Objective: to study the effect of early dysphagia screening and rehabilitation nursing on the health of patients with Alzheimer's disease. Methods: 108 patients with Alzheimer's disease who went to our hospita...Objective: to study the effect of early dysphagia screening and rehabilitation nursing on the health of patients with Alzheimer's disease. Methods: 108 patients with Alzheimer's disease who went to our hospital for treatment from December 2018 to January 2021 were selected and divided into reference group and experimental group according to the computer grouping method, with 54 patients in each group. The reference group received general nursing intervention, while the experimental group received early dysphagia screening and rehabilitation nursing. The effects of the two intervention measures on the health level of the two groups were observed and compared. Results: after the nursing intervention, the dysphagia of the experimental group was greatly reduced, and the health indicators of the two groups were better than those of the reference group, with statistical significance (P < 0.05). Conclusion: in the nursing of patients with Alzheimer's disease, early screening of dysphagia and rehabilitation nursing can help to implement targeted rehabilitation nursing in time, optimize the swallowing function of patients with Alzheimer's disease, improve the health level of patients and the quality of life of elderly patients.展开更多
To investigate the impact of digital literacy on the health of older adults,based on the four-wave micropanel data from the China Family Panel Studies,a digital literacy indicator system was constructed using the fact...To investigate the impact of digital literacy on the health of older adults,based on the four-wave micropanel data from the China Family Panel Studies,a digital literacy indicator system was constructed using the factor analysis method.The health of older adults was characterized from the perspectives of overall health levels and internal health inequalities among older adults,and the theoretical mechanism was empirically examined through fixed-effects regression,threshold,and moderating-effects models.Policy recommendations are proposed to accelerate the construction of a digital literacy cultivation system for the elderly,promote digitally empowered public health services,and encourage age-appropriate upgrading of digital health facilities.The results show that for every 1-unit increase in digital literacy,the overall self-assessed health level of the elderly increases by approximately 0.052 units on average,and the health relative deprivation index,which reflects health inequalities of older adults,decreased by about 0.013 units on average.There was heterogeneity in the effect of digital literacy on the health of the elderly,which was more significant among rural-dwelling elderly people,those aged more than 65 years,and females.The mechanism analysis shows that the variables reflecting medical experience and health management awareness play a moderating role in channels through which digital literacy affects older adults’health.展开更多
The total concentrations of Cd,As,Pb,Cr,Ni,Co,Zn,Cu,Ag,Hg,and Mo were determined in the atmospheric dust of the city of Yerevan by atomic absorption spectrometry(AAnalyst PE 800).Heavy metal pollution levels were eval...The total concentrations of Cd,As,Pb,Cr,Ni,Co,Zn,Cu,Ag,Hg,and Mo were determined in the atmospheric dust of the city of Yerevan by atomic absorption spectrometry(AAnalyst PE 800).Heavy metal pollution levels were evaluated by calculating geo-accumulation(I_(geo)) and summary pollution(Z_c) indices.Potential human health risk was assessed using the United States Environmental Protection agency's human health risk assessment model.The results show that mean contents of all elements tested except Ni and Cr were substantially higher than local geochemical background values.According to the I_(geo),Yerevan territory is strongly-to-extremely polluted by As,Ag,Hg,Mo,and Cd.The Z_c assessment indicated that very high pollution was detected in 36%of samples,high in 32%,average in 12%,and low in 20%.The health risk assessment revealed a noncarcinogenic risk(HI >1) for children at 13 samplings sites and for adults at one sampling site.For children the risk was due to elevated levels of Mo,Cd,Co,and As,while for adults,only Mo.Carcinogenic risk(>1:1,000,000) of As and Cr via ingestion pathway was observed in 25 and 14 samples,respectively.This study,therefore,is the base for further detailed investigations to organize problematic site remediation and risk reduction measures.展开更多
Germany,as a western developed country,has an advanced medical level,especially in the health care of very immature premature infants.We trace the medical history of perinatology to understand the development of perin...Germany,as a western developed country,has an advanced medical level,especially in the health care of very immature premature infants.We trace the medical history of perinatology to understand the development of perinatal centers in Germany.After analyzing the classification and function,hierarchical management and quality control systems of German perinatal centers,we established a German standard level 1 perinatal center in the Chongqing Health Center for Women and Children(CHCWC).During more than two years of practice,we changed concepts,continuously updated clinical knowledge and skills,developed a series o f high-quality work processes and supervision systems and introduced advanced medical equipment.We believe that the experience of establishing a German standard level 1 perinatal center and perinatal center network in Chongqing is worthy of being promoted to the Chinese maternal and child health care system.展开更多
Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) ...Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.展开更多
This is an experimental study conducted on two groups of control and experimental using pretestposttest design, applying psychological intervention on the study sample. The present study aimed to determine the effecti...This is an experimental study conducted on two groups of control and experimental using pretestposttest design, applying psychological intervention on the study sample. The present study aimed to determine the effectiveness of collective education life skills on mental health and resilience of teachers in Zahedan. The population of the study included all teachers at schools with normal students and teachers at schools with exceptional students in Zahedan, among which 60 teachers at normal schools and 20 teachers at exceptional schools were selected and placed in two groups of experimental and control, respectively. Initially, members of the experimental group were taught 10 basic life skills in 10 2-hour sessions. Mental health and resilience questionnaires were distributed and gathered before and after the training sessions. Results indicated the positive effect of life skills training on mental health of teachers at schools with normal students and teachers at schools with exceptional students, which meant that the more the life skills training to teachers at schools with normal students and teachers at schools with exceptional students, the lower their mental health scores would be. Results also indicated the positive effect of life skills training on resilience of teachers at schools with normal students and teachers at schools with exceptional students, which meant that the more the life skills training to teachers at schools with normal students and teachers at schools with exceptional students, the higher their resilience scores would be.展开更多
BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and familie...BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and families.By integrating patient information across these three domains,it facilitates the delivery of tailored guidance,health risk assessments,and three-in-one health education.AIM To explore the effects of the HCH-CHM model on stroke risk reduction in highrisk populations.METHODS In total,110 high-risk stroke patients screened in the community from January 2019 to January 2023 were enrolled,with 52 patients in the control group receiving routine health education and 58 in the observation group receiving HCH-CHM model interventions based on routine health education.Stroke awareness scores,health behavior levels,medication adherence,blood pressure,serum biochemical markers(systolic/diastolic blood pressure,total cholesterol,and triglyceride),and psychological measures(self-rating anxiety/depression scale)were evaluated and compared between groups.RESULTS The observation group showed statistically significant improvements in stroke awareness scores and health behavior levels compared to the control group(P<0.05),with notable enhancements in lifestyle and dietary habits(P<0.05)and reductions in postintervention systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,self-rating anxiety scale,and self-rating depression scale scores(P<0.05).CONCLUSION The HCH-CHM model had a significant positive effect on high-risk stroke populations,effectively increasing disease awareness,improving health behavior and medication adherence,and appropriately ameliorating blood pressure,serum biochemical marker levels,and negative psychological symptoms.展开更多
This study maintains that university-level physical education does not currently include or implement health education.? As a consequence of this, college and university students have a very weak theoretical understan...This study maintains that university-level physical education does not currently include or implement health education.? As a consequence of this, college and university students have a very weak theoretical understanding of health.? This study maintains that university-level physical education should focus on the state of students’ health, using the principles of the health quotient.? Of particular importance are problems related to mental health, social adaptive ability, and lifestyle.? Physical education should incorporate instruction based on health quotient-related theories and techniques;doing so will lay a strong foundation for students’ lifelong physical education.? In addition to opening up new paths and methods in research related to the all-around health education of college students, this can also enrich and perfect the theoretical system of modern sports science, as well as provide a new line of thinking and perspective to university-level physical education reform.展开更多
Background: To identify health concerns of veterans with high-level lower extremity amputations.Methods: Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists,p...Background: To identify health concerns of veterans with high-level lower extremity amputations.Methods: Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists,physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire(SF-36) that assessed their ability to perform activities of daily living(ADL), instrumental activities of daily living(IADL) and life satisfaction(SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs.Results: The means of the Physical Component Summary(PCS), Mental Component Summary(MCS), SWLS, ADL and IADL were 48.58±29.6, 33.33±22.0, 19.30±7.7, 48.10±10.5 and 5.08±1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders;among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma(49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study.The Canadian-type of prosthesis was uncomfortable and not useful(27%) and excessively heavy(10%) according to the amputees.Conclusions: Understanding veterans’ characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.展开更多
Purpose: Physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to define the relationship between the physical activity level (PAL) and adult Saudi health-related quality of lif...Purpose: Physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to define the relationship between the physical activity level (PAL) and adult Saudi health-related quality of life (HRQoL). Methods: Participants of this study were 100 Saudi adult aged from 18 - 70 years. The 36-Item Short-Form Health Status Survey (SF-36) was used to measure the participant’s HRQoL. The SF-36 is comprised of 8 domains. The electronic version of the General Practice Physical Activity Questionnaire was used to categorize participants in terms of physical activity level into;inactive, moderately inactive, moderately active, and active. Descriptive and inferential statistical tests were used to treat the collected data. Results: Results showed that only 17% of the Saudi adults had active PAL. The PAL had significantly positive relationship with 4 domains of HRQoL including: physical functioning (P = 0.004), role limitations caused by physical health problems (P = 0.048), vitality (P = 0.009), and general health (P = 0.044). Results also confirmed that the younger the subject, the higher the PAL (P = 0.0001) and the better the HRQoL. This is true for all domains except the role limitations caused by emotional problems and emotional wellbeing. Conclusion: The poor physical activity level of adult Saudi negatively impacts their HRQoL.展开更多
In China, sports and physical activity （PA） have tradition- ally been an integral part of school curricula to promote fitness and enhance healthy growth among children and ado- lescents. Three decades of economic re...In China, sports and physical activity （PA） have tradition- ally been an integral part of school curricula to promote fitness and enhance healthy growth among children and ado- lescents. Three decades of economic reforms, however, have brought major changes in social, economic.展开更多
文摘Objective: to study the effect of early dysphagia screening and rehabilitation nursing on the health of patients with Alzheimer's disease. Methods: 108 patients with Alzheimer's disease who went to our hospital for treatment from December 2018 to January 2021 were selected and divided into reference group and experimental group according to the computer grouping method, with 54 patients in each group. The reference group received general nursing intervention, while the experimental group received early dysphagia screening and rehabilitation nursing. The effects of the two intervention measures on the health level of the two groups were observed and compared. Results: after the nursing intervention, the dysphagia of the experimental group was greatly reduced, and the health indicators of the two groups were better than those of the reference group, with statistical significance (P < 0.05). Conclusion: in the nursing of patients with Alzheimer's disease, early screening of dysphagia and rehabilitation nursing can help to implement targeted rehabilitation nursing in time, optimize the swallowing function of patients with Alzheimer's disease, improve the health level of patients and the quality of life of elderly patients.
基金The National Natural Science Foundation of China(No.72071042).
文摘To investigate the impact of digital literacy on the health of older adults,based on the four-wave micropanel data from the China Family Panel Studies,a digital literacy indicator system was constructed using the factor analysis method.The health of older adults was characterized from the perspectives of overall health levels and internal health inequalities among older adults,and the theoretical mechanism was empirically examined through fixed-effects regression,threshold,and moderating-effects models.Policy recommendations are proposed to accelerate the construction of a digital literacy cultivation system for the elderly,promote digitally empowered public health services,and encourage age-appropriate upgrading of digital health facilities.The results show that for every 1-unit increase in digital literacy,the overall self-assessed health level of the elderly increases by approximately 0.052 units on average,and the health relative deprivation index,which reflects health inequalities of older adults,decreased by about 0.013 units on average.There was heterogeneity in the effect of digital literacy on the health of the elderly,which was more significant among rural-dwelling elderly people,those aged more than 65 years,and females.The mechanism analysis shows that the variables reflecting medical experience and health management awareness play a moderating role in channels through which digital literacy affects older adults’health.
基金implemented in the frames of a theme "Studying geochemical stream of elements in atmospheric air of Yerevan"(No 13-1E220,2011) under agreement-based(thematic) financial support of the State Committee of Science to the Ministry of Education and Sciences RA
文摘The total concentrations of Cd,As,Pb,Cr,Ni,Co,Zn,Cu,Ag,Hg,and Mo were determined in the atmospheric dust of the city of Yerevan by atomic absorption spectrometry(AAnalyst PE 800).Heavy metal pollution levels were evaluated by calculating geo-accumulation(I_(geo)) and summary pollution(Z_c) indices.Potential human health risk was assessed using the United States Environmental Protection agency's human health risk assessment model.The results show that mean contents of all elements tested except Ni and Cr were substantially higher than local geochemical background values.According to the I_(geo),Yerevan territory is strongly-to-extremely polluted by As,Ag,Hg,Mo,and Cd.The Z_c assessment indicated that very high pollution was detected in 36%of samples,high in 32%,average in 12%,and low in 20%.The health risk assessment revealed a noncarcinogenic risk(HI >1) for children at 13 samplings sites and for adults at one sampling site.For children the risk was due to elevated levels of Mo,Cd,Co,and As,while for adults,only Mo.Carcinogenic risk(>1:1,000,000) of As and Cr via ingestion pathway was observed in 25 and 14 samples,respectively.This study,therefore,is the base for further detailed investigations to organize problematic site remediation and risk reduction measures.
文摘Germany,as a western developed country,has an advanced medical level,especially in the health care of very immature premature infants.We trace the medical history of perinatology to understand the development of perinatal centers in Germany.After analyzing the classification and function,hierarchical management and quality control systems of German perinatal centers,we established a German standard level 1 perinatal center in the Chongqing Health Center for Women and Children(CHCWC).During more than two years of practice,we changed concepts,continuously updated clinical knowledge and skills,developed a series o f high-quality work processes and supervision systems and introduced advanced medical equipment.We believe that the experience of establishing a German standard level 1 perinatal center and perinatal center network in Chongqing is worthy of being promoted to the Chinese maternal and child health care system.
文摘Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.
文摘This is an experimental study conducted on two groups of control and experimental using pretestposttest design, applying psychological intervention on the study sample. The present study aimed to determine the effectiveness of collective education life skills on mental health and resilience of teachers in Zahedan. The population of the study included all teachers at schools with normal students and teachers at schools with exceptional students in Zahedan, among which 60 teachers at normal schools and 20 teachers at exceptional schools were selected and placed in two groups of experimental and control, respectively. Initially, members of the experimental group were taught 10 basic life skills in 10 2-hour sessions. Mental health and resilience questionnaires were distributed and gathered before and after the training sessions. Results indicated the positive effect of life skills training on mental health of teachers at schools with normal students and teachers at schools with exceptional students, which meant that the more the life skills training to teachers at schools with normal students and teachers at schools with exceptional students, the lower their mental health scores would be. Results also indicated the positive effect of life skills training on resilience of teachers at schools with normal students and teachers at schools with exceptional students, which meant that the more the life skills training to teachers at schools with normal students and teachers at schools with exceptional students, the higher their resilience scores would be.
基金Supported by Guiding Project of Hebei Provincial Health Commission,No.20201190 and 20180220.
文摘BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and families.By integrating patient information across these three domains,it facilitates the delivery of tailored guidance,health risk assessments,and three-in-one health education.AIM To explore the effects of the HCH-CHM model on stroke risk reduction in highrisk populations.METHODS In total,110 high-risk stroke patients screened in the community from January 2019 to January 2023 were enrolled,with 52 patients in the control group receiving routine health education and 58 in the observation group receiving HCH-CHM model interventions based on routine health education.Stroke awareness scores,health behavior levels,medication adherence,blood pressure,serum biochemical markers(systolic/diastolic blood pressure,total cholesterol,and triglyceride),and psychological measures(self-rating anxiety/depression scale)were evaluated and compared between groups.RESULTS The observation group showed statistically significant improvements in stroke awareness scores and health behavior levels compared to the control group(P<0.05),with notable enhancements in lifestyle and dietary habits(P<0.05)and reductions in postintervention systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,self-rating anxiety scale,and self-rating depression scale scores(P<0.05).CONCLUSION The HCH-CHM model had a significant positive effect on high-risk stroke populations,effectively increasing disease awareness,improving health behavior and medication adherence,and appropriately ameliorating blood pressure,serum biochemical marker levels,and negative psychological symptoms.
文摘This study maintains that university-level physical education does not currently include or implement health education.? As a consequence of this, college and university students have a very weak theoretical understanding of health.? This study maintains that university-level physical education should focus on the state of students’ health, using the principles of the health quotient.? Of particular importance are problems related to mental health, social adaptive ability, and lifestyle.? Physical education should incorporate instruction based on health quotient-related theories and techniques;doing so will lay a strong foundation for students’ lifelong physical education.? In addition to opening up new paths and methods in research related to the all-around health education of college students, this can also enrich and perfect the theoretical system of modern sports science, as well as provide a new line of thinking and perspective to university-level physical education reform.
基金financially supported by Janbazan Medical and Engineering Research Center(JMERC)
文摘Background: To identify health concerns of veterans with high-level lower extremity amputations.Methods: Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists,physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire(SF-36) that assessed their ability to perform activities of daily living(ADL), instrumental activities of daily living(IADL) and life satisfaction(SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs.Results: The means of the Physical Component Summary(PCS), Mental Component Summary(MCS), SWLS, ADL and IADL were 48.58±29.6, 33.33±22.0, 19.30±7.7, 48.10±10.5 and 5.08±1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders;among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma(49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study.The Canadian-type of prosthesis was uncomfortable and not useful(27%) and excessively heavy(10%) according to the amputees.Conclusions: Understanding veterans’ characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.
文摘Purpose: Physical inactivity in Saudi Arabia is a growing challenge to public health. This study aimed to define the relationship between the physical activity level (PAL) and adult Saudi health-related quality of life (HRQoL). Methods: Participants of this study were 100 Saudi adult aged from 18 - 70 years. The 36-Item Short-Form Health Status Survey (SF-36) was used to measure the participant’s HRQoL. The SF-36 is comprised of 8 domains. The electronic version of the General Practice Physical Activity Questionnaire was used to categorize participants in terms of physical activity level into;inactive, moderately inactive, moderately active, and active. Descriptive and inferential statistical tests were used to treat the collected data. Results: Results showed that only 17% of the Saudi adults had active PAL. The PAL had significantly positive relationship with 4 domains of HRQoL including: physical functioning (P = 0.004), role limitations caused by physical health problems (P = 0.048), vitality (P = 0.009), and general health (P = 0.044). Results also confirmed that the younger the subject, the higher the PAL (P = 0.0001) and the better the HRQoL. This is true for all domains except the role limitations caused by emotional problems and emotional wellbeing. Conclusion: The poor physical activity level of adult Saudi negatively impacts their HRQoL.
文摘In China, sports and physical activity （PA） have tradition- ally been an integral part of school curricula to promote fitness and enhance healthy growth among children and ado- lescents. Three decades of economic reforms, however, have brought major changes in social, economic.
