Initial Education Research Articles

Discrimination Faced by Male Nurses and Male Midwives: A Systematic Review and Meta-Synthesis.

To consolidate and appraise available evidence on the experiences and perceptions of male nurses and male midwives facing discrimination. Qualitative systematic review. This review was informed by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The Critical Appraisal Skills Program checklist was used to appraise included articles, and extracted data were meta-summarised and meta-synthesised using Sandelowski and Barroso's two-step approach. PubMed, EMBASE, CINAHL, Scopus, Web of Science, PsycINFO, Cochrane Library, ProQuest (Dissertations and Theses Global) and ClinicalTrials.gov were sourced from the inception to December 2022. A total of 21 studies were included, involving 283 male nurses and 11 male midwives. Four themes were identified during the meta-synthesis: (1) It's a 'women's world', (2) discrimination within and beyond the workplace, (3) stereotypes and labels and (4) the silver lining. This review offered male nurses' and male midwives' perspectives on discrimination faced in nursing. There is a need to ensure gender equality in the nursing profession by reinforcing the importance and value of employing men in this profession. Future research should focus on examining the experiences of male nursing students and other healthcare stakeholders to understand discrimination faced by men in nursing from varied geographical and cultural backgrounds. The findings may provide helpful insights for planning supportive interventions, institutional adjustments, legislative changes, educational initiatives and research that benefit male nurses and male midwives. This qualitative systematic review consolidated and meta-synthesised the available evidence on male nurses' and male midwives' experiences of discrimination. These findings contribute to the understanding of male nurses and male midwives as a gender minority and the need for greater gender equality. PRISMA. No patient or public contribution.

Methan-o-poly: a giant collaborative game to "digest" the microbiology of green biogas production.

In an era of rapid change and global challenges, impactful educational experiences about sustainability become imperative. Especially in organic waste conversion bioprocess such as anaerobic digestion (AD). Here proposed, is a gamified approach to learn AD and hidden microbial interactions, bringing to real-life size an invisible phenomenon. In Methan-o-poly, participants roleplay cooperating microbes within a bioreactor engaged in four sequential mini-games to mimic organic waste degradation and methane production. Perturbations in the activity simulate real challenges, enhancing adaptability and problem-solving skills. Overall, this cooperative game promotes motivation, collaboration, and experiential learning. Its initial implementation received positive feedback across various age groups, enhancing green education initiatives.

Management of genetically determined kidney stone disease: consensus from a panel of urologists and nephrologists.

Available evidence suggests that monogenic causes of kidney stones are likely under-diagnosed, particularly in young adults, needing expert multidisciplinary recommendations to improve diagnosis, management and therapeutic outcomes. To increase the awareness among the medical community on the recognition of the signs and symptoms of genetically determined kidney stone disease in adult patients, with a special focus on primary hyperoxaluria (PH), a group of nephrologists and urologists started a consensus process through the Delphi method. A list of 40 statements (23 regarding genetically determined stone disease and 17 regarding primary hyperoxaluria) was defined by the authors and included in an online Delphi survey, which was sent to 16 urologists and 22 nephrologists with expertise in managing patients with kidney stone disease. An agreement threshold of 75% was established for consensus. After two rounds of Delphi voting, consensus was reached for 33 statements, 18 regarding genetically determined stone disease and 15 regarding PH. The Delphi process highlighted several areas of agreement with regard to the characteristic or anamnestic data suggesting diagnostic investigation, optimal diagnostic patterns, treatment strategies and management of patients with genetically determined nephrolithiasis. The process also highlighted some grey areas, which deserve further investigation and highlight the need for educational initiatives focused on rare diseases in the field of kidney stones.

Call-Push-Shock: A Community Education Initiative to Strengthen the Out of Hospital Cardiac Arrest Chain of Survival

Background: Out-of-hospital cardiac arrest (OHCA) is a global health concern with an incidence of 8.9 million people annually. More than 350,000 incidences of OHCA occur yearly in the United States, with an average survival of 10%. Provision of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use have been noted to significantly improve survival rates. Aim: The aim of this quality improvement project was to strengthen the OHCA chain of survival on the university campus and within the surrounding community. Methods: This was a multifaceted evidence-based quality improvement project involving community CPR/AED education, improving AED awareness, and policy creation. Results: Participant (n = 759) knowledge of CPR and AED use improved between pre-test (M = 3.34, SD = 1.18) and post-test scores (M = 5.23, SD = 0.82). Participant knowledge of AED locations in areas they frequent improved from 58% to 91%, and comfort level for performing CPR improved from 59% to 97% post implementation. Adoption of a Cardiac Emergency Response Plan for the university was achieved, an additional 23 AEDs were placed on campus and uploaded to an AED location app. Conclusion: There is strong evidence to support that communities who place an emphasis on strengthening the OHCA chain of survival report better OHCA outcomes.

Explainable Artificial Intelligence twin for metaheuristic optimization: double-skin facade with energy storage in buildings

Abstract The double facade solar chimney along with energy storage components is a sustainable building technology that harnesses the power of the sun to regulate indoor temperatures. Extensive research has been conducted on the theoretical simulation of such systems. The novelty of this work is to explore the potential of explainable artificial intelligence in improving the design and optimization of the double-skin solar chimney. The need for this research is owing to the high computational limitations of the physical model of such systems, thus the application of explainable artificial intelligence based upon Artificial Neural Network can address this research gap. The paper solved a validated physical model and demonstrates the suitability of Artificial Neural Network twins as computational-efficient subrogates that can be later used by a multi-objective optimization function to find the optimal design values for the facades of double-skin buildings. The results of the comparison between the physical and the Artificial Neural Network model show the practical advantage of utilizing the digital twin model without compromising accuracy. The results have indicated that the Artificial Neural Network can achieve a high coefficient of determination ranging from 0.921 to 0.999 on different performance indicators which implies a high goodness of fit. Accordingly, the optimization study based upon a non-sorting genetic algorithm (NSGA-II) has indicated a high ventilation rate of 2.86 1/h and an efficiency of 37.21%. The insights of this work have reflected that exploring the societal implications of sustainable building technologies such as the double facade solar chimney through educational initiatives can cultivate a new generation of society who not only understand the technical aspects but also appreciate the broader social and environmental contexts of their work, eventually to have future buildings with integrated passive systems.

Exploring Teachers' Perspectives on the Use of Reciprocal Teaching in Reading Comprehension

Scholars, educators and politicians have been interested in English language education for long. Though there’s a rising significance of English as a global language, there still needs to be agreement on the most effective techniques for teaching English language skills, especially English as a second language. Understanding the opinions and attitudes of English instructors towards language instruction could definitely assist in shaping educational practices and initiatives. This research sought to evaluate English instructors’ perspectives on English language education using the reciprocal teaching strategy. Reciprocal teaching is a cooperative learning strategy that aims to improve students' reading comprehension skills, with four components: predicting, clarifying, questioning, and summarizing. English language learning as a second language has become of a wide interest all over the world. As reading comprehension represents one of the key stones of English language learning, the problems of students in the secondary stages in Egypt need to be resolved as a way to facilitate their English language learning. This study is one of the efforts to enhance such students; reading comprehension. It is a descriptive quantitative case study. A teacher questionnaire was used for collecting qualitative data. After preparing, validating and administering the study tool, a questionnaire, to teachers who teach in the experimental language secondary schools, results were in favor of using reciprocal teaching for enhancing these students’ reading comprehension.

Assessment of Women’s Awareness of the Possible Risk of Stroke Associated with the Use of Oral Contraceptives Pills in Saudi Arabia: A Cross-Sectional Study

Background and Objectives: One of the most widely used reversible contraceptive techniques among women of reproductive age worldwide is oral contraceptives (OCPs). Despite their widespread use, OCPs are associated with increased risks of stroke, yet the extent of awareness of these risks among women remains insufficiently explored. This study aims to evaluate the level of awareness among women resident in Saudi Arabia regarding the potential risk of stroke linked to the use of OCPs. Materials and Methods: A cross-sectional descriptive study was conducted targeting women of reproductive age (18–49 years). Data was collected through an online self-administrated questionnaire distributed via social media platforms, encompassing sociodemographic characteristics, OCP usage patterns, and awareness of stroke risks, perceived side effects of OCPs, symptoms of stroke, and methods to reduce stroke incidence. Statistical analysis was performed using SPSS version 23, with descriptive statistics for categorical data and chi-square tests to assess associations. Results: A total of 516 women participated in the study. Of these, 148, or over a quarter (28.7%), of the participants reported using oral contraceptive pills; 86, or more than half (58%), who use OCPs are not sure what type of OCPs they use; 60, or over half of the participants (40.5%), have been using for less than a year. Over two thirds of the participants (350, 67.8%) are not aware that using OCP increases the risk of stroke. The most recognized side effect of OCPs use was weight gain (38.2%), while awareness of stroke as a side effect was significantly lower (24.6%). Additionally, 62.8% of respondents identified selecting the appropriate type of contraceptive as the best way to prevent stroke while taking OCPs. Conclusions: this study highlights the need for increased awareness and education about the potential risk of cerebral thrombosis associated with OCP use among Saudi women. Addressing this knowledge gap through targeted educational initiatives could help mitigate the risks and improve overall public health outcomes.

Fostering mutual understanding through multiperspectivity: insights from 14 cross-border history education initiatives in post-conflict societies

ABSTRACT In (post)-conflict contexts, the development of cross-border history education resources from multiple perspectives has been proposed as a way of working that can contribute to reconciliation. However, developing and implementing such a resource is challenging in contexts of recent conflict when perspectives on the past are so divided between countries. In this paper, we aim to better understand what hinders and what helps multinational teams in collaboratively developing cross-border history textbooks and resources. To answer this question, we interviewed 14 authors and editors of cross-border history resource initiatives from different parts of the world. As a result, we distinguish four levels of the context that makes each project unique: the political context, the collaboration process, the content of the resource, and the implementation of the final product. Though conditions differ across projects, the importance of support and collaboration, and the difficulty of sensitive topics and implementation in practice were common themes across projects. We provide advice for future projects and suggestions for future research on these cutting-edge projects.

Islamophobia di Kanada

Islamophobia, as a global phenomenon, has seen significant impacts in various countries, including Canada. This research aims to investigate the dynamics of Islamophobia in Canada, explore the factors that influence public perceptions, and analyse its impact on Muslims. Using media content analysis, community surveys, and case study methods, this research identifies a number of cases of discrimination, negative rhetoric, and violence faced by Muslim communities in Canada. The study also examines how the mass media plays a key role in shaping public perceptions of Islam, as well as the extent to which government policies and regulations reflect the protection of Muslim rights. Findings highlight trends of inequality in everyday life, including in the workplace, education, and social interactions. In addition, the research discusses the efforts that have been taken by the government, Muslim community organisations to address Islamophobia. In particular, focus is given to educational initiatives and interfaith dialogue as a way to promote mutual respect in Canada's multicultural society. The study concludes by highlighting the challenges still faced by the Muslim community in Canada and emphasising the importance of cross-sectoral cooperation to create an inclusive and equitable environment for all its citizens, regardless of religious or cultural identity.

Inequalities in total fertility rate in Sierra Leone, 2008–2019

BackgroundTotal fertility rate measures the average number of children a woman is expected to have during her reproductive age (typically 15-49 years). Despite the national decline in Sierra Leone, significant disparities in total fertility rates persist across socioeconomic and geographic lines. This study investigated the inequalities in total fertility rate among women in Sierra Leone between 2008 and 2019.MethodsWe utilized data from the three rounds of the Sierra Leone Demographic Health Survey conducted in 2008, 2013, and 2019. The World Health Organization’s Health Equity Assessment Toolkit was employed to calculate various inequality measures, including simple difference, ratio, population attributable risk, and population attributable fraction. The assessment focused on inequality across four stratifiers: economic status, level of education, place of residence, and sub-national province.ResultsThe total fertility rate declined in Sierra Leone throughout the period, dropping from 5.0 births per woman in 2008 to 4.3 births per woman in 2019. Economic disparity among women in the richest quintile compared with those in the poorest quintile increased from 3.0 births per woman in 2008 to 3.1 births per woman in 2019. The ratio between women in the richest quintile compared with those in the poorest quintile also increased from 1.9 in 2008 to 2.1 in 2019; the confidence interval suggest inequality, with women in the poorest quintile disproportionately affected. Inequality in education among women with secondary education or higher compared with those with no education decreased from 2.7 births per woman in 2008 to 1.9 births per woman in 2019. The ratio between women with secondary education or higher compared with those with no education decreased from 1.9 in 2008 to 1.6 in 2019, and the confidence interval suggest an inequality with women with no education disporportionately affected. Provincial inequality among women who resided in Western area compared with those in Eastern province decreased slightly from 2.3 births per woman in 2008 to 2.2 births per woman in 2019. The ratio between women who resided in Western province compared with those in Eastern province increased from 1.6 in 2008 to 1.7 in 2019 and indicate an inequality among women in the provinces.ConclusionThe results indicate substantial socioeconomic and geographical disparities in total fertility rate among women in Sierra Leone that require targeted policy interventions. The persistent and widening economic gap between women in the richest and poorest quintiles suggests that poverty reduction strategies and economic empowerment programs for low-income women need strengthening. While the decreasing educational inequality is encouraging, the continued disadvantage faced by women with no education indicates a need for enhanced educational access and adult literacy programs. The provincial disparities between Western and Eastern provinces point to a need for balanced provincial development policies and improved resource distribution, particularly in the Eastern province, where women face greater disadvantages. These implications collectively suggest that policymakers should adopt an integrated approach that combines economic empowerment, educational initiatives, and provincial development strategies to address these intersecting inequalities in TFR effectively.

Impact of Utilizing Renewable Energy Technologies on Managing Environmental Pollution in the Jordanian Renewable Energy Companies

Jordan faces critical environmental challenges that stem from rapid industrial growth and a burgeoning population, resulting in alarming levels of pollution. Conventional energy sources, heavily reliant on fossil fuels, significantly contribute to these environmental concerns, intensifying the urgency to explore alternative solutions. Renewable energy technologies, encompassing solar, wind, and other sustainable energy sources, present a promising path toward mitigating these issues while supporting long-term sustainability. This study delves into the role of renewable energy technologies in managing environmental pollution within Jordanian renewable energy companies. It examines the innovative strategies implemented by these companies, the obstacles they face, and the tangible benefits achieved through the adoption of such technologies. A qualitative approach was employed, incorporating interviews and surveys with industry stakeholders and reviewing secondary data from governmental and academic sources. Key findings highlight that the integration of photovoltaic solar panels, wind turbines, and other renewable systems has led to a notable reduction in air and water pollution. However, the study also identifies persistent barriers, such as high initial costs, limited infrastructure, and a lack of public awareness, which hinder broader implementation. The paper underscores the need for financial incentives, robust infrastructure, and educational initiatives to accelerate the transition toward renewable energy. By offering a comprehensive analysis, this research aims to provide valuable insights for policymakers, industry leaders, and researchers, advocating for collaborative efforts to harness the full potential of renewable energy in Jordan and beyond.

Assessment and Evaluation of Consumer Awareness and Self-Medication Use Practices Towards Over the Counter (OTC) Analgesics. A Cross-Sectional Study in Abha-Saudi Arabia.

To assess and evaluate consumer awareness and common medication use practices towards OTC analgesics, with a focus on the impact of irrational drug use and its implications for public health and safety. This includes identifying gaps in knowledge, evaluating the potential consequences of misuse, and discussing how these findings can inform future educational initiatives and policy development to promote safer medication practices. This was a cross-sectional, semi-quantitative survey of 750 Saudi volunteers both males and females aged between 18 and 65 years. A validated self-administered questionnaire was used among randomly selected volunteers with a history of OTC analgesic use. A total of 750 questionnaires were administered and the response rate was measured to be 75.6%. More than 50% of the study population used OTC analgesics without a prescription and reported using analgesics as soon as they start experiencing any pain. Paracetamol was found to be the most predominantly used analgesic. The most common indication of OTC analgesic use was reported for headache and toothache whereas irrational use of analgesics in terms of dose, frequency and indication was found to be to the extent of 50%. Primary source of information related to OTC analgesic use was obtained from pharmacy personnel (31.7%), and Patient Insert Leaflets (PIL) (28.7%). Majority of the respondents (64.3%) didn't know the safe maximum dose of Paracetamol, whereas 73.3% used to stop medicine only after experiencing some side effects. 52.4% of the respondents were not aware about the most common side effects, and potential interactions of analgesic medications. Our study highlights the menace of self-medication practices and irrational use of OTC analgesic by the study participants. Immediate remedial measure need to be taken to discourage self-medication and improve rational use of OTC drugs which can be achieved by focusing on improving the consumers' awareness of self-medication and the rational use of medications.

Abstract HUP16: Evaluating the Role of a Community Stroke Education Initiative for the Nashville Asian American and Pacific Islander Population

Abstract HUP16: Evaluating the Role of a Community Stroke Education Initiative for the Nashville Asian American and Pacific Islander Population

Promoting Traditional Music Literacy: A Case Study of Tuhu Preservation through School Education

This study investigates the current promotion of traditional music literacy through the preservation and integration of the Tuhu, a two-stringed bowed instrument deeply rooted in the cultural heritage of the Zhuang ethnic group, into school education. Despite its cultural significance, the Tuhu faces challenges such as declining skilled practitioners, limited formal educational initiatives, and insufficient institutional support. Employing a qualitative methodology, this research focuses on educational institutions in Guangxi Zhuang Autonomous Region, where the Tuhu holds historical and cultural importance. Data were gathered through interviews, observations, and document analysis involving five key informants, including educators, performers, and cultural practitioners. The findings reveal significant barriers, including the aging demographic of Tuhu practitioners, lack of formal curricula, and minimal integration into school programs. However, schools were identified as critical platforms for advancing Tuhu literacy through structured programs, interdisciplinary approaches, and digital tools. The study highlights the need for tailored educational resources, teacher training, and supportive policies to preserve and transmit this unique tradition. It concludes that integrating the Tuhu into school curricula can foster cultural awareness, strengthen Zhuang identity, and ensure the instrument’s survival. Future research should explore digital innovations, community-driven models, and comparative studies on traditional music preservation.

Factors associated with emergency department methicillin-resistant Staphylococcus aureus coverage in patients with skin and soft tissue infections in an urban, tertiary care emergency department.

Skin and soft tissue infections (SSTIs) are common and contribute significantly to morbidity and healthcare costs in emergency departments (EDs). The rise of antimicrobial resistance, particularly due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA), complicates treatment decisions. Objective physical examination findings suggesting need for empiric MRSA coverage are sometimes ignored. Improving initial antimicrobial selection in the ED, especially regarding MRSA, could enhance antimicrobial stewardship. We conducted a retrospective review of patient records for those who presented with SSTIs to an urban tertiary care ED between January 1, 2017, to December 31, 2019. Patients admitted during their initial visit were excluded. Data collected included demographics, vital signs, and laboratory results. Logistic regression was used to assess factors associated with the decision to provide MRSA coverage at presentation, reporting odds ratios with 95% confidence intervals. Among 1675 patients, 42.2% received empiric MRSA coverage. Factors associated with MRSA coverage included male gender, white race, intravenous drug use, immunocompromised status, systemic symptoms, tachycardia, presence of abscess, and surgical consultation. After adjusting for confounders, male gender, history of intravenous drug use, immunocompromised status, systemic symptoms, tachycardia, surgical consultation, and recent antibiotic use remained significantly associated. Several factors, not always aligned with clinical guidelines, influenced the decision to initiate MRSA coverage in the ED. Understanding these determinants may improve antimicrobial stewardship and reduce costs. Future research should focus on patient outcomes based on methicillin-sensitive S. aureus (MSSA) versus MRSA coverage decisions and educational initiatives to improve guideline compliance.

Influence of data review on community physicians’ treatment preferences in frontline esophageal cancer (EC).

501 Background: EC remains a global health challenge with a rising incidence and poor prognosis despite advancements in treatment modalities. Standard therapies include surgery, chemotherapy (CT), radiation therapy, and recently, targeted and immunotherapy. The PD-L1 inhibitors pembrolizumab (pembro) and nivolumab (nivo) received FDA approval for frontline treatment in EC in March and May 2021, respectively, based in part on the KEYNOTE-590 (KN590) and CheckMate 648 trials. In this study, we aimed to uncover rationale in physician preference for PD-L1 inhibitors in EC. Methods: US-based oncologists convened at two in-person meetings in April 2024 to discuss clinical and real-world data presented at the 2024 ASCO GI Cancers Symposium. Among data discussed included the KN590 5-year update. Survey questions were fielded at the meeting to capture participants’ impressions. Demographics were captured via an online survey ahead of the meeting. Responses from participants who manage EC and responded to all survey questions were aggregated. Results: 86 participants qualified; and, collectively, are 76% community physicians with 18 years average in clinical practice, see 18 patients median on clinic days, and spend 83% of their time in direct patient care on average. ECOG PS status (50%), tumor histology (52%), and location/stage (48%) were reported as critical factors in treatment decision-making; only 14% said PD-L1 status was a major factor. Participants were queried on a hypothetical patient case of esophageal squamous cell and adenocarcinoma before and after reviewing the KN590 data. Prior to reviewing KN590, physician preferences in the squamous cell 1L setting were split between nivo+CT and pembro+CT; following data review, pembro+CT was favored nearly 3:1. In the adenocarcinoma 1L setting, preference shifted from 60/40 nivo+CT to 60/40 pembro+CT, see Table. The cohort were most impressed with the overall survival (87%) and objective response rates (40%), and 55% would consider pembro+CT for both squamous cell and adenocarcinoma disease while 37% would consider it for PD-L1 CPS>10 squamous cell disease only. Conclusions: Our study showed PD-L1 status was not a major factor in clinical decisions. The shift in treatment preference toward pembro+CT for both patient cases following KN590 data review suggests an impact for data review to influence physician behavior. This highlights the importance of educational initiatives to disseminate clinical updates to providers. It is still to be determined the optimal platform and length for these initiatives, and to quantify their effectiveness. 65-year-old male patient with advanced EC;PD-L1 CPS ≥10;ECOG PS of 1 Squamous cell disease Adenocarcinoma Before After Before After Fluoropyrimidine (FP) + platinum (P)-based CT 1% 1% 1% 0% FP +P-based CT + nivo 55% 27% 60% 36% FP + P-based CT + pembro 43% 71% 38% 63% Nivo + ipilimumab 1% 1% 0% 1% None of the above 0% 0% 0% 0%

Factors Influencing Knowledge and Attitudes towards Second-Hand Smoking Exposure Among University Students: An Exploratory Study.

Despite extensive global research on second-hand smoking (SHS) exposure, there is a noticeable lack of studies focusing on the knowledge and attitudes of university students in Bangladesh. This cross-sectional study aimed to address this gap by assessing the levels of knowledge and attitudes towards SHS exposure among university students in Bangladesh. Utilizing a convenience sampling technique, data were collected from 383 university students, encompassing socio-demographic information, as well as knowledge and attitude-related inquiries. Statistical analyses were conducted using SPSS software, including independent t-tests and analysis of variance (ANOVA) and multiple linear regression. The findings revealed that participants exhibited a moderate level of knowledge and attitude towards SHS exposure. Multiple linear regression identified age, gender, mother's education, and self-rated health status as significant predictors of knowledge, explaining 12.9% of its variance (R2 = 0.129, F = 6.117, P < .001). Furthermore, age, gender, and living with parents emerged as significant predictors of attitude, explaining 14.7% of its variance (R2 = 0.147, F = 7.165, P < .001). The study highlights the need for interventions aimed at enhancing awareness and fostering positive attitudes towards SHS exposure among university students in Bangladesh. It is recommended that university authorities organize seminars and implement health education initiatives targeting vulnerable populations to address the findings and promote a smoke-free environment on campus.

304 Empowering me: an educational initiative addressing domestic violence among Latina women

304 Empowering me: an educational initiative addressing domestic violence among Latina women

Avatars at Risk: Exploring Public Response to Sexual Violence in Immersive Digital Spaces

As the metaverse emerges as a new frontier of human interaction, understanding public perceptions of crime in virtual spaces becomes crucial. This study delves into public perceptions of such crimes, focusing on reported incidents of sexual assault in virtual reality environments. We uncover complex dynamics, shaping threat perception in immersive digital realms by analysing YouTube comments through an innovative mixed-methods approach combining machine learning and empirical analysis. Our findings reveal that social norms and expectations are pivotal in influencing perceptions of threats, while technology-mediated interactions correlate with reduced perceived risks. Surprisingly, the oft-discussed blurring of virtual and physical realities shows no significant impact on threat perception. This research contributes to the expanding literature on the social construction of reality and public perception of emerging technologies. The results have implications for the development and governance of metaverse platforms, highlighting the necessity for comprehensive user education initiatives and culturally sensitive approaches to community guidelines and safety features.

Double Burden of Malnutrition: A Narrative Review of its Drivers and Mitigation Strategies in Urban Settings

Background: Double burden of malnutrition (DBM) is an emerging public health problem in urban settings where both undernutrition and obesity exist. This complex phenomenon is caused by socioeconomic disparities, urbanization, and dietary transitions, with women and children being proportionately affected. This study reviews the drivers of DBM and evaluates suitable mitigation strategies. Methods: A comprehensive review was performed using studies published between 2014 and 2024. Peer-reviewed articles examining the drivers, interventions, and outcomes of DBM within urban contexts were the target inclusion criteria. Data were extracted on location, target populations, methodologies, key drivers, interventions and outcomes which were then synthesized using thematic analysis. Results: Eighteen studies from Sub-Saharan Africa, Southeast Asia, and Latin America were included. Drivers known to be common among the reviewed studies include income inequality, poor dietary diversity, and cultural food practices that are further worsened by urbanization and sedentary lifestyles. By region, effective mitigation strategies included maternal nutrition literacy programs in Southeast Asia and Sub-Saharan Africa and taxation policies against unhealthy foods in Latin America. Gaps were identified in the areas of policy implementation and program scalability. Conclusion: Integrated, double-duty actions are needed to address the double burden of malnutrition in urban contexts. However, policy reform, community-based nutritional programs and educational initiatives targeted at vulnerable populations, are essential. Longitudinal and gender-specific research should be prioritized in assessing DBM’s trajectory and informing future sustainable interventions. The findings from this study offer actionable insights for policymakers and public health practitioners working to eliminate DBM in urban settings.