Sexual dysfunction is a common symptom in patients with schizophrenia, especially in chronically medicated patients. However, the relationship between sexual dysfunction and emotional response to sexual arousal in male patients with schizophrenia remains unclear. This study aimed to assess the incidence, risk factors of sexual dysfunction in males, and their clinical correlations to sexual arousal in male patients with schizophrenia in China.A total of 162 male patients, aged 18–50 years, with schizophrenia were recruited from a psychiatric hospital in Ganzhou. The clinical symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS). The Arizona Sexual Experience Scale was utilized to evaluate sexual dysfunction. Erotic images were selected from International Affective Picture System (IAPS). Sixty-eight out of the 162 subjects completed the erotic pictures reactivity task.Overall, 48 (29.6%) patients were measured as having global sexual dysfunction, 72 (44.4%) patients as having strength of sex drive dysfunction, 51 (31.5%) patients as having sexual arousal dysfunction, 55 (34.0%) patients as having penile erection dysfunction, 60 (37.0%) patients as having reached orgasm dysfunction, and 60 (37.0%) patients as having satisfaction with orgasm dysfunction. The sexual dysfunction patients had significantly higher scores on the negative symptoms of the PANSS. The only important predictor of sexual dysfunction was the severity of PANSS negative factor. The sense of pleasure and arousal post viewing erotic images in the sexual dysfunction group were lower compared to the non-sexual dysfunction group. The sense of pleasure and approach motivation were significantly negatively correlated with the severity of sexual dysfunction.This study shows that nearly one-third of young and middle-aged chronically medicated male inpatients with schizophrenia suffer from sexual dysfunction. The negative factor of the PANSS can be regarded as the risk factor of sexual dysfunction. Schizophrenia patients with sexual dysfunction experienced lower pleasure and higher avoidance motivation than non-sexual dysfunction patients when exposed to erotic stimuli. Sexual dysfunction is a serious side effect that commonly manifests in patients with chronic schizophrenia –3. PreviA variety of impacting factors, such as sex –17, age The purposes of our study are to explore: (1) the incidence, risk factors, and clinical correlates of sexual dysfunction in Chinese male inpatients with schizophrenia; (2) response to sexual arousal; and (3) the correlation between sexual dysfunction and emotional response to sexual stimuli.The subjects in the study were inpatients recruited from the Third People's Hospital in Ganzhou City, China. The survey was conducted from August 1, 2018, to July 31, 2019. All subjects met the criteria, as follows: (1) aged 18 years or above, Han Chinese; (2) self-report of heterosexuality; (3) meeting The Diagnostic and Statistical Manual of Mental Disorders IV, Text Revision (DSM-IV-TR) (2000) criteria for schizophrenia, two psychiatrists independently evaluated the mental status of the subjects based on the Structured Clinical Interview for DSM-IV-TR (SCID); (4) adherence to oral second-generation antipsychotics for at least 1 year; (5) be able to understand the requirements and content of the evaluation; (6) no other somatic diseases, such as diseases of the central nervous system, acute, unstable, or life-threatening diseases ; (7) normal or corrected-to-normal vision and normal color vision. The sociodemographic and clinical information of the subjects was collected by experienced researchers. Other pieces of information were collected from electronic medical records and ancillary resources. All the subjects underwent physical examination and blood biochemical tests. In total, 162 male patients were recruited in this study. All subjects had no addiction to drugs, alcohol, or other substances.The project was approved by the Ethics Committee of the Third People's Hospital of Ganzhou City (2018002). A trained researcher explained the purpose of the study, its procedures, and confidentiality of the information to the subjects in a language appropriate to their level of understanding and emotional state. Participants were also informed that the study was only a cross-sectional survey, that there would be no harm to them, and that they would not obtain any intervention. Each subject signed an informed consent form prior to participation in the study.All methods described in this study were carried out in accordance with the Declaration of Helsinki promulgated by the National Institutes of Health.The PANSS was used by two researchers who received training on how to assess PANSS. The interrater correlation coefficient of repeated measurements for the total score of PANSS was >0.8. The five-factor model of PANSS was used to evaluate the clinical symptoms of the subjects . Items PSociodemographic information included age, age of onset, education levels, marital status at the time of consultation, and family history of mental illness. Clinical data such as weight, height, smoking status, duration of illness, hospitalization numbers, and the use of antipsychotic and antidepressant medications were collected. Trained research assistants were responsible for collecting the sociodemographic and clinical data.The Mandarin Chinese version of the Arizona Sexual Experience Scale (ASEX) –37 was uPictures for the affective reactivity task included 10 erotic images of nude couples in erotic poses and 10 neutral images of dressed people in daily life. The pictures were all selected from the International Affective Picture System (IAPS) and have been used in previous studies –42. Acco*Power 3.1.9.2 program was used to perform a sample size based on effect size derived from a previous study , and the Greenhouse–Geisser method was run to adjust degrees of freedom. Using the type of pictures  as within-subject factors and sexual dysfunction (NSD and SD)as between-subject factors.p-values were double-tailed with significance level at 0.05. The continuous variables were presented in the form of mean ± standard deviation.SPSS 22.0 was conducted for all statistical analyses. Based on the effect sizes derived from a previous study , the samp < 0.05)  in male patients with chronic schizophrenia, strength of sex drive dysfunction was 44.4% (72/162), sexual arousal dysfunction was 31.5% (51/126), penile erection dysfunction was 34.0% (55/162), the ability to reach orgasm dysfunction and satisfaction with orgasm dysfunction was 37.0% (60/162). In addition, there were significant group differences in each domain of ASEX, including strength of sex drive, sexual arousal, penile erection, ability to reach orgasm, satisfaction with orgasm, and total score  .p < 0.01). After controlling for age and age of onset, a significant difference was observed in negative symptoms  between non-sexual dysfunction and sexual dysfunction groups.Sociodemographic and clinical variables of all patients are shown in p > 0.05) (p > 0.05) ], followed by clozapine [46 (28.40%)] and other second-generation antipsychotics . ANOVA showed no significant effect of antipsychotics on sexual dysfunction  . Eight p > 0.05) .r = 0.16, p = 0.04; Bonferroni corrected p > 0.05). Furthermore, a multiple stepwise regression was performed to predict sexual dysfunction with all sociodemographic and clinical variables. Only negative symptoms predicted sexual dysfunction in a statistically significant manner . The coefficients of the variable are shown in Pearson correlation analysis showed that sexual dysfunction was correlated with negative symptoms (p < 0.05). However, there was no significant effect of sexual dysfunction group, picture types, and sexual dysfunction group × picture types on approach motivation evaluation  and approach motivation  on sexual picture, and all passed the Bonferroni correction.Pearson correlation analysis showed that there was a significantly negative correlation between the severity of sexual dysfunction and the scores of pleasure  the percentage of global sexual dysfunction was 29.6% in young and middle-aged male medicated chronic inpatients with schizophrenia; (2) negative symptoms were a risk factor for sexual dysfunction; (3) sexual dysfunction patients experienced lower pleasure and approach motivation when viewing erotic pictures.Our cross-sectional clinical study indicated that nearly one-third of young and middle-aged chronically medicated male inpatients with schizophrenia suffer from sexual dysfunction, which was lower than those of the previous studies that used ASEX in schizophrenia patients in different sociocultural environments 30.7–84.5%) , 38, 43 4.5% , 38Most previous studies have shown that sexual dysfunction is correlated with the severity of psychopathology, and higher scores on the negative symptoms were correlated with the severity of sexual dysfunction , 48. In Notably, in our present study, compared with the non-sexual dysfunction group, the sexual dysfunction group showed lower pleasure and arousal induced by sexual stimuli. Furthermore, our study also found that sexual dysfunction was negatively correlated with pleasure and approach motivation elicited by erotic pictures, which is in line with previous investigations that indicated that hedonic response and intrinsic motivation were impaired in schizophrenia , 50–52. Our study had several limitations. First, as a cross-sectional study, no causal relationship of sexual dysfunction can be concluded. Second, the sexual dysfunction and emotion were all self-assessment, which may lead to biased results. Third, this study may not be representative because most of the participants in the current study were young and middle-aged men, and the average age of subjects was younger (28.41 years). In addition, our results were only applicable to hospitalized patients, and our findings may not be generalized to other subjects recruited from other locations in China. “Fourth, although we did not find significant differences in the effects of antipsychotic drugs on sexual dysfunction, we did not collect the antipsychotic dose data. Also, we did not measure medication adherence. Therefore, we do not know whether there was a correlation between antipsychotic dose or medication adherence and sex dysfunction in this study, which should be remedied in future investigation.” Fifth, the subjectivity of the responses should be considered as a limitation. In this study, the mean age of our patients was below 30, and for them, reporting sexual dysfunction might be an embarrassment. Moreover, some patients might have thought that the study would lead to a treatment for sexual dysfunction, since we did not write this down on the consent form. Sixth, homosexual preferences would affect response to the erotic stimuli and also the reporting of the response. In this study, whether a patient was heterosexual or non-heterosexual only depended on his self-report, and we did not have any objective measure. In particular, Chinese men are reluctant to admit non-heterosexuality, even if they are homosexual. Therefore, the real impact of homosexual preference to the erotic stimuli and reported responses warrant further investigation. Seventh, adherence to oral second-generation antipsychotics for at least 1 year, it is unclear that patients on treatment for 1 year is considered as chronic as one on treatment for 20 years, where inevitably long-term effects are added to sexual dysfunction. Finally, the sample size was small, especially the numbers of affective reactivity task analysis, which may limit the reliability of the findings.In conclusion, this study revealed that the prevalence of global sexual dysfunction was higher in young and middle-aged male schizophrenia patients than that in the general population. The negative symptom PANSS was the risk factor of sexual dysfunction. Furthermore, upon exposure to sexual stimulation, male schizophrenia patients with sexual dysfunction experienced lower pleasure and approach motivation. Thus, our findings in this study may provide new insights into understanding the psychopathological mechanism of sexual dysfunction so as to find potential solutions for sexual dysfunction in patients with schizophrenia. Clinicians should assess the sexual functioning of patients with schizophrenia and recommend appropriate antipsychotic medications in combination with physical therapy to improve negative symptoms, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). In addition, clinicians should implement concurrent psychotherapy to improve medication adherence, self-esteem, and self-confidence; promote interpersonal communications; adjust attitudes; and improve sexual experiences.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The studies involving human participants were reviewed and approved by the Ethics Committee of the Third People's Hospital of Ganzhou City. The patients/participants provided their written informed consent to participate in this study.XZ: conceptualization, methodology, writing—reviewing, editing, and supervision. DL: formal analysis, writing—original draft, and funding acquisition. HD, HG, WL, DZ, ZM, DaH, DoH, QM, and LQ: investigation, resources, and data curation. SL, MX, NZ, and HW: conceptualization, writing—review, and editing. All authors have contributed to and have approved the submitted version.This research was supported by Key R&D Program of Jiangxi Province (20202BBGL73106), Key R&D Program of Science and Technology in Ganzhou (201926), the Planning Program of Health Committee of Ganzhou (201911), the Planning Program of Health Committee of Jiangxi Province (20202089), and grants 81771139 and 81371477 from the CAS Pioneer Hundred Talents Program and the National Natural Science Foundation of China.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The weight gain (p < 0.001), level of physical activity (p < 0.001), and maternal well-being (p < 0.01) also had significant differences after the intervention. Even after controlling for potentially confounding variables, the maternal food practices regression model revealed that birth weight was directly correlated with the consumption of milk (p < 0.001), fruits (p < 0.01), and green vegetables (p < 0.05). As per the physical activity and maternal well-being regression model, the birth weight and crown–heel length were strongly related with the physical activity and maternal well-being of mothers at 36 weeks of gestation (p < 0.05). Combining the MOM intervention with standard antenatal care is a safe and effective way to improve maternal welfare while upholding pregnant mothers’ human rights.Maternal and child nutrition has been a critical component of health, sustainable development, and progress in low- and middle-income countries (LMIC). While a decrement in maternal mortality is an important indicator, simply surviving pregnancy and childbirth does not imply better maternal health. One of the fundamental obligations of nations under international human rights law is to enable women to endure pregnancy and delivery as an aspect of their enjoyment of reproductive and sexual health and rights and to live a dignified life. The aim of this study was to discover the correlation between the Maternal Observation and Motivation (MOM) program and m-Health support for maternal and newborn health. A comparative study was done among 196 pregnant mothers  with not less than 20 weeks of gestation. Maternal outcomes such as Hb and weight gain and newborn results such as birth weight and crown–heel length were obtained at baseline and at 28 and 36 weeks of gestation. Other secondary data collected were abortion, stillbirth, low birth weight, major congenital malformations, twin or triplet pregnancies, physical activity, and maternal well-being. The MOM intervention included initial face-to-face education, three in-person visits, and eight virtual health coaching sessions via WhatsApp. The baseline data on Hb of the mothers show that 31 (32.98%) vs. 27 (28.72%) mothers in the study and control group, respectively, had anemia, which improved to 27.66% and 14.98% among study group mothers at 28 and 36 weeks of gestation ( Pregnancy is a precious event that can influence maternal health and the health of future generations. Nutrition is vital for maternal and child health, and it is well acknowledged that well-balanced nutrition in early life is the foundation for long-term health . Poor maFor maternal, fetal, and newborn health, counseling women to promote awareness of the importance of maternal health prior to conception and in pregnancy and advocating a culturally accepted lifestyle modification in favor of a healthy weight is critical. Although a balanced diet is widely available in today’s globalized world, a shift to a high-fat, low-quality diet has resulted in inadequate vitamin and mineral intake during pregnancy . When thAccording to the World Health Organization (WHO) guidelines on “antenatal care (ANC) for a positive pregnancy experience” , counsel“Every mother and newborn receive quality care during the pregnancy, childbirth, and postnatal period”, the WHO envisions . There iNevertheless, the association between maternal nutrition and birth outcome is quite complex and influenced by biological, socioeconomic, and demographic factors. Understanding the relationship between maternal nutrition, pregnancy, and birth outcomes may serve as the basis for nutritional interventions. It will improve birth outcomes and the newborn’s long-term health, improving quality of life and lowering mortality, morbidity, and healthcare costs . Under the international human rights law, one of the fundamental commitments of nations includes enabling women to survive pregnancy and delivery as part of their enjoyment of sexual and reproductive health and rights and living a life of dignity . The humFor this, based on a woman’s preferences and available possibilities, we need novel, evidence-based methods of antenatal care to accomplish the “Every Woman Every Child” vision and the Global Strategy for Women’s, Children’s, and Adolescents’ Health. Maternal care also provides an opportunity to interact with and support women, families, and communities at a crucial period in a woman’s life.Poor maternal nutrition, resulting in either malnutrition or excessive weight gain, is common and significant in poor perinatal outcomes . Low BMIIron, folate, and vitamin A deficiency are all linked to anemia and associated with an increased risk of maternal and infant mortality . Anemia Pre-eclampsia has been related to calcium deficiency , and shoPregnancy is a time of physical and emotional stress, and psychological symptoms occur at a higher rate in pregnant women, adversely affecting pregnancy and postpartum outcomes . It is, Mobile health, or “m-Health”, technologies are increasingly being used to improve chronic disease management and encourage behavior change . Given tTo test the hypothesis that the Maternal Observation and Motivation (MOM) program with m-Health support during pregnancy would improve maternal and newborn health.A comparative study was done to assess the effect of the Maternal Observation and Motivation (MOM) program with m-Health support on maternal and newborn health. The study participants were pregnant women with gestational age not less than 20 weeks with a viable fetus confirmed by ultrasonogram. The study took place in six villages, 30–40 km from Chennai city and covered a population of 35,000. The eligible samples were 196 pregnant women who met the inclusion criteria and were ready to take part in the study. The non-probability convenient sampling technique selected 196 samples from six villages in the Chennai suburban area. The inclusion criteria were viable fetus, gestational age not less than 20 weeks, no severe illness, written consent for participation, and possession of a smart phone when recruited. The mothers from three villages were allotted to the study group (94 mothers) and those from three other villages were in the control group (102 mothers) for convenience and to avoid contamination. The CONSORT diagram is included in Section A: The sociodemographic characteristics of the participants included age, parity, education, occupation of the mothers, husband’s education and occupation.Section B: Food Frequency Questionnaire (FFQ) was created and used to collect the baseline data on diet history. Section C: Maternal outcomes such as height (Ht), weight (kg), hody mass index (BMI), and hemoglobin (Hb) at baseline, 28 weeks, and 36 weeks were obtained. In addition, the data related to maternal morbidity and mortality, such as spontaneous abortion, induced abortion, stillbirth, or live births, were obtained from a structured checklist. Section D: Newborn outcomes such as birth weight and crown–heel length were measured to the nearest 0.1 cm using fiberglass tapes . Secondary data such as low birth weight, small for gestational age, major congenital malformations, and twin or triplet pregnancies were also collected. Section E: The data were gathered using a self-structured pregnancy physical activity (PA) checklist. Section F: Maternal well-being was assessed using the World Health Organization-5 Well-Being Index (WHO-5)  tool.The participating pregnant women were followed up monthly at home by one of the investigators or research assistants. Information on specified gastrointestinal adverse effects was collected after four weeks of supplementation and the MOM program. If the mother had minor ailments such as constipation or heartburn, home remedies as per the WHO guidelines were given. If those symptoms persisted or worsened, mothers were referred to the nearby health centers/hospitals. The weight and Hb level in venous blood were assessed using HemoCue (HemoCue AB) at initial contact, 28-, and 36-weeks of gestation. Anemia was defined as having a hemoglobin level less than 11.0 g/mL. All participants in both groups were provided with two 3-day food diaries to quantify intakes and physical activity surveys to ascertain self-reported compliance, monitored by the investigating team.Pregnancy outcomes were classified as spontaneous abortion , induced abortion , stillbirth (birth of a dead fetus after 28 weeks’ gestation), or live birth (birth of a fetus with any sign of viability). The birth anthropometry was primarily measured by trained nurses within 72 h of birth. SECA electronic scales (SECA GmbH) were used to measure all birth weights to a precision of 10 g.The crown–heel length of the newborn was measured using standard procedures using domestically manufactured collapsible length boards that were accurate to 1 mm. Training of the interviewers/research assistants on anthropometric measurements was conducted periodically. Weighing equipment was calibrated monthly with standard weights. Inter-observer and intra-observer variation studies were conducted every month to ensure the quality of these measurements. The data were gathered using a self-structured pregnancy physical activity (PA) checklist. The duration of each day’s physical activity was recorded in the self-monitored diary. The “Fit” app was downloaded on the mothers’ smart phones to observe and motivate their PA to calculate the average weekly minutes spent on physical activity. Pregnancy is a time of physical and emotional stress, as well as progressive physiological and psychological changes. Psychological symptoms occur at a higher rate in pregnant women than in non-pregnant women and adversely affect pregnancy and postpartum outcomes. Therefore, the WHO-5, a short-form (five items) tool was used. The five items are as follows: I have felt cheerful and in good spirits; I have felt calm and relaxed; I have felt active and vigorous; I woke up feeling fresh and rested; and my daily life has been filled with things that interest me. Each item is rated on a six-point Likert-type scale of 0–5, with 0 indicating the lack of positive feelings during the preceding 2 weeks and 5 indicating consistent positive feelings. The total raw score, which ranges from 0 to 25, is multiplied by 4 to obtain the final score, with 0 representing the worst possible well-being and 100 representing the best possible well-being .Women in the control group received only the standard antenatal care, and the intervention group received routine antenatal care as well as a the “Maternal Observation and Motivation (MOM)” program. The MOM program began with a single face-to-face education session conducted for a group of 5–8 antenatal mothers.This education session was delivered at the first visit and emphasized the importance of nutrition; the effect of anemia and vitamin or mineral deficiency on the mother, the fetus, and the child in later life; the compliance of supplemental medications and nutrition supplement mixes; and the importance of the physical activity and emotional well-being of the mother during pregnancy. Participants were encouraged and were informed about a healthy diet, including adding fresh fruits and vegetables, milk and milk products. The recommended diet provided additional calories, proteins, and micronutrients that approximated the recommended levels. Under the Integrated Child Development Services (ICDS) program , the antAll women in the study group were given 100 tablets of iron (60 mg) and folic acid (0.5 mg) at initial contact according to the National Nutritional Anemia Control Program and the nutritional mix given by the government Tamilnadu 36]. Anemic mothers were given special consideration and followed the above protocol. The information received at the face-to-face education session was reinforced by smart phone, through WhatsApp messages every 2 weeks (sent by the research team). The research assistants did three follow-up, face-to-face, in-person home visits besides those at baseline, 26 weeks, 36 weeks of gestation, and after delivery. Among the four research assistants, three were nurses with master’s degrees in Obstetrics and Gynecology and one had a masters in Mental Health Nursing. The research assistants were given training on the assessment of data and counseling of mothers related to MOM and motivating the mothers to comply with the nutrition habits, supplements, regular physical activity, and mental well-being.The content of the WhatsApp messages was standardized to a specific theme on a 2 week basis with some discourse between the researchers and participants. Individual attention was given to each mother on her concerns about diet, physiological alterations related to pregnancy and its’ management, and follow up of nutrition supplementation. Individualized counseling was also given on minor ailments related to pregnancy, and one of the researchers also visited the mothers at least two times during the study period. The virtual meetings occurred eight times during the study period with three in-person visits.Official permission to conduct the study and ethical approval were obtained from the Institutional Ethical Committee with ICE/LCN/2021-02 dated 29 January 2021. Consent from the participants was collected before starting the study after explaining the aim of the study, their role, the confidentiality of the information, and their right to depart from the study at any point of data collection. A no-harm certificate was obtained from an obstetrician for the MOM program. The control group mothers were also assured that they were following the standard antenatal care protocol of the state government. Confidentiality and beneficence were assured throughout the study period.t’ test was used to compare differences between group means to compare the MOM intervention with the standard program. Multiple regression analysis was used to examine changes in birth weight of the newborn according to maternal food practices, physical activity, and maternal well-being. In regressions, birth measurements and maternal measurements were evaluated as continuous variables. Food practices, physical activity, and maternal well-being scores were analyzed as grouped variables, and p < 0.05 was considered statistically significant.The data were processed and analyzed by SPSS version 21.0. Armonk, NY using descriptive and inferential statistics. Analysis of data was done in accordance with intention to treat. Analysis of variance was used to examine the main effects of food practices among the two groups on the Hb level of the mothers. The ‘The dietary intake of the pregnant mothers was measured using a self-reported FFQ checklist on milk and milk products, green leafy vegetables, and fruits. These data were used for the regression analysis to determine their relationship with the maternal and newborn outcomes. In addition to this, the mothers were given nutritional supplements as per the Government of Tamilnadu.p < 0.001 as per repeated ANOVA.p < 0.001 level after intervention. The weight gain among the intervention group also showed a significant disparity at the p < 0.001 level. There was a significant variation between physical activity and maternal wellbeing groups at the p < 0.001 and p < 0.01 levels (The baseline data on Hb show that 31 (32.98%) vs. 27 (28.72%) of the study and control group had anemia, which was improved to 27.7% and 15.0% among study group mothers at 28 and 36 weeks of gestation. There was a significant dissimilarity in anemia status among the study and control group at the 1 levels . Similarp < 0.001 in crown–heel length and in birth weight and gestational age at birth at p < 0.01. The mean birth weight of the study group was slightly higher than that of the control group (2.78 ± 0.56 vs. 2.56 ± 0.49 kg). Similarly, the crown–heel length was 47.6 ± 3.0 vs. 46.8 ± 3.5 cm in the study and control group, respectively.The newborn outcomes show a significant difference between groups at p < 0.001), fruits (p < 0.01), and green vegetables (GLV) (p < 0.05) even after adjustment for potentially confounding variables such as sex, parity, gestational age at birth, and baseline weight of mothers (The birth weight was strongly related with the consumption at 36 weeks of gestation of milk ( mothers .p < 0.001) after adjusting the predictor variables such as sex; parity; and baseline weight of the mother; and intake of milk products, GLV, and fruits. Maternal well-being also showed a significant influence on the birth weight and crown–heel length of the newborn (p < 0.05)  .The data on preterm birth (PTM), spontaneous abortion, stillbirth, low birth weight, small for gestational age, major congenital malformations, and twin or triplet pregnancies were obtained from a structured checklist. There were only two spontaneous abortions and four small-for-gestation babies among the study participants .This study was done to compare the effect of the Maternal Observation and Motivation (MOM) program on maternal outcomes such as weight (kg) and Hb at baseline, 28 weeks, and 36 weeks and newborn outcomes such as birth weight, crown–heel length, and gestational age at birth. The data on preterm birth (PTM), spontaneous abortion, stillbirth, low birth weight, SGA, major congenital malformations, and twin or triplet pregnancies were obtained from a structured checklist. The strengths of our study were that it was community based, and the mothers were continuously observed and motivated by the qualified nurses for their compliance with the intervention as well as to promote their well-being, throughout their pregnancy. In addition, according to the WHO recommendations that pregnant women be followed up at least eight times during their pregnancy, in this project, the mothers had four face-to-face counseling sessions and eight virtual follow-ups with the healthcare professionals through smart phones.The baseline data on Hb of the mothers show that around 29% of them had anemia, which was improved to 27.7% and 15.0% among study group mothers at 28 and 36 weeks of gestation after the intervention. According to the findings of a study, globally, in 2016, an estimated 35.3 million pregnant women worldwide or 40% were anemic. Among them, 19% of women are affected by iron deficiency . The WHOIn addition, inadequate folate levels in the blood before conception and in the first trimester can cause severe fatal neural tube abnormalities. Spina bifida and anencephaly, the two most prevalent kinds of neural tube disorders, affect an estimated 300,000 babies each year ,41. Therp < 0.001 after the intervention, which denied the effect of daily snacking with leafy vegetables, fruit, and milk before conception and during pregnancy on the birth weight [According to a few prospective studies on maternal nutrition, after controlling for a variety of covariates, the maternal thinness, as defined by a low mid-upper arm circumference, was linked to all-cause maternal death (up to 42 days postpartum) in Nepal  as well h weight . Hence, As per the concept, the WHO’s shift of considering diet quality and promoting healthy eating practices on antenatal care recommends counseling on healthy eating and keeping physically active during pregnancy . Furtherp < 0.001 and p < 0.01 levels.This study’s strong point was that it adopted an individualized approach for pregnant women with in-person interactions and the most novel approach of m-Health support through smart phones. This allowed the investigators to meet the mothers often and give custom-made interactions and resolutions for the women. This was reflected in the study findings on physical activity, maternal well-being, and the outcome variables of the study. There was a significant dissimilarity between physical activity and maternal well-being among groups in the present study at p < 0.001 in crown–heel length, birth weight, and gestational age at birth at p < 0.01, respectively. The mean birth weight of the study group was slightly higher than that of the control group (2.780 ± 0.560 vs. 2.560 ± 0.490 kg). Similarly, the crown–heel length was 47.6 ± 3.0 vs. 46.8 ± 3.5 cm among the study and control groups. This could have been because the present study provided individual attention to the antenatal mothers and included regular monitoring and motivation to improve the mothers’ physical and mental well-being of the mothers.Nearly three million annual newborn deaths account for an estimated 44% of all under-five deaths globally. There is solid evidence for various therapies on prevention of this, provided alone or in packages, across both time and place continuums . While these interventions can prevent 70% of newborn fatalities (and more than one-third of stillbirths) , the mosp < 0.001), fruits (p < 0.01), and green vegetables (p < 0.05) even after adjustment for potentially confounding variables such as gender, parity, gestational age at birth, and baseline weight  even after adjustment for potentially confounding variables such as gender; parity; gestational age at birth; and baseline intake of milk products, GLV, and fruits. This finding suggests that the newborn outcome variables such as birth weight and crown–heel length were strongly linked with the mothers’ physical activity and maternal well-being of the mothers.As per the physical activity and maternal well-being regression model, the birth weight and crown–heel length were strongly related with the physical activity and maternal well-being of mothers at 36 weeks of gestation (Hence, this multi-component MOM intervention incorporating diet, nutritional supplements, physical activity, and maternal well-being by personal interaction with continuous observation and motivation through m-Health improved the maternal and newborn outcomes significantly. However, among the independent variables, physical activity and maternal well-being played a significant role in the improvement of newborn outcomes in addition to dietary habits, including intake of milk products, GLV, and fruits.Our results contrast with the results of RCTs conducted by two prospective studies ,43 that While reducing maternal mortality is an important indicator, simply surviving pregnancy and childbirth does not imply improved maternal health. The burden of maternal morbidity can have long-term consequences for women’s health and well-being. Adopting a human rights framework for universal health necessitates the provision of high-quality care not only during pregnancy and labor but also before and after childbirth. It is critical to broaden the focus on mortality to include morbidity to achieve health for all. This MOM intervention involving face-to-face counseling, constant motivation, and observation by m-Health improved compliance, physical activity behavior, and maternal well-being and eventually improved maternal and newborn health. Hence, it is a safe and effective measure to use the MOM intervention with standard antenatal care to improve maternal well-being from the human rights point of view and reduce the disease burden.


SD = 16.72). It found that broadcast use and television use were positively associated with obesity and showed an increasing trend over time. Cellphone use emerged as a risk factor for obesity in 2017 and showed an increasing trend. By contrast, newspaper use, television use, and internet use were negatively associated with SHS, and television use showed a decreasing trend in the association with SHS, while internet and newspaper use showed an increasing trend. In conclusion, media use was positively associated with obesity while negatively associated with SHS. It showed a decreasing trend in the associations between traditional media use and obesity, while revealing an increasing trend in the associations between new media use and obesity, as well as SHS. The practical implications of the findings are discussed.Obesity and suboptimal health status (SHS) have been global public health concerns in recent decades. A growing number of works have explored the relationships between media use and obesity, as well as SHS. This study aimed to examine the time trend of the associations between media use  and obesity, as well as SHS. The data were derived from three national random samples of the Chinese General Social Survey (CGSS), which was separately conducted in 2013, 2015, and 2017. In total, 34,468 respondents were included in this study, consisting of 16,624 males and 17,844 females, and the average age was 49.95 years old ( Over the recent decades, communication technology has changed dramatically. A variety of new media, including the internet, computers, cellphones, and social media have rapidly come to coexist with traditional media , which dominate individual’s leisure activities and spare time . Media uObesity has been a global public health concern which has caused various health problems and social burden ,6. RecenSHS is an intermediate state between health and disease conditions, characterized by declines in vitality, physiological function, and the capacity for adaptation . It inclAccording to the “biological-psychological-social” medical model, an individual’s health status is dictated by his/her biological, psychological, and social factors. Thus, SHS is usually measured or assessed by disturbance symptoms in terms of physiological, psychological, and sociological characteristics, namely physical SHS (PS), mental SHS (MS), and social SHS (SS) . Given tAs a critical predictor of SHS, screen-based media (SBM) has occupied a considerable portion of young peoples’ discretionary leisure time . The oveHowever, others have argued that individuals could significantly benefit from media use, whether in terms of physical health or psychological health. The social compensation hypothesis interprets that media use can compensate for what individuals lack in real life, including social resources and support . PrimariAlthough prior studies have provided valuable knowledge to understand the relationships between media use, obesity and SHS ,45,46,47What are time trends in the associations of media use with obesity (RQ1) and SHS (RQ2) in the period 2013 to 2017?What are the differences in time trends between new media use and traditional media use, separately, in their associations with obesity (RQ3) and SHS (RQ4)?Therefore, to gain a comprehensive and longitudinal view of the influence of media use, it is necessary to test the time trend of the supposed causality between media use and health status, as well as to consider the disparities between different media uses. The current study aims to reveal the time changes in the associations of media use with obesity and SHS from 2013 to 2017. Further, to compare the effects of different media use, we divided the media genres into traditional media  and new media (internet and cellphone). Hence, the specific research questions were proposed:The data was drawn from the Chinese General Social Survey (CGSS) in 2013, 2015, and 2017. The CGSS is a nationally presentative and continuous social survey project, implemented on the Chinese mainland by the Renmin University of China and Hong Kong University of Science and Technology annually since 2003. It has been broadly considered as the Chinese counterpart of the General Social Survey (GSS) in the United States. Using a stratified multi-stage probability proportionate to size (PPS) sampling method, samples were drawn from households in all 31 provincial units in Mainland China with three levels in each sampling frame: county or district, community, and household. In a selected county (district), four community-level units (neighborhood committees or village committees) were randomly selected. In a selected community-level unit, 25 households were selected, and in each selected household one adult was randomly selected for the survey ,54. CGSSMedia use was measured by the following question: “In the past year, how often did you use the following media?” Media types consisted of newspaper, magazine, broadcast, television, internet, and cellphone. The answers were independently rated as “never”, “seldom”, “sometimes”, “often”, and “always”.2. According to obesity criteria, the WHO defined overweight in adults as a BMI of 25.0–29.9 kg/m2 and obesity as a BMI of 30.0 kg/m2 or higher. However, accumulated evidence has consistently supported the use of lower BMI cutoffs in Chinese than those in whites [2 to define overweight and 28·0 kg/m2 to define obesity [2, overweight as a BMI of 24–27.9 kg/m2, and obesity as a BMI ≥ 28 kg/m2. Consequently, each respondent was characterized as obese or not by the cut-off value of 28. The attribute of obesity was marked as “yes” or “no”.Obesity was indicated by body mass index (BMI) that was calculated as weight/heightn whites ,56,57, a obesity . As prop obesity  for ChinSHS was measured by three questions with self-defined items. According to the “biological-psychological-social” medical model, SHS was defined as physical SHS (PS), mental SHS (MS), and social SHS (SS) . We seleAccording to prior studies’ outcomes for Cronbach  and BlanCovariates included sociodemographic characteristics, such as gender , age (years old), educational level (illiterate/primary school/middle school/high school/college or bachelor’s degree and above), and physical activity . Hukou  was included to control for the unobserved geographic characteristics of the respondents’ residential location. In China, people are mainly divided into two groups  based on their birthplace and lineage. Generally, people with agricultural hukou live in rural areas with disadvantages in terms of the economy, education, medical, housing, and other social resources. By contrast, non-agricultural hukou holders who live in urban areas with more public and social resources have a high quality of life. So agricultural hukou and non-agricultural hukou are also called rural hukou and urban hukou . Obesityp-values were two-sided, and a value of less than 0.05 was considered statistically significant.Descriptive statistics were employed to describe the characteristics of sociodemographic indicators, media use, rate of obesity, and SHS. One-way ANOVA was used to analyze the P-trend of each variable by period. Logistic regression models were applied to estimate the associations between media use and obesity separately in 2013, 2015, and 2017. The analysis results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), with all covariates being controlled. Multiple linear regression models were applied to estimate the associations between media use and SHS separately in 2013, 2015, and 2017. The results were presented as Beta and SE (standard Error) and controlled all covariates. To test whether the associations between media use and obesity as well as SHS varied over time, the cross-sections were pooled pairwise , and dummy-coded as an independent variable separately. For example, in the period of 2013–2015, 2013 was coded “0” and 2015 was coded “1”. Interactions of media type with the pairwise year were included separately in the adjusted models to determine whether the association changed significantly over the study periods ,64. All SD = 16.72). More than half of the respondents had less educational experience (64.08%) and were rural Hukou (58.98%), and all the respondents did physical activities  at a relatively low level. As for the frequency of media use, television was rated most among the six media types, while it showed a decline and downward trend from 2013 to 2017, as well as newspapers, magazines, and broadcast. However, internet and cellphone use had an increasing tendency during the same time period. In addition, the prevalence of obesity increased from 5.7% to 7.6%, and the score of SHS increased from 6.39 (SD = 2.61) to 6.84 (SD = 2.65) during 2013 to 2017. All changes between different years were statistically significant.As for the time trend of the association of media use with obesity see , the sigAs for the time trend analysis of the association of media use and SHS see , compareObesity and SHS have been worldwide health issues as living environments and life patterns have changed rapidly in the past decade ,65. The It revealed that the profiles of media use changed significantly in China from 2013 to 2017, and the changes varied depending on different media types. Traditional media, such as newspapers, magazines, broadcast media and television use, presented a decreasing trend, and newspapers and television declined more significantly. On the contrary, the use frequency of new media  maintained a significantly increasing trend from 2013 to 2017, and internet use increased more than cellphone use. These trends were consistent with the dramatic progress in communication technologies and the rapid growth in Chinese internet users. According to the 34–39th Statistical Report on Internet Development in China, the number of Chinese internet users, internet penetration rate, and cellphone users had increased by 22.2%, 10.9%, and 41.7%, respectively, from 2013 to 2017 ,69. HoweConsistent with the time trend of new media use, both the prevalence of obesity and the magnitude of SHS increased significantly from 2013 to 2017, indicating that a higher proportion of Chinese adults suffered from overweight and health problems during that period. These findings were in line with the latest research findings that the prevalence of Chinese obesity changed from 3.1% (2.5–3.7) in 2004 to 8.1% (7.6–8.7) in 2018 , and morBroadcast, television, and cellphone use were positively associated with obesity at different time points. Magazine use was negatively associated with obesity in 2013 while the association disappeared in 2015 and 2017. These findings suggested that both traditional and new media use might be risk factors for obesity. There was a significant time trend in the associations between media use and obesity in the study periods, and traditional media and new media demonstrated totally opposite tendencies. Traditional media use  showed a declining tendency in association with obesity from 2013 to 2017, while new media use  showed an increasing tendency during that period. Cellphone use was increasingly important in predicting obesity and this trend was more significant in 2017 see . The undCellphones are usually characterized by multiple functions and are easy to use for all age groups compared with traditional media. Previous studies also found that cellphone did indeed occupy a large amount of leisure time and even led to cellphone addiction (extensive use or overuse), which brought about obesity or other health problems ,75. FurtIn the existing literature, media use was demonstrated as a beneficial factor for SHS since it provided health information resources, social engagement, and social support . In thisTelevision showed a rapidly decreasing trend in the association with SHS from 2013 to 2017, while internet use showed a significant increasing trend. Further, the associations between internet use and SHS were stronger than the associations between television use and SHS in 2015 and 2017, indicating that internet use has displaced television and become the strongest predictor of SHS since 2015. The possible explanation is that the internet has been the leading platform and carrier of health information and has become more popular for health information access than television in the digital age . Free acThe current study is one of the few that looked at time changes in the associations of different media use with obesity and SHS. Although substantial outcomes were seen when interpreting the results, the following limitations should be considered. Firstly, the repeated cross-sectional data did not allow us to draw causal inferences about the relationships between media use and obesity or SHS. Thus, a panel study and follow-up data are recommended to assess the causal effect of media use on obesity or SHS in future. Secondly, based on second-hand data, the measures of SHS were on a self-defined scale with limited items, which failed to measure SHS comprehensively and precisely. Although we made efforts to better match the three facets of SHS , the measures were single item and participants may have responded to the question more subjectively in terms of self-rated physical or psychological health, which might underestimate or overestimate the accurate SHS level. Thus, our findings for SHS need to be validated in future studies and a more comprehensive measure of SHS, such as the Suboptimal Health Status Questionnaire-25 (SHSQ-25) , should Based on three nationally representative samples of CGSS from 2013 to 2017 we tested the time trend of media use and the associations with obesity and SHS. We considered the differences between traditional media use and new media use. The results confirmed significant time trends between media use and obesity as well as SHS from 2013 to 2017. Furthermore, our study highlighted that the trend differences between traditional media and new media use were significant. Namely, traditional media use showed decreasing trends, while new media displayed an increasing trend. These findings contribute to a better understanding of how changing media use is impacting adults’ health status.


Radionuclide contamination in terrestrial ecosystems has reached a dangerous level. The major artificial radionuclide present in the environment is cesium-137 (137-Cs). In humans, animals, and plants cesium ion (Cs+) behaves like potassium ion (K+) and it is localized mainly inside the cells. Pancreas and salivary glands secrete Cs in the intestine thus eliminating about 14% of ingested Cs with the feces, the remaining 86% is eliminated by the kidney with the urine. Ingested radiocesium can also cause in humans several cases of pancreatitis with secondary diabetes (type 3c), which are both on the rise in the world. The Author studied the correlation between the geographical map of mortality from pancreatic cancer (PC) and the map of nuclear plant accidents, atomic bomb testing, and radioactive fallout. The worldwide death rate of PC is increasing, but the exact cause is still not known. Published data in medical literature at World, European and Italian levels are reviewed and compared. 137-Cs, with a half-life of about 30 years, is still present in the environment for about 300–600 years. Autoradiographic studies in mice have shown that 137-Cs is concentrated in greater quantity in the pancreas, particularly in exocrine cells, where most malignant PCs originate. Some methods of radiocesium removal and PC prevention are also suggested. But there is still a persistent, and not entirely disinterested, the controversy between damage from high and low exposure to ionizing radiations. Radionuclide contamination in terrestrial ecosystems has reached a dangerous level. The major artificial radionuclide present in the environment is radiocesium 137-Cs). Worldwide, both the incidence and death rates of pancreatic cancer (PC) are increasing  1,2]. 37-Cs. Wo. 37-Cs. PC is the seventh leading cause of global cancer deaths in industrialized countries and the third most common cancer in the USA. Based on GLOBOCAN 2018 estimates, PC has been ranked as the 11th most common cancer in the world counting 458,918 new cases and causing 432,242 deaths  in 2018 [There is a great deal of controversy concerning the accuracy of the methods used to determine the biological damage of nuclear power plant accidents. Since 1986, the total death toll of the disaster has lacked consensus; as the medical journal “The Lancet” and other sources have noted, it remains contested . DetermiChristopher Busby reported  that the“Dear Comrades! Since the accident at the Chernobyl power plant, there has been a detailed analysis of the radioactivity of the food and territory of your population point. The results show that living and working in your village will cause no harm to adults or children.” Scientific American” [On 2 March 2012, Katherine Harmon in “Health—merican”  wrote th“Japan’s Post-Fukushima Earthquake Health Woes Go beyond Radiation Effects. Heart disease and depression are likely to claim more lives than radiation after the earthquake, tsunami, and nuclear accident, experts say. Some public health experts agree that the radiation fears were overblown, and comparing with the effects of the radiation exposure from Fukushima the number of expected fatalities are never going to be that large and in terms of the health impact, the radiation is negligible, the radiation will cause very few, close to no deaths.” Wings of Death: Nuclear Pollution and Human Health” (1995), that there were many misleading reports that, with apparently good intentions, seriously underestimated the far-reaching consequences of the Chernobyl nuclear catastrophe in 1986. After 1991, also many international diplomats and scientists allied to the nuclear industry evaded or denied the fact of a wide-scale public health disaster caused by radiation exposure. Efforts to spin the story about Chernobyl were largely successful; the official death toll ranges between 31 and 54 people. Busby criticized other researchers studying the health effects of low-dose radiation, and also a report of the United Nations, where was stated that that only 28 people have died since 2005 from radiation emissions in Chernobyl and that there is an “overreaction” to radiation low dose. In reality, according to his book, radiation exposure from the disaster caused probably between 35,000 and 150,000 deaths, or more, in Ukraine alone [Professor Christopher Busby, Scientific Secretary of the European Committee on Radiation Risk (ECRR) wrote in his book “Manual for Survival: A Chernobyl Guide to the Future” (2019). No major international study tallied the damage, leaving Japanese leaders to repeat many of the same mistakes after the Fukushima nuclear disaster in 2011 [Drawing on a decade of archival research and on-the-ground interviews in Ukraine, Russia, and Belarus, Kate Brown, professor of Science, Technology, and Society at Massachusetts Institute of Technology unveils the full breadth of the devastation and the whitewash that followed, in her book “ture” 201. No majo: Epidemiological Studies of Low Dose Ionizing Radiation and Cancer Risk, that the new epidemiological studies directly support excess cancer risks from low-dose ionizing radiation [Recently (2020), Hauptmann and other 15 international researchers of 8 nations and from Institutes of Biostatistics, Registry Research, Centers of Cancer Epidemiology, Radiation Epidemiology, U.S. National Cancer Institute (NCI), International Agency for Research on Cancer (IARC), and Radiation Effects Research Foundation of Hiroshima, conducted a study. They investigated definitively through meta-analysis the damage resulting from the “low doses”, that have affected the survivor populations of the atomic bomb explosions in Hiroshima and Nagasaki, and also in numerous accidents of nuclear plants that have occurred in the world. These scientists reported in JNCI Monographsadiation . The portion of the total radiation dose (in the air) contributed by each isotope has been plotted against time after the Chernobyl disaster . 137-Cs The metabolism of radionuclides, such as cesium and iodine in biology, has been studied by many scientists, initially only to investigate the new radiation damage of atomic explosions after 1945. Only later researchers have investigated the role of these elements in biology and physiology. Among these researchers are Nelson et al. (1961) , UllbergBut how can we study the low radiation damage of these nucleotides? Certainly not with a direct statistical study of 1 to 1. Since we are dealing also with low radiation doses , which, however, are very prolonged, even for years, the carcinogenic damage is detectable only with a stochastic analysis (on large numbers) because there is only an indirect cause-effect ratio of 1:100, or even more! On the other hand, the oncogenic damage of DNA on one chromosome allele becomes evident only subsequently and may occur after 8–10 or more years, transforming the affected cell into a cancer cell. (1)high but single dose  bioaccumulation, or short half-life radionuclide ,(2)low but continuous dose , or long half-life radionuclide .Two different ways of bioaccumulation of radionuclides in the body are: Iodine-131 may give a higher initial dose, but its short half-life of 8 days ensures that it will soon be gone. Iodine-131 remains in the environment for about only 100 days ,21. CesiThe International Commission on Radiological Protection (ICRP) sets radiation safety standards and recognizes that radiocesium bioaccumulates harmfully in humans. The reported ICRP-figure  comparesAbsorption of radioiodine (131-I) can lead to acute and chronic effects. Acute effects from high doses include thyroiditis, while chronic and delayed effects include hypothyroidism, thyroid nodules, and thyroid cancer (TC). It has been shown that 131-I released from Chernobyl caused an increase in the incidence of TC in the former Soviet Union and also in Fukushima, but TC mortality rates are generally low, even at higher tumor stages ,24. 131-Stable (non-radioactive) cesium (133-Cs) is an alkali metal, water-soluble, which exists naturally at very low concentrations in the soil as the Cs+ ion . Cs has Radioactive Cs (137-Cs and 134-Cs), a byproduct of nuclear fission of uranium, are produced from anthropogenic sources and rapidly incorporated into the food chain. Cs is absorbed by plants competitively with potassium and in its radioactive form it is the most dangerous radioisotope to the environment because of its long-term effects. Cesium-137 (137-Cs) half-live is about 30 years, which makes it present in the environment for about 300–600 years. 137-Cs decay by gamma and beta (electron) emissions produces highly ionizing radiation. Beta emission is very dangerous when radioactive Cs is ingested because it deposits all energy in a very short distance of 3–4 mm  . Flowering plants can transfer radiocesium from soils to honey bees, who can then concentrate the contaminant in honey . In the It has been found that 137-Cs can trace the transport of other radionuclides that have a high affinity for binding to soil particles (silts and clays). In recent years, considerable interest has been applied to the fate and transport of radionuclides, especially after Chernobyl (1986) and Fukushima Daiichi 2011) Nuclear Power Plant disasters. These accidents led to the release of large amounts of radionuclides into terrestrial and aquatic ecosystems . Ingesti11 NucleaIn 2020, Venturi reported in the Russian journal “Biosfera”  and part“Prussian Blue” (ferric ferrocyanide) is able to chelate Cs in the intestine and, preventing its reuptake, eliminates it with feces. Nielsen et al.  studied Upon renal insufficiency in man and rat, cesium level increases by 100% in the pancreatic tissue . Nelson The high concentration of 137-Cs in the germinal cells of the ovary and the testicle explains the genetic and reproductive damage, sterility, azoospermia, and furthermore, children’s heart diseases and malformations in the population, and also genetic mutations in animals and plants after the Chernobyl accident . In the Bioaccumulation is the process through which chemicals or radionuclides accumulate and are stored more easily in living organisms than in the environment. The accumulated concentration of chemicals or radionuclides increases then more rapidly than their removal by excretion and metabolism. It is greater in carnivores than in herbivores .The removal of the top few centimeters (5–10 cm) of soil and its burial in a shallow trench will reduce human and animal ingestion. Fertilizers containing potassium can be used to dilute radiocesium and limit its uptake by plants. In livestock farming, another countermeasure against 137-Cs is to feed to animals ‘Prussian Blue’, which prevents the chelated radiocesium from being recycled. It is useful also for the treatment of humans . The pancreas is metabolically a very active organ, which despite weighing only 80–100 g in humans it produces from 500 to 2000 mL of pancreatic juice daily. The pancreas has high blood perfusion from the pancreatic arteries and can accumulate inside its cells a considerable amount of radioactive 137-Cs able to damage cell DNA. According to the “Japan Intractable Diseases Information Center”, cases of severe acute pancreatitis increased rapidly by 34% in 2011, about 10 months after the Fukushima accident . Also, dHelicobacter pylori infection, and cigarettes smoking, the latter cause attributable to almost one-third of all PC. Carcinogens found in tobacco products may damage the pancreas, and smoking may add to the risks associated with other conditions, such as long-term inflammation of the pancreas (chronic pancreatitis). About 10 percent of PC is thought to relate to genetic factors and mutations. However, having a risk factor, or even many, does not mean that you will get cancer [The exact cause of PC is not known. General risk factors include the following: Age, with nearly 90 percent found among people aged 55 and older; gender, the cancer being somewhat more common in men than women; obesity; types I and II diabetes mellitus; chronic pancreatitis; liver cirrhosis, t cancer ,3. Some . In 2018, 458,918 new cases of PC were registered worldwide, representing 2.5% of all cancers. The age-standardized rate (ASR) incidence was highest in Europe  and North America , followed by Oceania . The lowest rate was observed in Africa with an estimated incidence of 2.2 per 100,000 people [The incidence of PC varies across regions and populations . In 20180 people . Differe0 people . The higIn Japan, PC is the fourth leading cause of cancer deaths. It is an aggressive disease where approximately 60–80% of patients already have distant metastasis at presentation with a poor survival rate. Especially after the nuclear accident of Fukushima, the PC has an unusually high frequency. The Japanese “Global Data” in 2019 predicted that this cancer will continue to increase in Japan in the next ten years, despite the decrease in the Japanese population. Epidemiologists predict an increase in cases from 42,000 cases in 2019 to 48,000 cases in 2029, with an annual growth rate (AGR) of 1.50%. The incidence of PC in Japan has increased continuously especially in the last decades. The rate of incidence in 2019 was almost double that of the US and about 50% higher than that of France, Germany, Italy, Spain, and the United Kingdom. This trend will likely continue in the next decades. According to Japanese researchers, the cause of this increase is unknown. While smoking, old age and obesity are strong risk factors, the Japanese population is not at greater risk of obesity and smoking-related diseases compared to other nations. Also, regarding the risk factor-age, Japan has an aging population, and it is susceptible to this type of cancer, similar to that of the aforementioned European nations. According to ‘Japanese Global Data Healthcare’, Pharmaceutical Technology (2020) , Japan h-~950 PBq from nuclear weapons testing -~85 PBq from Chernobyl ,-12–41 PBq from Fukushima .In the early 1970s, mortality from PC was low in Europe, stomach cancer being among the leading causes of cancer death . NowadayIndeed PC increase begins in the early 1980s and, in Europe, after the 1986 Chernobyl accident .In the counties of Sweden, Edling et al. (1982) reported that low-dose background radiation exposure significantly correlates with PC  . In UkraIn Italy, the incidence of PC is growing significantly , with a clear North-to-South gradient: compared to Northern Italy, in central Italy PC incidence levels are 29% lower in males and 26% lower in females, and Southern Italy, they are 25% and 28% lower, respectively. PC ranking among the causes of death from tumors is 4th in females, the total (M + F) PC mortality is 6%. These data correlate with the current exposure to 137-Cs in Italy ,49. In IIn 2016, social scientists and energy policy experts have reported that worldwide there have been 99 accidents at nuclear power plants from 1952 to 2009 (IAEA) ,5,51. DeMeusburger et al.  set out In 2020, in Ukraine, the number of PC cases increased by 8.7% (7.3% in men and 10.3% in women) in 2013, in comparison with 2003. PC incidence in children (age 0–17 years) was zero in 2003 and 4 in 2013. The age-standardized PC incidence rate was 5.9 in 2003  and 6.8 in 2013 . The age-standardized mortality rate was 5.0 in 2003  and 5.5 in 2013 . It should be noted, that in 2013, four children had PC, whereas normally in the rest of the world children are rarely affected .New metabolic pathways of Cs in the pancreas, salivary glands, and intestine are reported. The stochastic analysis of PC epidemiology may be the key to interpreting the etiology of PC, and some inflammatory pancreatic diseases and related types (3c) of diabetes, which are both on the rise in the world, and thus, the cornerstone of developing a possible effective prevention strategy. The reported data warrant investigations into an association between radioactive Cs and PC. If this correlation will be confirmed, preventive action may be possible by using table salt enriched in potassium and by a diet with fruits and vegetables, rich in potassium. In addition, the soil enriched with potassium is able to reduce 137-Cs uptake by plants . Food muFossil oil will likely run out within the next 50–80 years. Alternative energies: sun, wind, hydro, tides, etc. will probably not be able to provide us with the amount of energy needed for a world population, which perhaps will reach 10 billion. All this could cause hunger, poverty, wars, dictatorships, etc. What energy can we use and at what risk? I hope that this research will help to defend, in part, the world population from the looming risks of nuclear fission.


Clinical observations have long suggested that women are protected against paracoccidioidomycosis. 17β-estradiol, the main female estrogen, inhibits conidia-to-yeast transformation (C-to-Y), which is required for the infection establishment. However, experiments in murine models have yielded conflicting results, suggesting that C-to-Y inhibition, alone, fails to explain the female-associated protection and that sexual hormones may also act by modulating the host’s immune responses. Therefore, this issue remains unsolved. Strikingly, no studies have compared the severity of paracoccidioidomycosis between men and women. This retrospective case-control study compared 36 women with 72 age-matched men for clinical–demographic, laboratory, and chest imaging findings. Overall, paracoccidioidomycosis in women presented the main features described in the acute/subacute and chronic forms seen in men. Women also showed similar demographic features and clinical–laboratory and imaging severity scores as men. We additionally reviewed 58 paracoccidioidin skin test surveys undertaken by volunteers from endemic areas. Data accumulated from 10.873 tests showed that females and males are infected with similar magnitudes (21.9% vs. 25.2%) and that reactivity steadily increased with age, peaking after the age of 60. We discuss the paradox of similar infection rates but much lower disease prevalence in women, considering the current pathogenetic views of paracoccidioidomycosis, and we raise alternative hypotheses to account for this paradox. Paracoccidioides, estimated to dwell in the soil of the endemic areas in its filamentous form [Paracoccidioides immune status, particularly in relation to the cell-mediated immune responses [Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Brazil and also an important public health issue in other parts of Latin America. It is caused by the dimorphic fungi of the genera ous form . Patientesponses . The latesponses .Paracoccidioides spp. skin tests suggest that there are no gender differences in the rate of positive tests in endemic areas [Paracoccidioides spp. infection occurs equally in men and women . This is in sharp contrast with the gender difference in disease prevalence. Before puberty, PCM (disease) tends to affect both sexes more closely. This is well illustrated in the study by Romaneli et al., which showed that, in children up to 12 y/o, the male-to-female ratio was 1.5:1, while male predominance started in children between 12 and 15 y/o (7:1) [Paracoccidioides conidia and hyphae forms, thereby inhibiting their conversion to the parasitic yeast form, a key step in the pathogenesis of the mycosis. It was also shown that this binding induced a re-programming of gene expression of the fungus, in particular of signaling genes that regulate dimorphism, thus acting as a true receptor. Interestingly, however, experiments in which mice models of PCM were castrated and then hormonally reconstituted with their own or opposite sexual hormone, supported, on one hand, the in vitro findings of conidia to yeast (C-to-Y) transformation inhibition and subsequent resistance of females to develop severe disease. On the other hand, it showed that possibly 17β-estradiol, alone, is not sufficient to prevent infection establishment [Surveys with ic areas , leading/o 7:1) . In stud/o (7:1) ,7,8. The:1 . In s/o (7:1) ), that 1lishment . The autlishment .Therefore, this issue still remains unsolved. Strikingly, however, there are no studies comparing the severity of the disease between adult men and women with PCM.n = 70, 22 with A/SAF and 48 with CF). This was done in a blind fashion using the hospital’s registry code (six numbers and one letter) by one of the authors (T.G.N.d.B.) who does not have clinical activity at the hospital. In all cases, the diagnosis of PCM was done based on clinical and epidemiological grounds plus identification of typical forms in appropriately stained patients’ specimens or positive serological tests (a positive immunodiffusion test and a titer >1:8 in the counterimmunoelectrophoresis test) [The study was approved by the Hospital’s Ethics Committee (No. 3.079.825/2018). This was a retrospective case-control study of two cohorts of PCM patients admitted at the Instituto Central do HCFMUSP between 2001 and 2018 . First, women with a diagnosis of PCM within this period were identified in the hospital files/archives. Thirty-five cases were retrieved. Eleven were classified as having the A/SAF and twenty-four as having the CF. For each woman, we then searched for two corresponding men with the same clinical form of PCM diagnosed at the same time period and matched for age (±2 years) (is test) . Demographic and comorbidity data were collected from all cases. To compare the severity of the disease between women and men, we used clinical, laboratory, and imaging (pulmonary HRCT scans in CF patients) data. The selected clinical parameters were fever, weight loss, jaundice, splenomegaly, hepatomegaly, oral or nasal mucosal lesions, laryngeal involvement, lymph node enlargements , skin lesions, lung involvement, osteoarticular involvement, and central nervous system (CNS) involvement. A clinical score was calculated, with 0 for absence and 1 for the presence of abnormalities, from fever to laryngeal involvement; the presence of the last four types of involvement (from skin lesions to CNS involvement) was arbitrarily scored 2 due to the fact that they represent more severe or extensive involvement or hematogenic spread. For the lymph node enlargements, each localization was scored 1. The maximum possible clinical score was 21. The adrenal reserve was not included since it was not systematically investigated. The following laboratory parameters were selected, all of which were usually considered as correlates of disease severity : counterA thoracic high-resolution computed tomography (HRCT) done prior to or at the start of the treatment was available in 34 patients, 21 men and 13 women. Many exams were done only a few months after the initiation of the treatment, especially in nonhospitalized patients. The images were analyzed by two investigators blind to the patients’ clinical history, considering the types of radiological findings. Statistical analyses were carried out using Prisma software . The Mann–Whitney and ANOVA with Dunn’s post-test and Fisher exact test were used. The study was approved by the Hospital’s Institutional Board (No. 3.079.825/2018).Overall, PCM in women presented the main features described in large cohorts comprised mostly of men, with a clear distinction between the A/SAF and the CF. In both forms, there was a history of present or past link with rural areas, an association with tuberculosis in up to 10% of the cases, and a presence of other serious comorbidities that may have eventually caused a predisposition to mycosis, particularly cancer . StrikinIn order to determine whether sexual hormones play a role in the severity of the clinical manifestations and laboratory parameters, we compared age-matched men and women with PCM who were admitted at our institution between 2001 and 2017. Patients with the A/SAF and the CF were compared separately.Paracoccidioides antibody titers.No differences between A/SAF male and female patients were found regarding demographic data . Of the p < 0.0055). There were, in fact, some differences in the clinical expression, such as a higher frequency of fever and cutaneous lesions in men. Despite these differences, the average clinical score was similar in the two groups. Regarding laboratory work, males displayed anemia, hypoalbuminemia, and elevated CRP more frequently than women. Other parameters were also frequently abnormal but in a similar fashion in the two groups. Anti-Paracoccidioides antibody titers were equally elevated in both groups. Thus, in both the A/SAF and CF patients examined here, we could not detect a sizable gender-related difference in the severity of the mycosis.Although the overall demographic background was similar between both sexes, as for the A/SAF, an important difference was noted. While a diagnosis of prior tuberculosis, cancer, or other comorbidities was occasionally found in both groups/sides, and the presence of a smoking habit and rural exposure were the rule, the proportion of men in reference to alcohol abuse was much higher than in women (p < 0.05) ground-glass opacities while men displayed more frequently (p < 0.05) emphysema, the latter likely due to the fact that men were exposed to a higher tobacco load than women [As the lungs are the main target in the CF of PCM, present in at least 80% of the cases (as was the case with our patients), a detailed scoring of the parenchymal and pleural lesions in the HRCT scan was used to infer the severity of this involvement. CT scans were available for 13 women and 21 men. At least one abnormal pulmonary finding was observed in all 34 patients for which scans were available. Nodules, ground-glass opacities, and micronodules, typically the result of the injury by the infectious process, were the most common findings, present in ~two-thirds of the patients, while the other most common finding was emphysema, probably linked mainly to cigarette smoking. Interestingly, women presented more frequently , serology titers  or lung HRCT score .Hormonal influence on PCM severity was further assessed by comparing the female patients at and not at childbearing age. This was done only with the CF group since almost all A/SAF patients were of childbearing age. Ten CF women were 33–45 y/o (40 ± 4.3) and 15 were 49–68 y/o (56.4 ± 5.7). Interestingly, no significant differences between the two subgroups of CF patients were found regarding the clinical score  in 695 persons from a highly endemic county, the percentage of skin test reactors at early ages (2–10 y/o) was 11.1% but reached 62.1% among individuals older than 60 y/o [Another currently stated notion is that infection in endemic areas occurs predominantly or frequently early in life  . Howevern 60 y/o . This clParacoccidioides conidia and mycelia and inhibits their transformation into the parasitic form required for the establishment of the infection [Clinical observations have long suggested that female sex hormones could play a protective role in the development of PCM. Reports on large cohorts of PCM patients, comprised mainly of CF cases ≥90%), the most common clinical presentation of the disease, showed a high male-to-female ratio, ranging from 5:1 to up to 22:1 ,7,8. Hownfection ,9,48. 0%, the mFirst, we show here that the distinct features of the A/SAF and CF, established from large cohort studies comprising mostly males, were equally observed in the 36 adult women evaluated here, 11 with the A/SAF and 25 with the CF. The clinical and demographic features commonly ascribed to the A/SAF and CF of PCM were also present in women, except for alcohol abuse, more common in men, likely due to sociocultural factors/determinants. Notably, the quasimandatory association between the CF and smoking was also present in women. As expected, clinical scoring also showed the A/SAF to be more severe than the CF in women. Second, contrary to our initial expectation of less severe disease in women, the severity of the disease was largely comparable between males and females matched for age and clinical form, using either clinical, laboratory, or imaging parameters. To our knowledge, a single previous communication addressed PCM in women, reporting on 23 CF patients . These wParacoccidioides yeast cells, affecting neither their metabolism, growth, nor replication [On the contrary, some important issues are not considered when using the C-to-Y conversion mechanism to explain women’s protection against PCM. First, the CF arises from subclinical foci containing small proportions of replicating yeast cells amidst predominantly quiescent cells, a process that can take several years or even decades . Thus, elication . Once wolication .p = 0.6) was also not older than that of our CF women.While our cohort, on one hand, confirms the rarity of PCM in women, it also shows that the CF occurs in women either before or at/after the perimenopause: they were all older than 32 y/o, and 40% were at childbearing age. Interestingly, a comparison of the clinical, laboratory, and lung HRCT scores between the CF of PCM women at childbearing age and perimenopause showed no differences, challenging the role played by estrogens in curtailing the severity of the disease in women. Moreover, if this were true, women with the CF of PCM would be older than men. However, the mean age of our group of CF women (49.8 ± 9.8 y/o) was not older but rather similar to that reported for large cohorts of CF male patients, which had an average of 47–49 y/o at diagnosis ,6,7,8. IThe influence of gender on the A/SAF was also analyzed. The number of patients was small, but the results pointed in the same direction as in the CF: no major differences in comorbidities and epidemiological features, the severity of clinical manifestations, or pattern of laboratory markers of severity could be found between age-matched A/SAF male and female patients. Strikingly, our A/SAF women were at least 18 y/o and 82% were at childbearing age. Based on the facts that (i) the incubation period of the A/SAF is much shorter than that of the CF, weeks to months  and (ii) the menarche in Brazil is around 12 y/o , all patWhat would then be the role of estrogens in the natural history of PCM? Experimental studies have only partially helped to clarify this issue. Mice and other animal models in which yeast cells were inoculated showed mixed results, either no difference between males and females or females were more resistant , as wellParacoccidioides immune response and clearing the way to disease onset. This was not verified in our study since there were no marked differences in the type and number of associated comorbidities between males and females. Important limitations of our study, however, are the lack of appropriate gynecological investigation of the patients and the relatively small number of women with PCM assessed, especially the A/SAF, the latter maybe underpowering the statistical analyses.An alternative possibility is that the hormonal protection would be overcome by a higher frequency of comorbidities impacting the immune system, leading to an imbalance of the anti-Paracoccidioides lectin, the fungal burden was reduced in females, which also displayed better Th-1 responses and macrophage killing activity [On the other hand, sexual hormones can also regulate immune responses, biasing the immune reactivity of males and females ,54. Baseactivity .Based on the rationale that women have better cell-mediated immunity ,54, one Paracoccidioides spp. in environmental air and soil samples collected from endemic sites as well as with serological surveys of different mammalian species  of rural areas in Brazil showing high rates of anti-Paracoccidioides antibody responses and low rates in animals from urban areas [Paracoccidioides spp. does not seem to be a rare event. It is estimated that only a small fraction of the exposed men is successfully infected, i.e., the inhaled conidia convert into yeast cells in the lower respiratory tract, followed by an invasion of the epithelial lining, with the formation of subclinical foci containing live yeast cells, a proportion of them retaining replicative activity, as previously outlined [Paracoccidioides specific immune responses, the A/SAF develops [Our hypothesis to explain the high M:F ratio in the CF of PCM considers several factors. Part of the women’s protection certainly relies on the inhibition of the C-to-Y transformation in the lungs. As the skin test surveys suggest, persons living in endemic areas are frequently being infected/reinfected, probably with small inocula. This is consistent with the findings of studies showing frequent molecular detection of an areas ,67,68,69outlined . In the develops . OtherwiParacoccidioides spp. Finally, an additional aspect contributing to the male bias is that the host–parasite balance would be more susceptible to immune modulation in men than women, based on the findings that estrogens favor better cell-mediated immune responses, such as enhanced Th-1 cytokines secretion by T-cells and macrophage phagocytosis and nitric oxide release [How, then, would the course of events aforementioned apply to women at childbearing age (and at perimenopause)? According to experiments in female mice, inhaled conidia can survive in the airspaces for up to 96 h without yeast transformation , priming release ,54.The mechanisms that underlie the development of the A/SAF in childbearing aged women who have likely been infected a short time before the emergence of clinical manifestations, thus under the influence of estrogens, remain to be determined. The mechanisms may be related to those that underlie the paradoxical high fungal burdens that appeared in castrated male mice reconstituted with 17β-estradiol . Further


This study aimed to evaluate the knowledge, attitude, and practices of healthcare workers at the Federal Medical Centre, Owo towards LF.this was a cross-sectional study among 451 healthcare workers who were enrolled using a simple random sampling technique. Data were collected using a semi-structured interviewer-administered questionnaire and analyzed with SPSS version 23. Adequate knowledge, positive attitude, and good practice of LF infection, prevention, and control were determined by the proportion of respondents who scored >80% in each category. Descriptive statistics were done. Associations were explored using Chi-square tests.the mean age of respondents was 37.95±8.43 years, and 169 (37.5%) were doctors. The mean overall knowledge score was 18.33±2.14, and 236 (52.3%) had appropriate knowledge, 109 (24.2%) had a positive attitude, while 351 (77.8%) demonstrated adequate preventive practices towards LFIPC. Laboratory scientists had five times the odds of appropriate knowledge of LF IPC . Pharmacists had ten times odds of positive attitude towards LF IPC . Pharmacists had nine times odds of good LF IPC practices .disparities in knowledge, attitude, and practices of LF IPC exist among healthcare workers. To strengthen IPC, intervention strategies like training to address such gaps are needed. Mastomys natalensis rodents (commonly known as Multimammate rats), which is a natural reservoir for the virus and are ubiquitous in the country [Lassa Fever (LF) is a zoonotic disease caused by the Lassa virus. Lassa fever is named after Lassa town in Nigeria where it was first isolated. Humans contract the virus mainly through contact with infected excreta of  country . Infecte country . Seconda country . It happ country . Lassa f country . Lassa f country . This co country . Three s country .Nosocomial infection is a hospital-acquired infection that occurs among healthcare workers (HCWs), to patients or patient relatives through contact with contaminated beddings or secretions ,8,9. TheInfection prevention and control (IPC) has been described as a concept which aims at containing disease transmission either in health facilities or in communities . In the Study design: a descriptive cross-sectional design was employed.Study area: Federal Medical Centre, Owo. It is a tertiary health institution that provides primary, secondary, and tertiary levels of healthcare. It provides healthcare services to the residents of Ondo state, and neighboring states including Kogi, Edo, Ekiti, and Osun States. The Infection Control Ward (ICW) was created in January 2017 solely for the management of LF infection. It was renamed the LF Infection Control and Research Centre (ICRC) after the unprecedented outbreak of LF disease in the first few months of 2018. The ICW which was an 8-bedded ward was upgraded to a 34-bedded facility on 28th February 2018. The ICRC has a collaboration with Nigeria Centre for Disease Control (NCDC), and international organizations for research and management such as the Alliance for International Medical Action (ALIMA) and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID). The activities of the ICRC are controlled through an Emergency Operations Centre (EOC) that was set up to serve as the command center for all activities during an outbreak. Aside from clinical management of cases, a follow-up clinic exists for discharged patients in the facility.Study population: consenting staff members in clinical departments were studied.Sampling methods: this research used simple random sampling. A list of the clinical staff of the hospital was collected from the Administrative Department. From the available staff list, the units/departments were arranged serially. A table of random numbers was used to select at least one out of every three staff in each unit/department.Data collection: a semi-structured, interviewer-administered questionnaire was used which consisted of four sections; section A: sociodemographic characteristics; section B: knowledge of HCWs towards infection prevention and control; section C: attitude of HCWs towards infection prevention and control; section C: practices of HCWs towards infection prevention and control.Data management: questionnaires were checked for omissions and errors after collection and correction were made where necessary. Data were analyzed with the SPSS version 23. The data were summarized using mean and standard deviation for continuous variables, frequencies, and percentages for categorical variables. Knowledge, attitude, and practice scores were computed with “+1” assigned for correct response and “0” assigned for incorrect response. The maximum score possible for the knowledge section was 23, while attitude was 6 and practice was 20. Appropriate knowledge, positive attitude, and good practice were assigned scores >80% while inappropriate knowledge, negative attitude, and poor practice were assigned to scores ≤80%. These scores were graded using Bloom´s cut-off point. We conducted bivariate analysis on the sociodemographic characteristics of respondents and their levels of knowledge, attitude, and practices regarding LF IPC using Chi-square tests. The predictors of appropriate knowledge, positive attitude, and good IPC practices regarding LF were performed using Logistic regression analyses. Logistic regression analyses were performed on variables that were significant at <10% in the bivariate results. P-values < 0.05 were accepted as statistically significant.Ethical consideration: informed consent  was obtained from the respondents, who were made to understand that participation was voluntary. Information obtained was kept confidential and there was no consequence for non-participation. Approval for the study was obtained from Health Research Ethics Committee, Federal University of Technology, Akure, Ondo State and Federal medical Centre, Owo (FMC/OW/380/VOL.LXXXIX/165).2= 13.802, p= 0.003), ,  respectively. Also, a significant association existed between sex, and department and attitude of respondents towards LFIPC ,  respectively), but profession was not significantly associated with the attitude . We found significant associations between age , sex , profession  and department  of health workers towards LF IPC  of the health workers had appropriate knowledge of IPC measures for LF. This finding is the same as the findings from studies carried out among health workers in tertiary institutions ,17. A siA significant knowledge level was displayed by doctors and other frontline health workers in this study and this has been similarly reported in literature . The disThe level of positive attitudes towards LF infection, prevention and control was low compared to the high level of positive attitudes found in studies carried among healthcare workers in some tertiary institutions in Nigeria ,21. AnotRegarding practices on LF IPC, we found that a higher proportion of HCWs had good preventive practices for LF infection. This finding was corroborated by a study conducted among adult residents of a rural community in Edo State, Nigeria where a low level of positive practice on the prevention and control of LF infection was observed . A studyThe availability of soap for hand washing, water, wash hand basin, and 0.05% chlorine solution, and gloves were the most frequently mentioned facilities and supplies by respondents. The mention of the use of gloves in personal protection was similarly cited among health workers in Edo State Nigeria, and nursing and midwifery students in Turkey ,24. FaceHealthcare workers are expected to display high levels of knowledge, and positive attitudes and practices regarding the prevention and control of LF in healthcare settings. To enhance the IPC measures among healthcare workers, we hereby recommend the prompt provision of IPC facilities and equipment in adequate amounts to health facilities. Training and retraining of HCWs should be intensified regularly to improve the adoption of a positive attitude regarding LF among them. Also, an assessment of the knowledge level of HCWs on their knowledge of LF risks, and its prevention and control measures should be done regularly. This would help to identify existing gaps in their knowledge base of LF and to be able to channel intervention strategies to address such gaps.The control of LF infection is important and could be achieved through appropriate IPC knowledge, attitude and practice;Poor knowledge of IPC for LF among HCWs is unfortunate because HCWs are active agents of promoting compliance to disease preventive measures.A knowledge-attitude-practice gap exists among health workers towards prevention and control of LF;An assessment of the knowledge, attitude, and practices of health workers is needed to identify existing gaps in their knowledge base of LF and to be able to channel intervention strategies to address such gaps;To enhance adherence to LF infection prevention, and control practices, training, and retraining of health workers should be intensified regularly to improve the adoption of a positive attitude regarding LF among them.