Search results for: adequacy of health care

Authors: Santosh Kumar Yadav, Shobha Keswani, Nishat Quddus, Sohrab Ahmad Khan, Zuheb Ahmad Shiddiqui, Varsha Chorsiya

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Introduction: Early onset diabetes is more aggressive than the late onset diabetes. Diabetic individual has a greater spectrum of life period to suffer from its damage, complications, and long-term disability. This study aimed at assessing knee joint muscle performance under various durations of diabetes. Method and Materials: A total of 30 diabetic subjects (18 male and 12 females) without diabetic neuropathy were included for the study. They were divided into three groups with 5 years, 10 years and 15 years of duration of disease each. Muscle performance was evaluated through strength and flexibility. Peak torque for quadriceps muscle was measured using isokinetic dynamometer. Flexibility for quadriceps and hamstring muscles were measured through Ducan’s Elys test and 90/90 test. Results: The result showed significant difference in muscle strength (p<0.05), flexibility (p≤0.05) between groups. Discussion: Optimal muscle strength and flexibility are vital for musculoskeletal health and functional independence. Conclusion: The reduced muscle performance and functional impairment in nonneuropathic diabetic patients suggest that other mechanism besides neuropathy that contribute to altered biomechanics. These findings of this study project early management of these altered parameters through disease-specific physical therapy and assessment-based intervention. Clinical Relevance: Managing disability is more costly than managing disease. Prompt and timely identification and management strategy can dramatically reduce the cost of care for diabetic patients.

Keywords: muscle flexibility, muscle performance, muscle torque, type 2 diabetes

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Authors: Meng-Na Dai, Bao-Fang Wen, Gao-Pei Zhu, Chen-Xi Zhang, Jing Sun, Chang-Hai Tang, Zhi-Qiang Feng, Wen-Qiang Yin

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Based on the analysis of literature in the health emergency management in China with recent 10 years, this paper discusses the Chinese current research hotspots, development trends and shortcomings in this field, and provides references for scholars to conduct follow-up research. CNKI(China National Knowledge Infrastructure), Weipu, and Wanfang were the databases of this literature. The key words during the database search were health, emergency, and management with the time from 2009 to 2018. The duplicate, non-academic, and unrelated documents were excluded. 901 articles were included in the literature review database. The main indicators of abstraction were, the number of articles published every year, authors, institutions, periodicals, etc. There are some research findings through the analysis of the literature. Overall, the number of literature in the health emergency management in China has shown a fluctuating downward trend in recent 10 years. Specifically, there is a lack of close cooperation between authors, which has not constituted the core team among them yet. Meanwhile, in this field, the number of high-level periodicals and quality literature is scarce. In addition, there are a lot of research hotspots, such as emergency management system, mechanism research, capacity evaluation index system research, plans and capacity-building research, etc. In the future, we should increase the scientific research funding of the health emergency management, encourage collaborative innovation among authors in multi-disciplinary fields, and create high-quality and high-impact journals in this field. The states should encourage scholars in this field to carry out more academic cooperation and communication with the whole world and improve the research in breadth and depth. Generally speaking, the research in health emergency management in China is still insufficient and needs to be improved.

Keywords: health emergency management, research situation, bibliometrics, literature

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Authors: Francesco Ceresia

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Workplace aggression is broadly recognized as a main work-related risk for healthcare organizations the world over. Scholars underlined that nonfatal workplace aggressions can be also produced by Type II workplace aggression, that occur when the aggressor has a legitimate relationship with the organization and commits an act of hostility while being served or cared for by members of the organization. Several reviews and meta-analysis highlighted the main antecedents and consequences of Type II verbal and physical workplace aggression in the healthcare sector, also focusing on its economic and psychosocial costs. However, some scholars emphasized the need for a systemic and multi-factorial approach to deeply understand and effectively respond to such kind of aggression. The main aim of the study is to propose a qualitative model of Type II workplace aggression in a health care organization in accordance with the system thinking and multi-factorial perspective. A case study research approach, conducted in an Italian non-hospital healthcare organization, is presented. Two main data collection methods have been adopted: individual and group interviews with a sample (N = 24) of physicians, nurses and clericals. A causal loop diagram (CLD) that describes the main causal relationships among the key-variables of the proposed model has been outlined. The main feedback loops and the causal link polarities have been also defined to fully describe the structure underlining the Type II workplace aggression phenomenon. The proposed qualitative model shows how the Type II workplace aggression is related with burnout, work performance, job satisfaction, turnover intentions, work motivation and emotional dissonance. Finally, strategies and policies to reduce the strength of workplace aggression’s drivers are suggested.

Keywords: healthcare, system thinking, work motivation, workplace aggression

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Authors: Shatha Ahmad Alharthi

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Prior research suggests that reduced social interaction can negatively affect well-being and impair mental health (e.g., depression and anxiety), resulting in lower academic performance. The COVID-19 pandemic has significantly limited social interaction among Saudi Arabian school children since the government closed schools and implemented lockdown restrictions to reduce the spread of the disease. These restrictions have resulted in prolonged remote learning for middle school students with unknown consequences for perceived academic performance, mental health, and well-being. This research project explores how middle school Saudi students’ current remote learning practices affect their mental health (e.g., depression and anxiety) and well-being during the lockdown. Furthermore, the study will examine the association between social interaction, mental health, and well-being pertaining to students’ perceptions of their academic achievement. Research findings could lead to a better understanding of the role of lockdown on depression, anxiety, well-being and perceived academic performance. Research findings may also inform policy-makers or practitioners (e.g., teachers and school leaders) about the importance of facilitating increased social interactions in remote learning situations and help to identify important factors to consider when seeking to re-integrate students into a face-to-face classroom setting. Potential implications for future educational research include exploring remote learning interventions targeted at bolstering students’ mental health and academic achievement during periods of remote learning.

Keywords: depression, anxiety, academic performance, social interaction

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Authors: Sedigheh Kalantari

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Like many countries in the arid and semi-arid belt, Iran experiences a natural limitation in the availability of water resources. However, rapid socioeconomic development has created a serious water crisis in a nation that was once one of the world’s pioneers in sustainable water management, due to the Persians’ contribution to hydraulic engineering inventions – the Qanat – throughout history. The exogenous issues like the changing climate, frequent droughts, and international sanctions are only crisis catalyzers, not the main cause of the water crisis; and a resilient water management system is expected to be capable of coping with these periodic external pressures. The current dramatic water security issues in Iran are rooted in managerial, political, and institutional challenges rather than engineering and technical issues, and the country is suffering from challenges in water governance. The country, instead of rigorous water conservation efforts, is still focused on supply-driven approach, technology and centralized methods, and structural solutions that aim to increase water supply; while the effectiveness of water governance and management has often left unused. To solve these issues, it is necessary to assess the present situation and its evolution over time. In this respect, establishing water governance assessment mechanisms will be a significant aspect of this paper. The research framework, however, is a conceptual framework to assess governance performance of Iran to critically diagnose problematic issues and areas, as well as proffer empirically based solutions and determine the best possible steps towards transformational processes. This concept aims to measure the adequacy of current solutions and strategies designed to ameliorate these problems and then develop and prescribe adequate futuristic solutions. Thus, the analytical framework developed in this paper seeks to provide insights on key factors influencing water governance in Iranian cities, institutional frameworks to manage water across scales and authorities, multi-level management gaps and policy responses, through an evidence-based approach and good practices to drive reform toward sustainability and water resource conservation. The findings of this paper show that the current structure of the water governance system in Iran, coupled with the lack of a comprehensive understanding of the root causes of the problem, leaves minimal hope for developing sustainable solutions to Iran’s increasing water crisis. In order to follow sustainable development approaches, Iran needs to replace symptom management with problem prevention.

Keywords: governance, Iran, sustainable development, water management, water resources

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Authors: Aftab Yusuf Raj

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Human milk oligosaccharides (HMOs) are complex carbohydrates. They are 3rd most abundant solid component found in breast milk, after lactose and lipids. HMO has profound beneficial health benefit effects on infants and toddlers. They have diverse roles, in immuno-modulation, development of neonatal gut, influencing the commensal microbiota of developing gut, and anti-inflammatory functions. HMOs, gut and commensal microbiota of the gut work synergistically to bring positive impact on infant and toddler health. HMO influences the gut-brain axis, maintains good mental health and cognitive function and inhibits neuronal inflammation. HMOs are now applied in infant nutrition, and supplementation of HMOs in infant formula is a promising innovation for infant nutrition.

Keywords: HMO’s, gut, epigenetic modulation, bacteria

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Authors: Nai-Jiin Yang, Tyler Renshaw

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Prior research has suggested that youth internalizing and externalizing problems significantly correlate with student subjective wellbeing (SSW) and achievement problems (SAP). Yet, only a few studies have used data from mental health screener based on the dual-factor model to explore the empirical relationships among internalizing problems, externalizing problems, academic problems, and student wellbeing. This study was conducted through a secondary analysis of previously collected data in school-wide mental health screening activities across secondary schools within a suburban school district in the western United States. The data set included 1880 student responses from a total of two schools. Findings suggest that both internalizing and externalizing problems are substantial predictors of both student wellbeing and academic problems. However, compared to internalizing problems, externalizing problems were a much stronger predictor of academic problems. Moreover, this study did not support academic problems that moderate the relationship between SSW and youth internalizing problems (YIP) and between youth externalizing problems (YEP) and SSW. Lastly, SAP is the strongest predictor of SSW than YIP and YEP.

Keywords: academic problems, externalizing problems, internalizing problems, school mental health, student wellbeing, universal mental health screening

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Authors: Mohammed S. Bhader, Abdullah A. Ghaddaf, Anas Alamoudi, Amal Abualola, Renad Kalantan, Noura Alkhulaifi, Ibrahim Halawani, Mohammed Alhindi

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Background: Noninvasive neurally adjusted ventilatory assist (NAVA) is a relatively new mode of noninvasive ventilation with promising clinical and patient-ventilator outcomes for preterm infants. The aim of this systematic review was to compare NAVA to nasal continuous or positive airway pressure (NCPAP) or intermittent positive airway pressure (NIPP) for preterm infants. Methods: We searched the online databases Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared NAVA to NCPAP or NIPP for preterm infants < 37 weeks gestational age. We sought to evaluate the following outcomes: noninvasive intubation failure rate, desaturation rate, the fraction of inspired oxygen (FiO2), and length of stay in the neonatal intensive care unit (NICU). We used the mean difference (MD) to represent continuous outcomes, while the odds ratio (OR) was used to represent dichotomous outcomes. Results: A total of 11 RCTs that enrolled 429 preterm infants were deemed eligible. NAVA showed similar clinical outcomes to NCPAP or NIPP with respect to noninvasive intubation failure (RR for NAVA versus NCPAP: 0.82, 95% confidence interval (CI): 0.49 to 1.37), desaturation rate (RR for NAVA versus NCPAP: 0.69, 95%CI: 0.36 to 1.29; RR for NAVA versus NIPP: 0.58, 95%CI: 0.08 to 4.25), FiO2 (MD for NAVA versus NCPAP: –0.01, 95%CI: –0.04 to 0.02; MD for NAVA versus NIPP: –7.16, 95%CI: –22.63 to 8.31), and length of stay in the NICU (MD for NAVA versus NCPAP: 1.34, 95%CI: –4.17 to 6.85). Conclusion: NAVA showed similar clinical and ventilator-related outcomes compared to the usual care noninvasive respiratory support measures NCPAP or NIPP for preterm infants.

Keywords: preterm infants, noninvasive neurally adjusted ventilatory assist, NIV-NAVA, non-invasive ventilation, nasal continuous or positive airway pressure, NCPAP, intermittent positive airway pressure ventilation, NIPP, respiratory distress syndrome, RDS

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Authors: William Cheng, Rini Sekartini

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Background: Sleep is essential for children because it provides enhancement for the neural system activities that give physiologic effects for the body to support growth and development. One of the modifiable factors that relates with sleep is nutrition, which includes nutritional status, iron intake, and magnesium intake. Nutritional status represents the balance between nutritional intake and expenditure, while iron and magnesium are micronutrients that are related to sleep regulation. The aim of this study is to identify prevalence of sleep disturbance among Indonesian children and to evaluate its relation with aspect to nutrition. Methods : A cross-sectional study involving children aged 5 to 7-years-old in an urban primary health care between 2012 and 2013 was carried out. Related data includes anthropometric status, iron intake, and magnesium intake. Iron and magnesium intake was obtained by 24-hours food recall procedure. Sleep Disturbance Scale for Children (SDSC) was used as the diagnostic tool for sleep disturbance, with score under 39 indicating presence of problem. Results: Out of 128 school-aged children included in this study, 28 (23,1%) of them were found to have sleep disturbance. The majority of children had good nutritional status, with only 15,7% that were severely underweight or underweight, and 12,4% that were identified as stunted. On the contrary, 99 children (81,8%) were identified to have inadequate magnesium intake and 56 children (46,3%) with inadequate iron intake. Our analysis showed there was no significant relation between all of the nutritional status indicators and sleep disturbance (p>0,05%). Moreover, inadequate iron and magnesium intake also failed to prove significant relation with sleep disturbance in this population. Conclusion: Almost fourth of school-aged children in Indonesia were found to have sleep disturbance and further study are needed to overcome this problem. According to our finding, there is no correlation between nutritional status, iron intake, magnesium intake, and sleep disturbance.

Keywords: iron intake, magnesium intake, nutritional status, school-aged children, sleep disturbance

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Authors: Awan A. Zaima, Tanvieer Ayesha, Mirshahi Shahsoltan, Pocard Marc, Mirshahi Massoud

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Brain-derived neurotrophic factor (BDNF) is described as a factor helping to support the survival of existing neurons by involving the growth and differentiation of new neurons and synapses. Cancer diagnosis impacts the mental health, and in consequences, depression arise eventually hinders recovery and disrupts the quality of life and surviving chances of patients. The focus of this study is to hint upon a prospective biomarker as a promising diagnostic tool for an early indicator/predictor of depression prevalence in cancer patients for better care and treatment options. The study aims to analyze peripheral biomarkers from neuro immune axis (BDNF, IL21 as a NK cell activator) using co-relation approach. Samples were obtained from random non cancer candidates and advanced peritoneum carcinomatosis patients with 25% pseudomyxoma, 21% Colon cancer,19% stomach cancer, 10% ovarian cancer, 8% appendices cancer, and 10% other area of peritoneum cancer patients. Both groups of the study were categorized by gender and age, with a range of 18 to 86 years old. Biomarkers were analyzed in collected plasma by performing multiplex sandwich ELISA system. Data were subjected to statistical analysis for the assessment of the correlation. Our results demonstrate that BNDF and IL 21 down regulated significantly in patient groupas compared to non-cancer candidates (ratio of patients/normalis 2.57 for BNDF and 1.32 for IL21). This preliminary investigation suggested that the neuro immune biomarkers are down regulated in carcinomatosis patients and can be associated with cancer expansion and cancer genesis. Further studies on larger cohort are necessary to validate this hypothesis.

Keywords: biomarkers, depression, peritoneum carcinoma, BNDF, IL21

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Authors: Zulkifli Yusop

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The severity of December 2014 flood on the east coast of Peninsular Malaysia has raised concern over the adequacy of existing land use practices and policies. This article assesses flood responses to selective logging, plantation establishment (oil palm and rubber) and their subsequent management regimes. The hydrological impacts were evaluated on two levels: on-site (mostly in the upstream) and off-site to reflect the cumulative impact at downstream. Results of experimental catchment studies suggest that on-site impact of flood could be kept to a minimum when selecting logging strictly adhere to the existing guidelines. However, increases in flood potential and sedimentation rate were observed with logging intensity and slope steepness. Forest conversion to plantation show the highest impacts. Except on the heavily compacted surfaces, the ground revegetation is usually rapid within two years upon the cessation of the logging operation. The hydrological impacts of plantation opening and replanting could be significantly reduced once the cover crop has fully established which normally takes between three to six months after sowing. However, as oil palms become taller and the canopy gets closer, the cover crop tends to die off due to light competition, and its protecting function gradually diminishes. The exposed soil is further compacted by harvesting machinery which subsequently leads to greater overland flow and erosion rates. As such, the hydrological properties of matured oil palm plantations are generally poorer than in young plantation. In hilly area, the undergrowth in rubber plantation is usually denser compared to under oil palm. The soil under rubber trees is also less compacted as latex collection is done manually. By considering the cumulative effects of land-use over space and time, selective logging seems to pose the least impact on flood potential, followed by planting rubber for latex, oil palm and Latex Timber Clone (LTC). The cumulative hydrological impact of LTC plantation is the most severe because of its shortest replanting rotation (12 to 15 years) compared to oil palm (25 years) and rubber for latex (35 years). Furthermore, the areas gazetted for LTC are mostly located on steeper slopes which are more susceptible to landslide and erosion. Forest has limited capability to store excess rainfall and is only effective in attenuating regular floods. Once the hydrologic storage is exceeded, the excess rainfall will appear as flood water. Therefore, for big floods, rainfall regime has a much bigger influence than land use.

Keywords: selective logging, plantation, extreme rainfall, debris flow

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Authors: Ammar Ayad Issa Al-Rifaie, Zuhreya Muazu, Maysam Ali Abdulwahid, Dermot Gleeson

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The aim of this audit was to examine the efficiency of alcohol history documentation and screening for hazardous drinkers at the Medical Admission Unit (MAU) of Northern General Hospital (NGH), Sheffield, to identify any potential for enhancing clinical practice. Data were collected from medical clerking sheets, ICE system and directly from 82 patients by three junior medical doctors using both CAGE questionnaire and AUDIT-C tool for newly admitted patients to MAU in NGH, in the period between January and March 2015. Alcohol consumption was documented in around two-third of the patient sample and this was documented fairly accurately by health care professionals. Some used subjective words such as 'social drinking' in the alcohol units’ section of the history. CAGE questionnaire was applied to only four patients and none of the patients had documented advice, education or referral to an alcohol liaison team. AUDIT-C tool had identified 30.4%, while CAGE 10.9%, of patients admitted to the NGH MAU as hazardous drinkers. The amount of alcohol the patient consumes positively correlated with the score of AUDIT-C (Pearson correlation 0.83). Re-audit is planned to be carried out after integrating AUDIT-C tool as labels in the notes and presenting a brief teaching session to junior doctors. Alcohol misuse screening is not adequately undertaken and no appropriate action is being offered to hazardous drinkers. CAGE questionnaire is poorly applied to patients and when satisfactory and adequately used has low sensitivity to detect hazardous drinkers in comparison with AUDIT-C tool. Re-audit of alcohol screening practice after introducing AUDIT-C tool in clerking sheets (as labels) is required to compare the findings and conclude the audit cycle.

Keywords: alcohol screening, AUDIT-C, CAGE, hazardous drinking

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Authors: Isomar Lima da Silva, Alcilene Batalha Pontes, Aristeu Jonatas Leite de Oliveira, Roberto Maia Augusto

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Context: Mechanical ventilators are medical devices that help provide oxygen and ventilation to patients with respiratory difficulties. This equipment consists of a manual breathing unit that can be operated by a doctor or nurse and a mechanical ventilator that controls the airflow and pressure in the patient's respiratory system. This type of ventilator is commonly used in emergencies and intensive care units where it is necessary to provide breathing support to critically ill or injured patients. Objective: In this context, this work aims to develop a reliable and low-cost mechanical ventilator to meet the demand of hospitals in treating people affected by Covid-19 and other severe respiratory diseases, offering a chance of treatment as an alternative to mechanical ventilators currently available in the market. Method: The project presents the development of a low-cost auxiliary ventilator with a controlled ventilatory system assisted by integrated hardware and firmware for respiratory cycle control in non-invasive mechanical ventilation treatments using a manual artificial respiration unit. The hardware includes pressure sensors capable of identifying positive expiratory pressure, peak inspiratory flow, and injected air volume. The embedded system controls the data sent by the sensors. It ensures efficient patient breathing through the operation of the sensors, microcontroller, and actuator, providing patient data information to the healthcare professional (system operator) through the graphical interface and enabling clinical parameter adjustments as needed. Results: The test data of the developed mechanical ventilator presented satisfactory results in terms of performance and reliability, showing that the equipment developed can be a viable alternative to commercial mechanical ventilators currently available, offering a low-cost solution to meet the increasing demand for respiratory support equipment.

Keywords: mechanical fans, breathing, medical equipment, COVID-19, intensive care units

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Authors: Ismaila Oladunni Muhammed, Adegbenga Raphael Ashiru

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Construction industry has been attributed to be the engine growth of Nigerian economic and infrastructural development. It promotes infrastructural development and grows an average output of Nigerian Gross Domestic Profit. However, from this great prospect, yearly reports show that consistent accidents on construction sites in Zamfara State has affected a substantial number of workers as they become temporarily or permanently disabled, thereby making many construction sites a death trap. This posed a great threat to the industry’s sustainability, de- motivate workers from working in the industry, and further have negative impact on the economy as well. It is as a result of high construction site accident currently experiencing in Zamfara state that this research was carried out to appraise the sustainability of health and safety of construction workers on sites. The proper practice and compliance to Construction Health and safety laws are very vital to the output and growth of Zamfara State construction sector. However, a quantitative approach was adopted to justify the aforesaid statement which will provide a broader understanding of the study. Descriptive statistical analysis was obtained through Statistical Package for the Social Sciences (SPSS Version 20). Furthermore, the findings from the research highlighted that the performance and output of construction workers on construction sites depends on the proper practice of health and safety. The research findings also recommended ways to enhance employers and employee’s compliance with existing laws guiding health and safety on Zamfara State construction sites. Nevertheless, the purpose of the paper is to appraise the sustainability of Health and Safety on Zamfara State construction sites. This study further provided thorough information for resolving challenges of construction sites accidents to improve construction firm productivity and also ensured construction worker’s safety on site.

Keywords: construction industry, health and safety regulations, causes of accident, construction safety practices

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Authors: Neha Batra Bali, Monika Tomar, Vinay Gupta

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A reagentless biosensor for detection of urea based on ZnO-CuO composite thin film is presented in following work. Biosensors have immense potential for varied applications ranging from environmental to clinical testing, health care, and cell analysis. Immense growth in the field of biosensors is due to the huge requirement in today’s world to develop techniques which are both cost effective and accurate for prevention of disease manifestation. The human body comprises of numerous biomolecules which in their optimum levels are essential for functioning. However mismanaged levels of these biomolecules result in major health issues. Urea is one of the key biomolecules of interest. Its estimation is of paramount significance not only for healthcare sector but also from environmental perspectives. If level of urea in human blood/serum is abnormal, i.e., above or below physiological range (15-40mg/dl)), it may lead to diseases like renal failure, hepatic failure, nephritic syndrome, cachexia, urinary tract obstruction, dehydration, shock, burns and gastrointestinal, etc. Various metal nanoparticles, conducting polymer, metal oxide thin films, etc. have been exploited to act as matrix to immobilize urease to fabricate urea biosensor. Amongst them, Zinc Oxide (ZnO), a semiconductor metal oxide with a wide band gap is of immense interest as an efficient matrix in biosensors by virtue of its natural abundance, biocompatibility, good electron communication feature and high isoelectric point (9.5). In spite of being such an attractive candidate, ZnO does not possess a redox couple of its own which necessitates the use of electroactive mediators for electron transfer between the enzyme and the electrode, thereby causing hindrance in realization of integrated and implantable biosensor. In the present work, an effort has been made to fabricate a matrix based on ZnO-CuO composite prepared by pulsed laser deposition (PLD) technique in order to incorporate redox properties in ZnO matrix and to utilize the same for reagentless biosensing applications. The prepared bioelectrode Urs/(ZnO-CuO)/ITO/glass exhibits high sensitivity (70µAmM⁻¹cm⁻²) for detection of urea (5-200 mg/dl) with high stability (shelf life ˃ 10 weeks) and good selectivity (interference ˂ 4%). The enhanced sensing response obtained for composite matrix is attributed to the efficient electron exchange between ZnO-CuO matrix and immobilized enzymes, and subsequently fast transfer of generated electrons to the electrode via matrix. The response is encouraging for fabricating reagentless urea biosensor based on ZnO-CuO matrix.

Keywords: biosensor, reagentless, urea, ZnO-CuO composite

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Authors: Julie A. Baldwin, Robert T. Trotter, Mark Remiker, C. Loren Buck, Amanda Aguirre, Trudie Milner, Emma Torres, Frank A. von Hippel

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Introduction: In the past, there have been concerns about contaminants in the water sources in Yuma, Arizona, including the Colorado River. Prolonged exposure to contaminants, such as perchlorate and heavy metals, can lead to deleterious health effects in humans. This project examined the association between the concentration of environmental contaminants and patient health outcomes in Yuma residents, using a community-engaged approach to data collection. Methods: A community-engaged design allowed community partners and researchers to establish joint research goals, recruit participants, collect data, and formulate strategies for dissemination of findings. Key informant interviews were conducted to evaluate adherence to models of community-based research. Results: The training needs, roles, and expectations of community partners varied based on available resources, prior research experience, and perceived research challenges and ways to address them. Conclusions: Leveraging community-engaged approaches for studies of environmental contamination in marginalized communities can expedite recruitment efforts and stimulate action that can lead to improved community health.

Keywords: community engaged research, environmental contaminants, underserved populations, health equity

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Authors: Ryan Houser

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Introduction: Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the COVID-19 pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services, even in the accelerating environment of biothreats. Methods: This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS (Emergency Medical Services ) providers. The survey was available for one month in 2021, during which 190 EMS providers responded to the survey. Results: Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a CBRN agent. The provider Clinical Competency levels range from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution and community). Only 10% of the respondents are both willing and able to effectively function in a bioterror environment. Discussion: In order to effectively prepare for and respond to a bioterrorist attack, all levels of the healthcare system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.

Keywords: bioterrorism, prehospital, EMS, disaster, emergency, medicine, preparedness, policy

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Authors: Mohammad H. Yarmohammadian, Reza Safdari, Mahmoud Keyvanara, Nahid Tavakoli

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One of the greatest challenges in disaster and emergencies is patient tracking. The concept of tracking has different denotations. One of the meanings refers to tracking patients’ physical locations and the other meaning refers to tracking patients ‘medical needs during emergency services. The main goal of patient tracking is to provide patient safety during disaster and emergencies and manage the flow of patient and information in different locations. In most of cases, there are not sufficient and accurate data regarding the number of injuries, medical conditions and their accommodation and transference. The objective of the present study is to survey on patient tracking issue in natural disaster and emergencies. Methods: This was a narrative study in which the population was E-Journals and the electronic database such as PubMed, Proquest, Science direct, Elsevier, etc. Data was gathered by Extraction Form. All data were analyzed via content analysis. Results: In many countries there is no appropriate and rapid method for tracking patients and transferring victims after the occurrence of incidents. The absence of reliable data of patients’ transference and accommodation, even in the initial hours and days after the occurrence of disasters, and coordination for appropriate resource allocation, have faced challenges for evaluating needs and services challenges. Currently, most of emergency services are based on paper systems, while these systems do not act appropriately in great disasters and incidents and this issue causes information loss. Conclusion: Patient tracking system should update the location of patients or evacuees and information related to their states. Patients’ information should be accessible for authorized users to continue their treatment, accommodation and transference. Also it should include timely information of patients’ location as soon as they arrive somewhere and leave therein such a way that health care professionals can be able to provide patients’ proper medical treatment.

Keywords: patient tracking, challenges, disaster, emergency

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Authors: Karl Bryant Buan, Owaida Macadadaya Jr., Mon Eleazar Nonato, Zeke Andrew Palabrica, Charistabelle Mae Santiago

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This study explored the occupational health risks faced by employees in the Business Process Outsourcing (BPO) industry, particularly in the Telco Account department of Alorica. The study used a stratified sampling method and a diagnostic tool called Workplace Integrated Safety and Health (WISH) Assessment to measure and evaluate the employees' perception of workplace health and safety. The results showed that more than 50% of call center workers reported feeling emotionally drained, sleep deprived, burnt out, and in need of anxiety or stress medication due to their work. Additionally, there was a significant difference in the perception of employee diversity, specifically in terms of leadership commitment, participation, policies, programs, and practices. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) results revealed that most employees complained of discomfort in their lower back, shoulder, upper back, neck, and hip. The researchers recommended an implementation plan for alternative work set-up, a satisfaction survey for employees, team-building activities or programs, and motivational approaches through benefits, incentives, and rewards.

Keywords: WISH assessment, CMDQ, ANOVA, diverse SOGIESC

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Authors: R. Botrugno, S Basyuni, G. Nugent, I. Jenkyn, A. Ferro, H. Bennett, C. Hjalmarsson, J. Chu, V. Santhanam

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This trainee led randomised controlled trial (RCT) aims to assess various outcomes for resorbable versus non-resorbable sutures for traumatic lacerations to the face. Within this trial of resorbable versus non-resorbable sutures for traumatic lacerations of the face (TORNFace), patient recruitment was facilitated by trainees who were employed at an NHS University Teaching Hospital in the United Kingdom. The trainees received appropriate training prior to recruiting patients for the trial. This included the completion of a national research e-learning module and face-to-face training that was provided locally. The locally delivered training provided an understanding of the eligibility criteria for the trial and the consent process. Existing trainee skills were utilised involving clinical photography to record baseline data and delivering the intervention based on the treatment arm selected. Eligible patients who required primary closure of traumatic lacerations of the face were randomised into one of two treatment arms. These comprised of resorbable (vicryl rapide) or non-resorbable sutures (ethilon). Primarily the cosmetic outcome was assessed. Secondary outcomes included: complications rates, health care economics, and patient-reported outcomes. Remote follow-up of recruited patients utilised photographs of the facial laceration which had received the intervention. These took place at 1 week, 3 months and 6 months post-intervention. This study aims to demonstrate an example of trainee-led research within the specialty of oral and maxillofacial surgery. The available data for the randomised controlled trial will also be presented.

Keywords: laceration, suture, trauma, trial

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Authors: Ana Rita Conde, Pilar Mota, Tânia Botelho, Suzana Caldeira, Isabel Rego, Jessica Pacheco, Osvaldo Silva, Áurea Sousa

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Tourism promotes well-being and health to children with ASD and their families. Literature indicates the need to provide tourist activities that integrate the therapeutic component, to promote the development and well-being of children with ASD. The study aims to implement tourist offers in Azores that integrate the therapeutic feature, assess their suitability and impact on the well-being and health of the child and caregivers. Using a mixed methodology, the study integrates families that experience and evaluate the impact of tourism products developed specifically for them.

Keywords: austism spectrum disorder, children, therapeutic tourism activities, well-being, health, inclusive tourism

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Authors: Malgorzata Sekulowicz, Krystyna Boron-Krupinska, Paulina Morga, Blazej Cieslik

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Burnout is highly prevalent in health care employees, especially in physicians. It significantly reduces the efficiency of these employees, which can have negative consequences for both physicians and patients. Resilience and mindfulness enhancing positive emotions, leading to sustainable development and personal commitment, can have a significant impact on burnout. Therefore, the aim of this study was to determine the relationship between burnout symptoms and mindfulness and resilience among physicians. The authors conducted a cross-sectional survey study among seventy-four polish physicians. Participants filled out the following psychometric tools: the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Five Facet Mindfulness Questionnaire (FFMQ), Areas of Work-Life Survey (AWS), International Personality Item Pool (IPIP), the Resilience Assessment Scale (SPP-25) and the Mini-COPE Inventory. The relationship between burnout and resilience and mindfulness was assessed with path analysis. Analyzing the relationship between MBI-HSS components and mindfulness, a significant negative correlation of the FFMQ score with emotional exhaustion (-0.50, p < 0.05) and depersonalization (-0.43, p < 0.05) and a positive correlation with personal accomplishment (0.50, p < 0.05) was demonstrated. Analyzing resilience, a statistically significant relationship of SPP-25 with all tested components of MBI-HSS was demonstrated: emotional exhaustion (-0.54, p < 0.05), depersonalization (-0.31, p < 0.05) and personal accomplishment (0.35, p < 0.05). In the group of medical doctors, the higher the level of mindfulness and resilience, the lower the risk of burnout. Furthermore, the more frequently used active coping strategies (planning, acceptance), the lower the risk of burnout, while the use of passive, evasive strategies increases the risk of burnout. It may be worth considering implementing mindfulness intervention to effectively manage burnout symptoms in this group.

Keywords: burnout, medical doctors, mindfulness, physicians, resilience

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Authors: Cindy Davis, Samantha Rayner

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Secondary traumatic stress (STS) is an indirect form of trauma affecting the psychological well-being of mental health workers; STS is found to be a prevalent risk in mental health occupations. Various factors impact the development of STS within the literature; including the level of trauma individuals are exposed to and their level of empathy. Research is limited on STS in mental health workers in Australia; therefore, this study examined STS and related factors of empathetic behavior and trauma caseload among mental health workers. The research utilized an online survey quantitative research design with a purposive sample of 190 mental health workers (176 females) recruited via professional websites and unofficial social media groups. Participants completed an online questionnaire comprising of demographics, the secondary traumatic stress scale and the empathy scale for social workers. A standard hierarchical regression analysis was conducted to examine the significance of covariates, traumatized clients, traumatic stress within workload and empathy in predicting STS. The current research found 29.5% of participants to meet the criteria for a diagnosis of STS. Age and past trauma within the covariates were significantly associated with STS. Amount of traumatized clients significantly predicted 4.7% of the variance in STS, traumatic stress within workload significantly predicted 4.8% of the variance in STS and empathy significantly predicted 4.9% of the variance in STS. These three independent variables and the covariates accounted for 18.5% of the variance in STS. Practical implications include a focus on developing risk strategies and treatment methods that can diminish the impact of STS.

Keywords: mental health, PTSD, social work, trauma

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Authors: Geetha Baskaran, Andrzej Barjiela, Rong Qu

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Motivation: Nurse scheduling is a complex combinatorial optimization problem. It is also known as NP-hard. It needs an efficient re-scheduling to minimize some trade-off of the measures of violation by reducing selected constraints to soft constraints with measurements of their violations. Problem Statement: In this paper, we extend our novel approach to solve the nurse scheduling problem by transforming it through Information Granulation. Approach: This approach satisfies the rules of a typical hospital environment based on a standard benchmark problem. Generating good work schedules has a great influence on nurses' working conditions which are strongly related to the level of a quality health care. Domain transformation that combines the strengths of operation research and artificial intelligence was proposed for the solution of the problem. Compared to conventional methods, our approach involves judicious grouping (information granulation) of shifts types’ that transforms the original problem into a smaller solution domain. Later these schedules from the smaller problem domain are converted back into the original problem domain by taking into account the constraints that could not be represented in the smaller domain. An Integer Programming (IP) package is used to solve the transformed scheduling problem by expending the branch and bound algorithm. We have used the GNU Octave for Windows to solve this problem. Results: The scheduling problem has been solved in the proposed formalism resulting in a high quality schedule. Conclusion: Domain transformation represents departure from a conventional one-shift-at-a-time scheduling approach. It offers an advantage of efficient and easily understandable solutions as well as offering deterministic reproducibility of the results. We note, however, that it does not guarantee the global optimum.

Keywords: domain transformation, nurse scheduling, information granulation, artificial intelligence, simulation

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Authors: Monika Jurkeviciute, Amia Enam, Johanna Torres Bonilla, Henrik Eriksson

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Introduction: Many evaluations of eHealth interventions conclude that the evidence for improved clinical outcomes is limited, especially when the intervention is short, such as one year. Often, evaluation design does not address the feasibility of achieving clinical outcomes. Evaluations are designed to reflect upon clinical goals of intervention without utilizing the opportunity to illuminate effects on organizations and cost. A comprehensive design of evaluation can better support decision-making regarding the effectiveness and potential transferability of eHealth. Hence, the purpose of this paper is to present a feasible and comprehensive design of evaluation for eHealth intervention, including the design process in different contexts. Methodology: The situation of limited feasibility of clinical outcomes was foreseen in the European Union funded project called “DECI” (“Digital Environment for Cognitive Inclusion”) that is run under the “Horizon 2020” program with an aim to define and test a digital environment platform within corresponding care models that help elderly people live independently. A complex intervention of eHealth implementation into elaborate care models in four different countries was planned for one year. To design the evaluation, a participative approach was undertaken using Pettigrew’s lens of change and transformations, including context, process, and content. Through a series of workshops, observations, interviews, and document analysis, as well as a review of scientific literature, a comprehensive design of evaluation was created. Findings: The findings indicate that in order to get evidence on clinical outcomes, eHealth interventions should last longer than one year. The content of the comprehensive evaluation design includes a collection of qualitative and quantitative methods for data gathering which illuminates non-medical aspects. Furthermore, it contains communication arrangements to discuss the results and continuously improve the evaluation design, as well as procedures for monitoring and improving the data collection during the intervention. The process of the comprehensive evaluation design consists of four stages: (1) analysis of a current state in different contexts, including measurement systems, expectations and profiles of stakeholders, organizational ambitions to change due to eHealth integration, and the organizational capacity to collect data for evaluation; (2) workshop with project partners to discuss the as-is situation in relation to the project goals; (3) development of general and customized sets of relevant performance measures, questionnaires and interview questions; (4) setting up procedures and monitoring systems for the interventions. Lastly, strategies are presented on how challenges can be handled during the design process of evaluation in four different countries. The evaluation design needs to consider contextual factors such as project limitations, and differences between pilot sites in terms of eHealth solutions, patient groups, care models, national and organizational cultures and settings. This implies a need for the flexible approach to evaluation design to enable judgment over the effectiveness and potential for adoption and transferability of eHealth. In summary, this paper provides learning opportunities for future evaluation designs of eHealth interventions in different national and organizational settings.

Keywords: ehealth, elderly, evaluation, intervention, multi-cultural

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Authors: Regina Tedjasulaksana, Maria Martina Nahak, A. A. Gede Agung, Ni Made Widhiasti

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Strategic effort to realize the empowerment of community in school is through the peer group approach so that it needs to choose the students who are trained as the’ little dentist’ in order to have the cognitive and skills to participate in the school dental health effort (UKGS) program, such as providing oral health education to the other students. Aim: To assessed the effectiveness of peer group approach to enhance the oral health knowledge level of schoolchildren at primary school in Klungkung, Bali. Methods: Experimental study using the pre-post test without control group design. The differences of knowledge levels, tooth brushing behavior and oral hygiene status (using PHP-M index) of 10 students before and after trained as the little dentists were analyzed using paired t-test. The correlations between knowledge level and tooth brushing behavior and correlations between tooth brushing behavior and oral hygiene before and after trained as the little dentists were analyzed using Spearman. Furthermore, the trained little dentists provide oral health education to 102 students of grade 1 to 5 at their school once a week for 3 months. The students’ knowledge level scores of each grade were taken every 21 days as many as three times The difference of it was analyzed using Repeated Measured. Result: The mean scores among all little dentists before and after training for each of knowledge level were each 63.05 + 5.62 and 85.00 + 7.81, tooth brushing behavior were each 31.00 + 14.49 and 100.00 + 0.00 and oral hygiene status using PHP-M index were each 32.80 + 10.17 and 11.40 + 8.01. The knowledge level, tooth brushing behavior and oral hygiene status of 10 students before and after trained as the little dentists were different significantly (p<0.05). Before and after trained as the little dentists it showed that significant correlations between knowledge level with tooth brushing behavior (p<0.05) and significant correlations between tooth brushing behavior and oral hygiene (p<0.05). The mean scores of knowledge level among all students before (pre-test) and after (post-test (1),(2),(3)) getting oral health education from little dentists for each, of grade 1 were 40.00 + 17.97; 67.85 + 18.88; 81.72 +26.48 and 70.00 + 22.87, grade 2 were 40.00 + 17.97; 67.85 + 18.88; 81.72 + 26.48 and 70.00 + 22.87, grade 3 were 65.83 + 23.94; 72.50 + 26.08; 80.41 + 24.93 and 83.75 + 19.74, grade 4 were 88.57 + 12.92; 90.71 + 9.97; 92.85 + 10.69 and 93.57 + 6.33 and grade 5 were 86.66 + 13.40; 93.33 + 9.16; 94.16 + 10.17 and 98.33 + 4.81. The students’ knowledge level of grade 1,2 and 3 before and after getting oral health education from little dentists showed significant different (p<0.05), meanwhile there was no significant different on grade 4 and 5 (p<0.05) although mean scores showed an increase. Conclusion: Peer group approach can be used to enhance the oral health knowledge level of schoolchildren at primary school in Klungkung, Bali.

Keywords: small dentists, oral health, peer group approach, school children

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Authors: Candy Chieh Lee

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Objective: The purpose of this study is to investigate the relationship between visual perception and social function in patients with schizophrenia. The specific aims are: 1) To explore performances in visual perception and social function in patients with schizophrenia 2) to examine the correlation between visual perceptual skills and social function in patients with schizophrenia The long-term goal is to be able to provide the most adequate intervention program for promoting patients’ visual perceptual skills and social function, as well as compensatory techniques. Background: Perceptual deficits in schizophrenia have been well documented in the visual system. Clinically, a considerable portion (up to 60%) of schizophrenia patients report distorted visual experiences such as visual perception of motion, color, size, and facial expression. Visual perception is required for the successful performance of most activities of daily living, such as dressing, making a cup of tea, driving a car and reading. On the other hand, patients with schizophrenia usually exhibit psychotic symptoms such as auditory hallucination and delusions which tend to alter their perception of reality and affect their quality of interpersonal relationship and limit their participation in various social situations. Social function plays an important role in the prognosis of patients with schizophrenia; lower social functioning skills can lead to poorer prognosis. Investigations on the relationship between social functioning and perceptual ability in patients with schizophrenia are relatively new but important as the results could provide information for effective intervention on visual perception and social functioning in patients with schizophrenia. Methods: We recruited 50 participants with schizophrenia in the mental health hospital (Taipei City Hospital, Songde branch, Taipei, Taiwan) acute ward. Participants who have signed consent forms, diagnosis of schizophrenia and having no organic vision deficits were included. Participants were administered the test of visual-perceptual skills (non-motor), third edition (TVPS-3) and the personal and social performance scale (PSP) for assessing visual perceptual skill and social function. The assessments will take about 70-90 minutes to complete. Data Analysis: The IBM SPSS 21.0 will be used to perform the statistical analysis. First, descriptive statistics will be performed to describe the characteristics and performance of the participants. Lastly, Pearson correlation will be computed to examine the correlation between PSP and TVPS-3 scores. Results: Significant differences were found between the means of participants’ TVPS-3 raw scores of each subtest with the age equivalent raw score provided by the TVPS-3 manual. Significant correlations were found between all 7 subtests of TVPS-3 and PSP total score. Conclusions: The results showed that patients with schizophrenia do exhibit visual perceptual deficits and is correlated social functions. Understanding these facts of patients with schizophrenia can assist health care professionals in designing and implementing adequate rehabilitative treatment according to patients’ needs.

Keywords: occupational therapy, social function, schizophrenia, visual perception

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Authors: Kever Bruno Paradelo Gomes, Rosana Carvalho Cristo Martins

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Payment for Environmental Services (PSA) has been a strategy used since the late 1990s by Latin American countries to finance environmental conservation. Payment for Environmental Services has been absorbing a growing amount of time in the discussions around environmentally sustainable development strategies in the world. In Brazil, this theme has permeated the discussions since the publication of the new Forest Code. The objective of this work was to verify the perception of the resident farmers in the region of Ponte Alta, Gama, Federal District, Brazil, on environmental legislation and Payments for Environmental Services. The work was carried out in 99 rural properties of the family farmers of the Rural Nucleus Ponte Alta, Administrative Region of Gama, in the city of Brasília, Federal District, Brazil. The present research is characterized methodologically as a quantitative, exploratory, and descriptive nature. The data treatment was performed through descriptive statistical analysis and hypothesis testing. The perceptions about environmental legislation in the rural area of Ponte Alta, Gama, DF respondents were positive. Although most of the family farmers interviewed have some knowledge about environmental legislation, it is perceived that in practice, the environmental adequacy of property is ineffective given the current situation of sustainable rural development; there is an abyss between what is envisaged by legislation and reality in the field. Thus, as in the reports of other researchers, it is verified that the majority of respondents are not aware of PSA (62.62%). Among those interviewed who were aware of the subject, two learned through the course, three through the university, two through TV and five through other people. The planting of native forest species on the rural property was the most informed practice by farmers if they received some Environmental Service Payment (PSA). Reflections on the environment allow us to infer that the effectiveness and fulfillment of the incentives and rewards in the scope of public policies to encourage the maintenance of environmental services, already existing in all spheres of government, are of great relevance to the process of environmental sustainability of rural properties. The relevance of the present research is an important tool to promote the discussion and formulation of public policies focused on sustainable rural development, especially on payments for environmental services; it is a space of great interest for the strengthening of the social group dedicated to production. Public policies that are efficient and accessible to the small rural producers become decisive elements for the promotion of changes in behavior in the field, be it economic, social, or environmental.

Keywords: forest code, public policy, rural development, sustainable agriculture

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Authors: Maciej Bialorudzki, Zbigniew Izdebski, Alicja Kozakiewicz, Joanna Mazur

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The quality of sleep is extremely important for physical and mental health, especially among professional groups exposed to the suffering of the people they serve. The aim of the study is to assess sleep quality and various aspects of physical and mental health. A nationwide cross-sectional survey conducted in the first quarter of 2022 included 2227 healthcare professionals from 114 Polish hospitals and specialized outpatient clinics. The following distribution for each professional group was obtained (22% doctors; 52.6% nurses; 7.3% paramedics; 10.1% other medical professionals; 7.9% other non-medical professionals). The mean age of the respondents was 46.24 (SD=11.53). The Jenkins Sleep Scale with four items (JSS-4) was used to assess sleep quality, yielding a mean value of 5.35 (SD=5.20) in the study group and 13.7% of subjects with poor sleep quality using the cutoff point of the mean JSS-4 sum score as >11. More often, women than men reported poorer sleep quality (14,8% vs. 9,1% p=0,002). Respondents with poor sleep quality were more likely to report occupational burnout as measured by the BAT-12 (43.1% vs. 12.9% p<0.001) and high levels of stress as measured by the PSS-4 (72.5% vs. 27.5% p<0.001). In addition, those who declare experiencing a traumatic event compared to those who have not experienced it has an almost two times higher risk of poorer sleep quality (OR:1.958; 95% CI:1.509-2.542; p<0.001). In contrast, those with occupational burnout had more than five times the risk of those without occupational burnout (OR:5.092; 95% CI: 3.763-6.889; p<0.001). Sleep quality remains an important predictor of stress levels, job burnout, and quality of life assessment.

Keywords: quality of sleep, medical staff, mental health, physical health, occupational burnout, stress

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Authors: Muhammad Faisal Khilji, Rana Shoaib Hamid, Asim Qureshi

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A fifty years old female presented in the emergency department of a tertiary care hospital with complaints of migraine type headache for the last few months. Her last episode of headache was severe, increasing in intensity, associated with nausea but no fever, lasting more than 24 hours and not resolving with analgesics. On examination there was no neurological deficit. CT scan of brain showed a large Pedunculated, non-expansible, non-aggressive bony lesion in the clivus with its sharp fragment impinging into the pons. Findings were further confirmed with MRI brain. Trans-sphenoidal excision biopsy was done and histopathology proved the lesion to be osteochondroma of clivus.

Keywords: osteochondroma, clivus, headache, CT scan

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