Adolescent health literacy: factors effecting usage and expertise of digital health literacy among universities students in Pakistan.

BACKGROUND: Electronic health tools are of little use if the intended user lacks the skills to effectively engage them. Engaging eHealth requires a skill set, or literacy, of its own. The present study is an effort to probe the relationship of education and Institution (Independent Variables) with the usage and expertise in eHealth literacy (Dependent Variables) among university students. The research is conducted in 16 Higher Education Commission (HEC) Pakistan's recognized universities in Lahore. Both male and female students ranging from BS to PhD programs were the focus of the research. METHODS: Quantitative data was collected through survey method using stratified random sampling technique. There were different kinds of strata in population i.e. general universities, health sciences universities, engineering universities and animal sciences universities etc. The research encompassed a total of 89,664 students in 16 universities, from which sample size of 1513 was drawn through research advisor table (2006). Proportional allocation formula was used to specify the number of respondents from each university. Non-parametric statistics was used since data was not normally distributed. Kruskal-Wallis H test and Mann-Whitney U test were applied to measure the difference of effect of groups of independent variables on the dependent variables. RESULTS: The level of using digital health literacy was not same for all students, as the students of PhD and BS/Masters were significantly different from each other in terms of their usage of digital health literacy. Level of education showed a significant influence on level of expertise in eHealth literacy, confirming that changing the level of education had an effect on level of expertise in digital health literacy, but the size of effect was smaller. MS/MPhil and PhD students were significantly different from each other in their expertise in digital health literacy. CONCLUSION: Results of the study depicted that belonging to different categories of educational levels differently affect the level of usage and that of expertise in digital health literacy among university students.

Trends of caesarean section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990-2018.

BACKGROUND: Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15-49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018. METHODS: Secondary data from Pakistan Demographic and Health Surveys (1990-2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4029, 5721, 7461 and 8287 for the time periods of 1990-91, 2006-07, 2012-13 and 2017-18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR). RESULTS: The percentages of the mothers who had at least one delivery during the 5 years prior to each survey who had caesarean deliveries increased continuously from 3.2% in 1990-91 to 19.6% in 2017-18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socio-economic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births. CONCLUSIONS: The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering by caesarean section during the past two decades in Pakistan. Against this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated.

Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the Demographic and Health Survey, 2012-13.

BACKGROUND: The increasing rate of caesarean deliveries has become a serious concern for public health experts globally. Various medical and non-medical factors, such as maternal socio-demographics, are found to be responsible for this upsurge. Like in other countries, the rate of caesarean sections has increased in Pakistan as well. Therefore, there is a need to investigate the factors behind this increase. This study aims to assess the determinants associated with caesarean deliveries among child-bearing women aged 15-49 years in Pakistan. METHODS: Secondary data analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2012-2013. The analysis was limited to mothers aged 15-49 years, who had given birth to at least one child during the 5 years immediately preceding the survey (n = 7461). Maternal socio-demographic characteristics and pregnancy-related variables, including antenatal care utilisation, place of delivery and pregnancy complications were considered as independent variables. The association between caesarean section deliveries (outcome variable) and its determinants was assessed by calculating unadjusted and adjusted odds ratios with 95% confidence intervals using a multivariable binary logistic regression. RESULTS: Of the women who had given birth to at least one child during the previous 5 years, the percentage of mothers who delivered their babies through caesarean section was found to be 13.6%. The likelihood of caesarean deliveries was associated with mothers aged more than 24 years, women residing in Punjab province, women belonging to the richest class, women with higher education, women employed at professional/managerial/technical level, and women residing in an urban setting. Additionally, the women who had pregnancy complications, a high utilisation of antenatal care and delivered their babies in private hospitals were found to have higher chances of caesarean deliveries. CONCLUSIONS: The study revealed that there are a high percentage of women delivering babies through caesarean section in Pakistan. Therefore, strict measures need to be taken to deal with this concern. For example, detailed medical justifications by doctors for performing caesarean sections and awareness among women regarding the reduction of pregnancy complications can help to reduce the chances of malpractice related to caesarean deliveries.

Impact of automobile exhaust on biochemical and genomorphic characteristics of Mimusops elengi L. growing along roadsides of Lahore city, Pakistan.

Automobile exhaust releases different types of pollutants that are at great risk to the air quality of the environment and incidental distress to the nature of roadside plants. Mimusops elengi L. is an evergreen medicinal tree cultivated along the roadside of Lahore City. This research aimed to investigate physiological, morphological and genomorphic characteristics of M. elengi under the influence of air pollution from vehicles. Healthy and mature leaves were collected from trees on Canal Bank and Mall roads of Lahore as the experimental sites and control sites were 20 km away from the experimental site. Different physiochemical, morphological, air pollution tolerance index (APTI) and molecular analysis for the detection of DNA damage were performed through comet assay. The results demonstrated the mean accumulated Cd, Pb, Cu and Ni heavy metal contents on the leaves were higher than the control plants (1.27, 3.22, 1.32 and 1.46 µg mg-1). APTI of trees was 9.04. Trees in these roads significantly (p < 0.01) had a lower leaf area, petiole length and leaf dry matter content in comparison to control site. Increased comet tail showed that DNA damage was higher for roadside trees than trees in the control area. For tolerance of air pollution, it necessary to check the APTI value for the M. elengi at the polluted road side of Lahore city. For long-term screening, the source and type of pollutants and consistent monitoring of various responses given by the trees should be known.

How do energy technology innovation, financial inclusion, and digital trade help to achieve carbon neutrality targets?

The ultimate goal of carbon neutrality objectives is to bring greenhouse gas emissions down to a point where they are no longer a factor in escalating climate change and global warming. Adopting sustainable habits, technologies, and investments may be facilitated and accelerated by energy technology innovation, digitalization trade, and financial inclusion, which can substantially influence reaching carbon neutrality objectives. However, none of the past studies have examined the role of energy technology innovation, financial inclusion, and digital trade on the carbon neutrality targets in top polluted economies. To fill this vacuum, this study aims to investigate the effect of energy technology innovation, financial inclusion, and digital trade on carbon neutrality in the top 40 polluted economies across Asia, America, and Europe from 2004-2021. Two renowned econometric techniques are used for empirical analysis, including Two Stage Least Square (2SLS) and Generalized Method of Moments (GMM). The estimates of energy innovation, ICT trade, digital financial inclusion, foreign direct investment, and research and development spending highlight the adverse influence on carbon emissions in global, Asian, American, and European samples. Conversely, the per capita income and foreign direct investment cause carbon emissions to increase in Asia, America, and Europe. Thus, policy experts in top polluted economies should target an integrated policy with a central focus on energy innovation, digital trade, and financial inclusiveness to achieve carbon neutrality.

Green growth strategies in Asia: unleashing the heterogeneous asymmetry of ICT capital, financial fragility, environmental policy stringency, and education.

Financial fragility, ICT capital, environmental policy stringency, and education are the main factors that have also gained popularity regarding their impact on green growth. This study examines the impact of financial fragility, ICT capital, environmental policy stringency, and education on green growth. For analyzing the short- and long-run estimates, we have applied the panel QARDL model. The results of the panel QARDL model highlight that the estimates of non-performing bank loans and bank costs are negatively significant in both the short and long run, implying that financial fragility hurts green growth in the short and long run. Similarly, the estimated coefficients of the internet (mobile) and education estimates are positively significant in the short and long run, confirming that ICT capital and education are causing green growth, while environmental policy stringency promotes green growth only in the long run. Regarding the asymmetric effects of all the factors on green growth, the Wald test only confirms asymmetric effects in the long run. The study offers several significant recommendations for sustainable green development policies.

Education and its impact on renewable energy demand, carbon intensity, and green growth: do digital financial inclusion and environmental policy stringency matter in China.

Various targets need to be accomplished before the dream of sustainable development comes true. Among these targets, increasing renewable energy demand, reducing carbon intensity, and achieving green growth are the most noticeable. Therefore, the present study focuses on capturing digital financial inclusion's impact on renewable energy demand, carbon intensity, and green growth in the presence of ICT trade and environmental policy stringency in China. To empirically estimate the model, we have applied ARDL covering the time span from 1995 to 2020. The results state that the estimated coefficients attached to education, ATMS, and environmental policy stringency are positively significant in the renewable energy and green growth model and negatively significant in the carbon intensity model. From these results, we confer that education, digital financial inclusion, and environmental policy stringency are good for increasing renewable energy demand, reducing carbon intensity, and achieving green growth in China. In the short run, some of the estimates are negative; hence, we conclude that the results are inconclusive. The results recommend some imperative policy suggestions.

Financial deepening, financial innovation, and education as new determinants of green growth in China.

To address the issue of global warming, the agreed solution is to reduce GHG emissions. The plausible solution to reduce GHG emissions is to follow a green growth strategy that refers to the complete decoupling of economic growth from its environmental impact through the sustainable utilization of natural resources. Consistent with this view, this study investigates the impact of financial deepening, financial innovation, and education on green growth in China from 1996 to 2020. The empirical analysis of the model is conducted through quantile ARDL. The long-run estimated coefficients of financial institution deepening are positively significant across most quantiles, whereas the estimated coefficients of financial market deepening are positively significant in almost half quantiles. These results imply that the financial deepening of both financial markets and institutions can positively contribute to green growth. However, the estimates of financial innovations are significant and positive in higher quantiles, implying that financial innovation only contributes to the green when the rate of financial innovation is too high. The estimates of education are positively significant at higher quantiles. Our study highlights various policy suggestions that are aimed at instigating sustainable green growth in China.

Green growth as a determinant of ecological footprint: Do ICT diffusion, environmental innovation, and natural resources matter?

The nexus between green growth and ecological footprint is associated with crucial environmental implications. But this domain is not examined sufficiently and provides ambiguous findings. Furthermore, these studies have not addressed the role of natural resources, environmental innovation, and ICT in influencing ecological footprint. Our study analyzes the impact of green growth, ICT, environmental innovation, and natural resources on the ecological footprint ofemerging-7 and developed-7 economies. We employed CS-ARDL methodology to draw the long-run and short-run estimates of the said relationships. The obtained findings show that green growth, ICT, and environmental innovation reduce the ecological footprint in emerging economies in the long run. However, natural resources enhance the ecological footprint in emerging economies in the long run. Green growth, ICT, natural resources, and environmental innovation reduce the ecological footprint in the long run in developed economies. Based on these outcomes, the study recommends important policy suggestions.

Intravesical mitomycin C efficacy in acidic and alkaline urinary pH: impact on recurrence-free survival rate after TURBT.

Background: Urinary bladder tumor recurrence following transurethral resection of bladder tumor (TURBT) is a common issue. This study aims to determine how urine alkalinization affects bladder tumor recurrence after surgery. Materials and methods: Sixty patients receiving mitomycin C (MMC) therapy after TURBT were divided into two groups based on mean pH values. Twenty-six patients were in group A, whose urine pH was below 5.5. However, there were 34 patients in group B, and their urine pH was higher than 5.5. Both groups of patients were given intravesical MMC once weekly for 6 weeks following TURBT. A cystoscopy was performed as a follow-up at 3, 6, and 12 months. Urine pH and the recurrence-free survival rate were compared using Kaplan-Meier survival analysis and the COX proportional hazard model. Results: The mean time to tumor recurrence in group A (intravesical MMC in acidic urine) and group B (intravesical MMC in alkaline urine) was 12.48 versus 16.84 months, respectively. Alkaline urine pH was identified as an independent predictor of preventing the recurrence of superficial bladder tumors by univariate COX regression analysis. Age, sex, and mean tumor size did not affect the likelihood of tumor recurrence. However, smoking had an association with increased tumor recurrence. Conclusion: Tumor recurrence post-TURBT is delayed in patients with alkaline urine pH. Smoking is an independent risk factor for bladder tumors.

Understanding rural women's preferences for telephone call engagement with primary health care providers in Nigeria: a discrete choice experiment.

BACKGROUND: The COVID-19 pandemic has accelerated the use of mobile phones to provide primary health care services and maintain continuity of care. This study aims to understand rural women's preferences for telephone call engagement with primary health care providers in Nigeria. METHODS: A discrete choice experiment was conducted alongside an action research project that empowered primary health care workers to develop and implement a telephone call intervention to assess and enhance experiences with facility childbirth care. Between January and March 2022, 30 providers from 10 primary health care facilities implemented the choice experiment among rural women who had institutional childbirth to elicit service user preferences for telephone call engagement. The women were asked to express their preferred scenario for telephone call engagement with their primary health care providers. Generalised linear mixed models were used to estimate women's preferences. RESULTS: Data for 460 women were available for the discrete choice experiment. The study showed that rural women have preferences for telephone call engagement with primary health care providers. Specifically, women preferred engaging with female to male callers (ß=1.665 (95% CI 1.41, 1.93), SE=0.13, p<0.001), preferred call duration under 15 min (ß=1.287 (95% CI 0.61, 1.96), SE=0.34, p<0.001) and preferred being notified before the telephone engagement (warm calling) (ß=1.828 (95% CI 1.10, 2.56), SE=0.37, p<0.001). Phone credit incentive was also a statistically significant predictor of women's preferences for engagement. However, neither the availability of scheduling options, the period of the day or the day of the week predicts women's preferences. CONCLUSIONS: The study highlights the importance of understanding rural women's preferences for telephone call engagement with healthcare providers in low-income and middle-income countries. These findings can inform the development of mobile phone-based interventions and improve acceptability and broader adoption.

Comparison of plasma from healthy nonsmokers, smokers, and lung cancer patients: pattern-based differentiation profiling of low molecular weight proteins and peptides by magnetic bead technology with MALDI-TOF MS.

CONTEXT: Smoking is the major contributor of lung cancer (LC), which accounts for millions of death. OBJECTIVE: This study focused on the correlation between the proteomic profiling of LC patients, and healthy nonsmokers and smokers. METHOD: Pattern-based peptide profiling of 186 plasma samples was performed through reversed-phase chromatography-18 magnetic bead fractionation coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis and resulted data were evaluated statistically by ClinProTool. RESULTS: Marker peaks at m/z 1760, 5773, 5851, 2940, and 7172 were found with an excellent statistical figure. CONCLUSION: Selected marker peaks can be served as a differentiated tool of LC patients with high sensitivity and specificity.

Relationship of drug metabolizing enzyme genotype to plasma levels as well as myelotoxicity of cyclophosphamide in breast cancer patients.

PURPOSE: The cytotoxic drug cyclophosphamide (CP) is bioactivated into 4-hydroxy-cyclophosphamide (4-OH-CP) through cytochrome P450 enzymes and cleared through aldehyde dehydrogenase and glutathione S-transferase. This prospective study analyzes the influence of drug metabolizing enzyme genotype on (1) plasma 4-OH-CP:CP ratio and (2) myelotoxicity in breast cancer patients on 500 mg/m(2) cyclophosphamide. METHODS: Sixty-eight female breast cancer patients on FAC (fluorouracil, adriamycin, cyclophosphamide) were included. Genotyping of cytochrome P450 enzymes CYP2B6, CYP2C9, CYP2C19, CYP3A5, aldehyde dehydrogenase (ALDH3A1), and glutathione S-transferase (GSTA1) was done either through RFLP or pyrosequencing. Plasma CP and 4-OH-CP were measured immediately and 1 and 2 h after the end of infusion through LC-MS. The leukocyte count was determined on day 10 and 20 after chemotherapy. RESULTS: At CP dose of 500 mg/m(2), the 4-OH-CP:CP ratio was negatively affected by CYP2C19*2 genotype (p = 0.039) showing a gene-dose effect. Moreover ALDH3A1*2 genotype increased 4-OH-CP:CP ratio (p = 0.037). These effects did not remain significant in a univariate analysis of variance including all genotypes. GSTA1*B carriers were at increased risk of severe leucopenia (OR 6.94; 95% CI 1.75-27.6, p = 0.006). CONCLUSION: The myelotoxicity in patients receiving FAC is related to the activity of the phase-II enzyme GSTA1 but is independent of the formation of 4-OH-CP.

Clean energy consumption and CO2 emissions: does China reduce some pollution burdens through environmental regulation?

Environmental regulations are considered a prerequisite for environmental performance. However, very limited studies have explored the asymmetric relationship between clean energy consumption, environmental regulation, and CO2 emissions. This study scrutinizes the asymmetry phenomenon in environmental regulation-clean energy consumption and environmental quality nexus in China by using the time series nonlinear ARDL approach by covering the period 1993-2019. The result reveals that the impact of environmental regulation on clean energy consumption and CO2 emissions is asymmetric. A positive change in environmental regulation has a positive effect on clean energy consumption but a negative impact on CO2 emissions in the long run. While a negative change in environmental regulation has insignificant effects on clean energy consumption and CO2 emissions in the long run. The study suggests that China should need to revisit environmental regulation policies that could help in improving environmental quality.

The trade-off between economic performance and environmental quality: does financial inclusion matter for emerging Asian economies?

This study examines the role of financial inclusion on the environment-economic performance in the top five Asian emerging economies. The data used for empirical investigation covers the time period from 1995 to 2019. Financial inclusion is measured through bank branches, bank credit, and insurance premiums. To check long-run associations, the panel ARDL approach has been employed for empirical analysis. The empirical evidence confirms the significant associations between financial inclusion-GDP nexus and financial inclusion-CO2 nexus. The findings show that bank branches and bank credit have a significantly positive impact on economic growth and CO2 emissions in the long run. However, insurance premium has no impact on economic growth but it exerts a significant negative impact on carbon emissions in the long run. Furthermore, energy consumption is highly sensitive to economic growth and carbon emissions. The study delivers imperative points for pollution eradication and attaining sustained economic growth. There is a need for government-level efforts to align the targets of financial inclusion with economic growth and environmental policies.

Energy efficiency and green innovation and its asymmetric impact on CO2 emission in China: a new perspective.

Green innovation undoubtedly plays a significant role in generating employment opportunities, improving green economic activity, and increasing environmental sustainability. This study scrutinizes the effect of energy efficiency and green innovation on CO2 emissions for China using nonlinear autoregressive distributed lag (NARDL) from 1991 to 2019. Findings show that energy efficiency and green innovation contribute to reducing CO2 emissions in China. Energy efficiency and green innovation are also important nonlinear determinants of CO2 emissions. An increase in energy efficiency and green innovation lowers CO2 emissions, while a fall in energy efficiency and green innovation increases CO2 emissions in China in the long run. Some policy measures are suggested to attain carbon neutrality.

The asymmetric effect of technology shocks on CO2 emissions: a panel analysis of BRICS economies.

Technological innovation positively contributes to economic development in BRICS countries; their environmental consequences cannot be ignored. Thus, it is imperious to explore the impact of technological shocks on environmental quality. We used ARDL and NARDL models to draw empirical consensus on the data set from 1990 to 2019 for BRICS economies. The results of ARDL model reveal that technological shocks positively affect carbon emissions in the long-run and short-run. The findings of NARDL model reveal that positive shocks in technology positively affect carbon emissions in the long-run and short-run, implying that an increase in technological development triggers an increase in carbon emissions. However, the negative shocks in technology have a negative impact on carbon emissions in the long-run, inferring that a reduction in technological development leads to a decrease in carbon emissions. The negative shock in technology has no significant impact on carbon emissions in the short-run. The findings emphasize the importance of environmental friendly technology to achieving sustainable development goals.

Optimization of Wire Electric Discharge Machining (WEDM) Process Parameters for AISI 1045 Medium Carbon Steel Using Taguchi Design of Experiments.

With the growth of the manufacturing industry, the demand for alloy materials with high hardness, toughness, and impact strength has increased. Since products from such alloy materials are extremely difficult to manufacture with high accuracy and reduced surface roughness using traditional machining techniques, wire electric discharge machining can be used to machine such complex parts with more precision. In this case-study-based research, machining factors such as current, pulse-on time, and voltage are studied to determine their effects on the material removal rate for AISI 1045 medium carbon steel. The Taguchi L9 orthogonal array is used in the design of experiments for optimization. Statistical techniques such as analysis of variance and signal-to-noise ratio are used to identify the control parameters that matter most in bringing about optimal results. Based on the results, the current is the most crucial control variable in this investigation. Moreover, the maximum material removal rate obtained was 0.7112 mm3/min with the obtained optimized values of current (I) = 16 A, voltage (V) = 50 V, and pulse-on time (Ton) = 100 µs.

Re-evaluating the asymmetric conventional energy and renewable energy consumption-economic growth nexus for Pakistan.

To understand the nexus between economic growth and energy sources, in this study, we have selected Pakistan and collected data over the period 1980-2016. The neoclassical production function of Pakistan is augmented with conventional and renewable energy, capital, and labor. Conversely, the conventional and renewable models are being constructed by using GDP as an independent variable. This paper applied linear and nonlinear ARDL models to see whether the influence of conventional and renewable energy consumption on GDP per capita of Pakistan is symmetric or asymmetric and vice versa. Furthermore, the asymmetric causal effects between the energy variables and economic growth are also discussed. From the findings of the study, we deduce the long-run asymmetric effects of renewable energy on the economic growth of Pakistan. Similarly, the asymmetric effects of GDP, in the long run, are confirmed in both energy models. The symmetric and asymmetric causality results have recommended growth and conservation hypothesis. The findings propose that renewable energy is a significant factor in boosting the economic growth of Pakistan and a decline in the use of renewable energy could actually stem the economic growth of Pakistan.