School-aged Girls Research Articles

Out of School Girls in Nigeria: Implications for National Development

Education is a right for all children. Discriminating against either the boys or the girls has serious consequences for future national development. In Nigeria, there are alarming figures showing a large percentage of boys and girls of school age not attending formal education. The focus for this paper therefore is on the girl child bearing in mind the serious implications of not education them on the society. In 2019, 10.19 million children were found to be out of school and 38% of them were girls. Some of the factors attributed to this ugly situation in Nigeria are early marriage, early pregnancy, violence at schools, funding is targeted at boys, child/domestic labour, dangerous journeys to schools, kidnapping, poor sanitation in schools, dilapidated desks/chairs, few female teachers to encourage them to attend school, religious and traditional practices etc. The implications of not addressing these factors as identified in the paper will lead to slower economic growth and reduced income, gender disparity, child mortality rates in communities will soar, she cannot be a policy maker who influences national decisions and women will be less likely to have access to social protection. Finally, recommendations like adequate funding to the education sector, provision of enabling environment, create more awareness among rural dwellers on the need to enroll, retain and encourage the girl child to complete school, Girls4Girls and SHE4HE programmes of UNICEF be sustained, provision of adequate security for all children in and out of school were proffered.

Difference of Precocious Puberty Between Before and During the COVID-19 Pandemic: A Cross-Sectional Study Among Shanghai School-Aged Girls.

ObjectiveTo compared the incidence rates and clinical features of precocious girls before and during the COVID-19 pandemic among Shanghai school-aged girls, and explored the potential mechanisms.MethodsThis cross-sectional study collected medical data about precocious girls between 2016 and 2020 from Shanghai Children’s Medical Center. Data of inpatient precocious girls from March to August in 2016-2019 (n=246) and 2020 (n=237) were collected. Subjects with abnormal brain and pituitary gland MRI reports, other endocrine diseases or chronic diseases were excluded. Finally, 209 precocious girls were included in the 2016-2019 group and 191 precocious girls were include in the 2020 group. Monthly incidence rates and clinical features were compared between before and during the COVID-19 pandemic. Linear regression models were used to examine the associations between biomarkers to explore the potential mechanisms.ResultsMonthly incidence rates of precocious puberty in outpatient girls from March to December 2020 (0.44-1.36%) and in inpatient girls from March to August 2020 (27.04-47.83%) were higher than those in 2016-2019 (0.30-0.52% and 10.53-18.42%, respectively). Serum concentrations of GnRH were higher in the 2020 group than in the 2016-2019 group (2.81 vs 1.99 mg/L). Serum concentrations of MKRN3 (1.02 vs 1.93 ng/ml) and ghrelin (0.38 vs 0.88 ng/ml) were lower in the 2020 group than in the 2016-2019 group. Moreover, the serum concentration of ghrelin was positively associated with the serum concentration of MKRN3 [β=0.891 (95% CI, 0.612, 1.171); p<0.001].ConclusionsThese findings suggest an increased incidence of precocious puberty during the COVID-19 pandemic among Shanghai school-aged girls, which may be associated with decreased serum concentrations of MKRN3 and ghrelin, and indicated ghrelin as a potential regulatory mechanism of puberty.

Defining Optimal Cut-Points for Cardiorespiratory Fitness Associated With Overweight/Obesity in Children: A School-Based Study.

The main purpose of the study was to define optimal criterion-referenced cut-points for cardiorespiratory fitness (CRF) associated with overweight/obesity. In this cross-sectional study, participants were 1,612 children aged 7–14 years (mean age ± SD = 9.7 ± 2.4 years; 52.5% girls). CRF was assessed by the Maximal multistage 20-m shuttle run test, from which maximal oxygen uptake (VO2max) was estimated. Anthropometric indices included body-mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Receiver operating characteristic (ROC) curves were performed to determine cut-off points. In boys, the optimal cut-off points of CRF in defining overweight/obesity for BMI, WC, and WHtR were 44.6, 46.4, and 46.9 mlO2/kg/min. The areas under the curves (AUC) were 0.83 (95% CI 0.78–0.88, p < 0.001), 0.77 (95% CI 0.71–0.83, p < 0.001), and 0.90 (95% CI 0.86–0.93, p < 0.001). In girls, the optimal cut-off points were 41.0, 40.8, and 40.7 mlO2/kg/min for BMI, WC, and WHtR, with the AUCs of 0.86 (95% CI 0.82–0.90, p < 0.001), 0.83 (95% CI 0.79–0.88), and 0.88 (95% CI 0.84–0.93, p < 0.001). In conclusion, our newly developed cut-off points for CRF assessed by the Maximal multistage 20-m shuttle run test may adequately detect primary school-aged boys and girls with general and abdominal obesity.

Physical Activity Related to Body Muscle Mass Index and Stiffness Index in 7-to-10-Year-Old Girls.

The relationship between moderate-to-vigorous physical activity (MVPA) performance time and body muscle mass and stiffness index in pre-puberty school-aged girls has not been fully elucidated. The effect of sexual maturity on bone mass is more pronounced in girls. This study aimed to clarify the relationship between MVPA performance time and the above-mentioned factors. This was a prospective, population-based cohort study of 111 girls aged 7–10 years. Data were collected via medical examination, clinical measurements, and questionnaires. Spearman’s ρ analysis was used to determine the association between skeletal muscle mass index (SMI) and stiffness index, muscle strength, and MVPA performance time. Participants who met the recommended MVPA level accounted for only 24.3% (n = 27) of all participating girls (n = 111). The following factors were significantly positively correlated with MVPA level at spearman’s ρ analysis: SMI (r = 0.303, p = 0.001), stiffness index (r = 0.229, p = 0.015), grip strength (r = 0.283, p = 0.003), back muscle strength (r = 0.197, p = 0.038), and standing long jump distance (r = 0.288, p = 0.002). Multiple regression analysis’s results revealed that SMI (β = 0.237; p = 0.024) was associated with MVPA performance time. These results can help school-aged girls to pay adequate attention to having healthy physical activity habits to prevent the decline of skeletal muscle mass, stiffness index, and body muscle strength.

Gender Differences Influence Gender Equality Awareness, Self-Esteem, and Subjective Well-Being Among School-Age Children in China.

The objective of this study was to investigate and analyze the status and influential factors of gender equality awareness, self-esteem, and subjective well-being in school-age boys and girls. The results can help schools and teachers provide more effective gender equality and mental health education. In the study, 284 valid questionnaires were collected from a total of 323 school-age boys and girls in the Hunan Province, China (effective response rate of 87.93%). The questionnaire covered gender equality awareness, self-esteem, and subjective well-being, with the influencing factors analyzed through multiple linear regression. There was a significant correlation among children’s gender equality awareness in all areas examined (family, occupation, and school), with both boys and girls having the lowest awareness of gender equality in occupational fields. The children’s self-esteem and subjective well-being were significantly correlated as well. Gender equality awareness, self-esteem, and subjective well-being among boys and girls reflected different influential factors. Androgynous traits (neither feminine nor masculine) were conducive to the development of gender equality awareness and self-esteem among the children. Therefore, schools and teachers need to provide gender equality and mental health education according to the specific psychological characteristics of each boy and girl.

Образ тела, самооценка и риск нарушений пищевого поведения у девочек младшего школьного возраста

The aim of the study is to determine the degree of risk of eating disorders in girls of primary school age. The relevance of this issue is related to the earlier occurrence of a number of problems that are traditionally typical for adolescence. Procedure and methods. The study involved 68 girls aged 8—9 years studying in the 3rd grades of the school; the comparison group consisted of students of the 6th grades — 71 teenage girls aged 11—12 years. The following methods were used: Eating Disorder Inventory-2 (the “risk of eating disorders” scale), Body Appreciation Scale, Figure Rating Scale, Dembo-Rubinstein self-esteem scales. Results. It is shown that girls in primary school and adolescence have similar indicators of the risk of eating disorders, a tendency to thinness, a real and ideal body image, i.e. the problem under consideration, previously characteristic of adolescent girls, now requires attention in relation to girls who have not reached puberty. At the same time girls of primary school age are more satisfied with their bodies than teenagers. A significant negative correlation has been established between the risk of eating disorders and self-esteem, in particular, self-esteem of beauty (external attractiveness), abilities, self-confidence and happiness. High self-esteem can serve as a personal resource that helps reduce the risk of eating disorders at this age.

PHYSICAL EDUCATION IN THE LIFE OF SCHOOLCHILDREN AND STUDENTS

School-age and student girls enjoy attending physical education classes. However, with increasing age, the attitude of boys and girls towards physical education and sports is deteriorating. Only 40 and 32% of school-age boys and girls at age 12-17 do hygienic gymnastics in the morning. Among students, only 18% of boys and girls do morning exercises. Respondents in almost all age groups overestimate both the level of development of their own motor skills and theoretical knowledge.

Black Women Leaders: Sociopolitical Identity Development as a Pathway to Success

Although they have poked a few holes in the "concrete ceiling" that represents the barrier to Black women's entrance into influential jobs, Black women are still underrepresented in leadership roles in society. This commentary, which is offered through the lens of a Black woman in business leadership and higher education investigates ways to improve the educational achievement of young Black women, and to put them on a pathway to a lifetime of success in their post-college trajectory. Research asserts that resources are available to support the success of Black women and enable them to achieve influential roles in which they excel. This journey begins with school-age girls, specifically with their educational trajectory, which should provide teaching that models and exemplifies cultural acceptance. Exposing the inequality Black females experience in the school system enables opportunities for discussion and innovative techniques to emerge. However, this requires first acknowledging and celebrating Black girls as producers of knowledge in a socially stratified education system.

Temporal changes of cephaloscopic traits in school age boys and girls from central Greece

Conducting cephaloscopic studies in order to obtain the characteristics of ethnic groups inhabiting a particular geographical region not only helps to understand the frequency of distribution of human morphological traits, but also provides a basis for comparison between different populations. A sample of 2683 individuals of school age (12 to 17 years) of both sexes, divided into smaller groups according to age, sex and origin was analyzed in terms of 7 cephaloscopic traits. This contingent originates from the districts of Thessaly and EpirusCentral Greece, which represent about 10.1% of the population of Greece. During the study, standard anthropological equipment of Siber Hegner Maschinen AG - Zurich was used, according to the classical methodology of Martin &amp; Saller (1957). A cluster analysis revealed two main branches, dividing the compared groups by the chronology of the studies, as well as smaller branches, according to their sex. These results suggest a significant change in the frequencies of occurrence over time, with the territorial factor prevailing over gender in the present study. Available data obtained during the 1980s prove the opposite. A comparison of the percentages of occurrence of some scopic traits in boys and girls from Thessaly and Epirus according to bibliographic and current data demonstrates declining temporal deviation: differences between genders were higher 20 years before the present study.

ADAPTIVE CAPABILITIES OF MIDDLE SCHOOL-AGED GIRLS DEPENDING ON THE RATIO OF ADIPOSE AND MUSCLE TISSUE

The aim: This study aimed to determine the dependence of adaptive capacities of middle school-aged girls with excessive body weight and increased volume of adipose tissue on the ratio of adipose and muscle tissue volume. Materials and methods: 52 female subjects aged 10-12 years were examined and divided into 3 groups according to their BMI. Cardiorhythmogram was recorded in all subjects using the “CardioLab” hardware-software complex. The indices of heart rhythm variability (HRV) were determined at rest and after an active orthostatic test based on the recorded cardiothythmogram. Body weight and total fat tissue amount were determined using the Tanita BC-601 device. Results: The analysis of HRV indices revealed features of autonomic rhythm regulation depending on morphological body features of the middle school-aged girls, namely, on the amount of fat and muscle tissue. Obese subjects had higher values of VLF %, LF % and LF/HF indices, which indicate a higher sympathetic influence on cardiovascular system activity and less significant parasympathetic division of the autonomic nervous system (ANS), as well as the PARS index. This trend of HRV indices points to an unsatisfactory level of adaptation, tension of the regulatory systems and the possibility of their failure. In contrast, subjects with normal and excessive body weight had higher values of HF ms2, HF % and TR ms2, and lower values of VLF %, LF/HF and PARS, which points to the dominance of the parasympathetic part of the ANS, lower level of tension in their regulatory systems, a satisfactory level of adaptation, satisfactory functional reserves of the cardiovascular system and high capabilities of the body. Conclusions: Obese girls exhibited disturbances in the ANS functional state towards sympathicotony and increased functional activity of suprasegmental ANS divisions, which can be interpreted as an autonomic dysfunction.

ADAPTIVE CAPABILITIES OF MIDDLE SCHOOL-AGED GIRLS DEPENDING ON THE RATIO OF ADIPOSE AND MUSCLE TISSUE.

The aim: This study aimed to determine the dependence of adaptive capacities of middle school-aged girls with excessive body weight and increased volume of adipose tissue on the ratio of adipose and muscle tissue volume. Materials and methods: 52 female subjects aged 10-12 years were examined and divided into 3 groups according to their BMI. Cardiorhythmogram was recorded in all subjects using the "CardioLab" hardware-software complex. The indices of heart rhythm variability (HRV) were determined at rest and after an active orthostatic test based on the recorded cardiothythmogram. Body weight and total fat tissue amount were determined using the Tanita BC-601 device. Results: The analysis of HRV indices revealed features of autonomic rhythm regulation depending on morphological body features of the middle school-aged girls, namely, on the amount of fat and muscle tissue. Obese subjects had higher values of VLF %, LF % and LF/HF indices, which indicate a higher sympathetic influence on cardiovascular system activity and less significant parasympathetic division of the autonomic nervous system (ANS), as well as the PARS index. This trend of HRV indices points to an unsatisfactory level of adaptation, tension of the regulatory systems and the possibility of their failure. In contrast, subjects with normal and excessive body weight had higher values of HF ms2, HF % and TR ms2, and lower values of VLF %, LF/HF and PARS, which points to the dominance of the parasympathetic part of the ANS, lower level of tension in their regulatory systems, a satisfactory level of adaptation, satisfactory functional reserves of the cardiovascular system and high capabilities of the body. Conclusions: Obese girls exhibited disturbances in the ANS functional state towards sympathicotony and increased functional activity of suprasegmental ANS divisions, which can be interpreted as an autonomic dysfunction.

Реактивність системи мікроциркуляції крові у дітей молодшого шкільного віку на температурний фактор

The purpose of the study was to investigate the adaptive capacity of the blood microcirculation system in children of primary school age for a functional test with heating. The article deals with the study of the blood microcirculation system in primary school children by laser Doppler flowmetry and the study of the reserve capacity of tissue blood flow in children on a test with increasing temperature factor. Materials and methods. The research was conducted on the basis of the laboratory of physiological research of the Department of Anatomy and Physiology of People and Animals of Bohdan Khmelnytsky Melitopol State Pedagogical University. The surveyed contingent consisted of 80 practically healthy children aged 6 to 9 years old, secondary school students in Melitopol. Based on a comprehensive morphofunctional study, we obtained data on individual-typological features of blood microcirculation in primary school children and the reserve capacity of tissue blood flow using functional tests. It is established that the adaptive features of the blood microcirculation system in boys and girls of early school age are due to different levels of local and central mechanisms of microvessel regulation. Results and discussion. The results obtained during the thermal test indicate different levels of reactivity of the body to increasing the temperature factor and the neurogenic vasoconstrictor effects of the sympathetic nervous system on the vessels of the arteriolar part of the microcirculatory tract. The reaction to the thermal test directly depends on the individual-typological features of blood microcirculation. Conclusion. At a ratio of reaction to thermal influence in children with various types of microcirculation, the maximum increase in tissue perfusion was observed in children with type III of laser Doppler flowgram. This level of microvascular reactivity, as well as the relatively rapid recovery of blood flow after thermal hyperemia is explained by the fact that children with hyperemic type of microcirculation have increased microvascular tone due to neurogenic effects of the sympathetic chain of tissue blood flow regulation. Children with the hypoemic type of microcirculation, on the other hand, have a somewhat reduced sympathetic tone relative to the normoemic type, as a result of which the reserve of capillary blood flow is reduced and the time of blood flow recovery after thermal exposure is prolonged

Age features of the functional state of the vestibular sensory system in the pupils of the middle classes with the visual impairments

Disclosed the role of the functional state of the vestibular sensory system in the development of the children with the visual impairments. It was found that the vestibular analyzer is important in the management of the motor activity, development of the motor qualities, formation of the motor skills and abilities.&#x0D; Considered the indicators of the functional state of the vestibular sensory system in the pupils of the middle grades with the visual impairments, which were determined and evaluated according to the results of the stability of the vestibular analyzer before and after rotational loads in the Barani chair. The study was conducted on the basis of the municipal institution «Kharkiv special boarding school I–III degrees № 12». It was attended by 117 visually impaired pupils of 5th–10th grades, aged 10–16 years. To achieve the goal of the study, the following methods were used: theoretical analysis and generalization of scientific and methodological literature, physiological methods for the determining the resistance of the vestibular analyzer to rotational loads, methods of the mathematical statistics. A comparison of the results of the stability of the vestibular analyzer before and after rotational loads in the Barani chair in boys and girls of the middle school age with the visual impairments depending on age is presented. It is determined that the resistance of the vestibular analyzer to rotational loads in the Barani chair in the visually impaired pupils of the middle grades improve with age; after rotational loads – in boys they improve, in girls they change in waves.&#x0D; It is established that the best indicators of the stability of the vestibular analyzer before and after the rotational loads in the Barani chair observed in the pupils of the 10th grade, aged 15–16 years.

“We Need People to be Woken Up and See This!” Teens Learning Through Critical Analysis

AbstractThe continued dearth of realistic, culturally diverse characters in children's literature corresponds with the lack of diversity among those who create, publish, and review books. To address this problem, the researcher collaborated with six culturally diverse high school aged girls for a participatory action research (PAR) project that involved critical analysis of children's picture books that mirrored one or more facets of each girl's identity, with an eye to authenticity. The girls concluded that (1) omitting relevant details about a character's identities created cognitive dissonance for the reader, and (2) book creators who choose this approach create potential for cultural outsiders to glean inaccurate ideas. The positive impact on the participants included changes in their relations and/or changes in their thinking. When the project ended sooner than expected and with a different end product, the researcher's own thinking changed about measuring the success of a PAR project.

BMI status relative to international and national growth references among Pakistani school-age girls

BackgroundA sizable proportion of school-going children from developing countries has abnormal growth parameters, often not standardized with international reference values. We aimed to assess the prevalence of underweight, overweight, and obesity in the schoolgirls of Punjab according to international and local references.MethodsIn this population-based cross-sectional study, 10,050 school-going girls aged 8–16 years from 12 districts of northern, central, and southern Punjab were recruited. Estimates of normal weight, underweight, overweight and obesity were calculated in the girls according to three international BMI references including centers for disease control (CDC) 2000, the international obesity task force (IOTF) 2012 and world health organisation (WHO) 2007 in addition to a local reference for the population under study. We used Cohen’s kappa statistics to analyse the agreement of our data with reference values.ResultsThere was marked overestimation of underweight (23.9%, 14.5%, 15.2% and 4.37%), slight underestimation of overweight (5.3%, 7.3%, 7.9% and 8.97%) and moderate underestimation of obesity (1.9%, 1.5%, 2.2% and 5.67%) according to CDC, IOTF, WHO and local reference, respectively. When the weight status of the study cohort was compared with the local data, we found comparable results in all four weight categories.ConclusionWe recommend population-wide further studies to estimate the prevalence of weight status in school-age girls for devising appropriate references and for planning strategies for public health policy and management.

Contextual variations in associations between measures of aggression and withdrawal and functioning with peers: A replication study.

Data from 790 older school-age (Mage = 10.2 years, SD = 1.2 years) girls (N = 427) and boys from Barranquilla, Colombia (N = 449) and Montréal, Canada (N = 331) were used to replicate findings reported by Valdivia et al. (2005). This prior study revealed contextual variations in the association between two measures of social behavior, specifically aggression and withdrawal, and two measures of effective functioning with peers, specifically sociometric preference and friendship. The Montréal participants were primarily from families with European backgrounds. The ethnicity of the participants from Barranquilla can be described as Latinx/Caribbean. Multilevel analyses provided evidence of replication of place differences only for the associations between measures of aggression and sociometric preference. Stronger negative associations were observed between (a) measures of aggression and sociometric preference, (b) measures of withdrawal and sociometric preference, and (c) withdrawal and friendship in peer groups that were high in collectivism. These findings are interpreted as largely replicating the deep structure of the findings from the Valdivia et al. study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Large Trichobezoar in School-Aged Girl Presenting to the Emergency Department with Hematemesis.

Gastric bezoars are masses of foreign material found in the stomach, generally forming into a hard object. Gastric bezoars are categorized by the material of which they are composed, including but not limited to phytobezoars (plant matter), trichobezoars (hair), pharmacobezoars (medications), and other (e.g., tissue paper or Styrofoam).

The level of quality of life of schoolchildren with disorders of the autic spectrum in comparison with typically developed peers

In connection with the increasing the number of children with autism spectrum disorders (ASD) who enrolls in educational institutions of Ukraine, the issue of individualization of physical education (PE) of children with ASD in the school process becomes important. There is little data on the quality of life of schoolchildren with autism spectrum disorders. It does not allow to draw individual trajectories of physical education of such children, to help them to improve their adaptability. Most of studies have been performed on males. Objective: to analyze the level of cognitive, physical, emotional, social functioning and functioning in school of girls of primary school age with autism spectrum disorders and compare them with typically developed peers. It was found that there were no differences between the rates of girls with ASD and girls with typical development in walking and running, feeling of pain and low energy levels, the frequency of school absences due to doctor visits and the frequency of forgetting things. However, the level of development of cognitive, social and emotional functioning of girls with ASD is significantly lower than the indicators with typical development by all criteria. To overcome the problems with cognitive, social and emotional functioning of girls with ASD, it is recommended to select appropriate means of PE. In oder to improve the cognitive processes (attention, memory) of girls with ASD, we recommend to increase the amount of means that promote the development of coordination in PE classes; to improve physical functioning - exercises for developing muscle strength and endurance. The game activity with normal girls will help to improve the social well-being of girls with ASD. We should use oriental martial arts and oriental gymnastics to improve the psycho-emotional state of girls with ASD.

School Fees and Rebel Demobilization: Evidence from Uganda

The government of Uganda eliminated primary school fees during the insurgency of the Lord’s Resistance Army (LRA), a rebel group notorious for abducting school aged boys and girls to turn them into rebels through indoctrination and intimidation. Previous research shows that the no-fee policy, commonly known as the Universal Primary Education (UPE) programme, increases access to education mainly for girls. I test the hypothesis that UPE increases incentives of abducted girls to desert the LRA. Difference-in-differences estimates, which compare the change in desertion of girls in primary school age (treatment group) to the change of older females (control group), support the hypothesis. Investigating possible mechanisms, I find little support for the ‘standard’ opportunity cost hypothesis that dominates the literature, where education increases earning opportunities in the regular economy and thus makes staying with the rebels less attractive. Instead, the evidence supports a ‘novel’ opportunity cost hypothesis that has received little attention thus far: Girls long for education, and the prospect of going to school – which UPE increases substantially – entices them to abandon the rebels.

Macronutrient, nutritional status, and anemia incidence in adolescents at Islamic boarding school

Background: Anemia occurs due to the body's loss of red blood cells and decreased iron absorption. Globally, it is known that the prevalence of anemia is 1.62 billion, with the majority of anemia sufferers being a group of women who are not pregnant, as many as 468.4 million people. In addition, the highest prevalence of anemia in the group of school-age girls is 47.4%, while in men, only 12.7%.Objective: This study aims to determine the correlation between macronutrients and nutritional status with the anemia accident in adolescents at Islamic Boarding schools.Methods: This study used a case-control design with matching criteria aged 15-19 years, not menstruating, not fasting. Sampling with quota sampling of late adolescents with a population of 15-19 years 1,359 people, anemic case sample of 46 people and control without anemia 46 people, intake questionnaire using the SQ-FFQ, statistical test with Chi-Square.Results: There was a significant relationship between macronutrient intake [energy p=0.048; OR=3.3 (CI 0.965-11.28), protein p=0.036; OR=3.98 (CI 1.018-15.57)] and nutritional status [p=0.024; OR=5.35 (CI 1.088-26.32)] with anemia incidence. Less energy intake has a risk of 3.3 times anemia, lack of protein intake has a risk of 3.98 times, and malnutrition has a risk of anemia of 5.35 times.Conclusions: There was a significant correlation between energy, protein intake, and nutritional status with anemia incidents. Nutritional status has the strongest association with anemia. * Presented at the International Nutrition and Health Symposium (INHESION) on Sunday, November 15th, 2020, in Yogyakarta, organized by HIMAGIKA and the Department of Health Nutrition, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada