Medicinal plants’ use among patients with dyslipidemia: an Iranian cross-sectional survey

2018 ◽  
Vol 16 (3) ◽  
Author(s):  
Mohammad Hashem Hashempur ◽  
Seyed Hamdollah Mosavat ◽  
Mojtaba Heydari ◽  
Mesbah Shams
Keyword(s):  
Side Effects ◽  
Medicinal Plants ◽  
Demographic Data ◽  
Zingiber Officinale ◽  
Cross Sectional Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Herbal Preparations ◽  
Positive Effects ◽  
High Prevalence

Abstract Background Despite growing demand for medicinal plants, there is little data about their use by patients with dyslipidemia. We aimed to determine the prevalence, pattern, and associated factors for the use of medicinal plants among patients with dyslipidemia. Methods A 17-item semi-structured questionnaire was filled out by 195 patients with dyslipidemia in a cross-sectional study carried out in two academic endocrinology clinics in Shiraz, Iran. The questionnaire comprised of three main domains of demographic data (6 questions), clinical data (2 of them), and data related to the use of medicinal plants (totally 9 questions). Results A total of 77.4% of patients took medicinal plants. The most common medicinal herbs used by dyslipidemic patients were Zataria multiflora, Cinnamomum zeylanicum, and Zingiber officinale. Duration of dyslipidemia was significantly longer in herbal users than non-herbal users (p=0.04). Patients believing that concomitant use of conventional drugs and herbal preparations had synergic positive effects in addition to those persuaded that herbal preparations possessed less side effects, were significantly more likely to use medicinal plants (p=0.008 and 0.005, respectively). Additionally, most of the medicinal herb users (87.4%) changed neither the pattern nor the dosage of their medications all during herbal preparations use. Conclusions This study demonstrated a high prevalence of medicinal plants’ use among patients with dyslipidemia, which was associated with the duration of dyslipidemia, patients’ viewpoints about herbal preparations’ synergic positive effects, and their fewer side effects.

scholarly journals Hand Hygiene Knowledge, Perception, and Practices among Domestic Visitors to the Prophet’s Mosque in Al Madinah City Amid the COVID-19 Pandemic: A Cross-Sectional Study

2021 ◽  
Vol 18 (2) ◽  
pp. 673
Author(s):  
Hashim A. Mahdi ◽  
Hamza M. Assaggaf ◽  
Mohammad Alfelali ◽  
Omar B. Ahmed ◽  
Radi Alsafi ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Graduate Education ◽  
Formal Education ◽  
Demographic Data ◽  
Knowledge Score ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional Survey ◽  
Cross Sectional

This study aimed to assess hand hygiene knowledge, perception, and practices of visitors to the Prophet’s Mosque in Al Madinah City, Saudi Arabia. Using a self-administered electronic questionnaire, a cross-sectional survey was conducted among domestic residents, who visited the mosque between 31 July and 3 August 2020. Participants’ demographic data, hand hygiene knowledge, perception, and practices were collected. Four hundred participants aged 18–65 (median 36) years completed the survey, of which 215 (53.8%) were female. The visitors’ mean knowledge score about hand hygiene was 6.4 (± standard deviation (SD) 1.35) of total 12. Most participants (392, 98%) were aware of the role of hand hygiene in preventing Coronavirus Disease 2019 (COVID-19); nevertheless, 384 (96%) said hand hygiene lowers body immunity and 316 (79%) thought <60% alcohol is sufficient for hand disinfection. Males had a higher knowledge score than females (6.46 (±1.41) vs. 6.14 (±1.27), p = 0.02) and, visitors who had no formal education scored higher than those with post-graduate education (6.88 (±1.45) vs 5.73 (±1.12), p = 0.01). Washing hands with soap and water was the predominant method practiced after a meal (365, 91.7%), after toilet visit (354, 88.5%), after touching a surface (262, 65.7%), after waste disposal (332, 83.2%), and when hands were visibly dirty (357, 89.5%). Al Madinah visitors had moderate knowledge about hand hygiene, but demonstrated some knowledge gaps and negligence in practice that are crucial to curb the spread of COVID-19.

scholarly journals A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses

BMC Nursing ◽  
2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Liselotte N. Dyrbye ◽  
Tait D. Shanafelt ◽  
Pamela O. Johnson ◽  
Le Ann Johnson ◽  
Daniel Satele ◽  
...  
Keyword(s):  
Work Performance ◽  
National Sample ◽  
Cross Sectional Study ◽  
Inpatient Setting ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Academic Degree ◽  
High Performer ◽  
High Prevalence ◽  
The Relationship

Abstract Background Studies suggest a high prevalence of burnout among nurses. The aim of this study was to evaluate the relationship between burnout among nurses and absenteeism and work performance. Methods A national sample of U.S. nurses was sent an anonymous, cross-sectional survey in 2016. The survey included items about demographics, fatigue, and validated instruments to measure burnout, absenteeism, and poor work performance in the last month. Results Of the 3098 nurses who received the survey, 812 (26.2%) responded. The mean age was 52.3 years (SD 12.5), nearly all were women (94.5%) and most were married (61.9%) and had a child (75.2%). Participating nurses had a mean of 25.7 (SD 13.9) years of experience working as nurse and most held a baccalaureate (38.2%) or masters of science (37.1%) degree in nursing. A quarter worked in the inpatient setting (25.5%) and the average hours worked per week was 41.3 (SD 14.1). Overall, 35.3% had symptoms of burnout, 30.7% had symptoms of depression, 8.3% had been absent 1 or more days in the last month due to personal health, and 43.8% had poor work performance in the last month. Nurses who had burnout were more likely to have been absent 1 or more days in the last month (OR 1.85, 95% CI 1.25–2.72) and have poor work performance (referent: high performer; medium performer, OR 2.68,95% CI 1.82–3.99; poor performer, OR 5.01, 95% CI 3.09–8.14). After adjusting for age, sex, relationship and parental status, highest academic degree, practice setting, burnout, depression, and satisfaction with work-life integration, nurses who were more fatigued (for each point worsening, OR 1.22, 95% CI 1.10–1.37) were more likely to have had absenteeism while those who worked more hours (for each additional hour OR 0.98, 95% CI 0.96–1.00) were less likely to have had absenteeism. Factors independently associated with poor work performance included burnout (OR 2.15, 95% CI 1.43–3.24) and fatigue (for each point of worsening, OR 1.22, 95% CI 1.12–1.33). Conclusions These findings suggest burnout is prevalent among nurses and likely impacts work performance.

The Frequency of Using Herbal Medicines Among Patients With Hypertension in Kerman, Iran, 2012-2013

2015 ◽  
Vol 20 (3) ◽  
pp. 199-202 ◽  
Author(s):  
Haleh Tajadini ◽  
Kouros Divsalar ◽  
Mitra Mehrabani ◽  
Ali Akbar Haghdoost ◽  
Zahra Esmaili ◽  
...  
Keyword(s):  
Medicinal Plants ◽  
Herbal Medicines ◽  
Cross Sectional Study ◽  
Self Administration ◽  
Cross Sectional ◽  
Hypertensive Patients ◽  
The Past ◽  
Significant Difference ◽  
High Prevalence ◽  
Medical Plants

Introduction. The use of medicinal plants has dramatically increased in recent years. Given the increasing rate of hypertension and medical plants usage by these patients and considering drug interactions due to concomitant use with drugs, the present study aims to evaluate the rate of medicinal plants usage in hypertensive patients. Methods. This is a cross-sectional study (descriptive–analytical) in which 650 hypertensive patients referring to the subspecialty clinic of Kerman were questioned about medicinal plants usage by a medicinal plants questionnaire. Among these patients, there were 612 who consented to participate. After the variables were described, the data were finally analyzed using Stata 12. Results. The average age of those using these drugs in the past year was 58.8 ± 10 years. Of the total number of participants using medicinal plants, there were 58 males (23.5%) and 122 females (33.4%). There were 129 participants (72.5%) using medicinal plants through self-administration, 17 participants (9.5%) on experienced users’ advice, 16 participants (9%) as administered by herbalists, and 11 participants (6%) as administered by doctors. However, the most important resources for using a drug that prevents hypertension were family and friends (74 participants; 41.5%) and doctors (13 participants; 7.3%). According to the results, there was no significant difference between the level of education and medicinal plants usage ( P = .95); however, there was a significant difference between gender and medicinal plants usage ( P = .009). Discussion. According to the results indicating the relatively high prevalence of medicinal plants usage and their arbitrary use by hypertensive patients without consulting a specialist, it seems necessary to plan for more effective and secure public education and train people to provide herbal drug services for various diseases with hypertension being the most common one.

scholarly journals Myths, beliefs, and conspiracies about COVID-19 Vaccines in Sindh, Pakistan: An online cross-sectional survey

2021 ◽  
Author(s):  
Qamar Abbas ◽  
Fatima Mangrio ◽  
Sunil Kumar
Keyword(s):  
Side Effects ◽  
Cross Sectional Study ◽  
Vaccine Uptake ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Web Based ◽  
Major Barrier ◽  
Polio Vaccination ◽  
Relationship Of

Abstract Background Pakistan has already encountered intense opposition to polio vaccination due to myths and misinformation, now the unfavorable opinions of COVID-19 vaccinations among the population would have catastrophic consequences for attempts to end the pandemic. Methods A web-based cross-sectional study was conducted in the general population of Sindh, Pakistan in January 2021. 31 items based on vaccines availability, safety, and myths, the questionnaire was designed and randomly distributed through a google form link. Results were analyzed using descriptive and Chi-square tests. Results A total of 774 responses were recorded from 23 districts of Sindh, Pakistan. The majority of participants (n=00, 00.0%) were not aware of the presence of the COVID-19 vaccine in Pakistan. Results found the significant relationship of conspiracies and myths with an education level of participants, to make Muslims infertile, illiterate showed (Yes n=45, No=27) while postgraduate (Yes n=11, No=88) (χ2 = 109.6, P> 0.000). Participants showed doubt about the safety of vaccines, (Yes n= 464, 59.9%, No= 310, 40.1%). Other responses related to side effects of the vaccine were also highly significant, participants showed that vaccine side effects (Yes n= 462, 59.7%, No= 312, 40.3%), Pregnant or breastfeeding women should not get vaccinated (Yes n= 468, 59.8%, No= 311, 40.1%) and people with underlying conditions should not get vaccinated (True n= 389, 50.3%, False= 385, 49.7%). Conclusion The proportion of varying public doubts in vaccines’ safety and efficacy and the presence of myths, conspiracies will be a major barrier to vaccine uptake.

scholarly journals RISK FACTORS FOR CARDIOVASCULAR EVENTS IN RURAL NIGERIA: A CROSS SECTIONAL SURVEY AND A REVIEW OF THE CURRENT LITERATURE

2019 ◽  
Vol 9 (4) ◽  
pp. 370-375
Author(s):  
Anthonia A. Ikpeme*,Nchiewe E. Ani, Edoise M. Isiwele, Andrew E. Ekpenyong,Emmanuel E. Ekanem
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Rural Areas ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Cross River State

Introduction: Over 80% of cardiovascular deaths take place in low and middle incomecountries. These cardiovascular deaths are caused by modifiable risk factors. Evidenceis emerging that some of these factors maybe even more prevalent in rural areas whichare generally underserved.Aim: The aim of this study was to record risk factors for cardiovascular disease inrural communities in south southern Nigeria and review some related literature.Methods: A cross sectional study during clinical outreach activities that took placein 2016 to 2018 in several rural and few urban communities in Cross River State,Nigeria. Participating individuals gave full consent and ethical clearance obtained.Socio-demographic data, Anthropometric data and Blood sugar measurements wereobtained. Data extracted was transferred into EXCEL thereafter analysis was doneusing SPSS version 21. p values less than 0.05 were deemed statistically significant.Tests of significance included Anova, chi square and student t- tests.Results: Total population investigated over the 3 year period was 504. (2016-33.1%),(2017 -37.9%), (2018 – 28%) with a Female: Male distribution of 1:1.Most participants tended to be overweight across the years 59.7%, 59.1%, 73.7%,2016, 2017, and 2018 respectively. The prevalence of Hypertension was 10.71%. Nosignificant gender difference in the prevalence of Hypertension (6.94% males to 3.77%females, p=0.097). The prevalence of Diabetes Mellitus was 10.67%. There was nosignificant gender prevalence (6.67% males to 4.00% females, p =0.431)Conclusion: Cardiovascular disease remains relatively uncommon in Sub-SaharanAfrica, despite an increasing prevalence of risk factors, but it’s incidence is rising.Steps should be taken in Sub-Saharan Africa to prevent an epidemic. This involvesdetailed and regular screening for cardiovascular risk factors in rural communities.Key words: RISK FACTORS, Cardio vascular disease, South South Nigeria.

scholarly journals Side Effects of mRNA-Based COVID-19 Vaccines among Young Adults (18–30 Years Old): An Independent Post-Marketing Study

2021 ◽  
Vol 14 (10) ◽  
pp. 1049
Author(s):  
Abanoub Riad ◽  
Andrea Pokorná ◽  
Jitka Klugarová ◽  
Natália Antalová ◽  
Lucia Kantorová ◽  
...  
Keyword(s):  
Young Adults ◽  
Side Effects ◽  
Side Effect ◽  
Demographic Data ◽  
Herd Immunity ◽  
Age Groups ◽  
Common Side Effect ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Validated Questionnaire

Young adults had been widely perceived as a low-risk group for COVID-19 severity; therefore, they were deprioritised within the mass vaccination strategies as their prognosis of COVID-19 infection is relatively more favourable than older age groups. On the other hand, vaccination of this demographic group is indispensable to achieve herd immunity. A cross-sectional survey-based study was used to evaluate the side effects of mRNA-based COVID-19 vaccines among university students in the Czech Republic. The validated questionnaire was delivered in a digital form, and it consisted of demographic data; COVID-19 vaccine-related anamnesis; and local, systemic, orofacial, and skin-related side effects’ prevalence, onset, and duration. Out of the 539 included participants, 70.1% were females and 45.8% were <23 years old. The vast majority (95.2%) reported at least one side effect. The most common side effect was injection site pain (91.8%), followed by fatigue (62.5%), headache (36.4%), and muscle pain (34.9%). The majority of local side effects occurred after both doses (74.4%), while most systemic side effects occurred after the second dose only (56.2%). Most local (94.2%) and systemic (93.3%) side effects resolved within three days after vaccination. Females participants’ adjusted odds ratio (AOR) showed they were 2.566 (CI 95%: 1.103–5.970) times more likely to experience post-vaccination side effects, and the participants who received two doses reported an increased AOR of 1.896 (0.708–5.077) for experiencing side effects. The results of this study imply that mRNA-based COVID-19 vaccines are highly probably safe for young adults, and further studies are required to investigate the role of medical anamnesis, prior COVID-19 infection, and gender in side effects incidence.

scholarly journals Australian podiatrists scheduled medicine prescribing practices and barriers and facilitators to endorsement: a cross-sectional survey

2021 ◽  
Author(s):  
kristin graham ◽  
Lisa Matricciani ◽  
Helen Banwell ◽  
Saravana Kumar ◽  
Ryan Causby ◽  
...  
Keyword(s):  
Health System ◽  
Online Survey ◽  
Demographic Data ◽  
Public Funding ◽  
Local Anaesthetics ◽  
Cross Sectional Study ◽  
Barriers And Facilitators ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract BackgroundNon-medical prescribing is one healthcare reform strategy that has the potential to create savings in the health system as well as offer equitable and timely access to scheduled medicines. Currently there is a lack of information about prescribing practices of Australian podiatrists, making it difficult to assess if endorsement for scheduled medicines (endorsement) for podiatrists provides health system efficiencies or improved patient access and outcomes. Further, the uptake for endorsement remains low among Australian podiatrists. The aim of this research was to investigate the prescribing practices among Australian podiatrists as well as to explore barriers and facilitators that influence participation in endorsement. MethodsParticipants in this quantitative, cross-sectional study were registered and practicing Australian podiatrists and podiatric surgeons who were recruited through a combination of professional networks, social media, and personal contacts. Respondents were invited to complete a customised self-reported online survey. The survey was developed using previously published research, research team’s expertise and piloted with podiatrists. The survey contained three sections: demographic data including clinical experience, questions pertaining to prescribing practices, and barriers and facilitators of the endorsement pathway. ResultsRespondents (n = 225) were predominantly female, aged 25-45, working in the private sector. Approximately one quarter were endorsed (15%) or in training to become endorsed (11%). Of the 168 non-endorsed respondents, 66% reported that they would like to undertake training to become an endorsed prescriber. The medications most frequently prescribed include local anaesthetics, antimycotics, antibacterial agents, and analgesia. The most common indications reported for prescribing these medications include nail surgery (71%), foot infections and ulcerations (88%), post-operative pain (67%), and mycosis (95%). The most prescribed Schedule 2 medications were ibuprofen, paracetamol, and topical terbinafine. The most prescribed Schedule 4 medicines among endorsed podiatrists included lignocaine (84%), Cephalexin (68%), Flucloxacillin (68%), and Amoxicillin with Clavulanic acid (61%). ConclusionWhile podiatrists predominantly prescribe to assist pain, inflammatory, or infectious conditions, lack of public funding and pathology testing access limit podiatrists’ ability to maximise prescribing opportunities. Many barriers exist in the current endorsement for podiatrists, particularly related to training processes, including mentor access and supervised practice opportunities, requiring targeted enabling strategies.

scholarly journals Prevalence and risk factors for SARS-CoV-2 infection in children with and without symptoms seeking care in Managua, Nicaragua: results of a cross-sectional survey

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051836
Author(s):  
Jorge A Huete-Pérez ◽  
Kacey C Ernst ◽  
Cristiana Cabezas-Robelo ◽  
Lucia Páiz-Medina ◽  
Sheyla Silva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Symptoms ◽  
Age Distribution ◽  
Epidemiological Data ◽  
Cross Sectional Study ◽  
Comorbid Condition ◽  
Prevention Measures ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
High Prevalence

ObjectiveThis study aimed to capture key epidemiological data on SARS-CoV-2 infection in Nicaraguan children (≤18 years) seeking medical care, between 6 October and 16 November 2020.DesignIn this cross-sectional study, 418 children were recruited: 319 with symptoms characteristic of COVID-19 and 99 with no symptoms of illness. Children were tested for SARS-CoV-2 RNA using loop-mediated isothermal amplification. A questionnaire was employed to identify symptoms, risk factors, comorbidities and COVID-19 prevention measures.SettingResearch was carried out in four hospitals and two clinics in Managua, Nicaragua, where schools and businesses remained open throughout the COVID-19 pandemic.ParticipantsChildren were enrolled into a possible COVID-19 group if presenting with clinical symptoms. A comparison group included children lacking any COVID-19 symptoms attending routine check-ups or seeking care for issues unrelated to COVID-19.ResultsA high prevalence (43%) of SARS-CoV-2 infection was found, which was relatively equivalent in symptomatic and non-symptomatic children. Age distribution was similar between symptomatic and non-symptomatic children testing positive for SARS-CoV-2. Symptomatic children who tested positive for SARS-CoV-2 were 2.7 times more likely to have diarrhoea (26.7% in positive vs 12.0% in negative; OR=2.7 (95% CI 1.5 to 4.8), p=0.001) and were 2.0 times more likely to have myalgia (17.8% in positive vs 9.8% in negative; OR=2.0 (95% CI 1.0 to 3.8), p=0.04). Children with COVID-19 symptoms, who tested positive for SARS-CoV-2, were more likely to be under age 5 years and to have a pre-existing comorbid condition than children who tested positive but did not have symptoms.ConclusionsThis is the first paediatric study to provide laboratory-confirmed data on SARS-CoV-2 infection in Nicaragua, crucial for paediatric health services planning and a successful COVID-19 response. The high prevalence of the virus suggests widespread and sustained community transmission, underscoring the urgent need for robust data on the true extent of SARS-CoV-2 infection throughout Nicaragua.

Impostorism among the undergraduate students of Bangladesh: A cross-sectional study

2021 ◽  
Author(s):  
Md Shahjalal ◽  
Ahmed Hossain ◽  
Most Fatematujjuhora ◽  
Arifa Sultana ◽  
Shatabdee Hawlader ◽  
...  
Keyword(s):  
Undergraduate Students ◽  
Cross Sectional Study ◽  
Professional Lives ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Professional Performance ◽  
Significant Difference ◽  
Imposter Phenomenon ◽  
High Prevalence ◽  
The University

Abstract Background Imposter Phenomenon (IP) is a highly prevalent behavioural health issue affecting individual professional performance and regular activity. The current study focused on evaluating IP prevalence and assessing the factor contributing to IP among undergraduate students of Dhaka city. This was an analytical cross-sectional survey performed among undergraduate students between August to December 2020. The Young Imposter Scale (YIS) was used to determine the dichotomous assessment for the presence or absence of IP. Results Among the recruited 1,139 students, 378 (33%) had imposter syndrome. The prevalence was relatively higher (34%) among males compared to females (32%). Around one third (31.6%) reported that they face problems in sleeping. Our analysis shows that the sleeping problem of the student (p=<0.01) and academic year (p=0.04) had a statistically significant association with IP. Students who completed two academic years were more likely to have IP (AOR:1.18; 95% CI: 1.01-1.41). There was a statistically significant difference in the experience of IP across who had a sleeping problem than those who didn’t (AOR: 1.54; 95% CI: 1.25-1.90). Conclusion Our study revealed a relatively high prevalence of IP among undergraduate students, affecting their professional lives. Awareness-raising programmes should be arranged at the university level to help students to cope up with IP.

Nocturnal enuresis among children in Morogoro region in Tanzania: A cross-sectional survey

2020 ◽  
Vol 31 (1) ◽  
pp. 16-29
Author(s):  
Nehemia Kilongo ◽  
Francis F. Furia
Keyword(s):  
Family History ◽  
Demographic Data ◽  
Positive Family History ◽  
Cross Sectional Study ◽  
African Region ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Childhood Disorders ◽  
Factors Affecting ◽  
History Of

Background: Enuresis is common childhood disorders which affecting quality of life of children and causing significant psychosocial disturbances to children and their families. This condition has been widely reported globally with increasing data from sub-Saharan African region. In Tanzania there is no reports on its magnitude and therefore this study was carried out with the aim of determine the prevalence of this condition among children in Tanzania.Methods: This was a community based cross-sectional study conducted among children aged between 5 and 14 years recruited from 12 streets in Morogoro Municipality in Tanzania. Standardized Swahili questionnaire was used to collect data including socio-demographic details of parents,  children and presence of enuresis. Socio-demographic data included age of the child, sex, level of education of the parents, education of the child, presence of bed wetting, history of enuresis in the family.Results: Five hundred and ten children were recruited into this study out of which 271 (53.1%) were females and mean age of study participants was 9±2.8 years. Enuresis was noted in 19% (97/510) of children, 68% (66/97) and 32% (31/97) had primary and secondary enuresis respectively. Significantly higher prevalence rates of enuresis were noted for children aged below 8 years 26.4% (43/162) and those with family history of enuresis 47% (18/38) with p values of 0.01 and < 0.001 respectively. Forty-one (42.3%) out of 97 respondents whose children had enuresis reported to have punished their children and only 21.4% (20/97) reported to have sought treatment for their children.Conclusions: Enuresis is common among children in Tanzania particularly those with positive family history. Punishment to children with enuresis was noted in this study and only one in five parents/guardians sought treatment for their affected children. Therefore, there is a need for initiatives for raising community awareness about enuresis in Tanzania Key words: Enuresis in children, prevalence of enuresis in Tanzania, factors affecting enuresis in children.

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