Medicine and Health Sciences Commons^™

Heterogeneity In The Prevalence Of Premature Hypertension Among Asian American Populations Compared With White Individuals: A National Health Interview Survey Study, Sina Kianoush, Mahmoud Al Rifai, Anwar T. Merchant, Xiaoming Jia, Zainab Samad, Aneil Bhalla, Ayesha Khan, Dongshan Zhu, Salim S. Virani

Section of Cardiology

Background: Differences in prevalence of risk factors such as hypertension may explain heterogeneity in cardiovascular risk across Asian American populations.
Methods: We used National Health Interview Survey (NHIS) data from 2006 to 2018 among White, Chinese, Asian Indian, Filipino, and 'other Asians' (Japanese, Korean, and Vietnamese). Unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals were reported using logistic regression models for the association between race and self-reported premature hypertension (age old). Models were adjusted for sex, education, body mass index, smoking status, diabetes, and coronary heart disease.
Results: We studied 99,864 participants with history of hypertension (mean age, …

Multimodel Order Independent Component Analysis: A Data-Driven Method For Evaluating Brain Functional Network Connectivity Within And Between Multiple Spatial Scales, Xing Meng, Armin Iraji, Zening Fu, Peter Kochunov, Aysenil Belger, Judith Ford, Sara Mcewen, Daniel H Mathalon, Bryon A Mueller, Godfrey Pearlson, Steven G Potkin, Adrian Preda, Jessica Turner, Theo Van Erp, Jing Sui, Vince D Calhoun

Faculty, Staff and Student Publications

Background:

While functional connectivity is widely studied, there has been little work studying functional connectivity at different spatial scales. Likewise, the relationship of functional connectivity between spatial scales is unknown.

Methods:

We proposed an independent component analysis (ICA)-based approach to capture information at multiple-model orders (component numbers), and to evaluate functional network connectivity (FNC) both within and between model orders. We evaluated the approach by studying group differences in the context of a study of resting-state functional magnetic resonance imaging (rsfMRI) data collected from schizophrenia (SZ) individuals and healthy controls (HC). The predictive ability of FNC at multiple spatial scales …

Epigenetic Grimage Acceleration And Cognitive Impairment In Bipolar Disorder, Camila N C Lima, Robert Suchting, Giselli Scaini, Valeria A Cuellar, Alexandra Del Favero-Campbell, Consuelo Walss-Bass, Jair C Soares, Joao Quevedo, Gabriel R Fries

Faculty, Staff and Student Publications

Bipolar disorder (BD) has been previously associated with clinical signs of premature aging, including accelerated epigenetic aging in blood and brain, and a steeper age-related decline in cognitive function. However, the clinical drivers and cognitive correlates of epigenetic aging in BD are still unknown. We aimed to investigate the relationship between multiple measures of epigenetic aging acceleration with clinical, functioning, and cognitive outcomes in patients with BD and controls. Blood genome-wide DNA methylation levels were measured in BD patients (n = 153) and matched healthy controls (n = 50) with the Infinium MethylationEPIC BeadChip (Illumina). Epigenetic age estimates were calculated …

Revisiting Sex Differences In The Acquisition And Extinction Of Threat Conditioning In Humans, Zhenfu Wen, Jamie Fried, Edward F Pace-Schott, Sara W Lazar, Mohammed R Milad

Faculty, Staff and Student Publications

Findings pertaining to sex differences in the acquisition and extinction of threat conditioning, a paradigm widely used to study emotional homeostasis, remain inconsistent, particularly in humans. This inconsistency is likely due to multiple factors, one of which is sample size. Here, we pooled functional magnetic resonance imaging (fMRI) and skin conductance response (SCR) data from multiple studies in healthy humans to examine sex differences during threat conditioning, extinction learning, and extinction memory recall. We observed increased functional activation in males, relative to females, in multiple parietal and frontal (medial and lateral) cortical regions during acquisition of threat conditioning and extinction …

Development Of A Personalized Shared Decision-Making Tool For Knee Osteoarthritis And User-Testing With African American And Latina Women, Lynne C Jones, Anne M Maurer, Michael L Parks, Philip C Noble, Carla Harwell, Melvyn Harrington, Katherine G Bay, Charles L Nelson, Mary I O'Connor

Faculty, Staff and Student Publications

BACKGROUND: Patients with chronic knee pain are often unaware of treatment options and likely outcomes-information that is critical to decision-making. A consistent framework for communicating patient-personalized information enables clinicians to provide consistent, targeted, and relevant information. Our objective was to user-test a shared decision-making (SDM) tool for chronic knee pain.

METHODS: A cross-functional team developed a Markov-based health economics model and tested the model outputs with patient panels, patient and clinician focus groups, and clinical specialists. The resulting SDM tool was user-tested in a parallel-designed, randomized controlled study with 52 African American and 52 Latina women from geographically representative areas …

Potential And Pitfalls Of Mobile Mental Health Apps In Traditional Treatment: An Umbrella Review, Jerica Koh, Germaine Y. Q. Tng, Andree Hartanto

Research Collection School of Social Sciences

While the rapid growth of mobile mental health applications has offered an avenue of support unbridled by physical distance, time, and cost, the digitalization of traditional interventions has also triggered doubts surrounding their effectiveness and safety. Given the need for a more comprehensive and up-to-date understanding of mobile mental health apps in traditional treatment, this umbrella review provides a holistic summary of their key potential and pitfalls. A total of 36 reviews published between 2014 and 2022—including systematic reviews, meta-analyses, scoping reviews, and literature reviews—were identified from the Cochrane library, Medline (via PubMed Central), and Scopus databases. The majority of …

A Survey Study Of Speech-Language Therapists’ Experiences With Teletherapy At The Onset Of The Covid-19 Crisis, Jason A. Rosas

Dissertations, Theses, and Capstone Projects

The present study aimed to understand how delivering pediatric treatment services via ‘teletherapy’ affected speech-language therapists (SLTs) during the initial outbreak of the COVID-19 pandemic crisis in 2020. SLTs reported on their experiences with the change from in-person to remote service delivery via two national surveys distributed at the start of the pandemic between April 2020 and July 2020. To explain SLTs’ survey responses, this dissertation introduced the Professional Adaptation Model (PA Model). The PA Model facilitated evaluation of the SLTs’ professional environment and the psychological constructs of their professional identity believed to influence the transition to speech-language teletherapy. Specifically, …

The Differential Effects Of Acoustic Discriminations On Operant Learning Performance And Neurogenesis In Male And Female Zebra Finches, Kristena L. Newman

Dissertations, Theses, and Capstone Projects

Adult neurogenesis, the creation of new neurons, occurs throughout the lifespan in most organisms. However, though neuronal proliferation occurs daily, most of these neurons do not survive to become incorporated into preexisting neural circuitry and become fully functioning neurons. In the mammalian brain, adult neurogenesis occurs within the hippocampus, a brain region known to be important in learning and memory. In rats, successful acquisition of certain learning tasks increased new neuron numbers when the learning was sufficiently challenging (Curlik and Shors, 2011). It has also been demonstrated that a spatial discrimination task requires new neurons when the discrimination is more …

Oxytocin, A Lover And A Fighter: Maternal Trauma Exposure And Mother-Child Coregulation, Patricia M. Pehme

Dissertations, Theses, and Capstone Projects

The placenta is responsible for regulating the fetal growth and environment in preparation for the anticipated external life. To succeed, it continuously adapts and weaves in a variety of neuroendocrine signals from the maternal organism. If a mother was exposed to trauma and her physiology sustained a change in the functioning of the immune, autonomic and/or endocrine systems, the placenta may anticipate different external environments for her children as compared to children of mothers without trauma exposure. This dissertation examined possible underlying mechanisms of psychosocial trauma transmission from one generation to the next via the placental oxytocinergic pathway. Encompassing three …

The Impossible Situation? Impasse As Psychotherapeutic Paralysis, Possibility, And Progress, Leo Cancelmo

Dissertations, Theses, and Capstone Projects

Psychotherapeutic impasse has long been understood in the clinical literature as treatment stagnation and even failure, both from one-person and two-person psychodynamic perspectives. However, there is a dearth of empirical research that delves deeper to understand this complex and rich phenomenon. Using semi-structured interviews with nine psychodynamic therapists speaking about individual adult patients, this study examined experiences of impasse to better understand treatments that become embroiled in a kind of paralysis. Qualitative analyses revealed dyads where patients were conceptualized as struggling chronically with negative feelings about themselves and others, and who experienced traumatic personal histories. Impasse in and of itself …

Workforce Diversity And Health Equity: The Role Of Schools Of Public Health, Adashima Oyo

Dissertations, Theses, and Capstone Projects

The goal to eliminate health disparities and achieve health equity has remained a consistent public health and social welfare challenge for the United States. Schools of public health, despite being disproportionately White, are charged with the important task of training a diverse workforce of master and doctoral-level public health students to protect and promote the overall health of the nation with research, policy, and practice. Experiences and practices related to the recruitment, admission, enrollment, and graduation of students of color, specifically Blacks and Latinx, warrant further research. Positive deviance theory, critical race theory, and organizational culture theory informed this research. …

Recommendations For Whole Genome Sequencing In Diagnostics For Rare Diseases, Erika Souche, Sergi Beltran, Erwin Brosens, John W Belmont, Magdalena Fossum, Olaf Riess, Christian Gilissen, Amin Ardeshirdavani, Gunnar Houge, Marielle Van Gijn, Jill Clayton-Smith, Matthis Synofzik, Nicole De Leeuw, Zandra C Deans, Yasemin Dincer, Sebastian H Eck, Saskia Van Der Crabben, Meena Balasubramanian, Holm Graessner, Marc Sturm, Helen Firth, Alessandra Ferlini, Rima Nabbout, Elfride De Baere, Thomas Liehr, Milan Macek, Gert Matthijs, Hans Scheffer, Peter Bauer, Helger G Yntema, Marjan M Weiss

Center for Medical Ethics and Health Policy Staff Publications

In 2016, guidelines for diagnostic Next Generation Sequencing (NGS) have been published by EuroGentest in order to assist laboratories in the implementation and accreditation of NGS in a diagnostic setting. These guidelines mainly focused on Whole Exome Sequencing (WES) and targeted (gene panels) sequencing detecting small germline variants (Single Nucleotide Variants (SNVs) and insertions/deletions (indels)). Since then, Whole Genome Sequencing (WGS) has been increasingly introduced in the diagnosis of rare diseases as WGS allows the simultaneous detection of SNVs, Structural Variants (SVs) and other types of variants such as repeat expansions. The use of WGS in diagnostics warrants the re-evaluation …

High Prevalence Of Osteopathy In Chronic Pancreatitis: A Cross-Sectional Analysis From The Proceed Study, Phil A Hart, Dhiraj Yadav, Liang Li, Savi Appana, William Fisher, Evan Fogel, Chris E Forsmark, Walter G Park, Stephen Pandol, Mark D Topazian, Stephen K Van Den Eden, Santhi Swaroop Vege, David Bradley, Jose Serrano, Darwin L Conwell

Center for Medical Ethics and Health Policy Staff Publications

Background & aims: Chronic pancreatitis (CP) is associated with osteopathy (osteoporosis or osteopenia). However, existing literature is mostly limited to retrospective or administrative studies that have not clearly defined the prevalence and risk factors. Our aim was to identify patient- and disease-related associations with osteopathy in a prospective cohort study of CP.

Methods: We studied 282 subjects with definitive CP enrolled in the PROCEED study who had a baseline dual-energy X-ray absorptiometry (DXA) scan. Osteopenia and osteoporosis were defined using the lowest T-scores. Clinical data were collected using standardized case report forms. Comparisons were performed with a multivariate logistic regression …

Rates Of Laboratory Adverse Events By Course In Paediatric Leukaemia Ascertained With Automated Electronic Health Record Extraction: A Retrospective Cohort Study From The Children’S Oncology Group, Tamara P Miller, Kelly D Getz, Yimei Li, Biniyam G Demissei, Peter C Adamson, Todd A Alonzo, Evanette Burrows, Lusha Cao, Sharon M Castellino, Marla H Daves, Brian T Fisher, Robert Gerbing, Robert W Grundmeier, Edward M Krause, Judy Lee, Philip J Lupo, Karen R Rabin, Mark Ramos, Michael E Scheurer, Jennifer J Wilkes, Lena E Winestone, Douglas S Hawkins, M Monica Gramatges, Richard Aplenc

Center for Medical Ethics and Health Policy Staff Publications

Background: Adverse events are often misreported in clinical trials, leading to an incomplete understanding of toxicities. We aimed to test automated laboratory adverse event ascertainment and grading (via the ExtractEHR automated package) to assess its scalability and define adverse event rates for children with acute myeloid leukaemia and acute lymphoblastic leukaemia.

Methods: For this retrospective cohort study from the Children's Oncology Group (COG), we included patients aged 0-22 years treated for acute myeloid leukaemia or acute lymphoblastic leukaemia at Children's Healthcare of Atlanta (Atlanta, GA, USA) from Jan 1, 2010, to Nov 1, 2018, at the Children's Hospital of Philadelphia …

An Ultra-Brief Screening Scale For Pediatric Obsessive-Compulsive Disorder: The Oci-Cv-5, Amitai Abramovitch, Jonathan S Abramowitz, Dean Mckay, Heining Cham, Kennedy S Anderson, Lara J Farrell, Daniel A Geller, Gregory L Hanna, Sharna Mathieu, Joseph F Mcguire, David R Rosenberg, S Evelyn Stewart, Eric A Storch, Sabine Wilhelm

Center for Medical Ethics and Health Policy Staff Publications

Background: Obsessive-compulsive disorder (OCD) is an often disabling and chronic condition that is normally assessed using diagnostic interviews or lengthy self-report questionnaires. This makes routine screening in general health settings impractical, and as a result OCD is often under-(or mis-)recognized. The present study reports on the development of an ultra-brief version of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) which may be administered routinely as a screener for pediatric OCD.

Method: A total of 489 youth diagnosed with OCD, 259 non-clinical controls, and 299 youth with other disorders completed the OCI-CV and other indices of psychopathology. Using item analyses, we extracted five …

Will Anti-Vaccine Activism In The Usa Reverse Global Goals?, Peter J Hotez

Center for Medical Ethics and Health Policy Staff Publications

In the time of the COVID-19 pandemic, anti-vaccine activism in the USA accelerated, amplified and formed an alliance with political groups and even extremists. An organized, well-funded and empowered anti-science movement now threatens to spill over and threaten all childhood immunizations in the USA and globally.

Change During Cognitive And Exposure Phases Of Cognitive-Behavioral Therapy For Autistic Youth With Anxiety Disorders, Andrew G Guzick, Sophie C Schneider, Philip C Kendall, Jeffrey J Wood, Connor M Kerns, Brent J Small, Ye Eun Park, Sandra L Cepeda, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Objective: To evaluate improvement during the (a) cognitive and (b) exposure therapy phases of cognitive-behavioral therapy (CBT) for autistic youth with anxiety disorders.

Method: Participants were 148 autistic youth (aged 7-13; 77% male; 64% White) with clinically significant anxiety who were randomized to standard or adapted CBT. Clinician-rated anxiety severity was recorded at each appointment. Trajectories of change during (a) the cognitive phase and (b) the exposure phase of treatment were analyzed using piecewise multilevel modeling.

Results: Compared to the psychoeducation and cognitive therapy phases, the exposure phase corresponded with significantly more rapid symptom reduction, b = -.11, 95% CI …

Neuroanatomy In Mild Cognitive Impairment: Relationship To Functional Skills, Treatment Expectancy, And Comorbid Depression, Sara Rushia

Dissertations, Theses, and Capstone Projects

Mild cognitive impairment (MCI) is a neurocognitive disorder defined by cognitive decline in older adults. Although MCI has been studied for decades, there remain important areas to be explored in order to adequately characterize aspects of this disorder that provide information valuable for possible interventions and disease progression to dementia, including a better understanding of the neuroanatomical variables relevant to this disorder. Such neuroanatomical variables include cortical thickness, hippocampal volume, and white matter hyperintensities (WMHs). This dissertation consists of three separate studies aimed at addressing gaps in the literature on MCI in relation to brain morphometrics and under-studied characteristics involved …

Effects Of Lime (Citrus Aurantifolia Swingle) Peel Extract Addition To Periodontal Dressing On The Number Of Blood Vessels In The Gingival Wound Healing Process, Malianawati Fauzia, Savira Pratista Oktaviana

Journal of Dentistry Indonesia

Background: Periodontal dressings that are currently available can only protect wounds from mechanical trauma, but have no ability to accelerate wound healing. Lime (Citrus aurantifolia Swingle) peel extract added to periodontal dressing contains flavonoids which can stimulate the formation of new blood vessels, thus accelerating the healing process. Objective: To determine the effects of adding lime (Citrus aurantifolia Swingle) peel extract to periodontal dressing on the number of blood vessels in the gingival wound healing process. Methods: 32 rabbits with 2 mm wound made on the gingiva were divided into 8 groups. For the control groups of …

Factors Influencing The Choice Of Toothpaste And Investigation Of Those Most Commercialized By Students In Settat, Morocco, Abdellatif Rahim, Wissal El Karfi, Lalla Asmaa Katir Masnaoui, Bouchra El Amiri, Abdel Khalid Essamadi

Makara Journal of Health Research

Background: This study aimed to determine the factors influencing the choice of toothpaste by students in Settat (Morocco) and investigate the characteristics of those most commercialized in this region.

Methods: A close-ended questionnaire was developed and filled out. This was a cross-sectional study of 429 students who agreed to participate. Based on questionnaire data, the 15 most commercialized toothpaste by respondents were purchased, and their packaging was investigated.

Results: After analysis using Excel 2019, the results revealed that the major factors influencing the choice of toothpaste are brand 55%, family choice 48%, and media advertisements 40%. Moreover, …

Flint, Michigan Drinking Water Crisis, J. David Aiken

Cornhusker Economics

Briefly covers the Flint, Michigan drinking water crisis including providing some background, a timeline of events, and key takeaways from the perspective of public policy.

This article was originally prepared for distribution to students in Aiken's AECN 357 environmental and natural resources law course.

Pharmacy Performance Based On Financial Perspective Before And During Covid-19 Pandemic : A Case Study, Eva Sartika Dasopang, Ida Fauziah, Fenny Hasanah, Desy Natalia Siahaan, Dina Yunisma Rasyida Lubis

Pharmaceutical Sciences and Research

A pharmacy, aside from being a pharmaceutical care provider is also a functioning business. Thus, in the scope of business, pharmacy performance can be analysed using liquidity, activity, and profitability ratios. This study aimed to determine the performance of Pharmacy X based on a financial perspective before and during the COVID-19 pandemic. This research is a descriptive cross-sectional study that employed data obtained from sales and purchase records. The data were analysed using financial ratio analysis methods, including liquidity, activity, and profitability ratios. This study was conducted at Pharmacy X based on the amount of prescription and non-prescription income from …

Electromyographic Activity Of Masticatory Muscles In Asymptomatic Young Adults, Aneta Wieczorek, Malgorzata Pihut, Jolanta E. Loster

Journal of Dentistry Indonesia

Introduction: The masseter and the anterior part of the temporalis are the muscles mainly responsible for the clenching function. Clenching patterns and the activity of these muscles are not expected to differ between male and females, nor between different occlusal classes. Objective: The aim of this study was to determine whether the activity index of the masseter and temporalis muscles is related to occlusal class and gender. Methods: This study involved 145 eighteen-year-old Caucasian volunteers who underwent surface electromyography. The sEMG was analyzed at the moment of 100% occlusal contact. Occlusal classes were determined used plaster casts. …

Fractal Analysis Of Subchondral Cyst At Mandibular Condyle Detected On Panoramic Radiograph In A Group Of Thai Population, Aloysius Putut Wijanarko, Preeyaporn Srimawong, Suchaya Pornprasertsuk-Damrongsri, Apirum Janhom

Journal of Dentistry Indonesia

Objectives: This study aimed to analyze subchondral cyst on the mandibular condyle using fractal dimension (FD) measurement on a panoramic radiograph. Methods: This retrospective study examined 15 patients aged 24 to 75 years who had undergone panoramic radiography and cone-beam computed tomography on both sides of the mandibular condyles, between January 2013 and November 2017, in the Oral and Maxillofacial Radiology Clinic, Dental Hospital, Mahidol University. These 15 patients, all of whom had a subchondral cyst on one side of the mandibular condyle, constituted both the study and control groups: the 15 affected sides constituted the study group, …

The Effect Of Disc Displacement On Temporomandibular Joint Morphology In Patients With Disc Displacement, Melike Yurttaş, Esin Bozdemir, Şehnaz Evrimler

Journal of Dentistry Indonesia

Objective: To examine the morphological properties of temporomandibular joint structures by magnetic resonance imaging (MRI) on patients with and without disc displacement (DD). Methods: Thirty-eight patients with disc displacement and 13 patients without disc displacement were included. Age, gender, and clinical findings such as pain, joint sounds of patients were recorded. The patients were classified as anterior disc displacement with reduction (ADDWR) group, anterior disc displacement without reduction (ADDWoR) group, and control group on MRI. Disc morphology was categorized as biconcave, hemiconvex, biconvex, biplanar, or folded. Condyle morphology was characterized as convex, angled, flat, or rounded. Articular eminence …

The Practices Of Treating Deep Carious Lesions Compared With The Dental Curriculum In Turkish Dentistry, Leyla Kerimova, Erdem Karabulut, Kivanç Yamanel, Neslihan Arhun

Journal of Dentistry Indonesia

Objective: The aim of this cross-sectional study is to investigate Turkish dentists’ opinions and preferences regarding the management of deep carious lesions and compare them with modern dental education concepts as provided by dental schools. Methods: Questionnaire 1 and Questionnaire 2 were sent separately to dental practitioners via the Turkish Dental Association and to university department heads of restorative dentistry. The data obtained were analyzed using chi-square tests and one-way ANOVA tests (p < 0.05). Results: Regarding Questionnaire 1, most of the dentists (89.3%) responded that caries lesions should be removed completely up to the hard cut-off condition of …

Perspectives On Reproductive Health Education Among Javanese Parents, Bagoes Widjanarko, Ratih Indraswari, Aditya Kusumawati, Novia Handayani

Kesmas

This study aimed to investigate the perspectives of reproductive health education among Javanese parents of children aged 9-11 years. This cross-sectional study was conducted with 12,306 parents in Semarang City, Central Java Province, Indonesia, using a purposive sampling technique. Some parents agreed that reproductive health education at home was unnecessary (29.5%), taboo (45%), difficult (73.1%), and awkward (41.5%). Most parents (72.7%) were not transparent in providing reproductive health information to their children by using other terms to name the genitals, considering the politeness aspect. Good practices of providing reproductive health information are slightly more common in mothers (54.2%), unemployed parents …

Clinicians' Perspectives On The Effectiveness Of Trauma - Focused Cognitive Behavioral Therapy With African American Children: A Qualitative Study, Jada Carter

Doctoral Dissertations

Literature exploring clinicians' perspectives on the effectiveness of trauma-focused cognitive behavioral therapy with African American children who suffer from trauma-related disorders is very limited. The current study examined clinicians' perspectives on the TF-CBT model when utilized with this population, including their experiences working with African American children and families with observable types of trauma-related disorders. This research study also explored the various facets of trauma that African Americans encounter in childhood and the barriers that prevent them from receiving adequate mental health care. Thematic analysis was utilized to explore themes that emerged when treating African American children with TF-CBT. Five …

Spatial Analysis For Enhancing The Use Of Health Data Availability From Different Sources To Help The Decision-Making Process, Tris Eryando

Kesmas

Spatial analysis in public health has become a common method used by researchers to understand the distribution of public health aspects related to the surrounding environment. It can also be used to analyze individual information in the form of a dot and the location or line of aggregated information in a specific area of study. Another benefit is the possibility of using different data sources to be analyzed in one statistical model analysis, as long as the identification area is sufficiently clear as a key variable. Spatial analysis can show an object's distribution on a locational map and explain the …

A Stunting Prevention Risk Factors Pathway Model For Indonesian Districts/Cities With A Stunting Prevalence Of ≥30%, Nina Fentiana, Endang L. Achadi, Besral Besral, Abram Kamiza, Trini Sudiarti

Kesmas

The prevalence of stunting in Indonesian children aged 0-23 months is a public health problem caused by direct and indirect factors. This study aimed to discover the path of the relationship between various risk factors and the stunting prevalence of ≥30% in 165 districts/cities in Indonesia. Data were obtained from the 2018 National Basic Health Research, National Socioeconomic Survey, and the Statistics Indonesia with a cross-sectional approach. The secondary data on stunting and risk factors were aggregated at the district/city level from individual data; children aged 0-23 months. The path analysis used to determine a stunting prevention model showed that …