Mediating role of social support in dysphoria,despondency,and quality of life in patients undergoing maintenance hemodialysis

BACKGROUND Dysphoria and despondency are prevalent psychological issues in patients undergoing Maintenance Hemodialysis(MHD)that significantly affect their quality of life(QOL).High levels of social support can significantly improve the physical and mental well-being of patients undergoing MHD.Currently,there is limited research on how social support mediates the relationship between dysphoria,despondency,and overall QOL in patients undergoing MHD.It is imperative to investigate this mediating effect to mitigate dysphoria and despondency in patients undergoing MHD,ultimately enhancing their overall QOL.AIM To investigate the mediating role of social support in relationships between dysphoria,despondency,and QOL among patients undergoing MHD.METHODS Participants comprised 289 patients undergoing MHD,who were selected using a random sampling approach.The Social Support Rating Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and QOL Scale were administered.Correlation analysis was performed to examine the associations between social support,dysphoria,despondency,and QOL in patients undergoing MHD.To assess the mediating impact of social support on dysphoria,despondency,and QOL in patients undergoing MHD,a bootstrap method was applied.RESULTS Significant correlations among social support,dysphoria,despondency,and quality in patients undergoing MHD were observed(all P<0.01).Dysphoria and despondency negatively correlated with social support and QOL(P<0.01).Dysphoria and despondency had negative predictive impacts on the QOL of patients undergoing MHD(P<0.05).The direct effect of dysphoria on QOL was statistically significant(P<0.05).Social support mediated the relationship between dysphoria and QOL,and this mediating effect was significant(P<0.05).Similarly,the direct effect of despondency on QOL was significant(P<0.05).Moreover,social support played a mediating role between despondency and QOL,with a significant mediating effect(P<0.05).CONCLUSION These findings suggest that social support plays a significant mediating role in the relationship between dysphoria,despondency,and QOL in patients undergoing MHD.

Multidisciplinary diagnosis and treatment nutritional support intervention for gastrointestinal tumor radiotherapy:Impact on nutrition and quality of life

BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.

Association between Support and Satisfaction with Life among Older Adults in Ekiti, Nigeria: Findings and Implications

Many developing countries like Nigeria lack policy for the care of the older adults and this creates major challenges for the elderly population. The traditional family institution and community support that used to be safety nest are being adversely affected by westernization. This development might have adverse effect on life satisfaction among the older adults. This hospital based cross-sectional study was designed to determine the association between support and life satisfaction among older adults. A total of 128 subjects participated in the study out of which 28.9% were satisfied with life. Expectation of support was mainly from the family, less from the community and very low from the government. The level of support received from all sources generally fell short of expectations. Marital status and source of livelihood were significantly associated with life satisfaction. There is inadequate social support from the government and support from family and community fell below expectations. Expectations of support were the most strongly correlated with life satisfaction. Support for older adults must be addressed in order to meet their expectations and improve their level of satisfaction with life.

Enhancing adolescent mental health through cognitive and social support:Insights from study on depression in Chinese adolescents

Adolescent depression is a growing global health concern,affecting 14%of adolescents and leading to severe consequences such as academic failure,substance abuse,and suicidal ideation.The study by Yu et al,investigates the cognitive and social factors influencing depression in 795 Chinese adolescents.Findings reveal that negative life events(NLEs)and dysfunctional attitudes are strongly associated with depressive symptoms,while social support moderates the impact of NLEs but not dysfunctional attitudes.The study highlights the need for cognitivebehavioural interventions targeting perfectionism and autonomy,and the importance of strengthening social support systems in schools and communities.Culturally sensitive,holistic approaches to adolescent mental health are crucial for addressing both the internal vulnerabilities and external pressures contributing to depression.Further research is needed to explore the roles of peer and parental support and the long-term effects of these factors across diverse cultural contexts.

Health-related quality of life among congestive heart failure patients with preserved and reduced ejection fraction

Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used for this study.The stratified random sampling was applied for each subgroup.HRQOL was measured with the Minnesota Living with Hear t Failure Questionnaire.The data were analyzed using chi-square,Spearman's correlation analysis,and independent t-test.Results:A number of 67 respondents participated in the recent study.The total mean scores of HRQOL were significantly different(P=0.001)between heart failure(HF)patients with reduced and preserved ejection fractions,41.07±7.54 and 54.97±4.36,respectively.It related with the physical(mean±standard deviation[SD]=10.4±2.14;t=-10.08,95%CI=-12.46 to-8.34;P-value=0.001)and psychological(mean±SD=3.5±0.5;t=-6.68,95%CI=-4.55 to-2.45;P-value=0.001)domain.Strong correlation was found between age(r=-0.898,P<0.05),NYHA functional classes(r=-0.858,P<0.01),duration of HF(r=-0.807,P<0.01),family support(r=0.927,P<0.01),and quality of life(Qo L).Conclusions:HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction.Family suppor t is a fur ther determinant factor that has a positive correlation to the Qo L.

Casing life prediction using Borda and support vector machine methods

Eight casing failure modes and 32 risk factors in oil and gas wells are given in this paper. According to the quantitative analysis of the influence degree and occurrence probability of risk factors, the Borda counts for failure modes are obtained with the Borda method. The risk indexes of failure modes are derived from the Borda matrix. Based on the support vector machine （SVM）, a casing life prediction model is established. In the prediction model, eight risk indexes are defined as input vectors and casing life is defined as the output vector. The ideal model parameters are determined with the training set from 19 wells with casing failure. The casing life prediction software is developed with the SVM model as a predictor. The residual life of 60 wells with casing failure is predicted with the software, and then compared with the actual casing life. The comparison results show that the casing life prediction software with the SVM model has high accuracy.

Neurologic complications and neurodevelopmental outcome with extracorporeal life support

Extracorporeal life support is used to support patients of all ages with refractory cardiac and/or respiratory failure. Extracorporeal membrane oxygenation(ECMO)has been used to rescue patients whose predicted mortality would have otherwise been high. It is associated with acute central nervous system(CNS) complications and with long- term neurologic morbidity. Many patients treated with ECMO have acute neurologic complications, including seizures, hemorrhage, infarction, and brain death. Various pre-ECMO and ECMO factors have been found to be associated with neurologic injury, including acidosis, renal failure, cardiopulmonary resuscitation, and modality of ECMO used. The risk of neurologic complication appears to vary by age of the patient, with neonates appearing to have the highest risk of acute central nervous system complications. Acute CNS injuries are associated with increased risk of death in a patient who has received ECMO support. ECMO is increasingly used during cardiopulmonary resuscitation when return of spontaneous circulation is not achieved rapidly and outcomes may be good in select populations. Economic analyses have shown that neonatal and adult respiratory ECMO are cost effective. There have been several intriguing reports of active physical rehabilitation of patients duringECMO support that is well tolerated and may improve recovery. Although there is evidence that some patients supported with ECMO appear to have very good outcomes, there is limited understanding of the longterm impact of ECMO on quality of life and long-term cognitive and physical functioning for many groups, especially the cardiac and pediatric populations. This deserves further study.

Is current training in basic and advanced cardiac life support(BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala

BACKGROUND:Healthcare professionals are expected to have knowledge of current basic and advanced cardiac life support(BLS/ACLS) guidelines to revive unresponsive patients.METHODS:Across-sectional study was conducted to evaluate the current practices and knowledge of BLS/ACLS principles among healthcare professionals of North-Kerala using pretested self-administered structured questionnaire.Answers were validated in accordance with American Heart Association's BLS/ACLS teaching manual and the results were analysed.RESULTS:Among 461 healthcare professionals,141(30.6%) were practicing physicians,268(58.1%) were nurses and 52(11.3%) supporting staff.The maximum achievable score was 20(BLS15/ACLS 5).The mean score amongst all healthcare professionals was 8.9±4.7.The mean score among physicians,nurses and support staff were 8.6±3.4,9±3.6 and 9±3.3 respectively.The majority of healthcare professionals scored <50%(237,51.4%);204(44.3%) scored 51%-80%and 20(4.34%)scored >80%.Mean scores decreased with age,male sex and across occupation.Nurses who underwent BLS/ACLS training previously had significantly higher mean scores(10.2±3.4) than untrained(8.2±3.6,P=0.001).Physicians with <5 years experience(P=0.002) and nurses in the private sector(P=0.003)had significantly higher scores.One hundred and sixty three(35.3%) healthcare professionals knew the correct airway opening manoeuvres like head tilt,chin lift and jaw thrust.Only 54(11.7%) respondents were aware that atropine is not used in ACLS for cardiac arrest resuscitation and 79(17.1%) correctly opted ventricular fibrillation and pulseless ventricular tachycardia as shockable rhythms.The majority of healthcare professionals(356,77.2%) suggested that BLS/ACLS be included in academic curriculum.CONCLUSION:Inadequate knowledge of BLS/ACLS principles amongst healthcare professionals,especially physicians,illuminate lacunae in existing training systems and merit urgent redressal.

Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support?

BACKGROUND: Healthcare professionals have a duty to maintain basic life support(BLS) skills. This study aims to evaluate medical students' factual knowledge of BLS and the training they receive.METHODS: A cross-sectional, closed-response questionnaire was distributed to the fi rst-and fourth-year students studying at institutions in the United Kingdom. The paper questionnaire sought to quantify respondent's previous BLS training, factual knowledge of the BLS algorithm using five multiple choice questions(MCQs), and valuate their desire for further BLS training. Students received 1 point for each correctly identifi ed answer to the 5 MCQ's.RESULTS: A total of 3,732 complete responses were received from 21 medical schools. Eighty percent(n=2,999) of students completed a BLS course as part of their undergraduate medical studies. There was a signifi cant difference(P<0.001) in the percentage of the fourth-year students selecting the correct answer in all the MCQ's compared to the fi rst-year students except in identifyingthe correct depth of compressions required during CPR(P=0.095). Overall 10.3%(95% CI 9.9% to 10.7%) of respondents correctly identified the answer to 5 MCQ's on BLS: 9% of the first-year students(n=194) and 12% of the fourth-year students(n=190). On an institutional level the proportion of students answering all MCQ's correctly ranged from 2% to 54% at different universities. Eighty-one percent of students(n=3,031) wished for more BLS training in their curriculum.CONCLUSION: Factual knowledge of BLS is poor among medical students in the UK. There is a disparity in standards of knowledge across institutions and respondents indicating that they would like more training.

Basic life support:knowledge and attitude of medical/paramedical professionals

BACKGROUND:Basic life support(BLS),a key component of the chain of survival decreases the arrest-cardiopulmonary resuscitation interval and increases the rate of hospital discharge.The study aimed to explore the knowledge of and attitude towards basic life support(BLS)among medical/paramedical professionals.METHODS:An observational study was conducted by assessing response to self prepared questionnaire consisting of the demographic information of the medical/paramedical staff,their personnel experience/attitude and knowledge of BLS based on the 2005 BLS Guidelines of European Resuscitation Council.RESULTS:After excluding incomplete questionnaires,the data from 121 responders(27 clinical faculty members,21 dental and basic sciences faculty members,29 house officers and 44 nurses and health assistants)were analyzed.Only 9(7.4%)of the 121 responders answered≥11,53(43%)answered 7-10,and 58(48%)answered<7 of 15 questions correctly.The clinical faculty members,house officers and nurses/HA had a mean score of 7.4±3.15,7.37±2.02 and 6.63±2.16 respectively,while dental/basic sciences faculty members attained a least mean score of 4.52±2.13(P<0.001).Those who had received cardiopulmonary resuscitation(CPR)training within 5 years obtained a highest mean score of 8.62±2.49,whereas those who had the training more than 5 years back or no training obtained a mean score of 5.54±2.38 and 6.1±2.29 respectively(P=0.001).Those who were involved in resuscitation frequently had a higher median score of 8 in comparison to those who were seldom involved or not involved at all(P<0.001).CONCLUSIONS:The average health personnel in our hospital lack adequate knowledge in CPR/BLS.Training and experience can enhance knowledge of CPR of these personnel.Thus standard of CPR/BLS training and assessment are recommended at our hospital.

The impact of perceived social support, loneliness, and physical activity on quality of life in South Korean older adults

Purpose: The purpose of this study was to propose and test a conceptual model that explains the interrelationships among perceived social support, loneliness, physical activity(PA), and quality of life(QoL) among active older adults in South Korea.Methods: Data were collected from 332 individuals over the age of 65 using a systematic stratified convenience sampling method. Survey data were collected and analyzed using a structural equation model(SEM).Results: Perceived social support had a significantly positive effect on PA(b = 0.14, p < 0.01) and QoL(b = 0.28, p < 0.001) while decreasing loneliness(b = —0.55, p < 0.001). PA had a significant positive effect on QoL(b = 0.12, p < 0.01), and loneliness had a negative effect on QoL(b = —0.37, p < 0.001). Loneliness mediated the relationship between perceived social support and QoL.Conclusion: The SEM results of the current study support the proposed model that explained the interrelationships among perceived social support, loneliness, PA, and QoL among active older adults in South Korea. These findings suggest the importance of incorporating social support mechanisms for PA interventions in order to enhance QoL. The findings of this study can help create more effective health and physical education programs for the older generations in South Korea to enhance their QoL.

Short lessons in basic life support improve self-assurance in performing cardiopulmonary resuscitation

BACKGROUND:There are several reasons why resuscitation measures may lead to inferior results:difficulties in team building,delayed realization of the emergency and interruption of chest compression.This study investigated the outcome of a new form of in-hospital cardiopulmonary resuscitation(CPR) training with special focus on changes in self-assurance of potential helpers when faced with emergency situations.METHODS:Following a 12-month period of CPR training,questionnaires were distributed to participants and non-participants.Those non-participants who intended to undergo the training at a later date served as control group.RESULTS:The study showed that participants experienced a significant improvement in selfassurance,compared with their remembered self-assurance before the training.Their self-assurance also was significantly greater than that of the control group of non-participants.CONCLUSION:Short lessons in CPR have an impact on the self-assurance of medical and non-medical personnel.

Peer-assisted learning to train high-school students to perform basic life-support

BACKGROUND: The inclusion of cardiopulmonary resuscitation(CPR) in formal education has been a useful approach to providing basic life support(BLS) services. However, because not all students have been able to learn directly from certified instructors, we studied the educational efficacy of the use of peer-assisted learning(PAL) to train high-school students to perform BLS services.METHODS: This study consisted of 187 high-school students: 68 participants served as a control group and received a 1-hour BLS training from a school nurse, and 119 were included in a PAL group and received a 1-hour CPR training from a PAL leader. Participants' BLS training was preceded by the completion of questionnaires regarding their background. Three months after the training, the participants were asked to respond to questionnaires about their willingness to perform CPR on bystander CPR and their retention of knowledge of BLS.RESULTS: We found no statistically significant difference between the control and PAL groups in their willingness to perform CPR on bystanders(control: 55.2%, PAL: 64.7%, P=0.202). The PAL group was not significantly different from the control group(control: 60.78±39.77, PAL: 61.76±17.80, P=0.848) in retention of knowledge about BLS services.CONCLUSION: In educating high school students about BLS, there was no significant difference between PAL and traditional education in increasing the willingness to provide CPR to bystanders or the ability to retain knowledge about BLS.

Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study

BACKGROUND: The quality of chest compressions can be significantly improved after training of rescuers according to the latest national guidelines of China. However, rescuers may be unable to maintain adequate compression or ventilation throughout a response of average emergency medical services because of increased rescuer fatigue. In the present study, we evaluated the performance of cardiopulmonary resuscitation(CPR) in training of military medical university students during a prolonged basic life support(BLS).METHODS: A 3-hour BLS training was given to 120 military medical university students. Six months after the training, 115 students performed single rescuer BLS on a manikin for 8 minutes. The qualities of chest compressions as well as ventilations were assessed.RESULTS: The average compression depth and rate were 53.7±5.3 mm and 135.1±15.7 compressions per minute respectively. The proportion of chest compressions with appropriate depth was 71.7%±28.4%. The average ventilation volume was 847.2±260.4 m L and the proportion of students with adequate ventilation was 63.5%. Compared with male students, significantly lower compression depth(46.7±4.8 vs. 54.6±4.8 mm, P<0.001) and adequate compression rate(35.5%±26.5% vs. 76.1%±25.1%, P<0.001) were observed in female students.CONCLUSIONS: CPR was found to be related to gender, body weight, and body mass index of students in this study. The quality of chest compressions was well maintained in male students during 8 minutes of conventional CPR but declined rapidly in female students after 2 minutes according to the latest national guidelines. Physical fitness and rescuer fatigue did not affect the quality of ventilation.

Advanced trauma life support training: How useful it is?

We have tried in a recently published systematic review(World J of Surg 2014; 38: 322-329) to study the educational value of advanced trauma life support(ATLS) courses and whether they improve survival of multiple trauma patients. This Frontier article summarizes whatwe have learned and reflects on future perspectives in this important area. Our recently published systematic review has shown that ATLS training is very useful from an educational point view. It significantly increased knowledge, and improved practical skills and the critical decision making process in managing multiple trauma patients. These positive changes were evident in a wide range of learners including undergraduate medical students and postgraduate residents from different subspecialties. In contrast, clear evidence that ATLS training reduces trauma death is lacking. It is obvious that it is almost impossible to perform randomized controlled trials to study the effect of ATLS courses on trauma mortality. Studying factors predicting trauma mortality is a very complex issue. Accordingly, trauma mortality does not depend solely on ATLS training but on other important factors, like presence of well-developed trauma systems including advanced pre-hospital care. We think that the way to answer whether ATLS training improves survival is to perform large prospective cohort studies of high quality data and use advanced statistical modelling.

Theoretical knowledge and psychomotor skill acquisition of basic life support training programme among secondary school students

BACKGROUND: The aim of the study is to evaluate the theoretical knowledge and psychomotor skill acquisition of basic life support(BLS) by a group of secondary school students in Nigeria pre and post BLS training. METHODS: This was quasi-experimental study design with 210 participants. They were taught on adult BLS and all the participants practiced BLS on a Resusci-Anne manikin immediately after the training. Data were collected using American Heart Association(AHA) structured questionnaire and psychomotor skills checklist for BLS at baseline, and post BLS training.RESULTS: The pre-training knowledge score was 1.9±1.4. This increased after the BLS training to 11.4±2.4, and the mean difference between the pre and post BLS training scores was 9.48571. Pre-training psychomotor skill score was 0.00±0.00, this increased to 8.9±1.9 after the training, and the mean difference was 8.90000. The knowledge and psychomotor skill difference between pre and post BLS training was signifi cant(P<0.000).CONCLUSION: Most Nigerian secondary school students were not knowledgeable about BLS. Therefore, there is need for the creation of more awareness among the students.

Assessment of knowledge and attitude about basic life support among dental interns and postgraduate students in Bangalore city,India

BACKGROUND: Life-threatening emergencies can occur at anytime, at anywhere and in anyone. Effective management of an emergency situation in the dental office is ultimately the dentist's responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal complications. Therefore, health professionals including dentists must be well prepared to deal with medical emergencies. This study was undertaken to assess the knowledge about and attitude towards basic life support(BLS) among dental interns and postgraduate students in Bangalore city, India.METHODS: A cross sectional survey was conducted among dental interns and postgraduate students from May 2014 to June 2014 since few studies have been conducted in Bangalore city. A questionnaire with 17 questions regarding the knowledge about and attitude towards BLS was distributed to 202 study participants.RESULTS: The data analyzed using the Chi-square test showed that dental interns and postgraduate students had average knowledge about BLS. In the 201 participants, 121(59.9%) had a positive attitude and 81(40.1%) had a negative attitude towards BLS.CONCLUSIONS: Cardiopulmonary resuscitation should be considered as part of the dental curriculum. Workshops on a regular basis should be focused on skills of cardiopulmonary resuscitation for dental students.

Donors’ Quality of Life after Live Liver Transplantation and Social Support: A Correlation Study

Objective: Donors’ quality of life (QOL) and social support were investigated in this study. Method: The SF-36 scale and social support scale were used to survey the quality of life and social support of donors of live liver transplantation. Result: The PCS (Physical Correlated Score) is 84.78 ± 13.21, the MCS (Mental Correlated Score) is 80.71 ± 14.65, and the total score is 165.49 ± 22.63. The results show the significant difference at GH (General Health) & VT (Vitality) domain regarding the age, P < 0.05;while there’s a significant difference at BP (Body Pain) domain regarding the sex, P < 0.05. The social support score of male & female donors are 37.75 ± 7.50 and 44.00 ± 4.30, and the difference is significant, P < 0.05. The MCS and the social support score are correlated, the correlation factor is 0.483, P < 0.05. Conclusion: There’s no significant difference between the donors and the normal population. The age is the risk factor of QOL, and it should be paid more attention when we select the donor. Excellent social support relates to high quality of life.

Knowledge,attitude and anxiety pertaining to basic life support and medical emergencies among dental interns in Mangalore City,India

BACKGROUND: This cross-sectional study aimed to assess the knowledge, attitude and anxiety pertaining to basic life support(BLS) and medical emergencies among interns in dental colleges of Mangalore city, Karnataka, India.METHODS: The study subjects comprised of interns who volunteered from the four dental colleges. The knowledge and attitude of interns were assessed using a 30-item questionnaire prepared based on the Basic Life Support Manual from American Heart Association and the anxiety of interns pertaining to BLS and medical emergencies were assessed using a State-Trait Anxiety Inventory(STAI) Questionnaire. Chi-square test was performed on SPSS 21.0(IBM Statistics, 2012) to determine statistically signifi cant differences(P<0.05) between assessed knowledge and anxiety.RESULTS: Out of 183 interns, 39.89% had below average knowledge. A total of 123(67.21%) reported unavailability of professional training. The majority(180, 98.36%) felt the urgent need of training in basic life support procedures. Assessment of stress showed a total of 27.1% participants to be above highstress level. Comparison of assessed knowledge and stress was found to be insignifi cant(P=0.983).CONCLUSION: There was an evident lack of knowledge pertaining to the management of medical emergencies among the interns. As oral health care providers moving out to the society, a focus should be placed on the training of dental interns with respect to Basic Life Support procedures.

Availability of basic life support courses for the general populations in India, Nigeria and the United Kingdom: An internet-based analysis

BACKGROUND:The number of lay people willing to attempt cardiopulmonary resuscitation(CPR)in real life is increased by effective education in basic life support(BLS).However,little is known about access of general public to BLS training across the globe.This study aimed to investigate availability and key features of BLS courses proposed for lay people in India,Nigeria and the United Kingdom(UK).METHODS:A Google search was done in December 2018,using English keywords relevant for community resuscitation training.Ongoing courses addressing BLS and suitable for any adult layperson were included in the analysis.On-site training courses were limited to those provided within the country's territory.RESULTS:A total of 53,29 and 208 eligible courses were found for India,Nigeria and the UK,respectively.In the UK,the number of courses per 10 million population(31.5)is 79 and 21 times higher than that in India(0.4)and Nigeria(1.5).Course geography is limited to 28%states and one union territory in India,30%states and the Federal Capital Territory in Nigeria.In the UK,the training is offered in all constituent countries,with the highest prevalence in England.Courses are predominantly classroom-based,highly variable in duration,group size and instructors'qualifications.For India and Nigeria,mean cost of participation is exceeding the monthly minimum wage.CONCLUSION:In contrast to the UK,the availability and accessibility of BLS courses are critically limited in India and Nigeria,necessitating immediate interventions to optimize community CPR training and improve bystander CPR rates.