Background. Academic burnout and poor sleep are common among university students, and both are linked to psychological distress. Few studies have examined whether sleep quality helps explain the association between burnout and distress in student populations outside Western Europe, North America and East Asia. Methods. In a cross-sectional survey conducted between March and May 2025, 1,184 undergraduate students at four public universities in Ankara, Istanbul, Izmir and Erzurum completed the Maslach Burnout Inventory–Student Survey, the Pittsburgh Sleep Quality Index and the Kessler Psychological Distress Scale. Mediation was tested with structural equation modeling and bias-corrected bootstrap confidence intervals, adjusting for sociodemographic and academic covariates. Results. Overall, 61.8% of students reported poor sleep quality and 26.9% reported very high psychological distress. Academic burnout was associated with poorer sleep quality (β = 0.36) and with greater distress (direct β = 0.40). Sleep quality partially mediated the association between burnout and distress (indirect β = 0.12, 95% CI 0.09–0.15), accounting for 23% of the total effect. Exhaustion was the burnout dimension most strongly associated with poor sleep, and the indirect effect did not differ significantly between women and men. Conclusions. Poor sleep is a plausible pathway linking academic burnout to psychological distress among Turkish university students. Campus mental health services could combine burnout prevention with sleep-focused interventions, although longitudinal studies are needed to establish the direction of these associations.
Background. Dengue transmission in Bangladesh has intensified and spread beyond Dhaka city, yet hospital-based surveillance captures only a small fraction of infections. Population-based estimates of past infection in the rapidly growing peri-urban fringe are scarce. Methods. We conducted a community-based cross-sectional serosurvey in 32 randomly selected clusters in Savar and Keraniganj upazilas between October and December 2025. One resident aged 5–60 years was randomly selected per household, interviewed and tested for anti-dengue IgG by indirect ELISA, and each household was inspected for water-holding containers and Aedes larvae. Adjusted prevalence ratios (aPR) were estimated with modified Poisson regression and cluster-robust standard errors. Results. Of 640 households approached, 612 (95.6%) participated. Overall seroprevalence was 52.6% (95% CI 47.3–57.9), rising from 29.7% among children aged 5–14 years to 69.8% among adults aged 45–60 years. Only 58 of 322 seropositive participants (18.0%) reported a previous dengue diagnosis. Seropositivity was independently associated with water stored in uncovered containers (aPR 1.34, 95% CI 1.15–1.56), larva-positive containers at inspection (aPR 1.39, 1.19–1.62) and an active construction site within 100 m (aPR 1.18, 1.01–1.38), whereas screening on all windows was protective (aPR 0.76, 0.60–0.96). Conclusions. More than half of peri-urban residents had evidence of past dengue infection, most of it undiagnosed. Household water storage, unmanaged construction sites and unscreened housing are practical targets for integrated vector management in Dhaka's expanding periphery.
Background. Digital technologies are increasingly a condition for participating in global value chains, yet evidence on whether digital transformation improves export outcomes for small manufacturers in emerging economies is limited. This study examined whether digital transformation capability is associated with the export performance of Vietnamese manufacturing SMEs, whether international market agility mediates this association and whether export market turbulence moderates the effect of agility. Methods. Two-wave survey data were collected between October 2025 and February 2026 from owner-managers or export managers of 412 exporting manufacturing SMEs in the Ho Chi Minh City region and the Hanoi–Hai Phong corridor. Hypotheses were tested with covariance-based structural equation modeling, bootstrapped indirect effects and a latent interaction term. Results. The measurement model showed good fit, reliability and validity. Digital transformation capability was positively related to export performance (β = 0.21, p < 0.001) and to international market agility (β = 0.48, p < 0.001). Agility mediated 45% of the total effect (indirect β = 0.17, 95% CI [0.11, 0.24]), and its association with export performance was stronger under high export market turbulence (interaction β = 0.12, p = 0.009). Conclusions. Digital transformation capability supports the export performance of manufacturing SMEs mainly by enabling faster sensing of and response to foreign market change. Managers and SME support programs should pair digital investment with routines and skills that turn market information into timely commercial decisions.
Background. Chronic kidney disease of uncertain etiology (CKDu) is a leading cause of kidney failure among farming communities in the dry zone of Sri Lanka, but community-based estimates using confirmatory testing are limited. Methods. A cross-sectional survey was conducted in 2025 among adults aged 18–70 years engaged in agricultural work in 40 Grama Niladhari divisions of the Anuradhapura and Polonnaruwa districts, selected by two-stage cluster sampling. Participants completed a structured questionnaire and provided blood and urine samples. CKD was defined as an estimated glomerular filtration rate below 60 mL/min/1.73 m² or a urine albumin-to-creatinine ratio of 30 mg/g or more persisting for 3 months, and CKDu was defined with the national case definition. Associated factors were examined with multilevel logistic regression. Results. Of 3,200 adults invited, 2,946 (92.1%) participated. The prevalence of CKD was 12.3% (95% CI 10.8–13.8) and that of CKDu 9.1% (95% CI 7.8–10.4), and 82.5% of participants with CKDu were unaware of their disease. CKDu was more common in men (11.6% vs 6.2%) and increased with age. It was independently associated with drinking water from shallow dug wells (adjusted OR 2.04, 95% CI 1.47–2.83), low water intake during field work, long working hours in hot weather, agrochemical spraying without protective equipment and a family history of CKD (adjusted OR 2.37, 95% CI 1.75–3.21). Conclusions. CKDu affects about 1 in 11 agricultural workers in the North Central Province and is largely undiagnosed. Safe drinking water, measures to prevent heat stress and dehydration, protective equipment and community screening should be prioritized.
Background. Hypertensive heart disease (HHD) is a common and preventable consequence of long-standing hypertension, yet comparative data from Southeast Asia remain scarce. This study compared the determinants, clinical patterns, and treatment of HHD at two tertiary centers in Indonesia and Malaysia. Methods. We conducted a retrospective cross-sectional comparative study of 600 adults with HHD (300 per site) managed at tertiary hospitals in Makassar, Indonesia, and Kuala Terengganu, Malaysia, between January 2022 and December 2023. Demographic, clinical, echocardiographic, and prescribing data were extracted from medical records, and determinants of left ventricular hypertrophy (LVH) were assessed with multivariable logistic regression. Results. Mean age was 58.4 ± 10.7 years and 52.3% of patients were male. LVH was present in 72.0%, diastolic dysfunction in 48.7%, and heart failure with preserved ejection fraction (HFpEF) in 28.5%. Diabetes mellitus (36.8%) and dyslipidemia (41.2%) were more frequent in Makassar and were independent determinants of LVH (p < 0.05). Use of renin–angiotensin system (RAS) inhibitors was higher in Kuala Terengganu than in Makassar (68.7% vs 52.3%, p < 0.001), whereas calcium channel blockers were prescribed more often in Makassar. Conclusions. HHD at both sites carried a high burden of LVH and diastolic dysfunction, with diabetes and dyslipidemia as key modifiable determinants. The lower use of RAS inhibitors in Makassar indicates a treatment gap that could be narrowed through better formulary access and guideline-based prescribing.
Background. Screen use begins early in infancy in many urban settings, but prospective evidence linking toddler screen time to language development in Southeast Asia is limited. Methods. We recruited 642 children at their 12-month well-child visit in six government health clinics in Kuala Lumpur and followed them to 24 months. Screen time was measured with 3-day caregiver time-use diaries at 12 and 18 months. Expressive vocabulary at 24 months was assessed with validated Malay, Mandarin and Tamil adaptations of the MacArthur–Bates Communicative Development Inventories, and late talking was defined as fewer than 50 words or no word combinations. Associations were estimated with modified Poisson and linear regression adjusted for child, family and home language factors. Results. A total of 568 children (88.5%) completed the 24-month assessment. Median screen time at 18 months was 1.6 hours per day (IQR 0.8–2.7), and 208 children (36.6%) used screens for 2 hours or more daily. Late talking occurred in 25.0% of children with 2 hours or more of daily screen time compared with 9.8% of those with less than 1 hour (adjusted risk ratio 2.18, 95% CI 1.29–3.67). Each additional hour per day was associated with a 17-word smaller vocabulary (95% CI 10–24). The association was weaker when caregivers usually co-viewed (p for interaction = 0.038). Conclusions. Higher screen time at 18 months was associated with poorer expressive language at 24 months. Anticipatory guidance during well-child visits should address both the amount of screen use and caregiver engagement during viewing.
Background. Early childhood caries remains highly prevalent in India, and many affected children have limited access to restorative care. Silver diamine fluoride (SDF) and sodium fluoride varnish are both used to arrest cavitated lesions, but direct comparisons in Indian preschool populations are scarce. Methods. In this examiner-blinded, parallel-group randomized controlled trial, children aged 36–71 months with at least one active cavitated dentin lesion were recruited from 24 anganwadi centers and preschools in Chennai and allocated to 38% SDF applied every 6 months or 5% sodium fluoride varnish applied every 3 months. The primary outcome was lesion arrest at 12 months, assessed by visual-tactile examination and analyzed with generalized estimating equations to account for clustering within children. Results. A total of 222 children with 979 lesions were randomized, and 205 (92.3%) completed follow-up. At 12 months, 71.9% of lesions treated with SDF and 43.2% of those treated with varnish were arrested (adjusted odds ratio 3.24, 95% CI 2.31–4.55; p < 0.001). All lesions were arrested in 46.2% versus 18.8% of children, respectively. New lesion development did not differ between groups. Parental satisfaction with appearance was lower in the SDF group (68.3% vs 89.1%), and adverse events were mild and transient. Conclusions. Semiannual 38% SDF arrested substantially more cavitated lesions than quarterly fluoride varnish over 12 months. Its low cost and simplicity support its use in community programs for preschool children in India, provided that parents are counseled about permanent black staining.
Background. Anemia affects more than half of adolescent girls in India despite national programs for weekly iron and folic acid supplementation (WIFS) and deworming. Evidence on local determinants is needed to target interventions in rural and tribal communities. Methods. We conducted a community-based cross-sectional study among girls aged 10–19 years in 30 villages of Junnar and Ambegaon talukas, Pune district, between November 2025 and February 2026. Hemoglobin was measured in venous blood with an automated hematology analyzer, and anemia was defined using World Health Organization age-specific thresholds. Sociodemographic, dietary, menstrual and program exposure data were collected by interview, and determinants were assessed with multilevel logistic regression. Results. Of 880 eligible girls, 836 (95.0%) participated. The prevalence of anemia was 53.9% (451/836): 29.5% mild, 22.2% moderate and 2.2% severe. In adjusted analysis, anemia was associated with heavy or prolonged menstrual bleeding (adjusted odds ratio, aOR 2.05, 95% CI 1.36–3.09), thinness (aOR 1.72, 1.17–2.53) and scheduled tribe status (aOR 1.41, 1.03–1.93). Consuming at least 8 of 12 WIFS tablets in the previous 3 months (aOR 0.61, 0.45–0.83), minimum dietary diversity (aOR 0.66, 0.48–0.91) and deworming in the past year (aOR 0.74, 0.55–0.99) were associated with lower odds of anemia. Conclusions. Anemia remains highly prevalent among rural adolescent girls in western Maharashtra. Improving adherence to weekly supplementation, addressing heavy menstrual bleeding and thinness, and promoting dietary diversity, especially in tribal communities, should be priorities for the Anemia Mukt Bharat program.
Background. School closures and the shift to online learning during the COVID-19 pandemic increased screen time and reduced outdoor activity among children, raising concern about faster myopia onset. Population-based data on myopia among Indian schoolchildren after the pandemic are limited. Methods. A school-based cross-sectional survey was conducted between August and December 2025 in 30 government and private schools in urban Delhi selected by stratified cluster random sampling. Children aged 6–15 years underwent visual acuity testing and cycloplegic autorefraction, and parents completed a questionnaire on outdoor time, screen use, near work and parental myopia. Myopia was defined as a spherical equivalent of −0.50 D or less in either eye. Risk factors were examined using multivariable logistic regression accounting for clustering by school. Results. Of 5,400 eligible children, 4,862 (90.0%) completed the examination. The prevalence of myopia was 21.4% (95% CI 19.9–22.9), rising from 9.8% at 6–8 years to 32.2% at 12–15 years, and high myopia was found in 1.1%. Among myopic children, 61.2% were uncorrected or undercorrected. Myopia was independently associated with older age, female sex, private schooling, parental myopia (both parents: adjusted OR 3.12, 95% CI 2.41–4.04), spending less than 1 hour a day outdoors (adjusted OR 2.08, 95% CI 1.66–2.61) and recreational screen time above 3 hours a day (adjusted OR 1.92, 95% CI 1.53–2.41). Conclusions. About one in five schoolchildren in urban Delhi was myopic after the pandemic, a higher prevalence than reported in earlier surveys of the city. School-based programs that increase outdoor time, limit recreational screen use and provide spectacles are needed.
Background. Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery and is associated with stroke and mortality, yet rhythm monitoring usually ends when telemetry is discontinued or the patient is discharged. We assessed how many additional cases are detected by continuous wearable electrocardiogram (ECG) patch monitoring. Methods. In this prospective cohort study, consecutive adults without previous atrial fibrillation undergoing coronary artery bypass grafting (CABG), valve surgery, or both at a tertiary heart center between March 2024 and February 2025 wore a single-lead ECG patch for 14 days, applied at the end of surgery, in addition to standard care with in-hospital telemetry, daily 12-lead ECGs, and symptom-driven assessment. The primary outcome was atrial fibrillation lasting 30 seconds or longer. Results. Of 412 enrolled patients, 398 (96.6%) had at least 72 hours of analyzable recording (mean age 66.2 ± 9.4 years; 24.6% women). Standard care detected POAF in 112 patients (28.1%), whereas the patch detected it in 151 (37.9%), identifying 39 additional patients (9.8%). In 27 of these 39 patients (69.2%), the first episode occurred after discharge, and 31 (79.5%) were asymptomatic. Episodes lasted 24 hours or longer in 6 patients, and oral anticoagulation was started in 14 (35.9%). Skin irritation occurred in 7.3% of patients. Conclusions. Extended patch monitoring detected POAF in about one in ten patients in whom standard care found none, mostly after discharge and without symptoms. Its effect on anticoagulation decisions and clinical outcomes should be evaluated in randomized trials.