Search results for: community health agents
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 13685

Search results for: community health agents

10175 The Walkway Project: An Exploration of Informal Public Space Upgrading in Gugulethu, Cape Town

Authors: Kathryn Ewing

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Safe and accessible public spaces are vital elements of our South African cities. Public spaces hold the potential to act as important, vibrant places for learning, exchange, and practice. Public walkways, however, are some of the most neglected and extremely dangerous public spaces experienced in the local neighborhood of Gugulethu in Cape Town. Walkways feel insignificant, being recognized as informal and undetermined or retain complex fragments of formal erven. They are generally out of sight connecting minor streets and informal settlements. Community residents refer to the walkways as unsafe and dirty spaces. Local authorities allocate minimal to no municipal budgets nor maintenance plans resulting in a lack of basic services, particularly lighting and green infrastructure. ‘The Walkway Project’ presents a series of urban stories collected from co-design workshops, emotional mapping exercises, and fieldwork, including urban walks and urban talks. The narrative interprets the socio-spatial practice and complexity of informal public space in Gugulethu, Cape Town. The Walkway Project research, interrelated to the Master of Urban Design teaching and design-research studio, has a strong focus on participatory and engaged learning and action research methodology within a deliberate pedagogy. A consolidated urban design implementation plan exposes the impact and challenges of waste and water, opening the debate on relevant local solutions for resilience and safety in Cape Town. A small and neglected passage connecting two streets, commonly referred to as iThemba Walkway, is presented as a case study to show-case strategic urban design intervention strategies for urban upgrading. The iThemba walkway is a community-driven project that demonstrates active and responsible co-design and participatory development opportunities. In March 2021, when visited on an urban walk, the public space was covered by rubble and solid waste. By April 2021, the community cleaned the walkway and created an accessible passage for the school children to pass. Numerous co-design workshops have taken place over the past year. The walkway has emerged as a public space upgrading project facilitated, motivated, and implemented by multiple local partners and residents. Social maps from urban walks and talks illustrate the transformation of iThemba Walkway into an inclusive, safe, resilient, and sustainable urban space, linked to Sustainable Development Goal number 11, sustainable cities and communities. The outcomes of the upgrading project facilitate a deeper understanding of co-design methods, urban upgrading processes, and monitoring of public space and informal urbanism.

Keywords: informal, public space, resilience, safety, upgrade, walkways

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10174 The Importance of Optimization of Halal Tourism: A Study of the Development of Halal Tourism in Indonesia

Authors: Rizqi W. Romadhon, Nur Arifan

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Halal Tourism is a part of tourism industry which is based on Islamic Principle and addressed to the Muslim tourist. The potency of halal tourism is very broad to be developed, because the growth of Muslim populations is rapidly increasing. Indonesia is one of the biggest countries with Majority of its population is Muslim, therefore human resources and natural resources have very good potential to be part of the Halal tourism industry. But the fact is Indonesia can not optimize the potential of human resources and natural resources as well as neighboring countries carried out. This paper will discuss the reasons of the importance of developing Halal tourism, and the factors influencing the success of developing halal tourism in Indonesia, and also the optimization strategies which can be adopted by the government so that the Halal tourism industry in Indonesia has a sustainable competitive advantage. The existence of this research is expected to government, tourism agents and others can optimize the potency of Indonesia’s Human resources and natural resources for developing Halal tourism industry in Indonesia.

Keywords: halal tourism, Islamic principle, optimization, sustainable competitive advantage

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10173 Online vs. in vivo Workshops in a Masters’ Degree Course in Mental Health Nursing: Students’ Views and Opinions

Authors: Evmorfia Koukia, Polyxeni Mangoulia

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Workshops tend to be a vivid and productive way as an in vivo teaching method. Due to the pandemic, COVID-19 university courses were conducted through the internet. Method It was tried for the first time to integrate online art therapy workshops in a core course named “Special Themes of Mental Health Nursing” in a MSc Program in Mental Health. The duration of the course is 3-hours per week for 11 weeks in a single semester. The course has a main instructor, a professor of psychiatric nursing experienced in arts therapies workshops and visiting art therapists. All art therapists were given a certain topic to cover. Students were encouraged to keep a logbook that was evaluated at the end of the semester and was submitted as a part of the examination process of the course. An interview of 10 minutes was conducted with each student at the end of the course from an independent investigator (an assistant professor) Participants The students (sample) of the program were: nurses, psychologists, and social workers Results: All students who participated in the courses found that the learning process was vivid, encouraging participation and self-motivation, and there were no main differences from in vivo learning. The students identified their personal needs, and they felt a personal connection with the learning experience. The result of the personalized learning was that students discovered their strengths and weaknesses and developed skills like critical thinking. All students admitted that the workshops were the optimal way for them to comprehend the courses’ content, their capability to become therapists, as well as their obstacles and weaknesses while working with patients in mental health. Conclusion: There were no important differences between the views of students in online and in vivo teaching method of the workshops. The result has shown that workshops in mental health can contribute equally in the learning experience.

Keywords: mental health, workshops, students, nursing

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10172 Everyday Interactions among Imprisoned Sex Offenders: A Qualitative Study within the 'Due Palazzi' Prison in Padua

Authors: Matteo Mazzucato, Elena Faccio, Antonio Iudici

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Prison is a social reality constructed by everyday interactions between an inmate, other social actors (cellmates, prison officers, educationalists and psychologists or other detainees) and the external world which participates in this complex construction through the social discourses on prison reality and its problems. Being a detainee means performing a self dealing with processes of stereotypization, attribution of a social role and prejudices assigned by various interlocutors and depending on what kind of crime one has been convicted of. Among all inmates, sex offenders are the ones who risk more to be socially condemned beyond a legal sentence since they have committed one of the most hated and disapproved crime. Regarding this, prison has to be considered as a critical context in which all community expectations and beliefs are converged: for common sense, rapists and child molesters are dangerous people who have to be stigmatized, punished and isolated. Furthermore, other detainees share a code of conduct by which the ‘sex offender’ is collocated at the lowest level of the social hierarchy of the prison. The penitentiary administration too defines this kind of detainee as a ‘vulnerable person to protect’ while prison staff considers him as a particular inmate who has to be treated and definitely changed. Considering all the complexities connected with being imprisoned as a sex offender, our research aimed at exploring how people convicted of sex crimes are called upon to manage all these hetero-narrations about their selves. Set this goal, textual data retrieved from this qualitative research show that sex offenders tend to not face the stigma assigned to them. They are rather used to minimize the story telling about their selves and costruct alternative biographies to be shared with other inmates. Managing narrations about their selves in this way permits to distance them from all the threats perceived living together with other detainees but it blocks sex offenders’ ri-signification of their offences during prison treatment. Given these results, prison administration should develop activities in order to create fields of interaction between detainees where experiencing new versions of their selves spendable even in external social situations. Regarding this it’s important to re-consider prison as part of the community and the sex offenders as a member of it.

Keywords: interactions, qualitative research, prison reality, sex offender

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10171 Methotrexate Associated Skin Cancer: A Signal Review of Pharmacovigilance Center

Authors: Abdulaziz Alakeel, Abdulrahman Alomair, Mohammed Fouda

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Introduction: Methotrexate (MTX) is an antimetabolite used to treat multiple conditions, including neoplastic diseases, severe psoriasis, and rheumatoid arthritis. Skin cancer is the out-of-control growth of abnormal cells in the epidermis, the outermost skin layer, caused by unrepaired DNA damage that triggers mutations. These mutations lead the skin cells to multiply rapidly and form malignant tumors. The aim of this review is to evaluate the risk of skin cancer associated with the use of methotrexate and to suggest regulatory recommendations if required. Methodology: Signal Detection team at Saudi Food and Drug Authority (SFDA) performed a safety review using National Pharmacovigilance Center (NPC) database as well as the World Health Organization (WHO) VigiBase, alongside with literature screening to retrieve related information for assessing the causality between skin cancer and methotrexate. The search conducted in July 2020. Results: Four published articles support the association seen while searching in literature, a recent randomized control trial published in 2020 revealed a statistically significant increase in skin cancer among MTX users. Another study mentioned methotrexate increases the risk of non-melanoma skin cancer when used in combination with immunosuppressant and biologic agents. In addition, the incidence of melanoma for methotrexate users was 3-fold more than the general population in a cohort study of rheumatoid arthritis patients. The last article estimated the risk of cutaneous malignant melanoma (CMM) in a cohort study shows a statistically significant risk increase for CMM was observed in MTX exposed patients. The WHO database (VigiBase) searched for individual case safety reports (ICSRs) reported for “Skin Cancer” and 'Methotrexate' use, which yielded 121 ICSRs. The initial review revealed that 106 cases are insufficiently documented for proper medical assessment. However, the remaining fifteen cases have extensively evaluated by applying the WHO criteria of causality assessment. As a result, 30 percent of the cases showed that MTX could possibly cause skin cancer; five cases provide unlikely association and five un-assessable cases due to lack of information. The Saudi NPC database searched to retrieve any reported cases for the combined terms methotrexate/skin cancer; however, no local cases reported up to date. The data mining of the observed and the expected reporting rate for drug/adverse drug reaction pair is estimated using information component (IC), a tool developed by the WHO Uppsala Monitoring Centre to measure the reporting ratio. Positive IC reflects higher statistical association, while negative values translated as a less statistical association, considering the null value equal to zero. Results showed that a combination of 'Methotrexate' and 'Skin cancer' observed more than expected when compared to other medications in the WHO database (IC value is 1.2). Conclusion: The weighted cumulative pieces of evidence identified from global cases, data mining, and published literature are sufficient to support a causal association between the risk of skin cancer and methotrexate. Therefore, health care professionals should be aware of this possible risk and may consider monitoring any signs or symptoms of skin cancer in patients treated with methotrexate.

Keywords: methotrexate, skin cancer, signal detection, pharmacovigilance

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10170 Availability of TB Infection Control Plans at Rural Hospitals of South Africa

Authors: Takalani Tshitangano

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Background: In Limpopo province the rate of new tuberculosis (TB) cases increase daily. The Infection Control (IC) plan is one of the essential actions for TB IC. This study aimed to establish the availability of these plans at health care facilities. Objectives: The objectives were to explore and describe the awareness and knowledge of health care workers (HCWs) of the availability and content of TB IC plan; and to identity the role of infection control committees from the perspective of HCWs. Method: A qualitative approach using a cross-sectional descriptive design was adopted. The target population was all HCWs from the seven hospitals of Vhembe district. A purposive sampling approach was used to select 57 participants. The approval to conduct this study was obtained from the relevant authorities and participants. Data were collected through seven focus group discussions comprising five to 10 members. An unstructured discussion guide was used to collect data, and an open-coding method was used to analyse the data. Lincoln and Guba’s criteria ensured trustworthiness of the study findings. Results: Findings revealed that HCWs were not aware of the availability and the information contained in the TB IC plans. No person was designated as TB IC officer at hospital level. There was lack of a TB IC Committee and teams as well as ineffective utilisation of those that did exist. Conclusions: It was concluded that if the TB IC plans are not available at health care facilities, then the TB IC practices implemented by HCWs vary, resulting in TB nosocomial infection transmission. It was recommended that the World Health Organisation’s TB IC plans be adopted and implemented in Vhembe district.

Keywords: health care workers' awareness, health care workers' knowledge, availability of TB infection control plans, rural hospitals

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10169 Associations between Mindfulness, Temporal Discounting, Locus of Control, and Reward-Based Eating in a Sample of Overweight and Obese Adults

Authors: Andrea S. Badillo-Perez, Alexis D. Mitchell, Sara M. Levens

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Overeating, and obesity have been associated with addictive behavior, primarily due to behaviors like reward-based eating, the tendency to overeat due to factors such as lack of control, preoccupation over food, and lack of satiation. Temporal discounting (TD), the ability to select future rewards over short term gains, and mindfulness, the process of maintaining present moment awareness, have been suggested to have significant, differential impacts on health-related behaviors. An individual’s health locus of control, the degree to which they feel that they have control over their health is also known to have an impact on health outcomes. The goal of this study was to investigate the relationship between health locus of control and reward-based eating, as well as the relation between TD and mindfulness in a sample (N = 126) of overweight or obese participants from larger health-focused study. Through the use of questionnaires (including the Five Facet Mindfulness Questionnaire (FFMQ), Reward-Based Eating Drive (RED), and Multidimensional Health Locus of Control (MHLOC)), anthropometric measurements, and a computerized TD task, a series of regressions tested the association between subscales of these measures. Results revealed differences in how the mindfulness subscales are associated with TD measures. Specifically the ‘Observing’ (beta =-.203) and ‘Describing’ (beta =.26) subscales were associated with lower TD rates and a longer subjective devaluation time-frame respectively. In contrast, the ‘Acting with Awareness’ subscale was associated with a shorter subjective devaluation timeframe (beta =-.23). These findings suggest that the reflective perspective initiated through the observing and describing components of mindfulness may facilitate delay of gratification, whereas the acting with awareness component of mindfulness, which focuses on the present moment, may make delay of gratification more challenging. Results also indicated that a higher degree of reward-based eating was associated with a higher degree of an external health locus of control based on the power of chance (beta =.10). However, an external locus of control based on the power of others had no significant association with reward-based eating. This finding implies that the belief that health is due to chance is associated with greater reward-based eating behavior, suggesting that interventions that focus on locus of control may be helpful. Overall, findings demonstrate that weight loss interventions may benefit from health locus of control and mindfulness exercises, but caution should be taken as the components of mindfulness appear to have different effects on increasing or decreasing delay of gratification.

Keywords: health locus of control, mindfulness, obesity, reward-based eating, temporal discounting

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10168 Participatory Action Research with Social Workers: The World Café Method to Share Critical Reflections and Possible Solutions on Working Practices in Migration Contexts

Authors: Ilaria Coppola, Davide Lacqua, Nadia Ranìa

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Over the past two decades, migration has gained central importance in the global landscape. Europe hosts the largest number of migrants, totaling 92.9 million people, approximately 37.4 million of whom are regular residents within the European Union's borders. Reception services and different modes of management have received increasing attention precisely because of the complexity of the phenomenon, which necessarily impacts the wider community. Indeed, opening a reception center in an area entails major challenges for that context, for the community that inhabits it, and for the people who use that service. Questioning the strategies needed to offer a functional reception service means listening to the different actors involved who daily face the difficulties involved in working in the field. Recognizing the importance of the professional figures who work closely with migrant people, each with their own specific experiences has led researchers to study and analyze the different types of reception centers and their management. This has led to the development of intervention models and best practices in various countries. However, research from this perspective is still limited, especially in Italy. From this theoretical framework, this study aims to bring out an innovative qualitative tool, such as the world café, the work experiences of 29 social workers working in shelters in the Italian context. Most of the participants were female and lived in the Northwest regions of Italy. Through this tool, the aim was to bring out and share reflections on the critical issues encountered in working in reception centers, with a view to identifying possible solutions for better management of services. The World café represents a tool used in participatory action research that promotes dialogue among participants through the sharing of reflections and ideas. In fact, from critical reflections, participants are invited to identify and share possible solutions to provide a more functional service with benefits to the entire community. Therefore, this research, through the innovative technique of the World café, aims to promote critical thinking processes that can help participants find solutions that can be introduced into their work contexts or proposed to decision-makers. Specifically, the findings shed light on several issues, including complex bureaucratic procedures, insufficient project planning, and inefficiencies in the services provided to migrants. These concerns collectively contribute to what participants perceive as a disorganized and uncoordinated system. In addition, the study explores potential solutions that promote more efficient networking practices, coordinated project management, and a more positive approach to cultural diversity. The main results obtained will be discussed with a focus on critical reflections and possible solutions identified.

Keywords: participatory action research, world café method, reception services, migration contexts, social workers, Italy

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10167 Speech Community and Social Language Codes: A Sociolinguistic Study of Mampruli-English Codeswitching in Nalerigu, Ghana

Authors: Gertrude Yidanpoa Grumah

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Ghana boasts of a rich linguistic diversity, with around eighty-seven indigenous languages coexisting with English, the official language. Within this multilingual environment, speech communities adopt bilingual code choices as a common practice, as people seamlessly switch between Ghanaian languages and English. Extensive research has delved into this phenomenon from various perspectives, including the role of bilingual code choices in teaching, its implications for language policy, and its significance in multilingual communities. Yet, a noticeable gap in the literature persists, with most studies focusing on codeswitching between English and the major southern Ghanaian languages like Twi, Ga, and Ewe. The intricate dynamics of codeswitching with minority indigenous languages, such as Mampruli spoken in northern Ghana, remain largely unexplored. This thesis embarks on an investigation into Mampruli-English codeswitching, delving into the linguistic practices of educated Mampruli speakers. The data collection methods encompass interviews, recorded radio programs, and ethnographic observation. The analytical framework employed draws upon the Ethnography of Communication, with observation notes and transcribed interviews thoughtfully classified into discernible themes. The research findings suggest that a bilingual's tendency to switch from Mampruli to English is significantly influenced by factors such as the level of education, age, gender, perceptions of language prestige, and religious beliefs. In essence, this study represents a pioneering endeavor, marking the first comprehensive study on codeswitching practices within the Mampruli-English context and making a significant contribution to our understanding of Mampruli linguistics, covering the social language codes reflecting the speech community. In a region where such research has been scarce for the past four decades, this study addresses a critical knowledge gap, shedding light on the intricate dynamics of language use in northern Ghana.

Keywords: codeswitching, English, ethnography of communication, Mampruli, sociolinguistics

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10166 Advances in Health Risk Assessment of Mycotoxins in Africa

Authors: Wilfred A. Abiaa, Chibundu N. Ezekiel, Benedikt Warth, Michael Sulyok, Paul C. Turner, Rudolf Krska, Paul F. Moundipa

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Mycotoxins are a wide range of toxic secondary metabolites of fungi that contaminate various food commodities worldwide especially in sub-Saharan Africa (SSA). Such contamination seriously compromises food safety and quality posing a serious problem for human health as well as to trade and the economy. Their concentrations depend on various factors, such as the commodity itself, climatic conditions, storage conditions, seasonal variances, and processing methods. When humans consume foods contaminated by mycotoxins, they exert toxic effects to their health through various modes of actions. Rural populations in sub-Saharan Africa, are exposed to dietary mycotoxins, but it is supposed that exposure levels and health risks associated with mycotoxins between SSA countries may vary. Dietary exposures and health risk assessment studies have been limited by lack of equipment for the proper assessment of the associated health implications on consumer populations when they eat contaminated agricultural products. As such, mycotoxin research is premature in several SSA nations with product evaluation for mycotoxin loads below/above legislative limits being inadequate. Few nations have health risk assessment reports mainly based on direct quantification of the toxins in foods ('external exposure') and linking food levels with data from food frequency questionnaires. Nonetheless, the assessment of the exposure and health risk to mycotoxins requires more than the traditional approaches. Only a fraction of the mycotoxins in contaminated foods reaches the blood stream and exert toxicity ('internal exposure'). Also, internal exposure is usually smaller than external exposure thus dependence on external exposure alone may induce confounders in risk assessment. Some studies from SSA earlier focused on biomarker analysis mainly on aflatoxins while a few recent studies have concentrated on the multi-biomarker analysis of exposures in urine providing probable associations between observed disease occurrences and dietary mycotoxins levels. As a result, new techniques that could assess the levels of exposures directly in body tissue or fluid, and possibly link them to the disease state of individuals became urgent.

Keywords: mycotoxins, biomarkers, exposure assessment, health risk assessment, sub-Saharan Africa

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10165 Indigenous Healers and Indigenous Trauma: Healing at the Intersections of Colonial, Intergenerational, and Individual Trauma for Indigenous Peoples in Canada

Authors: Suzanne L. Stewart, Mikaela D. Gabriel

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Background: Indigenous People face multiple barriers to successful life transitions, including housing, employment, education, and health. Current statistical trends paint devastating life transitions for Indigenous Peoples, but colonization and its intergenerational impacts are typically lacking as the crucial context in which these trends occur. This presentation will illustrate the massive impact of colonization on Indigenous Peoples; its intergenerational transmission, and how it impacts Indigenous clients seeking mental health treatment today. Methods: A qualitative, narrative inquiry methodology was used to honour Indigenous storytelling and knowledge transmission. Indigenous Elders, outreach workers, and homeless clients were interviewed and narratively analyzed for in-depth trends and themes. Impact: This research provides a wealth of in-depth information as to the life transition needs of Indigenous clients, identify the systemic impacts of colonization to the health and wellbeing of Indigenous People, and strategies for mental health treatment.

Keywords: indigenous trauma, indigenous peoples of canada, intergenerational trauma, colonial trauma and treatment

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10164 Legislating for Public Participation and Environmental Justice: Whether It Solves or Prevent Disputes

Authors: Deborah A. Hollingworth

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The key tenets associated with ‘environmental justice’, were first articulated in a global context in Principle 10 of the United Nations Declaration on Environment and Development at Rio de Janeiro in 1992 (the Rio Declaration). The elements can be conflated to require: public participation in decision-making; the provision of relevant information to those affected about environmental hazards issues; access to judicial and administrative proceeding; and the opportunity for redress where remedy where required. This paper examines the legislative and regulatory arrangements in place for the implementation these elements in a number of industrialised democracies, including Australia. Most have, over time made regulatory provision for these elements – even if they are not directly attributed Principle 10 or the notion of environmental justice. The paper proposes, that of these elements the most critical to the achievement of good environmental governance, is a legislated recognition and role of public participation. However, the paper considers that notwithstanding sound legislative and regulatory practices, environmental regulators frequently struggle, where there is a complex decision-making scenario or long-standing enmity between a community and industry to achieve effective engagement with the public. This study considers the dilemma confronted by environmental regulators to given meaningful effect to the principles enshrined in Principle 10 – that even when the legislative expression of Principle 10 is adhered to – does not prevent adverse outcomes. In particular, it considers, as a case study a prominent environmental incident in 2014 in Australia in which an open-cut coalmine located in the regional township of Morwell caught fire during bushfire season. The fire, which took 45 days to be extinguished had a significant and adverse impact on the community in question, but compounded a complex, and sometime antagonistic history between the mine and township. The case study exemplifies the complex factors that will often be present between industry, the public and regulatory bodies, and which confound the concept of environmental justice, and the elements of enshrined in the Principle 10 of the Rio Declaration. The study proposes that such tensions and complex examples will commonly be the reality of communities and regulators. However, to give practical effect to outcomes contemplated by Principle 10, the paper considers that regulators will may consider public intervention more broadly as including early interventions and formal opportunities for “conferencing” between industry, community and regulators. These initiatives help to develop a shared understanding and identification of issues. It is proposed that although important, options for “alternative dispute resolution” are not sufficiently preventative, as they come into play when a dispute has arise. Similarly “restorative justice” programs, while important once an incident or adverse environmental outcome has occurred, are post event and therefore necessarily limited. The paper considers the examples of how public participation at the outset – at the time of a proposal, before issues arise or eventuate to ensure, is demonstrably the most effective way for building commonality and an agreed methodology for working to resolve issues once they occur.

Keywords: environmental justice, alternative dispute resolution, domestic environmental law, international environmental law

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10163 Non-Governmental Organisations and Human Development in Bauchi State, Nigeria

Authors: Sadeeq Launi

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NGOs, the world over, have been recognized as part of the institutions that complement government activities in providing services to the people, particularly in respect of human development. This study examined the role played by the NGOs in human development in Bauchi State, Nigeria, between 2004 and 2013. The emphasis was on reproductive health and access to education role of the selected NGOs. All the research questions, objectives and hypotheses were stated in line with these variables. The theoretical framework that guided the study was the participatory development approach. Being a survey research, data were generated from both primary and secondary sources with questionnaires and interviews as the instruments for generating the primary data. The population of the study was made up of the staff of the selected NGOs, beneficiaries, health staff and school teachers in Bauchi State. The sample drawn from these categories were 90, 107 and 148 units respectively. Stratified random and simple random sampling techniques were adopted for NGOs staff, and Health staff and school teachers data were analyzed quantitatively and qualitatively and hypotheses were tested using Pearson Chi-square test through SPSS computer statistical package. The study revealed that despite the challenges facing NGOs operations in the study area, NGOs rendered services in the areas of health and education This research recommends among others that, both government and people should be more cooperative to NGOs to enable them provide more efficient and effective services. Governments at all levels should be more dedicated to increasing accessibility and affordability of basic education and reproductive health care facilities and services in Bauchi state through committing more resources to the Health and Education sectors, this would support and facilitate the complementary role of NGOs in providing teaching facilities, drugs, and other reproductive health services in the States. More enlightenment campaigns should be carried out by governments to sensitize the public, particularly women on the need to embrace immunization programmes for their children and antenatal care services being provided by both the government and NGOs.

Keywords: access to education, human development, NGOs, reproductive health

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10162 Tourism in the Information Age

Authors: Suleyman Karacor

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The main purpose of this study is to investigate tourism marketing in the information age because of the importance and sensitivity. In the twenty-first century as a result of today's the increasing competition and product diversification in the tourism sector, tourism businesses must take into account exogenous variables such as new technological developments, commercial experience and consumer demand. In the information age, tourist product consumers tend to reserve their leisure time and expenditure on more active opportunities for different experiences instead of living the same experience again. Increasing the number of agents in the tourism sector, travel opportunities offering different experiences and more intensive use of modern technology helps to present diversification of leisure activities for tourists. From the perspective of tourists, travel costs are still important for buying the touristic products but maintaining a high level of tourist satisfaction is also of increasing importance. Tourists tend to prefer activities that add value. A real tourist product must be able to create value and new priorities for tourists. Therefore this study aims to review recent significant developments in international tourism marketing research and practices. To this end, this study reviews tourism marketing-focused articles.

Keywords: information age, tourism marketing, tourism marketing mix, management

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10161 Design, Synthesis, and Evaluation of Small Peptides for Managing Inflammation: Inhibition to Substrate Approach

Authors: Palwinder Singh, Baljit Kaur, Sukhmeet Kaur

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Amongst a library of rationally designed small peptides, (H)Gly-Gly-Phe-Leu(OMe) was identified, reducing prostaglandin production of COX-2 with IC50 60 nM vs. 6000 nM for COX-1. The 5 mg Kg-1 dose of this compound rescued albino mice by 80% from capsaicin-induced paw licking and recovered it by 60% from carrageenan-induced inflammation. The mode of action of the compound for targeting COX-2, iNOS, and VGSC was investigated by using substances P, L-arginine, and veratrine, respectively, as the biomarkers. The interactions of the potent compound with COX-2 were supported by the isothermal calorimetry experiments showing Ka 6.10±1.10x104 mol-1 and ΔG -100.3 k J mol-1 in comparison to Ka 0.41x103 ±0.09 mol-1 and ΔG -19.2±0.06 k J mol-1 for COX-1. This compound did not show toxicity up to 2000 mg Kg-1 dose. Furthermore, beyond the conventional mode of working with anti-inflammatory agents through enzyme inhibition, COX-2 was provided with a peptide-based alternate substrate. Proline-centered pentapeptide iso-conformational to arachidonic acid exhibited appreciable selectivity for COX-2 overcoming acetic acid and formalin-induced pain in rats to almost 80% and was treated as a substrate by the enzyme. Hence, we suggest small peptides as highly potent and promising candidates for their further development into an anti-inflammatory drug.

Keywords: small peptides, cyclooxygenase, inflammation, substrate

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10160 Assessment of Air Pollution Impacts On Population Health in Béjaia City

Authors: Benaissa Fatima, Alkama Rezak, Annesi-Maesano Isabella

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To assess the health impact of the air pollution on the population of Béjaia, we carried out a descriptive epidemiologic inquiry near the medical establishments of three areas. From the registers of hospital admissions, we collected data on the hospital mortality and admissions relating to the various cardiorespiratory pathologies generated by this type of pollution. In parallel, data on the automobile fleet of Bejaia and other measurements were exploited to show that the concentrations of the pollutants are strongly correlated with the concentration the urban traffic. This study revealed that the whole of the population is touched, but the sensitivity to pollution can show variations according to the age, the sex and the place of residence. So the under population of the town of Bejaia marked the most raised death and morbidity rates, followed that of Kherrata. Weak rates are recorded for under rural population of Feraoun. This approach enables us to conclude that the population of Béjaia could not escape the urban pollution generated by her old automobile fleet. To install a monitoring and measuring site of the air pollution in this city could provide a beneficial tool to protect its inhabitants by them informing on quality from the air that they breathe and measurements to follow to minimize the impacts on their health and by alerting the authorities during the critical situations.

Keywords: air, urban pollution, health, impacts

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10159 Phenology and Size in the Social Sweat Bee, Halictus ligatus, in an Urban Environment

Authors: Rachel A. Brant, Grace E. Kenny, Paige A. Muñiz, Gerardo R. Camilo

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The social sweat bee, Halictus ligatus, has been documented to alter its phenology as a response to changes in temporal dynamics of resources. Furthermore, H. ligatus exhibits polyethism in natural environments as a consequence of the variation in resources. Yet, we do not know if or how H. ligatus responds to these variations in urban environments. As urban environments become much more widespread, and human population is expected to reach nine billion by 2050, it is crucial to distinguish how resources are allocated by bees in cities. We hypothesize that in urban regions, where floral availability varies with human activity, H. ligatus will exhibit polyethism in order to match the extremely localized spatial variability of resources. We predict that in an urban setting, where resources vary both spatially and temporally, the phenology of H. ligatus will alter in response to these fluctuations. This study was conducted in Saint Louis, Missouri, at fifteen sites each varying in size and management type (community garden, urban farm, prairie restoration). Bees were collected by hand netting from 2013-2016. Results suggest that the largest individuals, mostly gynes, occurred in lower income neighborhood community gardens in May and August. We used a model averaging procedure, based on information theoretical methods, to determine a best model for predicting bee size. Our results suggest that month and locality within the city are the best predictors of bee size. Halictus ligatus was observed to comply with the predictions of polyethism from 2013 to 2015. However, in 2016 there was an almost complete absence of the smallest worker castes. This is a significant deviation from what is expected under polyethism. This could be attributed to shifts in planting decisions, shifts in plant-pollinator matches, or local climatic conditions. Further research is needed to determine if this divergence from polyethism is a new strategy for the social sweat bee as climate continues to alter or a response to human dominated landscapes.

Keywords: polyethism, urban environment, phenology, social sweat bee

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10158 Prefectorial Participation in Inclusive School Governance: A Shrewd Strategy for Building an Inclusive Society

Authors: Thomas Jerome Yeboah

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Inclusive school leadership is not a standalone project. It is spread across a broad array of individual leaders in the school. Successful inclusive education thrives on collaborative, shared, and participatory leadership. School prefects are generally not included in leadership discourses in respect of the implementation of inclusive education and the benefits inherent in it, yet they live at the closest proximity to the learners and wield much influence over them. The purpose of this study was to investigate how the participation of school prefects in inclusive school governance could be used as a strategy to prepare them to champion the course of individuals who live with disability and special needs in order to build a more inclusive society. The exploratory study employed a purposive sampling technique to select ten (10) school prefects from five (5) inclusive schools in Ghana. Semi-structured interview was used to glean information from the selected participants to answer the research questions raised in the study. Results from the study were thematically analysed. The study concluded that the school prefects could be agents of societal transformation who would be capable of creating an environment where those with disability and special needs would be accepted by society as ‘normal.’

Keywords: inclusive society, participation, inclusive school leadership, societal transformation, school prefects

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10157 Bioinspired Green Synthesis of Magnetite Nanoparticles Using Room-Temperature Co-Precipitation: A Study of the Effect of Amine Additives on Particle Morphology in Fluidic Systems

Authors: Laura Norfolk, Georgina Zimbitas, Jan Sefcik, Sarah Staniland

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Magnetite nanoparticles (MNP) have been an area of increasing research interest due to their extensive applications in industry, such as in carbon capture, water purification, and crucially, the biomedical industry. The use of MNP in the biomedical industry is rising, with studies on their effect as Magnetic resonance imaging contrast agents, drug delivery systems, and as hyperthermic cancer treatments becoming prevalent in the nanomaterial research community. Particles used for biomedical purposes must meet stringent criteria; the particles must have consistent shape and size between particles. Variation between particle morphology can drastically alter the effective surface area of the material, making it difficult to correctly dose particles that are not homogeneous. Particles of defined shape such as octahedral and cubic have been shown to outperform irregular shaped particles in some applications, leading to the need to synthesize particles of defined shape. In nature, highly homogeneous MNP are found within magnetotactic bacteria, a unique bacteria capable of producing magnetite nanoparticles internally under ambient conditions. Biomineralisation proteins control the properties of the MNPs, enhancing their homogeneity. One of these proteins, Mms6, has been successfully isolated and used in vitro as an additive in room-temperature co-precipitation reactions (RTCP) to produce particles of defined mono-dispersed size & morphology. When considering future industrial scale-up it is crucial to consider the costs and feasibility of an additive, as an additive that is not readily available or easily synthesized at a competitive price will not be sustainable. As such, additives selected for this research are inspired by the functional groups of biomineralisation proteins, but cost-effective, environmentally friendly, and compatible with scale-up. Diethylenetriamine (DETA), triethylenetetramine (TETA), tetraethylenepentamine (TEPA), and pentaethylenehexamine (PEHA) have been successfully used in RTCP to modulate the properties of particles synthesized, leading to the formation of octahedral nanoparticles with no use of organic solvents, heating, or toxic precursors. By extending this principle to a fluidic system, ongoing research will reveal whether the amine additives can also exert morphological control in an environment which is suited toward higher particle yield. Two fluidic systems have been employed; a peristaltic turbulent flow mixing system suitable for the rapid production of MNP, and a macrofluidic system for the synthesis of tailored nanomaterials under a laminar flow regime. The presence of the amine additives in the turbulent flow system in initial results appears to offer similar morphological control as observed under RTCP conditions, with higher proportions of octahedral particles formed. This is a proof of concept which may pave the way to green synthesis of tailored MNP on an industrial scale. Mms6 and amine additives have been used in the macrofluidic system, with Mms6 allowing magnetite to be synthesized at unfavourable ferric ratios, but no longer influencing particle size. This suggests this synthetic technique while still benefiting from the addition of additives, may not allow additives to fully influence the particles formed due to the faster timescale of reaction. The amine additives have been tested at various concentrations, the results of which will be discussed in this paper.

Keywords: bioinspired, green synthesis, fluidic, magnetite, morphological control, scale-up

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10156 Physical Activity and Mental Health: A Cross-Sectional Investigation into the Relationship of Specific Physical Activity Domains and Mental Well-Being

Authors: Katja Siefken, Astrid Junge

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Background: Research indicates that physical activity (PA) protects us from developing mental disorders. The knowledge regarding optimal domain, intensity, type, context, and amount of PA promotion for the prevention of mental disorders is sparse and incoherent. The objective of this study is to determine the relationship between PA domains and mental well-being, and whether associations vary by domain, amount, context, intensity, and type of PA. Methods: 310 individuals (age: 25 yrs., SD 7; 73% female) completed a questionnaire on personal patterns of their PA behaviour (IPQA) and their mental health (Centre of Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder (GAD-7) scale, the subjective physical well-being (FEW-16)). Linear and multiple regression were used for analysis. Findings: Individuals who met the PA recommendation (N=269) reported higher scores on subjective physical well-being than those who did not meet the PA recommendations (N=41). Whilst vigorous intensity PA predicts subjective well-being (β = .122, p = .028), it also correlates with depression. The more vigorously physically active a person is, the higher the depression score (β = .127, p = .026). The strongest impact of PA on mental well-being can be seen in the transport domain. A positive linear correlation on subjective physical well-being (β =.175, p = .002), and a negative linear correlation for anxiety (β =-.142, p = .011) and depression (β = -.164, p = .004) was found. Multiple regression analysis indicates similar results: Time spent in active transport on the bicycle significantly lowers anxiety and depression scores and enhances subjective physical well-being. The more time a participant spends using the bicycle for transport, the lower the depression (β = -.143, p = .013) and anxiety scores (β = -.111,p = .050). Conclusions: Meeting the PA recommendations enhances subjective physical well-being. Active transport has a substantial impact on mental well-being. Findings have implications for policymakers, employers, public health experts and civil society. A stronger focus on the promotion and protection of health through active transport is recommended. Inter-sectoral exchange, outside the health sector, is required. Health systems must engage other sectors in adopting policies that maximize possible health gains.

Keywords: active transport, mental well-being, health promotion, psychological disorders

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10155 Utilization of Antenatal Care Services by Domestic Workers in Delhi

Authors: Meenakshi

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Background: The complications during pregnancy are the major cause of morbidity and deaths among women in the reproductive age group. Childbearing is the most important phase in women’s lives that occur mainly in the adolescent and adult years. Maternal health, thus is an important issue as this as this is important phase is also productive time for women as they strive fulfill their capabilities as an individual, mothers, family members and also as a citizen. The objective of the study is to document the coverage of ANC and its determinants among domestic workers. Method: A survey of 300 domestic workers were carried in Delhi. Only respondents in the age group (15-49) and whose recent birth was of 5 years preceding the survey were included. Socio-demographic data and information on maternal health was collected from these respondents Information on ANC was collected from total 300 respondents. Standard of living index were composed based on households assists and similarly autonomy index was computed based on women decision making power in the households taking certain key variables. Cross tabulations were performed to obtain frequency and percentages. Potential socio-economic determinants of utilization of ANC among domestic workers were examined using binary logistic regressions. Results: Out of 300 domestic workers survey, only 70.7 per cent per cent received ANC. Domestic workers who married at age 18 years and above are 4 times more likely to utilize antenatal services during their last birth (***p< 0.01). Comparison to domestic workers with number of living children two or less, domestic workers with number of living children more than two are less likely to utilize antenatal care services (**p< 0.05). Domestic workers belonging to Other Backward Castes are more likely to utilize antenatal care services than domestic workers belonging to scheduled tribes ((**p< 0.05). Conclusion: The level of utilization of maternal health services are less among domestic workers is less, as they spend most of their time at the employers household. Though demonstration effect do have impact on their life styles but utilization of maternal health services is poor. Strategies and action are needed to improve the utilization of maternal health services among this section of workers as they are vulnerable because of no proper labour legislations.

Keywords: antenatal care, domestic workers, health services, maternal health, women’s health

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10154 Exploratory Factor Analysis of Natural Disaster Preparedness Awareness of Thai Citizens

Authors: Chaiyaset Promsri

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Based on the synthesis of related literatures, this research found thirteen related dimensions that involved the development of natural disaster preparedness awareness including hazard knowledge, hazard attitude, training for disaster preparedness, rehearsal and practice for disaster preparedness, cultural development for preparedness, public relations and communication, storytelling, disaster awareness game, simulation, past experience to natural disaster, information sharing with family members, and commitment to the community (time of living).  The 40-item of natural disaster preparedness awareness questionnaire was developed based on these thirteen dimensions. Data were collected from 595 participants in Bangkok metropolitan and vicinity. Cronbach's alpha was used to examine the internal consistency for this instrument. Reliability coefficient was 97, which was highly acceptable.  Exploratory Factor Analysis where principal axis factor analysis was employed. The Kaiser-Meyer-Olkin index of sampling adequacy was .973, indicating that the data represented a homogeneous collection of variables suitable for factor analysis. Bartlett's test of Sphericity was significant for the sample as Chi-Square = 23168.657, df = 780, and p-value < .0001, which indicated that the set of correlations in the correlation matrix was significantly different and acceptable for utilizing EFA. Factor extraction was done to determine the number of factors by using principal component analysis and varimax.  The result revealed that four factors had Eigen value greater than 1 with more than 60% cumulative of variance. Factor #1 had Eigen value of 22.270, and factor loadings ranged from 0.626-0.760. This factor was named as "Knowledge and Attitude of Natural Disaster Preparedness".  Factor #2 had Eigen value of 2.491, and factor loadings ranged from 0.596-0.696. This factor was named as "Training and Development". Factor #3 had Eigen value of 1.821, and factor loadings ranged from 0.643-0.777. This factor was named as "Building Experiences about Disaster Preparedness".  Factor #4 had Eigen value of 1.365, and factor loadings ranged from 0.657-0.760. This was named as "Family and Community". The results of this study provided support for the reliability and construct validity of natural disaster preparedness awareness for utilizing with populations similar to sample employed.

Keywords: natural disaster, disaster preparedness, disaster awareness, Thai citizens

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10153 Women Entrepreneurs in Health Care: An Exploratory Study

Authors: Priya Nambisan, Lien B. Nguyen

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Women participate extensively in the healthcare field, professionally (as physicians, nurses, dietitians, etc.) as well as informally (as caregivers at home). This provides them with a better understanding of the health needs of people. Women are also in the forefront of using social media and other mobile health related apps. Further, many health mobile apps are specifically designed for women users. All of these indicate the potential for women to be successful entrepreneurs in healthcare, especially, in the area of mobile health app development. However, extant research in entrepreneurship has paid limited attention to women entrepreneurship in healthcare. The objective of this study is to determine the key factors that shape the intentions and actions of women entrepreneurs with regard to their entrepreneurial pursuits in the healthcare field. Specifically, the study advances several hypotheses that relate key variables such as personal skills and capabilities, experience, support from institutions and family, and perceptions regarding entrepreneurship to individual intentions and actions regarding entrepreneurship (specifically, in the area of mobile apps). The study research model will be validated using survey data collected from potential women entrepreneurs in the healthcare field – students in the area of health informatics and engineering. The questionnaire-based survey relates to woman respondents’ intention to become entrepreneurs in healthcare and the key factors (independent variables) that may facilitate or inhibit their entrepreneurial intentions and pursuits. The survey data collection is currently ongoing. We also plan to conduct semi-structured interviews with around 10-15 women entrepreneurs who are currently developing mobile apps to understand the key issues and challenges that they face in this area. This is an exploratory study and as such our goal is to combine the findings from the regression analysis of the survey data and that from the content analysis of the interview data to inform on future research on women entrepreneurship in healthcare. The study findings will hold important policy implications, specifically for the development of new programs and initiatives to promote women entrepreneurship, particularly in healthcare and technology areas.

Keywords: women entrepreneurship, healthcare, mobile apps, health apps

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10152 Associations between Autistic and ADHD Traits and the Wellbeing and Mental Health of Secondary School Students with a Focus on Anxiety and Depression

Authors: Japnoor Garcha, Andrew P. Smith, A. James

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There has been a significant increase in the prevalence and estimates of neurodevelopmental disorders, especially autism spectrum disorders, in the last decade. The literature has seen increasing research on understanding wellbeing and mental health. To understand the association and interaction of wellbeing and mental health with autism and ADHD, a survey was given to 560 secondary school students. The survey used the wellbeing process questionnaire, the autism spectrum quotient, the ADHD self-report scale, and the strengths and difficulties questionnaire. The analysis conducted using SPSS showed that there was a significant correlation between anxiety, depression, A.Q., and ADHD. Anxiety and depression were also significantly correlated with all wellbeing and SDQ variables. The regression analysis showed that anxiety was significantly associated with positive wellbeing, negative wellbeing, emotional problems, and prosocial behaviour, whereas depression was significantly associated with positive wellbeing, negative wellbeing, physical health, flourishing, conduct problems, emotional problems and peer problems.

Keywords: ADHD traits, anxiety, autistic traits, depression

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10151 Challenges in Providing Protection to the Conflict-Affected Refugee Children in Pakistan: A Critical Analysis of the 1951 Refugee Convention

Authors: Faiz Bakhsh, Tahira Yasmeen

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The Afghan refugee children in Pakistan are considered as the most vulnerable persons in danger of being abused and treated badly as compared to the minimum criteria of the protection of refugee children under 1951 refugee convention. This paper explores the impact of the 1951 refugee convention on the protection of refugee children, affected by the armed conflict in Afghanistan, residing in refugee camps in Pakistan. Despite, protection available under Refugee Convention, there exist millions of refugees in the world, including a huge portion of women and children, that remain unprotected, and their protection remains a challenging task for the world community. This study investigates the status and number of refugees in Pakistan, especially children; protection and assistance of refugees under Refugee Convention; protection of the rights of refugee children in Pakistan; and implementation of the rules of Refugee Convention relating refugee children in Pakistan and measures for the protection of refugee children in Pakistan. This socio-legal study utilizes a qualitative research approach and applies mixed methods of data collection. The primary data is collected through the interpretation of the legal framework available for the protection of refugees as well as domestic laws of Pakistan. The secondary data is collected through previous studies available on the same topic. The result of this study indicates that lack of proper implementation of the rules, of the Refugee Convention, relating protection of refugee children cause sufferings to refugee children including the provision of basic health, nutrition, family life, education and protection from child abuse. Pakistan needs a comprehensive domestic legal framework for the protection of refugees, especially refugee children. Moreover, the government of Pakistan with the help of the United Nations High Commissioner for Refugees (UNHCR) must prioritize the protection of Afghan refugee children as per standard criteria provided by the refugee convention 1951.

Keywords: refugee children, refugee convention, armed conflict, Pakistan

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10150 Sample Hospital Buildings as Modern Health Facilities in Early Republican Turkey

Authors: Mehmet Sener, Emre Kishali

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The establishment of republic brought radical changes related to the modernization of life in early republican Turkey considering the revolutions in socio-economical, cultural and political aspects. These changes also had many influences on the formation of city planning and architectural medium that the arrangements related with health facility production had an important place amongst them. While the health services were witnessing great transformations with all its sides, socio-cultural and architectural framework of these facilities necessitated the adaption of new conceptual approaches which led to the construction new hospital buildings by the republican state with a name ‘Sample Hospital’. In this period, the state constructed sample hospitals in some cities (Adana, Ankara, Erzurum, İstanbul, Konya, Sivas and Trabzon) for the aim of being a good example for further hospitals sheltering all the characteristics of a contemporary health complex for that day. In this study, these six hospitals will firstly be elucidated considering their historical evaluations and current situations. Then, being one of the most significant modern heritages of republican history, the ways to provide the interrelationship of these complexes with the rapidly evolving current world will be discussed by proposing solutions or approaches coming from the fields of city planning, architectural preservation, engineering and architectural history together with an awareness of the socio-economic conditions, health services and architectural medium of Turkey. These hospitals are complexes composed of building ensembles which have functional relationships with each other. So, some strategies will be proposed for the preservation, renovation, and refurbishment of these complexes with an awareness of the possibility of the conflict between conservation practices and today’s health facility standards. Accordingly, the addition or removal of some elements in the complex or the suggestion of some architectural changes for the modernization of these health facilities will be investigated considering the requirements of the contemporary architectural design of health facilities. Since these hospitals are highly complex structures and have vastly changing design and construction standards, they cannot be used without adopting necessary architectural and technological interventions. So, the adaptive re-use of these buildings instead of demolition or the preservation of their overall characteristics becomes inevitable for the sustaining of these health facility heritages in Turkey. In this context, a multidisciplinary analysis will be made in this study on ‘Sample Hospital’ concept and buildings existing in Turkish modern architectural history within the framework of the adaptive reuse of these health complexes.

Keywords: adaptive re-use, conservation, early republican Turkey, sample hospital

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10149 Bio-Medical Equipment Technicians: Crucial Workforce to Improve Quality of Health Services in Rural Remote Hospitals in Nepal

Authors: C. M. Sapkota, B. P. Sapkota

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Background: Continuous developments in science and technology are increasing the availability of thousands of medical devices – all of which should be of good quality and used appropriately to address global health challenges. It is obvious that bio medical devices are becoming ever more indispensable in health service delivery and among the key workforce responsible for their design, development, regulation, evaluation and training in their use: biomedical technician (BMET) is the crucial. As a pivotal member of health workforce, biomedical technicians are an essential component of the quality health service delivery mechanism supporting the attainment of the Sustainable Development Goals. Methods: The study was based on cross sectional descriptive design. Indicators measuring the quality of health services were assessed in Mechi Zonal Hospital (MZH) and Sagarmatha Zonal Hospital (SZH). Indicators were calculated based on the data about hospital utilization and performance of 2018 available in Medical record section of both hospitals. MZH had employed the BMET during 2018 but SZH had no BMET in 2018.Focus Group Discussion with health workers in both hospitals was conducted to validate the hospital records. Client exit interview was conducted to assess the level of client satisfaction in both the hospitals. Results: In MZH there was round the clock availability and utilization of Radio diagnostics equipment, Laboratory equipment. Operation Theater was functional throughout the year. Bed Occupancy rate in MZH was 97% but in SZH it was only 63%.In SZH, OT was functional only 54% of the days in 2018. CT scan machine was just installed but not functional. Computerized X-Ray in SZH was functional only in 72% of the days. Level of client satisfaction was 87% in MZH but was just 43% in SZH. MZH performed all (256) the Caesarean Sections but SZH performed only 36% of 210 Caesarean Sections in 2018. In annual performance ranking of Government Hospitals, MZH was placed in 1st rank while as SZH was placed in 19th rank out of 32 referral hospitals nationwide in 2018. Conclusion: Biomedical technicians are the crucial member of the human resource for health team with the pivotal role. Trained and qualified BMET professionals are required within health-care systems in order to design, evaluate, regulate, acquire, maintain, manage and train on safe medical technologies. Applying knowledge of engineering and technology to health-care systems to ensure availability, affordability, accessibility, acceptability and utilization of the safer, higher quality, effective, appropriate and socially acceptable bio medical technology to populations for preventive, promotive, curative, rehabilitative and palliative care across all levels of the health service delivery.

Keywords: biomedical equipment technicians, BMET, human resources for health, HRH, quality health service, rural hospitals

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10148 Legal Regulation and Critical Analysis for an Effectively Treatment of Pharmaceutical Waste

Authors: Merita Dauti, Edita Alili-Idrizi, Sihana Ahmeti –Lika, Ledjan Malaj

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The extermination and proper disposal of pharmaceutical wastes from expired and unused medications remains a disputable issue due to their specific nature and characteristics. Even though the hazards from these wastes are already well known in terms of environment and human health, people still treat them as usual wastes. At a national level, in many countries the management of pharmaceutical and medical wastes has been one of the main objectives in order to protect people’s health and the environment. Even though many legal regulations exist in this respect, there has not been a single law that would clearly explain the procedures of returning medicines, ways of selection, treatment and extermination of pharmaceutical wastes. This paper aims at analyzing the practices of pharmaceutical waste management and treatment in some European countries as well as a review of the legislation and official guidelines in managing these kinds of wastes and protecting the environment and human health. A suitable treatment and management of expired medications and other similar wastes would be in the interest of public health in the first place, as well as in the interest of healthcare institutions and other bodies engaged in environment protection.

Keywords: pharmaceutical waste, legal regulation, proper disposal, environment pollution

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10147 A Delphi Study to Build Consensus for Tuberculosis Control Guideline to Achieve Who End Tb 2035 Strategy

Authors: Pui Hong Chung, Cyrus Leung, Jun Li, Kin On Kwok, Ek Yeoh

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Introduction: Studies for TB control in intermediate tuberculosis burden countries (IBCs) comprise a relatively small proportion in TB control literature, as compared to the effort put in high and low burden counterparts. It currently lacks of consensus in the optimal weapons and strategies we can use to combat TB in IBCs; guidelines of TB control are inadequate and thus posing a great obstacle in eliminating TB in these countries. To fill-in the research and services gap, we need to summarize the findings of the effort in this regard and to seek consensus in terms of policy making for TB control, we have devised a series of scoping and Delphi studies for these purposes. Method: The scoping and Delphi studies are conducted in parallel to feed information for each other. Before the Delphi iterations, we have invited three local experts in TB control in Hong Kong to participate in the pre-assessment round of the Delphi study to comments on the validity, relevance, and clarity of the Delphi questionnaire. Result: Two scoping studies, regarding LTBI control in health care workers in IBCs and TB control in elderly of IBCs respectively, have been conducted. The result of these two studies is used as the foundation for developing the Delphi questionnaire, which tapped on seven areas of question, namely: characteristics of IBCs, adequacy of research and services in LTBI control in IBCs, importance and feasibility of interventions for TB control and prevention in hospital, screening and treatment of LTBI in community, reasons of refusal to/ default from LTBI treatment, medical adherence of LTBI treatment, and importance and feasibility of interventions for TB control and prevention in elderly in IBCs. The local experts also commented on the two scoping studies conducted, thus act as the sixth phase of expert consultation in Arksey and O’Malley framework of scoping studies, to either nourish the scope and strategies used in these studies or to supplement ideas for further scoping or systematic review studies. In the subsequent stage, an international expert panel, comprised of 15 to 20 experts from IBCs in Western Pacific Region, will be recruited to join the two-round anonymous Delphi iterations. Four categories of TB control experts, namely clinicians, policy makers, microbiologists/ laboratory personnel, and public health clinicians will be our target groups. A consensus level of 80% is used to determine the achievement of consensus on particular issues. Key messages: 1. Scoping review and Delphi method are useful to identify gaps and then achieve consensus in research. 2. Lots of resources are put in the high burden countries now. However, the usually neglected intermediate-burden countries with TB is an indispensable part for achieving the ambitious WHO End TB 2035 target.

Keywords: dephi questionnaire, tuberculosis, WHO, latent TB infection

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10146 Evaluate Existing Mental Health Intervention Programs Tailored for International Students in China

Authors: Nargiza Nuralieva

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This meta-analysis investigates the effectiveness of mental health interventions tailored for international students in China, with a specific focus on Uzbek students and Silk Road scholarship recipients. The comprehensive literature review synthesizes existing studies, papers, and reports, evaluating the outcomes, limitations, and cultural considerations of these programs. Data selection targets mental health programs for international students, honing in on a subset analysis related to Uzbek students and Silk Road scholarship recipients. The analysis encompasses diverse outcome measures, such as reported stress levels, utilization rates of mental health services, academic performance, and more. Results reveal a consistent and statistically significant reduction in reported stress levels, emphasizing the positive impact of these interventions. Utilization rates of mental health services witness a significant increase, highlighting the accessibility and effectiveness of support. Retention rates show marked improvement, though academic performance yields mixed findings, prompting nuanced exploration. Psychological well-being, quality of life, and overall well-being exhibit substantial enhancements, aligning with the overarching goal of holistic student development. Positive outcomes are observed in increased help-seeking behavior, positive correlations with social support, and significant reductions in anxiety levels. Cultural adaptation and satisfaction with interventions both indicate positive outcomes, underscoring the effectiveness of culturally sensitive mental health support. The findings emphasize the importance of tailored mental health interventions for international students, providing novel insights into the specific needs of Uzbek students and Silk Road scholarship recipients. This research contributes to a nuanced understanding of the multifaceted impact of mental health programs on diverse student populations, offering valuable implications for the design and refinement of future interventions. As educational institutions continue to globalize, addressing the mental health needs of international students remains pivotal for fostering inclusive and supportive learning environments.

Keywords: international students, mental health interventions, cross-cultural support, silk road scholarship, meta-analysis

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