Search results for: burden

Authors: Zahra Soltani Shal

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Introduction: The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. Healthcare resilience during a pandemic is crucial not only for continuous and safe patients care but also for control of any outbreak. Aim: The present study was conducted to discover the organizational variables effective in increasing resilience and continuing the work of nurses in critical and stressful pandemic conditions. Method: The study population is nurses working in hospitals for patients with coronavirus. Sampling was done purposefully and information was collected from 15 nurses through In-depth semi-structured interviews. The interview was conducted to analyze the data using the framework analysis method consisting of five steps and is classified in the table. Results: According to the findings through semi-structural interviews, among organizational variables, organizational commitment (Affective commitment, continuous commitment, normative commitment) has played a prominent role in nurses' resilience. Discussion: despite the non-withdrawal of nurses and their resilience, due to the negative quality of their working life, the mentioned variable has affected their level of performance and ability and leads to fatigue and physical and mental exhaustion. Implications for practice: By equipping hospitals and improving the facilities of nurses, their organizational commitment can be increased and lead to their resilience in critical situations. Supervisors and senior officials at the hospitals should be responsible for nurses' health and safety. A clear and codified program in critical situations and comprehensive management is effective in improving the quality of the work-life of nurses. Creating an empathetic and interactive environment can help promote nurses' mental health.

Keywords: organizational commitment, quality of work life, nurses resilience, pandemic, coronavirus

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Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis

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Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.

Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity

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Authors: E. Von Cheong, Carol Sinnott, Darren Dahly, Patricia M. Kearney

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Introduction and Aim: Adverse childhood experiences (ACEs) are all too common and have been linked to poorer health and wellbeing across the life course. While the prevention of ACEs is a worthy goal, it is important that we also try to lessen the impact of ACEs for those who do experience them. This study aims to investigate associations between adverse childhood experiences (ACEs) and later-life depressive symptoms; and to explore whether perceived social support (PSS) moderates these. Method: We analysed baseline data from the Mitchelstown (Ireland) 2010-11 cohort involving 2047 men and women aged 50–69 years. Self-reported assessments included ACEs (Centre for Disease Control ACE questionnaire), PSS (Oslo Social Support Scale), and depressive symptoms (CES-D). The primary exposure was self-report of at least one ACE. We also investigated the effects of ACE exposure by the subtypes abuse, neglect, and household dysfunction. Associations between each of these exposures and depressive symptoms were estimated using logistic regression, adjusted for socio-demographic factors that were selected using the Directed Acyclic Graph (DAG) approach. We also tested whether the estimated associations varied across levels of PSS (poor, moderate, and good). Results: 23.7% of participants reported at least one ACE (95% CI: 21.9% to 25.6%). ACE exposures (overall or subtype) were associated with a higher odds of depressive symptoms, but only among individuals with poor PSS. For example, exposure to any ACE (vs. none) was associated with 3 times the odds of depressive symptoms (Adjusted OR 2.97; 95% CI 1.63 to 5.40) among individuals reporting poor PSS, while among those reporting moderate PSS, the adjusted OR was 1.18 (95% CI 0.72 to 1.94). Discussion: ACEs are common among older adults in Ireland and are associated with higher odds of later-life depressive symptoms among those also reporting poor PSS. Interventions that enhance perception of social support following ACE exposure may help reduce the burden of depression in older populations.

Keywords: adverse childhood experiences, depression, later-life, perceived social support

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Authors: Ayşe Defne Öz, Özlem Bozkurt

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Alzheimer's Disease (AD) is counted as one of the most important global health problems and the main cause of dementia. The term dementia refers to a wide spectrum of disorders characterized by global, chronic, and generally irreversible cognitive deterioration. It is estimated that %60 % to 80 of the cases of dementia are because of AD. Alzheimer's is a slowly progressive brain disease. The reason for AD is unknown to the author's best knowledge, yet it is one of the topics that is most researched. AD shows the histopathologically abnormal accumulation of the protein beta-amyloid (plague) outside neurons and twisted strands of the protein tau (tangles) inside neurons in the brain. These changes are accompanied by damage to the brain tissue and the death of neurons. AD causes people to have difficulty remembering names or conversations. Some of the later symptoms are difficulty in talking and walking. Alzheimer's Disease is elevated by the illness and mortality of COVID-19. COVID-19 has affected many lives globally and had profound effects on human lives. COVID-19 is caused by SARS-CoV-2, which is a virus that attacks the respiratory and central nervous system and has neuroinvasive potential. More than %80 of COVID-19 patients have ageusia or anosmia, representing the pathognomic features of the disease. Patients with dementia are frail, and with the COVID-19 pandemic, including isolation, cognitive decline may exacerbate. Furthermore, patients with AD can be unable to follow the directions, such as covering their mouth and nose while coughing and can live in nursing homes which makes them more open to being infected. As COVID-19 is highly infectious and its management requires isolation and quarantine, the need for caregivers for AD management conflicts with that of COVID-19 and adds an extra burden on AD patients, caregivers, families, society, and the economy. Due to the entry of SARS-CoV-2 into the central nervous system, inflammation caused by COVID-19, prolonged hospitalization, and delirium, it has been reported that COVID-19 causes many neurological disorders and predisposition to AD.

Keywords: Alzheimer's disease, COVID-19, dementia, SARS-CoV-2

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Authors: D. Motlhanka, M. Mine, T. Bagaketse, T. Ngakane

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There is a plethora of evidence from numerous sources that highlights the triumph of naturally derived medicinal plant metabolites with antioxidant capability for repurposed therapeutics. As post-COVID-19 syndromes and non-communicable diseases are on the rise, there is an urgent need to come up with new therapeutic strategies to address the problem. Non-communicable diseases and Post COVID-19 syndromes are classified as socio-economic diseases and are ranked high among threats to health security due to the economic burden they pose to any government budget commitment. Research has shown a strong link between accumulation of free radicals and oxidative stress critical for pathogenesis of non-communicable diseases and COVID-19 syndromes. Botswana has embarked on a robust programme derived from ethno-pharmacognosy and drug repurposing to address these threats to health security. In the current approach, a number of medicinally active plant-derived polyphenolics are repurposed and combined into new medicinal tools to target diabetes, Hypertension, Prostate Cancer and oxidative stress induced Post COVID 19 syndromes such as “brain fog”. All four formulants demonstrated Free Radical scavenging capacities above 95% at 200µg/ml using the diphenylpicryalhydrazyl free radical scavenging assay and the total phenolic contents between 6899-15000GAE(g/L) using the folin-ciocalteau assay respectively. These repurposed medicinal tools offer new hope and potential in the fight against emerging health threats driven by hyper-inflammation and free radical-induced oxidative stress.

Keywords: drug repurposed plant polyphenolics, free radical damage, non-communicable diseases, post COVID 19 syndromes

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Authors: Nindyo Cahyo Kresnanto, Muhamad Willdan, Wika Harisa Putri

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Gunungkidul is one of the emerging tourism industry areas in Yogyakarta Province, Indonesia. This article describes how GIS can predict the development of tourism potential in Gunungkidul. The tourism sector in Gunungkidul Regency contributes 3.34% of the total gross regional domestic product and is the economic sector with the highest growth with a percentage of 18.37% in the post-Covid-19 period. This contribution makes researchers consider that several tourist sites need to be explored more to increase regional economic development gradually. This research starts by collecting spatial data from tourist locations tourists want to visit in Gunungkidul Regency based on survey data from 571 respondents. Then the data is visualized with ArcGIS software. This research shows an overview of tourist destinations interested in travellers depicted from the lowest to the highest from the data visualization. Based on the data visualization results, specific tourist locations potentially developed to influence the surrounding economy positively. The visualization of the data displayed is also in the form of a desire line map that shows tourist travel patterns from the origin of the tourist to the destination of the tourist location of interest. From the desire line, the prediction of the path of tourist sites with a high frequency of transportation activity can figure out. Predictions regarding specific tourist location routes that high transportation activities can burden can consider which routes will be chosen. The route also needs to be improved in terms of capacity and quality. The goal is to provide a sense of security and comfort for tourists who drive and positively impact the tourist sites traversed by the route.

Keywords: tourism development, GIS and survey, transportation, potential desire line

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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: Afshan Ejaz, Syed Asim Ali

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The reality is a combination of perception, reconstruction, and interaction. Augmented Reality is the advancement that layer over consistent everyday existence which includes content based interface, voice-based interfaces, voice-based interface and guide based or gesture-based interfaces, so designing augmented reality application interfaces is a difficult task for the maker. Designing a user interface which is not only easy to use and easy to learn but its more interactive and self-explanatory which have high perceived affordability, perceived usefulness, consistency and high discoverability so that the user could easily recognized and understand the design. For this purpose, a lot of interface design principles such as learnability, Affordance, Simplicity, Memorability, Feedback, Visibility, Flexibly and others are introduced but there no such principles which explain the most appropriate interface design principles for designing an Augmented Reality application interfaces. Therefore, the basic goal of introducing design principles for Augmented Reality application interfaces is to match the user efforts and the computer display (‘plot user input onto computer output’) using an appropriate interface action symbol (‘metaphors’) or to make that application easy to use, easy to understand and easy to discover. In this study by observing Augmented reality system and interfaces, few of well-known design principle related to GUI (‘user-centered design’) are identify and through them, few issues are shown which can be determined through the design principles. With the help of multiple studies, our study suggests different interface design principles which makes designing Augmented Reality application interface more easier and more helpful for the maker as these principles make the interface more interactive, learnable and more usable. To accomplish and test our finding, Pokémon Go an Augmented Reality game was selected and all the suggested principles are implement and test on its interface. From the results, our study concludes that our identified principles are most important principles while developing and testing any Augmented Reality application interface.

Keywords: GUI, augmented reality, metaphors, affordance, perception, satisfaction, cognitive burden

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Authors: Ena Arora, Rong Fan, Aleksandr Fuks, Kolawole Felix Akinnawonu

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Introduction: Leiomyomas are benign tumors that are derived from the overgrowth of uterine smooth muscle cells. Women with symptomatic leiomyomas who desire future fertility, myomectomy should be the standard surgical treatment. Perioperative hemorrhage is a common complication in myomectomy. We performed the study to investigate blood transfusion rate in abdominal myomectomies, risk factors influencing blood loss and modalities to improve perioperative blood loss. Methods: Retrospective chart review was done for patients who underwent myomectomy from 2016 to 2022 at Queens hospital center, New York. We looked at preoperative patient demographics, clinical characteristics, intraoperative variables, and postoperative outcomes. Mann-Whitney U test were used for parametric and non-parametric continuous variable comparisons, respectively. Results: A total of 159 myomectomies were performed between 2016 and 2022, including 1 laparoscopic, 65 vaginal and 93 abdominal. 44 patients received blood transfusion during or within 72 hours of abdominal myomectomy. The blood transfusion rate was 47.3%. Blood transfusion rate was found to be twice higher than the average documented rate in literature which is 20%. Risk factors identified were black race, preoperative hematocrit<30%, preoperative blood transfusion within 72 hours, large fibroid burden, prolonged surgical time, and abdominal approach. Conclusion: Preoperative optimization with iron supplements or GnRH agonists is important for patients undergoing myomectomy. Interventions to decrease intra operative blood loss should include cell saver, tourniquet, vasopressin, misoprostol, tranexamic acid and gelatin-thrombin matrix hemostatic sealant.

Keywords: myomectomy, perioperative blood loss, cell saver, tranexamic acid

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Authors: Musa Sekamatte

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Background: Zoonotic diseases continue to be a public health burden in countries around the world. Uganda is especially vulnerable due to its location, biodiversity, and population. Given these concerns, the Ugandan government in collaboration with the Global Health Security Agenda conducted a zoonotic disease prioritization workshop to identify zoonotic diseases of concern to multiple Ugandan ministries. Materials and Methods: The One Health Zoonotic Disease Prioritization tool, developed by the U.S. Centers for Disease Control and Prevention (CDC), was used for prioritization of zoonotic diseases in Uganda. Workshop participants included voting members representing human, animal, and environmental health ministries as well as key partners who observed the workshop. Over 100 articles describing characteristics of these zoonotic diseases were reviewed for the workshop. During the workshop, criteria for prioritization were selected, and questions and weights relevant to each criterion were determined. Next steps for multi-sectoral engagement for the prioritized zoonoses were then discussed. Results: 48 zoonotic diseases were considered during the workshop. Criteria selected to prioritize zoonotic diseases in order of importance were (1) severity of disease in humans in Uganda, (2) availability of effective control strategies, (3) potential to cause an epidemic or pandemic in humans or animals, (4) social and economic impacts, and (5) bioterrorism potential. Seven zoonotic diseases were identified as priorities for Uganda: anthrax, zoonotic influenza viruses, viral hemorrhagic fevers, brucellosis, African trypanosomiasis, plague, and rabies. Discussion: One Health approaches and multi-sectoral collaborations are crucial in the surveillance, prevention, and control strategies for zoonotic diseases. Uganda used such an approach to identify zoonotic diseases of national concern. Identifying these priority diseases enables the National One Health Platform and the Zoonotic Disease Coordinating Office to address the diseases in the future.

Keywords: national one health platform, zoonotic diseases, multi-sectoral, severity

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Authors: Ibrahim Umar, S Chindo, A Rajab

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Background: TB remains a disease of public health concern in Nigeria with an estimated incidence rate of 219/100,000. Kano has the second highest TB burden in Nigeria and is the leading state with the highest consistent yearly TB notification. House-to-house (H2H) active case search in the community was found to have major contribution to the total TB notification in the state. Aims and Objective: To showcase the impact of H2H community active TB case search (ACF) to yearly TB notification in Kano State, Northern Nigeria from 2012 to 2022. Methodology: This is a retrospective descriptive study based on the analysis of data collected during the routine quarterly and yearly TB data collected in the state. Data was analyzed using the Power BI with statistical alpha level of significance <0.05. Results: Between 2012 and 2013 there was no House-to-house active TB case search in Nigeria and Kano had zero contribution to TB notification from the community in those years. However, in 2014 with the introduction of H2H Active TB Case Search Kano notified 6,014 TB cases out of which 113 came from the community ACF that translated to 2% contribution to total TB notification. From 2014 to 2022 there was progressive increase in community contribution to TB case notification from 113 out of 6,014 total TB patients notified (2012) to 11,799 out of 26,371 TB patients notified (2022) in Kano State. This translated to 45% increase in community contribution to total TB case notification. Discussion: Remarkable increase in community contribution to total TB case notification in Kano State was achieved in 2022 with 11,799 TB cases notified from the community Active TB case search to the total of 26,731 TB cases notified in Kano State, Nigeria. Conclusion: in research has shown that Community-based H2H Active TB Case Search through Community TB Workers (CTWs) is an excellent strategy in finding the missing TB cases towards Ending TB in the world.

Keywords: tuberculosis(TB), active case search (ACF), house-to-house (H2H), community TB workers (CTWs)

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Authors: Tianqi Yin

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Following the establishment of the state of Israel, how to harmonize the relationship between Palestinians and Jews in Israel has always been an intractable problem. As the number of Palestinian Arabs in Israel has increased to over two million, the issue has become more severe. Due to a variety of factors, Israeli Palestinians and Israeli Jews often find it hard to interact with each other, let alone form a relationship. Multiple authors and directors have produced cultural works to touch on the issue, exposing the reasons for the irreconcilable relation between the two ethnic groups. This paper analyzes the representation scenes of the Palestinian-Jewish relationship in three prominent cultural works, each from a distinct perspective, to examine the intrinsic challenges from the Israeli side that curb the two ethnicities from interacting successfully. The first scene is from the Jewish perspective in Amos Oz’s memoir A Tale of Love and Darkness, in which young Oz, a Jewish boy, attempts to interact with Aisha, a young Israeli-Arab girl, but eventually failed because of an accident. The second scene is from a short Israeli film Bus Station which, from an outsider perspective, depicted a brief encounter between an Arab woman and a Jewish woman in Jerusalem. The third scene is the initially successful yet eventually failed relationship between Eyad, a Palestinian boy, and Naomi, a Jewish girl, in an elite Israeli high school from the 2014 film A Borrowed Identity, which is depicted through Eyad’s Arab perspective. Through the analysis of these three narratives, this paper argues that the burden of national responsibility, family influences, and Israeli government’s discriminatory policies are the three main factors on the Jewish side, in ascender order of importance, that make Arab-Jewish interaction hard in Israel.

Keywords: arab-Jewish interaction, ethnographic conflicts, israel, Jewish narrative, narrative styles

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Authors: Mykah W. Sumoldao, Maria Erissa C. Susa, Triny Cate M. Telan, Christian Arvin M. Torres, Jasmine I. Udasco, Franceis Jeramil M. Walis, Shellyn S. Wandagan, Janine May M. Warding, Queenie Diana Rose P. Zalun Hope Lulet A. Lomioan

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This descriptive phenomenological study explored the lived experiences of the primary caregiver of schizophrenia patients at the Acute Crisis Intervention Service in Cagayan Valley Medical Center. The research aimed to understand the emotional, physical, and financial challenges these primary caregivers face. Data was gathered through interviews with nine (9) primary caregivers and analyzed using Colaizzi’s seven-step method. Two main themes emerged: Experience/ Challenges (Emotional, Physical, and Financial Challenges) and Managing Mechanisms (Support Systems and Resilience and Commitment). The study found that primary caregivers deal with a complex mix of difficulties, often with limited resources. They rely heavily on personal strength, faith, family, friends and community support to manage their roles. The findings highlighted the need for better support systems to ease primary caregivers' burdens. Financial aid, respite care, and mental health support are crucial for improving primary caregivers' quality of life and the care they provide. Additionally, raising awareness about primary caregivers' challenges can foster a supportive community, with more help from local organizations and government entities. Thus, this study provided insights into the caregiving experiences of those supporting schizophrenia patients. It emphasized the importance of practical support and emotional resilience. By addressing these needs, a more supportive environment can be created, benefiting both primary caregivers and their patients.

Keywords: primary caregiver burden, mental health, primary caregiver well-being, primary caregiver

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Authors: Jakia Rajoana

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The key aim of this research is to achieve Sustainable Rural Tourism (SRT) through women’s empowerment in the Sundarbans area of Bangladesh. Women in rural areas in developing countries depend on biomass for their survival and that of their family. Yet they have an unequal access to resources as well as decision making, thus making them more vulnerable to any changes in the environment. Women in the developing countries experience gender inequality which is culturally embedded resulting into women having less access to and control over financial and material resources, information, and also a lack of recognition of their contribution as compared to men. Their disadvantaged social position is augmented by their extreme poverty, little or no power they have over their own lives vis-à-vis the disproportionate burden they bear in reproduction and child-raising. Despite the significance of the need to pay attention to gender related issues in sustainable rural tourism (SRT), research remains rather scant. For instance, there is very little research that illustrates the role of women in tourism in the Sundarbans area. Thus empirically, this research seeks to fill a significant gap by focusing on rural areas and in particular focus on considerably under-researched area, namely the Sundarbans women’s role in tourism. In order to fully comprehend their experiences and life stories, this research will apply the empowerment theory and consider it along with the research on sustainable rural tourism. Since, women’s empowerment can act as a potential tool for SRT development and also examine the role tourism plays in the lives of Sundarbans’ women. Methodologically, this study will follow a qualitative research design using an ethnographic approach. Participant observation, semi- structured interviews, and documentation will be the primary data collection instruments in four communities – Shayamnagar, Koyra, Mongla and Sarankhola – in the Sundarbans area. It is hoped that by focusing on the life stories of these invisible women, research is better able to engage with nuances inherent in marginal and significantly under-researched communities.

Keywords: gender, sustainable rural tourism, women empowerment, Sundarbans

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Authors: Florge Francis A. Sy

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Physicians develop emotional and psychological distress after facing a patient’s death. This can result in stress or burnout. Coping mechanisms in dealing with these deaths may be maladaptive. Determining grief, emotional impact, and coping strategies in physicians is necessary to identify those needing intervention. This can be done by employing validated assessment tools such as the Texas Revised Inventory of Grief (TRIG) scale, Impact of Events Scale (IES), and BriefCOPE tool, respectively. This prospective, observational study was done in a private hospital in Cebu City. Fifty-five internal medicine residents were included and tasked to answer a survey based on their most memorable patient death encounter. The TRIG, IES, and BriefCOPE scores were determined. Participants were divided into severe grief and non-severe grief based on TRIG scores, low-impact, moderate-impact, and high-impact based on IES, and low-use, moderate-use, and high-use based on the BriefCOPE. The differences in the groups’ characteristics were statistically determined, and a p-value of < 0.05 was significant. The participants’ average age was 28.45 years. Most were female and single. Most belonged to the non-severe group based on TRIG, a moderate-impact group based on the IES, and high-use group based on the BriefCOPE. However, 21.8% reported severe grief, 27.3% reported high-impact, and 10.9% had low use of coping strategies. The proportion of residents who encountered CPR prior to the patient’s death was greater in the severe group. Proportions of both high-impact and non-high impact groups were comparable. The proportion of female residents was higher in the high-use group. There were a number of residents who reported severe grief, high emotional impact, and low coping strategies. This highlights the need for interventions such as debriefing after CPR or formal training in residency programs in dealing with emotional burden to counteract maladaptive coping behaviors and prevent negative outcomes.

Keywords: residents, grief, emotional impact, coping, patient death

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Authors: Max Butler

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Melanoma accounts for 80% of skin cancer-related deaths globally. The poor prognosis and increasing incidence of melanoma impose a significant burden on global healthcare systems. Early detection, precise diagnosis, and preventative strategies are critical to improving patient outcomes. Dermoscopy is the gold standard for specialist assessments of pigmented skin lesions, as it can differentiate between benign and malignant growths with greater accuracy than visual inspection. In the United Kingdom, guidelines from the National Institute of Clinical Excellence (NICE) state dermoscopy should be used in all specialist assessments of pigmented skin lesions. Compliance with this guideline is low, resulting in missed and delayed melanoma diagnoses. To address this problem, a quality improvement project was initiated at Buckinghamshire Healthcare Trust (BHT) within the plastic surgery department. The target group was a trainee and consultant plastic surgeons conducting outpatient skin cancer clinics. Analysis of clinic documentation over a one-month period found that only 62% (38/61) of patients referred with pigmented skin lesions were examined using dermoscopy. To increase dermoscopy rates, teaching was delivered to the department highlighting national guidelines and the evidence base for dermoscopic examination. In addition, clinic paperwork was redesigned to include a text box for dermoscopic examination. Reauditing after the intervention found a significant increase in dermoscopy rates (52/61, p = 0.014). In conclusion, implementing a quality improvement project with targeted teaching and documentation template templates successfully increased dermoscopy rates. This is a promising step toward improving early melanoma detection and patient outcomes.

Keywords: melanoma, dermoscopy, plastic surgery, quality improvement

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Authors: Rami Hashish, Manon Limousis-Gayda, Caitlin McCleery

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Introduction: Mild traumatic brain injuries, also referred to as concussions, represent an increasing burden to society. Due to limited objective diagnostic measures, concussions are diagnosed by assessing subjective symptoms, often leading to disputes to their presence. Common biomechanical measures associated with concussion are high linear and/or angular acceleration to the head. With regards to linear acceleration, approximately 80g’s has previously been shown to equate with a 50% probability of concussion. Motor vehicle collisions (MVCs) are a leading cause of concussion, due to high head accelerations experienced. The change in velocity (delta-V) of a vehicle in an MVC is an established metric for impact severity. As acceleration is the rate of delta-V with respect to time, the purpose of this paper is to determine the relation between delta-V (and occupant parameters) with linear head acceleration. Methods: A meta-analysis was conducted for manuscripts collected using the following keywords: head acceleration, concussion, brain injury, head kinematics, delta-V, change in velocity, motor vehicle collision, and rear-end. Ultimately, 280 studies were surveyed, 14 of which fulfilled the inclusion criteria as studies investigating the human response to impacts, reporting head acceleration, and delta-V of the occupant’s vehicle. Statistical analysis was conducted with SPSS and R. The best fit line analysis allowed for an initial understanding of the relation between head acceleration and delta-V. To further investigate the effect of occupant parameters on head acceleration, a quadratic model and a full linear mixed model was developed. Results: From the 14 selected studies, 139 crashes were analyzed with head accelerations and delta-V values ranging from 0.6 to 17.2g and 1.3 to 11.1 km/h, respectively. Initial analysis indicated that the best line of fit (Model 1) was defined as Head Acceleration = 0.465

Keywords: acceleration, brain injury, change in velocity, Delta-V, TBI

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Authors: Yetunde M. Dairo, Johnny Collett, Helen Dawes

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Background and Aim: Engagement with physical activity (PA) research is poor among adults with intellectual disabilities (ID), particularly in those from residential homes. This study explored why, by asking managers of residential homes, adults with ID and their carers. Methods: Participants: A convenient sample of 23 individuals from two UK local authorities, including a group of ID residential home managers, adults with ID and their support staff. Procedures: A) Residential home managers (n=6) were asked questions about their willingness to allow their residents to participate in PA research; B) eleven adults with ID and their support workers (n=6) were asked questions about their willingness to accept 7-day accelerometer monitoring and/or the International Physical Activity Questionnaire-short version (IPAQ-s) as PA measures. The IPAQ-s was administered by the researcher and they were each provided with samples of accelerometers to try on. Results: A) Five out of six managers said that the burden of wearing the accelerometer for seven days would be too high for the people they support, the majority of whom might be unable to express their wishes. They also said they would be unwilling to act as proxy respondents for the same reason. Additionally, they cited time pressure, understaffing, and reluctance to spend time on the research paperwork as further reasons for non-participation. B) All 11 individuals with ID completed the IPAQ-s while only three accepted the accelerometer, one of whom was deemed inappropriate to wear it. Reasons for rejecting accelerometers included statements from participants of: ‘too expensive’, ‘too heavy’, ‘uncomfortable’, and two people said they would not want to wear it for more than one day. All adults with ID (11) and their support workers (6) provided information about their physical activity levels through the IPAQ-s. Conclusions: Care home managers are a barrier to research participation. However, adults with ID would be happy for the IPAQ-s as a PA measure, but less so for the 7-day accelerometer monitoring. In order to improve participation in this population, the choice of PA measure is considered important. Moreover, there is a need for studies exploring how best to engage ID residential home managers in PA research.

Keywords: intellectual disability, physical activity measurement, research engagement, research participation

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Authors: Simone Huber, Bianca Schnalzer, Baptiste Alcalde, Sten Hanke, Lampros Mpaltadoros, Thanos G. Stavropoulos, Spiros Nikolopoulos, Ioannis Kompatsiaris, Lina Pérez- Breva, Vallivana Rodrigo-Casares, Jaime Fons-Martínez, Jeroen de Bruin

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Developing new medicine and health solutions and improving patient health currently rely on the successful execution of clinical trials, which generate relevant safety and efficacy data. For their success, recruitment and retention of participants are some of the most challenging aspects of protocol adherence. Main barriers include: i) lack of awareness of clinical trials; ii) long distance from the clinical site; iii) the burden on participants, including the duration and number of clinical visits and iv) high dropout rate. Most of these aspects could be addressed with a new paradigm, namely the Remote Decentralized Clinical Trials (RDCTs). Furthermore, the COVID-19 pandemic has highlighted additional advantages and challenges for RDCTs in practice, allowing participants to join trials from home and not depend on site visits, etc. Nevertheless, RDCTs should follow the process and the quality assurance of conventional clinical trials, which involve several processes. For each part of the trial, the Building Blocks, existing software and technologies were assessed through a systematic search. The technology needed to perform RDCTs is widely available and validated but is yet segmented and developed in silos, as different software solutions address different parts of the trial and at various levels. The current paper is analyzing the availability of technology to perform RDCTs, identifying gaps and providing an overview of Basic Building Blocks and functionalities that need to be covered to support the described processes.

Keywords: architectures and frameworks for health informatics systems, clinical trials, information and communications technology, remote decentralized clinical trials, technology availability

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Authors: Yidan Xu, Pim Martens, Thomas Krafft

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Marine fishing, an energy-intensive activity, directly emits greenhouse gases through fuel combustion, making it a significant contributor to oceanic greenhouse gas (GHG) emissions and worsening climate change. China is the world’s second-largest economy and the top emitter of GHG emissions, and it carries a significant energy conservation and emission reduction burden. However, the increasing GHG emissions from marine fishing is an easily overlooked but essential issue in China. This study offers a diverse perspective by integrating the concepts of total carbon emissions, carbon intensity, and per capita carbon emissions as indicators into calculation and discussion. To better understand the GHG emissions-Gross marine fishery product (GFP) relationship and influencing factors in Chinese marine fishing, the relationship between GHG emissions and economic development in marine fishing, a comprehensive framework is developed by combining the environmental Kuznets curve, the Tapio elasticity index, and the decomposition model. Results indicated that (1) The GHG emissions increased from 16.479 to 18.601 million tons in 2001-2020, in which trawlers and gillnetter are the main source in fishing operation. (2) Total carbon emissions (TC) and CI presented the same decline as GHG emissions, while per capita carbon emissions (PC) displayed an uptrend. (32) GHG emissions and gross marine fishery product (GFP) presented an inverted U-shaped relationship in China; the turning point came in the 13th Five-year Plan period (2016-2020). (43) Most provinces strongly decoupled GFP and CI. Still, PC and TC need more effort to decouple. (54) GHG emissions promoted by an industry structure driven, though carbon intensity and industry scale aid in GHG emissions reduced. (5) Compare with TC and PC, CI has been relatively affected by COVID-19 in 2020. The rise in fish and seafood prices during COVID-19 has boosted the GFP.

Keywords: marine fishing economy, greenhouse gas emission, fishery management, green development

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Authors: Abdulkarim Yusuf

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Motivation: The Nigerian economy has seen significant macroeconomic instability, fuelled mostly by an overreliance on fluctuating oil revenues. The rising disparity between tax receipts and government spending in Nigeria necessitates government borrowing to fund the anticipated pace of economic growth. Rising public debt and fiscal sustainability are limiting the government's ability to invest in key infrastructure that promotes private investment and growth in Nigeria. Objective: This paper fills an empirical research vacuum by examining the impact of public debt on fiscal sustainability in Nigeria, given the significance of fiscal stability in decreasing poverty and the constraints that an unsustainable debt burden imposes on it. Data and method: Annual time series data covering the period 1980 to 2022 exposed to conventional and structural breaks stationarity tests and the Autoregressive Distributed Lag estimation approach were adopted for this study. Results: The results reveal that domestic debt stock, debt service payment, foreign reserve stock, exchange rate, and private investment all had a major adverse effect on fiscal stability in the long and short run, corroborating the debt overhang and crowding-out hypothesis. External debt stock, prime lending rate, and degree of trade openness, which boosted fiscal stability in the long run, had a major detrimental effect on fiscal stability in the short run, whereas foreign direct investment inflows had an important beneficial impact on fiscal stability in both the long and short run. Implications: The results indicate that fiscal measures that inspire domestic resource mobilization, sustainable debt management techniques, and dependence on external debt to boost deficit financing will improve fiscal stability and drive growth.

Keywords: ARDL co-integration, debt overhang, debt servicing, fiscal stability, public debt

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Authors: Oluyomi Stephen Adeyemi, Kentaro Kato

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Toxoplasma gondii is the etiological agent of toxoplasmosis, a common parasitic disease capable of infecting a range of hosts, including nearly one-third of the human population. Current treatment options for toxoplasmosis patients are limited. In consequence, toxoplasmosis represents a large global burden that is further enhanced by the shortcomings of the current therapeutic options. These factors underscore the need for better anti-T. gondii agents and/or new treatment approach. In the present study, we sought to find out whether preparing and capping nanoparticles (NPs) in amino acids, would enhance specificity toward the parasite versus the host cell. The selection of amino acids was premised on the fact that T. gondii is auxotrophic for some amino acids. The amino acid-nanoparticles (amino-NPs) were synthesized, purified and characterized following established protocols. Next, we tested to determine the anti-T. gondii activity of the amino-NPs using in vitro experimental model of infection. Overall, our data show evidence that supports enhanced and excellent selective action against the parasite versus the host cells by amino-NPs. The findings are promising and provide additional support that warrants exploring the prospects of NPs as alternative anti-parasite agents. In addition, the anti-parasite action by amino-NPs indicates that nutritional requirement of parasite may represent a viable target in the development of better alternative anti-parasite agents. Furthermore, data suggest the anti-parasite mechanism of the amino-NPs involves multiple cellular processes including the production of reactive oxygen species (ROS), modulation of hypoxia-inducing factor-1 alpha (HIF-1α) as well as the activation of kynurenine pathway. Taken together, findings highlight further, the prospects of NPs as alternative source of anti-parasite agents.

Keywords: drug discovery, infectious diseases, mode of action, nanomedicine

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Authors: Atsebaha Gebrekidan Kahsay, Tsehaye Asmelash, Enquebaher Kassaye

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Background: Salmonella remains a global public health problem with a significant burden in sub-Saharan African countries. Human restricted cause of typhoid and paratyphoid fever are S. Typhi and S. Paratyphi, whereas S. Enteritidis and S. Typhimurium is the causative agent of invasive nontyphoidal diseases among humans and animals are their reservoir. The antibiotic resistance of Salmonella is another public health threat around the globe. To come up with full information about human and animal salmonellosis, we made a systematic review of the prevalence, serotypes, and antibiotic resistance of Salmonella in Ethiopia. Methods: This systematic review used Google Scholar and PubMed search engines to search articles from Ethiopia that were published in English in peer-reviewed international journals from 2010 to 2022. We used keywords to identify the intended research articles and used a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to ensure the inclusion and exclusion criteria. Frequencies and percentages were analyzed using Microsoft Excel. Results: Two hundred seven published articles were searched, and 43 were selected for a systematic review, human (28) and animals (15). The prevalence of Salmonella in humans and animals was 434 (5.2%) and 641(10.1%), respectively. Fourteen serotypes were identified from animals, and S. Typhimurium was among the top five. Among the ciprofloxacin-resistant isolates in human studies, 16.7% was the highest, whereas, for ceftriaxone, 100% resistance was reported. Conclusions: The prevalence of Salmonella among diarrheic patients and food handlers (5.2%) was lower than the prevalence in food animals (10.1%). We did not find serotypes of Salmonella in human studies, although fourteen serotypes were included in food-animal studies, and S. Typhimurium was among the top five. Salmonella species from some human studies revealed a non-susceptibility to ceftriaxone. We recommend further study about invasive nontyphoidal Salmonella and predisposing factors among humans and animals in Ethiopia.

Keywords: antibiotic resistance, prevalence, systematic review, serotypes, Salmonella, Ethiopia

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Authors: Warda Jabeen, Romaisa Shamim Khan, Osama Shakeel, Ahmed Faraz Bhatti, Raza Hussain

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Background: The worldwide incidence of cutaneous melanoma (CM) has been on the rise over the past few decades. Primary prevention and early treatment remain the focus of management to reduce the burden of disease. This entails identification of risk factors to prompt early diagnosis. In Pakistan, there is a scarcity of clinico-pathological data relating to cutaneous malignant melanoma. Objective: The purpose of this study was to analyze the epidemiological and clinical characteristics of patients presenting with cutaneous malignant melanoma in Pakistan, and to compare the results with other studies. Method: Shaukat Khanum Memorial Cancer Hospital and Research Centre is currently the only dedicated cancer hospital in the country, accepting patients from all over Pakistan. Majority of the patients, however, belong to the northern half of the country. From the recorded data of the hospital, all cutaneous melanoma cases were identified and evaluated. Results: Between 1997 and 2017, a total of 169 cutaneous melanoma patients were registered at Shaukat Khanum. Mean age was 47.5 years. The highest incidence of melanoma was seen in the age group 40-59 years (n=69, 40.8%). Most commonly reported clinical subtype was unspecified melanoma (n=154, 91%). Amongst those in which T stage was reported, the most frequently observed T-stage at presentation was T4 (n=23, 13.6%). With regards to body distribution, in our study CM was seen most commonly in the lower limb including the hip. The yearly incidence of melanoma has increased/remained stable from 2007 to 2017. Conclusion: cutaneous malignant melanoma is a fairly common disease in Pakistan. Patients tend to present at a more advanced stage as compared to patients in developed countries. Identification of risk factors and tumor characteristics is therefore of paramount importance to deal with these patients.

Keywords: epidemiology of cutaneous malignant melanoma, cutaneous malignant melanoma, Pakistan, skin cancer

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Authors: Maria Francesca Scannone, Martina Bochicchio

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One of the major environmental problems today is hydrocarbon contamination. The promising sustainable technologies for the treatment of these contaminated sites involves the use of biological organisms. In Agri Valley (Basilicata Region) there is a living laboratory (natural oil seeps) where the selective pressure has enriched the environmental matrices with microorganisms, fungi and plant species able to use the hydrocarbons as a source of metabolic energy, to degrade or tolerate hydrocarbons. Observers visiting this area are fascinated by its unspoiled nature, and the condition of the ecosystem does not appear to has been damaged. The amazing resiliency observed in Tramutola site is of key importance to try to bring green remediation technologies, but no research has been done to identify high-performing native species. The aim of this research was to study how natural processes affect the fate of released oil or how individual species or communities of plants and animals are capable of dealing with the burden of otherwise toxic chemicals. The survey of vegetation was carried out, more than 60 species have been identified and divided into tree, shrub and herb layer. Plant data sheets have been completed only for the species that showed the most appropriate properties for phytoremediation. In general, members of the Salicales, Cyperales, Poales, Fagales, Cornales, Equisetales orders were the most commonly identified orders. They are pioneer plants with high adaptive capacity and vegetative propagation. The literature review has highlighted the existence of rhizosphere effect and a green liver model on selected plants. The study provides significant information on the environmental stress adaptation processes of many indigenous plants that are living and growing on a natural leak of crude oil and gas that migrates up through subsurface.

Keywords: green liver, hydrocarbon degradation, oil seeps, phytoremediation

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Authors: Namekong Fokeng Armand

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Background: Zoonoses are nowadays a serious public health problem in both developing and developed countries. They contribute to increase the economic burden. In case of emergence, rural populations are the most affected, hence the need to investigate risk practices in rural households of Penka-Michel (West Cameroon). Methods: This cross-sectional study was conducted from October to November 2021 among 200 heads of households living in the Penka-Michel health district (West Cameroon). It was done using a pre-tested and validated questionnaire, allowing to obtain socio-demographic, economic data, and data on zoonotic risk practices. Results: The participants [women (56%), men (44%)] worked mainly in the informal private sector (53%) and practiced agriculture secondarily (90%). Their highest level of education, for the most part, was a secondary school (50%); the average household size was 06 persons with a monthly income > 36270 FCFA (72%). 74% of household heads thought that animals can transmit diseases, and 17% had heard about zoonotic diseases through the media (65%). Rats caught in households (60%) were consumed there (74%), as was bush meat (61%) or dog meat (18%). For family food (90%), animals were slaughtered within the household (97%), rarely preceded by a veterinary inspection (6%). 87% of households practiced traditional rites with animal blood, 65% shared the same habitat as their animals, 41% did not systematically wash their hands after handling animals. More than 50% of households owned one or more dogs, usually strays (41%) and 48% of which were vaccinated (rabies). Many households had at least one: poultry (98%); pig (50%); dog (57%), cat (52%). 25% of households slaughtered sick animals for consumption, and 27% ate dead animals. Conclusion: This study identified numerous zoonotic risk practices in households in the Penka-Michel health district (West Cameroon). Concerted, multisectoral communication / awareness-raising actions are needed to break with these practices.

Keywords: zoonoses, risky practices, rural households, penka-michel, cameroon

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Authors: T. Aragaw, P. Gari

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In spite of social, political, and economic marginalization, women are still considered as the backbone of Ethiopia, one of the least developed countries in the world. The general purpose of this study was to assess factors that affect participation of women in politics, social and economic decisions at Kelem-Wollega Administrative Zone of Oromia Regional State, Ethiopia. Data used in this paper is mainly primary, and a few secondary data were incorporated. Respondents were selected using a systematic random sampling method and were placed questionnaires containing open-ended and closed-ended. Focus group discussion was also used for the study subjects in two offices. According to the information collected from the KWAZ Development and Social Service Office, a total of 18,473 tax-paying employees are present in the Zone, which is 14% of the total population of the Zone. Among the total number of employees in the Zone, 2,617 have been recruited for this study based on the criteria stated. This showed 1.8% of them were comprised of several churches and religious owned integrated development projects in the KWAZ. The 2,103 (80.34%) study participants responded personally, and they completed and returned the questionnaire to the researchers. The study revealed that in public institutions existed in KWAZ, the majority of women were having an educational status of diploma and lower, practicing lower non-decision making and leadership positions. Conclusion: Major barriers hindering women include: Socio-cultural attitudes, lack of necessary experience, education, the burden of domestic responsibilities, and lack of role models of women leaders in the Zone. Empowerment of women via social organizations, critical involvement of the government, and Affirmative action for women is critical. Further research is needed on the scope and challenges in implementing the strategies.

Keywords: women, affirmative action, leadership, empowerment, Ethiopia

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Authors: Alokananda Nath

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Land is an important issue anywhere in the world as it is one of the fundamental elements in human settlements. Since the urban areas are considered to be the drivers of economy for any country across the world and the phenomenon of ‘urbanization’ happening everywhere, there is always a greater pressure on urban land and its management. Many states in India have realized the importance of land as a valuable resource and have implemented certain framework for managing and developing land. But in West Bengal no such statutory framework has been formulated till now and a very out dated model of land acquisition for public purpose is practiced. Due to the lop-sided character of urban growth in the entire eastern region of India, the city of Kolkata continues to bear the burden of excessive growth of population and consequent urbanization of the adjoining areas at a rapid pace. This research tries to look into these conflicts with respect to the present pattern of development in the context of Kolkata and suggest a system for land management in order to implement the planning processes. For this purpose, five case study areas were taken up within the Kolkata Metropolitan Area and subsequent analysis of their present land management and development techniques was done. The findings reveal that there is a lack of political will as well as administrative inefficiency on part of both the development authority and the local bodies. Mostly the local bodies lack the financial resources and technical expertise to work out any kind of land management framework or work out any kind of model in order to manage the development that is happening. All these place undue strain on city infrastructure systems and reduce the potential of cities to contribute as engines of economic growth. The focus of reforms, therefore, ought to be on streamlining the urban planning process, judicious and optimal land use, efficient plan implementation mechanisms, improvement of titling and registration processes.

Keywords: urbanization, land management framework, land development, policy reforms, land-use planning processes

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Authors: Yu-Ching Liu

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Background: Family numbers usually take responsibility for taking care of their elderly relatives, especially parents. Caring for a patient with chronic diseases is a stressful experience, which makes carers suffer physical and mental health stress, difficulties maintaining family relationships and issues in participating in the labor market, which may lower their quality of life (QoL). The issue of providing care to relatives with chronic illness has been widely explored in Taiwan, but most studies focus on the need for full-time caregivers. Objective: The main goal of this study was to examine the topic of working carers involved in the decision-making process of LTC services and to explore what affects working carers considering when they choose the care services for their disabled, elderly relatives. Method: A total of 7 working caregivers were enrolled in this study. A face-to-face and semi-structured in-depth qualitative interview study were conducted to explore the caregivers' perspectives. Results: Working carers have a positive experience of using LTC service because it allows them to kill two birds with one stone, continue employment, and care for an elderly disabled relative. However, working carers have still been struggling to find friendly community-based LTC services. There were no longer available community services that could be used with the illness condition of patients getting worse. As such, patients have to be cared for at home, which might increase the caregiver burden of carers. Conclusion: Working family caregivers suffer from heavy physical and psychological burdens as they not only have to maintain their employment but care for elderly disabled relatives; however, the current support provided is insufficient. The design of services should consider working carers' employment situation and need rather than the only caring situation of patients at home.

Keywords: family caregiver, Long-term care, work-life balance, decision-making

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Authors: Nurunnahar Akter, Elena Kulinskaya, Nicholas Steel, Ilyas Bakbergenuly

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Although Hormone Replacement Therapy (HRT) is an effective treatment in ameliorating menopausal symptoms, it has mixed effects on different health outcomes, increasing, for instance, the risk of breast cancer. Because of this, many symptomatic women are left untreated. Untreated menopausal symptoms may result in other health issues, which eventually put an extra burden and costs to the health care system. All-cause mortality analysis may explain the net benefits and risks of the HRT therapy. However, it received far less attention in HRT studies. This study investigated the impact of HRT on all-cause mortality using electronically recorded primary care data from The Health Improvement Network (THIN) that broadly represents the female population in the United Kingdom (UK). The study entry date for this study was the record of the first HRT prescription from 1984, and patients were followed up until death or transfer to another GP practice or study end date, which was January 2017. 112,354 HRT users (cases) were matched with 245,320 non-users by age at HRT initiation and general practice (GP). The hazards of all-cause mortality associated with HRT were estimated by a parametric Weibull-Cox model adjusting for a wide range of important medical, lifestyle, and socio-demographic factors. The multilevel multiple imputation techniques were used to deal with missing data. This study found that during 32 years of follow-up, combined HRT reduced the hazard ratio (HR) of all-cause mortality by 9% (HR: 0.91; 95% Confidence Interval, 0.88-0.94) in women of age between 46 to 65 at first treatment compared to the non-users of the same age. Age-specific mortality analyses found that combined HRT decreased mortality by 13% (HR: 0.87; 95% CI, 0.82-0.92), 12% (HR: 0.88; 95% CI, 0.82-0.93), and 8% (HR: 0.92; 95% CI, 0.85-0.98), in 51 to 55, 56 to 60, and 61 to 65 age group at first treatment, respectively. There was no association between estrogen-only HRT and women’s all-cause mortality. The findings from this study may help to inform the choices of women at menopause and to further educate the clinicians and resource planners.

Keywords: hormone replacement therapy, multiple imputations, primary care data, the health improvement network (THIN)

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