Postmenopausal Research Articles

Osteosarcopenia in women with rheumatoid arthritis: association with nutritional status and physical condition

Objective: to evaluate nutritional status, muscle strength, functional status of skeletal muscles and physical activity (PHA) and their relationship with the osteopenic body composition phenotype in women in post menopause with rheumatoid arthritis (RA). Material and methods. The case-control study included 134 women in post menopause with RA, 52 of them had osteosarcopenia (OSP) according to densitometry and 82 had no decrease in bone mineral density (BMD) and muscle mass (mean age 62.0 ± 7.2 and 59.6 ± 7.5 years, respectively; p > 0.05). A clinical and laboratory examination as well as tests to assess muscle strength and functional status were performed. The MNA-SF and IPAQ questionnaires were used to determine nutritional status and physical activity. Results and discussion. Malnutrition was found in 51.9 % of patients, and low and average levels of PHA were found in 5.8 and 50.0 % of patients with OSP, respectively. Factors associated with OSP were identified: nutritional status according to MNA-SF < 12 points (odds ratio, OR 2.52; 95 % confidence interval, CI 1.10–5.77; p = 0.029), dietary calcium intake < 500 mg/day (OR 3.23; 95 % CI 1.49–7.01; p = 0.003), 25(OH)D level < 30 ng/ml (OR 4.55; 95 % CI 1.86–11.16; p = 0.001), moderate PHA < 1 hour per day (OR 2.67; 95 % CI 1.06–6.75; p = 0.037), walking < 1 hour per day and < 4 hours per week (OR 3.25; 95 % CI 1.26–8.38; p = 0.015 and OR 3.17; 95 % CI 1.19–8.46; p = 0.021, respectively). Conclusion. Reduced nutritional status was found in 51.9 % and average or low levels of PHA in 55.8 % of patients with OSP. The risk of OSP development was increased by low nutritional status, inadequate dietary calcium intake, low vitamin D levels, short duration of daily moderate exercise, and inadequate daily and weekly walking time.

Association between Weight Changes over a 4-Year Period and Health-Related Quality of Life in Middle-Aged and Older Adults in Korea: The Korean Genome and Epidemiology Study Cohort.

The relationship between weight change and quality of life remains controversial. This study aimed to investigate whether changes in body weight among participants in different baseline body mass index categories are associated with physical and mental health functioning. We conducted an analysis involving 5,106 adults who participated in the Korean Genome and Epidemiology Study, a cohort comprising Korean adults aged 40 to 69 years. We categorized participants into three groups based on body weight change, and physical and mental health were assessed using the 12-Item Short-Form Health Survey in year 4. We employed logistic regression analysis to assess the association between body weight change and poor functioning at year 4. We also utilized a generalized estimating equation to determine the relationship between weight changes and mental component summary (MCS) scores over the study period for each weight group. Weight gain in both the normal weight (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.13-3.11; P=0.01) and overweight groups (OR, 1.75; 95% CI, 1.05-2.91; P=0.03) was associated with poor MCS. Normal weight weight-losers were associated with a greater increase (2.69 points; 95% CI, 0.50-4.88) in MCS compared to weightmaintainers. Significant differences in mean MCS were observed for overweight weight-losers, obese weight-gainers, and underweight weight-gainers when compared to weight maintainers in each respective weight group. Different patterns of relationships between weight change and mental health-related quality of life were observed. Hence, it is crucial to focus on the mental health of middle-aged and older adults when assessing body weight changes.

The effectiveness of rehabilitation in vulvovaginal atrophy

Objective: to evaluate the effectiveness and safety of rehabilitation programmes in patients with vulvovaginal atrophy (VVA).Material and methods. The study involved 350 patients with VVA in surgical (n=140) and natural (n=140) menopause, the control group included 70 women without VVA. Patients with VVA were distributed into groups receiving complex “active” rehabilitation (surgical menopause: group 1A, natural menopause: group 2A) and “passive” rehabilitation (surgical menopause: group 1B, natural menopause: group 2B). Body mass index (BMI), vaginal pH, carbohydrate profile with calculation of insulin resistance index (HOMA-IR), inflammatory markers leptin, interleukin-6, tumour necrosis factor alpha, serum magnesium, and safety profile with evaluation of adverse events related to rehabilitation measures were assessed over 24 months.Results. BMI decreased significantly in groups 1A and 2A. Vaginal pH at 1-year follow-up decreased in groups 1A and 2A, but increased in groups 2A and 2B. BMI was higher than normal in all patients with VVA, as well as in the control group, demonstrating preobesity (groups 1A, 2A, control group) or first-degree obesity (initially in group 1B and throughout follow-up in group 2B). HOMA-IR initially reflected postoperative insulin resistance in groups 1A and 2A, but in those receiving complex “active” rehabilitation the dynamics of its reduction was the most pronounced. The concentration of inflammatory markers was initially increased compared to the control group and decreased over time in groups 1A and 1B, but only leptin levels reached the control group values by the end of the study. Serum concentration of magnesium levels was 0.71±0.12 mmol/l in group 1A, 0.71±0.10 mmol/l in group 2A, 0.76±0.08 mmol/l in group 1B, 0.72±0.17 mmol/l in group 2B (magnesium deficiency). When organic magnesium salts in combination with pyridoxine were supplemented in groups 1A and 1B, serum magnesium levels were restored to normal from the 3rd month of follow-up. No adverse events were registered.Conclusion. The personalised programme of complex “active” rehabilitation in patients with VVA is more effective than “passive” rehabilitation with comparable safety profile. Its implementation into routine practice will contribute to the improvement of the quality of health care for such patients.

A systematic review and meta-analysis of pediatric integrated primary care for the prevention and treatment of physical and behavioral health conditions.

To evaluate the effects of behavioral health interventions delivered within pediatric integrated primary care models on clinical outcomes. We searched Medline, EMBASE, CENTRAL, PsycINFO, and SCOPUS for studies published from January 1, 1998, to September 20, 2023. We included studies that evaluated onsite behavioral health integration in pediatric primary care using a comparator condition (usual, enhanced usual care, or waitlist). Outcome data on symptom change, impairment/quality of life, health indicator, and behavior change were extracted using Covidence software. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed Risk of bias analysis was conducted using the Cochrane Risk of Bias tool. We used multilevel meta-analysis to synthesize multiple outcomes nested within studies. Open Science Foundation pre-registration: #10.17605/OSF.IO/WV7XP. In total, 33 papers representing 27 studies involving 6,879 children and caregivers were included. Twenty-four studies were randomized controlled trials and three were quasi-experimental designs. Seventeen papers reported on treatment trials and 16 reported on prevention trials. We found a small overall effect size (SMD = 0.19, 95% confidence interval [0.11, 0.27]) supporting the superiority of integrated primary care to usual or enhanced usual care. Moderator analyses suggested similar effectiveness between co-located and integrated models and no statistically significant differences were found between treatment and prevention trials. Results suggest that integrated primary care is superior to usual and enhanced usual care at improving behavior, quality of life, and symptoms. Integrated primary care research needs improved standards for reporting to promote better synthesis and understanding of the literature.

Effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents

Objective The daily lives of adolescents have changed significantly because of COVID-19 pandemic. We investigated the effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents. Methods Data from the 2021 Korea Youth Risk Behavior Survey were used. In total, 54,848 survey participants were included in the analysis. Allergic diseases included allergic rhinitis, atopic dermatitis, and asthma. Changes attributed to COVID-19 included family economic difficulties, physical activity, breakfast skipping frequency, alcohol consumption, smoking, and depressive moods. Chi-square tests and multiple logistic regression analyses were conducted to examine the impact of changes in daily life attributed to COVID-19 on allergic diseases. Results Among the Korean adolescents surveyed, 29.8% experienced a deterioration in their economic status due to COVID-19, 49.1% reported decreased physical activity, 2.8% reported increased alcohol consumption, 1.0% reported an increase in their smoking behavior, and 36.9% reported an increase in depressive moods. Those diagnosed with atopic dermatitis, allergic rhinitis, or asthma within the previous 12 months accounted for 17.1%, 6.2%, and 1.0% of the population, respectively. Adolescents who were significantly affected by COVID-19 in their daily lives were frequently diagnosed with allergic diseases within the last 12 months. Conclusion Changes in daily life due to COVID-19, including decreased physical activity and increased depressive mood, were common in adolescents and were associated with an increased prevalence of allergic diseases. Since changes in daily life due to the pandemic may increase the burden of allergic disease, additional interventions for disease management should be considered.

Association of adverse childhood experiences with dietary patterns of school-age children: evidence from the birth cohort Generation XXI

BackgroundAdverse Childhood Experiences (ACEs) have been associated with health-risk behaviors and several chronic diseases in adulthood. However, the relationship between exposure to ACEs and dietary patterns at school age is unknown. ObjectivesTo investigate the association between ACEs and dietary patterns of 10-year-olds. MethodsThe study included 5034 children from the Generation XXI cohort, recruited in 2005/2006 in Porto, Portugal. ACEs were assessed through a self-administered questionnaire covering the first 10 years (y) of life, quantified and grouped into 5 dimensions: “abuse,” “school problems,” “death/severe disease,” “life changes,” and “household dysfunction.” Dietary patterns were identified by latent class analysis using data collected with a validated food frequency questionnaire. Five dietary patterns were studied: “low consumption,” “energy-dense foods,” “snacking,” “intermediate consumption,” and “healthier” (used as reference). Multinomial regression analyses were conducted, adjusted for the child’s sex, household income, family structure, and mother’s age [odds ratio (OR) and 99% confidence intervals (CIs)]. ResultsMost children were exposed to ≥1 ACE (96%), and ∼27% had reported 6 or more ACEs throughout life. Those reporting 4–5 and ≥6 ACEs were more likely to follow the “Energy-dense foods” dietary pattern compared with those with no ACEs (OR: 2.41; 99% CI: 1.00, 5.77 and OR: 2.65; 99% CI: 1.10, 6.39, respectively). Children exposed to “abuse” in the first 10 y showed 28% higher odds of following the “low consumption” dietary pattern when compared to children with no reported ACEs and using the “healthier” dietary pattern as a reference (OR: 1.28; 99% CI: 1.00, 1.63). ConclusionsExposure to ACEs was associated with less healthy dietary patterns in school-aged children. Results suggest a cumulative effect of the adverse experiences resulting in a dietary pattern higher in energy-dense foods. Children with ACEs reported under the dimension of “abuse” seemed to have reduced food consumption.

Assessing Photostability of mAb Formulations In Situ Using Light-Coupled NMR Spectroscopy.

Biopharmaceuticals, such as monoclonal antibodies (mAbs), need to maintain their chemical and physical stability in formulations throughout their lifecycle. It is known that exposure of mAbs to light, particularly UV, triggers chemical and physical degradation, which can be exacerbated by trace amounts of photosensitizers in the formulation. Although routine assessments of degradation following defined UV dosages are performed, there is a fundamental lack of understanding regarding the intermediates, transient reactive species, and radicals formed during illumination, as well as their lifetimes and immediate impact post-illumination. In this study, we used light-coupled NMR spectroscopy to monitor in situ live spectral changes in sealed samples during and after UV-A illumination of different formulations of four mAbs without added photosensitizers. We observed a complex evolution of spectra, reflecting the appearance within minutes of transient radicals during illumination and persisting for minutes to tens of minutes after the light was switched off. Both mAb and excipient signals were strongly affected by illumination, with some exhibiting fast irreversible photodegradation and others exhibiting partial recovery in the dark. These effects varied depending on the mAb and the presence of excipients, such as polysorbate 80 (PS80) and methionine. Complementary ex situ high-performance size-exclusion chromatography analysis of the same formulations post-UV exposure in the chamber revealed significant loss of purity, confirming formulation-dependent degradation. Both approaches suggested the presence of degradation processes initiated by light but continuing in the dark. Further studies on photoreaction intermediates and transient reactive species may help mitigate the impact of light on biopharmaceutical degradation.

Neuroinflammation is dependent on sex and ovarian hormone presence following acute woodsmoke exposure

Woodsmoke (WS) exposure is associated with significant health-related sequelae. Different populations can potentially exhibit varying susceptibility, based on endocrine phenotypes, to WS and investigating neurological impacts following inhaled WS is a growing area of research. In this study, a whole-body inhalation chamber was used to expose both male and female C57BL/6 mice (n = 8 per group) to either control filtered air (FA) or acute WS (0.861 ± 0.210 mg/m3) for 4 h/d for 2 days. Neuroinflammatory and lipid-based biological markers were then assessed. In a second set of studies, female mice were divided into two groups: one group was ovariectomized (OVX) to simulate an ovarian hormone-deficient state (surgical menopause), and the other underwent Sham surgery as controls, to mechanistically assess the impact of ovarian hormone presence on neuroinflammation following FA and acute WS exposure to simulate an acute wildfire episode. There was a statistically significant impact of sex (P ≤ 0.05) and statistically significant interactions between sex and treatment in IL-1β, CXCL-1, TGF-β, and IL-6 brain relative gene expression. Hippocampal and cortex genes also exhibited significant changes in acute WS-exposed Sham and OVX mice, particularly in TGF-β (hippocampus) and CCL-2 and CXCL-1 (cortex). Cortex GFAP optical density (OD) showed a notable elevation in male mice exposed to acute WS, compared to the control FA. Sham and OVX females demonstrated differential GFAP expression, depending on brain region. Overall, targeted lipidomics in phosphatidylcholine (PC) and phosphatidylethanolamine (PE) serum and brain lipids demonstrated more significant changes between control FA and acute WS exposure in female mice, compared to males. In summary, male and female mice show distinct neuroinflammatory markers in response to acute WS exposure. Furthermore, ovarian hormone deficiency may impact the neuroinflammatory response following an acute WS event.

Sense of coherence, mental health, and hair cortisol concentrations among older people during the COVID -19 pandemic: a cross-sectional study

BackgroundA person’s sense of coherence (SoC) is likely to affect coping when exposed to a life changing event like the COVID -19 pandemic, which impacted the older population especially hard, an age group that already suffers from a lot of mental illness. Thus, the aim of this study was to investigate the associations between SoC and mental health in older adults using both screening scales and hair cortisol concentrations (HCC).MethodA cross-sectional design studying a cohort of 70–80 years old, N = 260, set in Swedish primary care during the pandemic years 2021–2022. Instruments used are sense of coherence 13 (SoC-13), EQ-5D-3L, Geriatric depression scale 20 (GDS-20), Hospital anxiety and depression scale (HADS), and Perceived stress scale 10 (PSS-10). Sociodemography and factors concerning SoC, and mental health are explored. HCC are measured using radioimmunoassay. Outcome measures are factors independently associated with SoC. Linear regression models were performed with SoC as dependent variable, and priory path analyses explored whether associations with SoC were direct, or indirect via anxiety.ResultsSoC was significantly associated with anxiety (p < 0.001), perceived economic status (p = 0.003), belief in the future (p = 0.001), and perceived negative mental effect from the COVID -19 pandemic (p = 0.002). The latter was 96% indirectly associated with SoC (p < 0.001), whereas perceived economic status together with belief in the future was 82% directly associated with SoC (p = 0.17). HCC and sex were not significantly associated with SoC, but, noticeably, high HCC was equally distributed between women and men. Women reported significantly lower quality of life (p = 0.03), and more symptoms of anxiety (p = 0.001) and depression (p < 0.001).ConclusionAnxiety, belief in the future, perceived negative effect on mental health due to the pandemic, and perceived economic status were significantly associated with SoC. Anxiety is suggested to be important in explaining the association between perceived negative mental effect from the COVID-19 pandemic and SoC. Women reported significantly poorer mental health and life quality than men.

COVID-19 and Women's Health: A Panel Survey on the Perceptions of Family Caregiving among Middle-aged Korean Women

Background COVID-19 has significantly impacted society, economy, and health, altering family roles and caregiving concepts. Middle-aged women bear the responsibility of managing family health, educating children, and caring for the elderly. The pandemic has brought considerable changes to these roles. This study used data from the Korean Longitudinal Survey of Women and Families (KLoWF). Objective This study identifies factors that influence the perceptions of family caregiving among middle-aged Korean women during the COVID-19 pandemic. Methods Data from the 8th wave of the Korean Longitudinal Survey of Women &amp; Families (KLoWF) for the year 2020, provided by the Korean Women's Development Institute, was used. The samples consisted of 1,120 middle-aged women between the ages of 45 and 65. Variables included general characteristics, changes in women's lives due to COVID-19, family roles, and perceptions of family caregiving. The data were analyzed using t-tests, ANOVA, post-hoc analysis with Scheffé's test, Pearson correlation to examine relationships between variables, and hierarchical regression to identify factors influencing perceptions of family caregiving. Results The hierarchical regression model indicated that the factors influencing the perceptions of family caregiving among middle-aged women were age, changes in women's lives due to the pandemic, and family roles, with an explanatory power of 24.7%. Conclusion This study revealed changes in the patterns of family and caregiving roles among Korean middle-aged women during the COVID-19 era, providing foundational data for future studies on the life perceptions of Korean middle-aged women, proactive health management practices among women, and the development of sociodemographic policies.

A Closer Look into the Correlates of Spiritual Well-Being in Women with Breast Cancer: The Mediating Role of Social Support

The aim of this study was to gain insight into the relationship between spiritual well-being in breast cancer patients, psychological flexibility, social support, and personality traits. The research was conducted on 64 women (Mage=58.36, SD=11.30), while undergoing radiation therapy. Results showed that younger, less agreeable, and more conscientious patients were more likely to experience positive changes in life after the illness; greater perceived social support positively predicted sense of purpose/reason for being alive, and younger, more open to experience patients tended to be more hopeful. Full mediation effect of perceived social support was found – participants who were more agreeable and open to experience, through greater perceived support, achieved a higher sense of purpose/reason for being alive, while conscientious and psychologically inflexible individuals perceived less support, which resulted in diminished sense of purpose. Our results highlight the pivotal role of perceived social support, which could modulate and diminish negative psychological, spiritual and existential consequences of breast cancer.

Comparison of Cryoballoon vs. Pulsed Field Ablation in Patients with Symptomatic Paroxysmal Atrial Fibrillation (SINGLE SHOT CHAMPION): Study protocol for a randomized controlled trial

IntroductionSingle-shot devices are increasingly used for pulmonary vein isolation (PVI) in atrial fibrillation (AF). The Arctic Front cryoballoon (Medtronic) is the most frequently used single-shot technology. A recently developed novel pulsed-field ablation (PFA) device (FARAPULSE, Boston Scientific) has been introduced with the aim to improve procedural safety and efficacy. ObjectiveThis study will compare the novel FARAPULSE PFA device and the Arctic Front cryoballoon for first PVI in patients with symptomatic paroxysmal AF. MethodsSINGLE SHOT CHAMPION is a multicentre, randomized controlled trial with blinded endpoint adjudication by an independent clinical events committee. Overall, 210 patients with paroxysmal AF undergoing their PVI are randomized 1:1 between PFA and cryoballoon ablation. Continuous rhythm monitoring with an implantable cardiac monitor (ICM) is performed in all patients. ResultsThe primary endpoint is time to first recurrence of any atrial tachyarrhythmia (AF and/or organized atrial tachyarrhythmia) lasting ≥120 seconds and identified by the ICM within 91 and 365 days post-ablation. The composite procedural safety endpoint includes cardiac tamponade requiring drainage, persistent phrenic nerve palsy, vascular complications requiring intervention, stroke/transient ischemic attack, atrioesophageal fistula, and death occurring during or up to 30 days after the procedure. Key secondary endpoints include (1) increase in high-sensitivity Troponin on day 1 post-ablation, (2) analysis of post-ablation 3D electro-anatomical mapping (first 25 patients per study group), (3) AF burden, and (4) quality of life changes ConclusionSINGLE SHOT CHAMPION will evaluate the efficacy and safety of PVI using the novel FARAPULSE PFA for patients with symptomatic paroxysmal AF.

Effects of a pilot 12-week exercise program on breast cancer survivors’ quality of life.

e12525 Background: Previous studies have demonstrated that breast cancer survivors commonly experience a decrease in quality of life including an increased risk of depression, insomnia, cancer-related fatigue, and negative body image. Several studies have shown that exercise interventions, such as yoga, Pilates, water aerobics, and strengthening exercises can improve survivors’ quality of life. We implemented a 12-week exercise program in breast cancer survivors and evaluated quality of life changes. Here we discuss our findings evaluating 13 quality of life questionnaires. Methods: We evaluated 46 participants who completed a baseline and post 12-week questionnaire assessment. All participants underwent an exercise program 3 times/week for 90 minutes/session. We calculated differences in baseline and post 12-week quality of life through 13 questionnaires: Functional Assessment of Cancer Therapy - General (FACT-G) Physical, Social/Family, Emotional, and Functional, Social Support, Insomnia Severity Index, Brief Fatigue Inventory, Patient Health Questionnaire, and Body Image after Breast Cancer (BIBCQ) Vulnerability Scale (VS), Body Stigma Scale (BSS), Limitations Scale (LS), Body Concerns Scale (BCS), Transparency Scale (TS), and Arm Concerns Scale (ACS) and assessed the intervention's efficacy by comparing the baseline and post 12-week scores using paired t-tests. Results: The difference between baseline and post 12-week quality of life are presented in the Table. 7/13 questionnaires showed statistical significance: FACT-G Physical and Functional, Insomnia Severity Index, Brief Fatigue Inventory, Patient Health Questionnaire, and BIBCQ LS and BCS. Conclusions: Our study showed improvement in metrics evaluated in breast cancer survivors who underwent the personalized exercise program. Specifically, body image was improved with exercise which further exemplifies the impact of lifestyle changes on quality of life measures and is an important adjunct to future cancer survivorship studies. Clinical trial information: NCT04013568 . [Table: see text]

Integration of Islamic Values into English Language Teaching in the Digital Era: Challenges and Prospectives

The development of technology in the digital era brings significant changes in everyday life, particularly in the area of education. On the other side, technological development has negative effects on the behavior of the young generation. As a result, real efforts are required, such as incorporating Islamic beliefs into English language at school. This study focuses at how to integrate Islamic values into English language learning in the digital era. This study conducts literature reviews using a number of sources, including papers and research journals from prior and recent relevant studies. This study reveals that the integration of Islamic values occurs in all phases of learning. The challenge in integrating Islamic values are not only from the teachers, but from students and parents. The prospective of integrating Islamic values in teaching and learning English in the digital era has a positive implication, including the use of technology in learning, cultural understanding, and theoretical and pedagogical aspects of learning. Keywords: Islamic Values, English Language Teaching, Digital Era

O perfil dos egressos de um mestrado profissional: uma contribuição para o entendimento da relação formação-trabalho no SUS

ABSTRACT This article presents the profile of graduates, the effects of training, and the professional trajectory of the Professional Master’s Course in Public Health graduates at the Aggeu Magalhaes Institute. Of the 99 invited graduates who completed the program between 2013-2020, 54 responded to a questionnaire applied through the Lime Survey software. The descriptive and cross-sectional study used absolute and relative frequency cross-tabulation variables in the analysis, with the instrument covering the following themes: identification of the graduate and program/course; professional activity before and at the end of the program and expectations; current employment status and formation effects; evaluation of the formative trajectory. Among the respondents, most are female, aged between 31-40 years, trained as nurses, self-declared as black or brown-skinned, not having a disability, predominantly residing in Pernambuco, and did not enter through a quota system. As an effect on their professional life, it was found that the program increased prestige/recognition among colleagues, qualified them for activities they were already performing and also different activities, and brought salary increases leading to changes in personal and professional lives. The results are consistent with scientific findings in the same context, and the tool developed by FIOCRUZ made it possible to understand the relationship between education and work.

Tantangan Awal Perubahan Kehidupan (Penyangkalan Diri)

The process of repentance and life change does not happen overnight, but rather through a long journey full of challenges. Such challenges include fear and doubt, discomfort from old habits, rejection and criticism from others, temptations that can lead to setbacks, and the need for patience and perseverance. To overcome this challenge, believers are encouraged to always pray and ask God for forgiveness, read the Bible and listen to God, and put to death the lust of the flesh by taking up the cross, which means facing suffering and trials faithfully. Through these actions, a person's faith can grow strongly, enabling them to better face temptations and challenges. Ultimately, strong commitment and self-denial are the keys to living a new life in accordance with God's will.

Career paths of multiple jobholders: employers' perspectives and employees' experiences in retail and food service

PurposeMultiple jobholding (MJH) is assumed to be a growing phenomenon due to working life changes. This study presents new knowledge on the MJH career paths, from the perspectives of both employers and employees.Design/methodology/approachThe qualitative interview study was focused on retail trade and restaurant and food service industries in Finland, where MJH is a quite common work arrangement compared to other European countries. The data were analyzed with the concepts of the chaos theory of careers and with an abductive thematic content analysis.FindingsAccording to the results, several events and intertwined factors may lead individual careers gradually to MJH. Changing personal and family situations and leisure time needs attracted the careers towards MJH. MJH was not only a financial necessity to employees, but it also served their flexibility interests. The interviewed employers applied flexible non-standard employment arrangements mainly due to rapidly varying labor needs established in the industries. It was important for them to strengthen the non-standard core employees' sense of belonging to the work community. However, employees with work ability challenges were in risk to end up in peripheral positions at the labor market.Originality/valuePrevious research on multiple jobholding has not combined employers’ perspectives of MJH to employees’ experiences of career paths.

A Study on Satisfaction of Tamil Nadu Government Free Bus Travel for Women in Madurai City

Abstract: In May 2021, the Tamil Nadu government launched a scheme that made public city and town buses (with certain caveats) free for women. While the rides are completely free (with no restrictions on the number of trips per day or month), the scheme is applicable only on ‘white board’ buses. The white board buses are what are known as Ordinary Bus Routes and represent the most inexpensive category of service that halts at all bus stops on a given route. The state government has provided an annual subsidy of Rs.1,200 crore to state transport undertakings to compensate for the fare box loss due to the scheme. The Tamil Nadu Chief Minister has extolled the scheme as an ‘economic revolution’, enabling women to join the workforce. In the eyes of many though, free transport remains a political gimmick. It’s not unusual to find citizens who question why travel should be free; and why just for women. A free travel scheme though is not unlike free health services or free education. Some services are so closely linked to ‘public good’, that the cost they incur is easily offset by the good that they achieve. Public transport is one of these. In general, women in India struggle to attain financial independence and a promising career. These challenges are multiplied in the case of women from underprivileged communities as they start with little to no education and a higher dependence on men. Much of this is culturally driven. They are also mostly unemployed; and when they do find employment it is within the unorganized sector, earning low wages. In the majority of Indian families, men tend to have access to the household vehicle, while women generally rely on public transport. Considering that the percentage of women undertaking paid work in India is only 21% while the global average is 47%, mobility becomes a life changing factor that could make or break a woman’s access to work opportunities. On the other hand, women who decide to not work outside the house, still rely on public transport to run errands and manage the household. This again incurs a cost.

Tantangan Awal Perubahan Kehidupan (Penyangkalan Diri)

The process of repentance and life change does not happen overnight, but rather through a long journey full of challenges. Such challenges include fear and doubt, discomfort from old habits, rejection and criticism from others, temptations that can lead to setbacks, and the need for patience and perseverance. To overcome this challenge, believers are encouraged to always pray and ask God for forgiveness, read the Bible and listen to God, and put to death the lust of the flesh by taking up the cross, which means facing suffering and trials faithfully. Through these actions, a person's faith can grow strongly, enabling them to better face temptations and challenges. Ultimately, strong commitment and self-denial are the keys to living a new life in accordance with God's will.

Integration of socioemotional competencies in medical training: a case study on the assessment of an educational intervention in a disciplinary course

Background Medical education faces the challenge of integrating socioemotional competencies into its curriculum to train more complete and humane health professionals. This study evaluates the impact of an educational intervention aimed at medical students at the National Autonomous University of Mexico, focusing on the development of these competencies through the hidden curriculum of a physiology course. Methods The intervention adopted an integrated curricular design that included collaborative projects, guided debates, reflective journals, and role exchanges. A total of 31 undergraduate students participated, assessed before and after the intervention with the Adult Emotional Competence Inventory (AECI) and standardized disciplinary knowledge tests. The analysis focused on five areas: emotional awareness, emotional regulation, emotional autonomy, social competence, and life and well-being competencies. Results Significant improvements were observed in emotional awareness, emotional regulation, and emotional autonomy after the intervention, with no notable changes in social competence and life and well-being skills. Standardized test scores showed an increase, but there was no significant correlation with the development of emotional competencies. Conclusions The intervention was effective in enhancing certain socioemotional competencies in medical students, although it was not directly reflected in academic performance. It highlights the need for specific strategies to address all emotional competencies and suggests the importance of future research to better understand these dynamics within the educational field. Emotional education emerges as an essential component in medical training, fostering more resilient and empathetic professionals.