Public Health Institutions Research Articles

IJCM_367A: Mapping the Terrain of Learning: A Study on the Association between Self- Directed Learning Readiness and Learning Environment Dynamics among Students studying in a Public Health Institute in Kolkata

Background: Self-directed learning (SDL) is the process in which individuals take the initiative and learning environment involves all other aspects of the institute. Good SDL ability is the foundation of lifelong learning. Students’ perception of the educational environment plays a subtle role in learning and contributes to learning input and students’ achievement. Self- directed learning is integral to public health teaching Objectives: To assess the perceptions of learning environment and self- directed learning readiness and the association between the two among public health students Methodology: A cross-sectional study was conducted from July to December 2023 in a public health institute in Kolkata. A total of 102 participants across five courses were selected by Census method and their self-directed learning readiness (SDLRS) and perceptions of learning environment were assessed using a self-administered questionnaire. The collected data was analysed using descriptive and inferential statistics in SPSS, version 16. Ethical approval was taken from Institutional Ethics Committee of AIIH&PH, Kolkata. Results: The mean age of the study participants was 26.7 years and 64.7% of the study participants were from MBBS background. The median academic hours was 18 hours per week and around 37.3% of the participants were studying in the institute for less than 6 months and 20.6% for more than 24 months. There was significant positive correlation between SDLRS and Learning Environment (Spearman’s rho=0.281, p=0.004). SDLRS and perceptions of Learning environment improved with increase in duration of studying. Age(p=0.015) and prior academic qualification(p=0.016) were significantly associated with SDLRS. Conclusion: SDLRS is associated with positive Learning Environment. SDL ability can be improved by changing the learning environment to include new student-centered teaching methods. The duration of studying in the institute is also an important driver to inculcate self directed learning ability among the participants.

Determinants of public institutional births in India: An analysis using the National Family Health Survey (NFHS-5) factsheet data.

Institutional births ensure deliveries happen under the supervision of skilled healthcare personnel in an enabling environment. For countries like India, with high neonatal and maternal mortalities, achieving 100% coverage of institutional births is a top policy priority. In this respect, public health institutions have a key role, given that they remain the preferred choice by most of the population, owing to the existing barriers to healthcare access. While research in this domain has focused on private health institutions, there are limited studies, especially in the Indian context, that look at the enablers of institutional births in public health facilities. In this study, we look to identify the significant predictors of institutional birth in public health facilities in India. We rely on the National Family Health Survey (NFHS-5) factsheet data for analysis. Our dependent variable (DV) in this study is the % of institutional births in public health facilities. We first use Welch's t-test to determine if there is any significant difference between urban and rural areas in terms of the DV. We then use multiple linear regression and partial F-test to identify the best-fit model that predicts the variation in the DV. We generate two models in this study and use Akaike's Information Criterion (AIC) and adjusted R2 values to identify the best-fit model. We find no significant difference between urban and rural areas (P = 0.02, α =0.05) regarding the mean % of institutional births in public health facilities. The best-fit model is an interaction model with a moderate effect size (Adjusted2 = 0.35) and an AIC of 179.93, lower than the competitive model (AIC = 183.56). We find household health insurance (β = -0.29) and homebirth conducted under the supervision of skilled healthcare personnel (β = -0.56) to be significant predictors of institutional births in public facilities in India. Additionally, we observe low body mass index (BMI) and obesity to have a synergistic impact on the DV. Our findings show that the interaction between low BMI and obesity has a strong negative influence (β = -0.61) on institutional births in public health facilities in India. Providing households with health insurance coverage may not improve the utilisation of public health facilities for deliveries in India, where other barriers to public healthcare access exist. Therefore, it is important to look at interventions that minimise the existing barriers to access. While the ultimate objective from a policy perspective should be achieving 100% coverage of institutional births in the long run, a short-term strategy makes sense in the Indian context, especially to manage the complications arising during births outside an institutional setting.

Lessons Learned from Argentina's Struggles for Legal Abortion

This essay argues that abortion, as a practice and a political cause, challenges traditional and hegemonic health frameworks and contributes to the development of a feminist approach to health. The essay focuses on experiences and activism for legal abortion in contemporary Argentina, drawing some examples from other contexts. First, it argues that abortion reveals the extent to which health and sickness are entangled with symbolic and localized processes, including marked stigma, which influence the lived experience of health care. The essay analyzes how feminist activism in Argentina gradually changed these processes. Second, it contends that abortion as a health practice contributes to the deconstruction of traditional dichotomies between prevention and intervention and health and sickness, as well as to modifying hierarchical decision-making mechanisms. In the Argentine case, ensuring abortion access in public health institutions, with the help of activist professionals, allowed for the broadening of biomedical frameworks and a move toward more holistic approaches. Third, the essay analyzes how increasing access to medication abortion challenged monopolistic and exclusionary processes in the production and institutionalization of legitimate knowledge about health.

Measuring CO in an anti-smoking campaign in Virovitičko-podravska County in Croatia

Introduction Measuring carbon monoxide (CO) in exhaled breath with a visual representation can aid in smoking cessation by increasing smokers’ awareness of how smoking negatively affects their health and how many harmful substances they introduce into their bodies. Individuals attempting to quit smoking can regularly measure CO levels to monitor their progress in reducing this gas in their system.The national „Smoke Out Day” is a day aimed at encouraging smokers to quit smoking in the Republic of Croatia. It is celebrated on the first day of Lent, as it is a period when most people contemplate giving up something they enjoy throughout the year.The Institute of Public Health of Virovitičko-podravska County sets up a booth in one of the cities in County on that day. There we offer pamphlets to passersby with information about the harmful effects of smoking and provide them with the opportunity to measure carbon monoxide in their exhaled breath.ObjectivesThe aim of this study was to explore relationship between smoking status, smoke exposure and the levels of exhaled carbon monoxide.MethodsFor measuring CO we used piCO simple Smokerlyzer. From April 2015 till May 2023, 462 individuals have participated in this measurement. The data were processed using the Python programming language version 3.9 and the statistical library Pingouin version 0.5.3. Data visualization was performed using the Seaborn library version 0.12.2. The statistical analyses employed in this study are partial correlations. The Spearman method was used for partial correlations because it can identify nonlinear relationships and is more accurate and robust when the assumptions for Pearson correlation are not met.ResultsPartial correlation analysis indicates that there is a statistically significant relationship between the level of carbon monoxide and the following parameters:-Non-smoking status in years (rho = -0.526, p <0.001, two-tailed test).-Number of cigarettes smoked per day (rho = 0.369, p <0.001, two-tailed test).-Testing time after 3 PM (rho = 0.234, p <0.001, two-tailed test).-Number of years as a smoker (rho = 0.230, p <0.001, two-tailed test).-Age in years (rho = -0.179, p <0.001, two-tailed test).-Time spent in a smoky area (rho = 0.114, p <0.016, two-tailed test). ConclusionsIn summary, these results provide valuable insights into the factors associated with carbon monoxide levels in humans, with smoking-related variables, age, and testing time showing notable partial correlations. It is important to consider these relationships when assessing and managing carbon monoxide exposure and its potential health implications.Disclosure of InterestNone Declared

A Clustering-Based Optimization Approach for Hospital Miscoding Correction

This paper addresses the problem of correcting medical coding errors with respect to some coding recommendations. The problem consists in clustering medical codings and determining for each cluster the set of features to correct in order to maximize the financial benefits subject to coding correction effort constraints. For this purpose, we model the coding recommendation as a disjunction of hypercubes and introduce the concept of correction sets. A mixed integer linear programming model is then proposed to assign medical codes to correction sets in order to maximize the financial benefits. The miscoding is then explained by characterizing optimal clusters with association rules and coding error distribution. A case study on patient stays associated with malnutrition-related ICD codes is presented, and the performance of the proposed methodology is assessed in regard to the current coding staff practice. A significant increase in health services reimbursement is achieved with a limited number of subjects’ features reviewed. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —Medical miscoding has a significant negative impact on hospitals with a financial loss for under coding and a penalty for over coding. Whether a medical review is necessary for all descriptive features of a miscoded subject? Is it possible to reduce unnecessary medical reviews without compromising the goal of increasing hospital financial benefits? This article attempts to answer these questions with a data-driven optimization approach to determine a limited number of miscoding clusters and the set of features to review for each in order to best balance the financial benefits and the medical review workload. The application to a real-life case study leads to a significant increase in hospital fiscal revenue of nearly 6,992,489.69, while reviewing only a small number of descriptive features (5293 out of 22056 features, or 24% of features). Causes are also provided for each discovered coding error subtype to ameliorate medical coders’ coding practices. Furthermore, the proposed approach allows the decision-maker to balance the cost-benefit and the requirement of public health institutions (i.e., miscoding rate).

Study protocol to assess aflatoxin M1 health risks versus benefits of dairy consumption in Ethiopian children: an epidemiological trial and risk-benefit analysis

IntroductionIn Sidama, Ethiopia, animal-source foods can be difficult to access. Milk has important nutrients for child growth, but carries the risk of aflatoxin M1 (AFM1) contamination. AFM1 is a metabolite...

Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls’ health and education outcomes.

BackgroundMenstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these...

National public health institutes in the Eastern Mediterranean Region: Insights from experts in the field

National public health institutes (NPHIs) are crucial to the effectiveness of public health systems, including delivering essential public health functions and generating evidence for national health policies, strategies and plans....

Development of a workforce self-assessment tool for public health emergency preparedness.

In collaboration with six European public health agencies as part of the PANDEM-2 consortium, we have developed and validated a self-assessment tool that captures the workforce capacities and capabilities needed at the institutional level within National Public Health Institutes (NPHIs) to deal with public health emergencies. The work carried out in this study included (i) a review of existing tools for workforce assessment, (ii) focus group discussions and interviews to map the experiences and needs of NPHI's, (iii) the development of a tool for NPHI's to assess their workforce capacity and capabilities in public health emergency preparedness (PHEP) and (iv) refinement of the assessment tool via a Delphi study. Capacity markers were identified to assess the workforce required for PHEP functions and the availability of surge capacity during a public health emergency. The tool also enables NPHIs to analyze gaps in PHEP staff competencies. The assessment scores can assist NPHI pandemic preparedness by identifying and prioritizing training and recruitment needs. In line with EU Regulation 2022/2371 on serious cross-border threats to health, article 11 Training of healthcare staff and public health staff, Member States (MS) are tasked with assessing current workforce capacity and capability gaps. The PANDEM-2 workforce self-assessment tool aligns with this requirement and will support effective planning and development to strengthen the public health workforce capacity in EU MS.

IJCM_271A: Concerns and Considerations of Using Artificial Intelligence in Research: A Qualitative Exploration among Public Health Residents in Kolkata

Background: The advent of Artificial Intelligence (AI) technologies has undeniably revolutionized various domains worldwide. AIs emergence has sparked significant interest from public health research domain due to its transformative potential. Thus, understanding its impact from the grass-root level: perspectives of the young research students, training in the field of public health is crucial. Objective: To explore the perceptions regarding the concerns and considerations for use of AI tools in research among students of a public health institute in Kolkata Methodology: A descriptive qualitative study was conducted among students pursuing MD degree. Focus group discussion (FGD) was done among the participants till data saturation was achieved. Audiogram, notes and sociogram were made during the FGD. Verbatims of the FGD were transcribed. Codes were obtained inductively and categorized. Data coding and analysis was done with NVivo 14 and data visualization was done using RAW graphs 2.0 Results: The various concerns that arouse were lack of trust, lack of knowledge, ethical issues, inadept to use and the impact of its use on the researcher. The young researchers also contemplated that there needs to be extensive training, ethical policy adaptation and self-checks required for its use. There is a growing body of thought to find solutions for the limitations in its use and its prospects. Conclusion: Most participants agreed to the fact their knowledge regarding its utilization was sub-optimal. There was a notable lack of trust in using AI tools for research among them. Addressing these challenges require a multifaceted approach involving extensive training initiatives, ethical policy adaptation to facilitate responsible AI use and a call for researchers to act as self-checks, while using AI in research

Mapping the Terrain of Learning: A Study on the Association between Self-Directed Learning Readiness and Learning Environment Dynamics among Students studying in a Public Health Institute At Kolkata, India

Introduction: Self-directed learning (SDL) is the process in which individuals take the initiative and learning environment involves all other aspects of the institute. Good SDL ability is the foundation of lifelong learning. Students’ perception of the educational environment plays a subtle role in learning and contributes to learning input and students’ achievement. Self- directed learning is integral to public health teaching. Objectives: To assess the perceptions of learning environment and self-directed learning readiness and association between the two among public health researchers and also to elicit the factors associated with SDLRS. Method: A cross-sectional study was conducted from July to December 2023 in a public health institute in Kolkata. A total of 102 participants across five courses were selected by Complete Enumeration method and their self-directed learning readiness (SDLRS) and perceptions of learning environment were assessed using a self-administered questionnaire. The data was analysed in SPSS, version 16. Ethical approval was taken. Results: The mean age of the study participants was 26.7 years and 64.7% of the study participants were from MBBS background. The median academic hours was 18 hours per week, 37.3% of the participants were studying in the institute for less than 6 months and 20.6% for more than 24 months. The overall perception of learning environment was more positive than negative. There was significant positive correlation between SDLRS and Learning Environment (Spearman’s rho=0.281, p=0.004). Age (p=0.015) and prior academic qualification (p=0.016) were significantly associated with SDLRS. Conclusion: SDLRS was associated with positive Learning Environment. The overall perception of SDLRS was average and the SDL ability improved with duration of study in the institute and deteriorated with age of the study participants

Assessing the role of public education in enhancing food safety practices among consumers

Public education plays a crucial role in enhancing food safety practices among consumers, addressing the growing concern of foodborne illnesses globally In the contemporary landscape of food safety, public education emerges as a fundamental tool in empowering consumers with knowledge and practices to mitigate risks associated with foodborne illnesses. This paper delves into the pivotal role of public education initiatives in enhancing food safety practices among consumers. Through a systematic review of existing literature, this paper elucidates various strategies and approaches employed in public education campaigns aimed at promoting food safety awareness. The effectiveness of traditional media, social media platforms, educational programs, and targeted campaigns in disseminating key messages regarding proper food handling, storage, and preparation is examined. Additionally, the impact of these educational interventions on influencing consumer behavior towards adopting safe food practices is scrutinized, with a particular focus on understanding the correlation between education levels and adherence to recommended guidelines. Furthermore, the paper sheds light on the collaborative efforts of regulatory bodies, non-governmental organizations, and public health institutions in spearheading educational initiatives. It explores the synergistic relationship between education and policy enforcement, advocating for integrated approaches that combine educational interventions with regulatory measures to ensure comprehensive food safety management. Challenges and limitations in public education endeavors, such as information overload and cultural barriers, are also addressed. The paper emphasizes the importance of evidence-based strategies and innovative technologies in overcoming these obstacles and enhancing the efficacy of educational campaigns The indispensable role of public education in fostering a culture of food safety among consumers. By providing insights into the effectiveness of various educational approaches and their impact on consumer behavior, it offers valuable guidance for policymakers, public health professionals, educators, and stakeholders striving to promote food safety and safeguard public health.

SARS-CoV-2 variant typing using real-time reverse transcription-polymerase chain reaction–based assays in Addis Ababa, Ethiopia

ObjectivesThis study aimed to determine the SARS-CoV-2 variants in the first four COVID-19 waves using polymerase chain reaction (PCR)–based variant detection in Addis Ababa, Ethiopia. MethodsA cross-sectional study was conducted using repository nasopharyngeal samples stored at the Ethiopian Public Health Institute COVID-19 testing laboratory. Stored positive samples were randomly selected from the first four waves based on their sample collection date. A total of 641 nasopharyngeal samples were selected and re-tested for SARS-CoV-2. RNA was extracted using nucleic acid purification instrument. Then, SARS-CoV-2 detection was carried out using 10 μl RNA and 20 μl reverse transcription-PCR fluorescent mix. Cycle threshold values <38 were considered positive. ResultsA total of 374 samples qualified for B.1.617 Lineage and six spike gene mutation variant typing kits. The variant typing kits identified 267 (71.4%) from the total qualifying samples. Alpha, Beta, Delta, and Omicron were dominantly identified variants from waves I, II, III, and IV, respectively. From the total identified positive study samples, 243 of 267 (91%) of variants identified from samples had cycle threshold values <30. ConclusionsThe study data demonstrated that reverse transcription-PCR–based variant typing can provide additional screening opportunities where sequencing opportunity is inaccessible. The assays could be implemented in laboratories performing SARS-CoV-2 molecular testing.

Ultrasonic evaluation MAFLD in screening severety matabolic disorders

Metabolic dysfunction associated fatty liver disease (MAFLD) is a new proposed term for non-alcoholic fatty liver disease (NAFLD). a liver steatosis associated with Type 2 diabetes mellitus or increased physical weight/thickness, or with two or more metabolic disorders. This indicates metabolic abnormalities that result in fat accumulation in hepatocytes without the presence of alcoholic liver disease or other causes that would lead to hepatocyte abnormalities. Our goal was determine the correlation between certain stages of fatty liver disease determined by ultrasonography with increased body weight/obesity, diabetes mellitus and other metabolic disorders and with the values of biochemical parameters of liver enzymes. A prospective study was conducted at the public health institution Zivinice Health Center from August 2022 until January 2024 on a random sample of 101 patients. Observing the entire examined group, a difference in the gender distribution of hepatic steatosis is noticed, and graphically it is shown that men have hepatic steatosis more often than women. In fatty liver disease (MAFLD), stage G2 was most prevalent in 32% of patients. Ultrasonography, along with clinical and biochemical indicators, should be an integral part of screening and monitoring of metabolic disorders as it is a non-invasive and easily accessible imaging method and allows timely therapeutic action and prevention of hepatic and extrahepatic complications.

Üçüncü Basamak Bir Hastanenin Transfüzyon Merkezine Başvuran Donörlerde Sifiliz Tarama Sonuçlarının Değerlendirilmesi

Amaç: Kan bankacılığında Treponema pallidum'un neden olduğu sifiliz tanısı halk sağlığı açısından önemlidir. Donörler arasındaki olası vakaların yakalanması ve böylece donör kaybının en aza indirilmesi için en uygun algoritmanın benimsenmesi gerekmektedir. 2003 yılında Dünya Sağlık Örgütü ve 2010 yılında Avrupa Hastalık Önleme ve Kontrol Merkezi, sifiliz taramalarına Treponemal testlerle başlanmasını tavsiye etti. Bu çalışmada, kan bağışçısı adaylarında sifiliz taramasında reaktif Enzime Bağlı İmmünosorbent Test (ELISA) sonuçları ile yapılan doğrulayıcı testlerin sonuçlarının araştırılması amaçlandı.&#x0D; Gereç ve Yöntemler: Retrospektif olarak yapılan bu çalışmada, 2014-2021 yılları arasında Ankara Gülhane Eğitim ve Araştırma Hastanesinin kan bankasına kan bağışçısı olarak başvuran 69.127 bağışçı incelendi. Sifiliz tarama testinde reaktif çıkan donör adaylarından alınan örnekler, doğrulama testleri için Türkiye Halk Sağlığı Kurumu Mikrobiyoloji Referans Laboratuvarı'na gönderildi. Doğrulama testleri olarak Floresan Treponemal Antikor Emilimi (FTA-ABS) veya Treponema Pallidum Hemaglütinasyon Testi (TPHA) testleri kullanıldı.&#x0D; Bulgular: 128 donörde (%0,18) tekrar tekrar reaktif test sonuçları elde edildi. Doğrulayıcı bir test olarak 32 donöre TPHA uygulandı ve 11 pozitif sonuç (%34,3) elde edildi (Yanlış pozitiflik oranı = %65,7). FTA-ABS, doğrulama testi olarak 96 donörde yapıldı ve 59'unun (%61,4) testi pozitif çıktı (Yanlış pozitiflik oranı = %38,6). ELISA sinyal-kesme oranı beşin üzerinde olan 48 donörden 42'sinde FTA-ABS testi yapıldı ve 41 pozitif ve bir negatif sonuç elde edildi.&#x0D; Sonuçlar: Kan transfüzyonu ile ilişkili Treponema pallidum bulaşması önemli bir istenmeyen olay olduğundan, kan donörlerinin taranması için en uygun testlerin kullanılması gerekmektedir. Bu çalışma, FTA-ABS'nin ELISA-reaktif donörler için doğrulayıcı bir test olarak kullanılmasının, sifiliz tespit doğrulanmasını arttırdığını göstermektedir.

From Harmful Practices and Instrumentalisation, towards Legislative Protections and Community-Owned Healthcare Services: The Context and Goals of the Intersex Movement in Australia

People with innate variations of sex characteristics (also known as intersex traits or disorders or differences of sex development) have any of a wide range of innate physical traits that differ from medical and social norms for female and male bodies. Responses to these physical differences create experiences and risks of stigmatisation, discrimination, violence, and harmful medical practices intended to promote social and familial integration and conformity with gender stereotypes. As is evident globally, the Australian policy response to the existence and needs of people with innate variations of sex characteristics has been largely incoherent, variously framing the population as having disordered sex development in need of “fixing”, and a third sex/gender identity group in need of recognition, with only recent engagement by intersex community-controlled civil society organisations. This paper presents an overview of the context and goals of the intersex human rights movement in Australia. Australian intersex community organisations have sought to apply human rights norms and develop new infrastructure to address key health and human rights issues, and necessitating new ways of resolving policy incoherence. Together with human rights, mental health, and public health institutions, they have called for significant changes to medical models of care and reform to research and classification systems. Intersex community organising and resourcing have made a tangible difference. The Australian Capital Territory is the first jurisdiction in the country to move ahead with reforms to clinical practice, including a legislative prohibition of certain practices without personal informed consent, oversight of clinical decision-making, and investment in psychosocial support. A national community-controlled psychosocial support service has also commenced.

Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia.

Clinicians rely on local antimicrobial resistance pattern data to guide empiric treatment for seriously ill patients when culture and antimicrobial susceptibility testing results are not immediately available. This study aimed to analyse 5-year trends in antimicrobial resistance profiles of Escherichia coli and Klebsiella pneumoniae isolates. Bacteriology reports from 2017 to 2021 at the Ethiopian Public Health Institute were analysed retrospectively. Isolates were identified using either the VITEK 2 Compact system, the BD Phoenix M50 instrument, or conventional biochemical tests. Antimicrobial susceptibility testing was conducted using either the Kirby-Bauer disk diffusion method or the VITEK 2 Compact system and BD Phoenix M50 systems available at the time of testing. The Cochran Armitage trend test was employed to test the significance of antimicrobial resistance trends over time. P-values less than 0.05 were considered statistically significant. Of the 5382 bacteriology reports examined, 458 (9%) were on E. coli and 266 (5%) were on K. pneumoniae. Both K. pneumoniae (88%) and E. coli (65%) demonstrated high resistance to extended-spectrum cephalosporins. However, both K. pneumoniae (14%) and E. coli (5%) showed lower rates of resistance to carbapenems compared to other antimicrobials. In K. pneumoniae, resistance to carbapenems (from 0% to 38%; p < 0.001) and ciprofloxacin (from 41% to 90%; p < 0.001) increased significantly between 2017 and 2021. Both organisms showed very high resistance to broad-spectrum antibiotics. Additionally, K. pneumoniae demonstrated a statistically significant rise in ciprofloxacin and carbapenem resistance. This study emphasises the significance of regular reporting of local antimicrobial resistance patterns as this information can guide appropriate empiric therapy and efforts to address antimicrobial resistance issues.

Predicted risk factors associated with secondary infertility in women: univariate and multivariate logistic regression analyses.

Infertile women are those who regularly engage in unprotected intercourse for a period of at least 1 year and are unable to become clinically pregnant. Primary infertility means the inability of couples to conceive, without any previous successful pregnancies. Secondary Infertility refers to the inability to get pregnant for 12 months, after having a previous pregnancy for one time at least. The objectives of the current study were to analyze risk factors for secondary infertility and compare the predictive accuracy of artificial neural network (ANN) and multiple logistic regression models. The study was conducted at The University Institute of Public Health collecting data from Gilani Ultrasound Center 18 months after approval of synopsis. A total of 690 women (345 cases and 345 controls) were selected. The women selected for the case group had to be 20-45 years of age, had any parity, and had a confirmed diagnosis of secondary infertility. Multiple logistic regression (MLR) and ANN were used. The chance of secondary infertility was 2.91 times higher in women living in a joint family [odds ratio (OR) = 2.91; 95% confidence interval (CI) (1.91, 4.44)] and was also 2.35 times higher for those women who had relationship difficulties with their husband [OR = 2.35; 95% CI (1.18, 4.70)]. Marriage at an earlier age was associated with secondary infertility with β being negative and OR being < 1 [OR = 0.94; 95% CI (0.88, 0.99)]. For the logistic regression model, the area under the receiver operative characteristic curve (ROC) was 0.852 and the artificial neural network was 0.87, which was better than logistic regression. Identified risk factors of secondary infertility are mostly modifiable and can be prevented by managing these risk factors.

Occurrence of N-nitrosamines in the atmosphere and human health risk: A case study in an urban area of Chuncheon, Gangwon State, South Korea

This study aimed to investigate the occurrence of eight nitrosamines (NAs) in particulate (PM2.5) and gaseous phases and assess the human health risk associated with these compounds in an urban area of Chuncheon, Gangwon State, South Korea, across four sampling seasons. The findings revealed that the total concentrations of eight NAs measured during the sampling period exceeded the public health recommendation of 0.3 ng/m3 provided by the Norwegian Institute of Public Health, indicating a potential human health risk from NA exposures. In particular, the average total NA concentration observed in the gaseous samples during the winter of 2021 was 18.1 ± 6.46 ng/m3. The primary emission sources could potentially impact the concentrations of NAs in the atmosphere due to their significant positive correlation with primary emission species such as NO2, CO, and SO2. Moreover, the levels of particulate NAs during the summer were negatively correlated with O3, suggesting that their formation might be influenced by ozonation in the aqueous aerosol phase. In addition, the total NA concentrations measured in the gaseous phase were four to six times higher than those measured in the PM2.5 phase throughout the sampling period. Thus, domestic sources have the potential to impact the pollution levels of the research area more significantly than long-range atmospheric transport. In particular, the highest concentrations of NAs in the gas phase were observed during the winter, while the lowest concentrations were recorded in the summer, possibly influenced by photolysis. Nevertheless, the study suggested that tertiary amines might contribute to the presence of gaseous NAs in sunlight. Consequently, further studies focusing on the occurrence of tertiary amines in the gas phase should be considered. The cumulative lifetime cancer risks estimated from inhalation exposure exceeded the acceptable risk level of 10⁻6 for all age groups across all four seasons. Therefore, it is crucial to implement effective control measures to mitigate potential health risks associated with exposure to NAs.

Psychological features of HIV-infected patients depending on the stage of the disease

The relevance of the problem. Currently, the issue of HIV infection is acute all over the world, and the variety of HIV clinical forms is striking in its vastness and congruence with other pathologies. Among Russian and foreign publications devoted to psychological changes in patients with HIV infection, there is a lack of works on the relationship of their levels of resistance to the action of stress agents, the effectiveness of the formation of protective and compensatory behavior with differentiation by spheres (cognitive, emotional, and behavioral), and the absence or presence of alexithymia of varying degrees of severity in their personal psychological type with self-assessment of wellbeing, the severity of infection, and the presence of complications. The purpose of the study: to identify and compare the psychological characteristics of the personality of HIV-infected patients, depending on the stage of the disease. Materials and methods. We observed 150 male and female volunteers (83 and 67 patients, respectively), whose mean age was 37.5 (33.9; 42.1) years, living in the city of Saratov and the Saratov region. The patients were divided into three groups depending on the stage of the disease: Group I — the patients with HIV infection in the incubation stage (Stage 1 — incubation), Group II — the patients with steadily progressing HIV infection (Stage 2 — stage of primary manifestations and Stage 3 — subclinical); Group III — the patients with continuing HIV replication, accompanied by the death of CD4+ lymphocytes and the depletion of their population to zero (Stage 4 — stage of secondary diseases and Stage 5 — terminal). The patients were followed up at the public health institution Saratov Regional Clinical Center for AIDS Prevention and Control. Results. The following patterns, confirmed statistically, were revealed: the lower the resistance of the patients to the action of stress agents was, the higher their anxiety was and significantly more often both the tendency to alexithymia and its obvious clinical signs were revealed. Thus, it is advisable for all patients, regardless of the stage of progression of HIV infection, to determine the levels of stress resistance, since with a decrease in this indicator, their level of anxiety increases, a tendency to alexithymia appears, and sleep disturbances, mood disorders, memory impairment, and decreased performance occur, in contrast to patients with high stress resistance.