Search results for: psychological intervention
1166 Organisational Change: The Impact on Employees and Organisational Development
Authors: Maureen Royce, Joshi Jariwala, Sally Kah
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Change is inevitable, but the change process is progressive. Organisational change is the process in which an organisation changes strategies, operational methods, systems, culture, and structure to affect something different in the organisation. This process can be continuous or developed over a period and driven by internal and external factors. Organisational change is essential if organisations are to survive in dynamic and uncertain environments. However, evidence from research shows that many change initiatives fail, leading to severe consequences for organisations and their resources. The complex models of third sector organisations, i.e., social enterprise, compounds the levels of change in these organisations. Interestingly, innovation is associated with a change in social enterprises due to the hybridity of product and service development. Furthermore, the creation of social intervention has offered a new process and outcomes to the lifecycle of change. Therefore, different forms of organisational innovation are developed, i.e., total, evolutionary, expansionary, and developmental, which affect the interventions of social enterprises. This raises both theoretical and business concerns on how the competing hybrid nature of social enterprises change, how change is managed, and the impact on these organisations. These perspectives present critical questions for further investigation. In this study, we investigate the impact of organisational change on employees and organisational development at DaDaFest –a disability arts organisation with a social focus based in Liverpool. The three main objectives are to explore the drivers of change and the implementation process; to examine the impact of organisational change on employees and; to identify barriers to organisation change and development. To address the preceding research objectives, qualitative research design is adopted using semi-structured interviews. Data is analysed using a six-step thematic analysis framework, which enables the study to develop themes depicting the impact of change on employees and organisational development. This study presents theoretical and practical contributions for academics and practitioners. The knowledge contributions encapsulate the evolution of change and the change cycle in a social enterprise. However, practical implications provide critical insights into the change management process and the impact of change on employees and organisational development.Keywords: organisational change, change management, organisational change system, social enterprise
Procedia PDF Downloads 1281165 Collaborative Approaches in Achieving Sustainable Private-Public Transportation Services in Inner-City Areas: A Case of Durban Minibus Taxis
Authors: Lonna Mabandla, Godfrey Musvoto
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Transportation is a catalytic feature in cities. Transport and land use activity are interdependent and have a feedback loop between how land is developed and how transportation systems are designed and used. This recursive relationship between land use and transportation is reflected in how public transportation routes internal to the inner-city enhance accessibility, therefore creating spaces that are conducive to business activity, while the business activity also informs public transportation routes. It is for this reason that the focus of this research is on public transportation within inner-city areas where the dynamic is evident. Durban is the chosen case study where the dominating form of public transportation within the central business district (CBD) is minibus taxis. The paradox here is that minibus taxis still form part of the informal economy even though they are the leading form of public transportation in South Africa. There have been many attempts to formalise this industry to follow more regulatory practices, but minibus taxis are privately owned, therefore complicating any proposed intervention. The argument of this study is that the application of collaborative planning through a sustainable partnership between the public and private sectors will improve the social and environmental sustainability of public transportation. One of the major challenges that exist within such collaborative endeavors is power dynamics. As a result, a key focus of the study is on power relations. Practically, power relations should be observed over an extended period, specifically when the different stakeholders engage with each other, to reflect valid data. However, a lengthy data collection process was not possible to observe during the data collection phase of this research. Instead, interviews were conducted focusing on existing procedural planning practices between the inner-city minibus taxi association (South and North Beach Taxi Association), the eThekwini Transport Authority (ETA), and the eThekwini Town Planning Department. Conclusions and recommendations were then generated based on these data.Keywords: collaborative planning, sustainability, public transport, minibus taxis
Procedia PDF Downloads 611164 Factors Associated with Rural-Urban Migration and Its Associated Health Hazards on the Female Adolescents in Kumasi Metropolis
Authors: Freda Adomaa, Samuel Oppong Boampong, Charles Gyamfi Rahman
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The living and working environment of migrants and their access to healthcare services induce good or poor health. This study was conducted to assess the factors associated with rural-urban migration and its associated health hazards among female adolescents. A sample size of two hundred (200) was chosen in which all responded to questionnaires comprising closed-ended questions, which were distributed to gather data from the respondents, after which it was analyzed using the Statistical Package for Social Sciences (SPSS) version 20. The utilized three causes of rural-urban migration thus political, economic and socio-cultural. The study revealed that political situations such as regional inequality (65.4%) and ethnic conflicts (78.2%) whereas economic factors such as lack of amenities (82.3%), lack of employment in rural communities (77.4%), lack of education (74%), and poverty (85.3%) as well as socio-cultural factors such as divorced parents (65.6%), media influence (79.1%), family conflicts (59.4%) and appealing urban informal sector (65.2%) are major causes of migration. Respondents’ encountered challenges such as poor remuneration for services (87.2%), being maltreated by a colleague or worker (69%), sleeping in open space (73.3%), and harassment by the task force (71.4%) and teenage pregnancies (58.5%). The study concluded that the three variables play a key role in adolescent migration and when they travel they end up getting involved in serious health hazardous behaviors such as rapes as well as physical and psychological harassments’. The study, therefore, recommends that vocational training of the rural people on small scale industries (non-farm) activities that could generate an income for the rural household should be introduced.Keywords: rural, urban, migration, female health hazards
Procedia PDF Downloads 1351163 The Lived Experience of Risk and Protective Contexts of Blind Successful University Students in Sidist Kilo Campus
Authors: Zelalem Markos Borko
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The quality of life of people with blindness is significantly influenced by the level of resilience they possess. A qualitative approach of the descriptive phenomenological design was employed to address basic study objectives. The researcher purposely selected three blind graduate students from Sidist Kilo Campus and conducted a semi-structured interview to gather data. Data were analyzed by using thematic coding techniques. The present study found that personal characteristics such as commitment, living hope, motivation, positive self-esteem, self-confidence, and communication have shaped resiliency for successful university students with visual disabilities. The finding showed that the school environment is the place in which blind students had developed/experienced social, psychological, and economical competency and hope for their academic and entire life success. Furthermore, the finding showed that blind students had experienced individual, family, school, and community-related risks in the success track. Therefore, governmental and non-governmental organizations should provide training for students with visual impairments that focus on the individual traits that shape resilience for academic success, such as commitment, living hope, motivation, positive self-esteem, self-confidence, and communication and also community-oriented training should be to break the social stigma and discriminations for the individuals with the visual impairment.Keywords: blind students, risk and protective factors, lived experience, success
Procedia PDF Downloads 821162 Clinical and Microbiologic Efficacy and Safety of Imipenem Cilastatin Relebactam in Complicated Infections: A Meta-analysis
Authors: Syeda Sahra, Abdullah Jahangir, Rachelle Hamadi, Ahmad Jahangir, Allison Glaser
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Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (H.A.B.P.), and ventilator-associated bacterial pneumonia (V.A.B.P.). Objective: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. Search Strategy: We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. Selection Criteria: We included randomized clinical trials (R.C.T.s) with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. Analysis: For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A p-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, H.A.B.P., V.A.B.P.).Keywords: bacterial pneumonia, complicated intra-abdominal infections, complicated urinary tract infection, Imipenem, cilastatin, relebactam
Procedia PDF Downloads 2061161 Climate Change Adaptation: Methodologies and Tools to Define Resilience Scenarios for Existing Buildings in Mediterranean Urban Areas
Authors: Francesca Nicolosi, Teresa Cosola
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Climate changes in Mediterranean areas, such as the increase of average seasonal temperatures, the urban heat island phenomenon, the intensification of solar radiation and the extreme weather threats, cause disruption events, so that climate adaptation has become a pressing issue. Due to the strategic role that the built heritage holds in terms of environmental impact and energy waste and its potentiality, it is necessary to assess the vulnerability and the adaptive capacity of the existing building to climate change, in order to define different mitigation scenarios. The aim of this research work is to define an optimized and integrated methodology for the assessment of resilience levels and adaptation scenarios for existing buildings in Mediterranean urban areas. Moreover, the study of resilience indicators allows us to define building environmental and energy performance in order to identify the design and technological solutions for the improvement of the building and its urban area potentialities. The methodology identifies step-by-step different phases, starting from the detailed study of characteristic elements of urban system: climatic, natural, human, typological and functional components are analyzed in their critical factors and their potential. Through the individuation of the main perturbing factors and the vulnerability degree of the system to the risks linked to climate change, it is possible to define mitigation and adaptation scenarios. They can be different, according to the typological, functional and constructive features of the analyzed system, divided into categories of intervention, and characterized by different analysis levels (from the single building to the urban area). The use of software simulations allows obtaining information on the overall behavior of the building and the urban system, to generate predictive models in the medium and long-term environmental and energy retrofit and to make a comparative study of the mitigation scenarios identified. The studied methodology is validated on a case study.Keywords: climate impact mitigation, energy efficiency, existing building heritage, resilience
Procedia PDF Downloads 2401160 Real World Cancer Pain Incidence and Treatment in Daily Hospital
Authors: Alexandru Grigorescu, Alexandra Protesanu
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Background: Approximately 34-67 percent of cancer patients experience an episode of uncontrolled pain during the course of their disease, depending on the stage. The aim is to provide evidence-based data for pain prevalence, diagnosis and treatment recommendations on an integrative model of medical oncology and palliative care for patients with cancer diagnostic in a day hospital. Patients and method: Consultation registers and electronic records of 166 Patients (Pts) were studied from April 2022 to March 2023. Pts with pain syndrome were selected. The pain was objectified by the visual pain scale. To elucidate the causes of the pain, investigations were carried out: bone scintigraphy, CT scan, and PET-CT. The analgesic treatments were represented by weak and strong morphine, radiotherapy, and bisphosphonates. Result: During the mentioned period, 166 oncological patients (74 women and 92 men) were treated in the oncology day hospitalization service. There were 1,500 consultations, 40 of which were only for pain. The neoplastic locations were: gynecological, malignant melanoma, breast, gastric, bronchopulmonary, colorectal, liver, pancreatic, bladder, and kidney. 70 Pts presented pain syndrome. The causes of the pain were represented by bone metastases, compressive tumors, and post-surgical status. Drug treatment: Tramadol 47 Pts, of which 10 switched to a major opioid (Oxycodonum, Morphine sulfate), 20 Pts were treated with Oxycodonum as the first intention. In 5 patients ry to rotated morphine, 20 Pts received palliative radiotherapy, 10 Pts were treated with bisphosphonates. 2 Pts required neurosurgery consultation for an antalgic intervention. 5 Pts had important adverse reactions to morphine. All patients and their families were advised by a medical oncologist and psychologist for a lifestyle change. Conclusions: The prevalence of pain was similar to that described in the literature. In most cases, the pain could be managed in the day hospital. Weak and strong morphine represented the main pain therapy. Palliative radiotherapy was the second most effective therapy. Treatment with bisphosphonates was useful. Surgical interventions were rarely indicated. Discussions with patients and their families regarding the lifestyle change were important.Keywords: cancer pain, opioids, medical oncology, palliative care
Procedia PDF Downloads 661159 Systematic Review and Meta-analysis Investigating the Efficacy of Walking-based Aerobic Exercise Interventions to Treat Postpartum Depression
Authors: V. Pentland, S. Spilsbury, A. Biswas, M. F. Mottola, S. Paplinskie, M. S. Mitchell
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Postpartum depression (PPD) is a form of major depressive disorder that afflicts 10–22% of mothers worldwide. Rising demands for traditional PPD treatment options (e.g., psychiatry), especially in the context of the COVID-19 pandemic, are increasingly difficult to meet. More accessible treatment options (e.g., walking) are needed. The objective of this review is to determine the impact of walking on PPD severity. A structured search of seven electronic databases for randomised controlled trials published between 2000 and July 29, 2021, was completed. Studies were included if walking was the sole or primary aerobic exercise modality. A random-effects meta-analysis was conducted for studies reporting PPD symptoms measured using a clinically validated tool. A simple count of positive/null effect studies was undertaken as part of a narrative summary. Five studies involving 242 participants were included (mean age=~28.9 years; 100% with mild-to-moderate depression). Interventions were 12 (n=4) and 24 (n=1) weeks long. Each assessed PPD severity using the Edinburgh Postnatal Depression Scale (EPDS) and was included in the meta-analysis. The pooled effect estimate suggests that relative to controls, walking yielded clinically significant decreases in mean EPDS scores from baseline to intervention end (pooled MD=-4.01; 95% CI:-7.18 to -0.84, I2=86%). The narrative summary provides preliminary evidence that walking-only, supervised, and group-based interventions, including 90-120+ minutes/week of moderate-intensity walking, may produce greater EPDS reductions. While limited by a relatively small number of included studies, pooled effect estimates suggest walking may help mothers manage PPD. This is the first time walking as a treatment for PPD, an exercise modality that uniquely addresses many barriers faced by mothers has been summarized in a systematic way. Trial registration: PROSPERO (CRD42020197521) on August 16th, 2020Keywords: postpartum, exercise, depression, walking
Procedia PDF Downloads 2041158 Disrupting Patriarchy: Transforming Gender Oppression through Dialogue between Women and Men at a South African University
Authors: S. van Schalkwyk
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On international levels and across disciplines gender scholars have argued that patriarchal scripts of masculinity and femininity are harmful as they negatively impact constructions of selfhood and relations between women and men. Patriarchal ideologies serve as a scaffolding for dominance and subordination and fuel violence against women. Toxic masculinity—social discourses of men as violent, unemotional, and sexually dominant—are embedded in South African culture and are rooted in the high rates of gender violence occurring in the country. Finding strategies that can open up space for the interrogation of toxic masculinity is crucial in order to disrupt the destructive consequences of patriarchy in educational and social contexts. The University of the Free State (UFS) in South Africa in collaboration with the non-profit organization Gender Reconciliation International conducted a year-long series of workshops with male and female students. The aim of these workshops was to facilitate healing between men and women through collective dialogue processes. Drawing on a collective biography methodology outlined by feminist poststructuralists, this paper explores the impact of these workshops on gender relations. Findings show that the students experienced significant psychological connections with others during these dialogues, through which they began to interrogate their own gendered conditioning and harmful patriarchal assumptions and practices. This paper enhances insights into the possibilities for disrupting patriarchy in South African universities through feminist collective research efforts.Keywords: collective biography methodology, South Africa, toxic masculinity, transforming gender oppression, violence against women
Procedia PDF Downloads 4801157 From Division to Diversity: A Post Partition Study Exploring Identity and Culture in the Selected Works of Amitav Ghosh and Bapsi Sidhwa
Authors: Akanksha Dogra, Abhilasha Singh
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This paper revolves around the cultural complexities, cultural similarities, and national sentiments of the contemporary period. It deals with the idea of cultural hybridization and the failure of socio-psychological and cultural boundaries to include all the members of society. The writers like Amitav Ghosh and Bapsi Sidhwa have a significant mark to cultural imperialism and diversity which lead to fluid identity in the present society. The paper invokes that partition could have been a solution to social and religious homogeneity. As writers like Amitav Ghosh and Bapsi Sidhwa focus on historical fiction, as they do not indulge in border activities rather exhibits complex cultural complexities. In terms of identity they believe that it is constructed and fragmented which is further shaped by colonialism and displacement. They reflect on culture in relation to the disruptions and transformations experienced by communities. Further, the division not only led to the creation of national boundaries but forced individuals to form identities based on religion. The paper aims at analyzing the contemporary scenario and comprehending the multiplicity of cross-cultural interactions leading to convolutions. It fathoms cultural and political complexities as a result of nation and nation-building as a part of collective consciousness. The paper limits itself by comprehending Amitav Ghosh’s work The Shadow Lines and The Hungry Tide and Bapsi Sidhwa’s work Pakistani Bride and The Crow Eaters through the study of Homi K. Bhabha’s The Location of Culture and Edward Said’s Culture and Imperialism.Keywords: culture, imperialism, cultural hybridization, nation-building, hybridity
Procedia PDF Downloads 161156 Designing Garments Ergonomically to Improve Life Quality of Elderly People
Authors: Nagda Ibrahim Mady, Shimaa Mohamed Atiha
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In light of actual needs of elderly people and the changes that accompany age in eyesight, hearing, dexterity, mobility, and memory which make aged people unable to carry out the simplest living affairs especially clothing demands. These needs are almost neglected in the current clothing market obligate aged peoples to wear the available choices without any consideration to their actual desires and needs. Fashion designer has gained many experiences that can gather between ergonomics and stages of fashion designing process. Fashion designer can determine the actual needs of aged people and reply these needs with designs that can achieve Improvement to the life quality of aged people besides maintaining good appearance. Thus Fashion designer can help elderly people to avoid negative impacts age leaves on them, either it is psychological or kinetic or that of dementia. Ergonomics in clothing is considered the tools and mechanisms that are used to fit aged people satisfactions supporting them to improve their living using the least time and effort. Providing the elderly with comfort besides maintaining good appearance that can make self–confidence besides independence. From this point of view the research is looking forward to improve the life of aged people through addressing functional clothes that can make elderly independent in the wearing process. Providing in these designs comfort, quality, and practicality and economic cost. Suggesting the suitable fabrics and materials and applying it to the designs to help the elderly perform their daily living customs. Reaching the successful designs that can be acceptable to specialists and to consumers whom they confirm: it supplies their clothing needs and provides the atheistic and functional performance and therefore it gives them better life.Keywords: ergonomic, design garments, elderly people, life quality
Procedia PDF Downloads 5691155 Effectiveness of Educational and Supportive Interventions for Primiparous Women on Breastfeeding Outcomes: A Systematic Review and Meta-Analysis
Authors: Mei Sze Wong, Huanyu Mou, Wai-Tong Chien
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Background: Breastmilk is the most nutritious food for infants to support their growth and protect them from infection. Therefore, breastfeeding promotion is an important topic for infant health; whereas, different educational and supportive approaches to interventions have been prompted and targeted at antenatal, postnatal, or both periods to promote and sustain exclusive breastfeeding. This systematic review aimed to identify the effective approaches of educational and supportive interventions to improve breastfeeding. Outcome measures were exclusive breastfeeding, partial breastfeeding, and breastfeeding self-efficacy, being analyzed in terms of ≤ 2 months, 3-5 months, and ≥ 6 months postpartum. Method: Eleven electronic databases and the reference lists of eligible articles were searched. English or Chinese articles of randomized controlled trials on educational and supportive intervention with the above breastfeeding outcomes over recent 20 years were searched. Quality appraisal and risk of bias of the studies were checked by Effective Public Health Practice Project tool and Revised Cochrane risk-of-bias tool, respectively. Results: 13 articles that met the inclusion criteria were included; and they had acceptable quality and risk of bias. The optimal structure, format, and delivery of the interventions significantly increased exclusive breastfeeding rate at ≤ 2 months and ≥ 6 months and breastfeeding self-efficacy at ≤ 2 months included: (a) delivering from antenatal to postnatal period, (b) multicomponent involving antenatal group education, postnatal individual breastfeeding coaching and telephone follow-ups, (c) both individual and group basis, (d) being guided by self-efficacy theory, and (e) having ≥ 3 sessions. Conclusion: The findings showed multicomponent theory-based interventions with ≥ 3 sessions that delivered across antenatal and postnatal period; using both face-to-face teaching and telephone follow-ups can be useful to enhance exclusive breastfeeding rate for more than 6 months and breastfeeding self-efficacy over the first two months of postpartum.Keywords: breastfeeding self-efficacy, education, exclusive breastfeeding, primiparous, support
Procedia PDF Downloads 1371154 Effectiveness of Enhancing Positive Emotion Program of Patients with Lung Cancer
Authors: Pei-Fan Mu
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Background: Lung cancer is the most common cancer with the highest mortality rate. Patients with lung cancer under chemotherapy treatment experience life-threatening uncertainty. This study was based on the broaden-and-build theory using intentionality reflection of the body and internalization of positive prioritization strategies to enhance positive emotions of patients with lung cancer. Purpose: The purpose of this study was to use a quasi-experimental research design to examine the effectiveness of the enhancing positive emotion program. Method: Data were collected from a medical center in Taiwan. Fifty-four participants with lung cancer were recruited. Thirty participants were in the experiential group receiving the two weeks program. The content of the program includes awareness and understanding of the symptom experience, co-existing with illness and establishing self-identity, cognitive-emotion adjustment and establishing a new body schema, and symptom management to reach spiritual well-being. Twenty-four participants were in the control group receiving regular nursing care. Baseline, one month later and two months later, programmed measurements of symptoms of distress, positive emotion, and psychological well-being. Results: These two weeks of enhancing the positive emotion program resulted in a significantly improved positive emotion score for the experimental group compared to the control group. The findings of this study indicated that the positive emotion had significant differences between the two groups. There were no differences in symptom distress between the two groups. Discussion: The findings indicated that the enhancing positive emotion program could help patients enhance their life-threatening facing conditions.Keywords: positive emotion, lung cancer, experimental design, symptom distress
Procedia PDF Downloads 1001153 The Nursing Experience for an Intestinal Perforation Elderly with a Temporary Enterostomy
Authors: Hsiu-Chuan Hsueh, Kuei-Feng Shen Jr., Chia-Ling Chao, Hui-Chuan Pan
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This article described a 75 years old woman who has suffered from intestinal perforation and accepted surgery with temporary enterostomy, the operation makes her depressed, refused relatives and friend's care, facing low willingness to participate in various activities due to fear of changing body appearance caused by surgery and leave enterostomy. The author collected information through observation talks, physical evaluation, and medical records during the period of care from November 14 to November 30, 2016, we used the four aspects of physiology, psychology, society and spirituality as a whole sexual assessment to establish the nursing problems of patient, included of acute pain, disturbance of body image,coping ineffective individual. For patient care issues, to encouraged case to express their inner feelings and take part in self-care programs through providing good therapeutic interpersonal relationships with their families. However, it provided clear information about the disease and follow-up treatment plan, give compliments in a timely manner, enhanced self-confidence of individual cases and their motivation to participate in self-care of stoma, further face the disease in a positive manner. At the same time, cross-section team care model and individual care measures were developed to enhance the care skills after returning home and at the same time assist the individual in facing the psychological impact caused by stoma. Hope to provide this experience, as a reference for the future care of the disease.Keywords: enterostomy, intestinal perforation, nursing experience, ostomy
Procedia PDF Downloads 1401152 Investigating of Predisposing Factors for Domestic Violence against Women
Authors: Mozhgan Sigarchian, Shiva Alizadeh, Seyedeh Akram Nazarkardeh
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Introduction: The one of the most common forms of violence against women is domestic violence and it is one of the most acute social problems that affecting the individual physical and mental health and, in turn, the health of the family and the community. In all of the world especially in developing country, women suffer violent during her lifetime. Violence against women and girls is a serious threat to health and human rights. Several factors such as low literacy, the low income and poverty affects violence. The purpose of this study was to determine the factors conducive to domestic violence against women in Rasht, Iran, So that based on the findings, preventive measures can be taken to reduce violence and increase support for women. Methods: This is a descriptive-analytic study that was performed on 300 eligible women referred to clinics and physicians' offices in Rasht, Iran, 2017, by convenience sampling method. The questionnaire used included demographic questionnaires and domestic violence with 3 domains: physical, psychological, and sexual violence. Data were analyzed by SPSS software using independent t-test, Chi-square and Mann-Whitney tests. Result: The mean age in the group with and without domestic violence was 28.31 ± 6.097 and 32.52 ± 9.8, respectively. 168 women (56%) were reported to be violent. The results indicate that there is a significant relationship between age, husband's age, number of family members, and educational level of women with violence. But, there was no significant relationship between the duration of marriage, the education of husbands, the occupation of women and their husbands, housing situation, smoking with violence. Conclusion: The results showed that some factors such as education, age, and the number of families can affect the level of violence. According to the results, as well as a high prevalence of domestic violence among women in this study, it is suggested that training be given to families to increase women's empowerment and prevent violence against women.Keywords: domestic violence, predisposing factors, violence, women
Procedia PDF Downloads 2021151 Life Locked Up in Immigration Detention: An Exploratory Study of Education in Australian Refugee Prisons
Authors: Carly Hawkins
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Forced migration is at unprecedented levels globally, and many countries have implemented harsh policies regarding people seeking asylum. Australia legislates one of the harshest and most controversial responses in the world, sending any asylum seeker arriving by boat to indefinite offshore immigration detention. This includes children, families and unaccompanied minors. Asylum seekers and refugees are detained indefinitely by the Australian government in the Pacific Island countries of Papua New Guinea and Nauru. Global research on the impact of immigration detention has primarily focused on mental health and psychological concerns for both adults and children. Research into Australian immigration detention has largely overlooked the schooling and education of children detained in Nauru, despite refugee children spending more than five years in detention, a significant portion of a child’s life. This research focused on the experience of education for children detained offshore in Nauru from 2013-2019. 21 qualitative interviews were conducted with children, parents and service providers between 2021-2022. Interviews explored experiences of schooling, power structures, and barriers and support to education. Findings show that a lack of belonging and lack of agency negatively affected school engagement. A sense of hopelessness and uncertainty also affected their motivation to attend school, with many children missing school for months and years. The research indicates that Australia’s current policy of offshore detention has been detrimental to children’s educational experiences.Keywords: asylum seeker, children, education, immigration detention, policy, refugee, school
Procedia PDF Downloads 771150 Effects of a Simulated Power Cut in Automatic Milking Systems on Dairy Cows Heart Activity
Authors: Anja Gräff, Stefan Holzer, Manfred Höld, Jörn Stumpenhausen, Heinz Bernhardt
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In view of the increasing quantity of 'green energy' from renewable raw materials and photovoltaic facilities, it is quite conceivable that power supply variations may occur, so that constantly working machines like automatic milking systems (AMS) may break down temporarily. The usage of farm-made energy is steadily increasing in order to keep energy costs as low as possible. As a result, power cuts are likely to happen more frequently. Current work in the framework of the project 'stable 4.0' focuses on possible stress reactions by simulating power cuts up to four hours in dairy farms. Based on heart activity it should be found out whether stress on dairy cows increases under these circumstances. In order to simulate a power cut, 12 random cows out of 2 herds were not admitted to the AMS for at least two hours on three consecutive days. The heart rates of the cows were measured and the collected data evaluated with HRV Program Kubios Version 2.1 on the basis of eight parameters (HR, RMSSD, pNN50, SD1, SD2, LF, HF and LF/HF). Furthermore, stress reactions were examined closely via video analysis, milk yield, ruminant activity, pedometer and measurements of cortisol metabolites. Concluding it turned out, that during the test only some animals were suffering from minor stress symptoms, when they tried to get into the AMS at their regular milking time, but couldn´t be milked because the system was manipulated. However, the stress level during a regular “time-dependent milking rejection” was just as high. So the study comes to the conclusion, that the low psychological stress level in the case of a 2-4 hours failure of an AMS does not have any impact on animal welfare and health.Keywords: dairy cow, heart activity, power cut, stable 4.0
Procedia PDF Downloads 3111149 Neonatal Mortality, Infant Mortality, and Under-five Mortality Rates in the Provinces of Zimbabwe: A Geostatistical and Spatial Analysis of Public Health Policy Provisions
Authors: Jevonte Abioye, Dylan Savary
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The aim of this research is to present a disaggregated geostatistical analysis of the subnational provincial trends of child mortality variation in Zimbabwe from a child health policy perspective. Soon after gaining independence in 1980, the government embarked on efforts towards promoting equitable health care, namely through the provision of primary health care. Government intervention programmes brought hope and promise, but achieving equity in primary health care coverage was hindered by previous existing disparities in maternal health care disproportionately concentrated in urban settings to the detriment of rural communities. The article highlights policies and programs adopted by the government during the millennium development goals period between 1990-2015 as a response to the inequities that characterised the country’s maternal health care. A longitudinal comparative method for a spatial variation on child mortality rates across provinces is developed based on geostatistical analysis. Cross-sectional and time-series data was extracted from the World Health Organisation (WHO) global health observatory data repository, demographic health survey reports, and previous academic and technical publications. Results suggest that although health care policy was uniform across provinces, not all provinces received the same antenatal and perinatal services. Accordingly, provincial rates of child mortality growth between 1994 and 2015 varied significantly. Evidence on the trends of child mortality rates and maternal health policies in Zimbabwe can be valuable for public child health policy planning and public service delivery design both in Zimbabwe and across developing countries pursuing the sustainable development agenda.Keywords: antenatal care, perinatal care, infant mortality rate, neonatal mortality rate, under-five mortality rate, millennium development goals, sustainable development agenda
Procedia PDF Downloads 2051148 Diagnostic Clinical Skills in Cardiology: Improving Learning and Performance with Hybrid Simulation, Scripted Histories, Wearable Technology, and Quantitative Grading – The Assimilate Excellence Study
Authors: Daly M. J, Condron C, Mulhall C, Eppich W, O'Neill J.
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Introduction: In contemporary clinical cardiology, comprehensive and holistic bedside evaluation including accurate cardiac auscultation is in decline despite having positive effects on patients and their outcomes. Methods: Scripted histories and scoring checklists for three clinical scenarios in cardiology were co-created and refined through iterative consensus by a panel of clinical experts; these were then paired with recordings of auscultatory findings from three actual patients with known valvular heart disease. A wearable vest with embedded pressure-sensitive panel speakers was developed to transmit these recordings when examined at the standard auscultation points. RCSI medical students volunteered for a series of three formative long case examinations in cardiology (LC1 – LC3) using this hybrid simulation. Participants were randomised into two groups: Group 1 received individual teaching from an expert trainer between LC1 and LC2; Group 2 received the same intervention between LC2 and LC3. Each participant’s long case examination performance was recorded and blindly scored by two peer participants and two RCSI examiners. Results: Sixty-eight participants were included in the study (age 27.6 ± 0.1 years; 74% female) and randomised into two groups; there were no significant differences in baseline characteristics between groups. Overall, the median total faculty examiner score was 39.8% (35.8 – 44.6%) in LC1 and increased to 63.3% (56.9 – 66.4%) in LC3, with those in Group 1 showing a greater improvement in LC2 total score than that observed in Group 2 (p < .001). Using the novel checklist, intraclass correlation coefficients (ICC) were excellent between examiners in all cases: ICC .994 – .997 (p < .001); correlation between peers and examiners improved in LC2 following peer grading of LC1 performances: ICC .857 – .867 (p < .001). Conclusion: Hybrid simulation and quantitative grading improve learning, standardisation of assessment, and direct comparisons of both performance and acumen in clinical cardiology.Keywords: cardiology, clinical skills, long case examination, hybrid simulation, checklist
Procedia PDF Downloads 1111147 Suicide Prevention through Spiritual Practice
Authors: Jayant Balaji Athavale, Sean Clarke
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Background: According to the WHO, every year, more than 700,000 people die by suicide, which is one person around every 45 seconds. Suicide is the fourth leading cause of death among 15 to 29-year-olds globally. The most common situations or life events that might cause suicidal thoughts are financial problems/unemployment, rejections, relationship breakups, sexual/substance abuse and mental illnesses. Mental/psychological weakness caused due to defects in one’s personality is one of the main reasons why people feel they cannot cope in such situations and contemplate suicide. A WHO Mental Health Action Plan 2013–2020 lists a 4-point strategy to enhance mental health by ‘implementing strategies for promotion and prevention in mental health.’ Methodology: With 40 years of spiritual research background, the team at the Maharshi University of Spirituality has studied the spiritual root causes that can significantly affect one’s mental health and the solutions to improve it. Results/Findings: According to spiritual science, the time and nature of death are mostly due to spiritual reasons. A person would mostly contemplate and attempt suicide when he is spiritually most vulnerable. Spiritual practice, as per universal principles, helps in protecting a person spiritually and prevents him from getting such thoughts of self-harm or acting upon them by controlling such impulses. The University has had much success in helping people to overcome the defects in their personalities, including those with suicidal thoughts, through spiritual practices such as chanting the Name of God and the Personality Defect Removal (PDR) process developed by the Author. Conclusion: If such techniques were taught in educational institutions, they could be simple yet effective self-help tools to prevent thoughts of suicide and enhance mental health and well-being.Keywords: suicide, mental health, abuse, suicide prevention, personality defect removal
Procedia PDF Downloads 1981146 International Tourists’ Travel Motivation by Push-Pull Factors and Decision Making for Selecting Thailand as Destination Choice
Authors: Siripen Yiamjanya, Kevin Wongleedee
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This research paper aims to identify travel motivation by push and pull factors that affected decision making of international tourists in selecting Thailand as their destination choice. A total of 200 international tourists who traveled to Thailand during January and February, 2014 were used as the sample in this study. A questionnaire was employed as a tool in collecting the data, conducted in Bangkok. The list consisted of 30 attributes representing both psychological factors as “push- based factors” and destination factors as “pull-based factors”. Mean and standard deviation were used in order to find the top ten travel motives that were important determinants in the respondents’ decision making process to select Thailand as their destination choice. The finding revealed the top ten travel motivations influencing international tourists to select Thailand as their destination choice included [i] getting experience in foreign land; [ii] Thai food; [iii] learning new culture; [iv] relaxing in foreign land; [v] wanting to learn new things; [vi] being interested in Thai culture, and traditional markets; [vii] escaping from same daily life; [viii] enjoying activities; [ix] adventure; and [x] good weather. Classification of push- based and pull- based motives suggested that getting experience in foreign land was the most important push motive for international tourists to travel, while Thai food portrayed its highest significance as pull motive. Discussion and suggestions were also made for tourism industry of Thailand.Keywords: decision making, destination choice, international tourist, pull factor, push factor, Thailand, travel motivation
Procedia PDF Downloads 3941145 The Role of Acoustical Design within Architectural Design in the Early Design Phase
Authors: O. Wright, N. Perkins, M. Donn, M. Halstead
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This research responded to anecdotal evidence that suggested inefficiencies within the Architect and Acoustician relationship may lead to ineffective acoustic design decisions. The acoustician spoken to believed that he was approached too late in the design phase. The approached architect valued acoustical qualities, yet, struggled to interpret common measurement parameters. The preliminary investigation of these opinions indicated a gap in the current New Zealand Architectural discourse and currently informs the creation of a 2016 Master of Architecture (Prof) thesis research. Little meaningful information about acoustic intervention in the early design phase could be found from past literature. In the information that was sourced, authors focus on software as an incorporation tool without investigating why the flaws in the relationship originally exist. To further explore this relationship, a survey was designed. It underwent three phases to ensure its consistency, and was delivered to a group of 51 acousticians from one international Acoustics company. The results were then separated between New Zealand and off-shore to identify trends. The survey results suggest that 75% of acousticians meet the architect less than 5 times per project. Instead of regular contact, a mediated method is adopted though a mix of telecommunication and written reports. Acousticians tend to be introduced later into New Zealand building project than the corresponding off-shore building. This delay corresponds to an increase in remedial action for each of the building types in the survey except Auditoria and Office Buildings. 31 participants have had their specifications challenged by an architect. Furthermore, 71% of the acousticians believe that architects do not have the knowledge to understand why the acoustic specifications are in place. The issues raised in this investigation align to the colloquial evidence expressed by the two consultants. It identifies a larger gap in the industry were acoustics is remedially treated rather than identified as a possible design driver. Further research through design is suggested to understand the role of acoustics within architectural design and potential tools for its inclusion during, not after, the design process.Keywords: architectural acoustics, early-design, interdisciplinary communication, remedial response
Procedia PDF Downloads 2541144 Planning Strategy for Sustainable Transportation in Heritage Areas
Authors: Hassam Hassan Elborombaly
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The pollution generated from transportation modes, congestion and traffic heritage has led to the deterioration of historic buildings and the urban heritage in historic cities. Accordingly, this paper attempts to diagnose the transport and traffic problems in historic cities. In general and in Heritage Cities, and to investigate methods for conserving the urban heritage from negative effects of traffic congestion and of the traditional red modes of transportation. It also attempts to explore possible areas for intervention to mitigate transportation and traffic problems in the light of the principles of the sustainable transportation framework. It aims to draw conclusion and propose recommendation that would increase the efficiency and effectiveness of transportation plans in historic Cairo and consequently achieve sustainable transportation. Problems In historic cities public paths compose an irregular network enclosing large residential plots (defined as super blocks quarters or hettas). The blocks represent the basic morphology units in historic Cities. Each super block incorporates several uses (i.e. residential, non-residential, service uses and others). Local paths reach the interior of the super blocks in an organized inter core, which deals mainly with residential functions mixed with handicraft activities and is composed of several local path units; (b) the other core, which is bound by the public paths and contains a combination of residential, commercial and social activities. Objectives: 1- To provide amenity convenience and comfort for visitors and people who live and work in the area. Pedestrianizing, accessibility and safety are to be reinforced while respecting the organic urban pattern. 2- To enhance street life, vitality and activity, in order to attract people and increase economic prosperity. Research Contents • Relation between residential areas and transportation in the inner core • Analytical studies for historic areas in heritage cities • Sustainable transportation planning in heritage cities • Dynamic and flexible methodology for achieving sustainable transportation network for the Heritage Cities • Result and RecommendationKeywords: irregular network, public paths, sustainable transportation, urban heritage
Procedia PDF Downloads 5341143 Expression of Micro-RNA268 in Zinc Deficient Rice
Authors: Sobia Shafqat, Saeed Ahmad Qaisrani
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MicroRNAs play an essential role in the regulation and development of all processes in most eukaryotes because of their prospective part as mediators controlling cell growth and differentiation towards the exact position of RNAs response in plants under biotic and abiotic factors or stressors. In a few cases, Zn is oblivious poisonous for plants due to its heavy metal status. Some other metals are extremely toxic, like Cd, Hg, and Pb, but these elements require in rice for the programming of genes under abiotic stress resembling Zn stress when micro RNAs268 was importantly introduced in rice. The micro RNAs overexpressed in transgenic plants with an accumulation of a large amount of melanin dialdehyde, hydrogen peroxide, and an excessive quantity of Zn in the seedlings stage. Let out results for rice pliability under Zn stress micro RNAs act as negative controllers. But the role of micro RNA268 act as a modulator in different ecological condition. It has been explained clearly with a long understanding of the role of micro RNA268 under stress conditions; pliability and practically showed outcome to increase plant sufferance under Zn stress because micro RNAs is an intervention technique for gene regulation in gene expression. The proposed study was experimented with by using genetic factors of Zn stress and toxicity effect on rice plants done at District Vehari, Pakistan. The trial was performed randomly with three replications in a complete block design (RCBD). These blocks were controlled with different concentrations of genetic factors. By overexpression of micro RNA268 rice, seedling growth was not stopped under Zn deficiency due to the accumulation of a large amount of melanin dialdehyde, hydrogen peroxide, and an excessive quantity of Zn in their seedlings. Results showed that micro RNA268 act as a negative controller under Zn stress. In the end, under stress conditions, micro RNA268 showed the necessary function in the tolerance of rice plants. The directorial work sketch gave out high agronomic applications and yield outcomes in rice with a specific amount of Zn application.Keywords: micro RNA268, zinc, rice, agronomic approach
Procedia PDF Downloads 611142 Assessment of Trace Metals Contamination in Surficial and Core Sediments from Ghannouch- Gabes Coastline, Impact of Phosphogypsum Discharge, Southeastern of Tunisia, Mediterranean Sea: Geochemical and Mineralogical Approaches
Authors: Rim Ben Amor, Myriam Abidi, Moncef Gueddari
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The purpose of the present study is to assess the level and the distribution of CaO, SO3, Cd, Cu, Pb and Zn incore sediments of Ghannouch-Gabes coast, Gulf of Gabes, Tunisian Mediterranean coast. The XRD analyses indicate that the sediments of Ghannouch-Gabes coast are mainly composed of quartz, calcite, gypsum and fluorine reflecting the impact of the phosphate fertilizer industrial waste. The vertical distribution of surface sediments shows for all the elements analyzed, that the area located between the commercial and the fishing port of Gabes, is the most polluted zone, where the two harbors acted as barriers and limited the dispersion of phosphogypsum discharge. The abundance order of metals was found to be Zn > Cd > Cu >Pb and that the highest levels of heavy metals were found in the uppermost segment of the sediment core compared to lower depth subsurface due to a continuous input of PG release and showed that the area between the two harbor suffered from several types of pollutants compared to reference core C1, collected from non-industrialized area. The level of pollution was evaluated using contamination factor (Cf), pollution load index (PLI) and the geoaccumulation index (Igeo). The obtained results of Igeo allowed us to distinguish that the area between the commercial harbor of Ghannouch and the fishing harbor of Gabes is the most polluted where sediments are strongly contaminated for Pb, Cu and Cd. The pollution load index (PLI) of all sediments collected classified them as "polluted". According to contamination factor (Cf), the sediments can be considered as ‘considerable’ to ‘very high’ contaminated for Pb, ‘very high to moderate’ for Cd, ‘ moderate’ for Zn, between ‘moderate’ and ‘considerable’ for Cu. Statistical analyses show that heavy metals, fluoride, calcium and sulphate are resulting from the same anthropogenic origin. The metallic pollution status of sediments of Ghanouch -Gabes coast is worrying and requires a serious intervention.Keywords: trace metals, phosphogypsum, core sediments, accumulation factor, contamination factor
Procedia PDF Downloads 1431141 Tractography Analysis of the Evolutionary Origin of Schizophrenia
Authors: Asmaa Tahiri, Mouktafi Amine
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A substantial number of traditional medical research has been put forward to managing and treating mental disorders. At the present time, to our best knowledge, it is believed that fundamental understanding of the underlying causes of the majority psychological disorders needs to be explored further to inform early diagnosis, managing symptoms and treatment. The emerging field of evolutionary psychology is a promising prospect to address the origin of mental disorders, potentially leading to more effective treatments. Schizophrenia as a topical mental disorder has been linked to the evolutionary adaptation of the human brain represented in the brain connectivity and asymmetry directly linked to humans higher brain cognition in contrast to other primates being our direct living representation of the structure and connectivity of our earliest common African ancestors. As proposed in the evolutionary psychology scientific literature the pathophysiology of schizophrenia is expressed and directly linked to altered connectivity between the Hippocampal Formation (HF) and Dorsolateral Prefrontal Cortex (DLPFC). This research paper presents the results of the use of tractography analysis using multiple open access Diffusion Weighted Imaging (DWI) datasets of healthy subjects, schizophrenia-affected subjects and primates to illustrate the relevance of the aforementioned brain regions connectivity and the underlying evolutionary changes in the human brain. Deterministic fiber tracking and streamline analysis were used to generate connectivity matrices from the DWI datasets overlaid to compute distances and highlight disconnectivity patterns in conjunction with other fiber tracking metrics; Fractional Anisotropy (FA), Mean Diffusivity (MD) and Radial Diffusivity (RD).Keywords: tractography, evolutionary psychology, schizophrenia, brain connectivity
Procedia PDF Downloads 731140 Physical Activity Self-Efficacy among Pregnant Women with High Risk for Gestational Diabetes Mellitus: A Cross-Sectional Study
Authors: Xiao Yang, Ji Zhang, Yingli Song, Hui Huang, Jing Zhang, Yan Wang, Rongrong Han, Zhixuan Xiang, Lu Chen, Lingling Gao
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Aim and Objectives: To examine physical activity self-efficacy, identify its predictors, and further explore the mechanism of action among the predictors in mainland Chinese pregnant women with high risk for gestational diabetes mellitus (GDM). Background: Physical activity could protect pregnant women from developing GDM. Physical activity self-efficacy was the key predictor of physical activity. Design: A cross-sectional study was conducted from October 2021 to May 2022 in Zhengzhou, China. Methods: 252 eligible pregnant women completed the Pregnancy Physical Activity Self-efficacy Scale, the Social Support for Physical Activity Scale, the Knowledge on Physical Activity Questionnaire, the 7-item Generalized Anxiety Disorder scale, the Edinburgh Postnatal Depression Scale, and a socio-demographic data sheet. Multiple linear regression was applied to explore the predictors of physical activity self-efficacy. Structural equation modeling was used to explore the mechanism of action among the predictors. Results: Chinese pregnant women with a high risk for GDM reported a moderate level of physical activity self-efficacy. The best-fit regression analysis revealed four variables explained 17.5% of the variance in physical activity self-efficacy. Social support for physical activity was the strongest predictor, followed by knowledge of the physical activity, intention to do physical activity, and anxiety symptoms. The model analysis indicated that knowledge of physical activity could release anxiety and depressive symptoms and then increase physical activity self-efficacy. Conclusion: The present study revealed a moderate level of physical activity self-efficacy. Interventions targeting pregnant women with high risk for GDM need to include the predictors of physical activity self-efficacy. Relevance to clinical practice: To facilitate pregnant women with high risk for GDM to engage in physical activity, healthcare professionals may find assess physical activity self-efficacy and intervene as soon as possible on their first antenatal visit. Physical activity intervention programs focused on self-efficacy may be conducted in further research.Keywords: physical activity, gestational diabetes, self-efficacy, predictors
Procedia PDF Downloads 1041139 Modeling Route Selection Using Real-Time Information and GPS Data
Authors: William Albeiro Alvarez, Gloria Patricia Jaramillo, Ivan Reinaldo Sarmiento
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Understanding the behavior of individuals and the different human factors that influence the choice when faced with a complex system such as transportation is one of the most complicated aspects of measuring in the components that constitute the modeling of route choice due to that various behaviors and driving mode directly or indirectly affect the choice. During the last two decades, with the development of information and communications technologies, new data collection techniques have emerged such as GPS, geolocation with mobile phones, apps for choosing the route between origin and destination, individual service transport applications among others, where an interest has been generated to improve discrete choice models when considering the incorporation of these developments as well as psychological factors that affect decision making. This paper implements a discrete choice model that proposes and estimates a hybrid model that integrates route choice models and latent variables based on the observation on the route of a sample of public taxi drivers from the city of Medellín, Colombia in relation to its behavior, personality, socioeconomic characteristics, and driving mode. The set of choice options includes the routes generated by the individual service transport applications versus the driver's choice. The hybrid model consists of measurement equations that relate latent variables with measurement indicators and utilities with choice indicators along with structural equations that link the observable characteristics of drivers with latent variables and explanatory variables with utilities.Keywords: behavior choice model, human factors, hybrid model, real time data
Procedia PDF Downloads 1551138 Intergenerational Trauma: Patterns of Child Abuse and Neglect Across Two Generations in a Barbados Cohort
Authors: Rebecca S. Hock, Cyralene P. Bryce, Kevin Williams, Arielle G. Rabinowitz, Janina R. Galler
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Background: Findings have been mixed regarding whether offspring of parents who were abused or neglected as children have a greater risk of experiencing abuse or neglect themselves. In addition, many studies on this topic are restricted to physical abuse and take place in a limited number of countries, representing a small segment of the world's population. Methods: We examined relationships between childhood maltreatment history assessed in a subset (N=68) of the original longitudinal birth cohort (G1) of the Barbados Nutrition Study and their now-adult offspring (G2) (N=111) using the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We used Pearson correlations to assess relationships between parent and offspring CTQ-SF total and subscale scores (physical, emotional, and sexual abuse; physical and emotional neglect). Next, we ran multiple regression analyses, using the parental CTQ-SF total score and the parental Sexual Abuse score as primary predictors separately in our models of G2 CTQ-SF (total and subscale scores). Results: G1 total CTQ-SF scores were correlated with G2 offspring Emotional Neglect and total scores. G1 Sexual Abuse history was significantly correlated with G2 Emotional Abuse, Sexual Abuse, Emotional Neglect, and Total Score. In fully-adjusted regression models, parental (G1) total CTQ-SF scores remained significantly associated with G2 offspring reports of Emotional Neglect, and parental (G1) Sexual Abuse was associated with offspring (G2) reports of Emotional Abuse, Physical Abuse, Emotional Neglect, and overall CTQ-SF scores. Conclusions: Our findings support a link between parental exposure to childhood maltreatment and their offspring's self-reported exposure to childhood maltreatment. Of note, there was not an exact correspondence between the subcategory of maltreatment experienced from one generation to the next. Compared with other subcategories, G1 Sexual Abuse history was the most likely to predict G2 offspring maltreatment. Further studies are needed to delineate underlying mechanisms and to develop intervention strategies aimed at preventing intergenerational transmission.Keywords: trauma, family, adolescents, intergenerational trauma, child abuse, child neglect, global mental health, North America
Procedia PDF Downloads 851137 Thulium Laser Vaporisation and Enucleation of Prostate in Patients on Anticoagulants and Antiplatelet Agents
Authors: Abdul Fatah, Naveenchandra Acharya, Vamshi Krishna, T. Shivaprasad, Ramesh Ramayya
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Background: Significant number of patients with bladder outlet obstruction due to BPH are on anti-platelets and anticoagulants. Prostate surgery in this group of patients either in the form of TURP or Open prostatectomy is associated with increased risk of bleeding complications requiring transfusions, packing of the prostatic fossa or ligation or embolization of internal iliac arteries. Withholding of antiplatelets and anticoagulants may be associated with cardiac and other complications. Efficacy of Thulium Laser in the above group of patients was evaluated in terms of peri-operative, postoperative and delayed bleeding complications as well as cardiac events in peri-operative and immediate postoperative period. Methods: 217 patients with a mean age of 68.8 years were enrolled between March 2009 and March 2013 (36 months), and treated for BPH with ThuLEP. Every patient was evaluated at base line according to: Digital Rectal Examination (DRE), prostate volume, Post-Voided volume (PVR), International Prostate Symptoms Score (I-PSS), PSA values, urine analysis and urine culture, uroflowmetry. The post operative complications in the form of drop in hemoglobin level, transfusion rates, post –operative cardiac events within a period of 30 days, delayed hematuria and events like deep vein thrombosis and pulmonary embolism were noted. Results: Our data showed a better post-operative outcome in terms of, postoperative bleeding requiring intervention 7 (3.2%), transfusion rate 4 (1.8%) and cardiac events within a period of 30 days 4(1.8%), delayed hematuria within 6 months 2(0.9 %) compared other series of prostatectomies. Conclusion: The thulium LASER prostatectomy is a safe and effective option for patients with cardiac comorbidties and those patients who are on antiplatelet agents and anticoagulants. The complication rate is less as compared to larger series reported with open and transurethral prostatectomies.Keywords: thulium laser, prostatectomy, antiplatelet agents, bleeding
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