Special Journal of the Medical Academy and other Life Sciences.

PARENTAL KNOWLEDGE AND PRACTICES REGARDING SCREEN TIME AND ITS PERCEIVED IMPACT ON CHILD BEHAVIOR IN THE MALDIVES: A CROSS-SECTIONAL STUDY

Aishath Raya Nashid — 2026-08-16

Background: Excessive screen time among children has become a growing public health concern due to its potential effects on behavioural and developmental outcomes. In the Maldives, increasing access to digital devices has raised concerns regarding children's screen exposure and the role of parents in managing screen use. This study assessed parental knowledge and practices regarding screen time and examined its perceived impact on child behaviour.

Methods and Material: A cross-sectional study was conducted among 92 parents of children aged 5–15 years in the Maldives. Data were collected through an online questionnaire assessing parental knowledge, screen time management practices, children's screen use patterns, and perceived behavioural outcomes. Descriptive and comparative analyses were performed.

Results: Most parents were aware of recommended screen time guidelines and recognized the potential negative effects of excessive screen use. However, consistent enforcement of screen time rules varied. Television and smartphones were the most commonly used devices, with most children spending one to four hours daily on screens. Parents frequently reported reduced attention span, irritability, and sleep disturbances among children. Reduced attention problems were less common among children whose parents consistently enforced screen time rules.

Conclusion: Although parental awareness of screen time recommendations was high, implementation of effective screen time management practices was inconsistent. Strengthening parental guidance, promoting consistent screen time rules, and encouraging balanced daily routines may help reduce behavioural problems associated with excessive screen exposure among children in the Maldives.

COMPARATIVE ANALYSIS OF BIOIDENTICAL AND CONVENTIONAL HORMONE REPLACEMENT THERAPY IN MENOPAUSAL WOMEN: CLINICAL EFFICACY, SAFETY PROFILE, ECONOMIC IMPACT, AND CROSS-COUNTRY PERSPECTIVES

Chavan Akanksha Mahendra — 2026-08-16

Background: Menopause is a significant physiological transition characterized by declining ovarian hormone production and associated vasomotor, urogenital, psychological, and metabolic symptoms. Hormone Replacement Therapy (HRT) remains a cornerstone of menopausal symptom management; however, concerns regarding its long-term safety have increased interest in Bioidentical Hormone Replacement Therapy (BHRT). Differences in healthcare accessibility, socioeconomic conditions, and cultural attitudes further influence treatment selection worldwide. This study aimed to compare the efficacy, safety, economic burden, and utilization patterns of BHRT and conventional HRT among menopausal women across countries with diverse healthcare systems and Human Development Index (HDI) levels.

Methods and Materials: A retrospective cross-sectional comparative study was conducted using clinical and economic data collected between 2019 and 2024 from menopausal women aged 46–52 years in India, the United States, Malaysia, Brazil, South Africa, and Switzerland. Women receiving either BHRT or conventional HRT for at least six months were included. Data regarding symptom severity, treatment outcomes, adverse events, hormone-related cancer risks, cardiovascular complications, treatment costs, and patient satisfaction were analyzed using descriptive and comparative statistical methods. Multivariate analyses were performed to evaluate associations between therapy type and clinical outcomes while adjusting for demographic and country-specific factors.

Results: BHRT demonstrated superior symptom relief compared with conventional HRT, achieving greater reductions in hot flashes (80–90% vs. 50–70%), vaginal dryness (80–90% vs. 50–70%), night sweats (70–80% vs. 40–60%), and mood disturbances (70–80% vs. 40–60%). Lower incidences of breast, ovarian, and endometrial cancers were observed among BHRT users. Patient satisfaction and quality-of-life improvements were substantially higher in the BHRT group. However, BHRT costs were approximately 1.5–2 times greater than conventional HRT across all participating countries, limiting accessibility in low- and middle-income settings. High-HDI countries demonstrated greater utilization of personalized hormone therapies, whereas cost considerations strongly influenced treatment preferences in lower-HDI nations.

Conclusion: BHRT appears to offer superior clinical efficacy, improved quality-of-life outcomes, and a more favorable safety profile than conventional HRT for menopausal symptom management. Nevertheless, its higher cost and limited accessibility remain significant barriers to widespread adoption. Treatment selection should be individualized, balancing symptom severity, safety considerations, patient preferences, and economic factors. Future longitudinal studies with standardized BHRT formulations are needed to establish definitive evidence regarding long-term efficacy, safety, and cost-effectiveness across diverse populations.

IMPLEMENTATION OF A MENTAL HEALTH AWARENESS PROGRAM FOR EMPLOYEES OF A LOCAL ORGANIZATION

Afolabi Abdul-Raheem — 2026-08-16

Background: Workplace mental health has become a critical organizational concern due to increasing rates of stress, burnout, anxiety, and reduced employee well-being. Mental health challenges negatively affect productivity, job satisfaction, employee retention, and overall organizational performance. Sandbox Inc., a mid-sized technology company in Seattle, Washington, identified a growing need for structured mental health support due to rising absenteeism, stress-related concerns, and limited awareness of available resources. This project aimed to design, implement, and evaluate a Mental Health Awareness Program focused on increasing awareness, reducing stigma, promoting help-seeking behaviors, and fostering a supportive workplace culture.

Methods and Materials: A workplace-based intervention was implemented among approximately 500 employees at Sandbox Inc. The program included a comprehensive needs assessment using anonymous employee surveys and interviews with human resource personnel and managers. Based on the findings, two interactive workshops were developed and delivered by licensed mental health professionals. Additional interventions included the development of a digital and print mental health resource guide and the establishment of a peer support network supervised by the Human Resources department. Program effectiveness was evaluated using pre- and post-intervention surveys, workshop feedback forms, participation metrics, and qualitative feedback from employees and managers.

Results: The program demonstrated positive outcomes across multiple indicators of employee well-being and engagement. Employee comfort discussing mental health issues in the workplace increased from 41% to 67% following program implementation. Approximately 73% of workshop participants reported confidence in applying stress-management strategies learned during training. Workshop evaluations indicated that more than 85% of participants found the sessions highly useful and relevant. Utilization of workplace mental health resources improved, with the employee assistance program usage increasing from 4% to 9%. The peer support network maintained regular participation, while qualitative feedback suggested improvements in workplace communication, psychological safety, and organizational support for mental health.

Conclusion: The Mental Health Awareness Program effectively enhanced employee awareness, reduced stigma, increased confidence in managing workplace stress, and promoted access to mental health resources. The combination of educational workshops, resource materials, leadership support, and peer-based interventions contributed to positive cultural and behavioral changes within the organization. Sustained organizational commitment, ongoing training, expanded accessibility, and long-term evaluation are recommended to strengthen and maintain the benefits of workplace mental health initiatives. This project demonstrates that structured mental health programs can serve as valuable organizational strategies for improving employee well-being and fostering healthier workplace environments.

DEVELOPMENT AND IMPLEMENTATION OF A CHRONIC DISEASE SELF-MANAGEMENT EDUCATION (CDSME)

One Jessica Tsedi — 2026-08-16

Background: Chronic diseases such as diabetes, hypertension, cardiovascular disease, and arthritis are among the leading causes of morbidity, mortality, and healthcare expenditure worldwide. Effective management of these conditions requires continuous self-care, lifestyle modification, medication adherence, and informed decision-making. Chronic Disease Self-Management Education (CDSME) programs have emerged as evidence-based interventions that empower patients to actively participate in managing their health while improving quality of life and reducing preventable healthcare utilization. This project aimed to develop and implement a comprehensive CDSME framework within a community-based primary care clinic to enhance patient self-efficacy, health literacy, and long-term disease management outcomes.

Methods and Materials: A comprehensive program development approach was employed, integrating principles from public health, health education, and healthcare administration. An extensive review of current literature, evidence-based CDSME models, and expert consultations informed the design of a six-week educational intervention. The program incorporated structured curriculum development, facilitator training modules, participant educational materials, implementation workflows, and evaluation tools. Core curriculum components included chronic disease education, medication management, nutrition, physical activity, stress management, and effective communication with healthcare providers. Evaluation strategies included pre- and post-program assessments of knowledge, self-efficacy, satisfaction, attendance, and behavioural outcomes.

Results: The project resulted in the successful development of a comprehensive, evidence-based CDSME program framework tailored for implementation in community-based primary care settings. The curriculum emphasized patient empowerment, goal-setting, problem-solving skills, peer support, and culturally responsive education. Research findings supporting the program demonstrated that CDSME interventions improve disease knowledge, self-management behaviours, medication adherence, physical activity participation, and healthcare engagement while reducing emergency department visits and hospitalizations. The program framework also incorporated organizational integration strategies, facilitator training protocols, and continuous quality improvement measures to support sustainability and scalability.

Conclusion: The development and implementation of a Chronic Disease Self-Management Education program provide a practical and sustainable strategy for improving chronic disease outcomes and promoting patient-centred care. By enhancing self-efficacy, health literacy, and behavioural change, CDSME programs can contribute to improved health outcomes, reduced healthcare utilization, and increased organizational efficiency. The proposed framework offers a scalable model for community-based healthcare organizations seeking to strengthen chronic disease management, advance health equity, and support long-term population health improvement.

EPIDEMIC OF RHEUMATIC HEART DISEASE (RHD): A COST-BENEFIT MODEL COMPARING INVESTMENT IN PRIMARY PREVENTION (PENICILLIN FOR STREP THROAT) VERSUS BUILDING SURGICAL CAPACITY FOR VALVE REPAIR/REPLACEMENT IN A SPECIFIC LMIC REGION

Christopher G. Van Wyk — 2026-08-16

Background: Rheumatic Heart Disease (RHD) remains one of the leading causes of preventable cardiovascular morbidity and mortality in low- and middle-income countries (LMICs), particularly within the Southern African Development Community (SADC). Policymakers face a critical resource-allocation dilemma: whether to prioritize investment in primary prevention through the treatment of Group A Streptococcal pharyngitis with penicillin or to invest in costly surgical infrastructure for valve repair and replacement. This project aimed to evaluate the economic and public health impact of these competing strategies and identify the most effective policy pathway for reducing the burden of RHD across the SADC region.

Methods and Materials: A regionally calibrated cost-benefit analysis was conducted using a Markov cohort model developed in Microsoft Excel with Visual Basic for Applications (VBA). The model simulated disease progression from streptococcal pharyngitis to acute rheumatic fever and advanced RHD over a 15-year horizon (2026–2040). Data were obtained through systematic literature review, national health accounts, SADC procurement databases, WHO datasets, and stakeholder consultations. Costs, disability-adjusted life years (DALYs), benefit-cost ratios (BCRs), and net present values (NPVs) were calculated for primary prevention, surgical intervention, and hybrid investment scenarios. Sensitivity and probabilistic analyses were performed to evaluate model robustness.

Results: Primary prevention demonstrated superior economic performance, generating a BCR of 6.2:1, a net present value of approximately $187 million, and an estimated 42,000 DALYs averted. In comparison, investment in surgical capacity alone yielded a BCR of 0.9:1, a negative net present value of approximately $23 million, and 8,500 DALYs averted. However, prevention-only strategies failed to address the existing backlog of approximately 85,000 patients with advanced RHD requiring surgical intervention. A phased hybrid strategy combining prevention scale-up with the establishment of a regional surgical center in Zambia achieved a BCR of 4.3:1 while reducing the surgical backlog by 85% over the study period. Sensitivity analyses confirmed the robustness of these findings across a wide range of epidemiological and economic assumptions.

Conclusion: Primary prevention of RHD through timely diagnosis and penicillin treatment represents the most cost-effective investment for SADC member states. Nevertheless, exclusive reliance on prevention raises significant ethical concerns due to the unmet needs of patients with advanced disease. A phased hybrid approach that prioritizes prevention while strategically expanding regional surgical capacity offers the optimal balance between economic efficiency, equity, and long-term population health improvement. The findings provide a practical framework for policymakers seeking sustainable solutions to reduce the burden of RHD in resource-constrained settings.