitroglycerin, and prescribed calcium channel blockers, and long-acting nitrates. The symptoms were confirmed to be attributed to an atherosclerotic plaque. This case highlights the challenge of differentiating between coronary artery disease and cardiac symptoms, and emphasizes the necessity of thorough investigation in cancer patients with cardiac symptoms.

Evaluation of risk factors for gestational diabetes mellitus among women attending maternity and children’s hospital in Bisha, Saudi Arabia

Atheer H. Alqarni — 2025-12-31

Background: This study evaluated the prevalence and risk factors associated with gestational diabetes mellitus (GDM) among women attending the maternity and children’s hospital in Bisha, Saudi Arabia. The goal was to identify risk factors for GDM and explore the experiences and challenges women face in managing the condition.

Methods: A cross-sectional hospital-based study of 390 females was conducted in 2024. The qualitative and quantitative study captured sociodemographic characteristics, medical history, and qualitative insights into women’s experiences with GDM.

Results: The gestational diabetes rate was 16.4% among the studied group. The study identified younger age (OR=2.15, 95% CI: 1.12-4.10, p=0.021), underweight BMI (OR=3.27, 95% CI: 1.41-7.62, p=0.005), obese women (OR=1.95, 95% CI: 1.19-3.21, p=0.009), premature delivery (OR=1.65, 95% CI: 1.08-2.58, p=0.024), family history of diabetes (OR=1.74, 95% CI: 1.01-3.00, p=0.048), and hypothyroidism (OR=2.84, 95% CI: 1.67-4.81, p=0.001) as significant risk factors for GDM. Women expressed stress, lack of understanding, and an urge for better support and communication with their care providers. They also mentioned problems in adhering to dietary restrictions and coping with social interactions.

Conclusions: The research highlighted the importance of education, the role of health care guidance, and communication, to address the emotional and practical challenges that GDM faces. Addressing these areas is essential for enhancing maternal and child health outcomes.

Determinants of the occurrence of acute respiratory infections in under five children in South-Eastern Benin in 2023

Lamidhi Salami — 2025-12-31

Background: Acute respiratory infections are among the leading causes of morbidity and mortality in children under five years, particularly in low- and middle-income countries. This study aimed to estimate the prevalence of ARIs and to identify the determinants of their occurrence in children under five in the Sado arrondissement (or borough) in Benin.

Methods: This was an analytical cross-sectional study involving 131 children under five years and their mothers recruited by convenience sampling in the community and at the Sado health centre using the integrated management of childhood illness (IMCI) register. Data collected through a questionnaire were analysed using STATA version 14. The primary outcome was the occurrence of acute respiratory infections in the child. Associations between independent variables and the occurrence of acute respiratory infections were explored using bivariate analyses and multivariate logistic regression at a 5% significance threshold.

Results: The prevalence of acute respiratory infections was 64.12% (95% CI=55.45-71.95%). The determinants for the occurrence of acute respiratory infections were: mother’s marital status (OR=6.06; 95% CI=1.59-23.02; p=0.008), number of people living in the household (OR=0.34; 95% CI=0.12-0.94; p=0.038), cooking meals inside the rooms of the house (OR=0.39; 95% CI=0.16-0.91; p=0.030) and living near a dusty road (OR=3.19; 95% CI=1.18-8.58; p=0.022).

Conclusions: The high frequency of acute respiratory infections in Sado and the influence of sociodemographic and environmental factors underscore the necessity for integrated interventions. Strengthening mother’ awareness and control measures targeting these factors (housing conditions, exposure to domestic and environmental pollutants, social determinants) will sustainably reduce the burden of acute respiratory infections in children under five years.

Factors influencing the choice of healthcare provider among Riyadh residents: the role of social media and marketing strategies

Khalid Khulaif E. Alanazi — 2025-12-26

Background: In Riyadh, people are increasingly choosing healthcare providers through digital channels, in addition to traditional trust sources. In this study, we examined the factors influencing provider choice and how search engines, social media, online reviews and marketing affect clients' decision-making processes.

Methods: Authors conducted a cross-sectional survey among residents of Riyadh using a structured Arabic questionnaire distributed online. We employed a quota-guided, stratified convenience sampling approach based on gender, age, education and income. We provided descriptive statistics, chi-square tests and ANOVA. We also looked at correlations between digital influence and provider choice outcomes.

Results: The most important factors for choosing a provider were perceived clinical quality (74.9%), provider reputation (68.0%) and access to specialized physicians (63.2%). Cost (50.2%), location/accessibility (46.1%) and insurance coverage (45.2%) also played significant roles. Personal recommendations were the primary source of information (80.8%), followed by online ratings/reviews (53.9%) and official provider websites (38.1%). Google was the primary source of healthcare information (79.2%), while social media primarily raised awareness and assisted with initial shortlisting. People were cautious about advertisements and unverified reviews, often reporting “fake reviews” and “paid advertising” as significant challenges (66.4% and 65.1%, respectively). Choosing a provider based on social media ads/reviews was more common among females, employed individuals, insured participants and higher-income groups (p<0.05 for each).

Conclusions: Digital channels have a significant impact on the discovery and shortlisting of providers in Riyadh. Improving service quality, increasing the availability of specialists, providing transparent pricing and ensuring the authenticity of reviews could enhance patient decision-making and trust.

Awareness and perception of human papillomavirus and HPV vaccination and its program among reproductive-aged women in Taunggyi Township, Southern Shan State: a cross-sectional study with mixed-methods

Yin Yin Htwe — 2025-12-31

Background: In Myanmar, cervical cancer is the second leading cause of cancer-related deaths among women. The effective prevention strategies are human papillomavirus (HPV) vaccination and screening programs. This study aimed to identify awareness and perception of HPV and HPV vaccination, and its program among reproductive-aged women.

Methods: A cross-sectional study with mixed-methods was conducted at Taunggyi Township, Southern Shan State. About 340 reproductive-aged women from rural and urban areas were face-to-face interviewed. Two FGDs were conducted in selected areas.

Results: Most respondents (322, 94.7%) heard of HPV, but knowledge of HPV infection, and its preventive measures were very low. Perception of HPV infection and its vaccination was good. The primary source of information about HPV and its vaccine was healthcare providers (70%), social media (14%) and teachers (8%). Common barriers to HPV vaccination were cost and lack of information. Respondents’ residence (p=0.018, 95% CI=0.06-0.08) and income (p=0.003, 95% CI=1.47-92.0) were the associated factors of knowledge of HPV, while education status (p=0.004, 95% CI=1.39-6.45) and own HPV vaccination status (p=0.031, 95% CI=1.07-1.16) were significantly associated with perception of HPV. Only respondents’ income was statistically significant with knowledge of HPV vaccination (p=0.001, 95% CI=1.03-1.11). As a result of thematic analysis, the overall information towards HPV vaccination program was satisfactory, despite the knowledge gap.

Conclusions: This study indicated the need for targeted public health interventions that address knowledge gaps, enhance the opportunity for the role of healthcare providers and teachers and promote the HPV vaccination program by increasing accessibility and fostering community engagement.

Determinant of stunting among children aged 6-59 months in Kapenguria ward of West Pokot County, Kenya

Emily C. Sitienei — 2025-12-31

Background: According to the 2022 Kenya Demographic and Health Survey, 18% of children under 5 years in Kenya were stunted, with West Pokot County recording the second-highest prevalence at 34%. Nevertheless, there is a lack of robust evidence explaining the persistent factors contributing to these high levels of stunting. This study, therefore sought to assess the prevalence and predictors of stunting among children aged 6-59 months in Kapenguria Ward, West Pokot County, Kenya.

Methods: This cross-sectional study was conducted among 517 caregivers of children aged 6-59 months selected through multistage sampling. Data were collected using structured interviewer-designed questionnaires and analysed in SPSS. Descriptive statistics summarized participant characteristics. Associations were assessed through chi-square and t-tests and significant variables (p<0.05) were entered in a binary logistic regression to determine the predictors of stunting at 95% CI. Qualitative component involved thematic analysis to explore insights.

Results: Findings showed a 32.3% stunting rate. Significant predictors of stunting were household income (OR=0.314, CI=0.181-0.545, p=0.001) and phone ownership (OR=0.627, CI: 0.410-0.959, p=0.031). Child’s age (overall wald X2=19.515, p=0.001), breastfeeding status (OR=0.456, CI=0.286-0.729, p=0.001) and vaccination card ownership (OR=0.463, CI=0.299-0.718, p=0.001) were also significant factors influencing child stunting.

Conclusions: Stunting level in Kapenguria Ward has slightly decreased compared to 2022 rates, although still comparatively high as per WHO thresholds. These results highlight the necessity of multisectoral interventions, including poverty reduction, improved maternal-child healthcare and full child vaccination.

Knowledge, attitude, and practice of antenatal care among pregnant women: a community-based cross-sectional study in Bosaso, Puntland, Somalia

Elmi O. H. Elmi — 2025-12-31

Background: Antenatal care (ANC) is a crucial component of maternal health services, aiming to ensure the health of both the mother and the newborn during pregnancy. It serves as a comprehensive health service designed to detect, prevent, and manage complications during pregnancy, ultimately promoting positive maternal and neonatal outcomes.

Methods: A community-based cross-sectional study, conducted from February to May 2024 in Bosaso, Somalia, aimed to assess the knowledge, attitudes, and practices regarding ANC among pregnant women. A total of 384 participants were selected using clustered and systematic sampling from four villages in Bosaso. Data was collected through a structured pre-tested questionnaire and analyzed using statistical package for the social sciences (SPSS) version 21. Descriptive statistics, frequencies, and percentages were computed to assess ANC knowledge, attitude, and practice levels and correlation tests were conducted to explore associations between them.

Results: Most respondents were aware of ANC services (86.5%), with healthcare providers as the primary information source (46.4%). While many recognized the importance of ANC checkups (89.3%) and followed recommended practices, only 17% adhered to the ideal frequency of four or more visits. Statistically significant correlations were found between knowledge, attitude, and practice (p<0.01), indicating that awareness positively influences ANC practices.

Conclusion: This study highlights that the adherence to recommended visits remains low. A significant gap exists between ANC initiation and completion, with barriers to access and awareness. Strengthening knowledge, attitudes, and targeted interventions, such as community support and mobile reminders, could improve ANC utilization and maternal health outcomes.

An observational study of monitoring vital signs in children admitted to Ward 2 at Ola During Children’s Hospital, Freetown: an insight into the quality of nursing care

Abdulai Turay — 2025-12-31

Background: Reliable paediatric vital-signs monitoring enables early detection of deterioration, yet adherence varies in low-resource settings. To quantify ODCH nurses’ monitoring practices, protocol adherence and equipment/workflow barriers; and to examine factors associated with compliance.

Methods: Descriptive cross-sectional survey of nurses at Ola During Children’s Hospital, Freetown (25–30 August 2025). Consecutive sampling enrolled N=50 eligible nurses. A structured questionnaire captured practice, awareness/training, equipment and perceptions. Outcomes were protocol compliance (Always/Often) and a Vital-Signs (VS) Monitoring Index (0–1). Analyses used χ² with Cramér’s V, t-tests and Spearman’s ρ (α=0.05).

Results: Consistent monitoring was highest for temperature 98%, pulse 88%, respiratory rate 86%, SpO₂ 78%, but lower for blood pressure 42% and pain score 10%. Protocol compliance=58% (Always 48%, Often 10%), documentation “Always” =72%. VS Index: mean 0.67, SD 0.22. Guideline awareness strongly predicted compliance (χ² (1) =15.25, p=0.0001, V=0.552); recent training showed a medium association (χ² (1) =6.91, p=0.0086, V=0.372). Frequently reported barriers included lack of equipment 76%, high patient load 68% and inadequate staffing 68%; facilitators were functional equipment 73.5%, training 72%, adequate staffing 68% and clear protocols 52%. Several comparisons were non-significant, likely reflecting limited power (N=50).

Conclusions: Core observations are performed consistently at ODCH, but blood pressure and pain assessment are major gaps. Strengthening guideline uptake via brief, repeated training; ensuring child-appropriate BP cuffs and validated pain scales; embedding WHO-aligned frequency job aids/PEWS, and improving equipment readiness are feasible, high-yield steps to enhance monitoring reliability and patient safety.

Genotypic characterization and antibiofilm formation of resistant Escherichia coli isolates causing urinary tract infections among pregnant women at Kisii, Kenya

Simba M. Sosmus — 2025-12-31

Background: Urinary tract infections (UTIs) during pregnancy are among the most common infections worldwide, leading to poor perinatal and maternal outcomes. This study aimed at profiling ESBL-resistant genes and deducing the antibiofilm formation activity of Escherichia coli isolates obtained from pregnant women against the commonly used antibiotics.

Methods: Hospital-based cross-sectional study was conducted from March to June 2020, total of 199 pregnant women were involved. Mid-stream urine samples were collected and cultured on CLED at 37ºC overnight. Positive growths were biochemically analysed for the E. coli isolates identification, drug susceptibility tests were conducted by Kirby Bauer disc diffusion technique and the PCR technique was used to detect the ESBL genes. The antibiofilm formation was analyzed using the ordinary one-way ANOVA Dunnett’s multiple comparison tests (GraphPad Prism, version 9.3) and data was presented in bar graphs.

Results: Out of the positive growth, 28 (23.5%) isolates, E. coli species demonstrate resistance to selected antibiotics. From 12 (42.9%) isolates that shows high drug resistance were investigated for ESBL gene profiling, where 8 (42.1%) of them had blaCTX-M, 6 (31.6%) had blaTEM and blaSHV 5 (26.31%) and 8 (66.7%) showed the ability to form antibiofilm against the commonly used antibiotics with 91.66% statistical significance at different levels.

Conclusions: The MDR for commonly prescribed drugs and the high prevalence of bacterial UTI were observed with a significant number of ESBL producers. In light of these findings, biofilm formation with antimicrobial resistance genes in urinary tract infection may lead to difficult-to-treat infections.

Sanitation practices and health outcomes among undergraduates in a tertiary institution: a cross-sectional study in the middle belt

Oshimagye Victor Oye — 2025-12-31

Background: Globally, inadequate sanitation behaviours have accounted for numerous health risks. World Health Organization (WHO) reports that poor sanitation contributes to spread of diseases such as diarrhoea, cholera, and typhoid, which are responsible for a significant burden of morbidity and mortality, particularly in low- and middle-income countries in the world.

Methods: A cross-sectional descriptive study was carried at Benue State University, Makurdi, Nigeria, with a multistage sampling technique. Data was collected and analysed using SPSS (version 20.0).

Results: We observed insufficient handwashing facilities at strategic locations on campus (86.6), with inadequate awareness and education on sanitation behaviours, accounting for the improper sanitation among the students. Also, inadequate sanitary facilities such as insufficient number of clean and well-maintained restrooms (52.7%), poor waste management system as a result of insufficient waste collection and disposal services on campus (46.0%) as a result of lack of strict enforcement of sanitation rules and policies (41.8%) all were major contributing factors.

Conclusions: Accommodation and sanitation facilities in halls and hostels were found to be inadequate. Some reasons for the poor state of some of the facilities found in our study includes absent sanitation rules and policies on campus, lack of awareness campaigns or programs on campus to promote better sanitation behaviours, among others; were found to contribute significantly to the poor state of sanitation on campus.

Socioeconomic status and health awareness predictors of cervical cancer screening uptake among women aged 25-49 years in Kiambu sub-county, Kenya

Joyce W. Gachumi — 2025-12-31

Background: Cervical cancer is a major public health concern in Kenya, accounting for 12% of all cancer cases and being the leading cause of cancer-related deaths. This study aimed to identify the socioeconomic status and health awareness determinants of cervical cancer screening uptake among women aged 25-49 years in Kiambu town sub-county, Kiambu County, Kenya.

Methods: A descriptive cross-sectional design was used in this study, where both qualitative and quantitative data were obtained for purposes of triangulation. Multi-stage sampling technique was utilized to select study participants. Both chi-square and binary logistic regression were used to identify socioeconomic status and health awareness determinants associated with cervical cancer screening uptake. SPSS version 29 was used in quantitative data analysis. The cutoff for statistical significance was p≤0.05. Qualitative data were analyzed thematically.

Results: Cervical cancer screening uptake was at 40.2%. Earning between Ksh 20,001-30,000 (OR=5.4, 95% CI; 2.074-6.464, p<0.001), being married (OR=1.8,95% CI; 1.343-9.790, p=0.03), awareness of cervical cancer (OR=2.4, 95% CI; 1.342-4.122, p=0.003), and awareness of signs and symptoms (OR=1.5, 95% CI; 1.154-2.704, p=0.01) increased the odds of cervical cancer screening. Conversely, younger women aged 25-29 years (OR=0.22, 95% CI; 0.243-0.846, p=0.023) had reduced odds of cervical cancer screening uptake.

Conclusions: The uptake of cervical cancer screening was low among women aged 25-49 years in Kiambu sub-county. Awareness of cervical cancer signs and symptoms, awareness of cervical cancer, study respondents’ age, marital status income were socioeconomic status and health awareness predictors of cervical cancer screening. Efforts should be put in place to enhance awareness of cervical cancer.

A qualitative exploration of traditional medicine use in maternal health: experiences of healthcare providers in selected health care facilities in Zambia

Wanga Zulu — 2025-12-31

Background: Traditional medicine (TM) remains widely used by women in Zambia, especially during pregnancy and childbirth. Over the past years, researchers have tried to address the safe integration of TM in maternal health. Use of traditional medicine remains a dilemma to the Health Care Workers (HCWs) who have limited or no knowledge on the effects. This study explored the experiences of healthcare workers regarding use of traditional medicine among women during maternal healthcare.

Methods: A phenomenological design was conducted in Lusaka, Solwezi and Kaoma districts of Zambia between November 2020 and February 2021. In-depth interview (IDI) guide was used to collect data. A total of 80 HCWs participated in the study, of which majority (n=62) were Front line HCWs working in the Maternal health units and the remainder were Policy makers and programme coordinators serving at district, provincial and national level (n=18). Thematic analysis was used to identify key themes.

Results: HCWs reported mixed experiences. While some acknowledged the cultural significance of traditional practices, many raised concerns about their harmful effects, particularly during labor and delivery.

Conclusions: The study was observed a multifaceted mixture of cultural, personal and systemic constraints regarding use of traditional medicines in general. These findings confirm presence of a complex, tension-filled terrain shaped by systemic gaps, cultural beliefs and professional vulnerabilities spread across rural urban contexts in this population.

Utilization of child spacing services and associated factors among riverine Somali communities in Mandera County, Kenya

Hassan M. Odo — 2025-12-31

Background: Child spacing services are a range of healthcare and counselling services supporting one in making informed decisions about timed and spaced children. According to Kassim and Ndumbaro found that reproductive health (RH) right enable partners to decide to have or not to have children, number of children and when to do so.

Methods: A descriptive cross-sectional design study conducted in Mandera County between July 2024 to December 2024. SPPS version 25 was used for statistical analysis. Chi-square test was used to assess relationships between variables at a level of confidence of 95%.

Results: Results showed that the age of participants showed a statistically significant association with the uptake of child spacing services (p=0.014). Educational level attained was statistically linked with uptake of child spacing services (p=0.036), occupation (p=0.006), and number of children (p=0.028). However, the nuptial status did not show a significantly statistical linkage with the uptake of child spacing services (p=0.177). There was statistical relationship between knowledge level with the uptake of child spacing services (χ2=6.476, p=0.039). Religion, decision maker, threats by partner and stigma were social cultural factors that significantly affected uptake of child spacing services with a p<0.05.

Conclusions: The study further concludes that socio-demographic factors including age, educational level, occupation and number of children were significantly associated with uptake of child spacing services. Religion, decision makers, threats from partner and stigma were associated factors that influence uptake of child spacing services.

Knowledge, attitude, and practices of thalassemia amongst urban community members: a cross-sectional study

Besher Shami — 2025-12-31

Background: Thalassemia is a global health concern due to its high prevalence and the absence of a cure. Around the world, there are approximately 100 million carriers of beta-thalassemia, with roughly 100,000 of them being children. A KAP study on thalassemia can provide valuable insights into the perceptions, and behaviors of Pakistani individuals, communities, or healthcare professionals related to the disease.

Methods: We conducted a descriptive cross-sectional study in Rawalpindi, Pakistan. After taking consent, data was collected from 368 individuals, through a mixed-mode questionnaire that was administered both online and in person, from July 2^nd, 2023 to August 30^th, 2023. Data was collected and cleaned in excel and then imported into IBM^® SPSS v27 statistical package.

Results: Data was gathered from 368 individuals with 168 (43.8%) males and 206 (55.7%) females. The mean age of the participants was 34.57±13.19. Independent Samples T-test showed no significant difference in KAP Scores between both genders (p= 0.448). One-way ANOVA showed significant differences among different education level (F-statistic= 40.45, p=0.02). Lastly, bivariate correlation analysis between Age and KAP Scores showed a negative weak correlation (Coeff. = -0.25, p= 0.01).

Conclusions: The population mean scores for knowledge were 5.95±3.200 out of 12, for attitude, 6.40±2.032 out of 10, and for 3.49±1.526 out of 6. Higher Education led to higher KAP scores. Lastly, age was seen to negatively affect KAP scores, with higher KAP scores pertaining to thalassemia seen in younger individuals.

Effect of school-led total sanitation intervention on school attendance among pupils in primary schools within Baringo County, Kenya

Phanice K. Omari — 2025-12-31

Background: School attendance critically determines educational outcomes, especially in resource-constrained settings. Poor sanitation and hygiene cause illness-related absenteeism in primary schools. This study evaluated the impact of school-led total sanitation (SLTS) intervention on pupil attendance in Baringo County, Kenya.

Methods: A pre-post quasi-experimental design with non-equivalent control groups was conducted in six primary schools across two sub-counties in Baringo County. Three Mogotio Sub-County schools received SLTS intervention; three Baringo South Sub-County schools served as controls. Using multistage sampling, 440 pupils from grades 4-7 were enrolled. SLTS intervention included health club establishment, triggering, and health education. Data were collected at baseline and post-intervention using questionnaires and headteacher key informant interviews. School attendance was measured as absence in the previous two weeks, with chi-square analysis at p<0.05.

Results: At baseline, absence rates were similar between intervention (22.6%) and control (26.1%) schools (χ²=0.739, p=0.390). At the endline, intervention schools improved to 20.6% absence rates while control schools declined to 28.7%. However, this difference was not statistically significant (χ²=3.823, p=0.051). Illness remained the primary cause of absenteeism across groups (>70%), with no significant differences in illness-related absences or specific conditions, such as diarrhoea and respiratory diseases, between groups. School feeding programs strongly motivated attendance, while cultural practices, gender roles, and environmental factors acted as barriers.

Conclusions: School-led total sanitation intervention did not significantly improve attendance in the study. School absenteeism is multifaceted with multiple contributing factors. While SLTS may create enabling environments, comprehensive approaches addressing multiple absenteeism determinants are needed for meaningful attendance improvements.

Multilevel modelling of the predictors of malaria among under-five children in Nigeria: how do housing types and source of drinking water count?

Chukwuechefulam K. Imo — 2025-12-31

Background: Malaria remains a major public health issue, especially in sub-Saharan Africa (SSA), which still bears the brunt of the disease, with under-5 children disproportionately affected and Nigeria being one of the countries severely impacted. The study investigated predictors of malaria among under-5 children in Nigeria, with special focus on the impacts of housing types and source of drinking water.

Methods: Data analysis covered a weighted sample of 9,946 under-5 children from the 2021 Nigeria Malaria Indicator Survey. Descriptive and analytical analyses were conducted, including frequency distributions and logistic regression models at the multivariate level, using Stata software (version 15).

Results: The results showed that over half of the children lived in improved houses (53.67%) and nearly three-quarters (74.75%) had access to improved drinking water. However, more than half (54.41%) were still exposed to malaria risk. Children living in houses built with improved materials had a 32% (aOR: 0.68, CI: 0.53-0.87) lower risk of malaria compared to those in unimproved houses. Additionally, those with access to improved drinking water sources had a 15% (aOR: 0.85, CI: 0.67-1.06) reduced risk of malaria infection.

Conclusions: The study established a high malaria prevalence among under-5 children, even among those living in improved houses. Also, improved housing quality and access to clean drinking water significantly reduce the risk, highlighting the importance of environmental factors in preventing malaria. Policymakers should focus on enhancing housing and environmental conditions to prevent malaria, prioritising better homes, clean water access, and comprehensive prevention strategies, especially for high-risk areas and under-5 children.

Satisfaction level of patients admitted in medical wards of a tertiary care hospital regarding medical care provided by doctors and nurses: a cross-sectional study

Muhammad Owais — 2025-12-31

Background: Patient satisfaction in medical wards is influenced by various factors, such as hospital environment, length of stay, previous admissions, treatment cost, and discharge process. These aspects, including privacy, communication, and explanations provided to patients, significantly impact their overall care experience.

Methods: A cross-sectional study was carried out at Nishtar Hospital, Multan, from April 15, 2025, to July 15, 2025. Using non-random convenient sampling, approximately 184 patients admitted to medical wards were studied. The focus was on evaluating the care provided by doctors and nurses.

Results: A survey of 184 patients revealed varying satisfaction levels with doctors and nurses. Using a Likert scale, patients rated care aspects, with doctors generally receiving higher satisfaction scores than nurses.

Conclusions: Patients expressed greater satisfaction with doctors’ services than nurses. Key areas for improvement in nursing care include communication and responsiveness.

Predictors of quality of life among informal caregivers of patients with advanced cancer in palliative care: a cross-sectional study

Eranthi Weeratunga — 2025-12-31

Background: Family members and informal caregivers (ICs) have been suffering many problems, issues, and burdens, which impact the quality of life (QoL). Improving the QoL of ICs is a key aspect of palliative care (PC). This study aimed to determine the predictors of QoL among ICs of patients with advanced cancer in PC.

Methods: This cross-sectional study included 422 ICs who were selected conveniently and attended the PC unit and clinics at Apeksha Hospital, Maharagama, Sri Lanka. An interviewer-administered questionnaire, which included socio-demographic and clinical characteristics, was used to collect data. QoL of ICs was assessed using the validated WHOQOL-BREF scale; higher scores indicated higher QoL. Descriptive and inferential statistics were used.

Results: The mean±SD age of the ICs was 43.13±14.92. The majority of ICs and patients were female. The mean WHOQOL‐BREF domain scores of ICs were 26.56±12.30 for physical health, 20.64±3.23 for psychological status, 10.03±1.60 for social relations, and 24.76±3.72 for the environmental domain. Predictors of QoL among ICs were age (p<0.01), religion (p<0.01), education (p<0.05), family income (p<0.01), care level (p<0.01), physical illnesses (p<0.01), emotional strain (p<0.05), self-reported general health (p<0.01), medical conditions (p<0.05), psychological conditions (p<0.01), comorbidities (p<0.05), and family/friend support (p<0.05).

Conclusions: The physical QoL was considerably high, while all domains among ICs were impaired. It is recommended to consider the predictors of QoL of ICs comprehensively who live in third-world developing countries. Sri Lankan healthcare professionals must ensure that ICs have overall well-being and receive the proper support/resources to care for their patients.

Perception of medical students about their educational environment and anxiety evaluation among them: a cross-sectional descriptive study

Rizwana Riaz — 2025-12-31

Background: Perceptions of the educational environment and satisfaction with one's major significantly influence the preparedness of medical students for their professional careers. Anxiety, often prevalent among students, further impacts academic performance and mental well-being. This study aimed to assess medical students’ perceptions of their educational environment and to evaluate anxiety levels among them.

Methods: A cross-sectional descriptive study was conducted from January 2025 to June 2025 across various universities. The study included undergraduate medical students from the first to final year who had completed at least five months of study. Data were collected using the Dundee ready education environment measure (DREEM) scale to assess educational environment and the generalized anxiety disorder (GAD) scale for anxiety evaluation.

Results: Out of 200 participants, 61.5% were female and 38.5% were male. The majority were from clinical years (71.5%). Most students reported positive perceptions of their educational environment. However, a significant portion exhibited mild to moderate levels of anxiety. The average perception and anxiety scores varied across academic years. A significant association was found between perception and the field of study, while no association was found between anxiety and variables like age or gender.

Conclusions: Most students perceived their educational system positively, especially in areas related to teachers and academic atmosphere. However, a considerable number of students experienced anxiety, highlighting the need for enhanced support systems and coping skills among medical students.

Intrinsic capacity declines and fall risk among older adults: an integrated care for older people-based assessment at an urban health training centre in Western Maharashtra

Sakshi Sharma — 2025-12-26

Background: Intrinsic capacity (IC), defined by the world health organization (WHO) as a composite of all physical and mental capacities of an individual, is central to healthy ageing. The WHO integrated care for older people (ICOPE) step 1 screening tool is a rapid, feasible approach to detect early declines in locomotion, cognition, vitality, sensory function and psychological well-being. Indian evidence from primary care settings, especially urban health training centres (UHTCs), remains limited. To assess the prevalence of IC declines using the WHO ICOPE Step 1 tool among older adults attending an UHTC in Pune, and to determine associated factors.

Methods: A cross-sectional study was conducted among 120 older adults (≥60 years) attending the UHTC in Pune. Consecutive sampling was used. Data were collected using a structured questionnaire including socio-demographic factors, chronic diseases, falls, functional ability and the WHO ICOPE Step 1 screening tool.

Results: The mean age of participants was 68.9±6.4 years; 54.2% were female. IC decline was present in 72.5% of older adults. Domain-wise declines were: sensory (52.5%), locomotion (48.3%), psychological (35%), cognition (31.7%) and vitality (28.3%). Age ≥70 years (OR 2.1; p=0.04), multimorbidity (OR 2.3; p=0.03) and ≥1 fall in past year (OR 3.0; p=0.01) were significantly associated with IC decline. ADL/IADL dependence was reported in 41.6% of those with declines.

Conclusions: IC decline is highly prevalent among older adults attending the UHTC in Pune. The ICOPE step 1 tool is practical and effective for community and primary care screening.

Perceptions and responses to climate change: a community-based study in Assam, India

Ajit K. Dey — 2025-12-26

Background: Assam is among India’s most climate-sensitive regions, facing rising temperatures, erratic rainfall, floods, and landslides. These environmental changes significantly affect health, livelihoods, agriculture, and access to essential services. Understanding community perceptions and responses is crucial for designing effective, locally appropriate climate-adaptation strategies. This study aimed to assess community awareness and perceptions of climate change, its impacts on health and livelihoods, and the coping and adaptation strategies used by households in five climate-vulnerable districts of Assam.

Methods: A community-based cross-sectional mixed-methods study was conducted in Cachar, Hailakandi, Karimganj, Dima Hasao, and Karbi Anglong districts between May and November 2024. Quantitative data were collected from 200 participants using a structured questionnaire covering socio-demographic characteristics, climate awareness, perceived environmental changes, climate-linked health issues, and adaptive capacity. Six focus group discussions were conducted to capture qualitative insights. Quantitative data were analysed using descriptive statistics and logistic regression; qualitative data were analysed thematically and triangulated with survey findings.

Results: Of the participants, 65% were aware of climate change, with education emerging as a strong predictor of awareness (aOR=2.8, 95% CI: 1.3–6.2). A large majority (88%) reported more intense heatwaves, and 90% noted an increase in summer diseases. However, only 35% perceived increased disease during the rainy season. Respondents reported significant impacts on agriculture, water availability, livelihood stability, and healthcare access during floods and landslides. Qualitative findings reinforced these perceptions and highlighted limited knowledge of early warning systems and government adaptation measures.

Conclusions: Climate variability significantly affects health and livelihoods in Assam. Strengthening climate-resilient health systems, improving risk communication, and integrating local knowledge into adaptation planning are essential.

Perception of medical graduates towards government service, as a career option after graduation, in a medical college in the Bundelkhand region

Sudha Sharma — 2025-12-31

Background: Medical students generally opt for post-graduation/specialization before starting their working and take several attempts to clear their NEET-PG entrance exams. Even after several attempts all students do not get a seat of their choice and for those who want to work after MBBS, joining government service (PMS) can be one of the feasible options. This research paper wishes to determine the attitude of medical graduates and their willingness to join government service immediately after graduation.

Methods: A cross-sectional study was planned in April 2024 to May 2024, in MLB Medical College, Jhansi. All recently passed medical graduates who consented (eighty), were included in the study. A schedule was administered to enquire about their willingness to join service and the reasons for their choice. Chi square test was used to check for the associated factors.

Results: The mean age of participants was 25.38±2.2 years, 60% were males, 37.5% were from rural background, In the present study, 65/80 (81.3%) answered they would join a government job immediately after internship if offered one. The advantages mentioned were job security, a sense of purpose, diverse exposure and a fixed schedule. Issues of payment, less flexibility, transfers, no private practice , work place safety were highlighted. On applying chi-square test, mother’s education and father’s occupation were found to be significantly associated with accepting government job.

Conclusions: This study breaks the myth that medical graduates want to only opt for specialization policy makers can enable them to join these services and further the cause of universal health coverage.

Knowledge, attitude and practices regarding emergency first aid among management students in Northern India: a cross-sectional study

Indranil Samanta — 2025-12-26

Background: First aid is usually administered immediately after the injury occurs and at the location where it occurred consisting of a one-time, short-term treatment and requires little technology or training to administer. Studies have shown that 10-35% of post-accident deaths occur in the first 5 minutes and more than 50% occur in the first 30 minutes and 38% of deaths can be prevented on site if first aid treatment applied in the first five minutes.

Methods: The study was undertaken in a management institute to assess the knowledge attitude and practice of management students regarding emergency medical care, identify gaps for the same and give recommendations based on the findings.

Results: A total of 194 students participated in the study with a mean age of 36.89+8.11 years. The mean score in questionnaires pertaining to Knowledge was 13.87+2.6 (range 7 to 25). It was seen that there was a significant association between exposure to previous first aid training sessions and their knowledge (p=0.015). The attitude and practices of Management students was pro towards providing first aid.

Conclusions: The study identified key areas in which first aid knowledge was lacking. In line with the obtained results, Management students training on first-aid measures needs to be strengthened.

Impact of a child-to-child programme on knowledge, attitude and practices regarding tobacco hazards among government school children in urban Belagavi: an interventional study

Kalmeshwar Revagoud — 2025-12-26

Background: Tobacco initiation commonly begins during adolescence, making school-based preventive strategies essential. Peer-led and participatory approaches such as the child-to-child (CtC) method may enhance awareness and influence behavioural change. This study assessed the impact of a CtC educational intervention on knowledge, attitudes, and practices regarding tobacco use among government school children in urban Belagavi.

Methods: A pre- and post-test interventional study was conducted among 160 students from two government high schools. IX-standard students (trainers) were educated using structured sessions and subsequently trained VIII-standard students (trainees) following the CtC approach. A validated questionnaire assessed sociodemographic characteristics, knowledge, attitudes, and practices before and two months after the intervention. Wilcoxon signed rank test and Mann-Whitney U Test were used for analysis.

Results: Knowledge improved significantly in both groups, with trainers and trainees attaining post-test median scores of 17, compared to 11 and 9 at baseline (p<0.05). Attitude scores also improved markedly (trainers: 6 to 8; trainees: 3 to 8; p<0.05). Favourable attitudes toward tobacco avoidance increased substantially. Ever-use and past 30-day tobacco use decreased in both groups, while attempts to discourage tobacco use among family members increased. Awareness of environmental risk cues-such as tobacco sale points and anti-tobacco posters-also improved post-intervention.

Conclusions: The CtC approach effectively enhanced students’ knowledge, attitudes, and selected tobacco-related practices. Peer-led, child-centred strategies hold promise for strengthening school-based tobacco prevention initiatives and influencing family and environmental awareness.

Knowledge, attitude, and utilization of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana among general population of Bishnupur district: a cross-sectional study

Sandra Fernandez — 2025-12-26

Background: Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides healthcare to economically vulnerable populations, advancing Universal Health Coverage and supporting the sustainable development goals. This study aimed to assess the knowledge, attitude, and utilization of AB-PMJAY and to determine the associations between socio-demographic factors and knowledge, as well as between knowledge and attitude towards the scheme.

Methods: A cross-sectional study was conducted among the general population of Bishnupur district, Manipur (January 2023 to March 2024), using stratified multistage cluster sampling with proportional allocation. Data were collected through face-to-face interviews with a pre-tested questionnaire. Descriptive statistics, chi-square test, and binary logistic regression were employed.

Results: A total of 444 individuals participated in the study. Of these, 66.2% had heard of AB-PMJAY, of whom only 20.4% had adequate knowledge on AB-PMJAY, while a majority (86%) showed a favourable attitude, and 37.9% had utilized the scheme in the past year. Graduates (aOR: 4.972(2.42-25.42)), married individuals (aOR: 4.041(1.37-11.86)), homemakers (aOR: 4.585(1.44-14.52)), and those with chronically ill family members (aOR: 2.992(1.39-6.42)) had significantly higher odds of adequate knowledge on AB-PMJAY, while those from upper-middle (aOR: 0.241(0.10-0.64)) and middle socio-economic groups (aOR: 0.196(0.060-0.643)) had significantly lower odds compared to the upper class.

Conclusions: Despite over half having heard of AB-PMJAY, only two out of ten had adequate knowledge, eight out of ten had a favourable attitude, and four out of ten utilized it. Adequate knowledge was higher among graduates, married individuals, homemakers, and families with chronic illness, and was also significantly associated with a favourable attitude.

Understanding the dynamics of opioid substitution therapy retention: a qualitative analysis of injecting drug users in Chandigarh

Sukhbir Singh — 2025-12-31

Background: The World Health Organization (WHO) defines substance abuse as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Opioid substitution therapy (OST), which gradually and safely reduces an IDU’s opioid dependence. Several challenges at both structural and individual levels have arisen. Overcoming these hurdles is essential to fulfill the National AIDS Control Organization’s (NACO) mission to stop the spread of HIV. The present study aimed to identify the barriers to the OST program in Chandigarh and suggest strategies to overcome these challenges.

Methods: A community-based cross-sectional study was conducted among injecting drug users (IDUs) at the four OST centers in Chandigarh. The study employed a concurrent mixed-method approach.

Results: In this study, 81 respondents were surveyed, with 96.3% being male IDUs. The majority, 56.8%, were aged between 26 and 30 years, followed by 30.9% under 25 years. The most frequently injected drug was chitta (38.3%), followed by buprenorphine (9.9%), tapal (3.7%), and norphine (2.5%). With 66.7% of respondents indicated that time was an important and comfortable consideration to take OST. 65.4% of respondents indicated that the influence of OST influenced their decision to participate in the program. IDUs may leave OST follow-up if the dosage is inadequate to meet their needs. This can be a significant barrier to accessing OST.

Conclusions: This study underscored the necessity of a holistic approach to address the barriers to OST utilization among IDUs in Chandigarh. A comprehensive approach involving education, stigma reduction, increased treatment accessibility, and community involvement is crucial for enhancing the effectiveness of OST programs.

Compliance of bio medical waste management practices in a tertiary care teaching hospital in Northeast India

Samarpita Dutta — 2025-12-31

Background: The handling of medical waste has recently become a significant problem for all medical centres and healthcare organizations because of the risks it poses to both people and the environment. Objective was to evaluate the compliance of bio-medical waste management practices in different patient care areas in a tertiary care hospital of Agartala, west Tripura.

Methods: A cross-sectional study was conducted in a total of 58 patient care settings at Agartala Government Medical College for a period of fourteen days using a pre-validated checklist containing 20 items related to availability and condition of waste receptacles, segregation at source of generation frequency of removal of waste and 7 parameters for assessing needle handling practices.

Results: A total 58 patients care areas were evaluated. Maximum patient care areas (75.9 %), BMW guidelines were found displayed; in 65.5% patient care settings, location of chart was observed appropriate; and content of chart was readable in 63.7% user areas. Most of the user areas, the 4 colour coded bins were available ranging from 84.5% to 65.5%. About segregation of wastes, infected/soiled wastes were disposed of in yellow bins in 72.4% of user areas; Sharp glassware and metallic body implants were disposed of in blue bins in 81% of user areas; plastic materials were disposed of in red bins in 79.3% of user areas; and sharp wastes were disposed of in white bins in 60.3% of user areas.

Conclusions: The findings suggest that there is still need of improvement of BMW management practices in some user areas.

A comparative study to assess the nutritional status of preschool children attending the Anganwadi centres of selected urban and rural areas of Davangere

B. Rajeshwari — 2025-12-31

Background: Children are the foundation of a nation, and those in rural areas and lower socio-economic groups are vulnerable to malnutrition. This study aimed to evaluate and compare the nutritional status of preschool children and the socio-demographic factors affecting their growth in urban and rural Anganwadi centers (AWCs) of Davangere district.

Methods: An observational, descriptive, cross-sectional survey was conducted in year May 2023 to October 2024 in both urban and rural AWCs of the Davanagere district. A total of 120 children aged 3-5years children were selected using multistage sampling and were screened using anthropometric measurements such as height, weight and mid upper arm circumference. Socio-demographic information was collected using self-structured questionnaire. Data were analyzed using SPSS v20 with p<0.05. Descriptive statistics and chi-square tests assessed associations between nutritional status and dichotomized sociodemographic variables.

Results: In urban areas, 10% of children had moderate underweight and 5% had severe underweight, moderate stunting and severe stunting each, and 11.6% and 1.6% had moderate wasting and severe wasting respectively; whereas in rural areas, 6.6% had moderate underweight and 13.3% had severe underweight, 16.6% had moderate stunting and 5% had severe stunting, and 15% had moderate wasting with 5% showing severe wasting. Malnutrition was found to be associated with factors such as age of mother at marriage, family type, birth weight, breastfeeding practice, colostrum given and economic status of family.

Conclusions: Malnutrition exists in both settings, driven by maternal and socio-economic factors, warranting targeted interventions.

The impact of sleep quality and screen time on academic performances of students at University of Hyderabad: a cross-sectional study

Neha Chaudhary — 2025-12-31

Background: Sleep deprivation or low-quality sleep might influence mental, physical and cognitive functioning. And everyone being dependent on digital devices highlights excessive screen exposure, which leads to increased sleep problems, lower academic performances, and low self-esteem. However, this area needs to be explored more among university students. Hence, this study aimed to evaluate and establish a correlation between increase screen time, varying sleep quality and academic performance, as well as to assess the average screen time usage by students at University of Hyderabad.

Methods: In this cross-sectional study, a selection was made of 120 students from the age group 19-29 years, from January to April 2025, using convenience sampling. Data was collected using Pittsburgh sleep quality index (PSQI) tool and a self-structured questionnaire comprising of demographic details, screen time usage, and academic performance variables.

Results: The global PSQI score was calculated with 75.8% of respondents having poor/ low sleep quality (PSQI score >5). An average of 5.1 hours per day of screen usage was seen, with screen usage just before bed accounting for an average of 1.90 hours per day. A significant association was found between sleep quality and screen time with academic performance (p value <0.05), however, there no association was found between sleep quality and screen time (p value >0.05).

Conclusions: Sleep quality and screen time showed an association with academic performance. However, there was no significant association established between sleep quality and screen time.

Caregivers’ and stakeholders’ perceptions on treatment intervention of nutritional rehabilitation centre in Eastern India: a qualitative study

Angel Ivy Linda — 2025-12-31

Background: Severe acute malnutrition (SAM) prevalence in India has increased over the last decade. SAM children are admitted to nutritional rehabilitation centres (NRCs) for medical complications. NRCs have successfully achieved weight gain among SAM children; however, long-term weight gain is difficult to maintain. This study aimed to explore caregivers’ and stakeholders’ perceptions of the treatment interventions offered at NRCs in Bhubaneswar.

Methods: The research used qualitative methods, where nine in-depth interviews (IDIs) were conducted using a semi-structured interview guide among mothers of SAM children and their stakeholders. Transcripts from the recorded IDIs were prepared in English. ATLAS.ti version 7 software was used for in-depth thematic analysis using an inductive approach to generate top codes, sub-themes, and major themes. The study was approved ethically with written informed consent from the participants.

Results: The study found three major themes: perceived improvement in their child's health, a sense of being welcomed and cared for, challenging and unfamiliarity, along with a reluctance to accept intervention. Caregivers reported improvements in children’s health, including better adherence to daily routines, increased food intake, and notable weight gain. However, challenges included unfamiliarity with NRC environments, concerns about family care during their stay, and societal reluctance towards government health interventions. Stakeholders’ perspectives focused on the quality and effectiveness of services and interventions, and systemic hindrances to service provision.

Conclusions: Our findings suggest that community-level challenges persist in delivering NRC services. Public health measures are needed to increase awareness in the community about the prevention and management of SAM children.

Oral health related quality of life among elderly population in a rural field practice area of a government medical college in western Maharashtra

T. Basavaraj — 2025-12-31

Background: Oral health is a vital component of general well-being, particularly among the elderly. This study aimed to assess oral health-related quality of life (OHRQOL) and its socio-demographic determinants in a rural elderly population.

Methods: A cross-sectional study was conducted among 230 elderly residents aged 60 years and above in a rural field practice area of western Maharashtra. Data were collected using the geriatric oral health assessment index (GOHAI) and analyzed using SPSS version 20.

Results: The mean GOHAI score was 50.04±8.34. Poor OHRQOL (score <57) was observed in 75.2% of participants. Tobacco use emerged as a significant determinant of poor OHRQOL in the present study, with 82.9% of tobacco users reporting poor quality of life compared to 64.6% of non-users. Gender, age, education, occupation and co-morbidities showed no statistically significant associations. Although the relationship between income levels and OHRQOL in this study was not statistically significant, international literature has reported strong associations between socioeconomic status and oral health among older adults.

Conclusions: The study revealed a high prevalence of poor oral health-related quality of life (OHRQOL) among the elderly, with tobacco consumption being a key contributing factor. Community-based oral health interventions targeting modifiable risk factors are essential.

Long duration treatment of chronic insomnia in elderly shows poor cognition

Smita Singh — 2025-12-31

Background: Chronic insomnia is a common, underlined condition during old age. Long duration therapy for chronic insomnia leads to show symptoms of difficulty in day time functioning and other risk factors among geriatric population.

Methods: An observational, cross-section study was conducted in the out patient department of geriatric medicine, Sir Sunderlal Hospital, BHU, Varanasi, to see the association of cognitive functions on old age chronic insomnia patients under long duration drug therapy. The chronic insomnia patients (age >60 years) under long duration therapy (not less than twelve months) were screened for sleep quality and cognitive performance simultaneously with Pittsburgh sleep quotient index (PSQI) and Addenbrooke’s cognitive examination test, both in Hindi version.

Results: Chronic insomnia was seen in high prevalence of 26% among old age population. Cognitive performance was significantly decreased in working memory in chronic insomnia subjects compared to their healthy counterparts (0.85±0.55, 1.71±0.53), other domains like orientation and coordination also showed symptoms of mild cognitive impairment, difficulty in day time functioning and other co morbidities among geriatric population. Chronic insomnia was significantly associated with concomitant diseases which include diabetes, hypertension, and arthritis. Based in a clinically significant study, 23% of patients with chronic insomnia did not perceive the ailment, and 32% more elderly women had insomnia than men of the same age.

Conclusions: The study suggested the elderly population should be evaluated routinely for long-term use of hypnotic medications for chronic insomnia. The non pharmacological therapies may be included during treatment of geriatric population like maintenance of sleep hygiene; melatonin and bright light therapy.

Association of temperament (Mizaj) with dream characteristics and sleep quality using the Mannheim dream questionnaire: a cross-sectional study

Iqra Hashmi — 2025-12-31

Background: Mizaj (temperament) is a core concept in Unani medicine, reflecting an individual’s constitutional makeup and influencing physical, psychological and behavioral traits. Classical texts suggest that mizaj modulates dream patterns and sleep quality, yet empirical evidence integrating traditional temperament assessment with contemporary dream and sleep metrics is limited. To investigate the association between mizaj, dream characteristics assessed by the Mannheim Dream Questionnaire (MADRE) and sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) in a community-based adult population.

Methods: A cross-sectional study was conducted among 305 adults aged≥18 years in (Location), India. Mizaj was determined using the CCRUM Standardized Mizaj Assessment Proforma. Dream parameters (recall, vividness, valence, lucidity, nightmare frequency) were evaluated using the MADRE and sleep quality was assessed using the PSQI. Data were analyzed using ANOVA, Kruskal–Wallis tests and Tukey’s HSD for post-hoc comparisons. A p value <0.05 was considered statistically significant.

Results: Significant differences across mizaj types were observed for dream recall (p<0.0001), vividness (p<0.0001), lucidity (p<0.0001), nightmare frequency (p<0.0001) and PSQI global score (p<0.0001), while dream valence showed no significant variation (p=0.910). Safravi participants had the highest recall and vividness scores, Damvi and Safravi showed higher lucidity, Saudavi reported the highest nightmare frequency and poorest sleep quality and Balgami exhibited the best sleep quality.

Conclusions: Mizaj is significantly associated with multiple dream parameters and sleep quality, supporting both classical Unani theory and contemporary dream research. Temperament-based screening may offer a culturally relevant, low-cost approach for identifying individuals at risk of sleep disturbances and related psychological distress.

Knowledge, attitude, and practices of chewing areca nut among rural based community of Kadapa district, Andhra Pradesh: a cross-sectional study

Swetha Rajendra — 2025-12-31

Background: Chewing areca (betel) nut ranks among the top five traditional oral habits worldwide. It contains several alkaloids from the pyridine group, with arecoline being the most significant. Nitrosated derivatives of arecal alkaloids are linked to cancer risk. Globally, it is the fourth most prevalent psychoactive substance and is classified as a group-1 carcinogen. Objectives were to assess the knowledge, attitudes, and practices related to betel nut chewing among residents in and around Putlampalli village in the Kadapa district.

Methods: A questionnaire, developed by Khan et al along with informed consent, was used as the instrument. A cross-sectional study was conducted with 285 participants, featuring 28 questions to investigate the knowledge, attitudes, and practices of betel nut chewing in the rural areas of the Kadapa district.

Results: Among the 285 participants, 84.9% were females. The 26% believed that chewing betel nut is not harmful to health, while 30% acknowledged that it can cause throat cancer. Additionally, 17% did not consider betel nut chewing addictive, 71% were willing to quit the habit, whereas 29% were not. Furthermore, 63% reported using betel nut once every four weeks, and 3% chewed it daily. A significant 70% learned to chew betel nut from family members, while 20.7% and 2.1% learned from advertisements and tradition, respectively.

Conclusions: A higher percentage of women consume betel nut compared to men. Most individuals learn the habit from family members. The risk of oral cancer increases when the quid contains tobacco. Periodic screening and awareness programs are recommended.

Dietary habits and physical activity patterns among medical students in Northern Kerala: a cross-sectional study

Nivya Noonhiyil Kaithery — 2025-12-31

Background: The prevalence of non-communicable diseases (NCDs) in India is on the rise, significantly influenced by poor dietary habits and physical inactivity. Medical students, though academically aware of healthy lifestyles, may not necessarily adhere to them in practice. Objectives were to assess dietary habits among MBBS students of a medical college in Northern Kerala and to evaluate physical activity patterns among the same group.

Methods: A descriptive cross-sectional study was conducted among 113 second-year MBBS students at KMCT Medical College, Kozhikode, Kerala, during August-October 2024. A structured, pre-tested questionnaire with 40 items in English was used. It assessed socio demographic data, dietary habits, and physical activity levels. Data were analyzed using SPSS and results presented as percentages and frequencies.

Results: The mean age of participants was 21.76±0.92 years; 71.7% were females. While 92% were aware of lifestyle diseases and 98.2% knew the impact of unhealthy foods, 66.4% admitted following an unhealthy diet, and 72.6% expressed a need to improve it. About 52.2% never skipped breakfast, while 87.6% never skipped dinner. Junk food intake was common (98.2%), and only 14.2% consumed fruits daily. Regarding physical activity, 64.6% reported being active, mostly via walking or cycling (63.7%). However, 48% had sedentary time >10 hours/day and 22.1% reported no activity. Laziness (46%) was a major barrier.

Conclusions: Despite high awareness, students demonstrated poor dietary and physical activity behaviors. Structured interventions are necessary to bridge the gap between knowledge and practice, especially among future healthcare providers.

Knowledge and attitude of the general population toward common medical emergencies

Rashmi Shivalinge Gowda — 2025-12-31

Background: Medical emergencies, such as heart attacks, strokes, allergic reactions, or choking, can happen unexpectedly, and understanding the basic steps to take in these moments can make a significant difference in outcomes. Knowledge on how to tackle common medical emergencies empowers individuals to respond quickly and effectively in critical situations, potentially saving lives. Hence this study was done to assess the general population’s knowledge and preparedness in handling medical emergencies.

Methods: This cross-sectional study was conducted among general population above the age of 16 years in a tertiary healthcare centre, Mysuru. A total of 301 were included in the study after obtaining assent from the parents for those between the age of 16-18 years and consent from adults above 18 years consented. A semi-structured self-administered questionnaire was used to collect data and was analysed using SPSS 25 version.

Results: The questionnaire assessed awareness of medical emergencies across four scenarios. Heart attack and CPR: 96% identified it correctly, but 66.4% didn’t know CPR. Stroke and FAST: 85.7% diagnosed it, yet 66.1% were unaware of FAST. Choking: 87.4% identified it; 52.8% knew the Heimlich manoeuvre. Poisoning: 95.7% recognized it; nausea (29%) was the most cited symptom. A significant 79.1% had no prior training, but 91% were interested. Suggestions for awareness included workshops, social media clips, and posters in public spaces, with a focus on both urban and rural areas.

Conclusions: The research reveals gaps in public knowledge and skills for handling health emergencies, highlighting the need for better education and stronger emergency preparedness efforts.

Prevalence of non-alcoholic fatty liver disease using surrogate indices among adults attending a tertiary care hospital in Eastern India

Lipsa Preet Naik — 2025-12-31

Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as the most common chronic liver disorder worldwide and represents the hepatic manifestation of metabolic syndrome. In India, the burden of NAFLD is increasing rapidly due to rising prevalence of obesity, diabetes and sedentary lifestyles. Imaging-based diagnosis is resource-intensive, making surrogate indices useful for large-scale screening. To estimate the prevalence of NAFLD using fatty liver index (FLI) and to identify associated metabolic risk factors among adults attending a tertiary care hospital.

Methods: A hospital-based cross-sectional study was conducted at Hitech Medical College and Hospital, Bhubaneswar, over six months. Adults aged ≥30 years were enrolled. Anthropometric measurements and biochemical parameters were recorded. FLI was calculated using body mass index, waist circumference, serum triglycerides and gamma-glutamyl transferase levels. FLI ≥60 was considered diagnostic of NAFLD. Statistical analysis included descriptive statistics and multivariate logistic regression.

Results: Among 210 participants, the prevalence of NAFLD was 32.4%. NAFLD was significantly associated with obesity, diabetes mellitus, dyslipidemia and hypertension. Obesity and diabetes remained independent predictors on multivariate analysis.

Conclusions: Nearly one-third of adults had NAFLD as detected by surrogate indices. FLI is a simple, cost-effective tool that can be used for opportunistic screening in routine clinical practice.

Exploring the learning preferences using Kolb’s learning style inventory among undergraduate nursing students: a cross-sectional study

Anchal — 2025-12-31

Background: By identifying the predominant learning styles among undergraduate nursing students, educators can tailor instructional methods to enhance engagement, retention, and application of knowledge in both classroom and clinical settings.

Methods: A quantitative, descriptive, cross-sectional study was conducted from August to November 2023 including 150 undergraduate nursing students through convenience sampling technique. Kolb’s learning style inventory was used to collect the data for identifying the preferred learning style and socio-demographic tool was used for assessing the demographic variables. Validity of tool was done by panel of seven experts and internal consistency was assessed by test-retest method. Statistical analysis was employed by SPSS version 20.

Results: The findings revealed that the majority of participants exhibited a very strong preference for the accommodating learning style (65.3%), followed by assimilating (45.3%), converging (40%), and diverging styles (31.3%). Significant associations were found between the accommodating learning style and variables such as age (p=0.04), nature of stay (p=0.04), and medium of previous education (p=0.01). The diverging learning style showed a significant association with self-study habits (p=0.04), while the assimilating style was associated with religion (p=0.02). No significant associations were observed between the converging learning style and any sociodemographic variables.

Conclusions: Nursing education should incorporate diverse teaching strategies to accommodate varied learning styles and address sociodemographic influences, thereby enhancing student engagement and academic success. Further research is recommended to explore the broader implications of these findings in different educational and cultural contexts.

An investigation into the frequency of anemia and the relationship between pregnant women's educational attainment and anemia in Meerut City

Prem Kumar — 2025-12-31

Background: Anemia during pregnancy poses serious health risks for both mothers and infants, particularly in resource-limited environments. This study examines the prevalence of anemia among pregnant women in Meerut City, India, and analyzes its correlation with educational attainment.

Methods: A cross-sectional study was conducted from April 2025 to June 2025 across 28 UPHCs in Meerut City among pregnant women attending antenatal clinics in urban and semi-urban areas of Meerut City. Hemoglobin levels were measured to assess anemia status. Socio-demographic and educational information was gathered using structured interviews. Descriptive and inferential statistical analyses, including Chi-square to examine associations.

Results: Anemia was found to be highly prevalent among the study participants. A notable negative correlation was observed between educational attainment and anemia severity (p<0.05). Women with higher education levels demonstrated better dietary practices, greater awareness of anemia-related health risks, and higher adherence to iron supplementation. In contrast, women with lower education levels exhibited limited nutritional awareness, reduced use of maternal healthcare services, and limited understanding of anemia prevention and management.

Conclusions: The findings underscore the vital role of education in improving maternal health outcomes. Enhancing women's educational status may significantly reduce the burden of anemia and contribute to broader public health and social development goals. The study advocates for integrated policy approaches that link education and health sectors to achieve sustainable improvements in maternal and child health.

Supporting public health efforts in India and Nepal with probabilistic child death modelling

Dileep Kumar — 2025-12-31

Background: Child mortality remains a major public health concern in South Asia, shaping population dynamics and affecting family well-being. Understanding household-level mortality patterns is essential for identifying high-risk groups and developing effective interventions. This study analyzes child mortality data from households in Eastern Uttar Pradesh, India, and Nepal, where deaths are rare but occasionally clustered within families.

Methods: Four probabilistic models were applied to the observed number of child deaths per household: the Geometric distribution, the Inflated Geometric distribution to accommodate excess zeros, and the Himanshu compounded distribution. Model parameters were estimated using Maximum Likelihood Estimation (MLE). Model adequacy was evaluated through Chi-square goodness-of-fit tests comparing expected and observed household mortality counts.

Results: All models showed strong consistency with the empirical data. Chi-square test results produced high p-values (>0.95), indicating that each model successfully captured the zero-heavy structure and the infrequent higher mortality events present in the datasets from both regions.

Conclusions: The findings demonstrate that zero-inflated and compounded probabilistic models provide reliable representations of household-level child mortality in South Asia. These modeling approaches can support better identification of vulnerable households and improve the predictive accuracy of mortality assessments, contributing to more targeted public health strategies aimed at reducing child deaths.

Study to assess the knowledge, attitude and practice regarding prevention of anemia among adolescent girls in a view to develop an information booklet

Sangeet Sarita Sur — 2025-12-31

Background: Anemia especially more common in the developing countries for having numerous socio-cultural problems, lack of knowledge, poor attitude and practice to prevent from the beginning. National Family Health Survey, 2019-21 reported that 59.1% of adolescent girls (15-19 years old) are anemic and this count is higher in rural areas (~58.5%) compared to urban areas (~53.8%). To check the early onset of anemia in women, it needs to be addressed properly during adolescent being regarded as the transitional stage of transformation.

Methods: This study was conducted with 170 adolescent girls among the age group of 14 to 19 comprising of five classes from IX to under graduate 1^st year. The inferential statistics, χ² at α=0.05 and p<0.05 was tested with demographic variables for knowledge assessment. Attitude was rated with Bloom’s cut off scale along with practice assessment. A spearman correlation was given for overall assessment of the knowledge, attitude and practice.

Results: The inferential statistics, χ² at α=0.05 and p<0.05 shows the significant association of knowledge with the demographic variables like age, class and family size. Spearman correlation (ρ) justifies the moderate correlation between knowledge, attitude and practice score of the sample. Surface plot justifies the improvement of attitude and practice due to knowledge at par class and age.

Conclusions: Mean knowledge score at poor level might be a factor for developing average attitude which in turn directly influenced the practice not to a good level for adolescent girls needs to be addressed further through developing the self-structured teaching programme and information booklet.

Utilizing SWOC analysis as a thinking tool for enhancing understanding of pharmacology in second year MBBS students as part of preparation for the NEXT examination

Avinash Turankar — 2025-12-31

Background: This study assessed how well second-year MBBS students studying for the national exit test (NEXT) understood pharmacology using SWOC (strengths, weaknesses, opportunities, challenges) analysis.

Methods: 239 students from Government Medical College in Nagpur participated in a cross-sectional, parallel-group study. While the CD batch (n=121) did not receive SWOC instruction, the AB batch (n=117) did. A case-based MCQ test in the NEXT format was finished by both groups. Kendall Tau correlation and independent t-tests were used to assess the scores.

Results: The CD Batch outscored the AB Batch by a large margin (p<0.001). There was little correlation (τ=0.212, p=0.014) between MCQ performance and SWOC chart scores.

Conclusions: SWOC analysis may help with critical thinking in difficult situations, however it did not enhance MCQ performa.

A comparative study of nurses' knowledge and attitude towards impact of oral cancer on oral hygiene and nutritional status of patients with oral cancer in selected general and cancer hospital at Mysore and Bangalore with a view to develop self-instructional module

K. C. Yadav — 2025-12-31

Background: Cancer is burden for almost all societies in the world. It is estimated that approximately 20 million persons are suffering with cancer and every year 10 million die due to cancer.

Methods: A descriptive and comparative survey from January 2024 to June 2024 with a quantitative research approach was used. The non-probability convenient sampling technique was used, and 60 nurses (30 each from Cancer Hospital; and General Hospital) had given consent for participation in the study. The tools used for data collection were personal profile, structured knowledge questionnaire, modified Likert-type attitude scale, and opinionnaire for utility of SIM.

Results: The study found that 83.35% of General Hospital and Cancer Hospital nurses had strong knowledge, while 10% and 6.66% had low knowledge. All nurses from both institutions have mildly positive to extremely positive thoughts about how oral cancer affects oral hygiene and nutrition. Mean knowledge scores of nurses from General and Cancer hospitals were 14.73 and 16.33, and mean attitude scores were 149.80 and 150.20. Cancer hospital nurses' expertise and attitude correlated significantly. The results show that 86.67% of nurses believe SIM is a valuable source of information and content to assist them better manage oral cancer patients' oral hygiene and nutrition.

Conclusions: The study found that cancer hospital nurses had a higher mean knowledge score than general hospital nurses. Thus, knowledge and attitude are linked, and nurses with higher knowledge have a more positive attitude.

Use of the Kahoot! application for undergraduate medical students in community medicine

Rupali Sabale — 2025-12-31

Background: Nowadays, majority of the students all over the world are digital natives. Due to the advancement in internet and online technology, a various web-based games have been developed. One of the popular web-based learning tools is Kahoot! The aim of this paper was to explore the experience of using Kahoot! app as a tool for conducting quiz for undergraduate medical students.

Methods: The topic of contraceptive ppt was distributed to the third year MBBS medical students 2 days prior to the revision class. A 70-item e-quiz on this topic using Kahoot! app was conducted on a sample of 150 third year MBBS medical students in 2023. At the end of e-quiz, we got feedback through Google forms-created questionnaire.

Results: Out of 150 students, 66.6% (n=100) reviewed the pre-class PowerPoint, and 99.3% (n=149) provided positive feedback highlighting themes like organization, interest, fun, interaction, motivation, and knowledge reinforcement. Moreover, 98.6% (n=148) supported other faculty adopting this approach by sharing materials beforehand and using Kahoot! quizzes for a more student-driven and interactive learning experience.

Conclusions: As a part of teaching, Kahoot! app has made learning easier, more enjoyable, encourage the students to study and strengthens the student-centred learning. It is suggested that such study methods should be utilized more in teaching and can be incorporated in academic curriculum as well.

Risk factors for syphilis infection among people attending designated STI/RTI clinics in Meghalaya

Shikha Verma — 2025-12-31

Background: Syphilis remains a major public health concern in Meghalaya despite the availability of effective diagnostics and treatment. This study aimed to identify behavioral and sociodemographic risk factors associated with syphilis infection among attendees of designated STI/RTI clinics (DSRCs).

Methods: A matched case-control study was conducted across six DSRCs between May and June 2023, including 66 confirmed syphilis cases and 263 age-, sex-, and marital status-matched controls. Data on demographics, substance use, sexual behaviour and treatment-seeking were collected using structured interviews. Secondary record-based data (2017-2022) from all DSRCs were analysed to assess district-wise and temporal trends.

Results: Most participants were aged 26-35 years (cases: 48.5%; controls: 49.4%) and male (56.1% versus 57.8%). Alcohol use was reported by 56.1% (n=37) of cases and 41.8% (n=110) of controls. Extramarital sexual partnerships were common (72.1% versus 67.9%) and independently associated with syphilis (adjusted OR=2.86; p=0.026). Awareness of STI clinics was low (31.8% versus 35.7%). District-level analysis revealed the highest RPR positivity in East Jaintia Hills (up to 24%), followed by East Khasi Hills (20%) and West Jaintia Hills (9.6%).

Conclusions: Extramarital partnerships independently predicted syphilis infection. Strengthening behavioural interventions, partner notification, and district-focused screening is critical to curb transmission.

Bridging the gap: parental knowledge and attitude towards pneumococcal disease and vaccine among children under five: a cross-sectional study in Nagpur, India

Mohit Kumar — 2025-12-31

Background: Pneumococcal infection is a major public health concern and a leading cause of death among children under five, particularly in developing countries. Pneumonia accounted for 14% of all deaths among children under five in India, with an estimated 740,180 fatalities in 2019. Although pneumonia is vaccine-preventable, low awareness and knowledge hinder access to immunisation. This study aimed to assess the knowledge and attitude of parents toward pneumococcal disease and the pneumococcal conjugate vaccine (PCV) among children under five attending the immunisation clinic of Government Medical College, Nagpur.

Methods: A cross-sectional study was conducted from November 2022 to January 2023 among 340 parents/guardians of children under five who visited the immunisation clinic using a convenience sampling technique. Data were collected using a pre-tested, semi-structured questionnaire via face-to-face interviews, covering demographic details, awareness of pneumococcal disease and knowledge and attitudes regarding PCV. Data were summarised using frequencies and percentages.

Results: Among the participants, 37.7% were aged 26–30 years and 33.8% had attained a graduate degree or higher. Awareness of pneumococcal disease was reported by 85.6% of parents/guardians; however, knowledge of the pneumococcal vaccine and its benefits was limited. The main reason for non-vaccination among children was unavailability of the vaccine at health facilities.

Conclusions: While general awareness of pneumococcal disease was relatively high among parents, understanding of the PCV and its importance was inadequate. Strengthening parental education and ensuring consistent vaccine availability at health facilities are essential to improve PCV coverage and reduce childhood morbidity and mortality from pneumonia.

Study of the knowledge, attitude and perceived health effects due to climate change in residents of urban health training centre in Western Maharashtra

Preetham K. S. Gowda — 2025-12-31

Background: Climate change is one of the greatest global health challenges of the 21^st century. India is especially vulnerable to climate change due to its geographic locations. The impacts of climate change on urban areas are complex. The concentration of population in urban areas increases the complexity of response to such extreme weather events due to various reasons like lack of resources, capacities, and expertise. Aims and objectives were to assess the knowledge and attitude towards climate change and to determine the perception of health effects due to climate change.

Methods: This study employed a cross-sectional design with closed ended questions, face-to-face interview using a pre-tested questionnaire. Study was conducted with 385 participants and data were analysed using descriptive statistics with measures like Mean and SD for quantitative variables, percentages for qualitative variables.

Results: Participants were majority aged between 41-60 years (37.76%), 60.1% were male, 41.1% belonged to upper lower socioeconomic class. 74% participants had good knowledge towards climate change, 63.14% participants had positive attitudes towards climate change mitigation measures and 88.05% participants had good perception of health effects due to climate change.

Conclusions: Despite adequate baseline knowledge, gaps persist, necessitating targeted IEC (information, education, communication) interventions to improve public engagement and policy responsiveness, as 19.26% were unaware of the word climate change and gave neutral responses and an average of 70% agreed on statement that, government is not doing enough on climate change. The study recommends to enhance the awareness among the population through targeted IEC/BCC activities.

Spatial mapping and assessment of nutritional status and socio demographic determinants among under-five children in a rural region of Southern Karnataka: a cross-sectional study

Shweta Neminath Kurkuri — 2025-12-31

Background: Malnutrition remains a significant public health concern among under-five children, particularly in low- and middle-income countries. It includes both undernutrition and the rising issue of overnutrition. The objectives of the study were to assess the nutritional status of children under-five years of age and to identify socio-demographic factors influencing it.

Methods: A community-based cross-sectional study was conducted among 255 under-five children. These children were selected by simple random sampling in the rural field practice area of a medical college in southern Karnataka. Anthropometric measurements were taken and nutritional status was assessed using WHO Z-score classifications. Data analysis was carried out using Epi-Info and WHO Anthro Survey Analyser. Associations were assessed using Chi-square and Fisher's exact tests.

Results: Out of 255 children, 31.76% (81) were stunted, 20% (51) were underweight and 15.69% (40) were wasted, showing significant undernutrition. Also, 9.02% (23) and 12.55% (32) were overweight/obese by weight-for-length and BMI-for-age, respectively, indicating emerging overnutrition. This reflects the double burden of malnutrition in the group. Stunting was most prevalent among children aged 1 to 2 years. Underweight and wasting were more common in boys. A significant association was noted between socioeconomic status and underweight (p=0.035), with the highest prevalence of malnutrition in Class IV. No significant associations were found between other sociodemographic details and nutritional status.

Conclusions: The study reported a high burden of malnutrition, especially stunting and underweight, with an emerging trend of overweight and obesity. Socioeconomic status significantly influenced nutritional outcomes, highlighting the need for a multipronged approach.

Contraceptive decision-making among currently married couples in Kerala: a mixed-methods study

Anusree K. Mukundhan — 2025-12-31

Background: Contraceptive decision making refers to the ability of a women freely choose the contraceptive method they desired through the process of informed decision-making by effectively minimizing unnecessary pressure from important others. Women’s autonomy is often constrained by gender power imbalances and sociocultural norms. In Kerala, despite better educational and economic status, limited evidence suggests these advantages enhance their decision-making regarding contraception.

Methods: A community-based mixed-methods study was conducted in Thrissur and Thiruvananthapuram districts in Kerala. Multistage cluster sampling was employed in both the districts to get a total sample of 330 for the quantitative component. Bivariate and multivariable logistic regression were done to estimate the proportion and associated factors. Additionally, 19 in-depth interviews were conducted using purposive sampling to explore decision-making dynamics.

Results: Only 18.2% of women reported making contraceptive decisions independently. Employed women (APR: 2.94, 95% CI: 1.84–4.71, p<0.001) and women with both male and female children were more likely to decide independently (APR: 2.80, 95% CI: 1.46–5.30, p=0.002). Qualitative findings highlighted decision-making process among couples are often hindered due to couples’ limited knowledge, misconceptions and fear of side effects.

Conclusions: In Kerala, independent contraceptive decision-making among women remains relatively low. Limited knowledge hindered women’s ability to negotiate contraceptive use with their partners, often conform to prevailing social norms. Thus, interventions and policies should focus on raising awareness along with empowering women through financial independence and addressing deep-rooted social and gender norms.

Comparative assessment of probiotic properties of seven commercially available probiotic strains: an in vitro study

Amrutha S. Raj — 2025-12-31

Background: Probiotics are live microorganisms that, when administered in adequate amounts, confer health benefits to the host. Their ability to survive harsh gastrointestinal conditions such as low pH, bile salts, and toxic compounds like phenol is crucial for colonization and activity. The present study was undertaken to evaluate the probiotic properties of commercially available probiotic strains including Lactobacillus acidophilus, Limosilactobacillus reuteri, Lacticaseibacillus rhamnosus, Shouchella clausii, Weizmannia coagulans, Bacillus subtilis and Saccharomyces boulardii.

Methods: All strains were germinated in brain heart infusion (BHI) broth and subjected to standard probiotic property evaluation. Acid, bile, and phenol tolerance were assessed using modified BHI broth adjusted to pH 2.0, 0.3% bile, and 0.4% phenol, respectively, with viable counts determined at specific time intervals. Antagonistic activity was tested against E. coli isolates by agar overlay method.

Results: Among tested strains, Shouchella clausii and Weizmannia coagulans exhibited highest tolerance to acidic, bile and phenolic stress. Limosilactobacillus reuteri showed moderate tolerance, while Lacticaseibacillus rhamnosus and Lactobacillus acidophilus demonstrated fair survival rates. Saccharomyces boulardii and Bacillus subtilis recorded comparatively lower tolerance. Most isolates showed significant inhibitory activity against coliforms.

Conclusions: The study highlights the potential of commercially available probiotic formulations as effective candidates for gastrointestinal health. The survival ability of Bacillus species under harsh gut conditions suggests their suitability as stable probiotics. Further studies focusing on molecular mechanisms and clinical efficacy are warranted.

A cross-sectional study to estimate the prevalence of cloth usage as menstrual hygiene management among young female adults in an urban chawl of Mumbai

Abhiram M. Kasbe — 2025-12-31

Background: Menstrual hygiene management (MHM) is a key public health concern in India, where cultural and economic barriers restrict access to proper hygiene products. Safe hygiene practices in early adulthood are crucial for young women’s immediate and long-term health. The study aimed to assess the prevalence of cloth use for menstrual hygiene among young female adults. It evaluated factors that influenced the choice and examined the association between cloth use and genitourinary infections.

Methods: A cross-sectional study was conducted among young female adults aged 18-22 years residing in a chawl area of Mumbai. The sample size was 100, selected through systematic random sampling. Data were collected using a structured questionnaire.

Results: The prevalence of cloth usage was found to be 32%. The married young female adults, the low education level of the mothers, the source of information, and the poor knowledge regarding MHM were the factors that influenced the usage of cloth. Prevalence of genitourinary infections among the participants was 53% and was found to be associated with the use of cloth.

Conclusions: The study identified that 32% of young female adults in Mumbai’s chawl use cloth for menstrual hygiene, which was influenced by factors such as maternal education, marital status, source of information, and knowledge regarding MHM. To enhance reproductive health, it is crucial to improve access to affordable hygiene products and address the cultural barriers. Overcoming these obstacles will promote better menstrual hygiene practices and reproductive health.

Awareness, attitudes and practices regarding tobacco and the effectiveness of a school-based educational intervention among rural school children in Maharashtra, India

Sreevidya P. A. — 2025-12-31

Background: Tobacco use remains a leading cause of preventable morbidity and mortality worldwide, with adolescents being particularly vulnerable to initiation. In India, rural areas report higher tobacco use prevalence, necessitating targeted interventions. This study evaluates the effectiveness of a school-based educational intervention in improving awareness of tobacco-related health effects among 12 to 16 years old schoolchildren in a rural setting.

Methods: A pre-post educational interventional study was carried out among 236 schoolchildren in a rural area of Maharashtra. Baseline awareness attitudes and practices were assessed using a pre-validated questionnaire, followed by a structured educational intervention incorporating interactive audio-visual aids. Post-intervention assessments were conducted immediately and after three months. Knowledge and attitude changes were analysed using the Wilcoxon signed-rank test.

Results: Baseline knowledge about tobacco was high (94.5%), but misconceptions persisted regarding its health effects and legal regulations. Post-intervention, the proportion of schoolchildren with excellent knowledge (>70% score) increased from 40.7% to 48.7% in the immediate post-test but slightly declined to 45.5% at three months. Similarly, schoolchildren with an excellent attitude towards tobacco prevention improved from 66.9% at baseline to 71.4% at three months. The intervention significantly improved awareness and attitudes (p<0.05), but retention declined over time, highlighting the need for reinforcement.

Conclusions: The educational intervention significantly enhanced schoolchildren' knowledge and attitudes toward tobacco use and its health effects. However, knowledge retention declined after three months, underscoring the importance of periodic reinforcement. Integrating structured tobacco education into school curricula and involving parents in awareness programs could enhance the long-term impact.

Comparative assessment of menstrual hygiene management practices among urban and rural adolescent girls: a community-based cross sectional study from Maharashtra, India

Aparna Prakash — 2025-12-31

Background: Menstrual hygiene management (MHM) is vital for the health of adolescent girls, but practices differ widely between urban and rural areas due to sociocultural, economic, and educational factors. This study compared MHM knowledge, practices, disposal methods, restrictions, and reproductive tract symptoms (RTS) among adolescent girls in urban and rural areas of Maharashtra.

Methods: A community-based cross-sectional study was carried out involving 214 adolescent girls aged 12 to 19 years (107 from each area) in both urban and rural practice fields of a medical college, utilizing a non-probability chain-referral (snowball) sampling method. A validated questionnaire was employed for the survey, which took place over a period of 18 months. The data were analyzed using SPSS version 22, applying appropriate statistical tests.

Results: Mothers were the main source of information in both areas. Urban girls showed higher exclusive use of sanitary pads, while rural girls often combined them with cloth. Urban girls had better genital hygiene and bathing practices (p=0.004; p<0.001), but rural areas had a higher rate of proper menstrual waste disposal (55.7% versus 44.3%, p=0.001). Menstrual restrictions were more common among rural participants (p<0.05). Overall, 51.9% reported at least one reproductive tract symptom, with foul-smelling discharge (p=0.007) and difficulty urinating (p=0.013) more prevalent among urban girls.

Conclusions: Substantial urban-rural disparities exist in menstrual hygiene practices, disposal methods, and cultural restrictions. Strengthening school-based education, improving access to affordable sanitary materials, and addressing sociocultural barriers are crucial for improving adolescent menstrual health.

Community perceptions of climate change, lived experiences and health in a coastal village of Odisha: a qualitative study

Chelikam Veeraraghavendra Reddy — 2025-12-31

Background: Climate change poses notable risks to health and livelihoods, and overall wellbeing, particularly in coastal regions of India. Rural Coastal communities face recurring adverse climatic events that disrupt daily life, health and security. However, limited evidence exists on how such communities perceive. This study examined how community perceptions, lived experiences, and adaptive responses to climate change in a vulnerable coastal village in Odisha.

Methods: A qualitative study was conducted in Penthakata, a coastal fishing village in Puri district, Odisha, between August and November 2023. 27 residents aged 50 years and above were purposively sampled. Data were collected through in-depth interviews and analysed using Framework Analysis approach to identify themes.

Results: Participants perceived clear climatic shifts, including more frequent and intense cyclones, irregular rainfall, and rising temperatures. Extreme events caused extensive housing damage, food insecurity, livelihood disruptions, school interruptions, and increased waterborne, vector-borne, and heat-related illnesses. Mental health stress and major disruptions in healthcare access were common. Fishers reported declining near-shore fish, deeper-sea fishing, and economic instability. Misconceptions and religious attributions shaped climate and disease understanding. Limited relief, inconsistent compensation, and interstate welfare ineligibility substantially heightened vulnerability.

Conclusions: Climate impacts are shaped by the interaction of environmental exposure, livelihood fragility, cultural beliefs, health-system limitations, and structural governance barriers. Interstate welfare ineligibility emerged as a critical but overlooked determinant of vulnerability. Strengthening climate literacy, culturally aligned health communication, service preparedness, compensations, and social protection access is essential.

Anti-malarial stewardship for India: an evidence-based approach

Dipankar Pal — 2025-12-31

Plasmodium falciparum (Pf) is a public health problem in both rural as well as urban areas due to changing environmental condition and extensive movement of people. Artemisinin combination therapy (ACT) is the cornerstone of treatment for Pf malaria. However, parasite susceptibility to either artemisinin or the partner drug is getting changed globally. Malaria endemic countries are doing robust surveillance on anti-malarial resistance throughout the year. The recommended ACT regimen differs from country to country and also in different states of the same country.

Emergency department evaluation of blunt abdominal trauma in children: a systematic review and meta-analysis of patterns and outcomes

Huda Alsubhi — 2025-12-15

Blunt abdominal trauma is a leading cause of morbidity and mortality in children. Accurate and timely evaluation in the emergency department is critical for optimizing outcomes and minimizing unnecessary imaging or interventions. Objective of the study was to systematically review current evidence on evaluation patterns, diagnostic modalities, and clinical outcomes in pediatric patients presenting with blunt abdominal trauma to emergency departments. A systematic literature search was conducted in PubMed, Scopus, and Web of Science from January 2010 to June 2025. Studies reporting diagnostic approaches, imaging patterns, injury severity, management, and patient outcomes in children under 18 years were included. Data were extracted and synthesized qualitatively and quantitatively where appropriate. Twenty-two studies comprising 18,950 pediatric patients were analyzed. Physical examination combined with focused assessment with sonography for trauma (FAST) increased diagnostic accuracy and reduced computed tomography (CT) utilization. Non-operative management remained the mainstay for most solid organ injuries, with excellent survival rates exceeding 95 percent. Delayed diagnosis was associated with higher complication rates and prolonged hospital stays. Systematic evaluation protocols, including selective imaging and observation strategies, improve diagnostic precision and outcomes in pediatric blunt abdominal trauma. Future research should focus on refining risk stratification tools to further reduce radiation exposure without compromising safety.

Barriers and enablers to implementing point-of-care testing for anaemia diagnosis in pregnancy among healthcare workers in North Goa, India

Utkarsh Betodkar — 2025-12-31

Globally one fifth of the world’s population is affected by anaemia, with pregnant women being among the worst affected. In India, including Goa, anaemia prevalence among pregnant women has worsened per national family health survey (NFHS-5), prompting the launch of the Anaemia Mukt Bharat program. One key intervention was the provision of digital hemoglobinometers at sub-centres for point-of-care testing (POCT). Despite investments, implementation of POCT for anaemia diagnosis among pregnant women in Goa remains limited. This descriptive qualitative study was conducted in sub-centres of North Goa equipped with digital hemoglobinometers to understand enablers and barriers to POCT implementation. From December 2023 to April 2024, 11 in-depth interviews were conducted with healthcare workers and a state program officer. Data was analysed using thematic analysis guided by the consolidated framework for implementation research (CFIR). Three key enablers were identified: availability and benefits of digital hemoglobinometers, decentralized procurement, and strengthened health information systems. Healthcare workers valued the POCT devices for their ease of use and portability. However, barriers included staffing shortages, inconsistent supply of consumables, technical malfunctions, and limited opportunities for testing due to low patient follow-up. The lack of formal training and quality assurance also affects implementation. Digital hemoglobinometers have simplified anaemia testing at sub-centres, but administrative, logistical, and technical barriers hinder effective implementation. Addressing these challenges through consistent supply chains, formal training, and quality assurance can improve the utilization of POCT for diagnosing anaemia in pregnant women. Strengthening follow-up care and routine haemoglobin testing during antenatal visits is vital to reduce anaemia among this vulnerable population.

An observational study towards demographic profiling to assess the health seeking behaviour of transgenders in Chittoor town, Andhra Pradesh

Akshika Vinayagam — 2025-12-31

Transgenders (TGs) individuals, whose gender identity does not align with the sex assigned at birth, form less than 1% of the global population, with about 4.87 lakh in India and approximately 50,000 in Andhra Pradesh as of 2022. Existing research focuses primarily on sexual practices and HIV/STDs, leaving gaps in understanding their health problems and healthcare-seeking behaviour. Hence, this study was conducted to assess the healthcare-seeking behaviour of TG individuals. A descriptive research design with non-probability snowball sampling was adopted and data was collected through interviews with 15 TGs in Chittoor town, Andhra Pradesh, India. A self-structured questionnaire assessed their health-seeking behaviour. Data were analyzed using descriptive and inferential statistics. Among 15 TG participants, majority were residing in urban area (15, 100%), engaged in begging (14, 93%), unmarried (15, 100%) and sought health services from private hospitals (13, 87%). Most participants (11, 73%) had moderate health-seeking behaviour, while 2 (13.5%) had high and 2 (13.5%) had poor health-seeking behaviour, due to common barriers including refusal of medical care (13, 87%) and lack of health insurance (13, 87%). Chi-square test showed a statistically significant association between health-seeking behaviour and both occupation and family support during illness (p≤0.05). The study provides key insights into the health-seeking behaviour of TGs in Chittoor town. Despite moderate healthcare engagement, issues like lack of insurance, delayed care, and discrimination persist. Inclusive policies and targeted interventions are needed to improve access and quality of care.

Correlation between fast food consumption and lipid profiles

Muath A. Alsoliman — 2025-12-15

Abnormalities in lipid profile, known as dyslipidemia, refer to elevated levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), in addition to low levels of high-density lipoprotein cholesterol (HDL-C) in the blood. Dyslipidemia is widely spread among the population, and this rise in dyslipidemia is attributed to changes in dietary habits and shifts towards fast food predominated diet. The widespread consumption of fast food is linked to adverse health impacts, including rise in obesity, diabetes, and cardiovascular diseases. Fast food is characterized by large portion size and unusually high energy density. It contains higher levels of sugars, fats, and salt, in addition to suboptimal levels of dietary fibers and micronutrients. Moreover, due to the heavy processing and packaging of fast food, it usually contains harmful compounds and by-products that further exacerbate the undesirable health impacts of fast-food diet. This narrative review aims to outline current knowledge regarding the association between the rise in fast food consumption and lipid profile abnormalities, including how the poor nutritional composition of fast food contributes to fluctuations in TC, TG, LDL-C and HDL-C levels in the blood and development of dyslipidemia.

Emerging treatment for post-inflammatory hyperpigmentation in dark skinned individuals: a review of the current literatures

Obaro Enovwo Omatighene — 2025-12-31

Post-inflammatory hyperpigmentation (PIH) is a prevalent and psychologically distressing condition, particularly for individuals with dark skin (Fitzpatrick types III-VI). The heightened susceptibility and severity in this population are linked to unique molecular and structural skin characteristics, including a predisposition to inflammation, which can be exacerbated by conventional treatments like high-concentration chemical peels and aggressive laser therapies. This paper presents a narrative literature review that synthesizes current research on emerging and optimized treatment strategies for PIH in dark-skinned individuals. A focused search of peer-reviewed articles and clinical abstracts revealed that successful management relies on a multi-faceted approach. Key findings include the efficacy and favorable safety profiles of new topical agents such as azelaic acid, adapalene, and cysteamine cream, which possess dual anti-melanogenic and anti-inflammatory properties. Procedural advancements emphasize conservative, low-fluence laser techniques (e.g.,1064-nm Nd:YAG) combined with robust pre- and post-procedure regimens. Most importantly, a consistent, daily photoprotection regimen with broad-spectrum sunscreen is confirmed as the single most effective preventive measure. The review concludes that moving beyond conventional monotherapies to a nuanced, combination-based approach is essential for enhancing outcomes, minimizing adverse effects, and improving the quality of life for individuals with PIH in dark skin.

Current perspectives on the pathogenesis, molecular pathways, and therapeutic targets in diabetic retinopathy

Asra Warees — 2025-12-31

Diabetic retinopathy (DR) is a serious sight-threatening complication that occurs due to constant hyperglycemia. It is the most common and leading cause of vision impairment worldwide. The development and progression of DR involve a complex network of genetic and environmental factors. Vascular inflammatory pathways, oxidative stress and epigenetic modifications have been linked to the development of diabetic mediated retinopathy. Candidate gene studies have implicated variants in genes involved in glucose metabolism such as (ALR2), vascular regulation (VEGF) are closely associated with DR susceptibility. Hyperglycemia triggers several factors such as polyol pathway, advanced glycation end-products (AGEs) formation, activation of protein kinase C (PKC), dysregulation of the renin-angiotensin system (RAS). These pathways collectively induce oxidative stress, inflammation, vascular dysfunction and pathological angiogenesis that further intensify microvascular lesions resulting in DR pathogenesis. Emerging therapeutic strategies present anti-VEGF agents, PKC inhibitors, and drugs modulating RAS system. In addition, targeted medicine based on genetic risk profiling and novel gene therapy approaches hold great promise in DR treatment. Further research integrating multi-omics data, gene-environment interactions, and precise translational studies are required for improving DR management and associated risk factor.

An overview on some important factors affecting male fertility

Bhagwati Kumar Markanday — 2025-12-31

Infertility is a disease of the reproductive system. It makes a person unable to have children. It can affect both man and women. Any dysfunction in the reproductive system may lead to infertility. Infertility in males is observed as one of the major problem faced by several advanced countries. Over the past several years, a decline in male reproductive health has been reported. Globally, it has been noticed that the incidences of testicular cancer (TC) and poor sperm quality is increasing with time. Certain drugs, lifestyle, tobacco, smoking and alcohol all have a short and long term health effects, including effects detrimental to the production and quality of sperms. In his review we have tried to through some light on the important factors such as lifestyle factors and environmental factors, that can greatly influence over all health wellbeing including fertility.

Framework to measure effects of digital learning on students’ mental health

Alok Srivastava — 2025-12-31

COVID-19 has had a severe impact on the education sector with the closure of schools. The attempts for continuum of education during lockdown, particularly at school level, through digital learning mediums had limited success. The review brought out that very limited literature are available to assess the effect of digital learning on mental health of students. The review developed the operational definition of digital learning and mental health to make it as much inclusive of all mediums and elements for establishing connectedness between digital learning and mental health. The measuring framework, based on the secondary review, have 13 Likert-type five-point rating scale-based statements to capture the negative and positive effects of digital learning on mental health of the students. The measuring framework will be a useful tool for policy makers, counsellors and academicians to assess the interlinkage between digital learning and mental health outcomes, both positive and negative.

Fluoride in dentistry: benefits, risks, and public health implications

Yasser Alhawas — 2025-12-15

Dental caries is the localized destruction of dental hard tissues resulting from the acidic by-products, which are produced by the bacteria present in the oral cavity. Dental caries is considered the most common health condition affecting humanity, affecting 2.3 billion people worldwide. As a result, minimally invasive dentistry was developed to treat dental caries at an early stage and to decrease the high prevalence of dental caries among children and adults. Fluoride is one of the main components used in preventive measures in dentistry and in minimally invasive dentistry. It can inhibit enamel and dentin demineralization and induce enamel remineralization due to the replacement of fluoride ions with hydroxyl groups in the enamel hydroxyapatites, forming fluorohydroxyapatite, which has greater stability and reduced solubility in an acidic medium. Moreover, fluorapatite exhibits the lowest solubility and the greatest stability in the acidic medium. When these components are integrated into the composition of the enamel, it becomes more resistant to demineralization. Despite the presence of several studies confirming the benefits of fluoride in dentistry, it can result in multiple complications, such as dental fluorosis, skeletal fluorosis, and acute fluoride toxicity. Therefore, many countries have developed community water fluoridation to reduce the prevalence of dental caries. However, many individuals debated the ethics of community water fluoridation; therefore, several countries have developed alternatives to water fluoridation, such as fluoride in salt and milk. Therefore, policymakers should provide a regulatory framework that balances the benefits of community water fluoridation and preserves the public’s right. Additionally, caregivers and parents should be educated about the importance of topical fluoride, either in toothpastes or the topical fluoride that is applied professionally by dentists, to prevent the prevalence of dental caries in children.

Waiting for a safe birth: the untapped potential of birth waiting homes in India

Kalpana Pawalia — 2025-12-31

Maternal mortality remains a major global health issue, especially in Low- and Middle-Income Countries (LMICs) like India. Each year, around 19,000 Indian women die from mostly preventable pregnancy and childbirth complications. About 90% of these deaths are preventable with timely, quality care. The “three delays” model explains many of these deaths, particularly the delay in recognising the need for care and reaching medical facilities. Women in remote, tribal, and hard-to-reach areas face the greatest risks. Birth Waiting Homes (BWHs) residential facilities near health centres help overcome these barriers. Other LMICs have shown their effectiveness, but India lacks a comprehensive review of their use and impact. We analysed secondary data from state Records of Proceedings, Common Review Mission reports, the Health Management Information System, Health Dynamics of India, and field visits. Our review identified 733 operational BWHs across 15 states and Union Territories, mostly in tribal regions. Implementation varied widely, from 2 in Bihar to 249 in Madhya Pradesh. Low Mortality States invested more in BWHs, especially in hard-to-reach areas, and showed better outcomes than High Mortality States. Use of BWHs is strongly related to women’s education (p<0.001), proximity (average 3.8 km), and lower income. Key facilitators included quality care and supportive environments, while limited awareness and space acted as barriers. BWHs can significantly reduce maternal mortality by improving institutional deliveries. States should raise awareness and provide quality services around BWHs to ensure their full use.

Prakriti and neuroplasticity: integrative insights on cognitive health

Resmy Raj A. — 2025-12-31

Ayurveda explains diversity of physical, physiological, and psychological attributes of individuals through the concept of prakriti, or body constitution. This variability extends to several cognitive brain functions like learning, memory etc. Modern neuroscience explains these cognitive traits through the concept of neuroplasticity, which refers to the structural and functional rewiring of neural connection as a result of experience and learning. This article aims to explore the relationship between prakriti and neuroplasticity and to understand the factors influencing neuroplasticity. It also aims to hypothesize an integrative framework that combines Ayurvedic and neuroscientific approaches to optimize cognitive health. There is only less empirical research works are available that systemically explores the connection between prakriti and neuroplasticity. Integrating prakriti-based insights with neuroplasticity offers a personalized, constitutionally aligned approach to cognitive health. Robust empirical validation through biomarkers, standardized protocols, and clinical evidence are essential for establishing a valid interdisciplinary result.

Beyond the bones: the genomic and clinical landscape of vitamin D deficiency

Ahmed S. Naqvi — 2025-12-04

Vitamin D, a secosteroid hormone traditionally linked with bone health, has emerged as a pleiotropic regulator exerting systemic effects across immune, neurological, endocrine, respiratory, and metabolic pathways. This review explores the expanding scientific consensus on vitamin D's roles beyond musculoskeletal physiology, emphasizing its contributions to innate immunity, antimicrobial defense, tumor suppression, neurocognitive regulation, reproductive health, and gene expression via epigenetic pathways. Current evidence suggests that vitamin D modulates inflammation, improves insulin sensitivity, supports mucosal defense, and regulates transcription of multiple health-relevant genes. In diseases such as polycystic ovary syndrome (PCOS), periodontal disorders, multiple sclerosis, and metabolic syndrome, vitamin D deficiency is consistently linked with disease progression and poor clinical outcomes. Furthermore, its deficiency is associated with impaired quality of life, fatigue, reduced neuromuscular function, and increased infection susceptibility. Despite the variation in individual responsiveness and ongoing debates regarding universal supplementation, targeted screening and correction of deficiency in high-risk populations appear justified. This synthesis underscores the necessity for precision nutrition, personalized supplementation strategies, and integrative clinical guidelines to harness vitamin D’s full systemic potential.

Management of small hepatocellular carcinoma in cirrhotic patients: resection versus ablative therapies

Faisal Hasan Khadwardi — 2025-12-15

Hepatocellular carcinoma (HCC), the most prevalent liver cancer type, has a heterogeneous molecular and physiological basis with several contributing factors. Cirrhosis is the number one underlying factor for HCC, accounting for approximately 80% of cases. The recent advances in diagnostics and screening have led to a substantial increase in the number of patients diagnosed at an early stage with small HCC. The gold-standard curative treatments for early-stage HCC are thermal ablation or resection. HCC treatment is particularly challenging in cirrhotic patients due to liver dysfunction and their being prone to portal hypertension. Thus, choosing between thermal ablation and resection remains an unresolved debate that requires balancing radical removal of the tumor with preserving adequate functioning liver tissue. This review aims to explore the distinct etiology of HCC in cirrhotic patients and how it contributes to the development of malignancy. It also seeks to explore how cirrhosis affects the response to available treatment approaches by comparing the gold-standard methods used, ablation vs resection, taking into account recent evidence on liver cell preservation, portal hypertension consequences, and microvascular invasion, along with novel radiomics tools. To provide evidence-based recommendations for enhancing small HCC management in cirrhotic patients.

Beyond movement: exploring the combined impact of breathing exercises and the PEPSMAN protocol on cognitive and functional recovery in knee osteoarthritis

Gouri G. Nandgaonkar — 2025-12-31

Knee Osteoarthritis (KOA), a leading cause of disability globally, is linked to sedentary lifestyles, obesity, and chronic low-grade inflammation affecting joint and cognitive health. Physical exercise reduces oxidative stress and inflammation, benefiting brain health. The PEPSMAN protocol—combining patient education, exercise, and manual therapy—improves balance, pain, physical function, and reduces disability in KOA. Although limited, early evidence suggests combining PEPSMAN with breathing exercises offers additional benefits. This review synthesizes recent research on the interplay of inflammation, cognition, pain, and rehabilitation in Grade II–III KOA. A comprehensive search across databases like EMBASE, SCOPUS, DOAJ, PubMed, Google Scholar, and Web of Science identified peer-reviewed articles and clinical trials focusing on these factors in KOA.KOA progression associates with increased dementia and Alzheimer's disease risk; chronic pain significantly contributes to cognitive decline and functional impairment. Emerging studies reveal respiration influences cognitive performance. Combining breathing exercises with PEPSMAN enhances cognition and physical function in KOA by reducing inflammation, improving autonomic regulation, and promoting neuroplasticity, addressing joint symptoms and cognitive decline in a holistic approach. Chronic low-grade inflammation is central to KOA pathophysiology, driving joint damage and neurodegeneration linked to cognitive decline and Alzheimer’s disease risk. This highlights the need for integrative management targeting musculoskeletal and neurocognitive health.

Clinical picture, risk factors and management of pericoronitis in children

Shmookh Salman Almutairi — 2025-12-31

Pericoronitis is an inflammatory condition of the soft tissues surrounding a partially erupted tooth, commonly associated with the eruption of permanent molars. While it is more frequently reported in adolescents and adults, children are not exempt from its occurrence, particularly during the mixed dentition phase. In pediatric patients, the clinical presentation can vary widely, ranging from mild gingival discomfort to more severe symptoms such as swelling, trismus and lymphadenopathy. These manifestations are often misinterpreted as routine teething issues or gingivitis, leading to delayed recognition and management. The unique anatomical and behavioral factors present in children significantly influence the risk profile for pericoronitis. Immature gingival tissue, limited space for erupting molars, poor oral hygiene and uncoordinated brushing habits all contribute to the accumulation of debris and bacterial plaque beneath the operculum. Dietary habits rich in fermentable carbohydrates and insufficient caregiver awareness further heighten the risk. In some cases, systemic health conditions or immunosuppression may alter the inflammatory response, complicating diagnosis and prolonging healing. Management strategies in children must account for their developmental stage, level of cooperation and overall health. Conservative treatments such as irrigation, improved oral hygiene and analgesics are commonly effective in early cases. In more advanced or recurrent presentations, antibiotics or minor surgical interventions like operculectomy may be necessary. Laser-assisted procedures offer advantages in pediatric settings by minimizing discomfort and improving healing. Across all treatment options, preventive care and caregiver education are vital to reducing recurrence and improving outcomes. Understanding the clinical diversity, risk factors and treatment responses in children is essential for early detection and effective management of pericoronitis. Pediatric-focused approaches that integrate preventive strategies, timely intervention and interdisciplinary care can significantly reduce the burden of this condition during critical stages of dental development.

Impact of proton pump inhibitor use on microbiota and diversity

Ahmed S. Alsharef — 2025-12-31

Proton pump inhibitors are a class of drugs specifically administered to alleviate stomach acid. In cases of GERD, general GI disturbances and other medication-related GI symptoms, PPIs are widely prescribed globally. Typically, patients taking PPIS have a history of long-term use, which can lead to various health issues. Gut health primarily depends on gut microbiota and dysbiosis of the microbiota can result in numerous metabolic and infectious disorders. Recent research has focused on the impact of PPI usage on the diversity and composition of microbiota. This systematic review aimed to summarize the key findings from studies conducted from January 2015 to June 2025, including only interventional, cohort and case-control studies. After screening 1861 articles sourced from PubMed, Scopus, Clinical trials and other databases, only 12 studies were included in this review. Data revealed that both alpha and beta diversity are significantly increased in individuals after PPI use and there is a significant increase in the colonies of Streptococcus, Staphylococcus and pathogenic microbes such as E. coli. It has also been summarized that PPI intake can result in IBS and autoimmune disorders. Therefore, the unregulated use of PPIs should be restricted and research should be conducted to provide better alternatives.

Machine learning based prediction of risk of hypertension among people of Tamil Nadu

Tamilamudhan Manivannan — 2025-12-31

Hypertension is the one of the leading causes of cardiovascular morbidity and mortality. Early detection of individuals at elevated risk is critical, yet conventional prediction models fail to capture nonlinear and high-dimensional interactions among epidemiological and behavioral determinants. Machine learning (ML) offers new opportunities for accurate, population-level risk stratification. We conducted a secondary analysis of the Tamil Nadu STEPS survey 2020, applying supervised ML algorithms—including boosting, k-nearest neighbours, decision tree, random forest, and support vector machine—to predict hypertension risk. Predictors included demographic, anthropometric, lifestyle, and behavioral variables. Models were implemented in JASP, and their performance was evaluated using accuracy, area under the receiver operating characteristic curve (AUC), precision, recall, and F1 score. Among the algorithms tested, the random forest classifier demonstrated the most balanced performance (accuracy 65.5%, AUC 0.708, precision 64.2%, recall 65.5%, F1 score 64.7%). Feature importance analysis identified age as the strongest predictor, followed by waist circumference, while diet and physical activity contributed minimally. The confusion matrix confirmed the model’s balanced sensitivity and specificity, reducing both false negatives and false positives. This study highlights the potential of machine learning, particularly random forest models, for hypertension risk prediction in Indian populations. By leveraging routinely collected survey data, ML can enable scalable, non-invasive screening and inform targeted public health interventions. Integration of richer clinical and genetic features and ensemble methods may further improve predictive accuracy.

Effectiveness of nurse-led women wellness hubs in mitigating risk factors of noncommunicable diseases among adult women of South Asia

Rohit — 2025-12-31

Noncommunicable diseases (NCDs) such as diabetes, cardiovascular disorders, hypertension, and obesity are rapidly escalating among women in South Asia, driven by sociocultural disparities, limited access to preventive services, and gender-specific barriers in healthcare. Nurse-led women wellness hubs (WWHs) offer gender-responsive, community-based model for early screening, lifestyle modification, and risk reduction. This systematic review aimed to evaluate the effectiveness of nurse-led wellness hubs and analogous interventions in mitigating NCD risk factors among adult women in South Asia. Searches were conducted across PubMed, Scopus, CINAHL, Cochrane Library, Embase, and WHO global index medicus using standardized MeSH terms. Selection process adhered to PRISMA 2020 guidelines, and 22 studies met the eligibility criteria, including randomized controlled trials, quasi-experimental studies, mixed-methods evaluations, and systematic reviews. Evidence demonstrated significant improvements in behavioral and clinical markers, including reductions in blood pressure, improved dietary practices, increased physical activity, enhanced health literacy and higher screening uptake. Nurse-coordinated multidisciplinary strategies, culturally adapted interventions, and community peer-support models yielded the strongest outcomes. Although heterogeneity in study design and follow-up duration limits generalizability, findings support nurse-led hubs as feasible, scalable, and cost-effective platforms for NCD prevention in low-resource settings. Strengthening training, digital health integration, long-term evaluation, and policy-level investment is essential for sustainability. Overall, nurse-led WWHs represent a transformative pathway toward equitable, preventive, and gender-centered healthcare in South Asia.