Psychological dynamics of pandemic resilience: a tale of two cultures.

The present work endeavours to explore the experiences of university-level students from Pakistan and Nepal after the COVID-19 outbreak. A comprehensive electronic survey was carried out utilising a meticulous cluster sampling technique encompassing two distinct populations, i.e. Pakistan and Nepal, during the period extending from September 2022 to January 2023. A total of 2496 participants completed the questionnaire (Pakistani population: 55.45% and Nepalese population: 44.55%). We utilised the Mental Health Continuum-Short Form (MHC-SF), Pittsburgh Sleep Quality Index (PSQI), feeling of loneliness (UCLA), interdependent happy scale (IHS), and fear of COVID-19 scale (FCV-19S). Notably, a significant intercultural disparity was observed, particularly concerning the level of COVID-19 fear which was higher among the Nepalese population. However, this particular variable did not demonstrate any significant associations with other variables, except for the social dimension of MHC-SF. There was a negative correlation observed between this variable and IHS within the Pakistani population. Irrespective of the varying degrees of apprehension towards COVID-19 within the two distinct cultural contexts, there exists a significant positive correlation between the assessed psychological assets and individual well-being, as well as the resumption of regular activities after the outbreak.

Potential Correlation Between Self-Compassion and Bedtime Procrastination: The Mediating Role of Emotion Regulation.

Purpose: The present research aims to investigate the potential correlations between self-compassion and bedtime procrastination, a significant behavior related to sleep. In this research, we put forward the hypothesis that a reduction in negative affect and the implementation of adaptative emotion regulation strategies can elucidate the established connections between self-compassion and a decreased tendency for bedtime procrastination. Methods: Two cross-sectional online surveys (Survey I: n=241 and Survey II: n=546) were carried out via a convenient sampling method. Prior to their inclusion, all participants underwent a thorough assessment to confirm no evidence of clinical insomnia. The study participants in both survey investigations were asked to complete various psychometric assessments, including self-compassion, positive and negative affect, and bedtime procrastination; however, the study participants in Survey II additionally underwent the administration of a cognitive reappraisal assessment. Results: In Survey I, a multiple mediation analysis was conducted to examine the mediating effects of self-compassion on reducing bedtime procrastination through a reduction in negative affect. The results supported the hypothesized relationships, indicating that self-compassion had the expected mediated effects by mitigating negative affective states. However, contrary to expectations, higher positive affect did not mediate the relationship between self-compassion and reduced bedtime procrastination. The findings of Survey II were confirmed through the utilization of path analysis. Moreover, this analysis provided additional evidence to suggest that the mechanism of cognitive reappraisal could account for the observed decrease in negative affect associated with self-compassion. The present study found a notable and sustained impact of self-compassion on reducing instances of delaying bedtime activities. Conclusion: The present research contributes novel empirical evidence suggesting a negative association between self-compassion and the propensity to engage in bedtime procrastination. This relationship can be attributed partly to the implementation of an adaptative emotion regulation mechanism that effectively alleviates negative affect.

Potential determinants of vaccine hesitancy among celiac disease patients: a single cohort analysis.

Introduction: Though researchers and scholars have greatly emphasized addressing the influencing factors of vaccination hesitancy, little attention has been paid to patients with celiac disease. Addressing the variables hampering attitudes might help direct appropriate patient advocacy and doctor-patient communication endeavors to encourage vaccination among celiac disease patients. The present investigation seeks to explore the coverage against vaccine-preventable diseases, vaccination attitudes, and related possible factors among celiac disease patients in the Pakistani setting. Methods: A self-reported online survey was conducted in Islamabad, Pakistan, for celiac disease patients aged 18 and above. The questionnaire was completed by 226 participants, with a response rate of 43.8%. The influencing variables for vaccination hesitancy were examined, and 95% confidence intervals for the crude and adjusted odds ratios were computed. Results: Among the study population, the majority were females, with a ratio of 75.66%. A prominent proportion of 69.03% was observed for influenza vaccination, while 39.82% were unable to recall all of the vaccinations they had previously received. Only 7% of the patients were considered to have a negative attitude toward vaccination, compared to an estimated 76% who were in favor of it. The significantly positive influencing factors observed toward vaccination were being well-educated (graduate, master, or above), possible recurrence of vaccine-preventable diseases with declining vaccination coverage (adjusted OR: 13.36), and increased confidence in vaccines from health care experts compared to electronic media (adjusted OR: 8.41). Contrarily, practicing complementary and alternative medicines (adjusted OR: 5.59), willingness to get vaccinated again in the future (adjusted OR: 15.59), and prior negative perspectives (adjusted OR: 1.01) were the determinants with a significant negative association. Discussion: In conclusion, the outcomes of the current work raise the possibility that health practitioners may be accountable for inappropriately prescribing vaccines to this demographic since 77% of the participants had a favorable attitude toward vaccination. These findings could serve as a springboard for creating targeted immunization efforts to raise vaccination coverage against vaccine-preventive diseases among celiac disease patients.

Inflammatory biomarkers and cardiac injury in COVID-19 patients.

Introduction: Cardiac injury has received considerable attention due to the higher risk of morbidity and mortality associated with coronavirus disease. However, in a developing country, there is a scarcity of data on cardiac injury in COVID-19 patients related to inflammatory biomarkers. Methods: Therefore, the present research retrospectively analyzes data from three territorial hospitals in Pakistan's Punjab province to investigate the potential impact of the cardiac injury on the mortality and severity of COVID-19-infected patients. We evaluated 2,051 patients between January 16 and April 18, 2022, with confirmed COVID-19. The in-hospital mortality recorded for the selected sample size was about 16.28%. Results: The majority of the participants were identified as male (64%) with a median age of 65 years. Also, fever, fatigue, and dyspnea were reported as common symptoms. An aggregate of 623 patients (30.38%) had a cardiac injury, and when these patients are compared to those without cardiac injury, the participants were significantly older and had more comorbidities with higher leukocyte counts, elevated levels of C-reactive protein, interleukin-6, procalcitonin, myohemoglobin, creatinine kinase-myocardial band, serum creatinine, high-sensitivity troponin-I, N-terminal pro-B-type natriuretic peptide had a significant amount of multiple ground-glass opacity and bilateral pulmonary infiltration in radiographic results. Participants with heart injury required more non-invasive or invasive mechanical respiration than those who did not have a cardiac injury. Individuals with cardiac injury had higher rates of sepsis, acute respiratory distress syndrome (ARDS), d-dimer concentration, and respiratory failure than those without cardiac injury. Patients who had had a cardiac injury died at a higher rate than those who had not suffered cardiac damage. In the multivariable logistic regression analysis, participants with cardiac injury showed greater odds of COVID-19 mortality and were found associated with older age (OR = 1.99, 95% CI = 0.04-3.19), elevated cardiac troponin I (OR = 18.64, 95% CI = 13.16-23.01), the complication of sepsis (OR = 10.39, 95% CI = 7.41-13.39) and ARDS (OR = 6.65, 95% CI = 4.04-8.91). Conclusion: Cardiac injury is a frequent complication among patients with coronavirus-induced infection in Punjab, Pakistan, and it is significantly linked to a greater risk of in-hospital mortality.

Particulate air pollution and metabolic risk factors: Which are more prone to cardiac mortality.

This study explored multiplex, country-level connections between a wide range of cardiac risk factors and associated mortality within the South Asian Association for Regional Cooperation (SAARC) countries. The grey relational analysis (GRA) methodology is used to evaluate data from 2001 to 2018 to compute scores and rank countries based on cardiac mortality. Subsequently, we used the conservative (Min-Max) technique to determine which South Asian country contributes the most to cardiac mortality. The Hurwicz criterion is further applied for optimization by highlighting the risk factors with the highest impact on cardiac mortality. Empirical findings revealed that India and Nepal are the leading drivers of cardiovascular disease (CVD) mortality among all SAARC nations based on the results of the GRA methodology. Moreover, the outcomes based on the Hurwicz criterion and the conservative criterion indicated that CVD mortality is considerably impacted by household air pollution from the combustion of solid fuel, with India as a potential contributor in the SAARC region. The outcomes of this research may enable international organizations and public health policymakers to make better decisions and investments within the SAARC region to minimize the burden of CVD while also strengthening environmentally sustainable healthcare practices.

Uptake of COVID-19 booster shot among healthcare workers: A mediation analysis approach.

Since the thrust of previous research investigations has been on people's willingness to get immunized against the COVID-19 infection, the underpinning principle of compliance has received very little attention. Addressing the possible drivers and mechanisms influencing vaccine acceptance may provide significant insights for limiting the pandemic. In response, we intend to investigate the influence of decision regret and the consequences of post-vaccination adverse effects on the inclination to undertake booster shots. An electronic survey that was self-administered was conducted in Rawalpindi, Pakistan. The questionnaire was completed by 1,369 participants, with a response rate of 41%. 1,343 of them (98.10%) had received both doses of the COVID-19 vaccination. Besides, the present research has also adopted a mediation model. Our findings demonstrate that unfavorable vaccination responses in healthcare workers significantly affect their likelihood of receiving booster shots. Interestingly, healthcare workers who had adverse experiences after being immunized were more prone to regret their prior immunization decisions, which in response affected their decision to get a booster shot. The motivation to receive the booster dosage and adverse post-vaccination responses were mediated by decision regret. The outcomes suggested indissociable connections between unfavorable vaccination responses, decision regret, and the likelihood of receiving a booster shot. To strengthen immunization acceptance intent and enhance the likelihood of receiving COVID-19 booster shots, it is recommended that awareness of these post-vaccination adverse events be extensively integrated into immunization awareness programs and policy measures supporting booster doses.

Cardiovascular Disease Mortality and Potential Risk Factor in China: A Multi-Dimensional Assessment by a Grey Relational Approach.

Objectives: This study aims to investigate the impact of hypertension, diabetes, and high blood cholesterol on increased mortality from cardiovascular diseases such as coronary heart disease, stroke, and pulmonary heart disease in a multi-dimensional way. Methods: The grey relational analysis methodology is adopted to assess the connection between cardiac risk factors and related mortality. The Hurwicz and the Conservative (Min-Max) criterion approach are also utilized to identify the prospective risk factor that contributes the most to increased cardiac mortality. Results: The findings reveal that hypertension has a more grounded relationship with stroke and pulmonary heart disease mortality, whereas high blood cholesterol appears to be the leading contributor to deaths from coronary heart disease. The results based on the Hurwicz and the Min-Max criterion show a robust connection between dyslipidemia, coronary heart disease, and cardiovascular disease mortality. Conclusion: Combating uncontrolled blood cholesterol and blood pressure levels would necessitate a multi-pronged strategy at both the national and local levels. Besides, the suggested methodologies provide a valuable tool and additional practical knowledge for public health policymakers and decision-makers in drawing rational decisions to combat China's rising CVD burden.

COVID-19 vaccine reluctance and possible driving factors: A comparative assessment among pregnant and non-pregnant women.

The coronavirus disease of 2019 (COVID-19) constitutes a serious threat to pregnant women. One of the key strategies for preventing and managing the COVID-19 epidemic is vaccination. Herd immunity is significantly hampered by COVID-19 vaccine reluctance, which poses a potential threat to population health. Therefore, the present work intends to ascertain the incidence and severity of COVID-19 vaccine hesitancy among Pakistani pregnant women, the determinants driving their decision, and a comparative assessment with non-pregnant participants. This cross-sectional survey was carried out from November 2021 to February 2022. The validated vaccination attitude examination (VAX) scale about vaccination reluctance was undertaken by participants, who were also required to indicate whether they would be inclined to acquire the COVID-19 vaccine along with the reasons for reluctance. In comparison to the non-pregnant category with 353 participants, the group of 372 pregnant participants who responded to the questionnaire had a much greater proportion of hesitant respondents. Likewise, contrasted to 31% of non-pregnant participants, about 40% of them attributed their willingness to get vaccinated against coronavirus to social media. They also demonstrated a considerably stronger mean score on all subcategories of the VAX measure. The adjusted odd ratio findings showed that the independent factors for vaccine reluctance appeared to be trusting rumors on social media (adj OR: 2.58), not being afraid of covid-19 (adj OR: 2.01), not believing in COVID-19 existence (adj OR: 2.53), and not believing in vaccines (adj OR: 4.25). Uncertainty about the COVID-19 vaccine is very prevalent among expectant mothers. The investigation accentuates the pressing need to administer COVID-19 vaccination to the general public, including expectant mothers who might be anxious about the vaccine.

Socioeconomic Influence on Cardiac Mortality in the South Asian Region: New Perspectives from Grey Modeling and G-TOPSIS.

Background: Measuring the potential socioeconomic factors of cardiac mortality is fundamental to identifying treatments, setting priorities, and effectively allocating resources to minimize disease burden. The study sought to present a methodology that explores the connections between urbanization, population growth, human development index (HDI), access to energy, unemployment, and cardiovascular disease (CVD) mortality within the South Asian Association for Regional Cooperation (SAARC) nations to mitigate the cardiac disease burden. Methods: This investigation uses multiple-criteria decision-making methodologies to analyze data between 2001 and 2017 commencing with a mathematical grey incidence analysis (GIA) methodology to estimate weights and rank nations based on CVD mortality. Then, utilizing the conservative min-max model approach, we sought to determine which country contributes the most to CVD mortality among all South Asian nations. The grey preference by similarity to ideal solution (G-TOPSIS) method is adopted for further optimization by prioritizing the selected factors that have the greatest influence on CVD mortality. Results: The estimated statistic highlights that, among SAARC nations, Pakistan has a significant proportion of the disease burden attributable to cardiac events. In addition, HDI showed a significant contribution in the reduction of CVD mortality, whereas unemployment showed a significant contribution in the rise of CVD mortality among all selected variables. Conclusions: This investigation may facilitate researchers with a multiple-criteria decision-making roadmap to help them enhance the quality of their studies and their understanding of how to use multiple-criteria decision-making techniques to evaluate and prioritize the influencing factors of disease mortality in healthcare research. Further, the study outcomes provide additional practical knowledge for appropriate policy solutions.

Cardiovascular disease (CVD): assessment, prediction and policy implications.

BACKGROUND: The study aims to predict and assess cardiovascular disease (CVD) patterns in highly affected countries such as Pakistan, India, China, Kenya, the USA, and Sweden. The data for CVD deaths was gathered from 2005 to 2019. METHODS: We utilized non-homogenous discrete grey model (NDGM) to predict growth of cardiovascular deaths in selected countries. We take this process a step further by utilizing novel Synthetic Relative Growth Rate (RGR) and Synthetic Doubling Time (Dt) model to assess how many years it takes to reduce the cardiovascular deaths double in numbers. RESULTS: The results reveal that the USA and China may lead in terms of raising its number of deaths caused by CVDs till 2027. However, doubling time model suggests that USA may require 2.3 years in reducing the cardiovascular deaths. CONCLUSIONS: This study is significant for the policymakers and health practitioners to ensure the execution of CVD prevention measures to overcome the growing burden of CVD deaths.

Impact of Environmental Degradation on Human Health: An Assessment Using Multicriteria Decision Making.

Air pollution has emerged as a major global concern in recent decades as a result of rapid urbanization and industrialization, leading to a variety of adverse health outcomes. This research aims to investigate the influence of exposure to ambient and household particulate matter pollution (PM2.5), and ground-level ozone (O3) pollution on respiratory and cardiac mortality in Pakistan. We used grey incidence analysis (GIA) methodology to estimate the degree of proximity among selected variables and rank them based on mortality. Hurwicz's criterion is then adopted for further optimization by prioritizing the selected factors with the greatest influence on respiratory and cardiac mortality. The GIA findings revealed that asthma mortality is considerably impacted by exposure to ambient and household PM2.5 concentration while ischemic heart disease (IHD) mortality is potentially influenced by ground-level ozone exposure. Furthermore, results based on Hurwicz's analysis demonstrated that exposure to ambient PM2.5 concentration appeared as the most intensified factor of respiratory and cardiac mortality. This corroboration adds to the growing body of research demonstrating that exposure to ambient PM2.5 adversely leads to respiratory and cardiac risks, emphasizing the demand for further improvement of air quality in Pakistan. Besides, the suggested methodologies provide a valuable tool and additional practical knowledge for policymakers and decision-makers in drawing rational decisions.

Sectoral-based CO2 emissions of Pakistan: a novel Grey Relation Analysis (GRA) approach.

Global warming regarded as the major global issue over the past few decades, whereas carbon dioxide (CO2) emissions have been cited as one of the main causes of this problem. Therefore, this study aims to investigate the effect of energy consumption, economic development, and population growth on high CO2 emitting sectors of Pakistan such as transportation, industrial, and household. The data used in this study was taken from multiple databases from 2000 to 2018. We employed novel grey relational analysis (GRA) models to assess the connection between gross domestic product (GDP) per capita, population, energy consumption, and CO2 emission. Furthermore, the Hurwicz method was used to analyze which factor contributing more to CO2 emission. Result reveals that CO2 emission, gross domestic product per capita, population, and energy consumption showed a strong association among all sectors. Whereas, population contributes more to intensifying CO2 emissions in the transportation sector of Pakistan. This study provides useful insights for policymakers to take preventive and corrective measures to overcome CO2 emissions as well as sustainable development.

Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study.

A wide variation exists in the practice patterns of acute myocardial infarction (AMI) care worldwide, leading to differences in clinical outcomes. This study aims to evaluate the quality of process care and its impact on in-hospital outcomes among AMI patients in Pakistan, as no such study has been conducted in Pakistan thus far based upon recommended guidelines. We investigated a sample of 2663 AMI patients across 11 territory hospitals in Punjab province of Lahore, Faisalabad, Multan, Rawalpindi, and Islamabad from January 1, 2016 to December 31, 2017, with an in-hospital mortality rate of 8.6%. We calculated compliance rates of quality indicators (QIs) for all eligible patients. The association between process care and in-hospital outcome was assessed using hierarchical generalized linear model that adjusted for patient and hospital characteristics. In addition, we examined the effect of patient composite scores on clinical outcomes. Aspirin (73.08%) and clopidogrel (67.86%) indicated relatively better conformance than other QIs. The percutaneous coronary intervention also showed significantly low adherence. All QIs showed no significant association with in-hospital mortality. In contrast, 4 out of 8 QIs were observed positively correlated with in-hospital length of stay (LOS). The overall patient composite score was found to be statistically significant with in-hospital LOS. The assessment of quality of care showed low adherence to clinical care recommendations, and increased adherence was associated with longer in-hospital LOS among AMI patients. Evaluation of valid QIs for AMI treatment and their impact on in-hospital outcomes is an important tool for improving health care delivery in the overall AMI population in Pakistan. Low adherence to performance measures strongly compel to focus on guideline-based tools for AMI in Pakistan.