Mixed Approach Research Articles

"Emotional stress is more detrimental than the virus itself": A qualitative study to understand HIV testing and pre-exposure prophylaxis (PrEP) use among internal migrant men in South Africa.

South Africa has one of the highest rates of internal migration on the continent, largely comprised of men seeking labour in urban centres. South African men who move within the country (internal migrants) are at higher risk than non-migrant men of acquiring HIV yet are less likely to test or use pre-exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services. We recruited 30 internal migrant men (born outside Gauteng Province) during August 2022 for in-depth qualitative interviews at two sites in Johannesburg (Gauteng) where migrants may gather, a factories workplace and a homeless shelter. Interviewers used open-ended questions, based in the Theory of Triadic Influence, to explore experiences and challenges with HIV testing and/or PrEP. A mixed deductive inductive content analytic approach was used to review data and explain why participants may or may not use these services. Migrant men come to Johannesburg to find work, but unreliable income, daily stress and time constraints limit their availability to seek health services. While awareness of HIV testing is high, the fear of a positive diagnosis often overshadows the benefits. In addition, many men lack knowledge about the opportunity for PrEP should they test negative, though they express interest in the medication after learning about it. Additionally, these men struggle with adjusting to urban life, lack of social support and fear of potential stigma. Finally, the necessity to prioritize work combined with long wait times at clinics further restricts their access to HIV services. Despite these challenges, Johannesburg also presents opportunities for HIV services for migrant men, such as greater anonymity and availability of HIV information and services in the city as compared to their rural homes of origin. Bringing HIV services to migrant men at community sites may ease the burden of accessing these services. Including PrEP counselling and services alongside HIV testing may further encourage men to test, particularly if integrated into counselling for livelihood and coping strategies, as well as support for navigating health services in Johannesburg.

Sexism and women's access to justice: Feminist judging in Indonesian Islamic judiciary

Sexism in the judicial system is a persistent problem in countries where women frequently are held to a different moral standard than men. As such, some advocates and legal experts argue that feminist judging practices are necessary for ensuring women's access to justice. While many studies focus on the effect of sexism on gender inequality in politics, the extent to which sexism may lead to further gender inequality in the judiciary remains understudied. Additionally, much research on feminist judging relies on qualitative data from trial or court transcripts to determine judges' approaches, but quantitative examinations of feminist judging are still few. Drawing on a mixed methods sequential explanatory approach, our study examines how sexism contributes to shaping the support for feminist judging in the Indonesian Islamic judiciary. We use several cases of polygamy, marriage dispensation, divorce involving domestic violence, and post-divorce alimony as proxies to measure the support for feminist judging. The findings show that hostile sexism is not statistically associated with the support for feminist judging, but benevolent sexism facilitates judges' support for feminist approaches. Female judges are more likely to support feminist judging than male judges.

Investigating the Impact of Social Capital, Cross-Sector Collaboration, and Leadership on Social Innovation in Rural Social Enterprises

Objectives: This study aims to investigate empirical evidence regarding the relationship between social capital, cross-sector collaboration, leadership, and the development of social innovation in Indonesian villages with rural social enterprises, Badan Usaha Milik Desa (BUMDes). Methods/Analysis: The study employed a mixed approach, combining a quantitative survey, non-participative observation, and in-depth interviews. Data were collected from 280 BUMDes directors, communities, and village governments in the West Java province, Indonesia. The quantitative data were analyzed by structural equation modeling (SEM), and the hypotheses were tested against the variables investigated. The results were strengthened through in-depth interviews with five key informants. Findings: The findings reveal a significant positive effect of cross-sector collaboration and leadership on social innovation in BUMDes. However, social capital was found to have no significant effect on social innovation. Additionally, the study revealed a decline in community trust in rural Indonesia. Novelty/Improvements: This research provides empirical evidence on the influence of social capital, cross-sector collaboration, and leadership on social innovation in the context of rural social enterprises in developing countries. It makes a significant contribution to existing theory and has the potential to influence the development of rural social enterprise and social innovation, which has not been sufficiently researched to date. From an empirical perspective, this study provides evidence from West Java, Indonesia, regarding the relationship between these variables and indicators in the context of rural social enterprises in developing countries, where the sector is still at a developmental stage. Doi: 10.28991/HEF-2024-05-01-09 Full Text: PDF

Using Language Learning Strategies to Enhance Writing Skills: An Empirical Study of Student-Centered Learning Approaches In Saudi Context

Arabic is the mother tongue of Saudi students. The current research project aims to investigate the extent to which the learning strategies utilized by PSAU students effectively enhance their writing skills and modify their attitudes toward writing. In the present study, the methodology used has been qualitative and quantitative, which is a mixed approach. The reason behind using a mixed approach is that this study aimed to collect both qualitative and quantitative data concerning the learners’ writing strategies used during writing classes. The research uses observation, questionnaires, and interviews to collect the data. For the study, around 250 students will be selected from the writing courses of various PSAU colleges. The effectiveness of the students’ strategies used in learning employed by the students of PSAU for promoting writing skills and changing passive attitudes towards writing is expected to reveal the role and usefulness of improving writing skills as a result of using students’ strategies.

Factors Affecting Teaching and Learning of Religious and Moral Education (RME) in Ghanaian Junior High Schools: A Case Study of C. B. Mensah SDA Junior High School

Religious and Moral Education (RME) has caught the attention and interest of Ghanaians from the past to our contemporary times. The subject seeks to enforce knowledge and values capable of making individuals responsible and resourceful members of society. In current times characterized by moral decadence, the need for religious and moral education has become a necessity. To realize the communal hope of making RME a lucrative and highly patronized course or subject in the education system in Ghana, it is necessary to look at the factors that affect the teaching and learning of RME in the country. This paper therefore sought to find out the significant factors that affect the teaching and learning of RME and the means to address such issues. A mixed approach was adopted in gathering the data from the C. B. Mensah Adventist Junior High School in the Ashanti Region of Ghana. The study revealed that the RME curriculum is facing some difficulties in Ghana. These include scarcity of textbooks and shortage of professional teachers in the subject area. The study recommended that the government, and other stakeholders involved in or patronizing education, should collaborate in addressing the challenges and implement sustainable measures for enhancing the teaching and learning of RME in Ghana. The study is relevant for teachers and learners alike because it contributes to knowledge development by serving as secondary material for future research and policymaking. It also serves as insight for the government, parents, teachers, religious bodies, educationists, counselors and other stakeholders in the educational sector. Keywords: Education, Religious and Moral Education, Religion, Morality, Teaching, Learning

Ontological basis of the creative accounting phenomenon as a financial misstatement

PurposeThis article aims to contribute to the accounting knowledge literature by presenting the framework of creative accounting factors and evaluating their identified factors through an argumentation-based total interpretive structural modeling (TISM) approach.Design/methodology/approachThis study adopted mixed, inductive and deductive approaches to develop an integrated framework, validate its practicability and verify its effectiveness in selected manufacturing firms listed on the Tehran Stock Exchange (TSE), respectively. In developing the framework and implementation procedure, the study employed an exploratory data collection (qualitative) approach to review the phenomenon of creative accounting factors. Then, in this study’s second phase, TISM is used to develop the framework of creative accounting design. This study used two types of theoretical sampling in the qualitative part, including theoretical and snowball sampling. Also, the participants in the TISM process in this study were specialized analysts of the TSE.FindingsBased on the mixed method of this study, the result in the qualitative part provides the creative accounting framework of the existence of three categories. There are 6 components and 35 themes during 12 interviews. In the quantitative section, it was determined that two factors, namely the type of ownership firms and intrinsic objectivity, are the most effective drivers for the formation of creative accounting in TSE firms.Originality/valueSo far, it is rare to find preceding studies that have proposed, validated and practically tested an integrated creative accounting framework within the context of financial markets. Thus, the authors understand that this is the very first research focused on the development of a framework for capital market companies to continuously be competitive and could help financial decision-makers, practitioners and academicians in their perception of knowing more about the financial functions of firms.

Sequential Co-Immobilization of Enzymes on Magnetic Nanoparticles for Efficient l-Xylulose Production.

Multi-enzymatic strategies have shown improvement in bioconversion during cofactor regeneration. In this study, purified l-arabinitol 4-dehydrogenase (LAD) and nicotinamide adenine dinucleotide oxidase (Nox) were immobilized via individual, mixed, and sequential co-immobilization approaches on magnetic nanoparticles, and were evaluated to enhance the conversion of l-arabinitol to l-xylulose. Initially, the immobilization of LAD or Nox on the nanoparticles resulted in a maximum immobilization yield and relative activity of 91.4% and 98.8%, respectively. The immobilized enzymes showed better pH and temperature profiles than the corresponding free enzymes. Furthermore, co-immobilization of these enzymes via mixed and sequential methods resulted in high loadings of 114 and 122 mg/g of support, respectively. Sequential co-immobilization of these enzymes proved more beneficial for higher conversion than mixed co-immobilization because of better retaining Nox residual activity. Sequentially co-immobilized enzymes showed a high relative conversion yield with broader pH, temperature, and storage stability profiles than the controls, along with high reusability. To the best of our knowledge, this is the first report on the mixed or sequential co-immobilization of LAD and Nox on magnetic nanoparticles for l-xylulose production. This finding suggests that selecting a sequential co-immobilization strategy is more beneficial than using individual or mixed co-immobilized enzymes on magnetic nanoparticles for enhancing conversion applications.

Evaluation of the Impact of Informal Settlements on the Physical and Mental Health of Residents—Case Study Santa Marta—Bogotá, Colombia

The growth of the informal city in Latin America has caused its own dynamics related to urban unsustainability due to the disorderly occupation of the territory. The precarious characteristics of informal neighborhoods have increased the mortality processes in their inhabitants, increasing the poverty and marginality indexes in Latin American urban settlements. This work was developed within the international research project “Modeling informality in Latin America based on indicators of sustainable urban development. Case study Yomasa, Bogotá-Colombia”. This work was developed under the mixed research approach which allowed focusing on a nested concurrent design of dominant model (DIAC), which was carried out in the Santa Marta sector of the locality of Ciudad Bolivar, in Bogotá Colombia, with the participation of 20 people from the studied community and supported by 16 students of Civil Engineering of the Catholic University of Colombia. The work resulted in a total of 31 indicators related to neighborhood informality, 17 impacts on the territory, and 8 pathologies, establishing the intrinsic relationship between informality, poverty, and public health of the inhabitant at the urban level.

The Effectiveness of Mentoring Programs on Empowering Women Entrepreneurs in Tanzania: A Case of Babati District Council

Purpose: Women entrepreneurs in Tanzania are making significant contributions to their local economies, driving innovation, and creating employment opportunities. However, they still face numerous challenges, including limited access to financing, inadequate business skills, and gender-based discrimination.To address these challenges and unlock the full potential of women entrepreneurs, mentorship programs have emerged as a powerful mechanism.
 Methodology: The study examined the effect of empowering women entrepreneurs through mentoring programs, a case study of Babati District Council. The study used mixed research approach and employed sequential explanatory research design. Descriptive and regression analysis were used to analyze the data and presented by tables and figures.
 Findings: The findings revealed the strong relationship between mentorship programs and women entrepreneurs' empowerment, as evidenced by a high R-squared value of 0.76. This means that approximately 76% of the variation in women entrepreneurs' empowerment can be explained by mentorship programs. The significant relationship between mentorship programs and women entrepreneurs' empowerment is further supported by a low p-value of 0.001, indicating that the observed relationship is unlikely to be due to chance.The study concluded mentorship programs have a significant impact on women entrepreneurs' empowerment.
 Unique Contribution to Theory, Practice and Policy: From the findings, it recommended fostering mentorship opportunities to support and uplift women in their entrepreneurial journeys. This study has contributed to the advancement of knowledge and practice in the field of mentoring programs for women entrepreneurs in Tanzania. The research has provided valuable insights and recommendations that can guide policymakers, practitioners, and researchers in their efforts to support women entrepreneurs. The study proposed a theoretical framework that elucidates the means by which mentoring programs can empower women entrepreneurs. It also identified crucial elements of effective mentoring programs, including regular meetings, clearly defined goals and expectations, active listening, and constructive feedback. Additionally, the study pushed for policies that foster an enabling environment for women entrepreneurs, including access to financing, education, and networking opportunities. Such policies can facilitate the growth and development of women-led enterprises.

#VacunatorioVip. Aproximación al estudio de los escándalos de corrupción en Twitter (ahora X)

In February 2021, Argentina became embroiled in a political corruption scandal known as #VacunatorioVip, which emerged in the context of the covid-19 vaccination campaign. This commotion became a focal point of public debate and engagement on Twitter (now X), highlighting the intersection between political scandal, corruption, pandemic, and the role of Twitter as a digital public-media space. Taking this case, we propose to study how Twitter has transformed the dynamics of corruption scandals in the public sphere by studying internet users, narratives, and network topology. Using a mixed methodological approach that incorporates digital methodologies, we aim to contribute to the reflection on the impact of Twitter in shaping and amplifying corruption scandals.

The contribution of public-private partnership (PPP) to sustainability: governance and managerial implications from a literature review

Purpose Based on the theoretical background of stakeholder capitalism, the purpose of this paper is to contribute to the scientific debate on the topic of public–private partnerships (PPPs), considering in particular how this governance structure relates to the pursuit of sustainable development. Specifically, this objective will be pursued with a focus on stakeholder relations and governance aspects, to highlight enablers and barriers in change for sustainability. Design/methodology/approach The systematic literature review is applied starting with the use of keywords in Web of Science, which leads to the extrapolation of 629 articles on the topic of “PPP and sustainability”. Subsequently, through various skimming steps, 75 papers are sampled. A mixed (quantitative-qualitative) approach is then followed: a co-word semantic network to identify the pattern of discourse and a more in-depth and explanatory analysis of the papers. These quantitative and qualitative tools synergistically work together to evidence the main aspects related to the aim of the paper. Findings With reference to the governance structure and stakeholders of PPPs, the analyses highlight the shift towards a triadic type of relational governance that considers stakeholders (especially the community) in addition to public–private partners. This can improve the partnership's performance (particularly in sustainable development) and social legitimacy. With reference to the role of PPPs in the implementation of sustainable development, they have positive potential in terms of implementing sustainability and raising stakeholder awareness of it. Nevertheless, PPPs may entail risks to the implementation of sustainability. The findings lead to some concluding remarks on future research opportunities. Research limitations/implications The research leads to some managerial implications, such as the need to follow a competitive collaboration approach among stakeholders, to develop relational governance skills and related managerial tools and to incorporate sustainability aspects starting from the design of PPPs. Originality/value The originality aspect of this research is the consideration of a PPP by relating it to the pursuit of sustainability. Such an inter-organizational structure could be suitable to deal with the complexity inherent in the implementation of sustainability and is peculiar in terms of governance and stakeholder relations, considering that it is characterised by the presence of several partners of different nature (public and private).

PBL-Based Vocational Education Blended Learning Activity Design Research

There are disparities between vocational education personnel training and industrial development. The purpose of this research is to develop a PBL-based blended learning activity design aligned with vocational education talent training goals, leveraging the benefits of project-based and mixed learning approaches. The design encompasses problem clarification, goal determination, problem design, problem-solving, results display and evaluation, and summary activities. Employing a quasi-experimental research methodology, this study was conducted in the core course “Software Development Technology” within the software technology major of Vocational College X. Through comparative data analysis between the experimental and control groups, it was observed that students in the experimental group demonstrated varying degrees of improvement in their abilities related to demand analysis, software design, software development, and software testing in the field of software development technology. This finding affirms that PBL-based blended learning activities can effectively enhance students’ technical skills by extending learning opportunities in both space and time, thereby offering practical insights for vocational education talent training research.

Microfluidics produced ATRA-loaded PLGA NPs reduced tuberculosis burden in alveolar epithelial cells and enabled high delivered dose under simulated human breathing pattern in 3D printed head models

Tuberculosis, caused by Mycobacterium tuberculosis (Mtb), is second only to COVID-19 as the top infectious disease killer worldwide. Multi-drug resistant TB (MDR-TB) may arise because of poor patient adherence to medications due to lengthy treatment duration and side effects. Delivering novel host directed therapies (HDT), like all trans retinoic acid (ATRA) may help to improve drug regimens and reduce the incidence of MDR-TB. Local delivery of ATRA to the site of infection leads to higher bioavailability and reduced systemic side effects. ATRA is poorly soluble in water and has a short half-life in plasma. Therefore, it requires a formulation step before it can be administered in vivo. ATRA loaded PLGA nanoparticles suitable for nebulization were manufactured and optimized using a scalable nanomanufacturing microfluidics (MF) mixing approach (MF-ATRA-PLGA NPs). MF-ATRA-PLGA NPs demonstrated a dose dependent inhibition of Mtb growth in TB-infected A549 alveolar epithelial cell model while preserving cell viability. The MF-ATRA-PLGA NPs were nebulized with the Aerogen Solo vibrating mesh nebulizer, with aerosol droplet size characterized using laser diffraction and the estimated delivered dose was determined. The volume median diameter (VMD) of the MF-ATRA-PLGA NPs was 3.00 ± 0.18 μm. The inhaled dose delivered in adult and paediatric 3D printed head models under a simulated normal adult and paediatric breathing pattern was found to be 47.05 ± 3 % and 20.15 ± 3.46 % respectively. These aerosol characteristics of MF-ATRA-PLGA NPs supports its suitability for delivery to the lungs via inhalation. The data generated on the efficacy of an inhalable, scalable and regulatory friendly ATRA-PLGA NPs formulation provides a foundation on which further pre-clinical testing can be built. Overall, the results of this project are promising for future research into ATRA loaded NPs formulations as inhaled host directed therapies for TB.

Relationship between Grief and Loss Counselling and Adjustment of Social Behaviours among the Elderly in Sigowet-Soin Sub County of Kericho County

This study aimed to investigate the relationship between grief and loss counselling and the adjustment of social behaviours among the elderly in Sigowet-Soin Sub County of Kericho County, Kenya. The study utilized a person-centered theory and adopted a concurrent mixed methods research design, incorporating both quantitative and qualitative approaches. The quantitative study employed an experimental design, while the qualitative study utilized a case study design. The target population consisted of 60 elderly individuals, with 30 selected for the study group and another 30 for the control group using stratified random sampling. Data collection involved the use of questionnaires and in-depth interviews, with research instruments validated by experts and supervisors. The reliability of the instruments was determined through a pilot study in Sigowet-Soin constituency, employing test-retest method and Pearson correlation coefficient. Quantitative analysis involved descriptive and inferential statistics, presenting findings through frequency distribution tables, diagrams, pie charts, and bar graphs. Qualitative data was analysed thematically. The study revealed no statistically significant differences between the intervention group and control group in terms of grief and loss counselling (p >0.05). Thus, the study concluded that grief and loss counselling interventions did not help improve the social behaviours of the elderly. Grief and loss counselling has no significant effect in enhancing social behaviour of the elderly. The assessment of the grief and loss social behaviour reveals the need for further analysis to understand the effective strategies to assist elderly people cope up with the profound losses. Since the program implemented was not statistically significant. Further studies can help the influential factors on depression, stress management, self-esteem and relationship problems among the elderly.

Cross-modality person re-identification based on intermediate modal generation

In the context of cross-modal person re-identification, researchers often employ methods that utilize visible modality information to generate both an ‘X’ modality and a grayscale modality, enhancing the accuracy of person re-identification models. A lightweight network causes the ‘X’ modality through self-supervised learning of labels from visible images. In contrast, the grayscale modality is obtained through simple linear accumulation of the three RGB color channels from visual images. It can be observed that both the ‘X’ modality and grayscale modality are derived from visible images, which fails to establish a connection between the visible and infrared modalities. Therefore, this paper proposes an intermediate modality generation module to produce intermediate modality representations dynamically. By combining information from the visible, infrared, and intermediate modalities, the model is encouraged to capture modality-invariant features with cross-modal consistency. This enables person of the same identity to exhibit similar feature representations across different modalities, thereby mitigating the impact of distribution differences between visible and infrared modalities. Additionally, to facilitate the learning of appropriate intermediate modality representations, a distribution migration strategy is introduced. It guides the intermediate modality to maintain the correct distance from the visible and infrared modalities by optimizing the weights of the loss functions, preventing inadequate feature learning caused by an excessive focus on specific modality information. Furthermore, a mixed augmentation approach is proposed to alleviate disparities among multiple modalities further. By randomly cropping and combining regions of visible (infrared) modality images with infrared (visible) modality images, the generalization ability of the model in heterogeneous modalities is enhanced. Extensive comparative experiments are conducted on the SYSU-MM01 and RegDB datasets, yielding mAP values of 57.2% and 85.82%, respectively. The superior mAP performance on the RegDB dataset compared to most existing methods validates the effectiveness of the proposed approach.

Mixed methods research on satisfaction with athletes’ compensation

This study explores the factors influencing athletes’ compensation satisfaction and their configuration effects. A mixed research approach that combines regression analysis and fuzzy-set qualitative comparative analysis (fsQCA) was applied to process the survey data of 352 athletes from six provinces. The regression analysis results demonstrate that economic compensation, the compensation system, the external environment, and compensation fairness all have a significant positive effect on athletes’ compensation satisfaction. Accordingly, the fsQCA approach was applied to explore the combined effects of the factors influencing athletes’ compensation satisfaction, which verifies the conclusions drawn from regression analysis and provides improvement paths for increasing athletes’ compensation satisfaction.

Effects of immersive virtual reality for alleviating anxiety, nausea and vomiting among patients with paediatric cancer receiving their first chemotherapy: protocol for a randomised controlled trial

IntroductionAnxiety, nausea and vomiting are common side effects suffered by paediatric patients receiving chemotherapy. Emerging evidence supports the efficacy of immersive virtual reality (IVR) on improving anxiety and distress symptoms...

Reasons for Genital Dissatisfaction in a Sample of Brazilian Men.

Genital self-image (GSI) involves subjective perceptions, experiences, and feelings of individuals regarding their genitalia. A negative GSI contributes to lower sexual esteem and, consequently, negative sexual experiences and sexual dysfunction. In men, self-perception may be influenced by several factors, including penis size or shape, personal experiences, body image, general health status, sex education, and even the media they consume. This study aimed to understand the reasons that lead to dissatisfaction with GSI among Brazilian men. With a mixed approach, we present male perceptions regarding dissatisfaction with GSI captured from the following question: "If you are dissatisfied with your genitals, tell us for what reason(s)? (Optional)," which integrated the last questionnaire element of the original survey. Brazilian men over 18years of age from different Brazilian states were eligible. In this analysis, 376 responses were obtained. The data were analyzed using thematic content analysis. The participants expressed the reasons for dissatisfaction, which were grouped into two categories: (1) anatomical aspects and beliefs in the construction of GSI and (2) functional aspects. The results offer an understanding of men's perceptions of their genitals and may aid in clinical practice and research on how Brazilian men perceive their genitals. It is possible to improve knowledge about sexual health and increase positivity regarding genital perception by providing information about the reasons that lead to dissatisfaction with the genitals.

Mental health literacy and its associated factors among traditional healers toward mental illness in Northeast, Ethiopia: A mixed approach study.

Currently, the biggest issue facing the entire world is mental health. According to the Ethiopian Ministry of Health, nearly one-fourth of the community is experiencing any of the mental illness categories. Most of the cases were treated in religious and traditional institutions, which the community most liked to be treated. However, there were very limited studies conducted to show the level of mental health literacy among traditional healers. The study aimed to assess the level of mental health literacy and its associated factors among traditional healers toward mental illness found in Northeast, Ethiopia from September 1-30/2022. A mixed approach cross-sectional study design was carried out on September 130, 2022, using simple random sampling with a total sample of 343. Pretested, structured questionnaires and face-to-face interviews were utilized for data collection. The level of Mental Health Literacy (MHL) was assessed using the 35 mental health literacy (35-MHLQ) scale. The semi-structured checklist was used for the in-depth interview and the FGD for the qualitative part. Data was entered using Epi-data version 4.6 and, then exported to SPSS version 26 for analysis. The association between outcome and independent variables was analyzed with bivariate and multivariable linear regression. P-values < 0.05 were considered statistically significant. Thematic analysis was used to analyze the qualitative data, and the findings were then referenced with the findings of the quantitative data. The findings of this study showed that the sample of traditional healers found in Dessie City scored a total mean of mental health literacy of 91.81 ± 10:53. Age (β = -0.215, 95% CI (-0.233, -0.05), p = 0.003, informal educational status (β = -5.378, 95% CI (-6.505, -0.350), p = 0.029, presence of relative with a mental disorder (β = 6.030, 95% CI (0.073, 7.428),p = 0.046, getting information on mental illness (β = 6.565, 95% CI (3.432, 8.680), p = <0.001, and mental health training (β = 4.889, 95% CI (0.379, 6.455), p = 0.028 were variables significantly associated with mental health literacy. Traditional healers provide a variety of explanations for the causes of mental illness, including biological, psychological, and supernatural ones. The mean score of the Mental Health Literacy Scale (MHLS) is lower among traditional healers compared with other studies. Age, informal educational status, family history of mental illness, getting information on mental illness, and mental health training were significantly associated with mental health literacy. Therefore, different works to improve the levels of mental health literacy among traditional healers are essential.

An unexpected case of a dog from Poland co-infected with Dirofilaria repens and Dirofilaria Immitis.

Dirofilariasis is a vector-borne disease caused by parasitic nematodes of the genus Dirofilaria spp., considered an emerging concern in both veterinary and human medicine. Climate changes and human activities, such as pet travel, contribute to the spread of diseases to new non-endemic regions. Poland is dominated by subcutaneous dirofilariasis caused by D. repens infections. Cardiopulmonary dirofilariasis, also known as a heartworm disease is much more rare with only single autochthonous cases reported so far. Also, imported infections are observed sporadically in dogs traveling to endemic countries. In this study, we report the first case of a dog in Poland, never having traveled abroad, co-infected with Dirofilaria repens and Dirofilaria immitis. A 14-year-old mixed breed, an intact male dog with fever, lightly pale mucosal membranes, moderate abdominal pain, and a mild cough was presented in a veterinary clinic in Warsaw, Poland. The examination of the blood sample collected for complete morphology and biochemistry revealed the presence of live microfilariae. Presence of the DNA of both microfilariae species was detected using Real-Time PCR with species-specific primers. Since the remaining diagnostic methods like Knott's test, antigen test or echocardiography did not reveal the presence of D. immitis, we discussed the impact of microfilariae periodicity and low worm burden infections on the limited efficiency of these techniques. We strongly recommend using a mixed diagnostic approach for the most sensitive and specific diagnosis since the ideal diagnostic method does not exist, and several factors may contribute to misdiagnosis. Furthermore, we considered factors that contribute to the uncontrolled spread of dirofilariasis such as climate changes, introduction of new species of mosquitoes competent for the transmission of the disease, and wildlife animals as an important reservoir of this parasitosis. Given that Poland shares borders with countries classified as endemic and pre-endemic for D. immitis, such as Slovakia and Ukraine, it is reasonable to anticipate a rise in autochthonous heartworm infections and shifts in the epidemiological pattern of dirofilariasis in the coming years.