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Fulltext Psychometrics of Persian Version of the Ageism Survey Among an Iranian Older Adult Population During COVID-19 Pandemic

Sharif Nia H, She L, Rasiah R, Khoshnavay Fomani F, Kaveh O, Pahlevan Sharif S, et al.

Front Public Health, 2021;9:683291.
PMID: 34869136 DOI: 10.3389/fpubh.2021.683291

Background: Studies have revealed an increase in discrimination, neglect, and abuse among the older adult population during this period. This study assessed the validity and reliability of the Persian version of the ageism survey instrument tested on a sample of the Iranian older adult population during coronavirus disease (COVID-19) pandemic. An important move in counteracting ageism is to classify the ageism scale comprehensively by employing adequate psychometrics. Methods: The Persian version of the ageism scale was developed using a two-step procedure. The first step involved translating and revising the original scale to develop a Persian version of the ageism scale. The second step involved assessing the psychometric features of the newly adapted scale using construct validity through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) and thereafter assessing the reliability through the average inter-item correlation (AIC), Cronbach's alpha. The sample consisted of 400 older adults (age 65 and older), who were recruited through online data collection, with samples for EFA and CFA randomly selected from the total samples. Results: The Persian version of the ageism survey has three factors: age-related deprivation with five items, dignity with three items, and employment with three items; all of which explained 57.02% of the total variance. The outcome of the EFA was verified by the CFA, with internal consistency reliability being excellent (Cronbach's alpha was 0.725, 0.698, and 0.708 for the three factors). Conclusion: This study specifically offers a restructured three factors Persian version of the ageism survey for Iranian older adults with acceptable construct validity and reliability.
Fulltext Prevalence, Circumstances, and Risk Factors of Falls Among Community Dwelling Members of University of the Third Age

Ashari A, Hamid TA, Hussain MR, Ibrahim R, Hill KD

Front Public Health, 2021;9:610504.
PMID: 34900882 DOI: 10.3389/fpubh.2021.610504

Objective: Study aimed to identify the prevalence of falls and associated contributory factors among older Malaysians. Methods: A cross sectional study among community dwelling older adults aged 50 years and above. Self-administered questionnaires on history of falls in the previous 12 months, physical assessment and computerized and clinical measures of balance were assessed on a single occasion. Results: Forty nine (31.0%) participants fell, with 4.4% reported having multiple falls within the previous 12 months. Slips were the most prevalent cause of falls, accounting for 49% of falls. More than half (54.5%) of falls occurred in the afternoon while participants walked inside the home (32.7%), outside home (30.6%), and 36.7% were in community areas. More than half of respondents were identified as having turning instability. Step Test, turn sway, depression, physical activity level and edge contrast sensitivity were significantly worse for fallers (p < 0.05). Multiple logistic regression analysis showed that turning performance, visual acuity and back pain were significantly associated with falls risk, accounting for 72% of the variance of risk factors for falls among studied population. Conclusion: Falls are common among community dwelling older Malaysians. The findings provide information of falls and falls risk factors among community dwelling older adults in Malaysia. Future intervention studies should target locally identified falls risk factors. This study has highlighted the importance of instability during turning as an important fall risk factor.
Fulltext Psychometric Properties of the Persian Version of the Center for Epidemiological Studies Depression Scale Among the Iranian Public People During COVID-19 Pandemic

Sharif Nia H, Rahmatpour P, Sivarajan Froelicher E, Pahlevan Sharif S, Kaveh O, Rezazadeh Fazeli A, et al.

Front Public Health, 2021;9:728904.
PMID: 34970522 DOI: 10.3389/fpubh.2021.728904

Background: Several studies indicate a high prevalence of depression around the world during the period of the COVID-19 pandemic. Using a valid instrument to capture the depression of an individual in this situation is both important and timely. The present study aims to evaluate the psychometric properties of the Persian version of the Center for Epidemiological Studies Depression Scale (CES-D) among the public during the COVID-19 pandemic in Iran. Method: This is a cross-sectional study that was conducted in the Iranian population (n = 600) from April to July 2020. A two-part online form was used: sociodemographic characteristics and depression items (CES-D). The construct validity and internal consistency reliability of the scale were evaluated. Result: The results of the exploratory factor analysis illustrated two factors with 43.35% of the total variance of the depression were explained. Confirmatory factor analysis indicated that this model fits well. Internal consistency reliability was evaluated, and it was acceptable. Conclusion: The findings demonstrated that, in the Iranian sample, this depression scale yielded two factors (somatic and positive affects) solutions with suitable psychometric properties.
Fulltext A Predictive and Preventive Model for Onset of Alzheimer's Disease

Singhania U, Tripathy B, Hasan MK, Anumbe NC, Alboaneen D, Ahmed FRA, et al.

Front Public Health, 2021;9:751536.
PMID: 34708019 DOI: 10.3389/fpubh.2021.751536

Alzheimer's Disease (AD) is a neurodegenerative irreversible brain disorder that gradually wipes out the memory, thinking skills and eventually the ability to carry out day-to-day tasks. The amount of AD patients is rapidly increasing due to several lifestyle changes that affect biological functions. Detection of AD at its early stages helps in the treatment of patients. In this paper, a predictive and preventive model that uses biomarkers such as the amyloid-beta protein is proposed to detect, predict, and prevent AD onset. A Convolution Neural Network (CNN) based model is developed to predict AD at its early stages. The results obtained proved that the proposed model outperforms the traditional Machine Learning (ML) algorithms such as Logistic Regression, Support Vector Machine, Decision Tree Classifier, and K Nearest Neighbor algorithms.
Fulltext Impact of the COVID-19 Pandemic on Cancer Researchers in 2020: A Qualitative Study of Events to Inform Mitigation Strategies

Fox L, Beyer K, Rammant E, Morcom E, Van Hemelrijck M, Sullivan R, et al.

Front Public Health, 2021;9:741223.
PMID: 34966713 DOI: 10.3389/fpubh.2021.741223

Introduction: The COVID-19 pandemic has had an unprecedented impact on global health systems and economies. With ongoing and future challenges posed to the field due to the pandemic, re-examining research priorities has emerged as a concern. As part of a wider project aiming to examine research priorities, here we aimed to qualitatively examine the documented impacts of the COVID-19 pandemic on cancer researchers. Materials and Methods: We conducted a literature review with the aim of identifying non-peer-reviewed journalistic sources and institutional blog posts which qualitatively documented the effects of the COVID-19 pandemic on cancer researchers. We searched on 12th January 2021 using the LexisNexis database and Google, using terms and filters to identify English-language media reports and blogs, containing references to both COVID-19 and cancer research. The targeted search returned 751 results, of which 215 articles met the inclusion criteria. These 215 articles were subjected to a conventional qualitative content analysis, to document the impacts of the pandemic on the field of cancer research. Results: Our analysis yielded a high plurality of qualitatively documented impacts, from which seven categories of direct impacts emerged: (1) COVID measures halting cancer research activity entirely; (2) COVID measures limiting cancer research activity; (3) forced adaptation of research protocols; (4) impacts on cancer diagnosis, cases, and services; (5) availability of resources for cancer research; (6) disruption to the private sector; and (7) disruption to supply chains. Three categories of consequences from these impacts also emerged: (1) potential changes to future research practice; (2) delays to the progression of the field; and (3) potential new areas of research interest. Discussion: The COVID-19 pandemic had extensive practical and economic effects on the field of cancer research in 2020 that were highly plural in nature. Appraisal of cancer research strategies in a post-COVID world should acknowledge the potential for substantial limitations (such as on financial resources, limited access to patients for research, decreased patient access to cancer care, staffing issues, administrative delays, or supply chain issues), exacerbated cancer disparities, advances in digital health, and new areas of research related to the intersection of cancer and COVID-19.
Fulltext Ageing Population's Impact on Economic Growth in Malaysia From 1981 to 2019: Evidence From an Autoregressive Distributed Lag Approach

Mohd SNA, Ishak AA, Selvaratnam DP

Front Public Health, 2021;9:731554.
PMID: 35004564 DOI: 10.3389/fpubh.2021.731554

This study investigates the impact of the ageing population on the economic growth for short- and long-run estimations in Malaysia, by using time series data from 1981 to 2019. This study adopts the autoregressive distributed lag (ARDL) method with the Bound test approach for the long-run estimation and the vector error correction model for the short-run estimation. Several econometric diagnostic tests were applied for validation and the appropriate model specification basis. The estimated result of this work indicates that the age dependency ratio proxy for the ageing population variable has a significant negative impact on economic growth in Malaysia. A 1% increase in old age dependency will decline gross domestic product's (GDP's) growth by an average of 6.6043% at the 5% level of significance. Hence, an increase in the ageing population will impede economic growth. Although controlled variables (e.g., physical capital, labour participation, and human capital) have a significant positive impact on economic growth in Malaysia, there is evidence of a long- and short-run relationship between economic growth and the ageing population variable, and also the control variable.
Fulltext Assessment of Impact of Containment During the COVID-19 Epidemic and Coping Behaviours Using Newly Developed Assessment Tools

Wong LP, Alias H, Danaee M, Lee HY, Tan KM, Tok PSK, et al.

Front Public Health, 2021;9:787672.
PMID: 35004587 DOI: 10.3389/fpubh.2021.787672

Background: The confinement measures during COVID-19 had a massive effect on physical and psychological health in public. This study assessed the impact of containment and coping behaviour among the Malaysia public during the COVID-19 pandemic. Questions assessing the impact of containment and coping behaviours were developed and psychometrically tested. Methods: Exploratory factor analysis (EFA) was conducted with the items using principal component analysis extraction and Varimax rotation. Partial least squares structural equation modelling was used to determine the relationship between coping and impact. Results: The 13-item of impact and 10-item coping instruments were developed with three dimensions identified through EFA. Both scales demonstrated excellent composite reliability and good convergent validity. The survey findings revealed that the impact on individual psychological aspects was prominent, followed by well-being and lifestyle. Mindfulness and physical coping strategies were most commonly reported. Coping through seeking help from health professionals and hotlines had a positive direct effect on well-being and lifestyle (b = 0.231, p < 0.001), psychological (B = 0.132, p < 0.001), and employment-related (0.194, p < 0.001) impacts. Coping through mindfulness practise had a negative effect on well-being and lifestyle-related impact (B = -0.180, p < 0.001) and employment-related impact (B = -0.096, p = 0.008). Conclusions: Despite some limitation, the scales for measuring impact and coping behaviours have the potential to be used as a measurement tool in future studies. Findings highlight the enormous impact of the pandemic on psychological well-being and lifestyles. Health authorities should support individual coping as it was found to be an important resilience-related factor to mitigate the impacts of containment during the pandemic.
Fulltext Profile and Predictors of Maternal Quality of Life During Physiological Pregnancy: A Cross-Sectional Analysis

Ishaq R, Shoaib M, Baloch NS, Sadiq A, Raziq A, Huma ZE, et al.

Front Public Health, 2021;9:801035.
PMID: 35111720 DOI: 10.3389/fpubh.2021.801035

Background: Quality of Life (QoL) and its determinants are significant in all stages of life, including pregnancy. The physical and emotional changes during pregnancy affect the QoL of pregnant women, affecting both maternal and infant health. Hence, assessing the QoL of pregnant women is gaining interest in literature. We, therefore, aimed to describe the QoL of pregnant women during physiological pregnancy and to identify its associated predictors in women attending a public healthcare institute of Quetta city, Pakistan.
Methods: A cross-sectional study was conducted at the Obstetrics and Gynecology Department of Sandeman Provincial Hospital Quetta city, Pakistan. The respondents were asked to answer the Urdu (lingua franca of Pakistan) version of the Quality of Life Questionnaire for Physiological Pregnancy. Data were coded and analyzed by SPPS v 21. The Kolmogorov-Smirnov test was used to establish normality of the data and non-parametric tests were used accordingly. Quality of Life was assessed as proposed by the developers. The Chi-square test was used to identify significant associations and linear regression was used to identify the predictors of QoL. For all analyses, p < 0.05 was taken significantly.
Results: Four hundred and three pregnant women participated in the study with a response rate of 98%. The mean QoL score was 19.85 ± 4.89 indicating very good QoL in the current cohort. The Chi-Square analysis reported a significant association between age, education, occupation, income, marital status, and trimester. Education was reported as a positive predictor for QoL (p = 0.006, β = 2.157). On the other hand, trimester was reported as a negative predictor of QoL (p = 0.013, β = -1.123).
Conclusion: Improving the QoL among pregnant women requires better identification of their difficulties and guidance. The current study highlighted educational status and trimester as the predictors of QoL in pregnant women. Health care professionals and policymakers should consider the identified factors while designing therapeutic plans and interventions for pregnant women.
Fulltext Fischer Linear Discrimination and Quadratic Discrimination Analysis-Based Data Mining Technique for Internet of Things Framework for Healthcare

Hasan MK, Ghazal TM, Alkhalifah A, Abu Bakar KA, Omidvar A, Nafi NS, et al.

Front Public Health, 2021;9:737149.
PMID: 34712639 DOI: 10.3389/fpubh.2021.737149

The internet of reality or augmented reality has been considered a breakthrough and an outstanding critical mutation with an emphasis on data mining leading to dismantling of some of its assumptions among several of its stakeholders. In this work, we study the pillars of these technologies connected to web usage as the Internet of things (IoT) system's healthcare infrastructure. We used several data mining techniques to evaluate the online advertisement data set, which can be categorized as high dimensional with 1,553 attributes, and the imbalanced data set, which automatically simulates an IoT discrimination problem. The proposed methodology applies Fischer linear discrimination analysis (FLDA) and quadratic discrimination analysis (QDA) within random projection (RP) filters to compare our runtime and accuracy with support vector machine (SVM), K-nearest neighbor (KNN), and Multilayer perceptron (MLP) in IoT-based systems. Finally, the impact on number of projections was practically experimented, and the sensitivity of both FLDA and QDA with regard to precision and runtime was found to be challenging. The modeling results show not only improved accuracy, but also runtime improvements. When compared with SVM, KNN, and MLP in QDA and FLDA, runtime shortens by 20 times in our chosen data set simulated for a healthcare framework. The RP filtering in the preprocessing stage of the attribute selection, fulfilling the model's runtime, is a standpoint in the IoT industry. Index Terms: Data Mining, Random Projection, Fischer Linear Discriminant Analysis, Online Advertisement Dataset, Quadratic Discriminant Analysis, Feature Selection, Internet of Things.
Fulltext Effects of Smart City Construction on the Quality of Public Occupational Health: Empirical Evidence From Guangdong Province, China

Cheng H, Wang FF, Dong DW, Liang JC, Zhao CF, Yan B

Front Public Health, 2021;9:769687.
PMID: 34746088 DOI: 10.3389/fpubh.2021.769687

This article takes the Guangdong Province of China as the research object and uses the difference-in-difference model to evaluate the impact of smart city construction on the quality of public occupational health and intercity differences. The obtained results show that smart city construction significantly improves the quality of public occupational health, and it is still valid after a series of robustness tests. The effect of this policy is stronger in cities that belong to the Pearl River Delta region or sub-provincial level cities. This study indicates that the central government should improve the pilot evaluation system and the performance appraisal mechanism of smart cities from the perspective of top-level design during the process of promoting smart city construction, which aims to correctly guide local governments to promote the construction of smart cities. To achieve the full improvement effect of smart city construction on the quality of public occupational health, local governments should implement smart city strategies in a purposeful and planned way according to the actual situation of the development of the jurisdiction.
Fulltext A Cross-Sectional Assessment of Urinary Tract Infections Among Geriatric Patients: Prevalence, Medication Regimen Complexity, and Factors Associated With Treatment Outcomes

Akhtar A, Ahmad Hassali MA, Zainal H, Ali I, Khan AH

Front Public Health, 2021;9:657199.
PMID: 34733812 DOI: 10.3389/fpubh.2021.657199

Background: Urinary tract infections (UTIs) are the second most prevalent infection among the elderly population. Hence, the current study aimed to evaluate the prevalence of UTIs among older adults, medication regimen complexity, and the factors associated with the treatment outcomes of elderly patients infected with UTIs. Methods: A retrospective cross-sectional study was conducted at the Department of Urology, Hospital Pulau Pinang, Malaysia. The patients ≥65 years of age were included in the present study with a confirmed diagnosis of UTIs from 2014 to 2018 (5 years). Results: A total of 460 patients met the inclusion criteria and were included in the present study. Cystitis (37.6%) was the most prevalent UTI among the study population followed by asymptomatic bacteriuria (ASB) (31.9%), pyelonephritis (13.9%), urosepsis (10.2%), and prostatitis (6.4%). Unasyn (ampicillin and sulbactam) was used to treat the UTIs followed by Bactrim (trimethoprim/sulfamethoxazole), and ciprofloxacin. The factors associated with the treatment outcomes of UTIs were gender (odd ratio [OR] = 1.628; p = 0.018), polypharmacy (OR = 0.647; p = 0.033), and presence of other comorbidities (OR = 2.004; p = 0.002) among the study population. Conclusion: Cystitis is the most common UTI observed in older adults. Gender, the burden of polypharmacy, and the presence of comorbidities are the factors that directly affect the treatment outcomes of UTIs among the study population.
Fulltext An Empirical Model to Predict the Diabetic Positive Using Stacked Ensemble Approach

R S, M S, Hasan MK, Saeed RA, Alsuhibany SA, Abdel-Khalek S

Front Public Health, 2021;9:792124.
PMID: 35127623 DOI: 10.3389/fpubh.2021.792124

Today, disease detection automation is widespread in healthcare systems. The diabetic disease is a significant problem that has spread widely all over the world. It is a genetic disease that causes trouble for human life throughout the lifespan. Every year the number of people with diabetes rises by millions, and this affects children too. The disease identification involves manual checking so far, and automation is a current trend in the medical field. Existing methods use a single algorithm for the prediction of diabetes. For complex problems, a single model is not enough because it may not be suitable for the input data or the parameters used in the approach. To solve complex problems, multiple algorithms are used. These multiple algorithms follow a homogeneous model or heterogeneous model. The homogeneous model means the same algorithm, but the model has been used multiple times. In the heterogeneous model, different algorithms are used. This paper adopts a heterogeneous ensemble model called the stacked ensemble model to predict whether a person has diabetes positively or negatively. This stacked ensemble model is advantageous in the prediction. Compared to other existing models such as logistic regression Naïve Bayes (72), (74.4), and LDA (81%), the proposed stacked ensemble model has achieved 93.1% accuracy in predicting blood sugar disease.
Fulltext Effect of Brisk Walking on Health-Related Physical Fitness Balance and Life Satisfaction Among the Elderly: A Systematic Review

Bai X, Soh KG, Omar Dev RD, Talib O, Xiao W, Cai H

Front Public Health, 2021;9:829367.
PMID: 35174137 DOI: 10.3389/fpubh.2021.829367

BACKGROUND: Although the elderly frequently engages in brisk walking as a form of exercise, little has been reported in the literature about the effect of brisk walking on health-related physical fitness, balance, and overall life satisfaction.
OBJECTIVES: The purpose of this systematic review is to determine the effect of brisk walking on the elderly's health-related physical fitness, balance, and life satisfaction.
DESIGN: We conducted a comprehensive search from the PubMed, Web of Science, Scopus, and SPORTDiscus databases from January to September 2021. We selected studies through PICOS and conducted a systematic literature review according to the PRISMA guidelines.
RESULTS: Thirteen studies met all criteria; 11 were classed as low risk of bias, while two were classified as high risk of bias. Generally, brisk walking has been shown to improve cardiorespiratory fitness, muscular strength, and body composition. Limited evidence was presented on flexibility, muscular endurance and development and life satisfaction, and there was conflicting evidence on balance. Moreover, evidence of restriction proves that high-intensity (80-85%) brisk walking is more effective than moderate-intensity (60-75%) brisk walking on the aerobic capacity of the elderly. Furthermore, there was less research conducted on males.
CONCLUSION: Brisk walking has been shown to improve cardiorespiratory fitness, muscular strength, and body composition. Other outcomes (balance, flexibility, muscular endurance, and life satisfaction) and the impact of the intensity of brisk walking on the elderly should be confirmed. Therefore, there remains insufficient research on brisk walking, while single brisk walking cannot meet requirements of elderly in terms of their health-related physical fitness, balance, and life satisfaction. Future research should aim to examine the effectiveness of combining several types of exercises to promote general health in the elderly, as the World Health Organization recommends. Unintelligible FITT (frequency, intensity, time, type) principles of brisk walking training should be trenched for the results of scientific and effective physical exercise.
Fulltext An Exploratory Qualitative Study With Older Malaysian Stroke Survivors, Caregivers, and Healthcare Practitioners About Falls and Rehabilitation for Falls After Stroke

Ahmad Ainuddin H, Romli MH, Hamid TA, Sf Salim M, Mackenzie L

Front Public Health, 2021;9:611814.
PMID: 33987161 DOI: 10.3389/fpubh.2021.611814

Background: Studies on rehabilitation for falls after a stroke remain limited despite its impact being profound. This scenario justifies a deeper understanding of why falls in stroke rehabilitation received less attention. Current investigations on the perception of falls and stroke also proved inadequate. Therefore, this study aims to explore the perceptions and experiences of older Malaysian stroke survivors, spousal caregivers, and healthcare practitioners on falls in stroke rehabilitation. Method: A qualitative study of three focus groups with 18 individuals from one community-based stroke rehabilitation center was conducted. The discussions were audio-recorded, video-recorded, transcribed, summarized, and analyzed using thematic analysis. Results: Three themes emerged from the analysis: (i) perceived factors and consequences of falls after stroke, (ii) physical-based interventions predominate in rehabilitation for falls after stroke, and (iii) the role of home hazards in fall prevention is taken for granted. Although, awareness of falls is high, they are regarded as a peripheral issue in stroke. Rehabilitation interventions such as improved functionality are believed to be adequate and can indirectly prevent falls. Other interventions for fall prevention such as home hazards management are relatively less known. Conclusion: There is a need for more attention regarding home environment risk assessment and intervention among healthcare professionals, and more education for clients and caregivers is required. Although, other stroke interventions may also benefit stroke survivors, falls prevention should be a central component in stroke rehabilitation. As this study focused on a specific population, the findings should be validated with larger populations, and in diverse settings.
Fulltext Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation

Ahmad Ainuddin H, Romli MH, Hamid TA, Salim MSF, Mackenzie L

Front Public Health, 2021;9:611793.
PMID: 33748063 DOI: 10.3389/fpubh.2021.611793

Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
Fulltext Factors Associated With Underprivileged E-Learning, Session Jam Phobia, and the Subsequent Mental Distress Among Students Following the Extended University Closure in Bangladesh

Hossain MJ, Ahmmed F, Sarker MMR, Sarwar S, Bari MS, Khan MR, et al.

Front Public Health, 2021;9:807474.
PMID: 35223762 DOI: 10.3389/fpubh.2021.807474

Severe session jam phobia (SJP), the extent of underprivileged online education, and subsequent mental health disorders among students have emerged as distinguished global problems due to the overwhelming effects of coronavirus disease 2019 (COVID-19). The purpose of this research was to evaluate the impact of extended COVID-19 lockdown and its mediating factors on current e-Learning activities, the prevalence of severe SJP and psychological distress among university students in Bangladesh. A web-based cross-sectional study was conducted to assemble responses through Google Form by applying a simple snowball sampling technique among university students aged 18 years or above in Bangladesh. All ethical considerations were maintained, and univariate, bivariate, and multivariate analyses were employed to analyze the acquired data set. Among the total analyzed data (n = 1,122), the male and female ratio was almost 1:1, and a remarkable segment (63.7%) was aged between 21-24 years. Alarmingly, around 50-60% of the students were suffering from severe SJP, prevailing underprivileged education in the e-Learning platform, and severe mental distress. Logistic regression analyses demonstrated that the students from public universities, lower- and mid-income families, lower-aged, and junior years education groups were significantly (p < 0.05) more underprivileged than their counter groups. Besides, the monthly family income and university type significantly influenced the extent of severe SJP. Finally, the students who were female, rustic, come from low-income families (below 25,000 BDT), who had academic uncertainty, job insecurity, online exam phobia, and dissatisfaction with e-Learning education, were significantly suffering from moderate to severe mental distress. The current evidence demonstrates that a substantial number of Bangladeshi university students are struggling with extreme session jam phobia, underprivileged e-Learning education, and subsequent psychological distress, which need to be immediately addressed through concerted efforts by the government, parents, and university authorities.
Fulltext Editorial: Malnutrition: A Cause or a Consequence of Poverty?

Ma ZF, Wang CW, Lee YY

Front Public Health, 2021;9:796435.
PMID: 35059381 DOI: 10.3389/fpubh.2021.796435
Fulltext A Comprehensive Review on the Optical Micro-Electromechanical Sensors for the Biomedical Application

Upadhyaya AM, Hasan MK, Abdel-Khalek S, Hassan R, Srivastava MC, Sharan P, et al.

Front Public Health, 2021;9:759032.
PMID: 34926383 DOI: 10.3389/fpubh.2021.759032

This study presented an overview of current developments in optical micro-electromechanical systems in biomedical applications. Optical micro-electromechanical system (MEMS) is a particular class of MEMS technology. It combines micro-optics, mechanical elements, and electronics, called the micro-opto electromechanical system (MOEMS). Optical MEMS comprises sensing and influencing optical signals on micron-level by incorporating mechanical, electrical, and optical systems. Optical MEMS devices are widely used in inertial navigation, accelerometers, gyroscope application, and many industrial and biomedical applications. Due to its miniaturised size, insensitivity to electromagnetic interference, affordability, and lightweight characteristic, it can be easily integrated into the human body with a suitable design. This study presented a comprehensive review of 140 research articles published on photonic MEMS in biomedical applications that used the qualitative method to find the recent advancement, challenges, and issues. The paper also identified the critical success factors applied to design the optimum photonic MEMS devices in biomedical applications. With the systematic literature review approach, the results showed that the key design factors could significantly impact design, application, and future scope of work. The literature of this paper suggested that due to the flexibility, accuracy, design factors efficiency of the Fibre Bragg Grating (FBG) sensors, the demand has been increasing for various photonic devices. Except for FBG sensing devices, other sensing systems such as optical ring resonator, Mach-Zehnder interferometer (MZI), and photonic crystals are used, which still show experimental stages in the application of biosensing. Due to the requirement of sophisticated fabrication facilities and integrated systems, it is a tough choice to consider the other photonic system. Miniaturisation of complete FBG device for biomedical applications is the future scope of work. Even though there is a lot of experimental work considered with an FBG sensing system, commercialisation of the final FBG device for a specific application has not been seen noticeable progress in the past.
Fulltext The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

Godman B, Haque M, Leong T, Allocati E, Kumar S, Islam S, et al.

Front Public Health, 2021;9:671961.
PMID: 34249838 DOI: 10.3389/fpubh.2021.671961

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.
Fulltext Stigma, Social Support, Illicit Drug Use, and Other Predictors of Anxiety and Depression Among HIV/AIDS Patients in Pakistan: A Cross-Sectional Study

Ahmed A, Saqlain M, Umair MM, Hashmi FK, Saeed H, Amer M, et al.

Front Public Health, 2021;9:745545.
PMID: 34660521 DOI: 10.3389/fpubh.2021.745545

Introduction: Anxiety and depression in people living with HIV/AIDS (PLWHA) can lead to non-adherence to antiretroviral therapy (ART), morbidity, and mortality. Therefore, assessing the stigma, social support, and other determinants of anxiety and depression in PLWHA are important for developing further interventions. Methods: An institution-based cross-sectional study was conducted in 505 PLWHA, approached through systematic sampling, who paid routine visits to the ART center, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Data was collected by pretested validated hospital anxiety and depression scale (HADS). Version 26 of the SPSS was used to apply Logistic regression analysis to identify determinants, and the 95% confidence interval (CI) adjusted odds ratio (AOR) was calculated to assess the magnitude of the relationships. Results: In PLWHA, the prevalence of co-morbid depression and anxiety was 80%. Separately, 89.9% had depression, and 80.3% had anxiety. Use of illicit drugs [AOR = 1.87, 95% CI (1.01, 3.27)], low social support [AOR = 1.21, 95% CI (1.02, 2.25)], being male [AOR = 2.21, 95% CI (1.11, 5.49)], and HIV related stigma [AOR = 2.48, 95% CI (1.25, 6.02)] were significant predictors of depression. Having detectable viral load [AOR = 3.04, 95% CI (1.04, 8.86)], young age [AOR = 5.31, 95% CI (1.19, 29.39)], no formal education [AOR = 21.78, 95% CI (4.03, 117.62)], low [AOR = 1.70, 95% CI (1.12, 6.93)] or moderate [AOR = 2.20, 95% CI (1.79, 6.09)] social support, illicit drugs addiction [AOR = 1.17, 95% CI (1.03, 2.55)], and HIV stigma [AOR = 54.3, 95% CI (21.20, 139.32)] had a remarkable association with anxiety. Conclusions: Given the high prevalence of anxiety and depression among PLWHA, the Pakistan Ministry of Health should focus more on monitoring mental health, expanding mental health services, and developing interventions based on identified factors to treat depression and anxiety among PLWHA.

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