Search results for: public health surveillance

Authors: Ndivhudzannyi Rembuluwani, Francis Dacosta, Emmanuel Mhlongo

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The small-scale rock aggregate sector of the mining industry is a major source of employment for a significant number of people, particularly in remote rural areas, where alternative livelihoods are rare. It contributes to local economy by generating income and producing major and essential materials for the building, construction, and other industries. However, the sector is confronted with many challenges that hamper productivity and growth. The problems that confront this sector includes: health and safety, environmental impacts, low production and low adherence to mining legislations. This study investigated the challenges confronting selected small-scale rock aggregate mines in the Vhembe District of Limpopo province of South Africa, assesses the health, safety, low production and environmental impacts associated with aggregate production and to develop an integrated approach of addressing the multi-faceted challenges.

Keywords: health and safety, legislative framework, productivity, rock aggregate, small-scale mining

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Authors: B. Parchem, M. Watanabe, D. Modrakovic, L. Mathew, A. Franklin, M. Cao, R. E. Broudy

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Objective: Executive functioning (EF) deficits underlie several mental health diagnoses including ADHD, anxiety, and depression. Community mental health clinics face extensive waitlists for services with many referrals involving EF deficits. A pilot trial of a four-week group therapy was developed using key components from Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and mindfulness with an aim to improve EF skills and offer low-fee services. Method: Eight adults (M = 34.5) waiting for services at a community clinic were enrolled in a four-week group therapy at an in-house training clinic for doctoral trainees. Baseline EF, pre-/post-intervention ADHD and distress symptoms, group satisfaction, and curriculum helpfulness were assessed. Results: Downward trends in ADHD and distress symptoms pre/post-intervention were not significant. Favorable responses on group satisfaction and helpfulness suggest clinical utility. Conclusion: Preliminary pilot data from a brief group therapy to improve EF may be an efficacious, acceptable, and feasible intervention for adults waiting for services at community mental health and training clinics where there are high demands and limits to services and staffs.

Keywords: executive functioning, cognitive-behavioral therapy, dialectical behavior therapy, mindfulness, adult group therapy

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Authors: A. Andreasyan, C. Connors

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The Elliptic Curve Digital Signature algorithm-based X509v3 certificates are becoming more popular due to their short public and private key sizes. Moreover, these certificates can be stored in Internet of Things (IoT) devices, with limited resources, using less memory and transmitted in network security protocols, such as Internet Key Exchange (IKE), Transport Layer Security (TLS) and Secure Shell (SSH) with less bandwidth. The proposed method gives another advantage, in that it increases the performance of the above-mentioned protocols in terms of key exchange by saving one scalar multiplication operation.

Keywords: cryptography, elliptic curve digital signature algorithm, key exchange, network security protocol

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Authors: Sora Suh, Catherine Michener

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This paper examines the collaborative forms of advocacy that a group of four public school teachers took for their emergent bilingual students in one public school district. While teacher advocacy takes many forms in and out of the classroom, much advocacy work is done by individuals and less by collective action. As a result, individual teachers risk isolation or marginalization in their school contexts when they advocate for immigrant youth. This paper is intended to contribute to the documentation and understanding of teachers’ advocacy work as a collaborative act in teacher education research. The increase of ELs in US classrooms and a corresponding lack of teacher preparation to meet the needs of ELs has motivated the training of educators in linguistically responsive education (e.g., ESL, sheltered English instruction [SEI], bilingual education). Drawing from educational theories of linguistically responsive teaching for preparing educators, we trace the linguistically responsive advocacy work of the teachers. The paper is a multiple case study that tracks how teachers’ discussions on advocacy during a teacher preparation program leading to collaborative actions in their daily teaching lives in and out of school. Data collected includes online discussion forums on the topic of advocacy, course assignments on the topic of advocacy, video-audio recordings of classroom teaching observations, and video-audio recordings of individual and focus group interviews. The findings demonstrate that the teachers’ understanding of advocacy developed through collaborative partnerships formed in the teacher preparation program and grew into active forms of collaborative advocacy in their teaching practice in and out of school. The teachers formed multi-level and collaborative partnerships with teachers, families, community members, policymakers from the local government, and educational researchers to advocate for their emergent bilingual students by planning advocacy events such as new family orientations for emergent bilinguals, professional development for general education teachers on the topic of linguistically responsive instruction, and family nights hosted by the district. The paper’s findings present types of advocacy work in which teachers engage (pedagogical, curricular, out-of-school work) and provide evidence of collaborative advocacy work by a group of engaged educators. The paper highlights the increased agency and effective advocacy of teachers through teacher education and collaborative partnerships and suggests a need for more research on collaborative forms of teacher advocacy for emergent bilinguals.

Keywords: language education, teacher advocacy, language instruction, teacher education

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Authors: Aoife Prendergast

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The synergy between theory and practice can be considered elusive, the touchstone for the development of successful undergraduate programmes particularly in allied health professions such as social care. A 'pracademic' is a person who spans both the somewhat ethereal world of academia as a scholar and the pragmatic world of practice. This paper examines the concept of 'pracademia' in relation to the role of the social care practitioner and continuing professional development. It also assists in the understanding of the synergy between social care professionals and higher education. A consideration of the identity and position in terms of approach to regulation is explored as well as an acknowledgement of the strengths and opportunities for sharing power in hierarchical positions. The world of practice serves as the centre point of the academic compass for most professional programs. Just as schools of engineering and law are disciplined by the marketplace, which seeks well-trained students, so our social care programmes must perennially find ways to address the fast changing needs of practitioners, whether they be government, not-for-profit organizations, consulting firms or contractors. We may not expect such traditional academic disciplines as history, sociology, or political science to cater to the needs of external audiences or practitioners— indeed, these disciplines' insulation from public concerns and issues is considered a strength by some. This paper aims to explore the integration of academic teaching and research with the communities of practice in social care. This appears to be a fundamental aspiration of the social care profession. While building and integrating an important body of academic theory and concepts from a variety of disciplines, social care as a field has embraced a professional orientation by seeking to be relevant to practitioners at various levels. While teaching theory, social care programmes, and faculty are often acutely aware that their academic content and credibility, in part, rest on a deep connection with practitioners. While theory can be self-contained, the impact of our research and teaching arguably finds its most compelling and highest audience when it addresses the agenda items and concerns of practitioners.

Keywords: social care, pracademia, supervision, practice education

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Authors: Rebecca Keyte, Helen Egan, Michail Mantzios

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It is well acknowledged that ongoing adherence is a major concern within CF. However recently literature has indicated that non-adherence should not be viewed just in terms of medical regimens. There are other damaging behaviours that some chronically ill patients engage in which can be viewed as a form of non-adherence, such as risky behaviours. Risky behaviours are a major concern within CF, as they can have adverse health effects on patients regardless of patients adherence to medical regimens. The risky behaviours this research is predominantly focusing on are smoking, excessive alcohol consumption, illicit drug use and risky sexual behaviour. This research investigates patient’s beliefs about their CF and the impact their CF has upon their life, exploring rationales for why some patients engage in risky behaviours. This research utilises qualitative semi-structured interviews taking an interpretive perspective. Twenty-four adult participants have been recruited (16 male, age range 19–66 yrs) from two UK regional CF centres, with a median FEV1 61.77% predicted. Participants were recruited via clinician guidance, with 13 participants identified by clinicians as partaking in risky behaviours. However, during the interviews 17 participants were identified as partaking in risky behaviours, illustrating that not all patients offer full disclosure of engagement in such behaviours to their clinicians. Preliminary findings illustrate a variety of reasons as to why some CF patients engage in risky behaviours, with many participants stating that one challenge in terms of living with CF is accepting their illness. Disclosure of illness was also an issue, the desire to be seen as ‘normal’ was important to many. It is often possible for CF patients to hide their illness as they do not always appear to be unwell. However, literature indicates a desire for normalcy can be accompanied with the engagement of normalised risky behaviours, enabling patients to retaliate against their illness identity. There was also evidence of a life-orientated perspective amongst participants, with some reporting that their desire for fun and enjoyment was the reason for why they were engaging in risky behaviours. Some participants did not acknowledge the impact their risky behaviours could have upon their CF, and others rationalised their continuation with the behaviours by suggesting that they were in fact beneficial to their health. There was an apparent lack of knowledge around the implications of risky behaviours, with participants indicating that they had not been informed of such potential consequences by their clinicians. Given the adverse health effects of risky behaviours within CF, more effective health promotion measures are needed to both reduce and more importantly prevent these behaviours. Due to the initiation of risky behaviours within the CF population commonly occurring during adolescence, the researcher now proposes to conduct semi-structured interviews with paediatric patients to investigate their awareness and beliefs towards risky behaviours. Overall, this research will highlight reasons why some CF patients engage in risky behaviours, in order to inform interventions aimed to prevent the initiation in risky behaviours by increasing patient awareness.

Keywords: cystic fibrosis, health beliefs, preliminary findings, risky health behaviours

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Authors: Ragy Raafat Gaber Attaalla

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Despite having the greatest rates of mortality and morbidity in the world, low- and middle-income (LMIC) nations trail high-income nations in terms of the number of clinical trials, the number of qualified researchers, and the amount of research information specific to their people. Health inequities and the use of precision medicine may be hampered by a lack of local genomic data, clinical pharmacology and pharmacometrics competence, and training opportunities. These issues can be solved by carrying out health care infrastructure development, which includes data gathering and well-designed clinical pharmacology training in LMICs. It will be advantageous if there is international cooperation focused at enhancing education and infrastructure and promoting locally motivated clinical trials and research. This paper outlines various instances where clinical pharmacology knowledge could be put to use, including pharmacogenomic opportunities that could lead to better clinical guideline recommendations. Examples of how clinical pharmacology training can be successfully implemented in LMICs are also provided, including clinical pharmacology and pharmacometrics training programmes in Africa and a Tanzanian researcher's personal experience while on a training sabbatical in the United States. These training initiatives will profit from advocacy for clinical pharmacologists' employment prospects and career development pathways, which are gradually becoming acknowledged and established in LMICs. The advancement of training and research infrastructure to increase clinical pharmacologists' knowledge in LMICs would be extremely beneficial because they have a significant role to play in global health.

Keywords: low- and middle-income, clinical pharmacology, pharmacometrics, career development pathways

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Authors: Sara Parker, Kay Standing

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This paper will share insights into how menstruators bodies in Nepal are viewed and controlled in Nepal due to the deeply held stigmas and taboos that exist that frame menstrual blood as impure and polluting. It draws on a British Academy Global Challenges Research (BA/GCRF) funded project, ‘Dignity Without Danger,’ that ran from December 2019 to 2022. In Nepal, beliefs and myths around menstrual related practices prevail and vary in accordance to time, generation, caste and class. Physical seclusion and/or restrictions include the consumption of certain foods, the ability to touch certain people and objects, and restricted access to water sources. These restrictions not only put women at risk of poor health outcomes, but they also promote discrimination and challenge fundamental human rights. Despite the pandemic, a wealth of field research and creative outputs have been generated to help break the silence that surrounds menstruation and also highlights the complexity of addressing the harms associated with the exclusion from sacred and profane spaces that menstruators face. Working with locally recruited female research assistants, NGOS and brining together academics from the UK and Nepal, we explore the intersecting factors that impact on menstrual experiences and how they vary throughout Nepal. WE concur with Tamang that there is no such thing as a ‘Nepali Woman’, and there is no one narrative that captures the experiences of menstruators in Nepal. These deeply held beliefs and practices mean that menstruators are denied their right to a dignified menstruation. By being excluded from public and private spaces, such as temples and religious sites, as well as from kitchens and your own bedroom in your own home, these beliefs impact on individuals in complex and interesting ways. Existing research in Nepal by academics and activists demonstrates current programmes and initiatives do not fully address the misconceptions that underpin the exclusionary practices impacting on sexual and reproductive health, a sense of well being and highlight more work is needed in this area. Research has been conducted in all 7 provinces and through exploring and connecting disparate stories, artefacts and narratives, we will deepen understanding of the complexity of menstrual practices enabling local stakeholders to challenge exclusionary practices. By using creative methods to engage with stakeholders and share our research findings as well as highlighting the wealth of activism in Nepal. We highlight the importance of working with local communities, leaders and cutting across disciplines and agencies to promote menstrual justice and dignity. Our research findings and creative outputs that we share on social media channels such as Dignity Without Danger Facebook, Instagram and you tube stress the value of employing a collaborative action research approach to generate material which helps local people take control of their own narrative and change social relations that lead to harmful practices.

Keywords: menstruation, Nepal, stigma, social norms

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Authors: Garima Singh

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Objectives: Behavioral Crisis Center (BCC) is a community solution to a community problem. There has been an exponential increase in the incidence and prevalence of mental health crises around the world. The effects of the crisis negatively impact our patients and their families and strain the law enforcement and emergency room. The goal of the multi-disciplinary care model is to break the crisis cycle and provide 24-7 rapid access to an acre and crisis stabilization. We initiated our first BCC care center in 2020 in the midst of the COVID pandemic and have seen a remarkable improvement in patient ‘care and positive financial outcome. Background: Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (52.9 million in 2020). This number represented 21.0% of all U.S. adults. To address some of these challenges and help our community, In May 2020, we opened our first Behavioral crisis center (BCC). Since then, we have served more than 2500 patients and is the first southwest Missouri’s first 24/7 facility for crisis–level behavioral health and substance use needs. It has been proven to be a more effective place than emergency departments, jails, or local law enforcement. Methods: BCC was started in 2020 to serve the unmet need of the community and provide access to behavioral health and substance use services identified in the community. Funding was possible with significant investment from the county and Missouri Foundation for Health, with contributions from medical partners. It is a multi-disciplinary care center consisting of Physicians, nurse practitioners, nurses, behavioral technicians, peer support specialists, clinical intake specialists, and clinical coordinators and hospitality specialists. The center provides services including psychiatry care, outpatient therapy, community support services, primary care, peer support and engagement. It is connected to a residential treatment facility for substance use treatment for continuity of care and bridging the gap, which has resulted in the completion of treatment and better outcomes. Results: BCC has proven to be a great resource to the community and the Missouri Health Coalition is providing funding to replicate the model in other regions and work on a similar model for children and adolescents. Overall, 29% of the patients seen at BCC are stabilized and discharged with outpatient care. 50% needed acute stabilization in a hospital setting and 21% required long-term admission, mostly for substance use treatment. The local emergency room had a 42% reduction in behavioral health encounters compared to the previous 3 years. Also, by a quick transfer to BCC, the average stay in ER was reduced by 10 hours and time to follow up behavioral health assessment decreased by an average of 4 hours. Uninsured patients are also provided Medicaid application assistance which has benefited 55% of individuals receiving care at BCC. Conclusions: BCC is impacting community health and improving access to quality care and substance use treatment. It is a great investment for our patients and families.

Keywords: BCC, behvaioral health, community health care, addiction treatment

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Authors: Takamitsu Kodama, Eiji Kawamoto

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Introduction: Ultrasound in emergency room has advantages of safer, faster, repeatable and noninvasive. Especially focused Point-Of-Care Ultrasound (POCUS) is used daily for prompt and accurate diagnoses, for quickly identifying critical and life-threatening conditions. That is why ultrasound has demonstrated its usefulness in emergency medicine. The true value of ultrasound has been once again recognized in recent years. It is thought that all resident physicians working at emergency room should perform an ultrasound scan to interpret signs and symptoms of deteriorating patients in the emergency room. However, a practical education on ultrasound is still in development. To resolve this issue, we established a new educational program using high-fidelity simulators and evaluated the efficacy of this course. Methods: Educational program includes didactic lectures and skill stations in half-day course. Instructor gives a lecture on POCUS such as Rapid Ultrasound in Shock (RUSH) and/or Focused Assessment Transthoracic Echo (FATE) protocol at the beginning of the course. Then, attendees are provided for training of scanning with cooperation of normal simulated patients. In the end, attendees learn how to apply focused POCUS skills at clinical situation using high-fidelity simulators such as SonoSim® (SonoSim, Inc) and SimMan® 3G (Laerdal Medical). Evaluation was conducted through surveillance questionnaires to 19 attendees after two pilot courses. The questionnaires were focused on understanding course concept and satisfaction. Results: All attendees answered the questionnaires. With respect to the degree of understanding, 12 attendees (number of valid responses: 13) scored four or more points out of five points. High-fidelity simulators, especially SonoSim® was highly appreciated to enhance learning how to handle ultrasound at an actual practice site by 11 attendees (number of valid responses: 12). All attendees encouraged colleagues to take this course because the high level of satisfaction was achieved. Discussion: Newly introduced educational course using high-fidelity simulators realizes the circle of learning to deepen the understanding on focused POCUS by gradual stages. SonoSim® can faithfully reproduce scan images with pathologic findings of ultrasound and provide experimental learning for a growth number of beginners such as resident physicians. In addition, valuable education can be provided if it is used combined with SimMan® 3G. Conclusions: Newly introduced educational course using high-fidelity simulators is supposed to be effective and helps in providing better education compared with conventional courses for emergency physicians.

Keywords: point-of-care ultrasound, high-fidelity simulators, education, circle of learning

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Authors: S. Boulenouar, M. Sefir, M. Benahmed

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All facilities need medication and other pharmaceuticals for their operation. Management and supply is therefore to provide the different services of the facility goods and services in required quantity and quality. The permanent availability of drugs in the facilities is very difficult because most face many difficulties at the inventory management and drug supplies. Therefore, it is necessary for each health facility to know the causes for the malfunction of its management system to cope with them. It is in this context that we have undertaken to conduct this study to know the causes which should be taken into consideration by the concerned authorities to carry out their mission, which is to provide quality health care for the population. In terms of financial resources, the budget for medicines represents a significant part of the budget of the pharmacy. Our study shows that the share of the hospital budget reserved for the drugs procurement represent on average 70% of the budget of the pharmacy. The results show a state of lack of anticancer drugs at Oran teaching hospital. The analysis of the management process allowed us to know the level that the problem of stock-outs of anti-cancer drugs is at. Suggestions were made to that effect to improve the availability for these products and to respond better to the needs of patients.

Keywords: anticancer drugs, health care facility, budget, hospital pharmacist, hospital service

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Authors: Bagweneza Vedaste, Rugema Joselyne, Twagirayezu Innocent, Nikuze Bellancille, Nyirazigama Alice, Ishimwe Bazakare Marie Laetitia, Kaberuka Gerard, Mukeshimana Madeleine

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Background: Teen pregnancies have dramatically increased across the country in the past few years. Teen mothers usually face difficulties accessing the reproductive health (RH) services due to different reasons that include fear of getting discriminated or seen by other people. Some teen mothers do not also know their rights regarding the RH services, and they sometimes get discriminated. Little is known in Rwanda regarding how these teen mothers access the RH services compared to the general population, and views of teen mothers on their rights to access these services have not been clearly documented in the country. Specific Aims: To explore baseline information about SRH services among teen mothers; to explore factors that contribute to the use of SRH services among teen mothers; to identify strategies to increase awareness on SRHR (Sexual and Reproductive Health and Rights) among teen mothers in targeted area; and to explore views of teen mothers on rights for SRH services. Research design/Methodology: The qualitative exploratory descriptive research will be used among the teen mothers in five selected health centers of Rwamagana district. The study will use the qualitative descriptive study design. Setting: The study will be conducted in five selected health centers of Rwamagana district, which has been chosen due to a higher number of adolescent pregnancies in Eastern Province according to the DHS 2019-2020. Participants: The participants in this study will be teenage mothers who conceived after turning 11 but have delivered before turning 19. As the upper age for teenage is 19 years, this means that the researchers anticipated that those conceiving at 19 years may deliver in their twenties, which was the upper age limit in this study. Data collection measures: A semi-structured interview guide will be used to gather information from the respondents in focus group discussions. Significance: The findings of this study will provide a picture regarding the access of teen mothers to SRHS and their rights to SRH services. They will increase their awareness regarding SRH services and rights. Finally, the findings may help to address barriers faced by teen mothers to reach, pay and utilize SRHS.

Keywords: sexual and reproductive health services, inclusiveness, qualitative study, adolescent mothers

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Authors: S. Murr, S. Phillips

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One of the biggest challenges entering a market with a carsharing or any other shared mobility (SM) service is sound investment decision-making. To support this process, the authors think that a city index evaluating different criteria is necessary. The goal of such an index is to benchmark cities along a set of external measures to answer the main two challenges: financially viability and the understanding of its specific requirements. The authors have consulted several shared mobility projects and industry experts to create such a Shared Mobility City Index (SMCI). The current proposal of the SMCI consists of 11 individual index measures: general data (demographics, geography, climate and city culture), shared mobility landscape (current SM providers, public transit options, commuting patterns and driving culture) and political vision and goals (vision of the Mayor, sustainability plan, bylaws/tenders supporting SM). To evaluate the suitability of the index, 16 cities on the East Coast of North America were selected and secondary research was conducted. The main sources of this study were census data, organisational records, independent press releases and informational websites. Only non-academic sources where used because the relevant data for the chosen cities is not published in academia. Applying the index measures to the selected cities resulted in three major findings. Firstly, density (city area divided by number of inhabitants) is not an indicator for the number of SM services offered: the city with the lowest density has five bike and carsharing options. Secondly, there is a direct correlation between commuting patterns and how many shared mobility services are offered. New York, Toronto and Washington DC have the highest public transit ridership and the most shared mobility providers. Lastly, except one, all surveyed cities support shared mobility with their sustainability plan. The current version of the shared mobility index is proving a practical tool to evaluate cities, and to understand functional, political, social and environmental considerations. More cities will have to be evaluated to refine the criteria further. However, the current version of the index can be used to assess cities on their suitability for shared mobility services and will assist investors deciding which city is a financially viable market.

Keywords: carsharing, transportation, urban planning, shared mobility city index

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Authors: Milene Magalhães Pinto, Irlen Antônio Gonçalves

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This paper is within the area of History of Education in Brazil, having a descriptive and exploratory nature. It has been built on the belief that professional education is organized under political guidelines and solidifies through institutionalized discourses, allowing to know its mission concerning the society in which it operates by studying these speeches. Our purpose is to analyze how the Republican political culture yielded changes in public education through reforms to professional education in the First Republic, based on seven procedures of law that occurred in the Legislature of State of Minas Gerais. The Republican effort to reform the teaching was the result of a conception of society that aspired to advance the country by way of the national worker.

Keywords: professional education, republican political culture, education reforms, Brazil

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Authors: Mili Dutta, Lokender Prashad

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Introduction: Population ageing is a phenomenon that can be observed around the globe. The health-related quality of life (HRQOL) is a measurement of health status of an individual, and it describes the effect of physical and mental health disorders on the well-being of a person. The present study is aimed to describe the influence of socio-economic characteristics of elderly on their health-related quality of life in India. Methods: EQ-5D instrument and population-based EQ-5D index score has been measured to access the HRQOL among elderly. Present study utilized the Study on Global Ageing and Adult Health (SAGE) data which was conducted in 2007 in India. Multiple Logistic Regression model and Multivariate Linear Regression model has been employed. Result: In the present study, it was found that the female are more likely to have problems in mobility (OR=1.41, 95% Cl: 1.14 to 1.74), self-care (OR=1.26, 95% Cl: 1.01 to 1.56) and pain or discomfort (OR=1.50, 95% Cl: 1.16 to 1.94). Elderly residing in rural area are more likely to have problems in pain/discomfort (OR=1.28, 95% Cl: 1.01 to 1.62). More older and non-working elderly are more likely whereas higher educated and highest wealth quintile elderly are less likely to have problems in all the dimensions of EQ-5D viz. mobility, self-care, usual activity, pain/discomfort and anxiety/depression. The present study has also shown that oldest old people, residing in rural area and currently not working elderly are more likely to report low EQ-5D index score whereas elderly with high education level and high wealth quintile are more likely to report high EQ-5D index score than their counterparts. Conclusion: The present study has found EQ-5D instrument as the valid measure for assessing the HRQOL of elderly in India. The study indicates socio-economic characteristics of elderly such as female, more older people, residing in rural area, non-educated, poor and currently non-working as the major risk groups of having poor HRQOL in India. Findings of the study will be helpful for the programmes and policy makers, researchers, academician and social workers who are working in the field of ageing.

Keywords: ageing, HRQOL, India, EQ-5D, SAGE, socio-economic characteristics

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Authors: Rizwana Tabassum

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Introductive Statement: Delay in budget releases is often cited as one of the biggest bottlenecks to smooth and efficient service delivery. While budget release from the ministry of finance to the line ministries has been expedited by simplifying the procedure, budget distribution within the line ministries remains one of the major causes of slow budget utilization. While the budget preparation is a bottom-up process where all DDOs submit their proposals to their controlling officers (such as Upazila Civil Surgeon sends it to Director General Health), who consolidate the budget proposals in iBAS++ budget preparation module, the approved budget is not disaggregated by all DDOs. Instead, it is left to the discretion of the controlling officers to distribute the approved budget to their sub-ordinate offices over the course of the year. Though there are some need-based criteria/formulae to distribute the approved budget among DDOs in some sectors, there is little evidence that these criteria are actually used. This means that majority of the DDOs don’t know their yearly allocations upfront to enable yearly planning of activities and expenditures. This delays the implementation of critical activities and the payment to the suppliers of goods and services and sometimes leads to undocumented arrears to suppliers for essential goods/services. In addition, social sector budgets are fragmented because of the vertical programs and externally financed interventions that pose several management challenges at the level of the budget holders and frontline service providers. Slow procurement processes further delay the provision of necessary goods and services. For example, it takes an average of 15–18 months for drugs to reach the Upazila Health Complex and below, while it should not take more than 9 months in procuring and distributing these. Aim of the Study: This paper aims to investigate the budget distribution practices of an emerging economy, Bangladesh. The paper identifies challenges of timely distribution and ways to deal with problems as well. Methodology: The study draws conclusions on the basis of document analysis which is a branch of the qualitative research method. Major Findings: Upon approval of the National Budget, the Ministry of Finance is required to distribute the budget to budget holders at the department level; however, budget is distributed to drawing and disbursing officers much later. Conclusions: Timely and predictable budget releases assist completion of development schemes on time and on budget, with sufficient recurrent resources for effective operation. ADP implementation is usually very low at the beginning of the fiscal year and expedited dramatically during the last few months, leading to inefficient use of resources. The timely budget release will resolve this issue and deliver economic benefits faster, better, and more reliably. This will also give the project directors/DDOs the freedom to think and plan the budget execution in a predictable manner, thereby ensuring value for money by reducing time overrun and expediting the completion of capital investments, and improving infrastructure utilization through timely payment of recurrent costs.

Keywords: budget distribution, challenges, digitization, emerging economy, service delivery

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Authors: K. Volkonitskaya, S. Lyapina

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According to the National Monitoring Centre of innovation infrastructure, scientific and technical activities and regional innovation systems by December 2014. 166 technology parks were established in Russia. Comparative analysis of technological parks performance in Russia, the USA, Israel and the European Union countries revealed significant reduction of key performance indicators in Russian innovation infrastructure institutes. The largest deviations were determined in the following indicators: new products and services launched, number of companies and jobs, amount of venture capital invested. Lower performance indicators of Russian technology parks can be partly explained by slack demand for national high-tech products and services, lack of qualified specialists in the sphere of innovation management and insufficient cooperation between different innovation infrastructure institutes. In spite of all constraints in innovation segment of Russian economy in 2010-2012 private investors for the first time proceeded to finance building of technological parks. The general purpose of the research is to answer two questions: why despite the significant investment risks private investors continue to implement such comprehensive infrastructure projects in Russia and is business model of private technological park more efficient than strategies of state innovation infrastructure institutes? The goal of the research was achieved by analyzing business models of private technological parks in Moscow, Kaliningrad, Astrakhan and Kazan. The research was conducted in two stages: the on-line survey of key performance indicators of private and state Russian technological parks and in-depth interviews with top managers and investors, who have already build private technological parks in by 2014 or are going to complete investment stage in 2014-2016. The results anticipated are intended to identify the reasons of efficient and inefficient technological parks performance. Furthermore, recommendations for improving the efficiency of state technological and industrial parks were formulated. Particularly, the recommendations affect the following issues: networking with other infrastructural institutes, services and infrastructure provided, mechanisms of public-private partnership and investment attraction. In general intensive study of private technological parks performance and development of effective mechanisms of state support can have a positive impact on the growth rates of the number of Russian technological, industrial and science parks.

Keywords: innovation development, innovation infrastructure, private technology park, public-private partnership

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Authors: Dwarika P. Shrestha, Dipendra Gurung, Rushma Shrestha, Inger Rosdahl

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Introduction: Skin diseases are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of skin diseases and impact on quality of life in rural areas in Nepal. Materials and methods: A house-to-house survey was conducted, to obtain socio-demographic data and identify individuals with skin diseases, followed by health camps, where the villagers were examined. A pilot study was conducted in one village, which was then extended to 10 villages in 4 districts. To assess the impact on quality of life, the villagers were interviewed with Skin Disease Disability Index. This is a questionnaire developed and validated by the authors for use in Nepal. Results: In the pilot study, the overall prevalence of skin diseases was 20.1% (645/3207). In the additional 10 villages with 7348 (3651/3787 m/f) inhabitants, 1862 (721/1141 m/f, mean age 31.4 years) had one or more skin diseases. The overall prevalence of skin diseases was 25%. The most common skin disease categories were eczemas (13.7%, percentage among all inhabitants) pigment disorders (6.8%), fungal infections (4.9%), nevi (3.7%) and urticaria (2.9%). These five most common skin disease categories comprise 71% of all skin diseases seen in the study. The mean skin disease disability index score was 13.7, indicating very large impact on the quality of life. Conclusions: This population-based study shows that skin diseases are very common in the rural areas of Nepal and have significant impact on quality of life. Targeted intervention at the primary health care level should help to reduce the health burden due to skin diseases.

Keywords: prevalence and pattern of skin diseases, impact on quality of life, rural Nepal, interventions

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Authors: Maya de Vries Kedem, Abir Jubran, Diana Baron

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Employment in Israel offers Palestinian workers an income double what they can earn in the West Bank. The need to support their families leads many educated Palestinians to forgo finding work in their profession in the Palestinian Authority and instead look for employment in those sectors open to them in Israel, particularly the construction, agriculture, and industry sectors. The International Labor Organization estimated that about 1,200 workers in Israel die every year because of occupational diseases (diseases caused by working conditions). Construction workers in Israel are constantly exposed to dust, noise, chemical materials, and work in awkward postures, which require prolonged bending, repetitive motion, and other risk factors that can lead to illnesses and death. Occupational health is vastly neglected in Israel and construction workers are particularly at risk . As of June 2022, the Israeli quota in the construction sector for Palestinian workers stood at 80,000. Kav LaOved released a new study on the state of occupational health among Palestinian workers employed in construction in Israel. The study Roadmap to Health: Palestinian Workers in Israel's Construction Sector reviews the extent to which the health of Palestinian workers is protected at work in Israel. The report includes analysis of a survey administered to 256 workers as well as interviews with 10 workers and with 5 Israeli occupational health experts. Report highlights: • Among survey respondents, 63.9% stated that safety procedures to protect their health are rarely followed in their workplace (e.g., taking breaks, using protective gear, following restrictions on lifting heavy items, and having inspectors regularly on site to monitor safety). • All 256 Palestinian workers who participated to the survey said that their health has been directly or indirectly harmed by working in Israel and reported suffering from the following problems: orthopedic problems such as joint, hand, leg or knee problems (100%); headaches (75%); back problems (36.3%); eye problems (23.8%); breathing problems (17.6%); chronic pain (14.8%); heart problems (7.8%); and skin problems (3.5%). • Workers who are injured or do not feel well often continue working for fear of losing their payment for that day. About half of the 256 survey respondents reported that they pay brokerage fees to find an employer with a work permit, often paying between 2,000 and 3,000 NIS per month. “I have an obligation—I pay about NIS 120 a day for my permit, [and] I have to pay for it whether I work or not" a worker said. • Most Palestinian construction workers suffer from stress and mental health problems. Workers pointed to several issues that greatly affect their mood and mental state: daily crossings at crowded checkpoints where workers stand for hours; lack of sleep due to leaving home daily at 3:00-3:30 am; commuting two to four hours to work in each direction; and abusive work environments. A worker told KLO that the sight of thousands of workers standing together at the checkpoint causes “high blood pressure and the feeling that you are going to be squeezed.” Another said, “I felt that my bones would break.” In the survey workers reported suffering from insomnia (70.1%), breathing difficulties (35.8%), chest pressure (27.6%), or rapid pulse rate (12.2%).

Keywords: construction sector, palestinian workers, occupational health, Israel, occupation

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Authors: Peris Wanjiku

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The objective of this paper is to describe the development and implications of a national nursing workforce analytical system in Kenya. Findings: Creating a national electronic nursing workforce analytical system provides more reliable information on nurses ‘national demographics, migration patterns, and workforce capacity and efficiency. Data analysis is most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved its capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who decide to out-migrate are amongst Kenya’s most qualified. Conclusions: The Kenya nursing database is a first step toward facilitating evidence-based decision-making in HRH. This database is unique to developing countries in sub-Saharan Africa. Establishing an electronic workforce database requires long-term investment and sustained support by national and global stakeholders.

Keywords: analytical, information, health, migration

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Authors: Martin Kendra, Tomas Skrucany, Jaroslav Masek

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The noise is one of the negative elements influencing the human health. This article is due to the measurement of noise emitted by road vehicle and its parts during the operation. Measurement was done in the interior of common passenger cars with a digital sound meter. The results compare the noise value in different cars with different body shape, which influences the driver’s health. Transport has considerable ecological effects, many of them detrimental to environmental sustainability. Roads and traffic exert a variety of direct and mostly detrimental effects on nature.

Keywords: driver, noise measurement, passenger road vehicle, road transport

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Authors: Jonathan Josephs-Spaulding, Hannah Rettig, Simon Graspeunter, Jan Rupp, Christoph Kaleta

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Background: Recurrent urinary tract infections (rUTIs) are a global cause of emergency room visits and represent a significant burden for public health systems. Therefore, metatranscriptomic approaches to investigate metabolic exchange and crosstalk between uropathogenic Escherichia coli (UPEC), which is responsible for 90% of UTIs, and collaborating pathogens of the urogenital microbiome is necessary to better understand the pathogenetic processes underlying rUTIs. Objectives: This study aims to determine the level in which uropathogens optimize the host urinary metabolic environment to succeed during invasion. By developing patient-specific metabolic models of infection, these observations can be taken advantage of for the precision treatment of human disease. Methods: To date, we have set up an rUTI patient cohort and observed various urine-associated pathogens. From this cohort, we developed patient-specific metabolic models to predict bladder microbiome metabolism during rUTIs. This was done by creating an in silico metabolomic urine environment, which is representative of human urine. Metabolic models of uptake and cross-feeding of rUTI pathogens were created from genomes in relation to the artificial urine environment. Finally, microbial interactions were constrained by metatranscriptomics to indicate patient-specific metabolic requirements of pathogenic communities. Results: Metabolite uptake and cross-feeding are essential for strain growth; therefore, we plan to design patient-specific treatments by adjusting urinary metabolites through nutritional regimens to counteract uropathogens by depleting essential growth metabolites. These methods will provide mechanistic insights into the metabolic components of rUTI pathogenesis to provide an evidence-based tool for infection treatment.

Keywords: recurrent urinary tract infections, human microbiome, uropathogenic Escherichia coli, UPEC, microbial ecology

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Authors: Dirk Bruland, Paulo Pinheiro, Ullrich Bauer

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Introduction: Over 3 million children, about one quarter of all students, experience at least one parent with mental disorder in Germany every year. Children of mentally-ill parents are at considerably higher risk of developing serious mental health problems. The different burden patterns and coping attempts often become manifest in children's school lives. In this context, schools can have an important protective function, but can also create risk potentials. In reference to Jorm, pupil-related teachers’ mental health literacy (Teacher-MHL) includes the ability to recognize change behaviour, the knowledge of risk factors, the implementation of first aid intervention, and seeking professional help (teacher as gatekeeper). Although teachers’ knowledge and increased awareness of this topic is essential, the literature provides little information on the extent of teachers' abilities. As part of a German-wide research consortium on health literacy, this project, launched in March for 3 years, will conduct evidence-based mental health literacy research. The primary objective is to measure Teacher-MHL in the context of pupil-related psychosocial factors at primary and secondary schools (grades 5 & 6), while also focussing on children’s social living conditions. Methods: (1) A systematic literature review in different databases to identify papers with regard to Teacher-MHL (completed). (2) Based on these results, an interview guide was developed. This research step includes a qualitative pre-study to inductively survey the general profiles of teachers (n=24). The evaluation will be presented on the conference. (3) These findings will be translated into a quantitative teacher survey (n=2500) in order to assess the extent of socio-analytical skills of teachers as well as in relation to institutional and individual characteristics. (4) Based on results 1 – 3, developing a training program for teachers. Results: The review highlights a lack of information for Teacher-MHL and their skills, especially related to high-risk-groups like children of mentally ill parents. The literature is limited to a few studies only. According to these, teacher are not good at identifying burdened children and if they identify those children they do not know how to handle the situations in school. They are not sufficiently trained to deal with these children, especially there are great uncertainties in dealing with the teaching situation. Institutional means and resources are missing as well. Such a mismatch can result in insufficient support and use of opportunities for children at risk. First impressions from the interviews confirm these results and allow a greater insight in the everyday school-life according to critical life events in families. Conclusions: For the first time schools will be addressed as a setting where children are especially "accessible" for measures of health promotion. Addressing Teacher-MHL gives reason to expect high effectiveness. Targeting professionals' abilities for dealing with this high-risk-group leads to a discharge for teacher themselves to handle those situations and increases school health promotion. In view of the fact that only 10-30% of such high-risk families accept offers of therapy and assistance, this will be the first primary preventive and health-promoting approach to protect the health of a yet unaffected, but particularly burdened, high-risk group.

Keywords: children of mentally ill parents, health promotion, mental health literacy, school

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Authors: Hafsa Memona, Farkhanda Manzoor

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Cockroaches are termed as medically important pests because of their wide distribution in human habitation including houses, hospitals, food industries and kitchens. They may harbor multiple drug resistant pathogenic bacteria and protozoan parasites on their external surfaces, disseminate on human food and cause serious diseases and allergies to human. Hence, they are regarded as mechanical vector in human habitation due to their nocturnal activity and nutritional behavior. Viable eggs and dormant cysts of parasites can hitch a ride on cockroaches. Ova and cysts of parasitic organism may settle into the crevices and cracks between thorax and head. There are so many fissures and clefts and crannies on a cockroach which provide site for these organisms. This study aimed with identifying role of cockroaches in mechanically transmitting and disseminating gastrointestinal parasites in two environmental settings; hospitals and houses in urban area of Lahore. Totally, 250 adult cockroaches were collected from houses and hospitals by sticky traps and food baited traps and screened for parasitic load. All cockroaches were captured during their feeding time in natural habitat. Direct wet smear, 1% lugols iodine and modified acid-fast bacilli staining were used to identify the parasites from the body surfaces of cockroaches. Among human habitation two common species of cockroaches were collected i.e. P. americana and B. germanica. The results showed that 112 (46.8%) cockroaches harbored at least one human intestinal parasite on their body surfaces. The cockroaches from hospital environment harboured more parasites than houses. 47 (33.57%) cockroaches from houses and 65 (59.09%) from hospitals were infected with parasitic organisms. Of these, 76 (67.85%) were parasitic protozoans and 36(32.15%) were pathogenic and non-pathogenic intestinal parasites. P. americana harboured more parasites as compared to B. germanica in both environment. Most common human intestinal parasites found on cockroaches include ova of Ascaris lumbricoides (giant roundworm), Trichuris trichura (whipworm), Anchylostoma deodunalae (hookworm), Enterobius vermicularis (pinworm), Taenia spp. and Strongyloides stercoralis (threadworm). The cysts of protozoans’ parasites including Balantidium coli, Entomoeba hystolitica, C. parvum, Isospora belli, Giardia duodenalis and C. cayetenensis were isolated and identified from cockroaches. Both experimental sites were significantly different in carriage of parasitic load on cockroaches. Difference in the hygienic condition of the environments, including human excrement disposal, variable habitat interacted, indoor and outdoor species, may account for the observed variation in the parasitic carriage rate of cockroaches among different experimental site. Thus a finding of this study is that Cockroaches are uniformly distributed in human habitation and act as a mechanical vector of pathogenic parasites that cause common illness such as diarrhea and bowel disorders. This fact contributes to epidemiological chain therefore control of cockroaches will significantly lessen the prevalence of illness in human. Effective control strategies will reduce the public health burden of the gastro-intestinal parasites in the developing countries.

Keywords: cockroaches, health risks, hospitals, houses, parasites, protozoans, transmission

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Authors: Evelyn Osehontue Uroro, Richard Bright, Jing Yang Quek, Krasimir Vasilev

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Bacterial infections have been a challenge both in the public and private sectors. The colonization of bacteria often occurs in medical devices such as catheters, heart valves, respirators, and orthopaedic implants. When biomedical devices are inserted into patients, the deposition of macromolecules such as fibrinogen and immunoglobin on their surfaces makes it easier for them to be prone to bacteria colonization leading to the formation of biofilms. The formation of biofilms on medical devices has led to a series of device-related infections which are usually difficult to eradicate and sometimes cause the death of patients. These infections require surgical replacements along with prolonged antibiotic therapy, which would incur additional health costs. It is, therefore, necessary to prevent device-related infections by inhibiting the formation of biofilms using intelligent technology. Antibiotic resistance of bacteria is also a major threat due to overuse. Different antimicrobial agents have been applied to microbial infections. They include conventional antibiotics like rifampicin. The use of conventional antibiotics like rifampicin has raised concerns as some have been found to have hepatic and nephrotoxic effects due to overuse. Hence, there is also a need for proper delivery of these antibiotics. Different techniques have been developed to encapsulate and slowly release antimicrobial agents, thus reducing host cytotoxicity. Examples of delivery systems are solid lipid nanoparticles, hydrogels, micelles, and polymeric nanoparticles. The different ways by which drugs are released from polymeric nanoparticles include diffusion-based release, elution-based release, and chemical/stimuli-responsive release. Polymeric nanoparticles have gained a lot of research interest as they are basically made from biodegradable polymers. An example of such a biodegradable polymer is polycaprolactone (PCL). PCL degrades slowly by hydrolysis but is often sensitive and responsive to stimuli like enzymes to release encapsulants for antimicrobial therapy. This study presents the synthesis of PCL nanoparticles loaded with rifampicin and the on-demand release of rifampicin for treating staphylococcus aureus infections.

Keywords: enzyme, Staphylococcus aureus, PCL, rifampicin

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Authors: Deonie Botha

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Digital transformation and the digitization of occupational health and safety training have grown exponentially due to a variety of contributing factors. The literature suggests that digitalization has numerous benefits but also has associated challenges. The aim of the paper is to develop an understanding of both the perceived benefits and challenges of digitalization in an occupational health and safety context in an effort to design and develop e-learning interventions that will optimize the benefits of digitalization and address the associated challenges. The paper proposes, deliberate and tests the design principles of an e-learning intervention to ensure alignment with the requirements of a digitally transformed environment. The results of the research are based on a literature review regarding the requirements and effect of the Fourth Industrial Revolution on learning and e-learning in particular. The findings of the literature review are enhanced with empirical research in the form of a case study conducted in an organization that designs and develops e-learning content in the occupational health and safety industry. The primary findings of the research indicated that: (i) The requirements of learners and organizations in respect of e-learning are different than previously (i.e., a pre-Fourth Industrial Revolution related work setting). (ii) The design principles of an e-learning intervention need to be aligned with the entire value chain of the organization. (iii) Digital twins support and enhance the design and development of e-learning. (iv)Learning should incorporate a multitude of sensory experiences and should not only be based on visual stimulation. (v) Data that are generated as a result of e-learning interventions should be incorporated into big data streams to be analyzed and to become actionable. It is therefore concluded that there is general consensus on the requirements that e-learning interventions need to adhere to in a digitally transformed occupational health and safety work environment. The challenge remains for organizations to incorporate data generated as a result of e-learning interventions into the digital ecosystem of the organization.

Keywords: digitalization, training, fourth industrial revolution, big data

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Authors: Lola Vivour-Adeniyi, Oluwatoyosi Abikoye

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Gender-based violence (GBV) is a pervasive issue that demands a nuanced understanding to foster effective solutions. This study, conducted by the Lagos State Domestic and Sexual Violence Agency (DSVA), delves into the heart of Lagos State to uncover the realities of GBV, from the perceptions of its residents to the efficacy of support systems in place. Covering ten local government areas (LGAs) and drawing from a diverse range of demographics—gender, age, marital status, literacy levels, religion, and ethnicity—this research paints a comprehensive picture of GBV's impact. The narrative begins with the voices of the community, revealing a widespread awareness of GBV's multifaceted nature—physical, emotional, psychological, and structural. Through their stories, key drivers such as poverty, low education levels, and substance abuse emerge, illustrating the interconnected factors that sustain GBV. Despite a high level of awareness, there is a significant gap in knowledge about reporting mechanisms, highlighting an urgent need for improved accessibility and information dissemination on support services. Notably, inter-agency collaboration and public awareness campaigns play crucial roles in the community's fight against GBV. This study evaluates these efforts by the Lagos State Government, shedding light on successful educational interventions that have transformed community attitudes. Case studies of these initiatives provide examples of success, demonstrating the power of coordinated action and informed advocacy. In conclusion, the study calls for a robust, multi-sectoral approach—engaging government agencies, civil society organizations, and community stakeholders—to address GBV comprehensively. Recommendations include scaling successful models to other urban centers, enhancing reporting mechanisms for greater accessibility and confidentiality, and investing in ongoing research to refine our understanding of GBV's dynamics with the aim to foster a safer and more inclusive society, tackling the root causes of GBV and improving support for survivors.

Keywords: gender based violence, policy recommendations, public awareness, Iinter agency collaboration

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Authors: T. Benazzouz, K. Auhmani

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This paper presents a Hospital 4.0 Maturity Assessment Model based on the Industry 4.0 concepts. The self-assessment model defines current and target states of digital transformation by considering multiple aspects of a hospital and a healthcare supply chain. The developed model was validated and evaluated on real-life cases. The resulting model consisted of 5 domains: Technology, Strategy 4.0, Human resources 4.0 & Culture 4.0, Supply chain 4.0 management, and Patient journeys management. Each domain is further divided into several sub-domains, totally 34 sub-domains are identified, that reflect different facets of a hospital 4.0 mature organization.

Keywords: hospital 4.0, Industry 4.0, maturity assessment model, supply chain 4.0, patient

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Authors: Afifa Aslam, Muhammad Ibrahim, Abid Mahmood, Muhammad Usman Alvi, Fariha Jabeen, Umara Tabassum

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Many factors cause air pollution in Pakistan, which poses a significant threat to human health. Diesel fuel and gasoline motor vehicles, as well as industrial companies, pollute the air in Pakistan's cities. The study's goal is to determine the level of air pollution in a Pakistani industrial city and to establish risk levels for the health of the population. We measured the intensity of air pollution by chemical characterization and examination of air samples collected at stationary remark sites. The PM10 levels observed at all sampling sites, including residential, commercial, high-traffic, and industrial areas were well above the limits imposed by Pakistan EPA, the United States EPA, and WHO. We assessed the health risk via chemical factors using a methodology approved for risk assessment. All Igeo index values greater than one were considered moderately contaminated or moderately to severely contaminated. Heavy metals have a substantial risk of acute adverse effects. In Faisalabad, Pakistan, there was an enormously high risk of chronic effects produced by a heavy metal acquaintance. Concerning specified toxic metals, intolerable levels of carcinogenic risks have been determined for the entire population. As a result, in most of the investigated areas of Faisalabad, the indices and hazard quotients for chronic and acute exposure exceeded the permissible level of 1.0. In the current study, re-suspended roadside mineral dust, anthropogenic exhaust emissions from traffic and industry, and industrial dust were identified as major emission sources of elemental particulate contents. Because of the unacceptable levels of risk in the research area, it is strongly suggested that a comprehensive study of the population's health status as a result of air pollution should be conducted for policies to be developed against these risks.

Keywords: elemental composition, particulate pollution, Igeo index, health risk assessment, hazard quotient

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Authors: Caroline Picton, Lorna Moxham, Christopher Patterson, Dana Perlman, Ellie Taylor, Renee Brighton

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The purpose of this study was to extrapolate the meaning for people living with a mental illness of their participation in a therapeutic recreation experience. The study’s participants engaged in a five-day adventure camp, known as Recovery Camp, alongside undergraduate health care students. An interpretive phenomenological approach was used as an exploratory method to interview 25 participants (n=25). Van Kaam’s structured analytical framework guided the analysis of the transcribed narratives. The findings provide insight into using therapeutic recreation to enhance personal mental health recovery. Recovery Camp was viewed by participants as having a transformational effect on forming positive social connectedness and improving their self-identity. Participants perceived the Recovery Camp experience as one that gave them a sense of purpose and increased their motivation to undertake further activities. The insights gained of the benefits of therapeutic recreation for people living with a mental illness can be used to promote purposeful community engagement.

Keywords: interpretive phenomenology, lived experience, mental illness, personal mental health recovery

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