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Understanding the genetic structure and diversity of marine fish is crucial for a sustainable management program. We examined the genetic diversity and historical demographics of the yellowfin snapper, Lutjanus xanthopinnis Iwatsuki, Tanaka et Allen, 2015, in the coastal waters of east Peninsular Malaysia which is bordered by the southern part of the South China Sea using the mitochondrial genes (mtDNA) D-loop and Cytochrome b (Cyt-b). A total of 99 (D-loop) and 78 (Cyt-b) specimens of L. xanthopinnis were successfully sequenced from six locations within the range of species distribution along the Malaysian South China Sea. In the presently reported study, the lack of genetic differentiation among populations can be attributed to historical demographic events, eggs and planktonic larvae’ ability to disperse, spawning patterns, and the absence of physical barriers in the geographical landscape. Maximum likelihood gene trees demonstrated that the populations under study had limited structuring and formed a panmictic population that lacks support for internal clades. The AMOVA (Analysis of Molecular Variance) and population pairwise ФST values indicated high genetic exchange between the study areas. A high level of haplotype diversity (D-loop: 0.948–1.000; Cyt-b: 0.542–0.928), low nucleotide diversity (D-loop: 0.0095–0.0159; Cyt-b: 0.0022–0.0049) and starlike haplotype network indicates a recent expansion of L. xanthopinnis populations in Malaysian South China Sea. However, neutrality and goodness of fit tests revealed non-significant values. Furthermore, the BSP (Bayesian skyline plot) analysis estimated population expansion events during the late Pleistocene. During this epoch, the fluctuation in sea level may have led to an increase in the abundance of resources and favorable habitats for the yellowfin snapper. The presently reported findings could initiate efficient management strategies for L. xanthopinnis along the coastal areas of the Malaysian South China Sea and other nearby nations that share the same waterways.

Context: The COVID-19 epidemic has had a substantial influence on the mental health of chronic disease patients. However, there is a scarcity of research on them in Bangladesh. Aims: This study aims to explore the prevalence of and identify the risk factors for depression, anxiety, and stress symptoms during the COVID-19 pandemic among people with chronic diseases in Bangladesh. Materials and Methods: This cross-sectional study involving face-to-face and telephone interviews was carried out among Bangladeshi people diagnosed with chronic diseases between September and November 2020. The total sample size was 878, and a convenient sampling technique was used. Logistic regression analysis was performed to investigate potential influencing factors for depression, anxiety, and stress. Results: The mean age of respondents was 50.10 years. Among them, 35.0%, 36.0%, and 29.0% suffered from depression, anxiety, and stress symptoms, respectively. In multivariable logistic regression, depression had a significant positive association with higher age (≥60 years), lower income, rural residency, and loss of close family members due to COVID-19. Anxiety had a significant positive association with higher age (≥40 years), lower education, lower income, rural residency, and loss of close family members due to COVID-19. Stress had a significant positive association with higher age (≥40 years), no income, rural residency, and loss of close family members due to COVID-19. Conclusion: It is urgent to consider the risk of developing mental health distress among chronic disease patients, especially aged people, by health service providers and generate effective programs for emergency situations.

Objective Research over the past decade has extensively covered the benefits of electronic health records in developing countries. Yet, the specific impact of their limited access on doctors’ workload and clinical decision-making, particularly in Bangladesh, remains underexplored. This study investigates current patients’ medical history storage mechanisms and associated challenges. It explores how doctors in Bangladesh obtain and review patients’ past medical histories, identifying the challenges they face. Additionally, it examines whether limited access to digital health records is an obstacle in clinical decision-making and explores factors influencing doctors’ willingness to adopt electronic health record systems in such contexts. Method An online cross-sectional survey of 105 doctors with Bachelor of Medicine, Bachelor of Surgery/Bachelor of Dental Surgery (MBBS/BDS) degrees and at least 2 years of experience was conducted, covering (a) personal information, (b) workload, (c) patient history challenges, and (d) decision-making. Results Out of 105 participants, 51.4% of them use paper-based methods with 56% facing challenges, versus 20% using digital methods. Most (94.3%) interview patients directly, and 80.9% are interested in a web-based, comprehensive medical history system. An ordinal regression model identified that the physicians’ disciplines, workload, and efficiency level of the current workplace in facilitating patient history-taking variables significantly affected willingness to adopt the described electronic health record in the survey. Conclusion Doctors in Bangladesh encounter significant challenges related to workload and clinical decision-making, largely attributed to restricted access to patients’ past medical histories. Despite the prevalent use of paper-based records, there is a notable willingness among these medical professionals to embrace electronic health record systems, indicating a potential shift towards more efficient healthcare practices in the region.

Abstract The COVID-19 pandemic highlighted the urgent need to strengthen public health systems. In response, the United Nations Disaster Risk Reduction (UNDRR) Public Health System Resilience Scorecard (Scorecard) was applied in workshops across multiple countries. The aim of our research was to explore the workshop findings to develop priority strategies for strengthening public health system resilience. We conducted a workshop from 14 to 16 March 2023, at the UNDRR Global Education and Training Institute in Incheon, Republic of Korea. A sequential modified Delphi method was utilized to develop a set of prioritized resilience strategies. These were drawn from 70 strategies identified from 13 distinct workshops in eight countries. After two surveys, 23 strategies were finalized. Ten received ratings of “High” or “Very High” from 89% of participants. These related to the inclusion of public health risks in emergency plans, integrating multidisciplinary teams into public health, enabling local transport mechanisms, and improving the ability to manage an influx of patients. The Scorecard provides an adaptable framework to identify and prioritize strategies for strengthening public health system resilience. By leveraging this methodology, our study demonstrated how resilience strategies could inform disaster risk reduction funding, policies, and actions.

Understanding the reproductive biology of fishes is crucial to making accurate and scientifically sound recommendations for fisheries management. The presently reported study is the first to report the reproductive characteristics of the data-deficient and recently described yellowfin snapper, Lutjanus xanthopinnis Iwatsuki, Tanaka et Allen, 2015, collected from the eastern South China Sea, Malaysia. A total of 572 fish specimens were sampled monthly from March 2022 to April 2023 using a gillnet and a trawl net. Subsequently, these specimens were measured and weighed. Their total length (TL) ranged from 15.3 to 26.8 cm (19.25 ± 2.04 cm; mean ± SD). Their body weight (WB) ranged from 53.5 g to 279.7 g (114.5 ± 40.3 g; mean ± SD). For the reproductive biology study, the following parameters were determined: the sex ratio, gonadosomatic index (GSI), hepatosomatic index (HSI), spawning period, fecundity, condition factor (K), length at maturity, and the gonadal maturity stages. In the sex ratio, males (M) were significantly dominant over females (F) (M:F = 1:0.75) (χ2 = 11.18). Consequently, the monthly mean GSI of pooled sex revealed a consistent trend from January to August, indicating spawning seasons with peak periods in March and April. The batch fecundity of 67 mature females (16.0–25.2 cm TL; 64.5– 279.3 g W), was determined to range from 16 405 to 94 357 oocytes. The fecundity increased with gonad weight in contrast to weight and length. The length at first maturity of females and males was 14.53 and 20.56 cm, respectively. Females matured earlier than males. Macroscopic and histological examination of gonads revealed monthly variation in the ratio of gonad stages for males and females. This study offers crucial data on the reproductive biology of L. xanthopinnis, which will help with sustainable fishery management in this area and can be used as a reference for the management of similar fish populations in other regions of the world.

Background: Malnutrition is a major health concern among children especially in low and middle-income countries. However, there are limited studies on school health in Bangladesh. This study aimed to reduce malnutrition among primary school children in Bangladesh by increasing awareness and knowledge through school nurse-led health education. Methods and Materials: A prospective, open-label, parallel-group (1:1), cluster nonrandomized controlled trial on primary school children conducted in rural Bangladesh. The study lasted 13 months between September 2021 and September 2022. Four schools were selected and assigned to the intervention and control groups (CGs). Next, school nurses provided evidence-based health education to the children in the intervention group (IG) for 9 months to improve awareness and knowledge of malnutrition. Data were collected at baseline, midline, and endline. Results: Overall, 604 children were enrolled at the baseline; among them, 455 (CG, n = 220; IG, n = 235) completed the study. Changes in the malnutrition rate—the primary outcome—were not significant (P = 0.225). However, after adjusting the endline data with baseline and sociodemographic data, the children's body mass index improved significantly in the IG than in the CG (P < 0.05). Changes in eating behavior, and awareness and knowledge of malnutrition—the secondary outcomes—significantly differed between the groups (P < 0.001). Conclusion: The school nurse-led health education program significantly improved primary school children's awareness and knowledge of malnutrition. This study revealed the effectiveness of school nurses in reducing malnutrition among children, which may decrease future morbidity and mortality rates in children.

Background: Psychological distress may worsen during cancer treatment and affect well-being. Information on the prevalence of distress and its associated variables in cancer patients undergoing chemotherapy in rural Bangladesh has not been thoroughly explored. To address this, we aimed to assess psychological distress and its associated factors in patients with cancer undergoing chemotherapy. Methods: This cross-sectional study was conducted at a tertiary care hospital in rural Bangladesh. Only adult patients with cancer who were receiving chemotherapy were enrolled in this study. The validated Depression Anxiety Stress Scale was used to assess psychological distress. Frequency and percentages were used in descriptive analysis, and logistic regression analysis was performed to investigate potential associated factors for depression, anxiety, and stress. Results: Participants comprised 415 patients with a mean age of 46.3 years. The prevalence of depression, anxiety, and stress was 61.5%, 55.4%, and 22.0%, respectively. In the multivariate logistic regression analysis, patients with more than five family members and smokeless tobacco users had a significant association with depression, anxiety, and stress. In contrast, participants aged >60 years had a protective association with depression. Conclusions: Our findings show that patients with cancer receiving chemotherapy experience a high prevalence of depression and anxiety and that the use of smokeless tobacco and having six or more family members are associated with psychological distress. These findings will aid health professionals and policymakers in establishing and implementing improved care programs to ensure the greater mental health of cancer survivors, particularly in resource-limited settings.

Background: Excess salt consumption increases blood pressure, and therefore, this substudy was designed among rural hypertensive individuals to assess the baseline knowledge about hypertension (HTN), and dietary salt intake behavior and identify the potential predictors for urinary salt excretion in Bangladesh. Material and Methods: A total of 420 participants were enrolled after meeting the eligibility criteria during the 12 months of the study period. The participants received behavior changes related to short message services (SMS) and face-to-face education from community health workers. Results: Our study results found that 80% of the participants had positive knowledge of HTN. This study showed that the mean value of overnight urinary sodium excretion was 10.65 ± 3.00 at the 1st-month follow-up and 10.24 ± 3.03 at the endline. We found that mid-upper arm circumference (MUAC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly related to higher salt intake (P = 0.009, P = 0.011, and P = 0.005, respectively). However, participants had improved their MUAC, SBP, and DBP status in their 1st follow-up period, but still, significant associations were observed between them (P = 0.033, P = 0.011, and P = 0.002, respectively). Conclusion: This study's results found that sodium excretion among hypertensive participants was higher, and higher urinary sodium excretion was associated with overweight and BP in adults. Nonetheless, the real salt intake practice among the Bangladeshi population is still unknown, which demands further research.

Abstract Recurrent artery of Heubner (RAH) infarction is a potential complication following the surgical clipping of anterior communicating artery (A-comm) aneurysms. RAH plays a crucial role in supplying blood to the basal ganglia and anterior limb of the internal capsule. Understanding the pathogenesis, prognosis, and surgical result of RAH infarction is critical for providing the best care for patients. The literature study produced case reports and retrospective research on topics including the RAH infarct and A-comm aneurysm clipping. The importance of recognizing and controlling the risk of a RAH infarction in relation to A-comm aneurysm clipping is emphasized in this research. RAH infarction following clipping of an A-comm aneurysm has a complex pathophysiology, and by learning more about its causes, prognosis, and surgical results, medical personnel may better assist their patients. While further study is needed to overcome the obstacles highlighted here, the information presented here lays the groundwork for future research and adds to what is already known about the topic.

Adolescent girls are highly vulnerable to developing anemia due to reproductive immaturity, poor personal hygiene, and lack of nutritional intake and health education in rural Bangladesh. Digital health technology is a promising tool to overcome barriers and provide appropriate health guidelines. We aim to evaluate eHealth education's impact and changes in adolescent girls' knowledge, attitude, and practice regarding anemia. A 1:1 parallel randomized control trial was conducted among school-going adolescent girls in rural Bangladesh. A total of 138 anemic (mild and moderate) participants were enrolled. We randomized schools to reduce the health education bias through a simple coin toss technique, then allocated participants to the intervention group (n = 69) and control group (n = 69) by stratified random sampling technique. The intervention group received two online counseling sessions and 8-month eHealth education through mobile phone calls and short message service regarding anemia. The control group received the usual care. The primary endpoint changes the anemic level through changing knowledge, healthy lifestyle behavior, and an iron-rich food dietary plan. Per-protocol analysis will utilize to compare the control and intervention groups using SPSS software. Descriptive statistics (frequencies, percentages, mean, SD) will be employed, and continuous variables will be compared using the t-test/Mann–Whitney test. Two-way analysis of variance will assess outcome variables at baseline, 4 months, and 8 months. The 8-month intervention is designed from May 2022 to February 2023. Participants' age range of 10-14 years was 60.9% in the intervention group and 56.5% in the control group. Among the participants, 89.9% and 88.4% were mild anemic; 11.11 (SD ± 0.80) and 11.06 (SD ± 0.96) were mean hemoglobin in the intervention and control groups, respectively. eHealth education is expected to be an effective way to increase knowledge and healthy behavioral change, which can reduce the anemia burden among adolescent girls.

Capturing patients’ medical histories significantly influences clinical decisions. Errors in this process lead to clinical errors, which increase costs and dissatisfaction among physicians and patients. Physicians in developing countries are overloaded with patients and cannot always follow the proper history-taking procedure. The challenges have been acknowledged; however, a comprehensive understanding of the status and the remedies has remained unexplored. This paper aims to investigate the workload, history-taking challenges, and the willingness of the physicians to accept digital solutions. A cross-sectional online survey was conducted on 104 physicians across Bangladesh, featuring 22 questions regarding their professional environment, workload, digitization status of health records, challenges in history taking, and attitudes toward adopting digital solutions for managing patient histories; 92.67% of the physicians face high workloads, 88.46% struggle in medical history taking, and only 4.81% use digital medical records. About 70% struggle to complete the necessary history-taking steps, emphasizing the urgent need for solutions. A novel visualization system, the Smart Health Gantt Chart (SHGC), has been introduced for their instant feedback. A total of 93.27% of physicians expressed their willingness to use such a system. The proposed SHGC has the potential to enhance healthcare efficiency in developing nations, benefit physicians, and improve patient-centered care.

Abstract The once abundant delta smelt Hypomesus transpacificus is now on the verge of extinction. At the UC Davis Fish Conservation and Culture Laboratory, a refuge population has been maintained since 2008 as a safeguard against extinction and to breed and provide fish for research. Due to artificial aquaculture operations, it is assumed that the fish are impacted by life in captivity leading to questions about differences between cultured and captive wild fish. This study looked at the differences in fork length (FL), body weight (BW), fecundity (F) and condition factor (K) of cultured and wild (captive) delta smelt over the last 10 generations (2009–2018) to determine if there were any changes of life‐history traits between the two, which may indicate domestication. Results revealed that the cultured population had significantly higher FL, BW, F and K than the wild population. The correlation tests found significant positive relationships between all measured traits except FL and K of wild fish. Significant changes in the measured traits of the cultured population over time were found, whereas none was observed in most wild fish year‐classes. This study demonstrated changes of life‐history traits in a well‐managed fish population over 10 generations in captivity and provides critical information to the coming supplementation plan for the species.

Water pollution poses a global hazard to aquatic biota and ecological sustainability, causing a hazard to aquatic organisms such as fish. The aim of this study was to evaluate the impact of toxic chemical contaminants on histopathological biomarkers in the liver and kidney of olive barb (Puntius sarana) collected from the Surma River in comparison to a control group of fish. The histological bio-moni-toring assessment involved the sampling of thirty (30) table-sized fish collected from the four-sam-pling sites (i. Kajir Bazar, ii. Keane Bridge, iii. Shahjalal Bridge and iv. Burhanuddin Majar) of the Surma RiveronamonthlybasisduringtheperiodofSeptember2019toFebruary2020.Twenty(20)ta-ble-sizedfishofthesamespecieswererearedintheFishDiseaseDiagnosisandPharmacologyLaboratory, which has a controlled water quality system. In the present study, the river temperature was found to range from 19.7±1.57°C to 30.00±1.29°C. Dissolved oxygen of the surface water was observed to range from 4.15±0.31 to 4.82±0.67 ppm. The pH was found to range from 7.42±0.33 to 6.50±0.12. We observed several pathological changes viz., haemorrhage, lipid droplet, hypertrophy and hyperplasia, erythrocyte infiltration into blood sinusoid, pyknosis and hepatocyte degeneration in the liver tissues of P. sarana. The histopathological analysis of the kidney showed tubular degener-ation of the distal tubule, tubular degeneration of the proximal tubule, melanomacrophage centre, glomerular shrinkage, vacuolisation, necrosis and haemorrhage. The evidence of pathological alter-ations in the liver and kidney of olive barb P. sarana appeared to be a useful biomarker to assess the impact of the toxicity of water pollution in the Surma River.

Breast cancer is the most commonly diagnosed female cancer and the leading cause of cancer death. Early detection and treatment are important to reduce the number of deaths. Japan recommends mammography every two years for women over 40 years of age. However, in recent years, an increasing number of younger women have been undergoing breast cancer screening (BCS). To reduce the harms of BCS among young adults, our study extracted data from an online survey conducted in 2018 and applied χ2 tests and logistic analysis to identify the influencing factors regarding interest in undergoing BCS. The results of our analysis support the need for a reduction in the BCS rate through awareness regarding the harms of health screening among young people. In particular, for those who receive BCS through occupational screening, we believe that improving education on breast awareness, the accuracy of occupational screening, and breast self-examination methods could reduce the harms from BCS in younger age groups.

Abstract Background In January 2010, Haiti was hit by a 7.0-magnitude earthquake. The impact of the earthquake on Universal Health Coverage in mothers remains unclear. This study explores the association between the 2010 Haiti earthquake and access to the five quality essential health services among women who gave birth in the two years before and after the earthquake. Methods From the Sixth Demographic and Health Survey in Haiti, we extracted data for women aged 15–49 who had reported a live birth in the two years before and after the 2010 Haiti earthquake. We used difference-in-difference analyses for antenatal care, delivery care, and vaccination, and multivariate logistic regression analyses for family planning and malaria prevention, to assess the impact of the acute damage (household-level damage, such as housing damage and/or loss of a family member, or region-level damage, such as living in a region where 50% or more of the houses were damaged) of the earthquake on these mothers’ access to quality essential health services. Results Mothers who had not suffered acute earthquake damage were more likely to live in rural areas and had less education and household wealth. The difference-in-difference and multivariate logistic regression analyses did not show strong evidence of any significant association between acute earthquake damage and access to quality health services. However, after the earthquake, access to quality health services deteriorated for both mothers with and without acute earthquake damage (-5.6% and -6.2% for antenatal care, -6.5% and 0% for delivery care, and -9.5% and -13.1% for vaccination, respectively). Conclusions The earthquake adversely affected mothers’ access to quality essential health services regardless of their exposure to acute earthquake damage. Mothers in rural areas who avoided such damage might also have experienced long-term negative effects from the earthquake, which was likely exacerbated by other structural factors such as lower education and economic status.

Chronic subdural hematoma (cSDH) is one of the most studied clinical entities in the neurosurgical literature. Management of cSDH is complicated by its propensity to recurrence. Various factors for the development of recurrence of cSDH have been described in various clinical, epidemiological, and observational studies, yet the evidence available is limited. A systematic review and meta-analysis as per PRISMA guidelines to identify clinical and radiological factors which can predict the development of recurrence in cSDH. A total of 14 studies were included for the systematic review and meta-analysis after a comprehensive search of the online databases. Eight studies were of high methodological quality. Age, use of anticoagulants, obesity, seizure, and liver disease were found to be statistically significant clinical risk factors for the development of recurrence in cSDH. Among the radiological parameters, the internal structure of the hematoma and the width of the hematoma was found to be significant risk factor predicting the development of recurrence. Age >75 years, use of anticoagulation therapy, liver disease, and obesity were significant risk factors for cSDH recurrence. Pneumocephalus, internal architecture of hematoma, bilateral cSDH, the width of hematoma, and the presence of bilateral cSDH are important radiological parameters of the development of recurrent cSDH

Abstract Doctors in developing countries are too busy to write digital prescriptions. Ninety-seven percent of Bangladeshi doctors write handwritten prescriptions, the majority of which lack legibility. Prescriptions are harder to read as they contain multiple languages. This paper proposes a machine learning approach to recognize doctors’ handwriting to create digital prescriptions. A ‘Handwritten Medical Term Corpus’ dataset is developed containing 17,431 samples of 480 medical terms. In order to improve the recognition efficiency, this paper introduces a data augmentation technique to widen the variety and increase the sample size. A sequence of line data is extracted from the augmented images of 1,591,100 samples and fed to a Bidirectional Long Short-Term Memory (LSTM) network. Data augmentation includes pattern Rotating, Shifting, and Stretching (RSS). Eight different combinations are applied to evaluate the strength of the proposed method. The result shows 93.0% average accuracy (max: 94.5%, min: 92.1%) using Bidirectional LSTM and RSS data augmentation. This accuracy is 19.6% higher than the recognition result with no data expansion. The proposed handwritten recognition technology can be installed in a smartpen for busy doctors which will recognize the writings and digitize them in real-time. It is expected that the smartpen will contribute to reduce medical errors, save medical costs and ensure healthy living in developing countries.

Introduction: The purpose of this research was to predict mental illness among university students using various machine learning (ML) algorithms. Methods: A structured questionnaire-based online survey was conducted on 2121 university students (private and public) living in Bangladesh. After obtaining informed consent, the participants completed a web-based survey examining sociodemographic variables and behavioral tests (including the Patient Health Questionnaire (PHQ-9) scale and the Generalized Anxiety Disorder Assessment-7 scale). This study applied six well-known ML algorithms, namely logistic regression, random forest (RF), support vector machine (SVM), linear discriminate analysis, K-nearest neighbors, Naïve Bayes, and which were used to predict mental illness among university students from Dhaka city in Bangladesh. Results: Of the 2121 eligible respondents, 45% were male and 55% were female, and approximately 76.9% were 21–25 years old. The prevalence of severe depression and severe anxiety was higher for women than for men. Based on various performance parameters, the results of the accuracy assessment showed that RF outperformed other models for the prediction of depression (89% accuracy), while SVM provided the best result than other models for the prediction of anxiety (91.49% accuracy). Conclusion: Based on these findings, we recommend that the RF algorithm and the SVM algorithm were more moderate than any other ML algorithm used in this study to predict the mental health status of university students in Bangladesh (depression and anxiety, respectively). Finally, this study proposes to apply RF and SVM classification when the prediction of mental illness status is the core interest.

Context: Telepathology is a promising tool for remote communities to receive pathology services where professional diagnosis services are inadequate. Aims: We aimed to clarify how effective telepathology was when compared with conventional pathology service among rural communities of Bangladesh. Methods and Materials: We conducted a cross-sectional study in suburban and rural areas of Bangladesh between June and August 2020. We enrolled 117 participants who received both telepathology services from Thakurgaon Eye Hospital and conventional pathology service experience. The participant's satisfaction with the accessibility and perceptions were statistically compared. In addition, we summarized descriptive statistics using the frequencies and percentages of participants' responses. Statistical Analysis Used: Wilcoxon's Signed-rank test using SPSS statistic software version 25.00. Results: Among the study participants, service cost, travel cost, travel time, waiting time, and travel distance were significantly higher for conventional pathology than telepathology (P < 0.001). The majority of participants (94%) were satisfied with the telepathology experience; however, one out of 117 participants was dissatisfied with this service when their travel distance was far away (≥50 km). Among the participants, 91.5% thought that telepathology service was effective for their treatment, and 98.3% wanted to continue this service in their community. On an average, participants saved 58% (95% CI, 53.4–61.5) of cost using telepathology rather than conventional pathology service. Conclusions: Remote under-resourced communities received professional pathology services with less time-consuming and significantly lower costs using the telepathology approach. Where pathology services are absent/insufficient, telepathology is efficacious for primary diagnosis, screening, and referral through professional pathologists for the satisfactory treatment of unreached communities.

Simulation has shown good results in medical scenarios in which the patient's problem can be solved by following protocols previously established in clinical practice guidelines. Therefore, the implementation of simulation programs in neurocritical care improves the outcomes of patients at clinical centers because a properly trained professional will be able to provide the most effective care in the shortest time possible, safeguarding the patient's life. Some learning and simulation models that can be included in medical education to improve neurocritical vascular care include task trainers, full-body mannequins, standardized patients, and computer-based simulation. Specifically, medical simulation in academic training programs in health sciences has a great impact on the development of specific skills, which could potentially reduce medical-legal and economic issues, improve care, and result in the management of clinical events. Simulation is established as an essential educational tool, allowing the instruction of knowledge from an interactive perspective and offering a broader vision when it comes to medical practice. The objective of this article is to present evidence related to the usefulness and impact of medical simulation in neurovascular critical care education.

BackgroundChronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. ObjectiveThis study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. MethodsThis study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. ResultsThe study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P

Background: Sleep disorders have an enormous impact on occupational health and are counterproductive from an economic perspective. However, the processes of causing sleep disorders from psychosocial aspects have not yet been known. The purpose of this study was to describe how sleep disorders develop among workers with respect to different psychosocial conditions. Methods: A conventional qualitative content analysis was conducted with a semi-structured interview among twenty-seven workers (14 males and 13 females) who were diagnosed with sleep disorders or had a self-reported history of sleep difficulties. Study participants were recruited from a specialized clinic and communities using snowball sampling. This paper adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. Results: The results showed that there were four steps involved in the sleep disorders development process. Firstly, participants with sleep disorders developed ‘early warning signs’ with 11 categories of triggers; secondly, ‘aggravating factors’ on top of these early warning signs; thirdly, workers tried to ‘cope with’ their sleep disorders in the ways they thought would be effective. Finally, when coping failed to improve the quality of sleep, it led to the onset of sleep disorders. Conclusion: The development of sleep disorders and triggers of psychosocial factors were revealed. An occupational health nurse can bring these findings in practice for preventing worker’s sleep disorders.

Abstract Background Endoscopic third ventriculostomy (ETV) has been established as a viable treatment option for obstructive hydrocephalus of children over 6 weeks of age. ETV in pediatric groups may be unsuccessful due to the failure of absorption of cerebrospinal fluid (CSF) or reclosure of ventriculostomy stoma or due to infection. The exact cause is still debatable. Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear. This study aims to assess the surgical failure of ETV and its predisposing factors. Methods Thirty-four pediatric patients with hydrocephalus were analyzed retrospectively. The patients’ age limit was between 2.5 months and 14 years. This is a retrospective study of 34 patients in a single private hospital between June 2012 and January 2018. Patients having hydrocephalus in pediatric groups more than 6 weeks of age were included in the study. Results The mean age of all patients was 51.25 ± 53.90 months and the mean follow-up period was 50.47 ± 20.84 months. Of 34 surgeries, the success rate was 79% and the failure rate was 21%. Within 2 years, the success rate was 68.42% and above 2 years’ success rate was 93.33%. In this series, 7 cases of ETV were re-explored and found ventriculostomy stoma closure in 3 cases, the presence of the second membrane in re-exploration 2 cases, and presence of inflammatory arachnoid membrane in re-exploration 2 cases. The use of dexamethasone around the stoma in inflammatory stoma was useful, having no recurrence. In one patient of the second membrane probably due to absorption failure in communicating hydrocephalus re-exploration was failed and was managed successfully with VP shunt. Conclusions Predisposing factors causing ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, remnants of the second membrane inside the stoma, CSF absorption failure, infection/high protein in CSF and inappropriate patient selection.

Despite the importance of mud crab species (genus Scylla) in both coastal aquaculture and artisanal fisheries, knowledge of the species diversity and stock structure of mud crab population for their sustainable management across the coastal region of Bangladesh remains obscure. Therefore, the present study was conducted to delineate the diversity and stock structure of mud crab species based on the 24 morphometric length measurements and 27 morphometric ratios data collected from the three coastal regions (Chittagong, Cox's Bazar and Bagerhat) of Bangladesh. Based on the taxonomic keys, majority of the species (about 82.4%) were identified as S. olivacea, while the remaining (about 17.6%) was S. serrata. In consistent to our preliminary analysis, both the univariate proportion and multivariate analysis of the collected morphometric lengths and ratios data also distinctly divided the mud crabs population into two multivariate spaces as S. serrata and S. olivacea. For the further analysis of the stock structure of these two species, data were subjected to the univariate ANOVA, multivariate ANOVA, Canonical Variate Analysis (CVA), and Principal Component Analysis (PCA) according to their collection sites. Scatter plots of CVA scores between CV1 and CV2 and PCA scores between PC1 and PC2 showed that the individuals of both species clearly made clusters into three multivariate spaces with minimum overlaps according to their collection sites. In morphometric traits Linear Discriminant Function Analysis (LDFA), the average percentage of correctly classified (PCC) into the original groups of the S. olivacea and S. serrata was 100%. For stock discrimination, the average PCC into their original groups of collection sites were 100% and 99% for the S. olivacea and S. serrata, respectively. Finally, dendrogram based on the Euclidean distances consistently separated S. olivacea and S. serrata and stock structures similar to other multivariate analyses. In conclusion, our study shows that S. olivacea is the dominant mud crab species and S. serrata is the minor one, and the stock discrimination of each species should be considered in the management and conservation policy of these species along the coastal region of Bangladesh.

Introduction Multiple micronutrient supplementation (MMS) during pregnancy has a greater potential for reducing the risk of low birth weight (LBW) compared with the standard iron–folic acid supplementation. WHO recently included MMS on their Essential Medicines List. The Social Marketing Company (SMC) in Bangladesh is implementing a countrywide, market-based roll-out of MMS to pregnant women. We aimed to evaluate the implementation of the supplementation programme and its impact on reducing LBW.Methods and analysis A two-arm, quasi-experimental and mixed-methods evaluation design will be used to evaluate the impact of this 36-month roll-out of MMS. In the intervention areas, pregnant women will purchase MMS products from the SMC’s pharmacy networks. Pregnant women in comparison areas will not be exposed to this product until the end of the study. We will collect 4500 pregnant women’s data on anthropometric, socioeconomic, nutrition-related and relevant programme indicators during recruitment and bimonthly follow-up until the end of their pregnancy. We will measure children’s birth weight within 72 hours of birth and evaluate the changes in LBW prevalence. We will observe market-based MMS service delivery-related conditions of the pharmacies and the quality of the provider’s service delivery. Concurrently, we will carry out a process evaluation to appraise the programme activities and recommend course correction. Cluster-adjusted multivariable logistic regression or log-binomial regression analysis of quantitative outcome data will be performed. For qualitative data, we will follow a thematic analysis approach. We will consolidate our study findings by triangulating the data derived from different methods.Ethics and dissemination This study received ethical approval from the institutional review board of icddr,b (PR number 21001). We will recruit eligible participants after obtaining their informed written/verbal consent (and assent where needed) with full disclosure about the study. The results will be disseminated through peer-reviewed publications and conference presentations.Trial registration number NCT05108454.

Abstract Background We examined whether telecommunication-device-based distance interviews are inferior to face-to-face interviews in terms of facilitating behavioral changes and disease management in patients with diabetic nephropathy. We also examined the feasibility of a newly designed six-month telenursing program. Methods This study represents a post-hoc analysis of data from a randomized controlled trial, in which we compared the efficacy of remote self-management education with that of direct education for patients with diabetic nephropathy. The participants were 40 company employees, who were randomly divided into two groups. Over 6 months, the intervention group (n = 21) received three distance interviews using a tablet computer. Meanwhile, the control group (n = 19) received three face-to-face interviews. In addition, both groups received biweekly nine telephone calls. A triangulation approach was used. We first compared the two groups in inferiority tests. Then, we analyzed data from semi-structured interviews with all participants and nurses, examining whether trusting relationships and motivation were developed, and the accuracy of the information exchanges. Further, for the intervention group, we also enquired about the overall operability of the telenursing device. Results The completion rates for the program were 81.0 and 78.9% for the participants in the intervention and control groups, respectively. Both groups showed similar behavioral changes, and the participants verified the feasibility of the distance interviews. The participants in the intervention group felt that they understood the severity of their diseases and the necessity of self-management, and felt confidence in the nurses. On the other hand, their degree of behavioral change regarding self-monitoring was lower than that shown by the control group. Conclusion Our findings show that both interview methods are effective for encouraging the adoption of self-management; further, in terms of taking medication and improving the main clinical indicators, we found that the distance method is not inferior to the direct face-to-face method. However, when considering long-term effects, based on the respective degrees of improvement in behavioral change, the direct method seems to be more effective. Trial registration The trial was registered with the University Hospital Medical Information Network clinical trial registry (No. UMIN000026568 ) on March 15, 2017, retrospectively.

Background: Hypertension (HTN) is well established as a leading cause of common serious illnesses worldwide. We carried out this qualitative research to understand perception of and experiences related to HTN among rural Bangladeshi hypertensive women. Methods: A total of 74 female hypertensive participants who were diagnosed as HTN were purposively recruited in a rural community in Mirzapur, Bangladesh. A focus group discussion(FGD) was applied to share their perception and experiences. Transcripts were read in an iterative process, and a thematic analysis was performed. This paper is reported followed by COREQ checklist. Results: Three main themes were generated; (i) Perception of HTN based on experiences, (ii)Knowledge of management of HTN, and (iii) Barriers of management of HTN. Under the themes, seven subthemes were identified. The participants only knew about their high blood pressure(HBP) when they had symptoms, and they applied traditional remedies in the rural context to deal with those symptoms. Even though more than half of participants had relevant knowledge of how to manage HTN, but still there were social-cultural and economic barriers and lack of social infrastructure to access healthcare, existed to practice them. Conclusion: Based on our study reports, health education programs at the household and community level could be a potential starting point for any preventive and containment strategy in rural communities of Bangladesh.

The investigation of traditional medicinal plants is gaining prime importance day by day due to having a wide range of bioactive phytochemicals. The presence of diverse bioactive compounds makes medicinal plants more demandable for curing several diseases, such as inflammatory diseases, diabetes, and cancer. Leucas indica is commonly found throughout Bangladesh and traditionally used for medical purposes because of its great medicinal value to the folks. The present study addresses the evaluation of in vitro qualitative phytochemical, antioxidant, and cytotoxicity activities as well as in silico anticancer activity of methanolic leaf extract. Several standard methods were used for phytochemical analysis, which showed the presence of different phytochemicals. The plant exhibited adequate antioxidant activities through DPPH and H2O2 free radical scavenging assays. Moreover, promising cytotoxicity activity was estimated through a brine shrimp lethality assay. In addition, the present work emphasizes the in silico analysis, which finds the anticancer activity of the experimental plant based on pharmacokinetic analysis, molecular docking, and MD simulation. Four phytochemicals of the plant were selected from the literature and docked against two important protein kinases (AMPK and CDK6) that have a role in cancer progression. The docking revealed an encouraging binding score with a maximum score of 9.2 kCal/mol, where all the ligand-protein complexes showed stable conditions during simulation. According to this analysis, it can be believed that the selected ligands indicate promising anticancer activity. Moreover, the comprehensive analysis of both in vitro and in silico data shows that the leaf could be a potent source of drug and could serve as an effective therapeutic in the future.

Abstract Background Many genetic tests are now available due to evolution by the Human Genome Project. However, the growing use of genetic testing and screening may not only lead to improvements in public health and health promotion, but also trigger grave ethical, legal, and societal concerns. The involvement of community healthcare providers is expected in the future because they have direct contact with the residents through their health programs. The aims of the current study were to clarify how public health nurses perceive the relationship between genetics and professional duties and to identify opportunities and challenges of integrating genetics education into their professional duties. Methods In 2017, data were collected through a focus group interview. Content related to the ‘presence or absence of health consultation related to genetic issues as part of actual job duties’ and ‘training for handling genetic-related health consultations’ was extracted. Entire sentences were coded and categorized based on similar semantic content. Results Public health nurses had difficulties in recognizing genetic issues in public health activities. In some cases, genetic contents were included in conversation and consultation with the general public. Through the professional education and experiences, public health nurses needed specialized education, post-graduation studies and mentoring about genetics. Conclusions Public health nurses whose professional duties do not directly relate to genetics were exposed to genetics-related episodes on a regular basis without their awareness. The provision of accurate information and knowledge related to genetics by public health nurses would also provide an opportunity for clients to be informed about their latent genetic risks. Hence, there is a need for practical resources, the establishment of collaboration networks, and the development of professional organizations for public health nurses.

This cross-sectional study has evaluated the level of the COVID-19 response among the general people of Bangladesh through their COVID-19 basic knowledge, attitude and practice level to reduce the outbreak. A rapid self-administered online survey was conducted during the COVID-19 lockdown period in Bangladesh. Convenience and snowball sampling technique were followed in this study. The online survey was open for all Bangladeshi general people whether they were infected or not. For this study, total 616 Bangladeshi respondents participated where majority of them were from Dhaka city, one of the worst COVID-19 affected cities in the world. Normality of data was checked before statistical analysis. Majority of the respondents reported moderate safety of their current place from COVID-19 with high concern of their mental health during COVID-19 lockdown period. The total COVID-19 responses among these people were moderate along with the alarming high percentages of low COVID-19 responses. The respondents reported moderate COVID-19 knowledge level and moderate attitude level toward the COVID-19 control. They demonstrated that they followed practices to prevent the COVID-19 infection. Female respondents were identified with better COVID-19 responses compared to their male counterpart. Dhaka city residents had less confidence on their current place being safe from COVID-19. They also had low COVID-19 responses during the lockdown period compared to the residents living outside Dhaka city.

The rate of caesarean section (C/S) has been increasing globally. The proposed study aims to evaluate the effects of ultrasonography (USG) and health education in reducing unnecessary C/S among pregnant women. The secondary objectives are to increase antenatal care (ANC) and post-natal care (PNC) visit rates, increase USG use, increase institutional (hospitals and clinics) delivery, reduce delivery related complications and reduce the number of still births. This is a prospective, open-label, two-arm cluster randomized controlled trial (RCT). A total of 288 pregnant women are enrolled from two urban and two rural hospitals in Bangladesh. Women were screened during their first ANC visits, then written informed consent was taken from the participants. Women in intervention hospitals receive eight ANC visits, two additional USG, and health education eight times during their ANC visits. In contrast, participants at control hospitals receive usual care consisting of four ANC visits and two USG during their ANC visits. The primary outcome is to compare the rate of unnecessary C/S during PNC visits. This study obtained approval from the Institutional Review Board of North South University (2021/OR-NSU/IRB/0804), Bangladesh in November 2021 and was registered in clinicalTrails.gov (#NCT05135026).

BackgroundDespite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. ObjectiveThe aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. MethodsA parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. ResultsEnrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. ConclusionsIt is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial RegistrationClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID)DERR1-10.2196/30191

Background Information on comparative clinical and host characteristics of under-2 children with watery diarrhea caused by rotavirus, Enterotoxigenic Escherichia coli (ETEC), and Vibrio cholerae as single pathogens is lacking. We sought to investigate the sociodemographic, clinical, and host characteristics of under-2 children hospitalized due to these pathogens. Methodology We conducted a hospital-based case-control study using the icddr,b Diarrheal Diseases Surveillance System. Children of either sex,

Introduction: Providing self-management education for residents with cardiometabolic conditions in remote islands is a challenge due to the shortage of primary care practitioners (PCPs), specialist physicians, and nurses. Therefore, we applied telenursing with lifestyle-related chronic diseases in remote island residents in Japan. This project aimed to improve the self-management behavior, cardiometabolic indicators, self-efficacy, and quality of life (QoL) of residents with cardiometabolic risks. Methods: We chose Ōsakikamijima Island, Hiroshima Prefecture, Japan, which is designated under the Remote Islands Development Act. The project was conducted from 2013 to 2014. The residents aged over 40 and under 75 years old, selected from the annual specific health check-up examination and from PCPs for screening cardiometabolic risks (urinary protein, glycohemoglobin A1c, systolic and diastolic blood pressure (BP), Low-density lipoprotein cholesterol, High-density lipoprotein cholesterol, and triglyceride) were included. The effectiveness of telenursing for self-management education was 6-month-long with a 6-month follow-up and evaluated by a single-group pre-and post-test design. Face-to-face health education was applied at the initial interview followed by telenursing (biweekly telephone calls till third-month, and a monthly telephone call during the fourth and fifth-month) by the trained nurses outside the island. To enhance participants’ self-monitoring health behavior changes, the nurses used motivational interviewing and behavior change techniques based on the transtheoretical model. Results: A total of 130 residents, 42 agreed to participate, 41 finished the 6-month program, and 33 completed the 12-month follow-up. Most of their behavior changes like self-management behaviors, cardiometabolic indicators, and self-efficacy at 6-month were improved significantly except QoL. Among the 12-month study periods, self-management behaviors, body mass index, systolic BP, diastolic BP, and self-efficacy (sense of control), (all P

Background: Studies have labelled chronic kidney disease (CKD) among the adult population in urban Bangladesh. To address knowledge gaps on CKD, we aimed to generate data on prevalence, health and nutrition of CKD individuals living in rural and peri-urban Bangladesh. Methods: Participants were recruited from the Mirzapur Demographic Surveillance System by age-stratified random sampling. We screened participants by measuring serum creatinine and urine albumin to creatinine ratio, and collected socio-demographic, lifestyles and health information (phase I). After 3 months (phase II), we repeated the urine and blood tests as per the Kidney Disease Outcomes Quality Initiative guidelines. The glomerular filtration rate was calculated using the CKD Epidemiology Collaboration equation. Results: Among 928 participants, 872 completed the study. In phase I, probable CKD cases were 281 (32.2%); in phase II, confirmed cases were 192 (22.0%) (stage 1, 4.0%; stage 2, 11.8%; stage 3, 5.5%; stage 4, 0.6%; stage 5, 0.1%). In multivariable analysis, associated factors for prevalent CKD included aged ⩾60 years [adjusted odds ratio (aOR) 5.02; 95% confidence interval (CI) 1.85–13.65], hypertension (aOR 3.08; 95% CI 2.07–4.59), diabetes (aOR 2.52; 95% CI 1.60–3.96), presence of red blood cell in urine (aOR 3.20; 95% CI 1.71–5.98) and anemia (aOR 2.50; 95% CI 1.63–3.84). Conclusions: This is the first ever research on CKD prevalence in rural and peri-urban Bangladesh and recorded about 22%, which is higher than urban settings. Monitoring systems are needed to evaluate the overall burden and to mitigate risk factors with an emphasis on the rural and peri-urban population.

Abstract Background Chronic hepatitis, mainly B or C, increases the risk of hepatocellular carcinoma and remains an emerging issue in the globe. China has high rates of liver cancer incidence and mortality in the world. To address such challenges, adequate management of chronic hepatitis is required. Self-management education is one alternative for improving the hepatitis patients’ knowledge of the disease, mental health, and clinical management. This study aimed to examine the quality of life (QOL), psychological effects, and behavioral changes of a self-management program which allows continuity of care for chronic hepatitis B and C patients. Method In a six-month, randomized controlled trial, we invited 73 chronic hepatitis B/C inpatients to receive (i) two face-to-face education sessions provided by a nurse during hospitalization, and monthly telephone counseling at home after discharge; (ii) or usual care treatment (control group). The primary endpoint (patients’ QOL) and secondary outcomes (including self-efficacy, depression symptoms, perceived cognition of illness and behavioral changes) were assessed. In addition, we conducted qualitative data analysis to facilitate the evaluation of the interventions. Results Sixty (82.2%) out of 73 eligible patients with chronic hepatitis B/C (aged 34.9 ± 8.9 years) participated in the study. The intervention group (n = 30) significantly improved on outcomes including QOL, self-efficacy, perceived cognition of illness, and behavioral changes, whereas the control group significantly decreased their healthy behaviors. In terms of behavioral changes, alcohol avoidance, dietary adherence, and stress management also improved in the intervention group. However, there were no significant improvements in symptoms of depression. Most participants (80%) in the intervention group stated that they benefited from the program. Conclusions This program contributed to patients’ acquisition of self-management skills to cope with their illnesses, and significantly improved their QOL. This program serves as a reminder for nurses who care for patients with chronic viral hepatitis to acquire these skills as it would help them address the daily needs of their patients. Trial registration UMIN000025378. Registered December 23, 2016.

Abstract Restriction of dietary salt is widely recommended in the management of hypertension, but assessment of individual salt intake has drawn little attention. Monitoring nutritional salt intake through sodium excretion has been popular, because the main route for sodium (Na) excretion is through the urine. Nonetheless, direct measurement of dietary salt intake is time consuming and lacks accuracy. To collect a 24-h urine and measure the content is difficult method for most patients. In this review paper, we would like to explore the usefulness of measuring urinary salt excretion by using a self-monitoring device at home. Measuring daily overnight urine by the self-monitoring device at home will be useful for the management of hypertension suitable for each individual. From the recent increase of processed foods, the term “salt intake” would not accurately be equal to “sodium intake”. Devices measuring urinary sodium excretion have been developed and evaluated on their accuracy and correlation with sodium intake. They must be handy, simple and capable of measuring large populations to be useful for monitoring of daily salt intake and to guide salt restriction as well as the long-term effects by dietary salt intake.

The rapid decline of longfin smelt Spirinchus thaleichthys, a threatened euryhaline forage fish in California, is a serious concern for scientists and resource managers. To recover and conserve this species, a captive culture program was initiated, focusing on the collection, captive rearing and breeding of wild broodstock, and the rearing of their offspring. Although progress has been made in the collection of broodstock and the production and culturing of larvae, no studies have evaluated the rearing of juvenile life stages in captivity. The present study examines methodological considerations for culturing F1 juvenile longfin smelt, specifically, the first efforts toward weaning juveniles to a dry commercial pellet feed. Cultured juvenile longfin smelt were fed live Artemia only or co-fed Artemia and dry feed for 62 days, and the effects of feed type on juvenile survival, growth, body condition, and fatty acid profiles were examined. No significant differences were observed between feeding treatments, despite an 80% reduction in Artemia in the co-feeding treatment. Furthermore, examination of fish stomach contents at the end of the trial confirmed the transition to dry feed. This is the first study to indicate successful feeding by longfin smelt on dry commercial pellets, and suggests that juvenile longfin smelt can be fully weaned onto dry feeds. Results of this study are critical for closing the lifecycle of longfin smelt in captivity and developing a successful conservation culture program for this imperiled species.

Information on allometry, condition indices (CIs), and biometric traits (BTs) of marine bivalves are necessary for determining the growth pattern and the size at which harvest can be intensified to maximize production in aquaculture. These parameters of marine bivalves are largely regulated by the complex interactive effects of various ecological and physiological factors. Therefore, the present study aimed to apply an integrated multivariate approach to explore a comprehensive knowledge about how allometry, condition indices (CIs) and BTs are interlinked with various eco-physiological factors of cultured green mussel (Perna viridis), with a particular focus on the effect of seasonality. Six selected length-weight dimensions (shell length, shell width and shell height against total weight and soft tissue weight) were proved to be positively correlated with negative allometric relation (slope60 % of the variability. In both cases, PCA analysis further revealed that CIs and BTs increased with the increase of salinity, dissolved oxygen, food availability, plankton ingestion and GSI value, while they decreased with the increase of temperature, current speed and turbidity. Thus, our results clearly demonstrated that CIs and BTs of the green mussel were influenced by seasonality, ecological factors, plankton ingestion and reproductive cycle of the species. The findings of the present study represent a step toward a better comprehension of the CIs and BTs of P. viridis in relation to different eco-physiological factors and would be helpful to determine the ideal period for commercial exploitation, biodiversity conservation and future potential aquaculture of this commercially important species to a greater extent.

Introduction Caring for stroke survivors creates high levels of care burden among family caregivers. Previous initiatives at alleviating the care burden have been unsuccessful. The proposed study aims to evaluate the effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors. Based on the perceived needs of family caregivers, this intervention takes into account scientific recommendations to combine three different approaches: skill-building, psychoeducation and peer support.Methods and analysis Using a prospective, randomised, open-label, parallel-group design, 110 family caregivers will be enrolled from Dakahlia Governorate, Egypt between December 2019 and May 2020, and randomly assigned to either the intervention group or the control group. The tailored multidimensional intervention will be administered for 6 months, including three home visits, six home-based telephone calls and one peer support session. The primary outcome is the care burden as measured using the Zarit Burden Interview. Secondary outcomes include changes in the family caregivers’ perceived needs (Family Needs Questionnaire-Revised), coping strategies (Brief-Coping Orientation to Problems Experienced) and quality of life (WHO Quality of Life-BREF). Outcomes evaluation will be conducted at baseline (T0), month 3 (T1) and month 6 (T2). Independent t-test will be performed to compare the mean values of study variables between the two groups at both T1 and T2. After adjusting for confounding variables, analysis of covariance will be used to assess the effect of the intervention. In addition, repeated measures analysis of variance will be conducted to assess changes in effect over time.Ethics and dissemination This study was approved by the Research Ethics Committee of the Faculty of Nursing, Mansoura University, Mansoura, Egypt (P.0195). The results will be published in a scientific peer-reviewed journal, and findings will be disseminated at the local and international levels.Trial registration number NCT04211662.

Objectives: Creating a diverse and inclusive symbiotic society is specified in the sustainable development goals. In a symbiotic society, support for those who need, it is called “reasonable support.” However, it is unclear in the classroom that many children understand “reasonable” as a consideration to support children with special needs. The aim of this study is to identify the actual understanding of junior high school students and the challenges related to genetic diversity through school health teachers in readiness for developing a symbiotic society. Methods: A focus group interview was conducted for five school health teachers working in public junior high schools to identify the perspectives of their feeling about the current understanding of children in regard to genetics and diversity. Participants were recruited who agreed to engage voluntarily in this research. A qualitative descriptive design was used in this study. Results: The results of the analysis revealed three categories consisting of 67 codes and 10 subcategories. Three categories were identified: I—understanding the heterogeneity and diversity of children’s ambivalent minds; II—limitation of school health teachers’ involvement in genetics and diversity-related issues; and III—importance for children to understand heterogeneity and diversity to build life skills. Conclusions: School health teachers remarked on the limitations of learning and teaching genetics and diversity. They paid attention to the flexibility of a child. It suggests that the purpose of genetic education is to develop children’s life skills with the flexibility to live in the future. There is a need to consider new genetic education for school health teachers and students to learn about diversity.

Migration of an anadromous fish to heterogeneous environment continuously enforces a selective pressure that incorporates a wide range of life-history strategies by which individuals adapt to the prevailing conditions. Therefore, we used the landmark-based morphometric truss network method and nextRAD genotyping-based putatively adaptive SNP loci dataset to know how the anadromous Hilsa shad (Tenualosa ilisha) morpho-genetically adapt to the heterogeneous habitats across their migratory routes by investigating 300 individuals, collected from nine strategic sampling sites covering sea, estuary, and upstream freshwater rivers. Different multivariate and clustering analyses revealed that the riverine populations were morphometrically wider (broad type) than the estuarine and marine populations (slender type). In the case of riverine population, the north-western turbid population (the Padma and Jamuna rivers) had wider body depth than the north-eastern clear water population (the Meghna river). The linear model and spatial multivariate analyses further revealed that the outcomes of morphometric dataset were in complete concordance with the results of putatively adaptive SNP loci dataset for different Hilsa shad populations. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment analysis of the 36 genes, which are encoded by the putative adaptive SNP loci, supported the presence of multiple genes involved in the growth, metabolism, homeostasis and osmoregulation related functions. Several non-mutually exclusive hypotheses were attributed to explain the observation of continuum differentiation at both phenotypes and genotypes: (i) the genetic variation largely determines the morphometric discrimination, (ii) the interactive evolutionary processes and salinity predominantly contribute to the morphogenetic difference between the marine-estuarine and the freshwater riverine populations, (iii) environmental heterogeneity largely influences the genotypes leading to the phenotypic plasticity, and (iv) the local environmental heterogeneity may contribute to the morphogenetic divergence between the riverine populations. Finally, we concluded that the genetic adaptation, phenotypic plasticity and interactive ecological and evolutionary consequences jointly determine the morphogenetic divergence of Hilsa shad. The interaction of all of these forces and their relative strength in heterogeneous environments, however, made it rather challenging to determine the most probable selective pressure, which has shaped the Hilsa shad morphogenetic divergence across their diverse migratory habitats.

Background: After the Japanese nuclear power plant disaster in 2011, many residents became concerned about health effects of radiation. We aimed to evaluate the effectiveness of a training program for public health and school health nurses to improve their skills and expertise for better support to residents and students. Methods: This was a quasi-experimental study using single-group and pre-post comparison in 2016 in Hiroshima, Kagoshima and Hyogo prefectures of Japan. The educational evaluation was conducted through each sub-item of Bloom’s attainment goals. The evaluation of effectiveness was surveyed among 61 participants before and immediately after the workshop, and at 1-week and 1-month later. The analysis compared initial scores obtained before the workshop with subsequent responses. Where a significant difference was observed among three-group or more in the Friedman test, the Wilcoxon signed-rank test was used for two-group comparisons across the time periods. The significance level was set at P

ObjectiveLack of awareness about Diabetic Retinopathy (DR) is the most commonly cited reason why many persons with type 2 diabetes are non-compliant with referral instruction to undergo retinal screening. The purpose of this study was to evaluate the efficacy of a culturally, geographically and socially appropriate, locally adapted five-month-long health education on referral compliance of participants.MethodA prospective randomized, open-label parallel group study was conducted on persons with type 2 diabetes who underwent basic eye screening at a diabetes hospital between September 2017 and August 2018. Participants who were noncompliant with referral instruction to visit a hospital for advanced DR management were randomly divided into health education intervention group (n = 143) and control group (n = 156). Both groups received information regarding DR and referral instruction at the diabetes hospital. The intervention group was provided personalized education followed by telephonic reminders. The primary endpoint was 'increase in referral compliance' and the secondary endpoint was 'increase in knowledge of DR'. Multivariate logistic regression model was used to identify significant predictors of compliance to referral.ResultsA total of nine participants dropped and 290 completed the post intervention survey. The compliance rate in intervention group was found to be significantly higher than the control group (64.3% vs 28.2%; OR 4.73; 95% CI 2.87-7.79; pDiscussionOur results suggest that intensive health education on DR should be integrated with diabetes education as it may result in significantly improved referral compliance. Outcomes may be sustainable if interventions are institutionalized at referral point.Trial registrationClinical Trials.gov (Registration # NCT03658980); https://clinicaltrials.gov/ct2/show/NCT03658980.

Abstract Background Early diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB. Patients need to receive proper treatment through the National Tuberculosis Control Programme (NTP). This study describes various predictors for health seeking behaviour of TB patients and health system delay made by the different health care providers. Methods A cross-sectional study was conducted in a public health facility of a rural area in Bangladesh. Newly diagnosed smear positive pulmonary TB (PTB) patients who were ≥ 15 years of age were sequentially enrolled in this study. The socio-demographic characteristics and proportion of health care utilization by the patients, and health system delay made by the health care providers were calculated. Multivariate analysis was conducted to determine the independent association of the risk factors with the time to seek medical care. Results Two hundred and eighty patients were enrolled in this study. Among them, 73.6% were male and 26.4% were female. A hundred percent of patients primarily sought treatment for their cough, 170 (60.7%) first consulted a non-qualified practitioner while 110 patients (39.3%) first consulted with qualified practitioners about their symptoms. Pharmacy contact was the highest (27.9%) among the non-qualified practitioners, and 58.9% non-qualified practitioners prescribed treatment without any laboratory investigation. The average health system delay was 68.5 days. Multiple logistic regressions revealed a significant difference between uneducated and educated patients (OR 2.33; CI 1.39–3.92), and qualified and non-qualified practitioners (OR 2.34; CI 1.38–3.96) to be independent predictors of health system delay. Conclusions Compared to men, fewer women sought TB treatment. Uneducated patients and questionably qualified practitioners made for a longer delay in detecting TB. Increasing public health awareness and improving health seeking behavior of females and uneducated patients, and greater participation of the qualified practitioners in the NTP are highly recommended.

Background: Background: Pneumonia is a major cause of child mortality among children under 5 years, worldwide. Pneumonia infection may be caused by bacteria, viruses, or fungi in single or in both lungs. According to recent criteria developed by the World Health Organization(WHO) in September (2013), pneumonia can be classified into severe pneumonia, pneumonia and no pneumonia. Most of the deaths occur from severe pneumonia.Methods: Disease management of severe childhood pneumonia requires early identification,prompt referral and the availability of intensive quality care. Under 5 years old children with severe pneumonia should receive day care, with antibiotic treatment, feeding, and supportive care with similar 24-hour hospital treatment.Discussion: Considering that difficulties, International Centre for Diarrheal Disease Research,Bangladesh (ICDDR, B) initiated Day Care Approach (DCA) model, as an innovative, safe,effective and less expensive alternative to hospital management of severe childhood pneumonia.A 24 months old girl came to the health care center with severe breathing difficulty, cough,history of fever and head nodding. The management described below was continued daily until there was clinical improvement; no fever, no fast breathing, no lower chest wall in drawing, no danger signs, no rales on auscultation, and no hypoxemia. Conclusion: Considering the WHO case management protocol for severe pneumonia, DCA recommends that diagnosis of severe pneumonia should be based primarily on visible clinical parameters. On that basis, severe childhood pneumonia can be successfully managed at daycare clinics including for children with hypoxemia who is required prolong (4-6 hours) oxygen therapy.

Severe pneumonia is one of the leading contributors to morbidity and deaths among hospitalized under-five children. We aimed to assess the association of the socio-demographic characteristics of the patients and the climatic factors with the length of hospital stay (LoS) of under-five children with severe pneumonia managed at urban hospitals in Bangladesh. We extracted relevant data from a clinical trial, as well as collecting data on daily temperature, humidity, and rainfall from the Meteorological Department of Bangladesh for the entire study period (February 2016 to February 2019). We analyzed the data of 944 children with a generalized linear model using gamma distribution. The average duration of the hospitalization of the children was 5.4 ± 2.4 days. In the multivariate analysis using adjusted estimation of duration (beta; β), extended LoS showed remarkably positive associations regarding three variables: the number of household family members (β: 1.020, 95% confidence intervals (CI): 1.005–1.036, p = 0.010), humidity variation (β: 1.040, 95% Cl: 1.029–1.052, p < 0.001), and rainfall variation (β: 1.014, 95% Cl: 1.008–1.019), p < 0.001). There was also a significant negative association with LoS for children’s age (β: 0.996, 95% Cl: 0.994–0.999, p = 0.006), well-nourishment (β: 0.936, 95% Cl: 0.881–0.994, p = 0.031), and average rainfall (β: 0.980, 95% Cl: 0.973–0.987, p < 0.001). The results suggest that the LoS of children admitted to the urban hospitals of Bangladesh with severe pneumonia is associated with certain socio-demographic characteristics of patients, and the average rainfall with variation in humidity and rainfall.