Journal of Family Medicine and Primary Care

Considering the fact of growing elderly population in Bangladesh and breaking of the cultural tradition of family taking care of the elder generation, institutionalization has become popular. This cross-sectional study was designed to evaluate the level of depression, anxiety and stress among the elderly people living in OAHs and impact of sociodemographic, anthropometric, clinical characteristics and satisfaction levels about the institutional facilities on their depression, anxiety, stress levels. Three old age homes were selected by purposive sampling- Probin Nibash (Agargaon), Priyojon Nibash (Darus Salam Road) and Old Rehabilitation Center (Gazipur). A total of 175 participants were selected from these institutions, who met inclusion criteria. They were interviewed face- to- face with a semi- structured questionnaire. DASS-21 was used to evaluate their level of depression, anxiety and stress level. SPSS version 26 was used for statistical analysis. Most prevalent age group was found to be 66-70 years with a mean age of 75.31{+/-}7.72. Female participants (52%) were more than male respondents (48%). Most of the participants was graduates (38.3%). Most of the participants (90.3%) were widowed with 1- 2 children (80%). Half of the participants (50.3%) had non- government jobs previously, whereas 40% were housewives. Regarding communication, 68% never communicate with their family and most of them (80.6%) had no one to take care at their homes. More than half of the respondents (58.3%) had chronic diseases like hypertension (16.67%), diabetes (47.06%), heart disease (7.84%) etc. Majority of the participants were satisfied with the facilities like food (61.14%), recreation (83.43%), medical care (80.0%), caregiver services (96.57%), safety (98.86%), physical exercise (93.43%), social activities within the institution (99.43%) and funeral system (83.43%) provided by the institutions. Among all the participants, 80.57% had mild to extreme severe level depression, 68% had anxiety and 70.29% had stress. Depression was found to be associated significantly with female gender, less communication with family, 1-5 years of staying at OAHs (p<0.001). Anxiety was significantly associated with female gender and less communication with family (p<0.05). Stress was significantly associated with less communication with family, and 1-5 years of staying at OAHs (p<0.001).

Abstract Baclground: School teachers are the first responders in the early detection and referral of students with mental health issues and there is an urgent need for Mental Health Literacy training to support this. Childhood and adolescent mental health has emerged as a national health problem, so there is a need to plan an intervention program on mental health literacy for teachers in the schools of India as there are very few planned interventions. Objective: To design and test an intervention package for school teachers regarding mental health literacy. Materials and Methods: The training module on mental health literacy for school teachers was developed through a needs assessment, by conducting in-depth interviews with school teachers (n = 12), gathering experts' opinions on the content for the training manual (n = 12), and content validation of the training manual by experts (n = 7). Content validation index and kappa value was used for validation of the manual. Participants: School teachers were targeted in the development of the components of the training manual to orient them to mental health and mental illness, and to prepare them to manage school children with behavioural and mental health disorders and know when to refer. The contents covered the introduction to mental health and mental disorders, myths and stigma related to mental illness, common developmental, behavioural and mental health disorders in children, role of teachers, mental health first aid, and seeking help and finding support. The Kappa value was modified (K = 0.932) and showed that the content was very relevant to use for school teachers. Conclusion: School teachers' mental health literacy programs in India are vital interventions to address the mental health crisis in the country. With the development of structured MHL modules, India can start to overcome this huge treatment gap by enabling educators to become effective early intervention points.

Background: Globally and in Bangladesh, high-risk fertility behaviour (HRFB) continues to be a significant public health issue, contributing to negative health outcomes for both mothers and children. So, this study aimed to evaluate the trends, prevalence, determinants, and socio-economic inequalities associated with HRFB among presently married women of reproductive age by utilising data from the Bangladesh Demographic and Health Survey (BDHS). Methods: We analysed data from 19,060 currently married women aged 15-49 years. HRFB was defined as the presence of any of the following: maternal age (<18 or >34 years), short birth intervals (<24 months), or high birth order ([&ge;]4). Two outcome variables were constructed: a binary indicator for any HRFB (yes/no) and a three-category variable indicating no, single, or multiple HRFBs. Bivariate analysis was conducted to determine the prevalence of HRFB, and multilevel mixed-effect logistic and multinomial regression models were applied to identify determinants, accounting for the complex survey design. Socioeconomic inequalities were examined using concentration indices and concentration curves. Results: Overall, 58% of women experienced at least one HRFB, with 33% exhibiting a single HRFB and 25% multiple HRFBs. Women who married after age 18 years, had higher education, were exposed to media, or had educated husbands were significantly less likely to experience HRFB. Higher odds of HRFB were associated with rural residence, lower household wealth, and regions such as Mymensingh, Barishal, and Chattogram. Significant inequalities were observed, with HRFB disproportionately concentrated among women with lower wealth (CIX = -0.427, p<0.001) and no education (CIX = -0.268, p<0.001). Conclusion: In Bangladesh, HRFB remains prevalent and is unevenly distributed across socio-economic and geographic groups. Targeted interventions aimed at delaying early marriage, improving educational attainment for women and their partners, expanding mass media outreach, and increasing access to reproductive healthcare- especially among disadvantaged and rural populations- are essential for reducing HRFB and improving maternal health outcomes.

Background: Hypertension is a leading modifiable risk factor for cardiovascular disease and premature death worldwide. Despite effective pharmacological therapy, poor adherence to anti-hypertensive medication remains the primary barrier to achieving blood pressure control, with non-adherence rates reaching 45-65% in sub-Saharan African settings. In Zambia, uncontrolled hypertension contributes substantially to hospital morbidity and mortality, yet context-specific data on adherence barriers remain limited. This study assessed factors associated with adherence to anti-hypertensive medication among patients attending Railway Surgery Urban Health Centre in Ndola, Zambia. Methods: A cross-sectional study was conducted among 237 hypertensive patients attending Railway Surgery Urban Health Centre in Ndola. A structured, interviewer-administered questionnaire assessed socio-demographic characteristics, clinical factors, and medication adherence using the modified Hill-Bone Compliance Scale. Data were analysed using descriptive statistics, chi-square tests, and multivariable logistic regression (p<0.05). Results: The overall adherence rate was 41.4%, with 58.6% of participants classified as non-adherent. The mean adherence score was 19.8 (SD=4.6) out of a possible 32. The most common reasons for non-adherence were running out of pills (mean=2.6), being away from home (mean=2.5), and forgetting to take medication (mean=2.4). Age (p=0.006), education level (p=0.001), and monthly income (p=0.001) were significantly associated with adherence. Clinical factors significantly associated with poorer adherence included presence of comorbidities (p=0.027), experience of side effects (p<0.001), and medication regimen complexity (p=0.007). Multivariable analysis identified age [&ge;]51 years (AOR=2.89-3.24), secondary/tertiary education (AOR=2.84-3.56), monthly income [&ge;]K1,000 (AOR=2.21-5.89), absence of comorbidities (AOR=0.51), absence of side effects (AOR=0.36), and simpler regimens (AOR=0.34) as factors independently associated with adherence. Health system barriers included long distances, reliance on public transport, missed appointments due to transport problems (35.4%), medication stock-outs (38.4%), and inadequate counselling time (49.8% received <5 minutes). Conclusion: Adherence to anti-hypertensive medication at Railway Surgery Urban Health Centre is suboptimal, with multiple socio-demographic, clinical, and health system factors associated with non-adherence. Interventions should focus on regimen simplification, proactive side effect management, enhanced patient education, and addressing systemic barriers including medication supply and transport access.

Internet use has increased rapidly around the world, along with reports of overuse among internet users. This can affect not just the psychosocial well-being but also the physical health of the young population, who are its major victims. However, very limited studies have been conducted on internet addiction among the young population in Nepal. This study aims to find the prevalence of internet addiction and its associated factors among undergraduate students of the Institute of Medicine (IOM), Nepal. We conducted a cross-sectional study among 211 undergraduate students of IOM. A structured questionnaire was used to collect socio-demographic, academic, and internet-use-related information. Internet addiction was assessed using Youngs Internet Addiction Test. Descriptive and bivariate analyses were performed. Frequencies and percentages were calculated for univariate analysis, while bivariate analysis was performed to assess the association between the dependent and independent variables. One in two students had internet addiction, with 36.5% having mild addiction, 12.3% having moderate addiction, and 1.4% having severe addiction. The mean age ({+/-}SD) of the students was 21.6 {+/-} 2.0 years. The variable found to be associated with internet addiction was the duration of internet use per day. Students who used the internet for more than five hours per day were about 2.3 times more likely to have internet addiction than those who used the internet for five hours or less (OR = 2.399, 95% CI: 1.334-4.314). Internet addiction is a significant concern among undergraduate students and may increase if not appropriately addressed. Excessive and problematic internet use may contribute to mental health problems such as difficulty concentrating, anxiety, and compulsive behaviors, particularly among young people who are frequent users of the internet.

Background/Aims: In medical practice, the rising prevalence of infections in kidney transplant recipients (KTRs) is a notable concern. However, understanding the incidence and risk factors associated with infections in KTRs remains limited. This study aims to assess the incidence and factors associated infection among KTRs. Additionally, we also investigate the median time of each infection among KTRs. Methods: A retrospective cohort study was conducted from 1 January 2018- 31 December 2022 at Thailand's tertiary hospital. We performed univariable and multivariable logistic regression analyses to identify potential risk factors related infection and investigated for the incidence and median time of each infection among KTRs. Results: A total of 179 participants were included in this study. Our findings reveal the kidney from living donor was protective factor for infection among KTRs (aOR 0.063, 95% CI 0.005-0.792; p = 0.032). Urinary tract infections (UTIs)showed as the predominant pathogenic manifestation among KTRs (43%). The median time of UTIs, cytomegalovirus (CMV) infection and pneumocystis pneumonia (PCP) were 16, 57 and 94.5 days, respectively. Conclusions: Our study establishes that receiving a kidney from a living donor is a protective factor against post-kidney transplant infections. Particularly urinary tract infections were most common of infection. Monitoring urinary tract infections post-transplantation is recommended. Moreover, awareness of UTI, CMV infection and PCP should be concerned during 2-3 months after transplantation. However, due to a small sample size; we recommend to increase the number of particular participants in further investigations.

HIV infection significantly elevated the odds of cardiovascular diseases, including myocardial fibrosis. We aimed to determine the difference of late gadolinium enhancement (LGE), extracellular volume (ECV), T1, and T2 using cardiac magnetic resonance imaging (CMR) in patients living with HIV (PLWH) and healthy controls. The databases Scopus, Web of Science, Embase, and PubMed were searched systematically using relevant keywords. STATA version 17 was used for meta-analysis using random effect and fixed effect models for heterogeneous and non-heterogeneous analyses. An overall number of 13 studies were included in the current analysis involving 1425 PLWH and 766 healthy controls. PLWH showed significantly higher LGE (OR: 5.47, 95% CI: 1.90-15.64, p<0.001) and ECV (mean difference: 1.46, 95% CI: 0.21-2.71, p=0.02) compared to controls. However, differences in Left Ventricular Ejection Fraction (LVEF) were not significant (mean difference: -1.41, 95% CI: -2.81- -0.01, p=0.05). There were no meaningful disparities in pro B-type natriuretic peptide (BNP) values (mean difference: 8.67, 95% CI: 0.04-17.29, p=0.05) or T2 values (mean difference: 0.91 ms, 95% CI: -1.04-2.86, p=0.36), but T1 values were significantly higher in PLWH (mean difference: 13.78 ms, 95% CI: 9.16-18.40, p<0.001). In meta regression, LGE was correlated with nadir CD4 (z=-3.41, p-value<0.001). In addition, ECV was correlated with white race (Z=-3.97, p-value<0.001), Hepatitis C (Z=-2.08, p-value=0.037), and smoking (Z=2.05, p-value=0.041). HIV is related to a significantly elevated rate of myocardial fibrosis, and factors such as lower nadir CD4, white race, hepatitis C, and smoking were correlated with hepatitis C. Keywords: Myocardial fibrosis, HIV, AIDS, Cardiovascular diseases, Heart failure

BACKGROUND: War refugees are prone to psychiatric ailments due to multiple psychosocial stressors. Afghan refugees remain underrepresented in psychiatric studies. Therefore, a study exploring factors contributing to their mental health disorders is essential to guide rehabilitation efforts worldwide. METHODS: This descriptive cross-sectional study evaluates the demographics, psychosocial stressors, psychiatric illnesses, and psychotropic drug use among Afghan refugees visiting the Psychiatry Outpatient Department (OPD) in Islamabad, Pakistan. Convenience sampling was employed on a sample population (n) of 75 participants. Data was collected via a structured questionnaire and analyzed using SPSS v21.0. Qualitative and quantitative variables were analyzed statistically. RESULTS: Nearly 64%(n=48) of the participants were female. About 46.7%(n=35) of participants were uneducated, and 53.3%(n=40) were unemployed. 86.7%(n=65) of participants were married, while 2.7%(n=2) were divorced. 91%(n=61) of the married and divorced participants had an arranged marriage, 46.3%(n=31) had 5-8 children, and 67.2%(n=45) had experienced physical and/or emotional abuse. 74.7%(n=56) of the total participants reported a loss in the family, while 77.3%(n=58) had experienced trauma. 62.7%(n=47) had depression and associated psychotropic use, e.g., SSRIs (42.7%), TCAs (16%), and Benzodiazepines (13.3%). Alarmingly, 37.3%(n=28) reported a previous suicide attempt. CONCLUSION: This study explores the psychosocial stressors faced by Afghan refugees in Pakistan, including displacement, abuse, trauma, and family/income loss. It emphasizes the importance of evidence-based psychiatric care, rehabilitative interventions, and culturally sensitive care to counter psychiatric morbidities and underscores the need for future research to improve the mental health of refugees globally.

Objective: Hyperthyroidism and hypothyroidism related to iodine deficiency are major public health concerns in Afghanistan. This study aimed to assess the frequency of thyroid dysfunction among male patients referred for thyroid testing and its association with age, and to examine monthly trends in thyroid dysfunction at Asia Med Laboratory in Herat, Afghanistan, from July 2021 to January 2022. Methods: A retrospective analysis was conducted on 250 male patients aged 0-69 years. We measured Serum TSH, total T4, and total T3 levels, and thyroid status was classified using age specific reference ranges. In addition, the frequency of thyroid dysfunction was analyzed across age groups with monthly trends of thyroid state. Results: Overall, the euthyroid state consisted of 69.2% of participants, 24.8% with overt hypothyroidism, 3.2% with overt hyperthyroidism, and 2.8% with subclinical hyperthyroidism. Thyroid status differed significantly by age (p = 0.0135), with hypothyroidism increasing in older age groups and reaching its highest proportion among men aged 60-69 years (55.6%). Euthyroidism predominated in patients aged 10-39 years, while hyperthyroidism across age groups remained relatively infrequent. After September 2021, a threefold increase was observed in the total number of male patients referred for thyroid testing. During this period, the proportion of hyperthyroidism increased slightly, whereas hypothyroidism cases declined. Conclusion: In conclusion, hypothyroidism was more frequent with older age. The rise in absolute case numbers after September 2021 likely reflects increased patient referrals, underscoring the need for ongoing monitoring of thyroid function. The study may assist in the early management of thyroid disorders and in reducing their complications.

Background: Hepatitis B virus (HBV) seroprevalence reaches 10--12% among out-of-school youths in urban Southwest Nigeria, yet fewer than three in ten in this demographic have ever undergone HBV testing. E-health self-testing applications offer an accessible alternative delivery modality for hepatitis screening, but direct evidence comparing their acceptance against traditional laboratory-based delivery in informal commercial settings is lacking. Objective: To determine whether e-health app-guided hepatitis self-testing achieves equivalent disease detection and superior acceptance outcomes compared with traditional laboratory-based screening among out-of-school youths in a high-footfall commercial site in Ibadan, Nigeria. Methods: A cross-sectional parallel-arm pilot study recruited 120 out-of-school youths at commercial premises on Iwo Road, Ibadan (test group: n=60, e-health app-guided hepatitis B and C self-testing; control group: n=60, traditional laboratory-based testing using identical rapid diagnostic kits). Pre- and post-test structured questionnaires assessed technology readiness, behavioural intention, perceived ease of use, and adoption barriers. The Technology Acceptance Model (TAM) and Unified Theory of Acceptance and Use of Technology (UTAUT) provided the analytical framework. Group comparisons used chi-square and Fisher's exact tests (=0.05). Results: HBV seroprevalence was 10.0% in the test group and 11.7% in the control group (X2=0.087, p=0.769), confirming statistically equivalent detection across modalities. Hepatitis C virus was undetected in both groups. The test group demonstrated greater willingness to use e-health testing over traditional laboratory services (81.6% vs 70.0%), higher comfort with mobile health technology (75.0% vs 71.7%), and equivalent recommendation intent (93.3% vs 95.0%). Prior e-health service use was significantly higher in the test group (28.3% vs 13.3%; X2=4.09, p=0.043). Anticipated ease of use (75.0% "very comfortable") substantially exceeded experienced ease post-use (41.7% "very or extremely easy"). Privacy concern was the leading adoption barrier in both groups (30.0% vs 36.7%), outranking cost (25.0% vs 15.0%). Conclusions: E-health self-testing achieves non-inferior hepatitis B detection compared with traditional laboratory delivery while generating comparable acceptance outcomes. The gap between anticipated and experienced ease of use identifies usability as the primary design target. Privacy-centred tool design, not cost reduction alone, is the critical condition for scaling hepatitis e-health self-testing among out-of-school youths in urban Nigeria.

Background: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Historically, male sex was considered a cardiovascular risk factor however recent accumulating data suggest complex interaction between sex and CVD leading to specific inequalities affecting both males and females with specific cardiometabolic features. Methods: Data from a large nationwide screening cohort were used to assess the cardiometabolic burden among males vs females in Algeria. The prevalence and adjusted Odds Ratio (aOR) of major CVD diseases were compared across the study cohorts. Records of systolic (SBP) and diastolic blood pressure (DBP), as well as findings of clinical examination, ECG, and echocardiography were collected and reviewed for analysis. Results: A total of 21,522 patients were included among them 12,015 were females and 9,507 were males. The latter group had higher age (median age: 60 [51.00-68.00] vs 57 [49.00-65.00] years; p< 0.001), sitting DBP (83 [76.00-92.00] vs 80 [75.00-90.00]; p< 0.001), standing SBP (142 [130.00-160.00] vs 140 [124.00-154.00] mmHg; p< 0.001), smoking (22.1% vs 0.9%; p<0.001) and unknown diabetes (15.2% vs 13.2%; p< 0.001) rates. Moreover, females showed an overall worse cardiometabolic profile while males had a greater burden of ischemic heart disease, arrhythmia, conduction abnormalities, and left ventricular dysfunction. On multivariate analysis, female sex was correlated with higher aOR for known hypertension (aOR:1.55; 95%CI:1.40-1.72; p<0.001) and known dyslipidaemia (aOR: 1.23; 95%CI:1.09-1.39; p=0.001). On the other hand, female sex predicted lower risk of any CVD (aOR:0.84; 95%CI:0.72-0.98; p=0.028) and known cardiovascular disease (aOR: 0.79; 95%CI: 0.67-0.94; p=0.007). Conclusion: CVD affect males and females differently which reflects multifaceted biological, cardiometabolic, and sociodemographic disparities. These findings highlight the need to reduce the sex gap in the prevention and management of CVD. Keywords: Cardiovascular disease; Sex; Management disparities; Sex Gap; North Africa; Algeria

Background: Lung cancer is leading cause of cancer related death globally. It is second most prevalent cancer among women worldwide and ranks third among females in Nepal. Contributing factors are smoking, tobacco use, air pollution, and delayed diagnosis. Image-guided fine needle aspiration cytology (FNAC) is rapid diagnostic technique for evaluating lung lesions. It is minimally invasive procedure with less complications. This study examine histocytologic makeup of lung lesions and link the results. Materials and Methods: This cross-sectional observational study included 65 patients irrespective of age and sex presenting with lung masses at Chitwan Medical College and Teaching Hospital from April 2023 to September 2024. After clinical and radiologic evaluation, all cases underwent image-guided FNAC and biopsy. Only specimens with unequivocal malignant features were classified positive. Histopathology served as diagnostic reference standard. Results: FNAC diagnosed 90.8% as malignant and 9.2% as benign. Biopsy confirmed malignancy in 92.3% of cases. FNAC demonstrated a sensitivity of 98.33%, specificity of 100%, positive predictive value(PPV) of 100%, and negative predictive value (NPV) of 83.33%. Concordance between FNAC and histopathological subtyping was 98.46%. Adenocarcinoma was most common subtype, followed by Squamous cell carcinoma(SCC) and small cell carcinoma. Smoking was most common contributing factor associated with malignancy. Conclusion and implications: Image-guided FNAC is an excellent diagnostic accuracy tool which possess higher level of concordance with biopsy in evaluating lung masses. It should be considered as frontline diagnostic tool, especially in resource limited settings. Keywords: FNAC, Lung cancer, Biopsy, SCC, Adenocarcinoma, Small cell carcinoma, Nepal

Introduction Hearing loss (HL) affects over 1{middle dot}5 billion people globally and India shares a disproportionately high burden including Disabling Hearing Loss (DHL). HL affects an Individual socio-economically, but there are limited studies on the broader societal economic consequences of HL in India.Methods Using Cost-of-Illness (COI) approach, we studied the societal economic burden of HL in India. This study uses epidemiological and macroeconomic data and modelling to estimate the loss of Gross National Income (GNI) due to HL and DHL across three economic pathways. Uncertainty is evaluated using deterministic and Probabilistic Sensitivity Analyses (PSA).Results The model estimates that there are in India, 289 million and 85{middle dot}9 million people with HL and DHL respectively. Direct Loss of GNI and Indirect Loss of GNI (Caregiver burden) are estimated as INR 4,648{middle dot}4 billion (USD 55{middle dot}6 billion) and INR 3,268 billion (USD 39 billion) respectively. The Loss of GNI due to Low Education amongst those with HL is estimated as INR 1,041{middle dot}9 billion (USD 12{middle dot}45 billion).Discussion Economic burden of HL is presented across three pathways with Direct Loss of GNI due to DHL being the greatest. It also presents age stratified caregiver economic burden. The findings of the study help in estimating similar cost pathways, advocacy, and policy decisions towards reducing HL prevalence in India and LMICs. This study also highlights the need for India specific estimations related to the HL attributable low education, state-wise disaggregates, and prevalence studies. Funding This study has not received any funding.

Introduction: Professionalism is a conceptualization of obligations, attributes, interactions, attitudes, and role behaviors required for professionals with individual clients and to the society as a whole. Despite there is a known effect of low professionalism of nurses on health care delivery system, the study determining professionalism and affecting factors in Ethiopia is limited in to a few numbers. Therefore this study was aimed to assess perceived level of professionalism and associated factors among nurses working in Hadiya Zone public hospitals, south Ethiopia. Methods: An institution based concurrent mixed cross sectional study was conducted from May 09 to June 09/2022. A total of 376 nurses were selected by using Computer generated Simple random sampling techniques for quantitative study whereas Purposive sampling technique was used to select qualitative study participants. Epi data version 4.6 was used to enter the data whereas Statistical package for social science version 25 was used for the analysis of quantitative data. Ordinal logistic regression model was used to identify effects of independents on outcome variable. Results: A total of 360 nurses participated in the study with a response rate of 95.7%. The overall low perceived professionalism among nurses working in Hadiya zone found to be 40.3%. Variables such as Educational status (AOR= 0.045 (0.021, 0.096), Sense of accomplishment (AOR= 3.21(1.85, 5.55), and participating in professional associations (AOR= 5.302(2.82, 9.96) were significantly associated with professionalism. Qualitative study finding showed Salary, training, upgrading education; undermining nursing profession, inadequate facilities were the raised influencing factors of professionalism. Conclusion: This study revealed that professionalism among nurses was low and the associated factors were; level of education, taking training, participating in professional organizations, and sense of accomplishment. Ethiopian nursing association and Ministry of Health should focus on developing nurses professionalism.

Background: Abortion is safe when carried out using a method recommended by the World Health Organization (WHO), appropriate to the pregnancy duration, and by someone with the necessary skills. lobally, around 73 million induced abortions take place each year. Around 95% of maternal deaths occur in developing countries due to childbirth and pregnancy-related complications. Methodology: A descriptive cross-sectional study was used for the study among the married reproductive (20-45 years) age women using a non-probability purposive sampling technique. A self-developed semi-structured questionnaire was used via face-to-face interview for data collection. The collected data were analyzed using SPSS 16.0 version descriptive and inferential statistics were used to find the association between variables. Results: The findings of the study show that among 118 respondents, nearly two-thirds (57.6%) of the respondents had adequate knowledge and less than half (42.4%) of the respondents had inadequate knowledge regarding safe abortion. The study further shows that there was a significant association between the level of knowledge regarding safe abortion and education status and education level with p-value <0.05. Conclusion: The study concludes that nearly two third of the respondents have adequate knowledge regarding safe abortion. Educational status significantly influenced their level of knowledge. Thus, we could provide correct knowledge, education, and enhance awareness to married women in the reproductive age group.

Background Surveillance of adverse events following immunization (AEFI) and appropriate reporting are essential ingredients of an effective immunization programme. Despite increasing recognition by caregivers, the response to it remains a major problem, with the majority being inappropriate. This study is therefore intended to determine the prevalence, pattern, and determinants of caregivers response regarding AEFI in Nigerian hospitals. Methodology A descriptive cross-sectional study was conducted among 368 caregiver-infant pairs across 3 Nigerian hospitals, using semi-structured questionnaires to document sociodemographic characteristics and the prevalence, pattern, and determinants of caregivers response. Statistical analyses were performed using SPSS version 27. Predictors of AEFI and determinants of caregivers response were assessed using Pearsons chi-square and logistic regression. A p-value < 0.05 was considered statistically significant. Results The prevalence of AEFI was 71.7%, with inconsolable crying/irritability, fever, and swelling at the vaccination site as the leading cases. Infant age, weight, and gestational status at birth were predictors of AEFI occurrence. Only 8 (3.0%) caregivers presented at a healthcare facility when AEFI was noticed (appropriate response), while 360 (97.0%) did not (inappropriate). The relationship of the caregiver to the vaccinated infant (mother) was found to be a determinant of caregivers response to the occurrence of AEFI. Conclusion An increasing prevalence of AEFI that was not followed by an optimally appropriate response from caregivers has been demonstrated. This calls for more public enlightenment focusing on the need to report AEFI at healthcare facilities, as this will help in ensuring vaccine safety and improvement in the immunization programme.

Background: The main cause of urinary tract infections (UTIs) are Gram negative bacteria with Escherichia coli as the leading cause and other important pathogens such as Klebsiella pneumoniae, Pseudomonas aeuriginosa and Enterococcus faecalis. Over the years uropathogens have become resistant to commonly used antibiotics, including penicillin's, cephalosporins and fluoroquinolones. Antimicrobial resistance (AMR) in UTIs is mainly caused by the misuse and overuse of antibiotics, recurrent infections, and healthcare-associated factors such as catheterization. Objectives: The aim of this study was to describe the bacteriological profile and antimicrobial susceptibility patterns of uropathogens isolated from positive urine cultures at Chhatrapati Shivaji Subharti Hospital, Meerut, a tertiary care centre in North India and develop an institutional antibiogram to support empirical prescribing and antibiotic stewardship at this institution. Materials & Methods: The study analysed 50 positive urine culture samples and their antimicrobial susceptibility records from July 2025 to December 2025. The isolates were identified, and antimicrobial susceptibility testing was performed using the disc diffusion method and automated Biomerieux Vitek 2 Compact machine. The collected data was analysed using descriptive statistics and Fisher's exact test. Results: Gram-negative bacteria accounted for 80.0% (40/50) of the culture-positive urine isolates. Escherichia coli was the most frequently isolated uropathogen (n=23, 46.0%), followed by Klebsiella pneumoniae (n=12, 24.0%), Candida spp. (n=6, 12.0%), Enterococcus spp. (n=4,8.0%), Pseudomonas aeruginosa (n=3, 6.0%), and Enterobacter cloacae (n=2, 4.0%). Of the total, 74% (37/50) of isolates came from Inpatient samples. E. coli had a 100% resistance to ampicillin and ceftriaxone, 95.7% to ciprofloxacin and cefepime, and 73.9% to meropenem, with fosfomycin (86.4% sensitive) and colistin (69.6% sensitive) as the only effective antimicrobials. K. pneumoniae had 100% resistance to ceftriaxone, amoxicillin-clavulanate, and piperacillintazobactam; carbapenem resistance ranged from 83.3% to 91.7%, and colistin was the only consistently effective treatment (83.3% sensitive). Of all the 35 tested Enterobacteriaceae isolates, Extended-Spectrum Beta-Lactamases (ESBLs) positivity was 100% with Carbapenem-Resistant Enterobacterales (CRE) positivity at 85.0%. All the bacterial isolates met Multi-drug Resistant (MDR) criteria. 31 of 35 (88.6%) tested Enterobacteriaceae isolates showed ESBL and CRE copositivity. The six strains of Candida demonstrated total sensitivity to all the antifungal drugs used. Conclusion: There is a critical burden of AMR at this hospital with 100% ESBL positivity, 85% CRE, and 100% MDR among all bacterial isolates. This study provides the first baseline institutional antibiogram to guide empirical prescribing and antibiotic stewardship at Chhatrapati Subharti Hospital.

Social media has an estimated global user base of 3.5 billion. Adolescents, constituting over 90% of this group, and thereby university students. are extensively involved in social media use, emphasizing its significance in their daily lives. Excessive use of social media poses risks such as depression, affecting academic performance. The objective of this study was to determine the association between social media use and depression among university students in Urban Northern Tanzania. This was a cross-sectional study that involved university students from three universities. Data was collected through an online close-ended questionnaire. Statistical analysis included the use of frequencies, percentages, chi-square and bivariate logistic regression at 95% confidence intervals (CIs) and significance at p value <0.05. A total of 384 participants were enrolled in the study. 36.7% reported that they used social media for 1 to 3 hours daily. 58.1% of all participants reported high frequency of social media use for social purposes. 29.2% of university students who participated in the study were screened to have depression. The prevalence of depression increased with longer daily duration of social media use. Those using social media for more than 5 hours daily, had 3.049 times higher odds of being depressed. Moderate frequency of social media use for social purposes was linked to reduced depression. Daily duration of social media was significantly associated with depression levels among university students. Significant associations were also found between moderate use of social media for socializing, with lower risk of depression. We recommend that universities develop targeted mental health interventions and promote balanced, purposeful social media use among students.

Background: Disaster medicine has been a formal curricular recommendation in German health professions education since 2006, and comparable recommendations exist internationally. Evidence on implementation is confined almost entirely to human medicine, rests on faculty self-reports or small student samples, and measures delivery rather than retention. Whether curricular exposure is associated with willingness to serve has not been adequately examined in interprofessional samples. Objective: We aimed to characterize disaster medicine education across 7 health professions in Germany, distinguishing delivery from retention, to identify profession-specific gaps and training priorities, and to examine how educational and experiential factors relate to willingness to serve. Methods: We conducted an anonymous nationwide online cross-sectional survey of students and trainees across 7 health professions in Germany between July 9 and August 25, 2026, recruited through institutional distribution lists. The interprofessionally developed instrument comprised 48 items. We assessed delivery and retention of 12 disaster medicine topics (4-point scale), self-rated confidence in 22 clinical and nursing skills (6-point scale), desired content, formats, motivators and barriers, and formal and spontaneous willingness. For all rating scales, higher values denote the more favorable level. We derived a delivery-retention gap and a want-deficit index, examined the dimensional structure of the competence battery, tested for differential item functioning by prior civil protection engagement, and modeled willingness with a cumulative link model. Results: Of 8133 respondents (completion rate 87.5%), 33.1% had never been taught disaster medicine and 25.0% only in passing; 22.1% had comprehensive teaching including practical exercises. Across the 12 topics, the proportion able to retrieve content confidently never exceeded 23.9%; the delivery-retention gap reached 47.3 percentage points. More than half (54.6%) had never taken part in a practical exercise. Competence formed more than 1 dimension: 18 acute-technical items loaded 0.54-0.86 on the first factor, 4 relational and nursing items 0.14-0.28. Prior civil protection engagement was associated with higher confidence on every acute-technical item (Cliff delta 0.26-0.55) and lower confidence on all 4 relational items (-0.22 to -0.09). Willingness was high and homogeneous across groups (78.7% formal, 84.1% spontaneous), whereas competence varied by about 2 scale points. Adjusted, active civil protection engagement (odds ratio 2.49, 95% CI 2.12-2.94) and practical exercise experience (odds ratio 1.78, 95% CI 1.54-2.05) were the strongest predictors; curricular exposure contributed weakly (odds ratio 1.06 per SD, 95% CI 0.99-1.14). Conclusions: Two decades after the curricular recommendation, disaster medicine is largely absent from health professions education in Germany, and what is delivered is not retained. Willingness is nevertheless high and largely decoupled from competence, so qualification and recruitment require separate instruments. Curricula should be prioritized by the coincidence of demand and deficit rather than by coverage, built for retention, and should treat relational and nursing competence as a distinct learning objective.

Background The prevalence and pattern of secondary causes of first-onset psychosis (FEP) in Asian populations are understudied. Our objectives are to investigate the prevalence and pattern of secondary causes of FEP presenting in an acute medical setting in a metropolitan, Chinese-predominant population, and to investigate the prevalence and pattern of undiagnosed conditions presenting as psychosis. Method This is a retrospective observational study. We reviewed medical records of patients referred to the consultation psychiatry team at a tertiary acute teaching hospital in Hong Kong from January 2015 to Apr 2025. The inclusion criteria of the study are 1) age 18-64 at the time of the assessment, and 2) FEP confirmed by the consultation liaison team. Patients diagnosed with delirium were excluded. Result Among the 384 patients included in the study (mean age = 40.0 {+/-}13.7 years, 69% female), secondary causes of psychosis were found in 9.6% (n=37) of the cohort. Substance use is the most common secondary cause found (n=11, 2.9% of all FEPs) overall. Among those with secondary psychoses, patients' underlying conditions were revealed only by the workup in relation to the FEP in 16 of them, of which definitive or probable autoimmune encephalitis (n=5) and early-onset dementia (n=4) were the most common conditions uncovered. Conclusion The prevalence of secondary psychoses in our FEP cohort is lower than published international figures. Clinicians need to be aware of the suspicious clinical features suggestive of autoimmune encephalitis and early-onset dementia in FEP patients with otherwise unremarkable past history and toxicology test.