Health Improvement Research Articles

Utilizing Citizen Generated Data to enhance Women's Access to Sexual and Reproductive Health Services in Somalia: Insights, Barriers, and Pathways Forward

Purpose: This study was undertaken to capture citizen’s insights on practical steps that individuals, families, communities, and institutions could take to support the improvement of Sexual and Reproductive Health (SRH) services in Somalia. This includes raising awareness of issues affecting women's access to SRH, such as Gender-Based Violence (GBV) and Female Genital Mutilation (FGM). Methodology: This research employed a qualitative research design, utilizing semi-structured radio questions distributed through various channels such as radio promos, mini-dramas, interactive radio shows, and Short Messaging Service (SMS) on mobile phones. To enhance and validate the findings from the radio series, thirty Focus Group Discussions (FGD) involving 270 'hard-to-reach' participants were conducted across all Federal Member States (FMS) of Somalia, excluding Somaliland. Collaborating with 20 radio stations, a total of 4,268 participants from across Somalia were involved in this study. The qualitative data obtained was categorized into themes, and the subsequent information was analyzed using content analysis methodology for qualitative data, as well as descriptive statistics and inferential analysis through statistical package for social science (SPSS) version 25 and excel for quantitative data. The presentation of the data included the use of tables and figures. Findings: This study outlined key challenges in accessing quality SRH services for women in Somalia. Priorities included enhancing healthcare infrastructure and availability of SRH professionals, along with emphasizing health education on reproductive health and family planning. Food insecurity's impact, especially among displaced populations, was noted. GBV and FGM were highlighted, calling for comprehensive survivor care and male involvement in prevention. Collaboration between schools and the private sector was proposed for menstrual hygiene. Men's support for SRH access was deemed crucial. Addressing stigma around SRH access, GBV, and FGM was stressed, urging comprehensive awareness campaigns and improved healthcare provision for survivors. Unique Contribution to Theory, Practice and Policy: Addressing women's SRH in Somalia involves investing in healthcare infrastructure, expanding health education programs, ensuring access to nutritious food, and engaging men as allies in promoting women's SRH rights. Moreover, efforts to combat stigma, GBV, and FGM must be culturally sensitive and inclusive, involving religious and community leaders, and addressing underlying socio-economic factors contributing to these issues.

M-SAKHI - Mobile health solutions to help community providers promote maternal and infant nutrition and health: a description of development of the Program Impact Pathway using Theory of Change.

Behaviour Change Communication (BCC) intervention programmes often lack documentation of successful processes. This manuscript aims to describe the development of Program Impact Pathway (PIP) using Theory of Change (ToC) approach for a mHealth BCC intervention titled 'Mobile Solutions Aiding Knowledge for Health Improvement (M-SAKHI)' aimed at reducing stunting in infants at 18 months of age. The PIP was developed using ToC to design the intervention and plan its implementation. Literature review and data from previous pilots helped to identify health service gaps that needed to be addressed by the PIP of this intervention. M-SAKHI was implemented in 244 villages under governance of forty primary health centres of Nagpur and Bhandara districts of eastern Maharashtra in central India. The study investigators and the public health stakeholders participated in developing the PIP. M-SAKHI evaluation study recruited 2501 pregnant women who were followed up through delivery until their infants were 18 months old. The PIP was developed, and it identified the following pathways for the final impact: (1) improving maternal and infant nutrition, (2) early recognition of maternal and infant danger signs, (3) improving access and utilisation to healthcare services, (4) improving hygiene, sanitation and immunisation practices, and (5) improving implementation and service delivery of community health workers through their training, monitoring and supervision in real time. This paper will illustrate the significance of development of PIP for M-SAKHI. It can aid other community-based programmes to design their PIP for nutrition-based BCC interventions.

Relationship Between Frequency of Physical Activity, Functional Mobility, and Self-Perceived Health in People with Different Levels of Pain: A Cross-Sectional Study.

Background: Habits including regular physical activity are necessary for maintaining good health. Functional mobility, including walking and going up and down stairs, is essential for personal autonomy and well-being. Pain is a condition related to biological and psychosocial aspects that influence people's lives. Objective: The main objectives of this study were (1) to analyse the associations between physical activity frequency (PAF) and self-perceived health (SPH) and functional mobility (walking and going up and down stairs) in middle-aged and older people living in Spain with different pain levels; and (2) to analyse the risk factors for having a negative SPH and functional mobility difficulties by calculating the probabilistic risks adjusted by different variables (sex, body mass index, social class, civil status, smoking status, pain level, and PAF). Methods: A cross-sectional study based on the European Health Survey data in Spain (EHSS 2014-2020) and The Spanish National Health Survey (SNHS 2017) was carried out, with a final sample of 21,152 participants with ages between 40 and 79 years. Results: Associations between high pain levels and worse SPH and difficulties in walking and climbing stairs were found. Lower PAF levels were associated with higher-probability risks of having a negative SPH and difficulties in walking and climbing stairs. Conclusions: Physical inactivity emerged as an important risk factor for worse SPH and functional mobility. These associations underline the importance that PA programmes can play in the improvement of health and functional mobility, as well as in other aspects, in people with pain.

Look, over there! A streaker! – Qualitative study examining streaking as a behaviour change technique for habit formation in recreational runners

ABSTRACT Background Running as a form of physical activity is beneficial to overall health and wellbeing. The aim of the study is to examine ‘run streaking’ (i.e. running on consecutive days, for a minimum period of time or distance, typically at least one mile) as a technique for habit formation and behaviour change. Methods Qualitative semi-structured interviews with 21 recreational adult runners (11 female and 10 male). Run streak length ranged from a minimum of 100 days to over 4500 days. Transcripts were analysed using a hybrid deductive–inductive thematic analysis. Results Run streaking was reported to lead to several benefits, health improvements and a sense of accomplishment, although many run streakers reported running through injuries and lack of recovery. Accounts of run streaking showed features of automaticity indicative of habitual behaviour. Other behavioural processes identified included motivation, identity, self-regulation and social support. Behavioural streaking showed the potential to influence change in behaviours other than running. Conclusion Accounts of run streaking demonstrate an interplay between automatic and deliberate processes in the maintenance of running behaviour. Behavioural streaking is a technique that could be used in other behaviour change contexts beyond running to support habit formation.

Changes in Pain and Mental Health Symptoms Associated with Prescribed Medicinal Cannabis Use: A One-Year Longitudinal Study.

Chronic pain and mental health issues like depression and anxiety significantly contribute to disease burden in Western countries. While cannabinoids are suggested to have analgesic, anxiolytic and antidepressant properties, evidence, especially for long-term use, is inconclusive. This 12-month observational study evaluated the effects of prescribed medicinal cannabis for 96 patients suffering from pain, as well as sleep disturbances, depression and anxiety. Treatment outcomes for pain, depression, anxiety and sleep problems were assessed at 3, 6, and 12 months using validated instruments. Significant reductions were observed in pain scores and the interference of pain on daily functions, alongside improvements in mental health and sleep. Many patients reported notable improvements in pain severity and reduced use of pain medications in the first 6 months, with a decline at 12 months. Additionally, sustained improvements in depression, anxiety, stress and sleep were observed, with about half reporting substantial improvement. Adverse effects were common but mostly mild or moderate, most commonly dry mouth and sleepiness. These results show that prescribed medicinal cannabis treatment is associated with improvements in chronic pain and mental health symptoms, such as depression, anxiety and stress. However, findings also suggest reduced effectiveness with longer-term use, emphasizing the need for additional research.

A New Era of Tooth Preparation and Gingitage Retraction Technique: A Case Report

The demand for procedures intended to improve dental aesthetics has increased recently. Preserving the teeth and surrounding soft structures to the greatest extent possible is preferred in this situation by both patients and dentists. When using fixed prostheses, maintaining the stability and health of soft tissues is a constant struggle. Bone tissue health and soft tissue health are directly correlated. The long-term efficacy of prosthetic therapy thus depends on preserving tissue health and being free of mucositis. This case report describes the successful application of the gingitage technique in a patient requiring aesthetic enhancement of the gingival margins surrounding dental restorations. The patient presented with uneven gingival contours and mild inflammation around subgingival margins of existing restorations, compromising both function and aesthetics. Results demonstrated significant improvements in gingival health, a more balanced gingival margin, and an enhanced aesthetic outcome. Follow-up assessments revealed stable gingival contours and an overall increase in patient satisfaction. This case report underscores the effectiveness of the gingitage technique as a minimally invasive solution for enhancing soft tissue aesthetics and supporting the longevity of dental restorations.

The effectiveness of custom hard-shell 3D-printed foot orthoses in a cohort of patients who did not respond to treatment with custom ethylene-vinyl-acetate (EVA) foot orthoses

BackgroundPatients who do not achieve positive outcomes with custom ethylene-vinyl-acetate (EVA) foot orthoses will often be escalated to other services for treatment, which may include surgery. ObjectiveThis study aimed to explore the effectiveness of custom hard-shell 3D-printed foot orthoses for patients who did not respond to treatment with custom EVA foot orthoses and were being considered for treatment escalation. DesignAn eight-week clinical evaluation and a two-year review of relevant medical records. MethodThirty-six consecutive patients with a range of musculoskeletal lower limb pathology who remained symptomatic after 12-weeks use of custom EVA foot orthoses were fitted with custom hard-shell 3D-printed foot orthoses. The Foot Health Status Questionnaire was used to assess patients at baseline and eight-week follow-up in conjunction with the Client Satisfaction with Device module of the Orthotics and Prosthetics User Survey. Patients were categorised as responders or non-responders based on their change in pain scores. A review of relevant medical records two years after receiving their orthoses determined if patients required further treatment for their initial condition. ResultsAcross the full cohort there were significant improvements in pain, function and foot health. At follow-up, responders reported significantly improved pain, function and foot health compared with non-responders. Twenty-six patients (12 responders, 14 non-responders) required no further treatment for their original condition after two years. ConclusionsCustom hard-shell 3D-printed foot orthoses have the potential to improve pain, function, foot health, and provide satisfaction in patients with lower limb musculoskeletal conditions which do not improve with custom EVA foot orthoses.

Real-world analysis of safety, tolerability, and adherence to nirmatrelvir-ritonavir (paxlovid) in primary care COVID-19 outpatients.

This retrospective cross-sectional study aims to evaluate the safety, tolerability, and adherence of patients prescribed Nirmatrelvir-ritonavir (Paxlovid) in outpatient settings, focusing on its use in managing category 2 COVID-19 patients across three primary healthcare clinics in Selangor, Malaysia. Data were collected from the Paxlovid pharmacy registry and medical records at Klinik Kesihatan Seksyen 7, Klinik Kesihatan Seksyen 19, and Klinik Kesihatan Kelana Jaya between April 1, 2022, and November 30, 2022. This study analysed data from 415 category 2 COVID-19 patients aged ≥ 18years. The primary and secondary outcomes included the assessment of patient demographics, Paxlovid dosing, current medication, changes in drug regimen, adherence, and adverse drug reactions (ADR). Pharmacists follow-ups were conducted on days 3 and 5 post-medication initiation. The majority (79.5%) of the cohort experienced ADR, predominantly dysgeusia, diarrhoea, body ache, vomiting, and nausea. Despite this, the ADRs were generally well-tolerated, with no severe impacts reported. High adherence was observed, with 96.9% of patients completing the 5-day regimen. The primary reasons for non-adherence included adverse effect intolerability, dosing ambiguity, forgetfulness, concerns about ADR, and perceived health improvement. Notable medications interacting with Paxlovid were simvastatin, amlodipine, and atorvastatin, and 21.7% of 23 concurrent medications were found not to comply with the recommended interventions by the University of Liverpool COVID-19 Drug Interaction database. Paxlovid demonstrates a high level of safety and tolerability in outpatient COVID-19 patients, with optimal adherence observed. This study underscores the vital role of healthcare professionals in managing Paxlovid within primary healthcare and highlights the need for broader research and direct patient involvement to enhance treatment strategies against COVID-19.

From One Heath to One Sustainability: The Role of Contagious Mastitis Pathogens in Decreasing the Dairy Herd Sustainability.

Economic, social, and environmental sustainability are the results of efforts aiming to improve all aspects of milk production, respecting animal welfare and improving herd health. An epidemiological study was designed to assess the role of contagious pathogens (S. aureus and S. agalactiae) in a cohort of 120 dairy herds located in the southern regions of Italy. Milk quality was assessed using certified methods, and the prevalence of mastitis pathogens in bulk tank milk was determined using quantitative polymerase chain reaction. Welfare scores were assessed using a scoring card that has more than 100 items, including animal-based measurements. Statistical analyses were performed using general lineal model and logistic regression procedures. The results showed that S. aureus had a significant negative effect on the amount of milk nutrients delivered to the dairy plant, and on the level of welfare, whereas the presence of S. agalactiae did not show any significant association. The major risk factors associated with the presence of S. aureus were also identified to help prioritize control programs. These results support the "One Sustainability" approach, implying that an increase in animal productivity is related to the improvement of animal health and welfare and potentially leading to the mitigation of greenhouse gas emissions.

Mechanisms of Social Attachment Between Children and Pet Dogs.

An increasing body of evidence indicates that owning a pet dog is associated with improvements in child health and well-being. Importantly, the degree of the social bond between child and dog may mediate the beneficial outcomes of dog ownership. The formation of social bonds is an intrinsically dyadic, interactive process where each interactor's behavior influences the other's behavior. For this reason, it is critical to evaluate the biological mechanisms of attachment in both children and their pet dogs as a socially bonded pair. Here, we review the physical, mental, and emotional outcomes that are associated with pet dog ownership or interaction in children. We then discuss the evidence that suggests that the strength of a social bond between a child and their pet dog matters for maximizing the beneficial outcomes associated with pet dog ownership, such as possible stress-buffering effects. We review the existing literature on the neural and endocrinological mechanisms of social attachment for inter-species social bonds that form between human children and dogs, situating this emerging knowledge within the context of the mechanisms of intra-species bonds in mammals. Finally, we highlight the remaining open questions and point toward directions for future research.

The adoption and implementation of local government planning policy to manage hot food takeaways near schools in England: A qualitative process evaluation

IntroductionAccess to hot food takeaways, particularly near schools, is of growing concern for policymakers seeking to reduce childhood obesity globally. In England, United Kingdom (UK), local government jurisdictions are implementing planning policies to reduce access by restricting or denying planning permission for new takeaway outlets near schools. We used a qualitative approach to explore local government officers’ perspectives on the barriers to and facilitators of the adoption, implementation, and perceived effectiveness of these policies. MethodsIn 2021–2022, we conducted semi-structured interviews with 29 local planning (‘planners’) and public health government officers from 15 different local authorities across England who adopted a policy to restrict new takeaways. Data were analysed thematically. ResultsParticipants explained that they mostly thought the policies facilitated the refusal of applications for new takeaways near schools. However, participants speculated that businesses identified alternative opportunities to operate including functioning as ‘restaurants’ or within other locations. Effective working relationships between planners and public health officers were important for adoption and implementation, although planning and public health agendas did not always align and there were tensions between economic development and health improvement goals. The policy was adapted to suit local needs and priorities; in some cases, the policy was not used in areas where economic growth was prioritised. Clarity in policy wording and establishing a formal process for implementing policies including a designated individual responsible for checking and reviewing takeaway applications helped ensure consistency and confidence in policy implementation. ConclusionAlthough sometimes challenging, the policies were commonly described as feasible to implement. However, they may not completely prevent new takeaways opening, particularly where takeaways are relied upon to enhance local economies or where takeaway businesses find alternative ways to operate. Nevertheless, the policies can serve to shift the balance of power that currently favours commercial interests over public health priorities.

Cognitive Health Benefits of Everyday Physical Activity in a Diverse Sample of Middle-Aged Adults.

Physical activity has been associated with a wide range of health benefits including long-term benefits for cognitive and brain health. Whether episodes of everyday physical activity are associated with immediate cognitive benefits remains unknown. The purpose of the current study was to examine whether episodes of physical activity, occurring over the course of participants' daily lives, are associated with short-term improvements in cognitive health. Participants completed a 9-day ecological momentary assessment protocol involving 5 daily assessments of self-reported physical activity and ambulatory cognitive assessments of processing speed and visuospatial working memory. Data were analyzed in a multilevel modeling framework to explore changes in performance on each task associated with physical activity during the period leading up to the assessment as well as individual differences in average frequency of physical activity. Results of MLMs indicated that engaging in physical activity during the period (~3.5hr) leading up to an assessment was associated with improvements in processing speed equivalent to 4 years of cognitive aging. Such improvements were observed for both light and moderate-to-vigorous physical activity levels. No association was observed for visuospatial working memory accuracy; however, response time during the working memory task reliably mirrored the association observed for processing speed. The short-term benefits were observed, particularly, for individuals with an overall higher frequency of reported physical activity. Our findings suggest that engaging in everyday physical activity of any intensity level may have short-term, acute benefits for cognitive health and point to new potential targets for intervention. NCT03240406.

Physical Symptoms and Coping Strategies With Earthquake Stress Among Adults Living in Tent Cities: A Cross-Sectional Study.

This study aimed to examine the physical symptoms, coping strategies for earthquake stress and factors predicting coping strategies among adults staying in tent cities after an earthquake. A cross-sectional design was conducted. The study sample consisted of 706 adults residing in tent cities in three cities of earthquake-affected regions. Data were collected through face-to-face surveys and the Earthquake Coping Strategies Scale, starting from the 16th day after the earthquake in February-March 2023. Independent samples t-test, one-way analysis of variance, McNemar test and multiple linear regression analysis used for data analysis. The first three physical symptoms with the highest frequency after the earthquake were insomnia, frequent waking and difficulty falling asleep, respectively. Individuals with chronic illnesses, lower education levels, no previous experience with earthquakes and having undamaged homes more frequently used religious coping strategies. Individuals with higher incomes, employed individuals, non-smokers and those with having undamaged homes more frequently used positive reappraisal strategies. The present study concluded that physical symptoms were common among individuals in the post-earthquake period and that many individuals adopted religious coping strategies. Nurses can develop effective interventions for preventing physical and mental health problems in the post-earthquake period. They can contribute significantly as caregivers, leaders, researchers and advisors in health monitoring and improvement practices for individuals after earthquakes. The results of the study are instructive for designing prevention and improvement practices to minimise future destructive effects of earthquakes. Individuals mostly experienced sleep problems and preferred different coping styles in the early post-earthquake period. The physical and mental health of individuals can be improved by early intervention and encouraging effective coping methods after an earthquake. STROBE checklist. No patient or public involvement.

Effectiveness of Combined Pulmonary Rehabilitation and Progressive Muscle Relaxation in Treating Long-Term COVID-19 Symptoms: A Randomized Controlled Trial

Background: The aim of this study was to investigate the effects of pulmonary rehabilitation (PR) and additional progressive muscle relaxation (PMR) techniques in patients with long-term COVID-19 symptoms. Methods: We included 61 patients with long COVID-19 symptoms and randomly assigned them to two groups: PR only (group 1 with 30 subjects) and PR with PMR (group 2 with 31 subjects). The PR program consisted of gradual aerobic conditioning, strength training, and breathing exercises. Group 2 received additional 20 min daily sessions of progressive muscle relaxation techniques. Results: Following a 21-day intervention, it was observed that both groups had noteworthy improvements in lung function, exercise capacity, and sleep quality with statistical significance (p < 0.0001). Group 2 showed significant improvements in overall health (as measured by the General Health Questionnaire-12), patient health (as assessed by the Patient Health Questionnaire-9), general anxiety levels (as indicated by the Generalized Anxiety Disorders Scale-7), and sleep quality (as measured by the Pittsburgh Sleep Quality Index), with statistical significance (p < 0.0001), compared to group 1. Moreover, the statistical analysis demonstrated no significant difference in exercise capacity improvement between group 1 and group 2, as indicated by a p-value of 0.1711. Conclusions: The addition of progressive muscle relaxation to pulmonary rehabilitation significantly enhances mental health outcomes, particularly in reducing anxiety and improving sleep quality, for patients with long-term COVID-19 symptoms. These findings suggest that incorporating PMR into PR programs offers a valuable non-pharmacological approach to improving overall patient well-being during long-term COVID-19 recovery.

The association between surgical complications and compliance to the World Health Organization Surgical Safety Checklist: A retrospective analysis of hospital records.

The World Health Organization Surgical Safety Checklist (SSC), now used by healthcare providers worldwide, has proved to be useful in the improvement of patients' health through the reduction of mortality and morbidity after surgery. In the Emilia-Romagna region in Italy the SSC is accompanied by a document that registers any non-conformity (NC) identified during SSC completion. This study aimed to investigate the association between surgical complications and checklist compliance, in terms of incompleteness and presence of NCs, using data from the Modena Local Health Unit (LHU). We used data from surgeries performed in the Modena LHU between 2018 and 2022, with their SSC and related NC document. We estimated relative risks (RRs) of complications fitting three modified Poisson regression models. Model 1 included checklist incompleteness and NC presence, Model 2 adjusted Model 1 for patients' sex and age group, and Model 3 adjusted Model 2 for the other potential confounders. We also performed a sensitivity analysis estimating the same three models including death outcomes as complications. We found an increased risk of complications for both checklist incompleteness (unadjusted RR [uRR]= 2.04; 95% confidence interval [CI]: 1.17 to 3.54) and presence of NCs (uRR = 2.35; 95% CI: 1.71 to 3.22). Results were consistent after adjustment and in the sensitivity analysis. Improving checklist compliance can reduce the risk of surgical complications. In particular, NCs are a risk factor that must be further investigated to better understand their relationship with complications. We believe that NCs data recording is helpful for both researchers in the scope of surgical complications, and healthcare professionals in the operating room.

Applying an Evaluation Framework of Hospital CHA/CHIP Quality and Heterogeneity to Accredited Local Health Departments in Kentucky, 2015-2022.

This study aimed to assess the quality of community health assessments (CHA) and community health improvement plans conducted by Public Health Accreditation Board (PHAB)-accredited local health departments (LHDs) in Kentucky. Quality assessment of CHAs and community health improvement plan documents using criteria adapted from Pennel et al (2015). PHAB-accredited LHDs in Kentucky. Seventeen CHAs and community health improvement plan documents from PHAB-accredited LHD. Quality scores based on 17 evaluation criteria, including stakeholder involvement, data examination, plan feasibility, and LHD-hospital collaboration. The study found significant variation in the quality of CHAs and community health improvement plan documents. The highest scores were for partner involvement, data examination, and plan feasibility. The lowest scores were for LHD-hospital collaboration, use of evidence-based strategies, and plan evaluation. No community variables significantly predicted overall report scores. The quality of CHAs and community health improvement plan documents varies among Kentucky LHDs, highlighting the need for more robust guidance and standardized criteria. Strengthening hospital-LHD collaboration and focusing on evidence-based strategies can improve public health outcomes. Enhancing CHAs and community health improvement plan processes through legislative changes, better guidance, and improved collaboration between hospitals and LHD can lead to more effective public health interventions and outcomes.

Amelioration of Soil Fertility by the Application of Different Fruit Waste Composts

The soil health status of Bangladesh decreased day by day, particularly organic matter and major nutrient content. The organic matter content in most of the agricultural soil in Bangladesh is <2%, which indicates poor soil health condition. In Bangladesh, almost every day, an enormous amount of waste material is produced from different kinds of seasonal and unseasonal fruit’s peels. Lack of proper recycling methods, most of these wastes are thrown away in drains, cannels, rivers, etc. which indicates a major threat to environmental safety. Composts derived from the wastes of different fruit’s peels can be an excellent source of organic matter and essential nutrients for soil health improvement. Therefore, the present study was carried out to evaluate the changes in physicochemical properties and nutrient contents of experimental soil treated with compost prepared from different types of fruit’s waste. The compost was prepared accordingly using different types of fruits waste and then the collected compost was thoroughly mixed with the soil and kept for six months. The experimental treatment consisted of three organic composts (jackfruit peel compost, mango peel compost, and banana peel compost) and three rates of application (1000, 1500, and 2000 kg ha-1). The experiment was arranged in a factorial completely randomized design and replicated thrice. The analyzed data showed that, the physicochemical properties and nutrient contents of experimental soil varied significantly with the use of different types of fruit’s wastes compared to no waste added soil, except in the case of particle size. Soil mixed with mango peel compost at a rate of 2000 kg ha-1 resulted in a higher available N content (2520 mg kg-1) and available P content (42.56 mg kg-1), whereas the available K content (219.88 mg kg-1), EC (1.55 dS m-1) and CEC (1209.56 meq 100g-1) were found higher in soil treated with banana peel compost of 2000 kg ha-1. On the other hand, soil treated with jackfruit peel compost of 1500 kg ha-1 showed the higher available Ca content (1533.33 mg kg-1) and the jackfruit peel compost of 2000 kg ha-1 resulted in the higher organic carbon (1.98%) and organic matter (3.41%). The findings of this experiment revealed that, compost prepared from different types of fruit peels can be an excellent source of organic matter and nutrients and among the tested composts, mango peel compost was better to improve the physiochemical properties of soil and supply sufficient nutrients for plant growth.

Health optimisation for patients with obesity before elective orthopaedic surgery: a qualitative study of professionals’ views on restrictive approaches and future practice

BackgroundPreoperative health optimisation for elective surgery entails supporting patients to improve their health in preparation for their treatment and recovery. While there is consensus that this process should address obesity, approaches vary across England. Despite guidance from the National Institute for Health and Care Excellence to the contrary, restrictive approaches with body mass index thresholds for referral to arthroplasty are in use. This qualitative study aimed to investigate the views of professionals on the current use and future implications of these policies.MethodsSemi-structured interviews were conducted with 20 professionals including clinicians, commissioners, policymakers, and health service managers, with experience of developing and/or implementing health optimisation policies for elective arthroplasty. Participants were sampled from areas in England with and without restrictive policies. We undertook thematic analysis of the interview data.ResultsParticipants described pre-surgical health optimisation as an important trigger for health improvement but identified current resourcing and inadequacies in provision of weight management support as significant barriers to success. Participants expressed concerns about the appropriateness and fairness of including obesity as a determinant to restrict access to surgery. They described short-term financial pressures underlying the use of restrictive body mass index thresholds and a lack of an evidence base, such that policies amounted to rationing and risked exacerbations of health inequalities. The study identified four priorities for improvements to future health optimisation practices: developing and implementing national guidance with flexibility for local variation, initiating patient engagement in primary care with onward integration across all services, improving resourcing to support effective equitable impact, and addressing wider determinants of obesity through societal change.ConclusionsOverall, participants had limited expectations of the impact of health optimisation policies on obesity without additional support, investment, and national guideline implementation. They raised strong concerns over current restrictive approaches. We conclude that addressing concerns around weight management support service availability and impacts on health inequalities is essential for shaping effective health optimisation policies. Future policy direction should support health optimisation to be offered early (ideally in primary care). Health optimisation interventions should be non-restrictive, inclusive, and well-monitored, particularly around equality impact.

Social inequalities in adult mortality across Europe (18th-21st centuries): A critical analysis of theories and evidence

This study examines the historical evolution of socioeconomic disparities in adult mortality, with a focus on European societies. Despite the widespread improvements in population health, social inequalities in mortality are a pervasive phenomenon nowadays. This paper employs a critical analysis of both theoretical and empirical literature to investigate major international studies and their findings on longevity differences associated with socioeconomic status from the nineteenth century to the early twenty-first century. Findings reveal that adult mortality trajectories have differed notably across social classes and regions, with some areas exhibiting disparities before the demographic transition and others showing inequalities emerging later. Understanding these long-term health inequality trends sheds light on the changing influence of medical advances and their interplay with economic growth, educational disparities, environmental factors, state roles, and production distribution, which have shaped mortality disparities through different development stages. These factors elucidate the international heterogeneity of results until the mid-twentieth century and offer explanatory insights into observed north-south patterns in Europe. Our findings contribute to a deeper understanding of how advancements in public health, economic development, and social policies have shaped health outcomes over centuries. The implications of this research inform ongoing debates and health policy, emphasizing a nuanced interpretation of historical data to craft effective strategies that address health inequalities today.

From Traditional to Digital: Evaluating the Role of Spirituality in Mental Health and Therapy

The increasing number of mental health issues has obliged us to find new methods that are not only innovative but also so easy that they can be used by almost everybody. The given paper examines the progress and effect of the mental health and life- assisting chat-bot. The main idea of the chat-bot incorporates elements from the Bhagavad Gita, the ancient spiritual manual. Information was collected to measure the public's view of introducing spirituality into the traditional treatment, the results reveal that the majority back such a venture. A study (n=51) was conducted, and respondents were asked questions about their age, religion, opinion on spirituality and mental health, and choice for which method online therapy or traditional therapy. It was found that out of all the respondents, (80.4% aged 16-25) there was a large majority (88.2%) that mentioned the spiritual aspect of mental well- being. There were a lot (most responses were YES) of them have been into spiritual exercises when they faced the difficulties, they still believe that it still could be personalized intervention to use. Even as traditional therapy is the main option (70.6%), a significant number of respondents (29.4%) still feel comfortable with online help. Those research counterparts that focus on the role of technology in mental health improvements which tend to look to the public for a response, are the ones that discuss the chance for the Bhagavad-Gita chatbot as a supplementary tool. The proposed chatbot will make use of Natural Language Processing (NLP) in understanding a user query and generating an answer through reference to Bhagavad Gita. Key Words: Bhagavad Gita, Mental health, Chatbot, Spiritual therapy, Technology-assisted therapy