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With the surge of COVID-19 cases worldwide, vaccines against COVID-19 are also developing across the countries. However, the acceptability of COVID-19 vaccination among general people is questionable. The availability of several vaccines' options against COVID-19 has perplexed people regarding individual vaccines' efficacy and safety. Therefore, we aim to determine the acceptance, preferences, impact factors of future COVID-19 vaccines in Malaysia and the factors influencing the COVID-19 vaccination acceptance among vaccine demand and vaccine delay groups.An online-based cross-sectional survey was conducted among Malaysian residents 18 years and above of either gender using the snowball sampling technique. A self-administered questionnaire was made available to participants through various social media networks, email, and telegram. The data obtained from the survey were analyzed using SPSS version 25.0. Association between background characteristics and respondents were analyzed using the Chi-square test in the vaccine delay group and vaccine acceptance group.Total of 1282 responses were considered for the study, mainly from male respondents (71%). Among the respondents, 95.9% thought that vaccination would be an effective way to prevent and control COVID-19, and 96% would accept vaccination if the COVID-19 vaccine were successfully developed and approved for listing in the future. Essential factors influencing vaccination decisions were vaccine convenience (95.7%) and doctor's recommendation (97.3%). Bivariate analysis revealed that age less than 24 years, Malay race, living in urban areas, tertiary education, students, single marital status, family income (Malaysian ringgits) RM 4,850 to RM 10,959 andRM 10,960 were significantly associated with vaccine acceptance of COVID19 vaccination.All the factors influencing COVID-19 vaccine acceptance rates throughout the country should be studied on a larger scale, and appropriate steps to ensure vaccine acceptance among the public should be meticulously devised by the government and related authorities.Con el aumento de casos de COVID-19 en todo el mundo, las vacunas contra la COVID-19 también están en desarrollo en todos los países. Sin embargo, la aceptabilidad de la vacuna COVID-19 entre la gente en general es cuestionable. La disponibilidad de varias opciones de vacunas contra COVID-19 ha dejado perpleja a la gente con respecto a la eficacia y seguridad de las vacunas individuales. Por lo tanto, tenemos como objetivo determinar la aceptación, las preferencias y los factores de impacto de las futuras vacunas COVID-19 en Malasia y los factores que influyen en la aceptación de la vacunación COVID-19 entre la demanda de vacunas y los grupos de demora de la vacuna.Se realizó una encuesta transversal en línea entre residentes de Malasia de 18 años o más de cualquier género utilizando la técnica de muestreo de bola de nieve. Se puso a disposición de los participantes un cuestionario autoadministrado a través de varias redes sociales, correo electrónico y telegrama. Los datos obtenidos de la encuesta se analizaron con el programa SPSS versión 25.0. La asociación entre las características de fondo y los encuestados fueron analizados usando la prueba de χSe consideró un total de 1.282 respuestas para el estudio, principalmente de hombres encuestados (71%). Entre los encuestados, el 95,9% pensó que la vacunación sería una forma eficaz de prevenir y controlar la COVID-19, y el 96% aceptaría la vacunación si la vacuna COVID-19 se desarrollara con éxito y se aprobara para su inclusión en el futuro. Factores esenciales que influyeron en las decisiones de vacunación fueron la conveniencia de la vacuna (95,7%) y la recomendación del médico (97,3%). El análisis bivariado reveló que la edad24 años, la raza malaya, la vida en áreas urbanas, educación terciaria, estudiantes, estado civil soltero, ingresos familiares RM 4,850 a RM 10,959 yRM 10,960 (enTodos los factores que influyen en las tasas de aceptación de la vacuna COVID-19 en todo el país deben estudiarse a mayor escala, y el gobierno y las autoridades relacionadas deben diseñar meticulosamente los pasos apropiados para asegurar la aceptación de la vacuna entre el público.

Objectives To explore expert perspectives on risks associated with the pediatric electronic health record (EHR) for intimate partner violence (IPV) survivors and their children and to identify strategies that may mitigate these risks. Methods We conducted semistructured interviews with multidisciplinary pediatric IPV experts (nursing, physicians, social workers, hospital security, IPV advocates) recruited via snowball sampling. We coded interview transcripts using thematic analysis, then consolidated codes into themes. Results Twenty-eight participants completed interviews. Participants identified the primary source of risk as an abuser's potential access to a child's EHR by legal and illegal means. They noted that abuser's access to multiple pediatric EHR components (eg, online health portals, clinical notes, contact information) may result in escalated violence, stalking, and manipulation of IPV survivors. Suggested risk mitigation strategies included limited and coded documentation, limiting EHR access, and discussing documentation with the IPV survivor. Challenges to using these strategies included healthcare providers’ usual practice of detailed documentation and that information documented may confer both risk and benefit concurrently. Reported potential benefits of the pediatric EHR for IPV survivors included ensuring continuity of care, decreasing need to repeatedly talk about trauma histories, and communication of safety plans. Conclusions Our findings suggest the pediatric EHR may confer both risks and benefits for IPV survivors and their children. Further work is needed to develop best practices to address IPV risks related to the pediatric EHR, to ensure consistent use of these practices, and to include these practices as standard functionalities of the pediatric EHR.

This article aims to know (1) the implementation of a change management curriculum KTSP into curriculum 2013; (2) the implication of a change management to learning process; and (3) supports and obstacles factors in the implementation of a change management in SMAN I Kediri. This is a qualitative field research. The subjects are chosen using purposive sampling and snowball sampling. The data are collected by using interview, observation, and documentation. The technique of data analysis uses descriptive qualitative through inductive approach. The findings show that first the implementation management process of curriculum KTSP into curriculum 2013 in SMAN 1 Kediri consists of planning, organizing, actuating and controlling. In practice, the four steps run effectively. However, the controlling process still has not run effectively yet and real in the field. Second, the change management implied on the role of guidance and counseling (BK), the label of department (interest), teacher’s book and student’s book, lesson concept, assessment concept, and scientific approach. Third, the supports factors of the curriculum 2013 implementation in SMAN 1 Kediri are RSBI status, full day school, the students, teachers, and curriculum analysis. The obstacles factors are book procurement, facilities, and financial. Keywords ; a change management, curriculum KTSP 2006, curriculum 2013

AIM OF THE STUDY To describe prenatal stress and state anxiety levels in pregnant women living in Spain during the lockdown of the first wave of COVID-19 and its relation with obstetric factors, perception of health care, and concerns about the socio-sanitary situation. METHODS The present study is an observational, correlational, and cross-sectional quantitative study. The participants in the study were pregnant women recruited through non-probabilistic convenience and snowball sampling during the lockdown. A web link was provided to an online questionnaire designed for this research, which collected socio-demographic and obstetric variables, perceptions of health care received during the pandemic and preoccupations associated with COVID-19. It also included the Prenatal Stress Questionnaire (PDQ) and the State Anxiety Inventory (STAI-S). RESULTS Based on the responses of 695 pregnant women, the results showed a mean of 16.98 (SD=25.20) of prenatal stress and elevated levels of anxiety (M=25.20/ SD=11.07) in the first wave of the pandemic. Risk factors for prenatal stress and anxiety were the level of preoccupation associated with COVID-19 and previous mental health issues. A specific risk factor for anxiety was having more than one child and a protective factor were perceiving accessibility and availability of health care, with clear and consistent pregnancy care and follow-up protocols. CONCLUSIONS The lockdown period for COVID-19 was a stressful experience for pregnant women, highlighting the need to address their psychological well-being through clear and coherent protocols in terms of maternal-foetal health control and follow-up.

Purpose Sleep disturbances in childhood are an important pediatrics problem because of their influence on children's health and their strong correlation with behavior problems. The aim of the present study was to explore sleep disturbances during the COVID-19 pandemic in school-age children. Design and methods A cross-sectional survey design was used for data collection. From 1 to 15 February 2021, the study utilized snowball sampling techniques to gather data through an online survey. Parents of 1040 6–12-year-old schoolchildren completed the Socio-demographic Information Questionnaire and the Children's Sleep Habits Questionnaire. A multivariable logistic regression analysis was employed to pinpoint factors connected to sleep disturbances. Results The prevalence of sleep disturbances among 6–12-year-old children during the COVID-19 pandemic in Turkey was 55.5%. The most common sleep disturbances were bedtime resistance, sleep onset delay, and sleep duration. The children's ages, family relationships, and eating habits were linked to their sleep disturbances. Moreover, our results indicated that sleep disturbances were more common in the children of parents who felt helpless, apprehensive, and frightened during the COVID-19 pandemic. Conclusions Our work showed that the prevalence of sleep disturbances among school-aged children during the COVID-19 pandemic in Turkey was quite high. Practice implications Parents who are worried that their child is sleeping too much or too little should consult their healthcare provider for assessment of a probable sleep disturbance. School nurses should be educated children and their parents about the importance of enough sleep and factors that contribute to inadequate sleep among children during the COVID-19 pandemic.

Aim This study aimed to examine the social stigma experienced by healthcare workers caring for people diagnosed with COVID-19. Methods This research employed a qualitative-phenomenological approach. It was conducted at the COVID centers of the Hail region, Kingdom of Saudi Arabia. Both purposive and snowball sampling were used, resulting in 15 participants. However, saturation was identified in the 11th participant. Interviews were conducted online through a Zoom platform, with at least 50 min per participant. Thematic analysis was used in analysing the data. Results The nurses recorded four themes and three subthemes based on one-on-one interviews. These themes included (1) Labeling nurses as “COVID Nurses,” with a subtheme of frustration, (2) “Fear of the unknown,” with a subtheme of “uncertainties,” (3) Nurses’ need for support, and (4) the Love for the profession, with a subtheme of “nurses’ worth.” Conclusion Nurses who cared for patients diagnosed with COVID-19 experienced stigma. They were labeled “COVID Nurses.” They experienced fear of the unknown and uncertainties and felt they needed support. Despite these experiences, the nurses felt fulfilled as they have a high regard for their profession. The experiences of these nurses call for intervention to help them before, during, and after any health-related crisis. In this context, nurses will be prepared mentally and emotionally to face the challenges in their career.

Efforts to forecast coronavirus disease 2019 (COVID-19) case burden have been largely unsuccessful. Correlating responses from a national, demographically representative sample of US adults (N = 10,650) with subsequent COVID-19 infection rates, this article reports that for every 3% increase in intent to comply with public health recommendations, the authors estimate a 9% reduction in new COVID-19 cases during the subsequent 30 days., Objectives We sought to determine whether self-reported intent to comply with public health recommendations correlates with future coronavirus disease 2019 (COVID-19) disease burden. Methods A cross-sectional, online survey of US adults, recruited by snowball sampling, from April 9 to July 12, 2020. Primary measurements were participant survey responses about their intent to comply with public health recommendations. Each participant’s intent to comply was compared with his or her local COVID-19 case trajectory, measured as the 7-day rolling median percentage change in COVID-19 confirmed cases within participants’ 3-digit ZIP code area, using public county-level data, 30 days after participants completed the survey. Results After applying raking techniques, the 10,650-participant sample was representative of US adults with respect to age, sex, race, and ethnicity. Intent to comply varied significantly by state and sex. Lower reported intent to comply was associated with higher COVID-19 case increases during the following 30 days. For every 3% increase in intent to comply with public health recommendations, which could be achieved by improving average compliance by a single point for a single item, we estimate a 9% reduction in new COVID-19 cases during the subsequent 30 days. Conclusions Self-reported intent to comply with public health recommendations may be used to predict COVID-19 disease burden. Measuring compliance intention offers an inexpensive, readily available method of predicting disease burden that can also identify populations most in need of public health education aimed at behavior change.

Conservation agriculture (CA) is shimmering up as a potential solution to food security, biodiversity, mitigating climate change effects on agriculture and water scarcity challenges. Adoption of CA found to be related not only ecological factors, but also depends on the characteristics of the adopter, their level of perception and the decision-making process. This paper examines the interactions and inter-relationship among climate change perception, energy perception, and level of knowledge on CA as dependent variables with a set of operating agro-economic, social-ecological, communication variables from new alluvial zone of West Bengal. Total of 65 farm households are surveyed using non-random snowballing sampling method. From the study it has found that farmers’ perception on energy, climate change perception, and knowledge on CA are interwoven with each other. As the farmers of the study region are in initial stage of adoption they need access to proper CA-related information and Upgradation of functional education through training, workshops, or demonstrations. Here are the points of interventions for successful on-farm adoption of CA. While land fragmentation and fuel cost are came up as two important predictors.

Objective This study aims to determine the family experiences in treating members with diabetic foot ulcer. Method A qualitative study with descriptive phenomenology design, was conducted at Central Tapanuli Regency, and the participants were diabetic patients with foot ulcer. Furthermore, seven participants were involved accidentally using the snowball sampling method, and the data was collected during an in-depth interview. Results The results showed 5 themes, which includes (1) Ability of the family to fulfill the health responsibilities of its Members, (2) Efforts to Control Blood Sugar, (3) Treatment of Diabetic Foot Wounds, (4) Psychological responses during care, (5) The effects of foot ulcer treatment, diabetes in the family. Conclusions The involvement of family members by caring for people with diabetes and foot ulcer plays an important role in supporting system. This study provides an understanding on the role of the family in caring for the members with diabetic foot ulcers.

PurposeThe psychic distance often hinders the interaction between cross-border e-commerce (CBEC) and consumers. This paper aims to discuss the issues of psychic distance of consumers in the CBEC. In addition, it attempts to explain the factors that affect psychic distance from three dimensions of culture, economy and politics and the two different shopping behaviors caused by psychic distance.Design/methodology/approachThis research incorporates both theoretical and empirical studies. In this study, 249 validated questionnaires were selected from 300 Chinese CBEC consumers by snowball sampling, and the relationship between variables was tested using structural equation model (SEM). This was done through online research, and it is ensured that the data obtained are first-hand information.FindingsThe paper suggests the theoretical model operationalizing CBEC psychic distance and the empirical analysis results show that all the six influencing factors have a positive impact on the psychic distance of consumers. Logistics infrastructure barriers in the economic dimension are confirmed as the major influencing factor, and the significance of the political dimension is relatively small. Based on consumers' uncertainty of various kinds of information, psychic distance subconsciously causes consumers to deviate in the cross-shopping process.Originality/valueCurrently, research on e-commerce mainly focuses on saving trade costs and improving consumer welfare, while research on the internal impact of CBEC on consumers is insufficient. Psychic distance is a new concept in the field of cultural and social research. The originality of this paper is that the concept of psychic distance has been extended from overseas invested enterprises to research with CBEC consumers as the selected object. The obstacles of CBEC have been widely studied, but few are related to the closeness of consumers, or the inner feelings of consumers are ignored. In the context of CBEC, this paper lists the actual external factors and potential threats that may affect consumers' consumption concerns of CBEC from three dimensions. The real emotions of consumers in the face of these difficulties indirectly affect the purchase satisfaction and reduce the purchase desire. Consumer psychic distance is a real phenomenon in cross-border shopping, and it is almost inevitable for these difficulties. On the premise of inevitability, high psychic distance will slow down cross-border shopping in the eyes of consumers.

Background of the study: The village library is an interesting type of public library for research studies. The uniqueness of the village library lies in the role and function that is close to the life of the community in the village. The village library has a strategic role in developing human resources in the village. Purpose: The purpose of this study is to describe the factors that influence the development of village libraries in the Sleman Regency. The purpose of the next research is to discuss the relationship between the factors that are the driving forces and inhibitors of libraries in managing village libraries. Method: The approach method in this research uses descriptive qualitative. Descriptive qualitative research in which the researcher draws and extracts information from the phenomenon of village library development factors. The research location is in the village library in Sleman Regency. The informant selection technique uses snowball sampling as the main informant, which is then supplemented with proposive sampling. Findings: The results found internal factors that influence the development of the village library organization, among others, support of human resources, the formation of organizational structure, commitment from various stakeholders, internal and external regulations, allocation of funding for routine libraries, the use of technology, collaboration and networks built together with government and non-government institutions, the ability to analyze the needs of the community and innovation in dealing with the challenges of the village library, the relationship between these factors can support the success of the administration and management of the village library. Conclusion: Studies in village libraries in Sleman Regency show that there are village libraries that are capable of making changes (transformation), but there are also libraries that are not yet capable of transforming libraries.

Background Workplace heat exposure can cause a series of heat-related illnesses and injuries. Protecting workers especially those undertake work outdoors from the risk of heat strain is a great challenge for many workplaces in China under the context of climate change. The aim of this study is to investigate the perceptions and adaptation behaviors of heat exposure among construction workers and to provide evidence for the development of targeted heat adaptation strategies nationally and internationally. Methods In 2020, we conducted a cross-sectional online questionnaire survey via WeChat Survey Star in China, using a purposive snowball sampling approach. A total of 326 construction workers submitted completed questionnaires. The perceptions of workplace heat exposure were measured using seven indicators: concerns over high temperature, perception of high temperature injury, attitudes towards both heat-related training and regulations, adjustment of working habits during heat, heat prevention measures in the workplace, and reduction of work efficiency. Bivariate and multivariate regression analyses were used to identify the factors significantly associated with workers’ heat perceptions and behavioral responses. Results 33.3% of the respondents were moderately or very concerned about heat exposure in the workplace. Less than half of the workers (43.8%) were worried about heat-related injuries. Workers who have either experienced work-related injuries (OR = 1.30, 95% CI 1.03–1.62) or witnessed injuries to others during high temperatures (OR = 1.12, 95% CI 1.02–1.27) were more concerned about heat exposure compared to other workers. Most respondents (63.5%) stated that their work efficiency declined during extremely hot weather. The factors significantly associated with a reduction of work efficiency included undertaking physically demanding jobs (OR = 1.28, 95% CI 1.07–1.54) and witnessing other workers’ injuries during high temperatures (OR = 1.26, 95% CI 1.11–1.43). More than half of the workers were willing to adjust their work habits to adapt to the impact of high temperatures (81.6%). The internet was the most common method to obtain heat prevention information (44.7%), and the most frequently used heat prevention measure was the provision of cool drinking water (64.8%). Conclusions Chinese construction workers lack heat risk awareness and are not well prepared for the likely increasing heat exposure in the workplace due to global warming. Therefore, there is a need to improve their awareness of heat-related injuries, strengthen high temperature related education and training, and update the current heat prevention policies to ensure compliance and implementation.

Purpose The aim is to verify the impact of the Covid-19 pandemic on women's healthcare and medical assistance in Brazil. Patients and methods This exploratory cross-sectional study evaluated a non-probabilistic sample of women above 20 years old, carried out between August and September of 2020, through a snowball sampling using a Google Forms application. Results From a total of 2495 women, more than 70% have not been screened for cervical cancer (77.8% of 2244 women aged for screening), and more than 80% have not been screened for breast cancer (80.2% from 1325 women aged for mammography) during the pandemic. Also, 55.2% of the women did not undergo routine blood tests during the same period. The most frequent reasons for not performing screening and routine tests were: they were up to date; fear of contracting Covid-19; they decided to postpone it until after the end of the pandemic; they were unable to schedule the appointment at the healthcare center for whatever reason; and the healthcare center was only attending Covid-19 patients. Women with no comorbidities have performed significantly more mammograms and routine blood tests than women with comorbidities. In addition, women with comorbidities who were used to perform periodic medical follow-up have done it substantially more than women with no comorbidities during the pandemic. Conclusion As observed, there was a significant decrease in women's access to the healthcare system during this pandemic. Many participants reported that they had not attended any screening tests, and some reasons included fear of getting infected and due to the public measures of social distancing. The consequences are late diagnoses and a worse prognosis. It might impact the healthcare systems around the world in the next few years. Further studies should be done to follow these consequences.

Background Despite recent incentives through Medicare (Australia’s universal health insurance scheme) to increase retinal screening rates in primary care, comprehensive diabetic retinopathy (DR) screening has not been reached in Australia. The current study aimed to identify key factors affecting the delivery of diabetic retinopathy (DR) screening in Australian general practices. Methods A descriptive qualitative study involving in-depth interviews was carried out from November 2019 to March 2020. Using purposive snowballing sampling, 15 general practitioners (GPs) were recruited from urban and rural general practices in New South Wales and Western Australia. A semi-structured interview guide was used to collect data from participants. All interviews were conducted over the phone by one facilitator, and each interview lasted up to 45 min. The Socio-Ecological Model was used to inform the content of the interview topic guides and subsequent data analysis. Recorded data were transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes. Results Of 15 GPs interviewed, 13 were male doctors, and the mean age was 54.7 ± 15.5 years. Seven participants were practising in urban areas, while eight were practising in regional or remote areas. All participants had access to a direct ophthalmoscope, but none owned retinal cameras. None of the participants reported performing DR screening. Only three participants were aware of the Medicare Benefits Schedule (MBS) items 12,325 and 12,326 that allow GPs to bill for retinal screening. Seven themes, a combination of facilitators and barriers, emerged from interviews with the GPs. Despite the strong belief in their role in managing chronic diseases, barriers such as costs of retinal cameras, time constraints, lack of skills to make DR diagnosis, and unawareness of Medicare incentives for non-mydriatic retinal photography made it difficult to conduct DR screening in general practice. However, several enabling strategies to deliver DR screening within primary care include increasing GPs’ access to continuing professional development, subsidising the cost of retinal cameras, and the need for a champion ace to take the responsibility of retinal photography. Conclusion This study identified essential areas at the system level that require addressing to promote the broader implementation of DR screening, in particular, a nationwide awareness campaign to maximise the use of MBS items, improve GPs’ competency, and subsidise costs of the retinal cameras for small and rural general practices.

PurposeThis study mainly aimed to show that financial literacy is not always enough in explaining workers' individual pension plan ownership as financial literacy knowledge does not always result in financially literate decisions/actions, and in such cases perceived consumer risks can be used to explain the IPP ownership decision of workers.Design/methodology/approachThe data were collected via a questionnaire adapted from earlier questionnaires using convenience and snowball sampling methods with Internet based applications such as Facebook, Twitter, Instagram and WhatsApp. T-tests, ANOVA and Chi-Square tests were conducted to find out if there is a relation/interaction between individual pension plan (IPP) ownership and financial literacy, and perceived consumer risks (N = 651).FindingsIt is found out that financial literacy level does not have a statistically significant relation with individual pension system (IPS) involvement of workers in Turkey, but perceived consumer risks show differences based on IPP ownership.Originality/valueTo the best of authors’ knowledge, this study contributes to the literature being the first paper to study the relationship between financial literacy and workers' IPP ownership decisions in Turkey and it also shows that perceived consumer risks can be used for explaining workers' IPS involvement in cases where financial literacy knowledge does not translate into financially literate decisions.

ObjectivesFirefighter health has received a great deal of increased attention over the past decade, but most work has been specific to men in the fire service due to small numbers of women, likely due to challenges with recruitment and retention of women in the fire service. While findings suggest men in the fire service struggle with high rates of overweight and obesity due to a number of occupational challenges, limited data are available on large samples of women firefighters.MethodsUsing snowball sampling techniques, we conducted an online survey of both career (N=2,398) and volunteer (N=781) women firefighters.ResultsRates of obesity for both career (15.4%) and volunteer (31.6%) women firefighters were not only lower than men in the fire service (33.5% career and 43.2% volunteer), but also lower than the general population (41.1%). Women career and volunteer firefighters who engaged in heavy physical activity were less likely to be obese. Being a racial or ethnic minority firefighter was associated with being obese, as was serving more than 20 years in the fire service.ConclusionFindings highlight that women firefighters have been successful in overcoming the occupational risks, such as a challenging nutrition environment, inconsistent schedules, limited time for fitness, and the metabolic impact of shift work, that put firefighters at increased risk for obesity.

The use of plants for traditional medicines are community tradition in Indonesia. However, the use of plants for hereditary treatment has not been well documented. One of the solutions is an ethnomedicine study, in this study 5 villages located in Secang District, Magelang Regency. The sampling technique used is snowball sampling with observation using instruments and interviews. The number of respondents sample is 388 respondents. The results showed that the community utilized 96 plant species from 47 families. There are 3 types of diseases that use plants in their treatment with an ICF value of 1, namely sprains, nosebleeds, and menstrual flow. The most widely used parts for treatment are leaves (42.61%). The most frequently used processing method is the boiling technique with a percentage of 65.10% by way of use, which is drinking 77.05%. People most often consume with a frequency of 2x a day (74.87%). People usually use treatment during illness/ curative (76.74%). People get plants from their own yard (54.24%). Knowledge about treatment comes from family (hereditary) (72.43%). From some of the results, it can be used as a reference when conducting scientific verification of preclinical testing on test animals.

Introduction: The high level of morbidity and mortality due to environmental disease is a public health problem in Indonesia. One of the causes is the behavior of open defecation. Depok Village RT 03 RW 1 is3 an area that still often defecates openly, which is as much as 11.9%. One of the government's in-depth solutions to this problem is through the triggering method. Methods: This research is a research with a qualitative approach with a case study approach. The sampling technique or the determination of informants used in this research is snowball sampling. Data collection is done by observation, in-depth interviews, and documentation. Data analysis in this study used the Miles and Huberman technique. Results: The results of this study indicate that community participation in the STBM program, the first pillar of the community in Depok Village RT 05 RW 13, the community has participated both in community participation in receiving information, discussing and making decisions, and community participation in obtaining authority to manage resources and make decisions. Conclusion: It is hoped that the community will continue to improve the behavior of stopping open defecation and success or the achievement of a program cannot be separated from the participation of the community alone. Discussion: Analyzing community participation in receiving information, discussing, making joint decisions between the community and outsiders, and community participation in obtaining the authority to manage resources and make decisions about the STBM program. Pancoran Mas Health Center, Depok City.

This study aimed to evaluate the quality of life (QOL) of transgender (trans) people in Iran. In this cross-sectional study, participants were included in the study using the snowball sampling technique. Two hundred thirty-five transgender people from different provinces of Iran were identified and agreed to participate in the study. To measure the QOL of these individuals, we used the short form of the QOL SF-36 questionnaire, which was completed as self-administered. In this study, the highest and lowest mean scores of trans individuals’ QOL belong to the physical functioning (88.59 ± 13.81) and bodily pain (30.78 ± 25.68) domains, respectively. Moreover, the mean scores of mental health, emotional role, vitality, general health, and bodily pain domains were less than 50. Reassignment surgery, vocation, and age were significantly associated with quality of life score (P

This study aimed to explore post Covid-19 lockdown students’ satisfaction from some higher education institutions in Ethiopia. The study used descriptive and explanatory research designs. A total of 480 students were taken from twelve public Universities as a sample and 366 valid questionnaires were collected. Convenience and snowball sampling were used to select the employees from each University. Also, cross- sectional survey method was applied to collect data via a Likert scale questionnaire. Correlation and multiple regression modeling were used to predict the relationships. Initially, a pilot test was a sample of 35 students to check data scale reliability. The study found that all the independent variables (crush time, leadership, and students’ initiation, instructors’ commitment) variables had a statistically significant correlation with Students’ satisfaction. Moreover, the study founded that all the studied variables were predictors of students’ satisfaction (R2= 0.672); however, the predictors that had highest influence were instructors’ commitment and crushes time. Significant emphasis and devotion is required particularly on variables such as instructors’ commitment and crush time as they are identified as a significant influencer of students’ satisfaction. Universities shall focus on enhancing instructors’ commitment and they have to allocate adequate time as before COVID -19.

Objectives Healthcare workers (HCWs) are considered an important target group for the COVID‐19 vaccines. The current study assesses the knowledge and attitudes of Israeli HCWs regarding COVID‐19 immunization, and how various occupational and demographic factors may underlie COVID‐related knowledge and attitudes differences. Methods Following a pre‐test to validate measures, a cross‐sectional online anonymous survey was distributed to HCWs using a snowball sampling method. Results The survey was completed by 714 participants (mean age 39.9; range 18–74; 447 female), 52% doctors, 32% nurses, and the remainder by paramedical staff. Of the respondents, 553 (77.4%) answered the question are you in favor of getting the COVID‐19 vaccine, 105 (14.7%) were not sure, and 56 (7.8%) were not in favor. Doctors had higher odds of agreement as compared to both nurses (p

Objectives Since 2016, Canada has allowed for euthanasia based on strict criteria under federal medical assistance in dying legislation. The purpose of this study was to determine how Canadian intensivists perceive medical assistance in dying and whether they believe their approach to withdrawal of life-sustaining therapies has changed following introduction of medical assistance in dying. Design Electronic survey. Setting Participants were recruited from 11 PICU programs and 14 adult ICU programs across Canada. All program leaders for whom contact information was available were approached for participation. Participants We invited intensivists and critical care trainees employed between December 2019 and May 2020 to participate using a snowball sampling technique in which department leaders distributed study information. All responses were anonymous. Quantitative data were analyzed using descriptive statistics. Categorical variables were analyzed using Pearson chi-square test. Interventions Not applicable. Measurements and main results We obtained 150 complete questionnaires (33% response rate), of which 50% were adult practitioners and 50% pediatric. Most were from academic centers (81%, n = 121). Of respondents, 86% (n = 130) were familiar with medical assistance in dying legislation, 71% in favor, 14% conflicted, and 11% opposed. Only 5% (n = 8) thought it had influenced their approach to withdrawal of life-sustaining therapies. Half of participants had no standardized protocol for withdrawal of life-sustaining therapies in their unit, and 41% (n = 62) had observed medications given in disproportionately high doses during withdrawal of life-sustaining therapies, with 13% having personally administered such doses. Most (80%, n = 120) had experienced explicit requests from families to hasten death, and almost half (47%, n = 70) believed it was ethically permissible to intentionally hasten death following withdrawal of life-sustaining therapies. Conclusions Most Canadian intensivists surveyed do not think that medical assistance in dying has changed their approach to end of life in the ICU. A significant minority are ethically conflicted about the current approach to assisted dying/euthanasia in Canada. Almost half believe it is ethical to intentionally hasten death during withdrawal of life-sustaining therapies if death is expected.

Yi Luo,1,&ast; Suding Fei,1,&ast; Boxiong Gong,2 Tongda Sun,3 Runtang Meng4 1School of Nursing, Ningbo College of Health Sciences, Ningbo, Zhejiang, People’s Republic of China; 2Department of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China; 3Research Institute of Health Service, Ningbo College of Health Sciences, Ningbo, Zhejiang, People’s Republic of China; 4School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Runtang MengSchool of Public Health, Hangzhou Normal University, No. 2318, Yuhangtang Road, Yuhang District, Hangzhou, Zhejiang, 311121, People’s Republic of ChinaEmail mengruntang@hznu.edu.cnObjective: There is an increasing amount of evidence exploring the adverse effects of perceived stress or anxiety and depression independently on sleep quality during the COVID-19 outbreak, although the underlying mechanisms are unclear. The aim of the current study was to explore the role of anxiety and depression as a potential mediator between perceived stress and sleep quality among health care workers.Methods: Data were collected through an online survey using the snowball sampling method and comprised 588 current health care workers in Zhejiang and Hubei provinces, China, from February to March 2020. We administered the Sleep Quality Questionnaire (SQQ), the Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-4) and the sociodemographic characteristics and COVID-19-related characteristics questionnaire. Structural equation modelling (SEM) was used to examine the direct and indirect relationships between perceived stress, anxiety and depression, and sleep quality.Results: The average scores for sleep quality and perceived stress were 16.01 (95% CI [15.40, 16.57]) and 15.46 (95% CI [15.05, 15.87]), respectively. The positive rates of anxiety and depression symptom tests were 9.86% and 10.37%, respectively. The SEM results indicated that the original relationship between perceived stress and sleep quality was beta = 0.52 (P < 0.001) and reduced to beta = 0.25 (P = 0.045) while introducing anxiety and depression as mediating variables. Perceived stress was positively associated with anxiety and depression (beta = 0.78, P = 0.014), and anxiety and depression were positively associated with sleep quality (beta = 0.42, P < 0.001).Conclusion: Poor sleep quality and high perceived stress were common during the COVID-19 crisis. Reducing perceived stress could help reduce anxiety and depression symptoms, thereby improving sleep quality among health care workers. In an attempt to promote psychological resources, we should perhaps take multiple measures, including personal tailored intervention and organizational humanistic concern.Keywords: health care workers, sleep quality, anxiety, depression, perceived stress, COVID-19

Background Perinatal mental disorders are a leading contributor to morbidity and mortality during pregnancy and postpartum, and are highly treatable when identified early. However, many women, especially in low and middle-income countries, lack access to routine identification and treatment of mental illness in public health settings. The prevalence of perinatal depression and anxiety disorders, common mental disorders, is three times higher for South African women relative to women in high-income countries. The public health system has begun to integrate mental health into maternal care, making South Africa a relevant case study of perinatal mental healthcare. Yet studies are few. We sought to investigate healthcare providers’ perceptions of the barriers to early identification and screening of common perinatal mental disorders in public health facilities in South Africa. Methods Employing qualitative methods, we used purposive sampling to identify study participants, supplemented by snowball sampling. From September 2019–June 2020, we conducted in-depth interviews with 24 key informants in South Africa. All interviews were recorded and transcribed verbatim. We used a thematic approach to generate initial analytical themes and then conducted iterative coding to refine them. We adapted a delivery systems’ framework to organise the findings, depicted in a conceptual map. Results Reported barriers to early identification and treatment of mental illness in the perinatal period encompassed four levels: (1) structural factors related to policies, systems and resources; (2) socio-cultural factors, including language and cultural barriers; (3) organisational factors, such as lack of provider preparation and training and overburdened clinics; and (4) individual patient and healthcare provider factors. Conclusion Barriers act across multiple levels to reduce quality mental health promotion and care, thereby creating an environment where inequitable access to identification of mental disorders and quality mental health services was embedded into systems and everyday practice. Integrated interventions across multiple levels are essential to improve the early identification and treatment of mental illness in perinatal women in South Africa. We provide recommendations derived from our findings to overcome barriers at each of the four identified levels.

Background Substantial strategies to reduce clinical documentation were implemented by health care systems throughout the coronavirus disease-2019 (COVID-19) pandemic at national and local levels. This natural experiment provides an opportunity to study the impact of documentation reduction strategies on documentation burden among clinicians and other health professionals in the United States. Objectives The aim of this study was to assess clinicians' and other health care leaders' experiences with and perceptions of COVID-19 documentation reduction strategies and identify which implemented strategies should be prioritized and remain permanent post-pandemic. Methods We conducted a national survey of clinicians and health care leaders to understand COVID-19 documentation reduction strategies implemented during the pandemic using snowball sampling through professional networks, listservs, and social media. We developed and validated a 19-item survey leveraging existing post-COVID-19 policy and practice recommendations proposed by Sinsky and Linzer. Participants rated reduction strategies for impact on documentation burden on a scale of 0 to 100. Free-text responses were thematically analyzed. Results Of the 351 surveys initiated, 193 (55%) were complete. Most participants were informaticians and/or clinicians and worked for a health system or in academia. A majority experienced telehealth expansion (81.9%) during the pandemic, which participants also rated as highly impactful (60.1–61.5) and preferred that it remain (90.5%). Implemented at lower proportions, documenting only pertinent positives to reduce note bloat (66.1 ± 28.3), changing compliance rules and performance metrics to eliminate those without evidence of net benefit (65.7 ± 26.3), and electronic health record (EHR) optimization sprints (64.3 ± 26.9) received the highest impact scores compared with other strategies presented; support for these strategies widely ranged (49.7–63.7%). Conclusion The results of this survey suggest there are many perceived sources of and solutions for documentation burden. Within strategies, we found considerable support for telehealth, documenting pertinent positives, and changing compliance rules. We also found substantial variation in the experience of documentation burden among participants.

Objectives: To investigate the degree of public awareness, beliefs, and attitudes regarding major depression and available treatment options in the Saudi population. Methods: A community-based cross-sectional study of 1,188 participants was carried out from March to April 2021 in Ha’il, Saudi Arabia using an online self-administered questionnaire. Using a snowball sampling technique, the authors targeted the Saudi population living in Ha’il region. Results: Overall, 65.6% of the participants had good awareness regarding depression disorder in total. Of the participants, 72.9% had good awareness regarding general awareness, 85.4% regarding depression symptoms, 12.3% regarding risk factors, and 15.7% regarding treatments. Of the participants, 67.3% believed that depression was caused by lack of faith and 45.5% believed that depression was caused by “the evil eye” or black magic. Of the participants, 56% believed in faith healers as a legitimate treatment approach. Of the participants, 63.9% were willing to work with individuals with depression, 62.7% were willing to establish friendships with them, and 27.9% believed that individuals with depression had weak personalities. Conclusion: The general population exhibited good general awareness regarding depression and its symptoms, but knowledge of risk factors and treatments was poor. Our findings underscore the need for public educational programs to increase public awareness about the risk factors and treatment options for depression.

Background In 2018, Rwanda launched a 5-year hepatitis C virus (HCV) elimination plan as per the World Health Organization global targets to eliminate HCV by 2030. To improve awareness of HCV status, strategies are needed to ensure easy access to HCV testing by as-yet unreached populations. HCV-self-testing, an innovative strategy, could further increase HCV testing uptake. This assessment explores perceptions around HCV self-testing among members of the public and healthcare workers in Rwanda. Methods A qualitative study was undertaken in Masaka District Hospital, comprising individual interviews, group interviews and participatory action research (PAR) activities. Purposive and snowball sampling methods guided the selection of informants. Informed consent was obtained from all participants. A thematic analysis approach was used to analyse the findings. Results The participants comprised 36 members of the public and 36 healthcare workers. Informants appreciated HCV self-testing as an innovative means of increasing access to HCV testing, as well as an opportunity to test privately and subsequently autonomously decide whether to seek further HCV care. Informants further highlighted the need to make HCV self-testing services free of charge at the nearest health facility. Disadvantages identified included the lack of pre/post-test counselling, as well as the potential psychosocial harm which may result from the use of HCV self-testing. Conclusion HCV self-testing is perceived to be an acceptable method to increase HCV testing in Rwanda. Further research is needed to assess the impact of HCV self-testing on HCV cascade of care outcomes.

The aim of the study was to analyze marketing channel, marketing margin, and marketing efficiency of in North Sulawesi, Indonesia. The research was conducted in two cities, such as City of Manado and Tomohon, and one regency, such as Regency of Minahasa, as the trade center of cattle in North Sulawesi province. There were 120 respondents, consisting of 100 farmers, 10 livestock brokers or intermediaries, 5 collecting traders (business scale of 20-30 cattle), and 5 end user or end consumer of live beef cattle, business consumer, and owner or user of abattoirs as well as beef distributors in North Sulawesi. The determining of respondents was snowball sampling starting with information of farmers as owner or user of abattoirs or slaughterhouse as well as both business and end users or end consumers of beef cattle. Analysis of marketing channel was performed by descriptively qualitative analysis via interview to marketing agencies and farmers of beef cattle, likewise with the analysis of marketing margin and marketing efficiency. The result of study showed marketing channel of beef cattle from farmers in North Sulawesi consists of two channels, such as via livestock brokers or intermediaries and through collecting wholesalers. the marketing margin of live beef cattle in North Sulawesi was large enough as of IDR 8,400,000, where the biggest marketing margin was on end users or business consumers. The market of beef cattle in North Sulawesi tends efficient due to the equal profit share and share of marketing cost in each marketing agency.

Previous research suggested that regular physical activity (PA) is beneficial in both prevention and treatment of physical and mental conditions. Danish general practitioners' (GPs) have an ideal position to motivate inactive patients to increase their PA. Social prescribing (SP) enables GPs and other healthcare professionals in primary care to link patients to community-based activities of support provided by the community and the voluntary sector. This interview-based study aimed to explore viewpoints among Danish GPs regarding the advantages and disadvantages of applying SP to promote PA. The GPs were recruited through snowball sampling. Semi-structured interviews with nine Danish GPs were held via telephone or via Skype video conference. All interviews were audio-recorded and transcribed. Data were managed using the program NVivo 12 and analysed using the Framework Method procedure for analysis. The findings highlighted the need for tools to support GPs in providing an overview of patient-tailored options for PA in the local community. Advantages of applying SP to promote PA were related to the social aspect, the non-medical approach to a healthier lifestyle and the GPs' opportunity to signpost patients to PA in their local community. A supporting link-worker facilitating a bridge between general practice and community-based activities was identified as a pivotal component, specifically among patients with complex needs. Disadvantages of applying SP to promote PA were related to patients' expectations to general practice, stigmatising attitudes of society and lack of financial resources in patients. This study is the first to explore SP to promote PA in a Danish context. There is a need for an easy-to-use tool to support GPs in providing specific PA counselling. On this basis, SP appears as a promising tool for GPs to promote PA.

Purpose – The aim of the research is to determine the effect of psychosocial welfare measures such as impulsive use of the internet, which is an indispensable element of life today, and the fear of missing out, on impulsive buying and its effect on fatigue and personal anxiety caused by internet use. Design/methodology/approach – The main mass of the research consists of consumers who live in any province of Turkey, are 18 years of age and older, and shop online. Survey technique was used to collect data and surveys were created via Google Forms. Snowball sampling method was used. 5 scales used in the survey; They are “Impulsive Use”, “Fear of Missing Out”, “Impulsive Buying”, “Internet-Induced Fatigue” and “Anxiety”. The research data were analyzed with IBM SPSS 24 and IBM AMOS 27 statistical package programs. Structural equation modeling was used to test the hypotheses. Previously, frequency analysis of demographic variables, compatibility of data to normal distribution, exploratory and confirmatory factor analysis, reliability analysis were performed. Findings – According to the results of the research, when the observation values ​​of the variables were examined, the skewness and kurtosis values ​​of the variables were found to be between -2 and +2, and it was seen that they met the normal distribution condition. After the exploratory factor analysis, the factor loading of a question of the “Fatigue due to Internet” variable was less than 0.50 and the total explained. variancewas low, this 1 question was removed and confirmatory factor analysis was performed. It was determined that the goodness of fit values ​​of the confirmatory factor analysis were valid. As a result of the structural equation modeling, all four hypotheses were accepted and it was found that there was a significant and positive interaction between all tested relations. Impulsive use positively affects impulsive buying at a rate of 0.479, fear of missing out positively affects impulsive buying at a rate of 0.250, impulsive buying positively affects fatigue due to internet with a positive rate of 0.395 and impulsive buying anxiety positively with a rate of 0.323. Discussion – It has been observed that most of the data obtained as a result of the analysis support the relevant literature. However, some findings specific to this study, which had not been investigated before, were also reached. Various suggestions have been developed in line with the analysis results of the research.

Introduction: Given the recent constraints imposed due to the ongoing COVID-19 pandemic and the importance of the daily light-dark cycle for entraining the human circadian system, it is possible to state that the elderly are likely to be at serious risk of experiencing sleep-related problems. Whilst reduced or limited time outdoors, and thus, exposure to diurnal bright light appear to be detrimental to sleep and emotional well-being in old age, further research is required to confirm this relationship. Materials and Method: To build on earlier work, a two-week study was conducted in a sample of 79 community-dwelling older adults recruited by using snowball sampling method. Throughout the study, the participants were allowed to be outdoors from 10.00 a.m. to 1.00 p.m. on weekdays. Whilst the participants were performing their daily habitual activities, they were asked to keep an activity diary and report on their sleep quality and emotional wellbeing using two questionnaires. Results: The results demonstrated that participants’ daily time spent outdoors (49.13 minutes on average) positively correlated with their perceived sleep quality and emotional well-being at various –– but significant –– levels (p

This study aims to describe the impacts of development of Pela Village as a tourist village in Kutai Kartanegara, East Kalimantan. Pella village has very unique tourism potential to be developed. For the sustainability of tourism development in the tourist village of Pela, it is important to pay attention to the impacts of devel-opment of a tourism village. The data were collected by observation, interviews, and literature study. Inform-ants are taken from community leaders who understand the impacts of tourism development in the village using snowball sampling techniques. Data were analyzed by descriptive qualitative. The results showed that the development of Pela Village as a tourism village able to provide positive impacts for people's lives, both in terms of economic (as lodging business, tour operators, open food stalls); social (effective interactions occur between members of the community): cultural (keeping traditional fishing gear, Kuntau art, and the development of Jepen Dance); environmental (cleaning the village environment), and political dimensions (prioritized local communities as labor). The positive impacts is able to increase the enthusiasm of the local community in supporting the development of tourist villages. It is hoped that stakeholders will play an active role in supporting the development of Pela Tourist Village in the form of guidance, counseling, management, and promotion.

Aims: To identify the incidence and type of sharps injuries within a UK nursing student population. Background: Evidence suggests that nursing students sustain sharps injuries across the world, but there is a lack of data from the UK. Design: Questionnaire survey. Methods: A survey was administered to a volunteer sample of nursing students (n=1015) in a university, following which the survey was distributed to nursing students nationwide using snowball sampling via social media. Datasets from 1015 nursing students were available for analysis. Results: Sharps injuries were most likely to occur with glass ampoules, when preparing injections and to occur in the second year of the programme. Contributing factors to sharps injury were identified, with inexperience being the primary cause. Some nursing students reported psychological impacts after sustaining the sharps injury. Conclusion: Sharps injuries are common among nursing students, and can have many psychological consequences for an individual.

The development of rigorous, high-quality clinical guidelines increases the need for resources and skilled personnel within guideline-producing organizations. While collaboration between organizations provides a unique opportunity to pool resources and save time and effort, the collaboration presents its own unique challenges. To assess the perceived needs and current challenges of guideline producers worldwide related to guideline development and collaboration efforts. Survey questions were developed by the Guidelines International Network and the US GRADE Network, pilot-tested among attendees of a guideline development workshop, and disseminated electronically using convenience and snowball sampling methods. A total of 171 respondents representing 30 countries and more than 112 unique organizations were included in this analysis. The survey included free-response, multiple-choice, and seven-point Likert-scale questions. Questions assessed respondents’ perceived value of guidelines, resource availability and needs, guideline development processes, and collaboration efforts of their organization. Time required to develop high-quality systematic reviews and guidelines was the most relevant need (median=7; IQR=5.5–7). In-house resources to conduct literature searches (median=4; IQR=3–6) and the resources to develop rigorous guidelines rapidly (median=4; IQR=2–5) were perceived as the least available resources. Difficulties reconciling differences in guideline methodology (median=6; IQR=4–7) and the time required to establish collaborative agreements (median=6; IQR=5–6) were the most relevant barriers to collaboration between organizations. Results also indicated a general need for improvement in conflict of interest (COI) disclosure policies. The survey identified organizational challenges in supporting rigorous guideline development, including the time, resources, and personnel required. Connecting guideline developers to existing databases of high-quality systematic reviews and the use of freely available online platforms may facilitate guideline development. Guideline-producing organizations may also consider allocating resources to hiring or training personnel with expertise in systematic review methodologies or utilizing resources more effectively by establishing collaborations with other organizations.

Purpose While the financial relief efforts are struggling to keep up with the COVID-19 outbreak, there is a need for the diffusion of e-Zakat initiatives and work with fintech if governments truly strive to ensure that most vulnerable do not fall behind. The newly launched e-system – popularly known as ZAKATY (e-portal and smartphone application) – in Saudi Arabia is an example worth attention and study on how well people can accept and use the system and Zakat payer-centric e-services, especially amid such uncertain times. The purpose of this study is to explore how an extended unified model of acceptance and use of technology (UTAUT) can induce users to adopt the ZAKATY e-services provided by the General Authority of Zakat and Tax during this unprecedented challenge to pay Zakat online in an easy, fast and reliable way. Design/methodology/approach Drawing on a quantitative approach through an online administered survey, a total of 479 usable responses from individual Zakat payers were obtained using snowball sampling and analyzed through smart partial least squares (SmartPLS) software. Findings This study confirms the suitability and utility of the UTAUT model used in predicting Zakat payers’ intention to adopt the e-Zakat system and its services, indicating that the model possesses 72% of the predictive capability to explain variance in intentions. It also shows that all UTAUT constructs (i.e. performance expectancy, social influence and facilitating conditions) were statistically significant, except for effort expectancy. Online trust exerted a significant moderating effect on the relationship between UTAUT constructs and users’ intentions to uptake the system’s online services amid COVID-19. Practical implications To keep pace with rapid digital transformations amid the pandemic, Zakat institutions, as governmental entities, are likely pursuing to identify the main determinants that influence people’s intentions to engage in adopting e-Zakat services. This could be eventually translated into maximizing the proceeds of Zakat funds by developing ICT-based infrastructure and introducing reliable and efficient e-services that can be adopted by users. Originality/value Given the scarce literature on the relevance of e-Zakat systems’ adoption, this work could serve as a building block and springboard for literature and future research by empirically examining an extended framework derived from the UTAUT theory in the Zakat context.

This study aims to describe the application of the purchasing accounting system in the company and evaluate the internal control system in the company's purchasing accounting system. This research utilizes qualitative methods. The scope of research conducted in this study is an evaluation of internal control in the purchasing system at PT. Mulia Safety Service, which is located at Jl. Eastern Silver No. 232, Surabaya. Total respondents were determined using the snowball sampling technique—respondents who were selected to be key informants from the information manager of PT. Mulia Safety Service, then continued to other respondents based on recommendations from key respondents with assumptions related to the research conducted. Meanwhile, data analysis was carried out by collecting data, reducing data, presenting data, and analyzing data. The results showed that the internal control system for the purchasing accounting system at PT. Mulia Safety Service Surabaya is still not comprehensive. This is due to the dual function of the purchasing department (purchase function and receiving function) and the lack of document distribution (goods receipt form), which should also be accepted by the accounting department. Therefore, some improvements are needed. First, by creating a separate receiving section as a reception function or by giving this authority to the inventory section, and secondly, the receiving function also creates documents (goods receipt forms) so that not only the purchasing and inventory departments receive them but also the accounting department. This improvement is expected to optimize the purchasing accounting system at PT. Mulia Safety Service Surabaya.

Background: The second wave of the COVID Pandemic spread like wildfire, wreaking havoc on the healthcare system. Medical practitioners must have sufficient knowledge and practice to avoid getting infected and to limit the danger of disease transmission among patients. We conducted this study to assess the current Knowledge, Attitude, and Practice towards COVID-19 among medical practitioners in India. Methods: An online cross-sectional questionnaire based study on COVID-19 was conducted among Medical practitioners using snowball sampling technique over 1 month period (16th April 2021 to 15th May 2021). Knowledge, Attitude, Practice score relation to independent variables and correlation between scores were analyzed. Results: Out of 306 responses assessed, The Mean Knowledge score was 55.2±10.5 and 52.9% had Knowledge above the mean. Overall attitude score was 62.5±23.1, Only 46.4 % were confident in managing a COVID patient. The Overall practice score was 89.8±16 which is better compared to Knowledge and attitude. A statistically significant (p=0.04) higher knowledge was observed among Postgraduates. Males (p=0.03) and older people (p =0.002) had better attitude. Superspecialists had statistically significant better practice (p=0.006). Knowledge and attitude score correlation (p=0.03), symptom spread vs treatment outcome score difference (p=0.0005) were statistically significant. Conclusion: Only half of the medical practitioners had good Knowledge about COVID 19. Only less than half had confidence in managing COVID patients and also there was a lacuna in PPE usage. A unified treatment protocol and periodic training could improve clinical knowledge. Stronger healthcare and positive reinforcement of preventive practices could help in better handling of the pandemic in the future. Keywords: COVID-19, Pandemic, Knowledge, Attitude, Practice, Medical Practitioners, India, second wave

WeChat, a Chinese multi-purpose messaging, social media, and mobile payment app, is an emerging social media platform that has been integrated into the daily lives of Chinese people, including travel. However, despite the growing proliferation of WeChat, surprisingly, little attention has been paid to the gratifications obtained by Chinese travelers when using WeChat in travel-related decision-making. Adopting the well-grounded Uses and Gratifications Theory (UGT), this exploratory research paper aims to address this void in prior literature and identify why and how Chinese millennial travelers use WeChat to make hotel choice decisions. Findings stemmed from the semi-structured interviews using a combination of purposive and snowball sampling approaches with eighteen WeChat users reveals that hotel choice decisions through WeChat are influenced by various social, process, and content gratifications. As indicated in our findings, hotels in China should be aware of gratifications obtained by travelers in stimulating them to utilize WeChat in the hotel selection process. Further, our study contributes to extant UGT literature by emphasizing that it has specific relevance and should be given more prominence within tourism, hospitality, and social media literature.

The lockdown during the first phase of COVID-19 pandemic in India triggered an unprecedented humanitarian crisis. Labourers in the informal sector lost their jobs overnight and were stuck at their work places. The present study examines the risk of COVID-19 transmission among stranded migrant labourers and their livelihood challenges during the lockdown. A telephonic survey was conducted during the lockdown of first wave of COVID-19 pandemic to collect information from the stranded migrant labourers. The non-probability snowball sampling technique and structured questionnaire were used to draw the sample. Simple frequency distribution and standard statistical methods were used to accomplish the study objectives. The factors of COVID-19 transmission such as poor housing, co-morbidities, poor practice of WASH and COVID-19 precautions were significantly high among the migrant labourers. The lockdown created livelihood crisis among them. For instance, ration shortage (86%), financial distress (82%), reduction of wages (13%), job loss (86%) and anxiety for COVID-19 infection (81%) were often seen. Many of the labourers did not receive any ration kits (30%) and financial assistance (86%) during lockdown. The governmental assistance to overcome the stranded migrant labourers' challenges during lockdown was less than desirable. India needs to frame a sustainable and effective policy for social security for labourers, particularly in emergency situations.

Objective: This study aims to determine the effects of cachexia, causing major problems in the world and Turkey, on self-care agency and quality of life in cancer patients. Methods: The population of this cross-sectional and relationship-seeking study consisted of cancer patients in Turkey from April 1 to April 20, 2021. Using the snowball sampling method, 174 patients were sampled. “Patient Information Form,” “The European Organization for Research and Treatment of Cancer C30 Cancer Quality of Life Scale,” and “Exercise of Self-Care Agency Scale” were used as data collection tools. Results: In the study, 52 patients (29.9%) were found to have cachexia. Function, general well-being, symptom (except insomnia), and self-care agency, which are subdimensions of the quality-of-life scale, were found to be significantly lower in patients with cachexia than patients without cachexia (P < 0.001). It was determined that there was a significant negative correlation between the cachexia status of the patients and the five basic functions in the functional scale (physical, role, emotional, cognitive, and social function), general well-being, and self-care agency, and there was a significant positive correlation between the cachexia status of the patients and the symptom scale (P < 0.001). According to the results of multiple linear regression analysis, it was found that the factor that significantly affected the cachexia status of the patients was their self-care agency (P < 0.001). Conclusions: It was determined that cachexia caused significantly lower self-care agency and quality of life in cancer patients. Furthermore, quality of life was related to self-care agency.

Background: Empirical evidence suggests that stress related to a period of tribulation tends to weaken the system, further increasing the danger of diseases. Given this fact, additionally to having a high risk of contracting COVID-19, partly attributed to suboptimal protection, HCWs are susceptible to poor psychological state outcomes. Objective: This study aims to assess and compare demographic and psychological factors amongst frontline healthcare workers like young doctors Method: A cross sectional online survey was conducted by sharing Zung self-administered anxiety questionnaire using Google form. The consent was obtained from 100 participants and snowball sampling method was followed in the study. The Chi square and p value was also calculated to ascertain any significance level and association between different variables. Results: Out of 100 participants, 13(13.5%) were found to have anxiety disorder. Males were found to have higher anxiety level than females. Conclusion: The early identification of the psychological distress and a timely intervention will improve the quality of life of doctors and also reduce the severity of the psychological sequelae. © 2021, MedSci Publications. All rights reserved.

Intramuros, also known as the "Walled City," is one of the Philippines' prides and a top tourist spot in Manila. If marketed well, more people will go down memory lane and learn about this must-see destination. One will venture into its culture and learn the history within the walls. To make use of this advantage, a platform is effective. Thus, social media impact is seen nowadays as an effective way to create an impact in the tourism industry. This study aims to explore how social media affected the tourism growth in Intramuros as perceived by tourists from National Capital Region. This descriptive study utilized snowball sampling resulting in 400 respondents from the National Capital Region, aged 18 and above, who visited Intramuros. The findings revealed that social media has a significant part in Intramuros' tourism growth. Thus, social media serves as a popular platform among visitors to research trips and share their travel's most significant memories. Reviews and Feedback help determine the needed improvement of Intramuros, and social media serves as a cost-effective way to reach target audiences. The walled city's cultural, historical, and religious benefits are some of the factors that influence the tourist to visit Intramuros.

It has been almost a half year since COVID-19 has forced all nations to speed up their outbreak preparedness as it simultaneously created significant public anxiety. This study investigated the canonical relationship between factors of COVID-19 preparedness and anxiety and proposed a conceptual model framework on these factors in the contexts of Thailand. This mixed-methods study employed an explanatory sequential design to conduct a two-phase exploration. Quantitative data were collected in the first phase using online questionnaires. The sample included 2808 respondents selected through a convenience and a snowball sampling. Data collection was conducted from March 29 to May 16, 2020, and content analysis was employed to process these data. The quantitative analysis with canonical relationship between COVID-19 preparedness and anxiety was 0.403 at a moderate level (p-value < 0.01). Thai citizens with high preparedness on risk mitigation and long-term outbreak mitigation planning tended to congruently demonstrate high anxiety towards responses of the government and public sectors, corruption, and misconduct. The conceptual model framework of qualitative analysis on preparedness were classified into three levels, i.e., individuals, families and communities, and social networks. COVID-19 anxiety that was related to a) responses of the government and public sectors, and b) corruption and misconduct, and also showed direct impacts on work and life anxiety. Thai citizens recognized and understood that self-reliance is mostly needed to relieve pandemic-related anxiety. Cooperation with public and private bodies on precautionary measures was deemed essential to prevent a second wave of spread.

Introduction: HIV/AIDS phenomenon is one of the most serious public health challenges which includes wide range of epidemiological, social, economic and political dimensions. Therefore, its effective control requires involvement of different stakeholders. The present study aims to identify and analyze HIV/AIDS stakeholders in Iran.Methods: This qualitative stakeholder analysis was conducted in 2018 nationwide both retrospectively and prospectively. Identification and analysis of stakeholders was carried out by the review of related literature and policy documents and official websites, as well as holding semi-structured interviews with policy makers and other key informants. Purposive sampling was utilized and followed by snowball sampling until data saturation. Data were analyzed using framework analysis. Also, qualitative data analysis software MAXQDA (Version 11) and Policy Maker software (version 4) were applied.Findings: A total of 44 stakeholders were identified and categorized into 23 active and 21 inactive stakeholders. Despite the great importance of educating and informing pubic about HIV/AIDS, the Ministry of Education and Islamic Republic of Iran Broadcasting organization (IRIB), have moderate participation in this regard. Supreme Council of Health and Non-governmental organizations (NGOs) have low participation. The Ministry of Health and Medical Education (MoHME), State Welfare Organization of Iran, Iranian Blood Transfusion Organization, the State Prisons and Security and Corrective Measures Organization are interested in HIV/AIDS policymaking. The MoHME, as main body responsible for stewardship of the HIV/AIDS in Iran, does not have enough authority in handling the issue due to the low funding, institutional and structural deficits and insufficient human resources.Conclusion: The process of HIV/AIDS policy making is fragmented in Iran and despite multiple active and passive stakeholders in this field, there is no integrated system to involve all stakeholders in the process of AIDS policy-making. Therefore, given the importance of the issue, an upstream entity is needed in order to coordinate and mobilize all stakeholders associated with managing and controlling HIV/AIDS.

BackgroundStructural racism mediates all aspects of Black life. The medicalization of pregnancy and childbirth, and its detrimental impacts on Black birth, is well documented. The Black Lives Matter movement has elevated the national consciousness on all aspects of Black life, but significant attention has been directed toward the murder and dehumanization of Black men and boys. Black midwives, caring for Black people, using the Midwives Model of Care© which consistently demonstrates its efficacy and better outcomes for Black people, are uniquely positioned to witness the physical and psychosocial experiences of birthing Black boys in America.MethodsBetween 2011 and 2013, the first author conducted interviews with 22 Black midwives to understand their perceptions of, and experiences in, predominantly white midwifery education programs and professional organizations. Convenience and snowball sampling were used. This paper investigates previously unreported and unexamined data from the original study by focusing on the witness and insight of nine midwives who provided care for Black mothers of boys during pregnancy and childbirth.FindingsThe data presented three themes: It’s a Boy: On Restlessness and Complicated Uneasiness; Desensitization of Black Death; and, Physiological Impacts of Toxic Stress.ConclusionsThe findings demonstrate that caring for Black people must be simultaneously theorized and executed within an anti-racist, relationship-centered, reproductive justice framework. Black midwives are uniquely positioned to do this work. Greater attention, in practice and in research, is needed to investigate the birth experiences of Black mothers of boys.

Purpose During the Coronavirus Disease 2019 (COVID-19) pandemic, some changes in dietary intake were observed. However, the determinants of food choice and adherence to the Mediterranean diet (MD) in this period were not studied so far for Iranian adults. This study aimed to assess the food choice determinants changes and Adherence to the MD of Iranian adults. Design/methodology/approach This study was a cross-sectional study that was conducted from April 2019 to May 2020, based on the snowball sampling, and a total number of 2,540 adults from all the regions of Iran participated. The Food Choice Questionnaire was used to analyze food choice determinants, and the validated ten-item MD adherence screener was used to assess the adherence to the MD. Findings Before the COVID-19 quarantine, sensory appeal and price were the most important factors in Iranian food choice (with the highest scores), but during the COVID-19 pandemic the important food choice determinants were health and weight control. Consumption of vegetables (71.85% vs 40.07%), fruits (60.70% vs 38.74%), legumes (24.72% vs 12.38%) and nuts (14.33%) increased significantly after the outbreak of quarantine.

The aim of this descriptive study was to examine the views of parents with children between the ages of 3-6 on their children's daily life activities during the pandemic. The study sample was composed of 65 parents, among whom 60 were mothers, and five were fathers, who were selected with the snowball method and who had children between the ages of 3-6 and voluntarily participated in the study. The data were collected through the General Information Form and the Family Interview Form, which were developed in line with expert opinions. The collected data were analyzed using percentage and frequency values. The findings suggested that, during the pandemic, the children's family relationships were positively affected; the duration of using technological tools increased; the children started to wash their hands more carefully; and duration of activities, such as drawing and chores, and plays increased. It was also found that the children mostly preferred piece assembly games; their physical movement needs were not fully satisfied; and there was no change in their health conditions, self-care skills, diet, sleep patterns, interactive book reading, and purposes of using technology. In line with the findings, parents, experts were given specific recommendations.

The Covid-19 pandemic throughout 2020, made many community activities carried out at home. Thus, people are believed to use a lot of electrical energy for activities at home. The government has implemented various efforts in order to save energy by the community. . However, the visible phenomenon is that the use of electrical energy in households is still high. This study aims to determine the behavior of prepaid electricity consumption during the Covid-19 pandemic, which is carried out descriptively quantitatively, with a sample of 100 people through the snowball sampling technique. Collecting data through questionnaires and then tested using the Cochran Q-Test method. The results show that the behavior displayed by prepaid electricity consumers in consuming electricity during the Covid-19 pandemic is summarized as follows (1) Electricity is used to carry out activities at home, starting from gardening, in the kitchen, getting entertainment, studying, and working, 2) Electricity is used to support business opening shops during the Covid-19 pandemic, (3) The use of large electricity due to the large number of family members (4) The habit of forgetting to turn off electricity when leaving the house (5) Use of electricity to turn on the air conditioner all day longKeywords: consumer behavior, prepaid electricity, household sector, and the covid-19 pandemicJEL Classification: C42, D10, M00, O30DOI: https://doi.org/10.32479/ijeep.11403

Objectives: The purpose of this study was to determine the description of Antenatal Care in pregnant women infected with HIV/AIDS in Bonto Bahari District, Bulukumba Regency. Methods: This study used a qualitative method with a phenomenological approach. Data were collected through in-depth interviews with snowballing sampling techniques. The number of informants was six people consisting of one key informant and five primary informants. Results: The knowledge of pregnant women about HIV was low. In areas where HIV-infected pregnant women live, the health service centre is available such as a Public Health Centre (Puskesmas) that can be accessible. Pregnant women were looking for treatment at the Puskesmas around their area. Unfortunately, some pregnant women did not search for any treatment since they were afraid of their HIV status revealed by Health workers and people in Puskesmas. At Puskesmas, they only obtained poor service and discriminated from other non-HIV pregnant women. Those pregnant women acquired support from the family emotionally, financially, and information support. However, some of them also had no support from their families after knowing their illness. Conclusion: Knowledge of HIV/AIDS by pregnant women with HIV positive was low. After realising that their husbands were infected, they were furious and disappointed with their husbands. Besides, the health workers were not good at serving those pregnant women positively with HIV/AIDS. They tended to discriminate from other patients without HIV/AIDS. Family support for pregnant women was including emotional, financial, and information supports

BACKGROUND: Umbilical Cord Blood (UCB) stem cells are a non-invasive, effective alternative source of hematopoietic stem cells for the treatment of a variety of diseases. AIM: The aim of the study was to research knowledge, awareness, and attitudes of the general public and health professionals regarding the UCB storage. MATERIALS AND METHODS: A cross-sectional study was conducted with an online survey (n = 408) using the snowball method. RESULTS: A majority of respondents declared that they were not aware of UCB banking; however, people with an academic background in healthcare have a greater awareness of UCB banking. A subjective assessment found that their knowledge of UCB banking is better than that of non-professionals, however, they exhibited better knowledge and understanding of UCB use and banking in only a few aspects. People with an academic background in healthcare have a more polarized attitude toward cord blood banking and a higher percentage are unwilling to pay for UCB banking services. However, their preferences regarding public/private UCB banking do not differ significantly from those of non-professionals. CONCLUSION: Here, we show that there is not much difference between the laic and professional categories in terms of knowledge about the specific purpose and characteristics of UCB storage.