Search results for: physician resilience

Authors: Kuniko Muramoto, Tadashi Nakamura, Shiro Dan

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On March 11, 2011 the Great East Japan Disaster caused widespread damage. In the aftermath, we searched for ways to provide long-term support and enhanced resilience to affected areas, arriving at the Family Manga Exhibition: an art collection portraying family life. It became a tool for community outreach and intervention, and we implemented support programs by collaborating with local support agencies. This 10-year project has been touring through four prefectures in Tohoku since the disaster struck, bearing witness to the effects of disaster and recovery alike. At this five-year mark, we use a narrative perspective to present our findings and reflect on post-disaster community support. It is important to note that the exhibition’s art does not directly depict the disaster; it portrays stories of anonymous families instead. They stimulate viewers’ memories and remind them of their own family stories. We analyzed viewers' oral and written responses to the exhibition and discovered that family manga as an art form enhances the viewer’s sense of connection to people close to them. We also discovered that the viewers gained more universal perspective on their own situations by viewing the exhibition. Manga, we found, offered a certain safety by enabling the viewers to control how they would interact with the exhibition's content and themes. In addition, the purpose of the project was for us to become witnesses of the disaster and recovery. Supporters of the project became active listeners, functioning as interactive agents who helped forming stories. Voices of the story tellers and the listeners layered upon each other and, as a result, converged into brand new narratives. The essence of traumatic experience is ‘the sense of overwhelming powerlessness and isolation’. When we redefine trauma as ‘broken relationships’, we can say that ‘enhancing relationships’ and ‘weaving relationships’ are what strengthen our resilience. This project used narrative as a modality to fortify the resilience of people involved by enhancing the social capital of bonding, bridging, and linking. The manga exhibition functioned as a tool to achieve this end, suggesting that similar applications are possible. Programs we held in-between manga exhibitions also served to enhance narratives of resiliency in the regions. However, we will save that story for another time. We hope to continue collecting the precious and polyphonic voices of people to present as stories born out of the Great East Japan Disaster. This effort extends beyond the immediately affected area by helping us prepare our resilience for future disasters.

Keywords: community, manga, narrative, resilience

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Authors: Paulina Ramirez Leal

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Current debates have examined the effects of market-oriented development on gentrification, as well as the role of urban renewal, interventions, and planning policy in exacerbating this phenomenon. Despite the growing body of research recognizing the social impacts of gentrification, to date, there has been very little research directly investigating how resisting gentrification increases social cohesion, a crucial dimension of urban resilience. This contribution set out to explore these social impacts while identifying the different forms of protest and expressions of resistance to gentrification in Monterrey’s city center. The methods employed include documentary analysis and qualitative methods such as surveys and photographic documentation. Monterrey’s city center's ongoing process of gentrification illustrates the impacts of planning policies, specifically TOD. Some of the unintended consequences of the policy have resulted in inhabitants facing forced inner migration and displacement caused by vandalism of their homes and neighborhoods, as well as losing part of their urban identity.

Keywords: gentrification, social impacts, neighborhood identity, urban resilience, Monterrey’s City Center

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Authors: Xu Qian

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This abstract explores the importance of building resilience within families and offers evidence-based strategies for promoting positive parenting and enhancing emotional well-being. It emphasizes the role of effective communication, conflict resolution, and fostering a supportive environment to strengthen family bonds and promote healthy child development. Introduction: The well-being and resilience of families play a crucial role in fostering healthy child development and promoting overall emotional well-being. This abstract highlights the significance of nurturing resilient families and provides evidence-based strategies for positive parenting. By focusing on effective communication, conflict resolution, and creating a supportive environment, families can strengthen their bonds and enhance emotional well-being for both parents and children. Methods: This abstract draws upon a comprehensive review of existing research and literature on resilient families, positive parenting, and emotional well-being. The selected studies employ various methodologies, including surveys, interviews, and longitudinal observations, to investigate the factors contributing to family resilience and the strategies that promote positive parenting practices. The findings from these studies serve as the foundation for the strategies discussed in this abstract. Results: The results of the reviewed studies demonstrate that effective communication within families is a key factor in building resilience and promoting emotional well-being. Open and honest communication allows family members to express their thoughts, feelings, and concerns, fostering trust and understanding. Conflict resolution skills, such as active listening, compromise, and problem-solving, are vital in managing conflicts constructively and preventing negative consequences on family dynamics and children's well-being. Creating a supportive environment that nurtures emotional well-being is another critical aspect of promoting resilient families. This includes providing emotional support, setting clear boundaries, and promoting positive discipline strategies. Research indicates that consistent and responsive parenting approaches contribute to improved self-regulation skills, emotional intelligence, and overall mental health in children. Discussion: The discussion centers on the implications of these findings for promoting positive parenting and emotional well-being. It emphasizes the need for parents to prioritize self-care and seek support when facing challenges. Parental well-being directly influences the quality of parenting and the overall family environment. By attending to their own emotional needs, parents can better meet the needs of their children and create a nurturing atmosphere. Furthermore, the importance of fostering resilience in children is highlighted. Resilient children are better equipped to cope with adversity, adapt to change, and thrive in challenging circumstances. By cultivating resilience through supportive relationships, encouragement of independence, and providing opportunities for growth, parents can foster their children's ability to bounce back from setbacks and develop essential life skills. Conclusion: In conclusion, nurturing resilient families is crucial for positive parenting and enhancing emotional well-being. This abstract presents evidence-based strategies that emphasize effective communication, conflict resolution, and creating a supportive environment. By implementing these strategies, parents can strengthen family bonds, promote healthy child development, and enhance overall family resilience. Investing in resilient families not only benefits individual family members but also contributes to the well-being of the broader community.

Keywords: childrearing families, family education, children's mental health, positive parenting, emotional health

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Authors: Fouzia Ajmal

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Global Citizenship Education (GCED) could prove to be the best solution to prevent violent extremism as it will sustain a respect for all and build up a feeling of having a place with humankind. To meet the target 4.7 of sustainable development goals, it is important to focus on global citizenship education at all levels of education in general and in pre-service teacher education in particular so that the message and practices reach the young masses. The pre-service education is imperative to develop knowledge, skills and disposition of prospective teachers. The current study was conducted to investigate the integration of GCED in pre-service teacher education curriculum of Pakistan. The study was delimited to B.Ed (hons) Elementary Education programme. The curriculum of B.Ed Elementary developed by Higher Education Commission was analyzed through Curriculum Alignment Matrix. 31 course outlines were analyzed, and percentage was used to analyze the level of integration of GCED in courses. The analyses depicted that the concepts of civic sense, tolerance, duties and rights of citizens and fundamental rights of humans are partially aligned in a few of the courses. The tolerance, active citizenship, and respect for cultural diversity and religious harmony are evident in Pakistan Studies and teaching of social studies courses. The relevant books are also mentioned as resources in these courses. The intercultural understanding is not very evident while globalization is mentioned in a few courses. It is recommended that a deliberate effort may be made to integrate concepts of Global Citizenship Education so as to enable the prospective teachers in developing necessary skills to play their active role in promoting peace and building resilience to extremism in elementary school students.

Keywords: curriculum analysis, global citizenship education, preservice teacher education, resilience building

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Authors: Adane Kassa Shikur

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Today’s supply chains (SC) have become vulnerable to unexpected and ever-intensifying disruptions from myriad sources. Consequently, the concept of supply chain resilience (SCRes) has become crucial to complement the conventional risk management paradigm, which has failed to cope with unexpected SC disruptions, resulting in severe consequences affecting SC performances and making business continuity questionable. Advancements in cutting-edge technologies like artificial intelligence (AI) and their potential to enhance SCRes by improving critical antecedents in the different phases have attracted the attention of scholars and practitioners. The research from academia and the practical interest of the industry have yielded significant publications at the nexus of AI and SCRes during the last two decades. However, the applications and examinations have been primarily conducted independently, and the extant literature is dispersed into research streams despite the complex nature of SCRes. To close this research gap, this study conducts a systematic literature review of 106 peer-reviewed articles by curating, synthesizing, and consolidating up-to-date literature and presents the state-of-the-art development from 2010 to 2022. Bayesian networks are the most topical ones among the 13 AI techniques evaluated. Concerning the critical antecedents, visibility is the first ranking to be realized by the techniques. The study revealed that AI techniques support only the first 3 phases of SCRes (readiness, response, and recovery), and readiness is the most popular one, while no evidence has been found for the growth phase. The study proposed an AI-SCRes framework to inform research and practice to approach SCRes holistically. It also provided implications for practice, policy, and theory as well as gaps for impactful future research.

Keywords: ANNs, risk, Bauesian networks, vulnerability, resilience

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Authors: Sally Naji, Julie Gwilliam

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Climate change remains a challenging matter for the human and the built environment in the 21st century, where the need to consider adaptation to climate change in the development process is paramount. However, there remains a lack of information regarding how we should prepare responses to this issue, such as through developing organized and sophisticated tools enabling the adaptation process. This study aims to build a systematic framework approach to investigate the potentials that Neighborhood Sustainability Assessment tools (NSA) might offer in enabling both the analysis of the emerging adaptive capacity to climate change. The analysis of the framework presented in this paper aims to discuss this issue in three main phases. The first part attempts to link sustainability and climate change, in the context of adaptive capacity. It is argued that in deciding to promote sustainability in the context of climate change, both the resilience and vulnerability processes become central. However, there is still a gap in the current literature regarding how the sustainable development process can respond to climate change. As well as how the resilience of practical strategies might be evaluated. It is suggested that the integration of the sustainability assessment processes with both the resilience thinking process, and vulnerability might provide important components for addressing the adaptive capacity to climate change. A critical review of existing literature is presented illustrating the current lack of work in this field, integrating these three concepts in the context of addressing the adaptive capacity to climate change. The second part aims to identify the most appropriate scale at which to address the built environment for the climate change adaptation. It is suggested that the neighborhood scale can be considered as more suitable than either the building or urban scales. It then presents the example of NSAs, and discusses the need to explore their potential role in promoting the adaptive capacity to climate change. The third part of the framework presents a comparison among three example NSAs, BREEAM Communities, LEED-ND, and CASBEE-UD. These three tools have been selected as the most developed and comprehensive assessment tools that are currently available for the neighborhood scale. This study concludes that NSAs are likely to present the basis for an organized framework to address the practical process for analyzing and yet promoting Adaptive Capacity to Climate Change. It is further argued that vulnerability (exposure & sensitivity) and resilience (Interdependence & Recovery) form essential aspects to be addressed in the future assessment of NSA’s capability to adapt to both short and long term climate change impacts. Finally, it is acknowledged that further work is now required to understand impact assessment in terms of the range of physical sectors (Water, Energy, Transportation, Building, Land Use and Ecosystems), Actor and stakeholder engagement as well as a detailed evaluation of the NSA indicators, together with a barriers diagnosis process.

Keywords: adaptive capacity, climate change, NSA tools, resilience, sustainability

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Authors: Sami M. Alshareef

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In the rapidly evolving energy landscape, the integration of renewable energy sources and the electrification of transportation are essential steps toward achieving sustainability goals. However, these advancements introduce new challenges, particularly in maintaining frequency stability due to variable photovoltaic (PV) generation and the growing demand for fast charging stations. The variability of photovoltaic (PV) generation due to weather conditions can disrupt the balance between generation and load, resulting in frequency deviations. To ensure the stability of power systems, it is imperative to develop effective under frequency load-shedding schemes. This research proposal presents an adaptive under-frequency load shedding scheme based on the power swing equation, designed explicitly for the IEEE-9 Bus Test System, that includes PV generation and fast charging stations. This research aims to address these challenges by developing an advanced scheme that dynamically disconnects fast charging stations based on power imbalances. The scheme prioritizes the disconnection of stations near affected areas to expedite system frequency stabilization. To achieve these goals, the research project will leverage the power swing equation, a widely recognized model for analyzing system dynamics during under-frequency events. By utilizing this equation, the proposed scheme will adaptively adjust the load-shedding process in real-time to maintain frequency stability and prevent power blackouts. The research findings will support the transition towards sustainable energy systems by ensuring a reliable and uninterrupted electricity supply while enhancing the resilience and stability of power systems during under-frequency events.

Keywords: load shedding, fast charging stations, pv generation, power system resilience

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Authors: Juan Carlos Rubio Romero, Francico Salguero Caparros, Virginia Herrera-Pérez

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No one is in the slightest doubt about the high levels of risk involved in work in the construction industry. They are even higher in structural construction work. The Critical Decision Method (CDM) is a semi-structured interview technique that uses cognitive tests to identify the different disturbances that workers have to deal with in their work activity. At present, the vision of safety focused on daily performance and things that go well for safety and health management is facing the new paradigm known as Resilience Engineering. The aim of this study has been to describe the variability in formwork labour on concrete structures in the construction industry and, from there, to find out the resilient attitude of workers to unexpected events that they have experienced during their working lives. For this purpose, a series of semi-structured interviews were carried out with construction employees with extensive experience in formwork labour in Spain by applying the Critical Decision Method. This work has been the first application of the Critical Decision Method in the field of construction and, more specifically, in the execution of structures. The results obtained show that situations categorised as unthought-of are identified to a greater extent than potentially unexpected situations. The identification during these interviews of both expected and unexpected events provides insight into the critical decisions made and actions taken to improve resilience in daily practice in this construction work. From this study, it is clear that it is essential to gain more knowledge about the nature of the human cognitive process in work situations within complex socio-technical systems such as construction sites. This could lead to a more effective design of workplaces in the search for improved human performance.

Keywords: resilience engineering, construction industry, unthought-of situations, critical decision method

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Authors: Ali Alshahrani, Adel Almaai, Saad Garni

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Aim of the study: To explore duration and determinants of consultation time at a family medicine center. Methodology: This study was conducted at the Family Medicine Center in Ahad Rafidah City, at the southwestern part of Saudi Arabia. It was conducted on the working days of March 2013. Trained nurses helped in filling in the checklist. A total of 459 patients were included. A checklist was designed and used in this study. It included patient’s age, sex, diagnosis, type of visit, referral and its type, psychological problems and additional work-up. In addition, number of daily bookings, physician`s experience and consultation time. Results: More than half of patients (58.39%) had less than 10 minutes’ consultation (Mean+SD: 12.73+9.22 minutes). Patients treated by physicians with shortest experience (i.e., ≤5 years) had the longest consultation time while those who were treated with physicians with the longest experience (i.e., > 10 years) had the shortest consultation time (13.94±10.99 versus 10.79±7.28, p=0.011). Regarding patients’ diagnosis, those with chronic diseases had the longest consultation time (p<0.001). Patients who did not need referral had significantly shorter consultation time compared with those who had routine or urgent referral (11.91±8.42,14.60±9.03 and 22.42±14.81 minutes, respectively, p<0.001). Patients with associated psychological problems needed significantly longer consultation time than those without associated psychological problems (20.06±13.32 versus 12.45±8.93, p<0.001). Conclusions: The average length of consultation time at Ahad Rafidah Family Medicine Center is approximately 13 minutes. Less-experienced physicians tend to spend longer consultation times with patients. Referred patients, those with psychological problems, those with chronic diseases tend to have longer consultation time. Recommendations: Family physicians should be encouraged to keep their optimal consultation time. Booking an adequate number of patients per shift would allow the family physician to provide enough consultation time for each patient.

Keywords: consultation, quality, medicine, clinics

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Authors: Abhijit Trailokya

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Background: Cardiovascular diseases (CVD’s) are the major cause of morbidity and mortality in both developed and developing countries. Many clinical trials have demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering, reduces the incidence of coronary and cerebrovascular events across a broad spectrum of patients at risk. Guidelines for the management of patients at risk have been established in Europe and North America. The guidelines have advocated progressively lower LDL-C targets and more aggressive use of statin therapy. In Indian patients, comprehensive data on dyslipidemia management and its treatment outcomes are inadequate. There is lack of information on existing treatment patterns, the patient’s profile being treated, and factors that determine treatment success or failure in achieving desired goals. Purpose: The present study was planned to determine the lipid control status in high-risk dyslipidemic patients treated with lipid-lowering therapy in India. Methods: This cross-sectional, non-interventional, single visit program was conducted across 483 sites in India where male and female patients with high-risk dyslipidemia aged 18 to 65 years who had visited for a routine health check-up to their respective physician at hospital or a healthcare center. Percentage of high-risk dyslipidemic patients achieving adequate LDL-C level (< 70 mg/dL) on lipid-lowering therapy and the association of lipid parameters with patient characteristics, comorbid conditions, and lipid lowering drugs were analysed. Results: 3089 patients were enrolled in the study; of which 64% were males. LDL-C data was available for 95.2% of the patients; only 7.7% of these patients achieved LDL-C levels < 70 mg/dL on lipid-lowering therapy, which may be due to inability to follow therapeutic plans, poor compliance, or inadequate counselling by physician. The physician’s lack of awareness about recent treatment guidelines also might contribute to patients’ poor adherence, not explaining adequately the benefit and risks of a medication, not giving consideration to the patient’s life style and the cost of medication. Statin was the most commonly used anti-dyslipidemic drug across population. The higher proportion of patients had the comorbid condition of CVD and diabetes mellitus across all dyslipidemic patients. Conclusion: As per the European Society of Cardiology guidelines the ideal LDL-C levels in high risk dyslipidemic patients should be less than 70%. In the present study, 7.7% of the patients achieved LDL-C levels < 70 mg/dL on lipid lowering therapy which is very less. Most of high risk dyslipidemic patients in India are on suboptimal dosage of statin. So more aggressive and high dosage statin therapy may be required to achieve target LDLC levels in high risk Indian dyslipidemic patients.

Keywords: cardiovascular disease, diabetes mellitus, dyslipidemia, LDL-C, lipid lowering drug, statins

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Authors: Alireza Abbasi Moshaii, Farshid Najafi

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In this paper a new model for centre of motion creating is proposed. This new method uses cables. So, it is very useful in robots because it is light and has easy assembling process. In the robots which need to be in touch with some things this method is very good. It will be described in the following. The accuracy of the idea is proved by an experiment. This system could be used in the robots which need a fixed point in the contact with some things and make a circular motion. Such as dancer, physician or repair robots.

Keywords: centre of motion, robotic cables, permanent touching, mechatronics engineering

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Authors: Laurin Zemmrich, Nicolai Stickler

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With the ongoing debate over how to incorporate sustainability, resilience, and value creation into business strategies, many procurement departments are put under pressure by governments, consumers, non-governmental organizations, and other stakeholders to disclose more information about their supply chains. According to practitioners and experts, procurement benefits the supply chain by increasing transparency and accountability, recruiting new suppliers, and supporting sustainable and ethical sourcing strategies. While most procurement departments establish these objectives, the bulk of activities are not carried out or are not regularly monitored. With the full potential of targeted sourcing still to be realized, procurement executives, in particular, are seeking for short-term cost-cutting impacts to appease external shareholders. We overcome this limitation by using an abductive approach to research and integrating empirical data from a Gioia methodology study design with relevant literature. Our analysis demonstrates that the procurement department has six essential levers aligned with sustainability, resilience, and value creation objectives and contributes to developing a new intra- and interorganizational purpose within the supply chain. Three enablers are identified as having a value-creating effect on supply chain interactions. Additionally, we discovered two impacts that alter the power balance between buyers and suppliers during transactions and have a cost-cutting or cost-avoiding effect. While cost-cutting, cost-avoidance, and dependency-reduction impacts are desirable, redistributing power may also have negative consequences. The article establishes a first strategy framework for evaluating the influence of the procurement department on supply chain transactions, allowing managers to understand better and apply the sourcing function inside a supply chain and embed it throughout the business.

Keywords: supply chain management, resilience, sustainability, value creation, purpose

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Authors: Chenyi Ma

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Background: The second costliest hurricane in U.S. history, Sandy landed in southern New Jersey on October 29, 2012, and struck the entire state with high winds and torrential rains. The disaster killed more than 100 people, left more than 8.5 million households without power, and damaged or destroyed more than 200,000 homes across the state. Immediately after the disaster, public policy support was provided in nine coastal counties that constituted 98% of the major and severely damaged housing units in NJ overall. The programs include Individuals and Households Assistance Program, Small Business Loan Program, National Flood Insurance Program, and the Federal Emergency Management Administration (FEMA) Public Assistance Grant Program. In the most severely affected counties, additional funding was provided through Community Development Block Grant: Reconstruction, Rehabilitation, Elevation, and Mitigation Program, and Homeowner Resettlement Program. How these policies individually and as a whole impacted housing recovery across communities with different socioeconomic and demographic profiles has not yet been studied, particularly in relation to damage levels. The concept of community social vulnerability has been widely used to explain many aspects of natural disasters. Nevertheless, how communities are vulnerable has been less fully examined. Community resilience has been conceptualized as a protective factor against negative impacts from disasters, however, how community resilience buffers the effects of vulnerability is not yet known. Because housing recovery is a dynamic social and economic process that varies according to context, this study examined the path from community vulnerability and resilience to housing recovery looking at both community characteristics and policy interventions. Sample/Methods: This retrospective longitudinal case study compared a literature-identified set of pre-disaster community characteristics, the effects of multiple public policy programs, and a set of time-variant community resilience indicators to changes in housing stock (operationally defined by percent of building permits to total occupied housing units/households) between 2010 and 2014, two years before and after Hurricane Sandy. The sample consisted of 51 municipalities in the nine counties in which between 4% and 58% of housing units suffered either major or severe damage. Structural equation modeling (SEM) was used to determine the path from vulnerability to the housing recovery, via multiple public programs, separately and as a whole, and via the community resilience indicators. The spatial analytical tool ArcGIS 10.2 was used to show the spatial relations between housing recovery patterns and community vulnerability and resilience. Findings: Holding damage levels constant, communities with higher proportions of Hispanic households had significantly lower levels of housing recovery while communities with households with an adult >age 65 had significantly higher levels of the housing recovery. The contrast was partly due to the different levels of total public support the two types of the community received. Further, while the public policy programs individually mediated the negative associations between African American and female-headed households and housing recovery, communities with larger proportions of African American, female-headed and Hispanic households were “vulnerable” to lower levels of housing recovery because they lacked sufficient public program support. Even so, higher employment rates and incomes buffered vulnerability to lower housing recovery. Because housing is the "wobbly pillar" of the welfare state, the housing needs of these particular groups should be more fully addressed by disaster policy.

Keywords: community social vulnerability, community resilience, hurricane, public policy

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Authors: Snezana Svetozarevic

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The aim of the research was to determine whether there were significant changes in perceptions of family functioning by families in Serbia 12 months after the coronavirus (COVID-19) outbreak has been declared a global pandemic. Above all, what has protected families in the face of the global crisis caused by COVID-19. The Self-Report Family Inventory, II version (SFI-II; Beavers and Hampson, 2013) and the Inventory of Family Protective Factors (IFPF; Gardner et al., 2008) were used to assess family functioning and protective factors. Currently, families perceive their functioning as more problematic regarding family emotional expressiveness, conflict, cohesion, and global family health/competence. Adaptive appraisal based on positive coping experiences significantly predicted values on emotional expressiveness, conflict, leadership, and global family health/competence dimensions -a higher prevalence of this factor was associated with more optimal family functioning and fewer problems. The growing problem in family functioning with the beginning of the pandemic is inevitable. However, our research confirmed that it is not enough to take into account what families do to survive. It is equally important to learn about what they do to thrive i.e., to study the family resilience.

Keywords: family, coping, resilience, pandemic, COVID-19

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Authors: Joanna Konstantinou

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The study is about the challenges faced by entrepreneurs in a crisis context and in turbulent economies. The scope is to determine which factors, if any, are related to the success of a new business venture, such as innovation, access to funding and capital, enhanced digital skills, employment relations and organizational culture as well as a company’s strategic orientation towards international markets. The crisis context has been recorded to have affected the number of SMEs in the Greek economy, the number of people employed as well as the volume of the output produced. Although not all SMEs have been equally impacted by the crisis, which has been identified to affect certain sectors more than others, and although research is not exhaustive in that end, employment relations and patterns, firm’s age, and innovation practices in relation to employees’ learning curve seem to have a positive correlation with the successful survival and resilience of the firm. The aim is to identify important factors that can contribute positively to the success of a startup business, and that will allow businesses to acquire resilience and survive economic adversities, and it will focus on businesses of the Greek economy, the country with the longer lasting economic crisis and the findings will be lessons to learn for other economies.

Keywords: entrepreneurship, innovation, crisis, challenges

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Authors: Vinu Elias Jacob, Manoj Kumar Kini

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Disasters of all types are occurring more frequently and are becoming more costly than ever due to various manmade factors including climate change. A better utilisation of the concept of governance and management within disaster risk reduction is inevitable and of utmost importance. There is a need to explore the role of pre- and post-disaster public policies. The role of urban planning/design in shaping the opportunities of households, individuals and collectively the settlements for achieving recovery has to be explored. Governance strategies that can better support the integration of disaster risk reduction and management has to be examined. The main aim is to thereby build the resilience of individuals and communities and thus, the states too. Resilience is a term that is usually linked to the fields of disaster management and mitigation, but today has become an integral part of planning and design of cities. Disaster resilience broadly describes the ability of an individual or community to 'bounce back' from disaster impacts, through improved mitigation, preparedness, response, and recovery. The growing population of the world has resulted in the inflow and use of resources, creating a pressure on the various natural systems and inequity in the distribution of resources. This makes cities vulnerable to multiple attacks by both natural and man-made disasters. Each urban area needs elaborate studies and study based strategies to proceed in the discussed direction. Cochin in Kerala is the fastest and largest growing city with a population of more than 26 lakhs. The main concern that has been looked into in this paper is making cities resilient by designing a framework of strategies based on urban design principles for an immediate response system especially focussing on the city of Cochin, Kerala, India. The paper discusses, understanding the spatial transformations due to disasters and the role of spatial planning in the context of significant disasters. The paper also aims in developing a model taking into consideration of various factors such as land use, open spaces, transportation networks, physical and social infrastructure, building design, and density and ecology that can be implemented in any city of any context. Guidelines are made for the smooth evacuation of people through hassle-free transport networks, protecting vulnerable areas in the city, providing adequate open spaces for shelters and gatherings, making available basic amenities to affected population within reachable distance, etc. by using the tool of urban design. Strategies at the city level and neighbourhood level have been developed with inferences from vulnerability analysis and case studies.

Keywords: disaster management, resilience, spatial planning, spatial transformations

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Authors: M. Deligianni, P. Voultsos, E. Tsamadou

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Background/Introduction: Moral distress is a common occurrence for health professionals working in neonatal critical care. Despite a growing number of critically ill neonatal and pediatric patients, only a few articles related to moral distress as experienced by neonatal physicians have been published over the last years. Objectives/Aims: The aim of this study was to define and identify barriers to and facilitators of moral distress based on the perceptions and experiences of neonatal physicians working in neonatal intensive care units (NICUs). This pilot study is a part of a larger nationwide project. Methods: A multicenter qualitative descriptive study using focus group methodology was conducted. In-depth interviews lasting 45 to 60 minutes were audio-recorded. Once data were transcribed, conventional content analysis was used to develop the definition and categories, as well as to identify the barriers to and facilitators of moral distress. Results: Participants defined moral distress broadly in the context of neonatal critical care. A wide variation of definitions was displayed. The physicians' responses to moral distress included different feelings and other situations. The overarching categories that emerged from the data were patient-related, family-related, and physician-related factors. Moreover, organizational factors may constitute major facilitators of moral distress among neonatal physicians in NICUs. Note, however, that moral distress may be regarded as an essential component to caring for neonates in critical care. The present study provides further insight into the moral distress experienced by physicians working in Greek NICUs. Discussion/Conclusions: Understanding how neonatal and pediatric critical care nurses define moral distress and what contributes to its development is foundational to developing targeted strategies for mitigating the prevalence of moral distress among neonate physicians in the context of NICUs.

Keywords: critical care, moral distress, neonatal physician, neonatal intensive care unit, NICU

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Authors: Antonis Skouloudis, Konstantinos Evangelinos, Walter Leal-Filho, Panagiotis Vouros, Ioannis Nikolaou

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Organizational resilience capacity to extreme weather events (EWEs) has sparked a growth in scholarly attention over the past decade as an essential aspect in business continuity management, with supporting evidence for this claim to suggest that it retains a key role in successful responses to adverse situations, crises and shocks. Small and medium-sized enterprises (SMEs) are more vulnerable to face floods compared to their larger counterparts, so they are disproportionately affected by such extreme weather events. The limited resources at their disposal, the lack of time and skills all conduce to inadequate preparedness to challenges posed by floods. SMEs tend to plan in the short-term, reacting to circumstances as they arise and focussing on their very survival. Likewise, they share less formalised structures and codified policies while they are most usually owner-managed, resulting in a command-and-control management culture. Such characteristics result in them having limited opportunities to recover from flooding and quickly turnaround their operation from a loss making to a profit making one. Scholars frame the capacity of business entities to be resilient upon an EWE disturbance (such as flash floods) as the rate of recovery and restoration of organizational performance to pre-disturbance conditions, the amount of disturbance (i.e. threshold level) a business can absorb before losing structural and/or functional components that will alter or cease operation, as well as the extent to which the organization maintains its function (i.e. impact resistance) before performance levels are driven to zero. Nevertheless, while it seems to be accepted as an essential trait of firms effectively transcending uncertain conditions, research deconstructing the enabling conditions and/or inhibitory factors of SMEs resilience capacity to natural hazards is still sparse, fragmentary and mostly fuelled by anecdotal evidence or normative assumptions. Focusing on the individual level of analysis, i.e. the individual enterprise and its endeavours to succeed, the emergent picture from this relatively new research strand delineates the specification of variables, conceptual relationships or dynamic boundaries of resilience capacity components in an attempt to provide prescriptions for policy-making as well as business management. This study will present the development of a flood resilience capacity index (FRCI) and its application to Greek SMEs. The proposed composite indicator pertains to cognitive, behavioral/managerial and contextual factors that influence an enterprise’s ability to shape effective responses to meet flood challenges. Through the proposed indicator-based approach, an analytical framework is set forth that will help standardize such assessments with the overarching aim of reducing the vulnerability of SMEs to flooding. This will be achieved by identifying major internal and external attributes explaining resilience capacity which is particularly important given the limited resources these enterprises have and that they tend to be primary sources of vulnerabilities in supply chain networks, generating Single Points of Failure (SPOF).

Keywords: Floods, Small & Medium-Sized enterprises, organizational resilience capacity, index development

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Authors: Siyuan Cai

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COVID-19 has triggered the planning circles to think about how to improve the city's ability to respond to public health emergencies. From the perspective of the community, this article reviews the risk cases in Wuhan Chenjiadun Community and other communities under the epidemic, and analyzes the response to public health emergencies such as infectious disease outbreaks in the excellent cases of resilient epidemic prevention communities. Then, combined with the planning of the living circle, it demonstrates the necessity of integrating the concept of resilience into the 15-minute community living circle to make up for the shortcomings of infectious disease prevention. Finally, it is proposed to strictly control the source and tail of the epidemic in the layout of the living circle, daily health and epidemic emergency should be taken into account in planning, community medical resources should be decentralized in management, and the application of smart technologies in the planning of living circle should be fully emphasized, so as to improve the community's ability to respond to public health emergencies.

Keywords: pandemic, resilient cities, resilient community, 15-minute community life circle

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Authors: Anton Grobler

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Background: Psychological capital (PsyCap), consisting of Hope, Optimism, Resilience, and Self-efficacy, is a popular positive organisational behaviour construct utilised in the studying employee work and behavioral attitudes. Various scholars believe however that further validity research should be conducted on the PsyCap questionnaire (PCQ), outside of the founding research team and in more diverse settings, for the purpose of this paper, within the diverse South African (SA) context. Aim: The purpose of this study was to investigate the construct validity of the PCQ with specific reference to its psychometric properties within the diverse SA context. Setting: The sample includes a total of 1 749 respondents, ± 60 each from 30 organisations in South Africa. Method: This study utilised a cross-sectional design and quantitative analysis. The sample is relatively representative (in terms of race, gender) of the South African workforce. A multi-factorial model was statistically explored and confirmed (with exploratory factor analysis [EFA] and confirmatory factor analysis [CFA] respectively). Results: The study yielded a three-factor solution, with Hope and Optimism as a combined factor and Resilience and Self-efficacy made up of a reconfigured set of substantively justifiable items. Three items of the original 24 items were found not to be suitable. The three factors showed good psychometric properties, good fit (in support of construct validity) and acceptable levels of convergent and discriminant validity. Conclusion: The results support the original conceptualisation of PsyCap, although with a unique structural configuration. This resonates with the notion of scholars that further research should be conducted within diverse settings. This is necessary to ensure the valid measurement of the construct, which is considered to be one of the four criteria for a construct to be categorised as a positive organisational behaviour construct.

Keywords: positive organisational behaviour, psychological capital, hope, optimism, resilience, self-efficacy, construct validity

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Authors: Eleanor F. Willard

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The attrition rate on distance learning courses can be high. This research examines how online students often react when faced with poor results. Using q methodology, it was found that the emotional response level and the type of social support sought by students were key influences on their attitude to failure. As educational and psychological researchers, we are adept at measuring learning and achievement, but examining attitudes towards barriers to learning are not so well researched. The distance learning student has differing needs from onsite learners and, as the attrition rate is notoriously high in the online student population, examining learners’ attitude towards adversity and barriers is important. Self-report measures such as questionnaires are useful in terms of ascertaining levels of constructs such as resilience and academic confidence. Interviewing, too, can gain in depth detail of the opinions of such a population, but only in individuals. The aim of this research was to ascertain what the feelings and attitudes of online students were when faced with a setback. This was achieved using q methodology due to its use of both quantitative and qualitative methodology and its suitability for exploratory research. The emphasis with this methodology is the attitudes, not the individuals. The work was focused upon a population of distance learning students who attended a school on site for one week as part of their studies. They were engaged in a psychology masters conversion course and, as such, were graduate students. The Q sort had 30 items taken from the Academic Resilience Scale (ARS-30). The scale items represent three constructs; perseverance, reflecting (including adaptive help-seeking) and negative affect. These are widely acknowledged as being relevant concepts underpinning psychological resilience. The q sort was conducted with 19 students in total. This is done by participants arranging statement cards regarding how similar to themselves they believe each statement to be. This was done after reading a vignette describing an experience of academic failure. Commonalities and differences between the sorts from all participants are then analyzed in terms of correlations and response patterns. Following data collection, the participants' responses were initially analyzed and the key perspectives (factors) to emerge were labelled ‘persevering individuals’ and ‘emotional networkers’. The differences between the two perspectives centre around the level of emotion felt when faced with barriers and the extent that students enlist the help of others inside and outside of the university. The dominant factor to emerge from the sorts of ‘persevering individuals’ demonstrated that many distance learners are tenacious. However, for other students, the level of emotional and social support is pivotal in helping them complete their studies when facing adversity. This was demonstrated by the ‘emotional networkers’ perspective. This research forms a starting point for further work on engaging and retaining online students at university and can potentially provide insight into how universities can lower attrition rates on distance learning courses.

Keywords: academic resilience, distance learning, online learning, q methodology

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Authors: Miriam Schiff, Hadas Rosenne, Ran Nir-Paz, Shiri Shinan Altman

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To examine (1) the level, predictors, and subjective perception of professional quality of life (PRoQL), posttraumatic growth, roles, task changes during the pandemic, and perceived preparedness for the next pandemic. These variables were added as part of an international study on social workers in healthcare stress, resilience, and perceived preparedness we took part in, along with Australia, Canada, China, Hong Kong, Singapore, and Taiwan. (2) The extent to which background variables, rate of exposure to the virus, working in COVID wards, profession, personal resilience, and resistance to organizational change predict posttraumatic growth, perceived preparedness, and PRoQL (the latter was examined among social workers only). (3) The teams' perceptions of how the pandemic impacted them at the personal, professional, and organizational levels and what assisted them. Methodologies: Mixed quantitative and qualitative methods were used. 1039 hospital healthcare workers from various professions participated in the quantitative study while 32 participated in in-depth interviews. The same methods were used in six other countries. Findings: The level of PRoQL was moderate, with higher burnout and secondary traumatization level than during routine times. Differences between countries in the level of PRoQL were found as well. Perceived preparedness for the next pandemic at the personal level was moderate and similar among the different health professions. Higher exposure to the virus was associated with lower perceived preparedness of the hospitals. Compared to other professions, doctors and nurses perceived hospitals as significantly less prepared for the next pandemic. The preparedness of the State of Israel for the next pandemic is perceived as low by all healthcare professionals. A moderate level of posttraumatic growth was found. Staff who worked at the COVID ward reported a greater level of growth. Doctors reported the lowest level of growth. The staff's resilience was high, with no differences among professions or levels of exposure. Working in the COVID ward and resilience predicted better preparedness, while resistance to organizational change predicted worse preparedness. Findings from the qualitative part of the study revealed that healthcare workers reported challenges at the personal, professional and organizational level during the different waves of the pandemic. They also report on internal and external resources they either owned or obtained during that period. Conclusion: Exposure to the COVID-19 virus is associated with secondary traumatization on one hand and personal posttraumatic growth on the other hand. Personal and professional discoveries and a sense of mission helped cope with the pandemic that was perceived as a historical event, war, or mass casualty event. Personal resilience, along with the support of colleagues, family, and direct management, were seen as significant components of coping. Hospitals should plan ahead and improve their preparedness to the next pandemic.

Keywords: covid-19, health-care, social workers, burnout, preparedness, international perspective

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Authors: Roger M. Wall, David G. Proverbs, Yamina Silva, Danny Scipion

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This paper critically reviews the outcomes of a 4 day workshop focused on building resilience to El Niño related Flood Events in northern Perú. The workshop was run jointly by Birmingham City University (BCU) in partnership with Instituto Geofísico del Perú (IGP) and was hosted by the Universidad de Piura (UDEP). The event took place in August 2018 and was funded by the Newton-Paulet fund administered by the British Council. The workshop was a response to the severe flooding experienced in Piura during the El Niño event of March 2017 which damaged over 100,000 homes and destroyed much local infrastructure including around 100 bridges. El Niño is a recurrent event and there is concern that its frequency and intensity may change in the future as a consequence of climate change. A group of 40 early career researchers and practitioners from the UK and Perú were challenged with working together across disciplines to identify key cross-cutting themes and make recommendations for building resilience to similar future events. Key themes identified on day 1 of the workshop were governance; communities; risk information; river management; urban planning; health; and infrastructure. A field study visit took place on day 2 so that attendees could gain first-hand experience of affected and displaced communities. Each of the themes was then investigated in depth on day 3 by small interdisciplinary teams drawing on their own expertise, local knowledge and the experiences of the previous day’s field trip. Teams were responsible for developing frameworks for analysis of their chosen theme and presenting their findings to the whole group. At this point, teams worked together to develop links between the different themes so that an integrated approach could be developed and presented on day 4. This paper describes the approaches taken by each team and the way in which these were integrated to form an holistic picture of the whole system. The findings highlighted the importance of risk-related information and the need for strong governance structures to enforce planning regulations and development. The structured facilitation approach proved to be very effective and it is recommended that the process be repeated with a broader group of stakeholders from across the region.

Keywords: El Niño, integrated flood risk management, Perú, structured facilitation, systems approach, resilience

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Authors: Al-Amin, Huanjun Jiang, Anayat Ali

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Reinforced concrete frames (RC), especially Ordinary RC frames, are prone to structural failures/collapse during seismic events, leading to a large proportion of debris from the structures, which obstructs adjacent areas, including streets. These blocked areas severely impede post-earthquake resilience. This study uses computational simulation (FEM) to investigate the amount of debris generated by the seismic collapse of an ordinary reinforced concrete moment frame building and its effects on the adjacent pedestrian and road network. A three-story ordinary reinforced concrete frame building, primarily designed for gravity load and earthquake resistance, was selected for analysis. Sixteen different ground motions were applied and scaled up until the total collapse of the tested building to evaluate the failure mode under various seismic events. Four types of collapse direction were identified through the analysis, namely aligned (positive and negative) and skewed (positive and negative), with aligned collapse being more predominant than skewed cases. The amount and distribution of debris around the collapsed building were assessed to investigate the interaction between collapsed buildings and adjacent street networks. An interaction was established between a building that collapsed in an aligned direction and the adjacent pedestrian walkway and narrow street located in an unplanned old city. The FEM model was validated against an existing shaking table test. The presented results can be utilized to simulate the interdependency between the debris generated from the collapse of seismic-prone buildings and the resilience of street networks. These findings provide insights for better disaster planning and resilient infrastructure development in earthquake-prone regions.

Keywords: building collapse, earthquake-induced debris, ORC moment resisting frame, street network

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Authors: Lauren A. Bailey, Amber R. Childs, Nicola C. James, Murray I. Duncan, Alexander Winkler, Warren M. Potts

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For the persistence of fished populations in the Anthropocene, it is critical to predict how fished populations will respond to the coupled threats of exploitation and climate change for adaptive management. The resilience of fished populations will depend on their capacity for physiological plasticity and acclimatization in response to environmental shifts. However, there is evidence for the selection of physiological traits by capture fisheries. Hence, fish populations may have a limited scope for the rapid expansion of their tolerance ranges or physiological adaptation under fishing pressures. To determine the physiological vulnerability of fished populations in the Anthropocene, the metabolic performance was compared between a fished and spatially protected Chrysoblephus laticeps population in response to thermal variability. Individual aerobic scope phenotypes were quantified using intermittent flow respirometry by comparing changes in energy expenditure of each individual at ecologically relevant temperatures, mimicking variability experienced as a result of upwelling and downwelling events. The proportion of high and low-performance individuals were compared between the fished and spatially protected population. The fished population had limited aerobic scope phenotype diversity and fewer high-performance phenotypes, resulting in a significantly lower aerobic scope curve across low (10 °C) and high (24 °C) thermal treatments. The performance of fished populations may be compromised with predicted future increases in cold upwelling events. This requires the conservation of the physiologically fittest individuals in spatially protected areas, which can recruit into nearby fished areas, as a climate resilience tool.

Keywords: climate change, fish physiology, metabolic shifts, over-fishing, respirometry

Procedia PDF Downloads 103

Authors: Lynn Sheridan, Dennis Alonzo, Hoa Nguyen, Andy Gao, Tracy Durksen

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Disruptions to teaching (e.g., COVID-related) have increased work demands for teachers. There is an opportunity for research to explore evidence-informed steps to support teachers. Collective evidence informs data on teachers’ personal attributes (e.g., self-efficacy beliefs) in the workplace are seen to promote success in teaching and support teacher engagement. Teacher engagement plays a role in students’ learning and teachers’ effectiveness. Engaged teachers are better at overcoming work-related stress, burnout and are more likely to take on active roles. Teachers’ commitment is influenced by a host of personal (e.g., teacher well-being) and environmental factors (e.g., job stresses). The job demands-resources model provided a conceptual basis for examining how teachers’ well-being, and is influenced by job demands and job resources. Job demands potentially evoke strain and exceed the employee’s capability to adapt. Job resources entail what the job offers to individual teachers (e.g., organisational support), helping to reduce job demands. The application of the job demands-resources model involves gathering an evidence-base of and connection to personal attributes (job resources). The study explored the association between constructs (resilience, adaptability, commitment, self/collective efficacy) and a teacher’s engagement with the job. The paper sought to elaborate on the model and determine the associations between key constructs of well-being (resilience, adaptability), commitment, and motivation (self and collective-efficacy beliefs) to teachers’ engagement in teaching. Data collection involved online a multi-dimensional instrument using validated items distributed from 2020-2022. The instrument was designed to identify construct relationships. The participant number was 170. Data Analysis: The reliability coefficients, means, standard deviations, skewness, and kurtosis statistics for the six variables were completed. All scales have good reliability coefficients (.72-.96). A confirmatory factor analysis (CFA) and structural equation model (SEM) were performed to provide measurement support and to obtain latent correlations among factors. The final analysis was performed using structural equation modelling. Several fit indices were used to evaluate the model fit, including chi-square statistics and root mean square error of approximation. The CFA and SEM analysis was performed. The correlations of constructs indicated positive correlations exist, with the highest found between teacher engagement and resilience (r=.80) and the lowest between teacher adaptability and collective teacher efficacy (r=.22). Given the associations; we proceeded with CFA. The CFA yielded adequate fit: CFA fit: X (270, 1019) = 1836.79, p < .001, RMSEA = .04, and CFI = .94, TLI = .93 and SRMR = .04. All values were within the threshold values, indicating a good model fit. Results indicate that increasing teacher self-efficacy beliefs will increase a teacher’s level of engagement; that teacher ‘adaptability and resilience are positively associated with self-efficacy beliefs, as are collective teacher efficacy beliefs. Implications for school leaders and school systems: 1. investing in increasing teachers’ sense of efficacy beliefs to manage work demands; 2. leadership approaches can enhance teachers' adaptability and resilience; and 3. a culture of collective efficacy support. Preparing teachers for now and in the future offers an important reminder to policymakers and school leaders on the importance of supporting teachers’ personal attributes when faced with the challenging demands of the job.

Keywords: collective teacher efficacy, teacher self-efficacy, job demands, teacher engagement

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Authors: Zewdneh Zana Zate

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The study focuses on the evolutionary and ecological genomics of both wild and cultivated Coffea arabica L. at its center of origin, Ethiopia, aiming to uncover how this vital species may withstand future climate changes. Utilizing bioclimatic models, we project the future distribution of Arabica under varied climate scenarios for 2050 and 2080, identifying potential conservation zones and immediate risk areas. Through whole-genome resequencing of accessions from Ethiopian gene banks, this research assesses genetic diversity and divergence between wild and cultivated populations. It explores relationships, demographic histories, and potential hybridization events among Coffea arabica accessions to better understand the species' origins and its connection to parental species. This genomic analysis also seeks to detect signs of natural or artificial selection across populations. Integrating these genomic discoveries with ecological data, the study evaluates the current and future ecological and genomic vulnerabilities of wild Coffea arabica, emphasizing necessary adaptations for survival. We have identified key genomic regions linked to environmental stress tolerance, which could be crucial for breeding more resilient Arabica varieties. Additionally, our ecological modeling predicted a contraction of suitable habitats, urging immediate conservation actions in identified key areas. This research not only elucidates the evolutionary history and adaptive strategies of Arabica but also informs conservation priorities and breeding strategies to enhance resilience to climate change. By synthesizing genomic and ecological insights, we provide a robust framework for developing effective management strategies aimed at sustaining Coffea arabica, a species of profound global importance, in its native habitat under evolving climatic conditions.

Keywords: coffea arabica, climate change adaptation, conservation strategies, genomic resilience

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Authors: Tzen-Ying Ling

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Recently, the resilience of dwellings in urban areas has been deliberated, as to accommodate the growing demand for changing the demography and rapid urbanization. The need to incorporate sustainability and cleaner production thinking have intensified to mitigate climate risks and satisfy the demand for housing. The modular thinking satisfies both the pressing call for fast-tracked housing stocks; while meeting the goal of more sustainable production. In the other side, the importance of the dwelling as a podium for well-being and social connectedness are sought to explore the key human/environment design thinking for the modular system in dwelling. We argue the best practice incorporates the concept of systemic components thinking. The fieldwork reported in this paper illustrates the process of the case study in a modular dwelling unit prototype development; focusing on the systemic frame system design process and adjustment recommendation hereafter. Using a case study method, the study identified that: (1) inclusive human dimensional factoring through systemic design thinking results in affordable implementations possibilities. (2) The environmental dimension encourages the place-based solution suited for the locality and the increasing demand for dwelling in the urban system. (3) Prototype design consideration avails module system component as dwelling construction alternative. (4) Building code often acts as an inhibitor for such dwelling units by the restriction in lot sizes and units placement. The demand for fast-track dwelling construction and cleaner production decisively outweighs the code inhibition; we further underscored the sustainability implication of the alternative prototype as the core of this study. The research suggests that modular thinking results in a resilient solution suited for the locality and the increasing demand for dwelling in the urban system.

Keywords: system prototype, urban resilience, human/environment dimension, modular thinking, dwelling alternative

Procedia PDF Downloads 149

Authors: J. Burlakovs, Y. Jani, L. Grinberga, M. Kriipsalu, O. Anne, I. Grinfelde, W. Hogland

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The worldwide future sustainable economies are oriented towards the sea: the maritime economy is becoming one of the strongest driving forces in many regions as population growth is the highest in coastal areas. For hundreds of years sea resources were depleted unsustainably by fishing, mining, transportation, tourism, and waste. European Sustainable Development Strategy is identifying and developing actions to enable the EU to achieve a continuous, long-term improvement of the quality of life through the creation of sustainable communities. The aim of this paper is to provide insight in Baltic Sea Region case studies on implemented actions on tourism industry waste and beach wrack management in coastal areas, hazardous contaminants and plastic flow treatment from waste, wastewaters and stormwaters. These projects mentioned in study promote successful prevention of contaminant flows to the sea environments and provide perspectives for creation of valuable new products from residuals for future circular economy are the step forward to green innovation winning streak.

Keywords: resilience, hazardous waste, phytoremediation, water management, circular economy

Procedia PDF Downloads 154

Authors: Ming-Juei Chang, Hui-Ing Ma, Tsung-Hsueh Lu

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Introduction: Because of the advance of medical care (e.g., ventilation techniques and gastrostomy feeding), more and more children with CP can live to adulthood. However, little is known about the use of health care services from children to adults who have CP. The patterns of utilization of ambulatory care are heavily influenced by insurance coverage and primary care gatekeeper regulation. The purpose of this study was to examine patterns of ambulatory care utilization among individuals with CP in Taiwan, a country with universal coverage and no gatekeeper regulation. Methods: A representative sample of one million patients (about 1/23 of total population) covered by Taiwan’s National Health Insurance was used to analyze the ambulatory care utilization in individuals with CP. Data were analyzed by 3 different age groups (children, youth and adults) during 2000 to 2003. Participants were identified by the presence of CP diagnosis made by pediatricians or physicians of physical and rehabilitation medicine and stated at least three times in claims data. Results: Annual rates of outpatient physician visits were 31680 for children, 16492 for youth, and 28617 for adults with CP (per 1000 persons). Individuals with CP received over 50% of their outpatient care from hospital outpatient department. Higher use of specialist physician services was found in children (54.7%) than in the other two age groups (28.4% in youth and 18.8% in adults). Diseases of respiratory system were the most frequent diagnoses for visits in both children and youth with CP. Diseases of the circulatory system were the main reasons (24.3%) that adults with CP visited hospital outpatient care department or clinics. Conclusion: This study showed different patterns of ambulatory care utilization among different age groups. It appears that youth and adults with CP continue to have complex health issues and rely heavily on the health care system. Additional studies are needed to determine the factors which influence ambulatory care utilization among individuals with CP.

Keywords: cerebral palsy, health services, lifespan, universal coverage

Procedia PDF Downloads 349