This study examines the Vietnamese government's regulatory mechanisms for ensuring quality healthcare. Its primary objective is to analyze the evolution of Vietnam’s healthcare system, assess the effectiveness of current regulations, and provide evidence-based recommendations for future improvements. The research traces the historical development of healthcare policies and highlights key reforms that have shaped the current landscape. Through thematic and content analyses, the study explores complexities in healthcare access, including freedom of choice, health insurance participation, and coverage disparities. Despite notable progress, challenges remain, such as high insurance premiums, co-payment burdens, policy reform inefficiencies, and social security gaps. The government has introduced new health insurance strategies and innovative reimbursement mechanisms. Key recommendations include expanding health insurance coverage, enhancing support for medical practitioners, and leveraging digital health technologies. Addressing these systemic issues can help Vietnam create a more sustainable, equitable, and efficient healthcare system for its population.
We aimed at assessing mortality and disease burden attributable to air pollution in Albania. This analysis was based on the mortality and morbidity estimates for Albania supplied by the Global Burden of Disease 1990 and 2021 studies, reported by the Institute for Health Metrics and Evaluation. In Albania, during 1990-2021, the decline in mortality rate and promotional mortality due to air pollution was among the steepest in the Southeastern European region. The (age-standardized) proportional mortality due to air pollution in Albania in 1990 (≈25%) was considerably higher than in Central Europe (17%), in Eastern Europe (15%), and especially in the Western European region (9%). Nonetheless, in 2021, this difference was substantially reduced: 9% (Albania), 6% (Central Europe), 5% (Eastern Europe), and 3% (Western Europe). Seemingly, interventions targeting household air pollution have been effective in Albania. Future efforts, however, should focus on controlling outdoor air pollution, particularly fine particulate matter (PM2.5), to prevent an increase in respiratory and cardiovascular diseases. Hence, continued focus on reducing ambient particulate matter pollution in Albania is needed to further align with the European Union standards.
Neuroendocrine Disruptors (NEDs) are increasingly recognized as a significant environmental and public health concern, particularly in low-resource settings where environmental contamination and inadequate waste management may increase human exposure. NEDs include a heterogeneous group of exogenous chemicals capable of interfering with hormonal and neurotransmitter systems, thereby altering neuroendocrine regulation and potentially affecting multiple physiological processes. This review examines the main sources of exposure to NEDs in populations living in low-resource environments, with particular attention to micro- and nanoplastics, pesticides, bisphenols, phthalates, and dioxins. Evidence from experimental and epidemiological studies indicates that these contaminants may influence neurodevelopment, reproductive health, metabolic regulation, and immune function. Vulnerable populations—including pregnant women, fetuses, children, and occupationally exposed workers—appear particularly susceptible to the effects of NED exposure. In addition, environmental pathways such as contaminated water, food products, cosmetics, and electronic waste represent important routes of human exposure, especially in regions characterized by rapid industrialization and limited regulatory oversight. The review also discusses the challenges faced by low- and middle-income countries in monitoring and mitigating exposure to neuroendocrine disruptors. Finally, emerging strategies aimed at reducing environmental contamination are explored, including improved waste management policies, preventive public health measures, and the potential application of artificial intelligence technologies for the rapid detection of nano-microplastics in consumer products. Strengthening research capacity and environmental health policies in low-resource settings is essential to reduce exposure and protect vulnerable populations.
Substance use among university students is a growing public health concern, often contributing to adverse health outcomes and reduced academic performance. This study aimed to examine the association between mHealth CBT-informed psychoeducational text messaging interventions and substance use frequency among undergraduate students at Jimma University, Ethiopia. A quasi-experimental study design was employed, involving 140 students with substance use allocated equally into intervention (n = 70) and control (n = 70) groups by campus. Substances assessed included tobacco, alcohol, cannabis, and khat. Substance use frequency (low/moderate/high) was measured using the validated WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The intervention group received three months of mHealth CBT-informed psychoeducational text messages addressing knowledge and skill-building, while the control group received no study-related text messages, follow-up calls, or mobile credit incentives during the study period. Endline assessment was conducted immediately following the intervention. Ordinal logistic regression was used to assess associations, adjusting for baseline substance use frequency. After adjusting for baseline imbalance (intervention: 82.9% high use vs. control: 45.7%; p < 0.001), the intervention was associated with significantly lower odds of higher substance use frequency (OR = 0.10, 95% CI [0.03-0.31], p < 0.001). Higher self-esteem and low monthly income were also associated with reduced odds (OR = 0.10, p = 0.010), (OR = 0.06, p = 0.013) respectively. The findings suggest that mHealth CBT-informed psychoeducational text messaging intervention was associated with reduced substance use among university students. However, due to the non-randomized design and baseline imbalance, causal inference is limited.
Inadequate information of pulmonary tuberculosis prevention contributes to poor conduct in controlling its spread. E-learning health management education is an effective way to change individuals' attitudes toward improved health. This study sought to assess the effects of E-learning health management education on behaviors targeted at avoiding the spread of pulmonary tuberculosis. The research design used was pre-experimental, with a one-group pre-post-test procedure. The Wonokromo Community Health Center had a population of 37 patients with pulmonary tuberculosis, and the sample included all 37 respondents chosen using a non-probability sampling approach called total sampling. The independent variable is E-learning health management education, and the dependent variable is behavior aimed at limiting the spread of pulmonary tuberculosis. A Likert scale questionnaire was employed as the study tool. The data was analyzed using a T-test, with significance defined at α = < 0.05. The consequence. The E-learning health management education intervention had a significant impact in preventing tuberculosis transmission (p < 0.001). This demonstrates a link between e-learning health management education and preventative behavior for pulmonary tuberculosis transmission. Prior to administering the E-learning health management education program among patients, the majority of participants had negative attitudes on limiting the spread of pulmonary tuberculosis.
Anxiety disorders are a major public health concern in low- and middle-income countries due to the lack of culturally validated screening tools. Although the Generalized Anxiety Disorder Assessment-7 (GAD-7) is widely used, limited research exists on its cross-cultural psychometric validation in Pakistan. This study aimed to translate, culturally adapt, and psychometrically validate the GAD-7 in a Pakistani clinical population. Following a standard forward–reconciliation–backward translation procedure, the GAD-7 was translated into Urdu and reviewed by a multidisciplinary expert panel. The final version was administered to 267 participants. Exploratory and confirmatory factor analyses were conducted. Internal consistency and model fit indices were assessed. Criterion validity was evaluated using Receiver Operating Characteristic analysis. The adapted GAD-7 demonstrated high internal consistency (Cronbach’s α = 0.896). Confirmatory factor analysis indicated both models demonstrated excellent fit; however, one-factor model was retained as the more parsimonious solution. Factor loadings were statistically significant and within acceptable ranges. ROC analysis demonstrated excellent diagnostic accuracy (AUC = 0.970), with an optimal cutoff score of 10 yielding sensitivity of 98.6% and specificity of 81.4%. The Urdu GAD-7 is a reliable, valid, and clinically useful instrument for screening anxiety in Pakistani populations. While multidimensional representations may offer theoretical insight, the scale functions effectively as a unidimensional measure. The findings support its use in both clinical and research settings, particularly for early detection of anxiety in resource-limited contexts.
Bullying is a widespread public health concern among adolescents worldwide. Our objective was to assess the prevalence and sociodemographic correlates of bullying others and being bullied among Albanian adolescents. A cross-sectional study conducted in Albania in 2022 included a nationwide representative sample of 5454 schoolchildren aged 11, 13 and 15 years (≈52% girls; response rate: 96%). Data on bullying others and being bullied were gathered, along with sociodemographic factors of adolescents. Binary logistic regression was used to assess the associations of bullying perpetration and victimization with adolescents’ sociodemographic factors. About 7% of adolescents reported bullying others and 8% being bullied at least two or three times a month in the past couple of months preceding the survey. Independent positive correlates were male gender, older age, and higher family affluence (perpetration); age 13, father’s unemployment, and lower family affluence (victimization). Bullying among adolescents in transitional Albania is relatively common, with distinct sociodemographic patterns: perpetration reflects “empowerment”, whereas victimization signals “vulnerability”. These findings highlight the need for targeted prevention in Albania and comparable transitional settings.
Our aim was to assess the psychometric properties of the “EORTC QLQ-PR25” in Albania and to determine the links between disease characteristics and treatment in men with prostate cancer. A study conducted in Tirana during April 2024–December 2025 included 74 consecutive men diagnosed with prostate cancer who completed the EORTC QLQ-PR25 questionnaire (response: ≈94%). The EORTC QLQ-PR25 demonstrated excellent internal consistency across all subscales (Cronbach’s alpha range: 0.85-0.91), with very high reliability for the overall scale (α=0.94). Higher symptom burden and poorer overall quality-of-life were significantly associated with radical prostatectomy, metastatic disease, high Gleason score (9-10), and extracapsular tumour spread (all P<0.05). Patients undergoing radical prostatectomy reported the worst outcomes across all symptom domains, as well as the lowest general quality-of-life and health status scores. Seemingly, the EORTC QLQ-PR25 is a reliable and clinically valid instrument for assessing prostate cancer-specific quality-of-life among Albanian men. Also, symptom burden and quality-of-life impairment were strongly associated with disease severity and invasive treatment. Our findings support the integration of patient-reported outcomes into routine prostate cancer care in Albanian-speaking countries.
Osteoporosis is a major cause of bone fragility and musculoskeletal pain, conditions that substantially reduce quality of life. Vitamin D plays a central role in calcium homeostasis and bone mineralization, while Vitamin B12 deficiency has been associated with impaired bone health and neuromuscular symptoms. However, their combined impact on Bone Mineral Density (BMD) and pain remains incompletely understood. We conducted a cross-sectional study at the Rheumatology Clinic of the University Clinical Center of Kosova (January 2022–August 2024). A total of 136 patients (aged 18–75 years) with chronic musculoskeletal pain underwent Dual-Energy X-Ray Absorptiometry (DEXA) to assess BMD in the lumbar spine and femoral neck. Serum 25-hydroxyvitamin D and Vitamin B12 levels were measured, and pain intensity was evaluated using the Visual Analog Scale (VAS). Osteoporosis was highly prevalent, affecting 59.6% of patients in the right femur, 65.4% in the left femur, and all patients in the spine. Patients with lower Vitamin D levels reported significantly higher pain scores (r = –0.55, p < 0.01), while elevated Vitamin B12 levels showed a positive correlation with pain (r = 0.59, p < 0.01). BMD values in all skeletal sites were negatively correlated with pain severity, with the strongest association observed in the spine (r = –0.73, p < 0.01). Vitamin D deficiency was strongly associated with both lower BMD and greater musculoskeletal pain, whereas Vitamin B12 variations showed complex correlations requiring further study. Early detection of osteoporosis and systematic monitoring of vitamin status may support more effective management of pain and bone health in affected patients.
Infective Endocarditis (IE) is a rare but potentially lethal infection of the endocardium and heart valves, native or prosthetic. Staphylococcus aureus-associated IE was identified as the most common cause of IE and is an independent predictor of mortality. Most cases of IE are left-sided and involve a single valve. Here we report a case of Staphylococcus aureus bivalvular endocarditis (MVE) in a patient with a history of intravenous drug use and provide a literature review of MVE identification, treatment, and prognosis. Our patient underwent a 4-week course of intravenous antibiotic therapy for infective endocarditis. Serial Transthoracic Echocardiography (TTE) during hospitalization demonstrated a reduction in the size of the vegetations on both the mitral and tricuspid valves. Upon clinical stabilization, the patient was transitioned to oral antibiotic therapy for an additional two weeks. At discharge, the patient was in stable condition and was advised to continue outpatient follow-up. Routine surveillance with TTE every three months was recommended to monitor for recurrence or progression.
Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium Tuberculosis (Mtb), and its burden is exacerbated by the increasing prevalence of Non-Insulin-Dependent Diabetes Mellitus (NIDDM). This case-control study aimed to identify risk factors associated with TB among patients with NIDDM in Banjar Regency, Indonesia. A total of 93 respondents with TB or TB with NIDDM were included using a purposive sampling technique. Data were collected via questionnaires and medical records, analyzing demographic characteristics, history of TB exposure, and health parameters. The results showed that gender, education level, smoking history, hospitalization history, and a family history of TB were significantly associated with TB among NIDDM patients. These findings highlight the need for targeted interventions to reduce TB risk among individuals with NIDDM, including enhanced screening, public health education, and lifestyle modifications.
Adolescence is a critical phase of life that needs extra attention. One common issue among adolescents is engaging in premarital sex, which can have serious negative effects, especially for girls. Girls need to develop the ability to firmly say no to premarital sexual activity, which is known as sexual assertiveness. This study aimed to examine the influence of sexual assertiveness on premarital sexual behavior in adolescents. This was an observational study using a cross-sectional design. The independent variable was the sexual assertiveness and the dependent variable in this research was premarital sexual behavior. This research was conducted in June – August 2024 in classroom settings at UNUSA. The sample in this study consists of 92 female students who have a boyfriend. The sampling technique used purposive sampling technique. Data collection in this study was carried out face to face through interviews and questionnaires. The instruments used were the sexual behavior scale and the Sexual Assertiveness Questionnaire (SAQ). Analysis used a simple linear regression test. The results of the statistical test show a value of ρ = 0,000 (p < 0,05), which means there is an influence of sexual assertiveness on premarital sexual behavior in adolescents. Adolescents with strong sexual assertiveness are better able to avoid engaging in premarital sexual activities, helping them steer clear of its negative consequences. The results of this study are expected to be the basis for designing interventions or educational programs aimed at improving sexual assertiveness skills as a form of self-protection in maintaining adolescent reproductive and mental health.
Depression and incontinence in older people living at home have become a global issue; however, the research around this area is limited in Indonesia. This study aimed to determine the prevalence of depression among older people with Urinary Incontinence (UI), Fecal Incontinence (FI), and Double Incontinence (DI) in Indonesia. This study used data from a community project dataset for case management processes in older people in an urban area of Bali in 2022. The dataset used was 970 older people aged 60+. We measured six variables in our study: age, gender, depression, UI, FI, and DI. A multivariate logistic regression analysis was conducted to explore the determinants of depression in older people. Most respondents were female (55.3%). Findings showed that the prevalence of depression, urinary, fecal, and double incontinence were 8.0%, 4.7%, 9.1%, and 2.8%, respectively. Depression was associated with age and all types of incontinence, but not gender. Logistic regression showed that the strongest predictor of depression in older people was FI (OR 3.151), followed by age, with OR 2.243. Nurses and other health workers should conduct more active screening for depression and incontinence for better management of these global health issues.
A mother's role is crucial in meeting the physical and psychological needs of her child, such as affection, love, and attention. By leveraging a culturally relevant and interactive medium, this study examined how shared play experiences foster emotional connections and strengthen family bonds. It examines the use of a low-cost, modified Snakes and Ladders game to improve mother-child attachment, focusing on the caregiving practices of mothers who rarely engage in beneficial play activities. A pre-experimental design with a one-group pretest-posttest design was employed, with 160 respondents selected through stratified random sampling. The data were analyzed using a paired-sample t-test. The analysis revealed a significant increase in attachment (p<0.000). The game encouraged structured, enjoyable interactions that promoted communication, cooperation, and emotional closeness between mothers and their children. The modified Snakes and Ladders game is an effective tool for enhancing mother-child attachment by fostering mutual support, understanding, and trust. However, this study is limited by its pre-experimental design, which lacks a control group, and its focus on a specific age group and cultural context. Future research could explore the impact of the game in diverse settings and with different populations to validate its broader applicability. These findings suggest the potential for culturally relevant, low-cost games to be integrated into parenting interventions to strengthen familial relationships.
The incidence of herbal medicine consumption is significant among postpartum mothers. However, its long-term use may pose potential risks. This study aimed to investigate the correlation between sociodemographic factors, beliefs, and behaviors related to the consumption of herbal medicine among postpartum mothers in Indonesia. This study employed a cross-sectional correlational design with a sample of 170 postpartum mothers (1-42 days postpartum), determined using G*Power version 3.1. Purposive sampling was used for participant selection. The variables included sociodemographic factors, beliefs, and behaviors related to herbal medicine consumption. Data were analyzed using the Kruskal-Wallis and Mann-Whitney tests. The findings revealed that residency (p=0.001), age (p=0.043), education level (p=0.0001), number of children (p=0.0001), pregnancy complications (p=0.006), and labor complications (p=0.027) were significantly correlated with beliefs regarding herbal medicine consumption. Meanwhile, age (p=0.039) and number of children (p=0.0001) were significantly correlated with herbal medicine consumption behavior. This study highlights the strong influence of sociodemographic factors on the use of postpartum herbal medicine. While many mothers perceive herbal medicine as beneficial, monitoring its long-term effects and potential risks is essential. Future research should focus on ensuring safe use of herbal medicine, integrating traditional and modern healthcare practices, and enhancing education on evidence-based postpartum care.
Soil-Transmitted Helminth (STH) infection is a neglected tropical disease prevalent in many low-income, developing countries with poor environmental sanitation. Children of preschool and school age are particularly vulnerable to STH infection. This study aimed to evaluate the sensitivity and specificity of clinical complaints in detecting STH infection among elementary school-aged children living in coastal areas of Indonesia. A descriptive, observational design was employed, involving 64 children. Data were collected through a structured questionnaire that assessed respondent characteristics and symptoms, followed by a stool examination using the Kato-Katz method to confirm the status of STH infection. The findings revealed a prevalence rate of 21.9% for STH infection. Among the reported complaints, diarrhea demonstrated the highest sensitivity (78.6%). In terms of specificity, complaints of itching around the anus and frequent diarrhea yielded the highest specificity values, at 82% and 74%, respectively. These results highlight key symptomatic indicators that could support early detection and targeted interventions for STH infections in coastal regions.
Prolonged respiratory disorders in post-COVID-19 patients still exist after patients return to the hospital. Deep breathing exercises are recommended that can increase the vital capacity of the lungs. This study aimed to identify the effect of a deep breathing exercise on vital lung capacity in post-COVID-19 patients. The intervention group (20) received deep breathing exercises, and the control group (20) received standard care. The vital lung capacity was evaluated after two weeks. The findings show that there is increased functional capacity for both groups. There is increasing the functional capacity increased in L from a mean of 1.73 with SD 0.38 to 1.87 with SD 0.37 (p=0.000, CI 95%) in the intervention group, and in the control group, it increases from 1.63 with SD 0.21 to 1.73 with SD 0.21 (p=0.008, CI 95%). The finding of the t-test result showed a significant difference in the average value of the vital lung capacity before and after the intervention between the intervention and the control groups (p = 0.008; 95% CI = 0.02-0.07). A deep breathing exercise improves the vital lung capacity of post-COVID-19 patients.
Effective leadership and a supportive organizational culture play a crucial role in shaping the quality of nursing care, affecting not only the environment but also nurses’ skills and attitudes. This study explores how various factors related to nurses—such as their competence and attitudes—interact with leadership and organizational culture to impact nursing care and patient satisfaction. We aimed to identify previously overlooked connections that can improve patient outcomes. To conduct this research, we analyzed data from 125 nurses working in inpatient wards at an Islamic Hospital in Indonesia using a cross-sectional design. In August, we gathered information through validated questionnaires and examined the data using SmartPLS 3.2.8 with partial least squares structural equation modeling (PLS-SEM). Our results indicate that organizational factors significantly impact nursing practices (p = 0.000) and the quality of nursing care (p = 0.019). Moreover, the work conditions and experiences of nurses were found to greatly influence both the nurses’ competencies (p = 0.000) and the care they provide (p = 0.002). Additionally, factors related to nursing significantly affect both the quality of care (p = 0.004) and patient satisfaction (p = 0.002), with nursing care having a strong positive impact on patient satisfaction (p = 0.000). Interactions among organizational factors, nursing attributes, and care practices, as well as the working conditions of nurses, played significant roles in boosting patient satisfaction (p = 0.039 and p = 0.0016). Leadership, organizational culture, and nurse factors play significant mediating roles in strengthening the relationship between nursing care and patient satisfaction. These findings highlight the importance of strengthening organizational and nurse-related factors to improve nursing care quality and patient satisfaction.
Self-consciousness regarding health status is crucial for individuals with Type 2 Diabetes Mellitus (T2DM) to engage actively in lifelong diabetes self-management. However, existing instruments have not fully incorporated aspects of nurse partnership, dialogue, and pattern recognition related to diabetes knowledge, self-management skills, and self-care abilities. This study aimed to develop and validate the Self-Consciousness of Health Status (SCHS) instrument for patients with T2DM and chronic complications. Instrument development occurred in three phases: Phase One involved a literature review and a three-round e-Delphi to generate the item pool. Phase Two tested content validity with five experts, and construct validity with confirmatory factor analysis (CFA) among 602 participants. Internal consistency and test-retest reliability were also assessed. Phase Three finalized the scale and score interpretation. CFA confirmed the SCHS structure, consisting of 77 items across four dimensions. The scale demonstrated strong model fit (Chi Square p > 0.05, RMSEA p > 0.05) and standardized factor loadings between 0.516–0.908 (p < 0.05). SCHS is a valid and reliable tool to measure health self-consciousness in patients with T2DM and chronic complications.
Community-dwelling older adults are a vulnerable group frequently affected by anxiety, which may impair their health, functioning, and quality of life. Progressive Muscle Relaxation (PMR) is a therapeutic method designed to induce relaxation and potentially reduce anxiety. This quasi-experimental study investigated the effect of PMR on anxiety levels among older adults in Pangkalpinang City, Indonesia, conducted from April to May 2020. A total of 138 participants were assigned to intervention (n=67) and non-intervention (n=71) groups. The intervention consisted of ten PMR sessions over five weeks, delivered twice weekly in small groups. Data were collected using the Geriatric Anxiety Inventory and analyzed via Wilcoxon and Mann-Whitney tests. The intervention group exhibited a significant reduction in anxiety from pre-test to post-test (p = 0.0001, p < 0.005), whereas the non-intervention group showed no meaningful change. The between-group comparison indicated a moderate effect (p = 0.0001, p < 0.005). PMR demonstrates beneficial outcomes in reducing anxiety among older adults; however, its implementation should involve trained health professionals and take into account individual conditions.
