Search results for: primary health care

Authors: Aminu Bashir Mohammad, Agwu Ezera, Abdulrazaq G. Habib, Garba Iliyasu

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Background: Drug resistance tuberculosis (DR-TB) continues to be a challenge in developing countries with poor resources. Routine screening for primary DR-TB before commencing treatment is not done in public hospitals in Nigeria, even with the large body of evidence that shows a high prevalence of primary DR-TB. Data on drug resistance and its genetic determinant among follow up TB patients is lacking in Nigeria. Hence the aim of this study was to determine the prevalence and genetic determinant of drug resistance among follow up TB patients in a tertiary hospital in Nigeria. Methods: This was a cross-sectional laboratory-based study conducted on 384 sputum samples collected from consented follow-up tuberculosis patients. Standard microbiology methods (Zeil-Nielsen staining and microscopy) and PCR (Line Probe Assay)] were used to analyze the samples collected. Person’s Chi-square was used to analyze the data generated. Results: Out of three hundred and eighty-four (384) sputum samples analyzed for mycobacterium tuberculosis (MTB) and DR-TB twenty-five 25 (6.5%) were found to be AFB positive. These samples were subjected to PCR (Line Probe Assay) out of which 18(72%) tested positive for DR-TB. Mutations conferring resistance to rifampicin (rpo B) and isoniazid (katG, and or inhA) were detected in 12/18(66.7%) and 6/18(33.3%), respectively. Transmission dynamic of DR-TB was not significantly (p>0.05) dependent on demographic characteristics. Conclusion: There is a need to strengthened the laboratory capacity for diagnosis of TB and drug resistance testing and make these services available, affordable, and accessible to the patients who need them.

Keywords: drug resistance tuberculosis, genetic determinant, intensive phase, Nigeria

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Authors: Melaku Tsehay

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The Consortium of Christian Relief and Development Associations (CCRDA), and the CORE Group Polio Partners (CGPP) Secretariat have been working with Global Alliance for Vac-cines and Immunization (GAVI) to improve the immunization data quality in Afar and Somali Regional States. The main aim of this study was to compare the quality of immunization data before and after the above interventions in health facilities in the pastoralist communities in Ethiopia. To this end, a comparative-cross-sectional study was conducted on 51 health facilities. The baseline data was collected in May 2019, while the end line data in August 2021. The WHO data quality self-assessment tool (DQS) was used to collect data. A significant improvment was seen in the accuracy of the pentavalent vaccine (PT)1 (p = 0.012) data at the health posts (HP), while PT3 (p = 0.010), and Measles (p = 0.020) at the health centers (HC). Besides, a highly sig-nificant improvment was observed in the accuracy of tetanus toxoid (TT)2 data at HP (p < 0.001). The level of over- or under-reporting was found to be < 8%, at the HP, and < 10% at the HC for PT3. The data completeness was also increased from 72.09% to 88.89% at the HC. Nearly 74% of the health facilities timely reported their respective immunization data, which is much better than the baseline (7.1%) (p < 0.001). These findings may provide some hints for the policies and pro-grams targetting on improving immunization data qaulity in the pastoralist communities.

Keywords: data quality, immunization, verification factor, pastoralist region

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Authors: Chenxu Fang, Qikai Guan

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Riverside public space in mountainous cities has unique scenic resources and humanistic connotations and is an important place indispensable to the activities of urban residents. In recent years, with the continuous development of society and the expansion of the city, the public space along the riverside has been affected to a certain extent. Based on this, this study is based on the concept of health and safety through the study of riverfront space in the local section of Jialing River in Chongqing City; according to the actual use function of riverfront public space, the riverfront public space in mountainous cities is categorized into leisure and recreational riverfront space, ecological conservation waterfront space, and composite function waterfront space. Starting from the health and safety elements affecting the environment in the riverfront public space, the health and safety influencing factors of the riverfront public space are categorized into three major categories, namely, material, non-material, and social, and through the field research and questionnaire collection, combined with the analysis of the Likert scale, the important levels of the health and safety influencing factors of different types of the riverfront public space of the mountainous cities are clarified. We summarize the factors affecting the health and safety of mountainous riverside spaces, map their importance levels to the design of different types of riverside spaces, and put forward three representative paths for the governance of the safety and health of mountainous riverside public space.

Keywords: health and safety, mountain city, riverfront public space, spatial governance, Chongqing Jialing River

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Authors: Samar Mousa, Rebecca Shirley

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Injuries to the hand account for 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. Functional impairments as a result of hand injuries often necessitate absence from employment, resulting in reduced productivity estimated to incur an additional £600m loss to the UK economy. Appropriate and early management is vital to preserve anatomy, prevent stiffness and allow function. The initial assessment and management of hand injuries are usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In our plastic surgery department at Stoke Mandeville hospital Buckinghamshire trust, we carried out an audit project to detect errors in hand splinting in the period between April 2022 and July 2022 and find out measures to support junior doctors, nurses and hand therapists in providing the best possible care for hand trauma patients. Our standards were The British Society for Surgery of the Hand (BSSH) standard of care in hand trauma, AO surgery reference and Stoke Mandeville hospital hand therapy mini protocol Feb 2022 During the period of 4 months, 5 cases were identified. Two cases of wrong splint choice, two cases of early removal of the splint and one tight splint that required change. In order to avoid those mistakes, a training program was given to junior doctors and nurses in collaboration with the hand therapy team regarding ways of splinting the hand in different injuries like fractures, tendons injuries, muscle injuries and ligamentous injuries. In addition to, a poster hung in the examination rooms and theatres to help junior doctors reach the correct decision.

Keywords: splinting, hand trauma, plastic surgery, tendon injury, hand fracrture

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Authors: Bonnie Clough, Tamara Ownsworth, Vladimir Estivill-Castro, Matt Stainer, Rene Hexel, Andrew Bulmer, Wendy Moyle, Allison Waters, David Neumann, Jayke Bennett

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The success of global vaccination programs is reliant on the uptake of vaccines to achieve herd immunity. Yet, many individuals do not obtain vaccines or venipuncture procedures when needed. Whilst health education may be effective for those individuals who are hesitant due to safety or efficacy concerns, for many of these individuals, the primary concern relates to blood or injection fear or phobia (BII). BII is highly prevalent and associated with a range of negative health impacts, both at individual and population levels. Exposure therapy is an efficacious treatment for specific phobias, including BII, but has high patient dropout and low implementation by therapists. Whilst virtual reality approaches exposure therapy may be more acceptable, they have similarly low rates of implementation by therapists and are often difficult to tailor to an individual client’s needs. It was proposed that a piloted robot may be able to adequately facilitate fear induction and be an acceptable approach to exposure therapy. The current study examined fear induction responses, acceptability, and feasibility of a piloted robot for BII exposure. A Nao humanoid robot was programmed to connect with a virtual reality head-mounted display, enabling live streaming and exploration of real environments from a distance. Thirty adult participants with BII fear were randomly assigned to robot-pilot or virtual reality exposure conditions in a laboratory-based fear exposure task. All participants also completed a computer-based two-dimensional exposure task, with an order of conditions counterbalanced across participants. Measures included fear (heart rate variability, galvanic skin response, stress indices, and subjective units of distress), engagement with a feared stimulus (eye gaze: time to first fixation and a total number of fixations), acceptability, and perceived treatment credibility. Preliminary results indicate that fear responses can be adequately induced via a robot-piloted platform. Further results will be discussed, as will implications for the treatment of BII phobia and other fears. It is anticipated that piloted robots may provide a useful platform for facilitating exposure therapy, being more acceptable than in-vivo exposure and more flexible than virtual reality exposure.

Keywords: anxiety, digital mental health, exposure therapy, phobia, robot, virtual reality

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Authors: Chiu-Wen Chang, I-Yun Chang, Wei-Ting Chen, Hui-Ping Ho, Ruei-Hun Chang, Joh-Jong Huang

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Kaohsiung City is located in the tropical region where has Aedes aegypti and Aedes albopictus distributed; once the virus invades, it’s can easily trigger local epidemic. Besides, Kaohsiung City has a world-class airport and harbor, trade and tourism are close and frequently with every country, especially with the Southeast Asian countries which also suffer from dengue. Therefore, Kaohsiung City faces the difficult challenge of dengue every year. The objectives of this study was to enhance dengue clinical care, border management and vector surveillance in Kaohsiung City by establishing an larger scale, innovatively and more coordinated dengue prevention and control strategies in 2016, including (1) Integrated medical programs: facilitated 657 contract medical institutions, widely set up NS1 rapid test in clinics, enhanced triage and referrals system, dengue case daily-monitoring management (2) Border quarantine: comprehensive NS1 screening for foreign workers and fisheries when immigration, hospitalization and isolation for suspected cases, health education for high risk groups (foreign students, other tourists) (3) Mosquito control: Widely use Gravitrap to monitor mosquito density in environment, use NS1 rapid screening test to detect community dengue virus (4) Health education: create a dengue app for people to immediately inquire the risk map and nearby medical resources, routine health education to all districts to strengthen public’s dengue knowledge, neighborhood cleaning awards program. The results showed that after new integration of dengue prevention and control strategies fully implemented in Kaohsiung City, the number of confirmed cases in 2016 declined to 342 cases, the majority of these cases are the continuation epidemic in 2015; in fact, only two cases confirmed after the 2016 summer. Besides, the dengue mortality rate successfully decreased to 0% in 2016. Moreover, according to the reporting rate from medical institutions in 2014 and 2016, it dropped from 27.07% to 19.45% from medical center, and it decreased from 36.55% to 29.79% from regional hospital; however, the reporting rate of district hospital increased from 11.88% to 15.87% and also increased from 24.51% to 34.89% in general practice clinics. Obviously, it showed that under the action of strengthening medical management, it reduced the medical center’s notification ratio and improved the notification ratio of general clinics which achieved the great effect of dengue clinical management and dengue control.

Keywords: dengue control, integrated control strategies, clinical management, NS1

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Authors: Mojtaba Mirmontazemi, Habibollah Dadgar

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Bone is the most common metastasis site in some advanced malignancies, such as prostate and breast cancer. Bone metastasis generally indicates fewer prognostic factors in these patients. Different radiological and molecular imaging modalities are used for detecting bone lesions. Molecular imaging including computed tomography, magnetic resonance imaging, planar bone scintigraphy, single-photon emission tomography, and positron emission tomography as noninvasive visualization of the biological occurrences has the potential to exact examination, characterization, risk stratification and comprehension of human being diseases. Also, it is potent to straightly visualize targets, specify clearly cellular pathways and provide precision medicine for molecular targeted therapies. These advantages contribute implement personalized treatment for each patient. Currently, NaF PET/CT has significantly replaced standard bone scintigraphy for the detection of bone metastases. On one hand, 68Ga-PSMA PET/CT has gained high attention for accurate staging of primary prostate cancer and restaging after biochemical recurrence. On the other hand, FDG PET/CT is not commonly used in osseous metastases of prostate and breast cancer as well as its usage is limited to staging patients with aggressive primary tumors or localizing the site of disease. In this article, we examine current studies about FDG, NaF, and PSMA PET/CT images in bone metastases diagnostic utility and assess response to treatment in patients with breast and prostate cancer.

Keywords: skeletal metastases, fluorodeoxyglucose, sodium fluoride, molecular imaging, precision medicine, prostate cancer (68Ga-PSMA-11)

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Authors: Arezoo Fallahi

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Introduction: Exposure to second-hand smoke is an important global health problem and threatens the health of people, especially children and women. The aim of this study was to determine the effect of education based on the Health Belief Model on preventive behaviors of exposure to secondhand smoke in women. Materials and Methods: This experimental study was performed in 2023in Sanandaj, west of Iran. Seventy-four people were selected by simple random sampling and divided into an intervention group (37 people) and a control group (37 people). Data collection tools included demographic characteristics and a second-hand smoke exposure questionnaire based on the Health Beliefs Model. The training in the intervention group was conducted in three one-hour sessions in the comprehensive health service centers in the form of lectures, pamphlets, and group discussions. Data were analyzed using SPSS software version 21 and statistical tests such as correlation, paired t-test, and independent t-test. Results: The intervention and control groups were homogeneous before education. They were similar in terms of mean scores of the Health Belief Model. However, after an educational intervention, some of the scores increased, including the mean perceived sensitivity score (from 17.62±2.86 to 19.75±1.23), perceived severity score (28.40±4.45 to 31.64±2), perceived benefits score (27.27±4.89 to 31.94±2.17), practice score (32.64±4.68 to 36.91±2.32) perceived barriers from 26.62±5.16 to 31.29±3.34, guide for external action (from 17.70±3.99 to 22/89 ±1.67), guide for internal action from (16.59±2.95 to 1.03±18.75), and self-efficacy (from 19.83 ±3.99 to 23.37±1.43) (P <0.05). Conclusion: The educational intervention designed based on the Health Belief Model in women was effective in performing preventive behaviors against exposure to secondhand smoke.

Keywords: women, health behaviour, smoke, belive

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Authors: Anindita Sen

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Oral fluid is a promising diagnostic matrix for drugs of abuse compared to urine and serum. Detection of methamphetamine in oral fluid would pave way for the easy evaluation of impairment in drivers during roadside drug testing as well as ensure safe working environments by facilitating evaluation of impairment in employees at workplaces. A membrane-based point-of-care (POC) friendly pre-treatment technique has been developed which aided elimination of interferences caused by salivary proteins and facilitated the demonstration of methamphetamine detection in saliva using a gold nanoparticle based colorimetric aptasensor platform. It was found that the colorimetric response in saliva was always suppressed owing to the matrix effects. By navigating the challenging interfering issues in saliva, we were successfully able to detect methamphetamine at nanomolar levels in saliva offering immense promise for the translation of these platforms for on-site diagnostic systems. This subsequently motivated the development of a handheld portable light meter device that can reliably transduce the aptasensors colorimetric response into absorbance, facilitating quantitative detection of analyte concentrations on-site. This is crucial due to the prevalent unreliability and sensitivity problems of the conventional drug testing kits. The fabricated light meter device response was validated against a standard UV-Vis spectrometer to confirm reliability. The portable and cost-effective handheld detector device features sensitivity comparable to the well-established UV-Vis benchtop instrument and the easy-to-use device could potentially serve as a prototype for a commercial device in the future.

Keywords: aptasensors, colorimetric gold nanoparticle assay, point-of-care, oral fluid

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Authors: Pranee Liamputtong

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Childlessness in non-Western societies has wide-ranging social implications and profoundly affects the gender identity and well-being of women. The aspirations of women in these societies are shaped by various sociocultural expectations, encompassing social norms and their own social standing. Currently, there is limited knowledge regarding the perceptions and experiences of Zimbabwean migrant women living in Australia regarding childlessness and motherhood. This paper explores the cultural perspective on children in Zimbabwean society and investigates the personal and social consequences of infertility, as well as the cultural expectations of motherhood among Zimbabwean migrant women residing in Australia. The perceptions and experiences of this migrant community are of utmost importance in order to prevent misunderstandings about the core essence of motherhood among Zimbabwean women. Ultimately, this will lead to the provision of sensitive and culturally appropriate healthcare and social support for migrants in Australia's multicultural society. The study adopts a constructivist paradigm and employs qualitative methods, including in-depth interviews, drawings, and photo elicitation, involving 15 Zimbabwean women. Thematic analysis was employed to analyze the data. In Zimbabwean culture, the ability to bear a child holds significant meaning for women. Children not only ensure the continuity of society but also provide social security, as parents rely on their children for care in old age. Childlessness jeopardizes a woman's social status and carries social repercussions that have a profound impact on their gender identity and well-being. Cultural expectations of motherhood place the sole responsibility for the emotional and physical care of children on the mother. Despite residing in Australia, the procreative value has not diminished for Zimbabwean women. Raising awareness of the procreative needs of Zimbabwean women in a culturally sensitive manner would enhance the emotional well-being of these women.

Keywords: motherhood, culture, migrant women, Zimbabwe, Australia

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Authors: Abdullah Ali Salamai

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Smart healthcare management systems (SHMS) play a vital role in medical centers. SHMS has various risks and threats that affect patient care. So, risk management is the best choice to identify and mitigate these risks. This study proposed a multi-criteria decision-making (MCDM) framework for identifying risks in SHMS and selecting the best project in SHMS to reduce risks. This study used the MCDM method to deal with conflict criteria. There are two MCDM methods: CRiteria Importance Through Intercriteria Correlation (CRITIC) and Additive Ration Assessment (ARAS). The CRITIC approach is used to compute the criteria weights, and the ARAS algorithm is used to select the appropriate projects in SHMS. The neutrosophic set (NS) was applied with MCDM methods to deal with inconsistent data in the evaluation process. The results show the Health Data Informational System project is the best. Sensitivity analysis was conducted to show the stability of the rank. The comparative study was conducted to show the effectiveness of the proposed methodology. The outcomes demonstrate the rank of projects is stable through all scenarios, and the proposed methodology is effective compared with other MCDM methods.

Keywords: risk management, portfolio management, smart healthcare, neutrosophic set, MCDM

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Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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Authors: J. Jebunnesa, Y. Budd, T. Mason

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COVID-19 changed the pedagogical expectations of early childhood education as many teachers across Australia had to quickly adapt to new teaching practices such as remote teaching. An important factor in the successful implementation of any new teaching and learning approach is teacher preparation, however, due to the pandemic, the transformation to remote teaching was immediate. A timely question to be asked is how early childhood teachers managed the transition from face-to-face teaching to remote teaching and what was learned through this time. This study explores the experiences of early childhood educators in Australia during COVID-19 lockdowns. Data were collected from an online survey conducted through the official Facebook forum of “Early Childhood Education and Care Australia,” and a constructivist grounded theory methodology was used to analyse the data. Initial research results suggest changing expectations of teachers’ roles and responsibilities during the lockdown, with a significant category related to transitioning teacher identities emerging. The concept of transitioning represents the shift from the role of early childhood educator to educational innovator, essential worker, social worker, and health officer. The findings illustrate the complexity of early childhood educators’ roles during the pandemic.

Keywords: changing role of teachers, constructivist grounded theory, lessons learned, teaching during COVID-19

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Authors: Tsega Asresa, Getahun Tigistu, Melaku Bayih

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Computer vision is a subfield of artificial intelligence that allows computers and systems to extract meaning from digital images and video. It is used in a wide range of fields of study, including self-driving cars, video surveillance, medical diagnosis, manufacturing, law, agriculture, quality control, health care, facial recognition, and military applications. Aromatic medicinal plants are botanical raw materials used in cosmetics, medicines, health foods, essential oils, decoration, cleaning, and other natural health products for therapeutic and Aromatic culinary purposes. These plants and their products not only serve as a valuable source of income for farmers and entrepreneurs but also going to export for valuable foreign currency exchange. In Ethiopia, there is a lack of technologies for the classification and identification of Aromatic medicinal plant parts and disease type cured by aromatic medicinal plants. Farmers, industry personnel, academicians, and pharmacists find it difficult to identify plant parts and disease types cured by plants before ingredient extraction in the laboratory. Manual plant identification is a time-consuming, labor-intensive, and lengthy process. To alleviate these challenges, few studies have been conducted in the area to address these issues. One way to overcome these problems is to develop a deep learning model for efficient identification of Aromatic medicinal plant parts with their corresponding disease type. The objective of the proposed study is to identify the aromatic medicinal plant parts and their disease type classification using computer vision technology. Therefore, this research initiated a model for the classification of aromatic medicinal plant parts and their disease type by exploring computer vision technology. Morphological characteristics are still the most important tools for the identification of plants. Leaves are the most widely used parts of plants besides roots, flowers, fruits, and latex. For this study, the researcher used RGB leaf images with a size of 128x128 x3. In this study, the researchers trained five cutting-edge models: convolutional neural network, Inception V3, Residual Neural Network, Mobile Network, and Visual Geometry Group. Those models were chosen after a comprehensive review of the best-performing models. The 80/20 percentage split is used to evaluate the model, and classification metrics are used to compare models. The pre-trained Inception V3 model outperforms well, with training and validation accuracy of 99.8% and 98.7%, respectively.

Keywords: aromatic medicinal plant, computer vision, convolutional neural network, deep learning, plant classification, residual neural network

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Authors: Esther Paul, Ibrahim A. M. Alzaydani, Al Hakami, Caryl Beynon

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Research Objectives and Goal: The main aim of the current study was to explore the perspectives of healthcare workers on Healthcare-associated infections (HAI) and infection control measures in a tertiary care Hospital in Abha, Saudi Arabia. As per our knowledge, this is perhaps the first qualitative study on HAI to be done in Saudi Arabia. The goal of the study was to understand the perspectives of the healthcare workers on the current protocol and guidelines for HAI and infections control measures in the hospital, the effectiveness of the current protocol for HAI and infection control measures and ways of reducing the incidence of HAI and improve infection control measures. Methods used: A qualitative research design was used to collect the data from 25 healthcare workers consisting of doctors and nurses, recruited by Snowball strategy via semi-structured interviews which were audio-recorded and transcribed verbatim immediately. An interview guide consisting of open-ended questions about the existing HAI and infection control practices in the healthcare facility, the awareness of the healthcare workers about HAI and the need for safe infection control measures were used to collect the data. The transcribed data were analyzed using the thematic analysis method. Results: Using thematic analysis four themes were identified.1.Knowledge of HAI and infection control 2. Infection control measures in practice 3. The gap in infection control measures and HAI 4. Required Implementations. The first theme covered the participants' knowledge on HAI, its definition, the types of HAI and the infection control measures.Most of the participants were aware of HAI and had some idea of the definition of HAI, its significance and the dangers posed by HAI, but few residents had no idea of the types of HAI. The second theme was focussed on the infection control measures in practice. Most of the participants were aware of the importance of infection control measures like hand hygiene, catheter care, and waste disposal. The nurses were responsible for most of the disinfection and sterilization measures and practiced it effectively. However, some doctors and residents had no inkling about these measures. The third theme emphasized that although most of the participants were aware of HAI and infection control measures and were in practice. There were some lacunae regarding their knowledge of the different types of HAI, Personal Protective Equipment practices, communication among the healthcare personnel and the hospital administrations and the means of waste disposal. The fourth and the final theme identified that most of the participants felt the need for implementations of changes regarding existing protocols, workshops/seminars, methods of waste disposal and sterilization and disinfection practices. Conclusion: The current qualitative study concluded that there is a need for better educational programs and hands-on training for all the healthcare personnel including the paramedical staff as well. The residents should have adequate knowledge of infection control practices to guide the nurses and should share the responsibility with the nurses in the practice of effective infection control measures

Keywords: healthcare-associated infections, infection control measures, perspectives, qualitative

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Authors: Farhat Nigar

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Social stress is stress which arises from one's relationships with others and from the social environment. When a person finds that they are not capable of coping with a situation, stress arises. Sanitation workers faces a lot of discrimination from the society which leads to stress and have severe impact on their mental health. Sanitation workers face lot of work pressure which sometimes leads to mental health problems, but there is lack of proper data of sanitation workers dealing with mental health problems which is a big obstacle before evolving policies for the welfare of sewage and septic tank workers which needs attention. The objective of the study is to find out the effect of social stress on the mental health of sanitation workers and to explore the scope of social work in coping with mental health problems of workers. This descriptive and analytical study was conducted on 100 sanitation workers of Aligarh city through convenience sampling. Data were collected from respondents by schedule and interview method. Most of the respondents said that they don’t enjoy equal status in society and at the workplace as well which leads to stress. Many of them said that social stress leads to poor performance in the workplace. Some of the workers feel depressed when their work is not appreciated and recognized in society. Majority of respondents has stress in financial and employment-related difficulties. Thus it can be said that social stress has several impacts on mental health which leads to poor performance, lack of confidence, and motivation which sometimes leads to depression. Social work can play a very important and challenging role in overcoming these difficulties by providing education, motivation and guiding them and by making them aware of their rights and duties.

Keywords: discrimination, health, stress, sanitation workers

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Authors: Habila Nuhu

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Natural radionuclides in the environment can significantly contribute to human exposure to ionizing radiation. The knowledge of their levels in an environment can help the radiological protection agencies in policymaking. Measurement of natural radioactivity in major soils in the tin mining state of Perak Malaysia has been conducted using an HPGe detector. Seventy (70) soil samples were collected at widely distributed locations in the state. Six major soil types were sampled, and thirteen districts around the state were covered. The following were the results of the 226Ra (238U), 228Ra (232Th), and 40K activity in the soil samples: 226Ra (238U) has a mean activity concentration of 191.83 Bq kg⁻¹, more than five times the UNSCEAR reference limits of 35 Bq kg⁻¹. The mean activity concentration of 228Ra (232Th) with a value of 232.41 Bq kg⁻¹ is over seven times the UNSCEAR reference values of 30 Bq kg⁻¹. The average concentration of 40K activity was 275.24 Bq kg⁻¹, which was less than the UNSCEAR reference limit of 400 Bq Kg⁻¹. The range of external hazards index (Hₑₓ) values was from 1.03 to 2.05, while the internal hazards index (Hin) was from 1.48 to 3.08. The Hex and Hin should be less than one for minimal external and internal radiation threats as well as secure use of soil material for building construction. The Hₑₓ and Hin results generally indicate that while using the soil types and their derivatives as building materials in the study area, care must be taken.

Keywords: activity concentration, hazard index, soil samples, tin mining

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Authors: Ransford Kwaku Afeadie

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Purpose – The health challenges that characterises most of the migrants’ urban slums raise a lot of concern for their well-being. Health-seeking behaviour becomes an important step towards maintaining a healthy life. The importance of contextual issues is necessary to help meet specific community health needs and programmes. Therefore, this study aims to bridge the knowledge gap by investigating health-seeking behaviour disparity among rural-urban labour migrant slum dwellers before and after migration to the urban slums of Madina in the Greater Accra Region, Ghana. Design/methodology/approach – The author used explanatory sequential approach of research investigation. Questionnaire and interview guides were used to collect data from the respondents; however, in the absence of an existing reliable sampling frame, the various communities were selected by the use of cluster sampling proportional to size. At the second stage, a simple random sampling was used to select the various household heads. A total of 241 questionnaires were retrieved from the respondents representing a response rate of 100%. The author used the purposive sampling technique to conduct eight in-depth interviews and six key informants’ interviews. Findings – The author found various discrepancies in many of the activities that could fulfill substantial health-seeking behaviour in the slum as compared to migrant’s places of origin. The reason for coming to the slum amidst many settlements needs and low education background are the factors that accounted for this. This study, therefore, contradicts the proposition held by the health belief model. It is, therefore, important to note that contextual issues are key, in this case, rural-urban migrant slums present a different dynamic that must be taken into account when designing health programmes for such settings. Originality/value – Many, if not all the, studies on health-seeking behaviour have focused on urban slums without taking into account urban migrants’ slums. Such a failure to take into account the variations of the health needs of migrants’ urban slum settings can eventually lead to a mismatch of health programmes meant to address their challenges. Therefore, this study brings to the fore such variations that must be taken into account when designing health programmes. The study also indicates that even with the same people, there were disparities in terms of health-seeking behaviour in the slum and at places of origin.

Keywords: health-seeking behaviour, rural–urban migration, urban slums, health belief model

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Authors: Tripta Dixit, Smita Sahu, William Selvamurthy, Sadhana Srivastava

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India is battling with the issues of accessibility, affordability and availability of quality health to the masses. Indian medical heritage which dated back to 3000 BC unveils the rich knowledge pool which has undergone a perceptible change over years, such as eradication of many communicable diseases, increasing individual awareness of quality health and import driven medical device market etc. Despite a slew of initiatives the holistic slogan of ‘health for all’ remains elusive and a concern for the nation. The 21st-century projects a myriad of challenges like cultural diversity, large population, demographic dividend and geographical segmentation leading to varied needs of people as per their regional conditions of climate, disease prevalence, nutrition and sanitation. But these challenges are also opportunities for the development of indigenous, low cost and accessible technologies to tackle them. This requires reinforcing the potential of indigenous technologies in coordination with prevailing health issues in various regions of country. This paper emphasis on the strategy for exploring the indigenous technologies with entrusted up-scaling to meet the diverse needs of the people. This review proposes to adopt technology transfer as a strategy to establish a vibrant ecosystem for identifying and up-scaling the indigenous medical technologies with diligent hand-holding for public health.

Keywords: health, indigenous, medical technology, technology transfer

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Authors: Panas Gerasimos, Kotidou Varvara, Halkiopoulos Constantinos, Gkintoni Evgenia

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As a result of growing technology and briefing by the internet, users resort to the internet and subsequently to the opinion of an expert. In many cases, they take control of their health in their hand and make a decision without the contribution of a doctor. According to that, this essay intends to analyze the confidence of searching health issues on the internet. For the fulfillment of this study, there has been a survey among doctors in order to find out the reasons a patient uses the internet about their health problems and the consequences that health information could lead by searching on the internet, as well. Specifically, the results regarding the research of the users demonstrate: a) the majority of users make use of the internet about health issues once or twice a month, b) individuals that possess chronic disease make health search on the internet more frequently, c) the most important topics that the majority of users usually search are pathological, dietary issues and the search of issues that are associated with doctors and hospitals. However, it observed that topic search varies depending on the users’ age, d) the most common sources of information concern the direct contact with doctors, as there is a huge preference from the majority of users over the use of the electronic form for their briefing and e) it has been observed that there is large lack of knowledge about e-health services. From the doctor's point of view, the following conclusions occur: a) almost all doctors use the internet as their main source of information, b) the internet has great influence over doctors’ relationship with the patients, c) in many cases a patient first makes a visit to the internet and then to the doctor, d) the internet significantly has a psychological impact on patients in order to for them to reach a decision, e) the most important reason users choose the internet instead of the health professional is economic, f) the negative consequence that emerges is inaccurate information, g) and the positive consequences are about the possibility of online contact with the doctor and contributes to the easy comprehension of the doctor, as well. Generally, it’s observed from both sides that the use of the internet in health issues is intense, which declares that the new means the doctors have at their disposal, produce the conditions for radical changes in the way of providing services and in the doctor-patient relationship.

Keywords: cognitive models, health marketing, e-health, psychological factors, digital marketing, e-health services

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Authors: Yung-Hui Tang, Yan-Chiou Ku, Li-Chi Huang

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Aim: The aim of this study is to explore the effect of the Humanoid Diagram Teaching (HDT) strategy on novice nurses’ care ability and retention rate. Methods: This study was a quasi-experimental study using two groups concurrently with repeat measurements sample consisted of 24 novice nurses (12 in each experimental and control group) in a medical center in southern Taiwan. Both groups all received regular training program (nursing standard techniques and practices, concept map, mini-CEX, CbD, and clinical education and training), and experimental group added the HDT program. The HDT strategy includes the contents of patients’ body humanoid drawing and discussion for 30 minutes each time, three times a week, and continually for four weeks. The effectiveness of ＨDT was evaluated by mini-CEX, CbD and clinical assessment and retention rate at the 3rd month and 6th month. Results: The novice nurses' care ability were examined, only CbD score in the control group was improved in the 3rd month and with statistical difference, p = .003. The mini-CEX and CbD in the experimental group were significantly improved in both the first and third month with statistical differences p = .00. Although mini-CEX and CbD in the experimental group were higher than the control group, but there was no significant difference p > .05. Retention rate of the experimental group in the third month and sixth month was significantly higher than the control group, and there was a statistically significant difference p < .05. Conclusions: The study reveals that HDT strategy can help novice nurses learning, enhancing their knowledge and technical capability, analytical skills in case-based caring, and retention. The HDT strategy can be served as an effective strategy for novice training for better nurse retention rate.

Keywords: humanoid diagram teaching strategy, novice nurses retention, teaching strategy of nurse retention, visual learning mode

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Authors: Golyasamin Khanehzaei, Mohd. Bakri Ishak, Ahmad Makmom Hj Abdullah, Latifah Abd Manaf

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Abstract—Management of clinical waste is a critical problem worldwide. Immediate attention is required to manage the clinical waste in an appropriate way in newly developing economy country such as Malaysia. The increasing amount of clinical waste generated is resulted from rapid urbanization and growing number of private health care facilities in developing countries such as Malaysia. In order to develop a sensible clinical waste management system and improvement of the management, information on factors affecting clinical waste generation has the crucial role. This paper is the study of management characteristics of clinical waste and the level of efficiency of clinical waste management systems operating in private clinics located in Selangor, Malaysia. Are they following the proper international standards? By taking all of this in consideration the aim of this paper is to identify and discuss the current trend, current challenges and also the present opportunities among the challenges of clinical waste management in private clinics of Selangor, Malaysia. The SWOT analysis was characterized for the evaluation of strengths, weaknesses, opportunities and threats. The methodology for this study was constituted of direct observation, Informal interviews, Conducting SWOT analysis, conduction of one sustainability dimensions analysis and application. The results show that clinical waste management in private clinics is far from an ideal model.

Keywords: clinical waste, SWOT analysis, Selangor, Malaysia

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Authors: Mohammed Qutishat, Loai Abu Sharour, Kholoud Al-Damery, Ibtisam Al Harthy, Sulaiman Al-Sabei

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Background: The 2019 coronavirus outbreak (COVID-19) has been declared a pandemic and has greatly affected both patients and healthcare workers. This study was conducted to explore the extent of posttraumatic stress disorder (PTSD) experiences among nurses as a result of the COVID-19 pandemic in Jordan. Method: This study used a cross-sectional study design with a convenience sampling approach. A sample of 259 participants completed the study questionnaires, including a sociodemographic questionnaire and the posttraumatic stress disorder checklist for DSM‐5, between May and July 2020. Result: The prevalence of PTSD among the study participants was 37.1%. The majority of study participants who exhibited PTSD symptoms presented the lowest level of PTSD (17%). The results indicated significant differences in overall COVID-19-related PTSD according to the participant’s age (F = 14.750, P = .000), gender (F = 30.340, P = .000), level of education (F = 51.983, P =.000), years of experience (F = 52.33, P = .000), place of work (F = 19.593, P = .000), and working position (F = 11.597, P = .000), as determined by one-way ANOVA. Conclusion: Nurses must be qualified and accredited to cope with reported PTSD cases and their consequences in relation to COVID-19 outbreaks. Close collaboration with a multidisciplinary team is required to recognise, manage, and encourage safety literacy among health care professionals and individuals diagnosed with or suspected of PTSD due to COVID-19 outbreaks or any other viral outbreaks.

Keywords: PTSD, nursing, coronavirus, pandemic, infectious disease

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Authors: Ghazi R. Reda Mahmoud Reda

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Among the metal that forms hydride´s, Mg and Ti are known as the most lightweight materials; however, they are covered with a passive layer of oxides and hydroxides and require activation treatment under high temperature ( > 300 C ) and hydrogen pressure ( > 3 MPa) before being used for storage and transport applications. It is well known that small graphite addition to Ti or Mg, lead to a dramatic change in the kinetics of mechanically induced hydrogen sorption ( uptake) and significantly stimulate the Ti-Hydrogen interaction. Many explanations were given by different authors to explain the effect of graphite addition on the performance of Ti as material for hydrogen storage. Not only graphite but also the addition of a polycyclic aromatic compound will also improve the hydrogen absorption kinetics. It will be shown that the function of carbon addition is two-fold. First carbon acts as a vacuum cleaner, which scavenges out all the interstitial oxygen that can poison or slow down hydrogen absorption. It is also important to note that oxygen favors the chemisorption of hydrogen, which is not desirable for hydrogen storage. Second, during scavenging of the interstitial oxygen, the carbon reacts with oxygen in the nano and microchannel through a highly exothermic reaction to produce carbon dioxide and monoxide which provide the necessary heat for activation and thus in the presence of carbon lower heat of activation for hydrogen absorption which is observed experimentally. Furthermore, the product of the reaction of hydrogen with the carbon oxide will produce water which due to ball milling hydrolyze to produce the linear H5O2 + this will reconstruct the primary structure of the nanocarbon to form secondary structure, where the primary structure (a sheet of carbon) are connected through hydrogen bonding. It is the space between these sheets where physisorption or defect mediated sorption occurs.

Keywords: metal forming hydrides, polar molecule impurities, titanium, phase diagram, hydrogen absorption

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Authors: Terigele

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Cultural products are always shelved into different classes of a hierarchy that separates so-called highbrow and lowbrow cultures. This study illustrated that audiences might even construct a hierarchy according to the origin countries when consuming certain products. Chinese audiences now have access to TV series from all around the world thanks to the internet. TV series from different origin countries show some particular features in terms of length, theme, plots, accessibility, seriousness etc. Their audiences were therefore stereotyped because of what they watch. Based on in-depth interviews with 20 participants, this research has following findings: 1) Most popular origin countries of foreign TV series in China are Korea, the United States, the United Kingdom, Japan and European countries in a descending order. Korean TV series are most popular because they are less serious and more accessible compared to others. 2) In the hierarchy of the TV series, European TV series stand on the top followed by British and American TV series. Japanese TV series are also categorized into highbrow class. Korean TV series are at the bottom and always seen as lowbrow cultural products. 3) Most audiences consume TV series from more than one origin countries and have different needs when watching them. Participants reported that they watch European TV series because those TV series are more artistic than their counterparts and of great quality. They watch British and American TV series mainly to improve their English and to learn about the culture. They find Japanese TV series very enjoyable with a large variety of themes and impressive lines. Audiences watch Korean TV series mostly to entertain and kill time. 4) Audiences do care about cultural taste. Especially those who watch European, British and American TV series usually tend to consider audiences who watch nothing but Korean TV series to be shallow. On the other hand, Korean TV series’ audiences seem to care less about the hierarchy of the TV series. Even when they discuss the hierarchy, they tend to accept the judgments with ironies and jokes. Future studies can dig deeply into the genre and content of TV series with different origin countries and also investigate more about the psychology of audiences regarding the gender, age, education, socioeconomic status etc.

Keywords: foreign TV series, hierarchy, popularity, uses and gratification

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Authors: Ahmed Hamzi, Bryan Norman

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Having scribes help document patient records in electronic health record systems can improve hospitalists’ productivity. But hospitals need to determine the optimum number of scribes to hire to maximize scribe cost effectiveness. Scribe attendance uncertainty due to planned and unplanned absences is a primary challenge. This paper presents simulation and analytical models to determine the optimum number of scribes for a hospital to hire. Scribe staffing practices vary from one context to another; different staffing scenarios are considered where having extra attending scribes provides or does not provide additional value and utilizing on-call scribes to fill in for potentially absent scribes. These staffing scenarios are assessed for different scribe revenue ratios (ratio of the value of the scribe relative to scribe costs) ranging from 100% to 300%. The optimum solution depends on the absenteeism rate, revenue ratio, and desired service level. The analytical model obtains solutions easier and faster than the simulation model, but the simulation model is more accurate. Therefore, the analytical model’s solutions are compared with the simulation model’s solutions regarding both the number of scribes hired and cost-effectiveness. Additionally, an Excel tool has been developed to facilitate decision-makers in easily obtaining solutions using the analytical model.

Keywords: hospitalists, workload, optimization cost, economic analysis

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Authors: Ivy Chumo, Sheillah Simiyu, Hellen Gitau, Isaac Kisiangani, Caroline Kabaria Kanyiva Muindi, Blessing Mberu

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The global sanitation workforce bridges the gap between sanitation infrastructure and the provision of sanitation services through essential public service work. Manual pit emptiers often perform the work at the cost of their dignity, safety, and health as their work requires repeated heavy physical activities such as lifting, carrying, pulling, and pushing. This exposes them to occupational and environmental health hazards and risking illness, injury, and death. The study will extend the studies by presenting occupational health risks and suggestions for improvement in informal settlements of Nairobi, Kenya. This is a qualitative study conducted among sanitation stakeholders in Korogocho, Mukuru and Kibera informal settlements in Nairobi. Data were captured using digital voice recorders, transcribed and thematically analysed. The discussion notes were further supported by observational notes made during the interviews. These formed the basis for a robust picture of occupational health of manual pit emptiers; a lack or inappropriate use of protective clothing, and prolonged duration of working hours were described to contribute to the occupational health hazard. To continue working, manual pit emptiers had devised coping strategies which include working in groups, improvised protective clothing, sharing the available protective clothing, working at night and consuming alcohol drinks while at work. Many of these strategies are detrimental to their health. Occupational health hazards among pit emptiers are key for effective working and is as a result of a lack of collaboration amongst stakeholders linked to health, safety and lack of PPE of pit emptiers. Collaborations amongst sanitation stakeholders is paramount for health, safety, and in ensuring the provision and use of personal protective devices.

Keywords: sanitation, occupational health, manual emptiers, informal settlements

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Authors: Tareq Aljaber

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The number of mobile health apps is growing at a fast frequency as it's nearly doubled in a year between 2015 and 2016. Though, there is a lack of an effective evaluation framework to verify the usability and reliability of mobile phone health education applications which would help saving time and effort for the numerous user groups. This abstract describing a framework for evaluating mobile applications in specifically mobile health education applications, along with a guidance select tool to assist different users to select the most suitable mobile health education apps. The effective framework outcome is intended to meet the requirements and needs of the different stakeholder groups additionally to enhancing the development of mobile health education applications with software engineering approaches, by producing new and more effective techniques to evaluate such software. This abstract highlights the significance and consequences of mobile health education apps, before focusing the light on the required to create an effective evaluation framework for these apps. An explanation of the effective evaluation framework is going to be delivered in the abstract, beside with some specific evaluation metrics: an efficient hybrid of selected heuristic evaluation (HE) and usability evaluation (UE) metrics to enable the determination of the usefulness and usability of health education mobile apps. Moreover, an explanation of the qualitative and quantitative outcomes for the effective evaluation framework was accomplished using Epocrates mobile phone app in addition to some other mobile phone apps. This proposed framework-An Evaluation Framework for Mobile Health Education Apps-consists of a hybrid of 5 metrics designated from a larger set in usability evaluation and heuristic evaluation, illuminated grounded on 15 unstructured interviews from software developers (SD), health professionals (HP) and patients (P). These five metrics corresponding to explicit facets of usability recognised through a requirements analysis of typical stakeholders of mobile health apps. These five hybrid selected metrics were scattered across 24 specific questionnaire questions, which are available on request from first author. This questionnaire has been sent to 81 participants distributed in three sets of stakeholders from software developers (SD), health professionals (HP) and patients/general users (P/GU) on the purpose of ranking three sets of mobile health education applications. Finally, the outcomes from the questionnaire data helped us to approach our aims which are finding the profile for different stakeholders, finding the profile for different mobile health educations application packages, ranking different mobile health education application and guide us to build the select guidance too which is apart from the Evaluation Framework for Mobile Health Education Apps.

Keywords: evaluation framework, heuristic evaluation, usability evaluation, metrics

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Authors: Siddhant Yadav, Rylea Ranum, Hannah Alberts, Abdul Kalaiger, Brent Bauer, Ryan Hurt, Ann Vincent, Loren Toussaint, Sanjeev Nanda

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Background and significance: Fibromyalgia (FM) is a chronic pain disorder also characterized by chronic fatigue, morning stiffness, sleep, and cognitive symptoms, psychological disturbances (anxiety, depression), and is comorbid with multiple medical and psychiatric conditions. It has an incidence of 2-4% in the general population and is reported more commonly in women. Oxidative stress and inflammation are thought to contribute to pain in patients with FM, and the adoption of an antioxidant/anti-inflammatory diet has been suggested as a modality to alleviate symptoms. The aim of this systematic review was to evaluate the efficacy of specialized diets (ketogenic, gluten free, Mediterranean, and low carbohydrate) in improving FM symptoms. Methodology: A comprehensive search of the following databases from inception to July 15th, 2021, was conducted: Ovid MEDLINE and Epub ahead of print, in-process and other non-indexed citations and daily, Ovid Embase, Ovid EBM reviews, Cochrane central register of controlled trials, EBSCO host CINAHL with full text, Elsevier Scopus, website and citation index, web of science emerging sources citation and clinicaltrials.gov. We included randomized controlled trials, non-randomized experimental studies, cross-sectional studies, cohort studies, case series, and case reports in adults with fibromyalgia. The risk of bias was assessed with the Agency for Health Care Research and Quality designed, specific recommended criteria (AHRQ). Results: Thirteen studies were eligible for inclusion. This included a total of 761 participants. Twelve out of the 13 studies reported improvement in widespread body pain, joint stiffness, sleeping pattern, mood, and gastrointestinal symptoms, and one study reported no changes in symptomatology in patients with FM on specialized diets. None of the studies showed the worsening of symptoms associated with a specific diet. Most of the patient population was female, with the mean age at which fibromyalgia was diagnosed being 48.12 years. Improvement in symptoms was reported by the patient's adhering to a gluten-free diet, raw vegan diet, tryptophan- and magnesium-enriched Mediterranean diet, aspartame- and msg- elimination diet, and specifically a Khorasan wheat diet. Risk of bias assessment noted that 6 studies had a low risk of bias (5 clinical trials and 1 case series), four studies had a moderate risk of bias, and 3 had a high risk of bias. In many of the studies, the allocation of treatment (diets) was not adequately concealed, and the researchers did not rule out any potential impact from a concurrent intervention or an unintended exposure that might have biased the results. On the other hand, there was a low risk of attrition bias in all the trials; all were conducted with an intention-to-treat, and the inclusion/exclusion criteria, exposures/interventions, and primary outcomes were valid, reliable, and implemented consistently across all study participants. Concluding statement: Patients with fibromyalgia who followed specialized diets experienced a variable degree of improvement in their widespread body pain. Improvement was also seen in stiffness, fatigue, moods, sleeping patterns, and gastrointestinal symptoms. Additionally, the majority of the patients also reported improvement in overall quality of life.

Keywords: fibromyalgia, specialized diet, vegan, gluten free, Mediterranean, systematic review

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Authors: Elene Zhuravliova, Tamar Barbakadze, Irina Kalandadze, Elnari Zaalishvili, Lali Shanshiashvili, David Mikeladze

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Background: Multiple sclerosis (MS) is an inflammatory, neurodegenerative disease, which is accompanied by demyelination and autoimmune response to myelin proteins. Among post-translational modifications, which mediate the modulation of inflammatory pathways during MS, methylation is the main one. The methylation of DNA, also amino acids lysine and arginine, occurs in the cell. It was found that decreased trans-methylation is associated with neuroinflammatory diseases. Therefore, abnormal regulation of the methyl cycle could induce demyelination through the action on PAD (peptidyl-arginine-deiminase) gene promoter. PAD takes part in protein citrullination and targets myelin basic protein (MBP), which is affected during demyelination. To determine whether MBP charge isomers are changing the methyl cycle, we have estimated the concentrations of methyl cycle metabolites in MBP-activated primary astrocytes and oligodendrocytes. For this purpose, the action of the citrullinated MBP- C8 and the most cationic MBP-C1 isomers on the primary cells were investigated. Methods: Primary oligodendrocyte and astrocyte cell cultures were prepared from whole brains of 2-day-old Wistar rats. The methyl cycle metabolites, including homocysteine, S-adenosylmethionine (SAM), and S-adenosylhomocysteine (SAH), were estimated by HPLC analysis using fluorescence detection and prior derivatization. Results: We found that the action of MBP-C8 and MBP-C1 induces a decrease in the concentration of both methyl cycle metabolites, S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH), in astrocytes compared to the control cells. As for oligodendrocytes, the concentration of SAM was increased by the addition of MBP-C1, while MBP-C8 has no significant effect. As for SAH, its concentration was increased compared to the control cells by the action of both MBP-C1 and MBP-C8. A significant increase in homocysteine concentration was observed by the action of the MBP-C8 isomer in both oligodendrocytes and astrocytes. Conclusion: These data suggest that MBP charge isomers change the concentration of methyl cycle metabolites. MBP-C8 citrullinated isomer causes elevation of homocysteine in astrocytes and oligodendrocytes, which may be the reason for decreased astrocyte proliferation and increased oligodendrocyte cell death which takes place in neurodegenerative processes. Elevated homocysteine levels and subsequent abnormal regulation of methyl cycles in oligodendrocytes possibly change the methylation of DNA that activates PAD gene promoter and induces the synthesis of PAD, which in turn provokes the process of citrullination, which is the accompanying process of demyelination. Acknowledgment: This research was supported by the SRNSF Georgia RF17_534 grant.

Keywords: myelin basic protein, astrocytes, methyl cycle metabolites, homocysteine, oligodendrocytes

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