international journal of research and public health

International Journal of Environmental Research and Public Health

Subject Area and Category

• Health, Toxicology and Mutagenesis
• Public Health, Environmental and Occupational Health

Multidisciplinary Digital Publishing Institute (MDPI)

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16604601, 16617827

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The set of journals have been ranked according to their SJR and divided into four equal groups, four quartiles. Q1 (green) comprises the quarter of the journals with the highest values, Q2 (yellow) the second highest values, Q3 (orange) the third highest values and Q4 (red) the lowest values.

The SJR is a size-independent prestige indicator that ranks journals by their 'average prestige per article'. It is based on the idea that 'all citations are not created equal'. SJR is a measure of scientific influence of journals that accounts for both the number of citations received by a journal and the importance or prestige of the journals where such citations come from It measures the scientific influence of the average article in a journal, it expresses how central to the global scientific discussion an average article of the journal is.

Evolution of the number of published documents. All types of documents are considered, including citable and non citable documents.

This indicator counts the number of citations received by documents from a journal and divides them by the total number of documents published in that journal. The chart shows the evolution of the average number of times documents published in a journal in the past two, three and four years have been cited in the current year. The two years line is equivalent to journal impact factor ™ (Thomson Reuters) metric.

Evolution of the total number of citations and journal's self-citations received by a journal's published documents during the three previous years. Journal Self-citation is defined as the number of citation from a journal citing article to articles published by the same journal.

Evolution of the number of total citation per document and external citation per document (i.e. journal self-citations removed) received by a journal's published documents during the three previous years. External citations are calculated by subtracting the number of self-citations from the total number of citations received by the journal’s documents.

International Collaboration accounts for the articles that have been produced by researchers from several countries. The chart shows the ratio of a journal's documents signed by researchers from more than one country; that is including more than one country address.

Not every article in a journal is considered primary research and therefore "citable", this chart shows the ratio of a journal's articles including substantial research (research articles, conference papers and reviews) in three year windows vs. those documents other than research articles, reviews and conference papers.

Ratio of a journal's items, grouped in three years windows, that have been cited at least once vs. those not cited during the following year.

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International Journal of Public Health

An independent journal of the Swiss School of Public Health (SSPH+)

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The IJPH , PHR journals and its publisher are members of the Committee on Publication Ethics.

Call for papers

Submission open

THE IMPACT OF ULTRA-PROCESSED FOOD CONSUMPTION ON HEALTH IN LOW- AND MIDDLE-INCOME COUNTRIES

• Licia Iacoviello
• Sukshma Sharma
• Marialaura Bonaccio

TRENDS IN ADOLESCENT HEALTH AND WELLBEING - 40 YEARS OF THE HBSC STUDY

• Andrea Madarasova Geckova
• Sophie D. Walsh
• Caroline Residori
• Christina Schnohr

PSYCHOLOGICAL SAFETY IN HEALTHCARE SETTINGS

• Bojana Knezevic
• Paulo Sousa
• Reinhard Strametz
• 2,052 views

MITIGATING AND ADAPTING TO CLIMATE CHANGE: EVIDENCE FOR PUBLIC HEALTH

• Katarzyna Czabanowska
• Nino Kuenzli
• Inês Paciência
• George Richard Lueddeke
• Ana Ribeiro
• 2,978 views

Special issues

Submission closed

DIGITAL DEMOCRACY AND EMERGENCY PREPAREDNESS: ENGAGING THE PUBLIC IN PUBLIC HEALTH

• Sonja Merten
• Giovanni Spitale
• Nikola Biller-Andorno
• 2,201 views

AGEING AND HEALTH IN SUB-SAHARA AFRICA

• Stephen Ojiambo Wandera
• Tobias Vogt
• Alyson Van Raalte
• Elke Loichinger
• 4,244 views

HUNGER, FOOD SOVEREIGNTY & PUBLIC HEALTH

• Lyda Osorio
• Janeth Mosquera Becerra
• 3,007 views

CALL FOR YOUNG RESEARCHER EDITORIALS (YRE): PUBLIC HEALTH IN LATIN AMERICA - CHALLENGES AND PERSPECTIVES

• Peter Francis Raguindin
• Diana Buitrago-Garcia (YRE)
• Germán Guerra (YRE)
• Ana Cecilia Quiroga Gutierrez
• Jonila Gabrani (YRE)
• 4,673 views

Volume 69 - 2024

Volume 68 - 2023, volume 67 - 2022, volume 66 - 2021.

Original Article

Published on 06 May 2024

Sexual and Gender Minority Status and Suicide Mortality: An Explainable Artificial Intelligence Analysis

• T. Elizabeth Workman
• John R. Blosnich
• Cynthia A. Brandt
• Melissa Skanderson
• Joseph L. Goulet
• Qing Zeng-Treitler

Published on 01 May 2024

Gaza Ceasefire: Improve WASH, Promote Cooperation

• Oliver Razum
• Nadav Davidovitch
• Timothy McCall
• Stav Shapira

Published on 30 Apr 2024

Nurse Staffing, Work Hours, Mandatory Overtime, and Turnover in Acute Care Hospitals Affect Nurse Job Satisfaction, Intent to Leave, and Burnout: A Cross-Sectional Study

• Sung-Heui Bae

Published on 29 Apr 2024

The Pre-Exposure Prophylaxis Stigma Scale: Measurement Properties of an Adaptation in German and French

• Alexander Ort

nino kuenzli

Swiss Tropical and Public Health Institute (Swiss TPH)

Basel , Switzerland

Editor-in-Chief

andrea madarasova geckova

University of Pavol Jozef Šafárik

Košice , Slovakia

olaf von dem knesebeck

University Medical Center Hamburg-Eppendorf

Hamburg , Germany

heresh amini

Icahn School of Medicine at Mount Sinai

New York , United States

Associate Editor

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Swiss School of Public Health

Inter­na­tional journal of public health.

The International Journal of Public Health (IJPH) publishes scientific articles relevant to global public health, from different countries and cultures to raise awareness and understanding of public health problems and solutions. The Journal welcomes submissions of original research, critical and relevant reviews, methodological papers, and manuscripts that emphasize theoretical content. IJPH publishes commentaries and editorials. Special issues highlight key areas of current research. The Editorial Board's mission is to provide a thoughtful forum for contemporary issues and challenges in global public health research and practice.

Co-Editors-in-Chief: Nino Künzli (Switzerland), Andrea Madarasova Geckova (Slovakia and The Netherlands) and Olaf von dem Knesebeck (Germany)

Managing Editor: Christopher Woodrow ( christopher.woodrow@swisstph.ch )

SSPH+ is the owner of the International Journal of Public Health since 2010. IJPH is published open access by Frontiers, Lausanne.

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Article processing charges (APC)

APC for IJPH comprise of the production costs of the publisher (not discounted) and the editorial costs of the owner, the Swiss School of Public Health (SSPH+). SSPH+ discounts the editorial costs for first authors from low and middle income countries according to the research4life country classification (group A and B countries).

2022 -2024: IJPH offers waivers for first authors from low and middle income countries ( GLOBEQUITY , funded by the open science program of swissuniversities).

The above fees and discounts are valid for articles submitted on or after February 1, 2021. APCs may be subject to periodic revision. The invoiced APC is the one valid at the time of manuscript submission.

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2021 marks the 100th birthday of the International Journal of Public Health! Read the anniversary editorials:

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Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Affiliations.

• 1 Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei 235000, China.
• 2 Department of Psychological Medicine, National University Health System, Kent Ridge 119228, Singapore.
• 3 Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge 119228, Singapore.
• 4 Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Kent Ridge 119077, Singapore.
• PMID: 32155789
• PMCID: PMC7084952
• DOI: 10.3390/ijerph17051729

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20-24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression ( p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression ( p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

Keywords: anxiety; coronavirus; depression; epidemic; knowledge; precaution; psychological impact; respiratory symptoms; stress.

• Anxiety Disorders / epidemiology
• Anxiety* / epidemiology
• Betacoronavirus
• China / epidemiology
• Coronavirus
• Coronavirus Infections / complications
• Coronavirus Infections / epidemiology
• Coronavirus Infections / psychology*
• Cross-Sectional Studies
• Depression* / epidemiology
• Disease Outbreaks*
• Health Status
• Mental Health*
• Middle Aged
• Pneumonia, Viral / complications
• Pneumonia, Viral / epidemiology
• Pneumonia, Viral / psychology*
• Resilience, Psychological*
• Surveys and Questionnaires
• Young Adult

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International Journal of Public Health Research

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Public health research, predictive models for forecasting coronavirus disease 2019 cases: relevance to public health services, the impact of 2013 haze on emergency department utilizations for acute respiratory diseases: a retrospective study, demographic characteristics associated with missed follow-up appointments among tuberculosis patients at hospital shah alam, selangor: a retrospective study from january to june 2023, the effect of healthy house indicators on the incidence of acute respiratory infection in tangerang regency, banten province, pembinaan dan validasi soal selidik faktor sosiobudaya berkaitan covid-19 dalam kalangan orang asli di malaysia, students views and perceptions on outdoor air pollution in iskandar puteri, malaysia, filipino students' adversity quotient and school connectedness, a cross-sectional study on diploma students' knowledge, attitudes, and preventive behavior about covid-19 in northeastern thailand, review article, the roles of socio-environmental factors influencing the transmission, prevention, and control of covid-19 and tuberculosis disease: a review, environmental risk factors of parkinson’s disease: a scoping review, brief communication, population growth demand and challenges of health equality among immigrants towards healthcare services in malaysia, make a submission, information.

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Driving the Best Science to Meet Global Health Challenges

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Communication Technology, Media Use and the Health of Our Kids

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The rising burden of noncommunicable diseases in four Mediterranean countries and potential solutions

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The International Journal of Public Health Science (IJPHS) , with p-ISSN 2252-8806 and e-ISSN 2620-4126, is an interdisciplinary journal that publishes papers on all aspects of public health science. This journal is published by Intelektual Pustaka Media Utama (IPMU) in collaboration with the Institute of Advanced Engineering and Science (IAES) . The IJPHS provides an ideal forum for authors and readers from all over the world to discuss more sophisticated public health research and practice. The focus is on originality and excellence. The journal welcomes high-impact articles on emerging public health science, including epidemiology, biostatistics, nutrition, family health, infectious diseases, health services research, gerontology, child and adolescent health, behavioral medicine, rural health, chronic diseases, health promotion, evaluation, and intervention, public health policy and management, health economics, occupational health, and environmental health. This journal has SINTA 1 accreditation from the Republic of Indonesia's Ministry of Education, Culture, Research, and Technology, and it is indexed by Scopus , with CiteScore: 0.9 and SNIP: 0.284. Scopus indexes all published papers since the 2019 issue. This journal was also listed in the Scimago Journal Rank in Q4, with a SJR of 0.18.

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• 2024 : Vol. 13 No. 1 , Vol. 13 No. 2 , Vol. 13 No. 3, Vol. 13 No. 4
• 2023: Vol. 12 No. 1 , Vol. 12 No. 2 , Vol. 12 No. 3 , Vol. 12 No. 4
• 2022: Vol. 11 No. 1, Vol. 11. No 2, Vol. 11 No. 3 , Vol. 11 No. 4
• 2021:  Vol. 10 No. 1, Vol. 10 No. 2 , Vol. 10 No. 3 , Vol. 10 No. 4
• 2020:  Vol. 9 No. 1 , Vol. 9 No. 2 , Vol. 9 No. 3 , Vol. 9 No. 4
• 2019: Vol. 8 No. 1 , Vol. 8 No. 2 , Vol. 8 No. 3 , Vol. 8 No. 4
• 2018: Vol. 7 No. 1, Vol. 7 No. 2 , Vol. 7 No. 3 , Vol. 7 No. 4
• 2017: Vol. 6 No. 1 , Vol. 6 No. 2 , Vol. 6 No. 3 ,  Vol. 6 No. 4
• 2016: Vol. 5 No. 1, Vol. 5 No. 2 , Vol. 5 No. 3 ,  Vol. 5 No. 4
• 2015: Vol. 4 No. 1 , Vol. 4 No. 2 , Vol. 4 No. 3 , Vol. 4 No. 4
• 2014: Vol. 3 No. 1 , Vol. 3 No. 2 , Vol. 3 No. 3 ,  Vol. 3 No. 4
• 2013: Vol. 2 No. 1, Vol. 2 No. 2 , Vol. 2 No. 3 , Vol. 2 No. 4
• 2012: Vol. 1 No. 1, Vol. 1 No. 2

Vol 13, No 2: June 2024

Table of contents.

International Journal of Public Health Science (IJPHS) p-ISSN: 2252-8806, e-ISSN: 2620-4126

This journal is published by the  Intelektual Pustaka Media Utama (IPMU)  in collaboration with  Institute of Advanced Engineering and Science (IAES) .

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Year : 2024 – Volume: 14 Issue: 2

Current Issue Articles

Original research article, histopathological types and clinical profile of primary lung cancer diagnosed in a tertiary care centre in kerala –a cross sectional study.

http://dx.doi.org/ 10.5530/ijmedph.2024.2.1

Ok Mani, Safa VP

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Background: The second most common cancer and the main cause of death from cancer worldwide is lung cancer. The stage of the cancer, mutation, and histological type all affect the prognosis and course of treatment. There is no adequate data about histological subtypes lung cancer in our area. The aim of this study is to evaluate the smoking status, histological subtypes, clinicoepidemiological profile, and interdependencies among those suffering from lung cancer. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India. From May 2, 2021, until May 7, 2022. Histopathologicaly confirmed lung cancer patients were studied. The data was collected by using a semi-structured proforma, and SPSS 20 was used for analysis. Results: The mean age of the patients (n=124) was 63.42 + 9.11 (SD) years. The common symptoms were cough (71.8%), breathlessness (62.9%), chest pain (35.5%), and loss of weight (31.5%). Among the patients 86.3% are males and 80.6% are smokers. Adenocarcinoma was the commonest histopathological subtype (45.9%) followed by squamous cell carcinoma (37.9%), small cell carcinoma (10.5%) and other neuroendocrine tumors (5.6%). Squamous cell carcinoma was the commonest subtype among males (42.1%) and smokers (44.6%). Adenocarcinoma remained commonest among females (82.3%) and non-smokers (87%). Cough was significantly higher in squamous cell and small cell carcinomas (p=0.04). Dyspnea remained the most prevalent symptom in adenocarcinoma (64.9%). Conclusion: Adenocarcinoma was the commonest subtype. Squamous cell carcinoma had higher prevalence among males and smokers; adenocarcinoma was higher among females and non-smokers. The commonest symptom was cough. Cough was significantly higher in squamous cell and small cell carcinomas. Dyspnoea was the most prevalent symptom in adenocarcinoma. Keywords: Lung cancer, Smoking, Adenocarcinoma, Squamous cell carcinoma, small cell carcinoma.

Page No: 1-8 | Full Text

HISTOPATHOLOGIC SPECTRUM OF INFECTIOUS SKIN LESIONS IN A TERTIARY CARE HOSPITAL IN THE GARHWAL REGION

http://dx.doi.org/ 10.5530/ijmedph.2024.2.2

Anamika Singh, Pawan Bhat, Sachan Bhat

Background: Skin is the largest organ of the body and is constantly harmed by a variety of environmental factors resulting in various kinds of neoplastic and non-neoplastic skin lesions. Among the non-neoplastic skin lesions, infective skin lesions are very commonly encountered in India, possibly due to the hot and humid environment, and lack of general awareness regarding infectious diseases. Very few studies, if any, have been conducted in the Garhwal region regarding infective skin lesions. Hence, present study was carried out to determine the spectrum of infective skin lesions. Aim and Objective: Present study was carried out to understand the spectrum of various skin lesions in correlation with age, sex and type of clinical lesion at a tertiary care hospital in Garhwal region. Materials and Methods: Study Design: Non-interventional, cross-sectional, retrospective study was carried out from January 2022 to December 2023, on all skin biopsies diagnosed as infective skin lesions in the department of pathology, Veer Chandra Singh Garhwali institute of medical sciences and research irrespective of age and sex. Results: Out of the 63 cases studies, leprosy was the most common infective skin lesion followed by tubercular dermatoses. Male predominance was present, with the most commonly encountered age group being 41-50 years. Presence of a hypopigmented patch was the most common clinical finding. Conclusion: Leprosy was the most common infective skin lesion encountered in our study followed by tubercular dermatoses. Due to the wide range of clinical presentation in infective skin diseases, histopathological examination is necessary to make an accurate diagnosis. Keywords: Infective skin lesions, leprosy, tubercular dermatoses.

Page No: 9-13 | Full Text

COMPARATIVE ANALYSIS OF LAPAROSCOPY AND LAPAROTOMY FOR MANAGEMENT OF ABDOMINAL TRAUMA: A RETROSPECTIVE STUDY

http://dx.doi.org/ 10.5530/ijmedph.2024.2.3

Avadhesh Ramanuj, Sanjay Karangiya, Bhavikkumar Ishvarbhai Pateliya, Mitesh Varsangbhai Chavda

Introduction: The utilization of laparoscopy in managing abdominal trauma, either diagnostically or therapeutically, has been on the rise. However, its comparative outcomes with conventional laparotomy, especially concerning therapeutic management, remain unclear. Methods: This retrospective cohort study involved patients from trauma center of an Indian medical college. 78 patients who underwent laparoscopic interventions for abdominal trauma were included in the laparoscopy group (LP group). Another 78 patients who underwent laparotomy (LT group) were matched based on baseline characteristics, causes of injury, and hemodynamic parameters. Perioperative clinical parameters and short-term survival were compared between these two groups. Results: Baseline characteristics were similar between the LP and LT groups. The most common cause of trauma was traffic accidents, and the predominant surgical intervention was bowel repair/resection. Operation time did not significantly differ between the two groups, while the post-operative complication rate was slightly lower in the LP group without statistical significance. Opioid use was lower in the LP group compared to the LT group. Additionally, hospital stay was significantly shorter in the LP group. One patient in the LT group died due to an intra-abdominal abscess and multiple organ dysfunction syndrome 20 days postoperatively, whereas all patients in the LP group recovered and were discharged. Conclusion: Laparoscopy is deemed feasible and safe for treating hemodynamically stable abdominal trauma patients when performed by experienced surgeons. Laparoscopy appears to offer advantages such as reduced pain and quicker recovery while maintaining similarly favorable clinical outcomes compared to conventional laparotomy. Keywords: Abdominal trauma, hemodynamically stable, laparoscopy, laparotomy

Page No: 14-17 | Full Text

THE SIGNIFICANCE OF LIPID PROFILE AND POSITIVE TROPONIN-I IN PREDICTING CARDIAC EVENT

http://dx.doi.org/ 10.5530/ijmedph.2024.2.4

Pal Singh Yadav, Ajay Kumar Meena, Rishi Ram Meena

Background: Cardiac troponins (cTn) are specific biomarkers of myocardial injury and have a well-established role in guiding the management of chest pain.5,6 An elevated troponin-I (cTnI) has also been associated with a poor prognosis in critical illness, pulmonary embolism, cardiac and non-cardiac surgery, stroke, and end-stage renal disease. Materials and Methods: This study was conducted in Department of Medicine in RBM Hospital & Shree Jagannath Pahadia Medical College, Bharatpur, Rajsthan. This cases control study was included 100 control and 250 cases. The duration of study was over a period of one year. Results: Among the 250 cases examined, 96 tested positive for Troponin-I, while the remaining cases tested negative. Among the Troponin-I positive cases, 64 were male and 32 were female, indicating a higher predominance of Troponin-I positivity among males. Significant differences (p < 0.01) were observed in these variables between the cases & control groups. Conclusion: The present study shows in the patients who developed chest pain due to cardiac event as confirmed by positive troponin-I test were having lipid parameters in the risk level as suggested by ATP III. Keywords: Troponin-I (cTnI), Myocardial injury, Biomarkers.

Page No: 18-21 | Full Text

CLINICO-SOCIAL FACTORS ASSOCIATED WITH TUBERCULOSIS AND DIABETES MELLITUS COMORBIDITY IN SOUTH INDIA – A CASE- CONTROL STUDY

http://dx.doi.org/ 10.5530/ijmedph.2024.2.5

Praveen G S, Sanjay S Kambar, Sajna M V, Binu Areekal

Background: Despite control strategies, tuberculosis remains a significant public health problem in many countries. Along with effective control measures currently available, it is essential to identify and target the risk factors of developing active TB to tackle the heavy burden of the disease. This study aims to find out the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. Materials and Methods: A case-control study was done to assess the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. The study was done from a parent study conducted in South India to study the prevalence of diabetes mellitus among registered tuberculosis patients. Those patients diagnosed with both tuberculosis and diabetes mellitus were taken as cases, and those patients with tuberculosis without diabetes mellitus were taken as controls. Cases and controls were above the age of 15 years. The calculated sample size was 115:345, as there were only 92 cases in the parent study. All were taken. Social factors like age, gender, occupation, and socio-economic status, as well as clinical factors like various symptoms, symptom score, type of tuberculosis, category, and treatment outcome, were studied in this study. Data was coded in Excel and analyzed using SPSS version 16. Chi-square analysis was done to find out the association and odd’s ratio. Results: There was a significant difference in age between cases and controls. All symptoms are significantly higher (Chi-square 27.6p-0.0001) among those who have tuberculosis and diabetes co-morbidity when considering each symptom separately. Extrapulmonary tuberculosis was found more among controls. In this study, it was found that relapse and treatment after default were significantly higher among cases(Chi square 23.4 p-0.000034). Conclusion: A significant difference was found among TB patients with DM as co-morbidity when compared with patients without DM. Uncontrolled diabetes will be one challenge for TB elimination. Hence, periodic screening is necessary to find out DM and the proper measures to be followed to control. Keywords: Diabetes co-morbidity, Symptom score, treatment outcome.

Page No: 22-25 | Full Text

TO EVALUATE THE INTERPERSONAL SKILLS OF INTERNS IN ORTHOPEDICS USING MINI-CLINICAL EVALUATION EXERCISE – AN INTERVENTIONAL STUDY FROM NORTH INDIA

http://dx.doi.org/ 10.5530/ijmedph.2024.2.6

Kuldip Singh Sandhu, Ashim Sharma, Affia Sachdeva, Annie Sandhu, Daljinder Singh

Background: Medical undergraduates having lack of interpersonal skills may lead to severe deficiencies in health services. Currently these were not being trained or assessed at workplace for their behavior and communication skills during their medical curriculum. During this study, mini-CEX (mini clinical evaluation exercise) was used as a work place based assessment (WPBA) tool to assess the interpersonal skills of interns and providing them concurrent feedback. The aim of this study was to evaluate and improving the interpersonal skills of interns posted in orthopedic department during their rotatory internship while assessing the acceptability, feasibility and effectiveness of mini-CEX assessment as a tool. Materials and Methods: This prospective and interventional study was conducted in department of orthopedics of our hospital settings between July to November of 2022. The forty interns who participated in this study were on rotatory internship in our department and 06 volunteered faculty members were also included. The mini-CEX form as assessment tool structured by American Board of Internal Medicine was used in this study. Each intern undergone six rotatory assessment sessions, on mini-CEX forms with each of the faculty comprising a total of 240 sessions. Participants at the end of their internship submitted their perceptions on an anonymous validated questionnaire which contains both open ended and closed ended questions (Likert 5-point scale). Statistical Analysis: The descriptive data having frequencies were analyzed using Microsoft Excel software. Thematic analysis was used for qualitative data of open ended questions. Results: Most of interns (36/90%) and all included faculty members had shown that mini-CEX assessment tool has encouraged them and helpful in improving their communication skills. On comparison of their first through 6th encounters, interns had shown improvement in their mean min-CEX score for skill development and competencies with improvement in communication skills. This improvement was statistically significant. (p<0.05). Conclusion: Our study had shown that mini-CEX as WBPA too is an acceptable, effective as well as feasible method for assessing the interpersonal skills of interns in clinical settings. Keywords: interns, interpersonal, encounters, skills.

Page No: 26-31 | Full Text

A STUDY OF EFFICACY AND ROLE OF TERIPARATIDE(rh-PTH) THERAPY IN SURGICALLY CORRECTED COMMINUTED FRACTURES AT A TERTIARY CARE CENTER

http://dx.doi.org/ 10.5530/ijmedph.2024.2.7

Raju Dande, Rajendar Reddy B, Mohammed Faisal, Sannith Kumar Korutla

Background: To study the efficacy of teriparatide therapy in surgically corrected comminuted fractures. Materials and Methods: Prospective observational study was conducted in 50 patients of either gender who are skeletally mature presenting with comminuted fracture or nonunion after surgical correction, without comorbidities who are medically fit for taking the teriparatide are included in study. Results: One third of the patients belonged to the age group of 30-39 years and 40-49 years. 82% of the study population were males, 18% of them were females. 70% of the study population were injured on the right side, 30% of them were injured on the left side. 76% of the study population lower limbs were injured, 30% of them had injury on the upper limbs. 74% of the study population had Road Traffic Accident. 36% of the study population had fracture of femur. 6% of them had fracture of both tibia and fibula. 2% of them had fracture of both radius and ulna. Only one patient had fracture neck of humerus. 42% of the study population showed signs of radiological union after 3-4 months of drug administration, followed by within 3 months (30%), 5-6 months (20%). 92% of the study population had achieved complete radiological union at the end of one year follow up. 44% of the study population showed complete radiological union after 7-9 months of drug administration. Complete range of movements was achieved in 52% of the study population. The range of movements was increased in 40% of the study population. 8% of the study population had restricted movements at the end of the study period. 56% of the study population had experienced side effects. 52% of the study population had nausea, 28% of them had dizziness and 18% had hypercalcemia. Conclusion: The present study concluded that the efficacy of teriparatide in surgically treated comminuted fracture healing cases is 92%. The drug was tolerated well with minor side effects like nausea and dizziness. Keywords: Teriparatide, comminuted fracture, Radiological union.

Page No: 32-39 | Full Text

A STUDY OF PREVALENCE OF APPENDICOLITH AND ITS ASSOCIATION WITH SEVERITY OF APPENDICITIS

http://dx.doi.org/ 10.5530/ijmedph.2024.2.8

Manas Ranjan Pattnaik, Suveer Bhargava, Ravindra Singh

Background: Acute appendicitis is one of the most frequent cause of pain abdomen. Acute Appendicitis can present as complicated or uncomplicated. Complication are abscess, gangrene, perforation. Most common cause of Appendicitis is luminal obstruction by appendicolith. Appendicolith is also known as faecolith/ stercolith/ coproliths is composed of faecal concretions or pellets, calcium phosphates, bacteria and epithelial debris and can lead to luminal obstruction followed by appendicitis. They are seen in 10% of patient with acute appendicitis. Objective: To study any association between appendicolith and its effect on recovery of patient with appendicitis. Materials and Methods: This is prospective study carried out from January 2021 to December 2023 in Command Hospital and Military hospital Jammu in all patients of Acute Appendincitis. Data was collected in terms of age, sex, presentation, TLC score, USG/CT, Mantrls score, surgery done, intra op finding, appendicolith seen or not and histopathology. Results: Out of 170 patients who underwent appendicectomy, 139 patients were more than 20 years of age (81%). Following appendicetomy, appendicolith was found 33patient (19.41%).11 patients were less than 20 years of age (33%).There were 36 female patients (21%) of appendicitis.139 patient presented in acute phase (82%) and operated upon. Rest were operated as cold cases as int appendicectomy. Lap appendicectomy was done in 143 cases (84.1%). Rest was open appendicectomy. Acute appendicitis was found in 9 cases with appendicolith (33%).Complicated appendicitis was found in 24 cases with appendicolth (72.7%). Conclusion: Appendicolith is commonly present in more than 20-year age group. Mantrls score is higher in appendicitis with appendicolith. TLC is also more than 10000 in majority of patients with appendicolith. Majority patient presented in acute stage and were operated upon. Presence of appendicolith was associated with higher TLC, higher Mantrls score and complicated intraop and HPE finding. Keywords: Acute appendicitis, Appendicolith, TLC, HPE finding, HPE finding.

Page No: 40-42 | Full Text

COMPARATIVE EVALUATION OF PROPOFOL KETAMINE AND PROPOFOL FENTANYL IN ERCP/ENDOSCOPIC PROCEEDURES

http://dx.doi.org/ 10.5530/ijmedph.2024.2.9

Sangeeta Chauhan, Krishna Kumar Tripathi

Background: Aims: To find the ideal drug combinations which can be used during day care surgeries and procedures. This study was conducted to valuate and compare the efficacy, and haemodynamic stability of ketamine and entanyl combination with propofol. Also compared were the incidence of side effect, the time of awakening and recovery time. The discharge criteria in both groups was also compared. Materials and Methods: The study was conducted in 50 patients of age group 18-50 years of either gender belonging to ASA grade I or II, were divided into two groups of 25 each. They underwent elective ERCP of approximately 1 hour duration. Group I received Propofol- ketamine while group II received Propofol-fentanyl for induction and maintenance of anaesthesia. Postoperatively, time for awakening, recovery time ‘(by modified Aldrete scoring system) and discharge status (by modified post anaesthetic discharge scoring system) were recorded and compared in two groups. Results: Profol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressure as compared to Propofol-ketamine during induction and maintenance of anaesthesia. Fall in respiratory rate was greater in Propofol- fentanyl group as compared to Propofol-ketamine group. The recovery time in group II was longer than group I. Discharge criteria is significantly earlier in group I. Conclusion: Both Profol- ketamine and Propofol-fentanyl combination reduce rapid, pleasant and safe anesthesia with only a few untoward side effects and propofol-ketamine produces better haemodynamic statistic, during anaesthesia, but recovery and smooth discharge was seen with propofol fentanyl group. Keywords: Propofol, Fentanyl, Ketamine, Day care surgery, ERCP, Endoscopic proceedures.

Page No: 43-48 | Full Text

COMPARATIVE EFFICACY OF DEXMEDETOMIDINE AND CLONIDINE IN CARDIAC VALVULAR SURGERIES: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

http://dx.doi.org/ 10.5530/ijmedph.2024.2.10

S. Syed Mohammed Jazeel, S. Dhivakar, Vivekanandhan.N, Sri Hari Vignesh R

Background: Dexmedetomidine and Clonidine, both α2-adrenergic agonists, are commonly used in cardiac surgery for their hemodynamic stabilizing properties. However, comparative data on their efficacy in cardiac valvular surgeries remain limited. Materials and Methods: We conducted a prospective randomized controlled study involving 60 patients undergoing elective cardiac valvular surgeries between September 2019 and August 2020. Patients were randomized to receive either Clonidine or Dexmedetomidine. Intra-operative hemodynamics, anesthetic requirements, and post-operative recovery times were compared between the two groups. Results: Dexmedetomidine demonstrated superior efficacy in reducing heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure compared to Clonidine. Patients receiving Dexmedetomidine required lower doses of inhalational anesthetics, opioids, and muscle relaxants. Additionally, Dexmedetomidine was associated with shorter durations of mechanical ventilation (398.00 ± 51.47 vs. 475.67 ± 35.15 minutes, P < 0.0001) and length of stay in the post-operative ICU (53.90 ± 3.75 vs. 60.60 ± 3.78 hours, P < 0.0001) compared to Clonidine. Conclusion: Dexmedetomidine offers superior intra-operative hemodynamic stability, reduced anesthetic requirements, and faster post-operative recovery compared to Clonidine in patients undergoing cardiac valvular surgeries. Keywords: Dexmedetomidine, Clonidine, Cardiac surgery, Hemodynamics, Anesthetic requirements, Post-operative recovery.

Page No: 49-55 | Full Text

A STUDY ON UTILIZATION OF HEALTH APPLICATIONS AND ITS AWARENESS AMONG PEOPLE

http://dx.doi.org/ 10.5530/ijmedph.2024.2.11

Koppala Ravi Babu, Gnanasekar Thirugnanam, Siral Hegde, Erukula Ramanjaneyulu

Background: Mobile health applications are a relatively new phenomenon in the healthcare industry, but their use is expanding rapidly for both general health and specific medical needs. Objective: To compare the utilization of the health apps among patients visiting pharmacies and health stores hospital and it awareness among people. Materials and Methods: A cross-sectional descriptive study was conducted with the general population who were using mobile health apps in the state between January 2023 to June 2023. The participants in the study were recruited from retail pharmacies and health stores located in different areas in the cities. Clients visiting the pharmacies and health stores were approached and invited to participate in the study, and those who agreed were interviewed. The inclusion criteria included smartphone owners who were using health-related apps, of age ≥ 18 years old, and those who could speak the English language. Results: Out of 270 individuals, 52% of the sample were male and 48% were female, and the mean age (SD) of participants was 29.74 (11.74). In this study, 31% of the participants reported using their health apps on a daily basis, 40% at least once weekly, and 25% monthly. The main benefits of mobile health apps were tracking of health status (49%), followed by motivation (24%) and gaining knowledge about health and fitness (20%). The main issues reported by the participants included inaccuracy of the app (12.5%), inconvenience (5%), and not being user-friendly (8%). Conclusion: These apps inspired the participants to keep up their wellbeing and exercise while assisting them in tracking and better managing their health. To ensure evidence-based and efficient app use to achieve the desired health outcomes, further opportunities for improvement have been found. Keywords: Digital health, digital patients, health apps, mhealth, teleconsultation.

Page No: 56-59 | Full Text

COMPARISON BETWEEN DEXMEDETOMIDINE AND ESMOLOL AS EFFECTIVE PRETREATMENT REGIMENS ON ATTENUATION OF HAEMODYNAMIC PARAMETRES DURING ELECTROCONVULSIVE THERAPY

http://dx.doi.org/ 10.5530/ijmedph.2024.2.12

Altafuddin Ahmed, Alangkrita Sarmah, Jyostna Dutta, Hilan Chakrabarty

Background: Modified Electroconvulsive Therapy (ECT) under anesthesia is an important modality in the treatment of severe persistent depression, bipolar disorder and schizophrenia; specially in case resistant to pharmacological therapy; but this procedure has got many side effects, specifically the hemodynamic alteration is markedly observed. Aim: The aim of present study to compare between Dexmedetomidine and esmolol as effective pretreatment regimens on attenuation of hemodynamic parameters during electroconvulsive therapy. Materials and Methods: After getting approval of the study protocol by the institutional ethics committee (H) of Assam Medical College and Hospital, Dibrugarh and getting written informed consent from the patients and their relatives, fifty cases aged between 20-40 years belonging to ASA grade I and II scheduled for ECT are included in the study and grouped in 2 groups of 25 patients each. Group E received IV esmolol 1mg/kg body weight diluted up to 10ml of normal saline and infused within 2 minutes as premedication. Group D received IV Dexmedetomidine 0.5 mcg/kg diluted to 10ml of normal saline and infused within 10 minutes as premedication. Hemodynamic parameters heart rate (HR), systolic blood pressure, diastolic blood pressure and mean blood pressure at baseline (before induction), after study drug infusion and after ECT application were recorded at different time intervals and presented along with demographic data. Statistical analysis was done with SPSS software using student t-test and Chi square test. Results: In this study, the baseline systolic blood pressure, diastolic blood pressure and mean blood pressure was statistically insignificant. The heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was significantly decreased in both esmolol and Dexmedetomidine group after drug administration and at 1,3,5 and 10 min post ECT shock. However, the decrease in MAP was statistically insignificant in both the groups after premedication, at 1,3,5,10 minutes of delivery of ECT shock. The mean time of return of spontaneous respiration was statistically insignificant. Conclusion: Based on the present hospital based observational study, we came to the conclusion that an intravenous premedication agent in ECT, both esmolol at a dose of 0.1 mg/kg and Dexmedetomidine at a dose of 0.5 mcg/kg results in attenuation of cardiovascular (HR, BP, MAP) effects but more reduction of hemodynamic parameters were seen in the Dexmedetomidine compared to esmolol. The mean blood pressure however was unaffected. Keywords: Dexmedetomidine, esmolol, modified Electroconvulsive therapy, hemodynamic parameters.

Page No: 60-63 | Full Text

Case Report

A rare case of retroperitoneal liposarcoma complicated with giant colonic diverticulum: case report.

http://dx.doi.org/ 10.5530/ijmedph.2024.2.13

Amitabh Goel, Vandana Bansal, Laalji Patel, Sonal Nivsarkar, Dolly Mehta, Sana Afrin, Saranshi Shrivastava, Rahul Patidar

The co-occurrence of retroperitoneal liposarcoma and a giant colonic diverticulum poses diagnostic challenges due to their uncommon nature and overlapping clinical presentations. Here, we present a unique case report of a 76-year-old female with hypertension and myasthenia gravis who presented to Vishesh Jupiter Hospital, Indore and diagnosed with retroperitoneal liposarcoma complicated by a giant colonic diverticulum detailing its presentation, diagnostic journey and management strategies. Keywords: Retroperitoneal liposarcoma, Giant Colonic Diverticulum.

Page No: 64-69 | Full Text

TO COMPARE EFFICACY OF LAPAROSCOPIC CHOLECYSTOSTOMY AND INTERVAL CHOLECYSTECTOMY VERSUS OPEN CHOLECYSTECTOMY IN CASES OF DIFFICULT GALLBLADDER

http://dx.doi.org/ 10.5530/ijmedph.2024.2.14

Krishna Chowdary Amirineni, Niharika Adusumilli, Rao Haneesha, Kola Praveen kumar, S B J L Harshini5, R Indu

Background: To evaluate and compare efficacy of laparoscopic cholecystostomy and interval cholecystectomy versus open cholecystectomy in cases of difficult gallbladder. Materials and Methods: This study will be conducted in Department of General surgery, Kamineni Hospital, Hyderabad between October 2012 to December 2014. The facilities, expertise and the necessary Infrastructure are available in this hospital. A comparative observational study, which included 40 patients of difficult gallbladder who needs cholecystectomy. Ethics committee’s permission has been taken. Results: In the present study, there were difficulties associated with Laparoscopic cholecystostomy like subjecting the patient to a second surgery, carrying a drain, longer hospital stay and increased expenditure. Laparoscopic cholecystostomy followed by Interval chole- cystectomy was safe with less postoperative morbidity associated with faster patient recovery and satisfaction as documented by less postoperative pain, earlier resumption of oral feeds, earlier full mobilization and discharge home, as well as lesser complication rate with least possible scar. Conclusion: In conclusion, the study supports the view that laparoscopic cholecystostomy followed by interval cholecystectomy is safer and efficacious and offers definitive advantages over open conversion and should be an available option for all patients requiring emergency cholecystectomy. Keywords: Cholecystectomy, Laproscopic, Gall Bladder, VAS, Postoperative.

Page No: 70-75 | Full Text

ROLE OF NEBULISED HYPERTONIC SALINE IN THE TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDREN AGED 4 WEEKS TO 2 YEARS

http://dx.doi.org/ 10.5530/ijmedph.2024.2.15

Ritesh Veerlapati, Soma Santosh Kumar

Background: To study the effect of nebulised 3% saline on hospitalized children aged 4weeks to 2 years with acute bronchiolitis with regard to decrease in respiratory distress and duration of hospital stay. Materials and Methods: This was a hospital based prospective interventional non blinded controlled trial done in the age group of 4 weeks to 2 yrs admitted with acute bronchiolitis with a Respiratory Distress Assessment Instrument (RDAI)score of 4 to 15 [on a scale of 0 (mild) to 17 (severe)] in a teritiary care centre. Results: The most common presenting complaint in our study was cold which was present in 43 (76.79%) cases followed by cough in 41 (73.21%). This was followed by hurried breathing in 31 (55.36%). Wheeze was present in 29(51.79%) cases and fever in 28 (50%). The two groups were comparable with respect to baseline characteristics. The number of children who improved with treatment in Study group was 19(63.3%) and in control group was 11(36.70%). When compared to control group, there was statistically significant (p=0.015) improvement in the study group. This showed that the nebulised 3% saline nebulisation was useful in symptomatic improvement in the clinical condition of significantly more number of children. There was significant reduction in RDAI scores and improvement in saturation after 6hr, 12hr and 24hrs of initiation of treatment in Study group. Conclusion: The present study concluded that there was significant decrease in Respiratory rate and RDAI scores with the use of 3% NS nebulisation. The duration of hospital stay was less and the time required for change of treatment was more in Study group, but statistical significance could not be established. Keywords: Bronchiolities, RDAI Score, NS nebulisation, wheeze.

Page No: 76-81 | Full Text

A STUDY ON EVALUATION OF RISK FACTORS AND OUTCOMES OF EMPYEMA THORACIS IN PEDIATRIC AGE GROUP.

http://dx.doi.org/ 10.5530/ijmedph.2024.2.16

Soma Santosh Kumar, Ritesh Veerlapati

Background: Empyema thoracis is a life-threatening complication of pneumonia in children, especially below 5 years of age. The treatment outcomes depend upon the nutritional state of the child and provision of medical care to administer appropriate antibiotics. This study was done with an aim to evaluate the risk factors and outcomes of children with empyema thoracis. Materials and Methods: A total of 100 children who presented to the OPD with empyema thoracis, over a period of 18 months were included in the study. Results: Majority of the children were below 5 years of age and most of them were males. Most of the participants belonged to lower socio-economic status. Anemia was the most commonly associated risk factor. ICD was removed within 1 week. Conclusion: Early initiation of antibiotics along with ICD tube placement can allievate the immediate clinical or delayed complication. Keywords: empyema thoracis, pediatric, pneumonia.

Page No: 82-84 | Full Text

SELF INDUCED ABORTION AMONG WOMEN ADMITTED IN A TERTIARY CARE CENTRE - A CROSS SECTIONAL STUDY

http://dx.doi.org/ 10.5530/ijmedph.2024.2.17

Jaya Singh, Minakshi Singh, Anil Kumar Malik, Minali Raja, Chitra Joshi, Yesvant Singh Pal

Background: While medically supervised abortion adhering to guidelines boasts a success rate of 92-97%, the widespread availability of abortion pills over the counter has led to rampant self-administration, resulting in frequent complications. Despite the perception of unsupervised medical abortion as unsafe, many women utilize it for pregnancy termination and birth spacing. Aim of the Study: The aim of this study was to study the implications of self-administration of abortion pills by pregnant women. Materials and Methods: Retrospective cross sectional study done in Government Doon Medical College & Hospital between the period of August 2022- july 2023. Case sheets were analysed to obtain data regarding self-administration of abortion pills and complications secondary to its administration. The following data were collected- Age, marital status, parity, duration of pregnancy as perceived by the women, confirmation of pregnancy, duration between pill intake and visit to hospital, whether any intervention done elsewhere, any known medical or surgical complications, Hb level on admission, whether patient was in shock, USG find-ings, evidence of sepsis, blood transfusion, treatment given and duration of hospital stay. Descriptive analysis of the collected data was done. Results: Among the 148 cases of abortion in the study period, 75 patients had self-administered abortion pills. Among these 75 patients 26.6% had consumed abortion pills after the approved time period of 63 days of which 20% had consumed pills after 12 weeks of gestation. The most common presentation was excessive bleeding (73.33%) Severe anaemia was found in 37.33% of the patients and 8% of patients presented with shock. The outcome was as follows: 66.66% of the patients were found to have incomplete abortion, 13.33% had failed abortion and 5.22% of patients had incomplete abortion with sepsis. Surgical evacuation was performed in 33.33% of the patients whereas 46.66% of the patients required surgical evacuation with blood transfusion. Medical methods were used in 9.33% of the patients whereas 6.66% required transfusion along with medical methods. Conclusion: The study sheds light on the increasing trend of self-administered MTP pill intake among women and underscores the importance of ensuring adequate education, counseling, and support for safe and effective self-administration practices. Further research is warranted to explore the long-term outcomes and implications of self-administered MTP pill intake in diverse healthcare settings. Keywords: Medical termination of pregnancy, Maternal mortality, abortion, complications.

Page No: 85-90 | Full Text

SERUM ZINC LEVELS AND THE SPECTRUM OF DIARRHEA IN CHILDREN (6 MONTHS TO 5 YEARS): ACUTE, CHRONIC, AND PERSISTENT PRESENTATIONS

http://dx.doi.org/ 10.5530/ijmedph.2024.2.18

Khushbu Rani, Manisha Kumari, Navin Kumar Sinha, Uday Kumar

Diarrhea causes an estimated 2.5 million child deaths in developing countries each year. It is the third leading killer of children in India today and is responsible for 13% of all deaths in children less than five years of age and kills an estimated 300,000 children in India each year. Diarrhea is one of the clinical manifestations of zinc deficiency in humans. 25 children (aged 6 months-5 years) of either sex suffering from diarrhea and admitted in paediatric ward and emergency of RDJMMCH, Muzaffarpur were selected for the study. Serum zinc levels were estimated by colorimetric kit method and compared with those of 25 healthy age-matched controls. It was observed that the serum zinc levels were significantly lower in children suffering from diarrhea (39.26 ± 12.18 vs. 78.60 ± 11.63 µg/dl, p<0.05). However, there was a negligible correlation between diarrhea and gender. Thus, diarrhea is associated with an increased loss of zinc in feces so that children with diarrhea would be at an increased risk of zinc deficiency. Zinc supplementation is now being recommended by WHO, UNICEF, and countries around the world for the supportive treatment of all diarrhea episodes among children, and this should be encouraged in routine clinical practice. Keywords: Diarrhea, Zinc, Children, Deficiency, Supplementation.

Page No: 91-93 | Full Text

PULMONARY FUNCTION TESTS IN DIABETES MELLITUS TYPE 2: A CASE CONTROL STUDY IN A TERTIARY CARE CENTRE OF UTTAR PRADESH

http://dx.doi.org/ 10.5530/ijmedph.2024.2.19

Yesvant Singh Pal, Deepika Tiwari, Anil Kumar Malik, D.P. Tiwari, Minakshi Singh

Background: Diabetes is a micro-macrovascular disorder with debilitating effects on many organs. Pulmonary complications in diabetes mellitus with the loss of pulmonary reserve may become clinically important. The relationship between DM and pulmonary function tests (PFTs) remains important because of potential epidemiological and clinical implications. Aim of the Study: The aim of this study was to measure pulmonary function tests (PFTs) in diabetes mellitus type 2(DMT2) subjects and to determine the correlation of glycosylated haemoglobin (HbA1c) with pulmonary function tests inDMT2 patients. Materials and Methods: This study was conducted in the Department of Physiology, Subharti Medical College in collaboration with Department of Medicine, Chattrapati Shivaji Subharti Hospital, Meerut A total of 100 non-smoker subjects of either sex in the age group of 30-50 years were recruited. The subjects were divided into 2 groups -Group A: 50 having history ofDMT2 and Group B: 50 Normal controls. The selected patients were evaluated by taking detailed history and thorough clinical examination was done. Test for Plasma Glucose and HbA1c was done. Pulmonary function tests was done by Spirometry recording FVC, FEV1,FEV1/FVC ratio and PEFR. The data so collected was subjected to standard statistical analysis. Results: Majority of subjects were between 40-50 years while only 6 were between 50-60 years of age. The sex distribution in both cases and controls was similar. All the respiratory parameters were lesser in subjects with diabetes than non- diabetics except FEV1/FVC ratio which showed slight increase in cases than control. Statistically significant decrease occurred in FVC, FEV1 (P<0.05) & PEFR (P<0.000) while increase in FEV1/FVC ratio was statistically insignificant giving an indication about probable deterioration in lung functions in asymptomatic diabetics. Conclusion: Lung functions need to be checked periodically to assess the severity of impairment in DMT2 patients. Keywords: Pulmonary Function Tests, Diabetes Mellitus Type 2, Glycosylated haemoglobin (HbA1c), complications.

Page No: 94-98 | Full Text

CUTANEOUS MANIFESTATIONS OF EARLY NEONATES IN A TERTIARY CARE HOSPITAL

http://dx.doi.org/ 10.5530/ijmedph.2024.2.20

Maripati Lavanya, Subhash Reddy Dudhipala, B Raghavendra Rao, Pranitha Raireddy

Background: Aims: To study various cutaneous manifestations in early neonates that is within 7 days from the birth, fromAntenatal wards, dermatology outpatient department and Neonatal intensive care unit(NICU). Materials and Methods: It is a cross-sectional study including 150 neonates from OPD of Department of Dermatology, obstetrics and gynecology ward and NICU. Results: The percentage of consanguineous marriage and non – consanguineous marriage in the parents of neonates were seen as 16% and 84% respectively. The commonest cutaneous manifestations found in our study were that of pigmentary type i.e. Mongolian spot amounting to 22% of the cases most commonly over the lumbosacral region. The physiological desquamation was the commonest finding of papulosquamous changes that were seen in our study amounting to 18% of cases. The next commonest condition was of Erythema toxicum neonatorum amounting to 12% of the cases most frequently observed on the trunk. Acrocyanosis amounted to 8% of the cases in this study. The nasal lesions were demonstrated in all the cases of Sebaceous gland hyperplasia amounted to 6% of our case study. 5.3% of the cases were hypertrichosis lanugosa occurring over the shoulder, trunk and limbs. Miliaria accounted for 5.3% of the cases. It was more common in neonates admitted in NICU. Milia was found in 4% of the cases and most commonly occurred in neonates with birth weight >2.5kg. Of the solitary lesions Café au lait macules which were seen in our study amounted only to 2 %. The 2 % of cases wherein vernix caseosa seen were prominently observed in the axilla. Axillary hyperpigmentation amounted to 2 % of the cases. In our study two neonates demonstrated congenital melanocytic nevi amounting to 2 % of the cases. Other skin changes included amounting to 10 % of the total cases. Conclusion: Awareness of cutaneous manifestations in neonates helps us to differentiate between the benign transient lesions from the pathological conditions, so that timely intervention and necessary follow-up may be done where needed as well as to give assurance to the anxious parents. Keywords: Mongolian spot, papulosquamous, Erythema toxicum neonatorum, hypertrichosis lanugosa.

Page No: 99-104 | Full Text

EFFECT OF KNOWLEDGE, PRACTICE OF MENSTRUAL, REPRODUCTIVE HYGIENE AND AVAILABILITY OF SANITARY FACILITIES ON SCHOOL ABSENTEEISM IN URBAN AND RURAL AREAS OF DEHRADUN: A COMPARATIVE STUDY

http://dx.doi.org/ 10.5530/ijmedph.2024.2.21

Anupama Arya, Nandini Singh, Arushi, Hem Chandra

Background: Proper education and menstrual hygiene management facilities form a pathway for the overall growth and development of an adolescent girl. Poor availability of menstrual hygiene facilities in school can have a negative impact on the reproductive health of a girl as well as contribute to school absenteeism, sometimes resulting in school dropout. This study evaluates the various factors associated with school absenteeism during menstruation, and to assess knowledge of reproductive health. Objectives: 1. To assess the various factors affecting school absenteeism among adolescent girls. 2. To assess the availability and quality of sanitation facilities available in school washrooms 3. To evaluate the knowledge and practice of reproductive health in adolescent school going girls. Materials and Methods: A school based cross sectional study was conducted among 505 school girls urban and rural areas (Government and Private schools) in Dehradun, Uttarakhand. A semi-structured, pretested close and open-ended questionnaire was prepared in both Hindi and English language to obtain maximum results. Data Entry was done in MS excel and was analysed in SPSS software. Results: 51.56% girls in urban areas and 31.33% girls in rural areas remained absent from school during menstruation. Despite good level of knowledge of RTI/STIs 21, 48% girls in urban areas and 24.10% girls in rural areas said that they have had infection during or around menstruation. The sanitary facility in rural schools was less than that available in urban areas. Only 34.94% girls in rural areas reported of having soaps available in their school washrooms. Conclusion: Adolescent girls should be given appropriate knowledge regarding menstruation and reproductive health. This study is able to identify the lack of knowledge and hygiene facilities which can be improved in bringing them out of misconceptions and promote menstrual health and hygiene and increase the education among girls. Separate functioning sanitary facilities are necessities that should be in school at all girls empowerment and improvement in reproductive health is to be achieved. Keywords: Adolescent girls, Menstrual hygiene, Practices, School sanitation, School absenteeism, RTI, STI.

Page No: 105-110 | Full Text

THE STUDY OF PREVALENCE OF LV DIASTOLIC DYSFUNCTION IN TYPE 2 DIABETES MELLITUS

http://dx.doi.org/ 10.5530/ijmedph.2024.2.22

Valarmathi S, Jayanthi N, Senthil C, Ganapathy V

Background: The intertwined narrative of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) unfolds like a historical epic, with each chapter revealing new layers of complexity and challenge. This study aims to the prevalence ofdiastolic dysfunction in type 2 diabetes mellitus patients and to study the clinical profile of patients with diastolic dysfunction. Materials and Methods: The study was conducted on 100 patients. Patients with clinical features of acute appendicitis aged between 15 and 65 years were included in this study. he neutrophil Lymphocyte ratio would be obtained by dividing the percentage of neutrophils to the percentage of lymphocytes from the data available from differential leukocyte count. All patients was subjected to ultrasound examination of abdomen. Based on evidence in medical literature diagnostic categories for ultrasound abdomen are as follows. Results: The prevalence of diastolic dysfunction was found to be 59.37%. Within this subset, 5.3% were aged between 30 and 40 years, 17.5% were aged between 41 and 50 years, majority comprising 43.8%, were aged between 51 and 60 years, and around 33.4% were aged between 61 and 70 years. Notably, the majority of individuals with diastolic dysfunction were male, accounting for approximately 52.6% of the cases. Regarding the duration of diabetes among those with diastolic dysfunction, approximately 73.7% had been diagnosed within the past 1 to 10 years, while 22.8% had been diagnosed between 11 and 20 years ago, and only 3.5% had been diagnosed for over 20 years. Furthermore, in terms of body mass index (BMI), the majority fell within the range of 25.0 to 29.9 (50%), followed by 37.5% falling within the range of 18.6 to 24.9. The ejection fraction (EF) levels averaged 58.055.48 in the diastolic dysfunction group and 61.215.04 in the non-diastolic dysfunction group. Conclusion: The findings of this study underscore the multifaceted nature of diastolic dysfunction in the context of diabetes mellitus, emphasizing the need for comprehensive assessment and management strategies to address this significant cardiovascular complication in diabetic patients. Keywords: Ventricular dysfunction, diabetes mellitus, age, Type 2, risk factors, prevalence.

Page No: 111-115 | Full Text

Case Series

Lupus nephritis in males: a case series.

http://dx.doi.org/ 10.5530/ijmedph.2024.2.23

PL Venkata Pakki Reddy, M. Sreedhar Sharma, Soma Ananth, Aditya

Background: The prevalence of systemic lupus erythematosus (SLE) in the general population ranges from 8 to 180 cases per 100,000 individuals. The female to male ratio varies from 6 to 13 cases in females for every 1 case in males. Several observations suggest an estrogen effect as a potential explanation for this gender difference. In children, the impact of sex hormones is assumed to be minimal, resulting in a female to male ratio of 3 to 1. We report a case series of five male patients who presented at the Kurnool Medical College, Kurnool in the state of Andhra Pradesh and were diagnosed to have lupus nephritis (LN). Male patients with SLE typically present with renal involvement and seizures rather than photophobia and skin manifestations. The prognosis for male patients also appears to be more severe. Therefore, despite the rarity of male patients with lupus, the symptoms are life-threatening, and early detection of the disease is crucial for improving patient outcomes. Keywords: Lupus Erythematous, Estrogen, Seizurs, Photophobia, Luupus Nephritis.

Page No: 116-118 | Full Text

THE ANTI-HYPERTENSIVE EFFECTS OF HIGH DOSE TELMISARTAN AND LOW DOSE COMBINATION THERAPY TELMISARTAN + AMLODIPINE IN PATIENTS WITH HYPERTENSION, AT GGH, BY DEPARTMENT OF PHARMACOLOGY, KURNOOL MEDICAL COLLEGE, KURNOOL, ANDHRA PRADESH - A PROSPECTIVE STUDY”

http://dx.doi.org/ 10.5530/ijmedph.2024.2.24

Haritha. Pulla Reddy, Rajanikanth. M, Anush. K, Lakshmi Kameswari.V

Hypertension is defined as a systolic blood pressure (SBP) of 140 mm Hg or more, or a diastolic blood pressure (DBP) of 90 mm Hg or more. Globally, an estimated 26% of the world’s population (972 million people) has hypertension, and the prevalence is expected to increase to 29% by 2025, driven largely by increase in economically developing nations. Hypertension affects one in four individuals worldwide. ARBs, CCBs are first line of therapy of hypertension and has out shifted the use of ACEIs. Telmisartan is the preferable ARB, Amlodipine a third generation CCB are commonly prescribed for hypertension in INDIA. Telmisartan has a very high lipophilicity and high volume of distribution which offers advantage of good tissue penetration over other sartans. Amlodipine a DHPs of CCBs is prescribed because of less negative inotropic and high vascular selectivity. The present study comprises of 60 patients (both men and women) of 18 and above age, who are suffering from idiopathic hypertension to know the efficacy of low dose combination therapy of Telmisartan(40mg) with Amlodipine (5mg) against high dose monotherapy of Telmisartan(80mg). In present study, a low dose combination therapy of Telmisartan 40mg + Amlodipine 5mg has demonstrated significantly greater BP reduction in both SBP and DBP compared to high dose monotherapy with Telmisartan 80mg.The combination therapy with Telmisartan 40mg + Amlodipine 5mg is well tolerated with a safety profile similar to the monotherapy with Telmisartan 80mg. Keywords: CCB- Calcium channel blocker, ARB- Angiotensin receptor blocker, SBP-Systolic blood pressure, DBP- Diastolic blood pressure.

Page No: 119-124 | Full Text

ANALYZING DIFFERENT METHODS OF FOOT DEFECT RECONSTRUCTION AND THEIR OUTCOMES: A PROSPECTIVE STUDY

http://dx.doi.org/ 10.5530/ijmedph.2024.2.25

Syeda Asfia Tamkeen, Kommu Vijay Babu, N. Nagaprasad, Lakshmi Palukuri

Background: Foot defects requiring reconstructive surgery pose significant challenges in plastic and reconstructive surgery. Understanding the demographic characteristics, clinical presentations, surgical interventions, and outcomes of foot reconstruction is essential for optimizing patient care. This prospective observational study aimed to analyze the demographics, clinical presentations, surgical interventions, and outcomes of elective foot reconstruction surgeries. Materials and Methods: Over a 24-month period, 50 cases undergoing elective foot reconstructive surgery were studied. Demographic data, including age, sex, etiology, and comorbidities, were recorded. Clinical characteristics such as foot involvement, defect size, structures exposed, associated fractures, and vascular status were assessed. Surgical interventions and complications, including type of reconstruction and post-operative outcomes, were documented. Functional outcomes and patient satisfaction were evaluated during follow-up. Results: The majority of patients (72%) were aged 18-40 years, with males comprising 84% of the study population. Trauma was the leading etiology (88%) of foot defects, and 22% presented with associated comorbidities. Most defects were right-sided (68%) and ranged from 5-10 cm in size (70%). Bones and tendons were commonly exposed (48%), and 60% of patients had associated fractures. Lateral supramalleolar flap and RSA flap were the most common reconstruction procedures (both 26%). Flap necrosis and donor site morbidity affected 8% and 24% of patients, respectively. Despite challenges, 94% of patients reported satisfaction with the outcome of their reconstruction. Conclusion: Elective foot reconstruction surgeries present complex clinical scenarios. This study provides insights into the demographics, clinical characteristics, surgical interventions, and outcomes of foot reconstruction, aiding in optimizing patient management and improving surgical outcomes. Keywords: Foot reconstruction, plastic surgery, reconstructive surgery, clinical characteristics, surgical interventions, outcomes.

Page No: 125-130 | Full Text

EXPLORING HEMOGLOBIN DISORDERS IN REPRODUCTIVE-AGE FEMALES: A PROSPECTIVE OBSERVATIONAL STUDY IN RURAL HARYANA, INDIA

http://dx.doi.org/ 10.5530/ijmedph.2024.2.26

Navtej Kumar, Neha Batra, Surbhi Rajauria, Charu Batra Atreja, Agam Hans, Maninder Kaur

Background: Hemoglobinopathies, a diverse group of genetic disorders affecting hemoglobin synthesis or structure, pose substantial public health challenges worldwide. Understanding their prevalence and spectrum, especially among reproductive-age females, is crucial for planning effective prevention and treatment strategies. Aim: This prospective observational study aimed to investigate the frequency of hemoglobinopathies among reproductive-age females in a rural tertiary care centre in Haryana using high-performance liquid chromatography (HPLC). Materials and Methods: Over the course of one year, 149 females aged 15 to 45 years were included in the study. Blood samples were collected and analysed using HPLC to identify haemoglobin abnormalities. Results: Haemoglobin HPLC analysis revealed haemoglobinopathies in 14.1% of cases, with β-thalassemia trait being the most prevalent (11.4%). Other hemoglobinopathies identified included HbD Punjab trait and HbE trait. Haematological indices provided insights into different parameters across various hemoglobinopathies. Conclusion: Hemoglobinopathies represent a significant healthcare challenge in India, particularly among women of reproductive age. This study emphasizes the importance of screening for carriers using haemoglobin HPLC, as it facilitates the provision of tailored counselling and management strategies to alleviate the impact of these disorders. Keywords: Haemoglobinopathies, reproductive-age group, blood disorder, Anaemia, haemoglobin.

Page No: 131-134 | Full Text

PROSPECTIVE CLINICAL STUDY ON THE REPAIR OF UNCOMPLICATED ISOLATED EXTENSOR TENDON INJURIES OF THE HAND IN A TERTIARY CARE CENTER IN HYDERABAD

http://dx.doi.org/ 10.5530/ijmedph.2024.2.27

Kommu Vijay Babu, Syeda Asfia Tamkeen, Raja Kiran Kumar Goud Ireni, Palli Shirin

Background: Extensor tendon injuries are common and can significantly impact hand function. The treatment and management of these injuries vary widely, influencing the functional outcomes. To evaluate the efficacy of different management protocols (early active mobilization vs. immobilization) in the repair of uncomplicated isolated extensor tendon injuries and to assess the outcomes based on the Total Active Range of Motion (TAM). Materials and Methods: This prospective analytical study included all cases of extensor tendon injuries treated in the Department of Plastic and Reconstructive Surgery. Patients were assigned to either an early active mobilization/physiotherapy protocol or to immobilization due to non-compliance based on specific criteria. The primary outcome measure was the improvement in TAM as suggested by the American Society for Surgery of the Hand. Results: A total of 66 patients with 100 tendon injuries were included. The majority were males (87.8%), with the most affected age group being 10-30 years (77%). The index finger was the most frequently injured. Outcomes showed 70% of tendons had good to excellent recovery. Early active mobilization yielded fewer complications and better functional outcomes compared to immobilization. Conclusion: Early active mobilization significantly enhances recovery in extensor tendon injuries of the hand. This protocol also demonstrated lower complication rates, making it a preferable treatment strategy in compliant patients. Keywords: Extensor tendon injuries, early active mobilization, immobilization, hand surgery, Total Active Range of Motion (TAM), functional outcomes.

Page No: 135-141 | Full Text

FEASIBILITY OF PRIMARY CARE NURSE BASED GENETIC INFORMATION AND COUNSELLING SERVICE DELIVERY FOR MAINSTREAMING IN OVARIAN CANCER PATIENTS- A MIXED METHOD STUDY

http://dx.doi.org/ 10.5530/ijmedph.2024.2.28

Priyanka Singh

Background: Genetic testing for Breast Cancer (BRCA) gene 1 and 2 mutations in epithelial ovarian cancers is recommended to guide prognosis, adjuvant treatment and prevention of second malignancies in the patient and in the carrier family members or relatives. Prevalence of BRCA and other cancer- causing mutations is not known in most regions in India and is inadequately explored. Main-streaming genetic testing has the potential to increase uptake of testing in patients and identify at-risk carrier population in whom primordial or primary prevention of genetic cancers can be implemented with good outcomes. Materials and Methods: A mixed method study was conducted with aim to explore feasibility of a primary care nurse based genetic counselling modality for ovarian cancer patients, along with exploration of factors affecting its uptake, using a structured objective survey questionnaire followed by key informant interviews to develop qualitative questionnaire for further phase of the study. Results: The uptake of genetic testing among patients was good and among healthy relatives was negligible. The affecting factors were lack of awareness and economic. The qualitative study interview explored reasons for low uptake of tests, satisfaction with the counselling and impact of test results on patients. Conclusion: The pretest counselling was effective and post-test counselling necessitated counselling by specialist oncologist. The uptake of genetic testing was affected by level of awareness and costs. Keywords: Mainstreaming genetic testing, Nurse led counselling, Ovarian cancer.

Page No: 142-146 | Full Text

A STUDY ON SURGICAL OUTCOME OF PROXIMAL HUMERUS FRACTURE TREATED WITH PROXIMAL HUMERAL NAILING

http://dx.doi.org/ 10.5530/ijmedph.2024.2.29

Kumaresapathy.S, Praveen.B, Karthikeyan. E. S, Manikandan.R

Background: The proximal humerus is the third most common fractured bone in the body, making up about 4%-5% of all fractures. Incidence occurs mostly after distal radius fractures and hip fractures. Fractures of the proximal humerus are more common among the elderly. Studying the outcomes of proximal humeral nailing fixation for two- and three-part proximal humeral fractures was the primary focus of this prospective observational study. This study was conducted to assess the clinical, radiological and functional outcome of treating Neer 2, 3-part proximal humerus fracture using intramedullary proximal humerus nailing and to know the advantages, disadvantages and complications of the procedure. Materials and Methods: A prospective study was conducted in K A P V govt Medical College& MGMGH, Trichy. This study included the patients with fracture of proximal humerus requiring surgical interventions, after taking their consent, were analyzed clinically and radiologically. All the patients selected for the study were evaluated as per the history & mode of injury, necessary clinical and laboratory investigations. The pre-operative and immediate post-operative X-ray were evaluated. The patients were evaluated clinically and radiologically in their subsequent follow-up every 6 weeks till fracture union and at 1 year after surgery. Results: The time for union (weeks) was 11 to 14 weeks in86.66% of the participants. Most of the patients had follow-up till one year. The mean post op NEER score 75.17 ± 5.85 at 6 weeks, it was 79.63 ± 5.3 at 3 months, it was 83.23 ± 5.28 at 6 months, it was 88.5 ± 5.48 at final score.36.67% and 63.33% of the participants had NEER 2 and 3part type of fracture injury. Among the study population with post-op complication, 10.00% of them had varus malunion, 6.67% of them had rotator cuff injury, 3.33% of them had glenohumeral protrusion. We found that 63.33% of them had excellent outcomes, 26.67% of them had satisfactory outcomes, 10.00% of them had unsatisfactory outcomes. Conclusion: We discovered that individuals with both two and three-part fractures exhibit successful fracture union. Post-operative NEER score was improved with the patients treated. We found that there was a good outcome with a smaller number of complications found in the treatment of proximal humeral nailing. Keywords: Proximal Humerus, NEER scores, Post-operative, Proximal Humerus Nailing.

Page No: 147-151 | Full Text

A CLINICAL STUDYOF LATERAL NECK SWELLINGS IN ADULTS IN TERTIARY CARE HOSPITAL

http://dx.doi.org/ 10.5530/ijmedph.2024.2.30

Rizwaan N, Sathish Kumar K N, Suvaries Princy Maria Salvodar

Background: Lateral neck swellings in ENT have various causes, commonly found in the anterior triangle of the neck. Accurate diagnosis through imaging, FNAC, and biopsy is crucial for appropriate treatment, ranging from conservative management to surgery. Understanding incidence, etiology, pathology, and clinical behaviour is important for effective management and follow- up. Materials and Methods: Institutional Ethical committee approval was obtained and informed consent was taken from the study subjects. Patients with lateral neck swellings underwent clinical examination and FNAC, followed by further investigations based on FNAC reports. Lymph node biopsies were taken for histopathological examination. Management was based on the final diagnosis, and patients were followed up for six months. Results were analyzed and tabulated. Results: In our study of 96 patients, lateral neck masses were most common in individuals aged 46-59, with an equal male-to-female ratio. The majority of cases (82.29%) were from low socioeconomic status. Metastasis in cervical lymph nodes was the most frequent cause of lateral neck swellings, primarily in males aged over 45, and tubercular lymphadenitis was the second most common cause in females aged 18-30. The clinical diagnosis had high sensitivity (87.18%) and specificity (92.98%) for detecting malignant lesions, and these values increased when the histopathological examination was used as the gold standard. Conclusion: To evaluate and manage lateral neck swellings, a multidisciplinary approach is necessary, including medical history, clinical examination, imaging, and pathological investigations like FNAC and HPE. Prompt and accurate diagnosis is critical to prevent morbidity and mortality, and management depends on the underlying cause. Effective management requires close communication between the clinician and the pathologist. Keywords: Cervical Lymphadenopathy; non-thyroid neck swellings; Benign; Malignant; Fine-needle aspiration cytology; Histopathological examination; Neck metastasis; Tuberculosis; Lymphoma.

Page No: 152-158 | Full Text

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Addressing loneliness and social isolation in 52 countries: a scoping review of National policies

• Nina Goldman   ORCID: orcid.org/0000-0002-3058-1251 1 , 2   na1 ,
• Devi Khanna   ORCID: orcid.org/0000-0002-9254-0869 1   na1 ,
• Marie Line El Asmar   ORCID: orcid.org/0000-0002-0733-3911 3 ,
• Pamela Qualter   ORCID: orcid.org/0000-0001-6114-3820 1 &
• Austen El-Osta   ORCID: orcid.org/0000-0002-8772-4938 2  

BMC Public Health volume  24 , Article number:  1207 ( 2024 ) Cite this article

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Even prior to the advent of the COVID-19 pandemic, there was ample evidence that loneliness and social isolation negatively impacted physical and mental health, employability, and are a financial burden on the state. In response, there has been significant policy-level attention on tackling loneliness. The objective of this scoping review was to conduct a loneliness policy landscape analysis across 52 countries of the UN European country groups. Our policy analysis sought to highlight commonalities and differences between the different national approaches to manage loneliness, with the goal to provide actionable recommendations for the consideration of policymakers wishing to develop, expand or review existing loneliness policies.

We searched governmental websites using the Google search engine for publicly available documents related to loneliness and social isolation. Seventy-eight documents were identified in total, from which 23 documents were retained. Exclusion of documents was based on predetermined criteria. A structured content analysis approach was used to capture key information from the policy documents. Contextual data were captured in a configuration matrix to highlight common and unique themes.

We could show that most policies describe loneliness as a phenomenon that was addressed to varying degrees in different domains such as social, health, geographical, economic and political. Limited evidence was found regarding funding for suggested interventions. We synthesised actionable recommendations for the consideration of policy makers focusing on the use of language, prioritisation of interventions, revisiting previous campaigns, sharing best practice across borders, setting out a vision, evaluating interventions, and the need for the rapid and sustainable scalability of interventions.

Conclusions

Our study provides the first overview of the national loneliness policy landscape, highlighting the increasing prioritisation of loneliness and social isolation as a major public health and societal issue. Our findings suggest that policymakers can sustain this momentum and strengthen their strategies by incorporating rigorous, evidence-based intervention evaluations and fostering international collaborations for knowledge sharing. We believe that policymakers can more effectively address loneliness by directing funds to develop and implement interventions that impact the individual, the community and society.

Peer Review reports

Introduction

The significant increase in research on loneliness and social isolation over the last decade, and especially following the advent of the COVID-19 pandemic [ 1 , 2 , 3 ] highlighted the detrimental consequences of loneliness to individuals, society and governments worldwide. For older adults, the pandemic led to feelings of loneliness due to a lack of companionship and connections, which can negatively impact cognition, and mental health [ 4 ]. The paradox of social distancing, intended to protect older adults, further isolated them and exacerbated the negative effects of loneliness [ 5 ]. A longitudinal study on adolescents showed that they also experienced social isolation from peers, and that resulted in increases of loneliness due to COVID-related school closures [ 6 ]. Evidence shows that a lack of social connection impacts physical and mental health [ 7 ], employability opportunities [ 8 ], and how it is related to social disparities [ 1 , 9 ]. In response, there has been significant policy-level attention on loneliness, with, for example, the United Kingdom of Great Britain and Northern Ireland (GB) [ 10 ] and Japan [ 11 ] both appointing a Minister for Loneliness in 2018 (GB) and 2021 (Japan) respectively. In a joint press statement, both an EU Commissioner and the Japanese Loneliness Minister agreed that “loneliness and social isolation pose crucial challenges to the cohesion, economy and mental and physical health in 21st century societies across the world” [ 12 ]. In November 2023, the World Health Organization highlighted the importance of social connection, recognising the significant and often underestimated impact of loneliness and isolation on our health and well-being. This recognition led to the launch of its Commission on Social Connection (2024–2026), which aims to address this issue as a public health concern [ 13 ]. However, little is known about the extent that loneliness is currently included in national strategies and policies across the world.

Loneliness is often defined in psychological terms as an unpleasant feeling that people experience when they perceive their social relationships to be qualitatively or quantitatively inadequate [ 14 ]. The quality, rather than the quantity, of social relationships plays a greater role in loneliness [ 15 ]. While temporary loneliness is a natural human experience, chronic loneliness has serious negative consequences for health and life expectancy. There are three main types of loneliness: intimate (also known as emotional) loneliness, relational (also known as social) loneliness and collective loneliness, first identified by McWhirter (1990) [ 16 ], and empirically validated by Hawkley et al. (2005) [ 17 ] and Panayiotou et al. (2023) [ 18 ]. Loneliness is distinct from social isolation, which Nicholson Jr. (2009) [ 19 ] defines as “a state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts, and they are deficient in fulfilling and quality relationships” (p. 1346). This does not mean that socially isolated individuals necessarily feel lonely and vice versa.

There are different scales to measure loneliness and social isolation. The most commonly used instruments for measuring loneliness are the indirect measures from De Jong Gierveld Loneliness Scale [ 20 ] and the full UCLA Loneliness Scale [ 21 ], as well as the direct measure from the UK Office for National Statistics [ 22 ]. However, what these definitions fail to measure is the “intensity, frequency and duration of loneliness. Loneliness can be acute (i.e., transient) or chronic (i.e., enduring), and it can be mild to severe in its intensity” [ 23 , p.2]. There are also a variety of scales to measure social isolation, but there is no consensus on which should be used [ 24 ]. Some common scales include the Lubben Social Network Scale [ 25 ], the Cudjoe social isolation typology [ 26 ] or a social isolation index used by Shankar et al. [ 27 ].

Our study contributes to existing literature by presenting an overview of current governmental documents that address loneliness and social isolation. Our intention is that the scoping review would be used by federal agencies or local communities who want to develop their own strategies to address loneliness and social isolation, or by researchers to gain an overview of the policy landscape.

The aim of this study was to characterise the policy landscape relevant to tackling loneliness and social isolation across the UN European country groups to identify commonalities and differences between national approaches to loneliness. A secondary aim was to provide actionable recommendations including their implications based on the scoping review for the consideration of policy makers to help promote the rapid and widescale adoption and diffusion of sustainable, scalable and evidence-based interventions to manage loneliness.

We conducted a scoping review based on Mak and Thomas’ recommendations (2022) [ 28 ] to identify (i) how loneliness and social isolation are defined, (ii) the common characteristics between loneliness policies across countries, (iii) which population groups were targeted, and (iv) whether there was an identifiable commitment to action and funding. We contextualised findings using five domains (geographic, social, health, economic, political) that all affect or are affected by experiences of loneliness and social isolation. We have taken every step to make the scoping review as clear and reproducible as possible, following the PRISMA-ScR guidelines [ 29 ] [see file: Supplementary Material _PRISMA-ScR-Checklist].

Eligibility criteria

A multi-method review approach inspired by Schnable et al. (2021) [ 30 ], including a qualitative policy analysis, was used to identify and describe the characteristics of a collection of national-level government documents with reference to loneliness and social isolation. As national policy documents and commissioned governmental strategies and action plans are not available on a central database, a systematic review was not feasible.

We retrieved and reviewed policy documents that address loneliness or social isolation from a total of 52 countries from the UN European Country Groups: Albania (AL), Andorra (AD), Armenia (AM), Australia (AU), Austria (AT), Azerbaijan (AZ), Belarus (BY), Belgium (BE), Bosnia and Herzegovina (BA), Bulgaria (BG), Canada (CA), Croatia (HR), Czechia (CZ), Denmark (DK), Estonia (EE), Finland (FI), France (FR), Georgia (GE), Germany (DE), Greece (GR), Hungary (HU), Iceland (IS), Ireland (IE), Israel (IL), Italy (IT), Latvia (LV), Liechtenstein (LI), Lithuania (LT), Luxembourg (LU), Malta (MT), Monaco (MC), Montenegro (ME), Netherlands (NL), New Zealand (NZ), North Macedonia (MK), Norway (NO), Poland (PL), Portugal (PT), Republic of Moldova (MD), Romania (RO), Russian Federation (RU), San Marino (SM), Serbia (RS), Slovakia (SK), Slovenia (SI), Spain (ES), Sweden (SE), Switzerland (CH), Türkiye (TR), Ukraine (UA), United Kingdom of Great Britain and Northern Ireland (GB), and United States of America (US). We chose this geographic focus of Europe because the European Union was the first supranational union of states to put loneliness on its agenda with a policy brief published in 2018 [ 31 ]. To ensure comprehensive coverage of European nations, we chose the UN European country groups, recognising that they include some members beyond the continent’s geographical borders.

Articles including policies, reports, strategies and policy briefs were included in the analysis if they were (i) from the two UN country groups under study, (ii) officially published or commissioned by a national government, (iii) publicly available, (iv) published between 1 January 2003 and 1 July 2023, (v) related directly to loneliness and social isolation or indirectly by using other language such as social connection, (vi) published in any language.

Information sources

The main information sources were governmental websites of relevant ministries and departments of the 52 selected countries. Additionally, we used the Google search engine for all publicly available national policies related to loneliness and social isolation.

We conducted desktop research using the key terms “loneliness” and “social isolation” for all publicly available national policies, including a review of government websites to generate an asset map of key policy documents and white papers from each country. Online searches were conducted between 1st February 2023 and 1st July 2023.

Internet searches, using the Google search engine, included the following keywords: [(“loneliness” OR “social isolation” OR “social connection”)] and [(“policy” OR “strategy” OR “actions” OR “reports”) and “Country”]. If this did not yield any results for a specific country, we searched for the government website of that country using primary (loneliness and social isolation) and secondary (strategy/policy) terms to determine if governments published documents on loneliness and social isolation. The Google website translator was used to navigate non-English governmental websites.

Selection of sources of evidence

The documents were not limited to policies, but also included national strategies, technical reports, brochures and webpages published by government agencies, studies commissioned by a government agency, governmental press releases, and parliamentary enquiries from politicians to federal ministers or councillor regarding data on loneliness in their respective countries. If multiple strategies/policies from the same government were found, the most recently published one was included. We focused on national level documents only (excluding any regional strategies).

Where documents retrieved were not in English, they were translated into English using a paid (subscription) version of DeepL Pro, a powerful and sophisticated online translator. For reasons of pragmatism, no attempt was made to quality assure the translation with native speakers.

We excluded 40 documents after a first round of reviews where there was no disagreement between the researchers. For 20 documents there was no consensus, so a third researcher reviewed the documents. After reviewing each document, consensus was reached to exclude 16 of the 20 documents. Documents were excluded for the following reasons: (i) loneliness and social isolation were only mentioned in passing and did not elaborated on the issue of loneliness, or loneliness was not part of a proposed intervention, (ii) highlighted or acknowledged loneliness as a problem but we could not identify any detail or strategies or commitments on how to address it, (iii) short news piece or press releases that did not specifically touch on loneliness or social isolation, (iv) documented queries raised by political representatives addressed to parliament, (v) research articles not commissioned by the government, (vi) local focus, not national, (vii) NGO reports not commissioned by a government and (viii) older versions of included documents.

Data charting process

The principal investigator (NG) developed a coding matrix using Excel based on the study objectives and considerations from Braun and Clarke (2006) [ 32 ]. This matrix was first tested on the British documents (NG, DK, MLEA), as we knew these to be extensively detailed. In an iterative process this matrix was reviewed and adapted after testing it on a random selection of five sources of evidence (NG, DK, MLEA, PQ). After a final round of reviewing and adapting, all authors agreed by consensus that they have captured all desired variables needed to address the study objectives. Each policy document was coded independently by at least two investigators (NG, DK, MLEA) to minimise human error in information extraction.

The configuration matrix was completed for all sources of evidence containing information on: (i) document overview (title, publisher, year of publication, original language of publication), (ii) recommended measurement tool for loneliness, (iii) definitions for loneliness, social isolation and other language around social connection, (iv) target group of policy, (v) proposed or suggested actions by government (raising awareness, funding pledge, call for a development of a loneliness measure, proposed interventions or actions, type of evidence cited, commitment to work with specific charities), and (vi) five key domains (geographic, social, health, economic, political) that affect or are affected by experiences of loneliness and social isolation. We also coded whether the documents referred to five domains (geographic, social, health, economic, political) that have been shown to affect or are affected by experiences of loneliness and social isolation.

Synthesis of results

The data of the configuration matrix were consolidated and are presented as Table  1 , Supplementary Table A [see file: Supplementary Material_Table   A ], and within the text where a presentation in table format was not deemed useful (for data items 3–5 as detailed above). We used the document analysis as proposed by [ 33 ] to analyse all the included documents. This approach is based on an iterative processes of qualitative content analysis [ 34 ], with a specific thematic analysis [ 32 ]. The configuration matrix captured all extracted data from which the authors (NG, DK, MLEA) could identify emerging sub-themes within these broad pre-defined domains of loneliness (geographic, social, health, economic and political domain) using thematic analysis [ 32 ]. To create recommendations, two authors (NG, PQ) reviewed the extracted data, with the team revisiting the sources of evidence where needed.

Our scoping review identified 79 sources of evidence that discussed loneliness and social isolation from across 32 countries in both UN European country groups. We excluded a total of 56 documents after two review rounds for reasons shown in the PRISMA flowchart Fig.  1 . This yielded a subset of 23 documents that were included in our final analysis.

PRISMA flow chart based on [ 24 ]

Wider awareness of loneliness and social isolation in our study area

Here, we delve into the sources of evidence that were excluded from our study, but which are nonetheless noteworthy because they illustrate the momentum of the international conversations around loneliness. In some countries (AT, CH), we found parliamentary enquiries asking about data on loneliness in their respective countries, and whether there were any strategies in place to alleviate loneliness. DE does not have a loneliness strategy, but the governmental Committee for Family Affairs, Senior Citizens, Women and Youth has partially funded the organisation (the Competence Network on Loneliness (KNE)) which looks at the causes and consequences of loneliness and promotes the development and exchange of possible prevention and intervention measures in DE. NZ is a good example where there was no specific policy, despite there being great public awareness. They have an established nationwide trust called “Loneliness New Zealand Charitable Trust”. While some countries had excellent resources targeted at policy makers (e.g. CA), they have not yet been translated into a nationwide policy to address loneliness and social isolation. In countries where there was no national strategy, some cities have designed their own regional strategies or organisations, e.g. Barcelona [ 57 ], Helsinki [ 58 ], or Vancouver [ 59 ]. A map highlighting the loneliness policy development landscape across 52 countries of the UN European Country Groups is shown in Fig.  2 .

Current state of the loneliness policy landscape across the study area. Map created with [ 28 ]

It is important to note that for many countries in the study area we could not identify any resources that met the inclusion criteria. It is difficult to assess why loneliness and social isolation are not on the policy agenda of more national governments. Connel and t’ Hart [ 60 ] have developed a typology of policy inaction. Three of the five types may apply to our context: Type I: Calculated inaction. Governments may make a strategic decision not to act, or not to act now, because they believe that the costs of action outweigh the perceived benefits, or because they want to see a stronger evidence base on an issue. Type II: Ideological inaction. Government inaction as a product of ideology, where governments rely on non-governmental and not-for-profit organisations to address the issue of loneliness. The strong third or social-economy sector in the European Union [ 61 ], which includes more volunteers than paid employees, could give the impression that loneliness and social isolation can be managed without government policies. Type IV: Reluctant inaction. Governments do not act because they perceive an absolute or relative lack of resources to fund loneliness and social isolation policies. This may be the case for the less economically strong countries in our study area that do not have policies in place.

Characteristics of sources of evidence

Table  1 gives an overview of the 23 documents that we included in our analysis. Half the documents were published after 2020. Seven documents had to be translated into English. Certain countries released documents in conjunction with one another. For instance, Denmark published a National Strategy and an Action Plan simultaneously in 2023 that were complementary. Similarly, GB’s 2021 Action Plan builds on the GB Loneliness Strategy published in 2018.

Results of individual sources of evidence

For each of the included sources of evidence, we extracted information with our configuration matrix presented in the section Data items . We believe that presenting the results this way will better suit our study objectives, i.e., to highlight common and unique themes.

Target group of policies

Eight documents (from AL, CA, IT, MT, US) were targeted specifically at the older adult population, often classified as age 65 + years. Definitions, causes and proposed interventions for loneliness and social isolation in those documents were contextualised within the framework of old age. The other documents addressed the general population, often highlighting that there are specific groups that are more vulnerable to becoming lonely or socially isolated. Five of the documents identified target groups at increased risk of loneliness (AU, IE, CH, GB, DK). For instance, children (IE), young adults ages 18–25 years (AU, DK, IE, GB), older adults ages 65 + years (AU, CH, IE, GB), people with disabilities & special needs (AU, DK), people suffering from mental illness (CH), those with long-term illness (GB), migrants and refugees (AU, CH, GB), lower income households (AU), and people living alone (AU, CH), people with lower levels of schooling (CH), single parents (CH), young single men (CH), care leaver (GB), victims of domestic violence (US), LGBTQ + individuals (US) and minorities (DK, US).

Defining loneliness and social isolation

Of the 23 documents included in the review, 11 documents from seven countries (AU, AT, CA, DE, NL, GB, US) provided specific definitions of loneliness and social isolation. Those definitions were based on academic sources, explicitly referenced and cited, except for AT which based their definition on general “experts” rather than a specific source. Peplau and Perlman (1982)’s widely used framework is drawn upon in multiple documents, and some countries (AU, DE, NL, GB) go further in their definitions to distinguish between different types of loneliness, (e.g., social, emotional, and existential loneliness in the NL document).

The 11 documents that used a specific definition of loneliness used the Peplau and Perlman (1982) definition that highlights differences between loneliness and social isolation. Documents noted social isolation as an objective lack of social relationships, while loneliness is considered to be the subjective feelings as a result of that social isolation.

Across all the documents included in our review, both with and without specific definitions of loneliness, other language used around social connection can be classified as follows:

Inclusion in wider society, which includes the terms social inclusion (CZ, DK, IE, MT), social integration (CA) and social participation (DE, NL, CH).

Connecting with others, which includes the terms social networks (CA, DK, DE), social support (CH, US), social connection (AU, US), and social contacts (AT, DE, NL, GB).

Existing resources, which includes the terms social resources (CH), social capital (CH, CA), and social skills (CA, NL).

Covering a deficit, which includes the terms social exclusion (AL, CZ, CA), social vulnerability (IT, CA) and social recovery (AU).

Relationship between loneliness and mental health, which includes the term social wellbeing (GB), and discussions of social prescribing (GB) and the contribution of loneliness to poor mental health (IE).

Mental health, which includes the term social wellbeing (GB), and discussions of social prescribing (GB) and the contribution of loneliness to poor mental health (IE).

Funding pledges

Despite the governmental strategies and action plans to reduce loneliness and social isolation, we found little evidence of a commitment to funding. We identified concrete funding pledges or already provided funding for AL (0.75 m USD for 5 years), DK (145 m USD for 2014–2025), GB (24.8 m USD in 2018; 44.5 m USD in 2020), and NL (10.7 m USD per year for 2022–2025; 5.5 m USD 2018–2022) governments. DK provided a detailed overview of initiatives that can be achieved within the already approved budget, initiatives that could be delivered within existing financial frameworks and over 80 initiatives that should be advanced but required additional funding. The Australian government has not yet made a funding pledge but has received a specific budget and initiative proposal for funding from an alliance of three different national organisations. Other government strategies either stated that different ministries are to ensure the necessary financial and human resources for initiatives that fall under their respective jurisdiction (MT) or did not specify funding pledges, merely stating that adequate funding needs to be identified (IT). We identified that some governments (DE, SE) are (partially) funding research on loneliness to gather scientific evidence to help them build their own policy.

Interventions and partnerships

Strategies, policies and action plans proposed a variety of interventions, while technical reports focused on reviewing existing evidence. We have provided many intervention examples across various domains in the policy landscape analysis section below. Of those countries and documents included in our analysis, only AU and GB have committed to work with specific charities, organisations or initiatives to address loneliness and social isolation. Other governments (CA, IE, IT, MT) stated their intention to work with NGOs and local services, but did not mention any specific organisations.

Development of a loneliness and social isolation measure

None of the documents called for the development of new tools to measure loneliness or social isolation. US, DK and GB reviewed existing measures of loneliness for use in possible interventions and strategies. Notably, GB described its own use of a consistent and direct measure of loneliness, developed by the Office of National Statistics (ONS) in 2018. The Direct Measure of Loneliness is a single item measure developed by the ONS that should be used in conjunction with three questions from the University of California Los Angeles (UCLA) Loneliness Scale. A US documents considered multiple ways in which loneliness and social isolation should be measured in research and recommended the appropriate choice of measures in targeted interventions and in major health strategies. The US did not call for the creation of a new measure, but rather recommended the use of existing validated tools tailored to the purpose of proposed interventions. DK’s national strategy considered the applicability of adult measures to adolescents and children.

Policy landscape analysis

This section highlights the wider policy context of the loneliness debate. All 14 countries that have published documents on loneliness are aware that loneliness touches many different dimensions (geographical, health, social, economic, and political; see Table  2 for a brief overview). In 91% ( n  = 21) of the analysed documents, the social and health dimension was most prominent, highlighting the impact of loneliness on various aspects of people’s lives and across age groups, as well as the health implications. However, not all dimensions were addressed with the same level of detail. An extensive overview of the different dimensions touched upon in every document can be found in the Supplementary Table A . For each of the five dimensions, we have identified themes that recur across the documents. We have also added some intervention examples to show how loneliness could be addressed in this dimension from a policy perspective.

Geographic dimension

Most documents (74%, n  = 17) touched on various geographic dimensions that influence or are influenced by loneliness. Four governments observed geographical variation in loneliness prevalence within their country (AU, CA, DE, GB). Only one document suggested reforming the digital environment (US). Within the geographic dimension the following themes were most often mentioned as being influential regarding loneliness and social isolation in the context of geography: (i) place or residence and housing, (ii) public transport, (iii) community services, and (iv) urban planning.

Place of residence and housing

Four governments (AU, CA, DE, GB) reported that the place of residence (urban or rural) significantly influences loneliness. Loneliness levels were also considered to vary due to population changes (AT, DE) but acknowledged that regional distribution was complex and cannot be solely attributed to urban-rural differences. Relocating to a new place was also reported to lead to feelings of being disconnected from familiar social networks and support systems. Additionally, insufficient affordable and suitable housing contributed to social isolation. Living conditions were mostly mentioned in connection with older adults where the effect of the type of housing was mentioned to affect social interactions and feelings of loneliness (CA, DK). Intervention examples to manage loneliness as a result of a change in residence, or loss of housing include working within local municipal authorities’ strategies on housing policies and reform plans (IT, DK, NL), creating models of apartments that foster community life (AL, DK), creating flexible housing solutions to support life transitions, e.g. homes that can be adjusted in size or adapted to changing needs (DK).

Public transport

The impact of public transport, especially access and affordability, was mentioned as a key issue for social integration, especially for older people (AL, CA). The place of residence (especially if rural) was recognised as a barrier to public transport use. Intervention examples that were put in place to address this issue include an increase of public transport access for the poorer older adults by subsidising the costs locally (AL, DK), and further strengthening accessible transport for communities in residential areas specifically (DK, GB).

Community services

Limited awareness of or access to community services contributed to loneliness. Financial support and grants for rural projects are needed to promote social inclusion. GB, DK and NL documents highlight the importance of the central government working together with local authorities, as the latter play a key role in actively supporting local transport, voluntary groups and initiatives that promote social cohesion and reduce isolation. Intervention examples included subsidies for community work to promote social inclusion specifically in rural areas (CZ), expanding the services in and of community centres (AL), and promoting the use of tailored community-based services (US).

Urban planning

There was general awareness that the physical environment can pose challenges to social participation, especially for the more vulnerable groups, e.g. older adults (CA), in terms of access to public toilets or walkability. Intervention examples included cultivating a sense of belonging that should be considered by urban planners (CA, IT), ensuring proximity to public services (IT), access to public toilets (CA), establishment of healthy and active movement paths (IT) aimed at encouraging walking groups (IT, CH), maximising the use of underutilised community spaces (GB), and use of participatory design in the development of child-friendly neighbourhoods in local environments (CH).

Social dimension

Most documents (90.9%, n  = 20) highlighted a range of interrelated social factors associated with loneliness; the social determinants covered various aspects of people’s lives that shape experiences of loneliness across age groups. Throughout these documents were notes on groups more vulnerable to loneliness as well as everyday life transitions and triggers. Some risk factors for loneliness such as lacking contact with family and friends, the negative impact of unemployment, and inadequate income support were also prominently highlighted.

Groups vulnerable to loneliness

Many governments identified groups more vulnerable to loneliness and social isolation, in line with research findings (AL, CA, IT, MT, NL, CH, GB, US). The following groups were identified as more vulnerable to becoming lonely or socially isolated: single parents, widows, newly retirees, single households, those living in changing family structures, immigrants with language barriers or low socioeconomic status, individuals dealing with addiction, those from the LGBTIQ + community, young adults (around 18 to 29), older adults (above 80), individuals that experience bullying or harassment, and individuals with criminal records. The importance of cultivating inclusive communities and establishing safe spaces for individuals, particularly for groups like migrants, single parents, and older adults was emphasized. Interventions were often tailored to specific groups. For example, community-led interventions targeted older adults who were homebound or in residential long-term care (MT). Others strengthened the resources of older people caring for relatives (CH), invested in a Carers Action Plan (GB), levelled up the volunteering infrastructure through collaboration of the voluntary sector and the government especially for those out-of-work (GB), developed social prescribing pilots and peer support groups (GB, US), facilitated befriending and socializing (AU), and linked vulnerable groups of people in the form of self-help and enabled them to help each other (CH). Here are some examples of targeted interventions for specific groups:

Women: language classes for women who do not speak the local language with crèche facilities alongside the classes (GB), Mitigate the risks of lifelong gender inequalities that result in female old-age poverty and gender pension gaps by ensuring adequate levels of income security for older women (MT).

Men: increase offers for older (single) men such as Men’s Meeting Places or Men’s Communities (DK), active aging centres to mitigate against the tendency of older men to experience difficulties in seeking help and talking about loneliness (MT).

Young people: Strengthen detection of loneliness in day care, primary schools and educational institutions (DK), provide education courses as a source of mitigating loneliness among children (DK), create more binding communities for young people without education and jobs (DK).

Older adults and low-income households: offer free local cultural and leisure activities (CH), increase public transport access (AL), guaranteeing the living minimum and gradual improvement of lowest pensions (AL), activation of computer literacy paths (IT).

Everyday life

The impact of events like the pandemic on individuals and communities was noted, with reference to mental well-being and social interactions, including potential changes in post-pandemic work patterns that might limit personal engagement. The absence of support or opportunities within society, communities, and workplaces is discussed as hindering social integration and fosters loneliness. The role of technology and social media as both a potential mitigating and exacerbating factor was recognized. Intervention examples include enhancement of popular traditions by developing new forms of technologically-oriented interactions, while still including cultural heritage (IT), expansion of existing community interventions (MT) including specific funding allocated to national, local, and community levels (AU), development of national and community awareness or anti-stigma campaigns (AU, CA, DK, DE, IE, NL, GB, US), and awareness spreading specifically towards politicians, administrations, managers, health care providers and others who work on loneliness (DK, US).

Health dimension

The health dimension of loneliness was very prominent in most documents (91%, n  = 21), often noting that socially isolated individuals faced an increased risk of engaging in negative health behaviours. The evidence of interconnection between chronic illnesses, mental health and social isolation was also highlighted. Overlapping with recommendations identified in the social domain, the need for policy development to prioritize social function among older individuals, aiming to enhance their overall health and well-being, was mentioned by (AT, DE, IE).

Institutional intervention examples included the development of an integrated health and social system on a community basis (AL, DK), national training for health practitioners and community care services to systematically identify, monitor and direct people experiencing loneliness (AU, DK, MT, US), linking healthcare practitioners with researchers to further evaluate and use loneliness assessment tools in clinal settings (US), and the inclusion of loneliness and social isolation in electronic health records (AU, US).

Physical health

Documents noted the evidence that individuals with higher levels of chronic diseases, geriatric syndromes, reduced mobility, chronic pain, frailty, hearing and sight impairment, urinary incontinence, or other health issues necessitating long-term care were more susceptible to loneliness. Governments acknowledged these links, often targeting interventions to support disabled people. Intervention examples included the provision of sensory impairment guides for those whose social lives are impacted by a change in their senses due to accidents or disabilities (GB), strengthening bridge-building for civil society and other actors was recommended in the context of in-system transitions and among high-risk groups (DK), the establishment of mobility centres to help people stay mobile or provide information on alternative modes of transport (GB), increased focus on digital inclusion of older and disabled to reduce loneliness as they face reduced mobility (GB), and the advancement of physical activity interventions, especially promising for improving the health outcomes of older adults (US).

Mental health

The policy documents showed empirical evidence that individuals experiencing depression, mental health problems and addiction were at risk of social exclusion. Depression and anxiety are specifically mentioned as significant factors in the context of loneliness; the consequences of loneliness are also discussed, with reference to the increased risk of depression, suicide, anxiety disorders, dementia, and reduced cognitive abilities. Intervention examples included the introduction of community care for people with mental health problems (CZ), while others focused attention on cognitive behavioural therapy, interpersonal psychotherapy and mindfulness (US). The reduction of addictive substances in populations at risk of social exclusion was targeted (CZ); mental health literacy programs were also discussed (DE, IE), specifically in reference to school education initiatives such as social emotional learning programs for use in preschool, school, and youth settings (IE); mental health literacy campaigns were also highlighted (DE, IE).

Economic dimension

Economic factors relating to loneliness were also addressed most documents (74%, n  = 17). In line with research evidence, documents noted that unemployment, receiving income support, and dissatisfaction with financial situation contribute to loneliness. The need for allocating more resources to combat poverty and address the loneliness experienced by older individuals was emphasised, with reference to the fact that it plays a crucial role in enhancing their overall well-being and quality of life. The following themes were prominent within this dimension.

Economic poverty stemming from insufficient income was identified as a key concern for the older adult population. Notably, social exclusion and family poverty were found to be directly linked, posing a risk to children as well. One document (AU) noted that men ages 25–44 years with high incomes and women of all ages with low incomes have been to be more susceptible to loneliness, revealing a discrepancy based on gender. The economic burden of loneliness extended to health service utilization costs, especially for mental health services. Intervention examples included allocating more resources to combat poverty and address the loneliness of older people specifically (IT), guaranteeing dignified living conditions through the adoption of the minimum pension and the gradual improvement of the lowest pensions by offering sustainable support for the poorer elderly was also suggested within the economic domain (AL), early support interventions for children from disadvantaged families, including support for their parents (CH), and more widely to reduce risk of social exclusion due to over-indebtedness (CZ).

Unemployment

Lack of affordable and suitable housing and care options was noted as being linked to social isolation. Loneliness and lack of social support could lead to reduced community participation, hindering employment prospects and workplace progress. This can result in reduced productivity, lower job satisfaction, increased absenteeism, and longer recovery times due to stress and health issues, which in turn negatively affects the economy. Intervention examples included facilitation of the integration of vulnerable individuals into the workforce (CZ, DK), prevention of loneliness among the unemployed through volunteerism and community initiatives (GB, DK), focus on ensuring a smooth transition from work to retirement (DK), working in collaboration with job centres (GB), and creating a cultural shift in work environments for employees at risk of social exclusion (CZ).

Political dimension

Political factors pertaining to loneliness and social isolation were only identified in few documents (30%, n  = 7), indicating less governmental awareness of the political implications of loneliness. Instances of elderly individuals being denied many rights were observed to be associated with loneliness (AL). Additionally, the effects of COVID-19 lockdown policies were connected to the loneliness because of social isolation. DE mentioned the political relevance of loneliness as it correlates with decreased political engagement of individuals. Thus, it was stated that implementing political measures at the federal level is imperative to effectively foster a more socially connected society (DE). One of the documents mentioned the need for the government to establish a comprehensive national strategy targeting loneliness, accompanied by the allocation of sufficient funding, with active engagement from regions and municipalities, especially when it comes to implementation (DK). Furthermore, the same document underscored the contribution of various other key stakeholders, including research institutions, foundations, employers, and civil society, in combating loneliness (DK). Multiple countries acknowledged the relevance of working across government bodies and levels in combatting loneliness (AU, DE, NL, GB). One document highlighted the need for a “connection-in-all-Policies” [ 62 , p.49] approach as social connection, an antidote to loneliness and social isolation, is relevant in all sectors (US).

To our knowledge, this is the first study to characterise the loneliness policy landscape across the UN European country groups (52 countries). The scoping review provided comprehensive coverage of how countries address loneliness and social isolation on a national level, allowing for a much clearer understanding of the diversity in country-level strategies and better coordination across countries in tackling loneliness. This is particularly important because loneliness and social isolation have been increasingly identified as a public health concern [ 63 , 64 ]. The findings of this review can be used by a wide range of stakeholders including federal agencies and local community groups who want to develop their own strategies to address loneliness and social isolation, or by researchers to gain an overview of the policy landscape.

Summary of principal findings

While not all governments (14 of 52 countries; 27%) had official documents that addressed loneliness, the vast number of documents we identified (79 documents) highlight the growing momentum in the loneliness discourse in the study area. The inclusion of research findings in the vision and strategy documents from different nations suggests widespread evidence-to-policy across the world and calls for a cross-disciplinary approach to addressing loneliness, including efforts to leverage asset-based community development and place-based approaches to tackling loneliness [ 65 ].

All 14 countries that published documents on loneliness demonstrated an awareness that loneliness impacted various dimensions including geography (through place of residence and housing, public transport, community services, urban planning), social (some groups are more vulnerable to loneliness than others, social support, technology), health (physical and mental), economics (income, unemployment) or politics (effects of COVID policies, political engagement, working across sectors to address loneliness). Notably, none of the documents reviewed acknowledged that (i) most research on physical health and loneliness is cross-sectional, where the researcher measures both the outcome and the exposures of the study participants at the same time, and thus, the findings of these studies cannot be used to make causal inferences, and (ii) such work does not control for other predictors of health, including, for example, socioeconomic status and actual health conditions. These are important considerations because (a) we cannot be certain that healthy individuals are more likely to get sick if they experience loneliness compared to other healthy individuals who do not experience loneliness, and (b) whether the link between loneliness and health is actually driven by structural inequalities that determine our physical and social environments. We have also found that the documents rarely mention the transient nature of loneliness and the discourse often seems to frame loneliness like an illness that can be treated. The documents also did not address the cultural context (i.e. beliefs, values, religion) that can shape expectations of relationships and the welfare regime.

Policy targets proposed in the documents

Most countries in our sample showed some attempt at raising public awareness about loneliness (AL, AU, CA, DK, DE, IE, IT, MT, NL, CH, UK, US). Such policies are often informative, but there appeared to be a lack of deadlines and appropriate funding. That means the strategy cannot be evaluated. Another point of concern is the perception that loneliness is something that only affects older adults. Some documents lacked information about how to address loneliness, probably because here is limited evidence of what works and for whom. Also absent was a commitment to evaluation of interventions, which is crucial to verify the effects of any intervention and any risks related to action.

Recommendations for policy makers

Despite the adoption of an evidence-to-policy approach to loneliness, given the issues noted above, we encourage policymakers to be cautious in making claims in relation to loneliness, and to ensure that part of their strategy includes the funding of research that fill the gaps in knowledge. Policymakers should also ensure that the work they quote includes study populations that are well-represented in all relevant demographics and that the research is able to make causal claims about how loneliness impacts health. The World Health Organisation (WHO) and the European Union have identified the limits of their own knowledge and skills in this field, commissioning experts to write evidence gap reports [ 66 , 67 ] or GB and DK for example have had loneliness researchers help write their vision and strategy.

Policymakers should also adopt a similar approach in relation to interventions that address loneliness. A recent meta-analytic review [ 68 ] suggested that in order for interventions designed to reduce loneliness to be effective, matching the intervention to the loneliness type is essential, whereas a one size fits all will not be effective. For example, social support interventions and social and emotional skills training are all promising interventions for reducing loneliness, albeit they are usually only appropriate for loneliness that is linked to the perceived absence of a close friend or partner and perceived lack social encounters and acquaintances respectively. Such an understanding of the nuances surrounding loneliness interventions is absent from the documents we evaluated, and policymakers will want to fill that gap in their knowledge so that appropriate decisions about intervention work, and suitable funding, can be provided. The effects of current interventions have been shown to be only moderate, highlighting the need for funding for rigorous and systematically developed interventions that are also appropriately evaluated.

Based on our scoping review and underlying evidence we propose a list of actionable recommendations for national and regional governments wishing to establish or incorporate loneliness into their policy documents (Table  3 ). In sum, we believe that revisiting previous national and local campaigns to identify connection points for loneliness interventions is an effective way to include loneliness into the policy agenda. For example, a walkability campaign that focuses on making cities more pedestrian friendly will benefit individuals in terms of physical health and mental health but it also increases the likelihood of social encounters when walkability is higher [ 69 ]. We also believe that sharing best-practice approaches internationally and accessible to everyone ensures the development of a strong knowledge base. The EU has taken the lead as the first supranational union to address loneliness amongst its member states by recently organizing various roundtables and conferences around loneliness [ 70 ]. Globally, WHO has recently published an evidence gap report on in-person interventions for reducing social isolation and loneliness [ 67 ]. Lastly, we argue that policies would be meaningless if there are no concrete funding streams allocated towards evidence generation, intervention design and implementation and the evaluation thereof. Because our review could not identify clear funding streams for all countries, we strongly encourage policy makers to make the funding streams transparent within their loneliness policies.

Limitations

The primary limitation of our scoping review was concerned with identifying documents from countries that did not provide information in English. That limitation was partially overcome by the use of Google’s website translator. Another limitation is the reliance on machine translation for the identified documents. Documents were translated into English from German, Danish, Finnish, French, Dutch and Norwegian using DeepL. For German and French, the quality of the translation was checked by the author team and considered sufficient to meet our study aim. The cross-sectional design of our scoping review also does not account for how a country’s policy may have changed over time. This is a general issue in policy evaluation. That limitation can be overcome by conducting this review every two to four years. Another challenge with our study is that the data reflect the existence of policies and not the effectiveness of their implementation. Further, only funding that was explicitly allocated to reducing loneliness and social isolation was considered. We acknowledge that other initiatives that received governmental funding pledges, such as establishing community centres for older adults, might also reduce feelings of loneliness. However, it is beyond the scope of the current paper to identify which initiatives specifically reduce loneliness and how much funding has been allocated to them, especially as evidence on which interventions have proven successful are scarce. Additionally, there may be other funding streams we are not aware of or that might have been part of other documents (e.g., state budgets) not included in this analysis.

More work is needed to assess if the various proposed interventions are implemented and successful. Evaluating interventions is crucial if we want to effectively use the pledged funding, to identify what tools (online or other) are being developed to promote loneliness interventions on national and regional levels and to map out the role of the emerging national loneliness networks.

Our study provides the first comprehensive overview of the national loneliness policy landscape across 52 countries, highlighting the increasing prioritisation of loneliness and social isolation as significant public health and societal issues. While the momentum in addressing loneliness is evident, with most policies being informed by scientific evidence, gaps remain, particularly around intervention strategies and their effectiveness. Our findings urge policymakers to not only sustain this momentum but to also strengthen their strategies by incorporating rigorous, evidence-based intervention evaluations and fostering international collaborations for knowledge sharing. This approach can enhance the understanding and addressing of loneliness, ensuring interventions are well-targeted, effective, and scalable. By addressing these issues, policymakers can more effectively manage loneliness by directing funds to develop and implement interventions that impact the individual (e.g. through therapy or befriending services, thereby improving public health outcomes) and the community and society by making them genuinely inclusive, thereby increasing social cohesion.

Availability of data and materials

The references to the documents supporting the conclusions of this article are provided in Table  1 . Should a link have expired, contact the corresponding author for a pdf version of the translated and original document in question.

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Acknowledgements

The authors thank the following students for assisting with compiling the dataset of government documents: Selma Akbas and Laura Baldini. The authors also thank the following students for assisting with the first round of document coding: Kim Aleppo, Izma Ahmed, Angela Benson, Emma Marchong, Sathana Sivanantham, Keyi Le, Yaxuan Shi, Ruifeng Ding and Yiming Bi. The authors would also like to thank Mahmoud M M Al Ammouri for creating the map displayed as Fig.  2 . The lead author also thanks Claudia Kessler from Public Health Services based in Switzerland for insightful discussions on the Danish and Dutch national loneliness policies.

This research was unfunded. Nina Goldman is supported by the Swiss National Science Foundation (SNSF), Bern (Grant #: 214225). Austen El-Osta is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Northwest London. The views expressed are those of the authors and not necessarily those of the SNSF, NHS, NIHR or the Department of Health and Social Care. AEO is the guarantor.

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Nina Goldman, Devi Khanna and Marie Line El Asmar contributed equally to this work.

Authors and Affiliations

Manchester Institute of Education, University of Manchester, Ellen Wilkinson Building, Devas Street, Manchester, M13 9PL, United Kingdom

Nina Goldman, Devi Khanna & Pamela Qualter

School of Public Heath, Faculty of Medicine, Imperial College London, Charing Cross Hospital, Reynolds Building, St Dunstan’s Road, London, W6 8RF, United Kingdom

Nina Goldman & Austen El-Osta

North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom

Marie Line El Asmar

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Contributions

All authors contributed substantially to this study: Conception (N.G., A.EO.) and design of the work (N.G., A.EO., P.Q.); Data collection (N.G.); Data analysis and interpretation (N.G., D.K., M.L.EA.); Drafting the article (N.G., D.K., M.L.EA.); Critical revision of the article (P.Q., A.EO.); Final approval of the version to be submitted (N.G., D.K., M.L.EA., A.EO., P.Q.)

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The authors span multiple nationalities and levels of seniority. All authors are based at three UK institutions (University of Manchester, Imperial College London and Hampshire Hospitals NHS Foundation Trust). The lead author is a human geographer researching loneliness from a spatial perspective, the second author has a background in international social and public policy, the third author is a medical doctor conducting mixed methods research in the area of public health, the fourth author is the UK's leading scientific expert on child and adolescent loneliness and the last author is a mixed methods public health researcher and is principal investigator of the Measuring Loneliness in the UK (INTERACT) study.

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Correspondence to Nina Goldman or Devi Khanna .

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Goldman, N., Khanna, D., El Asmar, M.L. et al. Addressing loneliness and social isolation in 52 countries: a scoping review of National policies. BMC Public Health 24 , 1207 (2024). https://doi.org/10.1186/s12889-024-18370-8

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Received : 06 December 2023

Accepted : 17 March 2024

Published : 01 May 2024

DOI : https://doi.org/10.1186/s12889-024-18370-8

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Main article content, public health awareness on flea infestations of domesticated goats in otapha, rivers state, nigeria, emmanuel green ekine, chinonye oluchi ezenwaka.

This study investigated flea infestation on domesticated goats in Otapha, Rivers State, Nigeria. A total of 100 domesticated goats reared in Otapha were subjected to flea screening and 61% were reported positive. Fleas were removed from the skin of goats by hand picking and by the used of forceps. The detected fleas were stored in 50% alcohol and conveyed to the laboratory for bioassay. The recovered fleas were identified to species level using flea pictorial key. Flea infestation was noticed in all the settlements where goats were sampled. The encountered flea species in this study were Ctenocephalides canis (24.4%), Ctenocephalides felis (25.6%) and Pulex irritans (50.0%). The high manifestation of flea species in this study suggests that the environmental conditions in Otapha were favourable for rapid growth and survival of flea among goats in the settlements. The result further implied that the inhabitants of Otapha lack the basic diary methods to adequately domesticate goats hence can be highly vulnerable to flea-borne infections such as murine typhus. The response, the   attitude and habit of animal owners indicated that they had zero idea concerning the necessity for veterinary visit for the purpose of disease diagnosis, animal treatment and care. Hence, they employ no precautionary measures to mitigate flea populations on the animal skin, thereby putting the animals at high risk of infestation and making goat owners more vulnerable to flea- borne infections. 

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