Acceptability and feasibility of intra-peer and social media approach for HIV self-testing among men who have sex with men in Karachi: lessons from a pilot study.

OBJECTIVE: To use a peer-to-peer and social media approach to reach out to men who have sex with men (MSM) and to distribute human immunodeficiency virus self-testing kits among them in an urban setting. METHODS: The cross-sectional, pilot study was conducted by a community-based organisation in Karachi from November 2020 to February 2021, and comprised men aged 18 years or above who have sex with men. The subjects were provided one human immunodeficiency virus self-testing kit (HIVST) per person by trained outreach workers. It was an oral fluid-based kit. Data related to demographics, behavioural patterns and human immunodeficiency virus testing detail was collected on a structured questionnaire with some open-ended questions. The analysis of qualitative data was done manually, using content analysis technique in which all common responses were grouped that led to the generation of themes. RESULTS: There were 150 male subjects with mean age 31.5+/-8.7 years. Overall, 62(41.3%) subjects had received up to 15 years of formal education, 94(62.6%) were first-time testers; 139(92.7%) performed the test at home; 11(7.3%) used the kit at the community-based organisation's office. In terms of results, 1(0.7%) participant had a reactive result which was later confirmed as positive for human immunodeficiency virus. Of the total, 145(96.6%) participants found the instructions and the kit easy to use on their own, 83(55.3%) preferred a social media-based approach, and 68(45.3%) preferred the peer-to-peer approach. CONCLUSIONS: The HIVST was found to be acceptable among men who have sex with men, while peer-led and social media approaches seemed to be an effective method of information dissemination.

Eco-physiological evaluation of multipurpose tree species to ameliorate saline soils.

Salinity is a widespread soil and underground water contaminant threatening food security and economic stability. Phytoremediation is an efficient and environmental-friendly solution to mitigate salinity impacts. The present study was conducted to evaluate the phytoremediation potential of five multipurpose trees: Vachellia nilotica, Concorpus erectus, Syzygium cumini, Tamarix aphylla and Eucalyptus cammaldulensis under four salinity treatments: Control, 10, 20 and 30 dS m-1. Salinity negatively impacted all the tested species. However, E. cammaldulensis and T. aphylla exhibited the lowest reduction (28%) and (35%) in plant height respectively along with a minimal reduction in leaf gas exchange while V. nilotica, S. cumini and C. erectus showed severe dieback. Similarly, the antioxidant enzymes increased significantly in E. cammaldulensis and T. aphylla as Superoxide Dismutase (87% and 79%), Catalase (66% and 67%) and Peroxidase (89% and 81%), respectively. Furthermore, both of these species maintained optimum Na/K ratio reducing the highest levels of soil ECe and SAR, suggesting the best phytoremediation potential. The present study identifies that E. cammaldulensis and T. aphylla showed effective tolerance mechanisms and the highest salt sequestration; therefore, may be used for phyto-amelioration of salinity impacted lands. Novelty statement Although previous studies evaluated the tolerance potential of many tree species, comparative and physiochemical evaluation of multipurpose tree species has been remained unexplored. In this scenario, eco-physiological characterization of multipurpose tree species may inform tree species for phytoremediation of saline soils according to the level of salinity. Optimizing tree species selection also improves the success of wood for energy and revenue generation while restoring degraded soils.

Role of needle aspiration and surgical excision in management of suppurative Bacillus Calmette Guerin lymphadenitis.

The aim was to determine the role of needle aspiration and surgical excision in the management of suppurative Bacillus Calmette Guerin (BCG) lymphadenitis. This prospective study was done in Rafha Central Hospital, over 1.5 years. Thirty two patients were enrolled after informed consent. Needle aspiration was done if size of lymphadenitis was up to 3cm. Surgical excision was done primarily for size more than 3cm or in cases of failed aspiration. Eighteen were males and 14 were females. Median age was 3.75 months (IQR 2-7). All were full term with normal birth weight and vaccinated in first 2 days of life. Predominantly single region of lymphadenitis was involved in 75% cases; with left axilla being mainly affected (56.3% cases). Needle aspiration was done in 18 cases and surgical excision was carried out in 14 cases. Resolution of lymphadenopathy was 7 days in cases of surgical excision, while within 60 days in cases of aspiration. Failure of aspiration was noted in cases of multiple, matted suppurative lymph nodes.

RISK CHARACTERIZATION OF MATERNAL AND NEONATAL TETANUS IN VIEW OF TETANUS VACCINATION CAMPAIGNS IN PAKISTAN.

BACKGROUND: Pakistan is one of the remaining 24 countries which have not yet achieved Maternal and Neonatal Tetanus Elimination (MNTE), The country adopted high-risk approach for 56 out of 119 districts with country-wide Tetanus Toxoid (TT) provision in Routine Immunization (RI) during early 2000-2003. The TT's mass campaigns could only cover 13% of high risk districts for 2009- 2011, and mostly for the Punjab province. To achieve MNT elimination, the country needs risk mapping for cost-effective intervention. METHODS: We used both the quantitative and qualitative methods to conduct risk characterization. All the three available data sets (Reported EPI coverage data, PDHS 2012-13, and PSLM 2010-11) were assessed. A mix of core and surrogate indicators-for risk categorization was used through ranking and scoring the aggregated data and considering the past tetanus campaigns' coverage. Tetanus Toxoid (TT2+)-coverage of pregnant women and delivery in health facility, both received more weightage in scoring. We based the higher and lower cuts off points for each indicator on data ranges. The districts with higher scores, i.e., 10.5 and above were ranked good followed by medium (5.5-10.4) and low performing (less than 5.5). Consultations with the national and provincial field officers were utilized to understand the local context. RESULTS: In Pakistan, there are 139 districts out of which, 60 are the high risk districts for tetanus. Highest percentage is for Baluchistan (83%) followed by Sindh (52%), and Khyber Pakhtunkhwa (40%). Most of the Punjab is at medium risk (55%), followed by KP (52%), and Sindh (39%). CONCLUSION: Pakistan is at medium to high risk of MNT with a great variation at the sub-national level. Campaigns aiming to these districts may bring the country closer to MNT elimination target.

Upgrade of egg quality through different heat-combating systems during high environmental temperature.

The aim of the study was to find out the effect of various heat-combating systems (HCS) on the egg quality characteristics of commercial laying hens during high environmental temperature of the year. Three hundred pullets were wing banded and randomly divided into 15 experimental units comprising of 20 pullets each. These units were randomly allotted to five treatment groups, replicated thrice according to four heat-combating systems (desert cooling, water sprinkling, time limit feeding, ascorbic acid supplementation), and the control was maintained under the same housing system. The mean values of egg weight, eggshell thickness, Haugh unit, thick albumen height, yolk height, and yolk diameter were calculated. The layers kept under the influence of desert cooling produced eggs with more weight and thicker shells than those under other systems. Results of the present study did not show any difference in the shell thickness between water sprinkling and ascorbic acid supplementation as compared to the control group. Haugh unit and yolk index values obtained from the layers kept under various HCS did not significantly differ from those of the control group. All HCS significantly reduced the occurrence of blood spots in the eggs as compared to the control. All the treatments in general markedly reduced the incidence of meat spots in the eggs especially with the supplementation of ascorbic acid being the most effective. Among all of the treatments, the desert cooling system proved to be the best for producing better-quality eggs during hot periods of the year with less humidity.

Impact of different priming and sowing techniques in combination with different seed rates on wheat growth and yield.

Wheat (Triticum aestivum L.) is a staple crop of immense economic importance, especially in the agronomic context of Dera Ismail Khan, Khyber Pakhtunkhwa (KPK), Pakistan. Understanding the effects of various agronomic practices, such as priming techniques, sowing methods, and seed rates, on wheat yield and growth is crucial for optimizing production and ensuring regional food security. To study the effects of priming and sowing techniques in combination with seed rates on short (Israr Shaheed) and long (Gomal) duration, three experiments were conducted at the agronomic research site of Gomal University, Dera Ismail Khan, Pakistan, wheat varieties. In the first experiment, various priming techniques were used. Among different techniques used Farmyard manure priming produced the tallest plants at 111.3 and 125.3 cm, the maximum number of tillers (335.7 and 345.0 m-2), longest spikes (8.6 and 7.6 cm), maximum spikelets (27.2 and 31.0 spike-1), maximum number of grains (45.5 and 48.7 spike-1), maximum grain yield (4.4 and 4.6 t ha-1) and maximum harvest index (38.7 and 41.5%) respectively for Israr Shaheed and Gomal. Conversely, compost manure produced heavier grains than other interactions (49.2 and 42.3 g) while sodium chloride showed the maximum biological yield (12.4 and 11.8 t ha-1) for Israr Shaheed and Gomal correspondingly. In 2nd experiment, different sowing methods were tested on two wheat varieties Israr Shaheed and Gomal. Dry sowing followed by flooding produced tallest plants measuring (105.5 and 101.7 cm), maximum number of tillers (398.2 and 406.7 m-2), longest spikes (8.3 and 7.2 cm), maximum spikelets (29.8 and 35.5 spike-1), maximum number of grains (54.3 and 51.6 spike-1) and maximum grain yield (4.3 and 4.6 t ha-1) respectively for Israr Shaheed and Gomal. Israr Shaheed and Gomal showed maximum 1000-grain weights (45.3 and 45.0 g) in sprouted seeding in flooded fields respectively. The highest biological yield (13.6 t ha-1) was in dry seed in the flooded field while the maximum harvest index (33.5 and 33.9%) was recorded in soaked seed followed by flooding for Israr Shaheed and Gomal. In the last experiment, different seed rates were studied. The results showed that plants grown with seed rate 150 kg ha-1 showed the tallest plants at 111.0 and 111.7 cm, maximum number of tillers (411.6 and 408.2 m-2), longest spikes (7.8 and 7.7 cm), maximum spikelets (34.3 and 34.3 spike-1), maximum number of grains (50.8 and 47.2 spike-1), maximum grain yield (4.6 and 4.5 t ha-1) and maximum harvest index (38.4 and 36.7%) respectively for Israr Shaheed and Gomal. The maximum number of 1000-grains weight (g) was found on 200 and 250 kg ha-1 for Israr Shaheed and Goma-8, respectively giving 45.2 g while biological yield was the highest in 175 kg ha-1 respectively. Conclusively, the results indicated that yield and yield attributes in wheat were enhanced up to 150 kg ha-1 seed rate when interacted with farmyard manure priming along with dry sowing of seed followed by flooding. Future research should explore the integration of advanced irrigation techniques and nutrient management practices to further enhance wheat productivity in the Dera Ismail Khan region.

Determinants of immunization in polio super high-risk union councils of Pakistan.

BACKGROUND: The current polio epidemiology in Pakistan poses a unique challenge for global eradication as the country is affected by ongoing endemic poliovirus transmission. Across the country, 40 union councils (UCs) which serve as core reservoirs for poliovirus with continuous incidences of polio cases are categorized as super-high-risk union councils (SHRUCs). METHODOLOGY: A cross-sectional survey was conducted in 39 SHRUCs using a two-stage stratified cluster sampling technique. 6,976 children aged 12-23 months were covered. A structured questionnaire was used for data collection. Data were analyzed using STATA version 17. RESULTS: Based on both vaccination records and recall, 48.3% of children were fully-, 35.4 % were partially-, and 16.3% were non-vaccinated in the SHRUC districts. A child is considered fully vaccinated when h/she completed vaccination for BCG, OPV0, OPV 1-3, Penta 1-3, PCV 1-3, IPV, and MCV1. Vaccination cards were seen for over half of the children in the SHRUC districts of Khyber Pakhtunkhwa (KP) and the majority of the SHRUC districts in Sindh, except for the SHRUC district of Malir the districts of Balochistan. Results for polio vacancies show that 60.9% of children from the SHRUC districts were vaccinated with at least three doses of OPV and one dose of IPV, while 20.4% were vaccinated with any OPV doses or IPV and 18.7% of children did not receive any polio vaccines. The dropout rate between vaccine visits was higher than the WHO-recommended cutoff point of 10% for all vaccine doses in the SHRUC districts. The likelihood of being fully vaccinated was higher among the children of educated parents. Full vaccination was found significant among the children of any SHRUC districts compared to district Killa Abdullah. CONCLUSION: Context-specific strategies with more focus on community engagement and targeted mobilization, along with robust monitoring mechanisms, would help address the underlying challenges of under-immunization in the SHRUCs.

A pediatric HIV outbreak in Pakistan.

Background: Following reports of an outbreak of HIV infection among children in Larkana District, Pakistan, an international team investigated the extent and cause of the outbreak between April and June 2019. Aims: To investigate the incidence of HIV among children in Larkana District, Pakistan and describe the distribution of cases by time, place and person. Methods: Self-referred persons were tested for HIV using the national testing protocol. Local epidemiology of HIV was reviewed to generate hypotheses. An infection prevention and control (IPC) team conducted site visits and reviewed IPC practices. Results: Between 25 April and 27 June 2019, a total of 30 191 persons were tested for HIV in Larkana District, and 876 of them tested positive. Of those who tested positive, 719 (82%) were children aged <15 years. Traditional skin piercing procedures and transmission from high-risk populations to children were ruled out during the investigation. Informative interviews with parents or guardians of a convenience sample of 211 children aged <15 years showed that 99% of children had an injection or infusion for medical treatment within the past 12 months. Our investigation identified lack of HIV prevalence data for the general population including tuberculosis patients and those who attended antenatal care services. Conclusions: Investigations indicate that unsafe healthcare practices in formal and informal healthcare settings as the most likely cause of the 2019 outbreak of HIV infection in Larkana, Pakistan. Measures should be taken to improve IPC practices at the facility level, especially in pediatric and antenatal care clinics.

The Role of CSR Information on Social Media to Promote the Communicative Behavior of Customers: An Emotional Framework Enriching Behavioral Sciences Literature.

Studies have shown that an organization's corporate social responsibility (CSR) activities affect customer behaviors such as loyalty and satisfaction. In spite of this, the role of social media in informing customers about a brand's CSR activities and in fostering customer advocacy behavior (CADB) has been underexplored. To fill this knowledge gap, this study investigates the relationship between the CSR-related communication of a banking organization and CADB. This study also examines how emotions such as customer-company identification (CCI) and gratitude as a mediator and a moderator. Using a self-administered questionnaire (n = 302), we collected data from banking customers. Hypotheses were evaluated by using structural equation modeling, which revealed that CSR positively predicts CADB, whereas there are mediating and moderating functions of CCI and GA. Theoretically, this study highlights the role of human emotions in behavior formation from the standpoint of social media. Practically, this study provides important insights for the banking sector's administrators to realize the important role of CSR communication, using different social networking websites, for converting customers into brand advocates.

Green bond as a new determinant of sustainable green financing, energy efficiency investment, and economic growth: a global perspective.

The purpose of the study is to test the role of green bond financing on energy efficiency investment and economic growth. To achieve the study objective, fuzzy decision-making modeling technique is applied. The results revealed that bank loans are now the main source of financing for energy efficiency projects. Project-based financing might be replaced with Energy Performance Contracts (EPC) warranting energy efficiency investment. Moreover, green banks invest both public and private funds in energy efficiency promoting economic growth. The usage of green bonds for financing environmentally beneficial projects or companies is limitless. Providing for screening energy efficiency investment proposals with small payback hurdle rates might have large opportunity costs. Green bonds can be used to remove the financing barriers for green finance and sustainability tool. On this, study provides policy implications to key stakeholders; if suggested policy suggestions implemented successfully, these would help to enhance scope of green bond financing to uplift energy efficiency financing and green growth successfully.

Novel mutations in RDH5 cause fundus albipunctatus in two consanguineous Pakistani families.

PURPOSE: To identify the underlying genetic causes of fundus albipunctatus (FA), a rare form of congenital stationary night blindness that is characterized by the presence of white dots in the midperiphery of the retina and delayed dark adaptation, in Pakistan. METHODS: Two families with FA were identified by fundus examination, and genome-wide single nucleotide polymorphism genotyping was performed for two individuals from family A and six individuals from family B. Genotyping data were subsequently used to identify the identical homozygous regions present in the affected individuals of both families using the online homozygosity mapping tool Homozygosity Mapper. Candidate genes selected from the homozygous regions were sequenced. RESULTS: Three identical homozygous regions were identified in affected persons of family A (on chromosomes 8, 10, and 12), whereas a single shared homozygous region on chromosome 12 was found in family B. In both families, the homozygous region on chromosome 12 harbored the retinol dehydrogenase 5 (RDH5) gene, in which mutations are known to be causative of FA. RDH5 sequence analysis revealed a novel five base pair deletion, c.913_917delGTGCT (p.Val305Hisfs*29), in family A, and a novel missense mutation, c.758T>G (p.Met253Arg), in family B. CONCLUSIONS: We identified two novel disease-causing RDH5 mutations in Pakistani families with FA, which will improve diagnosis and genetic counseling, and may even lead to treatment of this disease in these families.

Food Systems' Transformation to Address Malnutrition in Selected Countries-Panel-Data Analysis on Undernourishment and Obesity.

Global awareness of the 2030 Sustainable Development Goals (SDGs) has heightened the importance and role of food systems' transformation in accelerating countries' progress to achieve such goals in a timely manner. The agricultural and food systems' transformation goal is to build resilience to vulnerabilities, shocks, and diseases such as undernourishment and obesity. The objective of this study is to specify the agricultural and food systems' factors that contribute to reducing the impacts of undernourishment and obesity in selected populous and high-income countries. This study used panel data from 2000 to 2020, applying fixed and random-effect econometrics models to conduct the analyses. Results indicated that the per capita Gross Domestic Product (GDP), level of urbanization, and flood losses at food retail from a food systems perspective were the most influential factors in the prevalence of undernourishment. Meanwhile, the supply of fatty food was the significant nutrition variable affecting undernourishment. The cereal import dependency, per capita GDP, percentage of food imports from the value of food export, and value of domestic food production factors were the influential food system variables affecting the prevalence of obesity. Cereal import dependency and dietary energy supply are the significant factors affecting the prevalence of obesity. This study recommended a set of policy actions to address malnutrition, including sustainable and balanced food and nutrition systems' transformation, food trade openness, and efforts to reduce adversary impacts of urbanization.

Glycine Improved Cryopreserved Spermatozoa Quality in Achai Bull.

Achai is a small size cattle breed, resilient to harsh and cold environment. Cryopreservation of Achai bull semen may help to improve its genetics and preserve the germplasm. Reactive oxygen species (ROS) affects the structural and functional integrity of the spermatozoa. During freezing and thawing processes, the ROS make changes in the spermatozoa quality parameters and reduce total antioxidant capacity (T-AOC) of semen that is considered as marker of oxidative stress. This study was designed to determine the effect of glycine along with vitamin E on post-thawed spermatozoa quality and total antioxidant capacity in Achai cattle. The semen collection was done twice a week from four mature fertile Achai cattle bulls (n = 4). The glycine was utilized as 0 mM, 5 mM, 10 mM, 15 mM, and 20 mM along with vitamin E @ 2.3 mM added constantly in each concentration. The control group contained all extenders except glycine. The results revealed that post-thawed spermatozoa motility was found significantly higher (P < 0.05) at 10 mM as compared to 5 mM, 15 mM, and 20 mM. Compared with control group, glycine concentration at 10 mM and other concentrations increased progressive and fast motility (%), curvilinear, straight line, and average path velocity (µm/s). Moreover, beat cross frequency (Hz) was higher (P < 0.05), and post-thaw viability (%), plasma membrane integrity, and mitochondrial membrane potential were significantly higher (P < 0.05) at 10 mM of glycine concentration in comparison to control and other glycine concentrations. Besides, acrosome integrity (%) and DNA integrity (%) as well as post-thawed T-AOC were also significantly higher (P < 0.05) at 10 mM of glycine concentration as compared to other glycine concentrations and control group. It is concluded that 10 mM of glycine along with vitamin E @ 2.3 mM improved cryopreserved semen quality of Achai bull.

Advancing the debate on hotel employees' environmental psychology by promoting energy-saving behavior in a corporate social responsibility framework.

Considering the vulnerable climatic conditions in most parts of the planet, a successful transition toward a carbon-free future is a critical challenge worldwide. In this respect, around 35% of the world's total greenhouse gas emission (GHG) is associated with the power sector (especially electrical energy). To this end, a vast of electrical energy has been used by the people in buildings. Specifically, a significant amount of energy in buildings is used for heating, cooling, and ventilation. While the available literature highlights the importance of neat, clean, and green electrical energy for the decarbonization of society, a critical gap exists in such literature. That is, most of the literature under this stream deals with the supply side (production) of electrical energy, while the demand side (consumption at an individual level) was neglected. To bridge this critical knowledge gap, this study investigates how the CSR engagement of a hotel organization can promote the energy-related pro-environmental behavior (ERPEB) among the employees with the intervening effect of employees' environmental commitment (EMEC) and Green intrinsic motivation (GRIM). Further, the conditional indirect role of altruistic values was also tested in this study. The data were collected from different hotel employees in Pakistan with the help of a self-administered questionnaire. We tested the hypothesized relationship through structural equation modeling (SEM). The results confirmed that CSR can be a potential motivator to impact the ERPEB of employees, while EMEC and GRIM mediated this relationship significantly. The findings of this study also confirmed the conditional indirect role of altruistic values. These findings offer various theoretical and practical contributions which are conversed in detail.

Adjustment of self-initiated and organizational expatriates: The moderating role of cross-cultural training.

Globalization and the international labor movement made the ability to work anywhere globally. These individuals are usually organizational expatriates (OEs) deployed to overseas assignments by their employers or self-initiated expatriates (SIEs) who choose to relocate and work in a foreign country. Therefore, this study examines and contrasts the variations in cross-cultural adjustment (CCA) between Chinese SIEs and OEs in Pakistan. Furthermore, it aims to understand how cross-cultural training (CCT) influences the adaptation of Chinese SIEs and OEs. Data were obtained from 35 Chinese expatriates with 17 SIEs and 18 OEs employing a qualitative technique and were analyzed via thematic analysis in MAXQDA 20. According to the study, both SIEs and OEs face distinct hurdles to their CCA in Pakistan, including cultural taboos, language obstacles, and work variations. While numerous aspects that will favorably affect their CCA, including the accessibility of necessities, the friendliness of the Pakistani people, and the brethren relations between Pakistan and China, assist them in making a smooth transition to life in Pakistan. Furthermore, the results indicate that the mediating role of pre-departure CCT and the host country mentors' support and facilitations acquired through online resources contribute to both Chinese SIEs and OEs' CCA in Pakistan.

Acceptability and feasibility of HIV self-testing among transgender people in Larkana, Pakistan: Results from a pilot project.

BACKGROUND: HIV self-testing (HIVST) is an innovative HIV testing approach that effectively reaches those who do not otherwise test, including key populations (KPs). Despite potential benefits, HIVST is not currently implemented in Pakistan. The high risk of HIV among transgender (TGs) persons is among the highest risk group for HIV in Pakistan, yet knowledge of HIV status remains low in this key population group. We conducted a pilot project to assess the acceptability and feasibility of distributing HIVST to TGs in Larkana. METHODS: Eligible participants were 18 years or above and self-identified as transgender ("hijra"). One oral fluid HIVST kit per person was distributed free of cost in the community by trained transgender peer outreach workers (ORW). Participants could request a demonstration of the HIVST procedure before performing self-testing which was provided by the trained ORW. Demographic characteristics of participants were collected. The ORW followed up with phone calls two days later to record if HIVST kits were used, the results, and whether assistance was required. RESULTS: Between November 2020 and February 2021, 150 HIVST kits were distributed to eligible TGs. The average age of participants was 25.5 years (standard deviation: 7.0). Over a third (52, 34.7%) had no formal education, while (16, 10.6%) had attended at least five years of schooling. Over one-third (58, 38.6%) of participants were first-time testers. One hundred and thirty-nine (92.7%) participants reported their results within two days. For the remaining 11 participants, ORWs had to contact them. All participants reported using HIVST kits within three days. A majority (141, 94%) used the kit in their homes, and the remaining nine (6%) used it at the community-based organization's office. Overall, a small proportion (11, 7.3%) of participants requested a demonstration of the test procedure before performing HIVST. Four (2.7%) participants who had performed unsupervised self-tests reported reactive HIVST results; all were linked to treatment within five working days once their HIV result was confirmed. The majority (136, 90.6%) of participants felt that self-testing was easy to perform independently, and 143 (95%) reported that they would recommend HIVST to their peers. CONCLUSION: HIVST is acceptable among TGs and identified by first-time testers as undiagnosed infections. Peer-led distribution appears to be a feasible approach for implementation in this setting. HIVST should be considered for routine implementation and scale up to reduce testing gaps among Pakistan's key population, particularly TGs.

Predictors of Child's Health in Pakistan and the Moderating Role of Birth Spacing.

There is a consensus that better health should be viewed both as a means and an end to achieve development. The level of development should be judged by the health status of the population and the fair distribution of health services across the people. Many determinants affect a child's health. This study aimed to explore a child's health predictors and the moderating role of birth spacing on the association between mother's health care services utilization (MHCSU) and a child's health. In this study, we used the dataset of Pakistan Demographic and Health Survey 2017-18 to explore the predictors of child health and the moderating role of birth spacing through binary logistic regression, using SPSS version 20. The results showed an association of mother's age (35 to 49 years), her education (at least secondary), health care services (more accessible), father's education (at least secondary), their wealth status (high), and exposure to mass media to improved child health. However, the effect of a mother's employment status (employed) on her child's health is significant and negative. The coefficient of moderation term indicated that the moderating role of birth spacing on the association between MHCSU and a child's health is positive. We conclude that birth spacing is a strong predictor for improving a child's health. The association between MHCSU and child's health is more distinct and positive when the birth spacing is at least 33 months.

Breast Cancer Risk and Human Papillomavirus Infection: A Bradford Hill Criteria Based Evaluation.

BACKGROUND: The association between human papillomavirus (HPV) and human breast cancer (BC) has already been thoroughly studied worldwide with contradictory findings. Although the researchers have tried to minimize the conflict using statistical meta-analysis because of its shortcomings, there is still a need to evaluate the correlation between HPV and BC using any additional method. OBJECTIVES: This study was launched to investigate the correlation between HPV and BC through the application of Bradford Hill criteria postulates. METHODS: Population-wide studies associating HPV with BC were searched using the PubMed database. Then, the information of HPV burden in BC, normal/benign samples was analyzed, and ultimately Bradford Hill criteria postulates were applied on the collected evidence to explore the relationship between HPV and BC. In addition, to make the outcomes more authentic, we also reviewed the methodologies of previous studies to address the propensity of false results. RESULTS: After a careful evaluation of the obtained data against major Bradford Hill criteria postulates, it was noted that all these postulates, including strength, consistency, biological gradient, temporality, plausibility, experiment, specificity, and analogy were not fulfilled. CONCLUSION: The results of the present study have failed to establish a causal association between HPV and BC, but they did suggest HPV as a cause-effective agent or at least a co-participant in the pathogenesis of BC. Because of the weakness of association, particularly the lack of consistency between studies and the lack of effect specificity, more research into Bradford Hill criteria postulates is required.

Family and Academic Stress and Their Impact on Students' Depression Level and Academic Performance.

Current research examines the impact of academic and familial stress on students' depression levels and the subsequent impact on their academic performance based on Lazarus' cognitive appraisal theory of stress. The non-probability convenience sampling technique has been used to collect data from undergraduate and postgraduate students using a modified questionnaire with a five-point Likert scale. This study used the SEM method to examine the link between stress, depression, and academic performance. It was confirmed that academic and family stress leads to depression among students, negatively affecting their academic performance and learning outcomes. This research provides valuable information to parents, educators, and other stakeholders concerned about their childrens' education and performance.

Impact of Sleep Deprivation on Job Performance of Working Mothers: Mediating Effect of Workplace Deviance.

The current study takes its philosophical roots from organizational behavior and psychology domains to investigate the impact of sleep deprivation on the job performance of mothers working in primary, secondary, and higher education institutions (HEIs) of Pakistan. It also examines the mediating role of workplace deviance in the relationship between sleep deprivation and the job performance of working mothers. The authors followed the non-probability convenience sampling technique to study the relationship between sleep deprivation, workplace deviance, and job performance. The structural analyses indicated that sleep deprivation has a significant negative impact on the job performance of working mothers and sleep-deprived individuals often tend to perform poorly at the workplace. Such workers are also more likely to engage in workplace deviant behaviors. Moreover, workplace deviance is also found to act as a mediating variable in the relationship between sleep deprivation and job performance. The present research bridges the literature gap on the rarely investigated factors, namely sleep deprivation and workplace deviance, and provide a detailed understanding of how these factors can influence the performance of working mothers, specifically in Pakistan.