Search results for: antiracist healthcare policy

Authors: Desjardin, Michaels, Martinez, Ulmann

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Copper IUD is one of the most efficient and cost-effective contraception. However, pain at insertion hampers the use of this method. This is especially unfortunate in nulliparous women, often younger, who are excellent candidates for this contraception, including Emergency Contraception. Standard insertion procedure of a copper IUD usually involves measurement of uterine cavity with an hysterometer and the use of a tenaculum in order to facilitate device insertion. Both procedures lead to patient pain which often constitutes a limitation of the method. To overcome these issues, we have developed a modified insertor combined with a copper IUD. The singular design of the inserter includes a flexible inflatable membrane technology allowing an easy access to the uterine cavity even in case of abnormal uterine positions or narrow cervical canal. Moreover, this inserter makes possible a direct IUD insertion with no hysterometry and no need for tenaculum. To assess device effectiveness and patient-reported pain, a study was conducted at two clinics in Fance with 31 individuals who wanted to use a copper IUD as contraceptive method. IUD insertions have been performed by four healthcare providers. Operators completed questionnaire and evaluated effectiveness of the procedure (including IUD correct fundal placement and other usability questions) as their satisfaction. Patient also completed questionnaire and pain during procedure was measured on a 10-cm Visual Analogue Scale (VAS). Analysis of the questionnaires indicates that correct IUD placement took place in more than 93% of women, which is a standard efficacy rate. It also demonstrates that IUD insertion resulted in no, light or moderate pain predominantly in nulliparous women. No insertion resulted in severe pain (none above 6cm on a 10-cm VAS). This translated by a high level of satisfaction from both patients and practitioners. In addition, this modified inserter allowed a simplification of the insertion procedure: correct fundal placement was ensured with no need for hysterometry (100%) prior to insertion nor for cervical tenaculum to pull on the cervix (90%). Avoidance of both procedures contributed to the decrease in pain during insertion. Taken together, the results of the study demonstrate that this device constitutes a significant advance in the use of copper IUDs for any woman. It allows a simplification of the insertion procedure: there is no need for pre-insertion hysterometry and no need for traction on the cervix with tenaculum. Increased comfort during insertion should allow a wider use of the method for nulliparous women and for emergency contraception. In addition, pain is often underestimated by practitioners, but fear of pain is obviously one of the blocking factors as indicated by the analysis of the questionnaire. This evaluation brings interesting information on the use of this modified inserter for standard copper IUD and promising perspectives to set up a changement in the standard of IUD insertion procedure.

Keywords: contraceptio, IUD, innovation, pain

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Authors: Tess Hartland, Moitree Banerjee, Sue Churchill, Antonina Pereira, Ian Tyndall, Ruth Lowry

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Background: Sexual health services and policies for middle-aged and older adults are underdeveloped, while global sexually transmitted infections in this age group are on the rise. The Interreg cross-Europe Sexual Health In Over 45s (SHIFT) project aims to increase participation in sexual health services and improve sexual health and wellbeing in people aged over 45, with an additional focus on disadvantaged groups. Methods: A two-pronged mixed-methodology is being used to develop a model for good service provision in sexual health for over 45s. (1) Following PRISMA-ScR guidelines, a scoping review is being conducted, using the databases PsychINFO, Web of Science, ERIC and PubMed. A key search strategy using terms around sexual health, good practice, over 45s and disadvantaged groups. The initial search for literature yielded 7914 results. (2) Surveys (n=1000) based on the Theory of Planned Behaviour are being administered across the UK, Belgium and Netherlands to explore current sexual health knowledge, awareness and attitudes. Expected results: It is expected that sexual health needs and potential gaps in service provision will be identified in order to inform good practice for sexual health services for the target population. Results of the scoping review are being analysed, while focus group and survey data is being gathered. Preliminary analysis of the survey data highlights barriers to access such as limited risk awareness and stigma. All data analysis will be completed by the time of the conference. Discussion: Findings will inform the development of a model to improve sexual health and wellbeing for among over 45s, a population which is often missed in sexual health policy improvement.

Keywords: adult health, disease prevention, health promotion, over 45s, sexual health

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Authors: Wei Zhang, Chye Kiang Heng, John Chye Fung

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Background: The world’s demographics is currently undergoing the largest wave of both rapid ageing and dramatic urbanisation in human history. As one of the most rapidly ageing countries, Singapore will see about one in four residents aged 65 years and above by 2030 in its high-rise and high-density urban environment. Research questions: To support urban seniors ageing in place and interdependence among senior residents and their informal caregivers, this study argues a community-based care model with bottom-up mutual help networks and asks how neighbourhood built-environment influences the formulation and facilitation of bottom-up mutual help networks in Singapore. Methods: Two public housing communities with different physical environment and rich age-friendly neighbourhood initiatives were chosen as the case studies. The categories, participants and places of bottom-up mutual help activities will be obtained via field observation, non-structural interviews of participants, service providers and managers of care facilities, and documents. Mapping and content analysis will be used to explore the influences of neighbourhood built-environment on the formulation and facilitation of bottom-up mutual help networks. Results and conclusions: The results showed that neighbourhood design, place programming, and place governance have a confluence on the bottom-up mutual help networks for senior residents. Significance: The outcomes of this study will provide fresh evidence for paradigm shifts of community-based care for the elderly and neighbourhood planning. In addition, the research findings will shed light on meaningful implications of urban planners and policy makers as they tackle with the issues arising from the ageing society.

Keywords: Built environment, Mutual help, Neighbourhood, Senior residents, Singapore

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Authors: Irene Kretchy, Frances Owusu-Daaku, Samuel Danquah

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Hypertension is the leading risk factor for cardiovascular diseases, and a major cause of death and disability worldwide. This study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on mental health and medication adherence to conventional hypertension therapies. Methods: A hospital-based mixed methods study, using quantitative and qualitative approaches was conducted on hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms, and coping mechanisms with the aid of standard questionnaires. Information from the quantitative phase was analyzed with the Statistical Package for Social Sciences (SPSS) version 20. The interviews from the qualitative study were audio-taped with a digital audio recorder, manually transcribed and analyzed using thematic content analysis. The themes originated from participant interviews a posteriori. Results: The experiences of side effects – such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion - were categorized as no/low (39.75%), moderate (53.0%) and high (7.25%). Significant relationships between depression (x 2 = 24.21, P < 0.0001), anxiety (x 2 = 42.33, P < 0.0001), stress (x 2 = 39.73, P < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association are reported – depression [OR = 1.9 (1.03 – 3.57), p = 0.04], anxiety [OR = 1.5 (1.22 – 1.77), p = < 0.001], and stress [OR = 1.3 (1.02 – 1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95% CI 1.07 – 1.85), p = 0.04] with social factors, media influences and attitudes of primary caregivers further explaining this relationship. The personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments, and interventions made by clinicians were the main forms of coping with side effects. Conclusions: Results from this study show that contrary to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The result offers more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care. Additionally, medication side effects should be considered as a possible cause of non-adherence among hypertensive patients, thus addressing this problem from a Biopsychosocial perspective in any intervention may improve adherence and invariably control blood pressure.

Keywords: biopsychosocial, hypertension, medication adherence, psychological disorders

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Authors: Azusa Katsumata

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Where there is collaboration between universities and companies in the educational context, companies seek ‘knowledge’ from universities and provide a ‘place of practice’ to them. Several universities have introduced activities aimed at the mutual enlightenment of a diversity of people in career education. However, several programs emphasize on delivering results, and on practicing the prepared materials as planned. Few programs focus on unexpected failures and setbacks. This way of learning is important in career education so that classmates can help each other, overcome difficulties, draw out each other’s strengths, and learn from them. Seijo University in Tokyo offered Tokyo Tourism, a Project-Based Learning course, as a first-year career education course until 2016. In cooperation with a travel agency, students participate in planning actual tourism products for foreigners visiting Japan, undertake tours serving as guides. This paper aims to study the 'learning platform' created by a series of processes such as the fieldwork, planning tours, the presentation, selling the tourism products, and guiding the tourists. We conducted a questionnaire to measure the development of work-related skills in class. From the results of the questionnaire, we can see, in the example of this class, that students demonstrated an increased desire to be pro-active and an improved motivation to learn. Students have not, however, acquired policy or business skills. This is appropriate for first-year careers education, but we need to consider how this can be incorporated into future courses. In the questionnaire filled out by the students after the class, the following results were found. Planning and implementing travel products while learning from each other, and helping the teams has led to improvements in the student workforce. This course is a collaborative project between Japanese universities and the 2020 Tokyo Olympics and Paralympic Games committee.

Keywords: university career education, platform of learning, project-based learning, collaboration between university and company

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Authors: Elidrissi Laila, El Rhaoussi Fatima-Zahra, Haddad Fouad, Tahiri Mohamed, Hliwa Wafaa, Bellabah Ahmed, Badre Wafaa

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Introduction: Metabolic Dysfunction Associated with Non-Alcoholic Fatty Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), is the leading cause of chronic liver disease. The cardiometabolic risk factors associated with MASLD represent common health issues and significant public health challenges. Medical students, being active participants in the healthcare system and a young demographic, are particularly relevant for understanding this entity to prevent its occurrence on a personal and collective level. The objective of our study is to assess the level of knowledge among medical students regarding MASLD, its risk factors, and its long-term consequences. Materials and Methods: We conducted a descriptive cross-sectional study using an anonymous questionnaire distributed through social media over a period of 2 weeks. Medical students from various faculties in Morocco answered 22 questions about MASLD, its etiological factors, diagnosis, complications, and principles of treatment. All responses were analyzed using the Jamovi software. Results: A total of 124 students voluntarily provided complete responses. 59% of our participants were in their 3rd year, with a median age of 21 years. Among the respondents, 27% were overweight, obese, or diabetic. 83% correctly answered more than half of the questions, and 77% believed they knew about MASLD. However, 84% of students were unaware that MASLD is the leading cause of chronic liver disease, and 12% even considered it a rare condition. Regarding etiological factors, overweight and obesity were mentioned in 93% of responses, and type 2 diabetes in 84%. 62% of participants believed that type 1 diabetes could not be implicated in MASLD. For 83 students, MASLD was considered a diagnosis of exclusion, while 41 students believed that a biopsy was mandatory for diagnosis. 12% believed that MASLD did not lead to long-term complications, and 44% were unaware that MASLD could progress to hepatocellular carcinoma. Regarding treatment, 85% included weight loss, and 19% did not consider diabetes management as a therapeutic approach for MASLD. At the end of the questionnaire, 89% of the students expressed a desire to learn more about MASLD and were invited to access an informative sheet through a hyperlink. Conclusion: MASLD represents a significant public health concern due to the prevalence of its risk factors, notably the obesity pandemic, which is widespread among the young population. There is a need for awareness about the seriousness of this emerging and long-underestimated condition among young future physicians.

Keywords: MASLD, medical students, obesity, diabetes

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Authors: Ashima Sharma, Tapan K. Chaudhuri

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Human Serum Albumin (HSA) is one of the most demanded therapeutic protein with immense biotechnological applications. The current source of HSA is human blood plasma. Blood is a limited and an unsafe source as it possesses the risk of contamination by various blood derived pathogens. This issue led to exploitation of various hosts with the aim to obtain an alternative source for the production of the rHSA. But, till now no host has been proven to be effective commercially for rHSA production because of their respective limitations. Thus, there exists an indispensable need to promote non-animal derived rHSA production. Of all the host systems, Escherichia coli is one of the most convenient hosts which has contributed in the production of more than 30% of the FDA approved recombinant pharmaceuticals. E. coli grows rapidly and its culture reaches high cell density using inexpensive and simple substrates. The fermentation batch turnaround number for E. coli culture is 300 per year, which is far greater than any of the host systems available. Therefore, E. coli derived recombinant products have more economical potential as fermentation processes are cheaper compared to the other expression hosts available. Despite of all the mentioned advantages, E. coli had not been successfully adopted as a host for rHSA production. The major bottleneck in exploiting E. coli as a host for rHSA production was aggregation i.e. majority of the expressed recombinant protein was forming inclusion bodies (more than 90% of the total expressed rHSA) in the E. coli cytosol. Recovery of functional rHSA form inclusion body is not preferred because it is tedious, time consuming, laborious and expensive. Because of this limitation, E. coli host system was neglected for rHSA production for last few decades. Considering the advantages of E. coli as a host, the present work has targeted E. coli as an alternate host for rHSA production through resolving the major issue of inclusion body formation associated with it. In the present study, we have developed a novel and innovative method for enhanced soluble and functional production of rHSA in E.coli (~60% of the total expressed rHSA in the soluble fraction) through modulation of the cellular growth, folding and environmental parameters, thereby leading to significantly improved and enhanced -expression levels as well as the functional and soluble proportion of the total expressed rHSA in the cytosolic fraction of the host. Therefore, in the present case we have filled in the gap in the literature, by exploiting the most well studied host system Escherichia coli which is of low cost, fast growing, scalable and ‘yet neglected’, for the enhancement of functional production of HSA- one of the most crucial biomolecule for clinical and biotechnological applications.

Keywords: enhanced functional production of rHSA in E. coli, recombinant human serum albumin, recombinant protein expression, recombinant protein processing

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Authors: Sakulsri Srisaracam

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Social media has become an important source of information for the public and the media profession. Some social issues raised on social media are picked up by journalists to report on other platforms. This relationship between social media and mainstream media can sometimes drive public debate or stimulate social movements. The question to examine is in what situations can social media conversations raise awareness and stimulate change on public issues. This study addresses the communication patterns of social media conversations driving covert issues into mainstream media and leading to social advocacy movements. In methodological terms, the study findings are based on a content analysis of Facebook, Twitter, news websites and television media reports on three different case studies – saving Bryde’s whale, protests against a government proposal to downsize the Office of Knowledge Management and Development in Thailand, and a dengue fever campaign. These case studies were chosen because they represent issues that most members of the public do not pay much attention to but social media conversations stimulated public debate and calls to action. This study found: 1) Collective social media conversations can stimulate public debate and encourage change at three levels – awareness, public debate, and action of policy and social change. The level depends on the communication patterns of online users and media coverage. 2) Patterns of communication have to be designed to combine social media conversations, online opinion leaders, mainstream media coverage and call to both online and offline action to motivate social change. Thus, this result suggests that social media is a powerful platform for collective communication and setting the agenda on public issues for mainstream media. However, for social change to succeed, social media should be used to mobilize online movements to move offline too.

Keywords: public issues, mainstream media, social media, social movement

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Authors: Tongpong Sriboon, Prapita Thanarak, Chaitawatch Khunrangabsang

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Nowadays, the usage of power generated from photovoltaic system has been promoted significantly in Thailand. The targeted result which is to increase the Solar Power Generation in 2036 to 6000 megawatts (MW) was planned by Alternative Energy Development Plan (AEDP 2015) and Power Development Plan (PDP 2015). The solar rooftop 200 MW was promoted and supported under the Feed-in Tariff scheme (FiT) in two phases; phase I in 2012 and phase II in 2015. However, the number of people interested in supporting the projects reduced due to many reasons which range from the first process to the last that is to sell electricity back to Electricity Authority. This paper will review this situation especially in total electricity generated from solar rooftop system during the day that has been sold back to the grid utility in different capacity FiT rates. With many stakeholders involved, the regulations and criteria were established to maintain the standard of the system. Besides, lots of problems have occurred during the processes including reliability and quality. These problems were shortly followed by other irrevocably issues concerning politics, social, economic etc. In order to effectively develop solar PV power system in Thailand, the problems and solutions were compared to those from six countries including Japan, Australia. America, China, German and Malaysia. This paper particularly focuses on policies and measurement implemented to encourage the rising in solar PV system interest. This review enables one to gain insight into the nature of the changes that have taken place in each and every country mentioned above as well as the underlying reasons behind them. Brief analysis is carried out on identify key challenges and opportunities for solar PV application. This could help create a development path that is suitable with situations to enhance the overall performance of solar PV power generating system in Thailand.

Keywords: solar PV rooftop, PV policy, self-consumption, solar PV power generation

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Authors: Brian Kwok

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Hong Kong is well-known for its name as "the Pearl of the Orient", due to its spectacular night-view with vast amount of decorative neon lights on the streets. Neon signs are first used as the pervasive media of communication for all kinds of commercial advertising, ranging from movie theatres to nightclubs and department stores, and later appropriated by artists as medium of artwork. As a well-established visual language, it displays texts in bilingual format due to British's colonial influence, which are sometimes arranged in an opposite reading order. Research on neon signs as a visual representation is rare but significant because they are part of people’s collective memories of the unique cityscapes which associate the shifting values of people's daily lives and culture identity. Nevertheless, with the current policy to remove abandoned neon signs, their total number dramatically declines recently. The Buildings Department found an estimation of 120,000 unauthorized signboards (including neon signs) in Hong Kong in 2013, and the removal of such is at a rate of estimated 1,600 per year since 2006. In other words, the vernacular cultural values and historical continuity of neon signs will gradually be vanished if no immediate action is taken in documenting them for the purpose of research and cultural preservation. Therefore, the Hong Kong Neon Signs Archive project was established in June of 2015, and over 100 neon signs are photo-documented so far. By content analysis, this project will explore the two components of neon signs – the use of visual languages and vernacular tacit knowledge of neon makers. It attempts to answer these questions about Hong Kong's neon signs: 'What are the ways in which visual representations are used to produce our cityscapes and streetscapes?'; 'What are the visual languages and conventions of usage in different business types?'; 'What the intact knowledge are applied when producing these visual forms of neon signs?'

Keywords: cityscapes, neon signs, tacit knowledge, visual representation

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Authors: Fareena Alladin

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In the Caribbean, issues of food security, health and taste are intricately linked, seen most clearly in the increasing incidence of lifestyle diseases among children coupled with a taste for high calorie and Westernized diets. In order to fully appreciate this link, the role of nutrition environments must be examined. To this end, the present study incorporates tenets of Bourdieu’s social constructivist theory with the Community Nutrition Environment Model. The aim of this study was to examine the relationships between availability of and access to healthy/unhealthy foods within nutrition environments, namely the household and school, and the development of taste preferences for healthy/unhealthy foods among primary school children in a selected educational district in Trinidad and Tobago. A cross-sectional survey of 400 children between the ages of 9 and 11 years was conducted. Data analysis was conducted using SPSS 24. Results indicated that availability of healthy food at home was positively correlated with preference for vegetables, and negatively correlated with preference for salty snacks and fast food. The availability of unhealthy food within the home was found to be negatively correlated with preference for vegetables and positively correlated with preference for salty snacks. Access to unhealthy foods at school had a positive correlation with preference for fast food. These findings highlight the role of the food environment in shaping taste preferences, and point to the need for interrogating the centrality of food security concerns in emerging health concerns of Caribbean countries. Such interrogations are a necessary part of the development of research agendas, and policy formulation and implementation.

Keywords: food security, nutrition environment, taste preference, Trinidad and Tobago

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Authors: Samira Essabari

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What, unfortunately, governs the Moroccan educational philosophy and policy today is a concerning neoliberal discourse with its obsession with market logics and individualism. Critical education has been advocated to resist the neoliberal hegemony since it holds the promise to reclaim the social function of education. Significantly, the mounting forms of sexism and discrimination against women combined with hegemonic educational practices are jeopardizing the social function of teaching and learning, hence the relevance of feminist critical pedagogy. A substantial body of research worldwide has explored the ways in which feminist pedagogy can develop feminist consciousness and examine power relations in different educational contexts. In Morocco, however, the feasibility of feminist pedagogy has not been researched despite the overwhelming interest in gender issues in different educational settings. The research on critical pedagogies in Morocco remains very promising. Yet, most studies were conducted in contexts which are already engaged with issues of theory, discourse, and discourse analysis. The field of ESP ( English for Specific Purposes) is pragmatic by nature, and priority in research has been given to questions that adhere to the mainstream concerns of need analysis and study skills and ignore issues of power, gender power relations, and intersectional forms of oppression. To address these gaps in the existing literature, this participatory action research seeks to investigate the feasibility of Feminist pedagogy in ESP higher education and how it can foster feminist critical consciousness among ESP students without compromising their language learning needs. The findings of this research will contribute to research on critical applied linguistics and critical ESP more specifically and add to the practice of critical pedagogies in Moroccan higher education by providing in-depth insights into the enablers and barriers to the implementation of feminist critical pedagogy, which is still feeling its way into the educational scene in Morocco.

Keywords: feminist pedagogy, critical pedagogy, power relations, gender, ESP, intersectionality

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Authors: Syue-Wen Lin

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Objective: This article discusses the nursing experience of caring for a uterine cancer patient who experienced cardiogenic shock and was weaned off ECMO. The patient was placed on ECMO due to cardiogenic shock and initially struggled with anxiety caused by the physical discomfort from the disease and multiple medical devices, as well as the isolation in the ICU and restrictions on physical activity. Over time, the patient was able to wean off ECMO and perform daily activities and rehabilitation independently. Methods: The nursing period was from January 6 to January 9. Through observation, direct care, interviews, physical assessments, and case reviews, the intensive care team and bypass personnel conducted a comprehensive assessment using Gordon's 11 functional health patterns. The assessment identified three main nursing health problems: pain, anxiety, and decreased cardiac tissue perfusion. Results: The author consulted a psychologist to employ open communication techniques and empathetic care to build a trusting nurse-patient relationship. A patient-centered intensive cancer care plan was developed. Pain was assessed using a pain scale, and pain medications were adjusted in consultation with a pharmacist. Lavender essential oil therapy, light music, and pillows were used to distract and alleviate pain. The patient was encouraged to express feelings and family members were invited to increase visits and provide companionship to reduce the uncertainty caused by cancer and illness. Vital signs were closely monitored, and nursing interventions were provided to maintain adequate myocardial perfusion. Post-ECMO, the patient was encouraged to engage in rehabilitation and cardiopulmonary training. Conclusion: A key takeaway from the care process is the importance of observing not only the patient's vital signs but also their psychological state, especially when dealing with cancer patients on ECMO. The patient's greatest source of comfort was the presence of family, which helped alleviate anxiety. Healthcare providers play multiple critical roles as advocates, coordinators, educators, and counselors, listening to and accepting the patient’s emotional responses. The report aims to provide clinical cancer nurses with a reference to improve the quality of care and alleviate cancer-related discomfort.

Keywords: ECMO, uterine cancer, palliative care, Gordon's 11 functional health patterns

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Authors: C. V. Nnamani, O. L. Adedeji

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The contemporary global economic meltdown has devastating effect on the Nigerian’s economy and its frantic search for alternative source of national revenue aside from oil and gas has become imperative for economic emancipation for Nigerians. Apicultural entrepreneurship could provide a source of livelihood if the basic knowledge of those plant genetic resources needed by bees is made available. A palynological evaluation of those palynotaxa which honey bees forage for pollen and nectar was carried out after standard acetolysis method. Results showed that the honey samples were highly diversified and rich in honey plants. A total of 9544.3 honey pollen, consisting of 39 honey plants belonging to 21 plant families and distributed within 38 genera were identified excluding 238 unidentified pollen grains. Data from the analysis equally revealed that Elaeis guineensis Jacq, Anacardium occidentale L, Diospyros mespiliformis Hochist xe ADC, Alchornea cordifolia Muell, Arg, Daniella oliveri (Rolfe) Hutch & Dalz, Irvingia wombolu Okafor ex Baill, Treculia africana Decne, Nauclea latifolia Smith and Crossopteryx febrifuga Afzil ex Benth were the predominant honey plants. It provided a guide to the optimal utilization of floral resources by honeybees in these regions, showing the opportunity and amazing potentials for apiculture entrepreneurship of these palytaxa. Most of these plants are rare, threatened and endangered. It calls for urgent conservation techniques and step by all players. Critical awareness creation to ensure farmers knowledge of these palynotaxa to ensure proper understanding and attendance boost from them as economic empowerment is needed.

Keywords: palynotaxa, acetolysis, enterprise, livelihood, Nigeria

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Authors: O. O. Oguntoye

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Product consumption constitutes an important consideration for sustainable development. Seeing how product consumption could be highly unsustainable, coupled with how existing policies on corporate responsibility do not particularly address the consumption aspect of product lifecycle, conducting this research became necessary. The research makes an attempt to provide a framework by which to gauge corporate responsibility of product suppliers in terms of their commitment towards the sustainable consumption of their products. Through an exploration of relevant literature, independently established ideas with which to assess a given product supplier were galvanised into a four-criterion framework. The criteria are: (1) Embeddedness of consumption as a factor in corporate sustainability policy, (2) Level of understanding of consumption behaviour, (3) Breadth of behaviour-influencing strategies adopted, and (4) Inclusiveness for all main dimensions of sustainability. This resulting framework was then applied in a case study involving a UK-based furniture supplier where interviews and content analysis of corporate documents were used as the mode for primary data collection. From the case study, it was found that the supplier had performed to different levels across the four themes of the assessment. Two major areas for improvement were however identified – one is for the furniture supplier to focus more proactively on understanding consumption behaviour and, two is for it to widen the scope of its current strategies for enhancing sustainable consumption of supplied furniture. As a generalisation, the framework presented here makes it possible for companies to reflect with a sense of guidance, how they have demonstrated commitment towards sustainable consumption through their values, culture, and operations. It also provides a foundation for developing standardized assessment which the current widely used frameworks such as the GRI, the Global Compact, and others do not cover. While these popularly used frameworks mainly focus on sustainability of companies within the production and supply chain management contexts (i.e. mostly ‘upstream’), the framework here provides an extension by bringing the ‘downstream’ or consumer bit into light.

Keywords: corporate sustainability, design for sustainable consumption, extended producer responsibility, sustainable consumer behaviour

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Authors: Avinash Kishore, Suman Chakrabarti

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In September 2013, the parliament of India enacted the National Food Security Act (NFSA) which entitles two-thirds of India’s population to five kilograms of rice, wheat or coarse cereals per person per month at one to three rupees per kilogram. Five states in India—Andhra Pradesh, Chhattisgarh, Tamil Nadu, Odisha and West Bengal—had already implemented somewhat similar changes in the TPDS a few years earlier using their own budgetary resources. They made rice—coincidentally, all five states are predominantly rice-eating—available in fair price shops to a majority of their population at very low prices (less than Rs.3/kg). This paper tries to account for the changes in household consumption patterns associated with the change in TPDS policy in these states using data from household consumption surveys by the National Sample Survey Organization (NSSO). NSS data show improvement in the coverage of TPDS and average off-take of grains from fair price shops between 2004-05 and 2009-10 across all states of India. However, the increase in coverage and off-take was significantly higher in four out of these five states than in the rest of India. An average household in these states purchased three kilos more rice per month from fair price shops than its counterpart in non-treated states as a result of more generous TPDS policies backed by administrative reforms. The increase in consumption of PDS rice was the highest in Chhattisgarh, the poster state of PDS reforms. Households in Chhattisgarh used money saved on rice to spend more on pulses, edible oil, vegetables and sugar and other non-food items. We also find evidence that making TPDS more inclusive and more generous is not enough unless it is supported by administrative reforms to improve grain delivery and control diversion to open markets.

Keywords: public distribution system, social safety-net, national food security act, diet quality, Chhattisgarh

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Authors: Mohammed Alassim

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In 2014, a UN survey stated that: "The greatest challenge to the adoption of whole-of government, which fundamentally rests on increased collaboration, is resistance to change among government actors". Change management has experienced both theoretically and practically many transformation over the years. When organizations have to implement radical changes, they have to encounter a plethora of issues which leads to ineffective or inefficient implementation of change in most cases. 70% of change projects fail because of human issues. It has been cited that” most studies still show a 60-70% failure rate for organizational change projects — a statistic that has stayed constant from the 1970’s to the present.”. E-government involves not just technical change but cultural, policy, social and organizational evolution. Managing change and overcoming resistance to change is seen as crucial in the success of E-government projects. Resistance can be from different levels in the organization (top management, middle management or employees at operational levels). There can be many reasons for resistance including fear of change and insecurity, lack of knowledge and absence of commitment from management to implement the change. The purpose of this study is to conduct in-depth research to understand the process of change and to identify the critical factors that have led to resistance from employees at different levels (top management, Middle management and operational employees) during e-government initiatives in the public sector in Saudi Arabia. The study is based on qualitative and empirical research methods conducted in the public sector in the Kingdom of Saudi Arabia. This research will use triangulation in data method (interview, group discussion and document review). This research will contribute significantly to knowledge in this field and will identify the measures that can be taken to reduce resistance to change, Upon analysis recommendations or model will be offered which can enable decision makers in public sector in Saudi Arabia how to plan, implement and evaluate change in e-government initiatives via change management strategy.

Keywords: change management, e-government, managing change, resistance to change

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Authors: Rabin Paudel, Dambar Bahadur Mahato, Prabin Poudel, Bijaya Neupane, Sakar Jha

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Understanding Human-Elephant Conflict (HEC) is very important in countries like Nepal, where solutions to escalating conflicts are urgently required. However, most of the HEC mitigation measures implemented so far have been done on an ad hoc basis without the detailed understanding of nature and extent of the damage. This study aims to assess the current scenario of HEC in regards to crop and property damages by Wild Asian Elephant and people’s perception towards existing mitigating measures and elephant conservation in Buffer zone area of Bardia National Park. The methods used were a questionnaire survey (N= 178), key-informant interview (N= 18) and focal group discussions (N= 6). Descriptive statistics were used to determine the nature and extent of damage and to understand people’s perception towards HEC, its mitigation measures and elephant conservation. Chi-square test was applied to determine the significance of crop and property damages with respect to distance from the park boundary. Out of all types of damage, crop damage was found to be the highest (51%), followed by house damage (31%) and damage to stored grains (18%) with winter being the season with the greatest elephant damage. Among 178 respondents, the majority of them (82%) were positive towards elephant conservation despite the increment in HEC incidents as perceived by 88% of total respondents. Among the mitigation measures present, the most applied was electric fence (91%) followed by barbed wire fence (5%), reinforced concrete cement wall (3%) and gabion wall (1%). Most effective mitigation measures were reinforced concrete cement wall and gabion wall. To combat increasing crop damage, the insurance policy should be initiated. The efficiency of the mitigation measures should be timely monitored, and corrective measures should be applied as per the need.

Keywords: crop and property damage, elephant conflict, Asiatic wild elephant, mitigation measures

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Authors: Tris Kee

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This research investigates social sustainability factors in transitional housing projects and their impact on fostering healthy living environments that promote physical activity and social interaction for residents. Social sustainability is integral to individual health and well-being, as emphasized by Goal 11 of the 2030 Agenda for Sustainable Development, which highlights the importance of safe, affordable, and accessible transport systems, green spaces, and public spaces catering to vulnerable populations' needs. Communal spaces in urban environments are essential for fostering social sustainability, as they serve as settings for physical activities and social interactions among diverse socio-economic groups. Factors such as neighborhood social atmosphere, historical context, social disparity, and mobility can influence the relationship between existing and transitional communities. Mental health effects can be measured through housing segregation, mobility and accessibility, and housing tenure. A significant research gap exists in understanding the living environment of transitional housing in Hong Kong and the social sustainability factors affecting residents' mental and physical health. To address this gap, our study employs a mixed-methods approach combining survey questionnaires and interviews to gather both quantitative and qualitative data. This methodology will provide comprehensive insights into residents' experiences and perceptions. Our research's main contribution is identifying key social sustainability factors in transitional housing and their impact on residents' well-being, informing policy-making and the creation of inclusive, healthy living environments. By addressing this research gap, we aim to provide valuable insights for future housing projects, ultimately promoting the development of socially sustainable transitional communities.

Keywords: social sustainablity, affordable housing, transitional housing, high density housing

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Authors: Deanne McArthur, Melinda Wall, Claire Hanlon, Dana Agnolin, Krista Davis, Melanie Dennis, Elizabeth Glidden, Anne Marie Smith, Claudette Thomson

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Background and significance: Patients with eating disorders have traditionally been an underserviced population within the publicly-funded Canadian healthcare system. This situation was worsened by the COVID-19 pandemic and accompanying public health measures, such as “lockdowns” which led to increased isolation, changes in routine, and other disruptions. Illness severity and prevalence rose significantly with corresponding increases in patient suffering and poor outcomes. In Ontario, Canada, the provincial government responded by increasing funding for the treatment of eating disorders, including the launch of a new day program at an intermediate, regional health centre that already housed an outpatient treatment service. The funding was received in March 2022. The care team sought to optimize this opportunity by designing a program that would fit well within the resource-constrained context in Ontario. Methods: This case study will detail how the team consulted the literature and sought patient and family input to design a program that optimizes patient outcomes and supports for patients and families while they await treatment. Early steps include a review of the literature, expert consultation and patient and family focus groups. Interprofessional consensus was sought at each step with the team adopting a shared leadership and patient-centered approach. Methods will include interviews, observations and document reviews to detail a rich description of the process undertaken to design the program, including evaluation measures adopted. Interim findings pertaining to the early stages of the program-building process will be detailed as well as early lessons and ongoing evolution of the program and design process. Program implementation and outcome evaluation will continue throughout 2022 and early 2023 with further publication and presentation of study results expected in the summer of 2023. The aim of this study is to contribute to the body of knowledge pertaining to the design and implementation of eating disorder treatment services that combine outpatient and day treatment services in a resource-constrained context.

Keywords: eating disorders, day program, interprofessional, outpatient, adolescents, transitional aged youth

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Authors: Chee Fei Chang, May Yee Ng

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As a result of its geographical location, flood is a natural disaster that happens regularly in Malaysia. Every year, heavy rainfall is brought by the cyclical monsoon to the East coast of Peninsular Malaysia. In recent years, the occurrence of unexpected heavy downpour somehow connected to climate-change phenomena is also on the increasing trend. Ironically, despite that Malaysians have suffered significant monetary losses as a result of the recurring floods in past many decades, little has been done by the government from the perspective of taxation. Perhaps due to political reason or as a populist measure, the federal and local government are more inclined to offer small cash handout then rolling out long-term tax policy or measure in relieving the financial and tax burden of the victims and affected business entities. Except for the one-off tax break granted to affected businesses in 2007, the authors have not found any income tax exemption or deduction order gazetted with regard to flood disaster. Hence, it is imperative for this study to explore the need and challenges of implementing flood inflicted disaster tax relief or credit in Malaysia. This research consists of two major parts. First, the assessment of relevant tax policies/ measures with regard to non-government organisations and other affected parties. Content and thematic analyses will be applied on current tax legislations and orders issued for this part. Second, a comparative analysis will be conducted benchmarking various disaster tax reliefs and credits implemented in developed countries. Resulting from the increasing climate change-related disasters in Malaysia, the findings of this study will shed light on the importance of introducing disaster tax relief measures to assist individual victims as well as the affected businesses.

Keywords: climate-changed related disaster, disaster tax credits, tax relief for victims, tax measures for disaster recovery

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Authors: Duran Fiack, Jeremy Cumberbatch, Michael Sutherland, Nadine Zerphey

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Civic leaders have increasingly relied upon local climate adaptation plans to identify vulnerabilities, prioritize goals, and implement actions in order to prepare cities for the present and projected effects of global climate change. The concept of sustainability is central to these efforts, as climate adaptation discussions are often framed within the context of economic resilience, environmental protection, and the distribution of climate change impacts across various socioeconomic groups. For urban centers, the climate change issue presents unique challenges for each of these dimensions; however, its potential impacts on marginalized populations are extensive. This study draws from the ‘just sustainabilities’ framework to perform a qualitative analysis of climate adaptation plans prepared by 22 of the 100 largest U.S. cities and examine whether, and to what extent, such initiatives prioritize social equity improvements. Past research has found that the integration of sustainability in urban policy and planning often produces outcomes that favor environmental and economic objectives over social equity improvements. We find that social equity is a particularly prominent theme in local-level climate adaptation efforts, relative to environmental quality and economic development. The findings contribute to the literature on climate adaptation and sustainability within the urban context and offer practical insight for local-level stakeholders concerning potential obstacles and opportunities for the integration of social equity initiatives into climate adaptation planning. Given the likelihood that climate changes will continue to impose unique challenges for marginalized communities in urban areas, advancing our understanding of how social equity concerns are integrated into adaptation efforts is likely to become an increasingly critical area of inquiry.

Keywords: climate adaptation plan, climate change, social equity, sustainability

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Authors: David P. Horton, Gary Lynch-Wood

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Western populations are aging, prone to various lifestyle health problems, and increasing their demand for health and social care services. This demand has created enormous fiscal and regulatory challenges. In response, government institutions have deployed strategies of behavior modification to encourage people to exercise greater personal responsibility over their health and care needs (i.e., welfare responsibilisation). Policy strategies are underpinned by the assumption that people if properly supported, will make better health and lifestyle selections. Not only does this absolve governments of the responsibility for meeting all health and care needs, but it also enables government institutions to assert fiscal control over welfare spending. Looking at the regulation of health and social care in the UK, the authors identify and outline a suite of regulatory tools that are designed to extract and manage the resources of health and social care services users and to encourage them to make (‘better’) use of these resources. This is important for our understanding of how health and social care regulation is responding to ongoing social and economic challenges. It is also important because there has been a failure to systematically examine the relevance of resources for regulation, which is surprising given that resources are crucial to how and whether regulation succeeds or fails. In particular, drawing from the regulatory welfare state concept, the authors analyse the key legal and regulatory changes and mechanisms that have been introduced since the 2008 financial crisis, focusing on critical measures such as the Health and Social Care Act and regulations introduced under the National Health Service Act. The authors show how three types of user resources (i.e., tangible, labor, and data) are being used to assert fiscal control and increase welfare responsibilisation. Amongst other things, the paper concludes that service users have become more than rule followers and targets of behavioral modification; rather, they are producers of resources that regulatory systems have come to rely on.

Keywords: health care, regulation, resources, social care

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Authors: Corlia van der Walt, Michele K. Havenga

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The study considers corporate governance regulation and practice in South African higher education institutions and makes recommendations for the improvement of current governance practices in this sector. The development of corporate governance principles and practices in South Africa, culminating in the King IV Report on Corporate Governance which was launched in November 2016, is discussed. King IV enjoys international recognition as a progressive corporate governance instrument. It was necessitated by the fundamental changes in business and society nationally and globally, as well as by the significant changes to South African company law introduced by new legislation. Corporate governance and the corporate form are narrowly associated, but there is general recognition that the principles of ethical and effective leadership are not restricted to corporations. Thus King IV was drafted with the express aim that it should apply to all organisations, regardless of their form of incorporation, and the report includes specific sector supplements in support of this aspiration. The South African higher education sector has of late been under intense scrutiny, and a few universities have been placed under administration because of poor governance practices. Universities have also been severely impacted by the consequences of what is generally known as ‘#FeesmustFall’, a student led protest movement initially aimed against the increase of fees at public universities, but which rapidly expanded to also include other concerns. It was clearly necessary to revisit corporate governance policy and practice in the sector. The review of the current higher education governance regime in light of the King IV recommendations, lessons from company law regarding the entrenchment and enforcement of corporate governance principles, and a comparison of higher education governance practices in selected other jurisdictions led to recommendations for the improvement of governance practices in South African higher education. It is further suggested that a sector supplement for higher education institutions may provide additional clarity. Some of the recommendations may be of comparative value for international higher education governance.

Keywords: committees, corporate governance, ethical leadership, higher education institutions, integrated reporting, King IV, sector supplements, sustainability

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Authors: Aksana N. Popel, Volha A. Sujayeva, Olga V. Kоshlataja, Irеna S. Karpava

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Introduction: It is a known fact that cardiovascular pathology and its complications cause a more severe course and worse prognosis in patients with comorbid kidney pathology. Chronic kidney disease (CKD) is associated with inflammation, endothelial dysfunction, and increased activity of the sympathoadrenal system. This circumstance increases the risk of cardiovascular diseases and the progression of kidney pathology. The above determines the need to identify cardiorenal changes at early stages to reduce the risks of cardiovascular complications and the progression of CKD. Objective: To identify risk factors (RF) for the development of CKD in elderly patients with chronic ischemic heart disease (CIHD). Methods: The study included 64 patients (40 women and 24 men) with a mean age of 74.4±4.5 years with coronary heart disease, without a history of structural kidney pathology and CKD. All patients underwent transthoracic echocardiography (TTE) and kidney ultrasound (KU) using GE Vivid 9 equipment (GE HealthCare, USA), and cardiac computed tomography (CCT) using Siemens Somatom Force equipment (Siemens Healthineers AG, Germany) in 3 months and in 1 year. Data obtained were analyzed using multiple regression analysis and nonparametric Mann-Whitney test. Statistical analysis was performed using the STATISTICA 12.0 program (StatSoft Inc.). Results: Initially, CKD was not diagnosed in all patients. In 3 months, CKD was diagnosed: stage C1 had 11 people (18%), stage C2 had 4 people (6%), stage C3A had 11 people (18%), stage C3B had 2 people (3%). After 1 year, CKD was diagnosed: stage C1 had 22 people (35%), stage C2 had 5 people (8%), stage C3A had 17 people (27%), stage C3B had 10 people (15%). In 3 months, statistically significant (p<0.05) risk factors were: 1) according to TTE: mitral peak E-wave velocity (U=678, p=0.039), mitral E-velocity DT (U=514, p=0.0168), mitral peak A-wave velocity (U=682, p=0.013). In 1 year, statistically significant (p<0.05) risk factors were: according to TTE: left ventricular (LV) end-systolic volume in B-mode (U=134, p=0.006), LV end-diastolic volume in B-mode (U=177, p=0.04), LV ejection fraction in B-mode (U=135, p=0.006), left atrial volume (U=178, p=0.021), LV hypertrophy (U=294, p=0.04), mitral valve (MV) fibrosis (U=328, p=0.01); according CCT: epicardial fat thickness (EFT) on the right ventricle (U=8, p=0.015); according to KU: interlobar renal artery resistance index (RI) (U=224, p=0.02), segmental renal artery RI (U=409, p=0.016). Conclusions: Both TTE and KU are very informative methods to determine the additional risk factors of CKD development and progression. The most informative risk factors were LV global systolic and diastolic functions, LV and LA volumes. LV hypertrophy, MV fibrosis, interlobar renal artery and segmental renal artery RIs, EFT.

Keywords: chronic kidney disease, ischemic heart disease, prognosis, risk factors

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Authors: Mengdie Ruan

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The authors investigate how subjective well-being (SWB) and social trust changed in China over the period 2010–2020 by relying on data from six rounds of the China Family Panel Studies (CFPS), then re-examine Easterlin’s hypothesis for China, with a more focus on the role of social trust and estimate income-compensating differentials for social trust. They find that the evolution of well-being is not sensitive to the measures of well-being one uses. Specifically, self-reported life satisfaction scores and hedonic happiness scores experienced a significant increase across all income groups from 2010 to 2020. Social trust seems to have increased based on CFPS in China for all socioeconomic classes in recent years, and male, urban resident individuals with higher income have a higher social trust at a given point in time and over time. However, when we use an alternative measure of social trust, out-group trust, which is a more valid measure of generalized trust and represents “most people”, social trust in China literally declines, and the level is extremely low. In addition, this paper also suggests that in the typical query on social trust, the term "most people" mostly denotes in-groups in China, which contrasts sharply with most Western countries where it predominantly connotes out-groups. Individual fixed effects analysis of well-being that controls for time-invariant variables reveals social trust and relative social status are important correlates of life satisfaction and happiness, whereas absolute income plays a limited role in boosting an individual’s well-being. The income-equivalent value for social capital is approximately tripling of income. It has been found that women, urban and coastal residents, and people with higher income, young people, those with high education care more about social trust in China, irrespective of measures on SWB. Policy aiming at preserving and enhancing SWB should focus on social capital besides economic growth.

Keywords: subjective well-being, life satisfaction, happiness, social trust, China

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Authors: Chia-Ching Sun, Li-Yin Chien, Chun-Ting Hsiao

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Background: Appropriate gestation weight gain benefits pregnant women and their children; however, excessive weight gain could raise the risk of adverse health outcomes and chronicle diseases. Nevertheless, there is currently limited evidence on the effect of physical activities on pregnant women’s gestational weight gain. Purpose: This study aimed to explore the correlation between the level of physical activity and gestation weight gain during the second and third trimester of pregnancy. Methods: This longitudinal study enrolled 800 healthy pregnant women aged over 20 from six hospitals in northern Taiwan. Structured questionnaires were used to collect data twice for each participant during 14-27 and 28-40 weeks of gestation. Variables included demographic data, maternal health history, and lifestyle. The International Physical Activity Questionnaire-short form was used to measure the level of physical activity from walking and of moderate-intensity and vigorous-intensity before and during pregnancy. Weight recorded at prenatal checkups were used to calculate average weight gain in each trimester of pregnancy. T-tests, ANOVA, chi-squared tests, and multivariable logistic regression models were applied to determine the predicting factors for weight gain during the second and third trimester. Result: Participants who had achieved recommended physical activity level (150 minutes of moderate physical activity or 75 minutes of vigorous physical activity a week) before pregnancy (aOR=1.85, 95% CI=1.27-2.67) or who achieved recommended walking level (150 minutes a week) during the second trimester of pregnancy (aOR=1.43, 95% CI= 1.00-2.04) gained significantly more weight during the second trimester. Compared with those who did not reach recommended level of moderate-intensity physical activity (150 minutes a week), women who had reached that during the second trimester were more likely to be in the less than recommended weight gain group than in the recommended weight gain group (aOR=2.06, CI=1.06-4.00). However, there was no significant correlation between physical activity level and weight gain in the third trimester. Other predicting factors of excessive weight gain included education level which showed a negative correlation (aOR=0.38, CI=0.17-0.88), whereas overweight and obesity before pregnancy showed a positive correlation (OR=3.97, CI=1.23-12.78). Conclusions/implications for practice: Participants who had achieved recommended physical activity level before pregnancy significantly reduced exercise during pregnancy and gained excessive weight during the second trimester. However, women who engaged in the practice of physical activity as recommended could effectively control weight gain in the third trimester. Healthcare professionals could suggest that pregnant women who exercise maintain their pre-pregnancy level of physical activity, given activities requiring physical contact or causing falls are avoided. For those who do not exercise, health professionals should encourage them to gradually increase the level of physical activity. Health promotion strategies related to weight control and physical activity level achievement should be given to women before pregnancy.

Keywords: pregnant woman, physical activity, gestation weight gain, obesity, overweight

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Authors: Chimuanya Osuji, Kido Uyamasi, Morgan Bradley

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Introduction: Obesity is a major risk factor for many chronic diseases, with higher rates occurring among certain populations. Even though disparities in obesity rates exist for those with disabilities, few studies have assessed the association between disability and obesity status. This study aims to examine the association between type of disability and obesity status among US adults during the Covid-19 pandemic (2019-2021). Methods: Data for this cross-sectional study was obtained from the 2019, 2020 and 2021 NHIS. Multinomial logistic regressions were used to assess the relationship between each type of disability and obesity status (reference= normal/underweight). Each model adjusted for demographic, health status and health-related quality of life variables. Statistical analyses were conducted using SAS version 9.4. Results: Of the 82,632 US adults who completed the NHIS in 2019, 2020, and 2021. 8.9% (n= 7,354) reported at least 1 disability-related condition. Respondents reported having a disability across vision (1.5%), hearing (1.5%), mobility (5.3%), communication (0.8%), cognition (2.4%) and self-care (1.1%) domains. After adjusting for covariates, adults with at least 1 disability-related condition were about 30% more likely to have moderate-severe obesity (AOR=1.3; 95% CI=1.11, 1.53). Mobility was the only disability category positively associated with mild obesity (AOR=1.16; 95% CI=1.01, 1.35) and moderate/severe obesity (AOR=1.6; 95% CI=1.35, 1.89). Individuals with vision disability were about 35% less likely to have mild obesity (AOR=0.66; 95% CI=0.51, 0.86) and moderate-severe obesity (AOR=0.66; 95% CI= 0.48, 0.9). Individuals with hearing disability were 28% less likely to have mild obesity (AOR=0.72; 95% CI= 0.56, 0.94). Individuals with communication disability were about 30% less likely to be overweight (AOR=0.66; 95% CI=0.47, 0.93) and 50% less likely to have mild obesity (AOR=0.45; 95% CI= 0.29, 0.71). Individuals with cognitive disability were about 25% less likely to have mild obesity and about 35% less likely to have moderate-severe obesity. Individuals with self-care disability were about 30% less likely to be overweight. Conclusion: Mobility-related disabilities are significantly associated with obesity status among adults residing in the United States. Researchers and policy makers should implement obesity intervention methods that can address the gap in obesity prevalence rates among those with and without disabilities.

Keywords: cognition, disability, mobility, obesity

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Authors: Methembe Mdlalose

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This paper synthesizes the findings of a study that utilized a purposive sampling methodology laced within a grounded theory analytical framework with LED managers, mayors, and traditional leaders representing six municipalities of uThukela District of KwaZulu-Natal, South Africa. The paper critiques the two institution’s micro-relations within local governance and their overall impact on the general development discourse of rural areas. The study is located in the province of KwaZulu-Natal, a part of South Africa that experiences extremely low levels of development in rural areas and suffers from high rates of inequality, poverty, and unemployment. The paper unpacks the role of two significant stakeholders in the local sphere. Considered as the two dominant stakeholders at the local level, questions of compatibility between traditional leaders and municipal councillors often surge, as the two institutions (who represent two autonomous entities) that operate within the same operational boarders. The discussion around community development lies very deeply on accountability, which assures citizens that fruitless spending is curbed and good governance is maintained. If development is to be assured, it is vital to monitor accountability within government spheres and its departments. It is further essential to monitor the relations within local government. The findings of this research confirmed how relationships between traditional leaders and councillors can and have contributed to economic development or its stagnation thereof in rural areas. In addition, the findings revealed that there is an extensive need for the two stakeholders to work collectively, as this is a vital move in planning for development. Furthermore, the better accountability of local government and a better understanding of how clear policy and its implementation is may be a valuable asset in the discourse of community economic development in rural areas.

Keywords: economic development, traditional leadership, democratically elected councillors, local governance

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Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

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Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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