"An obedient wife never says "no" to her virtual god." High fertility conceptions and barriers to contraceptive use among mothers of Southern Pakistan: a qualitative study.

ISSUE: Biomedical approaches want to change locals' behaviors without understanding the sociocultural rationales and contextualizing the cultural and structural backdrop of women's agency. OBJECTIVES: This study explored the perceptions and practices of rural mothers about fertility and reproductive health and further examine the lack of preference for contraception and birth spacing in Southern Pakistan. METHODOLOGY: Using purposive sampling we recruited 15 healthcare providers and 20 mothers from Southern Punjab. Key informants and in-depth interviews were used for data collection. We extracted themes and sub themes to analyse qualitative data. FINDINGS: Five major themes identified preventing birth spacing and contraceptive use: (1) cultural barriers (2) economic difficulties and demographic factors; (3) gender-related hurdles; (4) spiritual and religious obstacles, and (5) medico-ethical complications. Nearly, ten sub-themes contributing to these major themes were: custom of girls' early marriages, in-laws' permission for contraception, women's concern for medical complications and preference for safer methods, misuse of contraceptive methods by the medical community, mothers' perception of contraception as sinful act and controlling birth is against faith, economic and rural-ethnic factors for high fertility, masculine disapproval of condom use, and wishing to give birth to male children. SUGGESTIONS: We advocate for understanding the sociocultural explanations for low contraceptive use and urge practice of more natural methods of birth spacing over commercial solutions. The study suggests socio-economic development of less developed communities and empowerment of poor, illiterate, and rural women along with behavior change communication strategies.

Political Economy of Maternal Child Malnutrition: Experiences about Water, Food, and Nutrition Policies in Pakistan.

This study examined access to water, food, and nutrition programs among marginalized communities in Southern Punjab, Pakistan, and their effects on nutrition. Both qualitative and quantitative data were used in this study. We held two focus group discussions (one with 10 males and one with 10 females) and conducted in-depth interviews with 15 key stakeholders, including 20 mothers and 10 healthcare providers. A survey of 235 households was carried out to evaluate water and food insecurity, with the data analyzed using Wilcoxon's rank-sum test, t-test, and Pearson's chi-square test. The results revealed that 90% of households experienced moderate-to-severe water insecurity, and 73% faced moderate-to-severe food insecurity. Household water and food insecurity were positively correlated with each other (correlation coefficient = 0.205; p = 0.004). Greater household water (p = 0.028) and food insecurity (p < 0.001) were both associated with higher perceived stress. Furthermore, lower socioeconomic status was strongly related to higher levels of water (p < 0.001) and food insecurity (p < 0.001). Qualitative findings highlight the impact of colonial and post-colonial policies, which have resulted in water injustice, supply issues, and corruption in water administration. Women face significant challenges in fetching water, including stigma, harassment, and gender vulnerabilities, leading to conflicts and injuries. Water scarcity and poor quality adversely affect sanitation, hygiene, and breastfeeding practices among lactating mothers. Structural adjustment policies have exacerbated inflation and reduced purchasing power. Respondents reported a widespread lack of dietary diversity and food quality. Nutrition programs face obstacles such as the exclusion of people with low social and cultural capital, underfunding, weak monitoring, health sector corruption, and the influence of formula milk companies allied with the medical community and bureaucracy. This study concludes that addressing the macro-political and economic causes of undernutrition should be prioritized to improve nutrition security in Pakistan.

The impact of intermittent fasting during Ramadan on psychomotor and cognitive skills in adolescent athletes.

Introduction: Intermittent fasting (IF) represents a dietary intervention similar to caloric restriction, characterized by the strategic limitation of food consumption. Among the diverse array of practices for IF, Ramadan IF (RIF), a religious observance in Islam, mandates that healthy adult Muslims abstain from both food and drinks during daylight hours. In sports, researchers have extensively studied IF effects on health, including sleep and physical performance, but its impact on cognitive functions during RIF remains understudied. Therefore, this study was conducted to evaluate the influence of RIF on psychomotor and cognitive performance among young female athletes. Methods: To achieve this purpose, a cohort of 23 female handball players, aged 17.2 ± 0.5 years, participated in a series of six testing sessions: one conducted prior to Ramadan (R0), and others during the first (R1), second (R2), third (R3), and fourth (R4) weeks of Ramadan, followed by a session in the week after Ramadan (R5). Each session involved assessments using a Simple Reaction Time Test (SRT), Choice Reaction Time Test (CRT), Vigilance Test (VT), and Mental Rotation Test (MRT). Additionally, dietary intake, body composition, and Pittsburgh Sleep Quality Index (PSQI) scores were evaluated during these periods. Results and discussion: The obtained data illustrated that there was a decrease in SRT, CRT, VT, and MRT performances during R1 in comparison to R0 (all p < .001). This reduction was also observed in R2, R3, R4, and R5. Notably, during the fourth week of Ramadan (R4), these cognitive and psychomotor parameters were significantly lower than during the earlier weeks (R1, R2, R3; all p < .001). Furthermore, a gradual decrease in total PSQI scores, sleep quality, and sleep duration was observed throughout the Ramadan period, reaching the lowest levels during R4. These findings illustrate that RIF has a significantly detrimental impact on neuromuscular and cognitive abilities as well as sleep quality in young female athletes. The study also highlights a fluctuating pattern in cognitive function across the four weeks of Ramadan, with the most pronounced decline observed during the final week of fasting illustrating the importance of conducting similar studies on normal individuals from both genders with larger sample size.

Activated omega loops for anterior crossbite correction in transitional dentition.

Key Clinical Message: Several approaches can correct pseudo-Class III anterior crossbite. 2 × 4 appliance, compressed open-coil springs, Class III elastics, etc. All cause either soft tissue lacerations, smile line flattening, or upper incisor overproclination. This paper describes a novel method to tip lower incisors into a normal overjet without compromising the upper dentition. Abstract: In pseudo-class III cases, a "two by four" multibracketed appliance has been utilized to put the incisors into a typical overjet during transitional dentition. Compressing a rectangular super elastic archwire creates continuous force, but its length restricts activation and risks cheek impingement. Open-coil springs on rigid archwires advance incisors labially, although a 4-5 mm of wire distal to the molar tube may injure soft tissue. Reciprocally anchored Class III intermaxillary elastics restore anterior overjet through lower incisor lingual tipping and upper incisor proclination. Class III elastics extrude maxillary molars and mandibular incisors, rotating the dental occlusal plane counterclockwise and reducing maxillary incisor exposure and aesthetics. A unique method is reported in this report to tip the lower incisors back into normal overjet without affecting the upper dentition.

Clear Aligner Orthodontics: What is the Evidence for their Efficacy?

Orthodontic treatment with the Invisalign® appliance (and other clear aligners) may be more aesthetically appealing to most adult patients when compared with conventional fixed appliances. When the first clear aligner systems were introduced into the market some 20 years ago, they were very basic in their mode of force delivery. In the last ten years, the Invisalign® system has undergone some remarkable changes and refinements in order to deliver more predictable treatment outcomes and allow for the treatment of more complex malocclusions. However, there remains an issue in terms of differences between the predicted and achieved tooth movements. Some tooth movements are more difficult to achieve than others. This article aims to examine the evidence of effectiveness and predictability of Invisalign® appliances for the correction of different tooth movements.

Relationship Between Work-Family Conflict and Depressive Symptoms Among Male Firefighters in China: Job Types and Family Structure as Moderators.

OBJECTIVES: This study aims to examine the relationship between work-family conflict and depressive symptoms while considering job types and family structure as moderators. METHODS: In July and August 2021, 1328 male Chinese firefighters completed an online cross-sectional survey. RESULTS: The results indicated that work-family conflicts among Chinese firefighters presented a significant association with worse depressive symptoms. More specifically, strain conflict and behavioral conflict had positive relationships with worse depressive symptoms, while time conflict had a negative relationship. In addition, job types moderated the association between work-family conflict, strain conflict, and behavior conflict with depressive symptoms. CONCLUSIONS: This study shows that work-family conflict is significantly associated with depressive symptoms among Chinese firefighters. Our findings advocate working system reform for Chinese firefighters, and more attention is needed on their mental health protection in the future.

Gender difference in the relationship between personality traits and changes in depressive symptoms before and after the COVID-19 outbreak: A follow-up study among Chinese adults.

OBJECTIVES: Increasing depressive symptoms have become an urgent public health concern worldwide. This study aims to explore the correlation between personality traits and changes in depressive symptoms before and after the COVID-19 outbreak and to examine the gender difference in this association further. METHODS: Data were obtained from the China Family Panel Studies (CFPS, wave in 2018 and 2020). A total of 16,369 residents aged 18 and above were included in this study. Multinomial logistic regression analysis was used to examine whether personality traits were associated with changes in depressive symptoms. We also analyzed whether there was an interaction effect of gender and personality traits on depressive symptoms. RESULTS: Conscientiousness, extroversion, and agreeableness are negatively associated with depressive symptoms, while neuroticism and openness are positively related. Gender moderates the relationship between personality traits and depressive symptoms. Compared to men, women have demonstrated a stronger association between neuroticism (OR = 0.79; 95 % CI = 0.66, 0.94), conscientiousness (OR = 1.40; 95 % CI = 1.15, 1.69), and persistent depressive symptoms. LIMITATIONS: Given its longitudinal study design, it is insufficient to draw a causal inference between personality traits and depressive symptoms. CONCLUSION: Personality traits and their various dimensions are correlated with changes in depressive symptoms. Persistent depressive symptoms are positively related to neuroticism and negatively associated with conscientiousness. Women demonstrate a stronger association between personality traits and persistent depressive symptoms. Thus, in Chinese adults' mental health intervention and prevention programs, personality and gender-specific strategies should be considered, especially in the context of the COVID-19 pandemic.

Royal London Space Planning as a learning tool for postgraduate Orthodontic students. A mixed methods study.

OBJECTIVE: To assess the effectiveness of the Royal London Space Planning (RLSP) as a learning tool among postgraduate orthodontic students as well as investigate students' attitudes to its use. The RLSP tool is a structured method of orthodontic case assessment and treatment planning. DESIGN: A prospective cohort study of first year postgraduate orthodontic students who attended teaching of the RLSP. SETTING: Postgraduate teaching institute. PARTICIPANTS: First year postgraduate orthodontic students. METHODS: The outcome measured was the accuracy in assessment and planning of a standardised orthodontic simulated case before and after teaching. Qualitative assessment was conducted through focus group and a semi-structured format after the teaching. RESULTS: Nineteen students were included in the study. There was an overall improvement in assessment and planning of 20% after the teaching intervention (P < 0.05). Assessment improved by 34% in comparison to treatment planning, which improved by 17% (P < 0.05). The impact of the RLSP was most noticeable on the assessment of crowding in the lower arch which improved by 37% after teaching (P < 0.05). Students felt using the RLSP tool made them more confident and was advantageous to use in training; most felt they would not use the tool after qualification. CONCLUSION: The RLSP tool is an effective method of teaching assessment and treatment planning to postgraduate orthodontic students. The effect of the RLSP is greater at assessments and less significant for treatment planning. The participant students felt the RLSP improved their confidence in assessment and treatment planning.

Contextualizing the standard maternal continuum of care in Pakistan: an application of revised recommendation of the World Health Organization.

Objective: This study utilizes recent nationally representative data to contextualize the standard maternal continuum of care (SMCoC) in Pakistan. The revised SMCoC framework encompasses at least eight antenatal care visits, skilled birth attendants during delivery, and postnatal care within 48 h of childbirth. Methods: The study used a sample of 3,887 ever-married women aged 15-49 from the latest Pakistan Demographic and Health Survey (PDHS) conducted in 2017-18. Several statistical methods were employed: descriptive statistics, bivariate, multilevel logistic regression models, and Fairlie decomposition analysis. Results: Only 12% of women had accessed full SMCoC services in Pakistan. Education and the wealth quintile emerged as pivotal factors influencing the utilization of SMCoC. The likelihood of full SMCC utilization was more likely among higher educated women (OR: 3.37; 95% CI: 2.16-5.25) and those belonging to the wealthiest household wealth quintile (OR: 4.95; 95% CI: 2.33-5.51). Media exposure, autonomy, healthcare accessibility, residence, and region were also identified as significant predictors of SMCoC utilization among women. Conclusion: In conclusion, while most women did not utilize full SMCoC services in Pakistan, the pattern is substantially varied by background characteristics. Education, wealth quintile, mass media exposure, and autonomy were significant factors, along with geographical aspects such as healthcare accessibility and region. The study underscores the need for a multifaceted approach to ensure equitable access to full SMCoC services for women in Pakistan, addressing individual, socioeconomic, and geographical factors.

Overweight/Obesity Prevalence among Under-Five Children and Risk Factors in India: A Cross-Sectional Study Using the National Family Health Survey (2015-2016).

The occurrence of overweight and obesity has increased in recent years in India. In this study, we investigate the prevalence and associated risk factors of overweight/obesity among children aged 0-59 months in India. Using data from the 2015-2016 National Family Health Survey-4 (NFHS-4), the research sample included 176,255 children aged 0 to 59 months. Bivariate and multivariate techniques were used to analyze children's risk factors for overweight/obesity. We identified that the prevalence of overweight/obesity among children aged 0-59 was 2.6% in India. The study findings reveal that factors such as child sex, age, birth weight, birth rank, maternal education, number of children, age at marriage, mother's BMI, media exposure, social group, and dietary diversity score were most significantly correlated with childhood overweight and obesity in India. Furthermore, we found that male children (ARR: 1.08) aged between 0 and 11 months (ARR: 3.77) with low birth rank (ARR: 1.24), obese (ARR: 1.81) children whose mothers married after the age of 18 (ARR: 1.15), children who belong to a scheduled tribe family (ARR: 1.46), and children who consumed 7-9 food items (ARR: 1.22) were at highest risk of being overweight and obese. However, breastfeeding (ARR: 0.85) and Muslim families (ARR: 0.87) appeared to be protective factors with respect to childhood overweight and obesity in India. Pertinent public health programs, clinical follow-up, and awareness about sedentary lifestyles can help to reduce overweight/obesity risks in children.