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Background: It is widely accepted that for HIV-positive persons on highly active antiretroviral treatment, high levels of adherence to treatment regimens are essential for promoting viral suppression and preventing drug resistance. Objectives: This qualitative study examines factors affecting the adherence to HIV/AIDS treatment among patients with HIV/AIDS at a local hospital in Malaysia. Methods: The data from purposefully selected patients were collected by in-depth interviews using a pretested interview guide. Saturation was reached at the 13th interview. All interviews were audio-taped and transcribed verbatim for analysis using thematic content analysis. Results: Fear and stigma of perceived negative image of HIV diagnosis, lack of disease understating, poor support from the community, and perceived severity or the treatment side effects were among the reasons of nonadherence. Appropriate education and motivation from the doctors and reduction in pill burden were suggested to improve adherence. Conclusion: Educational interventions, self-management, and peer and community supports were among the factors suggested to improve adherence. This necessitates uncovering efficient ways to boost doctor–patient communication and recognizing the role of support group for the social and psychological well-being of the patients.

The Upper Indus Basin (UIB) of Pakistan is home to three largest mountain ranges: Karakoram, Hindukush, and the Himalayas. There’s a hovering danger of reduced water resources due to climate-induced warming, since the Indus Basin relies mostly on snow and glacier melt runoff from these mountains. In this study, the hydrology of these areas is studied to estimate variability in water resources under changing climate. A coupled hydrologic/hydraulic model, MIKE SHE/MIKE HYDRO RIVER, was used to calibrate and validate the model using streamflow data at the Shatial gauge station. The bias-corrected multi-model ensemble dataset accessed from the coordinated regional climate downscaling experiment (CORDEX) for two scenarios RCP 4.5 and RCP 8.5 were used up to the end of twenty-first century for the projection of stream flow. The calibrated model depicts an increase of 86% for RCP4.5 and 97% for RCP8.5, dominated by increased snow melt contribution due to consistent warming trends (average increase of 2.3 and 4 °C, annually for RCP 4.5 and 8.5, respectively). The most prominent increase was observed in winter months when predicted flows increased by 300% from historic. With predicted annual average available water of 4500 m 3 /s under RCP8.5, the study concludes that the available water would relieve some of the water stress in the country. However, the increased availability of water can also cause catastrophic floods. More flood defense and storage structures are needed to improve management practices in the downstream areas, particularly during wet and dry years.

Background Non-specific neck pain is the most prevailing musculoskeletal disorder which has a large socioeconomic burden worldwide. It is associated with poor posture and neck strain which may lead to pain and restricted mobility. Physical therapists treat such patients through several means. Post isometric relaxation and Myofascial release therapy are used in clinical practice with little evidence to be firmed appropriately. So, this study was conducted to explore the effect of Post-isometric relaxation in comparison to Myofascial release therapy for patients having non-specific neck pain. Methodology Sixty patients were randomly allocated to Post isometric group and the Myofascial group. The treatment period was of 2 weeks. All the patients were evaluated using the Visual analogue scale (VAS), Neck disability index (NDI), Universal Goniometer, and WHO BREF Quality of life-100 in the 1st and 6th sessions. Recorded data was entered on SPSS 21. Data were examined using two-way repeated ANOVA to measure the variance of analysis (group x time). Results Analysis of the baseline characteristics revealed that both groups were homogenous in terms of age and gender i.e. a total of 60 participants were included in this research study 30 in each group. Out of 60 patients, there were 20(33.3%) males and 40(66.7%) females with a mean age of 32.4(5.0) years. Participants in the Post Isometric group demonstrated significant improvements ( p  < 0.025) in VAS, NDI, Cervical Extension, left side rotation ranges, and QoL (Social Domain) at the 2-week follow-up compared with those in the Myofascial group. In addition, the Myofascial group indicated significantly better improvement in the mean score of CROM (flexion and right and left side bending). Conclusion The study demonstrated patients with nonspecific neck pain can benefit from the post isometric relaxation with significant improvement in pain, disability, cervical ROM, and Quality of life compared with myofascial release therapy. Trial registration Clinical Trial registered on clinicaltrial.gov (NCT number) NCT04638062 , 20/11/2020 (prospectively registered).

Burnout is a growing concern among healthcare professionals and students, as it increases the risks of dropping out of higher education, clinical errors and could also lead to maladaptive behaviours such as alcohol abuse. This scoping review aimed to identify all the available literature on effective interventions to address burnout in healthcare students. This scoping review was conducted according to the six-stage protocol by Arksey and O'Malley. Electronic database searches on several platforms, including PubMed/Medline, EMBASE, CINAHL, ERIC, PsycINFO, and Cochrane, for studies published after 2000. Studies were only included if they evaluated the effectiveness of an intervention in addressing burnout among healthcare students using a validated burnout measurement tool, both before and after the intervention. Analysis was carried out using the thematic analysis approach. Searches identified 3517 studies, of which 10 met the inclusion criteria. Three studies were randomised controlled trials, two were comparative cohort studies with an interventional and a control group, and in five studies, one cohort was assessed. Training in mindfulness, emotional intelligence and relaxation techniques significantly reduced burnout. Several interventions, including training in mindfulness and emotional intelligence, can be successfully implemented to reduce burnout in healthcare students. Long-term results are necessary to evaluate the sustainability of benefits associated with these interventions, and moreover, longitudinal studies must demonstrate advantages in dropout rates, employment status, and satisfaction with employment to establish long-term effectiveness in addressing burnout.

The ActiGraph (AG) accelerometer is widely used to assess physical activity (PA) in heart failure (HF) patients. However, the validity of the AG in this population remains unexplored. Therefore, this study examined the criterion validity of the AG-GT9X for measuring step counts (SC) and energy expenditure (EE) among HF patients. 16 patients with HF with preserved ejection fraction (mean age = 60.3±12.1yrs) completed a total of 41 symptom-limited cardiopulmonary exercise tests on a treadmill across multiple time points (median (IQR) = 2.5 (1.5-3.5)). All participants wore the AG (model: GT9X) on both the right ankle and waist locations during the test. Manually counted steps and indirect calorimetry-derived EE served as criterion measures. AG-derived EE was estimated using six different prediction equations previously developed for waist-worn AG. AG-derived measurements were compared with criterion measurements by calculating correlation coefficients, equivalence tests with two one-sided tests, mean absolute percentage error (MAPE), percentage bias, and Bland-Altman plots using mixed models to account for the nested nature of repeated measures within subjects. Ankle-worn AG-SC was significantly equivalent to the criterion (p < .05) and had lower MAPE (<10%) compared to the waist location, regardless of PA intensity level. Sasaki-EE was significantly equivalent to the criterion (p < .05), with the lowest percentage bias overall (0.7%). The ankle-worn AG-SC and Sasaki-EE showed better accuracy among HF patients in laboratory settings. Further research is warranted to cross-validate the results in different settings.

By 19 June, 90 619 covid-19 cases have been identified,3 mostly concentrated in urban areas.4 As a result of the government’s actions—such as enforcing lockdown, shutting down educational institutions and offices, and putting restrictions on the movement of vehicles5—people in urban communities are staying at home, reducing mobility and physical activity.6 Furthermore, being confined at home, people have indulged in binge eating,7 which may be linked to the increase in depressive illnesses amid the pandemic.8 Regardless of the pandemic, 68% of urban college students in the country consume fast food regularly, and 29.9% of them are obese.9 Processed food industries and restaurants are loosely regulated in Bangladesh, and the nutritional value of food is often overlooked.10 All these factors are leading to increased overweight and obesity, which is associated with weakened immunity.11 Early reports indicate a substantial epidemiological shift in vulnerable age groups for covid-19 in Bangladesh compared with other countries. There is a dire need for large scale epidemiological studies to investigate this association as well as public health programmes to improve knowledge and practice in order to reduce obesity among urban populations through healthy eating and exercise. 10.1038/oby.2001.31 11331430 9 Banik R Naher S Pervez S. Fast food consumption and obesity among urban college going adolescents in Bangladesh: a cross-sectional study.

The current scoping review is an attempt to explore the key reasons, determinants, patterns and prevalence related to self-medication with antibiotics (SMA) among the lay public. An online search was conducted using Google Scholar, Science Direct, ProQuest and PubMed. A two-phase mapping approach was used. In the first phase, studies were screened. In the second phase, the data were extracted from selected studies followed by the assessment of data quality. A total of 24 studies were included; 20 were cross-sectional, 3 were qualitative and one was observational. The most common indications were flu, cough, common colds, sore throat, diarrhea, toothache and fever. The most common determinants reported were past good experience and suggestions from friends or relatives. The use of SMA was observed to be more frequent in younger aged individuals belonging to low- or middle-income groups. The prevalence rate was reported to be high among the South Asian lay public and may be a major contributor to antibiotic resistance. In conclusion, this scoping review identifies a need for education campaigns and mass media campaigns to strengthen lay public awareness about the side effects and risks associated with SMA. In addition to this, there is a need to implement strict policies by government agencies to restrict over the counter availability of antibiotics.