Higher Education Level Research Articles

Prevalence of obesity, determinants, and its association with hyperglycaemia among community dwelling older adolescents in India

BACKGROUND Globally, obesity and diabetes mellitus (DM) are emergent public health concerns in the adolescent population. India, home to the largest adolescent population and the second largest diabetes cohort is experiencing rapid but unplanned urbanization, with accompanying unhealthy nutritional transition, and sedentary lifestyle. AIM To determine prevalence and determinants of obesity and hyperglycaemia and their association among community-dwelling older adolescents (15-19 years) in India. METHODS This cross-sectional analysis from the national family health survey-5 included data of 258028 adolescents aged 15-19 across India (2019-2021). The survey employed stratified two-stage sampling, with systematic random sampling in rural and urban areas. Statistical analysis included descriptive statistics, bivariate, and multivariable logistic regression, employing generalized linear models. RESULTS The weighted prevalence of DM was 1.09% including 0.77% [95% confidence interval (CI): 0.72-0.83] previously diagnosed and 0.32% (95%CI: 0.29-0.35) newly diagnosed cases detected on survey screening. On adjusted analysis, increasing age, higher education levels, higher wealth index, and overweight/obesity were the factors significantly associated with presence of DM. Only 61% of the adolescents with previously diagnosed DM were on anti-diabetes treatment. The weighted prevalence of overweight/obesity among older adolescents was 6.9% with significantly higher odds in the male sex, having higher educational levels, urban residence, and those with a higher wealth index. CONCLUSION Nearly one in hundred older adolescents in India have diabetes, with one in three undiagnosed. Strengthening DM screening and treatment access among adolescents through public health programs is urgently warranted.

Educational Differences in Fertility Among Female Same-Sex Couples in Finland.

Same-sex couples increasingly often live in legally recognized unions and have children as a couple. The accessibility of parenthood, however, depends on intersecting contextual and couple-level characteristics. Using Finnish register data on female same-sex couples who registered their partnership in 2002-2016, a period of important legal reforms regarding same-sex parenthood, we explore how education and the existence of prior children predict childbearing within the same-sex partnership. Female couples' likelihood of having a child within five years of registering a partnership increased from 20% to 45% over the observation window. This increase was not universal. The likelihood increased from 24% to 55% for couples with a tertiary education but decreased from 27% to 9% for couples with primary and lower secondary education. Couples with the highest level of education and no prior children born before the partnership were the most likely female couples to have a child. Educational differences in childbearing were only marginally explained by couples' income levels. The results highlight how intersectional factors shape female couples' fertility behavior. Intensifying educational differences in couples' fertility might reflect changes in couple-level characteristics and institutional barriers to childbearing that merit more attention.

Syndemic approach to chronic kidney disease, cardiovascular disease and educational level: a longitudinal cohort study in northwest Italy

IntroductionChronic kidney disease (CKD) and end-stage renal disease (ESRD) represent significant public health challenges, linked to an elevated risk of cardiovascular disease (CVD) and influenced by socioeconomic disparities. This longitudinal...

Information Needs Among Thai Women Breast Cancer Patients During the Initial Treatment Phase: A Cross-Sectional Study.

To examine the information needs of breast cancer patients during the initial phase of treatment and to analyse the factors that influenced these needs. Providing comprehensive and timely information during early breast cancer treatment is crucial for informed decision-making and effective coping. Healthcare providers must address these needs to enhance patient support and improve outcomes. A cross-sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A total of 123 post-mastectomy patients were selected through purposive sampling and completed the Thai version of the Sri Lankan Information Needs Assessment Questionnaire-BC (SINAQ-BC). Direct associations between demographic data and information needs were analysed descriptively, while bivariate analysis and linear regression were used to identify significant predictors of information needs. The findings revealed that patients exhibited high overall information needs (224.7/260.0), with the greatest demand focused on physical care, treatment and diagnosis. In contrast, needs related to disease specifics and psychosocial care were less prominent. A total of 94 respondents (76.4%) expressed a particularly high demand for information regarding physical care. Education level was identified as an influencing factor, accounting for 7.7% of the variance in information needs among women with breast cancer. Patients with higher education levels had significantly greater information needs. Nursing staff should provide customised information packages that are tailored to the participants' education levels. Further testing of the Thai version of the SLINQ-BC would also be warranted. Patients are increasingly expected to manage their own care even as medical treatment grows more complex and technical. Nursing staff can contribute to the care of patients by being ready to evaluate, monitor and address breast cancer patient's individual information needs in the early stage of treatment based on factors such as educational level. No patient or public contribution because the nature of the study's design, data analysis and writing did not require patient or public contribution.

Understanding preoperative health-related quality of life in rotator cuff tear patients: role of patients’ characteristics

BackgroundAssessing health-related quality of life (HRQoL) is a widely employed method in orthopedics to evaluate patient well-being and measure the effectiveness of surgical interventions. Understanding the relationship between specific baseline factors and preoperative HRQoL can help clinicians identify patients at risk for low quality of life and thus, develop preventive strategies that adequately address individual patient needs. The objective was to assess associations between baseline factors and preoperative HRQoL in patients undergoing arthroscopic rotator cuff repair (ARCR).MethodsThis study is part of a multicenter prospective Swiss cohort study that included patients undergoing ARCR between June 2020 and November 2021. Data were derived from baseline and surgery forms. HRQoL was assessed using the European Quality of Life 5-Dimension 5-Level (EQ-5D-5L) questionnaire to calculate EQ-5D index and EQ VAS scores. Univariable and multivariable linear regression models examined associations between the 21 factors and preoperative HRQoL. Final models were determined using stepwise backward regression.ResultsA total of 973 included patients (mean age [SD], 57.3 [9.4] years; 611 men [63%]) had a mean [SD] EQ-5D index and EQ VAS of 0.70 [0.23] and 68.7 [19.8], respectively. Being male (regression coefficient (β), 0.05; 95% CI [0.02–0.08]), having a higher age (β, 0.02; 95% CI [0.01–0.03]) and higher education levels (e.g., university, college: β, 0.11; 95% CI [0.06–0.16]) were associated with a higher EQ-5D index. Increased body mass index (β, -0.02; 95% CI [-0.04 to -0.01]) and worse sleep quality (β, -0.03; 95% CI [-0.04 to -0.03]) were associated with a lower EQ-5D index. Factors negatively associated with overall EQ VAS health were depression (e.g., moderate: β, -12.70; 95% CI [-16.18 to -9.21]), presence of at least one comorbidity (β, -3.71; 95% CI [-5.91 to -1.52]), and pain (β, -1.81; 95% CI [-2.36 to -1.26]).ConclusionOur results suggest that preoperative HRQoL is highly associated with sociodemographic and patient-related factors. Specifically addressing these factors may improve orthopedic care.

A quantitative survey on exposures, knowledge, attitudes, and practices (KAP) related to swine influenza among villagers in different regions of Thailand

This analytical cross-sectional study aimed to determine factors influencing knowledge, attitudes, and practices (KAP) toward the swine influenza virus (SIV) among pig farm owners, workers, and villagers in selected provinces of Thailand. This study was carried out from February to December 2022 in pig farms and villages across the provinces. A structured and standardized quantitative questionnaire was utilized to collect data on socio-demographic variables and KAP related to SIV from 215 participants. The quantitative data was analyzed in two steps using R software. The study findings showed that the average knowledge score on SIV was 6.92 out of 12, indicating moderate understanding of SIV in study participants. Attitudes towards SIV were generally positive, with an average score of 3.74 out of 5. Practices for SIV prevention averaged a score of 3.63 out of 5. Key factors associated with better SIV knowledge included higher education levels, higher monthly income, and direct involvement in vaccination processes. Moreover, those with higher education, employment on pig farms, and prior vaccination experience showed more positive attitudes towards SIV. Occupations related to pig farming and the availability of vaccination services significantly influenced SIV prevention practices. The findings highlighted that improved education and stronger connections with healthcare professionals and the pig farming sector may significantly enhance KAP regarding SIV among targeted populations. In contrast, participants with limited exposure to health services or pig farming activities, such as nearby villagers, require specialized educational interventions. This study recommends that local health authorities should develop and implement communication strategies and interventions focused on educating pig farm owners, managers, and villagers about SIV to mitigate the risks associated with SIV and other zoonotic diseases.

Respiratory syncytial virus vaccination among US adults aged ≥60 years

BackgroundRespiratory syncytial virus (RSV) vaccines have been recommended for US adults aged ≥60 years for nearly one year. However, the extent of vaccination coverage and the factors influencing uptake remain underexplored. This study aimed to evaluate national and state-specific RSV vaccination coverage among US adults aged ≥60 years and to identify demographic and socioeconomic factors that influence vaccination uptake.MethodsThis cross-sectional study analyzed data from the US Census Household Pulse Survey, from January 9 to March 4, 2024, which included 49,322 adults aged ≥60 years. Participants self-reported their RSV vaccination status along with demographic and socioeconomic information. Multivariable Poisson regression was used to identify factors associated with vaccination uptake.ResultsAs of March 4, 2024, RSV vaccination coverage among US adults aged ≥60 years was estimated at 22.2% (95% CI, 21.6%-22.7%). State-specific vaccination coverage ranged from 12.4% in Mississippi to 33.1% in Colorado. Coverage was higher in older age groups, with 21.2% among those aged 65-69 years, 28.1% among 70-74 years, 31.9% among 75-79 years, and 30.2% among those aged ≥80 years, compared to 10.8% among those aged 60-64 years. Racial/ethnicity disparities were evident, with lower coverage among Hispanics (18.3%) and non-Hispanic Blacks (17.6%) compared to non-Hispanic Whites (23.3%). Coverage was similar between males (22.6%) and females (21.8%). Factors positively associated with vaccination included older age, higher education level, higher household income, unemployment, and residing in the Midwest or West. Conversely, being non-Hispanic Black, uninsured, experiencing financial difficulties, and lack of COVID-19 vaccination were associated with reduced likelihood of receiving the RSV vaccine.ConclusionsDuring the first RSV season after the recommendations for RSV vaccination in US adults aged ≥60 years, uptake shows promise but is marked by significant disparities related to race/ethnicity, socioeconomic status, and geographic location. Efforts to address these disparities are crucial to enhance vaccination coverage and reduce the impact of RSV on this vulnerable population.

Enhancing hospital protection measures reduces frontline medical workers’ stress during the pandemic

Frontline medical workers (FMWs) faced high stress levels in frontline clinics during the COVID-19 pandemic. This study aims to alleviate FMWs’ psychological stress by enhancing protection measures, which includes refining the selection process, improving protective measures for their work in frontline clinics, and determining the appropriate time for evacuation. A Chinese-language-version stress questionnaire, covering stress-related issues and sociodemographic characteristics, was administered to FMWs in Shanghai during the COVID-19 pandemic in 2022, yielding 107 valid responses. The questionnaire’s reliability and validity were subsequently confirmed. Exploratory factor analysis (EFA) was applied to the stress-related questions, with the KMO and Bartlett’s test values of 0.886, 877.8522 (df = 120, p < 0.0001), respectively. Structure equation modeling (SEM) was used to confirm the factors and measure the relationships among the stress-related questions, factors and sociodemographic characteristics. The parameters of SEM named SOFAIDC were significant with SRMSR, RMSEA, AGFI, NFI, and PNFI being 0.0422, 0.0507, 0.9946, 0.9958, and 0.7615, respectively. Paired sample t-tests revealed the significant decrease in FMWs’ stress score of the current week and the previous week, with all t-values being negative and significant (p < 0.01). A latent growth model (LGM) named LGM30 verified the overall decreasing stress trend over the weeks, with high R-squares (> 0.80), significant positive linear and negative quadratic time parameters. Based on the trajectory analysis, a stress scorecard with an AUC of 0.856 was developed. This study found that there are four factors for FMWs’ psychological stress (anxiety about infection, exhaustion, lack of cognition for infection, and hesitant feeling), and improving targeted hospital protection could alleviate FMWs’ psychological stress through SOFAIDC, as all the total effect of factors or items from the feeling of being protected by hospital were negative. Meanwhile, although overall FMWs’ stress trend has decreased, 22.43% of FMWs have maintained or experienced a high stress trend, and the stress might increase over weeks in frontline clinics. To perfect hospital protection to alleviate FMWs’ psychological stress, the scorecard could be used to select FMWs with low-stress trends, LGM30 could be used to determine the withdrawal time (such as week 8), and targeted hospital protections could be designed based on the relationships between feeling of being protected by the hospital and factors in SOFAIDC, such as providing adequate protective equipment, improving the rationality of FMWs’ work schedules, recruiting personnel with higher education levels, and paying adequate monetary compensation.

Positive Coping Style and Family Resilience of Caregivers of COPD Patients: The Chain Mediating Roles of Caregiver Burden and Resilience.

To investigate the association between positive coping style and family resilience, considering the mediating factors of burden and individual resilience within caregivers of chronic obstructive pulmonary disease (COPD) patients. A cross-sectional survey. A total of, 204 caregivers of COPD patients were recruited using convenient sampling from April 2023 to May 2024 to investigate general information, family resilience, individual resilience, caregiver burden and positive coping styles on caregivers of COPD patients. Influencing factors were primarily identified using Mann-whitney U test and Kruskal-Wallis H test. Spearman correlation analysis was used to explore the correlation between family resilience, positive coping, caregiver burden and resilience. Linear regression was used to analyse the influencing factors of family resilience of caregiver. Structural equation modelling was used to detect the mediating effects of caregiver burden and resilience. The STROBE checklist was followed. The family resilience of caregivers was positively correlated with positive coping styles and individual resilience, and negatively correlated with caregiver burden. The family resilience of caregivers increased with the improvement positive coping style and individual resilience, and decreased with the increase of caregiver burden. Caregiver burden and resilience played the chain mediating roles between positive coping style and family resilience. Family caregivers of COPD patient with higher education levels also have higher family resilience. Higher positive coping style may lead to higher family resilience of caregivers of COPD patients by reducing caregiver burden and promoting resilience. There are individual differences in the level of family resilience of caregivers of COPD patients, and nurses can provide personalised interventions to different family caregivers by understanding their characteristics and needs. Nurses can improve the family resilience of caregivers by guiding them to adopt positive coping styles, reducing burdens and promoting resilience. This study was conducted with the participation of caregivers of COPD patients who contributed data by completing study questionnaires.

Intensive care nurses’ knowledge of pressure injury prevention

BackgroundPressure injuries (PIs) remain a significant public health concern due to their high prevalence among critically ill patients admitted to intensive care units (ICUs). Despite advancements in science and technology related to PI prevention, the prevalence continues to rise. A key factor contributing to this rise is inadequate knowledge and limited use of evidence-based practices by nurses, resulting in prolonged hospital stays and poor patient outcomes. This study aimed to determine the knowledge of intensive care nurses regarding pressure injury prevention.MethodsA descriptive cross-sectional design was used to collect data from 101 nurses working in four ICUs at an academic hospital in Gauteng Province, South Africa. The revised Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0) was utilized to gather data from a convenience sample of intensive care nurses. Descriptive and inferential statistics were employed to analyze the data, with statistical tests including the Shapiro-Wilk test, univariate and multivariate linear regression, and Cronbach’s alpha coefficient tests. A p-value of less than 0.05 was considered statistically significant.ResultsThe mean knowledge score of the nurses (N = 101) was 42.16% (SD 12.09), indicating poor knowledge of PI prevention. The lowest scores were observed in the areas of “prevention of pressure injuries” (25%) and “classification and observation” (39.5%). Higher levels of education (14.00; 95% CI 2.90–25.11; p = 0.014), seniority (15.58; 95% CI 2.92–28.24; p = 0.016), and years of experience (6.38; 95% CI 9.70–5.45; p = 0.039) were statistically significant predictors of better prevention and management of PI.ConclusionThe findings of this study demonstrate that intensive care nurses have poor knowledge of prevention measures, classification, and observation of stages. This may hinder their ability to effectively utilize risk assessment tools in clinical practice. Improving training and providing intensive care nurses with adequate information about evidence-based practices to prevent PI could strengthen their contribution to patient safety. These findings underscore the need for continuous, mandatory training programs for intensive care nurses to stay updated with the latest evidence and practices in PI prevention.

Prevalence of and factors Influencing Oral Health Behaviours in 2-Year-Old Children: a cross-sectional analysis of data from the KUNO-Kids health study.

This questionnaire-based investigation aimed to assess Oral Health Behaviour (OHB) in 2-year-old children taking part in a birth cohort study and to identify relationships between general health, socioeconomic as well as psychosocial factors and OHB. Factors examined were single parent status, migration background, child's sex, parity, maternal age, education and social support, paternal employment, parental mental and physical health and child health, data for which were collected at birth, 4 weeks, or 1 year. Participants who answered all OHB questions at 2-years (n=730) were included. Nutritional score (NS), tooth brushing score (TS), and dental check-up score (CS) were used to calculate overall OHB score. Overall OHB in this cohort was good. 62% ate fruit or vegetables daily, 75% brushed 2-3 times daily and 61% had already had a dental check-up. Children of single-mothers had significantly lower OHB scores. NS was significantly higher for children with migration background, children of mothers with better physical health or higher educational level, but lower for children of mothers reporting poor social support. TS was significantly lower in children of single-mothers and children of fathers reporting poorer mental health. CS was significantly higher in children of multiparous mothers. This study highlights the relevance of social support and parental health, in contributing to OHB patterns. Families with special healthcare needs or less robust social support may have difficulty maintaining good OHB.

Knowledge, attitude, and practice of Palestinian critical care nurses about hemodynamic instability in patients with cardiovascular diseases

BackgroundManaging hemodynamic instability in critically ill patients due to cardiovascular disease or, in particular, coronary artery disease requires an integrated and responsive approach. The complexity lies in simultaneously addressing the underlying cardiovascular pathology and managing its systemic effects. The complexity described above involves a careful balance of interventions, including fluid and electrolyte management, pharmacological support, and, in some cases, mechanical circulatory support. The dynamic nature of hemodynamic instability necessitates constant vigilance and rapid adaptation of treatment strategies to align with the evolving clinical picture. So, this study aims to investigate the knowledge, attitude, and practice of Palestinian critical care nurses about hemodynamic instability in patients with cardiovascular diseases.MethodA cross-sectional design was conducted on 300 nurses in 30 hospitals in the West Bank and East Jerusalem of Palestine. Data were collected using a self-administered questionnaire composed of four sections covering the socio-demographics, knowledge, attitudes, and practices of the sample. Quantitative statistical analysis was done using Statistical Package for Social Sciences (SPSS) software.ResultsThe nurses demonstrated an almost low overall level of knowledge about hemodynamic instability, with a mean score of 2.7 on a 7-points scale. Additionally, nurses generally expressed a high positive attitude toward their practice, with a mean score of 3.8 on a 5-point scale. Although; Palestinian nurses showed a low level of knowledge about hemodynamic instability but expressed positive attitudes toward their practice. The practice level was also moderate with a mean score of 2.3 on a 5-point scale. Significant differences were found with a higher attitude of male nurses and higher knowledge with bachelor or higher educational levels. Other variables showed non-significant differences.ConclusionsSeveral challenges were identified, including lack of training and resources, within this study context. Educational interventions and improved access to resources could improve nurses’ knowledge and practice in managing hemodynamic instability.

Parental Education and Attitudes Towards Institutionalization of Children in West Java, Indonesia

BackgroundIn low- and middle-income countries, orphanages are often perceived as a means to secure education for children. Consequently, many parents send their children to orphanages, unaware of the potential risks involved. ObjectiveThis study aims to explore caregivers' attitudes toward child institutionalization in the context of placing children in orphanages. Participantsand Settings: Data were collected from 736 caregivers of children aged 0-7 years in Cianjur, West Java, Indonesia, in 2017. MethodsDescriptive analysis and logistic regression were used to assess caregivers’ attitudes and the likelihood of agreeing or disagreeing with six statements about child institutionalization. ResultsThe study found that most caregivers agreed that poor children are better off being raised in orphanages, but parents remain responsible for the child even after placement. Logistic regression showed that caregivers with higher levels of education were less likely to agree with placing children in orphanages compared to caregivers with lower levels of education. ConclusionsThis study highlights the importance of higher formal education in reducing caregiver support for institutionalization.

Attitudes and Acceptance of the Palestinian Population Towards COVID-19 Health Precautions and Vaccinations: A Cross-Sectional Study.

COVID-19 is a new pandemic and the best protection against this infection is by vaccination. This study aims to assess the commitment to COVID-19 health precautions and willingness to receive vaccination among the Palestinian population. An online-based survey was carried out for an observational cross-sectional study. A total of 1367 participants were recruited conveniently between February and June 2021. To carry out comparisons, Mann-Whitney or Kruskal-Wallis was used for numerical variables and chi-square or Fisher's exact for categorical. Multiple logistic regression was used to evaluate health precautions and multinomial logistic regression was used to observe willingness for vaccination. The commitment to the majority of health precautions was predicted by perceiving COVID-19 threat, educational level, and city residency (p < 0.05). Social distancing and sterilizer usage were associated with city residency (p < 0.001). Students, males, and unemployed participants were less committed to health precautions (p < 0.05). Vaccination willingness was less predicted by the perception of an ineffective vaccine (p < 0.001), perceiving no threat of COVID-19 (p < 0.05) or perception of threat for old/or chronic diseases (p < 0.05), employed participants (p < 0.05), without chronic diseases (p < 0.05), and not committed to wearing a mask (p < 0.001). COVID-19 threat perception, high education level, and city residency predict more commitment to health precautions, in contrast to male students and unemployed participants. On the other hand, having no chronic diseases, perception of ineffective vaccines, unperceived COVID-19 threat, and unwillingness to wear masks predicted less vaccination acceptance. Therefore, it is critical to increase awareness about the COVID-19 threat, health precautions, and vaccination efficacy. This study is cross-sectional. Future works concerning changes in Attitudes toward COVID-19 health precautions and vaccination should be encouraged, including vaccinated participants.

Applied Sunnah During Hot Weather And Rainy Season: The Philosophy Of Faith And Mitigation Measures

The Sunnah of Prophet Muhammad (PBUH) encompasses various aspects of life. This paper aims to elevate the role of the Sunnah as a source of knowledge, while also applying it as a guide for life. The Sunnah guidance during hot weather and rainy season is among the important practices should be applied to gain the promising rewards for following the Sunnah, and also to provide benefits for daily life activities. This paper, based on thematic hadith research, gathers several hadiths related to the chosen topic, using the dorar.net/hadith application. This application was chosen because its credibility and authenticity have been proven through studies at the higher education level. All collected hadiths are ensured to be authentic, either classified as sahih or at least hasan in which are accepted as sharia evidence in Islamic law. If there is a difference of opinion among hadith scholars regarding the status of a hadith, prioritization will be made based on hadith methodology. The Arabic text of the hadith is included to receive blessings and for personal reflection. If the hadith text is long and contains various issues, the focus will only be on the desired issue from the sub-topic provided, without addressing other issues. The study found that the Sunnah of Prophet Muhammad (peace be upon him) related to hot weather and rain is highly significant, comprehensive, and suitable to be applied in human life. The Sunnah of Prophet Muhammad (peace be upon him) teaches humans to be aware and have faith in Allah (S.W.T.), in His power and to believe in the unseen, the Angels, and the Day of Judgment. Additionally, the application of the Sunnah, such as seeking shade, pouring water over the head, drinking cold beverages, avoiding crowds, and keeping oneself clean and fragrant, are very practical mitigation steps to reduce the negative effects of extreme heat. Meanwhile, the Sunnah's application in fostering awe toward natural phenomena, allowing raindrops to touch the body, praying, performing salah, expressing gratitude, not complaining, and avoiding superstitious beliefs reflects a deep sense of dependence on Allah (S.W.T.) and is very practical for spiritual aspects.

The Influence of the Visionary Leadership of Madrasah Heads, Organizational Culture and Motivation for Achievement on the Performance

Background:Changes in the education sector present significant challenges and problems for communities, influencing various sectors, including the social domain. Educational institutions, such as madrasahs, are crucial in addressing these challenges. Purpose:This study aims to analyze the impact of the visionary leadership of madrasah heads, organizational culture, and achievement motivation on teacher performance. Methods:A quantitative approach with path analysis was used in this research. Data collection was conducted through a questionnaire, followed by normality, validity, and reliability tests. The data were processed using SPSS software for path analysis. Results:The study found that visionary leadership of madrasah heads, organizational culture, and motivation for achievement significantly influenced teacher performance. Conclusions:The findings suggest that strengthening visionary leadership, enhancing organizational culture, and fostering achievement motivation can improve teacher performance in madrasahs. However, the study is limited to madrasah aliyah (high school) level, and future research is recommended at higher educational levels.

Association between education level and access to disease-modifying treatment in patients with multiple sclerosis in France.

We hypothesized that differences in access to disease-modifying treatments (DMTs) could explain the association between socioeconomic status and disability progression in multiple sclerosis (MS). This study aimed to analyze the association between education level and DMT use in France. All patients from OFSEP network with MS onset over 1996-2014 and aged ⩾ 25 years at onset were included. Three time-to-event outcomes were investigated using flexible parametric survival regression models: time from MS onset to first DMT (any) and to platform therapy, and time from platform therapy to switch to high-efficacy therapy. Overall, 7563 patients were included (mean follow-up 12.6 ± 5.9 years). The percentages of patients aged less than 40 years at MS onset and who initiated treatment before the age of 40 years were significantly higher in the groups with a higher education level. The time-to-event outcomes showed no major difference in DMT practices according to education level, except for women who had a significantly shorter time to DMT initiation in medium to very high education level groups versus low, at 5 years from MS clinical onset. Our results suggest that the association between education level and MS disability progression does not solely reflect different therapeutic practices, particularly in men.

Unveiling the numerical insights: A study on number sense skills of first graders and their teachers

This study explores the number sense skills of classroom teachers and first-grade primary school students in Uşak, Turkey, examining the impact of various demographic factors. A quantitative research design was employed, utilizing a survey model to gather data from 102 teachers and 341 students. The Number Sense Test (Teacher Form), developed by Kayhan Altay (2010), and the Number Sense Screener (Student Form), adapted by Uyanık Aktulun (2018) based on Jordan et al. (2010), were used as measurement instruments. The results revealed significant differences in number sense skills among teachers based on gender, professional experience, and training, and among students based on gender and parental education levels. Male teachers exhibited higher number sense skills compared to female teachers, and those with more professional experience and specific number sense training performed better. Among students, males outperformed females in certain number sense subcomponents, and higher parental education levels were associated with better student performance. These findings highlight the importance of targeted professional development for teachers and the crucial role of parental education levels in children's numerical development. The study underscores the need for early intervention programs and parental involvement to foster strong number sense skills, which are foundational for later mathematical achievement.

The Government Policy with its Historical Background Through the Effort to Prevent the Jobless of Timor-Leste in Providing Job Management Opportunities in the State and Foreign Countries (A Qualitative and Quantitative Mixed Method Research Analysis on Re

Abstract: The research study with entitled is about the Government Policy with its State Historical Background through the effort to prevent the jobless of Timor-Leste in providing job Management opportunities in the state and foreign countries.” The objective of this research is to identify and search on the historical and economical background of the state in providing job opportunities to young people are employed in internal and foreign countries to fix their family’s economic conditions to support the state in reducing the unemployment and poverty in the country itself as a way to settle down the problems and obtain the solution. About this, the government of Timor-Leste has created a bilateral and multilateral cooperation agreement in the country through signing the mutual of understanding (MOU) with the foreign company’s organization in abroad. The economic problems and other matters are settled with the effort hard of the state’s government by providing funds to minimize and reduce the poverty and the economic problems of the living people in the state in the current day and the future. The method of this study is qualitative and quantitative mixed methods, observing, paraphrasing, and permutation in library research through collecting the facts by using online libraries, software, and hard book references. Some of the data files presented in this writing to complete this analytical research. The finding of this research is the jobless of the country are mostly employed by the government through mutual cooperation through bilateral and multilateral cooperation to reduce the unemployment in the internal country and abroad. From the total population are not finalized their studies in the school 30,7% and from the above population, 16,8% do their learning in the higher education level. Amongst the young between 14-24 years old do not access the education, unemployed, and training and it is hard for them to get the job competition. The total labor forces in 2009, there are 430,200 people in East Timor and the unemployment are 18% since 2010.

Knowledge and Attitude of Climate Change Impacts on Human Health among Community in Kuantan, Pahang, Malaysia

Background: Climate change poses significant threats to human health through increased frequency of extreme weather events, alterations in disease patterns, and impacts on food and water security. This study aimed to determine the levels of knowledge and attitudes regarding climate change and its health impacts among the community in Kuantan, Pahang. Methods: A cross-sectional study was conducted among 292 residents conveniently selected in Kuantan, Pahang’s areas. Data gathered between March to June 2024 using questionnaires through Google Form. Descriptive statistics, chi-square tests, and Fisher's exact test were used to describe the findings. Results: The findings indicate that 80.5% of respondents possess adequate knowledge about the health impacts of climate change, and 88.4% demonstrate positive attitudes toward mitigation and adaptation. A significant association exists between higher levels of knowledge and more favorable attitudes toward addressing climate change (p=0.045). Additionally, younger age and higher education levels are significantly associated with better knowledge of climate change on health impacts among the community in Kuantan. Conclusion: The study underscores the importance of enhancing community education to improve both knowledge and attitudes regarding the health impacts of climate change. These insights are vital for developing targeted public health strategies and fostering proactive community engagement in climate change mitigation and adaptation efforts.