Terms Of Health Outcomes Research Articles

Prenatal maternal immune activation predicts observed fearfulness in infancy.

Fear reactivity is an early emerging temperament trait that predicts longer term behavioral and health outcomes. The current analysis tests the hypothesis, an extension of prior research on maternal immune activation (MIA), that the prenatal maternal immune system is a reliable predictor of observed fear reactivity in infancy. The analysis is based on a prospective longitudinal cohort study that collected data from the first trimester and conducted observational assessments of temperament at approximately 12 months of age (n = 281 infants). MIA was assessed from immune biomarkers measured in maternal blood at each trimester; infant temperament was assessed using the Laboratory Temperament Assessment Battery assessment at 12 months; covariates included family and sociodemographic factors. Patterns of inflammatory markers across gestation reliably predicted observed temperament: elevated prenatal MIA was associated with high fear reactivity to novel stimuli. The findings provide novel evidence of prenatal origins of fear reactivity and suggest developmental mechanisms that may underlie early emerging individual differences in child temperament. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of the medical fitness model on long term health outcomes in older adults

BackgroundPhysical inactivity is common among older adults and is associated with poor health outcomes. Medical fitness facilities provide a medically focused approach to physical fitness and can improve physical activity in their communities. This study aimed to assess the relationship between membership in the medical fitness model and all-cause mortality, health care utilization, and major adverse cardiac events in older adults.MethodsA propensity weighted retrospective cohort study linked individuals that attended medical fitness facilities to provincial health administrative databases. Older adults who had at least 1 year of health coverage from their index date between January 1st, 2005 to December 31st 2015 were included. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in members. Members were stratified into low frequency attenders (< 1 Weekly Visits) and regular frequency attenders (> 1 Weekly Visits). Time to event models estimated the hazard ratios (HRs) for risk of all-cause mortality and major adverse cardiac event. Negative binomial models estimated the risk ratios (RRs) for risk of hospitalizations, outpatient primary care visits and emergency department visits.ResultsAmong 3,029 older adult members and 91,734 controls, members had a 45% lower risk of all-cause mortality (HR: 0.55, 95% CI: 0.50 – 0.61), 20% lower risk of hospitalizations (RR: 0.80, 95% CI: 0.75 – 0.84), and a 27% (HR: 0.72, 95% CI: 0.66 – 0.77), lower risk of a major adverse cardiovascular event. A dose–response effect with larger risk reductions was associated with more frequent attendance as regular frequency attenders were 4% more likely to visit a general practitioner for a routine healthcare visit (RR: 1.04, 95% CI: 1.01 – 1.07), but 23% less likely to visit the emergency department (RR: 0.87, 95% CI: 0.82 – 0.92).ConclusionsMembership at a medical fitness facility was associated with a decreased risk of mortality, health care utilization and cardiovascular events. The medical fitness model may be an alternative approach for public health strategies to promote positive health behaviors in older adult populations.

Effectiveness of dietetic care for cancer survivors in the primary care setting: A systematic review and meta-analysis of randomized controlled trials.

Nutrition plays an important role in cancer survivorship. This systematic review and meta-analysis aim to critically assess and quantify the effectiveness of nutrition care interventions provided by dietitians to survivors who have completed treatment for cancer. A systematic review of randomized controlled trials (RCTs) published from January 2004 to November 2023 reporting the effectiveness of primary care dietetic interventions with adult cancer survivors was conducted. PubMed, Scopus, CINAHL, Embase, ProQuest and PsycINFO databases were searched for key terms. Meta-analyses were conducted where there were sufficient studies of the same cancer type and outcomes. Twelve RCTs representing 1138 cancer survivors (519 breast cancer; 75 prostate cancer; 544 colorectal cancer) were included. Primary outcome measures included weight loss (n = 6), quality of life (n = 2), reducing lymphedema-related arm volume (n = 2), nutritional status (n = 1) and increasing fruit and vegetable intake (n = 1). Weight loss was observed in studies where this was the primary outcome. Results for quality of life varied.Meta-analyses of RCTs with breast cancer survivors showed that dietitian intervention achieved a mean of 3.7kg greater intentional weight loss and 2.3% greater body fat decrease than control (p < 0.0001). This study provides evidence for the effectiveness of primary care dietetic interventions by dietitians with cancer survivors, particularly with respect to intentional weight and fat loss in breast cancer survivors. Dietitians can play a key role in managing weight and improving long term health outcomes and prognosis for cancer survivors beyond the acute care setting.

Examining public perceptions and concerns about the impact of heatwaves on health outcomes using Twitter data

BackgroundHeat is becoming a global public health concern. This paper presents a comprehensive Twitter data analysis (2011–2023) to gain insights into public perceptions of heatwaves and their health-related concerns. MethodsA number (N = 2,070,197) of filtered tweets were included for analysis after preprocessing. Utilizing the Extractor of Demographic Characteristics (EDC) module, we extracted demographic attributes, including user type, gender, and age, highlighting the diverse voices in the Twitter conversation. Sentiment and emotional analyses were conducted utilizing BERT models. An active learning content analysis approach was employed using the GPT-3 model to identify health outcomes and concerns related to heat waves. ResultsOur results show that joy and anger were the dominant emotions, reflecting positive and negative sentiments surrounding heat waves. Public sentiment varied, revealing concern and optimism in response to changing weather patterns.In terms of health outcomes, the paper categorizes and analyzes a wide range of concerns during heat waves, from heat-related illnesses to mental health issues. These findings provide valuable insights into how different health concerns are distributed across gender, user type, and age categories. An overview of the measures people took to control these issues was also given. ConclusionsThis study illustrates the evolving dynamics of public emotional responses to heat waves, offering a holistic view of the various health-related concerns raised by the public during these extreme weather events. Such insights are essential for informing public health strategies and emergency responses to mitigate the adverse effects of heat waves and protect vulnerable populations.

Sustainable Career Trajectories in Switzerland: The Role of Psychological Resources and Sociodemographic Characteristics

In the current volatile and insecure professional context, developing and maintaining sustainable careers has become a major concern. This study contributes to the advancement of research on sustainable careers by applying the career sustainability framework in a 7-year longitudinal study on Swiss workers’ career trajectories ( N = 789). We thus aimed to (a) identify various types of career trajectories based on employment status (i.e., full-time employment, substantial part-time employment, marginal part-time employment, unemployment), (b) distinguish sustainable and unsustainable trajectories by investigating their outcomes in terms of health (i.e., self-rated health), happiness (i.e., career and life satisfaction), and productivity (i.e., income and promotion), and (c) predict the probability of falling into a (un)sustainable career trajectory based on psychological resources (i.e., personality traits and career adaptability) and sociodemographic characteristics (i.e., age, gender, and education level). Optimal matching analysis revealed a 4-cluster solution, with the traditional full-time and stable career trajectories being the predominant ones alongside more transitional or discontinuous trajectories. Differences in health, happiness and productivity were found between the four types. Furthermore, our results showed that being a woman, having a lower education level and higher neuroticism and agreeableness scores increased the likelihood of experiencing an unsustainable career.

Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials

ObjectivesTo examine the effectiveness of shared medical appointments (SMAs) compared with one-to-one appointments in primary care for improving health outcomes and reducing demand on healthcare services by people with one...

Mothers’ education and childhood anaemia in Uganda

ABSTRACT This article employs ordered probit to examine the effect mother’s education and other socio-economic and community factors on the prevalence of childhood anaemia in urban and rural areas and severity of anaemia in Uganda using the Uganda Demographic and Health Survey. In Uganda, 53% of children aged 6–59 months suffered from some degree of anaemia, with 24% being mildly anaemic, 27% moderately anaemic, and 2% severely anaemic (UDHS, 2016). Anaemia has substantial negative effects on the health and economic wellbeing of nations and communities. The study findings indicate that mother’s education attainment and the partner’s schooling and socio-economic factors are important in explaining the prevalence of childhood anaemia in Uganda. The major implication of these results is that raising women’s education improves their economic opportunities, and the behavioural responses and this can greatly improve children’s health outcomes in terms of low prevalence of childhood anaemia.

Fecal microbiota composition, serum metabolomics, and markers of inflammation in dogs fed a raw meat-based diet compared to those on a kibble diet.

Despite the potential health risks associated with feeding raw and non-traditional diets, the use of these diets in dogs is increasing, yet the health outcomes associated with these diets is not well understood. This study investigates the effect of feeding dogs a kibble or raw meat-based diets on fecal microbiota composition, serum metabolomics and inflammatory markers. Clinically healthy dogs with a history of consuming either kibble (KD, n = 27) or raw meat-based diets (RMBD, n = 28) for more than 1 year were enrolled. Dogs were fed a standardized diet of either a single brand of KD or RMBD for 28 days. Serum and fecal samples were collected for analysis of microbiota, metabolomics, and inflammatory markers. Multiple regression analysis was performed for each of the metabolites and inflammatory markers, with feed group, age and BCS included as independent variables. The fecal microbiota composition differed between the KD and RMBD groups. Beta-diversity and some indices of alpha-diversity (i.e., Shannon and Simpson) were different between the two diet groups. Sixty- three serum metabolites differed between KD and RMBD-fed dogs with the majority reflecting the differences in macronutrient composition of the two diets.Fecal IAP, IgG and IgA were significantly higher in RMBD dogs compared to KD dogs, while systemic markers of inflammation, including serum c-reactive protein (CRP), galectin, secretory receptor of advanced glycation end-products (sRAGE), haptoglobin, and serum IgG were similar in dogs fed either diet. Diet composition significantly affected fecal microbiota composition and metabolome. Although it had a potentially beneficial effect on local inflammatory markers, feeding RMBD had no impact on systemic inflammation. The influence of these changes on long term health outcomes provides an area for future study.

Evaluation of Polyurethane Production Quality using Statistical Process Control Approach

Manufacturing processes in the recent times prioritizes competitiveness and continuous improvement. This study examined production data from an indigenous polyurethane firm to monitor controllable variables (i.e., density, tensile strength, hardness, compression and elongation) for quality and improve outcomes. Data was subjected to statistical process control (SPC) using control chart methods of analysis. In addition to raising an alarm when a process deviates from control, control charts are crucial for determining internal and natural control limits. An analysis of the data revealed that at the beginning of production, 35DC (27084), 22DC (26543), 18DC (21805), and 16DC (20666) consumed more production material than 14DC (3833). According to the mean value, the majority of the production material is either consumed during the early stages of production or preserved or minimized during the later stages of production. To counteract this irregularity, it is important to pay greater attention to identifying the material that suffocates other production components during the first stages of production. Therefore, for better health outcomes in terms of ergonomics and acceptability and/or comfort (the feel-good factor) during usage, an ideal blend of polyurethane under controlled manufacture is needed.

Pairing Peer Education and Social Media for Adolescent Smokers with Disabilities

Tobacco usage for adolescents with and without disabilities is associated with negative outcomes in health and finance. To combat usage, inclusive peer-education combined with social media outreach may benefit efforts to minimize, prevent, and discontinue tobacco use in adolescents with and without disabilities. This article aims at concisely reviewing current literature associated with tobacco usage, associated with the term health outcomes, and social media usage; specifically connecting the relationships with adolescents with and without disabilities.

Smoking cessation encouragement by community pharmacists.

Background: Pharmaceutical care interventions have shown to improve health outcomes in specific patient populations. However, which smokers could be reached by community pharmacists in Belgium is unknown. Moreover, the impact of behavioural interventions for smoking cessation (such as brief motivational interviewing) on short term health outcomes remains unclear. Therefore, we aimed to describe the population reached and potential impact on health outcomes among persons who received a brief motivational interview by their community pharmacist.&#x0D; Methods: Demographics of approached smokers in Flemish community pharmacies during the months May-June 2021, and objectifiable outcomes of a brief motivational interview were retrieved from the pharmacy database. Smoking cessation aids use as well as the impact on cough, inhaler or exacerbation medication use was evaluated 90 and 180 days after the encouragement. Data were analysed using the Mann-Whitney U test, ꭕ² test and binary logistic regression analysis.&#x0D; Results: Community pharmacists provided a brief motivational interview to a broad population of smokers of both sexes, including young persons and persons without chronic medication use. Two out of three smokers were motivated to quit (67.7%) and a third of the included population (33.0%) purchased a smoking cessation aid on the index date (36.7% after 90 and 39.3% after 180 days). Smokers motivated to quit who purchased a smoking cessation aid on the index date had a significantly lower use of cough (OR = 0.37; p = 0.032) and inhaler medication (OR = 0.37; p = 0.009) after 90 days than those not motivated to quit. Effects were less pronounced after 180 days but still statistically significant for lower inhaler use (OR = 0.46; p = 0.031).&#x0D; Conclusions: By implementing a brief pharmaceutical counselling in Belgian community pharmacies, a broad range of smokers can be reached and triggered to start smoking cessation aids with suggestive short-term health benefits.&#x0D; Acknowledgements&#x0D; The authors want to thank the Flemish Pharmacists Network (VAN) for training the pharmacists and Farmaflux and the Association of Pharmacists Belgium (APB) for providing the data with special acknowledgements to Karel Verlinde, An Vanthienen, Corine De Winter and Marc Buckens.

Cost Effectiveness of Tofacitinib for the Treatment of Active Ankylosing Spondylitis in Greece.

Ankylosing spondylitis is a chronic, progressive, inflammatory, multidimensional, musculoskeletal disease primarily involving the axial skeleton. In addition, ankylosing spondylitis is associated with increased morbidity and mortality, significantly affecting productivity and overall quality of life. The aim of the present study was to evaluate the cost effectiveness of tofacitinib compared to currently marketed biologic treatment in patients with active ankylosing spondylitis who have responded inadequately to conventional therapy (biologic-naïve population) or previous biologic therapy (biologic-experienced population) in Greece. A published model comprising a decision tree and a three-state Markov model was adapted from a public payer perspective over a lifetime horizon. Adalimumab and secukinumab, having the highest market shares among biologics for the treatment of ankylosing spondylitis in Greece (standard practice), were selected as comparators in the analysis. Clinical parameters captured treatment response defined per Assessment of Spondyloarthritis International Society 20 response, short-term and long-term changes in Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores, long-term biologic treatment discontinuation, and adverse events. Efficacy, safety data, and utility values were elicited from the published literature. Direct costs pertaining to drug acquisition, monitoring, adverse events, and disease management costs were considered in the analysis (€2022). Model outcomes were patients' quality-adjusted life-years, total costs, and incremental cost-effectiveness ratios. All future outcomes were discounted at 3.5% per annum. A probabilistic sensitivity analysis was conducted to account for model uncertainty. In a biologic-naïve population, compared with adalimumab, tofacitinib produced an estimated 0.06 additional quality-adjusted life-years [QALYs] (10.67 vs 10.73), at additional costs of €2403 (€147,096 vs €149,500) resulting in an incremental cost-effectiveness ratio of €41,378 per QALY gained. In a biologic-experienced population, the total cost per patient for tofacitinib and secukinumab was estimated to be €151,371 and €145,757, respectively. In terms of health outcomes, tofacitinib was associated with a 0.13 increment in QALYs compared with secukinumab resulting in an incremental cost-effectiveness ratio of €42,784 per QALY gained. The probabilistic sensitivity analysis confirmed the deterministic results for both populations. Tofacitinib was estimated to be a cost-effective option for the treatment of active ankylosing spondylitis in Greece for both biologic-naive and biologic-experienced patients.

Physical activity has a more beneficial effect on the risk of all-cause mortality in patients with metabolic syndrome than in those without

BackgroundIt has not been clarified whether physical activity (PA) has more benefit in terms of health outcomes, including mortality risk, among those with metabolic syndrome (MS) compared to those without. Therefore, the aim of this study is to elucidate whether regular PA has interaction with MS on health outcomes.MethodsParticipants with no underlying cardiovascular diseases who underwent national health screening in 2009 were included. According to the metabolic equivalent (MET)-minutes/week, the amount of PA among the participants was grouped as follows: Group 1 (0 MET-minutes/week), Group 2 (1–499), Group 3 (500–999), Group 4 (1000–1499), and Group 5 (≥ 1500). Multivariable Cox proportional hazard models were applied to evaluate the impacts of the amount of PA on health outcomes among those with and without MS. Health outcomes included all-cause mortality and incident cardiovascular diseases (CVDs).ResultsOf 9,628,109 total participants, 335,970 deaths occurred during a median 8.3-year follow-up. After adjustment for age, sex, smoking status, alcohol consumption, and body mass index, the higher the PA amount was, the lower the risk of all-cause mortality in both those with MS [adjusted hazard ratio (aHR) compared with Group 1, 0.86 (95% CI 0.85, 0.87) in Group 2; 0.82 (95% CI 0.81, 0.83) in Group 3; 0.75 (95% CI 0.74, 0.77) in Group 4; and 0.78 (95% CI 0.76, 0.80) in Group 5; P for trend < 0.001] and those without MS [aHR compared with Group 1, 0.87 (95% CI 0.86, 0.88) in Group 2; 0.84 (95% CI 0.83, 0.85) in Group 3, 0.79 (95% CI 0.78, 0.80) in Group 4, and 0.82 (95% CI 0.81, 0.84) in Group 5; P for trend < 0.001]. The beneficial effects of the amount of PA on all-cause mortality were larger among those with MS than among those without MS in a multiplicative interaction (P for interaction < 0.001). The results were similar in the analysis of the relationship between the PA amount and incident CVD.ConclusionsMore PA was associated with a lower risk of all-cause mortality, which was more prominent in those with MS than in those without MS. Physicians should emphasize more the importance of PA in patients with MS.

OP124 Cost Effectiveness Of End-Stage Renal Disease Treatment Methods In Türkiye

IntroductionChronic kidney disease is an important public health problem and is a leading cause of morbidity and mortality worldwide. Hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (Tx) are the main treatments for this disease. The aim of this research was to determine the cost effectiveness of treatments for end-stage renal disease from the perspective of a reimbursement institution in Türkiye.MethodsA Markov model was developed to measure costs and health outcomes in terms of quality-adjusted life-years (QALYs). The model parameters were based on a six percent discount rate, lifetime time horizon, and a reimbursement agency perspective. The main outcome measures were the incremental cost-effectiveness ratio (ICER) and the cost per QALY. One-way and probabilistic sensitivity analyses were performed to determine parameter uncertainty.ResultsThe lifetime costs of HD, PD, and Tx were USD26,883, USD37,672, and USD31,227, respectively. The lifetime QALYs gained with HD, PD, and Tx were 5.21, 6.77, and 9.73, respectively. The cost per QALY of HD, PD, and Tx were USD5,161, USD5,567, and USD3,211, respectively. Compared with Tx, the ICERs for HD and PD were USD961 and USD2,178, respectively.ConclusionsCost differences have occurred between the treatment options for end-stage renal disease due to the increase in drug costs in Türkiye in recent years. As seen in the Markov model in this research, HD, PD, and Tx are complementary rather than rival treatments. This study found that the cost effectiveness of Tx is higher than HD or PD. However, the rate of Tx, which has a higher quality of life compared with HD, is around 22 percent in Türkiye; the rate for PD is four percent. It is therefore recommended that a health policy be developed to encourage kidney donation and promote PD as a superior alternative to HD for eligible patients.

Adolescent Perceptions of Adult-Mediated Healthcare Communication

ABSTRACT Adolescence is a time of rapid growth and development and may be accompanied by increased risk-taking behaviors and independence. Youth are particularly at risk for high levels of stress, decreased physical activity, unsafe sexual activity, abuse, depression, and suicide. Considering the unique health risks adolescents face, healthcare service access and utilization can play a pivotal role in promoting positive long term health outcomes throughout adulthood. At the same time, adolescents must often rely on parents/caregivers to mediate their healthcare access. Understanding how adolescents perceive adult interactions within healthcare is important for developing interventions that increase youth access to healthcare. We found that adolescents perceived adult-mediated healthcare experiences as either supportive (Subthemes: Recognition Builds Trust and Validation) or unsupportive (Subthemes: Adult-Focused Communication and Lack of Privacy). Based on our findings, we argue that prevention-focused interventions should include communication-based strategies. We discuss social work and healthcare practice and policy implications of these findings.

Effects of restrictive asylum-seeker healthcare policies: systematic review of evidence from Germany

Abstract Background Asylum-seekers’ entitlements to healthcare vary within and across European countries, over time, and between different nationalities. Within Germany, healthcare policies for asylum-seekers range from restrictions of both scope and access to healthcare to full health entitlements, depending on a person's legal status, duration of stay, country of origin, and place of residence. We seized these variations to study the effects of restrictive vs. inclusive healthcare policies on health status, health system outcomes (incl. health equity), healthcare provision, healthcare utilization, and efficiency. Methods We conducted a systematic review in five databases (PubMed, Web of Science, SCOPUS, LIVIVO, Google Scholar) to identify and analyse empirical studies on the effects of healthcare policies for asylum-seekers in Germany. Out of 1159 initial hits, 66 records were assessed for quality and included in the narrative synthesis. Results The synthesised evidence shows that more inclusive policies facilitate needs-based health care utilization, incl. broader utilization of ambulatory services and lower use of emergency services. They reduce complexity, fragmentation and bureaucracy for healthcare users and providers by simplifying authorisation and reimbursement. Evidence suggests that inclusive policies contribute to better subjective and mental health among asylum-seekers. We found no evidence for access restrictions being associated with cost savings or other health system benefits. Conclusions Restrictive healthcare policies are often justified with the need to protect fiscal resources and health systems. Yet, evidence from Germany shows that more inclusive healthcare policies for asylum-seekers hold benefits in terms of health system outcomes, while not entailing higher costs. Inclusive policies are thus not only normatively preferable to restrictive policy options; they also yield better performance from a health systems perspective. Key messages • Germany is a pertinent test-case for analyzing the effects of restrictive vs. inclusive healthcare policies for asylum-seekers. • Inclusive healthcare policies hold benefits in terms of health outcomes and health system performance, while restrictions fail to show advantages in fiscal or other domains of performance.

Benefits of sphingosine-1-phosphate receptor modulators in relapsing MS estimated with a treatment sequence model

BackgroundThree sphingosine-1-phosphate receptor (S1PR) modulators are currently available as disease-modifying therapies (DMTs) for relapsing MS in the Netherlands (i.e. fingolimod, ozanimod and ponesimod). We aimed to identify which S1PR modulator yields the highest benefit from a health-economic and societal perspective during a patient's lifespan. MethodsIncorporating Dutch DMT list prices, we used the ErasmusMC/iMTA MS model to compare DMT sequences, including S1PR modulators and eight other DMT classes, for treatment-naïve patients with relapsing MS in terms of health outcomes (number of lifetime relapses, time to Expanded Disability Status Scale (EDSS) 6, lifetime quality-adjusted life years (QALYs)) and cost-effectiveness (net health benefit (NHB)). We estimated the influence of list price and EDSS progression on cost-effectiveness outcomes. ResultsIn deterministic and probabilistic analysis, DMT sequences with ponesimod have lower lifetime costs and higher QALYs resulting in a higher average NHB compared to sequences with other S1PR modulators. Ponesimod remains the most cost-effective S1PR modulator when EDSS progression is class-averaged. Given the variable effects on disability progression, list price reductions could make fingolimod but not ozanimod more cost-effective than ponesimod. ConclusionOur model favours ponesimod among the S1PR modulators for the treatment of relapsing MS. This implies that prioritizing ponesimod over other S1PR modulators translates into a more efficacious spending of national healthcare budget without reducing benefit for people with MS. Prioritizing cost-effective choices when counselling patients contributes to affordable and accessible MS care.

Type of Refugee Accommodation and Health of Residents: A Cross-Sectional, Population-Based Cluster Analysis in South-West Germany.

Objectives: Few studies have assessed whether refugees' health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on variables on the accommodation and its physical context before assessing its association with health in multivariate analyses. Methods: We performed a cluster analysis based on a hierarchal, agglomerative clustering algorithm using Euclidean Distance and Ward's method. We analysed accommodation clusters based on number of inhabitants, degree of housing deterioration, urbanity of location (urban/rural distinction), and remoteness (walking distance to shops, medical or administrative services). In total, we analysed health and accommodation data of 412 refugees and asylum seekers from 58 different accommodation facilities in the federal state of Baden-Württemberg in the south-west of Germany. Results: Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and generalized anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Conclusion: Our findings inform policymakers on layout and location of refugee collective accommodation centres.

Effect of Dill Seed Tea on Lactation Among Postnatal Mothers Admitted in Tertiary Care Hospital

Breastfeeding is the most beneficial initial nourishment for newborns in terms of health outcomes. Galactagogues are substances that aid in increasing milk production. Galactagogues include herbs such as dill seeds, fenugreek, as well as medications like metoclopramide and domperidone. The objective of this study was to assess the effectiveness of dill seeds tea in promoting lactation among postnatal mothers admitted to a tertiary care hospital. A quasi-experimental research design with a quantitative approach was employed, and data was collected using a convenient sampling technique from 60 postnatal mothers, with 30 participants assigned to the quasi-experimental group and 30 to the control group. The quasi-experimental group received dill seeds tea in the morning for five days, consisting of 1 teaspoon of dill seeds, 200 ml of water, 1 teaspoon of jaggery, and half a teaspoon of cow ghee. The sample selection followed specific inclusion and exclusion criteria. The research tools utilized in the study included a questionnaire to gather demographic and obstetrical data, as well as a Likert scale to assess breastfeeding adequacy in postnatal mothers. The study results revealed that during the pre-test, the majority of the control group (86.7%) experienced inadequate lactation, while 13.3% had satisfactory lactation. In the experimental group, the majority (93.3%) had inadequate lactation, with only 6.7% experiencing satisfactory lactation. During the post-test, the control group had a majority of 76.7% with inadequate lactation. In contrast, the experimental group had 80% with adequate lactation and 20% with satisfactory lactation. The study’s findings indicate that the majority of postnatal mothers in both the experimental and control groups initially experienced insufficient breast milk production, but after receiving dill seeds tea, lactation improved among the postnatal mothers. Therefore, it can be concluded that dill seeds tea was effective in enhancing lactation in postnatal mothers.

REPRODUCTIVE COERCION AND ITS EFFECTS ON WOMEN’S REPRODUCTIVE HEALTH OUTCOMES- A CROSS-SECTIONAL STUDY

Objective Reproductive coercion is a constellation of behaviors obstructing a woman’s autonomy in reproductive decision-making. This contributes to unwanted reproductive health outcomes in terms of physical and mental morbidity and mortality. The objective was to quantitatively explore its contribution to reproductive health outcomes in women seeking health care for other reasons. Materials and Methods This was a cross-sectional analytical study where the data was collected on the Reproductive Coercion Scale (by Miller) from 424 patients. The independent variables were; worried about pregnancy, pregnancy testing, induced abortion, and unwanted pregnancy/birth and the dependent variable was the scale score of each item. Data was analyzed by Chi-Square/Fisher’s Exact test at Statistical significance of p ? 0.05. Results The mean age of women was 30.13 (SD=6.51) years. Half of the women 212 (50%) were between 20 to 30 years. The majority were housewives 403(95%), living in joint family systems 314 (74.1%), and uneducated 260 (61.3%). There was a significant difference between unwanted/being worried about not pregnant and threats to leave the wife if she did not get pregnant (p=0.03), compelled wife for unprotected sex (p=0.02), and deliberately removed condoms (p=0.02). A significant difference was reported with induced abortions; as the wife was advised against the use of contraceptives (p=0.01), compelled for pregnancy (p=0.03), deliberately barred use of condoms (p=0.03), deliberately removed condom during sex (P=0.05) and damaging condom on purpose (p=0.001). Significant responses were reported for unwanted pregnancy/birth against the items; leaving the wife for not getting pregnant (p=0.001), intentionally barred access to contraceptives (p=0.02), and deliberately damaged condoms (p=0.02). Conclusion Reproductive coercion is overtly denied but covertly reflected in the health-seeking behaviors of women with a significant impact on reproductive health outcomes. Key Words Induced abortion, Reproductive Coercion, Unwanted Pregnancy